#869 Type 2 Diabetes Pro Tip: Medical Team

March 15, 2023Scott Benner

A series for people with pre and Type 2 diabetes.

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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.

00:04:38 Regular check-ups are important.
00:07:03 Testing is important for diagnosis.
00:14:01 Lack of education for type 2 diabetes.
00:23:22 Take control of your health.
00:25:02 Knowing the consequences of diabetes.
00:34:48 Take charge of your health.
00:35:12 Take control of your diabetes.
00:40:16 Advocate for yourself in diabetes.
00:49:50 Take control of your health.
00:50:25 Blood sugar monitoring and therapy.

Scott Benner 0:00
Hello friends, and welcome to episode 869 of the Juicebox Podcast

Welcome back everyone. This is the third episode in our type two diabetes Pro Tip series. And today Jenny Smith and I will be discussing your medical team. While you're listening, please remember 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, or becoming bold with insulin. And don't forget, this is episode three. Episode Two was type two diabetes pro tip guilt and shame. And Episode One was type two diabetes Pro Tip series intro so we're up to three doing well, actually next week, fueling plan, the week after that tech. And the week after that is testing. Like what you'll ask your doctor to test for. It's coming together very nicely. I hope you're enjoying it. still much more to come. Don't forget, if you are a listener of the show, everything you buy it cozy eartha.com is 35% off when you use the offer code juice box at checkout. So if you're looking for some sheets or joggers, I actually really love the joggers. My sheets are great too. But jogger sir. Excellent cozy earth.com 35% off at checkout with the offer code juicebox. This episode of The Juicebox Podcast is sponsored by Dexcom, makers of the Dexcom G six and Dexcom G seven continuous glucose monitoring systems. Doesn't matter what kind of diabetes you have. Dexcom is the way to go. dexcom.com forward slash Juicebox Podcast is also brought to you by the contour next gen blood glucose meter, you need a great blood glucose meter, you might as well get one that's actually accurate and easy to use contour next one.com forward slash juicebox. There are links in the show notes and links at juicebox podcast.com. To these and all the sponsors. When you click on my legs, you're supporting the show and helping to keep it free and plentiful. Hey, Jenny, how are you?

Jennifer Smith, CDE 2:31
I'm great. How are you? Scott?

Scott Benner 2:32
I'm doing well. Thank you. Yay. So right before we recorded, you and I kind of went over what the next step was here, right? We've already recorded like an introduction to the series, we talked about guilt and shame. And then we said, do we talk about technology and medications and insulin next? Or do we talk about what might happen when you get to the doctor's office next, like what's the path that the story should take in the series? And we came down to? We're going to talk about medical care first. Yes. All right. So there's some stuff here from people, and we can definitely go over it. But I think I want to talk to you first about this. So I am a person who has type two diabetes, I'm listening to this, I've decided I'm going to do something I'm going to do. I mean, what I'm trying to think of what the average person is going to do, they're going to call their general practitioner and asked to get a physical probably

Jennifer Smith, CDE 3:28
correct, typically, or if they've got if they've had enough types of symptoms kind of building up that they're concerned about. They would call with a specific concern, right, not just to get a physical but like, I think something's going on. I feel like this. I don't like how I'm feeling. I'm tired all the time, et cetera. I think I really need to come in and many adults get into the habit of not even going for a yearly physical. Right? Because I'm healthy, I feel fine. And I get a cold once a year and everything is totally fine. And I'm up to date on everything. So what do I need to see my general practitioner for? Yeah, then you start feeling nasty, and many adults with a busy life. They put off that I'm not feeling quite right. And they put it off. And they put it off, because there are many things as an adult that we're trying to manage day to day and overall. And so you end up not taking care of yourself for a longer period of time that is probably appropriate.

Scott Benner 4:39
And you're sliding, you're sliding so slowly down that hill, in many instances, you don't recognize how far you've kind of gone, correct. Yeah,

Jennifer Smith, CDE 4:47
I mean, I think you know, as a preventative, quite honestly, if anybody takes anything away, it really should be. Even if you don't have diabetes, go to your general medicine. Medical Provider once a year, get your base labs done, get them done, get them evaluated, have a discussion, family history, all of those kinds of things. They should be being reviewed. Yeah. Because if you can catch a change in glucose levels, as we're talking about diabetes, if you can catch that earlier, I mean, what is it? I think the statistic is one in three Americans, right now has pre

Scott Benner 5:27
diabetes. How is that defined?

Jennifer Smith, CDE 5:31
So pre diabetes is, if we're looking at glucose levels, you're looking at fasting levels that are above 100, but not in the realm of diabetes. And if we're looking at a one C, which again, is a parameter that, I think it should just be added, with this yearly visit, every single year, you should just have an A one C thrown in there, kind of like they throw in cholesterol and you know, your complete panel, just throw the a one C in, if we can catch and have somebody know, well, goodness, this level has gone up, it's not where it used to be. pre diabetes is defined as the a one C 5.7, upwards to 6.4. And anything above 6.4 is diagnostic of of diabetes. So you've got this, this window of ability to navigate management. Again, the problem being that many adults have put off a lot of their own health care. Unless something really doesn't feel right. And sometimes that's you're well beyond prediabetes at that point,

Scott Benner 6:38
what are some things that I can see in my home? That I don't need to go to a doctor for? Like, I'm trying to like? Do you get tired after meals? Like what are indicators that your blood sugar is high, like physical indicators for people, not type ones, right? Like, is there anything I can like say to myself, geez, maybe this is an indicator for me? Or do I need to do the testing, even just to know.

Jennifer Smith, CDE 7:03
So pre diabetes, the unfortunate thing is that there are not really signs or symptoms, honestly, it really would involve testing. I think those who, who may be concerned already have had some testing done, everything looks like where it should be. But if you really want to keep up with it, get a simple glucose meter from your pharmacy, and just do your own random testing. And this would go because we know that type two has a genetic component to it. This would go for those who especially have a strong family history of type two, or maybe have some metabolic things that they already know about, that could potentially predispose them to diabetes.

Scott Benner 7:48
So what blood sugar Am I looking for? When do I test?

Jennifer Smith, CDE 7:52
Yeah, so fasting blood sugar should really be again, under 100, under 95, and somewhere under 95 to 100. Right? That's a fasting level. And that would be without diabetes, which is the reason that in diabetes, we focus on that, like, Oh, my fasting was at today, that's perfect. That's right where I want to be. And then you know, in terms of of diagnostic, then we not only often look at an E one C level, but also lab work that kind of goes along with that, right? So blood sugar levels in the aftermath of meals, if you're doing any of your own testing really, in they shouldn't be rising above that 140 mark, honestly, they should be kind of coming right back down on their own. So those are some of the things that you could be looking at, again, if you are someone who is trying to pay attention, and stop it before it gets to a diagnosis of type two diabetes.

Scott Benner 8:56
All right, well, okay, so now I'm motivated, and I'm gonna go to my doctor. Now, here's some feedback from people in the in the, in the group, but standard of care for type two globally is terrible. It goes like this Metformin, long acting insulin, eat better finger wagging. That's it, you know. So I know a number of people have type two diabetes. So I'm sort of calling off my knowledge from my private conversations with them. I'm going to make an amalgam of these people and talk about it, right. They go in, they don't know, they have a problem. We've already gone into this, right? There's no real symptoms, they find out they have this issue. And then what happens next is scattered and they leave more confused and scared now on top of being confused right before they were like, I'm fine. Then they get in there and they're like, oh, it's not fine. I have pre diabetes. I think I'm gonna get type two diabetes, or I have type two diabetes and They get a meter and no direction. And they get told to eat better and come back in six months, and we'll see if this gets better. That's about it. Right?

Jennifer Smith, CDE 10:10
That is, that's the best in a nutshell. 100%, correct? Absolutely. I mean, it is. Because consider going to the doctor, even if it's just a random once a year, right? And you think I'm feeling fine. I don't think there's anything going on here, right? And diagnostic for type two, not just pre diabetes is fasting levels above 126, which, in diabetes, were like, Man, my blood sugar's 120. You know? I'll take that. Take her, you know, I mean, some people are like, Oh, 120, I gotta like, go take a walk, I have to get that back down, or, you know, whatever your targets are. But in type two diagnosis, or diabetes diagnosis, it's fasting above 125 126. and above, right? So when we're looking at going to that doctor, maybe you did have some fasting levels done, maybe there wasn't an emergency in it, but there was a fasting level done. That should be an instant discussion that the doctor brings up, hey, your levels are here. I mean, many times they focus on the lipid panel, or like your cholesterol panel, right? Oh, look at this, and they want to add these medications in and whatever. But the other ones are very important. And glucose, I think is I want to say that it's missed. But I think it's, it's too coded over. And it's not explained well. So the doctor who spies it, and says, Well, gosh, you're fasting is here, let's have you come in again, and do another fasting level, or, Hey, this level means that you could have type two diabetes. And in order to best evaluate, let's get an E, one C done. This is what the a one C means this is what it will show us. And so you can see all of the steps of discussion that should be given to the person, just from one test result, you can't necessarily prove however, something like an A one C would be very, very beneficial. Because that's as we all know, a good overall of how your glucose has been managed by your body for a bit of time already, not just this one point of time fasting level.

Scott Benner 12:29
So So what's going to happen, right is that people are going to be told, eat better, that's it's going to be very simplified, they're gonna say you got to eat better. Meanwhile, you might go from actually eating perfectly well, to not knowing what the hell that means, like, you could run that gamut anywhere. But what I see when I speak to people, is that they go home, and they do eat better. And then they come back to the doctor, and nothing's changed most of the times. And then you get that like, hands up in the air feeling or you are you get put in a position where you're a person who really doesn't eat well. And now in your mind, you're picturing three little crowns of broccoli, and a quarter of a chicken breast with a little pepper, like sprinkled over it, you're like, Wait, that's how I like you don't mean, and then I talk to people who do that, they get that and then it doesn't matter. Because, you know, like, that's not the whole answer. Right?

Jennifer Smith, CDE 13:26
And what does what does? What does better in any sense mean? Betty better is nondescript, right? Yeah. It doesn't give you any good avenue to follow to improve in one way or another. So eat better? Well, gosh, Doc, do you know how I'm eating already. I'm already trying to do this, and this and this. And I might have one Friday, every other weekend, that I do something with my buddies, or, you know, I go out with my girlfriends or whatever. But in general, I do think that I'm doing pretty well. I think that what ends up happening in adult diagnosis is that you are given this information. It's very lacking in

Scott Benner 14:14
their education and their basic assumptions.

Jennifer Smith, CDE 14:17
They're based on assumptions that you can say that the doctor can tell you go eat better and go get active. The doctor thinks that as an adult, you you know what that means, right? That you can take that and you can run with that information. But as you know, those with type one really know, we need more information. So someone with type two who has lived a lifetime thus far into whatever age of diagnosis as an adult, you've gotten to, you're looking at a significant amount of change, and not having anyone point you to where to start. That's very frustrating. And so you might leave you know In terms of what, what can you ask, right? When you are at your doctor's office, and they say, Well, you know what your your levels are looking like this. And it looks like you have type two diabetes. Okay, Doc, what does that mean? Point me to some resources, right? Am I going to need some medicine? These are all questions that unfortunately you as the person, you have to start asking. Yeah, and a lot of people don't yeah,

Scott Benner 15:25
this is the time where you think yourself like, why am I listening to a conversation about type two diabetes with a guy who's the father of a type one, and a lady who's a type one and and you know, well, first of all, JD is also a nutritionist. But that's, you're listening to us because we know how to advocate for ourselves. And because that, that's where that's where the big differences between type one and type two become important type one diabetes, you get it, you're dead in three days, if you don't take care of yourself, right? So you have to figure it out. And then like it or not, most people don't get decent direction with type one diabetes, either. So you go home, and you're like, This is on me, like, I gotta, I gotta, I have to figure this out. I have to read about it, I have to find somebody who knows it's you get into a mad panic to figure it out, you know,

Jennifer Smith, CDE 16:15
either that or the person with type one, especially as a caregiver, or as an even as an adult diagnosis a type one a lot of people are, they beat down their doctors door? Yeah, they say, this is not working, you will call me back, you will respond to this. What can I do different? Where can I get more information? They are, again, I think advocate advocating in a way that means they're requiring someone to respond to their questions. Unfortunate with type two is, again, the way that somebody is sent out the door with a diagnosis. It's almost as if you're just given this little bit of information. But it's okay. If you if you just take what I gave you and you eat better, right? Don't worry about it. There's no definition to when to come back. Where to seek out additional help. What does your medication even do? I'm telling you to take this and do this this many times a week? What does that even mean? How am I gonna feel from this? So these are, these are all the questions that I think from an angle of type two diagnosis, you have to take it on yourself, and you have to go back to your medical team. And you have to say, Steve told me to do this. And I started with these base things like you said, I've cut down in my my eating or I've portioned better, or I've started to take a walk three times a week when I have some time. And how do I measure that this is doing anything, doctor? How do I know that this is making a difference? Right?

Scott Benner 17:51
That's what I was saying earlier, it's one of the biggest problems is that when you're when you have type one, you'll know you're not doing well in a few days when you slip into a coma and you're in DKA, right? But type twos don't have that happening in that moment. So you might go along just the way you like, you have to really think about this before you go to the doctor and did the blood tests. You thought you were okay. How would you like to know what your blood sugar is, without poking a hole in your finger, you can with the Dexcom G six continuous glucose monitoring system, which is available@dexcom.com forward slash juicebox. Not only this Dexcom offers zero finger sticks. But you can get your glucose readings right on your smart device that's your iPhone or your Android don't have a phone. That's okay. You can use Dex comms receiver on any of these devices, you're able to set up customizable alerts and alarms, setting your optimal range so that you'll get notified when your glucose levels go too high or too low. End, you can share this data with up to 10 followers. Imagine what that could look like your child could be at school, and their data could be available to you, your spouse, their aunt, the school nurse, anyone who you choose. My daughter has been wearing a Dexcom for ever, and it helps us in multiple ways. Around meals, we're able to see if our boluses are well timed and well measured. If they aren't, we can tell by how her blood sugar reacts and then go back the next time and make an adjustment. Without the Dexcom CGM were sort of flying blind, but not just at meals. Also during activity and sleep. The Dexcom offers us an unprecedented level of comfort and security, being able to see my daughter's blood sugars in real time and not just the number but the speed and direction is an absolute game changer if you're using insulin dexcom.com forward slash juice box head over there today to see if you're eligible for a free 10 day trial. file of the Dexcom G six. The Dexcom is at the center of how we have been able to keep our daughter's a one C, between five two and six two. for over seven years, we've been able to minimize variability and keep her blood sugar's in a stable range because of the information that we can see with the Dexcom. These are our results and yours may vary, but using Dex coms feedback has helped my daughter without any food restrictions, live a more normal and healthy life dexcom.com forward slash juice box. And guess what in about three weeks Arden's gonna start using the Dexcom G seven. So I'll be able to report back about that just as soon as we have some information. Okay, so you've got your CGM, you're all set with your Dexcom. But you still need a blood glucose meter, right, you're gonna have to check your finger. Sometimes, the one that doctor gives, you might not even be accurate. But you can know you can trust in your soul, that the contour next gen blood glucose meter is one of the most accurate meters you can find contour next one.com forward slash juicebox. couple of cool things about the contour meters. One of them is that they may be cheaper in cash than they are through your insurance that goes to the test strips as well. And those test strips have Second Chance testing, meaning if you kind of touch some of the blood, but don't get enough that you don't ruin the strip, or the accuracy of the test. By going back and getting more blood you got a second chance those strips that meter all the meters, check it out, go to my link contour next.com forward slash juice box. Click on Buy Now it's orange and blue. And it will take you to a number of places online links of that so number of places online where you can pick up the contour meters, places like Walgreens CVS Meijer, target right and more, you'll see it there at contour next.com forward slash juice box, get an accurate meter

then you get the blood tests you find out you're not. But then when you go back home again, things sort of go back to like the way they were correct. And as you get farther away from that doctor's appointment, you start feeling calm, okay? And then so you don't know that things are either getting worse or not getting better until the next time you think to call the doctor to make an appointment to get more bloodwork, which no one wants to do. It can come six months or a year sometimes. Yeah, and then you find out I'm either no better off or things are sliding further. And an exercise. Listen, it's obvious, you know, we all need exercise like like, right, like, that's fine. But people have lives. And they some people just don't exercise very much. Some people don't have the money to buy decent food. And some people don't know what any of this means. So you didn't know before you get to the doctor, you find out you're in a situation you still don't know anything different. The guy just said, eat better exercise, come back and see me sometime. Get yourself a meter, you have to dig in and figure out what this means. Like you have to decide like, am I gonna be the one that takes care of this? Or am I gonna sit around and pretend this isn't going to get worse, right? And I'm here to tell you it is going to get worse.

Jennifer Smith, CDE 23:35
Because there are a lot of if you kind of set it the right way. It's like you you've given this, you've gotten all this information, but on your end, now it's up to you, unfortunately, it's up to you to go and look for more like what does this mean? And there are there are a lot of good resources for type two diabetes management. I mean, the internet is endless, right? It is an endless wealth of of information where you get the information from could be great or not so great. But there there's a lot of good information but if you don't even know what you're supposed to be looking for, again, it's it's a sense of confusion and frustration. And you know, I think we talked about it before like this sense of, oh gosh, I've I've now I have this to take care of Clearly I've not done anything right It's like a It's a self blame and you feel bad about it and you're not you're not maybe you've got a family to take care of and now you've got also this thing to take care of for yourself and it's another load on the pack of stuff that you have to manage.

Scott Benner 24:48
Shame on you the shame and guilt pile on and it just and I think here is the place to say like I've done this in the type one series and in the in the pot To cast and I just think it belongs here to, I don't think people know why it matters that they have diabetes, I think they know that diabetes is bad. And then they relate it to people being overweight, and then they relate it to something they saw happen to their grandparents, right, like nobody really understands, there is a certain amount of glucose that should be in your blood. And when there's too much, it begins to rub. inside of your body, everywhere, blood glows, the tiniest little veins and your eyes, arteries everywhere, everywhere, there's a course glucose on there, and it's rubbing. So just think of yourself as being sandblasted from the inside out, like there's a certain amount of glucose that your body can deal with. And there's a certain amount not. So when you hear somebody say, Oh, my grandfather lost his leg to diabetes, you don't really know what that means. You know, when you hear somebody say, I had a heart attack, or he had typed he had diabetes, and he had a heart attack, he had a stroke, he doesn't see anymore, he can't feel his fingertips, all these things that you hear, it just means that the glucose inside of your blood, which was too much for it was rubbing, rubbing, rubbing, and it causes and I liked the way you describe it better causes little, like utopia we talked about at one time were kind of like, like, what's

Jennifer Smith, CDE 26:17
like little abrasions inside, right, and so your body then has to, to patch them, right? It has to heal that your body is a really good self healing machine. So it sees all of these scratches, if you will. And it wants to put a bandaid on it. And the problem with that is if you don't take steps in your life to improve the glucose levels, your body will continue to get deterioration in the vessels on the nerve cells and everything. And your body will continue to patch and patch and patch. And so, you know, I know people can't see me like my hands getting closer. But if you imagine a vessel as it's sort of narrowing, the reason that heart disease is a big part or could be a complication with diabetes is that the more vessel level damage that there is, the more narrow the vessels get from all of the healing and the patches that the body has tried to help. And so now your blood pressure goes up. And now cholesterol levels go up and all of these pieces. It's like a snowball effect, right? Yeah, yeah, I

Scott Benner 27:29
mean, I just try to imagine a three inch pipe and has a hole in it, you slap some putty in it, and then it starts leaking, again, you slap and more putty in the 20th time you slap them putty, nothing can go through the pipe anymore, you high blood pressure, right bloods moving through that pipe, you're restricting it, you're increasing the pressure, the blood in your system, high blood pressure, this is just, here's the thing. diabetes untreated, and a type one is going to, it's going to get your way before these things can happen. But in type twos, this is this is where you're on your way to it just it just is and you're not going to it's not going to stop on its own. So you have to step up and do something and when you run into a doctor who's given you, but now, bullshit, that isn't going to help you, and they just are running you back out of the office again, you can't just go well, that's what the doctor said. So I guess that's okay. Because the doctor won't be there. When an artery in your heart gets blocked. Or when your vision is that doctor won't know though you'll get a different doctor, then we'll say something to you, like, oh, did the last guy not telling you about this, which is not going to help you. It'll be fun. It'll be easy to be mad at somebody and to blame somebody. But if you really want out of this, you got to do what you need to do. And that's why in future episodes, we're going to talk about technology and medications and insulin. Because from my perspective, when I think about me, if you told me right now, I had pre diabetes, and I went and did the things that I was supposed to do. And I came back and nothing had changed. I would immediately go to getting help. Because yeah, so I can turn the ship around on my own. I don't want it to take on water. Like that's how that's how I would think of it I would go immediately to keep me as healthy as you possibly can. And slow deterioration as much as possible.

Jennifer Smith, CDE 29:27
Right. Yeah. And there are and that's why I think the word advocate right becomes really important any, any time you go to your doctor's office, even if it is just for your once a year checkup. You have to be rented ready to advocate for you. Hey, Doc, I've noticed this or I seem to have this Well, the doctor then in terms of what you've brought in, she'd say, Well, gosh, it sounds like you see the eye doctor right? I'm not seeing quite as well or my night vision is go Okay, let's go get that checked out. Right. But if you don't bring those As pieces up to your doctor, then the doctor can't provide back any further suggestion. And so with type two diabetes, advocating by saying, Well, gosh, you've told me to do these things in this first visit, what does it mean to have high blood sugar? The doctor should be able to answer that for you. Right? And on a very base level and what Hey, Doc, what should my blood sugar be? You said that it's high in this lab result that you have in front of you? Where should it be? What am I aiming for? So these are questions that you may not know to ask. So hopefully, you know, hearing this, you you may know better. And or you can help somebody, you can teach somebody else,

Scott Benner 30:44
I want you to be ready with questions and know the answers to the questions already. Otherwise, you'll accept anything that's told to you, and I'm telling you, you are going to get advice that sounds like I don't know, like, Hey, Doc, I have this cello here. I don't know how to play it. But I want to play Bach, what should I do? And the doctor is gonna say something like, oh, you should sit down, take the bow and play Bach and skip a lot of the stuff in the middle. And so you're gonna get a lot of, it just sucks. Like, I don't know another way to say it. And if doctors are listening, I'm sorry. Like, I know, you think like, oh, there's a lot of Doctor hating going on in here. Well guess what do a better job. You know, like, I think the problem is, is that for a lot of doctors, not all of them, they're going to see you with your type two diabetes coming. And they're just going to do the same thing everybody else does. They're just people. And they're just going to assume that you didn't live right. And this is basically something you've done to yourself. But that listening, it doesn't matter. That may or may not be true. None of that matters now, because here we are,

Jennifer Smith, CDE 31:48
right. And we need to take care of this now. And so from that level, you know, the doctors job, if there are doctors listening, certainly the doctors job at that primary care level is to be somewhat of an advocate in sending you out to the right person then, right, they should say, I don't know how to tell you how to check your blood sugar. Okay, but I want you to do it. So here are the education programs, or here is the diabetes educator, or here is the dietician that I'm going to send you to, for some baseline information. Yeah, they should have those as references and resources to provide to anybody, whether they ask for additional education or not, that should be on their prescription pad of, I've prescribed this medicine, I've prescribed this glucose meter, you also need to go and get information because I can't give it all to you. And I think even on a level of admitting that, I think many, many people hearing a diagnosis from a doctor would appreciate that that doctor says, I don't know much more about this, I have a baseline amount of information to provide you. These are the people that are going to help you navigate this in your life. Yeah,

Scott Benner 33:07
yeah, you have to find other people who already have succeeded. It's no different than anything else in the world, you have to look ahead of yourself and say, who's on this path, doing a good job? Like, I gotta go find out what they're doing. Because, you know, maybe they're, maybe their situations not going to be exactly the same as mine. But there'll be a lot for me to learn. And then I'll go find someone else who's having success and learn from them. Yeah, you can't learn from people who don't know, and you can't learn from people who are failing at it. Like you need to find someone who's doing and I know, failing and succeeding are bad words and healthcare and everything. But this is what we're talking about here. Like, like, you don't have forever. We all know that. Right? Jenny? Like doesn't go on forever. Yeah, unfortunately, once you're 60 your knee hurts anyway. Like, get in the game. You know what I mean? Like, this is this is the part here. Also, you have to realize that if you find a doctor, who is gung ho, and is like, no, no, we're going to stop this thing in its tracks. Here's this and this and this. Now, the here's the next thing, they don't tell you, that pill might make me nauseous. It might have me in the bathroom forever, that that doesn't make you feel good about taking the pill. And so you're even if you run into somebody who who knows what they're doing and knows how to help you, you still have to understand what's about to happen next. And is that supposed to happen? Is it supposed to happen to this degree should we be changing the the amounts the frequency, etc. You I know this sucks and people with type one who hear this will just know that this is part of their life, but this is a thing now. It's a thing you're in charge of. And and you you need to understand it and you need to stay on top of it. And you need to be the captain like piloting the ship. Like there's just you can't let anybody else do this for you. Because they're not going to be there. It is where you start seeing overlap in the conversation. And if you have type two diabetes or prediabetes, you don't know this. But Jenny and I are sitting here looking at each other. This is where the overlaps with type one start coming in. Like you have to, you need to go out get the information you need to be paying attention to the outcomes of what you do, you need to be thinking about what can be adjusted here is the time of you skipping through life is it's kind of over now that you're in charge of something important, you know,

Jennifer Smith, CDE 35:30
right. So and that's, that's hard for, as I said much earlier, from a lifestyle angle. This is a lot of adjustment. And when you're already as an adult, especially when you're already on a routine of doing things a certain way, and it gets you through your week, and you make it to the weekend. And then you've got other things that you have to do. You have to learn how to work this in. And unfortunately, it's not a well learn how to work it in in a couple of weeks, when I've got time, kind of like straightening up your office three weeks from now, when you've got time. That's not how this works. And I'm not I mean, it's not funny, but it makes me laugh a little bit, because honestly, it's, it's like a here and now you have to start making a shift and a change. And I think that's why the very simplified information the doctor gives you is like, we'll just walk out of this office and just change up a bunch of things. But it's downplayed to the degree that it's not really something to worry about too much. Yeah,

Scott Benner 36:31
they leave you feeling like it's not that big of a deal, right. And then and from the perspective of other people I've spoken to, then it goes on for a while. And one day, the doctor looks up and thinks that guy's been coming in here for two years, nothing's getting any better than they look up at you and yell at you. And they're like, you're gonna die. You're like, Wait, what the hell? Like, what, like, you gave me a meter, you told me to eat more chicken, like, now I'm dying. You know, like, it's just it's

Jennifer Smith, CDE 36:56
are the addition of so many more medications, like you said, you know, you've come in, you've come in routinely, you know, for the past two or three years. And while the doctor might now be looking at some baselines of numbers, while those numbers aren't improving, okay, well, as we all know, a one C again, is it's an average, it doesn't show day to day what's happening. So unless you've got finger stick data, or unless you can advocate and coverage is okay for you to get a continuous glucose monitor. All of these pieces could show the doctor that while he or she has been adding more medication that hasn't been helping, so there's got to be something else to provide, rather than just loading you up with more medicine.

Scott Benner 37:45
I'm gonna tell you right now, I the the insurance system works the way it works. And people's money is what it is. But you make me the king of the world. If you're not regular. If your body doesn't regulate your blood sugar, well, you get a glucose monitor a continuous glucose monitor, you're wearing a Libra or a Dexcom or something like that, if you put me in charge, because it just teaches you so much faster. I see how this food impacts I see what this medication did I see what my exercise? Did I see what my better sleep does like it all. It's right there for you. So yes, yeah, if you will argue

Jennifer Smith, CDE 38:20
Exactly. If you've got a good insurance, absolutely argue from the start, and it's snowing again. Do you know enough to argue, this is why I think this information is so important so that if you are more newly diagnosed or you're not, and you didn't know what to argue for, you're thinking, Well, why didn't anybody tell me about this? Yeah, gosh, I could have a lot more, you know, beneficial information. But I didn't know to even ask for.

Scott Benner 38:48
And now it occurs to me to say, a continuous glucose monitor is a device that you wear, and it's measuring, this is boring for you, but it's going to measure the glucose in your interstitial fluid and on a receiver or your cell phone, it's going to show you constantly where your blood sugar is the number if it's moving up, if it's moving down, how fast it's moving up, or how fast it's moving down. And then eventually these you know, these plot points give you a graph that show you the last three hours last 12 hours last 24 hours. And there's so much to learn from that. So while we're sitting here telling you learn about your diabetes, the easiest way to do that is to wear a glucose monitor. If you told me today I had pre diabetes, I don't think the doctor would get it out of his mouth before I said, I need a Dexcom right now give it to me. Right so

Jennifer Smith, CDE 39:37
and there are there are some platforms to that even there. They're like the weight loss types of platforms now that are using some of the continuous glucose monitors, just from an overall health like visibility. They they're not even specific to diabetes. They're just Hig get a continuous glucose monitor and use it with our weight management system. So you can see how the effect Have all of these things in your life? What what's happening,

Scott Benner 40:03
I'm recording soon with a person who uses the talks to people about how to use a glucose monitor just to see the impacts of the food on their life, not people who have diabetes, but for other health reasons. And it's just I'm telling you, you have to I know the word advocate seems boring, but you, you really just have to fight for yourself. You just you have to, like, I'm gonna kind of end with this, then I'll let Jenny say what whatever she wants to end with here. But my daughter is walking around now 18 years old. She is 16 years past the day she was diagnosed with type one diabetes, her a onesie has consistently been between five two and I used to say six, two, but now she's in college by herself. So between five, two and six, five, she lives every day. She's not afraid of her diabetes. She's using her insulin when she's supposed to she manages her food and her activity and her illnesses. And I am telling you that she is in that position right now because of two things. She's in that position right now, because of how seriously I took it when she was diagnosed. And because of how seriously she took it as she got older. It's all about I don't know, like, it's like, it's probably like trying to hold a tornado in your hands if you're a giant, right. But you can try, right? Like, it's not easy. But it gets easier. It's not, in the beginning, it is not something that will make sense to you. But you can make sense of it. And then it's not something fun. Like nobody, nobody listening, you know, was like, Oh, I know how my life's gonna go, I'll be great at T ball. And then I'll go to school and I'll meet a girl, then I'll go to college, we'll buy a house, we'll have kids probably get a dog, I'm gonna get a car, the car, I always wanted my whole life, those kids will have kids, it's going to be amazing. I'll go to Florida. Like, I know, that's what you thought was gonna happen, or some version of that, you know, people are probably like, this guy's idea of life is very boring, like so. But, but But okay, but like, you had some path that you thought you were gonna go on. And now suddenly, in the middle of it, somebody's like, No, you have diabetes. These other things still can happen. They can happen exactly the same way, except now there is an amount of your, of your bandwidth every day that's gonna go towards this. So you're gonna have to, you're gonna have to give it to it, or you don't end up in Florida at the end. Right, you know?

Jennifer Smith, CDE 42:27
And, you know, I think you bring in it's sort of like a, it's a behind the scenes to what you're saying, honestly, because I've said before, nobody would want to live in the land of Jenny. Suffer, Jenny. Because there, there are so many things that in everything you just said, all of these shifts and changes, unfortunately, from a light their lifestyle perspective shift. And from, from what we know about type two diabetes, there are many lifestyle things that we could be cleaning up in terms of potential prevention. Does that mean 100%? Prevention? No, it does not. But there are a lot of lifestyle things that you will end up learning you need to shift or change that are not well described by the doctor. But had we started with them earlier in life.

Scott Benner 43:26
You might be here now or maybe it would have happened later or less severe. Like, I think there's there's this thing, we're always going to be talking around that we don't want to blame people for further help. Oh, yeah. And we certainly don't want to, but you should know that somewhere everywhere. There's a person who stands six feet tall, super handsome, nice and lean, very athletic, blah, blah, blah, and has type two diabetes. Yes, right. And that same body style has type one diabetes. And somewhere there's a person who needs to lose 150 pounds, who has type two diabetes, there's also doesn't, right? And there's also somewhere a guy who needs to lose 150 pounds, who's never gonna get diabetes in his entire life. Like, the problem is, is that our brain shift to building a person in our head visually, that we think looks like didn't take care of themselves. And that is not a factor here. Like, but, but for the person it is a factor for it is a factor. It is a factor. Everybody like you can be you can be wildly overweight and healthy, you can be wildly in shape and have

Jennifer Smith, CDE 44:34
medical problems. Absolutely.

Scott Benner 44:36
Trying. The point is, is that the rhyme or reason to all that is bullshit, except to the person who it isn't. So if you're a person who eats poorly, and you know is you know, I don't know just eating food, you probably shouldn't be eating and you're carrying extra weight and you have type two diabetes. Well then here are the things that we can fix right now. And my

Jennifer Smith, CDE 44:57
you have to take the variables you have the ability to control. Yes.

Scott Benner 45:01
Yeah. And you also have to get rid of the. I don't know what like the pompous thing of like, well, I'm in such great shape. I can't have died. Well, yes, she can. So, right. Yeah, metabolic metabolic, right. Like, it's just, it's one of those. Yes. So I think that I think that I want people to, because I always come down on the side of when we start talking like this. It's like, I don't want to blame anybody, mostly because I don't think it gets us anywhere. Like, you know, like, we're in the point. Now, I obviously, this is a podcast, you listen to a podcast, you can easily turn on another podcast that would say to you, like, you haven't problems with your health, you know, whatever. They say, like who rose the boat, you get out there run 19 Miles eat a piece of chicken the size of a Bic lighter. That's your day? Yeah, you can do it. Like, I don't think that's reasonable for most people. Like I just don't you know what I mean? So, so here we are, we're in the situation, just because I'm not the person who's gonna run up the beach every morning at 4am Doesn't mean I deserve to die. Right? Right. Like I get a life too. So here's the ways to get to that. You don't need to be perfect to be healthy, and you don't need to be perfect to deserve things. And I think that, I don't know, like, I've just I've had some conversations with people specifically who have type two diabetes, and it feels like, it can feel like they're like, Well, I did this. And now this is what I get. And I just don't think that's the case. And I don't think it needs to be. So we're going to try to get you through that in this series. Yes. Cool. All right. I'm sorry, Jenny. Somehow, it was upbeat and a bummer at the same time. sad things and a happy voice. And it was confusing

Jennifer Smith, CDE 46:41
to me. I got something it was confusing.

Scott Benner 46:45
I just they think about people in my life who were in the situation. And there are some of them who are not doing anything about it. And I don't think it's because they can't, or because they don't want to, I think it's because it's confusing, and no one's helping them.

Jennifer Smith, CDE 47:00
Right. It's a lack of information. And it's a lack of, it's a lack of knowing where the right information is, or even where to start looking. Honestly. And so, again, from the standpoint of your medical practitioner, advocate and ask for more information, because I guarantee you, while doctors are educators in a in a sense, they are not an educator, they are not there to sit for 45 minutes, and teach you things. It's not their job, either. That's not their job, and but their job is to provide you with information about where to get the right stuff to navigate with. And so they should have references and resources, again, diabetes education classes, especially for type two diabetes, there are a series and a number of education like ours that you can have within a year's time based on insurance coverage. So those are things you may have to ask for them. But don't be shy. Don't be shy about asking for them say, Hey, Doc, great. I think you've given me some information. Now I know what I have. I know why I've had, you know, some blurry vision. I know why I've had to go to the bathroom a lot more. You know, I'm more thirsty than I ever used to be or whatever it might be. But now, I don't know what to do about that. So can you send me to somebody who can teach me you have to ask

Scott Benner 48:27
you're in the game. You're in the game. Now I know. It. I know. It used to be. I broke my arm. I went to the doctor, he put a cast on it. I came back in six weeks, he took the cast off of it. The doctor did the thing. I didn't feel good. I went to the doctor, I cut my hand I had a cold. There's a lot of resolution in those relationships, right? Yeah, a thing happens. You meet the person, the person resolves it for you. It's over. This is not that. No, so this is different. You're you're you're, you're a real adult now. And you're sick, you know, something. And it's and it's on you. And you know, it's funny. I'm getting ready to see a new doctor. And I've been building a list in my head and I literally just went back to when I was young and I started writing down everything that's ever happened to me. I'm like, I don't know how much of this I'm going to tell them or not. But I looked and I thought How the hell am I standing up? Like, like, my shoulder, my knee my this my that like, and I look back and I think like, this is where that song came from. Something something I never promised you a rose garden. mean, like, my expectation was my shoulder wasn't gonna stop working during my lifetime. But here we are. Yeah. And so it'll either hurt and it won't work or I will figure out the best path to get it fixed. But I'm not just going to show up and tell somebody and they're going to wave their magic Doctor wand over my head and it's all gonna be over so you have diabetes, take care of it. That's what I got. Now. I'm frustrated. I'll talk to you later.

Jennifer Smith, CDE 49:54
Okay, sounds good. Thanks. Got it

Scott Benner 50:04
First I want to thank Jenny for coming on the show and sharing all of her knowledge with us. Jenny works at integrated diabetes.com You can check her out on their website. I also I also, I also want to thank Dexcom, makers of the Dexcom G six and G seven continuous glucose monitoring systems dexcom.com forward slash juice box, find out what your blood sugar's doing, how fast it's doing it, and what direction it's going in. And of course, you need you want you desire an accurate blood glucose meter, contour next.com forward slash juicebox. Check it out, please, they're fantastic

if you have type one diabetes, please go to T one D exchange.org. Forward slash juicebox. You have to be a US resident have type one or be the caregiver of someone with type one to take their survey. But that survey helps move type one diabetes research forward. So please go check it out. Don't forget if you're listening to the podcast 35% off your entire order at cozy earth.com When you use the offer code juice box at checkout. And BetterHelp is a sponsor of the podcast and they're offering my listeners 10% off their first month of therapy. It's a great deal. I hope you can check it out. Better help.com forward slash juicebox. Now better help is the world's largest therapy service that is 100%. Online. They have over 25,000 licensed and experienced therapists, they can help you with a wide range of issues. All you have to do to get started is hit my link. answer a few questions about your needs and preferences in therapy. And that way better help will be able to match you with the right therapist from their network. Better help.com forward slash juicebox you're gonna get the same professionalism and quality as you expect from in office therapy. And if for any reason your therapist isn't right for you, you can switch to a new one at no additional charge. Do therapy on your terms, text chat, phone video call and you can even message your therapist at any time and then schedule a live session when it's more convenient. So if you're looking for someone to talk to check out better help. Thank you so much for listening. I'll be back very soon with another episode of The Juicebox Podcast.