#1722 DKA Has Been a Problem
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Pediatric CDCES Roxanna shares her traumatic adult diagnosis, recognizing Type 1 in her niece and nephew, and her philosophy on empowering families through practical diabetes education.
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Scott Benner (0:0) Here we are back together again, friends, for another episode of the Juice Box podcast.
Roxanna (0:14) My name is Roxanna, and I'm a pediatric CDCES. (0:18) And I've been living with type one for ten years now.
Scott Benner (0:22) Alright. (0:22) Let's get down to it. (0:23) You want the management stuff from the podcast. (0:26) You don't care about all this chitting and chatting with other people. (0:29) Juiceboxpodcast.com/lists.
Scott Benner (0:32) They are downloadable, easy to read, every series, every episode. (0:37) They're all numbered. (0:39) Makes it super simple for you to go right into that search feature. (0:42) In your audio app, type juice box one seven nine five to find episode one seven nine five. (0:48) Juiceboxpodcast.com/lists.
Scott Benner (0:53) If you're looking for community around type one diabetes, check out the Juice Box Podcast private Facebook group. (0:59) Juice Box Podcast, type one diabetes. (1:02) But everybody is welcome. (1:03) Type one, type two, gestational, loved ones, it doesn't matter to me. (1:08) If you're impacted by diabetes and you're looking for support, comfort, or community, check out Juice Box podcast, type one diabetes on Facebook.
Scott Benner (1:18) Nothing you hear on the Juice Box podcast should be considered advice, medical or otherwise. (1:22) Always consult a physician before making any changes to your health care plan. (1:30) The episode you're about to listen to is sponsored by Tandem Moby, the impressively small insulin pump. (1:36) Tandem Moby features Tandem's newest algorithm, Control IQ Plus technology. (1:41) It's designed for greater discretion, more freedom, and improved time and range.
Scott Benner (1:45) Learn more and get started today at tandemdiabetes.com/juicebox. (1:51) Today's episode is also sponsored by the Eversense three sixty five. (1:56) You can experience the Eversense three sixty five CGM system for as low as $199 for a full year. (2:03) Visit Eversense c g m dot com slash juice box for more details and eligibility. (2:09) The podcast is also sponsored today by US Med.
Scott Benner (2:14) Usmed.com/juicebox, or call (888) 721-1514. (2:21) You can get your diabetes testing supplies the same way we do from US Med.
Roxanna (2:25) My name is Roxanna, and I'm a pediatric CDCES. (2:29) And I've been living with type one for ten years now.
Scott Benner (2:32) Ten years? (2:33) How old are you?
Roxanna (2:34) I am 45 now.
Scott Benner (2:35) Oh, you have that young voice.
Roxanna (2:38) Yeah. (2:39) That's what that's what I hear. (2:40) I don't know if I look that way, but
Scott Benner (2:42) well
Roxanna (2:42) or feel that way, but maybe I sound that way.
Scott Benner (2:44) You should start a podcast because on a podcast, people don't get to see that often. (2:48) So it sounds like you Yeah. (2:50) No kidding. (2:50) If you told me you were, like, 16, I'd be like, I I buy it. (2:53) Why is it why is that?
Scott Benner (2:54) Why you feel like, are you not married?
Roxanna (2:57) I I'm not married and have no children.
Scott Benner (2:59) There's something you That's why. (3:01) It wasn't hard to figure out why life hasn't dragged you down yet. (3:04) I was like, oh, okay. (3:05) I see what's going on.
Roxanna (3:06) But I have four brothers, so I feel like that counts for something.
Scott Benner (3:09) Oh, you've had your ass beat a couple of times then. (3:11) I I see.
Roxanna (3:12) Several times.
Scott Benner (3:12) Okay.
Roxanna (3:13) Yeah. (3:13) Absolutely.
Scott Benner (3:14) But you're diagnosed in your thirties?
Roxanna (3:16) Yeah. (3:17) I was diagnosed when in 2016. (3:20) I was 36 at the time.
Scott Benner (3:23) Were you already doing this professionally?
Roxanna (3:25) I was. (3:26) So I was a, a pediatric ICU nurse
Scott Benner (3:29) Okay. (3:29) At the
Roxanna (3:29) time, and I had no idea what hit me. (3:33) I thought I had the flu. (3:35) It's very similar to all other your all the other diagnosis stories I hear.
Scott Benner (3:40) Yeah.
Roxanna (3:41) But I started not feeling well, and I had some other health stuff going on at the time as well that I felt like complicated the picture maybe a little bit. (3:48) But I'd taken care of hundreds of kids in DKA Mhmm. (3:52) And did not recognize it in myself. (3:54) I just knew I felt badly. (3:56) And it was traumatic for me, I'm sure, but similar to what you hear from everyone else.
Roxanna (4:01) But at the time, I was doing travel nursing and started not feeling well. (4:07) I just blew it off because I was a nurse, and it was the weekend. (4:11) And I was like, well, I am new to the city, and I didn't even have a PCP at the time, and I had to start my new contract on Monday.
Scott Benner (4:19) Okay.
Roxanna (4:20) So, thankfully, I my best friends knew I hadn't been feeling well. (4:25) I stopped answering my texts, and they didn't know my address because I had just moved in recently. (4:31) But they knew the apartment complex that I had been placed in for my travel agency. (4:36) So they called to do a welfare welfare check with the with the depart with the city department.
Scott Benner (4:40) Really?
Roxanna (4:41) And yep. (4:42) And they didn't couldn't find me at first. (4:45) And then my best friend called back and said, please, I will like, please just go check on her. (4:49) Something has got to be wrong. (4:51) So she walked them through where the apartment was because, again, she didn't have the address, but she knew what apartment it was.
Roxanna (4:58) Mhmm. (4:58) And thankfully, door was open because it was, like, late at night. (5:01) It's, like, ten or 10:30 at night. (5:02) And they found me down in my apartment. (5:06) I was already in a coma at that point.
Roxanna (5:08) My blood sugar was, like, 1,200. (5:10) I was septic. (5:11) My body temperature was, like, 89, and they pretty quickly he's like, I I don't know what's wrong, but something's wrong with her.
Scott Benner (5:19) Roxanne.
Roxanna (5:20) Went got in an ambulance, was intubated, and maxed out on pressers, and in coma for a couple days. (5:26) Almost died for sure.
Scott Benner (5:28) Wow. (5:29) Hey. (5:29) What kind of gift do you have to get your friend the following year for their birthday after they save your life?
Roxanna (5:33) I know. (5:35) I know. (5:35) I they are amazing people. (5:37) They definitely saved my life that day. (5:39) There was there's three of them, and they were all living in different states at the time, and they just they knew that I hadn't been feeling well and something wasn't right.
Roxanna (5:48) And How
Scott Benner (5:48) about that?
Roxanna (5:49) They were gonna fix it.
Scott Benner (5:51) I would text you once a year and go, hey. (5:53) Do you remember the time I saved your it's like, would definitely definitely do that.
Roxanna (5:59) So every September 11, because that's when it was, September 11
Scott Benner (6:02) Really?
Roxanna (6:02) Text back and forth and say, happy death day. (6:04) I say, you for saving my life.
Scott Benner (6:06) Wait. (6:07) September 11, I I seem to feel like that's a date I should know. (6:11) Wait. (6:11) Wait. (6:12) What year was it?
Scott Benner (6:13) 2015. (6:13) Oh, okay.
Roxanna (6:14) Some '20,
Scott Benner (6:15) Yeah. (6:15) Many years later. (6:16) But still
Roxanna (6:17) Yeah.
Scott Benner (6:17) You almost said you're on 09/11. (6:19) Yeah. (6:19) Yeah. (6:20) How about that? (6:20) Oh, my goodness.
Scott Benner (6:22) Well, isn't that a fun way to start off the podcast?
Roxanna (6:25) I know.
Scott Benner (6:25) So your friends you said you had other health issues going on at the same time. (6:29) Would you share what they are or what they were?
Roxanna (6:31) Yeah. (6:31) So I really started to fall apart. (6:34) I thought when I once after I hit, like, early thirties, it was mostly, like, GYN related, and they my GYN told me I had a hostile uterus, and that was a quote. (6:43) And I had a lot of, like, anemia and bleeding stuff going on. (6:48) Just weird kinda stuff that still unexplained.
Roxanna (6:51) I was on a million different tried a million different things to get the bleeding under control, and it just never worked. (6:59) Just stuff I just wasn't feeling well. (7:00) And I knew now I know that a lot of that was probably tied to, like, the type one diagnosis. (7:06) And when I look back, it was could have been caught probably a year prior. (7:12) I had fasting blood sugars in the two hundreds, and it just wasn't caught.
Roxanna (7:18) You know, they told me to stop eating yogurt.
Scott Benner (7:20) Wait. (7:20) When you had a fasting blood sugar in the two hundreds, they said no more yogurt?
Roxanna (7:24) Yeah. (7:24) They asked me what I what, you know, I had, like, the night before I came in and I said, well, I think I had some yogurt. (7:30) And they were like, well, don't eat that.
Scott Benner (7:32) That's the problem. (7:33) Hey. (7:33) Did you try tranexamite acid for for bleeding? (7:38) That's not one of the things they gave you?
Roxanna (7:40) No. (7:40) They busted it was basically a bunch of birth control pills that they tried, which then lent to me. (7:44) I had some pulmonary embolisms from that. (7:47) Oh. (7:47) From yeah.
Roxanna (7:48) So it was just a traumatic time. (7:51) Those early thirties were rough. (7:52) I was like, is this one getting old as life? (7:54) Because it is not fun.
Scott Benner (7:55) Also, thirties shouldn't be where things start going downhill like that. (7:59) I don't think.
Roxanna (8:00) Well, yeah. (8:01) And that's what I thought. (8:02) But I was like, I guess this is it. (8:04) I don't know. (8:04) I guess you just you're just tired, like, all the time and feel terrible.
Roxanna (8:08) And Best part
Scott Benner (8:09) of the ride's over already.
Roxanna (8:11) That's it.
Scott Benner (8:11) Any other autoimmune in your extended family?
Roxanna (8:15) Yes. (8:16) So now that I know, you know, I've asked. (8:18) My mom has Hashimoto's. (8:19) Mhmm. (8:20) My grandmother had Graves'.
Roxanna (8:22) Grandfather on my maternal side had MS. (8:25) And then two years after I was diagnosed, my niece was diagnosed, and then two years after that, my nephew was diagnosed with type one.
Scott Benner (8:30) Type one was coming. (8:31) Yeah. (8:32) You grew up not knowing your mom had Hashimoto's?
Roxanna (8:35) Nope. (8:36) I mean, I need to So she actually is was raised Catholic.
Scott Benner (8:42) She did
Roxanna (8:42) not raise us Catholic.
Scott Benner (8:43) That's fine.
Roxanna (8:44) But she herself was Yeah. (8:47) Yeah. (8:47) Catholic.
Scott Benner (8:48) Alright. (8:48) I get it. (8:48) I know the vibe. (8:49) I got everything going on here. (8:50) I'm like Chad GPT almost.
Scott Benner (8:51) I have enough data to make some pretty big leaps. (8:55) So Yeah. (8:56) Talk to enough people. (8:57) Your mom had a thing she took a pill for every day. (9:00) How many how many brothers and sisters do you have?
Roxanna (9:02) I have four brothers.
Scott Benner (9:04) Yeah. (9:04) That's right. (9:04) You said that. (9:05) I'm sorry. (9:05) Okay.
Scott Benner (9:06) Mhmm. (9:06) Did they know?
Roxanna (9:08) I still don't think they know, to be honest.
Scott Benner (9:10) Ah, awesome. (9:12) Now I practice know
Roxanna (9:13) that my my two youngest brothers are my half brothers. (9:16) So after my mom and dad got divorced, my dad got remarried, and I have two younger
Scott Benner (9:21) You have two younger brothers that are not your mom. (9:23) Yeah. (9:23) Wouldn't it be weird if they knew and no one else did?
Roxanna (9:26) Well, yeah. (9:26) But that's highly unlikely, Scott.
Scott Benner (9:30) Your mom wasn't keeping up with your dad's new family? (9:33) No.
Roxanna (9:34) No. (9:34) Gosh. (9:34) She barely remembers her names now.
Scott Benner (9:36) Might be apropos or nothing, then I'll find out later if I wasted your time or not and and asked you more than I should have. (9:42) But no, no marriage, no kids, is that on purpose or is that because
Roxanna (9:48) No. (9:49) I get asked this question
Scott Benner (9:50) a lot. (9:51) I imagine.
Roxanna (9:51) Especially being from where I'm from and the expectation, you know, all my best friends were married and, you know, had kids in their twenties, if not earlier. (10:01) Yeah. (10:02) It's never been something that I have dreamed of doing. (10:06) Like, I just it's never been on my to do list, I guess. (10:09) If it happens, it happens, but that's part of it.
Roxanna (10:12) I never was actively seeking it out. (10:15) And then I think part of it was I spent a lot of, like, my those early thirties, like, not feeling well. (10:21) And I traveled a lot. (10:23) Like, I was moving every three to six months, and that's not conducive really to meeting anyone either. (10:29) So I think it was, like, a combination of things.
Scott Benner (10:31) Did you date and mess around a little bit, or were you pretty, like, single?
Roxanna (10:35) Yeah. (10:35) Like, dating, for sure. (10:37) That definitely happened. (10:39) But now I just I don't know whether I'm just too old or just too tired. (10:42) Like, I just I don't know.
Roxanna (10:44) I just don't know if it's in the cards for me. (10:47) Yeah. (10:47) And that's okay. (10:48) Like, I don't that's not something that I have a strong desire to to do.
Scott Benner (10:52) I don't feel like you should. (10:53) I was just asking. (10:54) You you know the movie Scent of a Woman with Al Pacino by any chance?
Roxanna (10:58) I I know of it. (11:00) I don't think I've ever
Scott Benner (11:01) watched it. (11:01) No. (11:01) There's a scene at the end where, he's yelling at some people. (11:05) And, at some point, he yells, I'm too old. (11:08) I'm too tired.
Scott Benner (11:09) I'm too fucking blind. (11:11) Every time somebody says I'm too old, that line runs right through my head. (11:16) Yeah. (11:17) Because it just to me, the the the overall sentiment is I'd love to argue here, but I just don't have it in me. (11:23) The rest of that sense, by the way, is, I'm too blind, too blind to, I'd if I was the man I was if I was half the man I was ten years ago, I'd take a flamethrower to this place.
Scott Benner (11:32) And he's, like, in full Al Pacino mode. (11:34) It's awesome. (11:34) Nevertheless, I'm just interested for reasons that may end up being useless, and I I don't know. (11:41) Like, it it it might help the story come together, and it might have nothing to do with anything. (11:44) But I needed to understand this sort of moving forward.
Scott Benner (11:46) So I appreciate you telling me.
Roxanna (11:47) And I think there's some disappointment, like, in my family. (11:50) Like, I
Scott Benner (11:50) didn't Really?
Roxanna (11:50) Have kids and, you know, I didn't get married. (11:53) I didn't go that route. (11:54) I think part of the ones are, what did we do wrong?
Scott Benner (11:56) Well, are you disappointed?
Roxanna (11:59) I'm not. (12:00) But I think sometimes I feel like or maybe not disappointed, just like
Scott Benner (12:05) But you didn't do the thing What that they expected.
Roxanna (12:08) Yeah. (12:09) Like, what happened to that one? (12:10) Like, was it you know, because we modeled it wrong. (12:14) My parents have been divorced for a very long time, but I also don't see very many happy marriages, honestly, Scott. (12:20) Like, I just I don't.
Scott Benner (12:21) Kidding me? (12:22) I just took the trash out this afternoon. (12:24) Everybody looks happy when I do it. (12:26) How old were you when your parents got divorced?
Roxanna (12:29) Oh, gosh. (12:29) I think I was six or seven, and then my mom got remarried once. (12:33) And my dad this is his third marriage, I think. (12:38) But they've been together for a very long time now.
Scott Benner (12:41) Your mom's remarriage took? (12:42) Is he still around?
Roxanna (12:44) No. (12:44) Mm-mm. (12:45) They only lasted probably about a year.
Scott Benner (12:47) Oh, so as a young kid, you saw your original father, your OG dad go
Roxanna (12:52) Mhmm.
Scott Benner (12:53) Then new dad was there and gone. (12:54) Were there, other guys coming in and out, or did she give up after a bit? (12:58) So
Roxanna (12:58) No. (12:58) She was pretty much done.
Scott Benner (13:00) She's like, that's it. (13:02) I I ain't doing this again. (13:03) Well, that Yeah. (13:04) Maybe that's where I mean, maybe that got modeled on top of you somehow. (13:08) Yeah.
Scott Benner (13:08) You know?
Roxanna (13:09) Yeah. (13:09) Maybe so.
Scott Benner (13:10) Well, at least it opened you up to that travel nursing, which from what I understand pays pretty well. (13:14) So congratulations on that.
Roxanna (13:16) Yeah. (13:16) I had a good time doing that. (13:17) I don't do it any longer, but, I kinda stopped during COVID. (13:21) But Oh. (13:22) I definitely had some good experiences and saw a lot of things and learned a lot of things for sure.
Scott Benner (13:26) I bet. (13:27) Are you still a nurse today?
Roxanna (13:29) I am. (13:30) Yeah.
Scott Benner (13:30) Yeah. (13:30) Just doing it.
Roxanna (13:31) I'm a pediatric CBC. (13:32) Yes. (13:32) So Right. (13:33) Yeah. (13:33) I do a lot of I work in a clinic now, mostly outpatient stuff.
Scott Benner (13:37) You told me that. (13:38) I don't know why I didn't remember. (13:39) I'm up. (13:39) It's probably because it's Friday afternoon. (13:41) I apologize.
Scott Benner (13:42) And my wife is texting me about this thing at the same time. (13:44) Plus, I'm thinking about son of a woman now. (13:46) There's a lot going on in my mind.
Roxanna (13:47) Okay. (13:48) I get it.
Scott Benner (13:48) I'm sorry about that. (13:50) Okay. (13:50) So how do you and I end up together? (13:53) Because I feel like somebody hooked us up so that you could be on.
Roxanna (13:57) Kenny Fox is a mutual friend of ours. (14:00) So he kind of said, do you know what you should do? (14:02) You should get on the podcast with Scott Benner. (14:04) I was like, I sure. (14:06) Why not?
Roxanna (14:06) Cool. (14:07) Sounds like a good time.
Scott Benner (14:08) Why do you think Kenny thought by the way, Kenny is in the episodes called Fox in a Loop House. (14:13) I think there's six of them if you wanna know about DIY looping. (14:16) Kenny talks all about it in those episodes. (14:18) But why do you think he thought you were a good guest for the show? (14:25) I have always disliked ordering diabetes supplies.
Scott Benner (14:29) I'm guessing you have as well. (14:31) It hasn't been a problem for us for the last few years, though, because we began using US Med. (14:36) You can too. (14:38) Usmed.com/juicebox or call (888) 721-1514 to get your free benefits check. (14:46) US Med has served over one million people living with diabetes since 1996.
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Roxanna (16:33) I think because the position I'm in, right, as an educator for kids with diabetes, like, I touch a lot of, like, their, you know, diabetes management, and I use the podcast as a resource or recommend it as a resource for a lot of our families, whether newly diagnosed or not.
Scott Benner (16:52) Mhmm.
Roxanna (16:52) Because I have a touching point with every single, you know, kid that comes into our practice. (16:59) So I always recommend it, and he knew that. (17:02) And I have a little binder even that I have, like, you know, I've made that has Juice Box podcast on it with, you know, some QR codes and then all, like, the series that I recommend to the families that, you know, please, like, if you wanna understand it, like, you know, I will talk to you all. (17:18) You need to talk about whatever, but I think this is gonna be more helpful to you.
Scott Benner (17:24) Okay. (17:25) Thank you.
Roxanna (17:26) Yeah. (17:26) And so a lot of families take me up on it, and those families do incredibly well for the most part.
Scott Benner (17:31) Okay. (17:32) So, I mean, you're diagnosed a decade ago. (17:34) Fair enough.
Roxanna (17:35) Mhmm. (17:35) Mhmm.
Scott Benner (17:36) I mean, did you find the podcast before you you like, you and Kenny, like I'm trying to figure out, like, what the the timeline is. (17:42) Like, you find the podcast for you personally or you use it for professionally or, like, how does all that work?
Roxanna (17:49) It was definitely personally at first. (17:52) You know, the first couple of years after I was diagnosed were really rough for me. (17:56) I didn't know what I was doing. (17:59) I was one of those people that had no idea what really diabetes was. (18:03) I mean, I knew what it was.
Roxanna (18:04) Like I said, I'd taken care of lots of kids in DKA, but that was the extent. (18:09) I knew that these kids came in, and they were a lot of work. (18:12) Mhmm. (18:12) Mhmm. (18:13) And they were really sick most of the time.
Roxanna (18:14) And my job was just to because I did pick you. (18:17) I didn't do any of the education aspect. (18:19) I just wanted to get them out of the pick you as soon as possible to the floor where they could do whatever they needed to do, and that was kind of a mystery to me what happened after that.
Scott Benner (18:27) Yeah.
Roxanna (18:27) And when I was diagnosed adults, and this is part of the reason why I started doing what I'm doing now, I realized how bad the education was there. (18:36) It was assumed because I was a nurse that I kind of knew what I was doing, but they essentially handed me, you know, after a week and a half in the hospital, however long I was there, handed me two pens and said, you know, we'll see you in a month. (18:50) Like and I was like, wait. (18:51) What? (18:52) What do I do with this?
Roxanna (18:54) No. (18:54) Thank you. (18:55) Asked me to, like yeah.
Scott Benner (18:56) No. (18:56) Thank you. (18:57) No. (18:57) Out of, like, two things. (18:58) I'm good.
Roxanna (18:59) I was like, I'm was like, I have no idea. (19:02) So I really did miserably. (19:04) I was in think part of it was denial, I think, but part of it was I just didn't know what I was doing, and I didn't get much help from my endocrinologist.
Scott Benner (19:15) Okay.
Roxanna (19:16) Not that they were bad people,
Scott Benner (19:17) but
Roxanna (19:18) I think they are just they don't really know how to help, I think, a lot of the time. (19:23) So I did not do well. (19:26) You know, COVID hit, and I stopped traveling. (19:30) And I think I just realized, like, my niece was diagnosed, and that was kind of like a that triggering point for me to say, okay. (19:38) I've gotta figure this out.
Roxanna (19:40) Like, if not for me, like, for her. (19:42) Oh. (19:43) Because she was only, like, 10 or 11 at the time that she's diagnosed.
Scott Benner (19:46) If it wasn't for her diagnosis, do you think you would have gone on suffering personally?
Roxanna (19:51) I think yeah. (19:52) Maybe not indefinitely. (19:53) I think I would have, like, gotten to feel so badly that, hopefully, I would have turned things around. (19:59) But she was kind of like the starting point for me when I was like, okay. (20:03) Like, I've gotta figure this out.
Roxanna (20:05) And I did. (20:06) I started finding everything that I could about diabetes. (20:11) Podcasts, books, like, just anything I could figure out on my own. (20:16) And, you know, I certainly asked my endocrinologist some to help, but they are busy people.
Scott Benner (20:21) Yeah. (20:22) Can can you help contextualize something for me, best you can? (20:26) Right? (20:26) I mean, you do what you do for a living.
Roxanna (20:29) Mhmm.
Scott Benner (20:29) I guess what I would say there is that you'd think that most people listening would think that this would predispose you to doing well with diabetes. (20:36) So my my first question is, can you explain to those people why your ICU nursing background doesn't help you with your own type one? (20:46) Why would you settle for changing your CGM every few weeks when you can have three hundred and sixty five days of reliable glucose data? (20:55) Today's episode is sponsored by the Eversense three sixty five. (20:59) 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.
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Roxanna (21:51) Diabetes is so undereducated on, I think, because it's really complex, and it's not black and white, and there's a lot of gray in it. (22:01) So I think nursing school does not prepare you for diabetes management at all. (22:09) I don't think med school does either or PA school or a nurse practitioner. (22:13) Like, I don't think that's not gone over, like, in detail at all.
Scott Benner (22:16) Specific to diabetes, what does it prepare you for?
Roxanna (22:20) That it exists, that there's a disease out there that causes high blood sugars and a lot of problems. (22:26) Like, even the difference between type one and type two, like, I wasn't entirely clear on.
Scott Benner (22:31) How long had you been an ICU nurse?
Roxanna (22:33) Oh, close to ten years.
Scott Benner (22:35) If I asked you ten years ago, a day before you were diagnosed, how good of a nurse are you? (22:40) What what would you have said?
Roxanna (22:42) I would have said, I think I do an okay job. (22:45) Yeah. (22:45) As a baby nurse, I mean, I don't I didn't know anything starting out in nursing school either in general. (22:50) I do nothing about anything, much less diabetes. (22:53) But I think I had the potential to be a good nurse.
Scott Benner (22:57) But you had only started with babies. (22:59) There's only a certain amount of information you needed. (23:01) You were doing a good job at that.
Roxanna (23:04) Yes. (23:04) Yeah. (23:04) I mean, like, it was definitely you know, when I started out as an ICU nurse, it's very steep learning curve. (23:10) Like, there's a lot being thrown at you, and there are some sick kids that you're dealing with. (23:14) Diabetes is usually not like an acute know, you unless they're a DKA.
Roxanna (23:18) It's not like an acute you know, where you're gonna see someone in the ICU. (23:22) It's more of a chronic.
Scott Benner (23:23) Let me be more specific with my question. (23:26) If I asked you back then what kind of a nurse you are, you weren't disinterested. (23:30) You weren't just there for the check. (23:31) You weren't also doing, like, crack cocaine on the side. (23:35) You were No.
Scott Benner (23:36) You were, an an earnest employee doing their best with a good education behind you.
Roxanna (23:42) Absolutely. (23:42) Yes. (23:43) Yeah. (23:43) I'm one of those people that's gonna put in the effort to whatever I do
Scott Benner (23:47) Gotcha.
Roxanna (23:47) And do it well.
Scott Benner (23:49) And yet you were in no way prepared to take care of somebody with diabetes being yourself, so you also weren't prepared for somebody else to be doing it. (23:57) The next obvious answer or question, I believe, comes up is that how come this exists in specialty too? (24:03) Like, how come I can get to an endocrinologist who's also not well equipped?
Roxanna (24:08) Well, I mean, I think there are certainly endocrinologists out there that aren't well equipped, and I don't have an answer for that because they, of all people, should be equipped and should have some kind of grasp on what diabetes is. (24:21) But I have certainly met my share of endocrinologists that don't.
Scott Benner (24:28) Okay. (24:29) Like, also, let me say this upfront. (24:31) I imagine there are a lot of endocrinologists that are awesome. (24:34) And Yes. (24:35) Yeah.
Scott Benner (24:35) I'm not not
Roxanna (24:36) I work with some amazing providers.
Scott Benner (24:38) Even suggesting that that's not the case. (24:40) But when it goes wrong, do you see any common connectors between the ones it goes wrong with? (24:46) Are they ladder climbing, just there for the money? (24:49) Anything you could, like, say, oh, they all seem to have this in common?
Roxanna (24:53) I mean, maybe, like, just disinterest. (24:56) I mean, because endocrinologist is not they don't just do diabetes. (24:59) Sure. (24:59) Right? (25:00) Like, that's part of what they do.
Roxanna (25:02) So I think that endocrinologists can have their quote, favorites that they like to take care of. (25:09) Like, our, you know, not even just endocrinologists, but, like, our nurse practitioners and PAs too that are in endocrinology.
Scott Benner (25:15) Right.
Roxanna (25:16) You know, some are more interested in growth hormones. (25:18) Some are more interested in thyroid. (25:21) Like, so they all have, like, their their niche kinda, like, groups too unless you're a specific diabetologist, but those are even more hard to find. (25:30) So maybe that's part of it.
Scott Benner (25:32) Would you say that when somebody finds themselves in that situation, like, oh, I prefer, like, you know, you think it's conscious, I guess, is my question? (25:39) Or do you think that they're maybe unconsciously don't give the same effort to the things that they aren't maybe as learned about or not as interested in?
Roxanna (25:47) I think it's maybe it's that they get feel frustrated or, like, it's that they don't they can't understand it. (25:57) Right? (25:57) So they don't feel like they can ever have a grasp on it, especially if you don't have it or caring for someone with it.
Scott Benner (26:05) Yeah.
Roxanna (26:05) Diabetes is a really tough disease to understand if you're not in either one of those positions.
Scott Benner (26:10) Right. (26:10) Maybe they they have, like, impostor syndrome in inside of that to some degree.
Roxanna (26:15) Maybe. (26:15) Like, all they know is, okay. (26:17) Well, I know that this is what you're supposed to do, and, you know, are you doing it? (26:21) And they say yes, and it's still not working. (26:24) And you don't understand why.
Scott Benner (26:26) Okay.
Roxanna (26:27) And that's the same, I think, frustration families get too. (26:29) And that's why I think they lose a lot of faith in their the health care system and their providers because they're doing what their whoever told them to do, you know, their endocrinologist or nurse practitioner or whoever it is said, okay. (26:41) This is x amount of carbs. (26:42) If you just use this simple formula and dose, you know, when you eat carbs, then it should work, and your blood sugar should be fine. (26:51) Well, when that doesn't work, and most of the time that doesn't work because there are so many variables going on, then they're like, this doesn't work?
Roxanna (26:59) Like, what am I supposed to do? (27:00) And then the provider's like, I don't know.
Scott Benner (27:04) I don't know.
Roxanna (27:05) Try this.
Scott Benner (27:06) How the hell should I know,
Roxanna (27:07) Connie? (27:09) Exactly.
Scott Benner (27:11) Okay. (27:11) So I'm gonna take you back to your to your niece being diagnosed, and you start running around looking for information. (27:16) You kinda, you know, catch yourself out out of that fog maybe you're in. (27:21) What do you learn first? (27:22) What's more what's most valuable to you?
Scott Benner (27:24) What allows you to start laying a foundation under yourself and getting going?
Roxanna (27:29) I think the first thing that, you know, just even started me on the right path was just knowing that there were people out there that could do this, that were achieving. (27:38) It wasn't just something that's completely out of my control and unmanageable, which is kind of what I thought it was. (27:43) I think that gave me a lot of hope, and I just wanted to figure out what those people were doing. (27:48) And those people being, you know, like people I heard from on the podcast or, you know, I read Think Like a Pancreas and a couple other books. (27:57) Just anything that I could find to help me understand and understanding how insulin works.
Roxanna (28:03) I think that was, like, the first piece that, like, taught me, okay. (28:09) Now I know how insulin works. (28:11) Then I can match it to what other variable I have, understanding what it does to, like, my blood sugar. (28:18) And that, I think, was my first real understanding of diabetes, and a lot more has come. (28:25) And I still learn something new every day.
Roxanna (28:27) Right? (28:27) But I think that was the first piece that really helped me understand.
Scott Benner (28:32) I have a question that'll feel self serving if you don't like me. (28:35) If you do like me, it'll just sound like a question where we get to an answer. (28:38) The idea of understanding how insulin works being the basis for moving forward. (28:43) I mean, that's how I talk about it. (28:45) So do you think it because I told you to think it, or do you think it because you heard a bunch of stuff and that was your natural decision?
Roxanna (28:53) I think you certainly helped lead me there, if not, you know, if we're at the the starting point for it.
Scott Benner (29:00) Okay.
Roxanna (29:00) I don't know. (29:01) It just I think it just came to me. (29:03) Like, I was like, okay. (29:05) Well, this is how insulin works, then I can figure it out from here. (29:10) And I don't all the time, but at least I understand why, it's not working most of the time.
Scott Benner (29:16) Right. (29:16) I ask I I wanna be clear about why I asked because I'm trying to decide, is this the right answer, or is it just one of many right answers and you went with it because you heard me say it, and then it worked out for you. (29:30) Because when I started saying that out loud, I didn't I wanna be clear with everybody. (29:34) I didn't really a 100% know if that was right or not. (29:37) I just for me, I was like, this feels like to me, it all starts with understanding how insulin works.
Roxanna (29:42) Mhmm.
Scott Benner (29:42) And then if you don't have that, then not only are you incapable of covering food and and needs and etcetera, you don't understand why you're getting high. (29:51) You don't understand why you're getting low. (29:52) You can end up with a fear of insulin. (29:54) You don't use enough of it. (29:55) Like, it it snowballs.
Scott Benner (29:56) But you understand that, like, I I hope everyone listening understands, like, I didn't go to college. (30:01) Like, I don't have any background in this, like, like, professionally. (30:05) No one told me these things. (30:06) It all just started coming to me, like, as I was living through it. (30:10) So I was interested to know if you if there was a delineation between, like, the information and your understanding or if it if it all kinda blended together.
Scott Benner (30:18) But I appreciate your answer, but thank you. (30:20) I just wanted to make sure you understood why I was asking.
Roxanna (30:22) Yeah. (30:23) I do remember the first podcast I listened to of yours was the newly diagnosed or starting over because just by my searching, well, that's what popped up. (30:30) Right? (30:31) And I don't remember even exactly, like, what it said, but that kind of was what started me on, I can figure this out. (30:38) And from there, it just it just anything I could get a hold of, I wanted to know.
Scott Benner (30:44) Awesome. (30:44) Well, I'm glad. (30:45) I'm I'm glad it got you there. (30:47) So how long after you fix fix yourself up, do you offer this information back to your niece or do you like, I mean, do you guys become like a partner in crime here on this or how does that benefit her or did did it not?
Roxanna (30:59) My niece is pretty sure that I gave her diabetes. (31:02) Oh,
Scott Benner (31:03) but at thanksgiving would you hug her at thanksgiving or something like that? (31:06) Get your cooties on her?
Roxanna (31:07) Gone to I'd come home for Christmas. (31:10) I was there visiting, and we had gone to the movies and with my mom and my brother who it's her dad.
Scott Benner (31:16) Mhmm.
Roxanna (31:17) And she was sitting next to me, and she had gotten a box of Sour Patch Kids. (31:22) And she had had a big thing of water too. (31:25) So we went and saw this movie. (31:27) I don't remember what the movie was. (31:28) It wasn't a very long movie, but that girl, she ate her box of Sour Patch Kids and went through her water, my water, her dad's water, everyone's water, and had gone to the bathroom countless times.
Roxanna (31:39) And we left that movie theater, and I said, I think we need to check her blood sugar.
Scott Benner (31:46) Oh, you said it that fast.
Roxanna (31:47) She lost her mind.
Scott Benner (31:48) Yeah. (31:49) Well, say, honey, you just drank $24 worth of bottled water, so we're gonna have to check on this. (31:53) Okay?
Roxanna (31:54) She was so mad, and I was leaving the next day for my next contract. (31:57) So, she just was and my mom was like, you know, let's not make a scene. (32:02) Let's just go home. (32:04) Think about this. (32:05) And I was like, okay.
Roxanna (32:07) Like but I think we should check her blood sugar. (32:09) Like, she looks thinner. (32:11) I I felt like they didn't have that perspective because they see her all the time. (32:14) Was coming home. (32:15) I hadn't seen her in six months or
Scott Benner (32:17) You saw it.
Roxanna (32:17) You know, longer at that point. (32:20) And she was so bad at me. (32:22) She refused to say goodbye to me the next day. (32:24) She wouldn't come near me because she was afraid I was gonna poke her finger. (32:27) And then that was right before Christmas, and I went to do my next contract in, which was about three hours away.
Roxanna (32:34) And about two weeks later, I was working in the PICU, and the charging nurse came up to me and said, I just wanna let you know that your niece is being here in severe DKA.
Scott Benner (32:43) So I have a couple of questions. (32:45) First of all, when you said it, do you think they were like, oh, this one's got diabetes. (32:49) Now she thinks everybody has diabetes. (32:50) Was that there a vibe there like that? (32:53) Okay.
Roxanna (32:53) My brother told me to quit being dramatic is what he told me.
Scott Benner (32:56) Ah, hold on a second. (32:57) He must owe you a good birthday present too. (32:59) Yes. (33:00) And then my next question is more on a, like, a psychological difficulty level. (33:05) How hard was it knowing what happened to you leaving there, being sure she had type one and nobody was listening to you?
Roxanna (33:13) Yeah. (33:13) You know, looking back, like, I am mad at myself because that could have been prevented. (33:18) She was very sick.
Scott Benner (33:20) Right.
Roxanna (33:21) And it was it was just sad. (33:24) She, you know, rolled in and her and I was working at the time. (33:27) Right? (33:27) So she rolled in from the helicopter with my brother, like, right behind her, and my brother's just looking at me like and it took all I had in me not to say I told you so.
Scott Benner (33:36) No kidding. (33:37) Because she is half dead Or would it because it would have been inappropriate. (33:41) But you were thinking, you Oh, thank I told you this was gonna happen, and and no one listens to me. (33:47) And Yeah. (33:48) Do oh, I would have had all those thoughts I was
Roxanna (33:50) furious he let her get that sick and feel that badly. (33:52) I was I was mad. (33:54) That was definitely, I feel like, the starting point, you know, of it all. (33:58) And then, you know, a couple of years after that, when my nephew was diagnosed, who I was actually working here at the time at the same hospital that he came to, my brother called me and said, we're on the way to the ED. (34:09) And I said, why are you on the way to the ED?
Roxanna (34:12) And he said, well, I think, you know, has COVID or the flu or is sick, and he might have type two diabetes.
Scott Benner (34:19) And
Roxanna (34:20) I said, type two diabetes?
Scott Benner (34:22) How old?
Roxanna (34:23) He was 14, I think, at the time.
Scott Benner (34:26) Okay. (34:27) Wait. (34:27) Same brother or different brother?
Roxanna (34:29) Same brother.
Scott Benner (34:30) Same brother.
Roxanna (34:32) Yep. (34:32) And so I was like he's like, well, you know, we checked his blood sugar at home, and it was reading high or 400 or something. (34:41) I said, Jonathan, he has type one diabetes. (34:46) He was like, no. (34:46) I don't think so.
Roxanna (34:48) He really thought it type two, but gets there. (34:51) He's also in, you know, severe DKA, and he gets life flighted also too.
Scott Benner (34:55) Your brother's a little thick. (34:57) A little a little, like, in the head? (34:59) That's
Roxanna (34:59) the thing. (34:59) He's an incredibly smart guy. (35:01) Like, he he knows, like, and I think he knew, like, in his mind, as well. (35:07) I think he was just kind of hoping that it was that's not what it was.
Scott Benner (35:11) Can I say sometimes sometimes I let the stories tell the lesson, and sometimes I like to go back and point so that I make sure you guys don't miss the lesson in the stories? (35:22) I think and I don't love that as a podcasting thing. (35:26) Like, I was actually just listening to a podcast today where the guy explained to me what he was gonna tell me before he told me, and I said, you could've just told me. (35:32) I would've figured it out. (35:32) That's how I thought about it.
Scott Benner (35:33) But I think this is important to maybe highlight for a second. (35:37) Your brother, who you're describing as a bright person, right, who clearly loves his children Yes. (35:43) Is told by his sister, who's an ICU nurse who has type one diabetes, hey. (35:47) I think your daughter has type one diabetes. (35:49) And not only did he not listen, but it took him two weeks and an illness that was so unavoidable to actually come to grips with it.
Scott Benner (35:58) And then it happened to him again, and he had the same experience. (36:02) So I'm underlining that for everybody who finds themselves blaming themselves for not figuring it out sooner.
Roxanna (36:08) Mhmm.
Scott Benner (36:09) Like, because your brother didn't have to figure it out. (36:11) Someone told him, and he still couldn't bring himself to to make that leap. (36:17) Yeah. (36:17) So I wish people wouldn't hold themselves at, to such a high standard on this one. (36:23) I think it's an incredibly difficult thing to come to grips with or to figure out.
Roxanna (36:27) It really is. (36:28) And after my niece was diagnosed, you know, I am a firm believer in screening and that we should be doing it and hopefully one day at a general population level. (36:37) But at least, you know, now with, if you have family history, that it doesn't have to be that way. (36:44) It doesn't have to be like a traumatic diagnosis. (36:46) And I made everyone that was eligible to get testing at the time through trial net get, their antibodies tested, my my siblings.
Scott Benner (36:54) Well, yeah, you had a lot of power by then.
Roxanna (36:56) Yeah. (36:58) And the only one that did not get their auto weighted bodies tested was my Oh,
Scott Benner (37:03) sorry. (37:04) I was just I thought John I thought your brother John for sure was the one that was gonna be like, no. (37:08) I'll I'll remain hard headed on this. (37:09) By the way, your nephew didn't?
Roxanna (37:11) Yeah. (37:12) And I get it that he he also has Down syndrome. (37:14) So he is a little bit challenging for sure. (37:17) So getting him to
Scott Benner (37:18) He didn't want to do to
Roxanna (37:19) that would have been challenging, but ironically.
Scott Benner (37:23) I just interviewed a lady the other day who has, whose child has Down syndrome and type one.
Roxanna (37:28) Yeah. (37:28) He's hard. (37:29) He you know, my brother has his he works hard with them. (37:35) It's that's hard.
Scott Benner (37:36) It's a lot. (37:37) Yeah.
Roxanna (37:37) Yeah. (37:38) It's a lot. (37:38) I can't get him to wear a CGM or anything. (37:40) He's just living his best life.
Scott Benner (37:43) Okay. (37:43) Wow. (37:44) Alright. (37:47) You're like an oracle in that family that no one listens to.
Roxanna (37:50) Yeah. (37:50) I know. (37:51) That's what I say all the time. (37:52) So
Scott Benner (37:55) when I said to you, do your friends ping you once a year to say, do you remember when I saved your life? (38:00) I assume they don't because they're not related to you. (38:03) But I bet you're up your brother's ass all the time about this.
Roxanna (38:06) Yeah. (38:06) I try to keep it in check, but
Scott Benner (38:08) sometimes I just Yeah. (38:12) Sometimes you gotta, like, whip it out, I would imagine. (38:14) Right?
Roxanna (38:14) Yes. (38:15) But he has certainly helped me out with a lot of things myself. (38:18) So, I mean, he's he's an incredibly bright guy.
Scott Benner (38:22) Yeah. (38:22) He
Roxanna (38:22) really is. (38:23) He just, I think, it's just hard.
Scott Benner (38:25) I million percent think it's incredibly difficult to just make the leap.
Roxanna (38:28) So Yeah. (38:29) Screen. (38:29) Everyone should screen.
Scott Benner (38:30) Yeah. (38:30) No kidding. (38:32) But but what was I gonna say? (38:33) Oh, okay. (38:34) So now you have all this information.
Scott Benner (38:35) You got family members. (38:37) You're doing better, I imagine, at some point. (38:40) When do you make the shift in your profession? (38:42) Like, when do you say, hey. (38:43) I think I could teach this?
Roxanna (38:44) I think after I realized that I mean, if I can do this, like, surely anyone could do it.
Scott Benner (38:50) Yeah. (38:52) That's what you said. (38:55) You're like, well, I did it. (38:56) So by the way, that's what I say when I make the podcast. (38:58) I'm like, I figured it out.
Scott Benner (38:58) You guys should easily be able to do it. (39:01) Yeah. (39:01) And I just kind of it just kind of
Roxanna (39:03) fell on my lap, honestly. (39:04) I was COVID. (39:06) I decided to stop doing travel nursing and I was at home visiting and I was laying on the couch at like 02:00 at night, like just scrolling through possible job opportunities because I knew I didn't wanna travel anymore. (39:21) And there was a position for an educator at our local children's hospital. (39:27) And I was like, I think I could probably do that.
Roxanna (39:29) Like, I think that sounds like something I could do and, like, I would have a passion for.
Scott Benner (39:33) Mhmm.
Roxanna (39:34) And, I applied and, I think at, like, 2AM, and they called me at, like, 8AM, like, the next morning saying, can you come in for an interview? (39:43) Because I don't think anyone else wanted the job, quite frankly.
Scott Benner (39:46) They came in in the morning like, hey. (39:48) We got a sucker on the line. (39:49) Hold on a second.
Roxanna (39:51) That is exactly how it how I imagine this happened. (39:55) And I was hired very shortly after I went through a few interviews. (40:00) And, I don't think there was any other option. (40:03) So
Scott Benner (40:04) I was just talking to a nurse yesterday who was asking me about if I could put resources together for her to give to people because she shares the podcast with all people a lot. (40:13) She's like, could you make a printout or something that I could print out over and over again? (40:16) And we kinda talked back and forth about what it was. (40:18) And I chatted I was on the phone with her. (40:19) And I chatted with her for a couple of minutes.
Scott Benner (40:21) But what's going on? (40:22) She's like, oh, it's we're pretty rural. (40:24) And, you know, we did get an endocrinologist finally, but he filled up so quickly that it now takes a year to get an appointment with him.
Roxanna (40:32) Oh my.
Scott Benner (40:33) Like, that fast. (40:34) As fast as he got there, the the place was basically closed to new to new clients. (40:39) Like, just just like that. (40:40) Yeah.
Roxanna (40:41) We have actually had some luck, recruiting some good providers to us. (40:47) So we are we there was a time when it was really hard to get in, but now I feel like we are in a much better spot in terms of
Scott Benner (40:53) A little better.
Roxanna (40:53) Offering provider spots.
Scott Benner (40:55) Let me ask about the timeline one more time. (40:57) So you're diagnosed ten years ago ish? (41:00) Mhmm. (41:01) Okay. (41:02) Around COVID time, you maybe kinda pull it together a little bit, figure things out.
Scott Benner (41:06) Right?
Roxanna (41:07) Mhmm. (41:08) Yep.
Scott Benner (41:08) And now at that point, you have the podcast as a as a tool for yourself. (41:13) Mhmm. (41:13) Okay. (41:13) Yep. (41:14) You start doing this job how much later?
Roxanna (41:16) I mean, was around COVID. (41:18) Like, when I I got this job during COVID, that was, what, 2021?
Scott Benner (41:23) Okay. (41:24) Okay. (41:24) Yeah. (41:25) So I'm gonna ask a question again. (41:26) It's gonna sound self serving.
Scott Benner (41:27) I don't really mean for it to be, but I've been saying for years, maybe more privately than on the podcast that, like, one of my goals is to kinda help be part of putting a new, I don't know, generation of educators out into the world who are thinking more boldly about how to use insulin and stuff like that? (41:45) Like, is it fair to say that, like, not that you need me, but you're a protege of the podcast out there in the world kind of thing?
Roxanna (41:51) I would say yes. (41:53) I mean, I get a lot of my management, approach to how the podcast approach to diabetes.
Scott Benner (42:03) Okay.
Roxanna (42:04) Because that is kind of how I learned. (42:06) So, that's kind of how I
Scott Benner (42:08) How you teach?
Roxanna (42:08) Evolved into my own teaching and education.
Scott Benner (42:12) Okay. (42:12) So you learn that way, you manage yourself that way, you talk to people that way. (42:17) Are they having outcomes similar to yours? (42:20) Guess, so my question is is that we put all this I could be setting myself up for a big no here that I guess will make me cry. (42:26) But is that helping people?
Roxanna (42:30) I yes. (42:31) Sure. (42:32) Absolutely. (42:32) I think if they actually take the time to figure it out, and I'm not saying it's easy, but it does take effort on the parts of, like, the families. (42:44) I can't teach them everything.
Roxanna (42:47) I mean, I wish I could, but, you know, everyone's diabetes is also a little bit different. (42:52) And I hope that what I give them is the, like, impetus to, like, them to go further.
Scott Benner (43:00) Mhmm.
Roxanna (43:01) Because they spend, you know, what, point o 5% of their they come see even at coming seeing us every three months, they spend, like, point zero five percent of their lives with me and with the with our clinic. (43:13) My hope and what I want the families to know is that to, like, them to feel like empowered, I guess, is the right right word Mhmm. (43:23) To understand that diabetes doesn't it's always there. (43:26) Like, you can't come to us once every three to four months and expect to make us to make one change on your basal rate and to be okay.
Scott Benner (43:35) That's gonna be the whole thing. (43:37) And that is some people's expectation.
Roxanna (43:39) Yeah. (43:39) And that and that's what I really hope that families understand that they as long as they understand what they're doing and why they're doing it and doing it safely, like, they don't don't ask permission to change your carb ratio
Scott Benner (43:55) Right.
Roxanna (43:56) Or your basal rate. (43:57) Like, that's what I we are here to help you get through those questions. (44:01) But really, it's I want them to know that this is how diabetes is gonna work. (44:06) Okay. (44:07) That I want you to understand why you're doing it and how insulin works and all those things and the possible variables that could be in there.
Roxanna (44:14) It's going to be a lot on the family, and that's not fair. (44:17) But that's how diabetes is. (44:19) It's one of those rare diseases that, you know, you're kinda making decisions on your own. (44:26) We're not telling you how much to take or when to take it.
Scott Benner (44:29) It's you.
Roxanna (44:29) For the most part, it's on you.
Scott Benner (44:31) So this obvious doesn't need to be perfect, but one out of ten, two out of ten, three, four, five, six, seven, eight, nine out how many out of 10 families do you think have an outcome that makes you say, hey. (44:43) They get this and they're putting it to practice?
Roxanna (44:47) Oh, I would say, let's go with 60%.
Scott Benner (44:52) 60%. (44:53) Okay. (44:53) That's pretty great. (44:55) Do you think the other 40% get it at some point, or do you think there's another barrier that your interaction with them can't help with?
Roxanna (45:05) Oh, yeah. (45:06) I mean, I think they're certainly barriers. (45:09) I mean and I think some people, like, even myself, like, it just takes them a while to figure it out
Scott Benner (45:16) Right.
Roxanna (45:17) Or to want to figure it out. (45:19) Because you can talk until you're blue in the face to someone, and then tell they're ready, they're not ready. (45:25) Right. (45:25) And there's not really much you can do about it. (45:27) All you can do is offer them you know, continue to encourage and support and, you know, be there to answer their questions.
Roxanna (45:35) Mhmm. (45:36) Generally, like, threats or, you know, scaring kids
Scott Benner (45:40) No. (45:41) That's gonna
Roxanna (45:41) work. (45:41) Or families doesn't really work well. (45:43) Yeah.
Scott Benner (45:44) I mean,
Roxanna (45:44) there are some teenagers that it works well with, but, typically, it's not gonna work. (45:48) And there's nothing you can do to enforce that, at least nothing that I found that that works. (45:54) It just doesn't.
Scott Benner (45:55) Of those, like, 40% of people, do you still think some of them are gonna get it at some point?
Roxanna (46:00) I do. (46:01) Yeah. (46:01) I mean, I'm case in point. (46:02) I didn't get it at first.
Scott Benner (46:04) Right.
Roxanna (46:05) And I eventually got there, but it did take it did take a while of acceptance and learning and and all those things to get me where I am.
Scott Benner (46:15) Mhmm.
Roxanna (46:15) And not that I am perfect by any means, but I certainly, you know, am not
Scott Benner (46:20) Pretty far along.
Roxanna (46:21) Where I was. (46:22) Yeah. (46:23) Where I would literally just go to work and be like, oh, forgot to put my pump on after that shower. (46:29) Oh, well.
Scott Benner (46:30) Are there people that for whatever reason, financial, educational, intellectual, whatever, are there people who you've I gave you a million dollars and I made you bet, you'd bet against them ever figuring it out? (46:43) And do those people have anything in common that you can identify, if so?
Roxanna (46:48) I think that there's always a way. (46:51) It may not be a way that you expect or the traditional way. (46:54) I think a lot of it has to do with, the health literacy
Scott Benner (46:58) Okay.
Roxanna (46:59) And the way that it's approached. (47:02) Because we, you know, we approach everything, like, the same way, and every family is a little different. (47:07) Like, you know, some families do really well with they want all the information up front, and they're you know, why didn't you tell us this from the very beginning? (47:14) And some families need a slower introduction
Scott Benner (47:17) to
Roxanna (47:18) things to not feel so overwhelmed and, like, burdened by it and just throw their hands up immediately and say, this is impossible. (47:24) And they makes them give up right then and there. (47:27) So I think it's also about, like, sealing out families a little bit. (47:30) Right? (47:31) Like, everyone's kind of individualized in how they learn.
Roxanna (47:35) I think there's always help for families. (47:38) You just have to find what works for them, you know, whether that's
Scott Benner (47:44) I agree with you, by the way. (47:45) I think there are very rare instances where there's people who just couldn't get it.
Roxanna (47:51) Yeah. (47:51) I I mean, I agree.
Scott Benner (47:53) There's a way to reach up, I would say, most of them. (47:56) Yes. (47:57) My is my anticipation. (47:59) But that's also it's not like you have a podcast. (48:02) You can't talk into the rear five times a week and and make them listen.
Scott Benner (48:06) Right? (48:06) You have them for what? (48:08) A short amount of time quarterly?
Roxanna (48:11) Yeah. (48:11) I do one big class with all of our new kids that come in. (48:15) That's about three hours. (48:16) And then, you know, I'm there as needed kind of after that.
Scott Benner (48:20) How do you get that covered? (48:21) Because my my idea that I've now heard other people say, not only have they wanted to do the same thing, but, apparently, there are studies that again, this is one of these things that I thought I thought of and then I realized I didn't. (48:33) But why can't once a year why can't you take the whole practice? (48:37) I don't know how many people you see in the practice. (48:39) But, like, let's say it's, you know, let's say it's 500 families.
Scott Benner (48:42) How come you can't split them up into, you know, five days of a 100 and do, like, one, like, day long session with all of them to kind of, like, up I know it's a hard thing to bill. (48:54) Right? (48:54) But how do you but how are you doing the one session with the newly diagnosed kids? (48:58) Because you're billing for that too.
Roxanna (49:00) Well, as they can they in order to see a provider, then they have to go to the class first, whether that's being transferred in or whether they're a new onset. (49:08) Mhmm. (49:08) So they have to have a touch point with me before they're even see the provider. (49:14) And that a lot of families get upset with that or not upset. (49:17) Maybe don't understand, I guess, why.
Roxanna (49:19) They've had diabetes for ten years. (49:21) Like, why are we making them go to this, you know, class before they see a provider?
Scott Benner (49:24) Okay.
Roxanna (49:25) But it's a good way to, like, level set. (49:27) Right? (49:27) Like, to I don't know where they came from. (49:30) They could have had been bait not seen anyone for a while and be managing really well or would or have no idea what, you know, long acting insulin and versus rapid acting insulin.
Scott Benner (49:40) Yeah. (49:40) You have to start somewhere. (49:41) You have to get a baseline for everybody.
Roxanna (49:43) Right. (49:44) Yeah. (49:44) And just kind of introduction to how we think about diabetes and, you know, how we manage diabetes Sure. (49:52) And kind of assess where they are and, you know, what they need. (49:56) But that's
Scott Benner (49:58) Does my idea not carry water for you, or did I not articulate it correctly? (50:02) Like, I go speak at touch by type one, right, as an example. (50:05) There's a day there where there's somebody speaking. (50:08) Actually, there's, like, usually four people speaking every hour and you can pick a class to go to. (50:12) Like, is there not a world where you could bring everybody in, keep them there for, you know, a whole day, give them a a a symposium, have them sit through a number of different things, and and level them up in one day instead of trying to level them up fifteen minutes a time, four times a year?
Roxanna (50:30) I mean, I think in theory, yes. (50:32) That's great.
Scott Benner (50:33) Mhmm.
Roxanna (50:33) I don't think you would ever, just based on what I see here, get that level of engagement. (50:39) I mean, they don't even wanna come to the class most of the time. (50:44) Now most families afterwards find it very helpful, and some that's not I'm you know, I'm generalizing here. (50:49) Yeah. (50:50) Some are want to come, and they're very engaged, they're ready to ask questions.
Roxanna (50:54) But most are like, why on earth do I need to come to a class for three hours on diabetes?
Scott Benner (51:00) If you spend the three hours saying, you know, shoveling crap to them and comment it and send stuff that, like, you have to really, like, dig in and tell them something. (51:10) You know? (51:10) Like, you have to make them I mean, that's been my expectation and my finding when I do these public speaking events. (51:15) And I'm I'm certainly not throwing shade at anybody, but somebody's gonna feel that way. (51:20) I've seen sessions that I thought, oh my god.
Scott Benner (51:22) I'd get up and walk out of that. (51:24) Like, I I don't know why anybody's sitting in there. (51:26) Right? (51:27) And I don't just mean to touch, but I I gotta be honest with you. (51:29) I've every place I've ever spoken or been to, I've stuck my head into a room or sat in a room and thought, oh god.
Scott Benner (51:36) What a waste of time. (51:37) And, you know, and when people come out of my sessions, they're like, wow. (51:40) That was great. (51:41) Thank you. (51:42) Like, you know, so, like like I mean, you have to help them at that level.
Scott Benner (51:45) You can't just repeat stuff they've heard already or put them in front of somebody who's speaking who doesn't know what the hell they're talking about or is new to it or is gonna recite the, you know, the company line or something like that.
Roxanna (51:58) Yeah. (51:58) I I agree.
Scott Benner (51:59) I think I'm seeing the problems.
Roxanna (52:01) And I try to make my classes engaging, like, you know, I I do. (52:05) I try to, like especially these new kids that are coming in, and they don't they're easier, I feel like, because they don't know anything typically. (52:13) They don't know what, you know, pre bolusing is or either how insulin works. (52:19) They were sent home from the hospital with very black and white guidelines. (52:21) Like, you you know, you let your kid eat three times a day and free snacks in between, and, you don't correct, but, you know, this amount of times.
Roxanna (52:30) And, so I feel like the class, I hope, in part, it's like, you know, kinda opens their eyes a little bit about you don't have to be so restrictive. (52:40) Like, timing of insulin is important, and we talk about variables and, you know, technology and how important that is and glycemic index and glycemic load. (52:50) Like but some of it, you have to read the room a little bit too, if you know what I mean.
Scott Benner (52:54) Like Sure. (52:55) No. (52:55) No. (52:56) I do. (52:56) I understand.
Roxanna (52:56) Families aren't. (52:58) There are some families that have much better or coming in with much better health literacy than others. (53:03) Mhmm. (53:03) And then it gets really challenging when you put two of those families together or more than that, and they're all on different levels, and you're trying to engage all of them.
Scott Benner (53:10) Health literacy is a polite way of saying what?
Roxanna (53:14) Like, they don't understand how to count carbs or, like, their math skills are just not there.
Scott Benner (53:23) Gotcha.
Roxanna (53:25) Like, that's, I feel like, the polite way of saying it.
Scott Benner (53:28) Are we not slapping, islet pumps on those people? (53:31) Is that not a good idea?
Roxanna (53:33) Yeah. (53:34) We are very pro islet here. (53:35) We do a lot of islet pumps. (53:37) And not necessarily for just kids that were like, oh, they are never gonna figure this out. (53:43) Like, just for kids that are, like, burnout too
Scott Benner (53:45) Yeah.
Roxanna (53:46) And aren't gonna do anything. (53:47) Like, they're not doing anything now. (53:49) And I'm like, if you will just put this pump on and keep it charged and keep it filled with insulin, that's all I expect from you. (53:54) I don't even care if you're bolus. (53:55) Don't bolus.
Roxanna (53:56) Whatever. (53:57) Yeah. (53:58) Just put it on, and those kids do, really well.
Scott Benner (54:02) You're seeing good returns for that.
Roxanna (54:03) What is better.
Scott Benner (54:04) Well, what does that mean, like, a one c
Roxanna (54:06) wise? (54:07) Seven well, like, you know, their a one c's are hanging out ten, eleven, and they go down to a seven, seven and a half.
Scott Benner (54:12) That's hard to argue with, isn't it?
Roxanna (54:14) Yeah. (54:14) With, like, no effort on their parts as long as they are you know, the care and feeding of it is what they call it. (54:20) You know? (54:21) It charged. (54:21) Keeping it charged keeping it on.
Roxanna (54:24) That's all I can ask of them, and that's those teenage years are are tough enough. (54:29) And so I feel like that has helped kids get through
Scott Benner (54:31) I imagine.
Roxanna (54:32) A lot.
Scott Benner (54:33) Yeah. (54:33) I'm a proponent. (54:34) I am a specific use cases, I mean, I I'm I wanna just say, like, unless some things change, like, I wouldn't ask my daughter to wear a pump where she couldn't adjust her insulin or anything like that.
Roxanna (54:44) But Mhmm.
Scott Benner (54:45) For people in that situation, boy, it seems like a slam dunk to me. (54:48) You know?
Roxanna (54:49) Yeah. (54:49) I tried it. (54:50) I tried it for a while. (54:51) I mean, I've tried I've tried all the pump systems
Scott Benner (54:53) Mhmm.
Roxanna (54:54) For the most part, since I've been diagnosed anyway. (54:57) I tried to try them all, and it was not for me for sure. (55:01) Right. (55:02) Right. (55:02) I could see the utility in it, and how helpful it could be.
Roxanna (55:06) I mean, it wasn't horrible by any means. (55:08) Like, I I did okay, just not I'm way too much of a micromanager, I think, to have let that control, though.
Scott Benner (55:13) Right. (55:14) Hey. (55:14) Listen. (55:14) In fairness, I think they're the only palm company that doesn't buy an ad from me. (55:17) And I'm telling you, I if in this use case, I think it makes sense to wallpaper people with them.
Roxanna (55:23) Yeah. (55:23) Yeah. (55:23) Yeah. (55:24) Especially if they're in you know, most people with diabetes aren't even managed by endocrinologists. (55:28) A lot of them are managed in primary care.
Roxanna (55:30) So that's like
Scott Benner (55:30) Different issue.
Roxanna (55:31) A perfect kind of scenario for that situation.
Scott Benner (55:34) Right. (55:34) Because the doctors also double don't know what they're talking about in that in that scenario. (55:38) So you have people who
Roxanna (55:39) They're terrified. (55:40) Right? (55:40) Like, they just wait. (55:41) All I gotta do is put a weight in this thing. (55:43) Great.
Roxanna (55:43) Put it on.
Scott Benner (55:44) Yeah. (55:44) Yeah. (55:44) I I would imagine that's an interesting subset. (55:47) Those are and by the way, I would also imagine that that subset's a lot bigger than you and you might believe while you're listening. (55:53) But there's, people who are not having good outcomes, who don't have, for whatever reason, the the ability to do better, and they've got a doctor who's basically just like, here's insulin so you don't die.
Scott Benner (56:06) And they're like, I get the insulin from the guy so I don't die. (56:09) And that's the extent of their care. (56:10) Right?
Roxanna (56:11) Right. (56:11) Yeah. (56:12) Exactly. (56:12) And that is what most people in The United States, how they receive their diabetes care is in that that exact manner. (56:19) Not enough endocrinologists or, you know, their majority of people with diabetes are being managed by primary care.
Scott Benner (56:26) Yeah. (56:27) Well, you know, there's probably a world where you could make about a five episode podcast series that maybe wasn't more than about twenty minutes long a piece and just, like, email it to people in that scenario, and it it could easily help them understand why an eyelet pump would be a good vibe for them. (56:47) I wish I wish eyelid would reach out to me. (56:49) Feel like we could help those people. (56:50) Not that I'm sure they're doing fine on their own, but I really feel like there's an opportunity there.
Roxanna (56:54) Yeah. (56:55) Yeah. (56:55) I think they it's a great it's a a great option for for a lot of people.
Scott Benner (57:00) Yeah. (57:01) No kidding.
Roxanna (57:02) For sure.
Scott Benner (57:02) What's your a one c right now? (57:03) Can I ask you? (57:04) Put you on the spot.
Roxanna (57:05) I I mean, I maintain, like, a low to mid fives.
Scott Benner (57:09) Look at you. (57:09) Any special, special eating style?
Roxanna (57:13) No. (57:13) I kind of you know, I I mean, I try to eat healthy, quote, healthy, but I certainly eat Oreos every now and then and, you know, everything in, like, moderation is kind of my motto, but I'm definitely not low carb or Yeah. (57:27) You know, I do kind of naturally follow, an intermittent fasting just because I'm not a breakfast person.
Scott Benner (57:32) Mhmm.
Roxanna (57:33) But other than that, I kind of do what I want, eat what I want, but try to eat healthy. (57:41) Okay. (57:41) I have lots of fruits, vegetables, you know, protein kinda situation.
Scott Benner (57:46) Has your niece come to you for help yet, or does she still think you gave her diabetes and
Roxanna (57:49) Oh, heavens. (57:50) No. (57:50) I mean, I make her like, every once in a while, I make her come down, and I'm like, okay. (57:54) Let's look at your Dexcom, like, report because she was one of those kids that did not wanna pump. (57:59) She cried for four hours trying to get a Dexcom on her, and now she wouldn't live without it.
Roxanna (58:03) But every before when she was MDI doing injections, we'd sit down and look at her Dexcom report, and I'd make her go through it. (58:10) So she gets a pretty good idea of, like, what she's doing now. (58:13) Yeah. (58:13) And right now, she's doing she did actually get on a pump just this past summer. (58:17) She did Mobi and is really doing amazing on it.
Roxanna (58:21) I think her a one c is better than mine, honestly.
Scott Benner (58:23) Awesome. (58:24) Good for her.
Roxanna (58:25) Yeah. (58:26) She does she does great. (58:27) She is very independent and takes care of herself and knows what she's doing. (58:31) And I like to think that some of that came from me, but, you know, she's not gonna say that.
Scott Benner (58:36) Yeah. (58:36) No. (58:36) Okay. (58:36) And if everybody listening wants a pump and this is talking into it, in the show notes, you're a podcast player. (58:41) There are links to every pump company except for except for Eyelet.
Scott Benner (58:46) I'm pretty yeah. (58:47) Twist is in there. (58:49) Omnipod, Medtronic, Tandem. (58:52) Yeah. (58:53) I got them all.
Scott Benner (58:54) Go in there. (58:54) And even, CGMs. (58:56) By the way, Dexcom, the implantable Eversense. (59:00) I'm working really hard maybe in 2026 from you here and from, the good people at Libre about their CGM, so it might work out.
Roxanna (59:09) Yeah. (59:09) I'd love to try that twist twist pump in the Eversense, honestly.
Scott Benner (59:13) We
Roxanna (59:13) don't have it available in our area yet. (59:16) It's not quite out. (59:17) But
Scott Benner (59:18) It's twist pump is just loop
Roxanna (59:20) Yeah.
Scott Benner (59:20) Or in a new a new form factor.
Roxanna (59:22) It's not as good as loop. (59:24) No.
Scott Benner (59:24) It's loop it's loop that adjusts with Basal. (59:27) Right?
Roxanna (59:28) Yes. (59:28) It doesn't have the, the auto bolus
Scott Benner (59:30) Yeah.
Roxanna (59:31) Branch on it. (59:32) And I think that's coming, but it's it'll have to go through, like, the FDA, which I hear shouldn't be too painful. (59:37) But it doesn't have you can't do all the custom presets from what I understand. (59:41) Like, there there are two, like, set presets
Scott Benner (59:44) Mhmm.
Roxanna (59:45) That you will lose that kinda The functionality that you have with loop
Scott Benner (59:49) Well
Roxanna (59:50) right now.
Scott Benner (59:50) Once they get the auto bolus version out of it, I would I would say that's makes it even more valuable and more and I and I've heard the same thing that it's it's not fast track, but it's not it's certainly not something they're ignoring, I wouldn't say. (1:00:02) Right. (1:00:02) Yeah.
Roxanna (1:00:03) It's Yeah. (1:00:03) Coming. (1:00:03) I think it has has great potential. (1:00:05) As soon as it is in our area, will certainly give it a try
Scott Benner (1:00:09) Mhmm.
Roxanna (1:00:09) Before, we start doling it out to our children.
Scott Benner (1:00:13) What happened here? (1:00:14) Kenny relocated. (1:00:16) He and his family relocated. (1:00:18) They end up I know. (1:00:19) They end up at your children's hospital.
Scott Benner (1:00:21) So tell me the story.
Roxanna (1:00:22) Well, I just I I mean, I knew I knew of his name just from Loop because I am familiar with, like, looping. (1:00:30) I started well, I knew what looping was, but I started looping myself this past summer.
Scott Benner (1:00:34) Mhmm.
Roxanna (1:00:35) So I recognized the name for sure. (1:00:37) And I was like, what? (1:00:38) I don't think that there's no way. (1:00:41) Like, why would he be here of, all places? (1:00:44) And sure enough, it was him.
Roxanna (1:00:46) We connected, and he sat down and helped me with, like, some loop settings, because I had recently just started looping when he came through.
Scott Benner (1:00:55) Okay.
Roxanna (1:00:56) But, yeah, he saw the JuiceBox binder in class and was like, do you mind if I send a picture of that to Scott? (1:01:04) I was like, sure. (1:01:05) Why not? (1:01:06) Yeah.
Scott Benner (1:01:06) That's so nice.
Roxanna (1:01:07) So he did us in he said, I think this is great. (1:01:09) And he, you know, he had to he came to the class. (1:01:12) And, you know, if there's someone that knows a lot about diabetes and how insulin works, it's Kenny Fox. (1:01:18) And so he thought, you know, the class was at least you know, I think he I don't know if he loved it, but I think he thought it was useful.
Scott Benner (1:01:30) Hey. (1:01:30) That's a win. (1:01:31) Inside of a inside of a health system, that's a win.
Roxanna (1:01:34) I know. (1:01:35) Yeah. (1:01:35) Yeah. (1:01:35) And he was he was a lot of fun to do class with. (1:01:38) I think he was there were several other families in there.
Roxanna (1:01:41) And so we had a good time learning, and he was, you know, he's a very natural educator himself. (1:01:47) So we had a good time. (1:01:49) And he said, you know, he's like, you should before you you should reach out to Scott and do a a podcast. (1:01:56) And I said, why not? (1:01:57) And, actually, our our section chief did a podcast with you.
Roxanna (1:02:01) Name? (1:02:02) A couple years ago. (1:02:04) Doctor John Oden.
Scott Benner (1:02:06) John oh, John's in the, he's in the grand round series.
Roxanna (1:02:10) Yes.
Scott Benner (1:02:10) Yeah. (1:02:10) He was very impressive.
Roxanna (1:02:12) Yeah. (1:02:13) He's a very smart man.
Scott Benner (1:02:14) Yeah.
Roxanna (1:02:15) And has type one himself and takes really good care of our kids.
Scott Benner (1:02:19) No. (1:02:20) I remember thinking when he was done, everybody should have this guy for a doctor.
Roxanna (1:02:25) Yeah. (1:02:26) He's great. (1:02:27) So we are lucky to have him here for sure.
Scott Benner (1:02:29) How does that help the practice when the top thinks about it a certain way? (1:02:34) Does that actually reach everybody, or does that
Roxanna (1:02:37) Yes. (1:02:37) I think that is certainly very influential on how we manage diabetes because it you know, every protocol or practice or how we manage diabetes in the hospital kind of they look to our, you know, our department and therefore our section chief to say how we should do that. (1:02:56) Like, you know, what's the age cutoff for, like, prevola scene and, like, how how we manage, you know, sick day and ketones and that, you know, he's certainly a a voice of leadership, I'd say, in how we do all those things.
Scott Benner (1:03:11) That's awesome. (1:03:12) I'm having a problem here. (1:03:13) This is very embarrassing. (1:03:15) There's a rogue cricket in the room. (1:03:17) K.
Roxanna (1:03:17) I hear it.
Scott Benner (1:03:18) You can hear it. (1:03:19) Mhmm. (1:03:20) What am I gonna do about that?
Roxanna (1:03:22) I think just leave him.
Scott Benner (1:03:23) He's fine. (1:03:24) No. (1:03:24) But it gets in the recording, and now Rob is very upset somewhere. (1:03:28) You understand? (1:03:29) Like, in the few if in the future, Rob is like, what who am I working for?
Scott Benner (1:03:32) Is what he's thinking right now. (1:03:35) This guy can't keep a cricket out of his goddamn office. (1:03:38) I'm so careful with him.
Roxanna (1:03:40) Maybe, yeah, did he escape out of the
Scott Benner (1:03:43) I don't know. (1:03:43) What do
Roxanna (1:03:43) we do?
Scott Benner (1:03:44) Thing. (1:03:44) Yeah. (1:03:45) Well, listen. (1:03:46) I appreciate that you listen. (1:03:47) I that's very nice here.
Scott Benner (1:03:49) Alright. (1:03:49) Give me one second to see if I can figure this out. (1:03:52) I'll be back in two seconds. (1:03:54) I think I've isolated where he is.
Roxanna (1:03:57) It got silent, so you must have done something.
Scott Benner (1:03:59) The the key is to tap on the enclosure. (1:04:03) And once you tap on the right one wherever it is, it stops. (1:04:07) Yeah. (1:04:08) Yeah. (1:04:08) He won't stop for long.
Scott Benner (1:04:10) And then there's another trick where you can kinda, like, crack the door to change the air pressure in there, which kinda throws him off for a while. (1:04:16) So I've done my god. (1:04:19) Look at my life has come to. (1:04:21) I'm not gonna apologize, damn it. (1:04:23) I really like these things, and it's a very comforting part of my life.
Scott Benner (1:04:26) So you guys can all I I need something to take care of my kids got older. (1:04:29) Okay? (1:04:29) So leave me alone.
Roxanna (1:04:30) I'm I'm fine. (1:04:31) I was just gonna ignore I'm very good at tuning things out.
Scott Benner (1:04:34) I but what problem is is when I start talking, you'll hear it behind me. (1:04:38) Like like, Rob will cut out the gaps where you're talking and I'm not talking because that's the only place it's is recorded is on my mic. (1:04:45) So he can just chop that up. (1:04:47) But when I started asking you a question, as soon I open my mouth, you'll hear the chirping behind me at the same time. (1:04:52) Anyway, did you know it's not their legs that make the noise?
Scott Benner (1:04:54) It's they get wings as they get older?
Roxanna (1:04:57) And that's what they rub together?
Scott Benner (1:04:58) Yeah. (1:04:59) And that's what makes the noise. (1:05:00) And
Roxanna (1:05:01) I don't I think I thought I definitely think I thought it was their legs, but that makes sense.
Scott Benner (1:05:05) That's probably from Disney. (1:05:06) You thought that with Jiminy Cricket.
Roxanna (1:05:08) Probably so.
Scott Benner (1:05:08) Mhmm. (1:05:09) Mhmm. (1:05:09) Probably so. (1:05:09) They lied
Roxanna (1:05:10) to You're right.
Scott Benner (1:05:11) Wonder what else they lied about. (1:05:12) No. (1:05:12) Just kidding. (1:05:13) I I have nothing against
Roxanna (1:05:14) the this. (1:05:15) Camera. (1:05:16) Took a turn.
Scott Benner (1:05:17) Let's talk about Walt Disney, shall we? (1:05:21) I hear his head is mounted on a coffee can in a freezer somewhere. (1:05:24) Have you ever heard that?
Roxanna (1:05:26) I've heard all sorts of conspiracy theories about poor Disney.
Scott Benner (1:05:32) Poor poor Walt Disney's head and where it might be or where it might not be.
Roxanna (1:05:35) Yeah. (1:05:35) Just just somewhere. (1:05:36) It's probably somewhere in the park.
Scott Benner (1:05:41) That'd be awesome. (1:05:42) Wouldn't it?
Roxanna (1:05:44) I would.
Scott Benner (1:05:45) Under something in a freezer, nobody even remembers it
Roxanna (1:05:48) Where's Waldo?
Scott Benner (1:05:49) That's crazy.
Roxanna (1:05:50) Send people out to go find it.
Scott Benner (1:05:52) Finally, I'd go back to Disney again. (1:05:55) I'd be like, listen. (1:05:56) I'm on the I'm on oh, a head hunt. (1:05:57) I'd be on a head hunt. (1:05:58) Look at that.
Roxanna (1:05:59) Oh, a literal head hunt.
Scott Benner (1:06:00) Yeah. (1:06:00) Exactly. (1:06:02) When you came on, did you have any expectations or has this gone pretty much the way you expected?
Roxanna (1:06:06) No. (1:06:07) I just came on to I don't know. (1:06:09) Just be on it. (1:06:11) Yeah. (1:06:11) And, you know, Kenny kinda put me onto it and just about, I think, education and and screening, those are kind of my big the big things that I that I talk about.
Scott Benner (1:06:24) Yeah. (1:06:24) Trying to push people towards. (1:06:25) Mhmm. (1:06:26) Screening, obviously, is a really big deal right now because and I feel like I can just say this. (1:06:30) It's a big deal right now because my listen.
Scott Benner (1:06:34) This is from my perspective. (1:06:35) Okay. (1:06:36) Sanofi bought TZealed from Provention Bio. (1:06:41) And the only way they can get you to use it if they know you need it, so there's a big push for screening right now. (1:06:47) And I think that has something to do with the $3,000,000,000 they paid for TZeal.
Scott Benner (1:06:50) That's my thought.
Roxanna (1:06:51) Oh, yes. (1:06:52) And there is certainly Santa Fe is a big pusher of screening for that same reason. (1:06:57) But Mhmm. (1:06:58) You know, I see it more as TZILD is just the tip of the iceberg. (1:07:03) Like, we are moving in a direction where, you know, there are gonna be, like, cell therapies and, islet transplants that you have to like, you need to be screened, you know, if you want the benefits of these They of a lot of these therapies.
Scott Benner (1:07:17) Yeah. (1:07:17) They need to identify who you all are right now, right, and figure out better ways to do it, etcetera, and so on.
Roxanna (1:07:23) Right.
Scott Benner (1:07:23) They're the reason that you can't stop seeing Chrissy Teigen on things, in case you're wondering. (1:07:28) Yes. (1:07:28) Yeah.
Roxanna (1:07:29) Yeah. (1:07:29) So That was a huge boost, wasn't it?
Scott Benner (1:07:31) Yeah. (1:07:32) They were like, oh
Roxanna (1:07:33) Chrissy Teigen.
Scott Benner (1:07:33) Whose kid got diabetes? (1:07:35) Someone write her a check and let's get her into People Magazine. (1:07:38) That's pretty much Yeah. (1:07:39) My expectation on what happened there.
Roxanna (1:07:40) Exactly.
Scott Benner (1:07:41) So you'd like to see people get screened?
Roxanna (1:07:44) Yes.
Scott Benner (1:07:44) I mean, isn't that a difficult thing to pull off, like, talking I mean, you couldn't get your like, well, you did. (1:07:49) You got your family members to do it, honestly. (1:07:51) Overall, like, you did a good job. (1:07:52) But, like, for the average person, like, hey, my kid just got diagnosed with type one. (1:07:56) You call your sister and say, think you and your kid should get screened for diabetes.
Scott Benner (1:08:00) I'm thinking it'd just be like, oh my god. (1:08:01) You're such a pain in the ass, then that's the end of it.
Roxanna (1:08:04) Yeah. (1:08:04) I I do think it is hard. (1:08:06) Like, lot of times it is. (1:08:08) There are families that are ready to go and they wanna do it, but there are a lot of families that are hesitant. (1:08:14) And, like, it, you know, it does bring a sense of, like, anxiety.
Roxanna (1:08:18) I think it'd be anxiety provoking too Mhmm. (1:08:20) For a lot of these families. (1:08:22) And I completely understand that it's still like a very much a personal decision whether you wanna get them screened. (1:08:29) And a lot of families think, oh, well, I already have one kid with type one. (1:08:32) I will know.
Roxanna (1:08:33) Most of time, you don't know. (1:08:34) Yeah. (1:08:34) And I will tell that from experience.
Scott Benner (1:08:36) What was what was the gap of time between your brother's kids?
Roxanna (1:08:40) Two years.
Scott Benner (1:08:41) He forgot.
Roxanna (1:08:42) About two years.
Scott Benner (1:08:43) Yeah.
Roxanna (1:08:43) Yeah. (1:08:43) He forgot. (1:08:44) Yeah. (1:08:44) You know, a lot of people think that, oh, well, just the the PCP can do a a finger stick. (1:08:50) A finger stick isn't really the answer.
Roxanna (1:08:51) If they're already 300, you've missed the boat. (1:08:54) Right. (1:08:55) You wanna catch them early. (1:08:56) That's the whole point of early detection. (1:08:58) Right?
Roxanna (1:08:58) Is you prevent DKA. (1:09:00) That's the primary goal of, like, screening is prevention of DKA. (1:09:04) And then comes immunomodulating therapies with the new T cell that was, you know, that was FDA approved now if they qualify for it. (1:09:12) You know, offering them clinical trials is another big deal that we could that we can offer these families if we start screening them. (1:09:19) And I think in the future, it will be general population screening.
Roxanna (1:09:23) This will just be something that when your kid goes in for their well child checkup or for their lead screening or whatever, that they're gonna start checking for these autoantibodies so they can catch them, and prevent DKA. (1:09:35) DKA is a huge problem. (1:09:36) It it's not just like, oh, I had an episode of DKA. (1:09:39) It, you know, has lifelong impacts on a child or on an adult. (1:09:43) Yeah.
Roxanna (1:09:44) And if we can prevent that, let's do it.
Scott Benner (1:09:46) Hear that episode recently, that girl that had the dead skin tissue in her digestive tract from her DKA, that that's a life
Roxanna (1:09:52) that, like, vomited up or
Scott Benner (1:09:54) something like that. (1:09:55) Yes. (1:09:55) Problem now. (1:09:56) But listen. (1:09:57) What I'm gonna tell you is I'll be a little cynical.
Scott Benner (1:09:58) Now there's some money behind it. (1:10:00) Now you're gonna get the testing because DKA has always been a problem, but they haven't moved on it like this. (1:10:06) Like, so No. (1:10:07) Yeah. (1:10:07) So now there's some onus on them to be able to identify these people so they can use these newer drugs, and now you're gonna see yeah.
Scott Benner (1:10:15) Somebody gotta get off their ass now and figure it out.
Roxanna (1:10:17) There's this whole and I can't remember the name of it, but there's, like, a whole, like, I don't know, like, checklist that you have to go through to make something, quote, screenable in, like, The United States. (1:10:28) Right? (1:10:29) Like, there has to be an easy way to identify it is one of the things, and there has to be a treatment for it is one of the things. (1:10:35) And, like, there's, like, this checklist. (1:10:37) And I think all the things that were missing in type one was an actual treatment for it.
Scott Benner (1:10:41) Oh, I see.
Roxanna (1:10:42) So now that there's, like, TZL I think it's called the younger and who I can't remember. (1:10:46) I don't wanna mistake. (1:10:48) But now that they had TZL that's FDA approved, they've kinda hit that last checklist. (1:10:53) Right? (1:10:53) That last check on their list.
Scott Benner (1:10:55) Yeah. (1:10:55) I mean, again, that's now something we can sell because there's a treatment for DKA. (1:10:59) It's called insulin. (1:11:00) So you know?
Roxanna (1:11:01) Yeah. (1:11:02) Yeah. (1:11:02) So what if you prevent DKL to begin with?
Scott Benner (1:11:04) Right. (1:11:04) Right.
Roxanna (1:11:05) Right. (1:11:05) The point. (1:11:05) Yeah. (1:11:06) Like, you don't wanna get to that point. (1:11:07) You wanna introduce insulin initiation before they get to that metabolic, like, you know, emergency that they're they're in because that affects them for the rest of their lives.
Scott Benner (1:11:16) Yeah. (1:11:16) Yeah. (1:11:17) For sure.
Roxanna (1:11:17) So you wanna hit that up before it happens. (1:11:19) And then they don't have to have this traumatic, like, introduction into diabetes with spending two days in the hospital. (1:11:26) You could be life flighted somewhere in ICU. (1:11:28) Like, avoid that. (1:11:30) Like, that doesn't have to happen.
Roxanna (1:11:31) That you have to be screened and then monitored after and have this gradual introduction to education that doesn't hit you like a a baseball bat to the head where you're trying to learn how to keep your kid alive in two days in the hospital. (1:11:45) Yeah. (1:11:45) No. (1:11:45) I I listen It doesn't have to be that way.
Scott Benner (1:11:47) I'm a little cynical about why they're doing it, I'm happy it's being done. (1:11:50) You know? (1:11:51) Yeah. (1:11:51) Yeah. (1:11:51) So
Roxanna (1:11:51) Yeah. (1:11:52) I mean, yeah, I guess I don't really care why it's being done. (1:11:54) I just want it done.
Scott Benner (1:11:55) You just want it done. (1:11:55) Yeah. (1:11:56) And then just the idea of getting out, educating people, and giving them good information so they can hopefully make better decisions for themselves, grow their understanding, and maybe over time get to a point where they can say, this isn't too bad. (1:12:08) I'm doing okay. (1:12:08) Got a good a one c.
Scott Benner (1:12:10) My variability is not bad.
Roxanna (1:12:12) Mhmm.
Scott Benner (1:12:12) Yeah. (1:12:13) That's a it's a great purpose. (1:12:14) Do you think you'll do this for the rest of your career?
Roxanna (1:12:16) I think so. (1:12:17) I mean, picking nursing was not somewhere I was gonna stay forever. (1:12:21) It just wasn't you know, I learned a lot and, you know, I'm glad I did that, but I didn't really have, like, a passion for it. (1:12:29) And I don't until I was diagnosed, I don't think I would have had a passion for this either, honestly. (1:12:35) But this is definitely where I'm supposed to be
Scott Benner (1:12:38) Yeah.
Roxanna (1:12:38) In helping what I well, I hope I'm helping families and these kids. (1:12:44) Just know that this is they can do it. (1:12:47) Like, this is something that is absolutely, like, possible, and their kids can have long, happy, healthy lives. (1:12:53) They just have to figure it out.
Scott Benner (1:12:56) Yeah. (1:12:57) Do you see any need or value in you continuing your education? (1:13:05) Is there anywhere that you see yourself going from here? (1:13:07) Do you like the level you're at? (1:13:09) Do you think it it suits your your goals well?
Roxanna (1:13:12) I think I'm happy where I am. (1:13:14) I don't you know, I've I know I could always go on, you know, get, you know, my master's and maybe do nurse practitioner, but I sometimes think it's it's more stress. (1:13:26) And I get to spend more time with these families in the position I am. (1:13:31) Our providers don't get to spend time like I do
Scott Benner (1:13:33) Yeah.
Roxanna (1:13:34) With these families. (1:13:35) So I think for what I wanna do and what I like to do and where I think I'm most helpful is having that flexibility to actually spend time with families.
Scott Benner (1:13:45) Okay.
Roxanna (1:13:46) Our providers don't do, you know, three hour classes or have the availability to sit down with the family when they just don't understand how to bolus for a meal or to sit down and look at their DexCom graph and say, okay. (1:13:59) What is happening here? (1:14:00) Like, what does this mean? (1:14:02) You know, how to make adjustments on your own. (1:14:04) Our providers don't have that kind of time to do that.
Scott Benner (1:14:07) Have you tried to and this isn't me saying to try to do this. (1:14:11) I've seen people do it. (1:14:13) Have you tried to put graphs into AI, ChatGPT, the Google one, like, or whatever, and say, hey. (1:14:21) What do you think? (1:14:22) This is a person using type one diabetes.
Scott Benner (1:14:24) What do you think they need to do? (1:14:25) Have you tried doing that yet?
Roxanna (1:14:27) I have not personally, but families have because they'll send the messages saying, hey. (1:14:33) This is what ChatGPT thinks I should do.
Scott Benner (1:14:36) Right. (1:14:36) And I think it can be
Roxanna (1:14:38) I mean, I am I am pro AI. (1:14:41) Like, I can't wait till we can unleash DexCom graphs on AI for actual knowledge on progression of, like, early type one. (1:14:50) I think that's where I would really like to see it go. (1:14:53) Yeah. (1:14:54) I think it can be actually pretty helpful and insightful.
Roxanna (1:14:57) I mean, not perfect, but I think it can give some pretty good insights assuming you let it know all the variables that are going on.
Scott Benner (1:15:05) Mhmm.
Roxanna (1:15:05) I think that's the key. (1:15:06) Because even when I blindly look at a Dexcom graph, I don't know. (1:15:10) I see a flat line overnight. (1:15:11) I don't know that they're up feeding their kid Smarties every, you know, forty five minutes just to keep their blood sugar at 80. (1:15:18) I just see, wow.
Roxanna (1:15:20) They're doing great. (1:15:21) And so I messaged back, I'm like, you guys are doing great. (1:15:23) No changes.
Scott Benner (1:15:24) And They're like, are you sure? (1:15:26) Because we don't sleep anymore. (1:15:27) Well, then they yeah. (1:15:28) They gotta give you the rest of the information. (1:15:29) I just I saw a a lady kinda shared her entire chat, and she's basically sat down and had, like, a conversation with it.
Scott Benner (1:15:38) And it it gave her a lot of valuable insights. (1:15:41) So Yeah. (1:15:42) That, you know, I was like, I wonder wonder how much longer it's gonna be before if that's not a thing you start talking to people about, like, start conversating with the answer machine and see what it says. (1:15:53) You you know? (1:15:54) Like, I don't know.
Scott Benner (1:15:55) Like, I have no idea. (1:15:56) I'm just I'm wondering when you're gonna see that happen or not happen or if it will or won't.
Roxanna (1:15:59) No. (1:16:00) I think AI is gonna play a large role in in helping people manage their diabetes. (1:16:06) I mean, even with, like, like, Guru where you can take a picture of your food and it kinda estimates the carb, we use that one a lot as a a good recommendation for our families because carb counting is hard. (1:16:19) It is an art and not a science, and, you know, no one really does it well. (1:16:23) It all becomes about estimation for the most part and more about, like, the meal composition.
Roxanna (1:16:29) And I think that is, you know, that is definitely AI at it at it at its best, helping families learn. (1:16:36) And so I think with Dexcom graphs and even, like, research stuff, like, you know, them putting, you know, these, like, digital twins in there and being able to get answers much quickly than they would in an actual research study because they have that ability to kind of simulate things, right, on a actual and versus, like, doing a clinical study that takes twenty years to complete. (1:17:01) So I think AI is important, and I think it will it's gonna tell us a lot about diabetes management and help a lot of people much better than endocrinologists can, honestly.
Scott Benner (1:17:10) I mean, I think that's maybe my bigger point. (1:17:13) It's not it's not like some people are I mean, oh, I guess, you know, some people have access to really great care, but even that really great care is limited to a certain number of times a year, limited ability for them to understand what's actually happening. (1:17:27) Like, you know what I mean? (1:17:28) Like, it's still it's still falls on the user. (1:17:31) And the and the people who don't have that great care or the understanding or a number of the things that we've talked about here today, they're just left to languish in, you know, basically in failure and, you know Yeah.
Scott Benner (1:17:42) And health health concerns that keep mounting. (1:17:45) I mean, I think you'd be better off sending the door prompt and saying, ask your questions here. (1:17:50) See if it makes sense. (1:17:51) Or maybe it'll even help you come back with ways to talk to me about what's happening or what whatever. (1:17:55) Like, I think it's gotta be worth trying, honestly.
Roxanna (1:17:59) Yeah. (1:17:59) I don't I don't disagree. (1:18:01) I think AI definitely plays a role in a helpful one for the most part.
Scott Benner (1:18:07) Yeah. (1:18:07) We'll see where it all goes. (1:18:08) Okay. (1:18:09) I really appreciate you doing this. (1:18:10) It was lovely speaking with you, especially on a Friday afternoon.
Scott Benner (1:18:12) Felt relaxed.
Roxanna (1:18:13) Yeah. (1:18:14) Yeah. (1:18:14) Same.
Scott Benner (1:18:15) You know, it isn't fair to say here you're a professional person, but I know who you are. (1:18:19) I know what you look like. (1:18:20) You're adorable. (1:18:21) Do we need should I do want me to send the boys over, or is that not what you're looking for? (1:18:25) Or, like, you
Roxanna (1:18:25) know No. (1:18:26) I don't know. (1:18:27) Maybe. (1:18:27) I don't know. (1:18:28) Maybe one day I'll be ready.
Roxanna (1:18:30) It's gonna have to be it's gonna have to be someone very nice though and who just does, I guess, whatever I want.
Scott Benner (1:18:38) Okay. (1:18:39) Well, if you're very nice and obedient and you're
Roxanna (1:18:43) you're looking sounds terrible.
Scott Benner (1:18:45) You're looking for a lady in her forties who's not up for bull maybe, go find Roxanna. (1:18:52) Yeah. (1:18:53) I'll be here. (1:18:55) That's awesome. (1:18:56) Well, I appreciate all the good work you do and that you took time coming on here to do this.
Scott Benner (1:19:00) I really do I do thank you a ton for adding your your voice to the podcast. (1:19:04) And I and I'm thrilled generally speaking that the podcast was valuable for you and that even if it's just your vibe that's made it into your practice, and your professional life, it means a lot to me that that happened. (1:19:16) So, thank you for telling me about that.
Roxanna (1:19:18) Yeah. (1:19:18) Of course. (1:19:19) Thank you for all you do.
Scott Benner (1:19:20) It's a pleasure. (1:19:21) Hold on one second. (1:19:22) Okay?
Roxanna (1:19:22) Okay.
Scott Benner (1:19:29) This episode of the Juice Box podcast was sponsored by US Med, usmed.com/juicebox, or call (888) 721-1514. (1:19:40) Get started today with US Med. (1:19:43) Links in the show notes. (1:19:44) Links at juiceboxpodcast.com. (1:19:48) Head now to tandemdiabetes.com/juicebox and check out today's sponsor, Tandem Diabetes Care.
Scott Benner (1:19:55) I think you're gonna find exactly what you're looking for at that link, including a way to sign up and get started with the Tandem Mobi system. (1:20:02) The podcast episode that you just enjoyed was sponsored by Eversense CGM. (1:20:07) They make the Eversense three sixty five. (1:20:10) That thing lasts a whole year. (1:20:12) One insertion.
Scott Benner (1:20:13) Every year? (1:20:14) Come on. (1:20:15) You probably feel like I'm messing with you, but I'm not. (1:20:18) Eversensecgm.com/juicebox. (1:20:21) Hey.
Scott Benner (1:20:22) Thanks for listening all the way to the end. (1:20:23) I really appreciate your loyalty and listenership. (1:20:27) Thank you so much for listening. (1:20:28) I'll be back very soon with another episode of the juice box podcast. (1:20:32) Hey.
Scott Benner (1:20:33) I'm dropping in to tell you about a small change being made to the Juice Cruise 2026 schedule. (1:20:38) This adjustment was made by Celebrity Cruise Lines, not by me. (1:20:41) Anyway, we're still going out on the Celebrity Beyond cruise ship, which is awesome. (1:20:45) Check out the walkthrough video at juiceboxpodcast.com/juicecruise. (1:20:50) The ship is awesome.
Scott Benner (1:20:52) Still a seven night cruise. (1:20:54) It still leaves out of Miami on June 21. (1:20:57) Actually, most of this is the same. (1:20:58) We leave Miami June 21, head to CocoCay in The Bahamas, but then we're going to San Juan, Puerto Rico instead of Saint Thomas. (1:21:06) After that, Bastille, I think I'm saying that wrong, Saint Kitts And Nevis.
Scott Benner (1:21:10) This place is gorgeous. (1:21:12) Google it. (1:21:13) I mean, you're probably gonna have to go to my link to get the correct spelling because my pronunciation is so bad. (1:21:16) But once you get the Saint Kitts and you Google it, you're gonna look and see a photo that says to you, oh, I wanna go there. (1:21:23) Come meet other people living with type one diabetes from caregivers to children to adults.
Scott Benner (1:21:30) Last year, we had a 100 people on our cruise, and it was fabulous. (1:21:35) You can see pictures to get at my link, juiceboxpodcast.com/juicecruise. (1:21:40) You can see those pictures from last year there. (1:21:42) The link also gives you an opportunity to register for the cruise or to contact Suzanne from Cruise Planners. (1:21:48) She takes care of all the logistics.
Scott Benner (1:21:50) I'm just excited that I might see you there. (1:21:52) It's a beautiful event for families, for singles, a wonderful opportunity to meet people, swap stories, make friendships, and learn. (1:22:02) If you're looking for community around type one diabetes, check out the Juice Box podcast private Facebook group. (1:22:09) Juice Box podcast, type one diabetes. (1:22:12) But everybody is welcome.
Scott Benner (1:22:13) Type one, type two, gestational, loved ones, it doesn't matter to me. (1:22:18) If you're impacted by diabetes and you're looking for support, comfort, or community, check out Juice Box podcast, type one diabetes on Facebook. (1:22:27) Have a podcast? (1:22:28) Want it to sound fantastic? (1:22:30) Wrongwayrecording.com.
Please support the sponsors
The Juicebox Podcast is a free show, but if you'd like to support the podcast directly, you can make a gift here. Recent donations were used to pay for podcast hosting fees. Thank you to all who have sent 5, 10 and 20 dollars!
