#1578 Fear of Hypoglycemia
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Scott and Erika discuss fear of hypoglycemia.
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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
Hello friends and welcome back to another episode of The Juicebox Podcast.
Low blood sugars can be incredibly scary, both from the perspective of the person having them, and from the people around you today, Erica Forsyth and I are going to talk about the fear of hypoglycemia in a way that I hope you find valuable. Check out erica@ericaforsythe.com
my grand rounds series was designed by listeners to tell doctors what they need, and it also helps you to understand what to ask for. There's a mental wellness series that addresses the emotional side of diabetes and practical ways to stay balanced. And when we talk about GLP medications, well, we'll break down what they are, how they may help you, and if they fit into your diabetes management plan, what do these three things have in common? They're all available at Juicebox podcast.com, up in the menu. I know it can be hard to find these things in a podcast app, so we've collected them all for you at 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 or becoming bold with insulin. Today's episode of The Juicebox Podcast is sponsored by the Dexcom g7 and the Dexcom g7 warms up in just 30 minutes. Check it out now at dexcom.com/juicebox. The show you're about to listen to is sponsored by the ever since 365 the ever since 365 has exceptional accuracy over one year and is the most accurate CGM in the low range that you can get ever since cgm.com/juicebox. The episode you're about to listen to is sponsored by tandem Moby, the impressively small insulin pump. Tandem Moby features tandems newest algorithm control, iq plus technology. It's designed for greater discretion, more freedom and improved time and range. Learn more and get started today at tandem diabetes.com/juicebox Erica. Welcome back Today we are going to talk about the fear of hypoglycemia.
Erika Forsyth, MFT, LMFT 2:27
That's right. Thank you. Good to be here.
Scott Benner 2:30
I appreciate I love it when you're stopping. So you know, this is just one, right? This is easy. People share their fears constantly online when I'm speaking to them, I think some people have the fear and they don't address it, and I was hoping that we could talk about it today a little bit and maybe find some practical steps for them to take that could help. Yes, that sounds good. Awesome, awesome. Well, what did you learn when you dug into the fear of hyperglycemia?
Erika Forsyth, MFT, LMFT 3:00
Okay, so I think it might be helpful for us to talk about what, what is it? So basically, it's, you know, you're experiencing symptoms that might feel like you are having either an actual panic attack or anxiety, but you're experiencing that intense fear about having a low blood sugar, you're anticipating having the low, or you're actually having the low, and the fear becomes so intense that you might keep your blood sugars higher than recommended to avoid the possibility of going low, Which might look like you're not giving yourself the full, you know, the suggested Bolus, if on your pump or MDI, you might be correcting at a higher number because you are anticipating and you feel that intense fear,
Scott Benner 3:55
yeah, you want to play the insulin game up a little higher, you Think, to avoid the frequency of low blood sugars.
Erika Forsyth, MFT, LMFT 4:03
Yes, and I think it's important to note that every person or caregiver has some fear of hypoglycemia, which we might also say fo H or just or fear. They might have some fear of going low. And that's that's common and helpful and adaptive, right? We want to be mindful of not crashing, yeah, but it becomes problematic when it interferes with your quality of life, the decisions you make on a daily basis. It interferes with your T, 1d management. Maybe your A, 1c is going higher as a result. Maybe it might not be also, the research has indicated there's not a direct correlation to experiencing fear of hypoglycemia and having a higher a, 1c although that can be experienced.
Scott Benner 4:52
So there's that layer of anticipation, right? Like something's going to happen, I'm going to be in line somewhere, I'm going to be driving or something. I'm going to get low out of. Nowhere. I think that's part of that anxiety. Is that correct?
Erika Forsyth, MFT, LMFT 5:03
Yes. And I think I have found not only my own life, but in kind of anecdotally, there's this public or social component too. And then there's the private, privately, when you're at home, maybe you're feel safer. You still might experience this fear, but you might be more comfortable going lower because you're at home, you're not worried about how you're going to look or speak. But then this public or social component, if you're going out to a restaurant with friends, if you're speaking, I notice I'm more hyper aware of my blood sugar even before recording right? And there's something about that, like, we don't want to have to deal with feeling low. We don't want to have to deal with maybe, is there any kind of embarrassment, and then you're gonna have to explain what you need. There's also, like, a time component, like, if you know you have, you're going to a doctor's appointment, and you don't want to go low during that appointment. You might experience it in different kind of environments, too differently that this, this type of fear. Does this
Scott Benner 6:04
happen to you professionally, like before you see a client, do you stop for a second assess where you are in an appropriate amount of time so you can fix it beforehand?
Erika Forsyth, MFT, LMFT 6:11
That kind of thing I do, yes, I mean, I I try to be in range, but I will notice I'm more vigilant meeting with a client who does not have diabetes. Oh, okay, then with someone who does, and I have had to treat either, you know, have a tab a glucose tablet, or I'll correct if I need to, you know, adjust, you know, with a Bolus. But I have noticed that difference,
Scott Benner 6:38
but you don't feel the same pressure if the person you're talking to has type one.
Erika Forsyth, MFT, LMFT 6:43
It's not correct, harsh, yeah, because then it's it's exactly why, you know, I think people like to meet with someone like myself who has type one, but there's an understanding. We don't have to explain it. We don't have to justify it. You just do what you need to do.
Scott Benner 6:59
You don't run the risk of one person not believing it's even true. Where, I've seen that too, where people like they explain their situation and they realize that they're met with somebody who's like, yeah, I don't really believe that you're just making it up. Or you hear that stuff all the time. So do you find yourself Can I ask you questions here? Do you find yourself doing the what do you guys call it catastrophic forecasting? Is that what they call it like, where you run scenarios in your head over and over again, like, Oh, this is going to happen. I'm going to go here. I'm going to get low this is like, you end up freaking yourself out. Is that the risk you run by doing that? And is that a thing people can really even control? Or do you think some people just get caught in that cycle? So
Erika Forsyth, MFT, LMFT 7:37
catastrophic thinking is basically, well, this kind of the if scenarios. What if this happens? Also, if this happened this one time? Is this going to happen all the time? Often, when we talk about this fear of hypos, we usually assume that someone might experience the heightened fear if they've had a seizure, or if they've had a really extreme low episode, or they passed out, you know, all the different levels of, like, an extreme low, right, I would say that's maybe 50% of the case. People don't have not had that experience, but they're trying to prevent that. So there's kind of like that, the actual you you're really wanting to avoid the experience and the feeling of the low, that's kind of like the management side. But then there's also this kind of psychosocial side of not one have to deal with it in front of other
Scott Benner 8:30
people I see. So it's possible that you've either had the experience and you're remembering it and wanting to avoid it, or you've heard about it and you're making up in your head what it could be. And therefore, either of these things is making you have that feeling of like, I just this can't happen. I need to make sure this doesn't happen, and then the result of that is a higher blood sugar that you accept.
Erika Forsyth, MFT, LMFT 8:48
Yes, and we'll get into kind of understanding what's going on cognitively, how those thoughts, those are distortions that we've talked about before. It feels like truth. It feels like reality, like this is going to happen. I'm going to feel out of control. This is going to if I dip below 150 and the arrows going down, I'm going to die. I'm going to, you know, whatever the worst case scenario is running through your head. It feels so strong, so that you kind of counter that by feeling like you have some sort of semblance of control and keeping yourself higher. Okay,
Scott Benner 9:24
let me ask you a question. So I don't have this experience. Obviously, I don't, I don't use insulin, right? But I have kids, and my children have, at times, been in really dire situations, and there's that feeling that comes the like tension in your chest, rapid heartbeat. You feel sweaty, out of control. You feel like you can't there's nothing you can do to help the situation. It's a feeling of being lost. Is that mimicking how it feels when your body betrays you, like, because that's what it feels like, right? Like your body betrays you, so like when that happens, I think the closest thing I have. A pair it to is when something happens to someone who I love so much that I can't help them at all. Like, am I anywhere near trying? Because I'm just trying to understand for people who don't have it, like, what is the feeling?
Erika Forsyth, MFT, LMFT 10:11
I think it's it's a two sided experience. There's the physical symptoms that we we all know well the shakiness, the kind of fast heart rate, the difficulty really thinking clearly. And then there's, there's kind of this uncertainty for a brief period of time of how quickly that feeling is going to go away. So that's where you you do feel a sense of out of control, because you but even though you can maybe, if you don't have this intense fear, in that brief moment, you feel like, okay, I know that these that this one glucose tablet or three tabs or Juicebox is going to break me up, but every time is different. So when you're in that space of feeling the low, it is scary, and you do feel a sense of out of control, but you also in that. And we'll get again, to these steps of like, okay, I know I have this many units of insulin board. I know I have this many carbs digested. I just need to sit here and wait. That's a hard process to get to.
Scott Benner 11:15
That could also be difficult because you're, you're altered to begin with, right and correct. So that's the over treating. That's where the like, I you just keep eating or keep taking stuff in, because you just, that's my assumption. So the assumption I make about over treating is either you can't do the math that you just described, like, how much is in, how much is digested, what have I covered? And so it's a panic, like, I'll just keep eating until, like, this goes the other way, right? Or it's the the fact that you're out of it to begin with. And, I mean, how are you going to keep track of this, even while you're trying to accomplish it? I have to tell you that, like when I see Arden get low and she, you know, she eats or treats something, and then she needs to sit for a minute, she seems so composed, right? Like, and she's, she's not a, like, a panicky person. And I have to remind myself that like, this isn't like me saying, Oh, I'm winded. Let me sit here for a second like there's a lot more going on that I can appreciate. And anyway, like I don't want to come off, like I understand this, like, from a personal perspective, I just, I'm trying to help people talk their way through it, because it is not, and has never been lost on me that she feels a certain way, and I don't know what that is, so it's just Yes,
Erika Forsyth, MFT, LMFT 12:27
and that there's like, the physical component, and what you were asking earlier about, like, kind of that emotional component of someone's there's nothing you can do to help that other person, like, kind of that helplessness, or perceived helplessness in that zone. If that becomes so overwhelming that you are avoiding that experience by keeping yourself higher, then you know that you might be dealing with that intense fear.
Scott Benner 12:54
So from a parenting perspective, people avoid doing things that might put them in peril so they never have to feel like that. And on the diabetes side, I'm going to keep my blood sugar higher, because if it gets too variable and low, I don't want to feel like this. So it's all about avoiding the feeling that comes with it. This episode is sponsored by tandem Diabetes Care, and today I'm going to tell you about tandems newest pump and algorithm, the tandem mobi system with control iq plus technology features auto Bolus which can cover missed meal boluses and help prevent hyperglycemia. It has a dedicated sleep activity setting and is controlled from your personal iPhone. Tandem will help you to check your benefits today through my link, tandem diabetes.com/juicebox, this is going to help you to get started with tandem, smallest pump yet that's powered by its best algorithm ever control IQ. Plus technology helps to keep blood sugars in range by predicting glucose levels 30 minutes ahead, and it adjusts insulin accordingly. You can wear the tandem Moby in a number of ways. Wear it on body with a patch like adhesive sleeve that is sold separately, clip it discreetly to your clothing or slip it into your pocket head now to my link, tandem diabetes.com/juicebox, to check out your benefits and get started today. Why would you settle for changing your CGM every few weeks when you can have 365 days of reliable glucose data. Today's episode is sponsored by the Eversense 365 it is the only CGM with a tiny sensor that lasts a full year sitting comfortably under your skin with no more frequent sensor changes and essentially no compression lows. For one year, you'll get your CGM data in real time on your phone, smartwatch, Android or iOS, even an Apple Watch, predictive high and low alerts let you know where your glucose is headed before it gets there. So there's no surprises, just confidence, and you can instantly share that data with your. Healthcare Provider or your family, you're going to get one year of reliable data without all those sensor changes. That's the ever since 365 gentle on your skin, strong for your life. One sensor a year, that gives you one less thing to worry about, head now to ever since cgm.com/juicebox, to get started.
Erika Forsyth, MFT, LMFT 15:22
Yes, it's avoid. It's an avoidance strategy, kind of behaviorally. But then there is this, you know, psychological component. And then, as I shared before we started recording, you know, there are not very many studies on how to treat and support people living with type one, or actually both type one and type two, psychologically around this fear, because it is that I think we're, obviously, we're talking about mental health more in the diabetes space, but also we're just, we're noticing, we're giving language. And I think there will be more specific studies around this,
Scott Benner 15:57
yeah, well, they're not gonna need a study. They can just listen to this conversation. That's right. Yeah, that's right. Yeah, that's right. We'll straighten out. Keep
Erika Forsyth, MFT, LMFT 16:03
going. I'm sorry. I think it's also important to note that you are not alone in this. From the American Diabetes Association, they have shared from studies that one out of every seven people living with diabetes, and it's the same for type one, type two experience, and have kind of endorsed experiencing the fo H, and also as a caregiver, you can experience this too obviously from more of a psychological component, because you aren't trying to avoid the fear of feeling the low, but you're trying to Avoid putting your child maybe it feels like in risk and in danger this next
Scott Benner 16:44
point. I mean, I'm super interested in this next point, so I just want you to keep going, but
Erika Forsyth, MFT, LMFT 16:48
that it can develop without a known traumatic low event. Yeah, that yes, yes. So, like, I think we kind of touched on this a little bit without having a seizure or a intense low event or episode, you can still deal and experience and work. You know, you're working really hard, I know, to try and manage the sphere so it is really common. It's not necessarily correlated to having a past episode.
Scott Benner 17:17
So if you asked me to explain to you how Arden treats her diabetes like I've said this a million times. I don't see her talking about herself like type one. I don't see her acting like it's burdening her, but it obviously is. It's burdening everybody to some degree or another, right? But what I've kind of come lately to think is what Arden is doing is she's taking kind of that youthful energy and applying it to diabetes, like, Ah, it's okay. I got it. She's not ignorant of it, and she's not ignoring it, but she she hits it with that, like it's gonna be okay. Let me just get through vibe like that. You know, at a certain age, you have right, and she has had the experience of a seizure, but I haven't seen her freak out about it, but as we're talking about it, like, I wonder, like, is it because of her attitude, or is it because she had to make a conscious decision not to freak out about it, because now she knows, like, she knows what it is, and when she explains it to you, like, in hindsight, she knows how scary it is and beyond scary, like, you know, we're not talking about the safety aspect of it here, but like, this is not an unreasonable thing to be worried about. Like, you can absolutely die from this. Yeah, that's not crazy. I just, I'm always gonna wonder, I guess, like, how she managed it, and if I think she's too young to ask her, like, I think I'd have to wait five more years to ask her, really, like, what did you apply to this situation? When you realize, like, this happens sometimes, and it's not like an hour before it happens, a red light goes off over your head, and it's like, you're gonna have a seizure in an hour, like you it's, you're okay, and then you are not okay. It's, it's that fast. So anyway, I don't know. I
Erika Forsyth, MFT, LMFT 18:51
think that's a good point, because the few studies that are out there have have said that there isn't a direct correlate. There is not a direct correlation between having a seizure and having this fear of hypos, this intense fear. So just because you've had a really severe low event, it doesn't mean that you will that you also experience this intense fear all the time. There there's no really direct correlation. Have
Scott Benner 19:18
you ever met somebody who has had a seizure. It's not about diabetes, like something else, like somebody has a seizure disorder or something like that. Like, I'm always impressed by the blase nature in which they talk about it like it really is, like there must just be a moment of just agreeance that you make with the with the universe at some point when you realize that you might be walking around and just have a seizure. Never seen a group of people handle that, like handle something so unknowable, so well. I guess that's what people with diabetes are doing too, right? They're just, you have no choice. Yeah, what else you gonna do? I'm like, Yes, I could sit here, but you know, I got things. I got. To do. So, have you ever dealt with this? Personally?
Erika Forsyth, MFT, LMFT 20:03
I have not personally interacted like people with who are either. Yeah, have epilepsy, but I understand the point, because there's it's also kind of, I'm thinking about people with anxiety who experience panic attacks most often. They show up out of the blue. There's no known trigger. So then that creates even more anxiety, right? Because you're anticipating when is this thing going to happen?
Scott Benner 20:28
Yeah, I'm guessing that whatever lets us drive cars is what lets us do this. Do you mean because you look around nobody is like, do you ever really think about driving while you're doing it? Like you're up on a highway and everyone's going 85 miles an hour in like, these death rockets, and at this point now, you remember 20 years ago the I it was like, Oh, these cell phones, everyone's gonna run into each other. And for a while, they did. And then we made a generation of people who learned to drive with their cell phone in their hand. They're awesome at it. I know we're not supposed to say that. Yes, no, no, I know we're not supposed to say that, but people are so good at driving with their phone in their hand now, like, it's not like I was on the highway the other day. I looked over and the guy next to me is looking down to his right, and not for a while, like, and I so I kept checking and looking back. He was looking and looking like, I'm like, he's reading something. And then you drive a little farther and there's a guy, another guy, he's got his phone up on his dashboard, a little holder. He's watching Sports Center. And I'm like, Oh my God. Like, so I got reading guy Sports Center. I got, I got a lady on Facebook. I got, like, I look around, I'm like, There's 50 cars around me. Half these people aren't even looking forward. We're all going 80 miles an hour. No one's hitting each other. I'm like, This is amazing. So, like, it's amazing. It is amazing, right? Like, so, whatever I think it is that lets us get involved in that activity which common sense would tell you not to do, right? Like, seriously, if you let Common Sense Decide you would not get in a car. We do that, and we do it so effortlessly. I wonder how much of whatever that is in people adaptability, I guess, and trust that we put into it. I guess you you end up applying it to this at some point, if you can. It just makes sense to me, but I don't
Erika Forsyth, MFT, LMFT 22:06
know, yes, I mean, then that we'll, we'll, we'll talk about that too. It's kind of trusting. No, am I jumping forward? I'm sorry, trusting the body, you know, trusting your body, trusting the medication. No, it's always good. You're always queuing, queuing me up for the next thing that's good. Go ahead. Okay, so also, these studies have have indicated that most of the time, if you are dealing with extreme fear of hypos, you may also be experiencing higher levels of general anxiety depression. So it often not. This is not all the time, but it doesn't often live by itself. Yeah, they do often go hand in hand.
Scott Benner 22:46
So if I'm experiencing fear of hypoglycemia, I could maybe step back and take a wider look at my life to see if I'm having anxiety in other places too.
Erika Forsyth, MFT, LMFT 22:55
Yes, okay, yes, that's that's a good starting point.
Scott Benner 22:58
That's helpful, yeah, okay, oh, that's very helpful to know. Oh, isn't that? I don't know why I never put that together. It's ridiculous that I didn't put that together. But okay,
Erika Forsyth, MFT, LMFT 23:07
again, not, not always the case, right? But they just have noticed that in the research. Yeah, that makes
Scott Benner 23:13
sense. All right. Are we going to talk about ways to address it? Now, the Dexcom g7 is sponsoring this episode of The Juicebox Podcast, and it features a lightning fast 30 minute warm up time that's right from the time you put on the Dexcom g7 till the time you're getting readings 30 minutes. That's pretty great. It also has a 12 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 g7 a no brainer. The Dexcom g7 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, uh, 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 Juicebox podcast.com, to Dexcom and all the sponsors. When you use my links, you're supporting the production of the podcast and helping to keep it free and plentiful.
Erika Forsyth, MFT, LMFT 24:27
Oh yes, I was going to note Yes, I want to talk about ways to address it. But also have noticed, and this is also reinforced in the research, people who have been managing type one or type two for a long time, doing finger pricking and then switching to CGM. In the last five ish years, they have noticed an increase, kind of increased fear of hypos, as they have gone from checking their blood sugar, whether it's three times a day or 15 times a day, to then having the constant fear. Feedback, but it also CGM have shown to reduce the fear of hypos. But also, I think, on the opposite side, have kind of increased some of the fear also,
Scott Benner 25:10
maybe, depending on where you come from, when you enter into using a CGM. So if a person's been you, you know, finger pricking their whole life, they don't have these problems. Whether they're having great outcomes or not. They're not passing out. They're not getting shaky. And so they think, well, this works. This is safe, right? And then you put a CGM on them, and they see the variability, and it freaks them out. No kidding, they just the arrows freak them out. That gets going up, it's going down. What are we going to do? Like, and so some people can't say, oh, well, this is what's always been happening, but now I see it. Some people just say I was almost willfully not ignorant, but I was almost willfully ignoring that these things could be happening in the background. I wasn't aware of them
Erika Forsyth, MFT, LMFT 25:49
absolutely. I mean, back in the day, we had no idea you just you were checking three to five times a day and hoping for the best. And so there is, you know, I know we've talked about this before, but there is, you know, that was, like the kind of the gift or blessing of just finger pricking is like you kind of did your thing, yeah? And obviously now it does, you know, kind of increase your ability to have better, like tighter management, yeah? But can also play with your emotional, you know, side of it too. This
Scott Benner 26:22
is, like the modern version of people going from mph and regular, because those people were just like, Look, if, if I didn't get sick and die, I got dizzy once in a while, and other than that, I was good. This all worked. That was the extent I interviewed so many people. The extent of them thinking I was like, I shot it in the morning. I shot it at dinner. You know, I maybe sometimes I got shaky or sweaty, but you know, those lows would come so slowly, they could mostly get in front of them. And nobody was really tracking a 1c the same way. So if they were standing up, they were healthy, and that was good, right? And then you bring those people forward and say, look, here's Lantis and levemir and, you know, like, Let's inject at every meal and count carbs. And they're like, Whoa, no, I'm I'm okay. Like, don't introduce all these other factors. And now the same thing leaving, I guess, just blood glucose meters to CGM, you're just introducing so much more data and so many more things to pay attention to. Oh, no kidding. I wonder how many people this is apropos of nothing that we're talking about, but I wonder how many people get left behind. Left behind because of that, like, every time there's a big jump, I wonder how many people just go, I'm alright, I'll stay here. You know what? I mean, it's interesting.
Erika Forsyth, MFT, LMFT 27:30
And whether or not is that, you know, access, the ability to even whether afford it or insurance, or is your doctor bringing it up, you know,
Scott Benner 27:39
yeah, all that is going to involve. But I'm saying, like, once you have the access and you can afford it, like, I wonder how many people see the data and just go up bridge too far, I'm good. I'll stay here. You know what I mean? Because i Because, you know how I think about it. Like, I think that if you're aware of how insulin works, and you have good tools, and you understand how food's impacting you, that most of the time you're going to be able to use insulin in a way that isn't going to leave you with great spikes or great drops, and that I would like if you, if you let me make a wish for you, I'd wish that you were in that space, right? But if you don't know how to use it in a way that you're having that feeling of, like, I'm brittle, like, you know what I mean? Like my blood sugar is all over the place, and this is freaking me out, then there is an argument to be made for mental health and well being that's more than just your blood sugar, yes, yeah. It's very person to person,
Erika Forsyth, MFT, LMFT 28:27
absolutely. And I think on that note, transitioning to maybe some tools around this. And this is something if you have been kind of struggling with this intense fear, I wish we could, we could fix it all in an episode. But these are some tools that that I use in sessions with people. And so just I want to encourage you to offer yourself Self Compassion. This is going to take time, because you could have been operating, you know, your neuro pathways and these that are like really dug in, deep and firm, and these distortions that you're going to not be okay when you go low. It takes time to change that. That's a shame. So to be patient with yourself, yeah, as you listen to these tools
Scott Benner 29:10
to expand on that. Like, how do you offer that to yourself? Like, because it probably seems, I mean, I'm going by the people I speak to when they're having a block like that, right? Like, they know intellectually where they should be, but they can't get there psychologically. People sometimes get mad at themselves for that too, yeah, yeah,
Erika Forsyth, MFT, LMFT 29:30
right. Or experience shame. Like, why can't I? Like, I know, I know where I want to go, I know what I want to do, but there's something interfering with me getting to that.
Scott Benner 29:40
Yeah, is there a way to help manage the shame while you're giving yourself the time to figure it out?
Erika Forsyth, MFT, LMFT 29:46
That's a great question. I mean, that's that's part of what therapy is about, but also reminding yourself you are undoing if it took you five years to get to this place you've been managing with keeping yourself. Yourself above 150 for safety. I'm just making up that number, right? It's going to take time. It might, I mean, hopefully not five years to change that, but it is going to take time. So just reminding yourself, like, Okay, you're moving the needle, and it might be just really slow, but to say, Okay, I'm changing. I'm being patient. I'm going to be kind to myself.
Scott Benner 30:19
Patience. That's what I was thinking. You have to find a way to be patient. I mean, that's a thing. I think everybody's got to find a way in their life to do that. I was not patient as a young person at all, and it it just really did. It takes a lot of time to stop thinking about it's ironic, right? It takes a lot of time to stop thinking about time like it's judging you. Yes, you know what I mean. And instead of just existing and being, and this does, this takes what it takes, and it will be as long as it is going to be, but at the end, we're going to be better off. Let's not worry about whether it's a week, a month or two years. Honestly, the losing weight for me was my last step in becoming a more patient person. You know what I did first to try to teach myself patience. I started growing cactuses because they grow so slow and so I would just think of, instead of like, I want this thing to bloom and grow and get to its full size right away so I can enjoy it. I bought a thing, and I said it could take me three years for this thing to grow to eight inches tall, and I have to be okay with that. I realized I wasn't very patient, and I started with a cactus to try to teach myself patience. So, you know,
Erika Forsyth, MFT, LMFT 31:30
that is, that's such a beautiful thing. I mean, it's, it's really hard to do in our culture when we have this, you know, immediate gratification type of culture, and, you know, do this for seven days, and you'll feel this way and look this way and drop this many pounds.
Scott Benner 31:46
Yeah, everybody wants it so fast. I have I'm I'll continue on with my stupid story for a second. I have three bushes around my mailbox. They get these yellow flowers on them. So the year you get them and plant them, they're going to have the yellow flowers. But as they're acclimating to the new place you put them, it takes two seasons for the yellow flowers to come back. So I put them out so pretty. Just it sets off the whole thing, you know. And the next year comes along, they get green, and they just sit there, green. And I was like, What is that like? Where are my yellow flowers? So I went and I looked it up, and I was like, two seasons like. I said, What the heck? And I was like, Okay. I just was like, okay, like, this year they're green bushes. Next year they're going to be green bushes. And I swear to you, I had forgotten about it, like in my mind, there are just three green bushes at the mailbox. And I am not lying to you. I can't believe this is coming up right now. The other day, I was pulling into my driveway, and I was like, oh my god, the yellow flowers. I was like, they're back. And it felt so satisfying, like that they were there. I was just like, awesome. Like, now I'm gonna get yellow flowers every year because I waited two years. I'm bitch
Erika Forsyth, MFT, LMFT 32:54
about that. Like, that's like, making me feel emotional. I don't know why.
Scott Benner 32:58
Oh my god, Eric, is cry. Are you crying? I don't
Erika Forsyth, MFT, LMFT 33:01
know. It's bringing tears to my eyes. I think it's like a beautiful illustration of patience.
Scott Benner 33:06
I swear to God, this happened. Like, I am not making any of this up. I just pulled it. I was like, Oh, I got my flowers. I was like, awesome. And I was like, they're gonna be yellow all summer. It's gonna be wicked. And like a next year, next year. I was like, I did it like, but it really did somehow more meaningful that I had to wait for them. Like, I know this is not me. Like, you know, it's not like I had to do sit ups every day to get a six pack for 20 years or something like that. But like, it was really a, I don't know, I just, I was really, I just felt grateful that when I realized that was gonna take two more seasons, I was just like, Okay, I guess that's just what it is. And I'm telling you that losing weight, like, I tried so many times, like, oh, in two weeks, I lost this many pounds. In a month, I lost this many like, I'm and then, you know, six weeks later, you're like, I can't keep doing this. Like, it's taken forever until I realized that it's the framing of the time that's when it all became easy, like, now I'm here, like I'm where I mean to be. I just said this with Jenny the other day, but you're one of the only people that looks at me all the time, like I'm a completely different person than I was two years ago. You are if I would have said I need to be here two weeks from now when I started, that's unreasonable. It wasn't going to happen. So anyway, like, if you're struggling with this, like the amount of the time isn't important. What's important is if you get there, yes, that's all. I'm sorry. That was 110 points. I just spoke 10 minutes on. I'm sorry,
Erika Forsyth, MFT, LMFT 34:29
but it is really crucial, because I do hear people getting frustrated with themselves, you know, okay, we talked about this once, and I'm still, I still can't do it like that's it is okay, and you're normal.
Scott Benner 34:43
I am overwhelmed by the number of people I see who beat themselves up or even sometimes mad at me, like I listened to your episode, and my a 1c, is not six. I'm like, Well, you don't, you know it's not that quick, that kind of thing, like, and I know how badly you want to get to the thing, but there's a process. Yes. So anyway, I'm sorry, you're you're next. No, it's good.
Erika Forsyth, MFT, LMFT 35:03
I think we mentioned this already, but I think it's important as you are starting to kind of face or if you're wanting to make changes around the fear, if it's impacted your quality of life, if it's impacted how you you know function, make decisions if it's impacted your management. And you're saying, Okay, I want to make changes. Also, just holding that as you are leaning into making some changes, you might experience increased levels of anxiety, which also, as we know, can feel like you're low. And so we're going to kind of walk you through some, hopefully some helpful tools. But I think it's important just to validate that like it is, it's, this is a complicated thing. As you're facing your fear, you're feeling the anxiety, and then that can trigger, oh my gosh, am I low? No, I'm anxious. I'm anxious about being low. It's, it is, you know, just a big thing to tackle. Yeah, okay, okay. So I think first we want to really understand the thoughts that are driving the behaviors. And we've talked about cognitive behavioral therapy, it's really has an emphasis on how our thoughts and our feelings impact our behaviors and vice versa. It's the cognitive triangle. You can start one way. You can start with your behavior, which might impact your thoughts and how you feel. Oftentimes, we are responding from our thoughts most of the time. So for example, if that thought is driving you, the thought of, if I go low, I'll pass out and no one will be there to help me, right? That's a pretty powerful thought. Yeah, yeah. That thought is going to make you feel anxious. I'm sure you're feeling the anxiety. If you're, if you're living with that thought driving you kind of all day long, then your behaviors are what we've talked about. You're going to reduce your basal, your suggested basal rates. You might eat more carbs. You might correct at a higher number, because that thought is, if I, if I go, if I dip below this number, I'm not going to be okay. And so that's impacting your behaviors and your feelings about it, okay? So what we want to do is challenge and examine that distortion, right? Whether that's kind of, that is kind of a catastrophic thought, right, that if this, if I go low, this is going to happen. And that feels like it's going to happen for sure, even though we can step out of our body and say, well, we probably isn't, yeah, it's harder than just changing your thoughts. But that's where you're going to start. So you're going to write down next to wherever your mirror, your kitchen table, in multiple places. I've gone low before, and I've treated it. And I have my my tool, my safety tools. So you could say I have my CGM, my glucose tablets, so and so is following me, and so you have that posted and printed everywhere. Yeah, okay, so that's what you're kind of living you're kind of meditating on that,
Scott Benner 38:06
Okay, should I keep going? I was just going to tell you that this helped me so much when I had back pain when I was younger person, just the idea of, like, the first time I had pain, that I went to a doctor, and the doctor told me there was a problem, and then I saw my back as broken, and then it hurt again, and it got worse, and it became like psychosomatic, I guess is the best way I can put it. I don't know if that's the right phrasing, but I read John sarno's book about back pain, and he told me to repeat, in my mind, my back is not broken. I'm okay. I'm not injured. I'm okay, and that helps so much. I can't begin to tell you. So anyway, yes, you can keep going. But
Erika Forsyth, MFT, LMFT 38:44
so that's so good. I mean, it is. I know it can become changing your thoughts. People can. It might feel like, well, it's, it's not as easy as that, and it isn't, but it's part of, that's part
Scott Benner 38:56
of stupid. The first time I read it, and then, yeah, then I did it and I did it and I did it, and I don't have to do it anymore. So
Erika Forsyth, MFT, LMFT 39:02
yeah, yes, easier said than done, particularly when you are starting to see the arrow diagonal down or straight down, regardless of the number. So again, I keep saying 150 but maybe your number is 200 and we kind of talk about like you have a psychologically safe range, right? If you're living with this intense fear most of the time, you've created the psychologically safe range that you feel comfortable in. But what we're wanting to do is get you to a medically safe range. Okay? So we're going to talk through some steps, and this is kind of a bit of exposure therapy, graduated exposure therapy. So as you're thinking about right now, what your psychologically safe range is, we're going to move you step by step, trying to get you to a medically safe range for one specific tool. I read this. Where is. Reframe your CGM, if you use one, if you don't, maybe reframe how you see your blood sugar meter. Use it as a safety net and not a threat detector. Yeah, I just love that. So you're, you're looking at your numbers, and instead of when we see the arrow down, be like, Oh no, I'm going, like, I'm going down. I'm gonna die. I'm gonna I'm gonna pass out. I'm not going to be okay. I'm feeling really scared to then to say this is also part of kind of changing, being aware of your thoughts is, oh, this is, this is my safety net. This is helping me. This is telling me I'm going low, but I'm okay. I have my tools, I have my my glucose tablets. I have all the things I need right here, right
Scott Benner 40:45
I want that beep, that beep, that beep, is there ahead of time so that I can stop a problem from happening. This is why I would preach all day long that your high alarm shouldn't be 400 or three. You shouldn't be like I don't want the thing to beep, so I'll turn the alarm off. You want it to tell you when you get to 130 so that you can stop the 130 with a tiny bit of insulin that is not going to make you low later. Like, this is, it's so funny that we're getting to this, but like, this is the basis of the Pro Tip series, right? Like, is that bumping and nudging and using small amounts of insulin to keep yourself in range so that you don't have, you know, emergent problems, high or low from all the insulin or the waiting and the mist timing of the insulin that can come from the waiting. It's interesting. Go ahead. I'm so
Erika Forsyth, MFT, LMFT 41:30
sorry. Yes, yes. And that's like the management side, like the How to side, yeah. And what we're trying to kind of fill in the blanks of, okay, what the feeling and the thoughts are driving some of those behaviors? So for like, the high alarm, if the if you're kind of psychologically safe, range is, oh, I'm okay, up until 250 we want to slowly bring that down. I think, to start with, I would suggest, most of the time, if you're living with this intense fear, you're looking at your CGM all of the time, or a lot of the time, at least. That's what the research shares. That's what I hear a lot, is you are just you're constantly staring at it. Okay, so we want to do two things. We're going to talk about, kind of the the ranges, but also, as soon as you get that urge to look at your CGM, you want to wait one minute. And that this is for people who are looking at all the time. If you're looking at it every five minutes, then bump it up by one minute. Wherever you are, bump it up by a minute. Okay, so that's part of the exposure therapy. So you get that, you feel this urge. I'm like, Oh, am I? Where am I? You're gonna pause, set a timer for a minute. Okay, okay. You're gonna do your deep breath. You can do your grounding activity. You can set a timer and do a loop around the space that you're in. You can say your mantra, I'm okay. I have my my glucose, I'm safe. You do the 12345, right? The Yeah, you can do the grounding technique, yes, okay, okay. So obviously you want to increase that. So you are going to experience, as you increase the time of looking at your CGM, you are going to experience anxiety, and that is okay. And so that's we're wanting to distract yourself by these coping mechanisms of deep, breathing, grounding exercise, whatever it may be. And then you get to reward yourself. And so increasing that from every one minute, five minutes, 10 minutes, hour to after meals, then then building in the trust with the alarms, yeah, okay, like with, you said, with the high blood sugar of the, excuse me, the high range number, most often people are setting or creating a higher like, let's say like 150 to 250
Scott Benner 43:58
for example. So with graduated
Erika Forsyth, MFT, LMFT 44:01
exposure therapy, if we're trying to bring you back into a medically safe range, you're going to go slow so you're going to move it by this is kind of going back to the patients and time piece. Yeah, it doesn't really matter if you're bringing your range down by one point or five points, you're doing it really slowly and in that you are again practicing coping mechanisms to calm your your nervous system, while same simultaneously increasing your kind of that frustration tolerance, that anxiety, as you Reduce the ranges. Does that make sense? Am I making sense?
Scott Benner 44:43
So you're trying to, like, extend that hyper vigilant space to keep like, I don't know, like your cortisol or your adrenaline from happening so frequently, right? And is that, am I making sense? Okay, yes.
Erika Forsyth, MFT, LMFT 44:55
So you're you're wanting to swing from being kind of hyper vigilant. To just like appropriately vigilant, right? Because it's it's impacting the quality of your life, emotionally and physically and so again, this is going to take time by reducing these numbers. And this is again building, then building, and trust with your alarms and with your body, the slower you do it, the better, honestly, because it will feel too scary. And then, as you're reducing your ranges and becoming more comfortable with being lower, you're also building trust with your body. You're building trust with your blood sugar. You're building trust with your insulin because you have these like micro increments that are also changing the way you're thinking, okay, so every day your range is lower and you don't crash and you don't have a seizure, you're building in more and more kind of mass experience to replace those cognitions, those distortions, with actual truth, like, oh, okay, I'm 149 and I didn't crash, yeah, I didn't I didn't have a seizure. Okay, I'm 148 I'm okay. As you're kind of playing around with this exposure to lower numbers, it's really important to have that you know kind of off the top of your mind, or that you work for you. So again, whether it's five finger breathing, it's flower candle breathing, it's putting your hand over your heart and doing five deep breaths, doing 54321, or 321, grounding, having something you enjoy in the house or in your workplace that you know you okay when I when I experience this scary moment, I'm gonna do X, Y or Z to calm my body and distract myself until I get to look at My CGM.
Scott Benner 47:00
Okay. That episode, by the way, 913, is the 54321, method that you and I went over if somebody wants to go listen to it, if they're looking for
Erika Forsyth, MFT, LMFT 47:08
a coping mechanism. Yes, awesome. Thank you. Yeah, thank you. That's basically grounding yourself to the present moment, using your senses, identifying things you can see, touch or hear. You can also add in smell and taste, but oftentimes it's easiest to do those, you know, sight, touch and sad sound.
Scott Benner 47:29
You know, I think maybe too it's probably important to remember that that feeling of a falling blood sugar or low blood sugar, it's probably mimics pretty closely anxiety to begin with, right? So if you're anxious and then that happens, the ramping up is is probably significant for people who are experiencing it.
Erika Forsyth, MFT, LMFT 47:47
Yes, and I think you know, there's the the physical fear again, of wanting to avoid feeling the low. And if a lot of what is preventing you from being in a medically safe range is not wanting to deal with it socially or publicly. I would also encourage you to kind of think about what is your relationship like with diabetes, right? And how which is a huge topic, right? But if you are constantly making decisions at your own expense, but to protect the other people around you, for example, if you're already eating out at a restaurant, maybe you're going low, or maybe you don't want to go low, so you're keeping yourself higher because you don't want people to have to feel uncomfortable with you having to correct or do anything you know that feels different in a public space, You are putting the comfort and needs of other people before your own medical safety. And I get that it's uncomfortable to feel low in public. It just is. It really is getting to a place of acceptance and understanding. You also need to take care of yourself, even if it makes other people feel uncomfortable if you have to get your supplies out in front of other people. Health
Scott Benner 49:04
First, I've been feeling organized since she was little, you know, like there's people who are gonna look weird or say something, we don't care about them. We care about you. We care about doing the right thing for you. That's step one. I felt for her, and I feel for anybody else who who is in a public situation and realizing that they're being looked at or judged, and it's hard for them, like, I have to tell you, like, it's not in my personality to care, but I speak to a lot of people who do, and the way they describe it to me, it's debilitating for them. They freeze because they're so concerned, and it's not, it's not just a conscious decision to be concerned about what other people think. It just is like, I don't make a conscious decision to kind of not care, like it's just wiring, you know what I mean? So you got to find a way to put yourself first.
Erika Forsyth, MFT, LMFT 49:53
So yes, and it's and it's a journey, and there's no going back to the time, you know. Like we need to you need to be okay with being okay in public, but certain age, yeah, that you everyone is on their own journey.
Scott Benner 50:10
It should be a goal of yours to try to get to that no matter how long it takes.
Erika Forsyth, MFT, LMFT 50:13
Yeah, I think it's, it's acceptance of the diabetes. It's acceptance of of you living with it. And it's not all of you, right? But it is. It is a part of you, yeah? But it's, it takes work,
Scott Benner 50:27
okay? You've done it again. In my opinion. I feel like, what's that cartoon Phineas? J whoopee, we've, what is that exact I can't, oh, my god, no. I said, so old. You don't know. Trust me, no, I don't know, but what is it? He said, finish. We've done it again, like they're just like, congratulating each other anyway. That's what I felt like just now. I felt like, what? All right, hold on a second. I'll look it up real quick.
Erika Forsyth, MFT, LMFT 50:50
So a cartoon that says we've done it again, I think
Scott Benner 50:53
he's a Phineas. He's like, yes, hold on, Phineas. J won cartoons, I don't worry. I've put chat GPT on. That's figuring it out right now for me. Okay, okay,
Erika Forsyth, MFT, LMFT 51:04
I'm like, I got a song that came up that I don't think a
Scott Benner 51:08
walrus. Is he a walrus? I swear to God, I haven't looked yet. If I'm right about him being a walrus, like, I'm gonna be like, cartoons used to not be as good as they are. Now, those of you who grew up are like, Oh yeah,
Unknown Speaker 51:19
I'd say they were actually better. I've seen Toy Story. You
Scott Benner 51:21
would not have enjoyed this if you think Toy Story is what it needs to look like. Also, Toy Story is 20 years old. So, yes, all right, here it goes. It's Tennessee tuck Oh my God, I am so old. It's Tennessee tuxedo. It's like a cartoon from the 60s. And I'm pretty sure,
Erika Forsyth, MFT, LMFT 51:38
okay, I have it up. Oh my gosh.
Scott Benner 51:41
There's no way you know any of this. Like, it's like,
Erika Forsyth, MFT, LMFT 51:45
it is a walrus and a penguin. It looks like a penguin and a walrus.
Scott Benner 51:51
I think the penguin would say to the walrus, if I'm not Jesus, anyway, I listen. Let's stop this. I hope you're not afraid. I hope you're not afraid of hypoglycemia after this or that. It helps you somehow. Oh, but anyway, I think Tennessee tuxedo would say to the walrus, Phineas J Whoopi, we've done it again. That's what I just thought. This could be early onset.
Erika Forsyth, MFT, LMFT 52:16
It must be a Friday,
Scott Benner 52:17
yeah, this could be dementia coming. I'm not gonna lie to you. All right, thank you so much. I really appreciate
Unknown Speaker 52:23
it. You're welcome.
Scott Benner 52:26
I've restarted the recording because I just got the return. I've mashed together 219 60s cartoons. This is what chatgpt tells me. So apparently in Mr. Magoo, they used to go, oh, Magoo, you've done it again. And Phineas J Whoopi would be told by Tennessee tuxedo after every lesson, Phineas J Whoopi, we've done it again. Oh, Phineas, you've done it again. So I'm misremembering the lines, but the lines were actually, Phineas J, whoopee, you're the greatest and, oh, Magoo, you've done it again. And my brain has melded those two together into Phineas J, Whoopi, you've done it again. How about that? By the way, I'm the only one listening to the PI even if Erica re listened to this episode, she shut it off by now. But like, I'm she's like, I'm not listening to this bullshit. Like we already did the thing with the free guy. See me. I'm trying to get the Saturday anyway. Oh my gosh. So everything you think you remember, you probably don't remember, and I'll see you later. Goodbye. Yeah, the podcast episode that you just enjoyed was sponsored by ever since CGM, they make the ever since 365 that thing lasts a whole year. One insertion every year. Come on. You probably feel like I'm messing with you, but I'm not. Ever since cgm.com/juicebox today's episode of The Juicebox Podcast was sponsored by the new tandem Moby system and control iq plus technology. Learn more and get started today at tandem diabetes.com/juicebox check it out. Dexcom sponsored this episode of The Juicebox Podcast. Learn more about the Dexcom g7 at my link. Dexcom.com/juicebox you Thanks. 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, Oh, 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. 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. Hey, what's up, everybody? If you've noticed that the podcast sounds better and you're thinking like, how does that happen? What you're hearing is Rob at wrong way recording doing his magic to these files. So if you want him to do his magic to you wrong way recording.com you got a podcast. You want somebody to edit it. You want rob you.
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