#1887 - Take Your Hands Off It: The Feelings
Part two: therapist Erika Forsyth on the mental side of diabetes — trusting your settings, hypervigilance, the pre-bolus wait, grief, and the self-compassion shown to lower stress and A1C.
Take Your Hands Off It: The Feelings
Cold Open & Sponsors 0:00
Here we are back together again, friends, for another episode of the Juice Box podcast. Excellent. Erica, this is either, depending on how this works out, either the second part of a two part episode where Jenny and I were the first part or nothing you hear on the Juice Box podcast should be considered advice, medical or otherwise. Always consult a physician before making any changes to your health care plan. I know that Facebook has a bad reputation, but please give the private Facebook group for the Juice Box podcast.
It gets a 150 new members a day. It is completely free, and at the very least, you can watch other people talk about diabetes. And everybody is welcome. Type one, type two, gestational, loved ones, everyone is welcome. Go up into the featured tab of the private Facebook group, and there you'll see lists upon lists of all of the management series that are available to you for free in the Juice Box podcast.
The episode you're listening to is sponsored by US Med. Usmed.com/juicebox or call (888) 721-1514. You can get your diabetes testing supplies the same way we do from US Med. Excellent. Erica, this is either, depending on how this works out, either the second part of a two part episode where Jenny and I were the first part, or it's gonna be an interstitial where I the listeners are hearing Jenny and then hearing you and back and forth.
We'll see how it goes. But how are you? Good. Good.
I'm I'm well, and I I like the, use of the inters inter
Interstitial? Interstitial. I think that's a tell is that about a television or a movie term, Isn't it?
I I immediately thought of the interstitial fluid.
Oh, interstitial fluid.
Interstitial fluid. No.
I was like, I think interstitial in movie making means am I wrong? Has
this how
we're starting? This is ridiculous. This is even when you ask, like, a like, if you should I admit to this? I sometimes feed my transcripts and ask it what good questions I asked and what bad questions I asked, and how many of my questions led to good answers and, like, that kind of
thing. Uh-huh.
And it says that sometimes I go on tangents too long, and I argued with it. I was like, I don't think I do.
So Well, yeah, you said you said inters did you say interstitial?
I thought I said interstitials because I think that's
Interstitial. And I thought of interstitial fluid, which is what we talk about in, you know, diabetes world.
Here it is. In movie making, interstitial usually means a short piece of material placed between larger sections of film showing episodic or programs, think connective tissue. I think I was pretty close to being right.
You are. You are.
I explained to my children recently, and they're like, you don't know what all the words mean that you use. And I was like, I know enough of what they mean. Thank you.
So No. I I yeah. I wasn't questioning the use of the word. I just asked I thought of
Oh, I
the other word. Immediately spiritual.
Immediately as you spoke, I thought I was probably wrong. So, anyway
Sorry. Don't
From Settings to Feelings 3:46
get me sorry at all. This is awesome. So, Jenny and I spent about an hour, you know, going through ways to reduce the practical load of diabetes. Right? And Jenny kinda hit on some things over and over again, better settings, better timing, less interaction, like less fiddling with things, less chasing.
But the reason I want to talk to you about it in the in the same conversation, different light, is because it occurred to me that somebody has something that's in their way, a speed bump or something. Even if a person like Jenny comes in and says, hey. This might be the fix to that problem. I noticed when I'm talking to people, there's always a, yeah, but. Yeah.
But Mhmm. You know what I mean? I'd you know, if you say to somebody, hey. Set some alarms, for example, on your CGM. And if it's not alarming, don't look at it.
They go, well, that sounds nice. But and I thought we would maybe walk through the things that Jenny had spoken about and see if we can find ways to make them feel more comfortable on the the psychological side of it. Sounds good?
Yes. Okay. I like it.
So first thing Jenny said was how do we remove, you know, the overwhelm? And it would be a lot about getting your settings right. So she talked about people in the diabetes community touching things constantly because they don't trust what they're seeing. But what I'm gonna ask you is that when we finally get their settings in a good place, why is it that some people might find it hard to step back, and how can we help them do that? 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's 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.
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Why It’s Hard to Trust the Settings 6:44
Yes. So and what what we're talking about is, guess, trusting. Right? Trusting the settings. Why does it feel challenging to trust the settings initially?
Or I mean, I think there's there's a time issue. Right? Like, it it takes time to build the trust that the basals of correction factors, etcetera, are actually going to
Work out.
Repeatedly work out, like, over, you know, mass experience to reset that fear
Mhmm.
That it's not.
Do you think the fear comes from initial miss like, guess it could come asking you is the wrong way. I guess it could come from it being wrong and them having outcomes that aren't desired, or it could just come from being new at something and just being afraid of it because it's new and they don't understand it. So the question is is that once those things get hammered out, whether it's Mhmm. Time in the simulator or better, more repeatable outcomes, a lot of people still find it difficult to just go, okay. Good.
And trust it and walk away. I I guess what I'm asking from you is how do you think they could maybe accomplish that?
So in improving trust, I think, connects to reducing the fear. And that that there's a lot of ways to do that. I think stepping back and noticing, okay. Why they really kind of go hand in hand. Right?
Like, every moment, every meal, every day that you feel like, wow. Okay. I I bolus. I it did what I wanted it to do. That worked out great.
But we also know that if it worked out, the settings were great and worked out well one day, it might not work out the same way the next day. So I think it's in those moments, how do you trust that the settings are still accurate enough?
Okay.
And I think there's there's a space of trying to stay really present. There there's a moment where you can work on one can work on being present as opposed to which is also really hard to do
I was gonna
say the nature of diabetes.
Yeah. But what does that look like?
So so in the moment, you're saying, okay. Wow. I thought the settings I thought I had the settings, and I'm working on building trust in in in not touching diabetes as you and Jenny kind of talked about it. Right? I'm not trying to overcorrect.
I don't wanna you know, I'm gonna try and trust the algorithm. I'm gonna trust what my my settings are even though today, it didn't work out as well as it did yesterday. And I think in that space, choosing to practice some there's there's so many layers and so many steps. So practicing patience with yourself, practicing patience and and also self compassion, which I imagine we'll get into later, that it's not about the you. It's not about the settings.
It's about, wow. Today didn't work out the same way, but I do know that yesterday and the day before, the settings worked. So it's staying staying present minded. I mean, there's there's even a concept sorry. Go ahead.
No. Because you have to believe it. So it's my finding from doing it for so long that, yes, there can be other variables, right, that might that might blow this off course. But for the most part, it goes this way. It goes the way you know, when the settings are good, when your basil's right, when your carb ratio is good, when you're timing your meals well, you know, when you're doing all that, there's not as much that's pushing you off course.
So the thing I said to Jenny when we were interviewing was I kind of sometimes imagine like a tennis ball just pushed into space and that it's just going to go, like, I don't know if everybody understands that. But if you move something through space, if nothing else touches it, it's just gonna continue on an exact straight line. Right? But eventually, something dust particles, a meteor, whatever, is gonna bump something and it's gonna move you around. And with diabetes, there are already enough things, like, in your life, in your day bumping around things, changing your blood sugars.
But I was saying to Jenny was is, like, if you can at all help it, you shouldn't be also one of those things by touching knobs and doing stuff that, you know, isn't kinda valuable. So once it's moving along and it's moving super smoothly, it's not reasonable to think, like you just said, that it's gonna do that forever. Maybe it'll do it for a day or two or a week, but eventually something's gonna happen again. But that doesn't mean that the plan is bad. Do you know what I'm saying?
Like, it doesn't mean the plan's bad. So how do you stay calm, centered, keep yourself from becoming another one of those variables batting at that tennis ball? Stop yourself from becoming your own worst enemy in that situation, I guess. That makes sense?
Psychological Flexibility & Noticing the Feeling 12:02
Yes. Okay. There there's a concept that we have talked about here and there over the various episodes called psychological flexibility, and it's from an acceptance and commitment therapy model. And we talked about thought diffusion when we feel like the thought is so strong that it's attached to us, and I'm putting my hand over my face. Like, the thought is fused to our bodies.
And when we're when we're practicing psychological flexibility, which is very much connected to practicing resilience, is noticing you're staying in the present. You're noticing, wow. My my blood sugar went higher or lower than I anticipated even though I thought my settings were spot on or accurate. And so you're you're noticing, okay. What is the feeling that's coming up here?
Am I feeling shame? Am I feeling fear? Am I feeling discouraged? Am I feeling like, ugh. I don't even wanna look at this anymore, you know, avoidance.
Are you note are you feeling exhaustion because you've worked so hard to get the settings right and then you had this blip? So you're noticing those emotions. We're not saying, like, ignore them. We're not saying dismiss them. No.
We're not saying push through, but you're noticing, okay. I'm I'm feeling frustrated. I'm feeling shame. And I'm also not telling myself I shouldn't be feeling this way because my settings are good. Right?
We're just you're like you're noticing them, and then you're you're then having because you're taking that pause, you're separating yourself from the feeling. You're then able to make a choice based on from the psychological flexibility emphasis, like, what is your value as opposed to fear, exhaustion, stress, burnout, shame.
Is your So yeah. Explain the value idea to me. So is it Okay. Your value is I'm gonna I'm I'm gonna choose to to focus on the the worry aspect, or or I'm I'm gonna gonna choose to focus on the, hey. Most of the time, this goes well.
There's probably nothing to change here, just an anomaly. Is that the idea?
Sort of. So within within ACT, it's focused on your values, which is your why. Like, what why are you showing up? Why are you even working on your your settings? Why are you motivated to keep going?
You know, is it is it family? Is it your health? Is it your job? Is it freedom? So it's your kind of bigger picture, and that might change, but kind of your your overarching value in life.
So saying, okay. My my if your value is to show up for for your family in a way, like, as best you can, in a in a good enough kind of way. So you're you're noticing, okay. Gosh. My set my sugar my butcher isn't where I wanted it to be.
I thought I had my settings right. I'm feeling so discouraged, or I'm feeling so disappointed or so frustrated. Okay. I'm gonna I'm noticing I'm having that thought, which also separates you from the thought that it's true. I'm noticing these thoughts.
I'm gonna pause. I mean, we're getting into the weeds here of steps going back to you resetting your nervous system. We'll get into that as well, I imagine. And then say, okay. I know I do know that it worked Monday, Tuesday, Wednesday for lunch.
Today, I'm not sure why or I do know why, but I'm not gonna react from the feeling. I'm just gonna notice the feeling. I'm I'm just gonna continue on because I wanna continue to show up for my family in a healthy way. So you're separating yourself from the the judgment
and the feeling in the thoughts. That helps you sort of just let go of it. And and instead of putting putting it on yourself, you put the recognizing it releases yourself from it, releases yourself. Is that is that about it?
It kind of it redo yeah. It reduces Yeah. Reduces the intensity of that emotion that you're experiencing in that moment. So you're you're noticing it, but you're not using it as an informed decision maker to say, I'm such a terrible person. I can't believe I messed up here, and now I'm I'm gonna go in and change everything.
Mhmm. Or throwing hands up in the air. I'm never gonna get it. No. These are all things we may feel at various stages in our relationship with diabetes.
Right.
But if we're speaking from the perspective that you feel like your settings have been proven to be as accurate as they can be. In those moments, practicing the skill of noticing the thought or or acknowledging the feeling without shame or judgment and then saying, okay. But what what am I really doing? What's the bigger picture? And moving from there.
Okay.
That kind of reduces some of that emotional load in that moment from this lens.
Mhmm. Okay. Alright. Now I listen. There's a I want everybody to know who's listening that I just I threw these two things at Jenny and Erica, and I told them we're gonna just have, like, flowing conversations to try to pick our way through it because I I think it's sort of silly to just say, oh, when this happens, do that, and everything will be fine.
I think you need to hear people with diabetes. And then you and Jenny are in a specifically unique position. I mentioned this with her. Both of you have had type one for over, like, thirty five years. And you're professionally attached to, you know, diabetes in different ways.
You with therapy or with, you know, coaching people. And I just think it's interesting to hear you talk through it. It doesn't have to be super smooth or sound like a sound bite. I think it's just interesting for people to listen to a conversation like that. I I've got my hands in this too much.
I'm messing everything up. The settings are all over the place. Every time something happens, I I feel badly. I react. I do something.
I'm trying to fix it. I'm probably making it worse. Then that compounds on itself. Then on the other side, I feel like I'm failing, etcetera, blah blah blah. I finally find someone to help me put my settings into into into practice.
How do I keep my hands off it after that? And just let it play out for a little bit to see if what I did is actually gonna be valuable or if there are adjustments to be made. And what I noticed from talking to people is and and Jenny said the same thing, is that often people have trouble keeping their hands off it long enough to find out what's happening. So I appreciate it. Yes.
Helicoptering, Hypervigilance & Cortisol 18:44
My follow-up to that would be, how do you how can someone tell the difference between them be paying attention to something and that they're being hyper vigilant or helicoptering? Can you do other ways for them to see the difference? Because nobody who's being a helicopter, caregiver or on their own self is thinking they're acting that way. They always, every time I talk to them, feel like they're completely justified in the way they're handling it. You know what I mean?
Yes. So the the question is can you say that again? Why this
I tell what's reasonable and needed and over the top with my attention on this stuff?
I think noticing how is it impacting or impairing your your daily functioning. Right?
Okay.
Noticing, paying attention, responding to alarms from a posture of of calm and not a threat. Yeah. Right? So high if you are responding based on fear. Right?
Fear, as we know, is is a survival response mechanism. And so if you are operating from a place where you you become hypervigilant And this this kind of connects to what we were talking about in the, in the other series of agency and anxiety. Right? We we want to know that when we do something, this next thing's gonna happen. But when it doesn't, that increases anxiety and often then increases that sense of hypervigilance.
Well, maybe if I if I pay attention to it more, I'm gonna anticipate that I'm gonna do better.
Yeah.
I'm gonna be a better manager of my diabetes. But what we know in research, you know, will, validate this that if you are operating and functioning from this hypervigilant state, your body is in that hyperarousal threat response state all of the time. So, a, if you're the person living with it, you are you're battling the those cortisol dumps all of the time. Because even if you aren't let's say, even if you or your blood sugar is in range, but you're in that hypervigilant anticipatory state, your body is is operating as if you are in a threat. Right?
Like, a threat for your body
is And actually being threatened is the same?
Same thing. Yeah. Your body cannot differentiate. So your your amygdala right. We talked about our brain.
Your your lid is flipped. Your amygdala is is firing. Your cortisol is being dumped. And so you're fighting that within your blood sugar just from a physiological perspective, and it's hard to make rational choices.
Yeah.
Right? Your your limbic system has gone off, or your your prefrontal cortex has gone offline, so you are having a difficult time making rational thought. But it feels like you're being safer. You you're trying to tell yourself, I'm I'm I'm anticipating. I'm I'm gonna focus.
I'm gonna stare at the number. I'm gonna course correct all of the time, But it's actually counterproductive to not only your body physically, but also emotionally because you cannot think clearly, and you have all of these hormones that are interfering with the actual insulin absorption.
Yeah. And if you can't think your way through that, just look around you. And if the people around you are looking at you like, uh-oh, mommy's out of her mind. Then just go away. Maybe I'm acting a little crazy right now.
But like, I it is hard because I've interviewed I've just recently interviewed a woman who has these what she would have called overreactions to things and hypervigilance when it wasn't necessary, and we talked through them. Like, that's not even needed. Like, and then she could intellectually say while we were talking, yeah. I I know that that sounds, like, over the top. I said, why do you do it?
She goes, I don't know. Like, I can't, like, I can't even just after we named it, she couldn't stop herself from it. So, I mean, there are so many I'm just saying there are so many good reasons to find a way to overcome that because it's not good for you. I think it's bad for your short and long term health. And I also don't think that it creates a good ecosystem around the diabetes in general, especially if you're the caregiver for somebody and you're always hair on fire.
And while maybe your children are looking at you like, I'm just trying to live over here, she's acting like I'm dying every five seconds, or he's acting like because I used to do it too. I used to I've I've shared this a million times. My wife put me aside one day, and she's like, you you every time you look at her blood sugar, you mutter under your breath like shit. And she's like, you have to stop doing that. She's like, it's it's just it's so negative all the time.
And I never thought of it that way, you you know, until somebody pointed it out.
Yes. So we're having awareness of what what are you thinking? What is your body actually physically feeling when you look at the number? And I think that the shift, if we're if we're kind of staying on the the psychological flexibility track, holding space for, like, okay. Oh, that was fear.
Right? Like, use you muttered under your breath. That is fear, right, or frustration. And so it's like, okay. Oh, fear is here.
Mhmm. So instead of saying, oh, I shouldn't be I shouldn't be fearful. I shouldn't be scared. I shouldn't be frustrated that, oh, fear is here. Yeah.
I'm gonna notice it. I'm gonna create some space from it. And then just even that quick little beat can help you're you're acknowledging that you aren't being controlled by it.
Right.
I mean, this is this going back to also CBT. Right? Like, oh, there it is. It's there.
I see that. I'm afraid. It's okay. Let's pause for a second. Nothing imminently bad.
I don't want you to pause in the middle of an actual medical emergency, but, like yeah. Because the diabetes really is is it is it's training you to expect a problem to come. And and then maybe at that point, you know, you become defensive. Jenny talked about it, and in in her her bit. And then you're waiting for the next thing to go wrong and waiting for the impact of it.
And then you're hypervigilant before you even are, to be perfectly honest. It is really like you ever walk into a situation where you people have beat and you just, like, everything's already on a nine and you're like, this is just simmering. This is gonna pop in two seconds. I think living with diabetes can feel like that sometimes. Like, what's about to happen?
What's about to happen? What's about is it gonna kill her? Is it that's how I would think all the time. Like, I always felt like I was two bad decisions away from killing Arden,
which Yes.
Is I mean, listen. Technically, you could make the argument, but in in a real in a in reality, that wasn't true. Do you know what I mean? Like, we we were not on death's door every five seconds, but it I don't know if I was being dramatic or if it's how it felt to me. I don't think I was being dramatic.
I think that is actually how I felt. And I do think over time, expecting a problem, having a problem arise, expecting it, having it arise, not being able to fix it. Because back then, we didn't have any, like I didn't have any data. Like, I didn't have any CGM to look at or anything like that. It was hard not to live in a constant, like, just a perpetual motion machine of, like, it's about to happen.
It's about to happen. If you thought you hear people all the time, like, you know, back in the day, like, you see a a low blood sugar overnight and you fix it. And then you sit up and watch it for two hours. Long after, you know it's okay. And nowadays, like, if that were to happen to me, I'd look at it, see it, go, I did the right thing again.
I I put my head back down again. And then the if the alarm goes off again, it goes off again. But, like, I I I would be comfortable enough to go back to sleep, and I know a lot of people won't feel that way in the beginning. So why does the absence of a problem like, why does the the waiting create anxiety? Do you have any is there, like, a a human reason around that?
Why Waiting Feels Like Anxiety 26:57
Because it's unknown, and and anxiety wants to creep in and say, better well, you you better anticipate. You better worry. Mhmm. Right? Like, worry, you know, is when you feel like you, by worrying, we think we're it's perceived to kind of control even though we don't know we're not actually controlling anything.
But if we we feel like, oh, if I just anticipate, if I worry, if I look, if I think, then maybe the next outcome, the next reading, I'll feel better. I think we also maybe while we're in the waiting, if we've latched our sense, value, our worthiness to the number, we're waiting for either that positive dopamine hit
Mhmm.
Of, oh, I'll lay stack the landing. We hear that all the time. Right? Yeah. Yeah.
We nail I nail that bullet.
Yeah. Yeah.
I got it. Yes.
I felt that way before for sure. Yeah.
Yeah. I got Sure.
Yeah.
That is totally normal and natural. I feel that way too sometimes on on a random meal that I don't eat, and I'm like, oh, okay. Yes. Right. Great.
That's awesome. But if it's patterned behavior and a learned response to assign your worthiness to the number, then in that waiting period, it's hard. You're like, am I am I gonna feel good about myself, or am I gonna feel crappy about myself Yeah. In these next few minutes?
I just have my I just thought, like, well, diabetes is like it's like a horror movie director who knows exactly how to make you, like, put you to the edge of their seat. And while you were talking, I typed off to the side. I was trying to figure out, like, what are the human concerns that horror movies play off of? And it it I I got back a couple of different hits. It said, sometimes it's that something bigger, stronger, or hungrier than you exists, that your home, your body, or your beliefs are not safe, that someone has chosen you and reason will not save you.
Your own body can betray you. Your mind may not be a reliable witness. Society is is oh my god. Society is thinner, like being held together more more delicately than we think. The place that should protect you is contaminated.
All of those things don't somehow mimic diabetes. I'd and that just popped up in my head while you were talking. Was like, that's that's a 100% what it's like to live with diabetes. Either as a all those things are there. Oh, isn't that interesting?
And so then that's where that comes from. Alright. So let's transition to the next thing that Jenny talked about then. We were talking about pre bolus thing because this is gonna fit right into this. Mhmm.
The Pre-Bolus Wait: Why It’s So Hard 29:35
Why is it so emotionally difficult to wait? So I brought up to Jenny, if if I if if I if I sat down at 07:30 at night, flipped on a baseball game, took a handful of pretzels with me, sat them on the table next to me, And I am one of those people who would not use a dish in that situation, in case you're wondering. And and I sat those pretzels next to me on a table, and then you looked at me and said, Scott, you have to wait ten minutes before you eat those pretzels. I'd go, okay. Now given a way that in a situation where someone's low, they're gonna be ultra hungry, that's not what I'm talking about.
But when a person with type one diabetes is in that same exact situation, and you say to them, hey, put your insulin in and wait ten minutes, and then you're gonna have a far better outcome, etcetera. There are far greater people more than I've than I would say opposite feel this way. That it feels to me when I'm talking to them. I hope I'm I wanna be clear about this. It feels to me when I'm talking about them that they do not want diabetes to tell them what they have to do.
Or I've now come to think of it even bigger now that we've done the body grief stuff, that there's that feeling of, like, well, my body should just do this. That's not right. It's not fair. I don't want it to be this way. But why do you think and this really speak from your own personal selfish Mhmm.
End here. Why is it hard to do that? Like, I know it's difficult to remember the bolus before you eat, but in a scenario where the food is not an imminent thing that you have to attack, what's so hard about waiting? I just watched Erica disappear back into the 20 year old part of her brain. I did.
I did.
I I was like, okay. Where
You know what I mean? I I know you know what I mean, but what do you think?
Yes. Okay. So there's the waiting there's the remembering we're not we're not talking about remembering to pray bolus.
Right. Because different that's a different problem.
That's a different thing because that's but that's also a very significant
Oh, yeah.
Factor Mhmm. Remembering and and it becoming habit. So I think the but I think it's important to note. Like because a lot of time it is I forget, but then we wonder why do why do I forget? Because it's not built in to the rhythm of the the meal.
It's not built into it's just not become a habit. Right? So there's that component that is quite frequently Yeah. Can I have your for
an yeah but right there, and we can go back and forth for a second?
Yes.
Yeah but, if dinner was falling into a volcano and it happened three times a day and there were three opportunities for you not to fall in the volcano, I guarantee you'd figure out how to do that. So why is it so keep going.
And I wanna say, oh, and I wanna come back to I don't I don't know. I wish wish hopefully, someone will do a study on this because there are moments where there might be intention around choosing to not pre bolus or kind of intentionally forgetting. Right? Because you're caught up in the moment. You don't wanna be different.
You I'm thinking of, you know, adolescents going to the corner store after school. You don't wanna, like, have everyone everyone's starting to eat. Right? There are moments where you don't want diabetes to interrupt the enjoyment, glow, pleasure of life.
Mhmm.
I think that's that's a category.
I'll share with you what Jenny said. She said I I'm well beyond caring about this anymore, but
Uh-huh.
She could remember sitting at a table and just looking at everybody and thinking, why can't you all just wait? I have to wait. And she talked about it as, like, socially wanting to eat while everybody else was eating. Okay. It's the part that, like, that came to her when she was talking about.
I find this. I have to tell you, I find this little slice of conversation worthy of its own 10 part series.
Yes.
Seriously, this this spot right here. Like, why why can't I remember to pre bolus? Why can't I remember to put my thyroid pill in my mouth at night before I go to bed? Like, these little things that from the external look very little that but are clearly not to the person living through it. Right?
And, you know, I, you know, I used the idea of, like, falling into a volcano, but the truth is is that if you were on a I don't know. If you were on a medication that you had to take three times a day or you were literally gonna just shut off, you would do it. You'd set timers. You'd build your life around it if you had to. I I know you don't want to build your life around pre bolusing, but it has such a crazy positive impact on your present day and your future health.
It is hard to like, it's hard for me when I watch Arden go, oh, I forgot. And then she just sort of keeps going. And I'm like, why does she not feel the weight of that? And I do. Like, when she doesn't pre bolus, I feel it like she's gonna fall into a volcano.
And I know she's not. Don't get me wrong. Like, for adults who are listening, I'm not out of my mind. I get it. Okay?
I was like, but but I feel that way. I'm like, ugh. Big big miss here. It's gonna ruin the next three hours of her life. And then two and a half hours later, if she's got a high blood sugar, she's like, dad, rub my head.
I have a headache. You know how hard it is not to go, oh, yeah. I know you do. Because your blood sugar went up to one ninety f u eight, and, like
That's a shame. No. You don't know that. It's in my head,
Erica. I have to swallow it and live with it in the pit of my stomach. Okay? And so so so, like, why doesn't she or does she feel that way, the protect herself from the shame, she doesn't allow herself to pretend it matters. I can.
Anyway, I think this is all fascinating. Somebody should do a study on this, by the way. Not me. I'm very busy making a podcast, but somebody else. I mean,
yeah, the the categories around why someone remembers, forgets, doesn't care, doesn't know about prebolising. So we we've talked about the this just totally forget, and you're wondering why do we forget.
Yeah.
I think some of the time, it is life, but I think in a bigger picture, what is your relationship, and what's the narrative around diabetes? And I I will share I I forget quite frequently around dinnertime because it's a different time and a different we've got busy, you know, extracurriculars, life, work in the evenings. But I have I have habit paired, habit tracked stacked. My morning kind of cover bolus, that's automated. I don't even think about it.
I do it. Yep. Lunch is a hit and miss, but I I I do pre bolus, but however much time I have varies, and I feel the effects of that. And then dinner, it's the variables. So I think the but the question when you're going back to Arden, like, is it the aftermath of not prebull is saying you have these physical symptoms Yeah.
That are uncomfortable. And sometimes that might happen enough. Like, if you're in a relationship with your diabetes in a way like, wow. That kinda sucked. I'm gonna remember to I'm gonna really be intentional in remembering next time.
Right.
But if you hate your diabetes, if you are in kind of a resentful relationship with it, then, of course, you don't wanna think about it. And this we talked about this last time too, but then you have to think about it on the backside.
Are You in a Fight With Diabetes? 37:18
Is it almost like like fighting with a parent? Like, you like, you almost like, there's something indulgent about the fight? Like, if you're does that make sense? So if you're not in a and if you're not in a place where you're just gonna say, hey. I wanna be peaceful with my type one.
I don't wanna have a headache two and a half hours after I eat. I don't wanna feel tired or whatever. Again, I'm I'm the wrong person to talk about this because I don't know what it feels like to to have that happen afterwards. But but I've I've decided I don't want those physical feelings anymore. I'm gonna I'm gonna figure out a concerted way to make make sure I do this.
Right? But if you don't, then you're in a fight with the diabetes a little bit. Like, I'm not gonna give in. I always come back to when people say, I don't let diabetes stop me. My my back of my brain question is always, does that mean you're doing the things that you have to be doing to make sure that it's not hurting you, or does it mean that it's hurting you and you're ignoring it and not you're you're not letting it stop you?
Does that make sense? Right. Yeah.
Yeah.
Yeah. We And we've talked about it before because I'm fascinated by the difference between in between those two sentences. And so I wonder if sometimes, like, you know, sometimes people relish a fight in a situation. Like, they feel like they're they're trapped in a lifelong blood feud with somebody, they love arguing with them. I wonder if people like the I'm not giving up.
You can't make me do it portion of that. I don't I really don't know. I'll tell you what I wrote down. I wrote a note for myself. It says, pre bolus documentary.
Look for 20 adults and 10 children to speak specifically on this tiny piece right here about why is it hard for you to pre bolus. I might string them all together in an hour and a half long conversation and let people tell their stories, and maybe somebody can figure it out inside of it. Because it's a it's a real thing. It's there's if you're listening right now and you're like, I don't understand why this matters, go listen to the pro tip series because pre bolus in your meals is, I think, paramount to having stability with your blood sugar. And it's hard for people to remember.
I absolutely acknowledge that. I and I'm not telling people just shut up and do it. I'm trying to understand why it's hard and philosophizing around it. So in this scenario here, you know, I thought one of the most interesting parts of Jenny's conversation was more about it was about the waiting to see what happens, waiting before you correct, waiting before you eat, waiting before you're intervening, and, like, and I just kept thinking, like, why is the waiting, like, so emotionally uncomfortable for some people? Like, why can't they just do it?
And I don't think there's an answer. I don't think you have the answer. I just think it's interesting to talk about. So I don't know. For you personally, though, what do you think?
Do you think you're in a fight with diabetes, or do you think it's just hard to remember?
I think I I was, for sure, in a in a fight as, you know, teen adolescent, and absolutely did not wanna think about I did not want diabetes. So anything that was revolved around thinking about it, didn't wanna do
it. Yeah.
So that that, you know, that was a lifestyle of avoidance.
Do you think this touches other parts of diabetes? Do you think there's, more emotional stuff rather than the understanding of the education? Like, maybe the parts Jenny went over where she's like, if you do these things here, you're gonna have easier outcomes. Like, maybe people know those things and just pampering themselves to do them, even making adjustments to settings or keeping their hands off the stuff when they're not sure what to do. I wonder how much of it is actually fired by by the emotion of it rather than the the nuts and bolts.
I would probably say, like, 99%.
Erica's like, the whole damn thing. It got me upset, I'll tell you. Yeah.
Well, I think they're thinking about that, you know, her Jenny sharing, you know, when you're when she's pre bolusing, and then she's sitting around the dinner table, maybe you're out at a restaurant, and she needs to wait longer. So there's that you're making that choice, and there's a cost for each choice. Because, alternatively, I'm thinking, well and I might do this. I would probably say, oh, gosh. I forgot your pre bowls.
The the dinner's here.
Mhmm.
And I don't wanna lose out on the experience of eating a meal that's warm, eating while other people are eating, connecting, and sitting there kind of uncomfortably while everyone's digging in.
Yeah.
So I would maybe make the choice which has a cost
You would.
To just bolus and eat and maybe add a few more, you know
Is it any different in your mind than having a cigarette after sex or drinking a little bit when you know it might shorten your life? Like, that kind of thing? Is it maybe the same idea? I'm gonna trade a little bit of later for a little bit of now?
Maybe.
I mean,
it's it's it's the cost analysis of of pleasure versus pain.
Mhmm.
And your so how painful? You're kind of I guess, you're in analyzing how painful is it and what's the cost of okay. But you know what? Actually, I know I'm gonna feel much better on the backside if I just wait a few more minutes.
Yeah.
Even though the food's here, everyone's eating.
And it's just a personal choice, mate. Hey. I should say for young people, sex is when people get naked and put their genitals together. I know you guys don't do it anymore. And smoking is, you take a cigarette, know this is another thing you guys don't do anymore.
I'm quasi blushing over here. I'm like, oh my gosh.
Did you not know what it was? I didn't mean to be the one to explain it to you. I'm so sorry. Your mom should have told you. No.
But you need to
get more worrying if there are children listening and they haven't There's
no kids listening. If your kids are listening, shame on you. What do you think of that?
No. I think that's even worse. Stop.
Oh. No. No. It's Performing. I just what I said in the reason, I was like, is that even a good example for people now?
I hear you're all just by yourselves playing video games. I don't know. I I grew up in a different time. Okay. Let's move Okay.
You want me you wanna move on. I wanna move forward.
So numbers have improved. Okay? CGM looks more like we wanted to. Our settings are working. Our time and range has gotten better.
Why might we still feel exhausted even though we've gotten all that done? Like, could the emotional exhaustion itself become a habit?
Yes. Because your your body, your mind has learned that it it kind of restricts itself. Right? It feels like safer to stay kind of just as you can the body stay in a threat mode long after the threat gets smaller? Yes.
Because you your neural pathways have been kind of wired. Your that old tape of you you better stay on it. You better stay hypervigilant. You better anticipate.
Mhmm.
That has become so ingrained that if you were to to try and separate from that, that would feel scary
Yeah.
Or too risky.
Comfortable in the Problem: Foreboding Joy 44:23
I I'm gonna I've said this before on the podcast, so I'm comfortable saying it again. Plus, for reasons that I completely understand, my family doesn't listen to this. So when I met my wife, it did not take me long to realize that she was more comfortable when something was going wrong. And when things were good, it she looked like a a rat in a trap. It was it was really, really very interesting.
It took me a long time to make her believe that too. She was not happier. She was more comfortable if there was a problem. It was like it was like she expected there to be a problem, here it was. So I got what I expected.
This is good. And then our lives got better and then and calmer. And whenever it was calm, she was always, like, waiting for the the other shoe to drop. She was always thinking something bad was about to happen. It took her a really long time to get past it.
So if that's happening to you, I mean, Erica, do you have any idea how they could work their way through that?
I mean, that's the concept of anxiety and productivity. And Brene Brown had no shocker that I'm referencing her, talks a lot about this comparison. And are you are you anxious because you are needing to do a lot of things, or does that kind of fuel the productivity, or do you feel like that's reducing the anxiety by running on the the hamster wheel? There's also concept that you just talking about is the the shoe always gonna drop.
Yeah.
And we've talked about this way back when I can't remember in which series, but the concept of foreboding joy. Like, as soon as you feel like your settings are in place, as soon as you feel like, oh, things are stable, is it hard to let go of that fear? And if that's something you're really interested in, you can look up, you know, the the concept of foreboding joy, which is that, like, oh, I don't know if I can fully be present. Yeah. Because you never know when something bad's gonna happen.
And while we can acknowledge that part of that is true with diabetes, we also don't wanna be kind of attached and connected and feeding that that thought, which is a fear based response and trauma based response.
Hard to believe you're in a safe place sometimes.
Yes.
Yeah. Yeah. I you know, it's funny. Our dog is sick. That's not the funny part.
Our dog is sick. And my daughter today said to Kelly, mom is sad the dog is sick, but she loves that there's stuff to do. And she's like, look at her. She's, like, in her glory. There's, like, she's, like, running around handling things.
Like, it's it it really I I looked up. I was like, oh, but she's a 100% right. Like, she is just like, Kelly's, like, in her she's literally in her glory today. She's like, there is this to do and this to do and this to do. It's all very important, and I'm gonna get it done and blah blah blah, and makes her comfortable.
Pretty interesting. So
Yes. And and that could be also feeding into that sense of agency. Right? Like, she it feels good to do stuff and to get the outcome. And, like, I do x, and I know y is gonna happen, and that feels good.
Like, she's and it's probably feeding into that, which those concepts aren't bad.
No. No. No. Not at all. She's not like, don't get me wrong.
Like, she's not I'm I'm not like, oh, there's a crazy person downstairs. She's just she's like, she likes for there to be things to do. That's all. Yes. I also think my wife's one of those people who's happy when she's working.
And I don't think that's sad. Like, I think somebody who wants to be sitting around or or wants to have that other kind of life would look at it as sad. I think she's really I think she's at her optimum when she's working, and she enjoys it. So I don't stop her. Okay.
Identity, Grief & Who You Are Now 48:13
The identity problem. Jenny talked about people who become the controllers. They they learn how to manage little every little variable. What happens when being hypervigilant becomes part of your identity? Because then if you're not constantly managing, what are you doing if that was your job?
Which kinda comes in on the back of what we just talked about here with Kelly, Fem, and Happy. So that's, I don't know. Again, like, you'll find a hobby, but your hobby can't be the diabetes. Because that comes as close to the, what's that, Munchausen's by proxy as I can as I as I can imagine. Like, you don't want there to be a problem that you have to deal with.
But what what happens when someone takes it away from you? I can yeah. I can only tell you that I know it's real and that when my kids got older after being a stay at home dad for a long time, I felt, like, rudderless for a while. Like, per I I felt like I didn't have a lot of purpose outside of my job for a little bit. But I I'd like to know what you think about it.
Identity is such a huge kind of integral part of one's not only grief process
Mhmm.
And thinking about from a caregiver perspective, but also the person living with it. You know, who who am I now that diabetes is here? Who am I now that I feel like I have to be a pancreas for my child? So there's there can be and I'm kind of going off track a little bit, but we'll come back
Please.
To the hypervigilance. I think there's a loss. Right? There's a a real sense of loss and a perceived sense of loss around one's identity of, you know, who who am I now? So there's that needs to be greeted.
And then there's a journey of, like, reintegration of, okay. Now diabetes is here to stay. Where am I going to assign? Going back to that values question. Like, why am I here?
What am I doing? How can I still continue on in my journey with diabetes? Like, you're on you know, hanging out on my shoulder, but not weighing me down and not dictating, controlling my path. And for a lot of caregivers, there's even a greater sense of loss of, you know, from Kelly's perspective who really enjoy work and working outside of the home, so to speak, but feel like they might have to let go of that a little bit. Two, feel like they're helping their child manage their diabetes, and then you're kind of escalating with what does that mean to be supporting.
Do I need to be hypervigilant? What if I can't be hypervigilant? What if I don't wanna be hypervigilant? And what are I guess, the bigger question yeah.
Go ahead. The bigger question. Sorry.
Bigger question is what narrative are you telling yourself around who you are in relation to your diabetes?
I've interviewed more than a few people who have left their jobs to be stay at home diabetes parents and then taken and they were, like, they were earners. You know what I mean? Like, those people were they were out in the world hustling, and they took that hustle and focused it at the diabetes when it didn't really need all that energy. Do do you know what I mean? And then it did become their their thing.
So oh, jeez. I don't I boy, I don't know. So but so people, you know, how do you just let go of it if that's been your role for so long? And then suddenly someone comes along because I would hate for to think that you could possibly be sabotaging getting your set because in the end, this conversation, like it or not, like all my conversations, is about timing and amount. Like, I'm just talking about getting your settings right and putting in the insulin in the right time and then all the things that come from that.
I would hate to see somebody get in the way of making a problem go away because they're more comfortable in the in the shit. And they and they don't know how to make it go. Like, they don't they want calm, but they don't know how to exist in calm. And would that could that cause you to subconsciously get in the way of of a smoother path because you don't know where it would lead you. I mean, it's it's some pretty deep stuff.
I don't know if that's a thing anybody would do consciously. But, you know, I've seen people block their own happiness in a lot of different ways. So it's not out of the question. That's for sure.
I think if that were occurring, that would be, you know, very unintentional, but that's become their normal and how they feel like that's the only way they can survive. Right? It's like, how how do I survive knowing that I'm trying to keep my child alive?
Yeah. Or themselves too.
Yeah. Yeah. And and for themselves. Yeah. So thinking through, you know, what is it?
What happens when being hypervigilant becomes part of your identity? And how do you let go of that once you feel like, okay. My child has gone off to college, or or I'm an an adult, and I feel like I've figured it out,
so to speak. This algorithm on them, it's working.
Like Yes.
Yeah. Right.
I think there there's probably again, every story is different, but I'm wondering and would be curious around what is that the going back to kind of the value worthiness of if I let go, if I pull back, if I start if I choose to go back to work and if my child is at school or if I choose to not look at my CGM while I'm at work for all day every day
Mhmm.
And something bad happens, who who's gonna be to blame?
Yeah. I know that feeling. That's gonna be me. Yeah. Yeah.
Yeah. No. No one's dying on my watch. That is how it is how
it feels.
You know? Right.
Right. Yeah. So we are so Mhmm. It is like
You're gonna say screwed.
You're gonna
say we're so screwed. I know. God, I'm sorry.
We're so we're so we are so self critical. And from a caregiver's perspective or living with it, if we are attaching so much blame and shame to any higher low
Yeah.
Of course, then the answer is gonna feel like, well, I gotta stay on it.
Mhmm. Mhmm. Yeah. Because it will think
the work is looking at what what are you believing to be true about yourself if you try and step away from staring at the screen all day?
What Does Emotional Success Look Like? 54:47
I can tell you that not thinking about it all day is a lifesaver, and it it can be done in a way that doesn't hurt someone's health. That's that's my takeaway after doing this for just about twenty years. So, anyway, the the last bit here is what would emotional success look like? So what Jenny described as practical success was gentle rolling hills on your CGM, fewer interventions, fewer surprises, and less interactions with diabetes. But what does an emotional success look like?
Like, how would someone know, you know, that they that they've reached that place?
I love yeah, we're looking back. The general I mean, maybe some emotional gentle rolling hills. I mean, I know that's that's
Oh, I don't after by the way, after the horror movie thing, I just think we should just just say yes. Do this, but with your mental health. Because, honestly, gentle rolling hills, so less less Uh-huh. Ups and downs, fewer times where you're intervening, fewer surprises, fewer interactions where you're actually touching the diabetes or touching, you know, your your mental health, I guess. I mean, is there better maybe maybe maybe everything is everything.
You right? Well, you should be called Gary Curtis and just, like, sit in the field and I I we're all connected. Have I talked to you about quantum entanglement, Erica?
Oh my gosh. No. So I like well, I mean, even just like
the
gentle gentle rolling hills, fewer surprises. So when we're when you're living in an a hyperarousal state, everything is gonna feel like an attack and a surprise. Right? So going back to noticing when you have a Pigor Valley, wow. That it's okay to feel the feelings connected to those.
It's not about dismissing, ignoring, setting aside, being like, I shouldn't I shouldn't have done that, or I shouldn't feel guilty.
Yeah.
But in that process, you're also letting go of perfectionism. That's, I mean, that's easier said than done. That's a journey. Noticing, like I guess they on guard like, when you're feeling on guard Mhmm. Going back to what Jenny I think you said she people you you feel like you maybe you're on the defense.
Right? Like, you're always having to respond, and so you're by countering that, you might feel like you're on offense. So you're in this constant wrestling. So when you're and I know you're kind of this is framed from, like, once you're getting the settings right, how do you let go? So just being really aware, and it might take, you know, a lot of interpersonal work through mindfulness, through therapy, through slowing down your thoughts, but noticing what you're attaching to the peaks and valleys when they do happen.
Mhmm.
I have to tell you, I got emotional here at the end. I because, you know, if you give me a minute, at the end here, don't don't leave just yet if you're listening. This really this whole, like, conversation with Jenny and Erica, it it kinda bloomed out of a different idea. I was thinking through a conversation I wanna have with Erica about how much can a person really focus on at one time. And as I worked my way through that conversation, it it got to where it is now.
Don't ask me how that happens. There's a lot of thinking in the shower, and and trying to figure things out. And none of this is planned. So these really were and I and I will say this, I think you have the heavier lift than Jenny because Jenny can fall back on, like, you know, nuts and bolts conversations. I'm asking you to pick into, you know, therapy ideas and the the workings of the human mind and ask off the cuff questions.
You know, answer off the cuff questions that I'm asking you. So I I I I want everybody to know that I think this is a pretty heavy lift for Erica. She should be applauded for having this conversation like this without Thanks. Real without preplanning. Seriously.
But when we got to the end and you said that, maybe it's just gentle rolling hills and fewer interventions and fewer surprises. I thought, oh my god. This all dovetailed together. So love. I didn't know that was gonna happen.
But I will tell you that it's been my first of all, I think if any of this is interesting to you and you'd like to get things together, go listen to the pro tip series that I did with Jenny. I think it'll help you understand your settings and your timing much better. And it is my belief based on my own personal experience that when your basil's right, when your carb ratio is dialed in, when you understand how food impacts, when you get the timing right, those things, they lessen in your mind. They become more back mind stuff that just happens automatically, and your life opens up. And it it's just easier.
So it'll it's a little bit of work up front for a lot of good coming later. But I didn't I just didn't realize that it was gonna that it was gonna be a carbon copy of itself. In the end, you know, these two conversations are almost exactly the same. They're just they're just from two different perspectives about diabetes. And I also don't think we can avoid or ignore any of what you and I just talked about or what people went through.
Self-Compassion & Starting With One Thing 1:00:01
When I said how much of diabetes is something, you said ninety nine percent. Like, I I felt that from you. Like, this thing is I think it's way more impactful on people, aside of their physical health then maybe we either believe or want to allow ourselves to believe or maybe even have the the nerve to to be conscious of. Because it's probably just it could be really sad if you think about it all the time, like what this is, you know, and and what it can be. But I think there's easier ways through it, and one of them, I think, is settings and timing and amount and all that jazz.
So I hope this helps somebody, and I appreciate you spending the time here. Is there anything that you want to add to this?
I do. Thank you. Thank you. I think the acknowledgment that you just where you were landing that, yes, it is complicated, and diabetes is hard, and it is complex both emotionally and, you know, logistically. And I think acknowledging that, yes, is very important.
And simultaneously being mindful of how much you are exposing yourself to the diabetes is hard, diabetes sex narrative. Because if that is something that is infiltrating your brain, mind, body all of the time, it is hard to pause and take space like we were talking about today and practice that psychological flexibility. So it's it's going back to, yes, diabetes is hard, and I am doing the best I can. And I'm gonna be learning these tools, and I'm gonna be compassionate to myself. One last thing that the research has shown from a study of people that I did look this up from type one and and type two found that those who practiced self compassion had lower a one c's and less emotional distress than those who did not.
And so if you're hearing all this that maybe that that what Scott spoke to Jenny with and what in our discussion today, and you were hearing yourself say, that must be nice, easier said than done. I'm never gonna get there. I'm never gonna figure this out. Just even noticing if that's your narrative, you know, practicing self compassion isn't just a a kind nice thing to do. It actually helps you biologically to reduce those stress levels and those cortisone levels.
So I just thought we could you know, I wanted to end there for at least for me on going back to that self compassion and grace narrative is so important.
Yep. I would say that also that if you feel like you can't do it, I I normally joke and say, listen. I can do it. If I can do it, you can do it. But I I've I've brought this up once or twice recently, but there's a meme online that says, you can do it.
Juicebox can help about the podcast. And I really think that. I think if you if you really think you can't do the nuts and bolts side of it, go through bold beginnings or small sips or the pro tip series, whichever one, like, seems like it fits you better, And just listen to Jenny and I just chat about these things, and it'll sink in eventually. And Jenny was talking today about I was talking about looking at a a graph and knowing kind of pretty immediately what to do, but there 's still sometimes when I look at them, like, I think this is what has to happen, but I need a couple of more minutes before I get to it. But generally speaking, I'm a whether she would like to hear this or not, I'm an expert on how Arden's blood sugar works and how our physiology works around diabetes.
I can look at a graph, assess the situation, and pretty accurately know what to do next. Right? And it's not a thing that I'm it's not like writing math on a paper. It just it just happens. It's sort of like when I I don't know another way to put it.
Like, looking at art and knowing it's beautiful. Like, I look at that diabetes and I go, we got a bolus a unit and a half right here. Or we missed that bolus. We didn't count the carbs right. Or, oh gosh, I bet you we missed fat in this.
I know it in a split second, and it comes from experience and time. It's all it is. It's just time in the simulator and having seen it enough times that I know what I I know what it is when I look at it. I don't have to be told, and I don't have to wonder. I think people can get to that.
It just and I just under I understand that if you didn't get a good leap into it, if a doctor didn't set you up well, if a parent didn't help you, if you got caught on the roller coaster and your blood sugars got high and you got brain fog and you're having bad outcomes and it feels like you're just, you know and it must feel like going on you ever see those movies where surfers get knocked under and they film them, like, flipping through under the weight? Like, I imagine that must be what it feels like eventually. Right? And if you're under there right now and you think I'm I'm getting pulled along, I'm never gonna come out of this, it's absolutely free. I don't make any money when you listen to it.
Just go listen to the pro tip series. Like, I think you'll feel better. And if you are are having trouble with the emotional side of it, Eric and I have recorded so many conversations about stuff. It's it's on the website. Like, go to the website, find the mental health section, pick proof, find something, listen, give yourself that grace.
And and I think you'll I think you'll pop up out of the surf eventually. And and I've seen it happen to so many people who, at one point or another, would have described themselves as beyond help. So I know it's possible. I I hope you can believe that. And thank you.
I Yes.
Again, I appreciate
that. Yes. Thank you. And starting with with one thing is always the best way to start. As you you say that often, and I think it's important to note that as as you share your journey and reflection and observation and skill, if you're thinking that must be nice.
Yeah.
As you're saying, go back. Start with the project series, but also even smaller than that, just start with one thing
Yeah.
And take away one thing at a time.
If you're looking at functional, get your basal right first. I have a note here from somebody. I won't bore you, but having her on soon. She said, I saw your little estimator online about settings, and I put my stuff into it and moved my basal up by, like, at, like, 40%. And she's like, look at my graph.
She was 40% deficient in her basil. She had no idea. That one little thing could be a big difference for her. Uh-huh. Mhmm.
Alright. Erica, go, go go ahead. It's the weekend. I I release you. Thank you so much.
Awesome. I'll talk to
you soon. This episode of the Juice Box podcast was sponsored by US Med. Usmed.com/juicebox or call (888) 721-1514. Get started today with US Med. Links in the show notes.
Links at juiceboxpodcast.com. I wanna thank you so much for listening and remind you, please subscribe and follow to the podcast wherever you're listening right now. If it's YouTube, Apple Podcasts, Spotify, or any other audio app, go hit follow or subscribe, whichever your app allows for, and set up those downloads so you never miss an episode, especially an Apple Podcast. Go into your settings and choose download all new episodes. A diabetes diagnosis comes with a lot of new terms, and you're not gonna understand most of them.
That's why we made defining diabetes. Go to juiceboxpodcast.com up into the menu and click on defining diabetes to find the series that will tell you what all of those words mean. Short, fun, and informative, that's defining diabetes.
- Trust is built from repeated lived experience, not a single good day. When a day goes sideways despite good settings, the skill is to notice the feeling — fear, shame, frustration — without treating it as proof the settings are wrong, and to resist overhauling everything. Erika frames this through psychological flexibility (from ACT).
- Hypervigilance feels safer but isn’t. Living in a constant threat-and-anticipation state keeps cortisol elevated, which makes clear decisions harder and can even work against your blood sugar. The goal is responding to alarms from calm rather than fear — and if that’s hard, support from a therapist can help.
- Worthiness isn’t a blood-sugar number. Much of the pain of “waiting to see what happens” comes from attaching self-worth to the outcome — the “stick the landing” dopamine chase. Noticing that pattern is the first step to loosening it.
- Not pre-bolusing is often emotional, not informational. People may know the benefit and still skip it — to not feel different socially, to not let diabetes dictate the moment, or out of a quiet fight with the disease. Naming which one it is matters more than being told to just do it.
- Self-compassion isn’t only kind — it’s measurable. Erika cites research linking self-compassion to lower A1C and less emotional distress. Pair it with starting small: take one thing off your plate at a time, and discuss any management changes with your care team.
- US Med — Where Arden’s diabetes supplies come from — this episode’s sponsor. Or call (888) 721-1514.
- Part 1 — Take Your Hands Off It: The Settings — The Jenny Smith half of this two-part conversation.
- Mental Wellness Series — Scott’s ongoing conversations with therapist Erika Forsyth.
- Diabetes Pro Tip Series — The settings-and-timing fundamentals with Jenny Smith.
- Bold Beginnings Series — The newly-diagnosed series.
- Juicebox Facebook Group — The private community — about 150 new members a day.
#1886 Game Set Match
Fifty-four years with type 1, diagnosed at three: stigma as a kid, retinopathy, a lost eye, gastroparesis, and the mental-health support that never came. An honest conversation about endurance.
Game Set Match
Cold Open & Sponsors 0:00
Hello, friends, and welcome back to another episode of the Juice Box podcast.
There were certain parents that wouldn't let their kids play with me because they were afraid that their kid would, catch what I had.
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57, and 54 Years In 2:35
Alright. So my name is Eric Gilbert.
Eric, how old are you?
57.
57. You have type one yourself?
I do.
How long have you had type one?
Fifty four years.
Wow. You were three.
I was three.
You weren't just three. You were three fifty four years ago.
Yes.
Oh, I can't wait to talk to you about this.
Yeah. 1971 is when, I was diagnosed.
The year of my birth?
Exactly.
Yeah. How do you like, Eric, when you're filling something out online and you have to scroll back in the year and it just takes forever to scroll that wheel to your birthday?
Your thumb gets sore after a while.
And then and the the thing that I'm noticing, I mentioned this to my wife recently, it used to be when I was younger and I scrolled, there were still a lot of dates behind my date and now there's not as many behind me anymore. Like, it's almost like they're like, yeah. Nobody born from here back is alive anymore, so we don't actually have to go to that. It's very upsetting. Have to
say That's right. Well, you know, surprisingly, my grandmother is 105 years old.
Is she really?
Yep.
Good for her. Or is it good for her, or is she like is she like, Eric, I got why won't he take me? Like, what what's her what's her quality of life?
She's pretty good, all things considered. She's up in a facility up in Wisconsin, and so she runs the roost there.
Look at her. That's pretty awesome.
Yep. Yeah.
Earliest Memories & Being Treated Like a Leper 4:10
Yeah. Yeah. Well, listen. What's your first memory of diabetes? I mean, you're diagnosed before you would even remember it.
Right? So
Yeah. I mean, some of the earliest memories I have is being rushed to the hospital to well, being rushed to the hospital is very little to have my blood drawn to have them check to see if my blood sugar was high. Another real vivid memory I have at a very young age is being extremely sick and being rushed to the hospital. And then the medical staff trying to put an IV in me, and they couldn't find a vein. And so they ended up sticking the needle into my shin Oh, okay.
To get fluids into me.
Eric, you remember that at three years old?
Oh, well, I don't know if I was three, but it was, you know, three, four, five. And, yeah, the pain of having a needle shoved into your shinbone at that age, is a lasting vivid memory.
Jeez. I would oh, gosh. That's not a great not a great memory to have. No. Did it get better from there, or what was it like I mean, what was it like growing up with diabetes over fifty years ago?
Antiquated. I was treated a lot like a leper back then because, you know, people didn't really know what diabetes was. So my mom reminded me when we were talking recently about this that there were certain parents that wouldn't let their kids play with me because they were afraid that their kid would catch what I had. So I just remember a lot of chaos and turmoil very young because, you know, at in 1971, in the early seventies, my parents were still, you know, young and trying to figure out how to keep me alive plus also raise their other baby son. So it was it was a lot of chaos.
And then just all of the unknown about the diabetes at that point
Mhmm.
The infancy of, you know, research and a true understanding of what diabetes is and how to treat it.
Oh, gosh. Your parents struggle a lot, do you think, with it, or was it because it was probably, what, one injection a day? Was it kind of out of sight, out of mind mostly, or have you ever talked to her about it?
It was it was a second full time job for my mom because, you know, she was when I was diagnosed, she was given a vial of insulin, say, keep your son alive. She was learning just as much as I was at that time. My dad was involved, but not as intimately as my mom was. You know, she had to cook meals for me all the time. She had to, you know, keep me alive and keep my you know, raising my brother at the same time.
So that's that's a big, responsibility, and duty for her.
Yeah. Did did you talk to her about it as an adult? Do do you know what her, I mean, her experience was? Did she ever share that with you?
I I don't think we've specifically talked about that.
Mhmm. Do you have the kind of relationship where you talk about stuff like that? You just don't talk about diabetes?
No. We she's always asking questions about the diabetes at this point, trying to I mean, I guess you can never not be a mom if you're a mom. So she's always concerned about my well-being, making sure I'm doing everything still I need to do, making sure that I'm getting to doctor's appointments, you know, things like that, helping out wherever she can. You know, she she picks up prescriptions for me when she goes to Costco and things like that. So it it's it's she's still very not as she's not as involved as she was when I was little, but she still is, an active participant in my management.
Mom, the Rock — and the Weight of Needing Help 8:30
Do you how does that make you feel that she's still interested after all this time?
Thank god.
Yeah? Why? Tell me what that support does for you.
Well, I mean, this is and especially having diabetes for fifty four years, it is draining, and it's difficult mentally a lot of the times. And so she's concerned about that. She's concerned about my well-being. She wants to see me succeed. And so, you know, she just takes an active role in making sure I'm doing okay.
She you know, at this point, she knows the signs of me getting low, and so she will give that nudge of, well, do you need something to eat, or should we stop so that you can get something to eat? You know, things like that. So I'm a appreciate
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Does it just give you the feeling like I'm not I'm not completely alone? There are people paying attention to me. Is it comforting? Did you have trouble over the years that would make her still worried about you today?
So yes. I mean, I appreciate that she still is interested in my well-being and making sure I'm doing well. Mhmm. There's been so many things over all the years where she has had to play a major role in my life because of the diabetes with all the complications and all that stuff that I'm sure we'll get into. Yeah.
So she'll you know, she was very very involved. I mean, at certain points of my life, she was, you know, my primary caregiver in my twenties and thirties Yeah. Just out of necessity. Hard hard
for her to let go of it, do you think?
I'm sure. Yeah. I mean, she's been involved with this since day one also. And but but she has also given freedom to take care of myself. She I mean, for lack of a better description of it, I'm sure as a young child, she babied me about it.
But that was out of the both of us learning and learning how to deal with this. So yeah. So, I mean, it's I'm very fortunate that I've had such strong family support
Mhmm.
At least from my parents. But still, it's a struggle. I don't feel necessarily seen all the time as you know, like, especially with my mom. Sometimes I wish that I wasn't seen by her, but, you know, that's just the mother's love for her child.
Yeah. Yeah. And so so even though it's interesting, isn't it? Even though you're really even at at this is really interesting, actually. So I'm gonna try to wrap my head around this.
So even though you've been at this for fifty four years, you're nearly 60 years old, You completely accept the idea that support is necessary for you, but it's still difficult to accept the support all the time. Sometimes it feels like too much.
Yes.
How do you square that circle?
Well, it's it is a necessity. I couldn't do this alone. I have friends that are supportive. I have friends that try to understand, but it's not the same as with my, like, with my mother. Mhmm.
She understands it. She's trying to keep up with understanding the evolution of the care for diabetes. My friends are sounding boards. My friends are shoulders to cry on. But she is, you know, she's the rock.
She's the one that when things are bad, I know I can go to her.
Yeah. Well, I mean, Eric, it's it shouldn't be lost to anybody listening that you're again, you're 57 years old, and that made you emotional.
Yes.
Yeah. You know, that's I don't know I don't know exactly how to unfold this completely because I'm obviously in in a I'm in your mom's position, and my daughter's had diabetes now for, gosh, almost twenty years. And I I see the same thing. Like, she needs help. She wants help.
She doesn't want help. She doesn't wanna think she needs help. And these things they're they're all happening at the same time. It it's not it's not like one day you feel one way and one day you feel the other way. When you're asking for help I mean, you're gonna tell me if you feel that way.
But when when you feel like you need help or you're asking for help, at the same time, there's another force inside of you that's making you feel bad for asking or making you feel like a child for needing it. Is that fair?
“I Don’t Want This” 17:07
I think it's fair. I think the way I see that statement of yours is is while it's correct, at least in my opinion, in in the way I think of things is I don't want this this damn disease. I never asked for it. So me having to ask for help, in my mind says that, oh, I'm I'm I'm not a complete person because I need help with this even though it's out of my control. Mhmm.
Now that is probably not good thinking because it's it's probably not correct thinking, because while my mom is willing to drop anything to help, and I'm sure you are the same way with your daughter, we have to we have to suck down our pride to ask for that help, and that's never easy for anybody.
I think you
And he
me, Eric, you already said the thing that I feel like is the core of the problem. You said, I don't want this. And that's the thing that strikes me. Because sometimes Arden and I will sit and talk about this stuff, and they're difficult conversations because she is sad and angry at diabetes, at me, at things that she shouldn't be. I feel the same way.
And and when when when you let all the emotions out and you let go of all the, I mean, the conscious stuff and you just let yourself be in it for a second, the only feeling I'm ever left with is I don't want this to be our situation. It just is. And Right. You you know, and what a there's the defeating piece of it. Right?
When you when you boil it all right down, you go, oh, we could fix all this right now if we could just make the diabetes disappear, which we can't do, so we can't so then that's where the problem begins to bubble up from. And then that's that's the first step of you losing perfection. Whatever the perfection of your personal relationship is on the day one when you're a little baby and she's holding you right there. Right? That first fracture happens, I don't know, when you wanna pick up a toy and she wants you to come into the other room or you don't wanna eat and she and so there these little fractures happen constantly between your consciousness and desires and her consciousness and desires.
And mostly, as humans, we're good at, like, growing up with those things and and keeping our relationships together. It's this thing right here, this diabetes thing is just it's way bigger than the rest of it. And you I think you can put safeguards in place and put great thinking practices in place and have good mindset and perspective and all of that. And all that does is what do they say? It puts lipstick on a pig.
You know what I mean?
Yep.
Yeah. And so at at the bottom, it's always gonna be that feeling of I I don't want this to be happening to me and and me thinking I don't want this to be happening to you. But at the same time, me thinking this isn't what I had in mind when I became a parent either. So Right.
Yeah. None of us signed up for this.
Exactly. Yeah. I'm sure there was an easier way to say what I just said. That was probably it. But yeah.
Anyway, it I think it's it's just really interesting to hear a person with your years of service in this thing, which I think maybe is how we should think about it. Your decades of service in in this diabetes thing, and and hers as well and everything else that comes with it. And to hear that you're still having the same feelings that probably an eight year old has, a five year old has, a 20 year old has with diabetes.
Yeah. It's it's never ending.
Yeah. But but having said that, Eric, do you think you live a good life?
I think I live a good life. Yes.
Yeah. Well, how well, let's figure out how to do that then. If that's the situation, how do you how do you get to the point where you can say that fifty years in?
A lot of a lot of support from my family
Yeah.
From my parents. Their their tireless efforts to help me. I'm sure it's the same with you that, you know, you're willing to do whatever you need to help your daughter no matter what, and that's the way they were. You know? As as a three, four, five year old, I think my mom was she was trying to absorb and learn as much as she could about diabetes so that she had a better understanding of it and then could translate that into how she cared for me.
And so, you know, I'm sure and I I I don't speak from that from that parental side of things. I only know because I live at 247, 365. And so I can't I I can't put myself in in my mom's or your position to understand that side of things
Yeah.
Because I don't have the perspective. That's I'm not the parent of a child with it. I am the child. And so, you know, in the early seventies and eighties, my mom was, like I said, a tireless tireless advocate to learn as much as she could to help me survive.
One of the most disappointing parental moments I've had is when you get down to saying to your child, I'm so sorry. I can't explain this well. You really won't understand unless you have your own kid. And because when somebody said that to me, I was like, what a cop out. You know what I mean?
But it's I'll tell you. Of all the things that you can't understand without the perspective, there's one of them right there. Like, I can't I can't articulate the drive inside of me to protect those kids. I don't I don't know how I can't put it into human words. It is only a feeling, you know, and and therefore, you get stuck in this situation.
I've been in the exact same situation you've been in probably where you're just you know, the person on the other side is like, I don't want this or need this. And you're saying, you don't understand. I can't not do this. Like like and then you and then if you're a good parent, then you have to swallow all of that and then stop. And that's really difficult.
That's that that really is the idea of, like, sometimes you just gotta let a high blood sugar be high for a little while so they can figure it out and that you hope that they manage it in a healthy way and it becomes a habit that helps them long term, but that you're not in charge of it turning out that way. That's a hard thing to, like it's a hard thing to accept. I think when you're raising kids do you have kids, Eric?
No. I don't.
No. When you have kids, the idea that you're gonna raise them to some sort of success and happiness, it it changes and morphs over time because I think the goal changes and morphs over time, which makes it all feel much more acceptable when it pivots and morphs. But when your end goal is a lifetime of health and you get farther and farther away from that when decisions are made, you can't pivot with that. You you don't you don't start thinking, like, I really hope this kid's a one c stays in a safe range. And then all of a sudden, it's a nine or a ten and eleven and you go, okay.
Well, I guess that's okay. It's be right? Because it's not. So Right. And if you push back, you're gonna you're gonna break your relationship up.
And if you don't push back, there's gonna be a health issue.
Yep. Yeah. Exactly.
You know, the only answer, Eric, is you did the right thing. Don't have kids. Wow. You can't you can't can't win, man. It's a win it's a game with no winning strategy.
Uh-huh. You know, even when you also, like, keep in mind when I say it's a game with no winning strategy, the saying you always want the thing you don't have is a 100% true, and it never shines brighter than when you parent a child well because they'll just find a different thing to be disappointed in. Because I think they're supposed to feel that disappointment to separate from you so they can go be an adult on their own. But then again, the health issue stops that from happening Yep. Sometimes.
Man, it's a shitty
Yeah. Right. Exactly. Exactly.
Well, what what
And we and we live it daily.
It's it right. Oh, not just daily. Right? It shifts by the hour sometimes.
By the minute.
Yeah. Yeah. Yep. What made you wanna come on and chat?
The Missing Mental-Health Support 26:14
Because well so for a couple reasons. One, I don't think there is enough, advocacy out there for somebody that's had type one for fifty fifty plus years. I don't think that people hear enough from somebody like me that's had it for over fifty years to see that, you know, it like, in your daughter's case, twenty years. Well, that seems like a lifetime, which it is, but you you can live successfully with this with this disease for as long as you want. Yeah.
And so, you know, I I think one of the biggest one of the biggest issues I see is that there is, excuse me, a tremendous lack of mental health support for type ones. And this is something I've struggled with for a very long time trying to find some help. And a year ago, I started with a a new doctor who is a, you know, a diabetic specialist. Mhmm. And she has she has a she's a concierge doctor that I found here in my town.
And she also has a counseling degree. And so in addition to all the work we do about the control issues, we've been getting into the the mental health side of things, and, you know, she's she's been a lifesaver. And because like I said, I've tried for years to find help on how to deal with the diabetes. And I've talked to, you know, various therapists and whatnot, and and nobody can relate. I was at a breakthrough t one d event a couple years ago, three years ago.
And so, like, one of the the big wigs from back in New York was there, and so, you know, they opened the floor up to questions. And so I asked a question about what's breakthrough doing about helping with, you know, the mental health side of things for diabetes. And the guy deferred to a panelist that was there, and it was a mother of a a child that had type one. And her answer was, we'll see a therapist. And that just struck me as a horrible response, and it filled me with anger and murderous thoughts towards this person because of I mean, I thought it was a flippant rote response.
Mhmm.
Especially, you know, as this thing
started In that setting too. Right? Yeah. Yeah. Yeah.
And, you know, and there was there were a number of people in the audience that were type ones. At that point, you know, I had, like, fifty one years, and so they recognized that or they asked anybody with over, like, forty years to stand up, and there was only, like, three of us. And then after fifty, there was just myself and a guy that was, like, in his seventies. And so to have that answer really set me off. And it just it just reconfirmed where I think there's a huge lack of support for all of us type ones.
What would you so, I mean, I hear the story. Like, you asked the guy attached to the organization. He's like, I don't know. Ask her. And she goes, I don't know.
You you so I get that, I mean, that's defeating in itself. But what would a good response have been? Like, what would you appreciate would have appreciated hearing?
I think something to the effect of, you know what? We we're doing something at breakthrough t one d. You know, let me give you some resources or here's my email. Email me, and I can get you in touch with those resources.
It would have been nice to know that they were working towards it and or had already thought about it, and they had a mechanism for spreading it.
Yes.
Okay. But they don't but in your experience, that was not offered?
No. And it's just you know, this will this will be my little soapbox. You know, I think, like, with especially breakthrough, they only care about the kids. They don't care if you've had type one for, in my case, fifty four years. You know?
I am, a black hole to them. You know? They only want my money for donations, but they're not willing to help me with anything. And that's been my experience over the years, not just with them. I mean, ten, twelve years ago, I was in a bad place, and I called Jocelyn's to see if they had any sort of direct mental health help.
And, I mean, I got passed around from department to department, and nobody had a solution. Nobody had an idea. Then there was you know, they couldn't even refer me to somebody that was you know, had a specialization in dealing with people with t one d for their mental health side of things. Yeah. Because, you know, we we can take care of the physical side of things.
I mean, hell, we've got so many different things that help, the pumps, the CGMs, all that stuff. But I just see that there is a huge lack of acknowledgment about the mental side of things.
I listen. I try to put effort into getting pump companies to make content with me that will help people use their pumps better because I even think that happens there where they're like, look. Here's the thing. And then you say, well, how do you use it? Yeah.
I don't know. You gotta go ask your doctor about that. And then you go to you know? And by the way, FDA does not allow pump companies to to give you direction about how to use their device. Actually, device manufacturers in general cannot act like doctors.
They're not allowed to. So forget that they're not allowed to, you know, but then they go, oh, don't Ask your doctor. You get to your doctor, and your doctor says, I don't really know much about that pump. And then Right. I mean, okay.
Great. So we're pumping out new new new content in the form of technology all the time, but but we're not really teaching people how to use it very well. And then, you know, I'm I I've tried over and over again to make content that will hopefully help people understand nuts and bolts ways of using their their devices better, even using the insulin better. Nobody even teaches you how to use insulin. Like, that's just this is your ratio.
Count your carbs. God bless. Like Right. Awesome. Thanks.
Have at it.
Yeah. Yeah. A little more to it than that, but okay, buddy. Right. And at the same time, like, I could put myself easily in the shoes of the people at the JDRF who are saying, like, look.
Here's what we're this is what we're focused on. We are not focused on the thing that you need. But then you're saying, well, if you're not, who is? Because no one else seems to be either.
Right.
Yeah. So is that just a thing that like, you either need one of those organizations to decide to be valuable in that space, or do you need its own organization to pop up and then who pays for that? And then how do you get the word out about it so people even know where it is with time? Like, almost makes the argument that it needs to be folded into a bigger place that already has attention and and you know where to go. Like, you think of them when you're going somewhere.
Right? It's a Right. Why going to the hospital can be frustrating when they can't help you? Because you're like, well, where else am I supposed to go in this situation?
And Right.
You you know, like, I I boy, do you think it's a limitation of society more than it is a limitation of JDRF, for example? It's hard not to be mad at them, though. Right, Eric? You've at this a long time.
Right. Right. And yeah. I mean, they're they're high on my list these days because, like I said, they just want the money. They don't care about if you're not a child, you know, by the age of, what, 16, 17, 18, you're an afterthought to them.
And so it's frustrating. In all honesty, I don't feel like outside of my family, my friends, doctor Sloan, the my my doctor I was mentioning, I don't feel like I have support. I don't feel like I have the support where I need it the most on, not necessarily a daily basis, but on a regular basis, meaning the the mental health side of things. How can somebody live with a disease, a chronic disease for fifty four years and not have some issues? How is it that you know?
And I mean and now talking to you, you understand because you you live vicariously through it with your daughter, and you do this podcast. But this is something that I can never take a vacation from. This is a twenty four seven, March issue. And as you said earlier, minute by minute, hour by hour, you know, thing that we have to address. That weighs that weighs mentally on somebody.
I mean, that's a big burden to carry. And so how and I I I appreciate your question of how do we do this? How how do we make this available? And that's that's the crux of the problem.
Yeah. You don't know. You're busy living with it. You you can't fix it too. Like, you need you really do need somebody else to put their brain onto it.
And Right.
Yeah. Yeah. And, you know, and and at this point
in life, I wish that, you know, ten years ago when I started, you know, identifying these issues, I wish I woulda had the ability to go back to school and get a a different degree than what I have. So that then I could have maybe, you know, been that that counselor for all these people.
What does what has worked for you over the years? You said you had an issue about ten years ago. Would you share what that was?
Gastroparesis & Losing 60 Pounds 36:55
So I've had a number of issues from the diabetes over the years Back in starting in, like, 2010, I started having stomach problems. And and and so from, like, December 2010 till January 2011, I lost 60 pounds. And it was you know, I went through testing, so much testing, and it was determined that I I have, gastroparesis.
Okay.
And so that was why I lost 60 pounds because I couldn't eat anything. I couldn't keep anything down. Anything I ate came right back out. And so, I mean, it got so bad that at one point, my doctor at the time was thinking that they're gonna have to put a feeding tube in me, and that did not sound appealing. And so I ended up going out to the Mayo Clinic out in Arizona.
They had a gastroparesis, excuse me, program out there that I went to and I learned about things and, you know, got educated on on how to deal with yet another side effect of the diabetes. Mhmm. You know, different eating, keeping the blood sugars down so that they don't go high, and that's what set it off. And so now, yeah, it's just another thing I live with, as a result of this diabetes.
Yeah. Hey. Do you listen to the podcast with any regularity?
I I listen to it, you know, a couple times a month.
Okay. Well, that's pretty regular.
The time. Yeah. Yeah. No.
But that that's that's regularity. So you but you're aware of how I tried to talk about it, about understanding how the insulin works, understanding how the food's impacting you, like that stuff. Is that a thing that would have been valuable for you to know sooner? Like, you just said, like, you know, what did they teach you? And the things they taught you are not, like, not incredibly, like, uncommon ideas modern day.
But I'm imagining as you were growing up, people didn't talk to you about stuff like that. Right?
Diabetes in the ’70s: Urine Strips & Pig Insulin 39:08
No. No. I mean, what what technology we had in the seventies and eighties is I mean, at the time at the time, it was revolutionary. Now, I mean, I think I I would guess the majority of people don't even know what we used to do. I mean, you're probably familiar with it, but when I was a little kid, I mean, how do you test for for, you know, sugars in your blood?
Well, had to pee into a little paper cup, take a little eye dropper, pull out some urine, put it in the test tube, five drops of urine in the test tube, and drop a tablet in it.
Yeah. It
fizz, and then it gave you a color spectrum, blue to, like, dark orange. Blue was you had negative sugar in your urine, and orange would meant that you had high high sugar in there. That's what we had. It wasn't until early eighties that they started coming out with the, you could test your blood sugar by pricking your finger and then putting that on a little strip, and then, you know, you had a meter that would read it. Yeah.
But Nice.
Probably feels like like a 10 lifetimes ago, I would imagine.
Yeah. Yeah. Exactly. You know, insulin back then was I mean, it was pig insulin derivative. We had two types, NPH and regular.
Mhmm.
The NPH was, you know, eight hour lasting, and so you do that. And I, you know, I I had a doctor back then that was a pediatrician endocrinologist. So, you know, he was he was very involved in diabetes and diabetes research, and so he always gave me the latest and greatest. I think it was high school when I first started doing multiple injections a day through all the research that was being done at the time. And, you know, anytime I would have to tell a doctor or a nurse or end up in the ER, you know, that I was on multiple shots a day, they're like, oh, well, you must be a really brittle diabetic if you're doing so many shots a day.
But, no, that's how your nondiabetic body works by having constant insulin throughout the day. That's what I'm trying to mimic. And so, you know, everything was such a shock back in that time period when I was first diagnosed. But I think there's at least for me, I think there was a lack of understanding about the bigger picture of diabetes. And and
every so every time something shifted or changed, you run into a person who really knows the way before that, but not this way. And then they become one of those people who's like, oh, you don't you you must be, brittle, for example. You're shooting so many times. So you're following you're following new teachings by being you know, trying to trying to honestly line up the insulin with the impact of the food. Right?
And then you then you're impacted by a person. You run into a person who says, oh my gosh. You must be doing this wrong because of this because they don't understand the new idea. And then the next new idea comes and it keeps happening. It keeps happening.
Fighting for the Next Thing, Not This One 42:40
Do you think that if someone from a big organization who is clearly not helping people in your situation right now, do you think they'd say, well, yeah, well, we're trying to do the thing, though. Like, we're trying to get to the next thing. Like, we're not we're we're not an organization that, like, is here supporting you day to day. We're an organization who is trying to make TZL work, make CGMs work, argue with, you know, legislators about something. Actually, I just remember something very recently.
Like, JDRF had a big, actually, that Eladon trial that's going on right now. I interviewed that doctor, and he gave a lot of credit to JDRF for their, like, basically, their work in DC about making things easier for him to do his work. And I I but it still seems incredibly unfair to me that you as the as the person with diabetes, like like, you're by the by the virtue of the day you're diagnosed or that anybody is diagnosed, you were planted on a timeline. And that timeline keeps shifting, but it doesn't it's not there for you anymore. Meaning, like, insulin gets better, pumps get better, people come up with algorithms that work better, organizations are busy fighting for the next thing, you know, at at the government level or or whatnot.
And you're back here going on the like, I'm the one living right now with the stuff that's available right now, and I need this kind of support. My hospital doesn't offer it. Just go talk to a therapist. How I don't even how am I gonna find a therapist who even understands diabetes? Like, I I'm sitting here listening to you, and I think that your converse that that your story is incredibly valuable to hear.
And I think it'll be incredibly valuable for everybody who listens to it. But my, like, my concerning takeaway forty minutes in is that the only person that this conversation is not gonna help is you. Does that make sense?
Well, it does. Yeah. And if I can help somebody else, hey. Great. I've I've done something that would that makes me feel good because I'm helping somebody else.
And, I mean, we haven't even touched on, you know, some of the other complications I have. But I think your your premise about, you know, these companies focusing on the next the next big thing is is, yes, they are they are working tirelessly trying to figure out how to cure this. I've been hearing for fifty four years that a cure is right around the corner. Yeah. You know, let's let's stop that false hope because it's been fifty four years in my case, and there's still not a cure.
Let's let's instead say, look. We are working diligently to make management the easiest it can so that you avoid complications. But further to your point, these these organizations, they they serve an important role. Like you said, the whole DC thing, the funding of all these research projects. But I think they could because who else is going to be?
You have type one or breakthrough t one d, JDRF, American Diabetes Association. I mean, those are the big ones. I don't know you even know if the American Diabetes Association is still around. But they are the ones that are in the public eye. They're the ones that the public, you know, probably is are are easiest to find those organizations.
Mhmm.
So why can't they incorporate somehow getting that mental health side of things? Because it's it's it it's not something that you can separate out. I wish I didn't have to, you know, have all these, you know, issues with my mind because that would make life much easier, not just for me, but for everybody. But how how do you how how do you deal with this on a daily, yearly basis? It's not easy.
Technology makes it easier, but that's still, it still is a drain mental drain.
Can I ask you two questions that both might be difficult to to answer?
Of course.
If I tell you let's just make up a scenario, right, where they do cure type one diabetes, but it's three hundred years from now. So you said even if I'm not helped by sharing today, hopefully, it'll help somebody else. So if what if your life being part of the, I don't know, part of the petri dish where they figure out how to die you know, how to cure diabetes three hundred years from now. Like, even though you won't be alive in three hundred years, if I told you that was definitely gonna happen, would you say, okay. Fine.
I understand you're not helping me, but eventually we're getting to it, or does that timeline make it like, because right now, what they're saying to you is five more years, five more years, five more years, which I think is I think it's cruel, by the way, to say that to people. Yeah. Right? But I get how it keeps people engaged. They think it it it lends hope to people.
I think it kinda does the the opposite. It's my opinion. But so my question is is that if you knew that what they were doing right now was gonna lead to a cure in three hundred years, would you stop would it would that stop you from feeling cross about how it's being handled right now? No. Okay.
And if they told you, listen. We can help you with the thing you're asking for right now, then we're not gonna get to the cure in three hundred years. Would you say, well, that's better serve the people that are here now, or would you say, no. No. No.
Leave me be. Let's let's go for that.
I would say let's see if there's a way that we can find a medium between those two extremes.
Yeah. Okay.
Because why should I be discounted now when when I'm here now? I mean, there there should be they should be able to balance it. Great. I I lead the way three hundred years from now. It's no longer.
So be it. You know? There's nothing I can do about that. Quit torturing me that there's a cure right around the corner. That's not fair as, you know, as what you said.
Mhmm.
But there's got to be a way to balance it.
I'm with you, Eric. I'm just I'm trying to play devil's advocate in a couple of weeks.
Yeah. No. No. I understand.
Yeah. Yeah. I'm I'm with you. I think that it should not be difficult for large organizations to put a strike team of people together to build even if it's just a list that you can email to somebody or a website you can go to to, like, search in your area to find, you know, a therapist that's either cash pay or or or otherwise may and and if those people don't exist, is there not something you could do to, I don't know, incentivize, young people going off to college to pick this up as a, you know, as a focus? I think that too when they're always telling us, like, there's not enough endos.
Well, spend some of that money on incentivizing people to be endocrinologists. You know what I mean? Like, what about, like, you know, you gotta go to med school, and med school costs x number of dollars. But guess what? If you become an endocrinologist and dedicate ten years to people with diabetes after you graduate, how about we'll pay, 20% of your of your student loans, or we'll give you a set amount of money?
Or, like, there's other ways to spend this money to try to spread good in the world. And and I don't even know that it takes that much. I'll say something now that I think is I hope it doesn't sound self serving. I don't I certainly don't mean it that way, but I think I motivate a lot of people to go into endocrinology and being a nurse practitioner and, helping people in the here and now. And that's just leading by example, really.
You you know? Like, there there's a lot of ways to there's a lot of ways to push towards good.
Right. And you're fortunate to have this platform that is so informative, and and it helps people.
Yeah. But can I yeah? But yeah. But it's not fortunate. I made this on purpose.
Sure.
Exactly. They could they could try and they and by the way, I I this is gonna sound like I'm talking about somebody specifically. I'm not I see all kinds of organizations with, like, this high mindedness that, like, they're gonna kinda copy the thing that I've done or, you know, try to do but they always do it wrong. They always make it too corporate. They always make it boring.
They always make it dry. They always turn it to something perfect on paper that nobody's gonna spend their time with. And then they'll they'll quietly and privately say, look. We made it available. They didn't want it.
Well, you made something available that doesn't fit into people's lives is what you did. You you know, like, you you it it has to be, like, you know, for for corporate people who are always running around saying stuff like meet people where they are, they sure as hell won't they're not good at meeting people where they are. They're good at meeting people where they think it looks good.
Right.
Yeah. Right.
You know, I mean, so I I think and this is just my perception that nowadays, you know, meaning the last five, ten years, I think that with the evolution of all the technology we have, it it has helped alleviate some of the complications that, you know, us type ones face.
Surely.
10,000 Lasers and a Volleyball: Losing an Eye 52:48
You know, better understanding, keeping your a one c's in range and and all that stuff. But, you know, one of so back in the mid nineties, starting '93, '94, I started having retinopathy issues. And I eventually, after so starting, like I said, like, in '93, I did my first laser laser shots in my eyes. Ninety four, ninety five, ninety six is when I went through living hell with my eyes. Over the over that period of time, I had over 10,000 lasers in in both my eyes.
I had, like, seven vitrectomies where they go and they suck the fluid out of your eye because it kept filling up with blood. Had a detached retina. And and finally, you know, I was I was three years of all this, my doctor was finally able to save both my eyes. I go out and playing volleyball. I get hit in the eye with a volleyball, and so that killed my right eye.
No kidding. Are serious? Yeah. Yeah. Yeah.
Because, you know, the eye was in a weakened condition at that point from all the surgeries and all the lasers and stuff. So yeah. So I lost my eye back in 1997.
No shit. Game set match, Eric. That's terrible. Oh, also a great title for your episode. Yeah.
Well, you go you go through all that, and you're like, that's it. I'm back to life, and then life hits you in the face, like, literally?
Literally. Literally. Yeah. Right in the
eye. Jesus. Oh,
I'm sorry. Yeah.
That sucks.
It does. It does. And so you
know? But did I
let that slow me down? No. You know? I I have I have vision on my left eye these days. It's not a 100%, but I can live.
I've had to learn how to readjust everything. Like, I had to stop playing, you know, a lot of contact sports, at that point back in the late nineties because of the depth perception. I've had to learn how to drive more cautiously because of the depth depth perception. I can't drive on open roads at night. I mean, I could get around the city with with enough, street lights and stuff, but I can't drive on the open road.
And, you know, I decided at that point in '97, '98 that I didn't have enough challenges. So I went to law school in starting in '99.
Did you really?
Yep. And so I I went through law school with one eye.
Are you an attorney now?
I am.
Oh, lovely. Kinda love your practice.
Right now, I am between jobs, but I had been doing construction litigation for a number of years.
K. Wow. That's really that's impressive, man. Yeah. Yeah.
Yeah. And so when I got done with law school and passed the bar, my right eye started, it became so painful that I couldn't live with the pain, so I had it, removed. And so now I have a prosthetic.
Oh, do you really? Do people know?
Yep. And no. I my right eye is, you know, semi closed on a permanent basis. Mhmm. And the eye does not does not move as much as the left eye, but the procedure I had, I went to a doctor in Fort Worth, Texas that was a specialist in, enucleations.
And so he did an implant where he tied all the nerve endings to this implant so the eye does move a little bit, but, I still look like there's something wrong with my with my face, with my eye.
Fascinating that they can do that. I knew a kid growing up, his father had I I mean, colloquially, I mean, we just call it a glass eye. Right? But, like Yeah. The kid the kid didn't know for a long till the kid till the dad told him he didn't even know.
And I was like, that's stunning. How did you not like but, you know, I guess you're just used to how people look. You don't think twice about it really when you're younger. Do you wear a patch, or do you do you how do you feel about it?
No. I mean, it's it's I have a prosthetic onion. So looks how you do it.
Yeah. That's how you roll. Do you ever wear a
patch? Only after procedures, you know, because you had to have it bandaged up and whatnot. But you know, as it
I'm sorry.
Go ahead.
No. I was gonna ask how having one eye made law school more difficult.
Oh, it was it was very difficult, because everything is about reading. And so, you know, what what took somebody maybe two hours, it take me four or five hours just because it it's difficult to, you know, read smoothly from line to line because it you know, it's makes it makes it difficult to track. And so yeah. So, I mean, you know, law school took a lot of work, long hours at the library and studying all the time. But, you know, it was
Worth it? You think it was worth it?
Yes. I agree with the
jobs now. You're probably like, well, I don't know about right now, but it was before. Right.
Right. It was something that it was a goal I wanted to do. And so it was worth it in that sense that even just with, you know, the one eye, I could do it, and I did it.
Showing it to yourself. Yeah. Yeah. Yeah. And do do you think AI is gonna mess with attorneys?
Yes.
Yeah. Because it's because they can read and understand so quickly.
Yeah. But they don't it's the you know, it's all the hallucination stuff where they make up cases and whatnot, and that's where Yeah. People are getting in big trouble.
They get past that, though, and then what? Like, law clerks? Like, that's gonna that's gonna hit people like that pretty hard. Right?
I I still think they're gonna have have the hurdle of unauthorized practice of law, and that's one of the the state rules in a lot of states, you know, that if you're not an attorney, you can't practice. So, know, eventually, they'll figure out how to get past that too.
Mhmm. Or they'll make somebody get certified to run the AI for the sit for the scenario or something like that?
Yeah. Something like that.
It's interesting. Yep. Man, so just to talk about your care for a little more. Like, you've obviously, you know, talking about your eye, you've had other issues. You know, do are are we not listing any of your other complications?
Can we just get them all out in the list to make sure we know what they are before we move forward?
Those are the main ones.
Managing Today: MDI, CGM & a GLP-1 59:57
The okay. We have them then. So Yes. Your care today, obviously, is insanely different than it has been. Probably you've probably iterated through diabetes a number of times over the years.
But how do you characterize how you manage today? Like, is are you I'm shooting for a five and a half a one c guy, or, like, what what's your goals?
Goals are to to have an a one c as close to six as possible.
Mhmm.
My my retina specialist, doctor down in Dallas, Texas, you know, he he's happy with things under, six five. So, you know, the last I think the last year, I've been six, six three, and six four.
That's awesome. And how do you accomplish that today? Like, what's your technology?
I have a CGM.
And you're MDI?
What?
Are you injecting insulin, or do you use a
Oh, yes. Yeah. Yeah. No. I still use I still use, pens.
I
Sorry. That that you're so old school. MDI, multiple daily injections. You were like, I don't know what what does that mean.
Yes. Exactly. I thought that was a new pump or something.
That's great. That was that's the first time that's happened in a while. You're like, MDI. I don't know what that is. Yeah.
So you're just with with the help of a CGM, you're managing with injections into a mid Sixes a one c? Yep. Fantastic. That's wonderful. Yeah.
Yeah. Yeah. I mean, talk to talk to people for a second. I mean, how big of a leap is continuous glucose monitoring?
Oh, it's life changing, especially for me. I am I am so desensitized to highs and lows.
Mhmm.
I I can't catch them. And so without the CGM, I probably would be in a lot worse shape than I am today. You know, my CGM was going off last night. I'm like, hey. You know, this is a great dream.
I keep hearing this beeping noise. I must be at a concert or something. No. I was 52. So I finally woke up and had a coke quickly.
And, know, would I have woken up if I didn't have a CGM? Who knows? I don't have to worry about it, luckily.
Yeah. No. It's a big deal. And do you adjust during the day? Like, I imagine you inject if you get a little too high, that kind of stuff?
Yes. Yeah. Yeah. I I you know, at this point, it's just second nature. Oh, you know, you wanna have a doughnut.
That's six maybe extra units. Pop that in there. Have the doughnut. French fries and hamburger, it's probably 10 extra units, you know, if you if you get a large fry or something. So it's just you know, by now, it's second nature.
But, I mean, I I am thankful that the CGM technology came around.
Yeah. Do
you And I started using I started using the Dexcom in 2011.
Okay. Yeah. It's early. Do you when you think of french fries as an example, do you think, like, oh, I just know french fries take extra over the carb count, or do you actually think about the fat impact of it? How how does like, when you're, like, taking care of it in the moment, what's your thought process?
I need to do extra insulin because of the the fries and the carbs. Okay. And, you know, it's it's interesting. I recently so things things for me have kinda changed over the last eight months because my doctor got me in a GLP one.
Oh, yeah.
Because and it and it's been great. I've lost, you know, thirty, thirty five pounds at this point.
Nice.
And it has done wonders for the management of the diabetes. Mhmm. My my Humalog pen now lasts, like, thirteen days, whereas before it was six to seven. Mhmm. My Tresiba lasts, you know, another week, week and a half than it used to just because I'm taking so much less insulin.
Yeah. It's interesting to hear how you quantify it. It's not like like, if you ask me, what does a GLP do for your daughter? I'd say, oh, it significantly decreases her insulin to carb ratio, her basal, her sensitivity. And you were just like, hey.
The pen lasts a lot longer, man. I'm using less insulin. Like, that's a really cool that's that's like some badass shit right there. You just you Yeah. You're you're a different era, man.
That's awesome. Right. Yeah.
Yeah. Yeah. I mean, it and it's it's like I said, it's been incredible what it has the GLP one has done for me. I mean, it's you know, granted, yes, it helps suppress the appetite, and so that's, you know, that's been helpful. But I was, you know, at before I lost all the weight, I struggled.
I mean, I worked out, you know, almost daily and would could get nowhere losing weight. Mhmm. And, you know, it's the the, what they call, the desensitization to the insulin when you're you know, have the extra weight. And so, I mean, holy cow. It's it's been pretty it's been cool that losing that much weight has had such an impact on the the control of the diabetes.
Oh, man. I see it with people all the time. It it Yeah. It really is I mean, your insulin sensitivity either rises or your insulin resistance goes away. I mean, you can think about it any number of ways.
It doesn't really matter. Right? It's just it takes less insulin to do the same job. You're you're probably getting low less frequently too, I would imagine. Is that happening?
I think I'm more steady.
Yeah. That that's another way
to put time?
More stable.
Yeah.
Yeah.
Right. Overnight still is a problem. And that's where I've I've had issues with that for a very long time.
What's your basal insulin? Were you using, like, Tresiba? Or
Yeah. Tresiba.
Okay. And you shoot it in the evenings?
In the mornings.
You shoot it in the morning. And you're still getting low overnight sometimes? Yep. So what do you think that is? Do you think it's, last meal of the day?
You're too heavy handed with that last meal, or what do you think it is?
I think there's any combination of it. You know, the like you said, the last meal of the day, that, what my activity level was throughout the day. Mhmm. If I did more activity, you know, I have a a tendency to drop in the middle of the night. You know, if I have too much of a snack before I go to bed, oh, then it do I get high and have to do a couple units to help bring it down?
And then does that crash me? Mhmm. And and and so it's always just it's frustrating, especially at night, living by myself. You know, I think there's I worry about it to an extent. But like I said, you know
Yeah. You're a great person to ask. So I'm just asking your perspective. I'm not telling you you're doing something right or wrong. Okay?
Why Not a Pump? 1:07:10
For that's not for you. You seem very reasonable. This is for the people listening. If I said to you, Eric, why don't you go get an insulin pump that has an algorithm running it that would, at midnight, detect that it thinks you're gonna get low in a half an hour and cut your base off and stop that low from happening? Why is that not an attractive idea to you?
So I see the benefit of that, and the benefit of the pump in general. But my problem with the pump is that, you know, a lot of them go on the back of your arm. And so with my one eye and my depth perception issues, I have a tendency to run into things. And insurance only pays for, you know, whatever it is, one or two a month or whatever the amount is. And so if I get if I get knocked off, I'm out, you know, whatever amount of money it costs.
And so then, you know, you're losing the insulin in that. And so while it's not conducive to my lifestyle at this point, maybe at some point it will. My doctor keeps, you know, having discussions with me about that. But I I just
Follow-up question. Are those things are those the things you're imagining will happen, or you've tried it and that's what happened?
Oh, I've tried, you know, like, the CGM on my arm Mhmm. The back of the arm, running into a door jam and ripping it off or, you know, getting it caught on something because, oh, I misjudged where that opening was.
Well, because you can I mean, you can wear pump sites on your abdomen? You could put them there. You could, I mean, my daughter wears her pumps on her legs sometimes or arm. But not her she doesn't particularly enjoy her arms. She does her abdomen a lot, her thighs.
I see people do it on the top of their butts. Like, there's all kinds of different places people wear stuff. I I would just I'm sorry. I would be worried that I'm I'm worried it's the wrong you're you're a grown person, but you're older than I am. But, like, all I would tell you is to try not to let your past experience, like, dictate what you think is going on now.
Because if Sure. You mean, even if you could get a couple of samples and try it for a half a hot minute, like, maybe that would happen. Like, you know, instead of making a complete switchover. I I mean, I'm just telling you, like, GLP, down weight, using less insulin, algorithm, trying to stop your lows, you might you might love that. You know what I mean?
Yeah. Yeah.
No. I I and it's it's you're not the first person to tell me I should look look into that. And, you know, it's something that I will, you know, consider at some point.
Setting your ways, Eric?
Very much so.
Yeah. Yeah.
Very much so.
Yeah. We all are. I was just wondering. Yeah. Yeah.
Right. Yeah. No. I and and I think I think part of it too is, the mentality of, damn it. Now I've got another thing attached to my body.
Okay. Why does that matter?
Some perceived freedom from this damn disease.
Okay. What if I said to you the freedom would come from not getting low as much, not being able to sleep more? Could you not see that as an exchange?
It is a different lifestyle thinking that scares me.
Okay. Well, that's fair.
Because because I've been doing it this way for so long. I I mean, I like I said, I don't doubt that there is much to gain from it. I mean, I think that's the evidence is the evidence exists that it makes a difference. So I'm just, you know, I'm just setting my ways, I guess. Antiquated thinking.
Yeah. I mean, it it's interesting because you you're a bright guy. I I didn't think you didn't know the things I was gonna say. I think it's just more interesting to listen through people's, you know, why why can't people change? Like, you because the truth is is that, I mean, you, you know, you have electricity in your house.
You must have enough money to, like, make this move if you have to. I mean, you're in between jobs. That's fair enough. Like but I'm imagining you'll be working again sooner than later. So, I mean, I don't know, man.
Like, I think it's worth trying. And then if you don't like it, like, fair enough. Whatever. But to say that it's definitely gonna be a problem or, you know, I'm it's something attached to me or another like, I mean, you you won't know till you do it. Right.
You know? And and it's just I I I can tell you right now that I watched my daughter use it, and the amount of effort she has to put into it is so insignificant compared to what you're describing even. It it's and I think it's just gonna get better too. You know? Like, I I mean, I I know you're probably been living for fifty years with people telling you, hey.
It's gonna get it's gonna get cured. Obviously, you don't believe that at this point and with, you know, with good reason. Right. But if I would imagine that that, like, it's just gonna keep getting better probably sounds like the same thing to you, but it I'm telling you, I'm watching it get better really quickly. Like, real
real That's interesting.
Really, really quickly. It's happening Yeah. Super fast. And I don't know. They're just they're great tools.
Be sad if my daughter wasn't using a pump because I I think it would add to her burden in the way you're describing imagining that a pump would, if that makes sense.
Right.
And sad sad's the wrong word. Like, if you're out there with MDI listening right now, you're like, don't be sad for I'm not sad for you. Like like, I'm just saying, I think I think you can do whatever you want. I think that's great. I think you're leaving a lot on the table by not at least giving it a shot, I guess, is my is the way I should put it.
Right. No. And I I I understand, and I appreciate that perspective.
Yeah. No. I imagine you do. You're a thoughtful guy. I'm I'm enjoying our conversation.
Yeah. Yeah. Anything that we haven't talked about that we should have or anything that feels like it got left out?
You know, at this point, I don't think so. I mean, I think we've covered
Did okay?
So yeah.
Aging With Type 1, Community & Starting Over 1:14:02
Yeah. That's fine. I appreciate it. And I appreciate you doing this too. And you're right.
There's not enough voices around this time of life, with all this. I I thought earlier to mention the t1dto100 website. I don't know if you know that one. I'm gonna pull it up here just so I make sure I have it. It's, it literally is t1d2100.com.
It's to help people navigate type one diabetes as they age.
Oh, interesting.
Run by a lady named Joanne Milo. She's been on the podcast to talk about it. But she's pretty, you know, locked in in the space and and, you know, she's an older person with type one. I'm sure she won't like it when when she hears that I said that, but she's a she's a she's a person of a certain age who has type one diabetes who's really focused on, you know, that. There's I know there are people who listen who are, you know, older too and simple concerns about, like, how do I place my pump when my hands get shakier?
How am I supposed to see these screens or do these touch screens and stuff like that? Like, a lot of things that you don't think about when you're designing for, you know, a younger person. Like, what happens when you get older? And Right. And do I lose my technology then?
Is that what happens? Like or and, I mean or is there gonna be some support? And, I mean, if we didn't learn anything from your conversation, we should have learned that there's probably not support. So Right. You really are on your own a little bit.
Yeah. Yeah. Yeah. Unless I mean, is community valuable for you at all? That that's that I I I didn't mean to, like, act like we were gonna stop talking and ask you another question.
But for a person like you who's lived for this many decades with it prior to the Internet, like, have you found the value of other people with type one, whether they're virtual or in person, or is that a thing that missed you because of your age?
I think it has, to a certain extent, missed me because of my age. I know that there's a fledgling support group here in Albuquerque that's just kinda getting going that, you know, a couple people are trying to start, and I've gone to an event with them, go to one with them this week. Good. But it it's it's the the it's the different perspective that I I I just can't necessarily grasp. You know?
I there you know, somebody like me, I've I've seen so much. I've gone through so much. I've dealt with so much that there's the the the discussions are incongruent from where I'm at. You know, I I want to engage and figure out how have how has one dealt with the burnout for multiple decades? You know, what what types of solutions or what types of steps do you have that helps alleviate that?
That is that's what I wanna hear as opposed to, well, you know, how do you use the CGM? Okay? You know, that's valid, and I'm not trying to discount it, but it's that the different levels of things. You know, can I help somebody understand how to use the CGM? To an extent, stick it in, follow it, you know, learn learn how to use it.
You know, that's very simplified, but I think there's value to them Yeah. To the communities. I just have not exposed myself to those.
Well, as you do that, I take my suggestion, if you would. Of course. It's not as much about you showing up and being like, I know how to do a thing. This is it. Now you listen and do it too.
I would say tell your story and just let that be what you you give to it. And then hope that they listen to your story and are able to reverse engineer and say, okay. Well, I haven't been out as long as he has, but he has real perspective that I don't have. But then be open to taking that same thing back from them. Because while they probably feel to you like they don't have as much knowledge or time in the simulator, What they have that you don't have as a starting point that is a starting point that was more is more modern than yours is.
Because I can tell you that I think the worst mistake you can make as a person who's been living with diabetes for five decades is to not appreciate enough to get over the nervousness that this thing is not the same as it was when you were younger and that you could reset yourself and start over in this new world if you wanted to. And that that probably would it probably would lend, I would think, not just health support, but mental health support too. Because a lot of the burden you've been describing over the conversation, it could be a burden based on your management style and your and your expectation of what diabetes is. I'm saying maybe it doesn't have to be that. Don't fight it.
Go with it and see what happens.
Sure.
Yeah.
No. And that makes sense.
Diagnosed today. If you were diagnosed today, you'd you'd somebody would say to you, we're gonna get you a continuous glucose monitor. Which one of these pumps do you wanna try? And you wouldn't say, oh, I don't want that thing stuck to me or but you would go, oh, is that how we do it? Okay.
Fine. Give me the thing. You know? And then whether you ended up with a t slim or a Medtronic or an Omnipod or a Twist or any of these other pumps, you'd quickly learn that, hey. This thing stops me from getting low, and my a one c is in the sixes, and, you know, it's not so bad.
Like like, you know, like, it it's I, you know, I gotta change it once in a while. And trust me, by the way, all that burnout stuff you're talking about, it's gonna apply to this new stuff too. Eventually, you're gonna get sick of swapping your site or you're gonna have a site go bad while you're at the movie or something like you know what mean? Like, it's all gonna happen. Right.
But your baseline changes. Like, your your expectation baseline changes, your health baseline changes, and, hopefully, your hopefully, your, like, mental burden changes. I I think one of the more interesting things about all of this is is that if I took somebody who was diagnosed last year and somehow was able to upload your feelings and experiences into them, they would probably realize that their shit ain't so bad. And yet Right. And yet, because that's the only perspective they have, their shit's pretty bad.
And and you do you know
what I mean?
Like and so, like, everything is just what you know. And I'm saying, you know, maybe there's some hope, you know, maybe there's some hope, Eric, that one day that, you know, the thing you know will lend you comfort when you try the new thing. And, that's what I would I would that's what I would encourage you to do, honestly.
And that makes sense. Yeah. You know? And I I appreciate that, that perspective and your willingness to, say those things to me because I need to hear it.
Yeah. Well, man, listen, man. You came on here to help people. I'm just hoping to help you a little bit too. And them, by the way, while they're listening, because most people feel the way you feel about especially if they've had this longer.
Right? Like, what are they gonna do? And even if they haven't had it longer, listening to your conversation, I mean, listen. Spoiler alert for those of you who are listening and haven't been around it this much longer. I'm not saying your life isn't difficult, but try to imagine your life through Eric's lens.
You you know what I mean? And maybe take a second to go, My pump shuts itself off before I get low. It's pretty awesome. You know? But, anyway, I I I really do appreciate you taking the time to share all this with everybody and me.
Yeah. I appreciate the opportunity to be able share it.
Oh, it was awesome. A great time, really. Yeah. Okay. Well, I I'm definitely gonna call this one game set match.
Okay.
Just because there wasn't a lot of lightheartedness in this. And, certainly, you getting hit with the volleyball is not one of them, but it was I do think it's a kind of a I think it can kinda be a poignant thought process here, which is, like, you fought through a thing and fought through it and fought through it and came out the other side, and then it still kicked you in the balls one more time. And Yep. And and but I don't hear a guy giving up, and I think that's really important.
Yeah. Because, you know, if I give up, what does that mean? I'm dead.
Yeah. Yeah. Right. Well yeah. Right?
Like, there's two options, get up and keep going or don't. And Right. Yeah. Yeah. I choose you.
Alright. Alright. Thank you. Hold on one second for me. Okay?
Of course. Thank you.
You just had a great time listening to the juice box podcast. You're on a high. You wanna do something else? Go to cozyearth.com and get yourself some beautiful sheets, towels, clothing. And don't forget those dryer balls.
20% off when you use the offer code juice box at checkout.cozyearth.com. Use the offer code juice box at checkout to save 20%. Listen to that deep voice. Go do it. I'd like to remind you again about the MiniMed seven eighty g automated insulin delivery system, which of course anticipates, adjusts, and corrects every five minutes twenty four seven.
It works around the clock so you can focus on what matters. The Juice Box community knows the importance of using technology to simplify managing diabetes. To learn more about how you can spend less time and effort managing your diabetes, visit my link, medtronicdiabetes.com/juicebox. I'd like to thank the blood glucose meter that my daughter carries, the Kontoor Next Gen blood glucose meter. Learn more and get started today at kontoornext.com/juicebox.
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- Decades of management carry a real mental load that advances in physical care don’t address. Eric’s point is that mental-health support for long-time type 1s is hard to find — and that a provider who understands diabetes (his has a counseling degree) can be a lifeline. If you’re struggling, it’s worth seeking that kind of help.
- A CGM can be life-changing, especially if years of highs and lows have dulled your ability to feel them. Eric credits his with catching overnight lows he’d otherwise sleep through. Talk to your care team about CGM options.
- Insulin needs aren’t fixed. A GLP-1 added by Eric’s doctor drove meaningful weight loss and steadied his numbers, stretching how long his insulin pens last. Any medication change should go through your care team.
- Today’s automated pumps can cut basal to head off lows and ease both the physical and mental burden — and they’re worth trying even after decades of doing it another way. A bad experience with old hardware doesn’t have to define what’s possible now. Explore options with your provider.
- You’re allowed to start over. A long-held management style and a fixed idea of what diabetes “is” can quietly become their own burden; revisiting both with fresh tools — and trading stories with people at different stages — can lighten the load.
- Contour Next Gen Meter — The blood glucose meter Arden carries — possibly cheaper in cash than through insurance. An episode sponsor.
- Medtronic MiniMed 780G — Automated insulin delivery with meal-detection technology — an episode sponsor.
- Cozy Earth — Bedding, towels, and apparel — use code JUICEBOX for 20% off. An episode sponsor.
- T1D2100 — Joanne Milo — Joanne Milo's resource for navigating type 1 diabetes as you age.
- Ask Scott and Jenny — The listener-question series with Scott and Jenny Smith.
- Juicebox Newsletter — Sign up at the bottom of the homepage.
#1885 Bolus 4 - Coffee
Wait, bolus 4 coffee - maybe!
Bolus 4 - Coffee
Cold Open & Sponsors 0:00
Welcome back, friends. You are listening to the Juice Box podcast. Jenny and I have been chitchatting for so long. We're almost out of time, but we're gonna do a bolus four for you. To begin with, let's just let's do coffee.
Please don't forget that nothing you hear on the Juice Box podcast should be considered advice, medical or otherwise. Always consult a physician before making any changes to your health care plan or becoming bold with insulin. Thinking about getting an algorithm pump? Don't know where to begin? Juiceboxpodcast.com.
Up in the menu, click on algorithm pumping, and you're gonna get a long list of a lot of episodes that will help you to understand better. Juiceboxpodcast.com. Find algorithm pumping. The episode you're about to enjoy was brought to you by Dexcom, the Dexcom g seven, the same CGM that my daughter wears. You can learn more and get started today at my link, dexcom.com/juicebox.
This episode of the juice box podcast is sponsored by Omnipod five. Omnipod five is a tube free automated insulin delivery system that's been shown to significantly improve a one c and time and range for people with type one diabetes when they've switched from daily injections. Learn more and get started today at omnipod.com/juicebox. At my link, you can get a free starter kit right now. Terms and conditions apply.
Eligibility may vary. Full terms and conditions can be found at omnipod.com/juicebox. Since we came here and did this, we should donate. Alright, guys. Listen.
Jenny, say testing for me real fast.
Testing.
Okay. Jenny and I have been chitchatting for so long. We're almost out of time, but we're gonna do a bolus four for you to begin with. Let's just let's do coffee. Oh.
Oh.
No Carbs, But Your Blood Sugar Rises 2:30
Because I don't know what the first thing about it, and I I was with somebody this weekend who said, oh, my blood sugar's been high. I've been drinking a lot more caffeine than I should have. And I was like, oh, okay. So, I'm just gonna ask you to talk my me through it. Why is coffee a thing that I assume if I look up doesn't carbs in it?
Is that right?
Why does that help people,
or does it?
So it does. Caffeine is I equate it similar to, like, an adrenaline hit.
Mhmm.
Right? So caffeine, why do most people drink caffeine?
I well, I've come to learn the whole world is medicated on caffeine or cigarettes
Of some kind.
Or a vape pen or something. I didn't know until I talked to everybody. But everyone's jacked up on something. Yes. So I'm
gonna get that. I mean, caffeine in coffee, black coffee, we're talking about to begin with. It can raise blood sugar levels essentially because it can reduce some insulin sensitivity based on the fact that caffeine kicks your energy into gear. Right? And so a typical cup of coffee, somewhere between, like, two hundred and two hundred and fifty milligrams of caffeine depending on your size and kind of coffee you drink, blah blah blah.
Right? So if you are a person who just likes black coffee and you're seeing a rise despite thinking, well, gosh. There aren't any carbs. You're right. There aren't any carbs.
But you're bolusing for something that requires you to cover a a rise in the blood sugar because of its effect. Right?
Is it measurable, or is it a thing you have
to figure out? Yeah. If you pay attention a 100%. If years ago when I started enjoying coffee, I don't like coffee black myself. I like to have a little bit of cream in it, But I would I tested it first without the cream to get an idea of what just happens with the coffee.
Right? And I eventually found that my typical cup of coffee takes about a unit of insulin. A cup
of okay. Is that is that eight ounces? Six
three? Eight ounces. Okay. Mhmm. An eight ounce cup of coffee or a one cup cup of coffee, not your Jethro cups from the, you know
The big gulp.
The gigantic gulp mugs that you get at the fancy
them Jethro cups. What is that? Is that, like, what is that
something to your They're gigantic. Jethro is, like, gigantic. Right?
So can no. No. I just thought maybe it was, like, something local to you.
Yeah. No.
Is there I mean, can is it reasonable to say that everyone is a unit for eight ounces, or is that not a reasonable thing to say? No.
Test Your Own Caffeine Rise 5:15
No. Mine, what I did to test, and this is what I recommend to most people who wanna get an idea is drink your cup of coffee with stable, nice looking blood sugar. Drink it. Don't bolus for it. Check the rise.
Mhmm. Check the rise. How much did your blood sugar go up, and where did it finally plateau from the effect of the coffee? Because that will happen. It'll happen even if you eat carbs without any bolus.
You will get to a point where the carbs finally have kind of hit enough, and now basil is just holding you flat there because you didn't bolus. Right? So if you can establish the rise amount on average that you get from a cup of coffee, then you can use your math based on your correction factor or your ISF Mhmm. To figure out how much insulin you need to prevent that rise.
Okay.
So I saw a rise in blood sugar over a couple of days of doing it. I averaged it, and I was like, oh, that's on in general, it's like a unit of insulin I need for a cup of coffee. So that's how I recommend figuring it out. A unit may not be necessary for everybody. It might be point three.
It might be two units. Depending on what your sensitivity to insulin looks like, that's what you're gonna base that on. And, you know, for today's pumps that really are driven by allowing you to take a bolus that it's not gonna subtract any insulin behind it, we often have to add carbohydrate. Right? So then if you know about what one unit does to cover the rise, you can equate that one.
You should also then cover that same number of grams of carb that is your insulin to carb ratio at that time of day. Okay. And then you can enter it, get the bolus rolling, and move forward.
Jenny’s Numbers: Cream, Sugar & a Unit Per Cup 7:01
Now you said you don't like black coffee. Do you sweeten it with something?
I do. I well, I put in a little bit of it's like a coconut milk creamer that I use. It's like a tablespoon. It's two grams of carb. Okay.
I haven't seen You don't put sugar in
it, though, I would imagine.
I don't put sugar in it.
No. But somebody's going to.
Of course. So Absolutely. If you look at any of the restaurant types of coffees or the, I guess, the coffee shop types of coffee, whether it's Dunkin' Donuts or Starbucks or whatever, most people don't go there for a cup of black coffee.
There's no one there. But but in your house, you you you know, you're one of those people who has a coffee maker that comes on in the morning, and the best part of waking up is Folgers in your cup or whatever. And you and you run downstairs and you have a cup.
Mine's the mine's the pour over. It's a drip cup. I don't we don't use a coffee maker. But yeah.
I'm a look at you. You're fancy. And so
Tastes better, honestly. And I don't like things running through plastic. So
Yeah. I don't know. I'm with you. It's just me. And but but somebody's gonna come down in the morning, have a cup.
Yes. But they're gonna put in the sugar, but they don't, like I mean, people I've watched people make coffee. They grab sugar and toss it. Toss it. It's a it's a it's an about thing.
So how does I mean, explain let's just pick a number. Like, how would two is two I don't I don't drink here's the thing you don't say out loud a lot. There's a couple things you shouldn't say out loud in pub in in mixed company because it really confuses people and causes them to look at you oddly. But I've never had coffee before.
Okay.
So I'm gonna say that now just so I can let you know. I don't know what I'm talking about. But is, like, is two tablespoons of sugar
That's a lot of that's a lot of sugar.
Teaspoons?
Two teaspoons would be about right. And if you compare it to what you might get at, again, a sort of a coffee shop if you're doing the packets Right. Each packet of sugar is a teaspoon, and it's four grams.
Okay. Well, that's a great way to so each packet's four grams of carbs. Yep. So for you specifically, if you had a eight ounce cup of coffee, you need a unit for your coffee, and then let's just say you're a person who then put in two packets of sugar. Yeah.
Now that's eight carbs. Let's just use your numbers. What would that be for you? Let's stick with you for a minute.
Yeah. So in the morning time, specifically, I have an insulin to carb ratio that's one to 11. I mean, if we just do it one to 10 to make it easy in terms of counting, right, that's an extra point eight units of insulin because I'm eating eight grams of carb as sugar on top of the one unit for the coffee.
Yeah. So now you have the coffee. We're adding the sugar for you and the creamer. So now you're up to, like, what, 15 carbs. So what would you do?
Would you do would you actually dial in the carbs? You would. But if you were if you were to spit on it, would you do two units maybe? You already love Omnipod five, the tubeless, waterproof, automated insulin delivery system. Now it's even stronger.
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Full terms and conditions can be found at omnipod.com/juicebox. The Dexcom g seven is sponsoring this episode of the juice box podcast, and it features a lightning fast thirty minute warm up time. That's right. From the time you put on the Dexcom g seven till the time you're getting readings, thirty minutes. That's pretty great.
It also has a twelve hour grace period, so you can swap your sensor when it's convenient for you. All that on top of it being small, accurate, incredibly wearable, and light. These things, in my opinion, make the Dexcom g seven a no brainer. The Dexcom g seven comes with way more than just this. Up to 10 people can follow you.
You can use it with type one, type two, or gestational diabetes. It's covered by all sorts of insurances and, this might be the best part. It might be the best part. Alerts and alarms that are customizable so that you can be alerted at the levels that make sense to you. Dexcom.com/juicebox.
Links in the show notes. Links at juiceboxpodcast.com to Dexcom and all of the sponsors. When you use my links, you're supporting the production of the podcast and helping to keep it free and plentiful. You think you go heavier?
I guess if I'm estimating, sure, I might go heavier, but I I use I mean, I use my pump. Right?
Yeah.
No. I I put the carbs in for the one unit that I require for the coffee. Right? The grams of carbs, that'd be, like, 11. Mhmm.
Right? And then, essentially, I'm gonna add the four extra, or the eight extra that comes to 19 grams of carb. Mhmm. And so, yes, about units, I guess. And then I look at my blood sugar.
Right? What's my blood sugar doing? Blah blah blah.
Tell the Pump It’s Carbs 12:11
Do I need to would you I'm just gonna use the word. Would you lie to the pump and tell it that you were having since you're one to 11, would you tell it 11 carbs for the coffee, or do you put in one and then bolus for the creamer, for example?
No. I put in the grams of carbs so that again, from based on the kind of algorithm you use Yeah. The acknowledgment of what you put in is how the system kinda follows it out and or helps you after. And so I definitely put it in as if it's a carbohydrate.
Okay. Let me hit everybody real quick. Heavy cream, point four grams per tablespoon. Half and half is point six or point seven. Regular flavored liquid creamer, five grams per tablespoon.
Powdered flavored creamer, two grams per half a teaspoon, zero sugar liquid creamer, of course, does not have any in it. That's just a breakdown of creamers just in case you're wondering.
And I want I love to bring up the creamer because, again, as you said, you know, heavy cream, half and half, whatever, it's pretty negligible. Mhmm. Right? I mean, unless you're really low insulin to carb ratio, you could have couple tablespoons of that without really much damage in terms of miscount of carbohydrates.
Yeah.
Creamers, Syrups & Shop Drinks 13:24
When you start getting into the flavored coffee meats and whatever other brand people are using with all the flavors and the sugars and everything, do you really sit in the kitchen and take a table tablespoon measure and pour into that and then pour it into oh, no. You're guessing. Dump it out of the jar. And on average, your dump is going to be about an eighth to a quarter cup depending on how heavy handed you are. Mhmm.
So look at the overage that you may be adding to just coffee because of lack of measurement.
Yeah. It sounds like creamer is the ketchup of drinks. You know
what mean?
You're like, I don't know. Yeah. Yeah.
Yeah. Well and then when you start looking at some of the restaurant style or the, you know, coffee shop kinda style stuff, not only is there there's usually just real milk or real creamer in it when they're making some of the specialty drinks.
Mhmm.
But let's look up some of the pumped liquid flavorings. Right? They do come sugar free, which is an a better option in terms of saving you the carbohydrates and the kick to your blood sugar. But many people don't like them. So or they don't like the sweeteners that's involved in it, so they're gonna do the regular sugar.
And most coffee shop places are doing at least two to four pumps of those syrupy sugars that go in for your fancy peppermint mocha that you get at, you know, the holiday times. And
there's so in the end, this is just there's more carbs in it maybe if you're doing stuff like that than you than you think. And on top of that, you're getting a kick from the caffeine.
Yes.
Tea, Soda & the Caffeine Nobody Counts 15:07
Do people see a rise from tea?
So I again, n of one We're
just using you
to I I don't. I don't see any rise in my blood sugar from tea. I have a cup of tea before I go to yoga in the morning. I drink it on the way there. In a fasted state, I don't have anything else.
I don't see any rise from that whatsoever. I usually do, like, a green tea or a white tea. Sometimes it's herbal tea, which, again, you shouldn't technically see an impact. But tea caffeine is fairly low comparative, whether it's a black tea or a white tea, or a green tea, very, very low compared to your cup of coffee.
Okay.
So hit wise, maybe you might, but I don't.
How does how does soda punch in comparison to coffee? I think you know what I mean? Is it is it not one is coffee just really zooshed up for caffeine? Maybe we should break that down so people can understand.
That's a great you know, a good question. Again, if it's just regular coffee, I wouldn't necessarily say, gosh. Drink a cup of regular coffee to treat a low blood sugar because it's gonna raise your blood sugar like soda will.
Okay.
So does definitely I mean, it's it's sugar. So it is almost a streamline, right, into bloodstream to kind of help. So coffee's not gonna really kick you like that, but I do in terms of, like, bolus strategizing. I pre bolus for my cups of coffee.
Okay. How much do you do?
Usually, if it's it's just my typical morning cup Mhmm. I will usually do about twelve to fifteen minutes is my average.
Okay. Alright. So it takes it takes because it will hit hard enough to mess you up if not.
Yes. Okay.
Well, that's interesting. What about so but if there's tea and I put I mean, some people put cream in tea and sugar in tea. So just treat it the same way, but don't worry about the caffeine effect from it.
For the most part, correct. Like a matcha latte or something like that, which is like a green tea powder, essentially, that's fluffed up with milk of some type. Right? And they may, again, then add a vanilla or some type of flavoring syrup to it. So you can see just the tea in and of itself probably wouldn't eat a bolus.
But if you're adding to it, then what you're adding if there is carb in it, absolutely, you need to consider and count.
Would a person with type two diabetes get hit with black coffee? Yeah. Yeah. They'd get the same feeling from it? Mhmm.
Okay. It's interesting. I it's one of the things that throughout my time in this, people are always talking about. Like, my you know, they don't know what's going on in the morning. And when somebody eventually says, do you drink coffee?
And then, you know, oh, I do. How come? There's no carbs in coffee. And then it starts that whole conversation. Yeah.
It's really it's super interesting. I I I brought this up here. Hopefully, this is fairly accurate. Average caffeine content in a brewed coffee, eight ounces, 95 milligrams. Standard cola, like Coca Cola, 34.
Diet cola, like Diet Coke, 46. Citrusy soda, like Mountain Dew, 54. Espresso, 63. Instant coffee, 62. So just brewed coffee has it's a lot.
I mean, that's obviously a lot more than than what we're seeing with everything else. Is caffeine impacting people all over the place and they don't do you think they don't think about it when you talk to people?
I definitely encounter enough people that when we're looking at blood sugar records and trying to navigate out is, like, what's coming where.
Mhmm.
Right? It's the where were things happening here? We're trying to make an adjustment. Is it basal? Is it a ratio?
Is it something that's not being counted? So we do talk through in pretty heavy detail. And beverages are a big place that I bring up because it often gets missed
Yeah.
In other, you know, health care discussion. Nobody really remembers to ask, well, gosh, you wake up in the morning and, you said, your your pod has been dripping coffee for you already, and it's ready to go. And you pour your cup while you're brushing your teeth or shaving or getting in the shower or whatever you're doing, and it's it's not a thought.
Yeah. I just looked at a Red
Go ahead.
Red Bull has eighty milligrams in it. So that's gotta be a thing. I see kids walking around with Red Bulls all the time. Mhmm. And they probably have sugar in it too.
And the Red Bull, I believe, does have sugar in it.
Okay.
I think there's a free version too. I've never had Red Bull. Like, I've never had any of those energy.
When I get tired, I go to sleep.
Right? I just I
guess I I guess the day is over. I'll go sleepy now. Let's see. A standard 8.4 ounce can of Red Bull contains 27 grams of sugar.
Okay. So There is a sugar free one, isn't there, if I remember correctly?
Sugar free alternatives, but they're still gonna have the car the the caffeine.
Mhmm. So That's a purpose for drinking it, really.
Well, I I would yeah.
The caffeine. Yeah. Right. I
I I think so. I I think in the eighties, people stopped doing this and they went to that caffeine and stuff. Mhmm. Yeah. There was a hand motion I did for Jenny that none of you are gonna know the answer to.
Wrap-Up & Good Coffee Stories 20:32
So around coffee, is there anything we missed here? Like, I know, like, you know, we didn't dig deep enough in just to see to see, but you guys really, I one of those Dunkin' Donuts or Starbucks coffees that are flavored and everything are gonna have way more carbs in it than you probably think, and then consider the caffeine as well. But I think the way Jenny laid it out, just, you know, kinda drink a a cup of black coffee or, you know, with minimal stuff in it to see what it does to you. That's great information to have. Like, how much can I expect this coffee to move my blood sugar without all the other impacts?
And then you maybe can have a better time in the morning and enjoy your coffee. I
Agreed.
I see people drinking it. You guys seem to love it. So Yeah. I just when I think of coffee, I think of I think of my parents smoking like, my dad smoking a cigarette and, like, the coffee and, like, all this. It's just not something I'm interested in because of that.
You know?
So That makes sense. It's a it's a negative association that you have along with it.
I did I I should say I I was in the Dominican Republic recently. I went out on a cruise to check out the cruise ship for the juice cruise.
Yeah.
We got off in the Dominican and we did a bunch of little, like like, stuff. And one of the things we went to, they brewed coffee, like, right from, like, beans that were, like, right
really good.
I don't know. I tried it. I felt like I was gonna die. So I tried it, but I I took a few sips, and I was like, oh, okay. And that was it.
They were rolling cigars too. I did buy cigars. They were really good.
Sure. They were.
I sent them to my brother. He already is complaining that they're gone.
So Good coffee too. I used to have a a friend who lived in Hawaii. When they would come back to visit, they would bring the Kona coffee.
Mhmm.
It is Just better. Really good coffee as well. Cool. Yeah.
It's awesome. Alright. Well, I appreciate you doing this with me. Thank you very much.
No. Thank you.
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- Black coffee has no carbs but can still raise blood sugar. Caffeine acts like an adrenaline hit and can reduce insulin sensitivity, so the rise is real even when you’re not eating anything.
- To find your own number, drink your usual cup on a stable blood sugar without bolusing and watch how far it rises and where it plateaus; then use your correction factor (ISF) to estimate the insulin that rise would need. Jenny’s is about a unit per 8-oz cup — but it could be 0.3 or 2. Work the math out with your care team.
- On many automated pumps a no-carb bolus won’t “stick,” so people enter the coffee’s effect as grams of carb (using their carb ratio) and announce add-ins like sugar and creamer as the carbs they are, so the algorithm accounts for it.
- The add-ins are where the carbs hide. Heavy cream and half-and-half are negligible; flavored liquid creamers (~5g a tablespoon) and shop drinks with several pumps of syrup add up fast — and free-pouring creamer from the jar means you’re guessing high.
- Tea usually has far less caffeine than coffee and may not move your blood sugar much on its own — but anything you add (milk, sugar, syrup, a matcha latte) still counts. Pre-bolusing coffee (Jenny does ~12–15 minutes) can blunt the spike. Confirm strategies with your care team.
- Omnipod 5 — Tubeless automated insulin delivery, now with a 100 mg/dL target option — an episode sponsor. Free starter kit at the link.
- Dexcom G7 — The CGM Arden wears — 30-minute warmup, up to 10 followers. An episode sponsor.
- Algorithm Pumping Series — Scott’s collection of episodes on automated insulin delivery.
- Bold Beginnings Series — The newly-diagnosed series with Scott and Jenny Smith.
- Juice Cruise — The community cruise Scott scouted in the Dominican Republic.