#513 Break in the Clouds

July 26, 2021Scott Benner

Sarah is a young adult living with type 1 diabetes. She is here today to share her story and talk about anexiety.

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DISCLAIMER: This text is the output of AI based transcribing from an audio recording. Although the transcription is largely accurate, in some cases it is incomplete or inaccurate due to inaudible passages or transcription errors and should not be treated as an authoritative record. Nothing that you read here constitutes advice medical or otherwise. Always consult with a healthcare professional before making changes to a healthcare plan.

Scott Benner 0:00
Hello, everyone, and welcome to Episode 513 of the Juicebox Podcast.

Today's show is called breaking the clouds. And my guest is Sarah. Now, I lost the first four minutes of this episode. I'm sorry, I don't know how it happened. But let me give you the quick overview. Hi, Sarah. Hi, Scott. So you've type one diabetes. Yeah. How old are you? I'm in college. Okay, that's pretty much it. You'll be able to enjoy the rest of the episode now. Please remember while you're listening that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, always consult a physician before making any changes to your health care plan are becoming bold with insulin.

I'd like to remind you that if you're looking for the diabetes pro tip for the defining diabetes series, you can look at diabetes pro tip com. They're also available through Juicebox Podcast COMM And right there in your podcast player. Alright, little more business. And then we get right to Sarah.

This episode of The Juicebox Podcast is sponsored by Omni pod. Find out more about the Omni pod dash, and all of the Omni pod products at Omni pod.com forward slash juice box. later in the show, I'm going to tell you about the Omni pod promise. The show is also sponsored today. By the Contour Next One blood glucose meter. I have never used a more accurate meter. I have never held a more comfortable meter. It is wonderful Contour. Next One comm forward slash juice box. I clicked on the wrong button just now. And cuts are off for everybody listening. So this is gonna feel like a really awkward edit. But is there this question already? She started to answer and I messed up. So hey, Sarah, do you think either of your parents had anxiety?

Sarah 2:21
I think that my dad might have had a little anxiety. In the same sense I do. He has what my mom calls like white coats, white coat syndrome, where he gets really nervous to go to doctors get a flu shot, he just is not until all that. So the fact that, Oh, your child was just diagnosed with Type One Diabetes, and you're gonna have to give her insulin shots every day, every day, you're gonna have to check her blood sugar with this little poker thing. And I think he just kind of shut down after that. Whereas my mom was more like the champion for me. She wanted to put me into clubs and get out. Sir, yeah. Oh, so it's interesting that they were both kind of on opposite ends of that?

Scott Benner 3:09
Well, you know, it's interesting, you said white coat syndrome, actually, because that's a very real thing. But it's got a finite definition, but I think of it as a little larger around diabetes. So the real definition of it is, it's like it's like a form of hypertension. So people have like a normal blood pressure. And then they go into a clinical setting and have their blood pressure checked. And it's crazy high. But it's not in the rest of their life. As far as anyone can tell. They just they see the white coat, they get nervous. Maybe it's nervous about being around a doctor or that you're about to be tested. You don't know what's gonna happen. I don't know what happens to people. But I always, in my mind, expand that around diabetes to think about, you know, you see so many people, or I talked to so many people are so confident about their diabetes, and they know what they're doing. And they're afraid to tell their doctor that they change their Basal rate, or they're afraid. They're afraid the doctors like everything looks great, you know, and they're thinking it's not I missed all my Bolus, but I corrected it. So you can't see it here. You know, and they won't tell them and I think of that as more of like the diabetes white coat, but it's very interesting. Your dad said nervous guy.

Sarah 4:20
Yeah, so and it's it's lovable about him. He definitely wants to be as helpful as he can. But like not having any diabetes in my family. It definitely was a big adjustment. And I'm the same way as my dad in the sense that we really hate change. So I'm glad that I was in a way I'm, I'm lucky that I was young diagnosed with diabetes, so I didn't have to deal with that.

Scott Benner 4:46
So you don't in your mind Connect anxiety and diabetes. You don't see it as I have anxiety because of my diabetes. You just didn't you have these two separate things.

Sarah 4:58
Yes. But the Diabetes definitely doesn't help my anxiety sometimes, like, for me, I'll get. I've been a lot better recently. Like, it's kind of crazy that my anxiety has gotten better during a pandemic. But it's the truth, I've been able to manage my diabetes even better over this year. Whereas my anxiety would, it would make me so overwhelmed that it got to the point where I was checking my number, maybe twice a day. This was before my CGM. This was when I was still using a manual checker. What are they called? Sorry? Oh, yes, sorry. I would check when I woke up and kind of after I did my homework and was about to go to bed. And that was the point where I was in my lowest with anxiety. And I would say I kind of suffered with a little bit of depression as well, without putting a name to it. In high school. It was, it was really interesting, because I kind of had that diabetes, white coat syndrome, where I was feeling kind of ashamed to go see my endocrinologist every three months, because I got that anxiety that, oh, my appointments coming up, I need to be on top of my diabetes were and it just, it was at the point where I just did not put that effort into my diabetes management. So I would feel so bad about myself, because my agencies were reflecting that my agencies were pretty high for my age, and for my age, and it was something that I was just ashamed of, and it was just really hard.

Scott Benner 6:57
Does the does the anxiety breed procrastination, because if you procrastinate, you don't have to deal with a thing that makes you anxious. But that doesn't make you anxious.

Sarah 7:13
For me, it's kind of interesting. I pride myself in being a really good student. So being in college, and I would prioritize schoolwork over my diabetes, if that makes sense. Like I would avoid the pressure of the diabetes, anxiety and deal with the anxiety I had over college. Which was not a great idea. But it was something that I did to cope, if that makes sense.

Scott Benner 7:43
You just felt like you had enough bandwidth for one of these things. And you chose school? Yes. What would happen when you ignored your diabetes, you're just talking about higher blood sugars, but you weren't checking anyway. So you wouldn't know if they were high or not. Right?

Sarah 7:55
Right. So it was kind of scary, actually, my numbers would be like, when I got around to checking them, my numbers would be, I'll just throw out a number, it would they would be in the three hundreds, low, three hundreds. And I wouldn't feel that. And that's when I realized, like, I used to be able to feel when my numbers were going high. And I used to be able to feel when they were going low. But it got to the point where I kind of just felt the same all day. If I was 110 or 310.

Scott Benner 8:26
So did you I'm sorry, did you used to play that game when you were younger? Like I feel myself getting higher? I'll give myself some insulin.

Sarah 8:33
I would check my numbers. And then I would be Oh, I was right. And then I kind of got that confidence. Like, Oh, I know I'm low right now. Because I'm feel shaky. I feel like a headache. And I would check my numbers back then. And then when I got more independent with diabetes, when I didn't have to call my parents every day from the clinic. I would be like, oh, I'll just skip checking my number at lunch because I feel fine. I don't feel low. I don't feel high. But what happened was, my numbers would steadily be high. And you do it was pretty bad.

Scott Benner 9:08
Yeah, you didn't recognize that your body had lost the ability to feel the difference anymore. Yeah,

Sarah 9:14
I can still feel when I'm low, for some reason, but I think my body just got used to the higher blood sugars, which is scary. It's

Scott Benner 9:25
what it does. Your body is trying its best to adapt and keep you alive as long as it can. Really is what it's trying for. So something starts going wrong, and it does its best to keep you alive. Whether it's you cut your leg and don't touch it and you know, it tries to clot you know, it's still gonna get infected, right, but right, it's gonna try to buy you another hour, a minute, another day for you to figure out how to save yourself. And it's cool. Sounds like you figured it out.

Sarah 9:51
Yeah, I'm so glad that I finally got the CGM because that was another thing. I was anxious to get a CGM because I was feeling like Oh, I'll just be this robot person with a insulin pump and a stain on my arm and people are gonna think that I'm like, no one's gonna think I'm weird. It was like such silly thoughts of anxiety, but that's what it does to you. It makes you feel just so low, I guess. And so now that I feel pride in having diabetes, and that I can teach people about it, and I'm an anti so I toe I even showed the kids that I nanny my little robot machine. I call it a robot machine because they think it's the coolest thing that Miss Sarah has this cool button on her arm and this cool little robot machine that she keeps in her pocket? And it's made me feel a lot better about that. And I'm so glad that I have the CGM. No, because I can check my number and make it kind of fun for people around me too.

Scott Benner 10:56
I'm glad I'm glad for you as well. But I have a question. So you said you had a lot of like worries like, Oh, I'm gonna look like you know, a machine. Bla bla bla. Yeah. Did you ever worry, my blood sugar's really high? I'm gonna kill myself.

Sarah 11:08
No, and that interesting. It's, it's, it's scary to think, think about because I wouldn't care if my number was high. I would just be like, okay, I just have to put some insulin in and I'll go to bed. Like I wasn't taking care of myself in that way. So it was really bad. Just

Scott Benner 11:27
I don't mean you specifically. But I just think it's incredibly interesting how our minds work. There. Yeah. You know, you're like, well, I don't want this thing on me that is going to be a large problem. Yeah, not having it might be causing me to, you know, have significant health concerns and pass earlier than I should or need to. And that's not even in an anxious person that your anxiety didn't train you on that idea and make you worry about that. I find that fascinating.

Sarah 11:57
It really is. And I had plenty of arguments with my mom about it, because she had wanted me to get it since I was first available to have a CGM. And I just was so stubborn and just worried about that, instead of the real problem of managing my diabetes. Yeah.

Scott Benner 12:14
How long? How many years? Do you think you were in that space where you weren't really managing? Well, and you're a once you said was high, but you didn't put a number on it. But

Sarah 12:24
oh, so it got to about it was like in the nines, okay, for about a year. And I was doing the I wasn't really managing for about two years, at the end of high school in the beginning of college,

Scott Benner 12:37
when you kind of translated away from your translate is not the right word. When you what's the word I want. transitioned? Oh, my God, sorry, you couldn't think of a word earlier. And now. So when you kind of transitioned away from your family management, and into that later, high school college time, so you maybe only had maybe two or three years in there, where you just weren't really on top of it? Did they think you were like, didn't you? Yeah.

Sarah 13:03
So I would go, I started going to my endocrinologist appointments by myself. So that was an easy way out for me to be like, Oh, yeah, my agency was good. I'm Shannon, who's my nurse practitioner, she was always so helpful with me. But I would just kind of it was kind of like in one ear out the other for a while, I kind of just avoided the change, because I didn't think that I could manage it well, but it's not the truth. Everybody can manage it. It's just the fact of motivating yourself to do it,

Scott Benner 13:45
I believe. Let me ask you, did you feel like you couldn't do it without your parents, but you were supposed to do it without them.

Sarah 13:52
I don't know if it was that I couldn't do it, necessarily. But it was just the change of going from my mom and dad over my shoulder all day, to being independent and having to not having to manage it by myself. But I kind of chose to because I was just tired of it, I guess. And it felt like it honestly felt kind of like a break from diabetes. I think that's where it comes from is like I was just so overwhelmed with everything a normal high schooler goes through, and then having diabetes. On top of that I was just like, ready for kind of an escape from it.

Scott Benner 14:29
I have to tell you that where I grew up, we call this we didn't have a name for it. But it was something that we recognized about girls who went to Catholic school their whole lives. Like they would graduate from high school and do something drastic, right. I mean, they'd start they cut their hair oddly, or data guy they would never date. Or, you know, some girls became really promiscuous. It's just like, which I don't even like that word because I don't think of it as that. That I just mean they just like, Sarah, what I mean is sort of banging a lot is what I'm saying I don't have a judgment about it like, like what it means, right? But they would just break from whatever. I always thought of it as they were being forced to stay in a cocoon. Mm hmm. And so that they didn't get let out slowly. It was just like, Hey, boys, I'm here. You don't mean like it just all at once kind of a thing and a run towards whatever wasn't their norm. And I wonder if you know, you're you talked about school being important to you. You sound like you live in the Virginia ish area. So it sounds like you're you probably have a you're probably like a real firm respect for your parents not wanting to let them down that whole thing? I'm about right about that, right?

Sarah 15:49
Absolutely. Yes, I'm the first person actually in my family to go to college. Well, so I think that's another factor of that I really want to get this degree and make myself proud a my parents. So I think I was very focused on that. And I just loved that kind of be my priority.

Scott Benner 16:09
And I wonder if the doing things like that, as you're growing up, I'm not talking about everybody, not just you. But I wonder if the doing things as you're growing up. Because you're supposed to, instead of because you want to write doesn't leave you with that feeling of I have to get away from this. And the very first minute, you have the opportunity, you escape it somehow. And it sounds to me, like your drive to be a good student, you had more stressors to do that than you did to take care of your diabetes. So you just, that's the one you chose. Right?

Sarah 16:43
So put the diabetes on the back burner.

Scott Benner 16:46
And you're you're a good student too, right? So it makes it easier, like you can gravitate towards the thing you know, you're going to succeed at when you run towards one of them. Exactly. I don't know if I'm right about that. I could be 100% wrong. But it's why. While we've been raising our children, we've tried really, really hard to mix what we want and hope for them with who they are. Instead of just saying, This is what you're supposed to do do this. And it's hard as a parent sometimes when you're like, Oh, I really do wish this is the path they were on. But it's not right for them. I shouldn't force them onto that path. You know, but but you know, good news, you figured it out, right? Well, yeah, what put what pushed you over the edge? What got you thinking about it differently?

Sarah 17:38
Um, honestly, I was just one day, I was like, wait, I don't want to die when I'm like 50 or 40s. You know, like, I don't want to let diabetes control me anymore. I was so scared and anxious for a long time that, well, diabetes, it's different every single day, what is the point of trying to fix my numbers, trying to adjust my bezels and trying to get the CGM to see how my trends are going. And one day, I was just like, Okay, this is enough. I am going to college to get a degree to have a career. But I'm not taking care of taking care of my health. What's the point of like, one or the other? I mean, I need to do both. I think it was just like, one day, I just was like, This isn't healthy, and I need to be healthy. And that's just kind of a Yeah,

Scott Benner 18:36
yeah. And the diabetes sounds like it. It impacted your goal. Like it finally was a prohibitive thing to you. Because you had the conscious thought, why am I planning for a future that I can't have? Right, right, I need to make sure my health is there so that this future I'm putting together for myself is isn't full of health issues, or maybe shorter that I that I want it to be? That's really Yeah, really interesting that you came to it so quickly. Did you have a like, if you feel like you still have some depression, or is it just the, the anxiety now?

Sarah 19:13
Um, I think it comes and goes, it's not major anymore. I think for about a year and a half. I was really low at a low point. But I was functioning like I had high functioning anxiety and depression. And I'm blessed to be able to see a therapist and I'm blessed to be able to have a consistent job that keeps me out of that dark place and having a therapist i think i My opinion is everyone with diabetes should seek a therapist, because it is helped me extremely like I can't even put it into words because I felt for so long, like a burden on my parents financially. Because diabetes is not cheap. It's an expensive disease. That's another part of it becoming independent, and paying for my CGM myself, and deciding to take my diabetes care into my own hands, has helped me realize that it's just something that I can make it I can get out of this dark place. And I can manage my diabetes the way I want to.

Scott Benner 20:25
That's cool. It even sounds like the idea of taking over financial responsibility alleviates you from the strain of feeling like you're stressing your parents financially. And so that's valuable for you. I was just trying to decide like Where did you find that like, spot a sunshine and a cloudy day where you could like stop and think I need to do better with my blood sugar's because I want to live a full life like you just got it you just got lucky, right? You had a you had a moment where it all just man's.

Sarah 20:58
So honestly, that we're in a global pandemic right now. But it is helps me figure out what I want to do. So for so long, I wanted to be a teacher, I still do want to be a teacher. But that that kind of sunlight that you're talking about is when I figured out, hey, why can't I teach about diabetes? Why can't I go that route of it. So I've focused on becoming a diabetes educator. And that's something that I've had a newfound passion for this year. And I think that's another part of it. Because I'm really excited about that. And because of struggling with anxiety and some depression about in my life, and it kind of regards diabetes, I think that I'll have a really good point for people to help them.

Scott Benner 21:51
Yeah, I bet you will. That's excellent. Well, cool. You're doing great. Did you find that having access to your blood sugars more regularly through a continuous glucose monitor? That changed your ability to manage? Like, what? What would you tell me your agency is now?

Sarah 22:12
Oh, my last agency was it was eight point something. So we're slowly coming away getting down. Yes. And I've been able to, I have a freestyle libri. And I love it. I can see on my app, and I scan it with my phone every day. And it's just pretty cool to like see it in the green, it has like a green graph. And when you go low, it goes red. And when you go high, it goes orange, like you know, and it's just pretty cool to visibly see my graphs everyday. Because then I have been able to focus on a specific time of day where like, I was waking up with really high blood sugars in the morning. And so like researching that and finding out about like the morning phenomenon where you're sometimes but people's blood sugar spike in the morning, like when they wake up. That has been really, it's kind of fun for me to be watching my numbers throughout the day. And that's actually really helped my anxiety to be able to get like a C as a whole day instead of thinking like, Oh, my numbers high right now. Let me go big, like think about it for hours, like oh, my numbers super, super high. What do I do? What do I do and being able to see it go down steadily on a graph has helped me I don't know if that makes sense. It makes it

Scott Benner 23:38
has really helped. It makes it aspirational. It makes it something that you feel like you can affect because you can see cause and effect. You can see, you know, I did this and then this happened I could do more next time or I could do it sooner, you know, you start really figuring out how to use the insulin because Sarah, that's really where you're at. Now, what's interesting is you're talking you're basically in year one of diabetes, right? It's crazy. It's not it happens to a lot of people. It really does. I've spoken to so many people who figure these things out at all different times of their life with diabetes. I'll tell you, I spoke with a woman once who was a mother. And she was a single mom, she had a bunch of kids. She was in her late 30s. And she said that the podcast helped her figure out that you know what was going on, but she had had diabetes, and she was like 16 Wow. And she had never fundamentally understood it. And this is where you are. It's like you just got diagnosed and someone explained it to you correctly. And you're starting to figure it out. How do you listen to the show?

Sarah 24:48
Yeah, so I first found your show by accident on Spotify. Over the summer, so I would say maybe like May or June is when I first listened and I was scrolling Cuz you have so many episodes, and it was like, Oh my gosh, where Why have I never heard of this before. So I really like took a deep dive into your show and listen to like a lot of podcasts about people who are about my age and with anxiety or like depression episodes especially. And it really helped me figure out like, oh, there's other people that struggle with this. And I can change this. And it's another interesting thing is I have two close friends that have type one diabetes, we met in high school, in the clinic in the nurse's office. And we've become really close friends because of diabetes. But it was almost like I had more pressure on me to manage better, because they would always tell me how great they're doing with diabetes. And I was kind of sitting there like, Oh, my numbers been in the two hundreds all day, but I wouldn't say that I just kind of felt that secret shame.

Scott Benner 25:58
Yeah. So you're, you're illuminating something that I've long believed, is that there's always been sort of this vein in diabetes in the diabetes space, like you don't talk about doing well, because it makes other people feel bad in the exact same way that you just explained. I've always thought, why don't we talk about doing well, and show somebody how to do well, at the same time, right? Because if those people would have said to you, hey, my blood sugar is 89. What's yours? And you said, 200? And they said, Oh, that's okay, here's the super easy secret how to fix that. You would have been like, Oh, cool. Thanks. And that would have been the end of it, except they didn't know why they were doing better than you. And by the way, you were a little kid, you might have had a too much. Or they might add 160 blood sugar, and you were like, Oh, my god, they're killing it. And you know, maybe they really weren't. So it's all perspective. But I understand that feeling of like seeing somebody do better than you and just shutting down. Because it's embarrassing to say, What's going on with you. But I think, in my opinion, unless you found them already, you're ready to jump to Episode 210. And listen to the pro tip series. Okay, and that's gonna help you figure out how to use your insulin better, I would honestly tell you, if you listen through the pro tip episodes, I would guess you're a once you would be in the sixes in like three or four months? Wow, I think I think it could I think you just don't fundamentally yet know how to manage your insulin.

Sarah 27:29
Right. And I think for a while not really understanding exactly what my disease was, was hard for me because being diagnosed so young, it kind of was like, managed for me for so long. And like we've been talking about the new independence of diabetes, and I'm kind of on I'm starting over basically with management.

Scott Benner 27:52
Okay. Yeah. No, I think that, I mean, it doesn't have to be difficult. But it is if you don't have the tools, and the tools, the tools or ideas, right, their concepts. And I'm talking to you now for 40 minutes, you're a bright person, you're motivated. There's no reason why you couldn't take these easy to use ideas and put them into practice. And I could even if you want, I'll walk through a couple of them with you right now. I honestly do, would you Are you up for that? or? Yeah, that'd be awesome. Cool. Okay, so Sarah, here we go. First of all, if your Basal insulin isn't right.

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Pure Basal insulin isn't right. Everything else isn't going to work. Okay. And by right I mean, away from food away from other influencers? Is your Basal insulin holding your blood sugar steady, at a number near 90? Is it.

Sarah 33:06
Um, I recently changed it and we're seeing that it's come down a lot. It's not around 90, but it's definitely lower than it used to be. Okay,

Scott Benner 33:15
so let's just say I don't know where it is now. But let's say it's at 150. And you're thinking, Oh, that's great, because I used to find stability at 200. So that's right, you're right. But more basil, like keep moving your basil up until it holds you stable and steady at a number that you're happy with. Okay? For me, I mean, we're shooting for like 85 with my daughter. But, you know, let's say you could just try for 100 for now. But the point is, is that if your basil is well dialed in, if you understand how to Pre-Bolus your meals, and you're pretty good at counting your carbs, or more accurately understanding the impact that carbs have on you, you're going to have an A one C in the sexes, and you're not going to have a lot of lows, and you're not going to spike high. And so that's sort of the next thing right? So first is Basal. The second is you have to Pre-Bolus your meal, so do you Pre-Bolus your meals.

Sarah 34:17
I tend to Bolus like as I'm sitting down with my food.

Scott Benner 34:21
Don't worry, I already knew that when you told me right one, say so. So now the next thing to do is you get your basil right. And then you learn your Pre-Bolus time. And you can do that easily by getting stable somewhere away from food like a few hours removed from food or insulin. Find yourself stable anywhere so you're stable 250 put in a Bolus that you think will move you from 150 to 90 and see how long it takes for that Bolus to begin working that amount of time is about your Pre-Bolus time. And now let's say that ends up being 15 minutes. Now you start Bolus in your meals, 15 minutes before you eat them. that stops the big spike, right? And it also keeps you from getting low after meals, because I'm also going to guess that you get low after you eat and have to retreat with food and then get high again, does that happen?

Sarah 35:17
It happens sometimes. But actually, what tends to happen is I'll kind of stay the same blood sugar. Ah,

Scott Benner 35:25
so you're going up and staying up. So you're not using enough insulin. And you need to pre write so

Sarah 35:34
and so we're changing that we're trying to insulin sensitivity is been a struggle for me

Scott Benner 35:41
the idea of how far a unit moves your blood sugar. Okay, well, so if your basil is wrong, it's going to be hard to figure that out. So yeah, imagine if the Basal insulin, I'm going to make up numbers here. But imagine your Basal insulin is at a unit an hour, just a nice round number. And it really should be, I don't know, a unit and a quarter an hour. So that means that every hour that you're awake, your Basal insulin is deficient by a quarter. So every four hours, you're missing a unit, or four 812 1624, you're missing six, is that right? six units of basil a day. And so if you had that insulin in your basil, your blood sugar would be lower. And it would be easier to impact a blood sugar with a correction. So saying that, you know, your insulin sensitivity is a unit for 50 points, but your basil is off by 20 or 40%. That's not accurate. So it's basil first, then Pre-Bolus. Then really understanding your meals and your food. And by that I just mean really having a firm grasp of the glycemic load and glycemic index of foods meaning that 10 carbs worth of watermelon is not going to move your blood sugar as far or need as much insulin as 10 carbs of white rice. Right, right. And once you have that down, and you can start making better decisions about your meals. Those are the three those are the cornerstones to me. Of course, if there was one more I would actually have a cornerstone, but let's triangle stones. Those are the three ideas, Basil Pre-Bolus really getting the amount of insulin you need for your meal down after that you branch off into what protein and fat due to like, later rises after you've eaten and understanding stuff like that. But honestly, that's that's the base of it right there. In my opinion. Does that all make sense to you?

Sarah 37:48
That's great. And I mean, it's something that is definitely going to take time. And I know it's not easy. It's easier said than done. But I'm very hopeful. I agree.

Scott Benner 38:04
And I don't agree. I okay. So what I'll say is, if you came here today, and said to me, hey, Scott, here's my libri controller and my pump. About four hours from now I could have your blood sugar stable at 85. And then we'd know your basil was right. And then we could figure out your Pre-Bolus and move on. It's it's hard because you don't have all the tools like the knowledge and I mean knowledge when I say tools to do the thing. So it seems like every idea is just the it probably feels like you're just throwing darts with your eyes closed, right? Like you're guessing like maybe this is where I turned up. It tells me this your basil profile? Is it one basil insulin all day? Or do you have a whole bunch of different segments

Sarah 38:53
I have on my pump, it's it goes by like, few hours at a time is a different basil. So like the morning is different than like lunchtime, and then the afternoon and then like dinnertime and then overnight.

Scott Benner 39:08
So I would tell you to consider that it's possible that because these all these ideas are kind of mismatched, that you're creating high and low segments during the day thinking that they're organic, that they're just happening, and that you're trying to move the basil around to stop them. So you have a feeling like I always get low between two and four in the afternoon. So we'll turn my basil down. And what I'll tell you is that the first time of any 24 hour period that your basil is wrong, if it's too weak, you're going to get higher later. Eventually you're going to Bolus at that high number which is going to make you lower later. If you get in the same pattern over and over again. You can fool yourself into believing I'm always low at nine NPM when the truth is, you're using too much insulin for your dinner at 6pm. And I'm making stuff up now. But yeah, you know, like, that's the idea. So that's why I'm saying, Basil Pre-Bolus. So the basil keeps things stable, the Pre-Bolus stops the spikes, not having the spikes stops the corrections. When you stop the corrections all the time, you're stopping insulin from being active once the food's out of your system. Now you're not having lows, etc, or you're using enough insulin at your meals, which is stopping a high, you know, and now you're sitting higher than you want to be forever waiting for it to come down. And the truth is, if a high blood sugar comes down on its own three, and four and five hours later, that could mean your basil is too strong at that point. So it's, it's it. I know, it seems super complicated, but I would tell you, seriously, try the pro tip episodes, I bet you they will help you. And I want you to let me know if they don't.

Sarah 40:59
Right. Yeah, that's it sounds really great. Cool. That's excellent.

Scott Benner 41:02
Well, tell me a little bit about your plans. After college, so what do you have to do to become a diabetes educator.

Sarah 41:11
So I'm not sure if it's different for different states, but at least in Virginia, there's a few different routes that I can take, I can become just a nurse straight up nurse, I can become a nutritionist, or a dietitian, or even an optometrist to get into an exam to sit for an exam to become a certified diabetes educator. So I'm still in the process of deciding which way I want to go with that, because right now, my program is teaching. And I'm going to graduate with my associates degree in the spring semester. So I'm focused on finishing that first. But fortunately, for me, a lot of the classes that I've already taken are like prerequisites for the nursing program. So that's kind of where I'm leaning towards

Scott Benner 42:08
nice. Do you like being around people and working with people? I love it. That's a good spot for you then. Yeah, there's some people try to become nurses. And they're not people, people, persons persons, people's people, persons. What is the What do you you're a people, person, people person, I'm not a people person.

Sarah 42:26
But at the same time, I'm kind of an introverted person, whereas I like my time to recharge. So we'll see how it goes. Being a nanny is is interesting. But you really got to be able to work.

Scott Benner 42:43
Yeah. Okay. So being introverted, does that mean that when you're around other people projecting an image that you think people want to see in a social setting drains? You

Sarah 42:57
know, I think it's more of, I prefer smaller groups, like I love to be around people. But when it becomes like, bigger groups, like more than like five people, I'm just kind of like, Girl, I can't really talk to all of you, and like, keep a conversation going, but maybe I'll just talk to one person. So that in that kind of way,

Scott Benner 43:18
that's interesting. When there are a lot of people, they all seem like individuals that need attention. Like you can't see people's background.

Sarah 43:26
Well, yes and no. So I like to Well, before the pandemic got like a party, for example, I would stick to like my group of friends. But I mean, that's normal. Yeah, so I'm not sure how to explain that. But

Scott Benner 43:41
yeah, well, I don't know, either. I'm just interested because I'm imagining myself in a group of like, many, many people, and I feel like I just see the sea of people around as just a blur of nothing. You don't have to be like, I don't see this on them. They could be there or not be there. I don't love gatherings like that either. Just so you know, I'm not. I'm not Yeah, that's not my favorite either. I don't know a lot of people who love to be around, you know, 100 screaming people. A lot of fun. For me at least.

Unknown Speaker 44:14
Wow.

Scott Benner 44:15
Okay, is there anything we haven't talked about that you want to talk about?

Sarah 44:20
I just wanted to mention, like, as we're going over the pro tips and things like I love all of the advice, and I really appreciate it. But it's important to remember for people with diabetes, in anxiety, like it is manageable, but it just takes a little bit more. What's the word? I guess, motivation for some people, it could be people with depression. It just takes a little bit more motivation to change these things. So I'm in a good place right now where I can Look at the three points you gave me. And I'm really excited to try this. But if you talk to me a year, two years ago, I would have just been like, Okay, that sounds great. But I don't think I'll be doing that right now, like, if Does that make sense? So it's important to remember that it's gonna, it's gonna work out, but it just, each person is different. And I totally respect that. And I just want to make sure that that's no one everybody listening can still remember, because I was definitely in the place where advice was more. So I was I was taking advice as insults in the past. And now I'm super excited about advice in diabetes, because I have that newfound hope for it.

Scott Benner 45:47
Oh, that's interesting. So advice felt like an insult. Meaning at some points, yes. Yeah. Just like, you know, hey, you know, you could do, you could get up and go for a walk. And that would be good for you. And you're like, I know, I'm lazy. And that's how it felt, right.

Sarah 46:01
And I know, a lot of people out there have anxiety and depression. But for people, like my boyfriend, who is an amazing support system, and all my friends, but I'm one of the only people in my, in my, I guess, bubble in my group that suffer with depression and anxiety as intense as I did. So for a while, it was hard to even reach out to be like, Hey, I'm struggling. And I in it, and sometimes it was just like, Well, why don't you go do this, like you said, and I think some it's important to remember that it's gonna be okay. You just have to? Yeah,

Scott Benner 46:43
that's interesting, because you found part of the podcast where it was people talking. And that made you feel like you're not alone. And that that was helpful. But I think, if I'm not wrong, what you're saying is that if you're anxious or depressed, that the process is going to take longer, right? Because you kind of have to make yourself right with a step and then move to the next one. And that even just saying, Hey, you know, it's basil Pre-Bolus. This, this is where you start. That could seem overwhelming to somebody Exactly.

Sarah 47:13
Because it's even though it's, we, as you were discussing it, you were like 1233 points, it's, we can do this in a couple of hours. For someone like me, it's more than that. It's more like, Well, what about this? What about this as an anxious person, you just think of all the bad things instantly, instead of like, Oh, this is going to be simple. We can fix this right now. You know, so, for people, I just want to make sure that everyone can can know that it that it just was gonna take a few more

Scott Benner 47:48
steps, I think, but and those steps are. So my 123 are really four or five, six, because Right, right, but 123 for you, if you have anxiety is how to how to get to a place where you can put those other things into practice.

Sarah 48:03
Right? And it's it's a lot of mental work.

Scott Benner 48:08
But, but are you unable to tell me what those other steps are? Because they're, do you even know what they were for yourself?

Sarah 48:16
See, I think it's different for each person. But for me, I would be like, Well, what about if I want to snack? What if I just go take a nap? What if I actually go do yoga? What if I go take a walk? What if somebody needs me to come to this? What if I'm working that day? And what if I'm have this big project to do tonight like that is kind of where I'm coming from? So like the anxiety of everything else in life? So with those steps, I

Scott Benner 48:45
say so the anxiety gives you worry about endless things that whatever you can imagine you're willing to worry about in that moment. Yeah. Like, like, what if I have to paint my room in the middle of this while we're Basal testing then right gonna happen? Scott, obviously, I'm gonna die. Like that. Right? Like it feel right. Like, I see. Okay,

Sarah 49:04
well, that's so like, when you were saying that, obviously, you're not gonna go to that place. But my brain is just like, what about this? What about this? And it's not like a bad thing. I'm just saying it's, it's some people. I mean, I kind of struggle with that, you know? No, I

Scott Benner 49:21
understand. I really do. I know people have anxiety. And I've spoken to a lot of people on the podcast who've been depressed or anxious and, and I'm never not it gives me a feeling of bewilderment, because I don't have that affliction, right? It's not happening to me, right? You know, if you said to me, you know, Scott later we're gonna go downstairs and get in the car and drive away. I don't start thinking like, Oh, I hope I don't fall on the steps or have a car accident or something like that. occurred to me. And it's

Sarah 49:49
Yeah, it's kind of funny, because that's your kind of talking how my boyfriend's explained things to me. So he's, we're like the ying and yang of that. So He has never struggled with anxiety. And I'm over here like, we would have what if this happened? What do we do this and then adding a long distance relationship on top of that, it's it's just a funny thing to me.

Scott Benner 50:12
Well, and it's tough because if you're the person with anxiety, it is not as easy as just being told Don't be anxious. Yeah, exactly. It would be like if someone came up to me and said, Hey, just stop having cancer. It doesn't work that way. And yet, people who don't have anxiety can't fathom what's happening to you. I know it's for me, I'm mesmerized and interested as you're talking, because everything you're explaining is completely foreign to me, I can't even put context to it. I just don't have I don't have that experience, you know, right. And to help you. Like, if you made it my empirical reason for being alive to help you not feel anxious. I don't know what I would say to you. You know, what I mean? Like, I can hope is that if your blood sugars become more stable, that'll be one less thing for you to be anxious about, maybe that'll free up another break in the clouds for you to do something else, you know,

Sarah 51:07
right. And that's, that's why I say I think it's super important for people with diabetes, even if you don't struggle with anxiety, or depression or, or any mental illnesses, I think it's still super important to see a therapist to talk to somebody about it, because it can be really stressful. Yeah.

Scott Benner 51:28
Can you similarly to what I similar to what I just said, Do you have trouble believing that some people just don't have anxiety?

Sarah 51:36
No, not at all. I, I've seen it firsthand, like my mom doesn't ever really share the same feelings as me in that sense. And neither does my boyfriend or my best friend even. So, it's kind of interesting. But I've also learned from them in that way, like they've helped me to be more carefree. Yeah, but saying so it's a good thing, I think to be a part of communities that people are like me, and then people that are like, you were just trying to learn from each other. Right?

Scott Benner 52:08
Again, a place where you can be aspirational. You can look up and say, Hey, they don't seem to be worried that the house is gonna fall. Why is that happening? Yeah, right. And so what happens when you're around people who don't have anxiety? Do you just like, do you find wimzie? Do you just close your eyes and jump? Like, how do you? How do you get to that? Like, how do they become impactful on you, when they're not anxious?

Sarah 52:31
Something that has really helped me is grounding. So I'll just, like, look down at my feet, like, no, count my fingers or something silly like that. And just think about where am i right now? So I'll be at someone's house. And I'm like, Well, why am I worrying about this thing that's a couple months away, or just like, you never know what you're gonna, your brain is gonna make you feel with anxiety sometimes. And so I like to look at them, see how their body languages and I kind of just imitate that. And then for some reason, for me, it helps to just kind of act like them. And then I'm all of a sudden calm, and it's just like, Well, why was I worried in the first place? And before therapy, I never really would try anything like that. So I would just, it just was like a snowball effect.

Scott Benner 53:26
Yeah, so you basically fake it till you make it for your own. You're tricking your brain into being like, we're cool. We did it. It's alright. Don't worry, right. And then it kind of lets go.

Sarah 53:36
Yeah, and it works for me. And I'm sticking to that. And that's kind of how I do with diabetes. Like, this morning, I woke up, my number was 207. And it's like, okay, that's how my mornings gonna go. But it's really, it's not a problem. Like I can Bolus for my breakfast, check my number right after keep up with it and didn't turn into anything other than that, you know. So that's exciting.

Scott Benner 54:03
That really is exciting for you. I'm glad. Yeah, that's excellent. I mean, that's how the only way to do this thing, right is you have to have a short memory, like having diabetes is like being a pitcher. You can't You can't give up a homerun and then turn back to the next batter and think I'm going to give up a homerun, again, this is what's gonna happen, I suck at this, this is gonna go poor, you just have to forget it and move on. And it really is. It's one of the steps I think of coming to terms with diabetes is you really do have to come to terms with this is what it is. It's always going to be this not every day, maybe but sometimes, and I have to be flexible, so that when it does pop up, I don't get mired down in it, to just fix it and move on. And that's it. Yeah, good for you. Wow. I think you're a really strong person. It's a lot of extra work that that, you know, some people don't have to do that you're having to do. And it's very cool that you didn't give up. It's Really great that you saw something and, and kind of ran. ran towards it. I'm, I'm very proud of you and I've only known you for like an hour. So thank you. Yeah, and your episodes gonna be called break in the clouds. Oh, that's awesome. That nice. That's beautiful. Thank you. Oh, no one's ever said that before once I got yelled at. I'm gonna clear up said this. She's like, No, you're not. I was like, I'm sorry, I won't. Like it's very easy to push me around

Sarah 55:28
when you mentioned pictures and and home runs and things that reminded me. I played softball in high school for two years. And in two years, I probably had about 40 juice boxes. And so my softball coach called me juice box, which is kind of funny that I'm on the Juicebox Podcast,

Scott Benner 55:49
juice box. Get into the field, you're playing second.

Sarah 55:52
Yeah, I would be in the dugout with the Capri Sun before the next inning was up. And it was I don't know, I was a mess.

Scott Benner 56:01
Well, listen, I think there's a world where you could go play softball again, your blood sugar wouldn't get low while you were playing? Absolutely. And that world, just for clarity is a built on a great basil rate Pre-Bolus in your meals and understanding your food. That's it. I am dying to hear back from you. So I will keep in touch. Yeah, I want to know how this goes. I really do.

Sarah 56:26
Yeah, I'm really excited to this year has definitely been crazy, is a good word to describe it, everybody. But it's been kind of the best year for me.

Scott Benner 56:37
So let's, let's end with that. Because I agree with you, this might have been good for a lot of people. So taking a lot of the variables out of your life, for the lockdown gave you more bandwidth to look at the things you need to look at Is that about right?

Sarah 56:53
That's right, it's definitely kind of the not really a break. But definitely a break from unnecessary stresses in my life. And I was really able to reconnect with myself. I know that's cheesy, but it's true. And being able to have the job that I have and be able to go to school online and take care of myself. It's been wonderful.

Scott Benner 57:20
It's made some space for you to operate in. Yeah, so between the anxiety, the diabetes, and the rat race of life, you were just you were you were inside like a snow globe, and somebody was just constantly shaking it. But now, somebody put the snow globe down and you're able to focus on what's around you and, and this nose kind of fall on everything still, when you're like, Okay, I can take care of my blood sugar better than I can do this. And then you just needed more time you needed a slower launch. To me like, I really do think that's what it is. And it's what you said earlier, right? Like you just, there's more steps for you to get to something. And while while everyone else is racing forward, you'd prefer to walk forward, because it's gonna take you a little longer to step over the roadblocks in front of you. But then once you get over those blocks, you're good, as long as you don't get into a group of more than five people. I'm just kidding.

Sarah 58:12
Yeah, I mean, it's, it's a really great way to think about it. And I don't think there's really anything wrong with that, recognizing it and making the change. Are you kidding, that's what's important.

Scott Benner 58:24
There's nothing wrong with whatever anyone needs to do, to get through their thing. You know, like, because everybody has something. And you know, you just need to make adjustments, like the world's not like the way the world looks, makes everybody feel like there are rules. Like, this is what I'm supposed to do. This is what I have to do. This is the timeframe, I need to accomplish these things. And, and if I'm not making a certain amount of money, or don't get to this point in a certain amount of time, this whole thing's an abject failure, and I'm gonna die penniless and alone. That's how everybody thinks about life. And you really shouldn't, there's a billion things going on around you, you can just find the spot where you fit and settle into.

Sarah 59:06
And I think that's just the best way to think about it. I become a real optimist this over this pandemic, which is, it's kind of ironic, you know, but I really agree. I think

Scott Benner 59:17
there's a place for everybody. Yeah, there really is. And if you're trying to jam yourself into a spot you don't fit, you really should stop doing that. Right. You know, it really is a it's just a fool's errand to make yourself into something that you're not. You're delightful, sir. I really appreciate you doing this.

Sarah 59:36
Thank you. I'm so glad that I was able to come on and if I can reach just one person struggling kind of the same way I was. I mean, that's so worth it to me.

Scott Benner 59:45
You're gonna reach a lot more than one person so so thank you very much for sharing your story. I Was it easy for you to talk about yourself? Or did did you find this troubling?

Sarah 59:55
So I reached out to you maybe in June or two I can't even remember. And you telling me December, I was like, Oh, that's gonna be great, whatever. Didn't think about it for a couple months, anxiety rolls around when I get the reminder. One week away, you have a zoom with the Scott and I'm like, Oh gosh, what am I gonna even talk about? But it's always like, so worth it after I do a big thing like this or, you know, it's kind of like the stage fright of a project in school. Yeah, in that way. Yeah. I mean, it was not hard to talk about myself, because I reminded myself that some other people might be feeling the same way.

Scott Benner 1:00:36
Yeah, well, you did great. And they definitely are feeling the same way. So it's very valuable for you to talk about it. Do I have to put this right out? Are you gonna or you're not gonna freak out if it takes a little while for it to go up?

Sarah 1:00:46
Oh, no, no. This was a really cool experience for me.

Scott Benner 1:00:50
I'm glad I really am.

Huge thanks to Sarah for coming on the show and sharing her story. Don't forget there's gonna be a little update from Sarah in a second. I also want to thank on the pod makers of the Omni pod dash and makers of the Omni pod promise for sponsoring this episode of the Juicebox Podcast, of course also to be thanked today. The Contour Next One blood glucose meter. You can find out more about that meter at Contour Next one.com forward slash juice box and the Omni pod is available to you at Omni pod comm forward slash juice box head over and find out more.

I reached out to Sarah to get an update. And here's what she said. I graduated with my associates degree in early childhood education this May. I also earned certifications in children's education, career studies, and early childhood development. I was inspired to become a diabetic educator, but realize that teaching young children is my true passion. Just this week, I was offered a lead teaching position. In a Montessori Preschool. She's very excited. But she still wants to continue to spread awareness for Type One Diabetes outside of her career. She also says that there's always room for improvement. But my diabetes management has gotten better and my agency is getting better. It's now at 6.4. She's super excited to be vaccinated and getting back out into the world and meeting her friends. And she was excited to come on the podcast. Thank you so much, Sarah, I was excited for having you. I am super sorry that I lost the minutes at the beginning where we were getting to know each other. I want to thank everyone for listening and let you know that I'll be back very soon with another episode of the Juicebox Podcast.