#1807 Spokane or Bust - Part 2
In part two, Cassie shares building confidence after diagnosis—finding community, navigating school nurses, improving A1C to 5.4, exploring tight range goals, and advocating for her son without burning out.
Companies that Support Juicebox
Key Takeaways
- Community Changes Everything: Finding a support system—like local Facebook groups and the Juice Box Podcast community—can transform the overwhelming sadness of a new diagnosis into empowerment and proactive management.
- Hospital Education is Just the Beginning: The initial diabetes education provided at diagnosis is necessary but often insufficient for daily living. Parents and caregivers must seek out real-world strategies to refine insulin timing and carb counting without burning out.
- Navigating School and 504 Plans: Building a confident relationship with the school nurse is crucial. Empowering your child to handle their technology and advocating for their specific medical orders ensures they avoid unnecessary highs or lows during the school day.
- The Value of New Tools: Modern tools, such as the Juice Box Podcast calculators (for settings and bolusing) and AI prompts for macro breakdowns, take the guesswork out of complex meals with fat and protein, making day-to-day management much easier.
- Monitoring Siblings and Autoimmune Risks: If a child has Type 1 diabetes, it's wise to monitor siblings for other autoimmune conditions, such as thyroid issues or celiac. Push for comprehensive labs, including Free T3 and ferritin, if symptoms arise despite a "normal" TSH.
Resources Mentioned
- US Med: usmed.com/juicebox or call (888) 721-1514
- Eversense 365: eversensecgm.com/juicebox
- Tandem Mobi: tandemdiabetes.com/juicebox
- Omnipod 5: omnipod.com/juicebox
- Dexcom G7: dexcom.com/juicebox
- Touched by Type 1: touchedbytype1.org
- Juice Cruise 2026: juiceboxpodcast.com/juicecruise
- Juicebox Docs: juiceboxdocs.com
- Settings Calculator: juiceboxpodcast.com/settings
- Bolus Calculator: juiceboxpodcast.com/bolusfour
- Wrong Way Recording: wrongwayrecording.com
Introduction and Sponsor Messages
Scott Benner Welcome back, friends, to another episode of the Juice Box podcast.
Cassie So my name is Cassie. I am a stay at home mom of three boys. They're 14, 12, and six, and my 12 year old is our type one diabetic.
Scott Benner This is part two of a two part episode. Go look at the title. If you don't recognize it, you haven't heard part one yet. It's probably the episode right before this in your podcast player. 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.
Scott Benner 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. 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. 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. While you're listening, please remember that nothing you hear on the juice box podcast should be considered advice, medical or otherwise. Always consult a physician before making any changes to your health care plan or becoming bold with insulin.
Scott Benner This episode of the Juice Box podcast is sponsored by Omnipod five. Omnipod five is a tube free automated insulin delivery system that's been shown to significantly improve a one c and time and range for people with type one diabetes when they've switched from daily injections. Learn more and get started today at omnipod.com/juicebox. At my link, you can get a free starter kit right now. Terms and conditions apply.
Scott Benner Eligibility may vary. Full terms and conditions can be found at omnipod.com/juicebox. The podcast is also sponsored today by the Dexcom g seven, the same CGM that my daughter wears. Check it out now at dexcom.com/juicebox. When did you realize that you needed to go find more information?
Moving Past the Sadness of Diagnosis
Cassie I had gotten to the point where I was so sad about it that I had to make a decision. It was either you are going to do just what they've told you. Right? You're only you're gonna use the little paper they gave you. Mhmm.
Cassie And you're gonna figure all this out, and you're gonna do all this math on this piece of paper, and you're gonna keep this log every day, you know, and just be sad, or you're going to find a better way because people obviously live with this and have for a long time. And so there's gotta be more information out there that makes this easier and better to understand. So either you can stay the same or you can try to be better. And in that moment, I decided that I wanted to be better. It was just a matter of how do I get better.
Scott Benner Yeah. Tell me about sad. What do you mean you were sad?
Cassie I felt like this had ruined his whole life.
Scott Benner Okay.
Cassie I was sad for the things I felt like he wasn't going to get to do.
Scott Benner Do you feel that way now?
Cassie I don't. No. Not anymore, which is really great.
Scott Benner What stopped you from feeling that way?
Cassie I think it was meeting other kids that had it. Meeting other kids and parents and getting you know, establishing a community of other people that could help you.
Scott Benner Yeah.
Cassie I felt like that's really what turned it around for me. And so this is actually how I found the podcast. They we have a an outreach group up there in Spokane. It's called STIX Diabetes Programs. They run a camp.
Cassie They're very involved with the ENDO's office. And so their outreach coordinator puts together, like, a little packet for you Mhmm. And they give that to you at diagnosis. They invite you to, to join their Facebook group. Right?
Cassie And so I was in the Facebook group, hadn't really introduced myself or anything. I'm just kind of watching things happen. We're obviously getting closer to school. And so I had asked a question about going back to school. Does anybody have any experience with the school?
Cassie The school nurse, do you have a school that you like or a nurse that you recommend? Right? Because I can ask to transfer the kid somewhere. Right?
Scott Benner Yeah.
Cassie And so someone had left a comment and said, my son doesn't go to that elementary school, but is at this middle school, which is where my oldest son was. So and the nurse there is great for the time that he gets there. Right? If you have any questions or you need help, let me know. Also, listen to the Juice Talk podcast.
Cassie It will really help you.
Scott Benner Oh, wow.
Cassie So that's where I had found out about the podcast.
Scott Benner That's awesome.
Cassie And so I immediately joined the group, and it was like that was and that was at the same time. Right? Like, I decided, am I going to better myself, or am I get or am I going to stay sad? So bettering myself is reaching out in this group and immediately provided with a resource, and then it was like the whole world opened as far as information was concerned. And I felt like I'd learned so much from the Facebook group alone.
Scott Benner Can you contextualize why what you were taught in the hospital led you to feel sad? Like, where was the gap? Now that you have more information, what's the gap that left you feeling lost?
Cassie I don't know. That's hard. I think it was just I didn't have a good grasp of what it was, I think, and it just felt so monotonous. I mean, we were sent home with so much stuff.
Scott Benner Mhmm.
Cassie Pen needles and syringes and insulin and a meter and, I mean, all this stuff. And so it just felt so monotonous to have to figure out exactly what he's eating. And then and at that time, right, they really want you to focus on counting carbs. And I already knew how to do that. That's not it wasn't hard for me.
Cassie Mhmm. But I'm the kind of person that will just measure everything. I'll measure all the food. And so now I'm, like, putting the peanut butter on the scale. Right?
Cassie Because I need to know how many carbs of peanut butter he's having so I can get it exactly right. And then I'm calculating exact the exact carbs and then trying to figure out the dosing on that. And then, well, do we round up or do we round down? Which one are we gonna do this time? Because we're, you know, on shots at the time.
Cassie It just felt so overwhelming. And how do I send them back to school on pen shots and then a nurse is gonna do this? How do I trust a nurse to do this when I don't even necessarily trust myself every time? It felt hard allowing somebody else to do that for your kid.
Scott Benner Hindsight, is there anything the hospital could have done differently that would have helped you, or maybe is it beyond their touch?
Cassie I don't know. Maybe we rushed home. Like, maybe if we'd stayed a little bit longer, we'd we had would have received a few more of those touches. Right? Because they would send in like, we did see the dietitian.
Cassie Like, she came in and did a thing with us. We saw our educator several times, which was great. But, like, they had a psychologist that would come in and talk with us. We didn't see them because we didn't stay long enough for that. And then, of course, like, me hearing about their outreach group and then the Facebook stuff, that was just for me going through the packet that they gave me.
Cassie Mhmm. Perhaps that would have been mentioned, right, if we had stayed a little bit longer. And so maybe because we shortened the stay, we didn't get the full experience. And then knowing that there were other people out there to talk to, there were different things you could try. I don't know.
Cassie Yeah. It's hard to say, but we really did wanna go home, and we had a good grasp of it. We put his Dexcom on in the hospital. We were able to show that we could give his insulin shots with no problem. Right?
Cassie And so they just felt like we had a good understanding. We were equipped, and we could go home if we wanted to. So
Scott Benner Plus there's a lot of honeymooning. So you're kinda getting a soft launch too.
Cassie Right.
Scott Benner Yeah. Yeah. But you don't know that at the time.
Cassie No. Nope. And we didn't really understand what that was like. They had mentioned the word, but we didn't really understand what that was like until we started hitting a lot of lows. And so then I got ahold of them.
Cassie I was actually calling every day. For a while, they wanted me to call every day and give them his numbers. Then they were, like, adjusting his CARB ratio and stuff. And so it wasn't until we hit a bunch of lows, and they're like, okay. Well, the honeymoon's probably kicked in now that he has insulin on board.
Cassie And so you're gonna see this that the pancreas is still helping a little bit. And I'm like, but you told me it was dead. Mhmm. Why is it working now? But he did tell us at it must have been our October appointment that he felt like the prolonged honeymoon that he's experiencing right now is because we were able to get the numbers in check so quickly.
Scott Benner He thinks you found the diabetes pretty quickly? Actually, hindsight, how long do you think it had been going on where he wasn't feeling well?
Cassie Oh, at least four weeks.
Scott Benner Four weeks. Okay.
Cassie Yeah. So he was diagnosed July 1, and I would say he was probably having symptoms the June. Noticeable. If I can look back, he it was all of June. He it was really ramping up.
The Type 1 Neighbor
Scott Benner When you saw it more.
Cassie Yeah. Mhmm.
Scott Benner So now this has been a great conversation, but we have not touched on one of the things that you put in your list.
Cassie Oh, yes.
Scott Benner Is that my fault?
Cassie No. I actually didn't even review it before we did this.
Scott Benner Okay.
Cassie At the time that I wrote that email, things have changed so much since then already.
Scott Benner Oh, let me read it to you then. Maybe you don't even relate to this. It says lack of education and general knowledge about type one in children. Mhmm. Getting buy and support from family members.
Cassie Mhmm.
Scott Benner School nurse relationships. Type one with sports. Relationship evolution with our type one neighbor.
Cassie Yes.
Scott Benner What do you wanna talk about in that?
Cassie So my neighbor is awesome. I love her so much. She was diagnosed as an adult. She was 19, and she just turned 40.
Scott Benner Cassie, real quick. If you say you love everybody, then when you say you love me, it doesn't really hit the same way.
Cassie I'm so sorry.
Scott Benner That's okay. But I mean
Cassie But I love everyone in their own unique way. Right? I know. It's just like telling
Scott Benner your child that they're your favorite, but they're all they're they're all a favorite for a their Has that ever seemed satisfying to one of your kids before?
Cassie It actually my type one likes that a lot. I'm like, you're my favorite. And he's like, but you tell that to my brother. And I'm like, I know. But he's my favorite because he's so cuddly, and you're my favorite because you're so intelligent.
Cassie And he's my favorite because he's so witty. And he's like, oh, I love that.
Scott Benner This kid's easily placated. I don't like that much. Because my kids are like, one of us has to be better than the other one. And we're like, we're like, no. And they're like, come on.
Cassie Well, I like to think of it that way for me, like, with my siblings. I am the favorite. I mean, my mom would probably disagree with that, but I think I am. So
Scott Benner You think your mom disagrees that she has a favorite?
Cassie That I'm the favorite.
Scott Benner Oh, wait. You think your mom has a favorite?
Cassie I think I'm my mom's favorite, but I think she would say no.
Scott Benner How many kids does your mom have?
Cassie Three.
Scott Benner What's wrong with you that you're not the favorite?
Cassie I don't know.
Scott Benner You know. What is it?
Cassie I'm too sassy, Scott.
Scott Benner Are you the most like her?
Cassie Probably. Yes.
Scott Benner Yeah. Okay. The one she likes the best is the one who acts the way she wishes people would be?
Cassie No. Probably not. No? No. Honestly, my mom probably does not have a favorite.
Cassie But
Scott Benner I feel like you're backpedaling now because you think they're gonna hear this.
Cassie No. She will probably hear this at some point. I actually didn't tell her about it, but I will tell her eventually.
Scott Benner Also, be honest. The one she's chosen is a favorite. She picked the wrong one. Right?
Cassie No. I I truly, I don't think she had a favorite.
Scott Benner Okay. Alright.
Cassie I don't think so.
Scott Benner Alright. I'll agree with you that you believe that.
Cassie If any of the kids were favorites, it's the grandkids.
Scott Benner Well, that's easy. That's
Cassie easy. I know. Right? Yeah.
Scott Benner Yeah. I'm just telling you, like, my kids are like, come on. Which one of us do you like better?
Cassie Which one of us do you like better? Sometimes I tell them it depends on the day. Like, today, it's the oldest.
Scott Benner They make a case for themselves too. And I'll tell you what, they're good arguments.
Cassie Yeah. They can be. They can be.
Scott Benner We've gotten it down to which one's easier. That's the new discussion. Which one of us is easier? And I was like, neither of you are easy. And then each of them is like, oh my god.
Scott Benner What about this about her? What about this about him? And I'm like, yeah. I mean, you're both the problem is what I'm telling you.
Cassie Right. You know? Yeah.
Scott Benner Alright. Okay. Alright. I believe you. I'm sorry.
Cassie No. You're fine. No. So my neighbor, we have a little community pool, and we get a membership there every summer. And so her and I will hang out and talk while the kids swim.
Cassie And this is where the lack of knowledge about diabetes ties in.
Scott Benner Okay.
Cassie She never told me she was type one. So then one summer because she's lived here, I don't know, five years now. One summer, I noticed tubing coming out from underneath her shirt. And I thought, oh, I wonder if that's an insulin pump. Oh, she must have this severe kind of diabetes.
Scott Benner Oh, you thought that when you saw the the tubing?
Cassie Yeah. Mhmm. And so and then that's what it was. She did. She had a pump.
Cassie She was on the t slim at the time, and so she would just, like, tuck it into the back of her swimsuit. And so we had kinda struck up a conversation. I'm like, hey. I didn't know you had diabetes. And she's like, oh, yeah.
Cassie I I have type one, and, you know, I was diagnosed at 19. And at that time, I I still thought it was probably type two, right, in what I understood as diabetes at the time.
Scott Benner Right.
Cassie Yeah. So in this time where he's ill, she's made comments about him at the pool. Gosh, man. He's looking a little bit thin. Man, his lips are turning blue like he's getting really cold in the water.
Cassie Like, he'd lost 12 pounds by the time he was diagnosed. And she's like, man, he's looking you know, he's going through a growth spurt or something. So when I texted her from the hospital and was like, Wes was diagnosed with type one diabetes. And she was like, I feel like such an asshole. How did I miss this?
Cassie Like, I am type one. And I couldn't even tell you that he was having symptoms.
Scott Benner She saw changes in him, but she didn't relate them back to diabetes.
Cassie No. Okay. And she goes, and these are all the same symptoms I was having. Yeah. Yeah.
Cassie So it was crazy. So the difference between where I think we're at and where she was at, she would say she didn't have a lot of support at the age of 19 when it came to this. So what's been cool about it is been able to, be able to relate to her. And, obviously, not the same. Right?
Cassie I'm a parent taking care of a child, and she is the type one. But being able to talk about it so she can she'll text me pictures of her graph and tell me, like, man, I missed the mark on this bolus. That sucks. Right? Or, you know, I had this really bad low today.
Cassie I must have given too much insulin. I feel like crap. Right? It's been cool to kinda talk about it back and forth. I had listened to all of the episodes available on the GLP stuff because I was so interested.
Cassie My mind went to, would they give it to Wes so that we can prolong his honeymoon as long as possible? Probably not, but that's where my mind went. Right? Can I get him something like that that we could microdose, and then we can just, like, try to keep this pancreas alive as long as possible? But in listening to that, then I was able to relay information to her and say, hey.
Cassie This is something I think would really help you. Like, I think based on where you're at, you should push your endo for this. I really wanna see this for you because she was experiencing a season of burnout. Right. And she did.
Cassie She ended up getting on a GLP one, and she has seen immense improvements. She ended up moving from the t slim to the Omnipod, and she loves it. It's been working so well for her. She feels like she has so much more freedom. So it's been really cool.
Cassie And I would say just from the conversations that her and I have had, the his diagnosis was a benefit in that relationship because it was almost like she had found a support system. You know what I mean?
Scott Benner Right. Wow. Does she listen to the podcast?
Cassie No. But I've told her about it. I don't know if she's ever listened to a single episode, but I've sent her ones where I'm like, hey. You need to listen to this. It's so good.
Scott Benner That's really nice for me to know. I appreciate you sharing that with me. Yeah. That means that it's possible that the thing I made helped the person who has never heard it before.
Cassie Yeah. Oh, yeah.
Scott Benner I like that.
Cassie Yeah. Absolutely.
Scott Benner Awesome. And she has diminished need for insulin. Her insulin needs have gone down.
Scott Benner You can manage diabetes confidently with the powerfully simple Dexcom g seven. Dexcom.com/juicebox. The Dexcom g seven is the CGM that my daughter is wearing. The g seven is a simple CGM system that delivers real time glucose numbers to your smartphone or smartwatch. The g seven is made for all types of diabetes, type one and type two, but also people experiencing gestational diabetes.
Scott Benner The Dexcom g seven can help you spend more time in range, which is proven to lower a one c. The more time you spend in range, the better and healthier you feel. And with the Dexcom Clarity app, you can track your glucose trends, and the app will also provide you with a projected a one c in as little as two weeks. If you're looking for clarity around your diabetes, you're looking for dexcom. Dexcom.com/juicebox.
Scott Benner When you use my link, you're supporting the podcast. Dexcom.com/juicebox. Head over there now. Today's episode is brought to you by Omnipod. We talk a lot about ways to lower your a one c on this podcast.
Scott Benner Did you know that the Omnipod five was shown to lower a one c? That's right. Omnipod five is a tube free automated insulin delivery system, and it was shown to significantly improve a one c and time and range for people with type one diabetes when they switched from daily injections. My daughter is about to turn 21 years old, and she has been wearing an Omnipod every day since she was four. It has been a friend to our family, and I think it could be a friend to yours.
Scott Benner If you're ready to try Omnipod five for yourself or your family, use my link now to get started. Omnipod.com/juicebox. Get that free Omnipod five starter kit today. Terms and conditions apply. Eligibility may vary.
Scott Benner Full terms and conditions can be found at omnipod.com/juicebox.
Cassie Yes. Yeah. She's increased her a one c dramatically. Like, it's been so good, and she's just thrilled.
Scott Benner Decreased.
Cassie Yes. Decreased. I'm sorry. Yeah. She's decreased it.
Scott Benner Yeah. Oh, that's wonderful.
Cassie Yeah. Yeah. So that's really cool.
Scott Benner Very nice. Look at you. You're out there, like, doing good works.
Cassie Doing the Lord's work. You know?
Scott Benner All I heard was that there are people who sit at the pool, and I thought, what am I doing wrong? That's all I heard, and that's all I thought. I said, what am I doing wrong? She's sitting at a pool.
Cassie Yeah. We sit in a pool. It was probably built in the eighties. I'm sure the lawn furniture is from the eighties as well. I mean, it's a thing, but it's usually the same families every year and we do.
Cassie We just go down and we Hang out. We just hang out at the pool
Scott Benner while the kids swim. I want that. I want a day where I hang out at the pool. I'm gonna do that. Yeah.
Scott Benner I don't have a pool, but I know.
Cassie We don't either. I mean, we could. The area that we live in, it gets pretty hot. Yeah. We could.
Cassie But yeah.
Navigating School Nurses and 504 Plans
Cassie No. At the time, like, when I had sent the email, we had made a turn in the relationship with our school nurse. And so because he was so newly diagnosed, it had been, like, seven weeks when he went back to school. She was so excited because she thought he was gonna be MDI, and then he wasn't. We got him on the Mobi three days before school started.
Cassie And so she was like, ugh. I don't know how to use this pump. I'm like, that's fine. He does.
Scott Benner It's got buttons on it. You'll figure it out. Let's go.
Cassie Yeah. And I don't think she ever managed it. Like, she never used it. She would just stand there, and he would bolus. So I would write a little note in his lunchbox.
Cassie He would put in his carbs, show her, administer his insulin, and then he'd eat his lunch.
Scott Benner I'm always surprised by how easily people are put off by technology sometimes. Yeah. It's just an insulin pump. It's not difficult to use.
Cassie Yeah. And she had experience with an Omnipod controller. Yeah. She had never seen the Mobi before, and so she was like, no. I don't he as long as he knows how, that's fine.
Scott Benner I watched my wife forward me a PDF today, and it looked like she had never seen a computer before the way she did it.
Cassie Oh, dear.
Scott Benner I think you'd be surprised by how many people record an episode of the podcast in the beginning before you guys hear what's happening is spent with them going, like, I'm so sorry. I'm so bad at technology. I'm like, it's not technology. It's Zoom. I mean, it I mean, there's not a lot to it, you know?
Scott Benner Or or when you say to something I say, hey. Listen. You know, your microphone just needs to be turned up. There's not enough volume in your microphone. Or I don't say microphone.
Scott Benner I go, I can't hear you. You know, you need to turn that up. You go into audio, there's settings in there. Well, in the audio, there's settings for speaker and there's settings for microphone and they can't hear me and they turn the speaker up. And they're like, oh, you're louder in my ears now.
Scott Benner I'm like, well, you turn up speaker? And I said, yeah. I said, well, turn up the microphone. That's the thing you're talking to me They go, oh, I'm sorry. I'm not good at this.
Cassie Oh my gosh.
Scott Benner Good at what? I I I don't Simple even
Cassie direction.
Scott Benner Yeah. There's sound going one way and coming back another way. Yeah. You talk into a thing, it reaches my speakers. I talk into a thing, it reaches your speakers.
Scott Benner Are we confused by this?
Cassie Confused. Yeah. Very.
Scott Benner So when somebody says, you know, I've never seen this insulin pump before. I'd rather you be MDI. I mean, what do you care?
Cassie I know. Yeah.
Scott Benner It's not that hard. It's that thing that puts people off. Any kind of change is difficult for for some people for some reason.
Cassie Yeah. But, like, the Facebook group is where I learned about texting diabetes. And then, of course, the podcast. Right? You've talked about it.
Scott Benner Yeah.
Cassie And then as soon as he was getting back to school, like, I'm on Spotify and I'm, like, searching keywords because I wanted to listen to every last episode you've ever had that talked about a five zero four plan. Mhmm. I mean, I was digging into it. Right? And so it started off a little I felt like she was overbearing.
Cassie And then it got to a point where she was like, well, I don't want you texting him and telling him to correct in class because I have to do that. Like, that's not in his medical orders. And I was like, I can tell him whatever I want, actually. So
Scott Benner That fine. Thanks. Don't worry. We got it. Yeah.
Scott Benner I'll never do it again. Don't worry.
Cassie Yeah. And then we also had, like, a a nurse. She shared schools at the time, and so we had a nurse that would come in one day a week. She was an LPN. She was the worst.
Cassie The worst. Mhmm. And I'm so glad she's not there this year. Even though I don't my kid's not there anymore. I'm so glad she's not there.
Cassie She would not follow our rules for treating Lowe's, and so she would make him do 10 to 15 carbs. And I was like, his medical orders don't even say that. The kid is so carb sensitive. Even at camp over the summer, they were like, we realized he only needed two or three. I'm like, I wrote that on his paper.
Cassie Mhmm. I told you he only needs two or three. You can't give him a 15 carb juice box. He'll reach 400 in, like, ten minutes. It just isn't gonna happen like that.
When Good Outcomes Face Medical Pushback
Scott Benner Yeah. I wanna pivot back here because we're kind of at the end, but I I wanna come full circle now that I understand your story. Right? You're going to the doctor. You've got the a one c from the sixes to the fives.
Scott Benner Right. I've now talked to you for a while. You're not crazy. Congratulations, Cassie.
Cassie You've Oh, thank you.
Scott Benner You're welcome. You've been diagnosed by a a nonmedical professional. It's not crazy. And you had some ideas. You were trying to chase after a more stable lower number.
Scott Benner You get there. The doctor tells you you're trying too hard. You're gonna burn yourself out. You weren't burned out. Mhmm.
Scott Benner No. You weren't concerned about burnout. And how long ago was that?
Cassie That was December. So it's been a full twelve months now.
Scott Benner Since he told you that?
Cassie Yes. And has
Scott Benner that been brought up again?
Cassie No. It actually has become more positive.
Scott Benner Okay.
Cassie Yeah.
Scott Benner And so he realized that you weren't burning out at some point, it sounds like.
Cassie Yes.
Scott Benner Okay.
Cassie Yeah. Yep. I think he realized that we weren't burning out. And so when we saw gosh. It must have been the October appointment.
Cassie So we had a Zoom one in July. It was, like, right after camp, so there was no a one c then. And then, of course, we got to October. Now it's been ten months, and his a one c was 5.4 again. That's awesome.
Cassie So we've maintained this almost a whole year now.
Scott Benner Yeah.
Cassie And at that point, he was like, man, great numbers. Good job. And I was like, thank you so much. I said, really? Honestly, I think a lot of this is just insulin timing.
Cassie We've really figured out the insulin timing.
Scott Benner Sure.
Cassie I review his reports every two weeks, and then I make basal adjustments as they're necessary so that we're keeping him stable in between. And so he's like, yeah. No. That's great. That's exactly it.
Cassie And he goes, so my encouragement to you, if you're ready to take the next step, there's a new metric that they're talking about. It's called tight range. And if you would like to see what that takes for him, 70 to one forty, you guys can start playing in that. But, hey. Let's play with the Dexcom reports real quick, and let's see how often are you in tight range, which they're saying 50% of the time.
Cassie Okay. Well, he's in tight range 73% of the time.
Scott Benner Yeah. So you're already there.
Cassie Yeah. So he goes, well, you're already there. So he goes, the only other challenge to you is just to increase that. It's just to do better at that.
Scott Benner I would ask him at some point, and I wonder if he would even remember. But I would ask him at some point, do you remember a year ago telling me, hey. Slow down. You're too in the weeds. Blah blah blah.
Scott Benner Like, why'd you say that to me? Yeah. And how come there's never been, you know, a mention of it again? How come you haven't said to me, hey, you know, I told you to slow down, but obviously, you were doing great. I see what you were concerned about, but that was not great messaging at the time for me.
Cassie Right. Yeah. No. It felt very defeating.
Scott Benner Yeah. No. People have it. Cassie, all the time. I mean, I'm telling you, it happens all the time that somebody comes to me or puts up a post and says, I went to the doctor today.
Scott Benner I was so excited to go
Cassie Mhmm.
Scott Benner Because we figured everything out and put it all into play, this was it. I was getting back my report card. It said what I wanted it to say and then I got yelled at for fifteen minutes. And I wonder if they really got yelled at or if somebody was just talking to them like, you got spoken to. And it feels like you're being yelled at because you tried so hard and then you did the thing that you were told was the pinnacle of it and then somebody said, oh, no.
Scott Benner You shouldn't do that. Like, people are fickle. Yeah. Like, everybody always wants to be tinkering and touching things and well, I don't know why that couldn't have just been like, hey, you're doing great. I do think it would be it's incumbent upon me to to say to you that if this is taking up too much of your time and intention, you do need to be worried about getting burned out on this.
Scott Benner But if that's not happening to you, then God bless you. You're doing a great job. How was it you're accomplishing this? You know what I mean? Like, why is that not the answer?
Scott Benner Hey. How'd you do that? You know? Like, maybe you know something I don't know. Would you share it with me?
Scott Benner It's never like that. It's always the everything's bad. Everything's gonna be bad. Let me just warn you. I'll be negative even if I don't think it's being negative.
Scott Benner People hear that negatively, and I I think they should, by the way. But alright. Well, I mean, it's fine now. So whatever. I guess don't rock the boat.
Cassie And the reason that I say he's great, like, son loves him. He is part of the camp that my son has gone to.
Scott Benner Mhmm.
Cassie I mean, he's really passionate about diabetes. The only reason that I say that I think it was coming from a good place, right, even though it felt crappy
Scott Benner No. But I believe it was too, I wanna say.
Cassie Yeah. Yeah. He has two type one kids.
Scott Benner Oh, the doctor does?
Cassie Mhmm. Our endo is a dad of two type ones himself. Yeah.
Scott Benner He's like, you don't wanna end up in the same booze hole my wife is in. Be careful.
Cassie Yeah. So one of our educators had told me at one point in time that he had actually gone back to school after his kids were diagnosed Wow. Specifically to specialize in
Scott Benner Endocrinology. What a good dude.
Cassie Yeah. In endocrinology. Yeah. And he's very passionate. He's a lovely man.
Cassie Yeah. And I think that he does really care about people. And so I think, honestly, it was coming from a good place, but it did. Like, it felt not good at the time.
Scott Benner Yeah. No. I understand the balance there. I wrote a blog. He went to medical school.
Scott Benner Jeez. I I thought they I didn't try as hard as I thought I did. He's he's like, wait. He was a doctor?
Cassie I believe he was a nurse.
Scott Benner Really? And became an MD?
Cassie He became a physician's assistant. He's PA.
Scott Benner Assistant. Hey. Listen. That's yeah. Again, all I did was write a blog.
Scott Benner That seems like harder. Very cool.
Monitoring Siblings for Autoimmune Issues
Scott Benner Well, do you have any concerns about your other boys? Do you get them tested?
Cassie So I haven't gotten them tested. Right off the bat, I had gotten the trial net kits. My oldest, who's 14, does not want to know anything at all whatsoever. And so we decided we would respect that if he does not wanna have blood work done and he doesn't wanna know. Because he has actually expressed to me, like, I found him in his room very upset.
Cassie And he said, I'm scared I'm going to get it. I can't do it. Wes is great at it. I can't do this. And I'm like, no.
Cassie I understand. And so he would rather not know. Like, if it happens, it happens. I don't have concerns for him. I have this weird mom gut feeling that maybe the youngest might.
Cassie He did want and but he's also the one that asks me, like, well, when do I get to have diabetes? And I'm like, well, you don't. I mean, you don't want it, but he's curious. He loves to check his blood sugar.
Scott Benner Yeah.
Cassie He's worn Astello for a little bit. He wore it for a couple of days. We saw some excursions on it. I was told not to worry about them, but he hit, like, one ninety on cereal. And I was like, that's wild.
Cassie He just randomly took his blood sugar a couple nights ago after we had oh, McDonald's. They get that, like, once a month at this point. He had McDonald's, and he just randomly decided to check his blood sugar. And three hours after eating, he was still one fifty. And I'm like, I don't know.
Cassie I don't know.
Scott Benner Fat. That's a lot of fat in that too. Was there a milkshake with it as well or something like that?
Cassie No. Nope. It was two cheeseburgers and a medium fry.
Scott Benner Have you tested it in the morning fasting?
Cassie We have, and he's usually, like, 100, one ten.
Scott Benner That's high.
Cassie I know. Yeah.
Scott Benner Yeah. Any other autoimmune in the family?
Cassie Yeah. So we do have my side of the family has, rheumatoid arthritis.
Scott Benner Mhmm. Mhmm.
Cassie And his side of the family has a ton of thyroid.
Scott Benner Interesting.
Cassie I only have it on one side on my side, and then he has it on both sides. His both his mom and his dad have thyroid.
Scott Benner How about your middle son? Because you said he was small. How's his thyroid?
Cassie They tested all of that in the summer at his one year mark, and everything came back beautifully.
Scott Benner We don't care about the numbers, though. What do we care about? We care about the outcome. So do you know what his t s h was?
Cassie You know, I knew you were gonna ask me this.
Scott Benner And what happened, Cassie?
Cassie I didn't look it up.
Scott Benner Mhmm. Is that information in the same place where the dustpan and the vacuum are at? Is that what's going on? Hold on a second. They I like that you said I I'm not good at cleaning that house.
Cassie No. I actually don't think. I know that it's online, like, in his portal.
Scott Benner Does he have any other thyroid symptoms?
Cassie Not that I'm aware of.
Scott Benner Do you know what
Cassie they are? I don't know. And I was honestly, I was like, I need to ask him about this. So my mom's side of the family is very small. My mom's only four nine.
Scott Benner Okay. That is small. Sorry. I didn't mean to laugh. That was weird.
Cassie My grandfather was, like, five foot. My grandmother was five one.
Scott Benner Oh my gosh.
Cassie Right? Very tiny people. I'm five four, but our oldest son is already five nine at 14. Like, he's huge.
Scott Benner Okay.
Cassie But then Wes is small, and, I mean, he would it's so funny. He had to do this, like, age verification thing on Roblox to use the voice chat with his friend, and they, like, scan the face. It's super creepy. I didn't really wanna do it. I put it off as long as I could.
Cassie Anyway, it estimated him to be nine.
Scott Benner They were like, stop it. This is a baby you put in front of us here. Don't don't try.
Cassie And he's and he's 12. But he is. Like so he was in jujitsu for a little bit. And, I mean, we figured that out. Keep the blood sugar up while he's doing that.
Cassie That was awesome. But he would often be paired with kids that were, like, second and third grade because they were the same size.
Scott Benner Okay. Here's the last thing we're gonna do together. I'm gonna read you're gonna say yes or no.
Cassie Okay.
Scott Benner Extreme fatigue, feeling tired, sluggish, or exhausted even after sleeping.
Cassie I wouldn't say often. No.
Scott Benner Feeling cold when others are comfortable, inability to warm up. Sometimes. Constipated, frequent or persistent difficulty making a poo poo?
Cassie Sometimes.
Scott Benner Dry hair, dry skin?
Cassie Yes. Very dry skin.
Scott Benner Puffy face, swelling particularly around the eyes?
Cassie Sometimes.
Scott Benner Hair loss? No. Have a raspy or deep throat, deep voice?
Cassie Yes.
Scott Benner Deep throat. I didn't mean that. Sorry. Deep throat. Muscle.
Cassie Raspy voice. Yes.
Scott Benner Talking about your 12 year old. Muscle weakness, feeling weak, particularly in the upper arms and thighs.
Cassie Thighs. Yep.
Scott Benner Brain fog, difficulty concentrating, forgetfulness, or fuzzy thinking.
Cassie Probably sometimes.
Scott Benner Does he have what they call low mood, apathy, lack of interest in activities, depression in other words? No. Slow movements. Moving or speaking more slowly than normal? No.
Scott Benner I slowed down to say that. That was interesting.
Cassie That was interesting.
Scott Benner Does he have any menstrual changes? Hold on a second. Let me skip that one. Look at me being funny. Joint muscle pain, aches, tenderness, or stiffness in muscle and joints?
Cassie Sometimes in the legs. Yeah.
Scott Benner Okay. Seriously, what was this TSH?
Cassie I'm I'm looking.
Scott Benner You're tell me it was like 2.3 or something like that, and they told you it was great.
Cassie Okay. Let me look.
Scott Benner Oh, here's one. Poor growth resulting in short stature, delayed development of permanent teeth, or delayed puberty.
Cassie Yeah. I mean, maybe. I mean, he's got all his teeth.
Scott Benner He's got all of his teeth. Look at him go.
Cassie He's got all of them. No. They said that they actually fell out very quickly for him. He's got all of his adult teeth now. Let's see.
Cassie Okay. Review now. There's things in here for Wes. Great. I'm gonna open this up
Scott Benner Uh-huh.
Cassie And I'm gonna see. I'm gonna tell you.
Scott Benner We're fine. We're at time, but that's fine. We can we can we can talk another minute. Don't worry. We're working on something.
New Tools: Juicebox Docs, Calculators & AI
Scott Benner I've revamped juiceboxdocs.com.
Cassie Oh, okay.
Scott Benner Yeah. So it's a list of doctors that listeners have sent in. It's really kinda cool. Like, you log on, the first one that pops up is in Alabama because it's in what you might call alphabetical order. And giving the example, Chelsea Zimmerman is at East Alabama Medical Center endocrinology, and there's a little badge.
Scott Benner It says she's a pediatric endo. There's also a little badge that says provider has type one. So there's, like, little badges, like, so you can kinda make through. There's an address you click on. It launches up a Google Map.
Scott Benner The you can click on the telephone number to make a phone call to them or you have a website link to click on. It's really pretty excellent. And you can search it. Like, for instance, you're in Washington. Right?
Scott Benner So I type in Washington, and just like that, there's somebody at the Mary Bridge Children's Outpatient Center in Washington. Oh. The doctor's clinic, Cavalion Place, Washington. Let's see. Advanced Diabetes and Endocrinology Care in let's see.
Scott Benner Washington again. So there's adults, pediatric. It's nice. It kinda pops up. Now we have Washington DC, Washington state.
Scott Benner And if they provide, like, good support for algorithms, if somebody says, hey. Look. They're really great with an algorithm. We have a little badge for that so you kinda know what you're looking at.
Cassie Oh, that's cool.
Scott Benner Yeah. It's great. And if you have a provider that you like, you can scroll to the bottom and submit your provider, and they'll show up in
Cassie the Perfect. Yeah. I remember looking at that in the beginning to see if there was anybody else we could find that might be close.
Scott Benner It's much better now. What they call searchable.
Cassie Searchable. Yeah. Yeah. Yeah. Searchable now.
Scott Benner Yeah. Yeah. Before, it was just my best attempt to, like, make a list. But now, I'll just say now with the advent of vibe coding through AI, you don't really need to know how to code to make stuff work anymore.
Cassie Yeah. That's crazy.
Scott Benner I'm sure all the coders are thrilled to hear that. And this is a very basic code. I also think that maybe, you know, data engineers are still probably pretty safe. And then also, telling people about stuff, juiceboxpodcast.com/settings. If you are looking to get, like, a basic starting point where your settings might be Mhmm.
Scott Benner This does it completely by weight. Oh. Do you know that boy's weight over there?
Cassie Sixty seven.
Scott Benner Sixty seven. So I put in sixty seven, and then it allows you to choose between highly sensitive, standard sensitivity resistant, or highly resistant to insulin. Where would you place him on that? Sensitive still? Because he's
Cassie Yeah. He's still pretty sensitive. Yeah.
Scott Benner It tells me from that that a starting point for his total daily insulin should be about thirteen point seven units. Does it seem right? Does he use about fourteen units a day?
Cassie Yeah. He's about 15.
Scott Benner Yeah. And it says that a a good place to start with his basal insulin would be six point eight five units a day or point three an hour. Do you have
Cassie That is almost spot on for him right now.
Scott Benner Hold on a second. One unit covers about 36 and a half carbs, it says.
Cassie His carb ratio is one to 15.
Scott Benner Okay. Well
Cassie Yeah.
Scott Benner Again, it's just a starting spot. And sensitivity factor, one unit moves him about a 131. Is that right?
Cassie Yeah. He's hit one to one twenty five.
Scott Benner Okay. And, that's just a little calculator that gave us all that just by putting in his weight.
Cassie That's crazy.
Scott Benner Mhmm. It's not. It's math. Now juicepodcast.com/bolusfour. This is the next one.
Scott Benner I'm super excited about this one. So now we take his insulin to carb ratio. What is it again? One unit covers 15. 15.
Cassie Mhmm.
Scott Benner Insulin sensitivity, we said was a 125? Yep. Target blood sugar, we're gonna make it 80. Let's pretend like he ate 50 carbs, and that meal just was 50 carbs. He's got no insulin on board.
Scott Benner His arrow is stable, and his blood sugar is currently a 110. Click calculate bolus. It tells you that he needs a bolus of about 3.57 and that you should pre bolus about eleven minutes. If suddenly that that meal had 10 units of fat in it or 10 grams of fat in it and hit calculate bolus again, it's still the same thing. Nothing different has changed.
Scott Benner And watch how it happens as I put the fat up. Now I'm at 15 grams of fat. Oh, at 15 grams of fat, it would like to see 3.57 as an initial extended bolus over three hours of point nine for a total of 4.47. The pre bolus is still at eleven minutes.
Cassie Oh, I love that.
Scott Benner Yeah. If I add protein in it, five grams of protein, and let's say I say his blood sugar is falling instead, and I hit calculate again. Well, now it says that's fine. We're still 3.57 as a a bolus again of one point o three over three hours to cover the fat and the protein, but it says please eat immediately because of hypo risk or low blood sugar.
Cassie Oh, okay. This is almost like that calculator that Nico shared, but it's, like, on steroids.
Scott Benner I made one of my own and kinda zhuzhed it up a little bit.
Cassie Now Yeah. I love that.
Scott Benner A lot of disclaimers. It's just a I'm not a doctor and I'm not a coder. None.
Cassie It's just a tool.
Scott Benner It's just a tool for you to look at, but it's Yeah. It's pretty awesome. Did you find his thyroid stuff yet?
Cassie I did. It's 1.54.
Scott Benner Damn it. It's not his thyroid. Has it ever been higher than that?
Cassie Not that I know of. This is the first time we've ever had it tested.
Scott Benner Keep testing it because they can bounce sometimes. But anything over 2.1, 2.2 with symptoms, you really gotta start asking for the medication.
Cassie Okay.
Scott Benner So look for bouncing. Like, there's a world where you check it again and it's much higher or it's super stable. It's did they do his iron by any chance? Do have low iron?
Cassie That's a good question too. Okay. I've got screenshots of everything. T four was a 7.1.
Scott Benner Okay.
Cassie Microalbumin Mhmm. Creatinine ratio, that's 15.
Scott Benner TSH was what? One point five?
Cassie One point five. Yeah. What is this? Tissue trans glutaminase IgA less than two. Some of these, I don't even know what they are.
Cassie They just said normal.
Scott Benner Did they do t three?
Cassie No. I don't think they did t three.
Scott Benner Okay.
Cassie Immunoglobulin, a.
Scott Benner Look at you.
Cassie One thirteen.
Scott Benner Look at you saying words. Hold on a second.
Cassie An a one c five point four.
Scott Benner Wait a second. If someone with thyroid symptoms despite normal TSH and total, comma, possibilities include free t three could be low symptoms often track more closely with did they do free t three?
Cassie No. Uh-uh.
Scott Benner Ask for it next time.
Cassie Okay.
Scott Benner Tell them to do a complete thyroid panel, not just TSH and t four.
Cassie Okay.
Scott Benner And then say, because here are some symptoms he's having.
Cassie Mhmm.
Scott Benner Alright. Also, low ferritin, iron deficiency, low b twelve, low vitamin d, that stuff could possibly cause some of those symptoms as well. Okay. Alright? Don't let it go though.
Scott Benner Don't just say like it was okay and then never pay attention to it again.
Cassie Oh, for sure. We're not really in that boat, So we wanna make sure that he's as healthy as possible.
Scott Benner Good. Good. Good.
Cassie I mean, is growing, and so it's just slow. And then they want to equate him being small to just, well, that's just family genetics.
Scott Benner Very well could be. I'm not saying otherwise. I'm just saying like
Cassie Yeah. No. But it is something that's very bothersome for him. I mean, to the point where he's like, well, mom, like, I've heard about, like, growth hormone. Like, is that something that the doctor would put me on to help me get bigger?
Cassie Mhmm. I'm like, well, probably not. But
Scott Benner Did you say probably not?
Cassie Yeah. I told him probably not.
Scott Benner Why not? Maybe they would.
Cassie I don't know. Yeah. I mean, that's a good question.
Scott Benner Mhmm. I also have a prompt I've been working on. So you drop the prompt into right now, I'm using it in Google Gemini. You drop the prompt and hit return. It says, please give me your insulin to carb ratio, your fat protein adjustment factor for worse off, or just type default if you don't know, and a link to a recipe.
Scott Benner Oh. So I gave it a one to 12 carb ratio. I told it default, and I gave it a recipe for baked ziti.
Cassie Mhmm.
Scott Benner You hit enter again, and it comes back and it says, hey. We've divided this recipe into one tenth. A tenth of this recipe, 47 carbs, 16 fat, 21 protein. You'd wanna do a bolus of 47 carbs at your insulin carb ratio. That's 3.91 units.
Scott Benner And then there's a extended bolus for the fat and protein. It gives it to you like that, 3.9 for the immediate, point nine five over four hours for the rest of it. It explains to you the strategy behind why you're doing it, and it breaks down the meal for you and tells you what was in the meal if you're interested in how it broke down the ingredients and all this stuff and how the ingredients impacted your blood sugar, like, in, like, two clicks. It's pretty
Cassie That's crazy.
Scott Benner Yeah. Yeah. Yeah. I'm hoping people find that stuff useful.
Cassie Now I just use my little recipe thing, and then I plug everything in and divide it, figure out my carbs.
Scott Benner See, the thing here is with the prompt, the prompt's already written. So you you really need to just drop in the link in your insulin to carb ratio.
Cassie Oh, that's so cool.
Scott Benner And it, tells you the rest. So I'm trying to figure out a way to share that. I'm not sure if I'm going to or not. But the other two calculators, did share. So they're on the website.
Cassie Well, there I mean, I've seen people ask about that. Like, if I'm creating a whole meal, how do I figure out what the carbs are?
Scott Benner Yeah. It's tough. It really is to break the whole thing apart. So Mhmm. Basically, what you what I've learned is simply put is that you can take any recipe and just say to chat GPT or to Gemini or whatever you're using, like, please, you know, I need to understand the, like, the macro breakdown of this recipe and how many carbs are in a serving, how many this is in a serving, that's in a serving.
Scott Benner And it does a really reasonably good job of giving you a return back.
Cassie Yeah. That's great. I love that.
Scott Benner Yeah. Good. Very cool. Okay. Cassie, you were awesome.
Scott Benner Thank you for doing this with me.
Cassie Well, thank you so much. I really appreciate it.
Scott Benner Alright. Hold on a second. K.
Closing & Sponsor Messages
Scott Benner This episode of the Juice Box podcast is sponsored by Omnipod five. Omnipod five is a tube free automated insulin delivery system that's been shown to significantly improve a one c and time and range for people with type one diabetes when they've switched from daily injections.
Scott Benner Learn more and get started today at omnipod.com/juicebox. At my link, you can get a free starter kit right now. Terms and conditions apply. Eligibility may vary. Full terms and conditions can be found at omnipod.com/juicebox.
Scott Benner Today's episode of the juice box podcast is sponsored by the Dexcom g seven, and the Dexcom g seven warms up in just thirty minutes. Check it out now @dexcom.comslashjuicebox. Okay. Well, here we are at the end of the episode. You're still with me?
Scott Benner Thank you. I really do appreciate that. What else could you do for me? Why don't you tell a friend about the show or leave a five star review? Maybe you could make sure you're following or subscribe in your podcast app, go to YouTube and follow me or Instagram, TikTok.
Scott Benner Oh, gosh. Here's one. Make sure you're following the podcast in the private Facebook group as well as the public Facebook page. You don't wanna miss please, do you not know about the private group? You have to join the private group.
Scott Benner As of this recording, it has 74,000 members. They're active talking about diabetes. Whatever you need to know, there's a conversation happening in there right now. And I'm there all the time. Tag me.
Scott Benner I'll say hi. Hey. Do you need support? I have some stuff for you. It's all free.
Scott Benner Juiceboxpodcast.com. Click on support in the menu. Let's see what you get there. A one c and blood glucose calculator. People love that.
Scott Benner That's actually, I think, the most popular page on the website some months. A list of great endocrinologists from listeners, that's from all over the country. There's a link to the private Facebook group, to the Circle community, and, we have a a fantastic thing there. American Sign Language. There's a great sign language interpreter who did the entire bold beginning series in ASL.
Scott Benner So if you know anybody who would benefit from that, please send them that way. Just go to juiceboxpodcast.com and click on support. While you're there, check out the guides like the pre bolusing guide, fat and protein insulin calculator, gosh, thyroid, GLP, caregiver burnout. You should go to the website. Click around a little bit on those menus.
Scott Benner It really there's a lot more there than you think. If you have a podcast and you need a fantastic editor, you want Rob from Wrong Way Recording. Listen. Truth be told, I'm like 20% smarter when Rob edits me. He takes out all the, like, gaps of time and when I go, and stuff like that.
Scott Benner And it just I don't know, man. Like, I listen back and I'm like, why do I sound smarter? And then I remember because I did one smart thing. I hired Rob at wrongwayrecording.com.
