#1660 Kind of Type One
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Julie Davis, 39, is a medical PA and dietitian with Type 3C diabetes. After chronic pancreatitis led to pancreas removal, her islet cells were transplanted—an incredible twist in her autoimmune journey.
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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
Friends, we're all back together for the next episode of The Juicebox podcast. Welcome.
Julie 0:14
Hi there. I'm Julie, and I have no pancreas.
Scott Benner 0:17
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Julie 2:13
Hi there. I'm Julie, and I have no pancreas. Joy.
Speaker 1 2:17
Do you want to hear something insane? Sure. I did an interview yesterday with a woman who is type 3c
Julie 2:25
really, there's not a lot of us.
Scott Benner 2:27
And then I was sitting last night doing my work. I know people think, what work could you possibly have, Scott? But I was, I was I was up late watching the Phillies play and working. And I thought, Oh, let me see what I'm doing tomorrow, because Julie on Friday, tomorrow, tomorrow, yeah, I'm flying out to Orlando to speak at the touch by type one conference. And so I was like, oh, it just hit me. I'm like, if I'm recording tomorrow, which I probably am, that'll be my last one for a few days. Like, I'm gonna get a couple days off. I wonder who I'm gonna be talking to. I'm gonna be talking to Julie, and I opened up your notes, and it's like, and I was reading down, I thought, that's insane. Like, yeah, did I put something online that got people to reach out on the same day or but that doesn't make sense either, because when people go to the schedule, they're not picking, like, the next available day. They pick all over the place. So anyway, randomness of randomness. Here you are. It's wild. Yeah, what happened to you that you ended up in this situation?
Julie 3:27
Long story. We'll keep it long, I guess we have time. I had autoimmune pancreatitis, along with a lot of other autoimmune conditions that I'm sure we'll touch on. And in May of 2024, had to have my pancreas removed because it decided to act up and was not getting any better. And that was kind of the last resort.
Scott Benner 3:50
Okay, so how
Speaker 1 3:51
old are you now? 39 How old were you the first time you thought I have autoimmune issues?
Julie 3:57
Oh, well, I was diagnosed with celiac disease at 18, okay, and so that was the first and then ulcerative colitis was at 21 and then the autoimmune pancreatitis started when I was 25
Scott Benner 4:11
No kidding, and you are married now I am. Yeah. How old were you when you got married? Oh, 30. Okay. You have any kids? I have three kids, three. Wow. Yeah, that's, that's the number of kids it is. Yeah, we have three girls. Oh, wow, congratulations. That's lovely. Sounds hard. May I be honest? That sounds horrifying?
Julie 4:32
Well, you want to hear how it's more horrifying. They're twins, and then another one. So oh
Unknown Speaker 4:37
my gosh,
Julie 4:38
yeah, no, it's great. They're wonderful.
Speaker 1 4:40
It's great. They're wonderful. In case they hear that. Yeah, Arden and I were going to bed last night. We were the last two up. We were just kind of messing around and talking, and she was doing some homework and and I was, like, excited. I was working, and then I was she's like, I'm gonna go to bed. I'm like, me too, but you know, I'm gonna do the dishes for like, I'm the one that's gonna load the dishwasher at the end of the night, so I'm doing that. And she. Comes over to me, and she just goes, Can you imagine if you had another daughter? And I said, No, honestly, I can't I said, You're enough of a problem. I don't know if I could handle more people.
Julie 5:12
Yeah, we're kind of in the thick of it there. The twins are five, and the youngest is three, and so I think this, this stage is hard, and then pray for me in about like, seven or eight years, when they're all, like, pre teens, teenagers.
Scott Benner 5:24
I like that. You think this is the thick of it. You're never not going to be in the thick of it. Yeah. So, okay, so you have this kind of, you know, histrionic layering of different autoimmune issues. Let me ask you, in your extended family, does this also exist? Celiac, etc,
Julie 5:40
you know, I'm the first who was diagnosed with celiac, but I suspect my my grandmother, on my mom's side, may have had something, you know, going on. She had less of GI issues. My mom has dermatomyositis, which is pretty rare, and then my sister has Hashimotos. I also have hypothyroid, which I assume is Hashimotos. We just never checked antibodies initially, before I was treated, I
Scott Benner 6:03
see, I'm sorry, did you say your mom has the onomatopoeia? What does she have? Dermatomyositis?
Julie 6:09
It affects the skin and muscle tissues. It's another autoimmune condition. Oh,
Scott Benner 6:14
is that like a weakening of the skin and muscle? It's
Julie 6:17
inflammatory. It can kind of affect the proximal muscle group, so like, your hips and shoulders, joint pain, kind of arthritis, kind of in the RA, kind of, I say, I say, okay, family, I guess if you will,
Scott Benner 6:32
okay, let's talk about it. Let's go through it. Celiac, what's the adjustment like? What's the impact like, psychologically?
Julie 6:39
So I was diagnosed in 2004 before being gluten free was cool, and now it's much easier. I had GI issues, kind of growing up my whole life. I was baller ballerina. Had issues that I had to kind of work through with that and trying to, you know, navigate bathroom issues and dancing and all of that. And went to the doctors, you know, growing up, and they, they tested me for Crohn's and Colitis when I was younger, and that was negative at that point in my life. But then when I was 18, I got re scoped, tested, and they diagnosed me with celiac. Went gluten free. It was very difficult. At that point, everything tasted like cardboard, and there weren't, you know, gluten free restaurants everywhere nowadays, you can kind of go anywhere and find something, but did pretty well once I got gluten out of my diet for four or five years, and then in college, started having GI symptoms again. And I was like, I swear I'm not, like, cheating on my diet, I promise that. You know, yeah, it's going well. But started having GI symptoms again. They did another scope and diagnosed me with alternative colitis at that point, and so started on some medications for that, and did okay, really, until the pancreatitis stuff started, the UC kind of progressed, and I was started on a biologic medication. And I think that's when it really kind of hit me, oh, this is like, kind of a big deal, you know, going in to get IV infusions and whatnot. And was doing okay, but then I they added on another medication, and I got pancreatitis. They initially thought it was from the medication they gave me, so they stopped that, and then I just kept getting pancreatitis, kind of back to back to back. Over a course of six months, I was in and out of the hospital, and like, four or five times, I think right, ended up going up to Mayo Clinic to get a special biopsy, and that's when they diagnosed it as autoimmune pancreatitis, type two, which is frequently linked with ulcerative colitis. And so it's the more rare type of autoimmune pancreatitis treated with steroids for a while. By that point, it was already chronic. So my pancreas already showed signs of damage. I already had this extra current pancreatic insufficiency. So as you know, your pancreas does more than just provide insulin. Yeah, so I had to start taking pancreatic enzymes, and that helped kind of regain weight and kind of get back to a better baseline. And I did fairly well for a while. I was getting endoscopic nerve blocks about every four to six months, so going under for the pain. Okay, chronic pancreatitis is very painful, so I would get a nerve block. It would work, you know, it would hurt for a few more days, until the steroid part kicked in, and then it would help for about four or five months, it would start to wear off. I would go back and get another one. Did that for about 12 years, and then the nerve block stopped working in the fall of 23 and so I, you know, I started losing weight, couldn't really eat, lots of pain. Got to the point where I was like, Okay, this isn't this isn't cool, because I was doing so well, like I had all three of my girls did well through pregnancy, postpartum, all that, and then just. Really couldn't handle the pain, couldn't keep my nutrition up, lost a lot of weight, met with my GI doctor, and we were kind of like bouncing ideas around. We tried another nerve block just to see if maybe they didn't get the right spot the last time, and it didn't work. And so I started kind of digging on my own, and started reading about the surgery that I ended up having, and it was, it was a big decision to make. I mean, taking a whole organ out, and at that point, I never thought it would be my pancreas that would be removed. I thought, if anything, it would be my colon, because my ulcerative colitis, whenever the pancreatitis started, had progressed to like pan colitis. They were talking about possibly removing my colon during an ostomy, all of this. But thankfully, the the infusions worked, and they have worked for quite some time, as far as that condition that's in remission, so that I'm still on the infusions about every eight weeks now, but yeah, decided to get my pancreas removed, and it kind of went fast from there, met with the surgical team in February of 24 and had it out in May of 24 so pretty quick process, once I made the decision to get it removed,
Scott Benner 11:11
would you describe the pain for me? It felt like
Julie 11:15
there was someone stabbing me between my rib cage, like right underneath my sternum constantly, and it radiated to my back, lots of nausea and just constant gnawing pain.
Scott Benner 11:29
It was terrible, and it would last for how long? When it happened constant,
Julie 11:33
like, it just didn't stop. Like, yeah, once the nerve blocks stopped working, it was just always there.
Scott Benner 11:38
Wow, did the nerve blocks have any unintended consequences that you didn't like or
Julie 11:44
No, I mean, they always made me hurt for a few days after, because you learn I'm a PA. And when you go through any kind of medical training, you learn like, don't mess with the pancreas, and you go in there and you stick a needle in it, you know it's gonna hurt for a few days until the the medications kick in, but then after that, like it, it did its job, it did what it was supposed to do. And not a lot of people get the relief from that kind of procedure, but it worked for me for 12 years, and so I was kind of caught off guard when it stopped working. Yeah,
Scott Benner 12:16
no judgment for me. But were you self medicating anything for the pain, or just sitting there and suffering?
Julie 12:21
No, I mean, I had a PRN prescription for pain medication, but didn't really like to use it. I don't like the way it makes me feel. You know, I got to the point towards the end there, before surgery, that I was having to take it at night, like I would just suck it up during the day and take it at night so I could sleep. I haven't had a lick of alcohol in years. I mean, it's just it wasn't caused by that. A lot of people think pancreatitis is only caused by, you know, drinking too much.
Scott Benner 12:46
But do people think that?
Julie 12:48
No, I think a lot
Speaker 1 12:50
of people do. Okay, no. I just meant, like, did it get so overwhelming that you were like, oh, I'll just take a little heroin or, you know, like, something like that. I mean, because pain is constant, pain is difficult to put into context. Yeah, it is. I mean, it just wears you down after a while, mentally, physically, yeah, emotionally, the whole thing, right? How did you manage dating and all that through that? That's crazy, like
Julie 13:14
did he, you know, during my dating life, I mean, everything was pretty well controlled with the nerve blocks. I met my husband. He's a physician. I'm a PA. We met in med school. PA school, okay? And he kind of knew off the bat, like I told him everything, you know. Because I'm like, Hey, I come with all these problems, you know, you still like me. And ironically, shortly after we started dating, I was, it was in the middle of PA school, I got admitted to the hospital for a little flare up. And I was like, okay, you know, if he sticks around, he's in it for the long haul. Yeah. And that was really the last flare I had. That was, I think, 2016 until everything started going awry in 2023 you could
Scott Benner 13:55
have just said I had him on the hook already, Scott, and I would have understood. But Well, that's, that's like, I mean, a lot of people bail on medical stuff, so that is very cool. Geez. I was struck, I think most, by your story, that you felt like you were preparing to have your colon removed. You've probably heard me talk about us Med and how simple it is to reorder with us med using their email system. But did you know that if you don't see the email and you're set up for this, you have to settle up. They don't just randomly call you, but I'm set up to be called if I don't respond to the email, because I don't trust myself 100% so one time I didn't respond to the email, and the phone rings the house. It's like, ring. You know how it works? And I picked it up. I was like, hello, and it was just the recording was like, US med doesn't actually sound like that, but you know what I'm saying? It said, Hey, you're I don't remember exactly what it says, but it's basically like, Hey, your order's ready. You want us to send it? Push this button if you want us to send it, or if you'd like to wait. I think it lets you put it off, like, a couple of weeks, or push this button for that. That's pretty much it. I pushed the button to send it, and if. Days later, box right at my door. That's it us. Med.com/juicebox, or call 888-721-1514, get your free benefits checked now and get started with us. Med, Dexcom, Omnipod, tandem freestyle, they've got all your favorites, even that new eyelet pump. Check them out now at us, med.com/juicebox or by calling 888-721-1514, there are links in the show notes of your podcast player and links at Juicebox podcast.com to us, med and all the sponsors. Let's talk about the tandem Moby insulin pump from today's sponsor, tandem diabetes care, their newest algorithm control, iq plus technology and the new tandem mobi pump offer you unique opportunities to have better control. It's the only system with auto Bolus that helps with missed meals and preventing hyperglycemia, the only system with a dedicated sleep setting, and the only system with off or on body wear options. Tandem mobi gives you more discretion, freedom and options for how to manage your diabetes. This is their best algorithm ever, and they'd like you to check it out at tandem diabetes.com/juicebox, when you get to my link, you're going to see integrations with Dexcom sensors and a ton of other information that's going to help you learn about tandems, tiny pump that's big on control tandem diabetes.com/juicebox. The tandem mobi system is available for people ages two and up who want an automated delivery system to help them sleep better, wake up in range and address high blood sugars with auto Bolus,
Julie 16:41
yeah. I mean, at one point that was, you know, part of the discussions if the infusions hadn't worked, and they talk about that. I was 25 when I went up there, so I went up there for my pancreas, but I saw the IBD team, ulcerative colitis team as well, and they were like, Yeah, you know, it's not just your pancreas that's messed up right now. It's your colon. It's like your whole GI tract. So they kind of presented options, and they said, if the medications don't work, we might have to remove your colon, but then you would probably have an ostomy until you're done having kids, because if you put it back together, then, you know, there's scar tissue that could make issues, you know, with that. And so, I mean, there were so many things to think about when I was 25 and, you know, just kind of living my
Scott Benner 17:25
life. Yeah, I was gonna ask that you had, did you have any backup from family or anything during this?
Julie 17:30
Yes, I have very supportive family. My mom went up there with me, my now husband, his family has been great through this whole process. So awesome. We've got a lot of support, thankfully. I'm
Speaker 1 17:41
going to ask a bummer of a question, sure. Do you worry about your girls?
Julie 17:45
I do all the time. You know, actually one of them has already been diagnosed with celiac because we started screening early, and there is actually type one on my husband's side of the family. And so I worry, just with the autoimmune kind of history on both sides, and I'm a medical professional, so I kind of, I get overly concerned about certain things, and I am, like, not concerned about other things. So it's kind of, you know, picking your battles and just trying to stay on top of everything,
Scott Benner 18:15
telling me your girls are out of the sunroof doing donuts, and you're like, that's fine. I don't worry about that. I got enough to worry about over here with this autoimmune stuff. You
Julie 18:23
know, actually, one of the youngest she fell off her day, her chair at the dinner table the other night and broke a clavicle. And I just was like, Okay, we're going to urgent care, get you in a sling, and you just kind of like, roll with it. You know, it's, it's terrible. I feel bad for her. She's only three, but, geez, just doing what I do for a living. I was kind of like, okay, what
Speaker 1 18:43
goes next? Talk about, if you would? I mean, I was gonna sound overly dramatic, but would you talk a little bit about the feeling of, like your body, kind of like repelling against you constantly. And, yeah, what does that feel like when you're when you're existing through it?
Julie 18:59
You know, it's, it's frustrating, because sometimes you get to, you know, that kind of woe is me, like, Why? Why do I have to deal with all of these things when other people, you know, all they the worst they ever get is, like a cold. And I'm like, you know, how many things can one person handle? I try to just take it day by day. And, you know, just deal with it, move on with my life. I think that most people you know who know me, they are like, Yeah, I mean, you would never know that you've got all these things that you're managing, because you just kind of deal with it and move on. I think sometimes there's a little bit of doing that too much where I don't want myself just like, accept the fact that this kind of sucks, you know, yeah, I think it's acknowledging, yes, it could be worse, but what I'm dealing with is actually pretty terrible. So, yeah,
Speaker 1 19:51
I interviewed a guy once who had, I don't know the technical term for it, right, but he had his whole, like, that colon and this, everything was just gone, right? And he got the he had. Bag and everything else. And it was from the same thing, like, he couldn't, like, live, yeah, he's constantly, you know, sick or in pain or in the bathroom, you know, like, etc, and just kind of horrifying. It's one of those episodes I didn't know what to say to him half the time, yeah, when he was telling his story, because you're just like, oh God. Like,
Unknown Speaker 20:18
it sounds so like, I think it's,
Scott Benner 20:21
I'm not gonna find the right word, but I think it's hard to, like, see it, because it's about going to the bathroom. And people are like, You know what I mean, like, but you
Julie 20:30
don't really want to talk about your bathroom habits and all that.
Scott Benner 20:33
Yeah, you talked around it. In the beginning. You were like, Oh, I was a ballerina, and I had to, like, you know, like, you didn't want to say, like, you know, I didn't want to myself, while I was like, you know, like, yeah, you're trying to avoid saying those things and yeah, because it all sounds not funny, but like, you know, it's ridiculous, and it's not things we talk about generally, out loud and right? But it's really, really impactful on your life.
Julie 20:54
It is. And I mean, I was a dietitian before I was a PA, and I work, you know, in a children's hospital, and have attended and been a counselor for the Crohn's Colitis camps. I was an adult when I started dealing with all I mean, I guess, you know, the symptoms started when I was a teenager, but when I was diagnosed, I was an adult, but seeing really young kids go through this, it's devastating. I mean, it's just, you know, you just feel for them, because you're like, I'm having to deal with this as an adult. And even seeing my daughter, who's navigating being gluten free since she was diagnosed when she was three, and just the social impacts on that, and just her saying, Mommy, why did God make me gluten free? You know, like, I don't want to be and it's okay for her to have a tantrum and cry because she didn't get a cupcake at the pre K graduation. But as an adult, I can't do that, you know? And I'm like, I go to a meeting and I can't eat anything unless I bring my own food a lot of the times. And I'm like, Man, I really want to have a tantrum right now, but I can't, because I'm an adult.
Scott Benner 21:56
I don't know Julie, I think it might be awesome if in the middle of a meeting you were just like, there's nothing for me to eat here. This isn't fair.
Julie 22:03
Yeah, I know it's, I mean, that's what I want to do sometimes, and I've been dealing with that for, you know, however long it's been almost 20 years
Scott Benner 22:11
now. Yeah, no. I mean, I can't imagine, honestly, I don't, I really don't know how to like to commiserate with you, even it's very, I think it's much more impactful than maybe first glance would say, Yeah, okay. So, so they, they jump in there and take out your pancreas, and now suddenly, you know, those enzymes are gone. Beta cells are gone. Like, there's, you know, you're not making insulin, you're you wake up. I mean, that's got to be the most shocking part, right? Like,
Julie 22:36
so they actually, it's, it's a cool procedure. It's not cool that I had to have it done. They actually, harvested my islet cells. And so they took my islet cells and put them in through my liver. And so now I have, I have some insulin production from my liver through my own, my own islet cells. They told me beforehand, about a third of people don't need insulin for a period of time, like their islet cells work well, a third of people need some insulin, you know, like a low basal rate, you know, some mealtime insulin, and then about a third of people are like a brittle diabetic. And so my surgeon did warn me that ahead of time, that people with autoimmune conditions tend to not have as great of an outcome. So they, they harvest the islet cells, and they, they have this, like goal number to get, and I got a great number of islet cells, but I, I'm on a pump, so I have, like, partial, you know, partial function of my islet cells. They say I have meaningful function, but I would kind of equate it to like a honeymooning diabetic, because it's very unpredictable. Some days I need very little insulin. I mean, I'm on a pump now, so, you know, I have a basal rate, which is pretty low, and then I need more, I think, at mealtime, than I do basal. But then other days I need, like, twice as much. And so it's kind of going back and forth and having different settings and all of that. So it's been an interesting journey. Yeah,
Scott Benner 24:03
also, I would imagine the gluten free foods are a little more carb heavy too. Yes, yeah. So it's an added level,
Julie 24:09
and I'm not one to like restrict carbs. I like my carbs. I eat my carbs, and so I've learned how to dose for them thanks to your podcast. Yeah, it's been a it's been an interesting ride, and I've learned a lot more, and have a lot more respect for type one diabetics than I ever had
Scott Benner 24:23
before. Yeah, right, especially in your job now, it probably is valuable, yeah, can I ask you swapping the pain for, you know, having diabetes, right? And so is there any way for me to ask you, in a way that you could actually answer, if it was worth it, it was, it was okay.
Julie 24:42
Yeah, there are new challenges, as you know, but I could not function. I was not, you know, I was kind of just going through the motions before the surgery, because I got to the point where I had lost 20 pounds, and I'm. Not a big person to begin with. I was weak. I was just tired all the time, which I'm still tired all the time. But who knows? That could just be having three young kids, but we could wonder what your TSH is. Oh, my TSH is great. I get that checked regularly. Yeah. Do you know what it is? It's like, 1.1
Scott Benner 25:17
it is great. Okay, how about how Hold on. We'll help. Maybe you're having trouble picking up the t3 Have you tried like cita
Julie 25:25
mill? I'm on CDE mill. I've actually been on site Amel since I was diagnosed, almost initially, when I was diagnosed with the thyroid issue, I had a great endocrinologist, or not endocrinologist, she was a primary care and she actually put me on both initially and the funny thing is that I was treated. So shortly after I was diagnosed with celiac, you know, on the gluten free diet, I started to be treated for depression. And it turned out it was really just my thyroid, because I was able to get off of those medications
Scott Benner 25:56
as soon as the thyroid meds came quickly, once I got my thyroid, I'm just gonna say, where did you find a good doctor? That's awesome. You know, I
Julie 26:03
think I just got lucky, and I've had good, good ones since then. My endocrinologist that I see now, she works pretty closely with the the transplant. It's, it's actually considered transplant surgery, but the transplant islet cell team and is pretty familiar with the very unique needs of the kind of type 3c I mean, 3c kind of can be just because you have damage, but it can also be because you have surgery on your pancreas or got it removed completely, like I did. So she's been really great at, you know, helping me manage both my thyroid and my insulin needs afterwards.
Scott Benner 26:42
I wish, I hope that everybody listens, because, I mean, thyroid issues, you know, mixed in with other autoimmune is not uncommon. Yeah, it doesn't mean you're gonna have it, but it's not uncommon. And I just helped a guy online this morning, this morning, who put his thyroid labs up and was asking a different question about the labs. And my eye was like, Hey, your TSH is like, over four, yeah. And I said, Are you taking medication? Yes. And I said, Do you have symptoms? What symptoms? I listed, like, I don't know, 10 or 15 of them, all of them. He's like, I got a lot of these. And I was like, Yeah, your TSH is way too high, yeah. And they What do I do? And I was like, yeah, go back to the doctor and tell him, Look, you need to medicate me under, under. Get me under two is what I you know, is what I said, Yeah. And you say, Oh, that's great. Thank you. Like, nobody, like, how is that the randomness that your doctor was not just, like, on top of it was like, also, here, take some CDE. No, do this. Blah, blah, blah, and that person's doctors telling them, like, you're
Julie 27:36
good, yeah, it's interesting. I don't, I don't know, as a medical professional, I know that we go by, like, evidence base and all of this, but I feel like you have to listen to your patients and, you know, okay, you're still having symptoms. And I, we went through IVF for all three of my girls. And they, those reproductive endocrinologists, are pretty good at, you know, saying, okay, pregnancy, you've got to be in this range, because especially if you're doing IVF, like, they're not, those embryos are not going to stick. If your thyroid is out of
Scott Benner 28:05
whack, it'd be nice if they'd share that with other physicians. That'd be great. Yeah, yeah.
Julie 28:09
So, I mean, I always try to keep mine as close to one as possible. And some, sometimes they check it and they're like, Oh, you're getting a little too hypo. I'm like, or hype, you know, your TSH is too suppressed. And I'm like, No, I'm good. I feel good.
Scott Benner 28:22
So if my eyes start popping out, we'll do something. But right now, I like where I'm at, yeah. Okay, awesome. I like that you're on top of this. How has your experience, personally, medically impacted? The kind of PA you are.
Julie 28:36
I am very detail oriented. I feel like having so many issues that have honestly been kind of in that vague diagnostic range, like my my celiac didn't have, like, the super high antibody levels, but it was diagnostic on a scope. And then my thyroid was never really super high, but I had that great doctor that was like, I think it's your thyroid. It's sub clinical. You know, it doesn't meet these lab criteria, but let's treat you. I think it gives me the motivation to, like, really listen. I work in pediatrics, so I'm mostly listening to the parents, but listen to the parents and say, okay, like I hear you. We'll dig into that further, rather than just being like, Oh, well, everything's normal. How do you
Scott Benner 29:24
have the time to do it when all I hear from people is, oh, these appointments are only 20 minutes long, and I don't have time to do all this with them. And how do you Yeah,
Julie 29:31
I mean, I work in the hospital now, so it's a little different than being in an outpatient clinic. I think you just have to, have to take the time it's I can validate that, like being in an outpatient clinic, they're seeing sometimes, like 30 kids in a day, so they don't really have the time, but finding ways to, you know, work it into your practice and improve your workflow in other ways so that you have the time or have the the I don't know. I guess, systems. It up to where you're able to do that, right?
Scott Benner 30:01
Wouldn't it be awesome if there was a person in the room with you doing the more diagnostic stuff, and then once that person came up with a, you know, a root cause, they could hand you off to a different person and say, All right, now I'll put it in that. Like, let's put the thing into action instead of, like, because you don't have time to stand there and go nuts the bolts, you know, A to Z on it. Like, I don't know functionally, why someone, I'm assuming, because they don't want to pay somebody. But, like, if, where you can't bill for it, or whatever it is, yeah, but it sucks that, you know people like struggle so long to get answers, and they're so close to them, and then they don't get a resolution still,
Julie 30:37
yeah. I mean, there are, there are things that they're kind of implementing to try to improve workflow, like they're doing some AI, like, for charting and stuff like that, which is cool. It's cool to see where, like, medicine is going, because it's all about, you know, the bottom line at the end of the day, I feel like with most of the big, you know, companies, is billing and, you know, seeing more patients and all of that, but you've got to have those workflow processes streamlined so that you can be quick, so you can actually do what you need to do. I
Scott Benner 31:09
see some companies developing AI tools. One of them, I thought was interesting, was, when you're seeing your clinician, you're basically you're being recorded the entire time it's listening, and then as soon as it's over, the complete like, notes are there for charts, the note? Yeah, charts, the note. It's pretty cool. And that way nothing gets missed. And you can, you know, have the AI, you know, kind of cross reference things that maybe a human might miss. Yeah, anyway, interesting stuff. You're good, you you're happy, is probably the wrong word, but, but you're, you're happy to be rid of the pain, I guess. And yes, now you're learning about diabetes. How long ago was this? Again, it's a year or so,
Julie 31:47
May of 24 so almost a year and a half. Okay, yeah. I mean, it's been a journey. I can't even remember when I first found the podcast, but I think I found it with the one you had, one other patient who had the same surgery as me a while back. I think it was like, Jen has no pancreas or something like that.
Scott Benner 32:10
I've had a couple, but they were longer ago. Yeah. And
Julie 32:14
so I listened to that, and then I was like, hmm, what else does he have to offer? And so I started just kind of binging the the podcast and learning all about, like, Pre-Bolus thing and, you know, chicken basal rates and all of this. And like I said, I have a great endocrinologist, but I think I've learned more on just the fine tuning listening to the podcast and kind of digging into that
Scott Benner 32:34
awesome, Oh, that's great. And so you're just searching for people with stories like yours, and that's how you found it. Oh, wow, does your husband get involved in your diabetes care? And if not, is that your decision or his? Or what do you think the vibe is?
Julie 32:51
He follows my Dexcom because he and my mom both follow it, just for safety reasons. He doesn't
Scott Benner 32:57
want to raise three little girls by himself. Is that why? Yeah, yeah. I
Julie 33:01
mean, occasionally, you know, Dexcom will be doing its crazy thing. And I mean, last night, I had to laugh. I woke up this morning after my I had a new sensor on, and it was doing the whole like, every five minutes, turning off, and like, having a sensor error. I ended up pulling it this morning. So I didn't sleep very well last night because it kept going off and I got, you know, the sugar pixel, and so that's beeping and buzzing. And I woke up this morning. I looked at him, I said, I'm so sorry that probably kept waking you up too. He was like, it's fine. You're good.
Speaker 1 33:32
It's okay. Everything's fine. We're gonna live you guys are in
Julie 33:39
your, what, late 30s. I'm actually older than him. Yeah, he's 34
Speaker 1 33:44
No kidding, good for you. Joy, yeah. How'd you do that? How'd you pull that?
Julie 33:50
The funny part about that is that before I went on a date with him, I text my friend, and I was like me, I don't know. I mean, he's only 25 I don't know, but he acts like an old man, so he acts
Scott Benner 34:02
like an old man. So it works yeah, it works out, yeah, right now, oh, I can't say this. Can I say? No, I can't say that. Sorry. I don't do that very often. So, you know, it must be somebody close to me, but I think it's funny because I can't say to a guy, Hey, how'd you pull a young girl? Awesome. But when you but you can say it to women and like, I know, right? I did it, yeah, but you have to find that balance right of like, older soul and right and I'm not wrong, am I that? Like, sometimes women in their mid 20s, because I think women can mature a little more quickly they stop, like, maybe it's not easy to date guys your own age. Is that? Is that kind of how it
Julie 34:43
works sometimes? And I mean, so I had a whole, like, two careers before I went to PA school. So I was a professional ballerina first, and then I was a dietitian. And so I went, I started PA school at 27 And I think some somewhere around there. And he went straight from college to med school. And so, you know, when we're starting to, like, do the married thing, you know, get engaged and kind of look at all these things, I'm like, you've never actually, like adulted
Scott Benner 35:16
college the whole time.
Julie 35:17
And so, I mean, I had to kind of go through some of those things, but, yeah, I mean, he's he's great, he's wonderful. So it all worked out
Scott Benner 35:25
for us. That's right, it's really great. What made you want to do this like, I mean, there's not a ton of stories like yours on the podcast, but, but what made you want to add yours to it?
Julie 35:36
I think because there's not a lot of stories out there, and because I've found just being able to relate to people. I think you hear that a lot doing what you do, that a lot of people come on because they found like community in other people's stories, and just knowing that, like, you're not alone, and there's other people dealing with the same things you are, whether it's having your pancreas removed or, you know, being woken up by your Dexcom overnight. I mean, it's, it's nice to know that there's other people out there dealing with the same thing.
Scott Benner 36:05
Yeah, I appreciate doing it. We kind of talked a little bit already that, like, some of these gluten free foods are higher in carbs and maybe a little more difficult to Bolus for so where can I ask you first, like, where do you have your A, 1c What's your variability look like?
Julie 36:18
You know, my last a 1c was 5.4 the highest it got was post surgery was 5.9 so it's, you know, it's kind of a different story than your, you know, type one being diagnosed in DK. And, you know, these a one CS and the thirteens, because I was not diabetic before, thankfully, and I have the islet cells, and so it's different, but it's the day to day. You know, management is similar, I
Scott Benner 36:45
guess is the best way to put that. Yeah, you said you're in a pump. What pump you on? Moby. Moby. Okay, so you got the tandem, Moby, tandem diabetes.com/juicebox Sorry, I just need you guys to click on, keep making the podcast. So you're wearing tandem. And did they help you set up your insulin needs, like, the they like, because I've heard those stories too, about, like, people get the surgery, and then the surgeon, who's the person you have contact with, is like, well, good luck. You have diabetes now, but we don't help with that. Like, what's, what's that initial
Julie 37:12
I mean, like I said, they work closely with an endocrinologist there who's really wonderful. I was initially on MDI novologinlantis or whatever, for like, three months. And she very quickly was like, I think you're gonna, you're gonna be on this, you know, longer term. Because the the first, I don't know, like, two or three months, your islet cells are kind of just like implanting into your liver, and so you don't really know what your ultimate function is going to be. And so initially they had me on, you know, the MDI, but the problem I was having was I really needed those, like, I almost probably should have gotten on, like the junior pens, because I needed sometimes, just like a half unit once she, you know, got everything set up to get me on the pump. And I got on the pump, I was like, Oh, this is so nice, because I can Bolus just like, a quarter unit, or, you know, a half unit, or whatever, one and a half. So she had taken, I guess, the the MDI dose and given me settings to start with. And we kind of checked in about every three months. I think it was little sooner initially, like maybe once a month, and she helped make adjustments. But then from there, I started making adjustments on my own, and she was fine with that, because she kind of knows my background, and, you know, I'm not having a lot of loads
Scott Benner 38:37
sorry to being, like, detail oriented, having a medical background already, like, you were, yeah, well,
Julie 38:42
and I already knew how to carb count. And so, like, yeah, I was a dietitian, like I said, I did a little bit of work in Endo. I mostly work in pulmonary, but did a little bit of work in endo when I was a dietitian, and so I knew how to carb count. That wasn't foreign to me. And I'm I was thinking, people come out of this surgery, and they don't know anything about diabetes, and they do have an educator in the hospital that comes and talks with you, but it's very basic, as you know, and so I think that the fact that I didn't have to learn that on top of learning how to manage the insulin was helpful.
Scott Benner 39:18
Okay, now it makes a lot of sense also, you know, it's funny, you said dancing in the vein, but then you said professional, because if you were a professional ballerina, what are you like, five six, like 95 pounds, like something
Julie 39:28
like that, not quite that small. No, I'm five seven. Yeah, because you're a little
Scott Benner 39:32
tall, I would imagine to be a pro, you'd have to be a little taller, right? And then,
Julie 39:36
you know, it's, it's funny, because you think that they're tall, but actually my height sometimes was a downside, because if, if you're on point, up on your tippy toes, and you're taller than the men that are partnering you, there's a problem.
Scott Benner 39:49
Oh, okay, so, oh, that's interesting. So you were a little taller for the game to begin with, yep, gotcha. But you're a smaller person, like, so not a lot of, I'm guessing, not a lot of body fat, like. That kind of stuff, right, right, right. Okay. And then so your needs are lower to begin with, plus, you've got the help coming from your liver, pancreas, yes, which awesome. And isn't that great that they could just put them in there and you didn't need any? I
Julie 40:13
mean, it's wild, yeah, like, when I read about it, I was like, seriously, they they're doing that. And then I kind of went on this deep dive, just learning more about the surgery. And I can't remember the specifics on how they figured that out, like, oh, maybe we can do this. I think they were trying to test some something for type one, and then they figured out they could do this. And then they, you know, did the surgery. And they actually do transplants, you know, occasionally in these like brittle type one diabetics of a donor pancreas, but then they have to be on immunosuppressants,
Scott Benner 40:43
right? So then there's a different challenge. Almost every person that I've spoken to with 3c says that they eventually just end up telling people they have type one because it's either too much to explain or they find pushback. You get the Oh, you don't really have type one. Have you experienced any of that?
Julie 41:04
Not completely. I usually, I think the way I say it is, I'm a diabetic now I'm treated like a type one, but it's because I have no pancreas. So I don't usually use the terminology 3c just because it's not super well known. I didn't teach us that
Scott Benner 41:22
in school. What about online? Do you have any problems online? You know,
Julie 41:26
I'm in the Facebook group. I don't really post. I kind of just watch and read. Okay, no, I haven't really run into a lot of it.
Speaker 1 41:35
Awesome. I'm good because, yeah, I don't particularly understand it so, but every once in a while, I'll see somebody gets the like, you don't have diabetes, like, and I don't know if it means like, you didn't go through the struggle I went through, or like, I wasn't 100% sure. So, okay,
Julie 41:52
yeah. I mean, I've, I've heard people having issues like that, but I haven't personally experienced it, thankfully,
Scott Benner 41:57
any perspectives or that you can bring to this as a person who doesn't go through the trauma of being diagnosed or misdiagnosed. Is there like when you hear other people's stories, is there anything you'd ever want to share that that you've seen or or see that? Does that make sense, that your perspective might lend itself to? I don't know. That's a terrible it's a terrible question. I'm trying to figure out, let me let me start again. Let me start again. Hold on a second. You're coming at it from a completely different situation, but you're ending up in the same space, right? I need insulin. And other people come on here all the time and tell their stories about like I got sick. I was sick for months. I didn't know. I was diagnosed as a type two, and it wasn't type two, it was type one. When you're listening to that, do you ever think, what's your response when you hear those stories? Does it make you feel any certain
Unknown Speaker 42:47
way? I
Julie 42:48
feel bad for them because they're not getting the appropriate treatment. I think that it's important for them to also share their stories, because I don't know how many medical professionals just happened to listen to your podcast, but you know, the information is getting out there. And I think that, you know, if you're a professional medical professional working with adults who come in, you know, you've got to keep that in your horizon. And I think there's probably more awareness now than there was, you know, five or six years ago. I'm in this pa group that I've seen that story come up a few different times, and there's a lot of type ones that are like, hey, you know, you might want to get checked for antibodies, because I think you probably have type one, not type two. And so it's kind of even in medical professionals to be told like, Hey, you might actually need to get re diagnosed. And they're people who have the knowledge, but it's just, you know, their doctor didn't think of it, or they also go through that misdiagnosis story, and, you know, I feel for them, because I've been through, oh, you just have IBS and, no, I actually had like, three different autoimmune diseases that eventually were diagnosed. I didn't just have an irritable bowel, you know,
Scott Benner 44:00
right, right. Did you grow up near I'm just making things up now, but by power lines or waste dump or do you have any, gosh, no.
Julie 44:09
I mean, I moved around. My dad was in the meetings industry, hotel business kind of stuff, so we moved around a bit. But I don't think I was near anything toxic.
Scott Benner 44:18
I don't want to just like, sound like a, you know, it's not a conspiracy, but there's a lot of autoimmune stuff going on in the world. Yes, and you know, if we go back 75 years, does this not exist, or does it exist in a way that we don't talk about, or that they didn't even talk about back then? Like, I really do wonder.
Julie 44:35
I think it's our food system. I mean, not to be conspiracy theorist, but I mean, look at, look at the way they're producing our food nowadays. And there's just a lot of food that's not food, it's chemicals and, you know, hormone disruptors and all of that. And I mean, I look at, I look at my daughter, and I'm thankful that we had her diagnosed early, and she's on her gluten free diet, and I pray that that's all she'll ever be diagnosed. With, I was looking at an article on, I think it was on the celiac foundation or something, that was kind of talking about how, if you're diagnosed early, it can hopefully prevent your immune system from attacking these other, you know, organs or whatever. And so I look, you know, I wasn't diagnosed till I was 18. Did my gluten free diet did well with it, but still had two other, three other things, you know, diagnosed in the following years. I think that there's a lot going on with our environment and our food system, to be
Scott Benner 45:28
honest. And you're wondering if having celiac undiagnosed for a while maybe led to the chronic pancreatitis and the other stuff. Yeah.
Julie 45:36
I mean, you think about if your immune system is that dysregulated, then it's gonna probably attack other organs. You know, it's interesting. You
Scott Benner 45:46
know, this is gonna sound obtuse for a second, but I guess that for people who listen, they're pretty aware. I have a couple of chameleons in the room here with me, and you know, they eat bugs. When you get into reptile keeping and you go find people who know what they're talking about, one of the first things that they will vociferously pound into your head is that you have to feed the bugs. Well, right? Where the reptiles won't be okay, right? Yeah, I believe it. If you feed those reptiles a shell, a husk with no nutrition in it, then it's not taking any nutrition, and then you are going to see long term problems, not right away, because it's eating and, you know, it is sustained to some degree, but you'll see problems. Their lifespans will be shorter. They might develop metabolic bone disease if they don't have the right amount of calcium that they take in, like little like things like that, that really are what you just said, which is, you know, the food system, if it's tainted or not up the snuff or whatever, you're going to have weird dysregulation down the line that nobody expected. And you also can't be upset, because you have to imagine, like with technology, that's now probably 5075, years old, people had to come to grips with the fact that there's a lot more people here, and we need to feed them, right, right? And they probably did the best they could. And you know, then weeds came, and they were like, oh, we can't have all these weeds. And, like, what are we gonna do? And then, you know, they said, Oh, we spray them, yeah, can't spray the weed killer on it kills the carrots too. Well. What if we genetically cross the carrots that they would be like, blah, blah. And then we'll just spray it everywhere. Yeah, right. And then, boom, then, you know, all that just keeps piling up. And then all of a sudden, some nice girl named Julie is pooping a lot. You're like, whoa. What happened? Yeah, or I'm anemic, or my kids got diabetes, or whatever else, even if, right now, like, if you if Julie, if you had the magic wand answer, and you were like, oh, you know, I know all the reasons. I don't know how the hell anybody would fix it, undo it, right? Yeah, right. Like, I was talking to somebody the other day, and I said, I feel like where we are societally is like, a bunch of extension cords that are, like, twisted up in knots and everything. And at this point, you're like, I don't know how to unknot these, but they're still passing the electricity through them, so let's just leave them in a pile and keep using them. Yeah,
Julie 48:01
yeah. Well. And, I mean, your your immune system is a lot from your gut. And so if you're if your guts not healthy, then, I mean, it makes sense that everything else is out of whack, exactly.
Scott Benner 48:13
Again, you know, going back to, like, what sounds silly to some people when you're talking about it, I think the words gut health make a lot of people go, okay, hippie, yeah, there's no way. I'll tell you the quickest story that I think makes my point about I don't know how to figure out what gut health is right or wrong, or how to fix it, or whatever, but it's super important, and we should figure it out that Arden suffers off and on with acne, and it can be worse or better at times, right? And we've done all kinds of different things to help her with it. GLP, helps her with it a little bit. Other things help her with it. Blah, blah. But she recently gets sick, bad tonsillitis, really, really bad tonsillitis, and the doctor first gives her an oral antibiotic, which doesn't touch the tonsillitis, by the way, but in three days, completely clears up her face. Yeah. What did that antibiotic do? In three days, it killed different bacterias in her stomach, right, right? And in her body and etc, and so on and so forth. And while she was on that antibiotic, four or five days, her skin looked perfect. Then the doctor's like, oh, this. Antibiotics not helping. It's not touching the the tonsil problem. I'll switch you to another one, but I noticed it enough to go take her to a dermatologist and say, hey, look, this is what happened. And, you know, like, so she was able to get help a different way. But, you know, most people aren't going to see that. And I'm not special for seeing it. I'm just in a weird position where, like, I don't know because of what I do for a living, and like, how many of these conversations I had? I'm like, I don't know. I'm just a little more dialed in, probably than the average person, right? I just don't think in a million years, most people would have put that together, right? But there it was, changed her gut, and something you would never expect to be impacted by that was suddenly different. And I just wonder. What else, honestly, you know, like, what else is is being impacted that you don't know about, and what do you do about it when you know, like, I don't think, I mean, honestly, you're a nutritionist. What's the difference between buying, you know, something in the group, a pepper that says, like, here it's a pepper, and this one's, like, here it's a pepper, it's cleaner. Like, I mean, is it like, I don't know, yeah.
Julie 50:20
I mean, it's, it's interesting to kind of be in the dietitian, but also a PA and, like, you want to do evidence based medicine and all of this, but there's not a lot of, I don't know if you will, funding to, like, look at some of the more hippie or crunchy, you know, things I try. I would say I'm sort of crunchy, you know, I practice evidence based medicine, but I also believe in, you know, gut health and feeding your kids well and preventing disease, if you can, things like that.
Scott Benner 50:50
So the details on this are going to be sketchy, because I make a lot of podcasts, so I'm going to be sharing with you a remembrance of how I felt. The guy I told you about earlier came on and talked about, what is it? The How do you what is that when you have your colon again, you get the bag of me? Yeah, it cost me. I'm sorry. All this pain, all this trouble, resolution, but it's not really resolution. He's he's more mobile now, but it's still not a great way to live, right? No, it's the thing he had to choose. And then I talked to somebody three months later, who talked about having his problems and the way they resolved them, and I don't remember the way they resolved them, and I do feel badly about that in this moment, somebody who's a better historian of the podcast than me might, but all I could think about was the guy from the months before. I'm like, Oh God, what if that would have helped him, right? And now it's too late.
Julie 51:41
Yeah, it's hard because I think back, and I've done elimination diets, and, you know, this, that and the other, and I don't think, I think at some point you have to accept and acknowledge that you're beyond the point where that's going to help. Too much damage has been done. But if you can, I don't know, I use my daughter again as an example, if you can prevent or find, you know, root cause and kind of make some changes before it gets to that point. Yeah, I think that's always a good, good idea. No, I
Scott Benner 52:16
really appreciate that. I appreciate your perspective on it too, because of everything you've been through because, I mean, I'm imagining, while you're talking, that you're sitting in a room somewhere making a decision to, like, say to somebody, like, open me up and take out a thing. And this thing's important. It's not my appendix, right? Which, you know, it's not even, like, I'll tell you eventually, Arden had her tonsils out recently, right? Consoles and adenoids, I was so worried about that. Yeah, you know you mean, like, I kept saying to the doctor, I'm like, Well, what is she losing, right? Like, I know what we're gaining. What is she losing? And the guy that takes out the tonsils, he's not some great genius. He's like, You know what I mean? And he's like, Ah, it's fine, nothing. I'm like, No, I don't think that's right. I was like, tonsils do something I do? Yeah, what do they do? And he's like, oh, yeah, protect you from getting sick about but it's okay. And I'm like, what? I'm like, was that part not important? He goes. But then you get to that point, and that's the point you were at, you have to make a decision, yeah, everything's so terrible. We know what this terrible is. I guess we'll take a flyer and find out what that terrible is, yeah, but life is finite, and I need to do something, right, yeah, yeah.
Julie 53:24
And I mean, I not my, not only my pancreas removed, you know, they take part of the small bowel. They have to reconnect everything. Thankfully, I was able to keep my spleen. Sometimes they have to take that out, which I had to get vaccines, just in case they had to take that out. You know, to be ahead your spleen has important functions, all of that. And then I ended up having two additional surgeries after the original surgery, one because a stitch wanted to pop out from inside, and then another one because I developed a hernia on the original incision. So it wasn't like, oh, it's out and everything's better. It's like, you know, it's been, it's been a long road the last year
Speaker 1 53:59
and a half, and you got little kids too, yes, yeah, surgery.
Julie 54:04
I had lifting restrictions, so, yeah, coming home and telling my, my, then two year old, I can't pick you up. Mommy can't pick you up. I had to stay, you know, at my parents house for a while because I didn't want to be tempted to pick them up, you know, all of that.
Scott Benner 54:17
But that must have made you feel like you were 12. Yeah, nothing like going home to see mom and dad. Yeah? And by the way, I'm seeing this for my own kids, and they're old, and you've and it's hard to ignore, right? When you're the kid, you look at your parent, you're like, oh, they took good, good care of me, though, sure. No, I know. But like, I see the kids, like, even if Kelly gets up off the sofa after sitting too long and she, like, is stiff for a half a second, I look at those kids, and they're looking at her, like, she going down, yeah? Like this, this is almost over, yeah, I don't know. It's hard to watch your kids see you look older. I can see that. Yeah. I don't enjoy it. You'll, you'll see one day, yeah, yeah. Or when they start questioning you, and you realize they're right, that's the worst, yeah, especially like on the big shifting stuff. Tough. You know, I don't know, like, a great example, it's just something like, it doesn't matter what it is, but something like, political related that I grew up with, it's in my head. You know what I mean? It's like, it's my reaction to something when it happens and they say, Well, what about this? And I go, No, that's not. Oh, my, that does make sense. Oh, geez,
Julie 55:18
these are actually functioning adults now that they're not
Scott Benner 55:21
just being jerks, they might have a point. Yeah. Okay, so is there anything that we haven't talked about that we should have? Did I skip over anything I didn't mean to? If I did, I don't think so. No, yeah, I'll let you go out like this. I put you in charge. You're a dietitian working for people with type one diabetes. Forget for a moment their feelings. Forget for a moment what they want or how they grew up, or what makes them happy. How would you tell a type one to eat? I would say, eat.
Julie 55:52
You know, well balanced fruits and vegetables. You know, lean protein. Have your carbs, but make sure you know how to Bolus for them. You can have your treats, but make sure, you know, everything's in moderation. I think that's, you know, our society gets so extreme about everything. You know, oh, we're gonna do no carbs, we're gonna do high fat, we're gonna do keto, we're gonna do this like, just eat a well balanced diet. Learn how to, how to Bolus for it. Make some adjustments if you need to. And you know, just know that. I think I said something about the variables when I signed up, you know, all those variables, man, though those could change so many things. And so I, you know, I'm still learning on that, but I think you also have to give yourself grace, because you can Bolus the same, you can have the exact same meal, and it can be a different outcome the next day. Yeah,
Speaker 1 56:41
and you don't know what the other variable was that made that change, right? No, okay, so everything in moderation. Yeah, there you go. That seems pretty reasonable to me. Thank you very much for taking the time to do this. I can't thank you enough. You too. I appreciate it. Did you have a good time?
Julie 56:58
Yes, did you? And I really do appreciate you having me on and appreciate the podcast, because I've learned a lot and I think you're doing a lot of good work. Oh,
Scott Benner 57:07
that's very kind of you. Thank you. Hold on one second for me, sure,
the podcast you just enjoyed was sponsored by tandem diabetes care. Learn more about tandems, newest automated insulin delivery system, tandem Moby, with control iq plus technology at tandem diabetes.com/juicebox there are links in the show notes and links at Juicebox podcast.com the conversation you just enjoyed was brought to you by us. Med, us, med.com/juicebox, or call 888-721-1514, get started today and get your supplies from us. Med. Today's episode was sponsored by skin grip. And skin grip, they understand what life with diabetes is like, and they know How infuriating it can be when a device falls off prematurely, and they don't want that to happen to you. Juicebox podcast listeners save 20% off of their first order when you use the link skingrip.com/juicebox links are also available in the show notes of your podcast player and at Juicebox podcast.com. Thank you so much for listening. I'll be back very soon with another episode of The Juicebox podcast. If you're not already subscribed or following the podcast in your favorite audio app like Spotify or Apple podcasts, please do that now. Seriously, just to hit follow or subscribe will really help the show. If you go a little further in Apple podcasts and set it up so that it downloads all new episodes, I'll be your best friend, and if you leave a five star review, ooh, I'll probably send you a Christmas card. Would you like a Christmas card
if you're living with type one diabetes. The after dark collection from the Juicebox podcast is the only place to hear the stories that no one else talks about, from drugs to depression, self harm, trauma, addiction and so much more. Go to Juicebox podcast.com up in the menu and click on after dark. There you'll see a full list of all of the after dark episodes. If you're looking to meet other people living with type one diabetes, head over to Juicebox podcast.com/juice, cruise, because next June, that's right, 2026, June, 21 the second juice Cruise is happening on the celebrity beyond cruise ship, it's a seven night trip going to the Caribbean. We're going to be visiting Miami Coke, okay? Saint Thomas and Saint Kitts, yeah, the Virgin Islands. You're going to love the Virgin Islands. Sail with Scott in the Juicebox community on a week long voyage built for people and families living with type one diabetes. Enjoy trop. Luxury, practical education and judgment free atmosphere. Perfect day at Coco basal kits St Thomas, five interactive workshops with me and surprise guests on type one, hacks and tech, mental health, mindfulness, nutrition, exercise, personal growth and professional development, support groups and wellness discussions tailored for life with type one and celebrities, world class amenities, dining and entertainment. This is open from every age you know, newborn to 99 I don't care how old you are. Come out. Check us out. You can view staterooms and prices at Juicebox podcast.com/juice, cruise. The last juice cruise just happened a couple weeks ago. 100 of you came. It was awesome. We're looking to make it even bigger this year. I hope you can check it out. The episode you just heard was professionally edited by wrong way, recording, wrong way, recording.com,
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