Scott Benner 6/21/25 Scott Benner 6/21/25

#1555 Dexcom President and Chief Operating Officer

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Jake Leach brings Dexcom news from ADA and answers some listener questions.

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

Scott Benner 0:00
We had so much good content this week, it didn't all fit between Monday and Friday. So because of that, you're getting a special episode today, ad free, with Jake leach from Dexcom.

Today's episode doesn't have any ads, but if you need something that one of the advertisers makes or supplies, please consider using one of my links. They're in the show notes of your podcast player and at Juicebox podcast.com when you use my links to get more information or to make your order, you are supporting the podcast while we're talking about that so many of you listen that aren't subscribed or following in a podcast app. And if you could do that for me, it would really help the show. Go into Apple podcasts and hit follow or go into Spotify, hit subscribe. You know these apps, they call it different things, but follow or subscribe, set yourself up to get new downloads doing just that simple task, that free thing that you can do, you will be supporting the production of the Juicebox Podcast and helping to keep it free and plentiful. Nothing you hear on the Juicebox Podcast should be considered advice medical or otherwise, always consult a physician before making any changes to your healthcare plan or becoming bold with insulin if you're looking for community around type one diabetes, check out the Juicebox Podcast. Private Facebook group. Juicebox Podcast, type one diabetes, but everybody is welcome. Type one, type two, gestational loved ones. It doesn't matter to me if you're impacted by diabetes and you're looking for support, comfort or community. Check out Juicebox Podcast, type one diabetes on Facebook. That's good to see Jake. I just hit record. Just so you know, yeah, sounds good. How's art and doing really well. I appreciate it. She's 21 she's had diabetes 19 years now. She's still in college. She had a little thing where she she woke up in her sophomore year, beginning of her sophomore year, and she's like, I don't think this is the right place, but she kept going, and then she's like, I'm gonna switch gears. And I was like, okay, so she went from Savannah and came home and changed to a psychology degree. Wow, cool. We had an issue where she had to get an injection. But she has sort of a, she's got a bit of a needle phobia, which is, I guess, an odd thing to for some people to think about with type one diabetes. But, yeah, we were, like, commuting to her to help her with stuff, and it was like, it was getting too much. So,

Jake Leach 2:34
yeah, no, it's, it's incredible. It's, actually, that's really interesting. You're talking about the needle phobia. But I could see, you know, with the more modern technologies we've all been working on, continuing to develop and innovate, it does kind of get to a point where someone with needle phobia can, or, you know, has an issue with needles, doesn't have to always face that, because the technology is

Scott Benner 2:53
so much better. Oh, for certain. I mean, you know, I didn't realize it at the time when you guys went from, I guess it was g5 that had the plunger, right? Yeah. G6 was the first auto applicator for us. It was just a button, push, yeah. And I remember the time when you made the switch, there was a segment of people who came to me and said, this is such a big deal. And I couldn't wrap my head around I was like, why does it matter? Like, that one wasn't bad. Like, you pinch it, you push the thing, you pull the collar back. It

Speaker 1 3:18
was over. It wasn't, you know, I didn't find it to be difficult. It's not till now that I realized that some people do not want to see how the sausage is made. So, oh, yes, I when we were designing the auto applicator for g6 I remember I had a video of a woman that was she had posted on the Internet, and it was, she was chasing her daughter around with a g5 trying to put it in her arm, or, you know, in her abdomen, yeah. And I showed it to the team, saying, Okay, this is what we're going to try and solve, exactly the anxiety of having to chase your, you know, four year old around to put a sensor on them. And so, yeah, it was the team got a kick out of it. They really it helped get everybody excited. I think you don't realize sometimes, till you look at it, there's a great story. Somebody at Omnipod told me that they used to have a photo of Arden up as like, a five year old in the office, and she had the pod on. And they always thought, like, oh, it's, you know, it's so, so small. It's so great. And they saw it on a little kid, and they thought, I wonder if we can make this any smaller, you know, because on her, it looked huge. And then they shrunk it down. And, you know, little stuff makes a big difference to people. I guess it's my point, absolutely. Yeah. So what have you guys been up to? What are you here to tell me about? Oh, we've been doing all kinds of stuff. You know, we've got new innovations coming on the g7 platform. We've been working on stello. We've been, you know, broadening awareness. You know, it wasn't that long ago that CGM is really kind of a tool focused on more intensive insulin users. And I think that's, you know, that's where the initial evidence for clinical outcomes, all that stuff was generated. But now, you know, as we continue to grow and conserve more customers, as we look at this type two population, you know, type two diabetes continues to increase. Around the world, and CGM is an amazing tool to help people better manage it. Lot of it in type two, as you know, you know, a lot of it's around kind of lifestyle and, you know, food and activity levels. And so, you know, CGM is a great tool to help people manage that differently and more effectively. And so we're just really out there trying to drive the messages around type two. And we have a type two report, basically a state of type two in the United States, specifically around CGM. We did this for in our European region earlier, or, I guess, late last year. And so now we're we did it again the US. We talked to over 100 healthcare providers. We talked to a lot of people. Over 300 people have diabetes, type two, and most of those folks are not taking insulin, so they're treating their type two with oral medications or other other medicine, non non insulin, and really just getting after their experience with CGM, the benefits. And really around the prescribers asking them, and you know, they very much see CGM as a as a critical tool for managing all of type two, not just those insulin users. What are they

Scott Benner 6:08
reporting back? What are people getting out of seeing the CGM data?

Jake Leach 6:11
So I think the main thing is that they all believe that 100% of these folks said CGM in combination should be used in combination with GLP ones and sglt twos all the time. You should always have CGM alongside so that you can see basically, how those, those different medications are helping, you know, helping improve blood glucose, but also the medications, again, as you know, they're not the only solution, right? A part of this is changing choices and habits and forming healthier habits to manage diabetes. And a CGM is perfect tool to show that, because it's just that instantaneous feedback of of a meal or, you know, activity level that causes glucose to be so much better controlled, they learn that very quickly, right people when they see that, you see in your own data. It's extremely quick to figure it out.

Scott Benner 7:03
So, you know, it's a lesson you hear people with type one talk about all the time. I mean, genuinely, I interviewed a person this morning, 44 years old. She was diagnosed when she was 22 and she said she kind of was able to pretend she didn't have diabetes. That was her coping mechanism. Then she got on a CGM, and then suddenly saw what was happening and realized, like, I can't, how am I going to ignore this, you know? And I even think back to, I mean, I don't know how long you guys have been coming on the podcast, but way, way back, Kevin told me I'm wearing the product, you know, like, I don't have diabetes, but I'm wearing it. And here's a list of three foods I don't think I'm going to touch anymore, just seeing what it did to my blood sugar while I was wearing it. Yeah. So I guess my point is, is that when we can talk to type ones who lived before CGM, and hear from those adults who are seasoned, and they're veterans of the fight, and they can tell you how big of a deal it is to see the feedback, it's interesting that we almost didn't, like, immediately just apply that to type two like, why did we have to, like, go talk to people to figure that out? You know what I mean? Like, it's, it's really great. I mean, it's fantastic that it's getting out there. So, but how does it get out there? Like, are you counting on an endocrinologist or a GP? Are you counting on the people who do you want to say, hey, you should try this thing if your loved one is newly diagnosed with type one diabetes and you're seeking a clear, practical perspective, check out the bold beginning series on the Juicebox Podcast. It's hosted by myself and Jenny Smith, an experienced diabetes educator with over 35 years of personal insight into type one our series cuts through the medical jargon and delivers straightforward answers to your most pressing questions, you'll gain insight from real patients and caregivers and find practical advice to help you confidently navigate life with type one. You can start your journey informed and empowered with the Juicebox Podcast, the bold beginning series, and all of the collections in the Juicebox Podcast are available in your audio app and at Juicebox podcast.com

Speaker 2 9:01
in the menu. Short answer that is, everybody right. I think it's a big focus of ours is just raising the awareness that CGM technology exists. Many people who have private insurance are start. We're starting to see coverage for all diabetes. You know, got three of the largest PBMs now have have Dexcom CGM on their lists of covered, covered devices. So we still have work to do with, you know, Medicaid and Medicare and, you know, all the pairs, like we always do, but we're starting to see lots of real world evidence being generated by people using both g7 and stello that have type two, and we're starting to see their their outcomes and how much improvements, no surprise, the improvements that they're making when they start using CGM. You can within the first month, we're seeing significant improvements in time and range. I love these studies, where we show, you know, a whole large population of folks go on CGM at this point in time, at the beginning, before they view. To CGM their their first week, they know they've low time and range, nowhere near the 70% goal for type two diabetes that the ADA has put out there. And then you know, within that 30 days, you know, you use three sensors, and before you know it, they're hitting a time and range goal that you know probably maybe felt not attainable without the right tools. And so you put CGM in their hands, and it's, it's really exciting to see, and that's while they do have a physician, I mean, a lot of that's just their own, their management themselves. They're now have data. They can do something about it. They can, they can hit their goals that have been really hard for them in the past to be able to achieve. So I love those studies. There's lots of people starting to use CGM, but it's awareness around the physicians. You know, if you have coverage, we want you to get a prescription and get it covered by your insurance company. If you don't have coverage, you've got, you've got the stello option. You know, sign up for a subscription, get it. You know, less than $100 a month, you could have CGM full time, right? Do you think those people are just seeing the impact of food and making different food decisions. Because, I mean seeing a turnaround that quickly in a few weeks, right? Like, it's not like they up their medication if they're on an oral or something like that, right? They just, they saw what was going on, and they're like, Oh, I'll make different decisions here. That's the vast majority of his different decisions. I think one of the other things I love to hear about is when users understand that, you know, modest levels of activity can have a significant impression. You know, just a walk, you know, just just a moderate walk around the block. We're not talking about running, running on a treadmill. That can also really help their glucose levels and so just a little bit activity. But I think, you know, the biggest impact is usually around diet, you know, food choices, meal compositions, all the things that we you know, may have been told before. You know, through through diabetes education, but when it's your own data on, you know, coming out in real time, and you can see that those numbers, you can see the graph. You can see the on Stella, we've got the spike detect feature that really helps try and focus in on the more impactful spikes during the day, and what helped you think through what happened there, and what could you do different? I it's an amazing education tool, and I just love hearing when folks are able to make some changes on their own, simply that improves their health.

Scott Benner 12:16
Like, what's the level of like? I guess. Where does your A, 1c, have to be if you're type two, like, before you're eligible, because insulin resistance can start way before your your a 1c, goes up, right? And if you're going to see a ton of people on glps, mostly have a lot of success, that success is going to be because they probably have insulin resistance that might not have thrown them into pre diabetes for years. Like, to me, like, that'd be a place to grab those people?

Jake Leach 12:41
Yeah, yeah. There's definitely approximately 100 million people in the US that have pre diabetes, and, you know, hundreds of millions more around the world, and the vast majority don't know they have diabetes, pre diabetes, right? They haven't been diagnosed. They're not aware. That's the group where raising awareness that the technology exists to give it a try. There's definitely people who, you know, didn't understand their their metabolic health or their glucose health until they tried stello, and then they realized, wow, okay, there's some stuff going on here. To take a closer look. Yeah, it's an amazing tool. Now that it's available over the counter, it's such a new a new thing, but raising the awareness, get it out there, by all means possible is kind of the way we're looking at it.

Scott Benner 13:22
I've shared it a lot on the podcast, but I'll fit in enough of it here that you know people will know I'm serious about this. I started taking a GLP two years ago. I just told you that I'm 62 pounds lighter than I was, but what I learned was it had very it did not have nearly as much to do with what I was eating as it did. I don't really know a way to describe that. Like, I used to be anemic all the time for no reason. My body never absorbed iron. I went on a GLP that stopped immediately. I used to my digestion didn't work well, that stopped. It fixed things about I hate to say it like that, but it changed things about me. I don't even completely understand. Yeah, my back doesn't hurt anymore. It used to be, I'm so embarrassed, but like, if we all went out to dinner and ate the same thing, I'd be four pounds heavier the next day just retaining water. Yeah, no, I don't drink, I don't smoke, I don't do drugs, I don't like, I'm active. Like, didn't matter, didn't matter what I did. And then, you know, I started using the GLP. So my point is, is, if that's true, and I believe it is. And I've just recently had an interview with a doctor who's kind of behind the scenes on helping to talk more about how diagnosis are going to go in the future. He seems to feel like it's not just going to be type one, type two, you know, but he said you're going to see dual diagnosis as soon for people with type one who also have insulin resistance, that's going to be he believes like a real diagnosis. I think that explains why some type ones go on a GLP and see great benefit, and some don't see any difference at all. That's right, I guess where I'm coming from is I wish somebody would have told me this 20 years ago. I know it didn't exist, but I can I see what my life's like now. And I. Wish I would have had this sooner. I

Speaker 2 15:01
guess it's the Yeah, the GOP, one class of drugs at all that, although they have been around for almost that long, 20 years, the new formulations, the once weekly is like all those things have really enhanced the the outcomes. And I think the outcomes are incredible. You know? I think what, what we've seen is particularly in in diabetes, the best outcomes are generated when when you're using the right medication, often on GLP, one alongside with the CGM. So understanding, you know, just even the medication adherence part, is something that we know doctors recognize when they're writing prescriptions is like, you know, if you can see how impactful the medication is to you, you're more motivated to take it, right? And so I think when you have a CGM, and it's showing you that, while also helping educate you on on, you know, meal compositions, activities and tracking things and a little bit of accountability too, right? If you learn a sensor, you know, there's a, there's an accountability component there too. So I think all that together is how it works produce, you know, fantastic outcomes for people. I can also see the impact it would have on the physicians who might not believe in it until they see it on the data, you know, because there's still plenty of people I've, I've had doctors say to me, like, well, you're gonna have to use that for the rest of your life. And I was like, no. I mean, no one says that to a thyroid person who needs thyroid replacement hormones. If this is what it needs, this is what I need. And you maybe it would stop people from having that experience where they've, you know, lost the weight, then the doctor takes the med from them, and then they're right back in that same situation again. I see a ton of benefit from it. So I wish you a lot of luck. I hope it, uh, I hope it goes well, getting it out there. Yeah, no, we're gonna keep, uh, we'll keep driving. And, you know, the job's global. There's, there's so many people around the globe that either have access to CGM and aren't using it yet, like they have coverage in some form, or that don't yet have coverage. We're out there every day, bringing the advocacy, bringing the clinical evidence. We have a very large clinical trial we're running right now in people type two who don't use insulin specifically, a randomized, controlled trial to show the outcomes that can be generated by wearing a Dexcom CGM for that population. And I think that will be an important evidence to use globally, not just here for the United States, to get more access and coverage, because CGM saves money in the first year. There's not too many therapies that, net the cost of the drug or the device are going to save you money in the beginning, but with CGM, people you know, have the information they need to better manage their diabetes. They're not going to the hospital as often. They're not showing, you know, not using as much of the healthcare system, because they are living healthier. All those things bear out pretty quickly, so you don't have to wait like, you know, months and months to get the outcomes.

Scott Benner 17:40
I have two hurdle questions. Do you have any data that says what the hurdle is? Once somebody actually has one to putting it on, and I know that we're not exactly a society of like, preemptively getting in front of something so like, because I'm thinking about like a friend of mine who whose family is still in India, and they talk about how much pre diabetes and type two is in their family, and there's a large population of people who, I mean, you would imagine that country would get a huge relief if they'd never progressed all the way to type two diabetes or pre diabetes,

Jake Leach 18:13
that's right, yeah. So I think the there has to be some level of engagement by the user to take the action, right? They got it. They have to have the interest level. They have to have the knowledge that, for example, CGM exists, and curiosity around using it, right? And so the biggest thing that we found is just making sure people know the technology exists, what it can do for them. And then also, we use our warriors, quite frequently, to talk about their experiences, to think there's nothing better than someone explaining. I mean, I can tell you how great CGM are all day long, but if you have someone who has a very personal story about how CGM changed their life, then I think that's resonates really well across users and so we are we have more and more now of our warriors are type two, in addition to all the type one warriors that we have around the world. I think we have over 30,000 warriors today that are out there telling, telling about their, you know, talking about their stories, their personal experiences with with their Dexcom CGM, and how to change their life. And that's that's worked well for us. But it's just, yeah, the job will never end in terms of making sure the technology people are aware of it. It's, you know, less than two mil, 2% of the people in the world using that have diabetes are using CGM. So there's still hundreds of millions of people that could benefit from the technology that don't have access to it. So that's, that's our focus as an industry, too. It's not just Dexcom. I think we're all focused on making sure people can get access to this technology. How would you be able to or would you be able to keep up with, like, What if everybody just woke up tomorrow?

Scott Benner 19:42
Was like, That guy's right. What would you do to ramp to ramp? But Jake would be like, I would just give I'd go home. I'd be like, I did it. I'll see you later.

Speaker 2 19:51
No, no, no in any like that. If something like that happened, I you know there isn't the capacity out there between us and all the. Folks that make CGM out there, there's not the capacity to service all those people overnight. But, you know, it never happens like that. It happens in stages of access. But, you know, I can tell you, one of the things that I'm always it's exciting, but also it's a lot of work all the time, is that ever, pretty much every quarter for us, is a record number of sensors manufactured. And it's been like that for many, many years, and we intend to keep it that way. So I think that scaling is a big part of what we do. We've learned a lot of lessons along those journeys from g5 to g6 to g7 and then to our next generation platforms as well. Big part of this is not just a feature set. Now. It's about building sensors in large scale, high reliability product for large scale. That's a big part of what we do. How much time does it take if you identify a defect in the process or something going wrong more often than it should? How long does it take to identify it and then change production so that it I'm trying to figure out what that window is, yeah, it's actually pretty quick in terms of our ability to, if we see an issue, to be able to correct it. And then for it usually takes a couple of months before users start seeing it in the field, because it goes through distribution channels and things. It can be pretty quick. But it also depends maybe on geographies. And, you know, in the United States, the largest volume is, you know, lot of stuffs running through pharmacies in the US. It's, you know, some of the highest volumes of that stuff goes, goes the fastest. But yeah, I think our goal is always to continue to come out with new, innovative features continue to enhance the reliability of the product. America. 15 day g7 is another improvement in accuracy. We've spent some time looking at all the g7 performance out there since we launched it a couple years ago, and we're able to take that and build some of those learnings into the new algorithm that's in the 15 day product. And so it's got even better, better performance.

Scott Benner 21:52
That leads me to a question that people send in, if there's people running around who are like, Look, I can't get my sensor to go past seven days. It just doesn't work for me past seven days. And they've come to grips with that, is changing to the new one that's going to last 15 days. Is that going to change their experience, or are they just going to be wearing a 15 day sensor that lasts them seven days once? What? You know? What I mean?

Jake Leach 22:10
Yeah, it's a really good question. Scott, I think it depends a lot on what their particular issue or situation is, right? Is it Are they having challenges with adhesive or are they having challenges with sensor probe remain accurately measuring glucose over that whole time. So I think it'll be a little different. We are as we've always have. We're always continually enhancing adhesives, so we've got another couple that are in the mix here in the near term that further enhance the adhesion of the product while balancing skin irritation and ensuring that we don't we don't get those. We every time we've made this adhesive change, we focused on folks that have sensitivities and making sure that we're not causing more of an issue there. Especially with g7 we actually had a significant improvement. We launched the new adhesive on the g7 product in terms of less, less reactions. So, but it's something we're always mindful of. But, yeah, I think, you know, depending on what the person's issue is, you know, they may also a 15 day. If their 10 day isn't lasting, their 15 day may also but one thing is, we replace sensors. You know, particularly if you get a sensor error, we're going to replace that sensor every time. If you have an issue, what I generally see is people, over time, learn what, what, where it was specific, where location works best for them, what adhesive combination works best for them. Frequently, a new user, if they do have an issue, they figure out over time how to resolve it as they use more and more sensors. But you know, it's part of the fact of CGM. Not all CGM sensors specifically last the full duration. It's a smaller percentage, but it does happen, and that's part of just the state of the art of the technology, and something that we're always working on, enhancing, extending. I mean, we took us a while to make sure we were ready to do 15 day because of that, we want to make sure that the vast majority of sensors make it to the full 15 days. And part of that was bringing it to stello first. We brought it Stella first. We've seen good performance with Stella 15 days, and now we're ready to continue extending it on to g7

Scott Benner 24:07
Listen, I've seen you pressured a number of times over the years. I've never thought that you guys have rushed just because you were getting pressure. I mean, I'm seriously like the Apple Watch functionality, like you could have buckled a bunch of times and just said, Look, here it is. It might work. It might not like, you know what I also wonder, I mean, you and I have talked about this before, but like, it's still like a an inanimate thing being inserted into a living person. Like it's, it's not a perfect scenario, right? Like, sometimes people get luckier and some don't. Sometimes, like you said, they find a place or a way and then it fixes their problem. I feel bad all the time when people tell me their their problems, and they say, What are you doing? I go, I have Arden wears right through the 12 hours. Like, yeah, she doesn't. She very, very, very rarely has a problem. I will tell you. We've seen a few of the insertions where the where the sensor wire ends up outside of the CGM, and you pop it off and throw away and put another one. But other. Than that. I don't know how to respond to them. She doesn't have adhesive allergies, and the thing lasts for so I just knock on wood, and I go, go, we're finally getting lucky about

Jake Leach 25:07
something. Yeah, the point when you started that was the that idea of, yeah, it's a sensor probe under the skin that, and that's in, you know, in terms of the science that's, that's what we work on the most, in terms of the way the body reacts to the sensor and different insertions. Sometimes it's, you know, works perfect, and other times, that particular just insertion has nothing to do with the physical sensor itself. It's a perfectly good sensor, but you know, your body's reaction to it in that, that state and time you know you get, maybe it doesn't last the full 10 days. So it's part of the science that we strive and work on and continue to enhance longevity. But yeah, I think anybody who does have issues, we always want them to come contact us. We want to hear about them, and we want to, you know, help them figure it out. That's, that's our number one, number one policy for customers. We're here to support you. We want to figure it out. We're not always perfect, but we strive to be, and we always strive to get better and better. Yeah, hey, I want to make sure.

Scott Benner 25:59
Do you have anything else for your announcement? Can I ask you a couple other questions?

Jake Leach 26:02
Well, I think other questions? Well, I think there's one really cool thing I wanted to tell you about. In g7 we've got a photo meal logging feature that we're launching here imminently, that allows you to take a picture of your food that you're about to eat. And so instead of having to manually log it, it does an automatic you take the picture. It uses AI to determine what the food is, gives you a description of it. It's pretty cool. I've been using it quite a bit. The demo version. It's pretty cool to be able to log your meals that way, and then it gets recorded into the into your glucose history. So you've got that capability to log those meals. And then, if you can imagine, once we have that out there, and people start using it, there's a whole host of things we can do in terms of meal recommendations, helping physicians understand meal compositions for patients and how to help them enhance things so that that feature is launching here very quickly, on g7 first, actually, we're bringing it g7 first. We're going to bring stello later this summer.

Scott Benner 26:57
Okay, are you going to sunset g6 at some point. And do you know when that is? Yeah, at

Speaker 2 27:03
some point we will. I think you know, our goal has been making sure we support customers across the whole spectrum, particularly aid users. And so Omnipod just launched their iOS app version that's compatible with g7 another lot of people waiting for that, that is going to help with the folks have been waiting to upgrade to g7 now they can. So at some point we will sunset g6 but we're not we're not ready to do that this point in time. We want to make sure everybody has a chance to get their upgrades through before we'd start talking about g6 discontinuation. So you brought up a second ago that the photo logging is AI looks at it and recognizes the food. I've been wondering what else you you might be thinking about with AI. And I'll tell you from just from my perspective, I've done some things, like built my own large language models that are just made out of the transcripts of the podcast. And all that is, is what, maybe 2000 conversations about diabetes at this point. There's almost nothing you can ask it that it doesn't know about diabetes now, and as you're talking about what you're talking about, I'm thinking, How long, I mean, we don't all eat that many different things, right? So how long is it going to be before I take a picture of the plate and it's already seen me eat this 10 times, and it goes, this is this much insulin? We're going to extend it this far? Like, is that a world we're looking for? I mean, I think there, as you know, there's enough variability in diabetes that it may not be just quite that perfect, but it will certainly be able to be Hey, when you ate this last time, here's what happened to your glucose. Good job. Great meal. Keep doing it. Or it could be, hey, here's a way you could do this differently. Maybe change a portion or something, swap something out for a protein, swap some carbs out, like, just basically switch it up a bit to really help them. It's like a great in the moment teaching tool, yeah. So I think we are, you know, AI is going to it's helping us in all kinds of different ways. As you, as you mentioned, it's a wonderful resource for information properly, kind of managed, right? We've been using it in the stello insight report, the generative AI and the AI technology that Google has their their vertex and Gemini technologies, those, it's really fun and cool to play with. We continue to come up with new use cases. You're going to see a lot, I think you're going to see a lot from from Dexcom and many other companies. Just in the way that we use AI technology for all different aspects of our lives, we're clearly very focused on applying it to diabetes and and continuous glucose monitoring, and I think it's going to make the products more engaging and going to give you better insights, ultimately, right, that are highly personalized and simple and easy to use, and really amplifies the value that we're already bringing. This is a very forward looking and if you're thinking about it, you might not be able to say it even but say it even, but you have everybody's data, if you've got their graphs, and you've got their logging of insulin and carbs. I mean, at some point that's got to be enough information to teach an A I D system with right to be predictive. Yeah, you could do absolutely. I mean, we we actually have one of the tools that we have with. And our research development team is a physiologic simulator that based on, you know, different activity levels, food levels, everything. Can predict glucose excursions, and you can, you can, basically can recommend the amount of insulin to take or a different type medication. We've used that to help develop quite a few things, including our basal optimization algorithms for insulin optimization, we've started using it for aid algorithms. We used it when we did the control IQ development. So we've been using simulators for a long time, and now the AI tools are just making them more powerful. So I absolutely think, I think that, and the real benefit here is you can really short circuit and speed up some of the innovation when you can do simulations and in silico modeling versus having to do large clinical trials, there's still often a point where you need to do some some trials to really prove safety. But, you know, the in silico stuff really gets you a long way. And so I think that's clearly one of the areas that AI is going to help us. I imagine that's how you figured out predictive low alerts. Yep, that's exactly how the predictive LOW Alert was developed. Was developed off of a lot of user data that you know. The whole goal with that was to make sure you know the urgent low soon. We didn't want to be alerting you if you're not really going to go low soon, right? And it's kind of funny, because if you wear that as someone who doesn't have diabetes, you'll you'll cut sometimes get those alerts just because the way your glucose dynamics look, but you know, those that particularly have diabetes or are dependent on insulin, it's very accurate in terms of its ability to predict without giving you too many nuisance alarms, that balance was purely driven by analyzing user data and figuring out the right time to alert. Yeah, I have a question from somebody that wants to know if you're exploring other ideas for different sensors. They brought up biomarkers, guys, they were really specific, or CCL two from subcutaneous tissue, like somebody who's listening knows more than I do. But are you? Are you looking into branching out different things? Yes, we are. We're, you know, if you think about the platform we have this wearable subcutaneous sensor probe that continuously measures an analyte. Today, it's glucose. There's quite a few others that we've been working on, both enzymatic and some that are not enzymatic. The use cases are pretty powerful. There's quite a bit of both chronic disease and other health conditions that you can better manage if you had some of these markers. And so, glucose is still our focus because of the significant need out there, but we've been for years working on a number of different programs that extend sensor sensing beyond glucose. We'll start talking more about those here soon. You definitely feel like there's an opportunity to increase the impact we can have by adding some additional analytes to the sensor.

Scott Benner 32:44
This is for me, but I'm 53 do I live to see a sensor that doesn't have to be inserted

Jake Leach 32:51
that's accurate enough to give insulin off of or is it just, do we just not possess that technology at this point? It definitely doesn't exist today, at least anything we've seen, and we've seen quite a bit, and we've evaluated a lot of non invasive so no, no sensor under the skin, and no, no sensor in contact with the actual glucose molecules. We've not seen anything that even comes close to the performance you would need to actually do the things we do today. You know, one of the things I've seen is there's some interest in, you know, them being able to categorize risk for high glucose, right? So, you know, those types of systems could potentially say, Hey, you're have a higher risk of exposure for glucose, so you might want to go wear a CGM. I mean, I think that's, that's the closest I've seen to a technology something like that. But when it comes to making food choices and better, and particularly managing diabetes with insulin. There's nothing that I've seen that's even close to being able to do that. But I love, I love all the, you know, I love the efforts. It's we stay close to the number of companies that are developing technology in this space. It just hasn't, hasn't come to fruition.

Scott Benner 33:59
I only ask because of the number of people who are duped by the fake ad of the pulse ox meter that says that it's a glucose monitor, and you don't have to get I don't know if you've seen that one, but it's been going people are taken in by that with the frequency I have a really big like, my group has like 70,000 people in it, right? Like they're active every day. And so the amount of people that I see who are taken in by that really what it makes me feel like this, but in their heart, they really wish that was true. Yeah, you know, yeah. So I was just asking the question to break their heart so they can stop

Speaker 2 34:27
thinking, yeah. I mean, I do think, I mean, it is, it's a it's been something that billions and billions of dollars have been invested in. I think it's just the science. When you get down to the physical science of it, it's just hard to you look at a pulse oximeter, it could tell, you know, blood oxygen based on the color of the blood, but you glucose, there's no color change. There's RFS been tried. So many things have been tried with great promise, but it doesn't play out when you get down to the actual physics. It shows the value of glucose sensing. And everybody who's who wants to try to get into that, that type of development, they're basically further. Validating just how important glucose is as a biomarker, just yeah, the sensing mechanism. I think we do the best at it, and we're going to keep innovating. I'm going to see if you'll tell me when g7 15 day is going to come out. But before I do, I want to know if there's any other stuff in the pipeline that you're able to talk about, smartphone, watches, pumps, any integrations that are coming. Nothing to talk about at this point. We're going to keep you know, driving new versions of our apps, new features. The photo, meal logging is a big deal. It goes across our whole platform. We got continued enhancements in identity management, right? Just making it easy, passwords and things you forget, those are linking, linking between partners, right? We've got our aura partnership with Stella, which has been very exciting to see the number of folks that are linking their stellos up with their aura apps. But there's improvements we can make in that process. There's just so many things we can do to further enhance the, you know, the experience around the products, and that's what we're focused on. Okay, awesome. Well, I appreciate it. Can you tell me when 15 day g7 is available later this year? Yeah, later this year? Yeah, definitely, yeah, it'll come out later this year. Yeah. Team's working hard right now, building inventory, getting them, getting ready for the launch. So it's coming

Scott Benner 36:08
right?

Speaker 2 36:09
Is there any connection between when people have problems with their g7 is there any connection to where it's being produced and the problem coming out of a certain place, or, like, at a certain time period or something like that? No, it definitely so the it's a really good question, because we do have multiple manufacturing sites now. For many years, we just manufactured sensors in San Diego, and then we opened a site in Arizona, and now we open a site in Malaysia as well. So we build sensors for the world in all those different locations. We have the exact same equipment in every single facility. We use the same automation equipment we use. The teams are all kind of trained in with the same technologies. Our experts are, you know, spend time in all of our factories making sure things are running so it definitely we don't have specific, you know, differences between factories. Even the way that we measure the performance the factory is exactly the same. And I can assure everyone that when I look at the performance of our product in the field, as well as what we've got coming out of the factories, very diligently, I actually spend a good amount of my time following up on that and making sure that we're always making a better sensor every day. And we do have consistent performance across factories. You know, we do have issues. They do pop up and we fix them quickly. It's part of just the scale that we operate at and continuing to build record new sensors every quarter. We're just continuing to learn and enhance and get better and better. I definitely want to make sure everyone understands that it is the same process, same performance across factories, no matter where it comes from. I mean, it just thinking about it from common sense. If you did identify a place that was making a mistake, I would assume you'd be able to fix it. You'd know what the mistake was. So, yeah, it's just the randomness of production. When something goes wrong, yeah, I think when if something, if it's, if it's something on our side, like a, say, a deployment issue, yeah, it's basically just sometimes, you know, there's a small percentage of sensors that, when you try to deploy them, they fail, and so we're always studying those. We want to hear about them from users. We want to replace them right away when that does happen, and G sevens continue to get better in terms of its its performance now which 15 day coming out in the higher accuracy and longer where. So we're continuing to invest in both future innovation, but also just continued reliability enhancements and making making the products

Scott Benner 38:21
better. Listen, I tell people the same thing all the time, but I always there are moments when I think they just think, well, yeah, Dexcom, they buy an ad on your podcast. What are you going to say? But you know, my daughter's been doing this for 20 years. We started with a meter. If I took you back then and gave you the first Dexcom, you'd be like, Thank you. I'll take you. Don't need to make it any better. This is perfect. Thank you. If you go back 40 years and find some old head who was on regular and mph, they'll tell you, if it doesn't work all the time, put another one on, because this stuff is awesome. I mean, listen, I've been watching you forever, you guys, you get better all the time. I've never seen you not working on making things better, sleeker, you know, more accurate. And listen, every time something comes up, I think if it's just like a fun thing, that's all like, the magnet thing with the g7 now, like, if you ever, like, you know, it goes on, but the magnet doesn't turn it on. You just get a magnet. You like, move it around and it pops on you. Like, hey, I figured it

Speaker 3 39:12
out that was, yeah, I saw some of that on social media too. At first, when I saw it, I was like, wow, that's interesting. And then I looked into it, I was like, oh, yeah, nope. That there was a particular failure mode we had that you could do that with, but we fixed that.

Scott Benner 39:24
Yeah, no. And, like I said, it doesn't happen anymore, but for like that couple of like, I mean, I think it happened twice, but it's interesting, though, because you watch a person online with a more of an engineering brain, who goes, like, look, there's a magnet in there. I think that the reason that battery doesn't start running until you put it on is because that magnet is doing something when it when it separates. So I would just hold the magnet up to it again and pull it away a couple times. I was like, That guy's a genius.

Jake Leach 39:47
I love the ingenuity and the passion of the community out there, and a lot of the feedback that we get from users gets put right into the product just because of that, because, you know, we're they're thinking of wonderful things for us to do. And. As well as what we're doing internally,

Scott Benner 40:01
they're the ones using it, right. So, yeah. So anyway, man, Jake, I really, I appreciate your time, and I hope you I know we're recording this ahead of time for ADA, but I don't know if you're going, but I hope you have a good experience. If you head off to the conference, yep, yep, I'll be there. Excited to be there, excited to meet with lots of our customers and physicians and, yeah, catch up. Awesome. All right, it was good to talk to you. You too. Scott, thank you.

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Scott Benner 6/20/25 Scott Benner 6/20/25

#1554 Stop Trusting People

Diagnosed at 35, Karen rides hard—mountain biking the Midwest with her family. Her path to T1D included MS and aneurysm misdiagnoses.

+ Click for EPISODE TRANSCRIPT

Scott Benner 0:00
Hello friends, and welcome back to another episode of The Juicebox Podcast.

Karen 0:14
My name is Karen, and I live in the northern plains of the United States of America, and I was diagnosed with type one diabetes at the age of 35 back in her favorite year of 2020,

Scott Benner 0:28
if this is your first time listening to the Juicebox Podcast and you'd like to hear more, download Apple podcasts or Spotify, really, any audio app at all, look for the Juicebox Podcast and follow or subscribe. We put out new content every day that you'll enjoy. Want to learn more about your diabetes management. Go to Juicebox podcast.com up in the menu and look for bold Beginnings The Diabetes Pro Tip series and much more. This podcast is full of collections and series of information that will help you to live better with insulin. Please don't forget that nothing you hear on the Juicebox Podcast should be considered advice medical or otherwise, always consult a physician before making any changes to your healthcare plan or becoming bold with insulin. I'm having an on body vibe alert. This episode of The Juicebox Podcast is sponsored by ever since 365 the only one year where CGM, that's one insertion and one CGM a year, one CGM one year, not every 10 or 14 days ever since cgm.com/juicebox this episode of The Juicebox Podcast is brought to you by my favorite diabetes organization, touched by type one. Please take a moment to learn more about them at touched by type one.org, on Facebook and Instagram. Touched by type one.org. Check out their many programs, their annual conference awareness campaign, their D box program, dancing for diabetes. They have a dance program for local kids, a golf night and so much more touched by type one.org. You're looking to help or you want to see people helping people with type one. You want touched by type one.org. This episode is sponsored by the tandem Moby system, which is powered by tandems, newest algorithm control iq plus technology. Tandem Moby has a predictive algorithm that helps prevent highs and lows, and is now available for ages two and up. Learn more and get started today at tandem diabetes.com/juicebox

Karen 2:38
My name is Karen, and I live in the northern plains of the United States of America, and I was diagnosed with type one diabetes at the age of 35 back in her favorite year of 2020,

Scott Benner 2:52
look at you making a big year out of it. You know what I

Karen 2:56
mean? Yeah. I mean, why not just jump all the way in with COVID and being diagnosed with type one. So it was quite the year, Scott, you're 40 now. I'll be 40 in June. Yep, awesome. Well, Happy Birthday a little early. Thank you. Of course, did you have COVID? I ended up having flu like symptoms back in October of 2020, where I ended up just being really sick with like fever, sinus congestion, like ear pain, like everything. So I did get tested for COVID, but they had said it was negative. So I just put it off of maybe having like influenza or something. So I didn't think much of

Scott Benner 3:39
it. Now that you know what COVID is. Do you think you had COVID? It could

Karen 3:42
have been, you know, I probably did have it. That was one of the things that my endocrinologist asked me was, did you have COVID? Because they were seeing an uptick in type one diabetes after somebody had COVID. Well,

Scott Benner 3:56
so listen, a lot of people are diagnosed after a virus of a number of different kinds. So, like, it makes sense that if we sprayed the world with a virus, a bunch of people who had, you know, auto antibodies, and maybe were on the edge, or one day, going to be on the edge, of having type one. It makes sense that they might have all gotten it, you know, at the same time afterwards. Also, like, I have no idea how well, none of us probably know how well those tests actually worked, like, here, jam this into your brain. You have COVID. No, you don't do another one. Oh, that one's different than this one. Awesome. Sit in your house. Sit in your house for a year. What was it 10 days?

Karen 4:34
I forget. Yeah, I think so. I think it was 10 days and it was like the whole flatten the curve of like two weeks. Everybody stay home. You know, yes, that turned

Scott Benner 4:43
into three years pretty quickly. Yeah, we just need you home for a couple of let's call it two weeks. It's gonna be probably two Christmas next year, summer,

Karen 4:53
Jesus kept on moving it. Yeah,

Scott Benner 4:56
lot, a lot of stuff happened you live. I know you're not saying. Exactly where you live, but you live out that part of the world that everybody thinks like this would be awesome. And then winter comes and I would run, right? I would run for my life. You

Karen 5:08
would probably run Scott like I honestly, I think about a month ago, like we had wind chills of 44 below.

Scott Benner 5:18
But what do you do then do you hide inside. You pray what goes on exactly? It's

Karen 5:23
business as usual. I mean, kids still go to school for the most part. I think only, like once we closed schools because it was super cold out. But I guess business as usual, I was out running to, like, the grocery store and whatnot, picking up stuff. So it didn't really stop me. We're just kind of used to it when it gets that cold. So that's ridiculous.

Scott Benner 5:45
Karen, no one's used to that. Now listen, like when you leave the grocery store on a day where there's wind chills, of, let's just be kind and say minus 20, not even minus 44 Do you curse the entire way to your vehicle

Karen 5:58
sometimes, but no, not all the time, like it's just, it's gonna get better. It's gonna get better. Like it's just us, just a little snippet of cold weather, like we're gonna get through this so, like, it's just making me stronger. Scott, I

Scott Benner 6:11
want to be clear that I live in New Jersey, where I don't think it really gets below, like, I mean, I don't know, it's not below freezing that often, right? Like, maybe it gets into the high 20s. Once in a while it doesn't matter. Like, this spring, it'll be 48 degrees, and I will, like, make the miscalculation of going to the grocery store without a sweatshirt on, and I will get out of my car, and I will be like, mother and just curse the whole web. Oh, I'm so cold. I'm so cold, I'm so cold. I'll just keep like, out loud. I'll be like, oh, people look up at me, I'll be like, This is insane, isn't it? And they're like, it's 48 degrees, and I'm like, I don't know, I caught a chill. So, you know, I think I would during the summer. I mean, it just it feels angelic to see the photos. It's nice

Karen 6:55
in the summer. I love it because, like, our our sun doesn't set until about 10 o'clock at night up here, and it is just amazing. Like, I love the summers up here so and, I mean, don't be fooled, we get some hot summers. Like, I think last summer, I was volunteering for a race, and it was 109 Scott and I was just melting again, like

Scott Benner 7:17
cursing, complaining the whole time. But actually, I'm better with the heat than the cold. For sure, this podcast is not about where I get cold at though. So although it should be, it should be, this would be a whole podcast of when I feel chilly. I don't think anybody would listen, but I would have such a good time just complaining about the weather. I'm going to be such a great old man one day. It's going to be awesome. So you're diagnosed out of nowhere, or do you feel like, like, did you see it coming? Did it creep up? Or did it hit you quickly?

Karen 7:45
I feel like it creeped up. Scott, so after I was sick, like, the end of October 2020, in November, I started getting, like, blurry vision, and I'm like, What is going on? Like, I don't think my vision, like, decreased that much so, like, it was almost to the point like I had, I was working in an office, and I had a calendar about maybe, like, five feet for me, and I could not see the numbers on it, so I'm over here, like, Well, I'm just gonna go to the pharmacy and get some eye drops. Maybe I have something in my eye, you know,

Scott Benner 8:18
in both eyes. You get something in both your eyes at the same time,

Karen 8:20
yeah, you know maybe, I mean, generally, I'm a pretty healthy person, so that didn't do the trick. So then I Karen, I

Scott Benner 8:29
gotta stop you for a second. You're gonna You're such a good storyteller, I'm running you over, and I apologize. But, like, did you actually put the drops in your eyes and when it was still blurry? Go, huh, can't believe it. Or, or were you like, yeah, I didn't think that was gonna work. I'm out nine bucks now. How did it, like, how did that feel? I'm being serious. Well,

Karen 8:45
no, it was one of those of like, Huh? I guess I don't have something in my eye, but the but the pharmacist said that, you know, it could cause some blurriness a little bit. So I'm like, I'll give it a day

Scott Benner 8:56
and it wait. You said the drop caused the blurriness? Yeah.

Karen 9:00
He's like, Well, when you put it in, it could be blurry for a little bit, so just give it a little time, and then it should clear

Scott Benner 9:05
up. I don't want to be an alarmist, but everyone listen to me for a second. Stop listening to everybody. Okay, just this. There's no one to trust. Eye Drops might make your vision. Hi, I'm here because I'm trying eye drops, because my eyes are blurry, and I think there might be something in them. Oh, no, they're still blurry. Oh, that could be the drops. It couldn't be that my eyes are Oh, my God, I don't know. I trust no one, please. It's over. Okay, talk to the Internet if it tells you something I don't know. Verify it two more times and just go with it. Jesus, don't listen to me. For goddamn Sure. Let me just say that right now. I know a lot of you are, but you're making a huge mistake anyway. Oh, I'm sorry. The drops didn't work. Go ahead.

Karen 9:50
No, it did not work. So I'm like, Okay, now what do I do? I'm like, well, I shouldn't maybe go into my eye doctor. So went in there, and I'm like, my eyes. This are blurry. What is going on, and they couldn't tell me why. And they're like, they seriously thought that I had Ms. They're like, we think that maybe you're developing Ms. And they were like, pulled out, like, this eyedrop dropper with a red cap on it. And they're like, What color is this? I'm like, it's red. They're like, you don't see pink. I said no, it's red. They're like, typically, like somebody developing ms would say that that is pink. So they were kind of like, you check out, fine. There's nothing wrong with you. Reiterate

Scott Benner 10:35
again, please stop listening to people like, I mean, I were we in a pearl Vision Center? What was going on exactly? This episode is sponsored by tandem Diabetes Care, and today I'm going to tell you about tandems, newest pump and algorithm, the tandem mobi system with control iq plus technology features auto Bolus, which can cover missed meal boluses and help prevent hyperglycemia. It has a dedicated sleep activity setting and is controlled from your personal iPhone. Tandem will help you to check your benefits today through my link, tandem diabetes.com/juicebox, this is going to help you to get started with tandem, smallest pump yet that's powered by its best algorithm ever control iq plus technology helps to keep blood sugars in range by predicting glucose levels 30 minutes ahead, and it adjusts insulin accordingly. You can wear the tandem Moby in a number of ways. Wear it on body with a patch like adhesive sleeve that is sold separately. Clip it discreetly to your clothing or slip it into your pocket head. Now to my link, tandem diabetes.com/juicebox, to check out your benefits and get started today, when you think of a CGM and all the good that it brings in your life, is the first thing you think about. I love that I have to change it all the time. I love the warm up period every time I have to change it. I love that when I bump into a door frame, sometimes it gets ripped off. I love that the adhesive kind of gets mushy sometimes when I sweat and falls off. No, these are not the things that you love about a CGM. Today's episode of The Juicebox Podcast is sponsored by the Eversense 365 the only CGM that you only have to put on once a year, and the only CGM that won't give you any of those problems the Eversense 365 is the only one year CGM designed to minimize the vice frustration. It has exceptional accuracy for one year with almost no false alarms from compression lows while you're sleeping, you can manage your diabetes instead of your CGM with the ever since 365 learn more and get started today at ever since cgm.com/juicebox, one year, one CGM,

Karen 12:48
I went to some local eye doctor here within my town, and I was just like, I left there, like, there is something wrong with me, but I don't know what it is. So I ended up going to work, I think, the next day, and I was just kind of chatting with my coworker, like, I don't know what's going on. Like, I don't know what to do. And she, she was really concerned about me. She's like, Karen, you need to you need to go in. I'm like, I don't want to go in. There's COVID. Like, everywhere. No matter where you go, there's like, COVID here, over there. Like, I don't want to go into a clinic and end up catching COVID And like taking it back home. I want to

Scott Benner 13:25
call this episode COVID here, COVID there, COVID everywhere, a new Dr Seuss story. I just love that. Like in the span of a very short amount of time you went from there might be something in my eye to Ooh, the drops that I put in my eye to clear out my eyes might be making my vision blurry. To, I have, MS, oh, no, there's nothing wrong with me, but I still can't see. What's the timeframe on this? Please. What is the timeframe from, hey, My vision's blurry to, you don't have, MS,

Karen 13:53
maybe just a couple days, I'm jumping

Scott Benner 13:55
off a roof. By then, I'm like, it's enough. I gotta get away from all you people. All right, so did your friend get you to a hospital?

Karen 14:01
So my friend was like, Okay, call my clinic, because what they called it back then was a clean clinic, basically meaning that they weren't taking any patients with COVID. So I'm like, oh, okay, sure, I'll go and I'll talk to this clinic. So I called them up and explained my situation, and they're like, well, we're not taking new patients right now. So I, I actually spoke to a doctor, and I kind of went through everything that I was experiencing. And he goes, I'm concerned about you. I'm concerned that you may have a brain aneurysm, Jesus Christ. So he's like, I highly suggest you go into the ER right away and get this figured out. Okay,

Scott Benner 14:44
this so they were able to figure it out, I imagine so.

Karen 14:47
Like, okay, I'm over here. Like, well, I don't feel like I'm dying right now. I don't know about going to an ER, but so I ended up just, I'm like, just whatever. I'm just going to the clinic. Like, I'm just gonna mask up. I'm gonna sit in a corner by myself and not look at anybody, and not trying

Scott Benner 15:07
to look at the floor so the COVID can't see me absolutely, exactly, by the way, if I had to bet, I'd think we all had COVID, by the way, at some point or another. I just think it probably varied and like, it's, I mean, how do you not so many people had it. How do you have I mean, unless you sat in your house and really, just, like, hunkered down. I realized later that I was the one that got sent to the grocery store. And it occurred to me later that, like, the three of them must have got together and been like, if we can, like, afford to lose one of them, I think it's him. It really feels hurtful in hindsight, I guess is what I'm saying. All right, I'm sorry now you have a brain aneurysm. Go ahead. Yeah,

Karen 15:47
now I have a brain aneurysm. So that's, that's great. So here I am sitting in this, in this waiting room, and everybody's coughing around me like I'm gonna get COVID. That's, that's it like it's just gonna happen, Scott, you know. So I get called into the doctor's office, and he's like, all suited up. I'm like, okay, great. Like, I hope you don't have COVID on you. So he, he went through, like, what is your symptoms? I'm like, well, blurry vision, extremely thirsty, and I lost 10 pounds in a week, you know? So I'm like, there's something not right here. And by the way, when I was experiencing all this, I was like, doing like, a fitness challenge at the gym, and one of the things was to drink X amount of water daily. And I was doing this with my sister, and she texted me one day she's like, I am struggling to get all this water in.

Scott Benner 16:39
You should have said it gave me a brain aneurysm. So stop complaining. Okay, right?

Karen 16:45
I'm over here, like, I don't know, I'm doing pretty good, like, I'm able to get it in. And she's like, I don't know how you can. I'm like, I don't know, but nothing would quench my thirst. I remember grabbing a sprite and like, I'm just gonna drink this. Like, I am just super thirsty. But anyway, yeah, well,

Scott Benner 17:02
you were being driven by certain death, which apparently makes you very thirsty when it involves your pancreas not working. Yeah, I guess. So. I can't wait to hear how this because I have a, you know, you just said to an ER doctor, I have blurry vision. I've lost a lot of weight. If you say that to me, I go, Oh, you have type one diabetes. And I want to reiterate what I said earlier. You shouldn't be listening. I barely got through high school. I got to think, if I'm an ER doctor, I hear that, and I go, oh gosh, you have type one. Let's check your blood sugar. But what did

Karen 17:31
he say? So he checked my blood sugar? Oh, good. Okay, he did. He's like, Well, let's check your blood sugar and go from there. And I think at the time, my blood sugar was like 400 so he looked at me and he said, You have type two diabetes. Can

Scott Benner 17:48
I curse? I don't know where you are on the religion scale. Close your ears for a second, Mother, 400 you have type two diabetes.

Karen 17:56
Yep, yeah. Go ahead. Yep. Type Type two diabetes. So I sat there and was like, What in the world? I swear he was going to have me Pinky promise him not to eat any sugar. And he sent me home and said, you cannot eat any sugar. And, like he said, it like three times to me, I'm like, Okay, I promise I will not eat any sugar. So, and I walked out of that clinic just like, I don't know what happened. So if you had type two diabetes, I was so confused, Scott that I didn't know. I'm like, a

Scott Benner 18:36
large portion of the population of the planet has type two diabetes. How come they can see their calendars,

Karen 18:43
right? Yeah, yeah. And I should back up a little bit to kind of talk about I was pregnant back in February of 2018 and had gestational diabetes then, so I remember going to, like, my doctors for like those follow up visits, and they're like, gosh, Karen, you are just killing it over here with, like, checking your blood sugar, eating what you need to eat, and whatnot. Where fast forward to walking out of that clinic. I thought to myself, I just got promoted to diabetes. Like, I now officially have

Scott Benner 19:19
diabetes. Like, my fault. I did too well with those blood sugar checks. And God, was like, she can handle it. And yeah, right now I hear, yeah, oh, Jesus,

Karen 19:27
you know, kind of like those work memes, like, when you do a really good job, you get promoted to something you don't want to be promoted to. And I'm just like, I got promoted.

Scott Benner 19:36
No raise and pay. They didn't change my title, but I got more work all of a sudden,

Karen 19:43
so I walked out of there and he had told me, you need to meet up, like, talk to your primary physician. Well, at the time, I didn't have a primary physician, because he just retired. He probably saw COVID coming. He was like, I'm out.

Scott Benner 19:56
I know what I'm gonna do. I'm gonna leave you. Yeah, yeah.

Karen 20:02
So I'm like, Oh, great. Now I gotta establish care with somebody. So I honestly was calling around just trying to find somebody. I had a doctor that I was gonna go visit with, but she was like, three weeks out. I'm like, I can't wait three weeks like, I don't know what's going on with me. So I got a primary physician pretty quickly, and she was the one that was like, Hey, I don't know if you have type two diabetes. Let's, let's go ahead and let's do some other testing on you.

Scott Benner 20:31
Yeah. Oh, I'm so glad, by the way. I'm stunned that the ER doc didn't voice the the Metformin on you. I thought for sure that was coming in the story.

Karen 20:40
Well, I think she actually put gave me Metformin. So really, I was on Metformin for a little bit. I can't remember if it was him or if it was her that put me on it. Gotcha.

Scott Benner 20:51
I mean, if she thought you had type one, I don't think she would have been the one to put you on Metformin.

Karen 20:57
That's me, guess it could have been him, because I remember, yeah,

Scott Benner 21:01
having conversations now, personally, with somebody like in their early 20s, you know, 140 pounds just lost 20 pounds, clearly has type one diabetes. That person left the ER, with metformin. He you have type two diabetes. Here's some Metformin. Luckily, they knew me and texted I was like, that kid does not have type two diabetes. This is, you know, I wouldn't take the Metformin if I was. You like, go find a better doctor. And that's what they did. But anyway, just unbelievable. I'm so sorry. Like, go ahead. You're having a horrible time. And you're also the mother of, like, a two year old at this point too, right?

Karen 21:31
Yeah, and two, two boys as well. So I looked at it, I'm like, Okay, I had a boy who was 12, another one who was How old was he? I think he was, he was seven at the time, and then a two year old.

Scott Benner 21:44
So, gosh, what are you trying to populate the planet? What's going on, right?

Karen 21:47
I mean, three kids. I'm like, after my last one, like, this is the last one. I'm not going to try to have another

Scott Benner 21:54
to keep me busy. Tell me the truth. The third one, not on purpose.

Karen 21:57
No, it was my husband wanted another child. You're like, okay, okay. So he's like, no more like,

Scott Benner 22:05
he's like, here, I'm gonna make a third baby and I'm going to work. So good luck with that. You're like, I have a job too. Wait a second. Hold on, boys. Never mind. Go ahead. I'm sorry. No, you're okay.

Karen 22:20
So I ended up going to my my new primary physician, and she had said, Okay, let's do some different testing on you, because I think that you are not a type two. I'm like, oh, then what I am i She's like, I'm thinking that you have Lada, you may need to have insulin. I'm like, okay, so we ran the test in she had messaged me later, and she's like, yes, you're gonna need insulin. So I'm referring you to an endocrinologist.

Scott Benner 22:48
Okay, well, was it nice to have an answer? Yes, it was very

Karen 22:52
nice to have an answer, because I was very confused with everything from MS, from blurry eyes to ms to brain aneurysm to type two and now type one. You know,

Scott Benner 23:04
you know, if you would have asked an AI or Google, you would have gotten a better answer than all the people you saw before that. I probably would have, Scott, no, I mean, if we type in right now, I have blurry vision, this, this, and my blood sugar is 400 it's going to say you have type one diabetes.

Karen 23:21
That's what I'm gonna do here on out, Scott. I'm just gonna use AI, like, tell me what I have

Scott Benner 23:25
stop trusting people. Is the name of this episode. Go ahead, I

Karen 23:29
went to go see the endocrinologist on November 18 of 2020, and that's where he was, like, we're stopping Metformin. They got me a Dexcom right away, which is wonderful. I remember them saying, like, well, you're gonna have to check your blood sugars. Karen, and I'm over here just thinking finger sticks like the whole time. I didn't know anything about a CGM, so I'm like, well, that's going to be kind of hard to do this all the time, because we're a pretty active family. We do a lot, a lot of mountain biking. So I'm like, Well, an exercise like, decre like, drops your blood sugar. So I'm like, Well, I guess I'll just stop on the trail and just check my blood sugar from time to time. But my diabetic educators, like, No, we're gonna get you a Dexcom here today and and send you home with it and get it all like, set up on you and whatnot,

Scott Benner 24:23
stop for the regular reasons on the bike trail. Now, yeah, it's interesting that that's how it popped into your head. Like, oh gosh, I know what blood sugar checks are, because I was gestational. How is that going to affect my bike riding? It's interesting. I always wonder how the news strikes different people. Like, yeah, what do they think of first, what scares them? What do they stay scared about? What do they figure out later? Get away from like, you have such a limited understanding of what you're, you know, being thrown into, and then all of a sudden you're trying to apply that limited understanding to the rest of your life. It's almost not even worth thinking about in the beginning. You wouldn't know that. But, you know, yeah. You just gonna come up with the wrong answers to a lot of things. They didn't hassle you about not being on insulin and giving you a CGM.

Karen 25:08
They gave me insulin right away at the endocrinologist office. So like that day, my husband and I left, and you gotta go pick up insulin, and you have to pick up bass me in the event that you have like, a super low low they got me all set up with that. I think I spent like two hours at that at the endocrinologist appointment, Scott, it was a long visit. Yeah.

Scott Benner 25:34
I wonder if they it just, it just struck me. I wonder if they do that, because I've seen a couple of people get diagnosed. Lot of they don't really need insulin yet, but they're like, Here, let's just give you, like, a basal pen so you have it. I wonder if they do that so the insurance won't argue about the CGM. I don't know. That just occurred to me. Maybe that's like, some sneaky good thing a doctor does know to do. All right, yeah, okay, by the way, I'm not saying don't listen to doctors. I'm saying don't listen to anybody. I just want, I tried to go out and pick up some takeout the other night, but can I tell you a story? So, like, yeah, we're visiting my mother in law for her birthday. We kind of sprung in on her. So we're like, let's we'll go bring a meal in, right? So we've nice restaurant nearby. Go, you know, order the food. They say, Come 45 minutes. I come like a gentleman, 40 minutes before, right? The girl goes, we're very behind. An hour and a half later, they bring out my food like, you know what I mean, like, it's now an hour and a half past when I ordered. So it's twice as much time as they said. She brings the food out. She goes, Listen, you waited so long. I'm so sorry. Let me go through this piece by piece. Make sure you get everything. I don't want you to get home without your food. I was like, That's lovely. Thank you. She pulled out the receipt. She took out a highlighter. This is this? This is that? This? This, you've got everything. I was like, Oh, you're a gem. Thank you so much. I got back to my mother in law's house. People are looking at me like they forgot who I was because I've been going for they're like, oh, yeah, that guy went out for food a couple of days ago. And, you know, I lay the I just wanted soup. Everyone's got their food, and I look in the bag and I'm like, where's my soup? So I don't trust her. Trust the people. It's over now. I can't, I can't everything was there. There must have been, there must have been 25 items in that bag, just not my goddamn soup, man. I've liked it. I've given up. I don't trust Karen. I don't trust you. I trust issues. I swear to God, like I don't know how many times I can be let down before I just say to myself, Why do I keep expecting this to go? Well, you know what I mean, do I sound like? I sound depressed? I'm not, Oh, my God, all right, I'm so sorry. You got a Dexcom, you got a doctor, you had this super long visit. And did you stop worrying about COVID?

Karen 27:53
Yeah. I mean, in a way, yeah, like, okay, huh? Worry about me having COVID, or, you know, trying to get it, you know, other than, you know, going to the grocery store and just your typical life, you know,

Scott Benner 28:06
what I mean is, is that, prior to this diagnosis, you know, you see this all the time, right? Like, people's perspective level, like you said, you know, I got promoted. Your perspective gets promoted really quickly when somebody tells you your kid or you have type one diabetes, like, you know, you hear people talk all the time about, like, Oh, I'm so worried about this or that, you know, then all of a sudden they just stop worrying about that stuff, because they're like, I got bigger fish to fry here. So, like, I was wondering if that happened to you, like, did you just go, Oh, I can't think about this COVID thing. I'm thinking about this. Yeah,

Karen 28:36
yeah, because it was so much to learn. Scott. I mean, they're they're now giving me insulin, and they're like, Oh, hey. Like, you need this to live, but if you dose too much, you could die from it. I'm like, Okay, awesome. Like, this is great. So I'm like, Just tell me what I need to do. And they're like, You have to learn that. I'm like, but, like, from who, like, how, from you. Scott, and I learned a lot from you. But now I'm really questioning if I should trust you. You

Scott Benner 29:11
probably shouldn't, although there is a shop back in the room and it's red, and I can see that it's red, so I don't have MS, at the very least,

Karen 29:16
that's good. I'm glad it's not pink.

Scott Benner 29:20
But seriously, they said, Look, this could kill you. There's a lot to learn. Get out there, kid, good luck. Well,

Karen 29:26
they set me up with like, Okay, this is how much you should take, like, carb ratio and so forth. I think I was looking in very much for like, black and white stuff, Scott and like, learning about type one now it's not black and white, yeah, because my my educators, like it's going to be different, because food affects you differently, you know, and, and that's where listening to your podcasts about, like, fat and protein and how you get, like, a rise with that later, like, I learned that from the podcast, you know.

Scott Benner 30:01
All listen, I learned that from the podcast. Sure, yeah, you know what? I mean, like, seriously, like, if you think I knew fat and protein made my kids blood sugar go up when she was, like, eight, I didn't know that, you know? I mean, I know it's a thing people knew I didn't know. And then you start having conversations, and somebody says something one day, and you're like, wait a minute, what? And then, you know, all of a sudden somebody's like, oh, you should talk to this lady from Canada. She's got a way of talking about, like, great, get her on. And then she's talking. You can even look at the Pro Tip series and see sometimes like, oh, he figured that out later, because if he didn't that clearly would be higher on that list. Like, do you know what I mean? Like, it's a journey for everybody, but it's, I think the podcast is just a great place to have a conversation so people can figure things out absolutely

Karen 30:44
and it it's very much. It is a journey, because I tell you what that that two hour endocrinologist appointment with a dietitian, with with the endocrinologist himself and a type one educator, like, it was like information overload, yeah? And I mean, I'm, I'm grateful for my husband being there with a clipboard, like writing down all these notes, Scott, you know, so that we can refer back to it. And if they would have told me about that, about fat and protein, like spiking your blood sugar later, or making it rise later, I don't know if I would have retained it. Well, you know, do you

Scott Benner 31:22
have any idea it hasn't been that long ago? So maybe you're a good person to ask, like, do you remember what you took away from that meeting,

Karen 31:29
that I would have to wear a CGM basically for the rest of my life, that I can't do anything to change type one diabetes, and that it was an autoimmune disorder.

Scott Benner 31:41
It took him two hours to get that to you. That's all you know that. That's what I

Karen 31:45
remembered. But, I mean, look at my husband's notes, and there was much more, but that's just what I took away. Like at that point, I couldn't tell you much of anything else. Meeting with the dietician, I knew some of that stuff just from having gestational diabetes, of like this has how you kill carbs and and so forth.

Scott Benner 32:04
What does your husband do for a living? That he owns a clipboard.

Karen 32:09
He works QA for a software company, so he gets to test all these programs and see if they break or not. So that's what he does. But for sure,

Scott Benner 32:19
you're gonna tell me like he was like, mobile, and he needed it, like, to lean on in his car or something like that. Anyway. Oh no, no. I'm like, Who owns a clipboard? It's awesome. He does page one at the top, it said, Get Karen pregnant a fourth time. Scratched out. He was like, never mind that not happening. So he kept, like, what we'll call copious notes. And like, Did you refer back to them afterwards? Or was he, like, acting like a coach at that point? Was he yelling out, like, don't forget this, or

Karen 32:51
I would go back and look at the notes, and along with the notes that they had taken, because I have, like, my chart where I can go in and look at the notes and so forth. He was a great support. He's like, Hey, Karen. Like, I think we got to do this. You know, looking back at my notes, this is what they said. But no, he was not a coach. Like yelling at me,

Scott Benner 33:11
if he's a regular boy, what he thought was, oh, who's gonna take care of these three kids? I gotta keep her alive. I mean, like, I wanted to, like, go to soccer once in a while, but I wasn't looking for the whole experience. So, oh yeah, Aaron, you gotta live. You gotta live.

Karen 33:30
I can't take care of these three kids and maintain a house. I

Scott Benner 33:33
don't have it in me to do the sit ups. It's gonna take the trick another lady into watching these kids. Oh yeah. So okay, well, that's, that's lovely. So he's got the notes you're referring back. That's your entree. You've got these two hours he's writing furiously awesome. You're not really retaining much, except, like, life shift things, which makes sense to me. So then, like, when you know the next day becomes the next month, like a month later, after that meeting, where are you like, And are any of those notes or anything that happened to you? Are they? Is any of it helping?

Karen 34:08
I feel like that. It was helping. Good, like, the next couple months and, and I should say Scott like, when I was diagnosed, November 18 of 2020, I was in extreme denial about it, you know, where I'm like, I am going to show them that I don't need insulin. You know, I I don't need this. I'm going to, I'm going to accomplish this with diet and exercise, which now, like, you can't know in

Scott Benner 34:36
that moment that that wasn't actually possible, and you just were like, I'm going to try anyway. Or did you actually think it was possible? Was possible? I

Karen 34:44
think it was like, I'm gonna try anyway. Like, because, like, when I had gestational diabetes, I only needed, like, a background insulin, you know, I didn't have to take insulin when I ate. So I'm like, that, I'm just gonna do a background insulin. And I think part of it, Scott, is because I was. I didn't want to give myself shots, you know, I didn't want to carry this fast acting insulin around with me everywhere and having to take like shots, like at a restaurant and or at work and so forth, and explain myself all the time. I just didn't want to do it. So I'm like, I'm going to show them that I don't need fast acting that I can, that I can manage with just a basal insulin. Did

Scott Benner 35:25
you ever say that out loud to anybody?

Karen 35:28
I asked my educator, because she called me, like, a couple days later after the long meeting, and she's like, how is it going? Karen, I said, pretty good. Like, I just want to know, like, do I have to take this fast acting insulin all the time. Can I just get away with taking basal, like an injection once a day? And she's like, typically not. I'm like, Okay, well, I'm

Scott Benner 35:52
gonna do it anyway, just so you know. And what was your plan to accomplish that? Was it like an eating style? Was it an exercise regimen? What were you like? What were you thinking was going to do that for you? I

Karen 36:02
was thinking it was going to be exercise and low carb, you know, I mean, and I did the low carb diet, I guess, and it didn't work out so well. You know, I found type one

Scott Benner 36:15
diabetes. I still had type one

Karen 36:16
diabetes, Scott. And I think the other thing that I didn't know, Scott, when I was in this denial, was that there's so many other factors that contribute to high blood sugars, rather than just the food that you put in your mouth. You know, I didn't realize that. I thought it was purely just because of the food. I didn't know that heat and cold and hormones and I mean the list goes on and affect your blood sugars,

Scott Benner 36:45
all things living, breathing, turning your head,

Karen 36:51
stress. You know exactly. It all affects it.

Scott Benner 36:53
How long are you on this journey to not use insulin well, just

Karen 36:58
just so that we're on the same page. I was using insulin, like I was doing fast acting. But I'm like, I think I'll get it like, to the point where I don't have to, you

Scott Benner 37:06
know, okay, I'm sorry. How long were you on the journey to trying to not use insulin? Yeah,

Karen 37:10
maybe a good six months. Wow. Of like, I'm gonna try to just eliminate all the carbs that I'm putting myself in and not have to do it.

Scott Benner 37:20
Did those six months end with a whimper or a bang? Did you go out fighting, or did you just slowly go, this ain't gonna

Karen 37:26
work? I went slowly like, this isn't gonna work, you know,

Scott Benner 37:31
or anything like that. No,

Karen 37:33
I didn't. I mean, there's time Scott that I remember just crying though, like I remember being at a bike race with my husband, and I was extremely hungry, but my blood sugars were so high, and I just remember just crying. I'm like, I'm hungry, but I cannot put more food in my mouth because it's just gonna, you know, spike it even higher. And I'm like, This is how people end up with eating disorders. You know? I'm just like, I need to eat. And, yeah, after that, I'm like, Okay, I need to change some

Scott Benner 38:07
stuff. I'm gonna give myself some insulin and have a sandwich. So, right, right?

Karen 38:11
And, yeah, and I was giving insulin at that time too, but I'm just like,

Scott Benner 38:15
just, did you not know how to use it at that point? I

Karen 38:19
think it wasn't going down like, I gave myself some insulin to get my blood sugars down, but it wasn't going down fast enough. It was warm, I was cranky, I had a sick, car sick kid, and I'm like, I just need, I just want to eat something, and I feel like I can't eat anything because my blood sugars are in the 200 and if I eat the sandwich right now we're just going to bump them up to 300

Scott Benner 38:43
bike and be a mom and all the other stuff. You guys got to stop riding bikes. It sounds like your biggest problem.

Karen 38:49
Oh yeah, that is what we live for. Some days, I tell you what, which I was writing this all out. Scott and I looked at it, we did a bike race about a month after I was diagnosed, I'm like, What was

Scott Benner 39:03
I thinking while you were doing the this isn't gonna stop me thing, right?

Karen 39:06
Yeah, I think I was like, this isn't gonna stop me. And then I looked at it again, and I'm like, I did another race in February of 2021, which, brace yourself. Okay. We ended up doing this race in winter with wind chills of 24 below, and I ended up walking hiking 20 miles for this race. Why

Scott Benner 39:31
do you have to hike to get on the bike? I don't understand. Well, okay, so this is a

Karen 39:35
fat bike race, and like a snowshoe race, basically, I don't have a fat bike for the snow. So I opted out to do a snowshoe. Karen, when

Scott Benner 39:44
we start this conversation, it would have been polite if you would have started by saying, I have a mental illness, but I would have known, while we were talking that, you know what, I was dealing with. Why, in God's name, would you do that?

Karen 39:57
Because that was on the path of this is not. Going to type one's not gonna stop me. Yeah, could you have

Scott Benner 40:03
learned to code or something instead? Like, why wasn't it like, type one's not gonna stop me. I'm gonna make my own app.

Karen 40:12
Nope, nope. And, and I think the other part is just, like, you just get cooped up and you're like, I need to get out of the house and do something. And that's, that's what we did. We traveled to go do this race and, and in fact, Scott, I heard you make a podcast. I don't know what it was, but anyway, you're like, I'm always surprised when people listen to the podcast. So just so you know, during that race, back in 2021 I was listening to your podcast and just well,

Scott Benner 40:42
then it's fine. No, then I don't have any trouble with it at all. So why didn't you just

Karen 40:47
say that? Yeah, listen to your podcast during this race. So listen

Scott Benner 40:51
now. I think you're making a lot of sense. You should be out there probably 18 hours a day learning, you know what I mean, really, really ride and let that thing run. And for all you listening, why not let it play overnight while you're sleeping too, right? Maybe you'll learn something while you're asleep.

Karen 41:07
You never know, save time, right? Oh,

Scott Benner 41:09
my God, I had I was watching a YouTube video when I fell asleep last night, and like, an hour later, I realized it was still happening, and I was like, oh god. I mean, how many other videos ran? Like, what is it? I now know that I don't want to know.

Karen 41:23
Yes, yes. Anyway,

Scott Benner 41:25
yeah, no, I didn't mean I'm so sorry. Let me apologize if you were I think you're not mentally ill for going out in the snow. If you're listening to my podcast, there's a guy online who's like, I left my keys at work and it like, turned into, like, five more hours of driving, and he's like, but I listen to the podcast the whole time, and I was like, Oh, right on.

Karen 41:46
I think I saw that. Yeah. I

Scott Benner 41:48
was like, Oh no, that's cool, Ryan, thank you. That's what we need, absolutely. So after all this, right, forget me for a second. Like, why does finding other information, like, in different forms. Like, how did that end up helping you more?

Karen 42:04
When I got diagnosed, I just start putting ladder in everything. You know, I think I came across like a ladder Facebook group, and somebody in there said, check out, like the Juicebox Podcast. So I'm like, Okay, I'm not one to, like, sit down and just read things. Like, I retain stuff better by listening so and honestly, Scott, I almost stopped listening to the podcast when I first started because, well, nothing that you did, I mean, it was more so like, I think the terminology of like, basal and Bolus, I never left that endocrinologist appointment knowing what those meant. And I'm like, I don't get this. I don't know what, what this guy is saying, you know? So it I'm like, I don't know. Like, I'm MDI, I'm not on a pump, you know, at the time. But now it doesn't really matter, you know, just learning about it, like it's the same, like it's still your basal insulin, you know, and you need a Bolus, whether you inject or if you have, if you're on a pump. So, you

Scott Benner 43:10
know, if people start hearing Bumper ads for the defining diabetes series, eventually they're gonna be like, ah, Karen, now I gotta listen to all that stuff, because he's like, Oh, I didn't know that. You know, it's funny. Like, when I was in the middle of making all that stuff, it was in the feed constantly, so people knew it was there. But once you get done, you're like, all right, there's 60 episodes of defining, like, short 10 minute episodes that explain terminology to you. I think podcasting is the best way to deliver this information. Like, I haven't seen a better way to help people with their diabetes than these kind of longer form conversation so far, but the format and the way the players work, what you would like is to be able to open up that app and see like those series at the top and then the new episodes underneath of it. But that's just not how the apps aren't designed for me. They're designed to work for everybody who has a podcast, and it's more episodic, really, the way they're set up. I did find myself talking to somebody the other day. I think it's why I said, develop your own app. When I was joking about other things you should do, because I thought, why don't I develop an app that I can set up the way I want it to be? That's a podcast app, and the problem would be getting into people's hands. The ease of getting podcasts to people is because you buy an iPhone and the podcast apps on the iPhone already. So, you know, I feel like it would be one of those things that like, if I could accomplish it and then somehow force it onto all your phones, it would be awesome. And it would really, you guys would love it. If you can't get people to adopt it, then you just have this great tool that's not being used and ends up costing me, you know, I'm gonna guess, like, $15,000 to get developed or something. Or something like that. So I don't know. I'm glad so it worked out for you. Like, why did you not quit? I

Karen 44:47
think just dedicate it to figure it out. You know, I think I took a break for a little bit, and then I'm like, No, there's more. Like, there's more that I need to learn. The podcast was about. Best way to learn it, like I said, like it was, I could just throw, like, earbuds in and go for a walk and listen, you know, instead of trying to sit down, read a book about it with having three kids, like, juggling all their activities and whatnot, where I'm like, I I can just listen to this in the car. I was listening to it at work as I worked, so it was the best way for me to get that information, Scott,

Scott Benner 45:27
I guess I'm not going to change anything. Have you ever watched a chameleon yawn because I just happened to me, and he just looked at me and he was like,

Karen 45:36
does he just does he think I'm that boring?

Scott Benner 45:39
No, no, he just moved you and I have been talking for 44 minutes. He's moved six inches in that time. Oh, the other one's running in circles, like it's a crack addict. Just so, you know. Well, is it ridiculous of me to say, like, what did you learn that really, like, was there a thing that got you moving? Was it like, Oh, okay. Terminology makes sense. Now, other things are making sense. Like, there's no secret sauce to it, though. Like, right? Like, it's not like I heard this one thing and it all fell into place. It's just time and absorbing things,

Karen 46:11
yes, it's absolutely time, absolutely the time, and just really focusing in what, what does this definition mean? You know, it was language that I've never heard before. So, and I think I finally just, like, I just got to Google this. Like, what is this guy talking about? So there's no secret to it, Scott, it's just

Scott Benner 46:33
time, yeah, and it's funny, because you can say all things like, Well, Scott, why don't you put like, a dictionary on your website, and it would be nice for the people who would use it, but like, most people wouldn't, like, that's the that's the thing. Like, when other people try to help, like, when I'm, like, brainstorming online, I'm like, How do I help you guys? And everyone's like, I'll do this. Do that. I'm like, Yeah, I've done that. Nobody. It doesn't work. Like, you know, you mean, like, it's one of those things that sounds good, and it probably is right, but the leap of getting someone to actually do it is, is nearly impossible, because you can't make anybody do anything. I think that's why the podcast works, because it's passive and, you know, you can make the argument I'm doing something else while I'm doing it. Does that make sense? You know, you mean, like, I'll go for a ride and I'll listen, I'll go for a walk and I'll listen, while I'm working. However that ends up happening. But if I say to you, like, you know, every piece of terminology you needs it, like Juicebox podcast.com/terminology, and you're going to be like, I'm not doing that right? Yeah. It's just, I don't know, like, it's a it's a weird thing trying to get the information to people. It's not as straight of a line as you would imagine.

Karen 47:39
Sure, sure, yeah. And I don't know if, if I would actually have gone to look at the terminology, I don't think I would have thought of that. No, I, I probably would have just what I did is just throw it in Google and, like, explain this to me, Google, you know, yeah, yeah, I hear you. Okay.

Scott Benner 47:57
All right, awesome. So now modern day. Like, how are things going and, like, what have you figured out and what are you still trying to accomplish? Yeah,

Karen 48:05
so I guess the other thing that I should state is that I did end up getting Hashimotos with it as well. So that was back in February of 2021, so symptoms

Scott Benner 48:17
at that time before you got the diagnosis, what was that? What were your symptoms? Losing hair, like, a lot of hair. So,

Karen 48:29
and I think being tired, although, like, I had a lot of tiredness when it came to, like, before I was diagnosed with type one, where I was just like, I'm not gonna go to the neighbor's house to go watch this movie or anything like that. I'm just gonna go to sleep. You know, yeah, you're beat up,

Scott Benner 48:48
just run down. Couldn't get rested, yeah?

Karen 48:51
And during that time, just extremely hungry. I remember eating like a rib eye and Scott, I was so hungry afterwards, and I was losing weight. I mean, that's all typical of type one, you know, but with Hashimotos, yeah, probably a little sluggish and losing a lot of hair. Okay, so which is, I guess, a little bit common in some of these colder states in the winter of I don't want to go outside because

Scott Benner 49:18
it's cold. Well, since it's negative 44 degrees outside. What if I sat here? Is there a lot of seasonal affective disorder like you? Is it a thing you guys talk about? Yeah,

Karen 49:28
yeah. A lot of times it's like, like, our sun goes down. I think the earliest is maybe 435, o'clock in the winter, and it's just like, oh, it's there. Seasonal Depression is a real thing. Scott, so we're all happy once, once the sun is out a little bit longer and we're getting that vitamin D from the sun. So let me ask you

Scott Benner 49:53
a couple of questions so that the Canadians don't get upset with me. Okay, what do you got there? Like, are there bison walking around? Island or moose, moose, moose. Me, is there a lot of, is it moose? Is moose? Is moose? Okay, yeah. Like, what you got, stuff like that. How about snakes? You got rattlesnakes? What else you got? Yes, we have

Karen 50:12
rattlesnakes around here. I think more west of me, we have those rattlesnakes. We have bull snakes. We have moose. Just going north of here, we have moose, the bison, they don't they don't just roam. They are international parks, although they have been known to escape before. So do you have any squirrels?

Scott Benner 50:31
Lots of squirrels. Could you say we have moose and squirrel please? You want me to say that? Do you not know Rocky and Bullwinkle, oh

Karen 50:41
yes, sorry not making the connection. You don't have to say

Scott Benner 50:44
it. I was just looking for it because you have that delightful accent that's not quite Canadian and not quite American.

Karen 50:51
I'm in between, right? Yeah, you're

Scott Benner 50:53
like, all right, but it's not, it's not so Wisconsin, it's more like, it's not. It's a great accent. But I just, it's, I just wanted to hear moose and squirrel, moose and squirrel. How's that? I appreciate it. Yeah, I'm just, you know, trying to keep things light. I hear bison, I hear rattlesnakes, and I don't hear moving van. Why is that? Why do you

Karen 51:15
we have a lot of family in the area and a lot of good friendships up here. We did live in Houston for a little bit, for about, I don't know, six months or so. We were helping a company relocate to the Houston area. They were working.

Scott Benner 51:31
Was that a ton of culture shock for you being in Houston? Or did you like it? It

Karen 51:35
was different. I tell you what. We ended up going through a hurricane at the time, and because we, I don't know, I don't know what we were thinking. Scott, we moved down there during hurricane season, and we moved back back north in December, when it was cold, so, but it was, it was definitely different, a lot busier. It was really fun just to experience a different place,

Scott Benner 52:01
you know, did you like the busy? No,

Karen 52:05
I don't like the busy. Sometimes the the town that I live in is a little too busy

Scott Benner 52:10
for me, you know, and it's not at all, right, no, compared to

Karen 52:14
Houston, no, it's not busy at all. So I

Scott Benner 52:16
love the idea that you're like, you know what we'll do this year, like, when there's hurricanes, we'll go to where there are hurricanes. Then when it's freezing cold, ungodly cold, where people shouldn't be. We'll go back then to there. You got the Snowbird thing backwards.

Karen 52:28
I know, right. I should reverse that. I need, like, one of those uno reverse cards to reverse it. Scott, we get this

Scott Benner 52:37
back. We're talking right now about like, maybe trying to go to Yellowstone for a vacation, like, to go that direction. And it sounds lovely, like, and I think I'd like to do it, but I know for sure that I would get the hell out of there. Like, I know if it was up to me to get from, like, Plymouth Rock to California, we wouldn't have got very far. I'm just I would have given up very, very, very quickly.

Karen 53:02
You should go to Yellowstone and experience it, right? You can see all the bison. You'll have bison traffic jams and whatnot. Well, I

Scott Benner 53:10
have to say bison when I'm there. Can I say it the way I say it? Or

Karen 53:14
what do you think I mean? You can say how you say it. So, what time

Scott Benner 53:18
of year would I be best off there? Probably the summer.

Karen 53:21
You can see old faithful and all the geysers and whatnot. We

Scott Benner 53:25
talk in So, August, July, June, when's best? I

Karen 53:29
couldn't tell you. I think anytime it's their busy time. So it's gonna be pretty busy

Scott Benner 53:34
there. But my daughter went to Manhattan yesterday to go to a museum. It's not busy for us. We'll be okay. You'll be okay. Can you imagine waking up one day and a friend calling you and saying, Hey, do you wanna go to the museum? You say, Yeah, sure. So you get up, you take a shower, you drive 20 minutes, you get on a train, you ride the train for an hour and 15 minutes, you get off, you walk through a city for 45 minutes to the museum. Does that sound insane to you? Yes, you know it's interesting. She was home by six. Oh, wow, yeah. She got up, left, went, did the museum back on the train, came back home? Like she Yeah, she was home by like, six or seven, wow, yeah. They literally just went to see that music to go through the museum, sure, wow. But you're like, oh God, that sounds horrible. We should not do that. Yeah, that

Karen 54:21
sounds too busy. I need to find somewhere else where there's not a lot of people, you know, yeah. Have you ever been to Manhattan? No, nope. I've been out to Baltimore for a work trip, but that's about it. Not man.

Scott Benner 54:35
One of my favorite things in in the world is to come up out of the subway with a person who's never been in Manhattan for the first time. Like to see them, like, walk up the stairs, or come up the escalator and just be like, Oh my God, to watch it hit them for the first time is it's really crazy. Like to see when they see a skyscraper, like, not like a tall building, but like a skyscraper to watch their. Brain try to make sense of all of it in the first couple of minutes, is really something

Karen 55:04
I'm sure. I'm sure I would look like a deer in headlights walking up there. You know, I've

Scott Benner 55:10
probably said this on the podcast before, but my sister in law got off the plane. I picked them up in Newark the first time. She was like, here and we get out in the parking lot of the airport. I should probably be so embarrassed. And she points to this building. She goes, that's the biggest building I've ever seen in my life. It was the Comfort Inn at the at the airport. It was like, 12 stories high, you know. And I was like, get the hell out of here, really. I said, Wait, do we get out on the highway? And we got out on the New Jersey Turnpike. And she basically, like, just shut down, oh my gosh, because it's like, I don't even know it's like, four lanes going in each direction. Everyone's driving 8590 miles an hour. Like, you know what I mean? Like, she's like, I've never seen this many cars before. I was like, well, they're all trying to kill us. So, close your eyes, we're in this game too, by the way. We're trying to kill them. Just so, you know, this is, it's, you know, it's like Mad Max, is what I'm saying, not the one with Mel Gibson. The new ones are really good.

Karen 56:08
Sure, we, we've been to San Diego before, and traffic there, I thought was crazy, with four lanes and everything, even Houston a little bit, but San Diego seemed worse.

Scott Benner 56:18
Yeah, hey, listen, I grew up here, and when I got out on the road in LA, I was like, Holy Hell, yeah. Like, it seemed like a lot to me. So, yeah, it's just really interesting, like to grow up in different scenarios. Like, obviously, you can walk outside when there's wind chills and you don't think anything of it. And my kids, when they were 18 years old, could drive 90 miles an hour, sure, yeah. You know, it's just different skills, really. Yeah, yeah. What have we not talked about that you wanted to talk about? Because I feel like you have a lot to say, and I feel like I'm I'm very chatty this week. You guys will notice when you're listening back, you're like, holy heck, I talked a lot this week. So what do you want to talk about? So

Karen 56:55
I took notes, Scott, like, I, like, jotted all this stuff down. I guess the you had asked, like, where am I now? Like, how am I? I don't know if he said coping with it, but, like, whatnot. But to kind of answer that question for you, like, I started the Omnipod five awesome January of 2023, and I was very resistant to it, so, but now, like my husband asked me the other day. He's like, Would you ever go back? But no, I never go back, you know. I will always have, like, a pump, and that's just what it has to be to keep me alive, you know. But really resistive to it. It was actually my diabetic educator who was like, let's try the in pen, you know. And slowly, kind of March me there. Like, okay, tried it. It worked, you know. And she's like, we should try the Omnipod or a pump, you can decide, Karen. And I'm like, Well, no, like, I started a new job. I just don't want to learn all this new stuff. And I'm like, maybe in like a year. She's like, maybe in like six months. I said, Fine, maybe in six months, we'll look at it. She was really she knew that I could do it and I would never go back to MDI.

Scott Benner 58:08
And that was your resistance. Is change was your resistance. You just didn't want to

Karen 58:13
change. I think Scott, it was because I didn't want another thing on me to make me stand out. I'm not one to really stand out or anything. And, like, I just don't want people to think, Oh, she's fragile, you know. Like, we can't ask her to do that, you know, because she, you know, she has a pump on her. And like, what's going on? What kind of work do you do? I work for the state government under a federal grant that helps people transition from nursing homes back into the community. So as long as it's safe transition,

Scott Benner 58:49
they're still letting you do that. It's a that hasn't been shut off yet. It hasn't

Karen 58:55
been shut off yet. There for there, for a while, I'm like, Oh, am I gonna have a job? But no, we're still going. You were worried you'd look fragile to people. Yeah, I did. I did. That's not a concern now. No, not as much. I mean, Scott, there's times that I will purposely, like, put my pump somewhere that people can't see it, and there's other times that I will show, show it like, if we have, like, some sort of, like, a bike race or something that pump is showing because if, for some reason, I crash, like, as far as having a low or maybe crash as well out there that somebody can see, like, this lady has something on her arm, like, no, yeah, maybe to, like, alert them, and I have, like, something that says, Like, hey, I'm a type one diabetic. Go get the see me in my jersey pocket. And, you know, use that on me. So

Scott Benner 59:47
trust we went over earlier. You probably shouldn't trust people. But okay, like, let's hope that happens. This is going to sound ignorant and but whatever, how many people like you actually lay eyes on in the course of a regular day? Not can. Surrounding your family,

Karen 1:00:00
oh my gosh, not much at all, because I work from home, and everything is through, like, teams, Microsoft, teams, meetings and whatnot, but it's going out into

Scott Benner 1:00:11
the world. Like, like, I had to go pick something up or something, and it's even that easy. Like, are you, how close are you to your groceries?

Karen 1:00:17
For example, it's just down the street, yeah,

Scott Benner 1:00:21
right. So, like, if you run out, like, is it like, a situation where you see 20 cars and, like, you know, less than a, fewer than 100 people, or, like, how does that like, what's it like? Yeah,

Karen 1:00:34
so definitely more than 100 people. It's, it's a major city that I live, live in. So I couldn't even tell you what her population is, which is kind of bad. I mean, there's 1000s of people, like, within, within the city or town, whatever you'll call it. Like, I have to

Scott Benner 1:00:50
tell you, I went to Kansas City to do a talk one time, and they and the guy was like, we're going to take you to the city. And as we were going into it, I was like, what I'm not even trying to be funny, like, Do you ever play Sim City where you build a,

Karen 1:01:02
like, a world? Yeah, I remember that back in the day, yes, okay, yep. Like

Scott Benner 1:01:05
it felt like after you planted the first four blocks and it popped up and everything around it was dirt. I was like, that's the city. Like, it was like an oasis of, like, small buildings, it looked like to me. And then I got there, I just went to the desk after I checked in, and I was like, I want to go get a meal. Like, you know, where can I go? Where can I eat? And the guy's like, oh, you know, go here, here, here. And I walked six, seven blocks. I didn't see 20 people. And I was like, What the hell is happening? I'm like, I thought this was the city. It's such a different world, like, from what I'm accustomed to. So, sure, but you are around a fair amount of people. When you go out and you're saying, That's too much. You're like, you wish there were few, yeah. Are you one of those people that sits around and goes like, I'm gonna get these kids out of here, then I'm gonna buy a two room cabin and die in it? Is that? Like,

Karen 1:01:50
No, maybe not, not a two room cabin? No, like, that would be a little too small for me. But to answer your question, like the city that I live in, I just googled it here. We have 75,000 people that live here. Okay, so if that kind of helps you a little bit, I think I don't live in like a small town of like 100 people, you know,

Scott Benner 1:02:10
yeah, my problem is, I'm watching 1923 right now. So everything feels, everything feels like Yellowstone, but like 100 years ago? Oh, sure, yeah. So it's not like that. You're saying, no, no, not like that, not like that. Are there places like that around you? Yeah. I mean,

Karen 1:02:29
we have some pretty small towns around here. I mean, there's for my job, like, we get referrals of people who are wanting to transition back home, and I'll get like, this name of this town. I'm like, do we have that in the state? I've never heard of this town before, and there's like 24 people that live in this town. You know, I just for

Scott Benner 1:02:50
fun, googled the town I live in. Uh huh. I live in a town that is 20 square miles, and we have a population of 16,000 people, like so, because I was like, 75,000 sounds like such a big number, but I'm like, I don't think it is, uh huh, because you just googled Google, like, square miles for where you live. Like, how many that there's 75,000 people are in? How much space? 35 square miles? Okay, so not, yeah, okay, so there's a lot of people there then, or is there a lot of people here? Which is it? I don't know how to think of it. I'll figure it out later. People are like, people are like, Hey, don't figure it out now, man, we're trying to listen to a podcast. Figure it out later. Yeah, don't you do that on your own time. How involved is your family with the diabetes. My

Karen 1:03:42
kids are well aware about it. In fact, I think there's one evening, Scott that I didn't feel good. I think I got up that morning to go work out, and I wasn't feeling good. I put my head on the table, and I was having a low at that time too. And I took something for the low and kind of recovered from that. But my now 11 year old, he was, he checked on me twice. He's like, Mom, are you okay? But yeah, I'm just tired, you know. And then he came back again, Mom, are you sure you're okay? I'm like, yeah. So they, they're all in tuned about, like, what I would need if, if something dramatic happen, and I couldn't respond. In fact, my six year old now she'll hear the alarms go off on my Dexcom and Omnipod, and she's like, Mom, you're low. I'm gonna go get you a snack. And like, she gets it. And she gets that. If I say no, my blood sugars are high, she'll be like, I'm gonna get your phone and you need to give yourself insulin. And, like, for a six year old, you get this pretty good.

Scott Benner 1:04:48
That's cool that she gets it. Does it make you feel bad?

Karen 1:04:51
Sometimes I think, like, okay, like my kids shouldn't have to worry about me at this age. So, like. Yeah, when I would do biking events, I would bike with my oldest, who is now 16, and he can out bike me. But I remember at that time he was 12, and saying, Hey buddy, if this happens, this is what you need to do, and dot, dot, dot. And I was thinking to myself, he shouldn't have to do that, though, you know, yeah, you shouldn't have to be responsible to keep me alive.

Scott Benner 1:05:24
But new reality, right? Like, it's just, it's

Karen 1:05:26
what it is now, yeah, yep, absolutely, to

Scott Benner 1:05:30
me, it's, it's, it's like, a movie, you know, an Armageddon kind of movie, or, you know, the zombies come or something. You're like, this isn't fair, but the zombies are here now. So this is what we do now. Like, you know, I mean, like, it's very abrupt and not fair, obviously, and certainly not what you were looking for, but you got to adjust. And there's just no doubt it's going to impact everybody. There's nothing you can do about it. Like, I hear people all the time saying, like, I don't want this to impact my kids. I'm like, well, it's gone. It is, yeah, right, right. Like, I don't want this to impact my whatever. I'm like, well, it's going to like, it's not going to like, you're going to find your way through it. It's just not going to look. Life isn't going to look the way you thought it was going to it doesn't make it bad. It's just different. And I think if you can get past that, then it is what it is like, you know, I hear people all the time say, like, Well, I'm just very worried about what this is doing to my like, you know, I have a type one, and they have a sibling, and I'm worried about how the sibling is, like, you know, I don't want it to affect them. And I'm like, well, wah, wah. Like, that's, you know, it's going to, and I don't even know how, and either, do you like, you're gonna, you'll find out, you know. But I don't think it's worth being sad about. It's just, you just got to adjust,

Karen 1:06:37
right, right? Because there's nothing that we can go back and change, you know, like, there's not a cure for it right now. And I think in some ways, Scott, it's like, hopefully I can be a role model for them to say, like, you know, when you go through hard things, like, you keep on moving, you know. And hopefully they're inspired by it. I don't know, maybe, maybe once they're past their teenage years. I don't know Scott, but

Scott Benner 1:07:04
it'll inform them. I was interviewing somebody, and they said a way they were handling something. And I just thought, that's not right. Like, you're giving your kids the wrong feeling here. Like, you know what I mean? Like, and I don't want to be too like, specific, I guess. But like, Sure, it's everything is attitude, and whether it works or not is, I don't know. Maybe it will, and maybe it won't. You can't have something bad happen and throw your hands up in the air and be like, Oh, that's it. See, it's over. We're dead, you know. Like, and then show people hopelessness, because then they're gonna model hopelessness, whether it's real or not. Like, you gotta fake it till you make it a little bit. And you gotta give your kids the idea that, like, we can do this, like, even if you can't, I think you have to say that you can, and then just do your best, because then the attitude you leave with is something hard happened. We tried. We're still alive. We did. It seems kind of obvious, I guess, but I don't, I don't know. Like, some people just get knocked over by things and they don't respond well,

Karen 1:08:01
right, right? And that's, that's my thought, like, definitely hope that they look at it as like, are things are going to happen in life like it? It doesn't matter who you are. You're going to have challenges, but it's how you respond to those challenges that is going to make your life different and and it

Scott Benner 1:08:22
sounds cliched and goofy, but it's really true. So yeah, everything's not going to be perfect, but, you know, there's versions of better, and you should be reaching if I've been helping somebody personally with their finances recently. Like, I forget how they put it, but like, the vibe was like, I'm never gonna be rich. And I was like, Yeah, well, most of us are, aren't going to be rich. Like, I was like, that's this. I was like, is that your goal? I was like, because if that was your goal, you probably shouldn't have gone to college for this. You can't just wish out loud, like, you know, I want to make tie dye T shirts. I'd also like to be a billionaire. Well, you know, that isn't going to work out like that. Like, I just kind of adjusted their thinking. I was like, Look, I said, you know how much money, like, would make you comfortable? Like, like, where you weren't worrying, and they gave me a number, and I said, Okay. I said, I think there's a way where 18 months from now, you could have that much money in savings. Like, here's how I would do that if I was you. And I said, and then, you know, 18 months from now, you can readjust your goal and make another goal. You keep moving, but so quickly, the this isn't what I wanted, this isn't what I wanted. So it's bad, so it's wrong. So I'm done, like, I can't do it. I'm like, so you're thinking about this way wrong. I'm like, you have to step back and see, see a bigger picture here. Like, I think even with the diabetes, like, there can be too much, you know, too much staring at the floor, just thinking about right now, and not enough big picture stuff, you know, right?

Karen 1:09:46
Yeah, well, you have to do something to change it, you know. So little steps, yeah, little by little, changing a little bit every day for the better, like it will get you there. It's like tortoise and the hare, you

Scott Benner 1:09:59
know? If you have a bad day, you don't give it's not over. You know, you don't go, no, go. Well, see, I didn't do, I didn't do a little better today. So I'll just, you know, just gonna throw myself on the floor. Now, I don't know, like, I don't want this to sound like a bro podcast where I'm just like, succeed. Get out there. This is just kind of how it works. You got to get up hopeful, and you have to, you got to keep trying. And doesn't always go well. And you can't be judging yourself moment to moment. It's got to be, got to be big picture. Like, I love somebody telling me, Hey, listen, my a 1c, was seven, seven. And three months later it was seven four. And I'm like, awesome. I bet you it's going to be seven next time. And then they keep, they keep, you know, like clunking away, and then one day they come back to you and they go, Look, I was seven seven, then I was seven four, then I was six, five, and now my a one c6, and I'm like, Yeah, it's awesome. It only took a year. But the problem is, for some reason you go back a year and say that to somebody go a year from now, your a 1c is going to be six. They go a year. Ah, it's forever. But, you know,

Karen 1:10:59
do you think that's because of the fast paced society that we live in, of, like, all right, I'm hungry. I'm just gonna go through. I'm just gonna run through, through a drive through, or something, you know, where we want everything, like, right now,

Scott Benner 1:11:12
well, there is an expectation that everything happens immediately. We've tricked ourselves, you know, with, like, with digital stuff, with stuff on your phone to think that, that I want something, and it comes immediately, like, That's it, like there's nothing you could say to me right now that I couldn't see in 10 seconds. Like nothing, like when you have that expectation then, yeah, stuff that takes longer probably feels like, you know, what the hell I'm never gonna get there. But I found that after being alive for a while, when you realize this is gonna sound strange, but when you realize you're not gonna die, you know what I mean? Like, this is it? I'm here. You can get a bigger view of things. Like, every everything doesn't feel to me at least as like, like so important to happen right now. Like, I It doesn't matter if it happens now or if it happens three years from now, or if I plan for it, and, you know, it dropped dead before it happens like it's none of that matters. I think what really matters is just good, positive direction, and, you know, incremental change,

Karen 1:12:15
yep, and knowing that you're going to have a bad day, but you're going to get up the next day and do better. It doesn't make for a bad life. Yeah, and

Scott Benner 1:12:23
listen, if something catastrophic happens to you that's different. Like, that's not what I'm saying. Like, right? Like, if that happens, then that's, it's, it's a shame. But then I think you navigate that the same way, like, we're all just navigating ourselves to death, like, so, like, it, you know, you either are going faster or slower, and you either have a lot of time left or a little bit of time left, you know, hopefully, so in the meantime, like, why would I want to make the time I have unpleasant that's like, odd to me, like, so I don't know. I guess when I was younger, though, I probably did it, you know. So it's easy for me now to say, like, oh, like, have big ideas and step back, see macro. But when I was 20, I was probably like, oh my god, I'm broke. This is never gonna work out. You know, yep,

Karen 1:13:09
yep, looking a lot of the micro instead of the macro, yeah,

Scott Benner 1:13:13
yeah. How am I gonna get a girl to talk to me? That's reasonable that you get one to talk to you, and you're like, Oh my god. So it's crazy. Probably thinking the same thing about me, you know what I mean, like and, and you're like, Well, that wasn't right. I just put six months into that. Everything can feel like, ah, but you could, you could just choose to look at it differently. Like, look, I spent six months with her, and we did some things that were fun. You know what I mean? Like it, and I've learned stuff about myself, and I'll just move on and do it again. Like, so sure. I don't know what I'm talking about anymore. I am super chatty this week, though. I wonder what that's about. I don't know. Probably feeling better. Have my nose fixed. I'm breathing well,

Karen 1:13:52
oh yeah, that's going well for you. Oh, awesome.

Scott Benner 1:13:55
My nose was so impeded that after the surgery, and I'm talking about an hour after the surgery, while I'm at home and Arden and I are eating cheeseburgers because she's like, are you hungry? I'm like, let's get a cheeseburger. She was like, I'm still messed up on the you know, from the whole thing, I have basically the equivalent of a giant tampon strapped under my nostrils, right? And, so I'm wrapped up. My nose is just bleeding. It's just bleeding. Like, you just change the thing. It bleeds again. Like, the whole thing, I'm, like, stuffing this cheeseburger in my mouth sideways and like, I'm like, oh, a friend. I haven't had a friend trying forever. It's like, so salty. It was awesome. And I stopped and took off the dressing at one point. Like, you're not allowed to blow your nose. So like, you just kind of, like, I'm sorry for people, but, like, you just jam some stuff up there and absorb as much odd as you can. And then you reapply your tampon, and you go back to it. And I put the thing back on, and I said to Arden, I'm breathing better right now than I was before the surgery. Like, if you're looking for, like, an indication of how poorly. I could move air through my nose. I was breathing better two hours after the surgery than I had prior to it. Wow. And now, like, a month later, and like, it's still healing, like there's, if you press on the bridge of my nose, still it's sore, like it's, like, not bad, but there's soreness. I know it's not healed yet, and I still can't, oh, you're gonna get me to say this out loud, Karen, I can't really pick my nose perfectly yet, which you don't realize how much you want to pick your nose until you can.

Karen 1:15:34
Sorry, that's great,

Scott Benner 1:15:37
right now, I still have to, like, put schmutz, like, I don't know what this is called Isabelle sent me this a Y r, it's like a gel spray, and it kind of keeps it moist, so you keep the inside moist. Then every once in a while, like, you know, you you go mining and clear it out, but you don't want it to bleed or anything, and it's still sore. But I'm super excited, because I think, like, a week from now, I'm going to be able to blow my nose without, like, without going out that didn't feel good, and I think that's when I'll be able to really assess what's going on, but I can breathe in and out through my nose. Like I mentioned this on the podcast, people will have heard it by the time they hear this, but you haven't heard me say it, okay. I very embarrassingly, ask the surgeon how people breathe like I was super serious. I was like, Hey, can I ask you a question? Is going to sound strange? And he's like, yeah. And I said, Do you breathe in through your nose and out through your mouth, or out through your mouth and in through your nose? And he goes, most people just breathe in and out through their nose. And I was like, Get out of here. Really? Oh, my, yeah. I was like, I was I was like, seriously. He goes, Yeah, he goes, he goes, like, when you're like, driving in your car or sleeping, most people just breathe through their nose. And I was like, oh, that's insane. And I actually said, Do you think I'll have to teach myself to do that? Like, I felt like I felt like an idiot, but I also felt, I felt like a child, you know, yeah, how long it's been,

Karen 1:16:59
wow. So you couldn't breathe that all through your nose.

Scott Benner 1:17:02
I would never move air through my nose. Wow, almost ever. No.

Karen 1:17:06
Gonna be a game changer for you. Scott,

Scott Benner 1:17:08
I know, right. I hope this makes me taller. I really feel like this could be the thing. That could be the thing. Can you imagine if I just got taller? You're like, Oh, my God, I just didn't have enough oxygen. Poor guy. But seriously, like the one thing that, I mean, the thing that pushed me over the edge was my dentist, believe it or not, but the thing that got me thinking about it, two years ago, I stopped being able to sing in the car. I was getting out of breath singing while I was driving.

Karen 1:17:37
You must enjoy singing, huh? While driving. I mean a little

Scott Benner 1:17:42
bit, a little bit, when I go off on, like, tangents on the podcast, I wasn't breathing.

Karen 1:17:49
Oh, you're gonna pass out, Scott. You've

Scott Benner 1:17:51
no idea. Like, it got so bad that Rob was, like, I had to start editing out where you gasped for air after you spoke. Oh, wow, yeah. So like I was talking and then ending and going, and he was editing that out so people wouldn't hear it. Okay, yeah, so, but anyway, the what really got me was my dentist, like, unlike you going to your eye doctor, I got decent advice, and it's probably because I live in civilization, but that's neither between here and there. He's like, there's so disgusting, but I already talked about picking my nose, so like, let's just finish strong. He said, There's a bacteria in your mouth that doesn't belong there. And I was like, what now? It's like that, that doesn't sound right. And he goes, No. He goes, we're gonna have to, like, kill it with an antibiotic. And I was like, I like, what the hell? So I took his, I took his, his medicine, man, medicine, you know, to kill my bacteria. But I asked him, I was like, How can this happen? And he said, I don't know. Like, this is a bacteria that's killed by the, like, the natural process of breathing. It really shouldn't be in your mouth. And I just stopped, and I said, I don't think I breathe well. And I explained to him how I breathe. And he goes, Are you serious? And I was like, yeah. I'm like, Have you ever noticed, like, sometimes, like, when you're working for a while in my mouth, like, I need to like, like, I need the suction to work. And he goes, Oh, I have seen you, like, kind of panic, like that. I was like, yeah. I was like, because I can't breathe through my nose. And he was like, oh, go to an ENT and I think between the not being able to sing in the car and the scary bacteria in my mouth. I don't remember what it was called, or I would tell you, I just literally, like, I left his appointment. I went out in my car and I called an ENT sure I got an appointment. I forced my way in the guy, like, you know, he numbs my nose because I'm gonna check your nose. I'll numb it a little bit. He sprayed something up there. I was like, okay, and he takes this metal rod and he goes way up my nose and just pushes off to the side, and he goes, breathe. And I went, Oh, that's awesome. And he did the other side. He goes, your nose is deviated on both sides, it's blocked pretty significantly. And I said, Yeah, I said I fell when I was a kid. Right? And he goes, Is this been your whole life? And I was like, I think so. So, so that's what caused it is from you falling my parents bought me a new pair of dress shoes. When I was five. I was upstairs, trying them on, getting dressed. We were going somewhere. My uncle was downstairs. I was a third of the way down this I remember this very clearly, I was a third of the way down the stairs. I could now see him like, you know how kind of the stairs kind of open up. He was sitting on the hearth. Do people know what that is you do because you live in the wilderness, but like the thing in front of your fireplace, and he was sitting, he was sitting on the hearth. And I was like, I saw him, and I was super excited to show him my shoes, and I lifted one of my feet up. And, of course, in 1976 shoes were made out of like, you know, wood and unbreakable, unbendable leather, and they were brand new. And my foot slipped out, and I went down this I fell down the stairs, and I like, I cry. I smashed my face going down the stairs. Oh so awful. Yeah, it was, I mean, listen, I don't remember a ton about being a kid, but I remember that and so, like, I remember being bloody afterwards, and my mom being panicked and all that stuff, and I've just never really breathed correctly after that. Like, we didn't do anything crazy, like go to a doctor or anything. Like the five year old just slid down wooden stairs on his face. He's probably all right,

Karen 1:21:21
you know, just put a band aid on it.

Scott Benner 1:21:24
Stop bleeding. Bad parenting is why I couldn't breathe for like, No, we were broke. Like nobody was, you know what I mean? Like, if I wasn't dead, nobody was going to it to a dog. Yeah, it's ridiculous. Yeah,

Karen 1:21:37
that was my family, too, growing up. Yeah, no, I think I had influenza for like, two weeks and didn't go to the doctor. I I remember trying to go upstairs to my bedroom to go to sleep, and I couldn't make it all the way upstairs. I had to stop halfway through and like, rest on the stairs, because I was that that week.

Scott Benner 1:21:56
She's no teenager. Did you have brothers and sisters? Yeah, yeah, yeah. They were older. There's others. If she doesn't make it, yeah, you

Karen 1:22:05
know she she's a baby of the family. It's fine

Scott Benner 1:22:08
all these kids, looking back, it was a huge mistake,

Karen 1:22:12
right? It's fine if she just dies on the stairs.

Scott Benner 1:22:14
Oh no, yeah. Well, we'll blame the flu. It'll be awful. In a long line of things in my life that I think, Oh, God, I should have done this a long time ago. You know what I mean? Like, yeah, just like, Why did I wait so long to do this? And I have one more thing on my list, like that, and when I after, I take care of that, I'll be okay,

Karen 1:22:34
sure, sure. I guess maybe, um, mine wasn't as long, but that's how I feel about a pump. Why didn't I do this sooner? You know, as soon

Scott Benner 1:22:43
as it is as you get it like I actually, I heard the podcast this morning. I don't sometimes hear it in its full like finished form, but somebody asked me to listen to it. So I listened, and an Omnipod ad came on, and I listened to it because I'm a good podcast listener, and I know that I should listen to the ads because it helps the podcaster. I heard myself say, my daughter's been using an Omnipod every day since she was four. And I thought, and that's really something, like, she's, she's gonna be 21 this summer, you know. And that ad is as, like, it's not an ad like, that is really, I mean, it is, but like, it's, it's me being really honest. Like, that thing has been like a real friend to her, you know. And I don't know where she'd be without it, so,

Karen 1:23:25
right? It's, it's been great, and I love the fact that it's tubeless, you know, yeah, I'm not getting caught up on door handles or other things because of tubing. And I think, just like the biking and the hiking and that kind of stuff. Like I, I wouldn't want to be kind of tethered to something like that. You

Scott Benner 1:23:46
know, also, if a different pumps right for you, then the different pumps right for you. Now, let's hope it's a different pump who also buys an out of the podcast. So we're talking about Medtronic tandem and maybe twist actually. So use the links in the show notes. But like, you should figure out what works for you. Like you, like tubeless. Other people I've heard say, I don't care about the tubing, you know, I like this about it more, like whatever works is, Listen, I'm not telling you you have to have an insulin pump. And if you look at the numbers, the vast majority of people with type one diabetes don't use an insulin pump. But I think they should. And I think that you would find, like, once you got over the Oh, like, I don't know how to use this. And like, once you got past all that, I think you'd say, oh, I should have done this sooner, yeah. And I anyway,

Karen 1:24:34
agree. Yeah, totally agree. And

Scott Benner 1:24:36
seriously, if you don't have a CGM and you have type one diabetes, like, I don't even know what to you, like, please, if you can afford it, like, please get it just it'll

Karen 1:24:44
change it. In her life, I'd be lost without a CGM. Let's just say that if I had to pick between an insulin pump or CGM, it'd be a CGM. I Yeah,

Scott Benner 1:24:54
absolutely 100% it would still be. Arden got up yesterday. She's on like, she's got a spring break, right? She's going. School from home now, like, Spring Break gets out of bed and she's like, Hey, you know, sent me a text. She goes, can you just look after the dog a little longer for me? I'm gonna jump in the shower. And I was like, All right, I look and her blood sugar's like, it's like, 110 and I don't know what happened. Like, usually the shower doesn't hit her like that, but her blood sugar, like, started, like, zooming up. Like, I'm not kidding. There's that algorithm just bolusing and pushing extra basal and bolusing and like, and it stopped her like, 190 and it brought it back down again. But if she wasn't on an algorithm like, her blood sugar just would have kept going up and up and up and up. And if she didn't have to CGM, we wouldn't even known about it, she would have, like, imagine if she got out of bed, tested and was like, Oh, I'm 110 This is awesome. I'm taking a shower. And then all that other stuff happens, and you're blind to it. And then the next time you go, maybe you go to eat 45 minutes later, and you probably think to yourself, I'm going to Bolus based on 110 right? But now your blood sugar is, I mean, she was 195 with the insulin that the algorithm was giving, she probably would have been 250 300 bolusing, bolusing for and you can say, Oh, well, she should have tested again. I'm like, and that's not wrong, but like, probably not how it ends up going. So she boluses for 110 or food when she's 250 or so, and then maybe what, like, starts feeling a couple hours later and checks your blood sugar and goes, Oh God, I'm 300 how'd that happen? Yeah,

Karen 1:26:25
you know, yeah. I mean, I same story here. I take a hot shower at all. I am, like, cruising up, you know. And I absolutely, I probably would have bolused off of like, a 110 blood sugar if I didn't have a CGM. And

Scott Benner 1:26:40
I'm just saying, like, let your mind tumble through that, like, because now you're you don't have a CGM, you don't have an algorithm. You figure out, like, four hours later, you're 300 and now your brain goes, Oh, I probably I didn't Bolus right from my meal, but maybe you did. Maybe it was the rise earlier. That's this problem, or maybe it's like, your basal is wrong. Like, who even knows? But then that's what happens, is your brain starts running in 1000 directions. It probably picks the wrong thing to think about. And now you're just, you know, you're sure that you know what went wrong. And it turns out it's something completely different, but you don't know, because you don't have the data. And it's, I'm just saying, like, I know everybody can't afford it. I know some people don't have insurance. I know some people's insurance doesn't cover stuff, but if you can afford it, CGM, and then, if you want to keep going, my opinion, an algorithm based insulin pump, and then get good settings in it, and learn how food impacts you, and then go live your life with your six a one say, you know, Yep, yeah. Anyway. All right, absolutely. Karen, this is going to be another text I get from Rob, where he goes. Hey, can you What are you doing? Going for 90 minutes like I'm I'm trying to live over here. Let me say goodbye to you, and thank you very much, and I appreciate you letting me be chatty. And for everybody listening, I'm sure next week I won't talk as much. Sorry. And if you don't like it, you it's my podcast. It

Karen 1:27:59
is your podcast. Whatever I want, damn it.

Scott Benner 1:28:02
People are like, Listen, I don't have to listen. Fair enough. Hold on one second for me.

Touched by type one sponsored this episode of The Juicebox Podcast. Check them out at touched by type one.org on Instagram and Facebook. Give them a follow. Go check out what they're doing. They are helping people with type one diabetes in ways you just can't imagine. I'd like to thank the ever since 365 for sponsoring this episode of The Juicebox Podcast, and remind you that if you want the only sensor that gets inserted once a year, and not every 14 days you want the ever since CGM, ever since cgm.com/juicebox, one year, one CGM. The podcast you just enjoyed was sponsored by tandem diabetes care. Learn more about tandems, newest automated insulin delivery system, tandem Moby with control iq plus technology at tandem diabetes.com/juicebox. There are links in the show notes and links at Juicebox podcast.com.

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Scott Benner 6/19/25 Scott Benner 6/19/25

#1553 Jordan Juice

A series of conversations with Jordan Wagner, CDCES. In this episode, diabetes management in the hospital.

+ Click for EPISODE TRANSCRIPT

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

Today's guest is Jordan Wagner, a nurse, a diabetes educator and a person living with type one diabetes, and today we're going to talk about preparing yourself for being in the hospital with type one diabetes. The podcast contains so many different series and collections of information that it can be difficult to find them in your traditional podcast app. Sometimes. That's why they're also collected at Juicebox podcast.com, go up to the top. There's a menu right there. Click on series, defining diabetes. Bold beginnings, the Pro Tip series, small sips, Omnipod, five ask Scott and Jenny, mental wellness, fat and protein, defining thyroid. After Dark, diabetes. Variables, Grand Rounds, cold, wind, pregnancy, type two, diabetes, GLP, meds, the math behind diabetes, diabetes myths and so much more, you have to go check it out. It's all there and waiting for you, and it's absolutely free. Juicebox podcast.com, please don't forget that nothing you hear on the Juicebox Podcast should be considered advice medical or otherwise, always consult a physician before making any changes to your health care plan or becoming bold with insulin.

This episode of The Juicebox Podcast is sponsored by the Omnipod five, and at my link, omnipod.com/juicebox you can get yourself a free, what I just say, a free Omnipod five starter kit, free. Get out of here. Go click on that link, omnipod.com/juicebox, check it out. Terms and Conditions apply. Eligibility may vary. Full terms and conditions can be found at omnipod.com/juicebox, links in the show notes, links at Juicebox podcast.com today's podcast is sponsored by us Med, us, med.com/juicebox you can get your diabetes supplies from the same place that we do. And I'm talking about Dexcom, libre, Omnipod, tandem and so much more. Us, med.com/juicebox or call 888-721-1514,

Jordan Wagner 2:26
I'm Jordan, and I'm 31 years old. Had type one diabetes roughly 26 years now, growing up with diabetes, I was very fascinated by it, learning about management and all that that led me to diabetes camps. I went to Chris Dudley basketball camp in Vernonia, Oregon. That was a huge influence in my life, of getting me really interested in living a healthy life with type one, and that you can really thrive with it like Chris Dudley was my role model growing up, played in the NBA for 16 years with type one, and that led me to look at like the healthcare field, and I really did not know what I wanted to do with that. But when my uncle went into a coma from low blood sugar, when I was a senior in high school, went to visit him, his nurse was a male nurse, and at that point, I didn't know that guys were nurses, and so I chatted with his nurse and his his nurse told me all about the nursing field, and really encouraged me to to look into that. And so that's what I did. I looked into it, and ended up going to nursing school, became a nurse, and knew that I ultimately wanted to be a diabetes educator. And so after nursing school, I ended up going to couple different hospitals, but worked on diabetic and kidney units just to get that experience there, and that that gave me enough experience, after about five years, or four or five years, to feel comfortable, to to sit for the the the board exams, or the the exams to be a diabetes educator. And so did that pass the exams, and I've been a diabetes educator ever since.

Scott Benner 4:02
That's awesome. Chris Dudley, by the way, on episode 515 of the podcast, okay, there you go, he was on talking about his is that camp still going? Do you know

Jordan Wagner 4:10
it actually is? Yeah. So I don't know. I don't know exactly where it's at now, they had to move the location, but it was in Vernonia, Oregon for the longest time, and it was just the greatest. I worked there on staff for a little bit. I went to went there as a camper for five years. I mean, I have lifelong friendships from it and it, it set me up very well to understand that I needed to take care of this if I wanted to to thrive like Chris Dudley did,

Scott Benner 4:35
yeah. Had a big impact on you. Huge impact. Yeah. Excellent. Yeah. So you became diabetes. You became an RN, first, yeah,

Jordan Wagner 4:43
yeah, so. RN, so I'm a BSN. RN, CD, CES, wow, yeah, okay, e, i, e, i, o, a lot of letters, I know. And

Scott Benner 4:52
then how long have you been by practicing as a diabetes educator,

Jordan Wagner 4:57
about five years a profession. Really, I always tell people, it's really been like 26 plus years with my personal experience at type one, but five years officially, right as a diabetes educator, how

Scott Benner 5:09
do we find ourselves knowing each other? Trying

Jordan Wagner 5:11
to think here, I think I joined the Facebook group a handful of years ago, and I just started seeing that it was making such a big impact in people's lives there, and I started sharing started sharing it with people at the at the hospital, and so I think that's how we got connected, was just through the Facebook group and posts over the years. Well,

Scott Benner 5:30
Jordan, I'll tell you that I pay attention to what you put on social media. And you know, I know you through, obviously, through the Facebook group, but at the same time, when I see a person like yourself who is so dedicated and thoughtful about how they're helping people, and sees this whole thing, you know, in a way that I think is very clearly, when that person says that you think I'm doing a good job, I'm very touched by that. Yeah, sincerely. You know, if I see you put something online that says, like, you know, you should try this podcast or take a look at this. I think I might be, I might really, actually be doing something right here. It's the same feeling I have as when, you know, when I met Jenny and and, you know, the first time she said to me, I forget exactly how she put it, but she's like, Scott, you could do this professionally. And I thought, like, I was really touched by that, yeah, you know. And so it means a lot to me that this thing that we're putting out there, you're seeing it, you believe in it enough to tell somebody else about it. I really appreciate that. Yeah,

Jordan Wagner 6:31
well, and I truly do believe in this wholeheartedly. I mean, even implementing things from the podcast into my own management. And when I found the podcast, I was like, Oh, I've had diabetes such a long time I can handle this, so I don't really need to learn anything else. And that was such an arrogant way to go about it. But I get into the podcast, and I'm like, Man, this is incredible. And just implementing things I learned on the podcast, I mean, I'm getting my a 1c and the high fives, low sixes, like, for years now, awesome. And it's really cool. It's just a really cool thing. So I believe in sharing that, because there's not a lot of good education resources out there. And so this is something that it's, it's a free resource, and it just benefits so many people. So it's something that people should know about.

Scott Benner 7:13
I'm gonna let you add to that resource. So I, if I let you, I mean, I'm, I'm gonna send you a note Jordan, and say, Hey, would you like to make a series on the podcast? You tell me what you want to talk about, and then come on and speak about it. So you you did. You sent a great list, and we're going to record a few times and put together a short series with you so that people can get you know, from your perspective, what might be important for them to pay attention to? Yeah, absolutely. Yeah. Where do you want to

Jordan Wagner 7:41
start? Yeah. Well, I think for this one right here, really want to talk about diabetes management in the hospital. That's just something that a lot of people might not have a lot of experience with outside of being diagnosed with diabetes. I know a lot of people being diagnosed with type one end up being in DKA when they're when they're diagnosed, and that's a very traumatic experience, potentially, but that also could be your only experience with going into the hospital. And so I think there's some things that I've seen as an inpatient educator that could be helpful for people to understand about going to the hospital, different situations, scenarios that may come up outside of that initial diagnosis. And so that's kind of what I really wanted to dive into here today.

Scott Benner 8:22
I'm happy to so we're talking about, you've got type one now, and you find yourself back in the hospital for some reason. Exactly, yeah, exactly. How do you manage that scenario? Right?

Jordan Wagner 8:31
Exactly, yeah. I mean, one of the biggest things I could start off by saying is that hospitals are unpredictable depending on what size hospital you're at. You know, you come in and maybe you need an MRI or something like that. You could be waiting for days to get that MRI, and you might need to be NPO, so nothing by mouth for the particular MRI. And so, you know, how are you going to navigate that, with your blood sugars going to something where you're not supposed to be eating or drinking, and then to find out at the end of the day, oh, a trauma came in and you've been bumped and you're gonna have to do this again tomorrow. So there's a lot of situations like that that come up, and the unpredictability can be really challenging.

Scott Benner 9:11
What usually happens then? Do they just keep people's blood sugars higher without

Jordan Wagner 9:15
a doubt? Yeah. So one thing I like to tell people is that a hospital is not there to fine tune the diabetes. It's there to stabilize it. And essentially, they care that you're in a safe spot. So from a doctor's perspective, if your sugar is 250 for multiple days at a time, you might not feel great at that, but they're looking at it and going, Oh, well, this person's not going low. They're not going crazy, crazy high, so we're good with that. So they're going to intentionally run you a bit higher. And you need to be you need to be aware of that. So I think as a type one, if you do have that tight control, you know you want tighter controlled blood sugars, you have to communicate that you may receive some pushback. That's something. Thing you have to be ready for, which I think is helpful when you have someone there to advocate for you, someone who knows your diabetes well, who can be there to advocate because we don't know the situation of why you're in the hospital, right? I mean, this could be a planned surgical procedure. You need to be in the hospital. Maybe you have, like, appendicitis, but, you know, there's accidents, right? Well, you could be driving down the road, have a car accident, you have type one diabetes, and now you're in the hospital as a type one you don't need to prep for every possible situation, but just have a general idea of going into potentially tough situation, like, what? What are you going to do, like, just maybe the thought exercise of, like, walking through this in your mind, like, come up with a plan. Because

Scott Benner 10:46
what happens real, real world. What happens is that somebody says 250 is fine, but if it happens to be 300 that's not so bad. Either you're sitting there feeling terribly or maybe you're, you know, I always think of it in a slightly different way, like, maybe you're a person who's already got like, an eight and a half or nine, a, 1c, and then you go to a hospital and see that the hospital was perfectly fine with your blood sugar being 250 then you go home thinking, like, well, I don't know why I'm trying so hard. 250 is okay. Diabetes comes with a lot of things to remember, so it's nice when someone takes something off of your plate. Us. Med has done that for us. When it's time for Arden supplies to be refreshed, we get an email rolls up and in your inbox says, Hi, Arden, this is your friendly reorder email from us. Med. You open up the email, it's a big button that says, Click here to reorder, and you're done. Finally, somebody taking away your responsibility instead of adding one. Us. Med has done that for us. An email arrives, we click on a link, and the next thing you know, your products are at the front door. That simple, US med.com/juicebox, or call, 888-721-1514, I never have to wonder if Arden has enough supplies. I click on one link, I open up a box, I put the stuff in the drawer, and we're done. Us. Med carries everything from insulin pumps and diabetes testing supplies to the latest CGM like the libre three and the Dexcom g7 they accept Medicare nationwide over 800 private insurers, and all you have to do to get started is call 888-721-1514, or go to my link, usmed.com/juicebox, using that number or my link helps to support the production of the Juicebox Podcast. Today's episode is brought to you by Omnipod. Did you know that the majority of Omnipod five users pay less than $30 per month at the pharmacy? That's less than $1 a day for tube free automated insulin delivery. And a third of Omnipod five users pay $0 per month. You heard that right? Zero? That's less than your daily coffee for all of the benefits of tubeless, waterproof, automated insulin delivery. My daughter has been wearing an Omnipod every day since she was four years old, and she's about to be 21 my family relies on Omnipod, and I think you'll love it, and you can try it for free right now by requesting your free Starter Kit today at my link, omnipod.com/juicebox, Omnipod has been an advertiser for a decade, but even if they weren't, I would tell you proudly, my daughter wears an Omnipod. Omnipod.com/juicebox Terms and Conditions apply. Eligibility may vary. Why don't you get yourself that free starter kit, full terms and conditions can be found at omnipod.com/juicebox,

Jordan Wagner 13:43
exactly, yeah. It sets up a really poor example, yeah. And in my opinion, and you know, as an educator, I'm always advocating for tighter controlled glucose levels. I see it from the doctor's perspective too. Like, yeah, they are managing a lot of tough situations. And like, for example, my hospital is a trauma one hospital, huge, 700 plus bed hospital, so a 250 blood sugar is pretty low priority for someone who might be having, like, a potentially fatal heart attack, right? So I get it from both sides, but I think the type one advocacy is going to be huge and making sure your blood sugars are well controlled in the hospital.

Scott Benner 14:20
I mean, the reason it's happening, it's not unreasonable, but it's also not valuable as an answer to you, the person whose blood sugar is that high, absolutely, yeah, oh, absolutely. Seriously. Like, if you're in a car accident and one medic shows up and one guy is worse than you are, I understand them going to him first. That's not helping you, and if you died later, the post mortem on that would be, well, I helped the person that was more direly in need. And everybody would go, Well, that was the right thing to do. Yeah, there's a difference between what the system can manage, what other human beings at a hospital can, you know, reasonably accomplish in a in a shift, and. And what you need, deserve and require, absolutely. Yeah, so you need to be the one who says, Look, you got me a 250 here, but I'm not okay with this. And what would you say then, like, what if you didn't, like, there's a difference between, like, if that happened to my daughter and I was there, I'd say, Look, you know, we just need to move this here and move this here. But what if move this here, but what if you just don't know what that thing to do is, you know, you don't want a 250 but you don't know what to say next? Yep.

Jordan Wagner 15:29
So that's where I think the planning ahead comes, comes into play here. So give me an example here. So I had surgery back in July. I didn't have to get to admit it to the hospital, but it was a hospital like scenario, the surgery center, I created a full page document outlining what I wanted to have done with my blood sugars, where I was comfortable, at my Dexcom information. So I gave my phone to the surgical tech, the RN there, and he had that and knew my phone password so he could always access the Dexcom. And then I had my wife, I had her trained up on my pump. And I know a lot of other people in this group have done that too, where they've trained a spouse on how to use a pump. And I presented that outline to the providers there so they had a clear understanding. So

Scott Benner 16:19
Jordan, did they listen to you because you're a professional? Do you think it's possible? Yeah, you're not gonna know that. Honestly,

Jordan Wagner 16:26
though, most people don't come in with a plan like that. Whether

Scott Benner 16:28
I was a professional or not, if I had a plan like that, people would be like, Ooh, this is fancy, and probably listen to it.

Jordan Wagner 16:33
They would most likely, you at least have a much better shot of them actually listening to it. Okay, if you have something typed up like that. And so I suppose it could be a smart idea to have a little something typed up. Like, it doesn't have to be the nitty gritty, but like, hey, if an accident happens and I'm hospitalized, I prefer my blood sugars to be in this range. This person is my go to if I'm not able to handle my pump or my my diabetes, things here, and then you just maybe carry that with you, right, keep it in your little bag, and then you've got that there. So then it's not that you're just getting hospitalized, and you go, Oh, crap. I don't know what I need to do. You've got you're like, I've already had this typed up and, like, maybe we can change a little thing here and there, but I've got a plan, and then you can present that to the doctor, yeah? Because

Scott Benner 17:19
if you're not pre prepared, then it's not a thing you're going to be able to do in the moment, right, right? Exactly. Yeah. Okay, yeah. I guess you could even keep it on your phone too, like in a Notes app or something like that, absolutely, and make sure that, like you're, you know, the person you're, whoever your person is in that situation, has access to it as well. Yeah, yeah. So what do you think needs to be on that, on that document?

Jordan Wagner 17:41
Sure. So I would say that if you're using insulin, you should have all of your your settings there well, so whether this is the pump or if you're on MDI, so multiple daily injections, have your long acting dose there, your meal time, doses, your correction factors, and have that easily accessible. Because here's another scenario that can come up. You've got a patient going, I don't want to be this high. I don't feel good. And the doctor goes, Okay, I hear you. We'll increase your insulin. It's not uncommon for doctors to make substantially large increases to insulin. Honestly, I think it's just maybe even a lack of understanding sometimes. I mean, if you say you have like a hospitalist doctor, they're a general doctor. They're very intelligent people, but they are managing so many different conditions that they might not have the expertise in insulin dosing. And so maybe you go, I need a little bit more Lantus. Well, a little bit more Atlantis to them, could be 10 to 15 units. And then all of a sudden, you're flat on your face the next day. So you actually

Scott Benner 18:40
talk a doctor into helping, then they do the wrong thing, then everybody gets scared, and now you're back to where you started, probably

Jordan Wagner 18:45
worse off you got it, yeah, all right, yep, okay, so having your baseline settings, that's gonna give them something to work with. Here's the other reality, too. A lot of people report their settings and they're not actually accurate. What I mean by that is, maybe I come in and say, oh, yeah, I take 25 units Lantis, but I haven't actually been doing that for a long time. It's just what's prescribed. So the doctor sees that, right? And then they're they're going to automatically, probably reduce your basal by about 20% so you'll be at 80% of your home dose. And so if you actually are following your prescriptions and taking what you report, you could be running high to start because they're playing it safe and reducing your basal rates there,

Scott Benner 19:28
right? You know it always, I mean, always shocks me when I say to somebody while I'm I'm interviewing them, I'm like, Well, what's your basal rate? And they go, I don't know. I have to look. I'm not that involved in ardent settings anymore. And I know ardent settings, yeah, not saying I'm special, but, like, it just, it's such a I mean, it's just your basal and, like, yeah, just know it, you know what I mean, like, because also for day to day, if you're not in the hospital, for day to day, remembering that, you know, I don't know you changed your basal from. 1.1 to point eight, five, and hey, I've been high for a couple of days now. Like, maybe just having that number in your head would make you think, Oh, yeah. Like, I've made my basal different before. Maybe I should put that back. Now, you

Jordan Wagner 20:12
got it. Yeah, that's and that's like that total, the whole idea of the basal testing, like, you got to know your your baseline before you're hospitalized. Because you get hospitalized, everything is going to get thrown out the window potentially. Who knows what's going on? Your body is going to be stressed out. It's already going to be running a little higher. Doctors might not be giving you enough insulin, so you have to understand your baseline. Yeah, and that's where taking the principles of this podcast and other episodes are going to be so important, so that time that you do get into that somewhat emergent situation, or you're in the hospital, you have a solid baseline to look at and then work with. I think

Scott Benner 20:50
it's important to say too, like, nobody wants to think about like, Oh, I'm gonna end up in the hospital one day. But the truth is, it might not be today, and it might not even be, you know, I don't know when it looks gonna be. You're all gonna end up in the hospital at some point, right? Be ready for. Be ready for. I mean, this whole diabetes thing is about, it's so funny that pre bolusing is such a big part of it, because pre pairing is really the core of the whole thing. Like, you just have to be ready and know what you're talking about, so that you're not, I don't know, so that when the fight starts, you don't find yourself diving behind a rock because you don't know what else to do, like you you need to know what you're going to do when the hands start flying. Like that's kind of the way I think about it. So absolutely,

Jordan Wagner 21:31
yeah. And speaking of the Pre Bolus there, so it's also not uncommon to be dosed with insulin after you've eaten your meal in the hospital, depending on your nurse, there might not really be that sense of urgency. So I've seen patients type ones eat a full meal. The nurse gets to them 3045, minutes later with their insulin, yeah. And then, you know, they're 350, 400 the next time, right? And then, if that's not done, well, you might have the doctor going, Wow, we don't. We do not have enough insulin here. And then bump up the insulin too much, and now you're low again, and you get stuck in this roller coaster mode here. So it's like advocacy, right? Being prepared. Those are some of the biggest things that could really hit home there. And then, as far as the like, the meals, you should probably have a conversation with the nurse and let them know, like I am a reliable person, if you're not struggling with, you know, nausea, vomiting, let them know that you can keep your food down and that you want your insulin 15 minutes ahead of time, even five minutes ahead of time, just just before you eat the food. Because in the hospital, most nurses are going to err on the side of, let's make sure this patient can actually eat the food before I give the insulin. Yeah, they're trying

Scott Benner 22:43
not to make more problems for them, functionally for themselves while they're working

Jordan Wagner 22:48
absolutely Yeah, and like, low blood sugar for a lot of people, seeing as, like, the absolute worst possible thing in the hospital. Like, it's, I've seen it before, where a patient goes low one time they're like 65 they barely felt it, not a big deal. But the doctor says, you know, we're gonna hold you another day to make sure that your blood sugars are stable

Scott Benner 23:07
while we make it less stable. Yeah. Also don't disregard the fact that that food coming from the cafeteria the hospital is garbage food. Oh, it is bad, right? So there's gonna be that impact as well. You know, you said something a second ago that I wanted to expound on, and I've had a number of experiences around this. Yeah, when you start off a medical procedure, I find it is very worth spending two minutes establishing with the physician that you are a solid person who understands the situation, absolutely not a cocky thing, not like I've been doing this forever. You don't need to tell me, like, just say, Look, I understand that you meet all kinds of people, but I want you to know this, my daughter's a 1c has been between five, two, and I forget what you know, 6264, whatever, for a dozen years. We know what we're doing. We know how to take care of these meals. I know how to keep her blood sugar stable. You tell me she can't eat overnight. I got no problem. I can bring her in with a stable blood sugar in the morning without her having eaten. We're here now. You want to put her under for 10 minutes. Don't worry, she's going to be okay, like, that kind of stuff like and give them a few examples of what you mean, what I've learned, I think, is that it doesn't take long for you to get across to them that not only do you know what you're talking about, but you might know better than they do, which I've actually seen it bring comfort to them.

Jordan Wagner 24:33
No, it's true. It can bring comfort there. And I like what you said that you you're giving them some examples, because a lot of professionals, health healthcare professionals they work with, like, they want the data, right, right? So if you're saying, Oh, here's my a 1c is, you do see people come in and, like, not want to talk with me, or one of the doctors, because they they say they know what they're doing, but then you look at their information, you go, respectfully, yeah, your a one Cs are eight to 11. Percent for I can see at least five years here. Well, I think

Scott Benner 25:02
what that could be sometimes is people saying, like, don't look at me, because I don't want to have to explain to you that I'm not doing as well as I would like to be, or that you would like me to be, right? And, you know, it kind of brings me to my next point, which I think I've made on the podcast number of times. But like, I grew up with a lot of friends who were police officers, yes, and these are guys that, if you knew them personally, they're just lovely people, right? But every day at work, everyone's lying to them all the time. So true, yeah, and then, except for the people who aren't, and then how do you figure out who's who, right? And I wonder if, if I'm a physician, and what I'm, first of all, I'm working in a hospital. This is a place where people come in emergent situations, right, right? And not just because you got hit by a car, but because something in your body broke down, or doesn't work, or something like that. The people they see with diabetes are not, generally speaking, the healthiest. On top of it patients. So then they start thinking, that's how everyone is, right? You start generalizing whether you want to or not, yep. And then you come in with your five, six, a, 1c, and like, I've been listening to Juicebox Podcast for a dozen years. Like, watch me do this. That's not what they're gonna think. And they co mingle, type one and type two together immediately. Big time. Yep, right? So now you're just a person with diabetes, and most of the people I know with diabetes that come in this hospital don't know what they're doing, so you don't know what you're doing, so I'm not going to listen to you, and you get written off before anybody speaks a word.

Jordan Wagner 26:26
It's so true, and that's why I think having that conversation is important. You know, physicians can be very quick in and out of the room, and so letting them know like this is important to me. I need to discuss this with you is going to be very important. You have to do that early on in your hospitalization, because I've also seen it where patients have a low A, 1c, and the physicians thought is, Well, surely this is false. Let's see if they have some like hemoglobin disorder, or maybe they have some kind of liver disease going on. The way,

Scott Benner 26:55
I try to think about that Jordan is like, imagine how many people they've seen that they can't believe that you're taking good care of yourself. So true. Yeah, their experience is so great that when you walk in there with your six and a half, even a seven probably, right. Like, like, they're like, well, this had to happen by mistake. Like, you know what I mean? Like, and we see that with regular endocrinologist appointments. I see it constantly. People find this podcast. They get their stuff together, right? They go back three months later, and they're like, go ahead, give me the needle, because they're dying for you to get that a 1c back. It comes out. They're super proud of themselves. They've been working super hard for three months. They roll out their lower, more stable, a 1c and the doctor goes, we got to cut your insulin back. You're getting low all the time. I've heard stories directly from dozens of people, probably more, who will say to the doctor, no, no, listen, here's what I figured out. Like, here's my they'll show them graphs like, I'm not getting low, and the doctors can't bring themselves to believe it, because they're so indoctrinated in what they've seen all these years. And you know, so

Jordan Wagner 27:59
true. Yeah. And I mean, building on top of that, you just said the graphs there, if you have a CGM, continue to wear that CGM in the hospital, because that's that's cold, hard evidence, for lack of better words, that that things are in control there. I mean, you could show them a clarity report of the last 90 days, or whatever it is, to show them that you're in control. But also that's going to help with even treatment decisions, yeah, because in the hospital setting, we're only using point of care testing, right? We're poking your finger. We're seeing where your blood sugar is at. If I can come into someone's room and see that they have a CGM on and I'm like, Oh, great, I can look at this graph and see and pinpoint where there's problem times. And maybe we need to adjust the food they're eating, or maybe we need to adjust their insulin, and that's something that you can report back to the doctor there. So whatever you do, keep that CGM on. Same goes for the insulin pump, truly. But I will also tell you that you're going to see some pushback from some of the doctors not wearing a pump or even a CGM. It could be both, but it's going to be way more heavy on the pump side.

Scott Benner 29:01
If somebody told me to take that CGM off of art, and I'd be like, That is not happening. Like you're not taking that off of her. Because also, I think your point is awesome. Now you're settled, and you're in the hospital for a stay. They don't want to give you your insulin at the right time. And you can turn to them and go, Look, here's what happened. This is what I told you was going to happen. Like, my blood sugar went up like this. If we would have just put the insulin right here, that wouldn't have happened. Like, can't we try that? Yes, or can't I keep my pump on and we do this together? Like, I know you've got a bunch of people to help, and it's probably hard. What I'm thinking is, even if I'm a nurse who wants to do this with you, now, there's a cascading effect here. I'm going to give you your insulin 15 minutes before you eat. Minutes before you eat, but I'm not in control when the food comes Correct, right? And now I'm going to have to I got 20 other people to help, and I got to worry that I gave you insulin and the food didn't show up, and you're in that room by yourself with the door closed, and all the other stuff that comes with it. What if they vomit? What if they do this? What if all the things that I've seen happen in. The past happen. So you get into that what if situation, honestly, Jordan, the way you're describing it, and where the conversation is leading me, what it tells me is, is that if it's not a joint effort between the hospital and you, there's no way to actually accomplish this 100% it's gotta be, yeah, it has to be that, right? And by the way, there's a new nurse and a new doctor every so many hours, you're gonna have to have this conversation over and over and over again, just because you told the first person doesn't mean the next one's gonna understand.

Jordan Wagner 30:32
You have to. And then, as hard as this is stay patient, because depending on which doctor you see, and for lack of better words, I'll say a neurodivergent doctor walks in who might be very impatient and not wanting to talk to you, and has an agenda, and only is going to speak to that agenda right there if you're not patient and you have a little attitude, because you've explained this 10 times now that doctor might flat just walk out of the room.

Scott Benner 30:59
Oh yeah, yeah. The 10th time you say it's got to be like the first time you said it Exactly,

Jordan Wagner 31:03
yeah. So, and that's that's challenging, because you might be in pain, you might be feeling terrible from a high blood sugar. And getting back to the earlier point of advocacy, that's where having that special person there for you who can speak to your needs, who can speak to the situations going on. Maybe when you fully can't it's gonna be so important. So you need to have that set up ahead of time. We all

Scott Benner 31:25
have the practice of explaining to Dexcom why we need a sensor replaced, and having to do it a second time. You just take that experience and use it in the hospital. Exactly. I should say, first of all, like, Arden's experience with CGM is very good. Like, we don't get a ton of 'em replaced, but it is crazy. Like, you know, if they, if they happen, and, you know, I don't know, in January, you got a call and they ask you their questions that there's, I mean, this the poor guy on the phone. This is the questions he's got to ask you. And then, you know, three months later, another one, a year later, two more, five years later, you're doing it again, and someone asks you where you're putting, you know, where do you put your sensor? Like, are you following the whatever? Like, there is that feeling inside of you, it feels like I've told you this six times over five years, right? You haven't that person doesn't work there for for six months, probably, and they're just reading to you from a list. So like that practice that you have to use in that situation of just saying, Look, I've said this 1000 times, but I haven't said it to this person even once exactly, you have to keep that in mind. You have to find a way to advocate but you know, I hate the word advocate for yourself, because it makes me feel like someone's not doing their job. I know, but you have to advocate for yourself, and you have to do it in a way that makes the other person want to help you. Absolutely, I know that shouldn't be the way it is. But human interaction like you've got to play the game. You have

Jordan Wagner 32:49
to Yeah, you really do, yeah, just go into it with respect. And what I would say also is it's also okay to disagree with the doctor, so you are in charge of your own health. And so let's say the doctor goes, All right, we're going to increase your insulin. You're going up 10 units Atlantis or 15. You can tell them, like, No, this, that's going to kill me, yeah, or that's going to drop me really low. Like, can we meet in the middle and maybe do seven or something like that? It's it's okay to do those things again. You are in charge. And you can also refuse anything to right? So I don't know, maybe again, with the insulin increase or a different medication, you have the right to refuse a medication. Just because it's prescribed does not mean you have to take it. It's it's within your rights to say, No, I don't want to take that. Right now, yeah, and a lot of patients don't. They don't know that, they'll go in and say, Well, the doctor said I need to do this, and that's why I did it. If you are someone who's really in tune with your body and really knows your diabetes, chances are you know way more about diabetes than the doctor in the moment treating you, right? So use that experience. So Jordan, I'm gonna

Scott Benner 33:52
ask you a question that's probably difficult to answer, right? Because what you do professionally, but is it not the case that most adults with type one just sneak their gear into the hospital and manage themselves privately and quietly.

Jordan Wagner 34:04
Yeah, we definitely see that. And so I'll tell you, our hospital policy is, if we encounter that, we have to bring security up to confiscate the insulin or the whatever medication they're using. That's, that's what I'll say, is, that's the policy there. But does, it happen? Yes, I do. I have encountered that where people are doing that.

Scott Benner 34:24
I mean, I've seen it with my friends. You know, when I was younger, friend of mine ended up in the hospital, calls me up and says, Listen, I need you to go to my house, get my syringes, get my insulin, get my whole kit and sneak it in here for me, because they're not helping me. Yeah. And he's like, and I can't get it accomplished. And then you're like, Okay, you know? So I brought him his stuff and he he hid it in a bag and kept it with him, and if his blood sugar got too high, he brought it back down again. Yeah. I mean, I see all the reasons why that's not a good idea. Like, don't get me wrong, and I'm not advocating for that. I'm advocating for you, setting it up with you. Or with a provider, right? Have

Jordan Wagner 35:01
that conversation, right? Get it straight. But yeah, I mean,

Scott Benner 35:05
there are going to be times where people are just, you're not going to get through to somebody, or maybe you're just not going to be a good communicator, like, maybe you'll just be in the moment when you're like, saying, like, I know what I'm doing, just shut up. And somebody's like, Oh, you're crazy. And then that's the end of the conversation. Yeah, it's tough. Also you have to open up for the possibility, and this is hard, but for some people listening, you might not know what the hell you're talking about. It's true. That's a tough one. Go take, you know, steel man, the doctor side of this. Now is it I got somebody standing in front of me ranting and raving that they know what to do? I look back at their records, they're they got a nine, a, 1c, for the last 10 years. That's not exactly indicative of knowing what to do. And now they're telling me, Don't listen to yourself, doctor, listen to me. And right? You believe in yourself because you think I'm doing great. Maybe that's what you think you know. So,

Jordan Wagner 35:52
right, right, you know. And there's, there's situations too, that despite having flawless control at home, that just, are you gonna throw you for a loop in the hospital, like, for example, steroids come into play all the time, right? That's gonna really, really throw your blood sugars up, especially if, like, let's say you're having an acute, uh, asthma attack, right? Or someone with COPD, they might hit you with some insanely high dose of the steroids, and you're, if you're not prepared, like, your sugar could go to 600 or more, right? And so in those cases there, maybe you do need to have the expertise of, maybe, like, an endocrinologist. So some hospitals are going to have endocrinologist in the hospital. That's not every hospital. Some hospitals have diabetes educators. Maybe it's like, that's the time we go, Hey, can we request the endocrinology team or the diabetes educator team to come on board my case and help out with this? Another scenario we see a lot is tube feeds. That's not something most people encounter on a daily basis, right? Maybe you're not able to eat by mouth for some reason, and they have a tube down your nose into your stomach. That's a lot of carbohydrates that you might not be used to having, and that's going to really throw off your insulin needs and

Scott Benner 37:06
hitting you differently than it normally hits you. So yeah, I mean, there are going to be times where it's not lost on me that if, you know, if my, if my kid went to the hospital and she ended up with like, 150 175 blood sugar for three days, but she wasn't low and she wasn't super high. I would say, You know what, it seems like everybody did a good job here, right? Yeah, you know what I mean? Like, I think it's like you're talking about two, 250, I feel nauseous now because my blood sugar is this high, nobody's doing anything about it. No, we're not doing simple things like, you know, trying to time our meal insulin, right? I think you fight the fight where the fight can be won and where it's safe for people. But I also would ask doctors to really remind themselves that high blood sugars are not a conducive scenario for healing.

Jordan Wagner 37:50
It is not at all right. I mean, the infections go they go way higher. The wounds don't heal. We have to have tighter control, and that's where I mean, I I personally advocate for the patients a lot of that we need this tighter control. And like Scott, like you said earlier, what is that teaching a patient who has an A 1c of eight, nine, and now we're at 250 all the time, and the doctors are saying, Oh well, we're okay right now. You're not having lows. We're working on your blood chairs a little bit. That's going to teach that person that, oh, well, 250 is not that bad. And like you said, then it turns to 300 and if we take the conversation

Scott Benner 38:25
around away from the individual and apply it to the greater good, I think that's the most important part of this conversation. So it's almost like the economy, like, you know, yes, this hurts, but if the whole thing gets better, you got hurt, but it's better going forward, right? And I think that that happens with diabetes all I mean, I think anybody who listened to the Grand Rounds series knows how I feel about it, but everything starts at minute one for every new person with diabetes, right? Yeah. And so going into the hospital is a new minute one, because it's an experience you've never had before. And if somebody is in that hospital who's already been told, Hey, listen, we're shooting for a seven, a, 1c, but yours is eight and a half. You're doing great. I know you're trying like so now all of a sudden, ADA says seven, you're hitting eight and a half. The doctor's trying to give you the benefit of the doubt, or doesn't know how to help you. So now you've been told eight and a half is okay. Meanwhile, Jordan's running around with a high five, low six, and so is my kid. And anybody else listen to this podcast, probably right. So you're at an you're an eight and a half, when you could be at a six, but instead, a person of you know that you're going to respect a doctor, somebody who went to school knows more than you. In your mind, that kind of thing has told you eight and a half is okay. We're shooting for seven, but eight and a half's okay. Then you go into the hospital. And you realize, man, they got my blood sugar 50 points higher than I got it right. They must know what they're talking about. And if you're not all tied into all of this, you could easily rewire yourself into thinking that that's okay without a doubt. Yeah, and it's rewiring the doctors who are saying. Saying, hey, when she left here, she was fine, so I guess it was cool that her her blood sugar was 275 while she was here, because she did. It's okay. It's such a slow slippery slope of like, just keep accepting a little worse. Just keep accepting a little worse, a little worse, a little worse, until you get to the point honestly, like, apply it to anything. 20 years ago. You know, if I would have told you that in it, that an entire generation of human beings could be captured by moving their finger up and down to see pictures, you'd go, that's insane. That'll never happen, right? But we did it. We slowly got everybody there. You can slowly get better or slowly get worse, right? And I just think that when you're presented with this is okay, your brain doesn't say, Oh, this is okay. I'll shoot for better. It's this is okay. I'll try a little less, and as it slowly drifts away, I'll just keep moving the line that I'm okay with absolutely, yeah. I think that's one of the biggest problems for people living with diabetes, not getting good information and good tools early enough on.

Jordan Wagner 41:10
Oh, without a doubt, yeah. And I would say from the hospital doctor's perspective, there's such a culture of, am I gonna get sued over this? You end up having doctors wanting to play things safer, to avoiding those critical low blood sugars, and in the immediate setting again, running 202 5300, that patient is considered safer than if their blood sugar dropped way too low. I think there's just a lot of things floating around on the doctor's mind. I mean, some of my doctor friends. You know they're seeing 2030 patients a day, oh, yeah, in the hospital. So they also don't have a ton of time to spend with everyone there, right? Not every

Scott Benner 41:48
one of your doctors is running around with 145 IQ and can keep 75 balls in the air all at one time. And remember to say to you at the end, hey, listen, we're gonna keep your blood sugar a little high here, but let's remember that's not okay. And as soon as we get you out of here, we need to put it back here. Yes, it's for this moment. It's not forever. I take your point like, how am I gonna even remember to say that in that scenario? Right? I'm only aware of it for having had all of these conversations. You know, after the fact, I have the benefit of talking to somebody who also has the benefit of hindsight. And so they can say, you know, when I look back over my life, this is how I slowly drifted to this place. I don't know how I'm supposed to explain that to an ER doctor who and then tell them at the end of the you know, at the end say, don't forget to tell them that. Hey, listen, this is just for during treatment times, but we're gonna put it back. And do you know how to do that? If you that? If you don't let me explain to you about pre bolusing and getting your setting

Jordan Wagner 42:46
like they can't do that, right? No, they won't do that. I mean, they really won't.

Scott Benner 42:50
They wouldn't or couldn't. It doesn't matter, like they Yeah, not gonna

Jordan Wagner 42:54
happen. It's not gonna happen, yeah, not, not in an inpatient setting. I mean, I've been in rooms with doctors before, and I assume it's just like I said. They're they've got other things going on. They're busy. And the patients get rid of the discharge, and they go, all right, make sure you take your insulin for your food, you know, make sure you're counting your carbs. Try to keep your blood sugar, you know, like under 180 or whatever, and all right. And then follow up with endocrinologist in two to three

Scott Benner 43:17
weeks. They say the banal crap that doesn't lead anybody to success, right, right? But they're covered. Yep, they covered their basis. Yep, for sure. Yeah. Listen, I've been upset about this for 20 years. I've told this story before, but I was in an elevator once at a blogging conference, and I just said to this person who had an incredibly popular blog, why do you talk to them like that when you know that's not true? And that person just said, it's not my job. I'm not sticking my neck out for this. And I was like, Oh, awesome, great. I was like, I'm gonna just go tell them how I take care of this, right? That person said to me, You shouldn't do that. And I was like, I'm going to, I get it. Like, I do get it. And also, by the way, I wasn't being asked to write a blog or make a podcast while I was helping you in the ER, like, like, you know, like, right? Is a different situation, but that's why, you know, maybe there are just some difficulties in life that are only able to be tackled in hindsight. Like, maybe there's just some stuff we can't actually get ahead of for reasons that are too complicated to fix or even understand. Maybe, I

Jordan Wagner 44:17
mean, it's a possibility. I mean, I think it's really important to learn from the past. Yeah, right. So if you had a poor experience in the hospital, learn from that. Maybe write down your thoughts so you can reflect upon it, and then if it happens again in the future, you have a different idea of how to go into the situation there. Well,

Scott Benner 44:36
Jordan, I want to make sure that you have out all your thoughts before I give you my big idea. In case there's a doctor listening. But do you have everything out?

Jordan Wagner 44:42
Yeah. I mean, there's a I want to just say a few more things, a couple topics I wanted to hit real fast, but going back to the surgery stuff, real fast, anesthesia is going to impact people differently. And what I mean by that is, some people detox it really well, and some people don't, upwards of roughly. 40% of the population have that MTHFR gene mutation, also known as the mother effer gene, and that is going to impact your ability to detox from anesthesia. So let's say that you have that gene mutation, you aren't able to detox anesthesia. You could feel really awful for three to five days where you're throwing up after the surgery. So that's going to require some adjustments to your your insulin dosing if you're on a pump, temporary basal is going to be a really good thing to look at. You may need to reduce the amount of insulin that you're getting so that you're not having lows that then you can't treat because you're so nauseous, that's something to think, to think about. Now, I never thought of this until I had the surgery myself, but they had to intubate me during my surgery because it was on my nose. But I woke up. My throat was so incredibly sore that I didn't want to eat food for for a while, and so again, I had to look at my insulin dosing there, reduce it at some times so that I wasn't having those low blood sugars. So there's those kinds of factors there that maybe you don't think about until you've been through it. Okay, like you said, the hindsight learning from the past. So maybe you learn from that you move forward and approach you differently next time, yeah,

Scott Benner 46:20
yeah. I've been under a number of times. Never have any trouble. And I just had a procedure where I was out for 45 minutes and I wasn't vomiting, but I felt like crap for about four or five days afterwards, yep, and I think they that anesthesiologist used a different cocktail than what I'm normally getting, and it really wrecked me for a while. I felt crappy for days.

Jordan Wagner 46:42
Yeah, and steroids are really common to use in that process. I had requested that no steroids be used during my procedure. That was helpful, but it's very common if you get a large dose of steroids in conjunction with anesthesia, so then you come up and it's a weird combination. So again, to tie this all back together. Having that person there to advocate for you throughout your hospital stay is like going to be one of the greatest things possible. Yeah, yeah, 100%

Scott Benner 47:09
I and it's listen. It's tough to have all the information you need and make sure there's somebody there with you, but again, I just think just be as pre prepared as possible. That's it. Yeah. Jordan's initial idea of having this all written down ahead of time is just, you know, I mean, it couldn't, it couldn't be a better idea. And put it on your calendar, like, every year, like, Hey, sit back down and make sure my emergency sheet is updated. Absolutely take 10 years to change your settings and or something like that. Yeah,

Jordan Wagner 47:38
yeah. That's a good way to do it, man, put in your calendar there and make sure it's, like, on a yearly basis, we have a, like, a go bag, like, if there was a major emergency I needed to go, and we just updated ours, not that long ago, updated all the diabetes supplies. It's a similar concept, right? Yes, it's being prepared for a situation before it happens. It's stuff

Scott Benner 47:55
that's not fun to do that one day you'll be super happy you did it absolutely, yeah, 100% anything else that I that?

Jordan Wagner 48:02
No, we covered everything there. I'm sure I'll get off this and be like, Oh, I forgot that. But that's

Scott Benner 48:06
okay. You're gonna come back tell people what we're gonna talk about next time. Yeah,

Jordan Wagner 48:10
so there's a couple other things I'd like to talk about. One of the big things would be like, how, like, nutrition and stress impact blood sugars there. Definitely wanna look at how Ultra processed foods are really hurting the health of people in this country and in the United States, eating a healthier diet without diving too much into it can actually really help with your insulin sensitivity and things like that. Okay, we'll look at different CGM and how that can compare to blood sugar checks and why there's some inaccuracies at times. There's quite a few things that can throw CGM off. So that would be something to look at, for sure. So we'll dive into a few different things there. Yep,

Scott Benner 48:46
just know that I if you enjoyed listening to Jordan, I just said to him, You tell me, if I gave you a series to talk to people about diabetes, what would you want to tell them? And he put a list together, and those are the things we're talking about. So yep, that's what you're going to hear in other episodes. Now, Jordan, if you have a minute to hear my big idea, hear my big idea, let's do it. Okay. So I don't wanna give away too much about how I do things, but I guess I'm gonna have to to say this. So I was telling Jordan before we started recording that I keep a list of all of the repetitious questions that are asked by people in the Facebook group, and then we pre create content for you so that we can answer those questions with that content. So instead of waiting to the moment when you say, like, I don't understand this, and then somebody having to sit down and, like, dump their thoughts out to give it back to you, which is good, we still see that happen through the community. People give their lived experiences, but somebody from the podcast, or you know me, or somebody who's helping with the Facebook group will also come and say you should try this episode. It has that information. Or here's a blog post that explains that that comes, not by mistake, that's a life lived helping people with telling. Bone diabetes and keeping track of that information in a repository somewhere, so that it is accessible. That's awesome. And what I found myself thinking was so again, this is going to be a bigger idea, but as the world gets more automated, we're going to lose more and more of those people who have been doing things forever, who just know how to do it and how it works best, and what needs to be addressed, and what's kind of bull. You know, sounds nice, but doesn't really help anybody like they're gonna have those ideas, and I am just a large proponent of people sitting down and talking into a microphone and then taking that audio and making it into a transcript, and then feeding a large language model with that transcript. Oh, that'd be crazy. And I'm telling you that if I was a hospital, I would hire three dorks. I would stick them in a corner, and one of those dorks would be in charge of you coming in and just telling your story as the RN, telling your story as the nurse, telling your story as the doctor, the things that you think are important, over and over again, and feed that large language model with everybody's lived experience. Wow. And then one day you'd have a prompt in front of you, 25 years from now, when people are still nurses, except that we've lost all the people who had the job for 40 years, and you know, knew what to do in the right situation, and everybody learned from them. And you could sit down at a prompt and say, This is what's happening right now. Here's this patient, like, what do you think I should do? And instead of, it's not the internet that's being asked, it's every person who's ever worked at that hospital and shared their experience. To give you a list of ideas of what to look into. I mean,

Jordan Wagner 51:43
that's incredible. That would be really incredible.

Scott Benner 51:45
I am telling you, I think it's a huge I'm literally trying to talk my son into starting a business where he just goes to other business and captures thought leaders ideas. I think it's, I genuinely think, instead of like, waiting for the Internet to give you the answer, or waiting for just a generalized, large language model to go out on the internet and pull back in the answer, like, why not get people who you trust to tell you what their experience was? And then one day you'll just have this, the hospital will have a, you know, I don't know, a pool of information, and then you can, you could, if you want, put a group of doctors in charge of it, to go look at it and say, You know what that part? Let's take that out, somebody to review it. And to, I don't, I'm telling you, man, it's a great idea. No one's going to listen to

Jordan Wagner 52:34
me. That is a great idea that, I mean, that would help a lot. Honestly, it would

Scott Benner 52:39
work for and it would work for anything, but it would work so much better in healthcare, because, like, if you want a bicycle shop, it would work, but it wouldn't be that valuable. But, like, but in healthcare where you have these doctors who just know this stuff because they've done it so many times, right, or you have a nurse who just has this information that was not taught to them in nursing school. That isn't a thing that's written down anywhere they just know works like that's the stuff that you need to keep and I think amplify. I'm behind the scenes doing it for all of you guys. Like my last gesture. I want my last gesture to be that when I'm done with all this Juicebox podcast.com, is just a prompt where you can ask questions, and you'll be asking it of everybody who's ever had a conversation on the podcast.

Jordan Wagner 53:29
I mean, it's, it's, that's such an incredible idea. Yeah,

Scott Benner 53:32
and it'll work. So I think it would. Yeah, no. 100% it absolutely will anyway, matter of just creating it. I know this isn't a patent, but don't steal my idea.

Jordan Wagner 53:41
There you go. All right, I won't hold on one second.

Scott Benner 53:51
This episode of The Juicebox Podcast is sponsored by the Omnipod five, and at my link, omnipod.com/juicebox you can get yourself a free, what I just say, a free Omnipod five starter kit, free. Get out of here. Go click on that link, omnipod.com/juicebox, check it out. Terms and Conditions apply. Eligibility may vary. Full terms and conditions can be found at omnipod.com/juicebox, links in the show notes, links at Juicebox podcast.com. The conversation you just enjoyed was brought to you by us. Med, us. Med.com/juicebox, or call 888-721-1514, get started today and get your supplies from us. Med, thanks so much to Jordan for spending his time with us. If you're enjoying Jordan on the podcast and you'd like him to come back, go find him on Instagram, the diabetic murse, and let him know how much you enjoyed him on the show. Hey, thanks for listening all the way to the end. I really appreciate your loyalty and listenership. Thank you so much for listening. I'll be back very soon with another episode of The Juicebox pod. Podcast, if you're looking for community around type one diabetes, check out the Juicebox Podcast. Private Facebook group. Juicebox Podcast, type one diabetes, but everybody is welcome. Type one, type two, gestational loved ones. It doesn't matter to me, if you're impacted by diabetes and you're looking for support, comfort or community. Check out Juicebox Podcast, type one diabetes on Facebook, the episode you just heard was professionally edited by wrong way recording, wrongway recording.com,

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