#1728 ADA Standards of Care for 2026
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Scott and Jenny review the newly released 2026 ADA Standards of Care, praising key updates like hospital safety protocols while critiquing the "slow drift" of official guidance compared to real-world management.
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Scott Benner (0:0) Welcome back, friends, to another episode of the Juice Box podcast. (0:14) If you're new to type one diabetes, begin with the bold beginnings series from the podcast. (0:18) Don't take my word for it. (0:20) Listen to what reviewers have said. (0:22) Bold beginnings is the best first step.
Scott Benner (0:24) I learned more in those episodes than anywhere else. (0:27) This is when everything finally clicked. (0:29) People say it takes the stress out of their early days and replaces it with clarity. (0:33) They tell me this should come with the diagnosis packet that I got at the hospital. (0:38) And after they listen, they recommend it to everyone who's struggling.
Scott Benner (0:41) It's straightforward, practical, and easy to listen to. (0:44) Bold Beginnings gives you the basics in a way that actually makes sense. (0:50) If you're looking for community around type one diabetes, check out the Juice Box Podcast private Facebook group. (0:57) Juice Box Podcast, type one diabetes. (1:00) But everybody is welcome.
Scott Benner (1:01) Type one, type two, gestational, loved ones, it doesn't matter to me. (1:06) 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. (1:16) Nothing you hear on the Juice Box podcast should be considered advice, medical or otherwise. (1:20) Always consult a physician before making any changes to your health care plan. (1:29) Jenny, I'm gonna spring this on you while we're recording.
Jenny Smith (1:33) Yay. (1:34) Which is not odd.
Scott Benner (1:35) No. (1:35) It's not odd at all. (1:36) But, you know, this one's a little out of left field. (1:38) We're gonna take a break this week from making bolus four episodes, which I have to tell you people are really enjoying. (1:43) So
Jenny Smith (1:43) we're gonna Awesome.
Scott Benner (1:44) We're gonna be making more of them. (1:45) I saw the ADA guidance came out the other day.
Jenny Smith (1:48) Yeah. (1:48) Right? (1:49) The 2026?
Scott Benner (1:50) 2026 guidance came out. (1:51) And I have to admit, like, the past, I've always been like, whatever. (1:55) Like, I don't really look at it too closely. (1:57) But this year, I thought, like, you know, everybody gets excited. (2:01) This marketing, this excitement or whatever?
Scott Benner (2:03) So I kinda dug into it a little bit. (2:05) And it is a lot it is a it's a it feels like a lot of nothing to me. (2:09) And I realized that it's something that probably moves on very slowly, but I thought it would be interesting to look at it and to kinda look backwards a little If bit you don't mind, like, I'm gonna scroll back to 2022.
Jenny Smith (2:22) Okay.
Scott Benner (2:22) Where the let's see how how I broke it down here.
Jenny Smith (2:26) Why 2022? (2:28) I'm just curious. (2:28) It's only four years ago. (2:29) It's not, like, a round five number. (2:32) So why that number?
Scott Benner (2:34) I wanna see if there's anything happening that just feels I guess what I wanna do is I I wanna show
Jenny Smith (2:38) people Significant enough indifference?
Scott Benner (2:40) Yeah. (2:40) And I'd like to show people that something that came up in 2022, 2023 is slowly being adjusted going forward. (2:47) It's not like, how do I mean this?
Jenny Smith (2:50) Okay. (2:50) A couple of
Scott Benner (2:51) go ahead.
Jenny Smith (2:52) No. (2:52) I was gonna say I I have one that I I know that we'll probably get into in terms of reviewing the current guidance that, again, just came out.
Scott Benner (3:01) Mhmm.
Jenny Smith (3:01) And that slow progression to something finally being in a standardized guideline
Scott Benner (3:08) Yeah.
Jenny Smith (3:09) That technically, I feel like has already been standard in the crowd of people I tend to work with or that you tend to speak to in terms of who listens. (3:21) Right?
Scott Benner (3:22) This is what throws me off about this. (3:23) Yeah. (3:24) I was prompted by I'm not trying to out anybody. (3:27) I was prompted by an email I got from a fairly big diabetes organization recently where they were like, oh my gosh. (3:35) Look at how exciting this is.
Scott Benner (3:37) And they their news I don't wanna say even what it was because I don't want people to know what it was like. (3:40) Like this Sure. (3:41) Amazing thing that's happening, blah blah blah. (3:42) And I thought, I've been talking about that for three years.
Jenny Smith (3:45) Right.
Scott Benner (3:45) Like, the mass of people see it like that. (3:48) Even, like, going back to 2022. (3:50) Right? (3:51) ADA is like screening is gonna be very important. (3:53) Screening.
Scott Benner (3:54) Screening. (3:55) Screening. (3:56) They've been talking about it now for, you know, a handful of years. (4:01) And in my opinion, where we're at is, you know, we're trying to screen to see if people are, you know, eligible for t zeal, but the process of screening them is just, it's insane. (4:12) Yeah.
Scott Benner (4:13) They're gonna get people who have not been diagnosed with type one yet early enough that they're eligible for t zealed. (4:19) And then if you find them, the answer is thirteen infusions over thirteen days. (4:24) You might have to fly somewhere and live in a hotel to do it. (4:27) And if we're lucky, this might stave off diabetes for a year or so. (4:30) Like, wow.
Scott Benner (4:31) Like, why does so much effort go into something like that? (4:34) Do you know what I mean?
Jenny Smith (4:35) Yeah. (4:36) I mean, I think in in terms of these standards, right, they are I don't know, honestly. (4:44) It's a really good question. (4:45) My thought is that from an organizational standpoint, it's almost like they're waiting to see enough momentum to be able to actually put it in there as a a trusted, valuable standard that they can suggest to the greater these standards are usually not even something people with diabetes look at.
Scott Benner (5:05) Right.
Jenny Smith (5:06) They really are from a clinical standpoint of what should we as clinicians be looking at now as this is what we should talk to people about diabetes about, or this is what we should try to move to as the new guidance rule or the new medication and why it holds value when all the data has been building to that statement, but it's already been happening.
Scott Benner (5:34) Yeah. (5:35) I don't say that people should run forward with their hair on fire and try everything that, like, randomly pops up in front of them. (5:41) I think the screening thing going back this many years because if you have any social media or you're around any contact with diabetes at all, you're gonna hear, like, screening rhetoric being pushed at you. (5:53) Right? (5:54) Like so what that to me means is that the machine thinks it's important.
Scott Benner (5:58) If the ADA thinks it's important, then I gotta think whoever supporting the ADA thinks it's important. (6:03) I don't know anything about anything, but Sanofi paid a lot of money for that drug. (6:07) So I gotta figure there's some, you know Some push. (6:10) Some push from that. (6:11) Yeah.
Scott Benner (6:11) I understand I understand all this. (6:14) But if that's how that works, then I want you to wonder about things like, I don't know, CGMs and GLP medications and micro dosing stuff and thinking differently in general about things that you see in your life working, but then go out and say, the machine is not telling me that this is important.
Jenny Smith (6:36) Right.
Scott Benner (6:36) I just think that it's it's 2026. (6:39) What's the guidance on a one c right now?
Jenny Smith (6:42) The guidance on a one c? (6:43) You tell me. (6:44) I know you're looking at it.
Scott Benner (6:45) 7.5 for kids. (6:46) Right? (6:47) And what is it for adults? (6:49) Seven?
Jenny Smith (6:49) Under seven.
Scott Benner (6:50) Under seven.
Jenny Smith (6:51) Mhmm.
Scott Benner (6:52) Okay.
Jenny Smith (6:52) I mean, it's and that has that has not changed at all. (6:56) And then that's a standard. (6:58) Right? (6:59) We all have the knowledge as well that it's it's kind of a standard that's not a hard box standard. (7:05) It's a there are wavy lines to it.
Jenny Smith (7:07) If you have this type of situation going on, we might expand that. (7:14) If you have, you know, hypoglycemia unawareness, if you are over the age of such and such or under the age of, you know, whatever
Scott Benner (7:21) Mhmm.
Jenny Smith (7:22) Then that gets a little bit wavy, but it's still they have to have a hard set value to put into something like this. (7:29) Again, from a medical from a medical liability standpoint, there has to be something that medical clinicians are using as their as their standard. (7:41) It's their starting point. (7:43) Right? (7:43) I do think that the standards and I've I actually looked at them when they came out for a couple of reasons.
Jenny Smith (7:50) I think some of the new things on the list are important because they've again been things that clinically that I've seen have been pushed to the background. (8:02) And so I think that standards like this putting them more to the front ground and saying, hey. (8:09) This is really important to pay attention to. (8:12) And this is why we know this now about this particular medication. (8:17) It can impact this condition, which got kind of a second or a third notice comparative to just a one c.
Jenny Smith (8:24) Mhmm. (8:24) Right? (8:25) So the newer the newer guidelines have things around I I think a big highlight is absolutely the GLP ones. (8:31) Yeah. (8:32) There's a huge highlighted piece of that, which most people with diabetes, especially with type one diabetes, have been hitting on and pounding their fist into the ground about being noticed
Scott Benner (8:46) Mhmm.
Jenny Smith (8:47) For a while already. (8:48) And yay. (8:49) Now the standards say, yes. (8:52) There's value to these medications.
Scott Benner (8:55) Let me be cynical for a second. (8:56) Sure. (8:56) Isn't it possible, Jenny, that I'm not a genius and that three years ago when I was like, gonna give my kid a little bit of this GLP and see what happens. (9:05) That maybe what was really going on when they were busy telling us, no. (9:07) No.
Scott Benner (9:08) No. (9:08) It's not for type ones. (9:09) It's only for type twos. (9:10) What they meant was is we don't have production ramped up yet. (9:13) So let's not everybody be dipping their toe into this pond yet.
Scott Benner (9:17) Like, I think that's the kind of I am not a conspiracy person. (9:20) I just think that this is very, like, realistic to look at. (9:23) Right? (9:24) Like and the reason I I dislike it so much is because not only is that three years of people not getting support maybe that would have been valuable for them
Jenny Smith (9:32) True.
Scott Benner (9:33) But it's three years of telling people, oh, no. (9:36) This thing is not for you. (9:38) And those people will never think about it again. (9:41) Right? (9:42) Like, that's the part I hate.
Scott Benner (9:43) Like, I hate when they tell me like, if you tell a parent a seven five a one c is a good target for your kid, I understand big picture. (9:54) Everyone hears this. (9:56) Everyone has different technology, ability to, like, use tools, access the tools, and we want everybody to be safe. (10:02) I don't not want everybody to be safe.
Jenny Smith (10:04) Of course.
Scott Benner (10:05) I'm worried about all the people that heard the number and will move forward for the rest of their life going seven Five's okay.
Jenny Smith (10:11) That that's the standard.
Scott Benner (10:12) Yeah.
Jenny Smith (10:13) Correct. (10:13) And partially because nobody then clears it up. (10:17) And once you've established that as your standard.
Scott Benner (10:20) Then that's it forever and ever.
Jenny Smith (10:22) Then that's it forever and ever unless you're the type of person or personality that says, I'm going to do more research. (10:30) Like, I was given that like, I think there there are several personalities within the scope of diabetes management. (10:37) Yeah. (10:37) Some who are given a standard like that to begin with Mhmm. (10:40) And and go off and say, okay.
Jenny Smith (10:42) Yes. (10:43) This is just it for life. (10:44) I was told 7.5 or under that is really great. (10:46) Fantastic. (10:47) And they never ask more questions, but I think their doctors are also not providing enough either
Scott Benner (10:55) Yeah.
Jenny Smith (10:55) To make them think that there are additional things that could be done. (10:58) And then there's the other avenue of people who absolutely take that as maybe this was the starting place because it was safe to begin with.
Scott Benner (11:06) Mhmm.
Jenny Smith (11:07) But I know, and I think especially because we have such a broad diabetes community in an online way that I did not have growing up. (11:16) There was nowhere else to look. (11:18) Right? (11:18) Books that were on it, you had to go to the library or had to, like, order them from someplace. (11:23) And there was not the Internet nor the online communication that we have today to see that there is better, there can be better.
Jenny Smith (11:32) And gosh, I should be asking more questions to my doctor about why did you give me this and why haven't we adjusted this now as things are changing?
Scott Benner (11:42) I'm gonna tell you a sad story that I don't know that I've ever told you before, and I'm sorry. (11:46) But Oh. (11:47) I it fits here. (11:49) And Okay. (11:49) I've been thinking about it a lot lately.
Scott Benner (11:51) So it pops in my head initially because Dexcom moves to the fifteen day sensor.
Jenny Smith (11:58) Yes.
Scott Benner (11:58) And Mhmm. (11:58) Everyone's like, mine doesn't even last ten days. (12:01) Now you're gonna tell me it goes fifteen, you know, blah blah blah. (12:03) And everybody's complaining. (12:04) Right?
Scott Benner (12:05) And then you're you know, you try to parse it in your head, like, really the Internet is where people come to complain. (12:10) My daughter wears an Omnipod right out or excuse me, a Dexcom right out ten days, twelve hours, almost every time. (12:17) Right?
Jenny Smith (12:17) Which is awesome.
Scott Benner (12:18) It's lucky. (12:19) I understand that. (12:20) But at the same time, like, the Internet's not full of people who show up to go, hey. (12:23) I just wanted to come by and say that my CGM lasts ten days all the time. (12:26) Right?
Scott Benner (12:27) So you get this feeling, you know, oh gosh. (12:30) It must not a thing must not work. (12:32) And then I saw somebody say something that really stuck to me, and it was more about the way they said it. (12:38) And I and I felt for them because I understand they're obviously either scared or having a bad experience or whatever, but, you know, why don't they fix the problems it has before they shove this down my throat? (12:49) And shove this down my throat is what stuck to me, and here's why.
Scott Benner (12:53) When I was getting ready to graduate high school, my best friend got diagnosed with type one diabetes. (12:58) Mhmm. (12:59) His name is Mike. (13:00) Mhmm. (13:00) Well, his name was Mike.
Scott Benner (13:02) And he was given regular an Miles per hour and that was it. (13:06) Mhmm. (13:07) And my entire life knowing and loving and being with Mike as a as a great friend, I thought of him as a person with kind of a strange temperament. (13:15) He was lovely and sweet, but sometimes he'd get angry out of nowhere. (13:19) I never understood that.
Scott Benner (13:20) Right? (13:20) And later at night, there was always a rule we didn't let Mike drive because he'd swerve and he wasn't like a great driver and we just thought Mike couldn't drive. (13:28) And, you know, that was just how we went along. (13:31) And Mike went along and he got up in the morning and he did his like, probably about this much injection and then we'd go eat breakfast and I'd see him do it again in the afternoon. (13:40) We never talked about his diabetes and it turns out that Mike didn't know much about his diabetes either and neither did his doctor.
Scott Benner (13:47) And Mhmm. (13:48) One day, we're adults and we're married and moved on. (13:51) Mike says to me, hey, I think my kidneys are failing And I I I'm gonna go to the doctor today. (13:58) And the next thing I know, Mike's on dialysis. (14:00) And then Mike loses his job because he's always on dialysis.
Scott Benner (14:04) And then his doctor says to him, I'm not kidding, and this is only about six years ago. (14:09) We should really try carb counting. (14:11) That's when they moved Mike to NovoLog and Atlantis. (14:17) Yeah. (14:17) Wow.
Scott Benner (14:18) And he's a bright guy. (14:19) He was lovely. (14:20) He had all kinds of interests. (14:22) He would have been a real great addition to this world moving forward. (14:26) And instead, he started having seizures because he didn't know how to use his his NovoLog.
Scott Benner (14:31) He crashed his car because he tried to bolt like he was at a comic bookstore picking up his books and injected before he went to the diner like he does all the time except he used to inject a much slower acting insulin before. (14:44) Onlooker said that my friend's car went down a private street between eighty and ninety miles an hour. (14:50) It went into a cul de sac spun in a circle before it crashed into a mailbox in somebody's house. (14:56) Mike was lucky he didn't get hurt. (14:58) A couple of months later, he fell out of bed having a seizure and broke his arm.
Scott Benner (15:03) And two years later, he was talking with his wife about what to have for dinner. (15:06) They decided on what to have. (15:08) He stood up out of his chair to go make it and fell forward on his face when his heart failed. (15:13) Right? (15:13) Yeah.
Scott Benner (15:14) And I always think sad that the EMTs came and they saved him. (15:20) And then three days later, I sat in a hotel room with my cell phone playing Mike's favorite music from when we were in high school and he died the next day.
Jenny Smith (15:27) I'm sorry.
Scott Benner (15:28) And I see that story as completely connected to this. (15:32) Because at some point at in Mike's life, someone said, this is how you take care of your diabetes. (15:38) And he believed them, and then he moved forward. (15:40) And all this crazy stuff that happened to him, we were all completely unaware of Sure. (15:44) As was he.
Scott Benner (15:46) Mike didn't think like, oh, I yell at people because my blood sugar's been high for three days.
Jenny Smith (15:50) Right. (15:51) He didn't make an association.
Scott Benner (15:52) No one knew. (15:54) And I guess I'm asking everybody to say, what do you think might be happening to you right now that you're not aware of? (16:00) Right? (16:01) While we're slow walking, telling people CGMs are important. (16:05) I'm I'm scrolling back now to 2018.
Scott Benner (16:07) CGMs for adults. (16:09) Expand CGM recommendations to all adults 18 and over. (16:12) Expand. (16:13) Like, my last thought here is, and then I really wanna hear what you think about all this, is that, it's been about a year or so now. (16:20) This very well respected doctor, in the diabetes space was I'm gonna make an announcement.
Scott Benner (16:26) I'm making an announcement. (16:27) I'm putting up a video. (16:28) I'm making an announcement. (16:29) You should all be there. (16:30) I went and looked, and he said they've been doing research for ten years now.
Scott Benner (16:34) And he is confident and and excited to tell us all that, you know, if you lower your alarm on your CGM, you'll have better outcomes. (16:44) They figured that out, Jenny. (16:45) Only took them about ten years. (16:47) So Yeah. (16:49) Yeah.
Scott Benner (16:50) I'm saying this is great. (16:52) I got nothing against the ADA. (16:53) I got nothing the way the machine works. (16:55) I understand slow, steady, make sure everybody's safe. (16:58) But for the everyone else, pay attention.
Scott Benner (17:00) Like, follow your common sense a little more.
Jenny Smith (17:02) Right. (17:03) Well, I think it also what it highlights for me is also that and I don't know what kind of doctor your friend Mike was going to.
Scott Benner (17:12) I'm sure he didn't either, by the way.
Jenny Smith (17:13) If it right. (17:14) He may not maybe it was a primary care. (17:16) And, unfortunately, primary care is like the jack of all trades. (17:20) Right? (17:21) They really know a little bit about a lot of things, but they are not they've not gone to schooling for a specialty.
Jenny Smith (17:27) That's where endocrinology does shine. (17:31) Whether you believe your endocrinologist is a great one or not, they still have a specialty in a lot of endocrine, not just diabetes either. (17:43) So those are the doctors that I believe, really hope, I guess, are looking at more than just these standards.
Scott Benner (17:57) Yeah.
Jenny Smith (17:58) It's the primary cares and the ones in the general public that I I truly think should be the ones getting these standards and having to check it off almost like a continuing education that they have looked at it, that they now acknowledge the value to these things because they do see the larger portion of people with diabetes, not endocrinology. (18:24) And again, for your friend Mike, my expectation is that he was probably going to a primary care or just a really bad endocrinologist who didn't know what they were doing with diabetes.
Scott Benner (18:36) Yeah.
Jenny Smith (18:37) Right? (18:37) Because that endo six years ago I mean, I've been using a CGM since 2005.
Scott Benner (18:47) Mhmm. (18:48) Yeah. (18:48) I looked the other I think, if if I got the if I it's now it's in the back of my head, but I think there's been, like, over 10 iterations of, like, Dexcom CGMs over, like, nineteen years or something.
Jenny Smith (19:00) Yes. (19:00) I didn't even start on Dexcom. (19:02) Yeah. (19:02) I started on Abbott's Navigator Mhmm. (19:05) Which was a phenomenal CGM.
Scott Benner (19:08) Kenny's like, why did they take that Navigator from this?
Jenny Smith (19:10) Loved it. (19:10) It was awesome. (19:12) But, you know, and then got kind of moved into Dexcom mainly because Navigator was leaving The US, and they were no longer gonna have it. (19:20) So I have had almost all of the iterations of Dexcom and can say that it is an enormous reason that I no longer set an alarm overnight to check my blood sugar.
Scott Benner (19:35) Yeah.
Jenny Smith (19:35) Prior to that, even my husband will tell you, like, the 2AM alarm, it went off every night. (19:40) And after a while, like, he didn't even pay attention to it anymore because it was just the norm. (19:44) Right? (19:45) Yeah. (19:45) Once I got a CGM, my goodness.
Jenny Smith (19:48) The value there and the value that it could have had for your friend, Mike, I think that he probably could have even started making associations on his own. (19:59) Even if no doctor told him anything about how to look at the data, he sounds like he was smart enough to probably start making associations of, gosh, my blood sugar is here, and I start acting like a jerk. (20:14) You know what I mean?
Scott Benner (20:14) That a lot, honestly. (20:16) Because, like, I where where didn't where did someone fail him? (20:21) And where did he not say, I gotta take care of this? (20:26) But I don't I just don't know. (20:27) Like, you know, we talk about how blood sugars affect your personality and your ability to think and fogging.
Scott Benner (20:32) I I just don't know where he was. (20:34) You you know what I mean? (20:34) And and that's the that's why it's why we made the grand rounds series. (20:38) Like, because I want people to start with a good knowledge. (20:40) Like, I it's why I talk about all this all the time.
Scott Benner (20:43) I I mean, honestly, you guys probably don't realize it, but a lot of the reason why I come at this the way I do is because of Mike. (20:49) I just don't talk about it because it seems distasteful. (20:51) But Mhmm. (20:53) His is an exploded example of what could happen. (20:57) I'm saying, like, you don't have to end up, you know, with heart failure and and kidney failure for this to be impactful on your life.
Scott Benner (21:04) You can have other small impacts along the way that you might not notice. (21:08) And and if you're counting on if you're counting on guidance to get you there, I'm saying, I I don't think I would do that. (21:16) Like, I because it's gonna lag behind. (21:19) Know? (21:19) Yes.
Scott Benner (21:19) Here look. (21:20) How does that guidance impact something like insurance coverage? (21:24) It defines medical necessity for technology. (21:27) It sets prior authorization criteria. (21:30) It justifies coverage for off label use, preventative screening at zero cost.
Scott Benner (21:35) Lag time, commercial lag. (21:36) It typically takes one to three years for a new ADA recommendation to be written into insurance medical policies. (21:43) Correct. (21:43) Yeah. (21:43) Everything takes too much time.
Jenny Smith (21:46) Too much time.
Scott Benner (21:46) Life is this long. (21:48) That's a big picture thing, and we should be doing that. (21:50) The idea is thank god. (21:52) Right? (21:53) But, like, for you personally, inside of your life, you don't have the 300 years that they're mapping this out over.
Scott Benner (22:00) You know? (22:01) You you've got this time right now, and I'm arguing you don't even have that much time because you're gonna get set into some sort of a comfortable rhythm that you won't look up from, and then it'll just be ten years later.
Jenny Smith (22:14) I I mean, the gist of it all is that it's too slow. (22:17) These standard recommendations, they wait, they gather data, they gather more data, they gather more data. (22:23) And finally, there's enough information for them to say, yes. (22:28) We can now state that this is of value and a needed, you know, discussion or a needed reference or a needed medication. (22:36) Even the I mean, if you look at the new and this is the first time, if I'm remembering correctly, this is the first time that they're acknowledging the AID systems inclusive and their value, inclusive of the open source DIY systems.
Jenny Smith (22:54) Right. (22:55) The first time. (22:56) How long have I been using an open source system? (23:01) I've been using one since early twenty seventeen.
Scott Benner (23:04) Yes.
Jenny Smith (23:04) That is a long time. (23:07) Right. (23:07) I have worked with person after person after person. (23:10) I have talked to doctors. (23:12) I did a presentation eons ago Mhmm.
Jenny Smith (23:17) At a ADCES conference about specifically the DIY open source AID systems, and what are you afraid of? (23:28) Get your head out of the sand. (23:30) Yeah. (23:30) Why are you not acknowledging this? (23:32) And a lot of the problems at that time were that came from the audience, it was there are no standards around using them.
Jenny Smith (23:40) We have not been educated on using them, and we are liable if we recommend them in office. (23:48) Those were the baselines. (23:50) So until a standard comes out that brings it to the forefront within the medical community, there is a liability issue to a lot of this.
Scott Benner (24:00) Right. (24:00) So you're not gonna until this until this guidance says, hey. (24:04) Do this. (24:05) Then doctors won't feel comfortable even if they know. (24:08) That's why by the way, this is partly why the podcast is so popular because this is why you guys get grabbed in a hallway on the way out of an appointment.
Scott Benner (24:15) Somebody just whispers in your ear, just try the Juice Box podcast. (24:18) They shove you out the door. (24:19) Yeah. (24:19) Have you tried did you read this book? (24:20) Did you do this?
Scott Benner (24:21) Like, get out of here. (24:21) Hurry up. (24:22) Don't let anybody hear me saying this to you. (24:24) My god. (24:24) If you don't go do this, you're gonna live like this forever.
Scott Benner (24:27) Jenny, if I And
Jenny Smith (24:28) there oh, go ahead. (24:29) No. (24:29) No. (24:29) Go ahead. (24:30) I was gonna say there are there are good doctors.
Jenny Smith (24:33) There are good endos. (24:34) There are good high risk doctors, you know, in the whole realm of pregnancy with diabetes. (24:39) They are they're too few and far between because the the good doctors are willing to step outside of the box and say, while this is not the recommendation, there is value in trying this because I can see I can see how this medication, for example, works. (24:59) I can see how this system works. (25:00) They're the ones that at at night at home, they're not sitting down and reading the next romance novel.
Jenny Smith (25:06) They're actually online reading about open source. (25:09) They're online reading about medications expanding the use and how could this actually work in the type one population despite it being a type two medication. (25:19) Mhmm. (25:19) But there aren't enough of them.
Scott Benner (25:21) No. (25:21) The ones I meet are special and Yes. (25:24) You know, they deserve a a medal. (25:25) If the guidance is there, then the insurance isn't gonna cover it. (25:29) If the insurance isn't gonna cover it, then the device manufacturers aren't gonna push for it.
Jenny Smith (25:33) Right.
Scott Benner (25:33) Right? (25:34) Like, so you're going to get slower, what, forward motion with technology, with with ideas because there's there's no pressure to do it. (25:43) If the guidance was there, then one company would stand up and go, oh, we're gonna do this, which would make the rest of them go, oh, hell, we gotta do this now too. (25:51) And then, you know, and then you'd get your stuff more quickly. (25:54) And it would and I'm telling you, I think it would it would value it would add value to your life.
Scott Benner (25:58) I wish I could find I can't even remember her name right now. (26:01) I feel bad. (26:02) One listener who reached out to me and was like, yo, your daughter should try a loop. (26:07) And, like, I thought she was here right now. (26:08) I'd kiss her on the mouth and buy her a car.
Scott Benner (26:10) Like like, I think I'd be dead, like, without that because of what you mentioned earlier. (26:15) Like, I wasn't sleeping. (26:17) Like like yeah. (26:17) Like, Arden was super healthy. (26:19) I was awake nineteen and a half hours a day.
Scott Benner (26:21) And and, like, so they and there's that thing. (26:24) Just poof. (26:25) All good. (26:26) Here we go. (26:27) And it works.
Scott Benner (26:28) And then you walk out in the world, and all you hear is, oh, I don't know. (26:31) I don't know. (26:31) I don't know. (26:32) Yeah. (26:33) And it's forever.
Scott Benner (26:34) And they're gonna I don't know you to death
Jenny Smith (26:37) To death.
Scott Benner (26:37) Is is what I think. (26:38) And Mhmm. (26:39) It just so I'm not picking on the ADA or the guidance. (26:43) I'm just trying to show you how slow it is. (26:45) Like, why did I go back, like, just a handful of years?
Scott Benner (26:49) Because if you go back a handful of years, what you see is not a lot of motion.
Jenny Smith (26:52) Much change. (26:54) You know, I think the other really good thing that could come from the standards and I said before, in general, I think these standards are really more for the medical community truly. (27:05) Right? (27:06) But I do think that as a person with diabetes, it behooves you to also take a look at what they are on the continuum every single year when they come out. (27:17) Mainly because if there are things that you have been trying to address and bring up with your doctor, they may pop into the standards.
Jenny Smith (27:27) And if the doctor's still giving you pushback, you can bring it and kinda say, hey. (27:31) Look.
Scott Benner (27:31) Yeah. (27:31) It's okay.
Jenny Smith (27:32) This is part of the standards. (27:33) Why are we not discussing this? (27:35) I've brought it up for two years already.
Scott Benner (27:36) Yeah. (27:36) That thing where you tell me the GLP is gonna make me go into DKA, we can stop saying that now.
Jenny Smith (27:41) Right.
Scott Benner (27:41) The paper says you don't have to say it to me anymore.
Jenny Smith (27:43) And look at the other benefits that are coming out of it. (27:45) The more research, the more information, the fact that, yes, gosh, it is very beneficial for those with type one diabetes. (27:52) And, yes, even the micro dosing was of those was something that was also not done in the typical endocrine practice. (28:01) It was a this is the dose. (28:03) This is the standard starting dose.
Jenny Smith (28:05) We titrate it this way up, up, up, and see how you tolerate things. (28:09) And again, the sort of the gray area thinkers in the medical community were like, well, type one's very likely, and we can now see they do need a different dosing strategy than most type twos using these meds. (28:23) But it doesn't mean we shouldn't use them. (28:24) It means that we should figure out how to dose it better.
Scott Benner (28:27) It's the crazy leap that I never understand. (28:29) Right? (28:29) Like, it's oh, well, it's there's a label warning for type ones because they go into DKA with and so I said to somebody, I'm like, wait. (28:36) So GLPs cause DKA in type ones? (28:39) And they go, well, no.
Scott Benner (28:40) And I'm like, well, what's the problem then? (28:42) Well, GLPs make it so that some type ones need so little insulin, they don't take enough insulin, and they go into DKA because they're not eating. (28:51) And I went, oh, well, that's not the same thing. (28:54) Like like, you're
Jenny Smith (28:55) There's a big difference.
Scott Benner (28:56) Yeah. (28:56) You're fixing the problem in an unnecessary way. (29:00) Like Entirely. (29:01) Yeah. (29:01) And so it's it's the baby with the bathwater thing.
Scott Benner (29:04) Like, I just don't throw the whole thing away because you bumped into the first problem. (29:08) Like, you you know what I mean? (29:08) Like, oh, no. (29:09) You know, we gave GL because these are studies. (29:11) We gave GLP to people with type ones.
Scott Benner (29:13) Some of them went to DK. (29:15) So there now there's a label warning about it. (29:18) That's a big leap, you know, because the GLP lowers my daughter's insulin needs by, like, 30%.
Jenny Smith (29:24) Yes.
Scott Benner (29:24) Yeah. (29:25) She not in DK. (29:27) She's good.
Jenny Smith (29:28) She's good. (29:28) Right. (29:29) Because you've also you also know enough about titrating insulin. (29:32) Right? (29:33) I mean, you look at
Scott Benner (29:34) the fixable problem, not the you know, I'm sorry. (29:36) Cut you off. (29:37) Go ahead.
Jenny Smith (29:37) Oh, no. (29:37) No. (29:38) No. (29:38) I was actually just gonna compare it to it's a major problem because if you compare it even to all of the pharmaceutical ads, which I would a 100% be the one that's like, we gotta get them off the television. (29:50) Right?
Jenny Smith (29:51) But, like, if you look at any of them, at the end, there's always a host of it could cause this, call your toe cause your toe to turn purple and fall off, But that's just a potential side effect. (30:02) Right? (30:03) But they have to list side effects.
Scott Benner (30:04) Yes.
Jenny Smith (30:05) But if you look at that from a medical perspective, doctors are still prescribing these for the value of what they're prescribing them for, and often, they don't even talk about the side effects. (30:16) But when it comes to something like diabetes and the value and the very low chance of any of the side effects and if doctors were actually reading the research the correct way, they'd actually see that things like DKA with type one and the GLP ones, there's a there's a path to that happening. (30:34) Yeah. (30:34) And if you educate your patient the right way, that's it's not gonna happen, and it isn't a 100%. (30:40) It's it's utterly ridiculous.
Scott Benner (30:43) And it here's what it leads to. (30:44) It leads to me or somebody like me, you know, stepping like, Jenny, I've said this a thousand different ways, but, the way that it it sticks to me the most is that when I started talking about GLP medications, some parts of the Internet came after me with a hot poker and tried to shove it right up my, Okay?
Jenny Smith (31:01) I'm sure
Scott Benner (31:01) they did. (31:02) And I was like, no. (31:02) You guys are like, you're missing the boat, but how does that happen? (31:05) Because the ad says, you know, be careful blah blah blah blah blah blah. (31:09) And then somebody hears that, and then you say online, like, hey.
Scott Benner (31:12) You know, I was I've been doing this. (31:13) It's really working. (31:14) Look into it if you want to. (31:16) You're gonna kill people. (31:17) That makes this happen.
Scott Benner (31:19) I know a person who was in the hospital and their guts were turned into a knot and but, like, okay. (31:24) Give I'm not saying that it doesn't happen to some people, but there's also millions of people it's not happening to.
Jenny Smith (31:30) Like Correct.
Scott Benner (31:31) It's fascinating, and it and it goes back to you're not gonna remember this, but, like, when we recorded that pro tip series in, like, 2020, you didn't even know me that well then. (31:42) And I was like, Jenny, listen. (31:43) I'm like, I'm tired of, like, common denominator teaching for people. (31:47) Like, I know there's 20 kids in the class and two of them are really having trouble, but why are we teaching to them all the time? (31:53) Like, can't we teach to everybody else and protect them at the same time?
Jenny Smith (31:58) Right.
Scott Benner (31:58) Humanity doesn't work there. (31:59) They go, nope. (32:00) Sorry. (32:00) We can't. (32:01) We'll all just pretend that that's the level that we're all working with and the rest of it, we'll just sit around and pretend it doesn't happen and it doesn't exist.
Scott Benner (32:08) I'm not down for that anymore. (32:10) So No. (32:11) Yeah.
Jenny Smith (32:11) Are there many if I was writing the standards
Scott Benner (32:15) Mhmm.
Jenny Smith (32:15) Again, this is where nobody would live in Jenny's world. (32:18) But, I mean, there were
Scott Benner (32:19) I'm try before you say that, I'm trying to imagine a world where you have a child with type one diabetes and someone tells you to keep their a one c at 7.5. (32:27) And it was a and they'd be like, oh, you're doing great. (32:29) You're almost at 7.5. (32:30) Yeah. (32:30) That would happen, wouldn't it?
Jenny Smith (32:32) No. (32:32) No. (32:32) No. (32:33) No. (32:33) In fact, I'd have many words.
Jenny Smith (32:36) Many words as well as I mean, you know me. (32:38) You see me all the time when we when we do this. (32:40) Right? (32:41) You know that I have literally no poker face. (32:43) Like, I do not play cards.
Jenny Smith (32:45) I have no ability to hide. (32:47) It just shows on my face. (32:49) And I'm quite sure the doctor would be like, what do you what? (32:52) Really? (32:53) You don't believe me?
Jenny Smith (32:54) Like, I have no problem voicing my opinion there.
Scott Benner (32:57) By the way, there's a drift that happens. (32:59) If you tell somebody 7.5, then 8.2 doesn't seem that far from 7.5. (33:04) And then next week, you know, or next month or three months from now, we come back again and it all went to eight five. (33:10) You know, it's not bad. (33:11) It only went up point 2.3.
Scott Benner (33:13) You're doing great. (33:14) We'll try again. (33:15) Like, you know, and you just zoom.
Jenny Smith (33:17) And what you're bringing in is also a slower drift. (33:20) Right?
Scott Benner (33:20) Yeah.
Jenny Smith (33:21) Most people have ups and downs in their life. (33:24) Variables that impacting and let's say 7.5 has been your gold standard because that's what you've been told, and now you're at 7.6 or 7.7. (33:34) Again, the drift is so small that you you have just a concept with those numbers
Scott Benner (33:40) Mhmm.
Jenny Smith (33:40) That that's not a big change. (33:42) Like, whole number value is going from 7.5 to 8.5, I think, is a very visible larger jump that somebody would probably acknowledge and say, well, gosh. (33:51) Absolutely. (33:52) Something major has changed. (33:53) But anytime there's a little decimal drift, we don't really acknowledge it.
Jenny Smith (33:59) And, I mean, point 1.2. (34:01) Again, it really that
Scott Benner (34:02) blood sugar if your a one c moves around a little bit. (34:04) I'm saying that you get lulled into, like, complacency.
Jenny Smith (34:07) Entirely. (34:08) And so then 7.8 becomes 7.9 Yeah. (34:11) Becomes 8.1, becomes 8.4. (34:14) And that drift continues, but because it's so slow Mhmm. (34:18) You don't acknowledge where you started and how much you've drifted over a time period when the drift didn't have to happen if you knew what to do.
Scott Benner (34:27) It works the same way in your mind as gaining weight, not cutting the weeds around your house or something. (34:32) You just accept more and more of something that on day one you weren't excited to accept.
Jenny Smith (34:36) Absolutely. (34:37) Right.
Scott Benner (34:37) Now listen. (34:38) This year, there's some I think they made some really nice improvements this year. (34:42) Mhmm. (34:42) First time GLP receptor agonists are explicitly listed as recommended treatments or options for obesity in people with type one. (34:49) That's a great step for you.
Jenny Smith (34:50) Hundred percent.
Scott Benner (34:51) Awesome. (34:51) Great step. (34:52) New recommendations state that there should be no requirement for c peptide levels present of antibodies or duration of insulin use before initiating an insulin pump or an AID system. (35:02) That's a really good one.
Jenny Smith (35:04) It is huge. (35:04) Yeah. (35:05) Yeah. (35:05) Yeah. (35:05) Absolutely.
Scott Benner (35:06) This one's nice. (35:06) Workplace advocacy. (35:07) New, guidance explicitly states that adults using diabetes technology like pumps or CGM should receive reasonable accommodations in the workplace. (35:14) Now that's nice, but it took us till 2026 to say that? (35:18) Like, that one one we could have slipped in ten years ago?
Scott Benner (35:21) You know what I mean? (35:22) Like, here's a great one. (35:23) Percent. (35:24) Hospital safety. (35:25) A new safety standard mandates that hospital policies must ensure basal insulin is never held for people with type one diabetes.
Scott Benner (35:31) That's a great one. (35:32) I clap for that one.
Jenny Smith (35:33) 100%. (35:34) And that should be something that in bold type red when somebody comes into the emergency department. (35:40) Right? (35:40) And they acknowledge type one diabetes, highlighted in red blinking lights as soon as they acknowledge that or it comes up in the system is another statement. (35:50) Don't hold insulin.
Scott Benner (35:51) Yeah. (35:52) It's just it's insane. (35:53) My point over, I would say to whoever added that this year, congratulations. (35:57) Where the hell was that before? (35:59) Like, you're in charge of what the hospitals think about when so when you when people say all the time, I just had doctor Beachcham on a while ago.
Jenny Smith (36:06) Yeah. (36:06) I love her.
Scott Benner (36:07) She was lovely. (36:08) Right?
Jenny Smith (36:08) She's great.
Scott Benner (36:08) Yeah. (36:09) As I'm talking to her, like, she says this one thing that, like, strikes me. (36:12) It's like like, look. (36:13) We we follow the like, there's guidelines. (36:15) We we have protocols.
Scott Benner (36:17) Those protocols come from stuff like this. (36:19) So you're telling me that you could have added this ten years ago, and then for the last ten years, the people went to the hospital with type one diabetes wouldn't have their pumps taken from them or have their blood sugar shot way up and treated like they were type two and just on vacation. (36:31) Like, because that is really what kinda happens. (36:33) Right? (36:33) I go back to 2025, like, here I mean, it's more about screening, teplizumab, but sleep, cannabis warnings.
Scott Benner (36:42) What are you making cannabis warning? (36:43) A new specific recommendation to avoid cannabis use in people at risk for DKA to the risk of cannabis hypermysis syndrome. (36:52) Oh, come on. (36:53) Kidding me. (36:56) Whole world's high.
Scott Benner (36:57) Jesus. (37:00) You ever walk outside? (37:01) What is that I smell? (37:02) It's weed, Jenny. (37:03) It's everywhere.
Scott Benner (37:04) Okay? (37:04) No. (37:07) No. (37:08) Not for type ones. (37:09) You guys can't have weed.
Jenny Smith (37:10) You can't have it.
Scott Benner (37:11) No. (37:11) It's gonna make No. (37:12) Cannabis hyper mysis. (37:14) I don't know what the fuck that says. (37:15) And, like like, it just that's
Jenny Smith (37:17) good job trying to read it.
Scott Benner (37:18) This one here
Jenny Smith (37:19) think Go go
Scott Benner (37:20) ahead. (37:20) No. (37:20) No. (37:20) No. (37:20) You go.
Jenny Smith (37:21) I think some of the the newer things that are in this, you already mentioned in terms of just GLP one, that takes a heavy hit of explanation in many different categories, things like kidney health and heart health, cardiovascular. (37:39) GLP ones are mentioned in many different places Mhmm. (37:44) Which is thankfully, again, slow, but it is continuing to highlight the value of what they're finding. (37:53) And as we all know, research takes a long time to put together enough sort of quantifiable information that suggests to the positive before any broad statement can be made. (38:06) Right?
Scott Benner (38:07) Yeah. (38:07) It just I I I I was I didn't interview the other day with a guy who makes a GLP one podcast. (38:13) And he was talking about all the things that, you know, they know it's helping with and all the things that they're wondering if it's helping with and testing to see. (38:21) It looks like it is if you look at the population. (38:23) And he got done, I joked about it.
Scott Benner (38:25) But I said, feel like what you just told me is I'm gonna live forever. (38:27) And, like and I know that's not so it's not what it's not really true. (38:31) But if all these little things are happening behind the scenes in your body and now they're happening at a lesser degree and it's gonna it's gonna increase your longevity. (38:41) And but back to the original point, we've demonized GLPs for so many years now that there's now gonna be a whole generation of people who will never try them because they have an idea in their head or it's that oh, that's the thing you cheat with to lose weight or you do. (38:58) No.
Scott Benner (38:58) How about that's the thing that'll make my kidneys work better or my fatty liver go away? (39:03) Right? (39:03) Right. (39:04) How about my cytokines are going down? (39:06) How about that?
Scott Benner (39:07) Yeah.
Jenny Smith (39:07) Look at two big words.
Scott Benner (39:09) I know a couple of words, Jenny. (39:11) I used apoplectic in an episode the other day. (39:14) Just so you know. (39:15) Yeah. (39:15) Damn right.
Scott Benner (39:16) I've heard words before.
Jenny Smith (39:19) You're funny.
Scott Benner (39:20) Yeah. (39:20) No, please. (39:21) I guess that I would ask you. (39:23) I'm gonna put I'm gonna put that crown back on here for a second. (39:26) Right?
Scott Benner (39:27) Oh. (39:28) If you were in charge, what do you want people doing, looking at, thinking about, how do you want them measuring? (39:35) Like like, what's a big picture way people should be thinking about this for themselves? (39:40) It's a big question, but I think you can answer it.
Jenny Smith (39:44) The big question about how they should be looking at the standards for themselves
Scott Benner (39:48) Is that is that? (39:49) Like, how should they running their lives? (39:50) Like, what did they get up in the morning and say to themselves, like, this is what I should be trying for? (39:55) Like, I'm not saying you're gonna get it every day, but, like, let me rephrase it. (39:59) In a world where this amount of insulin Mhmm.
Scott Benner (40:03) Keeps my a one c at this level and a greater amount of insulin would keep it lower Right. (40:10) And we know that the only fear is that people are like, oh, you're gonna get low. (40:13) That's it. (40:14) Like, what do you think people should be I I'm telling like, look, I'm I'm gonna cover your ass for you before you start talking.
Jenny Smith (40:19) Oh, no.
Scott Benner (40:20) I know some of you don't wanna pump, some of you don't want a CGM, some of you can't afford of it. (40:23) I'm not saying that. (40:25) I'm talking about perfect world.
Jenny Smith (40:26) Sure. (40:27) In a perfect world, it would be an option for all people to have access. (40:34) Right? (40:34) Mhmm. (40:35) So that they could have enough information to say this is where I am.
Jenny Smith (40:40) So the starting point of, okay. (40:42) I've been told the 7.5. (40:43) I've I've recently learned I should technically be lower than that. (40:47) It is a a lot about insulin knowledge. (40:51) And so my, I guess, standard would be teaching people enough about knowing their insulin and how it works for them so that as they're looking at their numbers, whether it's just a finger stick or their CGM, they can say, okay.
Jenny Smith (41:05) Well, this is my base as you were getting at. (41:07) Like, this amount of insulin is keeping me here. (41:09) But if I'm really aiming here now, how do I get there? (41:15) It is about sometimes lifestyle stuff, but it is also about insulin. (41:20) And, gosh, I've got a base that's holding me here.
Jenny Smith (41:23) I wanna be 20 to 30 points lower. (41:26) What if I just add a little bit more insulin? (41:30) And, again, I always encourage you to talk to your medical provider. (41:33) Don't just dial things up by 30 extra units, but even little titrations. (41:38) Let's say a meal is consistently sending you high and you're using three and a half units.
Jenny Smith (41:42) Well, goodness. (41:43) Three and a half up to four. (41:45) If you're on three units already for a meal is
Scott Benner (41:48) Yeah.
Jenny Smith (41:48) Half a unit is not really gonna but it is gonna help to move you forward. (41:52) So I think standards should go in the direction of teaching people how to move where they want to get to if they even know. (42:03) Mhmm. (42:04) You know, the broader population of people again think doesn't know enough, and that makes me sad.
Scott Benner (42:12) Yeah. (42:13) No. (42:13) I'm with you.
Jenny Smith (42:14) So if you have standards, I think it's it's the people who are already looking for more that are going to look for these standards as again, a way to bring into their doctor to say, hey, look at this. (42:27) Like, we've never talked about this. (42:28) I've been talking about it. (42:30) It's now a standard. (42:31) But other people are hoping that their clinician who has the white coat in on and has gone to school for eight, ten, twelve years that they should know these things Mhmm.
Jenny Smith (42:41) And that they're bringing it into the practice and helping them.
Scott Benner (42:45) But those people are waiting for the the the buttonless pumps, which I think are probably coming, but they're not gonna come as quickly as you hope. (42:52) You you know?
Jenny Smith (42:53) And there are years until that point of which there's stuff going on in your body that I mean, we've talked about it before, like the incremental little things that end up happening aren't like, gosh, I have diabetes and three days later I have heart disease. (43:08) That's not how this
Scott Benner (43:09) works. (43:10) Right.
Jenny Smith (43:11) It's incremental and it's it's unfelt. (43:14) You don't feel nor do you see the internal stuff that is going on until you get to the point of I mean, again, I you brought up Mike.
Scott Benner (43:25) You stand up to make dinner. (43:26) Yeah.
Jenny Smith (43:27) You stand up to make dinner or the doctor says, hey. (43:29) You know, your urine sample shows that you're spilling such and such. (43:33) I think you've got kidney disease. (43:34) Mike didn't feel anything going on.
Scott Benner (43:36) Nope. (43:36) He had no idea. (43:38) He really didn't. (43:38) Diabetes is not a cross we'll cross that bridge when we come to it situation. (43:43) Like, need to be you need to be thinking about it every day.
Scott Benner (43:46) And and I even take that not everybody's going to, and that's fine. (43:50) But I I just I really do wanna repeat again to anybody listening who makes a decision. (43:54) If the island's on fire and there's only so many boats, we still tell people the island's on fire so they have a chance to get away. (44:02) Correct. (44:02) Right?
Scott Benner (44:02) You don't get to make the decision about whether or not I die in the island fire. (44:07) Right? (44:07) Like, so
Jenny Smith (44:08) I I'd be looking for the largest branch to float on. (44:10) If the boats were full, man, I'd be looking for the door or whatever.
Scott Benner (44:14) You gotta give people a fighting chance.
Jenny Smith (44:16) You do.
Scott Benner (44:17) If your argument is, well, everyone's not gonna understand. (44:19) Everyone's not gonna have the bandwidth. (44:21) Everyone's not gonna have access, So we just won't tell anybody. (44:25) That's a terrible perspective to have. (44:27) Right?
Jenny Smith (44:28) It's also judging somebody from what you think you gathered out of a ten or fifteen minute office conversation with someone.
Scott Benner (44:36) Which isn't that funny considering that when I scroll back through this document, the ADA is always worried about people being treated properly.
Jenny Smith (44:45) 100%. (44:45) It's in the it's in these. (44:47) It's one of the things that treating people with individualization and empathy and and all the wordage that they can possibly use, but let's put it into a fact.
Scott Benner (44:57) Yeah. (44:57) Let's not then tell them a seven five's okay. (45:00) That's hilarious. (45:01) Like Right. (45:02) Everyone deserves to be treated well.
Scott Benner (45:04) Blah blah blah. (45:04) And now you know you know what it takes me back to? (45:07) I was at a blogging conference one time, and I got caught in an elevator with a person who
Jenny Smith (45:12) conference.
Scott Benner (45:13) I was. (45:14) There was a blocking conference for people with type one diabetes. (45:16) I don't know what to tell you. (45:17) They used to exist. (45:18) I got into an elevator with a person who I was like, oh my gosh.
Scott Benner (45:21) This person was like like one of the gold standard people in the space. (45:24) And I had gotten to over a couple of days watched them, And I was like, this person really knows what they're doing with their diabetes. (45:32) But public facing, it was a lot of like, woe is me and isn't this hard and blah blah blah. (45:38) And I was like, oh, you understand this one way, but you talk about it another way. (45:43) Another way.
Scott Benner (45:44) And I did at some point say to them, like, why don't you talk about it more like this? (45:47) And so I'm not getting involved in that. (45:50) Oh, yeah. (45:51) And those same people told me, I can't do what I'm doing. (45:55) Mhmm.
Scott Benner (45:55) And I I've complained about it enough. (45:57) I don't wanna complain about it again. (45:59) But when I started doing this, I got pulled aside by people who were like, you can't tell people how you manage your daughter's diabetes. (46:06) And I was like, why not? (46:07) I was like, it's just what we do.
Scott Benner (46:08) And they're like, yeah. (46:08) You're gonna hurt someone.
Jenny Smith (46:09) It's like having conversation with somebody you run into at the coffee shop, right, who wants to tell you about how they manage the exterior of their vehicle. (46:19) Well, you know what? (46:19) If you hold
Scott Benner (46:20) them Jenny, they can't see the big picture. (46:22) I'm just telling you. (46:22) Okay?
Jenny Smith (46:23) Yeah. (46:23) Yeah. (46:24) I don't And, you know, and and what you were talking about as well, I think you were seeing somebody as the front face of of, like, what they were spilling out into the community, but you also saw behind the scenes the fact that they were doing something different on a personal level. (46:44) Yeah. (46:44) When I went into this field specifically, I thought about eons ago when my parents got married, my dad was a smoker.
Jenny Smith (46:54) Mhmm. (46:56) My dad went to his primary care doctor, and his doctor told him to stop smoking, that it was going to be detrimental. (47:05) This was obviously at the point that that was coming to be
Scott Benner (47:08) Breaking news.
Jenny Smith (47:09) Breaking news. (47:10) And so, you know, it goes home thinking about this blah blah blah whatever. (47:14) And out in public, my dad sees his doctor smoking. (47:19) And he's like, what the and I remember that story. (47:23) Yeah.
Jenny Smith (47:23) Because when I went into doing something that is so it has become very visible now, especially. (47:31) Mhmm. (47:32) I don't want to tell someone one thing and not do it in my own life. (47:38) I don't think that's fair.
Scott Benner (47:40) Yeah.
Jenny Smith (47:40) I think that if you put something out there, then you should absolutely hold that as something that's also important for the value of your own life. (47:51) And I think that it's just being truthful in my opinion.
Scott Benner (47:55) I've said a thousand times. (47:57) I don't know how I was supposed to know all this and then just not tell anybody about it.
Jenny Smith (48:03) Pretend.
Scott Benner (48:03) Yeah. (48:04) Ridiculous. (48:04) It was ridiculous. (48:05) That person was having great outcomes and was, you know, really on the ball. (48:10) Then when they talked to people, was always like, oh, I know it's hard.
Scott Benner (48:13) It's okay. (48:14) And Mhmm. (48:14) Go two fifty. (48:15) You're fine. (48:16) Like, I'm not saying your blood sugar might not go to two fifty once in a while.
Scott Benner (48:19) I'm saying don't set that in people's minds as expectation. (48:22) Like, it's okay to say this is gonna go wrong sometimes, but here's our goal. (48:28) Like, there's and if you don't make the goal, it's not a failure. (48:31) It's just like, don't act like that's not the standard we're looking
Jenny Smith (48:36) that the goal can shift.
Scott Benner (48:37) Sure. (48:38) Right?
Jenny Smith (48:39) Yeah. (48:39) You you have somebody who starts with an a one c of 8.5, and you say, well, the initial goal is 7.5. (48:46) But this is a moving goal. (48:47) Eventually, we wanna get down here, and, eventually, we wanna have an average more around this. (48:52) Eventually, we don't want your your numbers to look like a, you know, the Rocky Mountains.
Jenny Smith (48:57) We want it to be a little smoother. (48:59) Eventually, eventually, and they're they are. (49:01) They're baby steps for some people. (49:03) Other people, no. (49:04) Not at all.
Jenny Smith (49:05) And some people gather all the information you want, and they apply it, and they go home, and they change everything.
Scott Benner (49:09) I get those notes. (49:10) They're those notes are crazy. (49:12) Great. (49:12) Yeah.
Jenny Smith (49:12) Yeah. (49:13) Fantastic. (49:14) But you have to have also from a clinical standpoint, you have to have the vision of where could somebody get to if I just give them this little nibble of information that could help right now.
Scott Benner (49:24) Right. (49:25) But I've spoken to clinicians who will tell you that there are people that come into their office that they don't even try to talk to because they've decided ahead of time they're not gonna figure it out. (49:34) I think I've had a conversation with somebody with an IQ from, like, 80 up to a 170. (49:39) And they all have the same concerns. (49:41) They all have the same roadblocks to understanding.
Scott Benner (49:45) And there's and by the way, I use the same language to get them all to a place where they can figure it out. (49:50) I I I have an example right now that I'm incredibly proud of, but I won't like, I don't wanna embarrass anybody. (49:56) But there's a person listening to this podcast right now that really is limited, and they're still doing well for themselves. (50:03) And so so everyone gets to know what happens when the island burns down. (50:08) It's up to them what they do with it.
Scott Benner (50:09) It's not up to you as to whether or not they die without ever having fought for themselves. (50:14) That's how
Jenny Smith (50:15) I what they can use.
Scott Benner (50:17) Right? (50:17) Right. (50:18) Don't stop them from I can't get a c peptide test until what was it? (50:22) You know? (50:22) And so I can't have a pump or I can't like, that's insurance bullshit.
Scott Benner (50:26) Like, don't
Jenny Smith (50:26) A 100%.
Scott Benner (50:27) Yeah. (50:27) Yeah. (50:27) Yeah. (50:27) Don't, I mean, don't try to pretend like that's some sort of rule. (50:30) There are so many rules around life and diabetes more specifically that have nothing to do with anything, and I try so hard.
Scott Benner (50:38) Like, you know, I like, I'll I'll be like, oh, it's the pot roast story about the short pan. (50:43) I'm try just trying to get you to think like, oh, maybe there's no reason I have to do this.
Jenny Smith (50:47) Right. (50:49) My pan is big enough. (50:50) I don't have to cut the ends off anymore.
Scott Benner (50:52) Get a bigger pan? (50:53) Like, how about I do something for my like, there's no I and listen. (50:57) Some of you are rule followers, and god bless you. (50:59) I don't know your what your illness is. (51:00) Okay.
Scott Benner (51:01) I was like, but, like, I'm not some crazy podcast. (51:04) You guys have been listening to me long enough now. (51:06) This just seems like common sense to me. (51:08) I'm not saying you all need to be on a GLP. (51:11) I'm not saying you all need to be doing anything.
Scott Benner (51:13) I'm saying, like, don't limit yourself. (51:15) To me, I've been having the same conversation about thyroid for eight years. (51:19) The amount of people who are not medicated well for their thyroids and how horrible it's impacting their lives is inconstionable. (51:26) Like, it's so simple to figure out. (51:29) And still, like, I talked to a woman the other day.
Scott Benner (51:31) Jenny, I said, list all your issues. (51:32) She listed them. (51:33) She got done. (51:34) I went, you have Graves'. (51:35) She goes, well, no.
Scott Benner (51:36) They said that, my test is, like, point one or something on the wrong I'm like, no. (51:41) You have Graves'.
Jenny Smith (51:42) Please find a good clinician who can actually
Scott Benner (51:44) pops out of the side of her head or her eyes fly forward, they'll go, she might have Graves. (51:49) Great. (51:50) Alright. (51:50) Listen. (51:51) Go fight for yourselves.
Scott Benner (51:52) Stop it, Jenny. (51:53) Thank you.
Jenny Smith (51:54) Yeah. (51:54) Of course.
Scott Benner (51:55) I I'm all upset now. (52:03) My diabetes pro tip series is about cutting through the clutter of diabetes management to give you the straightforward practical insights that truly make a difference. (52:12) This series is all about mastering the fundamentals, whether it's the basics of insulin, dosing adjustments, or everyday management strategies that will empower you to take control. (52:22) I'm joined by Jenny Smith, who is a diabetes educator with over thirty five years of personal experience, and we break down complex concepts into simple, actionable tips. (52:32) The diabetes pro tip series runs between episode one thousand and one thousand twenty five in your podcast player, or you can listen to it at juiceboxpodcast.com by going up into the menu.
Scott Benner (52:43) Okay. (52:43) Well, here we are at the end of the episode. (52:45) You're still with me? (52:46) Thank you. (52:46) I really do appreciate that.
Scott Benner (52:48) What else could you do for me? (52:50) Why don't you tell a friend about the show or leave a five star review? (52:54) Maybe you could make sure you're following or subscribe in your podcast app, go to YouTube and follow me or Instagram, TikTok. (53:03) Oh, gosh. (53:03) Here's one.
Scott Benner (53:04) Make sure you're following the podcast in the private Facebook group as well as the public Facebook page. (53:10) You don't wanna miss please, do you not know about the private group? (53:14) You have to join the private group. (53:16) As of this recording, it has 74,000 members. (53:19) They're active talking about diabetes.
Scott Benner (53:22) Whatever you need to know, there's a conversation happening in there right now, and I'm there all the time. (53:27) Tag me. (53:28) I'll say hi. (53:29) The Juice Box podcast is edited by Wrong Way Recording. (53:34) Wrongwayrecording.com.
Scott Benner (53:37) If you'd like your podcast to sound as good as mine, check out Rob at wrongwayrecording.com.
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