#1536 The Pitt

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ER PA turned T1D shares raw insights from both sides of the bed—especially what it's like inside The Pitt.

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

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

Jane 0:15
Hi, I'm Jane. I live in DC, and I've been a type one diabetic for about three years. I am 36 now, but I suppose I was 32 when I was diagnosed, but just so right around maybe three and a half years. But there was actually a window where I was considered not diabetics.

Scott Benner 0:34
The podcast contains so many different series and collections of information that it can be difficult to find them in your traditional podcast app. Sometimes, that's why they're also collected at Juicebox podcast.com, go up to the top. There's a menu right there. Click on series, defining diabetes. Bold beginnings, the pro tip. Series, small sips, Omnipod, five ask Scott and Jenny, mental wellness, fat and protein, defining thyroid, after dark, diabetes, variables, Grand Rounds, cold, wind, pregnancy, type two diabetes, GLP, meds, the math behind diabetes, diabetes myths and so much more, you have to go check it out. It's all there and waiting for you, and it's absolutely free. Juicebox podcast.com, nothing you hear on the Juicebox Podcast should be considered advice medical or otherwise, always consult a physician before making any changes to your health care plan. This episode of The Juicebox Podcast is brought to you by my favorite diabetes organization, touched by type one. Please take a moment to learn more about them at touched by type one.org on Facebook and Instagram. Touched by type one.org check out their many programs, their annual conference awareness campaign, their D box program, dancing for diabetes. They have a dance program for local kids, a golf night and so much more touched by type one.org. You're looking to help or you want to see people helping people with type one. You want touched by type one.org. I'm having an on body vibe alert. This episode of The Juicebox Podcast is sponsored by ever since 365 the only one year where CGM, that's one insertion and one CGM a year, one CGM one year, not every 10 or 14 days ever since cgm.com/juicebox, this episode is sponsored by the tandem mobi system, which is powered by tandems, newest algorithm control iq plus technology. Tandem Moby has a predictive algorithm that helps prevent highs and lows, and is now available for ages two and up. Learn more and get started today at tandem diabetes.com/juicebox

Jane 2:55
Hi, I'm Jane. I live in DC, and I've been a type one diabetic for about three years. No kidding. How old are you? I am 36 now, but I suppose I was 32 when I was diagnosed, but just so right around maybe three and a half years. But there was actually a window where I was considered not diabetic, so we can get into wait. So there you're

Scott Benner 3:16
going to try to tell me that something happened. People are like, you don't have diabetes, but you did,

Jane 3:20
oh, exactly. And I complicated out, I'm a physician assistant, and I've been in ER medicine for eight years. And so I, you know, have been treating type one diabetes and DKA mostly for the better part of my career. And so, yeah, it was, it was a whole ride to become type one after them being my patients, I

Scott Benner 3:39
realized I giggled in a weird spot for people, but like, my mind always races ahead to, like, where you're gonna just be like, Yeah, I don't know, Scott, like, I've seen it 800,000 times, but when I had it, I didn't notice it at all, or something like that. But let's we'll get that exactly. Yeah. So how about in your family, any other autoimmune stuff? No, not

Jane 3:56
a single thing. Not in any one of my family is very large, or my extended family is large, nobody. And do you have kids? I do. I have two kids, and I actually was pregnant when I found out I was a type one diabetic, really, yes, so that I actually have never yet been diabetic without breastfeeding or being pregnant. So the entire three and a half years I have been a type one diabetic, I have either been pregnant or breastfeeding, so it makes it really hard to know my baseline, essentially, which is really important when you're

Scott Benner 4:26
diabetic. So you see, you're like, see, that makes it really hard. And what I'm thinking is, well, when the breastfeeding is over, it's gonna be, you're gonna be like, Wow. Why is this so

Jane 4:32
easy? Yeah, I mean, I hope so. I hope so. I'm just like, man, what it would be like to be a male being diabetic, because you don't have to worry about the hormones, you know, the up and down. So, yeah, I know who knows how long that'll take, but I would have

Scott Benner 4:43
to say, You made me pick. I'd say boy type one probably a little easier, although in that growing time, like for the parents who are listening right now, I'm like, Oh, you, you never saw my son come home from soccer practice and, you know, eat everything totally that would be hard. Listen. Here's what I'll tell you. Yeah, I think you'd just prefer not to have type one diabetes. Yeah, exactly. Yeah. I don't think we need to start going, which ones got it harder, totally. But the hormonal thing is, is crazy. Breastfeeding, I know from people tough on you, right? Like, your body's constantly making stuff. You're burning calories, like, I've seen, seen, sorry, I've heard conversations from people where women are like, I'm eating like, Kind bars while the breastfeeding is happening, trying to keep my blood sugar. Yeah, that's crazy. Okay, so what was your first sign of, like, any kind of illness? Yeah, I

Jane 5:30
was about 28 weeks pregnant with my first child, a girl, and I went in for my glucose tolerance test, as you do, between the window of like, 24 and 28 weeks, and I just had and I just happened to hit it on the later side, and I failed spectacular. I was working in the ER when I got a call from the OBGYN office. And I actually was with the midwives at my program. I went to GW or PA school, George Washington University. I live in DC, and they have a really good midwife program. And I was, you know, low risk. I, you know, wasn't yet a geriatric pregnancy, and I had no health conditions. And so I was like, I loved the midwives from learning, you know, working there, and at one point they were like, you know, we're gonna have to kick you off of our program because your glucose came back at 267 I think I was like, in the ER, and I was just kind of stunned. And I went over to my co workers, and I was like, my glucose is 267 like, I've never checked my glucose in my life. Like, I think I had blood work maybe, like, once or twice before. Then I was not somebody, maybe, like most healthcare providers who ever, like, actually went to the doctor, but I, like, you know, didn't really have a reason to. And everyone was like, Okay, this is gestational diabetes. You have it really hard. Because I think at first I was like, Well, should I take it again and, like, make sure it's right? And they're like, well, with how badly that number looks, we don't think you need to take it again. And then, like, sunk in. I was like, Yeah, you're right. Isn't it

Scott Benner 6:51
funny how quickly you become a patient? Like, because if you gave me a glucose tolerance test and it came back 267, I said, We should do it again. That's probably not right. You go Shut up. Even

Jane 7:00
though, yeah, exactly as a provider viewers who tells people frequently they have diabetes. Like, I know a spot check, you know, over 200 for probably my non diabetic friends who might listen to this, like, just automatically means you have diabetes.

Scott Benner 7:13
Shane, stay in this space for a second with me, right? Like, what do you think cognitively happened to you when someone gave you that number. I think

Jane 7:21
I was thinking, wow, pregnancy is nuts. Like, man is my placenta just hate me, you know. Or, like, what's happening? Like, I've never heard of gestational diabetes being this severe unless you're already, like, close to being pre diabetic, and this just flips you more so into it, like,

Scott Benner 7:41
so ergo, I must have type one, right?

Jane 7:45
I was actually, no, I thought I had gestational because I couldn't wrap my mind around it. You'll, I'll get to, you know, like, how I eventually was, like, had to prove it to everyone that I had type one, which was a fight. I was just like, Okay, I just have one of the more crazy gestational diabetic presentations than I've heard of. And so what I was told then by the midwife program was like, we'll need to get you in with the maternal fetal medicine specialists, because now you're high risk being a gestational diabetes diabetic. And here's your instructions, add protein, exercise and don't eat sugar. Thank

Scott Benner 8:19
you everyone. Thank you. I appreciate all your help. Feel free to Bill my insurance for that.

Jane 8:24
Yes, exactly. And I, you know, and they're like, we'll set you up with a nutritionist, you know, which is, you know, interesting, because I am, generally, you know, a pretty healthy person. I love to run. I have been extremely athletic, generally, and eat very well at baseline. So when they're telling me this, you know, they don't know me over the phone. I think they're just like, yeah, I even had somebody who I was trying to talk to say, well, I bet you were, like, pretty diabetic beforehand, and this just like you probably would have gotten type two diabetes pretty soon. You know, anyway, with these numbers, who said that to you? It was actually a nurse practitioner at a a clinic that I went to who I really do respect the clinic at one medical clinic, and I've considered writing a note to them after this all, when I want

Scott Benner 9:07
you to ponder this thought for later. Okay, because I'm not going to ask it to you now. I just want you to ponder it as you're talking. Yes, do you see not just the community of medical people differently today, but do you see actual people that you work with differently 100% Yeah, but I want to know how it literally is for at the end of the conversation, it's gonna be the last thing I ask you, okay, okay, yes, so I'm sorry. No, it's

Jane 9:31
okay. We like. So I was like, okay, my instructions were, meet with a nutritionist, and this was and I was like, Okay, well, I don't know how much I could be doing it better. Like, that's cocky of me, you know. And I realize now I didn't know what now, what I knew about, what I thought I knew about nutrition then, so I've come a long way as well with, like, protein and my like, you know, protein, first carbs, second. Like, I didn't know that stuff. I didn't, nor did I need to, you know, ahead of time. But I was like, I'm generally pretty good on my diet. Like, I don't know how much I can diet more. There, you know. But I was like, I'll meet with this nutritionist. I got my a 1c back. Because then they were like, go ahead and go do some tests. And it was actually, don't think it was that bad initially, because it was like, once again, it was like, right after I got tested, I think it was like 7.6 which, you know, it's just definitely like, okay, that's diabetic. But I was like, had no clue what my base I had never gotten my a 1c tested before, had you felt off in

Scott Benner 10:21
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Jane 12:31
well, like, Yes, I look back. But the whole story for me being so like, a little bit like, gaslighting myself in some ways, like I had never been pregnant before, and I had no idea what pregnancy was, like, you know, so I felt weird. But like, like, for instance, going through pregnancy, I kind of expected getting pregnant. Like, like, I said, I'm I'm an active person. I'm pretty lean. But I thought, like, when I got pregnant, I was like, Yeah, I'm gonna be probably so pregnant. Like, my ears will be pregnant, my toes will be pregnant, my lips will be pregnant. Like, I will look pregnant, you know. And I remember, like, weighing in and being like, I'm not getting enough weight. Like, this is weird. Like, this is just not what I expected.

Scott Benner 13:07
Not even, like, a happily, like, look at me lean and pregnant, but like, maybe something's wrong. Yeah, I

Jane 13:12
don't think I was just like, wow, my body is doing the opposite kind of what I thought. Like, huh? Like, how often do you see people, like, look a little gaunt while they're I could probably have 20 babies, yeah, or just yeah, just like, Huh? You know, up until that point, probably the first six months, pretty normal. And then I started going down the scale, and my weighing was, like, I'd only gained 10 pounds at 28 weeks pregnant from when I was pre pregnant.

Scott Benner 13:35
No one waves a flag for that. Yeah,

Jane 13:36
exactly. My doctor said, Now, by now, I was in the Maternal Fetal Medicine at GW. It is a great program, but I don't think they know what to do with me, because I, like, went from being super healthy to being like, Okay, this is just weird. But he had been like, you need to eat more, but then also eat less. Like, you need to eat more, but I would bring my husband is very into Excel. I started finger pricking, being like, you know, gestational and after, I'll eventually get back to what the nutritionist told me and why I kind of thought I flipped into type one, but he tracked everything I ate and all of my blood glucose readings. And I was like, I know what this means for the baby. Like, I know with my medical backgrounds, like, which is, I think very it was helpful in so many ways. Like, I don't know if I would be alive, or at least would have gone to the ICU if I didn't have my background from how it went for me. Everyone assuming this was gestational, you know, yeah, he had a whole like, everything in Excel, and I brought it to my doctor, and I was just like, I'm eating eggs only, and my glucose is over 200 like, eggs only, like, I don't have like, anything else. And I'll spot check, and it'll be like, 203206 and like, you can look and I think only because I had it all tracked down. And that was, I think, my second visit. Because at first, you know, I was being told, okay, you're not getting enough weight. You should eat more. But then I would, you know, message in being like, Well, my blood sugar is, like, super high. And he's like, Okay, you need to eat less meals. Like. Less, little bit less. And I was like, You don't understand, I could not possibly be eating less.

Scott Benner 15:04
Also, could you stop saying competing things to me that's really, yeah, upset, yeah.

Jane 15:08
And I was like, I am eating like a rabbit at this point because I'm so worried about my blood sugar. And I think he was just like, okay, that maybe explains the weight loss in some way, you know. Like, somehow your glucose is really, really high. You're trying to eat a lot less

Scott Benner 15:21
somehow. Let's think, how could that be? Let's think about it. Yeah, and it's

Jane 15:26
just so weird. I don't know a single other person that has ever gotten type one while they're pregnant. Oh,

Scott Benner 15:30
please, let me just tell you I know like 20 people from making this podcast, but go ahead, yeah, yes,

Jane 15:34
yeah. And I've listened to some of them, but I just mean, like, in my personal life, I hadn't, like, at the time, and then, so actually, when I was meeting with my nutritionist, who was very, very sweet, who just kept going, Oh dear, oh dear. Like every time I'd say something, she's like, oh dear. And I'd be like, Could this be related to COVID? And this was in 2021 I was in healthcare, so I had gotten the vaccine December of 2020 like, right when it came out, and I hadn't gotten, managed to not have gotten COVID until August 2021 when delta was kind of on rampage, my symptoms and like the glucose tolerance test, happened to be four weeks later. Technically, you know, when you would think maybe a virus flipped you into type one with the time frame kind of it's plausible, you know? Yeah, I just had COVID for the first time a month ago. It was so mild I basically had the sniffles, and I just was wondering about the time frame, because I was like, something, and it was the first time, and I started looking up data on if COVID caused any links with gestational diabetes, because I knew it was making diabetes a lot harder to treat and doing things to my diabetic patients. And I was like, could it potentially make somebody who might not have been like, and I didn't really, gestational diabetes, you know, is its own thing for, you know, anyone who doesn't know it's like, the placenta is what is theoretically causing insulin resistance, you know. And ideally, once you like, birth the placenta, your body goes back to normal. You don't have diabetes anymore. So that was the assumption. She was like, I have no idea, but I'm gonna try to figure that out for you. And so we looked up some things, and it was just very new. Nobody had

Scott Benner 16:59
really, I was gonna say you're in the middle of it. It's not exactly full of answers. And I just can't wait from

Jane 17:04
10 to for 10 years from now, for, like, more things to come out on this. Because, like, since then, I have learned about the association, and I'm curious to know if you have with COVID and type one diabetes, specifically when pregnant. Because I have like, you know, through Reddit and other Facebook groups, and even like some friends of friends have, and I don't know if this matches like a regular percent of like people, but like them having, you know, no family history or anything, and getting COVID, and within a month, becoming type one while pregnant, and thinking that was gestational so I think, and I already know, like, from, you know, medical background, like when you're in your second semester a trimester, sorry, when you're in your tri second trimester and pregnant, you're immunosuppressed, and you are more likely to have viruses impact your immune system. Specifically in the second trimester, there's some weird links to

Scott Benner 17:55
when viruses have more impact. Yes, during pregnancy, I

Jane 17:59
remember learning that in school. And I don't know from my research yet, and I haven't really, you know, personally talked to people, but I've, I remember going on Reddit and seeing all these people who were like, Yes, I'm a type one after getting COVID while I was pregnant. And like, all of the people that were like, Yes, me too. Me too. Like, this is definitely a thing. And even, like my cousin knows, like two other girls in their 30s who were pregnant and then got type one. It's just like a weird like, after COVID, like, within a month of COVID. Love for more people to send me information on that, because I'm but I'm fascinated with, like, if there's going to be more to come with that. But I already had thought that there was something weird with the timing and the possibility of that. And, yeah, that's my best guess. Anyway, of so

Scott Benner 18:41
I've spent zero days in medical school, and I want everyone to keep in mind that my real focus of studying High School was baking. I have been making this podcast for a decade now and talking to a lot of people. And I have the experience of my daughter being diagnosed right after Coxsackie. I have the experience of researchers coming on here who are working on new drugs, who have brought up like the Coxsackie virus. There was a gentleman on here that said, I'd love to make a vaccine for Coxsackie, because I think if we could stop kids from getting Coxsackie, we might put off them getting type one diabetes. A virus can often precede a diagnosis. But the idea here is, I don't know, obviously, because I make a podcast, yeah, and I don't believe, based on anything I've heard so far, that a virus just walks into your body and goes, here, let me pull some wires off this pancreas, and it doesn't work anymore. Like, I think it's more like, you know, your body has an immune reaction. That reaction gets misguided, hits your beta cells in your pancreas, you have type one, but that you were very likely predisposed to that to begin with, and probably had auto antibodies pointing to type one diabetes before the virus got there. Yeah, now I don't know if being pregnant makes you more or less, by the way, I did try to look while you were talking, and yeah, I so inarticulately typed it. Our friend here chat, Chief. Game. Said, it sounds like you're trying to ask which I was like, Well, God, how horribly did I type that out. But like, is there a trimester that's more, you know, impacted by viruses? First trimester is a critical period when the embryos organs are forming exposure to certain viruses, Zika, rubella, during this window carry the highest risk of major structural birth defects or miscarriages about the baby, fetal growth and maturation problems are predominant in the third trimester, viral illnesses late in pregnancy or more likely to cause pre term labor, low birth weight, neonatal infections, rather than congenital malformations, the flu they use as an example, influenza infection now in the second trimester, it says organ systems are maturing. Viral infections can still cause problems, growth restrictions, neuro development issues, absolute risk of the major structural anomalies like Zika. But what about for the mother I

Jane 20:53
know curious, and I honestly so bad at using chatgpt, I could probably ask them a lot more

Scott Benner 20:58
if I could go back to college right now, I'd go back to college to learn how to talk to chat GPT. I think it's actually, I think it's going to be a job, yeah,

Jane 21:06
yeah. So I, you know, agree with what you're saying. I'm just curious, like, in terms of like, it flips you into like, yeah, the virus itself doesn't cause it, yeah. I want to be careful of what I'm

Scott Benner 21:15
all saying. Here we go. Hold, on hold. Second trimester maternal risk still relatively moderate. Many women tolerate common viral illnesses fairly well. However, some viruses, notably influenza and SARS, cov two, can begin to show higher rates of pneumonia or hospitalization compared to non pregnant women. What about type one diabetes? This thing's like, oh, yeah, I forgot you make that podcast. Yeah, I should know you by now, although it does, sometimes I ask it a question, and I don't like say what I'm asking it. It's like, Oh, you mean for this, although the overall maternal risk for most viruses remain moderate in early pregnancy, women with type one diabetes, nah, see, yeah, it's not leading me there. Can it? I'm just gonna use the word cause, even though that's not, that's not what I mean. But I'm trying to get it to think that way. And I don't know, yeah, I don't

Jane 22:02
know if anyone's really looking into it yet, you know, like, I just all of my things is anecdotal, based on word of mouth and Reddit, which could be correlation and not, you know. Like, listen,

Scott Benner 22:11
this is chat GPT. This is Oh, three. The the deep research version, some viral proteins share structural similarities with B cell antigens. When the immune system mounts an antiviral response, cross reactive T cells or antibodies may also target B cell proteins. I think that's what I said earlier. They call that molecular mimicry, bystander activation, viral infection of the pancreas or nearby lymph node system tissue can induce local inflammation. Cytokines and chemokins released in the process may non specifically activate, auto reactive T cells that were previously dormant. Certain viruses can infect and directly destroy B cells, beta cells. The resulting release of beta cell antigens can further fuel an autoimmune response that's called direct cytolysis. Isolus, chronic low grade infection, persistent viral infections in the gut or the pancreat islets can maintain a smoldering, inflammatory milieu, gradually eroding BSL mass over months and years. It says here, virus is implicated in type one onset enter a virus. So a key example would be Coxsackie. The second one is rubella. Third, mumps, fourth, CMV, what is that? Cytomegalovirus, yep, rotovirus and SARS, COVID. Two, that's the ones that it listed, and I didn't ask it to implicate viruses that came back with that on its own. So, I mean, listen again, not a doctor, but people get viruses. Their body goes wonky. If they're pre disposed to type one they end up with type one diabetes sometimes. So would you have gotten type one diabetes if not being pregnant you weren't pregnant, if you didn't get COVID, maybe later. I think

Jane 23:53
this is my theory. And like I said, this is just my own and, well, I guess I can't say it's a theory, just my own. Things is I just feel like I was in a state of immunosuppression by being pregnant, and I don't know I, like I said, I don't know enough. I'm not like an immunologist, for some reason I've internalized whether that's true or not, and like I said, I'd love to learn more about it, that if I wasn't pregnant while I had COVID, it would not the double effect would not have. I

Scott Benner 24:19
mean, I understand your thought process. I'll just tell you this. Like, you're probably getting type one at some point. Yeah, I'm curious. Batman's parents get killed in every universe where you hear the Batman story, do you see what I'm saying? I love Yes, totally. At some point, like, I try to think about this for Arden, by the way, this again, is not what we would call technical, but this makes me feel better about Arden, yeah, so it sucks that she got it when she was two, right? Totally. But if she didn't get Coxsackie when she was two, she got the flu when she was four, would she have gotten diabetes then, like, would it have happened when she got, like, another thing when she was 10? Like, like, I don't know, the kids got autoimmune issues. Mm. Get this isn't her only one, you know? So, yeah, I mean, at some point it feels like it makes sense that she was going to get type one. Now, would I have preferred she got it when she was 15 or 30 or two or nine or 35 or 63 like, I don't know, you know what I mean? Like, I just don't think it matters once it's happened, like, it's fun to fun funds, the wrong word, it's interesting to talk about. But like, it's all academic, because getting diabetes type one or type two sucks, no matter what age you are, yeah.

Jane 25:30
And, I mean, well, COVID, you know? Yeah, I'm curious if COVID is what did it for me, which is what I, you know, based on the list of it can you know whether or not I was pregnant or not. It was such a weird virus in the world. You know that I'm curious to know if another virus would have done it. And I guess I'm not convinced of that, but because I already was 32 you know, like, you know. But

Scott Benner 25:50
listen, I interview people every day that are 3330 430-740-4562, they get type one diabetes.

Jane 25:57
And I it could have, I think COVID was what did it for me based on the timing. It could have been something else.

Scott Benner 26:02
You might have a little bit of my magical thinking. I used to think like, if I can make it to this age, then this won't happen. If you get to that age, then that wasn't happening. If you're married for this long, you don't get divorced, if you like the only mean, yeah, do you think like that?

Jane 26:15
It's impossible to really know, but it is fascinating to think through.

Scott Benner 26:19
Can I ask a big question? Totally, why does it matter? It

Jane 26:22
doesn't I just think, like, it's more for educate, like, purposes of educating who I'd love to know the studies, like, I would just love to know, like to understand COVID more, because I think we have so far to go with that, you know. And we were seeing things in COVID that just weren't true for other viruses in a lot of ways. And it just such a weird virus and, you know? And so I'm just like, Man, I have not seen too many people talk about COVID and type one diabetes, but that was I was like, I think even early on, I was like, I think there's a link. Now, could have gotten it later or from something else, very possibly, but at least what I thought did it at that point was the combination of being COVID and I have no other autoimmune issues. Who knows? I'm going to get one? You know, I hope not.

Scott Benner 27:04
But I'll ask a couple of weird, difficult questions here. So when you're having these thoughts for three years, but the world's not letting us talk about COVID, is that hard? Like, because you want No, no, it's you end up on Reddit talking about it, then I don't know,

Jane 27:17
it was a weird number. Like, I said, I have no, like, a weird number of women in my same position. I'm

Scott Benner 27:21
saying, like, if you were at work and you saw a doctor and you were like, Hey, man, we've known each other a long time. Let me ask you a question. You think this COVID gave me type one diabetes? Are you worried that he's looking back at you going, Uh oh, this one I didn't realize she had a tin foil hat. Or no, I

Jane 27:33
was No, no, no, no, and I was No. Well, I had a lot of questions. Like, are you sure it's not the vaccine? And like, you think the vaccine gave you COVID? And I was like, well, it didn't really line up with the just the timing didn't make didn't make sense for it to be the vaccine, if, like, you know, and I'm not anti Vax at all, but just was like, I had the vaccine in December. It wouldn't based on the limited stuff I know. Like, I was like, I don't know. I don't have any clue. But it seems to be that it makes more sense timing wise, with all of a sudden my body shutting down. But who knows how long that was brewing. I'm gonna

Scott Benner 28:00
go out on a limb here and say, I don't think we should be saying anti Vax anymore. Oh yeah, I think there's, like, a way to, like, I don't know totally,

Jane 28:07
and there's dangerous too. There's dangerous to vaccines. I always want patients like, every every medication has side effects, every

Scott Benner 28:13
conversation deserves us to be able to talk about all of the variables without, like, labeling something like, if that was my point. Like, were you worried that, like, somebody would pre judge you? No, I

Jane 28:24
actually never expected to feel judged. Because I feel like I'm very pro, you know, just

Scott Benner 28:30
open mind, trying to figure out what's going on. Say,

Jane 28:32
yeah, exactly, yeah. I was just like, yeah, yeah, no. I actually never thought judgment would come into the picture, you know, because I am a healthcare provider, I, like you generally follow CDC recommendations, and I'm just like, we were seeing all these things. We were, you know, we were like, Okay, we're seeing diabetes get worse and hospitalizations increase, and a lot of other things. And like, I'm not an expert at all with COVID, but I was just like, it just seems to be such a weird timing. And then hearing and seeing some other people in my same position, I was like, weird. Yeah.

Scott Benner 29:03
I mean, I take your point, like, if you fell out of bed today and tomorrow, your legs started hurting and you didn't think, I wonder if this is because I fell out of bed. That would be an odd thing to skip over, yeah. And so it's not. And by the way, maybe that's not what happened, but it would be weird to just ignore it and pretend that it didn't

Jane 29:22
think maybe it's, like the red Jeep theory, like, unless you're looking for it, you're never gonna see it, sure, and so, you know, there's, that's why I just throw it out there.

Scott Benner 29:28
That's why I'm continuing the conversation. Because, like, in the end, you're never gonna know.

Jane 29:32
No, well, yeah, maybe not. I'm very curious. And, like I said, in like, retrospective data in the future, if they're going to, you know, because up until you said that I, like, in like, I do know, in the past, the list of viruses that had caused, not caused, like, careful with the wording, but were more likely to influence a type one response. But I COVID, you know, when I was in the middle of it, they hadn't put that on the list. You know, no.

Scott Benner 29:57
I mean, obviously the stuff about. COVID is still like, Listen, my wife has long COVID. It's horrible. I mean, who knows? Yeah, yeah. Like, it really, genuinely horrible. Like, it's got, you reading? It gets got, I'm reading research. It's like, hey, try now. I actually went to my wife the other day. I said you should try nicotine gum or a patch or something. And she's like, what now? And I'm like, I don't know. Like, I saw a thing, yeah. You know, once you're two years into a problem and nobody's helping you, you're down to, I saw a thing like, why don't we see if we throw this at the wall? Fit sticks? Yeah? And that's a place to be with your Yeah. I mean, at

Jane 30:31
this point I'm just fully type one, and I just am curious as to, like, the No, could I do anything differently? Probably not, you know. And it doesn't keep me up at night. It's just more like a huh? Because everyone asked why, you know, like, why? And I'm like, I had, you know, like, this is all I can point to, of a weird grouping of things I know to be, you know, true, and kind of coming up against me and causing me, anyway, to have this, what they thought was gestational diabetes, right? Interestingly enough, I also wondered if this factored in. I don't think it did, but I had this most severe, like, around that same time I was diagnosed with gestational I had this crazy rib pain, which I think was something called, like, intercostal neuralgia. I'm not sure, but it was like my nerves were trapped in, like this one dermatome, which is like a couple ribs that, like, went from my mid back around to my right, like, side, and my ribs would pop in and out even so, like, it would feel awful, and I was in so much pain, and so I was like, Is there, like, I don't know. Do I have a pancreatic mass or something like that, you know, like that could be causing my, you know, like, because my pain is right there. Can I ask you a question, though?

Scott Benner 31:37
Like, I just realized a little while ago that this was during your first pregnancy, because when you said, I've only ever been pregnant or breastfeeding with type one diabetes, I thought, God, is she breastfeeding a four year old and but I didn't, I didn't say that. And then, because I don't want to be judged, oh yeah. But then I realized you you meant like you were pregnant and then breastfeeding,

Jane 31:55
and then I got pregnant with my second while I was breastfeeding. Yes,

Scott Benner 31:59
yes, that's Yeah. How did that happen? So you had, you were newly type one and breastfeeding. Your husband was like, let's do it again. Yeah? Well, yeah, funny. Well, actually, so like, you didn't run, like, you weren't, like, get away.

Jane 32:10
Well, after I determined, okay, the rib pain was awful. It wasn't because of, you know, like, I had a pancreatic mass. It is some ultrasound and, like, or anything like that. Never really figured out what it was. But it was a little ironic that everyone was telling me to, like, go exercise when I, like, couldn't walk. I'd actually leave my job early. I was in so much pain when I was a brand new diabetic, you know, things like that, my doctor finally believed me. Was like, we're gonna put you on shots. We're gonna put you on injections, because this does seem severe. And then my my instructions, you know, for my injections were, if it's under 15 carbs, don't have to Bolus for it, which I'm sure is might be true for gestational diabetes, but you know, definitely not true for wasn't working out for you that way. Yeah, type one diabetes, exactly. And do a night snack. Don't Bolus for that. But like, before you eat, like, eat something protein heavy, like, mix with protein. But the instructions I was, like, given on, like, in my guidelines, and that I found on like, Instagram was like, mix raisins with nuts. Like, that's a great bedtime snack. You know what I mean? I'm like, now, if I knew now, I knew that was like, I was just like, eating a bag of raisins with nuts. But like, right before I went to bed, and didn't like, Bolus for that at all. Did

Scott Benner 33:13
you love the raisins and nuts? Or were you like, I can't believe I have to eat these. No, I just was, like, doing

Jane 33:16
it because I thought they're like, I'm supposed to control my blood sugar. And then, because I was now on injections, you know, and I was finger pricking, you know, now, knowing now what I'm, you know, like, I'm just like, Oh, thank God, I survived that, because, and my baby survived that, the

Scott Benner 33:33
doctor was trying to keep down big spikes at meals, and did and didn't want you getting low overnight, because that's how he thought About gestational women who he gave insulin to, exactly,

Jane 33:41
yeah, and that makes sense, but it's just like, yeah. You mean, under 15 carbs, your body should be able to handle it, you know. So I would like, I think just my finger sticks were just wildly inaccurate, you know, like, depending on when I checked, like I was following the one to two hour like, postprandial glucose check, like, after you eat, you do your checks, and in the morning and stuff like that. And I feel like I never could figure it out likely, because, like, what I know about my body now is I'm way more likely to spike, like, five to six hours later. I wasn't checking then, you know, he he was really well intentioned, called me even on the weekends, to see how I was doing, which was very nice. I don't think that was like, I think it was just all like, this lady, because I was in so much pain too. Like, I cannot understand, like, that's the most pain I've ever been in my life. So I was, like, in so much pain, couldn't bear barely, like walk, and then I was trying to figure out injections for the very first time. Now that I understand what, like a high blood sugar or a low blood sugar feels like was just wildly different and so much more empathy. Like, I remember being at IKEA and having my first low, because I was just newly on injections, maybe first week, and I took them seriously, but I was just like, well, I can just eat. What I didn't understand with a low is how much your brain slows down to the point where, like, even trying to remind yourself to eat is like swimming through like mud or something like that when you're low. Yeah. Yeah, and I nobody was with me, and I was just, like, very pregnant, and I was just trying to buy some stuff, you know, probably for the nursery at IKEA. And I remember being like, Oh, I feel really shaky. First time ever feeling that way. Let me check my blood sugar. I remember it being like, in the 30s, oh, juice. And being like, I think that's low. That sounds low. I know that's low. Let me see if I can keep checking out of my kitchen, like, I'm in line to check out. And I was like, Okay, I think this is bad enough. I need to go to the cafeteria, because I wasn't bringing snacks by myself. Like, I wasn't really, like, with gestational I guess you are on insulin, but like, I wasn't prepared for really being low quickly. Yeah, I wasn't bringing it.

Scott Benner 35:36
Or how far the goofer Nook is from the cashier at IKEA, I bet that was probably a problem, exactly.

Jane 35:41
So I got a chocolate bar in the line, and I remember sitting down. I don't know, I think I was at the same table for hours, but I remember like, because I just couldn't, couldn't get up. And I do remember being like, put the unwrap the chocolate bar. Like my brain was like, stringing one thought to the next thought, like, unwrap it, put it in your mouth chew it. And I was like, after I bounced back, I was like, Oh my gosh, I understand now how dangerous sometimes it is for you to be alone with low blood sugar, because you are thinking so slowly, like if it gets low enough. Now I you know, can usually nip it in the bud before that happens, but that was just my first ever instance of that happening.

Scott Benner 36:17
Was that fear after you got through that and look back on it. Did you live fearfully after that? No, I

Jane 36:23
didn't know enough to be fearful. What kind of a nurse Are you? Jane, APA, physician assistant.

Scott Benner 36:27
Sorry, you're a physician's assistant, right, right? You're working in you work in emergency medicine,

Jane 36:33
yeah. So I have all my own patients, like they're mine completely. Like, I don't know laws elsewhere, but like, you know, I manage their care, and I treat diabetic patients all the time, you know. And to that point, I just mean, like, it is different, being the person going through it, then being like, yes, I would have seen that number. Another, another point to your earlier question of how it changes. My practice is I would have probably shot that person with D 50, like, you know, dextrose, 50% solution, and spiked up their blood sugar because I was more comfortable with being high, because when we're, you know, in the ER, we're just, we don't want to

Scott Benner 37:03
be a low, yeah, but for people listening who were thinking, how can she not understand this, if that's her job? Like, tell them why that is. It's not because you're like, dopey, or you didn't pay attention in school, or you don't care, or anything like that. Like, explain, like, what the lead into your job is that lets you be so good at so many things. I watch the pit. I know what's going on. Oh yeah, I'm watching that right now. Of course, you are that leads you to be so valuable in people's emergency care. But then you get to something like this that every person listening to this is like, Oh my God, I know that. How does she How did she not know that? But

Jane 37:37
I guess, think back to the very first time, and maybe a lot of people are diabetic when they're kids. But like, nobody else knew more than I. Like, it was the very first time I'd ever used injections on myself, so I just didn't know my own body pattern. Like, I guess in the ER, we're notified of a low blood sugar, and we just treat it with either, like, now I'm much more likely to treat it with just orange juice, or, like, I don't want to make them spike high, so I'm not trying to load them with the sugary stuff.

Scott Benner 38:01
So is it that, professionally, it's a thing you're trying to stop, not a thing you're trying to understand. I don't manage it

Jane 38:07
on a day to day basis either. So that's a difference, you know? Like, I'm not that was a huge difference of being like, No, I'm trying to understand it. I'm trying to say, I guess I don't really understand, maybe I don't understand your question, because

Scott Benner 38:18
I think you've been in this profession for so long, you're not following my question. Like, so like, imagine if you went to get new tires, yeah, and when you were done, your tires were on the ground, not on the car, and your car was sitting on the ground, on its wheels, and the guy goes, you can leave now. Like, wouldn't you think, how could you not understand so completely this simple task of putting tires on my car. I think that's how people with diabetes feel when they're at a hospital and nobody seems to understand what's going on. You mean from the healthcare perspective, like, Why? Why? Like, yes, not. You personally, you professionally. How come you don't understand professionally as

Jane 38:54
a patient when you like, Why hadn't I understood that point that I was type one? Is that what you

Scott Benner 38:59
were? No, no, no, no. Like, I didn't realize I should have snacks to do that I'm walking around. I didn't know, like, all like, all that stuff. Like, I guess I'm putting myself in the perspective of people listening, yeah, I'm thinking that. They're thinking, I don't get how a person in the medical field wouldn't know this. Like, I I know that. Oh, okay,

Jane 39:14
okay. Because I'm like, Well, remember when it was your first week, but yet I am in the medical field. Well, I guess, because I'm never I'm only treating the emergency side, so I'm pretty good at like, I'm not going through people's first weeks of diabetes, I guess, even though I know the base stuff. But with insulin, I didn't take insulin as seriously as I do now, like, I know it can lead to lows, I know it can lead to highs. The lack of it can lead to highs. Too much of it can lead to lows. But, you know, didn't have the ins and outs of all of the insulin knowledge I know now, yeah, and I don't think I and now I know how dangerous of a drug it is. Yeah,

Scott Benner 39:48
I think people who are not involved in health care professionally, yeah, they make a generalized assumption that anything health care related, the health care person is going to understand. Oh, and

Jane 39:58
I that is one of my big takeaways. Is how. Little, little. I mean, at least from the ER perspective, we do not know, Matt, how to manage diabetes or type one diabetes, right? When you come in like we do not.

Scott Benner 40:07
I did a cold wind episode last year where an ER nurse with type one said to me that she'd be safer having a seizure at my house than in the ER she works in an

Jane 40:18
interesting seizure. How come? Oh, like, a diabetic seizure, yeah,

Scott Benner 40:22
yeah. She's like, you would, you would know what to do, handle it better than the people I work with this,

Jane 40:27
yeah? Because in, er, we know, you know, an inch deep and a mile wide, you know, and you know, we don't know the mile deep about diabetes that you get to know when you're diabetic yourself. That's

Scott Benner 40:37
why we're having this conversation, Shane, because you just put it so perfectly. No one's ever said that before, but that exactly highlights my point. We understand things an inch deep and a mile wide. Like, yeah, that really is. Is that a thing people say in the ER,

Jane 40:52
I don't know. Actually, I have thought it. I'm sure somebody has said it to me at

Scott Benner 40:56
one point. Well, guess what? I think that was incredibly valuable for people to hear, like, seriously.

Jane 41:01
And I'm constantly trying to now, like, diabetic patients are my favorite now. And I'm constantly trying to, like, talk to my like, I have my co workers pas or MDs, like, sit in with me going through some and you don't have a time for this, always in the ER, but like, going through what I'm talking to patients about so that they can learn I could get somebody stabilized, fine, but like to actually educate them. I think the problem is, you know, in the ER in which I work in and a lot of years in America, that is their primary care, we are seeing people repetitively, and if we don't do better, and like I said, there's a lot of constrictions with that. Like, it's definitely not all the ers fault, but just like, they're just not getting the tools they need from resources, or, like, knowledge wise, or who knows what to to manage this. And we are their primary care office, so I need to do a better job of trying to, like, you know, give them more tools, you know.

Scott Benner 41:51
I mean, it's awesome that I hate to say this, but, like, people say this all the time, like, oh, like, I wish somebody famous would get sick so they'd fix it. Or, like, hey, it's nice that a person in healthcare got this so now, like, your understanding will continue to grow. You'll work around people, you'll help them understand more. Like, there'll be a lot of good stuff that comes out. Oh yeah, Scott,

Jane 42:07
you'd be shocked at what my coworker said to me, no, go ahead. Even though we treat Type one all the time, they're like, couldn't get it. Like, when I became type one, which I'm sorry I keep like, getting haven't even gotten there. But like, they have been like, Well, does it go away really? A nurse asked you that. Pas, doctors, yeah, oh, yeah. Well, will it go away? You know, let's

Scott Benner 42:27
fast forward, because I'm on a bit of a time crunch today. So let's fast forward to, yeah, by actual, like, just what happened? Because you said at the beginning, like, I had to, like, force people to believe that I had it well.

Jane 42:38
And it's, I guess, just interior, like, how did you not know? Often is like, you know, how did you not know? As a healthcare provider, too, it was a traumatic birth, I guess, and I, like, lost a lot of blood, but anyway, like, my body was doing a lot of stuff in my birth, and so I they did one finger stick, or I did, really, I don't know if, you know, if they checked, but I did my finger stick, and it was 85 and I reported it to them. They're like, great, congratulations. You no longer have diabetes. And I ate like, a burger and fries. And I was like, excellent. This is, like, great life. You know, did you let out all the blood that

Scott Benner 43:05
had the glucose in it? You said you lost so much blood? I figured you lost so much blood. They replaced it with blood that didn't have glucose in it. Then tested your blood sugar. I'm like, Hey, you're 85 I

Jane 43:14
wonder about that too. I can't remember the timing. I was so out of it. I had, like, yeah, I lost so much blood. I hemorrhaged. And it was really true. Yeah, it was really traumatic. I like, could only tell how bad it was going when they called in, like, the ICU team, and then they, like, kept, like, saying, and we're gonna give her TX A which is the blood stopping medication that's really toxic, and then and we're gonna give her some antibiotics, which I know they were only gonna do if, like, I ripped through my rectum, which I did, you know. And I was like, Okay, this is going bad, you know, at least con, at least my daughter seems to be fine. That was the entirety of my diabetes care. I don't even remember if the glucose was before or after the blood, okay, like, I don't remember at what point I'd like, that's like a fever dream, a little bit to me. But I just remember thinking everyone has told me I had one of the hardest gestational cases I've heard of, and when I gave birth, I looked at that placenta and I was like, I'm so glad you're out of my body. This is, I'm done with this. And then why did I not know, like, in the next three months? And I just, you know, my daughter really, yeah, like things I don't know that. I'm curious, you know, maybe I'll chat GPT about it sometime. It's just my daughter had really bad colic. I was up all night, as many newborn moms are, but I just all of the things that you would think I still have diabetes. How can I not figure it out, especially having just had diabetes, it was I was extremely thirsty while I was breastfeeding. I was extremely hungry while I was breastfeeding. I was losing weight while I was postpartum, you know, I am breastfeeding, you know. And I was like, exhausted and tired and irritable. I also had a really hard time breastfeeding at first. I do not know to this day how my body did it like I was on this insane pump. One of my friends is a lactation consultant, yeah, and she had me on this power pumping like 20 minutes for every two hours. For two weeks, I was pumping to try to get my breast supply because I was extremely dehydrated. Now that I know that I was diabetic, like the diabetes never went away, I was still trying to breastfeed. I don't

Scott Benner 44:56
think people give women nearly enough credit, and I think women. Get a lot of credit for, especially around making a baby, but, like, my rectum rips. Everything's over. I don't care. Somebody's like, take care of the baby. I go the baby. My exactly, tore open. Oh yeah.

Jane 45:09
And I bled for three months, and I was wondering why I wasn't healing. And they're like, how do you go to a special they're like, Wow, you're really not healing. I

Scott Benner 45:15
would have been like, you still tried to breastfeed. I would have been like, give that kid a piece of lettuce, see if I can eat that couldn't

Jane 45:20
even, like, sit for a long time because I was, like, trying to heal down there, you know, like, three months of bleeding, and it was like, no wonder I wasn't healing one you know, because my sugar was so high I can't believe my body produced breast milk. I must have put it through the worst states, because when three months, three months took me three months, I finally was like, this is weird. I brought out my old glucometer from under the sink. Three months postpartum, I checked my blood sugar and my fasting was 440 what made you check it? It was the night before I went out to a really nice dinner, and I remember everyone being like, Man, I'm full. And I was just like, I could eat this entire everyone's plates, plus more. And I also was like, we had had a party, and I was like, eating frosting out of a tube. I was like, so hungry, and so craving sugar. Gotcha, you know? And I thought, but my thought was, man, breastfeeding is wild, you know, like, Huh? I'm apparently burning a lot of calories once again, and I am, like, really hungry. I

Scott Benner 46:15
would have stopped eating completely, trying not to go to the bathroom. I just want to say,

Jane 46:21
and yeah. So I just was like, exactly like, all of these things that I'm like, I could just explain that mentally by postpartum, but I was just like, breastfeeding. I still, yeah, my poor, my poor body, and then my, my fasting was 440 and then it was amazing to try to prove to people, even though I wasn't pregnant, that I was type one, because, like, the nurse practitioner at one medical and like I said, I have many friends that work there really like them as a company generally, I just think, wow, you've got ketones in your urine. You're fasting. Your sugar right now is in the three hundreds. It was like, the next day I got in with them. I had an old insulin pen I hadn't actually thrown away, weirdly, so I just injected myself with alantis. Because I was like, Nope, I think I'm type one. And I went in there, and she's like, I think you probably were predisposed to diabetes, and you just it never went away. And here's some Metformin, and come back in three months. And I was like, but this is my blood sugar. I know you could there's no body type, but I was like, I like that. Can, you know, completely be type two or type one or anything. But when she was just once again trying to be like, do a good job with dieting and exercise. I am, like, very small at this point, yeah, you know. And, like, I lost too much weight postpartum. Then you really should, you know? And so, man, I had to. Oh, and that's, man, getting an endocrinologist. I love my endocrinologist right now, but it was at least in DC during COVID. Six of the eight endocrinologists at the GW practice had left. I think they just were exhausted, and like, I was asking people, and they were like, the nurse literally told me they had enough. And so they were like, we're done. So they were rebuilding their entire technology practice. I couldn't get an endocrinologist appointment to save my life, and I even was looking for private endocrinologist. They were like, we've filled our diabetic quota. I was like, I will prescribe this medication on my own if I need to. But I am, would really love some help, because I do not know what I'm doing, you know. And I finally got a friend of a friend, whose co worker used to have an endocrinologist, who now lived in New Jersey, but she's the endocrinologist was still in DC, texted her because she still had her number, and was like, will you meet with my co worker's sister's friend? Because she is like a PA and she can't get an appointment, and like, Would you please meet with her? And she has been the best endocrinologist ever, and I skipped her nine month waiting list. I finally got my auto antibody tests. Was clearly type one, I kind of wanted to be like, Oh man, what a journey me. Just like, listen,

Scott Benner 48:38
I wish that, like, misdiagnosis of all kinds are such a common story on here, I don't even, like bat an eye at them anymore. Yeah, and even just like regular times, not regular times, like, you know, like COVID, not COVID, eight years ago, somebody I texted me personally, three months, three weeks ago, like, it's just it happens constantly. So I guess it's really hard to figure out. Now

Jane 49:01
I tell my patients, I'm like, you know, home, like, Man, this doesn't seem right. Like, this doesn't seem like a type two presentation. Or the problem is, like, they don't, like, we don't order those auto antibody tests from the ER, you know, and I like, they can't. They, just for a bunch of reasons, it's really hard to get an endocrinology appointment. Or their primary doctors don't know how to manage it. And at least in the ER, I like, I'm always like, you need to try to figure out, like, Has anyone told you you could be type one? Because please go and ask to get the testing, because this is fishy, you know, like, there's too many fishy things, and I do that more now than ever. I'm just like, please try to figure out if you're Lata or type one or whatever. Because, like, I'm seeing so many people to manage like a type two, that I just wonder, and their diabetes is like most of the patients I see in the ER, they're, they're, they're not in control, like with their injection regimen or their Metformin regimen. Often they're in the three hundreds, four hundreds, and who knows, for whatever reason, but I'm like, I think you need insulin. I'm not the one to start. You want, necessarily, from the ER, but, or, you know, but I also think you should be looking into these other things, and Does

Scott Benner 50:05
that scare you, sending them off, thinking they might not get that help? Oh, yeah.

Jane 50:09
Like, I have a type one who in DKA last week who, like, doesn't have a Dexcom because of insurance problems. So I'm like, you know, trying to reach out to social work to try to get some help. But just like, Yeah, from the ER. It's like, I can't make follow up appointments, and so anyway, I want to in the future, like, this is really inspiring me. Like, I want to do a, like, I don't know, diabetic management pa job maybe. Like, I know they're they're out there a little bit. My technologist actually would, like, told me she was like, hey, there's a PA job opening at this hospital. I think you should apply. But it was full time. And I still really love the ER, and I'd love to stay in the ER, but then do this, like, maybe part time in the ER, and then part time do diabetic management, because I'm like, what I want to do is not what

Scott Benner 50:48
I can do. What makes the ER attractive to you? So you see a little bit of everything,

Jane 50:51
and that's what I kind of love. And you never know if you're going to get something that's like, really serious, or just like a sore throat, you know, or even a sore something that looks like a sore throat ends up being like emergent, you know, do you have ADHD? No, I

Scott Benner 51:03
just like, wondering if, like, if that feeds that thing for people, I know, because it moves all the time, like,

Jane 51:08
juggling a lot, so I think, yeah, I don't know it actually, when I went into high school, I thought er was awful. I don't really love true emergencies. I was so scared. It's like, I don't know how I wound up here. Honestly, it doesn't fit in my personality completely. Like I don't really love people dying. And honestly, like, I'm in a level two trauma. So unlike the pit, which is like, level one, I don't, I do see gunshot wounds and things like that, but I'm not, like, constantly, people are not falling apart on me every day. You know, it's a lot of like, pancreatitis and, you know, appendicitis and people you can talk

Scott Benner 51:35
to a friend of mine's kid did a year at Hopkins in Baltimore, oh yeah. And then it's like, I gotta leave. Oh yeah, yeah. I asked her why, and she said, I no longer am upset when I see somebody shot, and I'm worried about myself for that reason. Honestly, I understand

Jane 51:50
that. Like, we have a guy I'm training right now, and he's so like, but she's in pain. And I'm like, Oh my gosh. Like, that's so sweet, but, yeah, I'm like, everyone's in pain here. You know, all of the like, veterans look at each other and we're like, man, we're callous a little bit.

Scott Benner 52:02
That's the cow. The cow she, she didn't want to feel callous, so she Yeah, also then she became a travel nurse, and her life is, like, awesome now, as far as I can tell. So yes,

Jane 52:11
that is really nice. Yeah, I made pump setting adjustments like a patient who had never I had a patient who was vomiting even, I think, last week to type one, and I was like, well, let's just, what pump Are you saying? Let's just, like, do you think you should, like, you know, lower your basal right now because you're vomiting, not able to tolerate a lot. Like, you know, let's lower your basal. And she's like, I've never done that on my own. Yeah, she didn't know how to do it. I was like, you've been a dad type one time. She was in her 50s or 60s, and I know, like, that generation of diabetes, you know, have just been through them, probably like, you know, the most change. Yeah,

Scott Benner 52:46
it's not as generational as you would hope, by the way, like I found myself saying the other day in a recording, if you just understood how insulin works, the timing and amount, that's most of it. But if you really want to succeed long term, you have to become comfortable making changes to your settings,

Jane 53:04
yes, and honestly, that's what I feel comfortable doing, that generally, because I think about it through a practitioner's mindset. But I I've learned a lot from your podcast as well. And and, oh, I tell my I told my endocrinologist about your podcast. I tell my patients to listen to it. I'm like, You listening to listen to like, you know that? Like, if you really want to get good, listen to these episodes, you know, things like that. And I'm still trying to get good, you know, at it, but I get frustrated wanting it to be perfect. Still, you know, where's your a 1c at will you share my most recent one was 5.9 I don't know if this is true for you, but I tend to trust my clarity app a little bit more than I feel like I do my blood, which is not probably accurate, you know, but I am like, Oh, I'm, you know. So my clarity is usually like, 6.1 so I go between like, 5.8 6.1

Scott Benner 53:50
Okay, yeah, that's awesome. I mean, and how's your variability? You low all the time, high all the time.

Jane 53:55
And, like, I like, and once again, like, I, I was pregnant for like, over a year and a half of the last three years I'm diabetic, so it's also, like, just trying to figure that out. Like, yeah. Like, so I was more strict when I was, you know, pregnant, than my a 1c now, which is just breastfeeding my let me look up my clarity right now. See what it is, yeah, this is, I'm curious to know what it is recently. I don't think it's been good recently, because I just go, I'm making me log in. I don't remember. Do you feel

Scott Benner 54:20
like you're just learning now, like, or you're through the fog of the pregnancies and the and the breastfeeding and everything, like you starting to feel like a person again? That makes sense. Yeah. I've

Jane 54:31
luckily felt like that for a while. I think I learn more things though every day. Like my endocrinologist, I think is like, wow. You know, people I will see in your podcast are very generally motivated. Like, I'm sure you talk to people who are, like, trying their best, but at least the most of the diabetes I come in touch with, I come in contact with, and my endocrinologist does just from what, what she usually says, she's like, you are doing far better than any of my other patients. I think you need to, like, back off, you know, like, you need to, like, calm down a little bit. I'm like, I want. To do like 13 different pump settings in my you know, which pump

Scott Benner 55:03
are using? Islam, are you using control IQ,

Jane 55:06
yes, I do control IQ, but I like to and I went on, I went on to slim actually, based on, we know what my endocrinologist had recommended. She said the algorithm at the time, three years ago, who knows? She said it was far better. And also the Dexcom at the time didn't have bolusing from your phone, which was important to

Scott Benner 55:23
me, not that, what do you mean?

Jane 55:24
I could Bolus to the T slim from my phone, but you couldn't from what other pump with at the time. If this is true with the Omnipod,

Scott Benner 55:33
Omnipod, yeah, okay, yeah. And I

Jane 55:35
don't think they had, like, the control IQ function yet for Omnipod, right? Like, that's more recent Omnipod

Scott Benner 55:40
five. Is Omnipod five three, you might have gotten there right before it came out.

Jane 55:45
Yeah. Like the Omnipod five came out after I had gotten this pump, so I'm interested in it. But so far, I've liked the T slim. I'm in control. IQ a lot. For a while I was in sleep mode all the time, which I know they've said to do in pregnancy. And just like another one of your podcasters, I listened to who, like, I was like, well, this seems to be smart. Like, why don't just keep in sleep mode all the time? And I realized that control that control is not as good,

Scott Benner 56:03
right? Have you listened to control? IQ, Ninja, yeah, I'm in the middle of

Jane 56:07
doing I'm halfway through those awesome, yeah, yeah. And so, yeah, I'm interested in those. And so I'm in control IQ, but like yesterday, I switched into manual because I was like, oh, what I can't do on the T slim, what you can do on the Omnipod is, I don't love that. I can't increase my Temp Basal when I'm on control IQ. I want both. And now you can, as of, like, just a couple months ago, but I haven't updated it yet, but you can do that. From what I believe on the Omnipod is you can increase your Temp Basal to, like, you know, 120 5% while you're on the control function. Yeah, is that correct? Because you couldn't do that up until very recently on the T slim, they just updated the software. Okay, yeah, they just did it for T slim too, which I'm excited about. But because I would go back and forth all the time between being like, Oh, I'm gonna lower my basal, or I'm gonna increase my basal and do an extended Bolus, or, you know, things like that that you can't do being on control IQ. But like last night, I did that and then forgot overnight to put myself back in sleep mode. So then, you know, I, luckily I didn't spike high, but I was like, woke up being like, why am I 160

Scott Benner 57:07
so you're using the algorithm, but you're you got your fingers in it a lot I do. And my

Jane 57:11
intercultural is like, let's make this so that there's a little bit less work for you. But I'm like, Yeah, but I want to just get better.

Scott Benner 57:18
Do you think you couldn't do that? You don't think you could do a five nine with less work?

Jane 57:21
I think I can. I just think I'm learning. And like, honestly, she like your podcast and hearing from people that have figured it out is more information than I've been able to get anywhere else. Okay,

Scott Benner 57:32
oh, well, I'm glad. Oh, thank you very much. That's awesome. Yeah, listen, you got to keep going through those algorithm episodes, because you'll get better at it. Yeah.

Jane 57:39
And I already have, like, and it's giving me like, I'm already pretty bold, and what I feel like I can do, but I feel like I'm like, oh yeah. Like, this isn't I? Once again, my endocrinologist is amazing. I've she just is so great. But she also, like, you know, is managing everything out there, and she doesn't know the nitty gritty of the things you talk about on your podcast, you know. So that's something she wants me to back off a little more, because often my lows will lead to highs, because I'll they'll suspend my, you know, my and I'm always trying to balance doing too much

Scott Benner 58:07
you're not letting it where you're not letting the algorithm letting

Jane 58:10
it work for me, right? Yeah, and where sometimes I'm like, I should just be on manual, because I almost have an inability to let it go, you know. But those two kids aren't keeping you busy enough. Yeah? I know. I know. Well, honestly, I'm like, man, what was I? Yeah, my brain cells, what it gets devoted to? Like, I'm like, when people would ask me how having kids was, I was like, honestly, diabetes, and trying to manage that is harder than having a newborn. Jane.

Scott Benner 58:30
I have to go backwards for a second. So you have this birth, you find out you have diabetes after the birth, your butthole rips, yeah, you've hemorrhaged, yes. And then how long is it before you're like, you know what we should do? Let's have a second baby, kid.

Jane 58:44
I know. I know what happened. My daughter had turned two when we started trying again. Two, no one. Oh my gosh. One. She turned one. We started trying because I wanted about two years apart. Is this

Scott Benner 58:56
a little bit about you wanting to space them away? But is it also about your age a little bit. Yeah, yeah,

Jane 59:01
totally. That factors in. I was 32 when I got pregnant, and just to turn 33 When I gave birth to my first and then I was like 34 and I just turned 35 just about exactly two years apart, yeah. So yeah, that factors in. I'm trying to think through whether I want a third now, I just don't know. Yes, I know. And honestly, it's like, I'm not even someone who, like, I like, I was like, Maybe I won't have kids. You know, I wasn't like, for sure, I want to be a mom. What happened?

Scott Benner 59:27
Oh, I don't know. How did the butthole thing not stop you? Seriously, I know,

Jane 59:33
right? Luckily, my second so this is what happened. My second child was an angel baby, and he is like, so, I mean, he's a hard, little, hard sleeper now, but, like, my first was like, and once again, I just like, I would love for chat, GPT or somebody to be like, from with a little bit I have researched, I don't believe the high, like, my glucose, I was, or, sorry, my my hyperglycemia was amazingly, like, really impacting my breast. I was like, looking back, I'm like, was my daughter just drinking? Like. Complete sugar in my breast milk

Scott Benner 1:00:02
or something. I was wondering, like, Is this, like, crappy milk she was getting? Like, why

Jane 1:00:05
she is starving in colicky or something like that, you know? Like, does this have any correlation? And I looked at one thing, and I think I was just too stressed to really figure it out at that point time, but I'd love to look into it again, being like, from the one thing I looked into was like, No, somehow your body and the amazingness that it is like, will be able to keep hyperglycemia from really going into like, it's able to separate from breast milk or something. Well, you're

Scott Benner 1:00:32
gonna feel better here, because our overlord says that it doesn't matter. I said, Can? I was really, like, blunt. I said, Can an uncontrolled type one breastfeeding makes subpar milk. I want to say, No, having poorly controlled type one diabetes does not make your breast milk subpar. In fact, even when blood sugars are higher fluctuating, human milk remains remarkably resilient, resilient in its basic nutritional composition. Yeah, that's what,

Jane 1:00:54
that's the little bit I had heard too, and it made me feel so much better. Didn't understand, you know, still understand the colic, but it made me feel so much better that I wasn't like, starving her or giving her something unknowingly for months. Yeah, but like, Isn't it amazing, though, that the body can be that sick, I agree, and also produce Yeah? It says if

Scott Benner 1:01:09
your diabetes isn't perfectly controlled, your breast milk will still provide protein, fat, carbohydrates and immune factors your baby needs. That's just insane. Go, ladies. I knew those boobs were awesome for more than one reason, and he was just

Jane 1:01:22
easier pregnancy. I did not have the pain I would, did not have to go, like, the birth was easier, like, it was all like, if I would have had her second, I'm pretty sure I'd be done. Yeah,

Scott Benner 1:01:30
I see, I see, and your husband's, like, helpful and all. Or do you know

Jane 1:01:35
he's the best, and he also is, like, after one though, he was like, I'm good. Oh, this is you now, if you want a second, great, like, I think two sounds probably good, but especially now, he's like, I'll leave that decision to you. He was like, you can figure that

Scott Benner 1:01:48
out. We got to wrap this up, because I have a meeting soon, and I apologize for that, but that was great. I am 53 I have two kids, and two seems good to me, yeah,

Jane 1:01:57
and I grew up with two, boy and a girl I'm super grateful for. And, yeah, I don't know. I guess a lot of my friends have three kids. Maybe it's just like, feeling like, oh, that's like, what? I don't know. People keep telling me, if I'm on the fence, how

Scott Benner 1:02:09
much did it cost you to go to college? Think about that for a second. Too much. Yes. Now, times that by two, yeah. And then probably times it by 10. For 20 years from now, aren't you hoping,

Jane 1:02:18
though, that it changes? I'm like, I'm like, I know it could just get more sense of part of me. It's like, expensive. Part of me is like, I just can't imagine it can get more sense. As a part of me just hopes

Scott Benner 1:02:27
it just changes. You're still young. I didn't realize how young you were. In your heart, that's lovely. No, it's gonna get worse. Everything gets worse. Yeah. Have you lived through this week with the rest of us? Do you have a 401? K, oh

Jane 1:02:37
yeah. Do I join by luckily? Yeah, I do the medicine. My husband does the finance. So guess

Scott Benner 1:02:43
what? He he's paying attention to it, and you're not. He's quietly banging his head against the floor right now. And to

Jane 1:02:49
top it off, he quit his job a couple weeks ago and is going to start something on his own. So you

Scott Benner 1:02:54
go over to him right now and say, I was thinking we should have a third kid and see if he doesn't throw you out a window. I know. Yeah, exactly. Well,

Jane 1:03:00
part of me did say, you know, I'd really love for you to have a, you know, a stable idea of what you're going to do in the future if we do decide to do this, because I also don't want to kids.

Scott Benner 1:03:09
Mommy left, yeah, yeah. She's at the bottom of a lake at the park now, yeah, yeah. I don't know. Listen, this wouldn't be the time to ask. Is all I'm saying. Like, for anybody, anybody who's watched their money for the last week. It has any kind of an investment. Is not busy going we should do some stuff now without definitely

Jane 1:03:26
wanting to. Yeah, I'm older and I want to space it out more. But I I feel like, who knows? I

Scott Benner 1:03:32
think three kids brings the two doesn't

Jane 1:03:35
good question. I I don't think anything.

Scott Benner 1:03:39
Are you hoarding babies? What's going on? So I think

Jane 1:03:42
three kids might it's my maybe. No, I think I love watching them play together. That's great. No, it brings a lot of heartache. I think you're right. I think it brings a lot of heart. It brings a hard couple years. I mostly this is what, this is what I always said about kids. I don't necessarily want them right now. I want them when they're 20 year on my Thanksgiving table, you know. And I feel like the future projection of being like, seeing that, and being like, Oh, I could just see what another person like does. Sounds appealing to me, but now, now just sounds incredibly hard, because it already is hard. Like, I'm not even, I'm not doing it really well right now, you know, like, it's hard, it's

Scott Benner 1:04:15
interesting. It really is. I mean, listen, I have hindsight. I've got years, and my kids are 25 and 20 and stuff like that. And I like, I can look back and tell you, I don't think another kid would have changed anything. For me, that's good to know. Yeah,

Jane 1:04:27
interesting. Because I think everyone else is like, Oh, if you're thinking of three, just do it. But that's all people have three kids, so who

Scott Benner 1:04:32
knows? Yeah, I'm just saying it's possible that you're using the same collecting mentality as people with fish tanks. And I'm worried for you. They're like, I built this tank, and it's running now, and it's awesome. And I do like looking at it, but it was so much fun building

Jane 1:04:44
the tank. Also, I have a two bedroom apartment in DC, you know, so you

Scott Benner 1:04:48
don't need, you'd need one less kid, yeah, exactly. We

Jane 1:04:51
I'm like, Yeah, my kid, actually, my Yeah, my son, who is a year and a half, is been in my closet for like, the entire time. So that was my gosh. So, like, yeah. Yeah, like, do we have the space? No, we don't have the space. We don't have the space or the money. The

Scott Benner 1:05:04
third one's gonna be like Harry Potter. He's gonna live under the stairs Exactly. At least they're gonna be used to little. Listen, things are expensive. Have two twos, enough. Trust me, you're fine. And

Jane 1:05:14
sure. I mean, man, the takeaway from my type one diabetic, this type one is expensive and insurance is impossible. So, yeah, I don't need more. Also, have

Scott Benner 1:05:21
you, and I hate to say this, but have you given any thought to the idea that could your kids get type one eventually?

Jane 1:05:26
I have. I I've listened to your podcast about one of one, somebody on your podcast who got their kid tested with the new testing that's out there. And I think I would think about that at least. I'll be hyper, and like to see if I can prolong if that, like, you know, if they are type one risk to prolong that, I'm, I'm losing my words of what that is, but the infusion, you know, to try to prolong that. So that sounds in like, I will, I will be interested in, like, trying to do what I can to you

Scott Benner 1:05:58
would consider, like, a tz old situation, if that,

Jane 1:06:01
yeah, that's it. That was the TZ. That was the word I was wanting, Yes, uh huh, a Tuesday situation, or in, like, you know, being aware of their symptoms and stuff like that. Yeah, yeah, no, yeah. Type one. Nobody else in my family has it, so I last I had checked correct me if I'm wrong, like, the risk is, like, you know, like, one to 3% or something like that, if your kid's getting it, and if you're the mom, I

Scott Benner 1:06:19
mean, listen, you your kids might never get type one, like, yeah. I mean, like, in they might, does your husband have any autoimmune on his side of the family? No, nobody like celiac or

Jane 1:06:29
no autoimmune on either side of the family? Yeah. And I have no other health conditions either. So in

Scott Benner 1:06:33
my opinion, just from making this podcast, that should help a little, hopefully. I mean,

Jane 1:06:36
that's what the data says. So I just got to go by so just Yeah. So I my hope is, you know, hope is that not, but also, I mean, I used to think before your podcast, in some ways, I used to think like, that would be my worst nightmare. Is not just having, about having my having, like, my baby habit. And now I just feel like, okay, so many parents can do it like you are more equipped to handle it like, especially now, like, with all the technology and everything, like, they just, it's not as bad as when I first got type one of thinking through my kids getting it, that really

Scott Benner 1:07:08
makes me feel good. Thank you. Yeah, it's true. I'm glad you feel that way. It's awesome. I do.

Jane 1:07:13
I'm like, okay, these moms, like, can do it, you know. So it's not the end of the world.

Scott Benner 1:07:17
Shane, I appreciate that. Thank you for doing this with me. Oh, thank you for having me on it. Did you have a good time? Yes, yeah, awesome. How did you find the podcast? Great

Jane 1:07:26
question. Oh, you read it. Read it. Oh, yeah. And Instagram, Instagram too. And I'm not even, I was not a redditor until this. So it's like, I until just me looking up diabetic things. And I also, like, am not, I'm never on the computer, because I work in the ER and I, you know, never, I'm never like looking on things. So I also never use chat GPT. I never, you know, do things like that. I started just looking at Reddit to see what type one day, how type one diabetes are managing things and and then they were all, like, a lot of people pointed me to this

Scott Benner 1:07:55
awesome well, thank you, Reddit. I appreciate that. Yeah, awesome. All right. Hold on one second for me. Yeah,

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

Hey, thanks for listening all the way to the end. I really appreciate your loyalty and listenership. Thank you so much for listening. I'll be back very soon with another episode of The Juicebox Podcast. Hey, kids, listen up. You've made it to the end of the podcast. You must have enjoyed it. You know? What else you might enjoy? The private Facebook group for the Juicebox Podcast. I know you're thinking, uh, Facebook, Scott, please. But no. Beautiful group, wonderful people, a fantastic community Juicebox Podcast, type one diabetes on Facebook. Of course, if you have type two, are you touched by diabetes in any way? You're absolutely welcome. It's a private group, so you'll have to answer a couple of questions before you come in. We make sure you're not a bot or an evildoer. Then you're on your way. You'll be part of the family. The episode you just heard was professionally edited by wrong way recorder. Recording, wrong way recording.com, you.

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