#1860 ER Match

Scott and Erika explore the psychology of wasted time, identity, and the real-world reach of diabetes advocacy.

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Key Takeaways

• Niche Diagnostic Limitations in the ER: Emergency departments are structured as stabilization nets for acute crises ("sick vs. not sick") rather than definitive management zones for chronic diseases. Specialized diagnostic tests—such as GAD antibody panels to distinguish Type 1 from Type 2 diabetes—often take over a week to process and are unavailable as rapid, in-house ER labs.
• Navigating Chronic Endocrinology Shortages: A severe systemic shortage of endocrinologists complicates immediate care for newly symptomatic patients. Navigating extensive insurance verifications can delay crucial specialized appointments unless professional peer networks or alternative clinical channels are utilized.
• Educational Gaps in Standard Medical Curriculums: Traditional nursing schools and general medical tracks focus heavily on acute, short-term stabilization of metabolic emergencies (e.g., fluid and electrolyte replacement in DKA) rather than teaching the detailed, intensive management skills required to safely navigate daily insulin therapy.
• Mitigating Clinical Cognitive Bias with AI: Medical professionals are susceptible to cognitive biases, such as attributing demographic patterns to common clinical conclusions (e.g., assuming an older patient has standard Type 2 diabetes or a recurring UTI). Advanced large language models present a valuable opportunity to handle the cognitive load and provide structured differential analysis.
• The Invisible Mental Burden of Adult Type 1 Diabetes: Managing an adult Type 1 diagnosis demands an immense, constant cognitive load. The chronic anxiety surrounding severe hypoglycemia highlights the profound impact of partner support systems, peer-led education, and targeted community outreach.

Resources Mentioned

• Juicebox Podcast Support Site: juiceboxpodcast.com
• Eversense 365 CGM: eversensecgm.com/juicebox
• US Med Supply Distribution: usmed.com/juicebox (Or call 888-721-1514)
• Tandem Diabetes Care (Tandem Mobi System): tandemdiabetes.com/juicebox
• Audio Production Platform: wrongwayrecording.com

FULL EPISODE TRANSCRIPT

Introduction and On-Site Support Tools

Scott Benner (0:00)

Welcome back, friends. You are listening to the Juice Box podcast.

Matt (0:13)

My name is Matt. Been diagnosed as a type one diabetic for just over one year, and I'm here with my beautiful wife, Chassis.

Scott Benner (0:22)

Hey. Do you need support? I have some stuff for you. It's all free. 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. That's actually, I think, the most popular page on the website some months.

Scott Benner (0:36)

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. So if you know anybody who would benefit from that, please send them that way.

Scott Benner (0:58)

Just go to juiceboxpodcast.com and click on support. While you're there, check out the guides like the prebolising guide, fat and protein insulin calculator, oh gosh, thyroid, GLP, caregiver burnout. You should go to the website. Click around a little bit on those menus. It really there's a lot more there than you think.

Scott Benner (1:17)

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. I'm having an on body vibe alert. This episode of the Juice Box podcast is sponsored by Eversense three sixty five, the only one year wear CGM. That's one insertion and one CGM a year.

Scott Benner (1:43)

One CGM, one year. Not every ten or fourteen days. Ever since cgm.com/juicebox. Today's episode is also sponsored by US Med, usmed.com/juicebox. You can get your diabetes supplies from the same place that we do, and I'm talking about Dexcom, Libre, Omnipod, Tandem, and so much more.

Scott Benner (2:07)

Usmed.com/juicebox or call (888) 721-1514. The podcast is also sponsored today by the Tandem MOBI system, which is powered by Tandem's newest algorithm, Control IQ Plus Technology. Tandem Mobi has a predictive algorithm that helps prevent highs and lows and is now available for ages two and up. Learn more and get started today at tandemdiabetes.com/juicebox.

ER Medical Careers and a Shocking Discovery

Matt (2:35)

My name is Matt. Been diagnosed as a type one diabetic for just over one year, and I'm here with my beautiful wife, Cassie.

Scott Benner (2:43)

Hey, Cassie. How are you?

Cassie (2:45)

Hi, Scott. I'm doing great. Thank you. I'm Cassie. I'm the wife of a type one diabetic. I'm an ER doctor, and he's an ER nurse.

Scott Benner (2:55)

No kidding. How long have you been married?

Matt (2:58)

I'll give you this one.

Scott Benner (3:01)

Do neither of you know, or are you just trying not to talk over each other?

Matt (3:06)

September '22?

Scott Benner (3:11)

That's not that many years ago, Matt. You should not be saying that like you're not a 100% sure.

Matt (3:16)

We travel a lot. We work nights. Our schedule is crazy, so it takes a lot to just remember the day of the week.

Scott Benner (3:21)

Yeah. Well, listen. Watch this. 30 pro. 08/03/1996. Boom. See that?

Matt (3:26)

Yep. Yep. I've been there and done that, and this life is much better now.

Scott Benner (3:32)

Okay. So you guys meet at work?

Matt (3:35)

We actually did. We worked in a different city years ago, and it it's a funny story. Actually, I'll let Chassie tell it. She's a better storyteller.

Scott Benner (3:45)

Go ahead, Chassie. I'll hear

Chassie (3:47)

We did, actually. We worked together for several years, and Matt was extremely shy. But we worked together for years in the same hospital and, honestly, never really spoke. I'm pretty friendly and outgoing, so for him to not speak to me tells you just how shy he was and how much he's come out of his shell. But, yeah, we worked together for years and and never really spoke for a very long time. And then now once he finally approached me and we started talking, now he doesn't really stop. So we we've been together for a while now.

Scott Benner (4:24)

You gotta be careful what you wish for, I guess. Matt, were you married at the time and you weren't talking cause you didn't want to do something inappropriate, or is that not the case? Were you not married when you guys started talking?

Matt (4:37)

I was married, previously for, we just talked about time. That was twenty years. Wasn't happy. It was in my head. It was in a tough space. So I kept to myself, kept my head down, just did my job, and just kept trucking on.

Scott Benner (4:49)

Yeah. I think he didn't wanna talk to you because he's afraid, you know, he's gonna hit on you while he was married. That's what I'm thinking. But, we'll go with he was quiet. And so when you get married, do you have any health issues at that point?

Matt (5:02)

When we got married us, I actually had, just been diagnosed with bladder cancer. And, it was at work, and Chassie was actually the one that found it.

Scott Benner (5:13)

No kidding. Okay. Well, tell me about that first.

Matt (5:16)

I had a few years with a little, hematuria, a little blood in the urine. Didn't really think anything of it. Talked to a couple other people because us in the medical field, we don't like to go get seen by other people.

Scott Benner (5:33)

You know how bad they are at their jobs. You've met them in person. So

Matt (5:36)

Oh, absolutely.

Scott Benner (5:38)

But, Matt, I gotta stop you before you even get into this story. Did you say you had blood in your urine for a couple of years?

Matt (5:44)

Not it wasn't, consistent. Maybe three times.

Scott Benner (5:49)

You still married this guy even though that happened? What what's going on?

Chassie (5:53)

I know. This imagine this kind of stubbornness, and now throw on some type one. Spoiler alert. You already know he's type one. Yeah. That kind of personality, and now with type one, it's a it's a fun roller coaster. It's marriage building skills.

Scott Benner (6:05)

I bet you. Okay. I'm sorry. So you noticed as you finally go see somebody, what happens then?

Matt (6:11)

Yeah. Well, I changed my diaper on my own, so she didn't have to help me with that.

Scott Benner (6:14)

Jesus.

Matt (6:15)

So

Scott Benner (6:16)

Look at you doing your part.

Matt (6:19)

Yep. So, yeah, it was it was sporadic just a couple times over a few years. Didn't think anything of it. Thought it may have been something else minor. We were at work one day, and she was like, you know what? Let me just go ahead and ultrasound you. Not looking for anything specific, just going over, you know, the body system with ultrasound. And, she got down to my bladder, and her eyes just got wide. And, which I was like, what? What? And she was quiet, and she's not a quiet person, which you'll learn. And she just showed me the video, and it was like this softball sized mask in my bladder. The only one thing really comes into your mind when you see something like that. Yeah. I think we had just started dating at that time. We weren't living together. It was just it was still new, so that's kind of an awkward start. So Yeah. I've heard I've heard

Scott Benner (7:09)

Tinder dates have gone wrong for much less than this. People will bail on anything.

Matt (7:15)

Yeah. I wouldn't know. I I never went that route, but, yeah, I couldn't see that being easy one to say, see you. But she had to work with me. So, you know, she made some calls. We got into, urology, went and did blood work, urine, had a CT scan, and all that stuff actually came back negative.

Scott Benner (7:32)

Okay.

Matt (7:33)

But we have a video of this mass and an ultrasound. And, her being the doctor and and knowing these other specialists, they were like, you know, come on in. We'll do a biopsy. I'm not trusting the other results. And, went in for a biopsy that ended up being a complete removal at the time. So I come out from anesthesia, and the doc's like, yeah. It was it was cancer.

Scott Benner (8:01)

And what did they take out? I'm sorry. What's a complete removal mean?

Matt (8:05)

Terminology wise, Chassie, do you have a term in the neoplasm?

Chassie (8:09)

Yeah. So he ended up all of Matt's blood work and lab work, even the CT scan was normal. So I sent my images to a colleague that's urology surgeon, and so he kinda knew what he was looking for when he went in and came out while Matt was still in anesthesia and said, oh, yeah. It's definitely cancer. I've I've got to remove all of this. So, yeah, came out, said it was definitely cancerous, but it was able to be resected at that time, and then we ended up getting pathology back that it was a transitional cell.

Scott Benner (8:43)

So What's that mean, transitional?

Chassie (8:46)

It's a type of bladder cancer. Basically, for us, it was not malignant, meaning it had not spread to other organs, but we know that this type of cancer has a thirty percent chance of recurrence in life. So Matt has to be under, obviously, ongoing surveillance.

Scott Benner (9:08)

Yeah. I know. So scrutiny.

Chassie (9:09)

With thirty percent recurrence, that's pretty high. And especially for a guy with no medical problems, no medications, yeah, that was a fun way to start dating.

Scott Benner (9:17)

Yeah. I imagine you thought I've either gotta marry this guy or leave and change jobs. Right? You can't you couldn't just go, oh, okay. Well, good luck, and, I'll see you around work. We're not anymore.

Matt (9:30)

I'm glad she's stuck around.

Scott Benner (9:32)

Yeah. No kidding. That's lovely. So is there damage to the bladder, or what's the recovery like?

Matt (9:36)

Every year, I've gone for one or two cystos where they go and take a look. I actually just went last week and got my five year clearance. The urine was clear from any cancerous cells, and the scope inside was completely negative. I've gotten some chemotherapy initially, and, luckily, it took. So right now, it's just maintaining urine and a scan, I think, once a year now. But, yeah, everything is gone. No issues. I'm not dribbling everywhere. You know? It's it's pretty good as far as that goes.

Scott Benner (10:09)

That a good sign, finally. Yeah. You keep going, you are gonna find her aligned one day.

Matt (10:14)

You know, she's she's dear

Scott Benner (10:16)

diary, he's dribbling. I'm out. So I did my best. Wow. And then tell me when that happened again, what year?

Matt (10:26)

That was, we found it in September 2020. Normally, it was under 50 and smokers or who was prevalent with. And at the time, I was 42. And, just to preface that, I was a a firefighter paramedic for a long time, and I worked on the hazardous materials team. And, we think it was a it's from the the foam that we use

Scott Benner (10:48)

Oh, really?

Matt (10:49)

to fight fires as an environmental exposure.

Scott Benner (10:52)

Matt, I gotta tell you. I worked in a paint shop in a sheet metal place for years, and every day that I don't die, I'm pretty amazed, honestly. Yeah. Yeah. Yeah. As a kid, I was just around I was just around a lot of shit in the air, and, you know, we didn't wear mat. Nobody did anything. You just walked in and worked.

Matt (11:10)

Oh, no. Yeah. Yeah.

Scott Benner (11:11)

So Yeah. I can't believe I don't have a problem from something like that.

The Sudden Onset of Type 1 Diabetes

Scott Benner (11:16)

How long after this process does the diabetes appear, and how do you figure that out?

Matt (11:21)

Well, I was good. Because it was September, '24. I had kinda stress really left the job here where we live now, And, we travel a lot, so we were preparing for a trip. But prior to the trip, I had been to a concert with a friend of mine, and there was, like, a beer tasting event, like, three hours prior to the concert.

Scott Benner (11:46)

Mhmm.

Matt (11:46)

So we go around the room. We're drinking all this beer, and I know I everything was fine right then because I wasn't peeing all the time. So drank all that beer, you know, peeked, like, maybe once or twice, watched a concert. Everything was good. Mhmm. And then we went to Turkey in November, and I'll just say that I may have had some touch up work that some people may do with turkey every now and then.

Scott Benner (12:16)

You get your eyes pulled back a little? What'd you do?

Matt (12:18)

Just a little just a little bit. Just a touch.

Scott Benner (12:20)

Nice.

Matt (12:22)

And, after that, they give you some steroids after I didn't realize at the time, but I my vision was getting blurry, my close vision, but my distance was fine. And I just had LASIK surgery done the year before, and my vision was perfect. So I contacted them, said, hey. My vision's a little blurry because I give you some medicine. And, they're like, oh, it should should go away. So I said that was November. And then sometime after that, I just started, like, peeing all the time. And I I drink a lot of water. I work out all the time. Mhmm. So it's normal for me to, you know, pee.

Scott Benner (13:00)

Yeah.

Matt (13:00)

This was just ridiculous. I I couldn't sleep and working night shift and trying to come home to sleep, and you're up every thirty minutes to an hour going to the bathroom. Like, what?

Scott Benner (13:11)

So you're peeing, like, on the hour almost?

Matt (13:13)

It was almost hourly. I'll drink a a gallon of water at work every shift, and I'll drink a gallon when I'm home. So it's normal, but this was to the point where I'm like, what the you know? Right. This is unreal.

Scott Benner (13:24)

And did you think, I'll just ignore this for a few years, and then if it gets bad enough, I'll have my wife look into it?

Matt (13:31)

Absolutely. Absolutely.

Scott Benner (13:33)

No. What do you do with that information once you realize it's like, you know, this isn't normal?

Scott Benner (13:39)

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Scott Benner (14:01)

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Scott Benner (14:34)

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Matt (15:36)

Well, my my vision got really bad, and it was it was pissing me off.

Scott Benner (15:41)

Yeah.

Matt (15:41)

I'm like, you know, these are kind of diabetic symptoms. I'm like, there's no way in hell that I'm diabetic. And so it goes on and on, and it's been, like, three months. And, like, I couldn't leave the house without, like, stopping in a parking lot or, you know, I had to plan everything. It just it was so ridiculous that Cassie finally talked to me, and she's like, let's go to urology. That's the only doctor I'd seen here.

Chassie (16:05)

It's true. It's true. But that is the only physician Matt had, and that was only because he had bladder cancer, and we were out So of that's the only place I could get him to go because I agree. These are all screaming. Yeah. He's not the stereotypical of what you think of, and that was such a hard barrier in his head to get through. He's like, I know I have the polyuria. I'm peeing all the time. I know I have polydipsia. I'm drinking water all the time. Mhmm. And he just made, you know, excuse after excuse thinking, no. It can't be. No. It can't be. No. It can't be. And so and he was suffering for three, four weeks probably, just miserable. And then when I finally said, Matt, you look ill. Mhmm. I mean, you you don't look well. Matt is a I know this is a podcast, but Matt's a big guy. I mean, he works out. He looks big and buff.

Scott Benner (17:05)

Yeah. Matt, you're a robust person. Like yeah.

Chassie (17:09)

He's thick.

Scott Benner (17:10)

Yeah. Yeah. Yeah. Yeah.

Chassie (17:10)

I mean, he is he is extremely muscular, extremely fit. And, Scott, he looked sick. I mean, he had lost 25, 26 pounds in two months unintentionally. And with his history of bladder cancer, that's always a cancer diagnosis.

Scott Benner (17:28)

Right. But, Matt, tell me something. When you think diabetes, can you kinda go through the psychological thing that stops you from wanting to—I know nobody wants to think they're sick in general, but why is diabetes, like, even a bridge too far beyond that? Because people talk about it all the time. I'm wondering if you can put it into words.

Matt (17:48)

Well, first off, type one had had never even entered my my mind. Unless you have a a connection to type one, I think it does you just don't even think of it.

Scott Benner (17:58)

Okay.

Matt (17:58)

You think type two, you think, you know, metformin. You think, oh, I gotta lose weight. I've gotta work out and get healthier, and I was already healthy. So to me, I'm like, there there's just no way. And not to put a negative, you know, light on it, but I'm like, if it is type two, what is there that I could change in my lifestyle? Because I'm the pickiest eater. I don't have a sweet tooth. Mean, my BMIs are are both because the height and weight, you know, that I don't go by that. And, because if it was just taking metformin or something like that and working out, there would be no problem. But I'm just stubborn, and I was like, there's there's no way this is gonna go away. And, when it was brought to my attention how much weight I had lost, and I just I'm not one that would weigh myself all the time, but it ended up being, like, thirty to forty pounds, you know, after the three months. And I didn't see it in my face till I started going back and looking at pictures, and I was like, it really got to me. Right. And I was like, okay. Let's let's go ahead and and get checked out.

Scott Benner (19:02)

At that point, are you thinking I'd prefer this to be diabetes because I don't want it to be cancer? Do you have to have that thought?

Matt (19:09)

Absolutely.

Cognitive Bias and ER vs. Specialized Medicine

Scott Benner (19:10)

Yeah. I would imagine. Also, let me just say here for everybody who who follows me on Instagram and knows this, but I'm having, my office—I'm having an office built in my basement. And so I'm doing my best, but there are gonna be times that you're just gonna hear banging in the background. And I don't think there's anything—we'll just have to use this as a time stamp in the podcast for when Scott got his own office finally and moved out of this tiny room making the podcast. But I'm doing my best not to speak while it's happening so editors can take it out later. But every once in a while, you're not gonna hear it, but I'm gonna hear it. That's gonna be stuck in my head.

Chassie (19:46)

On this episode, you can blame me. I was beaten mad in the background for being such a stubborn patient. So for this episode, it was me.

Scott Benner (19:53)

In fairness, every physician I've spoken to, nurse—you guys are all the same. Like, you should all have to walk around the hospital with a shirt on that says, do as I say, not as I do. You you know? So I take how it happens. Tissue urologist, do it or do you have to go find a doctor to actually give you a diagnosis?

Scott Benner (20:14)

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Matt (21:37)

Well, first thing they do, like, every visit, you go get the urine sample. Oh, by the way, I think the banging you hear is every time I say, his chassis hitting No.

Scott Benner (21:45)

Got it. Trust me. I have weird connector words. It took me years to stop them. I used to have stickies on my monitor with words and, like, lines put through them because I would use connector words when I was thinking. I've learned just stop talking until the next word comes to you. It's an easier way to handle it, but don't worry about it. You guys are doing great. Don't think anything of it.

Matt (22:04)

Okay. Good. Alright. So I give the urine sample. We go in the office, and the urologist comes in. He's a great guy. He goes, you've got sugar in your urine. And just like stomach sunk, he's like, it it's diabetes. Just like, you know, playing his name, it's diabetes. Mhmm. And still, you don't think type one. Right. It just doesn't occur. So he was like, let's go ahead and and refer you to, you know, local endo. So we leave the office, go ahead, immediately call on the way home, and it was just a garbage call. It's like, well, let—give us your insurance information. We'll call you back next week if, you know, your insurance works with our office. That just wasn't good enough for Chassis who, luckily, she did stick with me. And so loving and caring, she's like, let's find some other way.

Scott Benner (22:57)

Yeah. Chassie, you—there was not a half a second where you're like, I could have bailed back at the cancer thing. Well, Matt, what is it about you? You're so delightful that none of these health issues run her off.

Matt (23:08)

I just smell really good, I guess. I don't know.

Scott Benner (23:10)

It's the pheromones.

Chassie (23:12)

Ain't that terrible? I'm a forever doctor at work, at home. Like, I'm—I'm attracted to my patient, my husband. Like, I get to doctor at work. I doctor at home. I'm really committed to the field is what I'd like to think.

Scott Benner (23:24)

I thought some guy must have just been really terrible at Chassis in a former life, and she's like, this is a nice person. I'm sticking this out. Yeah.

Chassie (23:30)

You're so good at this game, Scott.

Scott Benner (23:32)

Oh, okay. Alright.

Matt (23:34)

I'm a long term study. That's all it is.

Scott Benner (23:37)

She's like, I can't wait to see how this turns out. What a funny way to think of yourself. She's just really, like, you know, interested in what's happening. I listen. I've said over and over again, I I'm only still married because my wife wanted our next kid to look like her first kid. She was probably like, how am I gonna move all this stuff out of the house by myself? You know what I mean? It's a lot of effort. Exactly. So wow, man. So you get in with somebody quicker than a week? Did she, like, shake down some person she knows and make them see you? What happened?

Chassie (24:13)

So it's one of the things that is so frustrating in health care. This is just a specific—our niche, obviously, with you is—is type one diabetes and for our diabetic patients out there. And I think we all can agree no matter where we're listening to this from, there are not enough endos. I wish that the world and the diabetic populations everywhere had more endocrinologists available. And even here, we live in Orlando, and there's just not enough to keep up with the patient needs. And so this was yet another example, and we were living it of how, you know, you need to see endocrinology, and you just can't get in.

Scott Benner (24:54)

Yeah.

Chassie (24:55)

And Matt was, again, he looked so unwell that I—I truly thought it was cancer, not diabetes. And so he was becoming more symptomatic and more symptomatic, and we obviously needed further testing. And he had no medications that he was taking for anything, and he looked so unwell. And he had to be unwell for me to even get him to the urology appointment. And I thought, let me reach out to my colleagues. And so there's a women's physician group that several of us are involved in in Orlando, and honest to goodness, I just called in a favor. Yeah. It was nothing more than just the graciousness of a colleague saying, oh gosh. Absolutely. I'll see him tomorrow.

Scott Benner (25:41)

So, Chassie, if that wasn't possible, I mean—and with your background and what you do for a living, like, he's a prime candidate to go to the ER. Right?

Chassie (25:50)

100%. And that's exactly where I would have taken him, where we would have ended up, and the only place that he would have been able to at least be thoroughly evaluated and keep him from being very, very ill.

Scott Benner (26:07)

Can I ask you a question, like, while we're on this subject here?

Chassie (26:10)

Of course.

Scott Benner (26:11)

You're an ER doctor, and you have a patient in front of you who you love who looks like you should go to the ER. But you were still like, let me see if I can get him to another doctor. What's the disconnect there? Like, how come everybody who comes on here talks about the ER and like, I mean, do you know I took my mom to the ER three times before someone found her cancer? They one time imaged her and said, this is a UTI, but she's so full of urine. It's hard to tell, so we're gonna drain her out and, blah blah blah. But they imaged her first. The urine blocked the scan. You couldn't see the uterine cancer she had. Right? And then they were like, oh, she should—I mean, three times till somebody found a mass that was huge. Like, how is that possible? I know you're a good doctor. Okay? I've met you. You seem like a reasonable person. What happens? Like, where—where's the disconnect in something like this? Like, how come you didn't just put him in a car and drive him to the ER? There's gotta be a reason, unless I'm thinking into it too far.

Chassie (27:11)

No. I'm so glad you asked that, and it's something that I think in the ER that we take for granted because, oh my gosh, every single patient all you want to do is everything for every patient. You know, we in the ER, remember, there is no specialty.

Scott Benner (27:31)

Mhmm.

Chassie (27:31)

You have to know everything from head to toe. I have this rash on my scalp. I'm vomiting. My baby has a rash. I've lost 30 pounds this week. And, again, I think most of us in the ER, we just wanna fix and cure everything, and the problem is that there's a saying in emergency medicine that we're a jack of all trades and a specialty to none.

Scott Benner (27:53)

Mhmm.

Chassie (27:54)

And, unfortunately, I wish that the ER could be a one stop shop for everything. That's just not how emergency medicine works. And the key to an emergency department is truly emergency things. Now these aren't things that necessarily aren't important and don't need further care, but these are emergent diagnosis. Like, in your population, DKA, those are all emergency things. But even something as simple as sending labs to actually test for, say, antibodies in your type one, not possible Yeah. in the ER. A biopsy for your mom's mask, not possible in the ER. And so the ER is this huge catch net for every single ailment, pain, symptom, rash, bump, lump, symptom of I don't feel good, anything. And you do as much as you possibly can, and then we really have to rely on our specialty colleagues for all of these higher level specific tests to kinda get you in the right direction. Now if I could be an OB GYN and an endocrinologist and a urologist and everything, I promise you, I would. I just am specifically trained in emergent situations and narrowing things down and being as thorough as I possibly can. And, again, referring for follow-up or consulting on my colleagues for those further evaluations and diagnoses and testing. Like, for example, no ER doctor can order antibodies for testing the difference between type one and type two.

The Limits of Clinical Tracking and Generalist Training

Scott Benner (29:38)

But why not? Because what it feels like is that you're involved in a a special kind of medicine that sort of like if this, then that. If my arm's falling off, you're the right place to go. Right? Like, that kind of thing. But if I have, you know, diabetes, I'm gonna send you to endo. But then we all know that when you say, well, you're gonna have to go to endo, like, they sent Matt out, and he called immediately and got told, you know, we'll talk to you next week. And, like, you know, if he was in DKA and you guys didn't have the background you have, like, you don't know where that would have ended up. He would have probably ended up back in the ER, but then DKA would have made them say, oh, he has type one diabetes. Right?

Chassie (30:16)

Exactly. Okay. Mhmm. Exactly.

Scott Benner (30:19)

From your perspective, like, what's the—because everyone says it's broken. It can't be fixed, but it doesn't seem that difficult to fix. I don't know. It feels like the map we use to get to the end is just a little skewed. You know what I mean? Like, let me give you an example and see if this goes anywhere. I had to take Arden into the hospital, I don't know, like, last year. She had an infection. And I was going through her symptoms with an AI model. And I had all the possibilities in front of me of what I thought was gonna happen, what could possibly happen. And the ER doc would talk to her, disappear in the back, come back again, and then talk to me. And it felt like she was reading the chat GPT answer that I had to me, which really made me think that she went in the back and did the same thing I did. And maybe not. Maybe just her training and her if this, then that, like, just comes out that way. And I it's possible she was just a great doctor. Like, I have no idea. But my point is that if she and I came to the same conclusion and I have no training, why can't that thing say, hey. This could be type one or type two diabetes. We get to order this lab, or we can contact Endo who could give us a script right now digitally. Like, why does that stuff not happen? Like, why is it always go wait and maybe you'll get sicker? Or if you don't, good for you. Like, why does it work that way?

Chassie (31:40)

So for example, let's use specifically since this is the Juice Box podcast, for example, type one testing. So there's only a couple of laboratories in the entire country that can test for GAD antibodies, which is one of the main antibodies that we look for to distinguish type one and type two. Right? Mhmm. So even if I'm standing in front of you and I have your blood and I send it off, that test takes over one week to complete.

Scott Benner (32:14)

Okay.

Chassie (32:15)

It is not a test that exists in, well, any hospital I've ever worked at, and I've worked in many. Tel—and so a lot of these diagnoses that we experience are really are they're very niche. These are things that take days to weeks to diagnose. And so that's one of the great things about the ER is that I hope nobody ever gets sick, but there's always a doc there twenty four seven to help get you through those things. And if if there's ever a gap in between, you know, managing you outpatient in the comforts of your own home, then that's when we utilize the emergency department and inpatient if we need to admit you. Now here's the thing. I knew Matt was not in DKA. I see DKA for years. I can look across the room and go, oh, boy. That's—oh, they're in DKA. And I knew that wasn't Matt. So did I know Matt didn't feel well? Yes. Did I know he needed other testing? Yes. Did he need to sit in a hospital room for days to a week until we get these answers?

Chassie (33:18)

No. No. Could we manage this outpatient? Absolutely. And if he needed to go to the ER in the meantime, even temporarily to be discharged, you know, back home and still wait, then that was an option. But I am I was very fortunate to know that, yes, Matt, we don't have all the answers. No. Matt doesn't feel good. Yes. We need to keep going. We're on a journey here to get diagnosed, treatments, things like that. But I also knew that we could always go twenty four seven anytime, anywhere if we needed to.

Scott Benner (33:50)

It would happen.

Chassie (33:51)

He just didn't need to at that point. He just felt bad, and we were impatiently waiting for follow-up and testing.

Scott Benner (33:57)

Yeah. Okay. I have a question. Like, if you had somebody with a 400 blood sugar and you gave them some insulin in the ER, brought their blood sugar down, took the insulin away, and it went right back up again. Isn't that a pretty good sign? It's type one and not type two? No. No? That wouldn't work?

Chassie (34:16)

No. I wish. Oh my goodness. You know how finicky diabetes is. I wish it was that simple, but no. And that's honestly, I think that the biggest takeaway as a physician with your patient—and I speak for me, but I hope I speak for all of my physician colleagues out there—is that's why it's so important just to have healthy conversations with your patients to say, hey. You know, it looks better now, but this can go on, and this can go up. It can go down. And if you're not feeling well—and Matt can attest to this. I tell my patients. If you're not feeling well or if something happens, it's okay. Just come back. I don't want you out there suffering and being miserable. Even if I can't do everything you need here from the ER, I don't want you out there in the world alone or being sick. And if you need something, that's okay. Our plan b is always you come back here. This is always a safe space. This is a safety net for you. And if we need to admit you to keep care going on, that is absolutely fine. I hope you never need to be admitted to the hospital. But if that's what it takes, then that's what we do.

The Endocrine Shortage and Individual Motivation

Scott Benner (35:19)

Can I ask you why—why do you think that there aren't more just diabetologists? Like, just people who are not full blown endos, but, like, just handle diabetes. If if diabetes is so prevalent in the population, why aren't students wanting to be doctors who take care of it? Is it because the prevalence is mostly type two and that people don't seek treatment until they're—is it a money thing? Can you not make money doing it? Like, I'm wondering why it feels like that's a thing everybody would be rushing to do because there's a need—you know, the need's there, and the need would translate to business.

Chassie (35:54)

Oh, the need is definitely there. Yeah. And, again, this is the Juice Box podcast. So our niche here is endocrinology and type one and type two diabetes, but there's also so many different disease processes out there that, you know, sometimes just grab your heart as a doctor or a nurse even or when you're young and your grandma goes through x, y, or z. And I do. I think all of us just have these different life moments that kinda draw you into where you end up in life and your job. Like, even with you, with Arden. I mean, look what Arden has brought you. That's led you down this path. And if she had had a, you know, a different process or struggled with a a different disease, I think that you'd probably be really passionate and be the next expert in x, y, or z.

Scott Benner (36:45)

Something different. Yeah. Yeah. I take your point.

Chassie (36:48)

That's the beauty of life is that experience is a great teacher. And I would like to say that, my gosh, I have an extra, extra deep place in my heart now for all of my diabetics, type one and type two. You know? Because when you live through something, it does. It makes you passionate about it, and it makes you wanna be more and learn more. And so I'm thinking that with the prevalence, like you're saying, surely there's so many young nurses and young doctors out there who are being affected by type one and type two diabetes, and they are. They're going to be passionate about this and go into these fields.

Scott Benner (37:22)

A great insight. I appreciate that. Seriously, that is a really great insight. Because I just—I always think of it as—I mean, I know everybody's—you're hoping your doctor is one of those people who just grew up thinking, like, I wanna help people. Some of them grew up with, like, I'd like to try to make some money. And so, like, why would those people not flood to where the need is because the need is billable? But it's just—I don't know. It's a real—it's very interesting. And that endo shortage is across the country

Chassie (37:47)

It is.

Scott Benner (37:48)

as far as I can tell from talking to people.

Chassie (37:50)

It is. And it's a career that's too long for you to just do it for the paycheck, I think. I'm sure there are people in every specialty or every field in the whole world that can do it for the paycheck, but medicine is a tough job if you don't actually really like what you do and like your patients. And Yes. you I think as a patient, you probably want the doc that enjoys that specialty and enjoys that niche because, again, it's just a win win all around.

Scott Benner (38:20)

Matt, you feel that with what you do? Like, if people are amenable, the job's easier?

Matt (38:25)

Oh, without a doubt. Okay. Alright. Well, you wanna treat everybody the same, and you normally can. But, of course, you get attitude and you have, you know, demands and, you know, it kinda—you keep a happy face and you keep doing your job the best you can and don't wish any ill will. You just wanna help people in in our field move on to the next one because they're definitely lining up waiting to—

Scott Benner (38:49)

But that attitude stretches. That makes the day a little longer.

Matt (38:53)

Yeah. Yeah. Gotcha. Okay. I do wanna say with as far as education goes, I actually recently looked into becoming a diabetic. I'm going blank on the name of the title of the certificate is.

Scott Benner (39:05)

Like a diabetes educator?

Matt (39:06)

Educator. Yes. And when I looked into it and the time it takes and, obviously, type one is at the forefront of my mind. And I looked into the certificate, and it was gestational. It was type two. It was type one. And to me, I thought it's too much to try to be a specialist at all of them. I'd rather be a specialist at one of them. And I think type two has a pretty good handle right now, but I just I need to be an advocate the most I can for type one. I've joined all these research groups, and I do wanna give a shout out to my endo, doctor Gujdraw. I've referred, like, four or five people to her just because she is so amazing. And we even have to drive to get to her, and I tell people she's worth the drive. Yeah. Just because she came from an educational background and teaching background, and I was blown away by the care I received by her. And I'd never met her before in my life, and she had this plan written down and explained things to me in ways that I've never known. Because coming from a paramedic background, you learn really just diabetes, like, one form diabetes. You're like, high or low. Mhmm. From an emergency standpoint, if it's low, you bring it up. If it's high, you bring it down. Sure. And it's like, are they conscious? Are they unconscious? Do they have a gag reflex? Can you just give them something to eat? You have to start not being give them d 50. That was my background. And then getting into nursing, I took a bridge program that was paramedic to RN. And I I can't speak for all courses and all schools, but I don't remember anything diabetic related. And you hear DKA and just your acidosis and this and that, and and DKA is not really a a sugar issue. It's a fluid issue and electrolyte issue, which leads to arrhythmias, and that's where your death comes from. And one of the reasons I didn't go to the ER is not that Jesse didn't say, hey. Do you wanna go? It was all on me. But I wasn't vomiting. You know? I wasn't worried about ketones. I—I stay in a ketonic state right now because of the way I eat. Yeah. I try to stay as low as low carb as possible. And, you wanna make sure your potassium is right, your fluid's right, and I take multivitamins and I drink water. So I wasn't worried about DKA. I mean, no matter how high the sugar got, I think I kept myself out of it. But, that's just the specialties are—I'd rather be a master at one even though—and I am an ER nurse, and you do learn a little bit about everything. But I wish there was more training on on diabetes when you go through the, you know, the RN course. I think it's because they're specialties like endo and these diabetic educators that they don't really lean on it.

The Future of Diagnostics and Personal Impact

Scott Benner (41:57)

Do you guys wonder if diagnostic stuff is gonna go more towards a computer?

Matt (42:03)

I think it is. It may be beneficial, but it may not. Like you're saying, imaging was missed on your mother. I've seen it time and time again. When you have imaging done in the ER, it gets sent off to the radiology, and, normally, it's not read in house. And we wait for the radiology, or that's their specialty to come back and say, hey. You know, this is what I see. And I've seen—just in chassis, I've seen time and time again where she looks at an X-ray, she looks at a CT that has a a negative read by the radiologist, and she's like, there's something there. There's just something there. So I called back and say, you know, of course, as polite as possible, can you take a look at this? And, you know, this is what I think I see. This—this is your spectrum, but this is what I'm seeing. And they've said, oh, yes. And, actually, in my case, that actually happened with my CT with my bladder cancer. They came back as negative. And I'm so thankful that I had her just with this video of the ultrasound to say, no. There's—there's something here. Yeah. And the call was made back to that radiologist who was very apologetic and, you know, made an addendum to the CT read. And, of course, now there's something there after it was removed. So I—I could be pissed off, and that makes me think how many people have missed, you know, diagnoses. And, it—it's a—it's a sad state of medicine there.

Scott Benner (43:28)

The thing that happened with my mom is that what would happen is basically the mass would block her bladder. Her bladder would fill up. She'd be in pain. She'd go to the ER. They'd image her, say, oh, her bladder's full, and then say, this must be a UTI, and then, you know, drain her, and then everything's fine. Then she's okay again. She goes back, and this happened again and again. But every time it would happen, someone would say, her bladder's full, so we can't really see what's going on. Like—but nobody ever said, so maybe we should scan her after we do it again. That didn't happen. I had to be the one to say that on, like, the fourth visit. I finally said, why don't you get the urine out of her and then scan her? That's it. And somebody went, oh, okay. And then they did that. So, I mean, I don't know what I'm talking about. I had to see it three separate times before it occurred to me to say something about it. But they knew each time that the full bladder was a problem, but then nobody did anything about it. They just said it. Oh, that was a problem, and then moved on again. And I assume it's too many people, not enough resources, people are tired, probably have an—you know, less trained people because it's moving so quickly. I realize there's a lot of big issues. I mean, these things must happen over and over again. Like, wouldn't a trainable AI model who you're teaching if this, then that could then figure out, oh, by the way, drain the bladder first. Instead of asking humans to hold so much information in their head, like, if you couldn't just have it that way and be a little more directive for—not that you wanna take the human part out of it, but just as a reminder, because how are you supposed to remember? Like, you know, Chastity, you said about it a little while ago. Like, you can't be great at everything. Like, you know what I mean? Like, you know, emergency medicine. So wouldn't it be cool if a voice came from over your shoulder and said, hey. Don't forget this or look at this real quickly? I don't know. Maybe I'm wrong, but it feels like that's gonna happen.

Matt (45:17)

That would be great. I—I always tell people we're practicing medicine. We're practicing, and, one day, we get it right. Yeah. Yeah. Just to keep it a little light. Yeah. But I do know for diagnostics, like, if they're doing ultrasound in the bladder, they want the bladder full because they get a better, you know, view. Mhmm. And it sounds like her bladder being full was causing pressure, causing more pain, but they absolutely should have scanned, you know, before and after. It's just kinda follow the steps, and they—they should have gotten there without you saying that. But, you know, it's situational and—

Scott Benner (45:49)

If people jump to conclusions, old UTI. Right? Yes. Overweight type two. Like, instead of just doing the steps in between, they make a leap. And that leap, you know, maybe sometimes works out and sometimes doesn't. But I don't It's when it doesn't work out is when it's scary.

Chassie (46:08)

No. I—I'm so glad you brought that up, and that is a constant challenge probably in any field, but especially in medicine that you'll have a cognitive bias because your brain is trying to pull in all this information and make connections. You know, we're the human body. We are so much more intimately connected than we even realize. And you try to make associations like you said, old lady, UTI. I bet that's it. And it's a beautiful thing of the brain. It's amazing that we can take all of these random data points and put them all together and come up with this. Not even in medicine, just in life. You take all of these data points and make sense of them. You know? And it's so important, and it's so humbling to be in medicine to unwire your brain and to think outside of the box and to think, oh, no. No. No. No. Disassociate that. Let's don't think about that. What if it isn't that? What if it's this, or could it be this? And it's—it's definitely a humbling part of medicine that I think you work so hard to learn and make associations and train and—and—have keywords and think, oh, gosh. I bet it's this. And yet you have to be so diligent to make sure that you don't associate all of those things, that you keep taking a step back and taking a step back and taking a step back as you're trying to dive into your patient and better understand them. And that's one of the beauties and one of the most frustrating parts of medicine is making it make sense and then taking nothing and making that make sense as well. So it is. It's a humbling part. And I think to your point, that AI definitely has a place in medicine and the rest of the world. Just anything that could help you be a better physician, a better nurse, a better podcaster, you know, a better investor, anything like that to make the human world better is fantastic. And there's definitely a role in taking some of the cognitive load out of medicine with AI, and there is. Yeah.

Scott Benner (48:14)

When I first started making this podcast, I'd just be angry about it. Like, why didn't they know? How come they didn't? Like, that kind of thing. But the more I've done this for years and years and spoken to more and more doctors and people who are actually in that situation, my takeaway is just that—I mean, there's too much information for one person to process. And that's why we talk about specialty all the time because if you put somebody in a unique enough position, you can maybe make them enough of an expert where they're gonna see it most of the time. I would have been alright with that right up until a couple of years ago when I realized somebody could just take a large language model for endocrinology and train it on everything that human beings have ever known about it. And then you're at the point now you can talk to it. You could say, here are my symptoms, and it can point you in a direction. And then blend that with the human artistry of, I've seen this before or I've—you know, somebody said that to me one time, like, that kind of stuff. I just think that we're asking too much of people. And in a situation where if you make a mistake, somebody has a really significant—you know, from death to, you know, injury and pain or whatever. I just think that we've reached our limit for what we can do. And the information's out there. Why not let something who's got the ability to hold more ideas in their head and draw more connectors? Like, why not let it do it? It makes sense to me. So

Chassie (49:34)

I love that. And I'll even interject and say, that's a beautiful metaphor for emergency medicine that sometimes we've done all we can do. Like, you know, let's go to the specialist. Like, let's keep going. Like, let's keep going. Let's figure this out. Because, yeah, you do. You tap out in what you can do and what you wanna do. And I don't know. That really hit home with what you just said about feeling like in the emergency department, that you wanna do everything in the world and you wanna fix everything. And how do we take all that information and—and still keep going and take the next step?

Scott Benner (50:09)

Well, sometimes you just get to the end of your knowledge. You know? Like, everything that's gonna occur to me has occurred to me. You know? Maybe I can sleep on it or think about it, but that's gonna be too late for a person in the ER. Right? Like, and that job you guys have already talked about. It's tiring. Weird hours, weird shifts, people yelling at you. Like, it's not even—it's nowhere near a utopic situation where you could sit and think. Maybe I'm out of my mind, but it—it—this seems obvious to me. So we'll find out what's gonna happen, but it makes a ton of sense to me.

Chassie (50:39)

No. I love it. I don't think that any forward thinking physician that just wants the best for their patients or any forward thinking nurse that just wants the best for their patients, I don't see how we—none of us would not be asking for more help. You know? If it's a better outcome for the patient, that's kind of what we're all here for anyway.

Scott Benner (50:57)

Yeah. Right. Who cares how you get to it? Somebody's better off, they're better off.

Matt (51:00)

I do wonder how that would be looked at. Like, you said, you use an AI model and you felt like the doctor went back and read the same model. And if it was common knowledge that, hey. We're using computers or AI to come up with a game plan, Are they gonna say, oh, this idiot just went back and googled, you know, my symptoms? At what point does it become, hey. This is the way things are done or, hey. They just don't know what they're doing and they're—you know, I could have googled it.

Scott Benner (51:25)

Yeah. I think the answer is my kid's kids will be okay with it. It's a generational thing. You're gonna—Yeah. I'm sure. You're gonna have to live through it. You know what I mean? So but it doesn't mean that they'll be right. By the way, I didn't—I was kind of comforted by it, to be perfectly honest. Like, you know, I mean, this wasn't some great detailed thing that I was figuring out about Arden, but, like, I was able to take her symptoms and say to myself, like, I think it might be this, but I don't wanna jump to a conclusion. Let me ask the model. The model came back and said, well, it could be this, this, or this. It most likely is this. And that made the most sense to me. I did not mention it to the doctor. And then, like I said, she came back. It felt like she was reading me back the same list I had in my pocket. And And see—you know—

Chassie (52:08)

That's a great doctor right there. That tells me that, yes, I wasn't there, but I'm gonna have faith in my colleagues out there. And, yes, that means that we are all on the same page, that we are all getting good information in, and you're getting good information out.

Scott Benner (52:22)

I felt the same way. Like, I felt like she was older, but not old old. And I thought she's probably been doing this forever. And the same if this, then that ran through her brain. She started with that, and she came up with the idea. I—I thought it was awesome, but it also proves out that if a human knows the entire map to the diagnosis, then we can write it down one time, and then the model can go find it too. I see all the other reasons where people's egos would get hurt by this or, you know, people are gonna say, well, why would I be a doctor if I'm just gonna be a button pusher? And, like, I mean, I can see all the—there's a lot of possibilities for where it could go wrong. But I don't know. I just see it as potentially valuable and something somebody should be looking into. You know? Because you guys are terrific. You love your jobs, and, you know, it'd be great if you could have more, I don't know, bullets in the gun when you're doing it. Matt said something earlier. Made me think of this. Arden's friend is in nursing school right now, and she just called me in the middle of the day. And she said, hey. We just had our diabetes lecture and everything. And I was like, right. And she goes, we're done.

Scott Benner (53:23)

And I said, okay. She goes, well, I'm not gonna learn more about diabetes. And I said, okay. And she goes, I couldn't keep Arden alive with what they taught me today. Wow. But she only knew that because she grew up with Arden. Yeah. So she was stunned. She's like Wow. I've said this on the podcast a few times because I really want people to hear it. Like, she's like, well, what else didn't they tell me about? And now I know all the stuff they didn't tell me about, and it freaked her out. And I said, listen. If you really wanna be freaked out, wonder about all the other things you thought you learned front to back that you completely think you understand now. Not just that this was the one thing you had enough context for to call it out and go, wait a minute. That's not nearly enough information to understand type one diabetes. Yeah. And I told her, I was like, listen. You are being trained just like you guys were talking about. I told her the same thing. I said, you are being trained to, like, save somebody in a moment, like, to see the big picture stuff that's gonna end their life and slow that thing down. You're not learning everything about anything. And it's just—she's 21. It was interesting to see how it hit her. You know? Like, it was shocking to her a little bit.

Matt (54:24)

It's almost like you have to have some tie to that disease process to learn more and know more. Like, the type one, when I went into my endo, and I didn't know anything about basal. I had no clue. Like I said, I knew high. I knew low. I knew how to fix that.

Scott Benner (54:41)

Yeah.

Matt (54:41)

But she's explaining basal to me like a sink faucet just dripping, a slow drip throughout the day. And I was like, damn. And in one of your other podcasts, I don't remember which title, but talked about when you go to the ER, it's like, listen to your type one patient. They know better than anyone, and it's absolutely true. And I've even talked to coworkers who if you saw me throughout the day, I'm type one consumes me. It takes every bit of my mind, every minute of every day. And they see me at work. I've got my phone open looking at my CGM, my pump's beeping, you know, my times change, and it's a diabetic haven, the ERs, because there's—there's cookies and, you know, snacks. That's—that's how you make nursing staff happy is you feed them crap. And—and I don't eat anything. And then I'll eat—like, I do protein bars, protein chips, and I'll even—something I learned from one of your podcasts going, I'm not afraid of insulin by far. I—I love to see bold with insulin. I'm very aggressive with insulin. Mhmm. So I'll go low, and I'll dose for what I'm eating. And they're like, you're crazy. You know? Like, no. Because it's going to go up, and I'm—can't do the fight with the high low roller coaster. Yeah. I said, you don't understand how this feels, you know, as a type one. I said, it goes low, and I get a horrible stomach pain. Like, my legs start trembling, and I go high. I get hot, sweaty, and it's horrible. Like, I'm not fighting that, and I've learned how to handle this. But you have to have that tie, and now when I see people with—I'll see an Omnipod on somebody, and I get goosebumps. It's like patient's family.

Chassie (56:22)

Yeah.

Matt (56:22)

And it's emotional to me. Yeah. I—I went to discharge a a little boy the other day who wasn't even my patient, but it was at shift change. And his mother's sitting there, and I see an Omnipod on the back of her arm. And I, like, pointed at it and, like, immediately got goosebumps. And, it's just become a whole—it's my life. I don't wish them on anybody, but I—I wish everybody would be as—as tuned into it as I am. And I wish everybody could—could manage it like I do, but it's taking a huge, huge mental hit on me. Yeah. I feel—I'm getting emotional right now even talking about it.

Scott Benner (56:58)

No. I feel it, Matt. I'll tell you, I have very not similar, but similar feelings when I look at all the people in the Facebook group and the people that come on and talk about how they feel. You know, I've said before, like, I've been doing this a really long time. So when somebody comes on and says, you know, this thing you taught me is really saving me, I feel incredibly emotional because I don't just think about them feeling better today. Like, I think about their future and, you know, the things that they're avoiding and, you know, the possibility of, like, having their own kids one day or, you know, wherever life's gonna take them. And then you, you know, juxtapose that over the knowledge of, like, you know, even your coworkers you just said. Right? They think you're doing it wrong. They don't understand. I spoke with an endocrinologist recently in a private situation, and I was talking about, you know, how fat impacts blood sugar, and this person didn't know what I was talking about. I mean, they were an older person who'd been doing this probably the better part of thirty years. And they weren't telling me, oh, that's not a thing I teach. It's too advanced. They were saying, what's this now?

Scott Benner (58:01)

Like, you know, and I'm like, yeah. You know, you have a high enough fat meal, slows down your digestion, often unbalances the bolus, and then you're left with a carb hit later that there's no insulin for. And they were like, I don't know what you're saying. And that's a person who's, like, front lines talking to somebody. And this was a not a small institution. It's not like I was talking to somebody in the middle of nowhere. Like, you know? So what chance do people have really, you know, to get enough of an understanding to do a good job for themselves? And there's no one to blame. I feel like this conversation proves that out. Like, you can't blame the guy in the ER where you get diagnosed. You can't even blame the endocrinologist, you know, because there's no training there for them either. Like, you are literally at the—it's a coin flip. Like, do I get somebody who looked into this further on their own and understands it better, or did I not? And then that's the path you get to go on. No matter which endo you get, you're gonna believe them when they tell you something. So then maybe if you get given bad information and you have enough trouble in your life, you might dig in and look for yourself, But that's not how most people's minds work. Like, I've been talking about this a lot lately because somebody called me direct. They were like, Scott, you're very direct, and I didn't know what they were talking about. I was like, what do you mean I'm direct?

Scott Benner (59:17)

You say what you mean? I'm like, everybody says what they mean. They're like, no. They don't. No. Recently, I had a young girl tell me, like, she only stuck up for herself in a doctor's appointment because she thought that's what I would do. And she said, otherwise, she would have just taken what was said to her and just accepted it. And when that's the case, then it's coin flip after coin flip as to whether or not like, just imagine you're walking through the earth, and every time you come to a fork in the road, you gotta flip a coin. And then walk in that direction with all the confidence in the world that you're moving in the right direction right up until you find out you're not. How do you find out you're not? You have neuropathy. How do you find out you're not? Like, you could trigger finger. You know, your blood sugar is 40, and then it's 400 all day long. And then you're caught in a situation where you're now altered. Like, mind's altered, and you need to make a good decision without any direction or knowledge. I'm telling you that this is what happens to people. It's so important that on day one, they get put in the right direction. Like, we made that whole grand round series. It really is made for doctors so that they can get you going on the right foot. Because once you put somebody on the right path, it's not a coin flip anymore when you get to the next fork. There's somebody standing there waiting for you to say, oh, this is the right way to go. Go this way now. And that's how you end up well. It's actually not that difficult. But, you know, explaining it to people, getting it spread out across the world, like, I mean, that's the part that's kind of impossible. Like, I think I'm having some impact on it, but not nearly enough. You know?

Chassie (1:00:49)

Do you remember what I told you when I first met you? I've—you've meet a lot of people. You probably don't.

Scott Benner (1:00:54)

I remember where we were standing, but I don't remember what we talked about.

Chassie (1:00:58)

So what I said to you when I met you is I thanked you for all the work that you've done, and I told you that I know how to treat sick versus not sick. And if Matt were dying right now, I can save his life. If Matt was struggling or crashing or in DKA or having a heart attack or had limb ischemia, losing his leg, I know how to save him. I can treat him and make sure he stays with us another day. But being his wife and living by his side minute to minute, hour to hour with type one diabetes, I felt so clueless, so lost. And to be honest, I told you that it made me feel dumb. And I thanked you for showing me how to be a partner to Matt and live through this with him and keep him well so I never have to see him in those states where he actually needs me. And that's the beauty of what you do, Scott, is that this is the day to day living life when you're not there with your doctor. You're not there with your nurse. You're not there with your nutritionist. You're not with a pharmacist. It's all of these moments in between where your impact is so huge because now, day to day, when Matt's not with his medical team, he's doing great.

Scott Benner (1:02:42)

Yeah.

Chassie (1:02:43)

And that's all I want for him.

Scott Benner (1:02:45)

That's very kind, and thank you. That touches me to hear you say that.

Matt (1:02:49)

He jumped in right before me. I—I was gonna say that hope when I first met you, standing there all alone like a lost puppy dog, I had to come to you and talk to you. I hope I didn't come off like an idiot because I remember being just so thankful to you. And, it was really the first to get to you was my endocrinologist who first visit with her. She said, listen to this podcast. So luckily, I had—it seems to be the right people at the right time in my life that everything my whole life has been timing. And luckily, the timing's on the right side for me now. I thank you. I think I didn't even—don't even know how to truly thank you, but—and even at the time when I met you, I hadn't listened to, like, the—I forgot how it worded on the website, the, like, the dark—

Scott Benner (1:03:37)

After dark stuff?

Matt (1:03:38)

Yeah. After—after dark stuff. Yeah. I didn't even know about that because I had just been listening on, like, YouTube. I have no social media. Tracey's on the Facebook page. So I just do YouTube, and I went up to the website. I was like, oh my god. There's so much more. So I'm just constantly going through it. I'd be in the gym. I'm listening to everything, and it just led me just from the basics, I've listened to the Omnipod stuff and the Dexcom stuff and how to—like, Neobold, and I've realized that I used my version of Neobold and didn't realize it till you came out with that podcast. Mhmm. I was like, shit. That's what I'm doing. Yeah. And I realized that I've learned so much just picking everything up and then trial and error. It's just amazing. And I wish I could teach everything I know to other people, but it's—unfortunately, Arden was diagnosed, but you've helped so many people, including her.

Scott Benner (1:04:29)

I don't know. I think she's the last one I helped. I was listening to her argue with me last night about changing her pump, and I was like—I was like—I was like, you ought to listen to my podcast.

Matt (1:04:40)

Can still hear you saying, oh, she loves going to Moe's. And she loves their queso, but she gets some Tostitos too. And there's a little things that just stuck with me, and I forgot what it was. Do you—not gummy bears. I forgot what her sugar thing was.

Scott Benner (1:04:54)

Yeah. She's using gummy bears right now, but she's pretty sick of them. So now I'm just eating them.

Matt (1:05:00)

Yeah. Yeah. Yeah. Yeah. I forgot what I have in my drawer now. I had some buy one, get one something little snacks, but I hardly ever need them. I'm so focused on it. My entire fear with diabetes was that one day, Chassis will find me on the floor, you know, unresponsive. And I think that's what kept me going and being so focused and a pain in her ass or a pain in everyone's ass because I'm—you know, like I said, it consumes me, but I don't wanna do that to her.

Scott Benner (1:05:31)

Oh, Matt, listen.

Matt (1:05:32)

Or anybody else, but—but her—her in particular.

Scott Benner (1:05:35)

Let me lighten this up for you. You've been very emotional and open. I feel like you were gonna have a great night tonight. I just wanna say that. I feel like she is like, oh, I did pick the right guy. This is awesome. Special night for you coming up, Matt. Make sure those little snacks are in the bedside table. Okay? Here we go. Here we go. You have no idea how hard we try to not be a patient. Well, no. But I—that fear you have, I mean, that's what motivated me when Arden was little. Like, I just did not want my daughter to be the kid that passed out at school. Like, that was Yeah. a lot of my initial motivation. You know what I mean? It's, just to try to avoid a problem for her. You know, I interviewed a woman the other day who helps people with diabetes. And I don't wanna give her details, but, like—because you guys will hear at some point. But my point is that I was listening to what she does, and I think she does a really good job at it. But her ability to reach people is one on one, or sometimes she'll go to, like, a a JDRF event, probably ends up talking to 40 people, which I think is amazing for those 40 people that are there. And I still don't think that I'm saying anything that a lot of other people out in the world aren't saying. I think that the thing I did was I just found a way to put a megaphone in front of it that other people have failed at doing.

Scott Benner (1:06:49)

And maybe they haven't tried or maybe it just hasn't worked out for whatever reason. My thought always was—and this started out as a competitive thing, but now talking more about, like, this idea of, like, spreading good information around, It's become more about that for me, obviously, over time. But it started out as competitive. Like, if I'm gonna make a podcast, I don't want 50 people to hear it. Like, I'm not wasting my time on that. Like, I want 5,000 people to hear it. I want 50,000 people to hear it. I want a 100,000 people to hear it. I have that kind of motivation. And so once I was able to build it up that big, now I'm like, okay. Now we're actually en masse. Like, look. Your endocrinologist said go listen to that podcast. You're in Orlando. I have an email that I answered two weeks ago from, like, Northern Canada where someone said, hey. I need a website where I can share your podcast easier with my patients. That's an endo there. And I looked this morning to see that the show was incredibly popular in New Zealand for some reason yesterday. And, like, that's the kind of stuff—I don't know. That's my—maybe I am more direct or aggressive or—I don't know. I don't honestly care. But what I'm saying is is that, like, it's nice to help a person. It's really nicer to help 10, and it's really cool to help a 100,000 of them. Like, that's how it's gonna spread around because then if you bump into a bad start at your physician's office, maybe you've got a real chance to get off of that coin flip path and onto a meaningful path sooner if the information is not just available. But, like, forget this podcast. This podcast, YouTube channels, any way people get information out, they're all stuck in and if a tree falls in the woods, does anybody hear its situation? There's probably somebody out there doing it better than me or understands it better than I do, but they're not as good as communicating it in this time in history. Like, that's the thing I'm really good at. And so, you know, I'm just hoping it reaches more people like you because listen to you. Like, you don't know Matt. Matt—if Matt was standing in front of you, he would give you the feeling that he could grab you by the side of your head and throw you if he wanted to. To hear him be vulnerable like this is strange because I've met him in person. And, like, you know, face to face, I wouldn't think of you, and this is me jumping to conclusions, obviously, but you wouldn't strike me as a kind of person who's running around with this fear inside of them. But if you are, then everybody is. You know what I mean?

Scott Benner (1:09:20)

So I don't know, man. Like, I'm glad the podcast helped you and that it's obviously making your relationship better, and I'm thrilled about that. But I just wanna make some more people hear it. Like, that's really what I'm trying to do. I I have a limited time on this planet, and I am trying to make it so that as many of you as possible don't suffer. That's really it. And, it all comes back and supports my daughter somehow. Yeah.

Matt (1:09:46)

Yeah. I don't care how anybody else does it. You're the guy.

Scott Benner (1:09:52)

But there's a lot of ways to do it, but I appreciate that. Thank

Matt (1:09:55)

But—but you don't have the ego. You're down to earth, but maybe because we're so, you know, open and forthcoming and honest that it just—you struck us as, you know, that—that you're it.

Scott Benner (1:10:05)

Now maybe what that tells you is that more people feel that way than you think because people pretend to be dainty or demure or, you know, like that kind of thing. But when you really start talking to them, more people have my attitude than don't. You know? Like, it maybe they don't have the nerve to say it out loud or stick up for themselves, but they have that feeling inside. Yep. You know? Like, a person who doesn't speak up still feels like they wish they could. I'll tell you that when I first started making the podcast, my wife was like, what's the tone you wanna strike? And I said, well, I mean, there's a lot I don't understand, so why don't I just be the avatar for the listener? And I'll come from the why—I—don't—understand—this perspective, somebody teach me. And that way you guys can feel more vulnerable and and let that information flow through. And, you know, it's just, I don't know. At this point now, it's a mix of everything. I can't dissect what this is anymore, to be perfectly honest with you.

Matt (1:10:57)

It's perfect. It's what everybody needed. That's what it is.

Scott Benner (1:11:00)

I appreciate that.

Chassie (1:11:00)

It is. It's—it's I'm telling you. It's great for the layperson, the medical person. I think that you are at a really interesting fork. We'll call it fork since you're talking about the coin flip. You're at that interesting fork where you can have the candid approach to diabetes, but you also have enough medical background and enough accurate knowledge to manage it too. And what a beautiful spot you're sitting at to be the candid, supportive dad, but to be so well informed that you can keep up with physicians and nurses and other medical professionals. And, again, say the things that all of us wanna say and maybe just don't communicate it from the patient side or just don't communicate it from the medical professional side. So enjoy that fork because you've taken it and you've shown amazing, amazing things

Scott Benner (1:11:52)

You're right.

Chassie (1:11:52)

to both sides of this. Yeah.

Scott Benner (1:11:53)

You're very nice. Listen. We're out of time, but let me ask you a question. Can I call this one Turkish Eye Lift or no?

Matt (1:12:00)

Because It's your podcast.

Scott Benner (1:12:03)

You can call it.

Scott Benner (1:12:06)

Also, you can—they get rid of these crow's feet for me? What does that cost?

Matt (1:12:09)

And I can tell you it's cheaper there if you wanna do it.

Scott Benner (1:12:13)

That's the place to go.

Matt (1:12:16)

I don't know about right now in the in this world, but it's the place to go.

Scott Benner (1:12:19)

Listen. I'm not leaving America right now. I don't I'm not looking to be judged outside of the country at the moment. So, you know, I'm I'm holding on. But travel plans have changed. Well, you guys are terrific. I wish you a ton of success. It sounds like you're obviously off to a really great start with all this. And, Matt, you know, I can't imagine what it's like living with that background noise of, like, you know, having to go check on cancer every six months or every year, but I hope you're able to not think about it day to day.

Matt (1:12:49)

Just become the way of life. I'm on the better end of it now. So and I've got a—the support system that I needed and never had before, and Chassis has been everything to me and almost as important as you are to me.

Scott Benner (1:13:02)

Almost, Chassis. You heard that?

Matt (1:13:04)

But she'll she'll get there. Yeah. She'll get there one day.

Scott Benner (1:13:06)

Yeah. Later tonight, she'll jump ahead of me in that race. I'm pretty sure. Yeah. So You guys are terrific. I'm so glad we were able to work this out so you could both be here. Thank you so much. I really appreciate it. Thanks so much. Thank you. Yep. Hold on one second. Okay? A huge thanks to US Med for sponsoring this episode of the Juice Box podcast.

Scott Benner (1:13:31)

Don't forget, usmed.com/juicebox. This is where we get our diabetes supplies from. You can as well. Use the link or call (888) 721-1514. Use the link or call the number, get your free benefits check so that you can start getting your diabetes supplies the way we do from US Med. The podcast you just enjoyed was sponsored by Tandem Diabetes Care. Learn more about Tandem's newest automated insulin delivery system, Tandem Mobi with Control IQ plus technology at tandemdiabetes.com/juicebox. There are links in the show notes and links at juiceboxpodcast.com. The podcast episode that you just enjoyed was sponsored by Eversense CGM. They make the Eversense three sixty five. That thing lasts a whole year. One insertion? Every year? Come on. You probably feel like I'm messing with you, but I'm not. Ever since cgm.com/juicebox. Thank you so much for listening. I'll be back very soon with another episode of the juice box podcast. If you're not already subscribed or following the podcast in your favorite audio app, like Spotify or Apple podcasts, please do that now. Seriously, just to hit follow or subscribe will really help the show. If you go a little further in Apple Podcasts and set it up so that it downloads all new episodes, I'll be your best friend. And if you leave a five star review, oh, I'll probably send you a Christmas card. Would you like a Christmas card? Have a podcast? Want it to sound fantastic? Wrong way recording.com.

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