Scott Benner 10/3/20 Scott Benner 10/3/20

#389 Dexcom CEO, Kevin Sayer

Fireside Chat

Dexcom CEO Kevin Sayer is back to chat about type 1 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.

Scott Benner 0:00
Hello friends and welcome to Episode 389 of the Juicebox Podcast. I have a treat for you. Let's welcome back the CEO of Dexcom, Kevin Sayre. Kevin and I are going to have a pretty chill about 30 minute conversation where we go over a number of things that are going on at Dexcom. It was really was nice. And Kevin and I have talked to each other so many times, it just felt easy. And I think that reflects in the conversation.

This episode of the podcast is not sponsored by anybody. So there won't be any ads. Just a few reminders. First reminder, the T one D exchange, once you to join their registry, T one d exchange.org. forward slash juicebox. You've heard me talk about it on other episodes, get in there, find out what it's about. It is not an ad t Wendy exchange has not bought an ad on this podcast. I do however, get you know, a couple of bucks for every one of you that signs up. So if you're looking for a way to support serious Type One Diabetes Research, while you know kicking a couple dollars back to your friend Scott T one d exchange.org. forward slash juice box. Here's some other stuff. You're looking for a great doctor to help you on your journey with Type One Diabetes, where you have one to share with other people, please go to my page juicebox docs.com, give a penny take a penny, give a doc take a doc, let's build a great list for people to use. And if you're looking to share those pro tip episodes with other people, you can of course send them back to Episode 210 of the podcast where they can start. Or they can head over to diabetes pro tip.com. The pharmacy for veterans. That's new. And that

Kevin Sayer, Dexcom CEO 2:09
is new for us.

Scott Benner 2:10
It seems very comprehensive for who it's helping.

Unknown Speaker 2:14
It is okay.

Scott Benner 2:16
How does it work? What what so any veteran goes into where How do they do that.

Kevin Sayer, Dexcom CEO 2:21
The VA system is one of the largest health systems in the country. And as a population, one in four veterans ends up with diabetes. And and so this is a group that really, we felt could use our sensor. The coverage is very similar to Medicare with respect to its intensive insulin users who get to CGM now on multiple daily injections or a pump. But the fact that we can now they can get it through their pharmacy channel rather than all the DMV paperwork that that many of our patients have to go through. As we work on simplifying a distribution channel, this was a great win for us. And we think a great win for veterans.

It'll be great for that group.

Scott Benner 3:06
And if I'm looking correctly here, you don't to get coverage. I'm seeing need to have diabetes, you require insulin, an insulin regimen of more than three injections a day or an insulin pump. Yeah, so it's low level here. Yeah,

Kevin Sayer, Dexcom CEO 3:24
it's low level and there is no copay. That's great. They just go get it. That's amazing. Yeah, it's a really good arrangement.

Scott Benner 3:32
Excellent. And that's just any. So veterans listening will know what a VA pharmacy is, or is there a way

Kevin Sayer, Dexcom CEO 3:38
they will know if they're on a VA health plan? Yes, gotcha. They'll understand that

Scott Benner 3:43
that's really astonishingly exciting. Especially because it's not just I think it's easy to think of veterans, right as older people, but there's plenty of people who are much money.

Kevin Sayer, Dexcom CEO 3:54
There's plenty of people in that system.

Scott Benner 3:56
Yeah, no kidding. Oh, and there's a link here. I'm gonna. I'll link to it so that people can go right to it. That's excellent. That is really exciting. The last time you were on, we talked a lot about COVID, bringing Dexcom sensors into hospital situations. And that seems to be growing from there. Can you tell me where it's gone?

Kevin Sayer, Dexcom CEO 4:18
Yeah, I can. You know, we were contacted by more than 200 hospitals and we've got into more than 100 of them in various degrees. bringing new technology to a hospital is never simple. And bringing new technology to a hospital pandemic, isn't. That's even a bigger challenge. We've learned a great deal. I tell you, the first learning is why our product will function and do very well in that environment. You know, in the beginning, and one of the reasons we didn't have a labeled indication there is if you go way back in sensor days, there were interferences that could cause the sensor we had an acetaminophen contraindication For example, which we don't have anymore, we have an interference layer on our membrane. So there was a perception that these things wouldn't even work in the hospital. And the FDA, in all fairness wanted us to do some more work, we'd spoken with them about hospital indication, for years, do some more work to make sure that that interferences didn't cause the sensor to be wildly variable. But when you had several hospitals back east, where diabetes and COVID were converging, and people had good knowledge on the diabetes side, we were getting flooded with phone calls. And I believe the FDA was getting flooded with phone calls, too. So we got that non enforcement, discretionary non enforcement waiver, go do this, we will let you go play in the you know, go be in that market and see what we can learn. And it's got the experience when we started, you know, based on the phone calls, it literally looked like our entire inventory has been going to the hospital because people wanted so many sensors. And then as we started getting through this, you're training ICU people to do something, use a product that we designed for patients to use in their homes. And, and so we had to figure out how to make it work in that environment, we purchased a whole bunch of phones, because the hospital doesn't have fun playing around and they don't want their healthcare professionals carrying around their own phones, with patients data on it. So we purchased phones, to get the data to the cloud, then you've got the whole internet and connectivity issues in hospitals, because they have very strict HIPAA requirements. And so we've walked through all those things to get everything figured out. And what we've learned is our product can have a big impact, it cuts down on pp. Significantly, it cuts down visits in the room. Now the care professionals don't have to go in the room of the people with diabetes and stick their finger, it really can be used to eliminate one of the things that can advance the disease, because if your body is fighting high glucose values, and oftentimes these patients it was in the foreign 500 range. Combined with respiratory issues, your immune system can't fight both. It just can't. And so if we can eliminate the diabetes, variability from it, that is very helpful. We need to get this data from the hospitals to show what we achieved here. And what we've learned. We want to take it, we want to build a file, we want to get back to the FDA and say, you know, this is what we've learned here, what are our next steps in creating a hospital application, the other learning on our so that's why we have the registry, we wanted an organized manner where data could be kept private and secure. Hospitals would be comfortable getting data to us. And we can compile the registry and then go to the FDA and say this is what we learned. This is the data we had this is the profile the patients. This is the compounds they were on when they were in the hospital. Here's how quickly they got out all those types of things and use it as a base. We think CGM in the hospital could provide wonderful benefit if you walk around a cardiology ward. And and and ask how many these patients have in particular type two diabetes as they get older. The numbers are pretty staggering. If we can control the diabetes part better. I mean, I've been in IC use, where if a patient has diabetes, there's 48 finger sticks a day. So a nurse has to walk in, stick their finger 48 times a day, every half hour, all night long. We put a CGM on that patient voice. They count much time and money that saves the system. And not only that, let somebody do the job they they signed up to do give care to patients rather than

Scott Benner 8:49
just checking and checking,

Kevin Sayer, Dexcom CEO 8:50
just checking and checking. So we think there's a really good opportunity here and we'll learn from the registry registry, what we're learning from our experience. I had to just shut my phone off. I'm sorry. And we'll be good. So it's, it's pretty exciting there. You know, there's good stories. And you know, one doctor told us a story about a patient who they were about to ventilate, but when they got under control with CGM, they didn't have to. It was the high blood sugars causing the patient could fight off the corona if they weren't trying to fight their high blood sugars. And I think there's a correlation to all these things.

Scott Benner 9:30
Well, I have a personal anecdote, I guess that I've never shared on the podcast before but my father, as an older man had congestive heart failure type two diabetes, but he fell and just kind of slipped off a chair actually and gashed his his shin badly enough that it wouldn't heal and he ended up in the hospital where I watched them ignore his blood sugar. Like it just wasn't a factor in his care. And he did. In fact, he passed away about a week later and You know, I realized he was not in great health to begin with, but he was not, you know, he was not on death's door prior to cutting his leg. And once he got into a hospital setting, I would tell him, I'm like that they're not they're not managing your diabetes. And he's like, they say, it'll be okay. They want it to be high. They don't want me to get low. And I couldn't talk him out of it. I couldn't talk him out of believing that his his body's ability to, to heal was directly related to you know, was compromised.

Kevin Sayer, Dexcom CEO 10:28
Yeah. Yeah, I had a very similar experience with my mom, she had a heart valve replaced and literally she couldn't leave the hospital because her blood sugar's were so high that because the heart valve operation didn't work base, the stress and anxiety in her body from that surgery. That's what they they couldn't fix. And I'm sitting up there. As I think it was right after I started, not long after I started Dexcom. I'm sitting there going, I can fix this. But yet I couldn't. And so I think someday we have a really good answer here.

Scott Benner 11:05
Yeah, no, institutionally, I think that this has a significant possibility of changing the way minds work around blood sugar management, while people are in the hospital.

Kevin Sayer, Dexcom CEO 11:15
And Scott, my other learning here, and this is, you know, this just goes to Dexcom. And how we work, we need to create the proper experience in the hospital for the caregivers. And for the patients. We are all about the experience for the customer and for the patient. And and one of the big learnings is taking a product that's meant to be used by you and your daughter at home. And and day to day isn't necessarily the same workflow, and visualizations and communications, as one of the one the hospital and one of the challenges. I've given the team after this experience. And with this registry, let's create the right thing. Let's create the right experience for this environment. So the product can be used when you create the right experience. No one's going to use the product even it's perfect anyway. Right. And so I think long term, that's another thing that comes to this, we will create the absolute right. Right experience for that environment.

Scott Benner 12:13
I'd also be interested to see how those two different uses end up feeding each other, like what will you learn in the hospital that will help the home user? What will you learn at home that helps the hospital use that? Yeah, I think that would would prop itself up?

Kevin Sayer, Dexcom CEO 12:28
I agree with that. Yeah.

Scott Benner 12:31
Okay, so I wanted to ask you, then about you guys are doing something with the University of Virginia about research, but I don't understand what it is.

Kevin Sayer, Dexcom CEO 12:38
That's okay. I'm happy to answer that question. You know, the week acquired a company called type zero back in 2018. They're the group who developed the and control study. And then the the algorithm, the control IQ algorithm used by tandem in that system. And the scientists, some of the scientists who were part of that remained at the University of Virginia, and there's a lot of knowledge. And a lot of great thought there. As far as what we could do in the future with diabetes. We felt the thought and the skills of these of these scientists at that university, combined with the people we had in Virginia would give us a great opportunity to create more tools for our patients in the future. And we wanted access to those guys. And we wanted to make sure that the group was funded, and really could continue to work with us. So that that's why we signed the agreement really, is to continue to develop more tools for our patients.

Scott Benner 13:35
And so they're just going to its research center, then like

Kevin Sayer, Dexcom CEO 13:39
three, its research center, and we will do research and develop, develop future applications for our technology with them

Scott Benner 13:45
for type one and type two, I'm guessing. Yep. Okay. That's where it

Kevin Sayer, Dexcom CEO 13:50
is open to where whichever directions, they think they can help us or directions that we would like to go.

Scott Benner 13:57
That's excellent. Well, I guess you guys are pretty busy in house doing what you're doing. And so this is sort of just another avenue, right?

Kevin Sayer, Dexcom CEO 14:05
You know, what, there are a lot of smart people out there who are trying to solve these problems. And to the extent we can have good relationship ships with them, and we're bigger now. I mean, there is some advantages to size five years ago, I didn't have a million dollars a year to commit anything to university. Now we do, right, and so and I don't even know what the financial terms are, I'm speaking a bit out of turn, right. And all that but but you know, where I'm headed, we really didn't consider ranges like this because we were so focused on managing our cash and everything. So through size and scale, we're able to do more and I think this is a really good investment on our part. We look we think there's going to be great things come out of this.

Scott Benner 14:45
Excellent. That's exciting. Okay, so 2020 as we all know is not been very exciting. Everyone's excited to get to 2021. I just for so many reasons that aren't aren't worthless thing, but I'm wondering what that Users should have to look forward to coming up.

Kevin Sayer, Dexcom CEO 15:05
Continued innovation, continued growth and support, I think our technology pipeline is, is still incredibly robust. So what we have coming. And what we have today, I mean, you know, let's not forget, we're only two years into GE six of these devices usually have a life cycle longer than two years. And we made a commitment to go faster and accelerate that lifecycle by moving to G seven, where literally every component of the system is different than what we do did with G six. So we'll continue to improve GE six, we have algorithm updates, we are, you know, looking at finer things like updating the share system, that user interface over time, we'll continue to refine that experience, we're very focused on G seven, we're back in the clinics, we're not giving g seven timelines, because I just can't give our playbook to everybody. But in the short term, g six really gets a lot of good things. And I think another one of our big efforts is just improve access for patients. I had a call yesterday, you know, and I get emails as you do, and most of my emails from patients do not relate to the product. Other than we'd love the product, it's I am having a hard time getting this and this guy was a hospital administrator. And he'd been in health care for 30 years. And I said, You know what, I'm gonna take this one and spend a little time on the phone. And it was a great conversation. And, you know, he said, I don't know how, and he was late in life, having used the product, I don't know how anybody would even manage this without it. I it's beyond me. So we want to create that experience and get more people access to the system. And his problem was very simple. He's on this auto ship plan every 90 days and insurance only let him order exactly 90 days later. And if if for some reason he runs out of sensors, even if they all last 10 days, he's days without. And, you know, he wanted to ask how are you going to solve that problem for me and we had a great discussion about it. He understood rise Kevin from and we we got them taken care of and gotten injured. But I think more access, getting to more people continuing to technology pipeline. And just, you know, having this needs to really become the standard of care, not just in the US but everywhere. And I think we've made great advances in us, we're looking at our international markets, how do we get more visible and more access in in more international markets, and I've personally challenged, the team must go be more aggressive, let's go get more people on this technology, because once they use it to God, they don't. Their lives are changed forever. It's 100%. True,

Scott Benner 17:59
I my first thought when you were talking was will the marrying for like, you know, control IQ on the pod five, that kind of stuff. Will that cause the insurance companies to believe that there can't be a lapse in me having a sensor right, because now my pump. Also, you know what I mean? Like is connected that the other thing is to I am, you know, as humbly as I can say this, I'm really very good at diabetes. And then if you take that data away, I become very average at it pretty quickly. And it's not that my daughter goes from you know, an average daily day of like 5581, c two a 12. But suddenly, we can't be as aggressive with meals as we'd like to be we can't be as fine with bagels as we'd like to be and then everything starts drifting the wrong way. You get very up and down. And before you know it, you feel very lost.

Kevin Sayer, Dexcom CEO 18:52
Well, I liken it, what kind of COI B with no data. Yeah. How could you possibly run a company without knowing where we are? right and so I don't need to know where we are we five minutes so I I can take peaks a little a little later. But no, I you can't you couldn't. And I you know, the insurance companies It is really interesting is as I talk to some of these guys they are so there are so many brilliant people there. But as you look at the hundreds of thousands, if not millions of people they have to take care of then you get down to the number of people that use our sensor. Yeah, absolutely. Gee, if I'm approving this pump that's dependent on the sensor, we shouldn't be waiting, we shouldn't have any problems. But by the time you get down to the number of people that is versus the number of people they take care of. Yeah, it's it's really hard for them as business people. Just to understand how all that works. And and I we've looked at models, Scott So I'll give you a perfect example. What if we sent an extra box to everybody just so that never happens? And you know what happens if I do that? They just use the box instead of place to next order. Oh, okay, most of them. And then then we run out anyway. And three months later, we've got that problem. And we sent a free box of sensors that cost us money that we didn't get revenues for, that the insurance company didn't have to pay for. And so I have come up with every mathematical model, and Chen, our marketing organization would tell you, I'm somewhat relentless on this. And I really haven't come up with anything simple.

Unknown Speaker 20:43
So you run into

Scott Benner 20:45
the failings of people. At some point,

Kevin Sayer, Dexcom CEO 20:47
you run into the and the failings of us as a company and the failings of our distributors, and the failings of drugstores and the thing, the biggest problem is getting this to people in an efficient, easy manner. It's almost, I would love to say we have it down. And we're a lot better than we used to be. We've made tremendous inroads here. But there's there's still more to go here and and you know, are pushed to the pharmacy to get this thing covered. As a pharmacy benefit. In most places

Scott Benner 21:19
you made me we, I'm sorry. Yeah,

Kevin Sayer, Dexcom CEO 21:22
we had, we now have more of our new patients come through the pharmacy than come through the the other channels now, which means they're giving it to the drugstore, and the copay at the pharmacy level. And James can get you the we can get the exact numbers, but a large percentage of I want to say 30% has zero copay. Oh, wow. If we can get him to that channel. So we have done our best as a company to make it more accessible and, and literally, that access been willing to compromise on on pricing. Because if our patients can get it easier, happy, guess what, they buy more, they're loyal and everything is good. It makes perfect business sense. Now

Scott Benner 22:01
I've seen incredible, you know, strides from you guys over the years for certain it's funny you you were talking about what would happen if I just gave everybody an extra box, you made me think about a buddy that we had in our 20s, who was always stressed out about not having money. And so I came up with this idea of us all throwing a little bit of money into a bank account for him. So that he had a cushion to take away that stress. Then we did we collected about 500 bucks, all of us and we we we put it in his bank account, and he spent it.

Unknown Speaker 22:30
And I was like, oh,

Unknown Speaker 22:33
we're trying to take your stress away.

Kevin Sayer, Dexcom CEO 22:35
Human nature.

Scott Benner 22:36
Yeah, it's just how it is? I think so. I really do. Oh, before I forget to mention this, and we run out of time, it's such a small thing. But a number of people asked me to tell you that the the process of ordering overlay patches is not probably as seamless as you hope. Yeah. So so I won't have

Kevin Sayer, Dexcom CEO 22:55
that on.

Scott Benner 22:57
Yeah, that was it. Nobody really I said, Hey, Kevin is coming on. They're like, tell them we want that overlay patch link to work better. And I was like, and everything on the UI side is great.

Kevin Sayer, Dexcom CEO 23:06
If this is your toughest user group question for me, man. It's over people. If you're listening to this podcast, you can do better than that

Scott Benner 23:14
come up with better questions. No, they, they just all seem kind of a happy accident. I mean, listen, not for nothing. Everybody wants to know when the g7 is coming. And I think that that ebbs and flows online, when someone discovers an image of it and reshares it as if it's, it's a new idea. And then it kind of gets everybody lit up again. But I agree with what you said earlier, I have a hard time arguing with you. I'm using g six with Arden. And it's been terrific. And it's been

Kevin Sayer, Dexcom CEO 23:42
it's a spectacular product. And we've tried to address in G seven, all the things that we can make better. But it's g six is really good. You know, I was talking I was reminiscing a bit the other day, as you look at the things we brought to market, the Dexcom in bringing connectivity directly to the phone and all these integrations the way we designed g six, you know, we made a commitment back in G five Scott and you appreciate the technology, we put a processor in the transmitter to whereby all we're sending to that phone app or to your pump or whatever is the number. So we can integrate across multiple platforms, we can communicate with multiple devices at the same time. The thought that went into some of these things, delayed technology for a long time. But we think we're gonna give the patients the opportunity to have the technology and the things that they want to sharing. Uh, you know, I got my first email on sharing data three days. After you remember the g4 receiver I've heard I don't remember what we call it, but the g4 receiver that would talk to the phone. Sure. And I mean three days into that I got an email from somebody saying we'd save their life. The proactive alerts and a lot you know, the the low glucose soon alarm. I think the numbers like 4 million patients have acted on a low glucose soon alarm and avoided a low glucose value, right at some point in time in the night. Those are our four main instance. Those are big innovations and big changes, and we'll continue to bring those to market. So yeah, again, listeners, don't sleep on Dexcom will be there.

Scott Benner 25:27
Well listen, if you're making me think of two things. So the The first thing is, and and maybe I can take your challenge up here. I could do a a focus group online. And then bring it out like this. If you want to hear people's ideas like do you just want to hear people's ideas? Or do you think you've had the advice that I

Kevin Sayer, Dexcom CEO 25:46
hear quite a few of them? Yeah. But I'm not averse to. I don't know if I'd want to do an online or have a discussion. But I am happy to address anything on a podcast like this. Yeah, we have, we have spent a lot of time listening over the past couple years. I'd like to say we're a lot better than that than we used to be. We used to be a bunch of scientists. Yeah, figuring out this is what we can do. Now our scientists, in addition to our consumer, people become listener. So we do a lot of focus groups and listen, but if you I mean, we could talk about that offline.

Scott Benner 26:21
But I'll bring it to you. I can go on Facebook and get everybody's thoughts and then just dump them in your lap. And inundate you with them if you want to.

Kevin Sayer, Dexcom CEO 26:30
My favorite user discussion was with an 11 year old who for his vacation came to San Diego, parents from San Diego, he had three pages of notes on a legal pad. He had questions about the chemistry, the chemicals used in the membranes. He had studied this so much it was it was an awesome us morning, I was blown away. That's cool. Why this kid? So Well, listen, and if you have some to bring me I happy to, we may or may not address them all, but I'll certainly listen. No, it'd be.

Scott Benner 27:00
It's interesting, I think just to hear, like, you know, down to the smallest idea. For instance, like people are like, I'd like to be able to set like a different alarm for a different time or I need a different tone sometimes or just the just the idea of what make wood in a perfect world make their their experience better. Maybe some of them are addressable, and maybe some of them aren't. But it might be something you haven't thought of. I am going to let you go. But let me ask you, because you said something a second ago about the chip being able to talk to more than one device, which leads me to ask you about right from the transmitter to Apple Watch. Because that is something people ask me about a ton.

Kevin Sayer, Dexcom CEO 27:37
That project is not going as fast as we wanted our Bluetooth radio is needed to evolve an Apple Watch technologies also evolved a bit, I think with I'm very confident will be there with G seven, I don't know where that progress is G six wise or with the next generation watch. Next, something, we'll just have to get back to you on it. It is moved, it's moved back on the list, because we've just had to deal with some other mainly getting g7 ready to go and that Bluetooth has taken priority over the direct to watch connection. Yeah, I bet I get it. I get and I get why people want it. There's a lot of complexity there. Because that watch has to be charged every day or every other day. And then the question is, what do you do for loosen alarms while the watch is charging? And what is it going to talk to? And there's some things we have to work out?

Scott Benner 28:24
Yeah, I think that's been a through line through a lot of things we've talked about today is that there's more going on, than maybe the average person would expect. It's not just so easy to throw Dexcom into a hospital and let them use it, etc.

Unknown Speaker 28:35
That kind of No, not at all. Yeah,

Scott Benner 28:37
well, I appreciate this, Kevin very much. Your time is always well appreciated by me. So

Kevin Sayer, Dexcom CEO 28:43
hey, thanks for having me again. Of course. I'll see you soon. You bet. Bye Bye. Take care.

Scott Benner 28:50
I always enjoy talking to Kevin and find out what's going on at Dexcom. Big thanks to him for coming on the show. Here's some other stuff T one d exchange.org. forward slash juice box. Go check it out. I joined the register. You can too. If you're a US citizen, and you have type one diabetes, or a US citizen who is the parent or caregiver of someone with type one. And you can jump right on. I answered every one of their very simple questions in less than 10 minutes, you could do absolutely the same. Just check it out. See what you think T one d exchange.org forward slash juicebox. Their research has brought some pretty amazing things to light for people with type one diabetes, and I would not be talking about them if I didn't believe in what they were doing. Don't forget again juice box docs.com if you're looking for a great doctor, or you'd like to suggest one to one of the other listeners of the podcast, and of course those diabetes pro tip episodes are right there in your feed. They begin at Episode 210. There's also for new listeners or people are just jumping on All of the Ask Scott and Jenny episodes are defining diabetes episodes. If you're really looking for management talk, this is where you go diabetes pro tip, defining diabetes, and ask Scott and Jenny, I think all of the other episodes are absolutely terrific. But if you really want to dig down and look at management talking about insulin, that's where you start. Look, I have a little time left here, so don't begrudge me if I tell you that, while this episode is not sponsored, there are sponsors of the podcast that you could visit and there are links in the show notes of your podcast player at Juicebox podcast.com. If you want to find out more about the Dexcom g six continuous glucose monitor, get a free no obligation demo of the Omni pod tubeless insulin pump find out more about g volt glucagon the Contour Next One blood glucose meter and touched by type one.org. And I already mentioned to you on the exchange. So anyway, look, I put this episode together for you on a Friday night. So don't don't hassle me. Let me just get out there and click on the links. Help me out a little bit, though. Wait, I'm back. There was something else? Hey, sorry. I apologize. I the abrupt stopping and starting may have been confusing. You should check out the private Facebook page. For the podcast. It's really something else. I'll let you decide if that's true or not. But it's called Juicebox. Podcast. Type One Diabetes. It's a private Facebook group has over 6000 users right now. And it might be the nicest place online to talk about type one. Really proud of the people that are there. Boom, boom, boom. Oh, you're loving the show. leave a review. I was a good one. Right on Apple. Right? Five stars say something really heartfelt. Nice. Spell all the words, right? Because it means less when you make a typo. I don't know why. But when you're reading like us a really great review. This person really loves us. Oh, they spell three words on? Yeah. Geez. Not as great. You don't mean just proofread it. I know. Now I'm asking you to leave a review and proofread it. But I mean, that's pretty much the minimum effort on that, don't you think? What else there's got to be something else. It's late on Friday night. spent the whole day putting together a bed for art and my knees hurt. I was like on the floor in the garage. And I gotta be honest with you. I feel like I'm gonna really feel it tomorrow. These are not your problems, but they are mine. And I am the one talking to the microphone. So I pretty much get to do whatever I want.

What else should I be saying to you guys? Hey, follow me on Instagram, too. If you uh, you know, if you're on Instagram, it's at Juicebox Podcast. That's pretty much it. You know, one last thing. A lot of people listen to the podcast online, which is cool. Like, if you want to listen on my website is fine with me. It's just, there's so many easier ways to do it. So I thought I'd go over them very quickly for people who end up listening to the show and don't know a ton about podcasts. First of all, if you have an iPhone, you just open the podcast app from iPhone search Juicebox Podcast, and then subscribe to it. Now be careful make sure you get Juicebox Podcast type one diabetes, because after this podcast got really popular. A lot of people had the idea to call their podcast that Juicebox Podcast they're trying to trick you into listening to their podcast, but don't do that. Listen to mine. Juicebox Podcast type one diabetes, search it right there in the app on your iPhone. The app is called podcasts. So it can't be that difficult to find. You can also listen on Google Play. We're brand new on amazon music. You can listen on amazon music now. Pandora, Pandora, people like Pandora, right? Stitcher, I Heart Radio, you can even say to Alexa to play the show. Oh, and Spotify. Right? Spotify is a place where a lot of people listen to things. So that's a place you should know about to in honesty, pretty much any of these applications that you've ever heard of. You can find the podcast and please remember, especially Android users who have to use a lot of third party apps for podcasts, you should not have to pay for a podcast app. Okay, there are good ones out there that are free. Actually at the top of Juicebox Podcast calm. It says subscribe and listen for any podcast app. As you kind of scroll through the different things you can click on. There's one that says subscribe on Android. And that just takes you to a page that shows you a ton of different podcast apps for your Android phone. podcast addict is very popular with people I hear people like pod kicker. Anyway, there's a lot of different players pick one don't pay for them was my point. podcast app should not cost money. This should never cost you any money. Spotify said actually, too, for those of you living overseas. Ghana, I think is an India based app. Starting to get some listeners there, so hey, Andy, what's up? You can also listen on player Fm radio.com and Deezer. I don't know what these are is, but I'm on Deezer. Alright. And these are the places you could listen to the podcast. Yeah, that was that was lame, lame, but I enjoyed it. And anyway, find the show on a podcast player and subscribe. It really is the easiest way to listen unless you love listening online and then Okay, do that. I'm not stopping you. It's cool. But you know, podcast players keep your place while you're listening so you can come back to shows it's a lot easier. Is that it? Alright guys, I'll see you. When I see you. Which will be sometime next week. We will be more episodes, the Juicebox Podcast. Thanks a lot for listening. I really, genuinely appreciate your time.

#388 Playing Jax

Tori is a D Mom to a young child

Tori is Jax mom and she's here to talk about their life with type 1 diabetes.

+ Click for EPISODE TRANSCRIPT

Scott Benner 0:00
Hello friends, and welcome to Episode 388 of the Juicebox Podcast. Today, I'm going to let you listen in on a conversation that I had with torey. She's the mother of two kids. Both of them are very tiny. One of them has diabetes. And here's the thing about Tory, and she doesn't know this. So this is going to come as a surprise to her. Almost every day on Instagram, Tory shares one of her son's Dexcom grants with me. And she's gotten so good at managing his diabetes, that his graphs sort of helped me believe that the podcast works. So while it's possible that I might be your cheerleader, the one who's telling you you can do it, like go ahead, try something Tory sort of mind. It's the interaction that she provides. And honestly that all of you provide, that helped me believe that the podcast is valuable. It's not an echo chamber. If somebody's talking back. I always very much appreciate seeing Tori's message. And I don't think I've ever told her that. So Tory, thank you. And people should follow Tory she's Tory tackles too. On Instagram. It's got some cute kids. 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.

This episode of The Juicebox Podcast is brought to you by the Contour Next One blood glucose meter. You're going to want to go to Contour Next one.com Ford slash juice box to check out the meter that Arden loves that I love. We all love it. It's the bomb diggity Contour Next One comm Ford slash juice box. Have you ever considered supporting people with type one diabetes by lending your information to research? super simple to do at T one d exchange.org. forward slash juice box. It's a quick and easy from your home right there on your phone simple way to advance Diabetes Research and support the podcast. I'll tell you a little more about it later in the show.

Tori 2:37
My name is Tori and I have two kids and my toddler is a type one diabetic.

Unknown Speaker 2:43
Okay.

Scott Benner 2:45
The toddlers how old

Tori 2:46
she is 21 months on March 2.

Scott Benner 2:49
Okay, we're not gonna use his name. So we're just gonna. We can if you want I just felt like you weren't.

Unknown Speaker 2:54
Oh, no, his name is Jack's.

Scott Benner 2:55
Oh, all right. Never mind that everybody. jack is a toddler. 21 months old. Yes. And he has had type one for how long?

Tori 3:04
He has had type one.

Do the math for me. I think nine months. Um, he was diagnosed in May right before he turned one a week before his birthday.

Scott Benner 3:16
May 2019.

Tori 3:18
Yes. 20. Yes.

Scott Benner 3:20
Pack ahead. Are you ready? Is it 2019? Or 2018? You're right.

Tori 3:23

He was born June 2018. Just last year. Okay. Yeah.

Scott Benner 3:28
So we know each other because of Instagram.

Tori 3:32
Yes, I actually came across your podcast too, because the night that he was diagnosed, we'll go into the whole diagnosis story whenever but, um, I was sitting there crying in the hospital room and I someone told me to join a Facebook group I posted in there, what should I expect going into this with a baby with diabetes? And someone mentioned to follow your podcast. So literally day one, I found your podcast and it was actually quite funny how the training differed from what you were saying. And so I'm sitting there like with two totally different rules, I suppose of how to do things. And I was like, This is so confusing.

Scott Benner 4:19
Was it was it? Was it scary or confusing? Or like what did you think in the, in the in this first month?

Tori 4:25
Well, at first I wanted to go with what the hospital was saying. Because I was like, well, his kids 15 now. Yeah, she was diagnosed really young. But, uh, you know, he's he's a baby. Like, I can't Pre-Bolus that's not

Scott Benner 4:40
also I'm a stranger on a podcast. Listen, yeah,

real quick before you go anywhere. Is there a fan running behind your anything? It's noisy.

Tori 4:50
can make the air conditioner just kicked off?

Scott Benner 4:54
Yeah, you're not allowed to be comfortable while we're doing this.

Unknown Speaker 4:57
Can you hear me better now?

Scott Benner 5:00
Did the fan stop running on the air conditioner? If so, try speaking. Okay, well, we need you're wearing some sort of noise cancelling headphones. So when you don't speak, I don't hear anything. So I'm gonna have to wait till you're into a sentence to know for sure.

Tori 5:14
Okay, cool. Yeah,

Scott Benner 5:16
yeah, no, I've been able to hear you the whole time. Just there was a noise behind you. So we're gonna see if it's going away. And

Tori 5:22
I wanted to listen to the hospital telling me what to do. First and foremost, because they saw the kid they were listening to our day to day lives. And I was like, well, this is this is the hospital. They deal with us every single day. And I'm just going to go with what they're telling me for the first little bit. And we didn't have a Dexcom yet, obviously. So, um, I was doing the whole letting him eat, subtracting what he didn't eat, and then giving him his insulin. And then when we got the Dexcom, I saw how often really let

Scott Benner 5:58
Tory listen to sound still there. And I really want to talk to you without without it.

Tori 6:02
Yeah, so it's all just gonna get edited out.

Scott Benner 6:04
It's hard to know. Depends when I listened back to it What I find interesting. So let's figure out what's going on. What kind of headphones you're using? Apple? Are you? Are they wired or wireless? Why? Okay, you're on your phone. Is your phone on Wi Fi? Yes. Okay. Are you near any other cell phones or stuff like that? Yeah. Okay. Were you in a room with the door closed? Yes. Are you still there?

Tori 6:37
Yeah, I moved into a bedroom. Okay.

Scott Benner 6:39
Nothing on because you sound better now. So it's interesting. Okay. Cool. All right. So. So I'll recap and we'll keep rolling. So you're in the hospital. You you go on Facebook to ask for people just opinion of like, what should I expect? I've got this little baby who's got Type One Diabetes all sudden, you're younger mom, too. Is that right?

Tori 6:58
Yes. I'm 28

Scott Benner 7:00
Oh, I was trying to make you younger, and you like not really 28 you should have been like, 100%. I'm a young mom. I'm 28. So but but so but your first baby? And yeah, by the way, you look younger. So congratulations. Yeah. And so you get conflicting information. Right away. There's a guy talking to you through your Apple headphones, that saying one thing, the hospital saying another thing? Initially you think maybe the difference lies in the ages, his daughter's 15. My kids, almost the larva Still, this is probably the difference. But what did you find moving forward?

Tori 7:38
Well, so we get the ducks calm after three weeks. And, and they really rushed it because we had a trip to go to Seattle that we had planned like six months ahead of time. And so and we live in Atlanta, so I was like, Oh my god, we're gonna be traveling on a plane across the country with a diabetic baby. Like I don't I don't know. We know. I need that next column. Where you live in Atlanta? Yes. Am I seeing you in two days? You are. I'll have the newborn with me.

Scott Benner 8:06
Oh, that'll be lovely. This is This has never happened to me before. I feel like I have triplets. You know, but okay.

Tori 8:12
But yeah, and so with all this, I'm also 20 weeks pregnant when he's diagnosed. So I was very emotionally unstable. And so they rush to get the Dexcom to me as soon as possible and get like the it approved, because it's not going to prefer you know, babies right away. And so we get the Dexcom. And I go, Okay, so I've been listening to this podcast, I'm gonna, I'm gonna just do as a hospitalist told me before, but I'm going to see what happens now that we just put the sticks Come on him. And he spikes to like 400 after a meal. And we weren't checking his blood sugar until the following meal, because they were like, you also can't have carbs next. So cheese sticks and beef jerky. And that's it. So um,

Scott Benner 8:57
so you know, he was eating and then three or so hours you didn't really check blood sugar, you know, put counted the carbs, but the insulin and if he got hungry in between, he stayed with lower carb stuff.

Tori 9:08
Yeah, yeah. And so I go to feed him his lunch next. And you know, I've been watching the effects calm, and he starts to make a downward trend right before his meal. So that's where it was getting to a point where if he was 180 when I gave him his insulin, and then by the time his next meal, he was 160. I figured Oh, my goodness. Yeah, like, that's a perfect ratio. But he was going all the way up to 400 or so hanging out there for two to three hours, and then he'd come back down ever so

Unknown Speaker 9:44
gently and yeah,

Unknown Speaker 9:45
man. Right,

Scott Benner 9:46
right. Where you felt like oh my gosh, I must be doing really well with this. He's.

Tori 9:51
Yeah. And so I would call the hospital and tell them what was going on. And they're like, Oh, he's perfect. He's perfect. He's perfect. But then when we got the dexcom on I immediately take it into my own hands. I was like, No, we're gonna we're gonna start doing it Scott's way. And so ever since then it was we went to our first

Scott Benner 10:12
story. Don't jump ahead, you're doing really well. We're not telling them the first 10 minutes on while you're doing Hold on a second. needs a little showmanship here. Hold on a second. Let me let me say this to you. So when that's happening, right, like there's this giant leap up and then a giant leap down. And then they say, You're doing great. Did you think that can't be possible? We're not doing great, because look how high his blood sugar's thing for so long, or was there confliction in you? Like,

Tori 10:42
well, I just stopped calling.

Scott Benner 10:46
Okay, so my next my next question is, would you say now there's any honeymoon type of function happening? Are you? Are you completely?

Tori 10:55
I actually think that this week, like the last two weeks, we've gotten out of the honeymoon phase, I really truly think so. Because I've had to put so much more inflammation.

Scott Benner 11:06
So and so this is super interesting, man. Because, yeah, your graphs are. Your graphs make me feel like, I don't know what I'm doing?

Unknown Speaker 11:16
No.

Unknown Speaker 11:18
Hold on a second.

Scott Benner 11:20
And so I've always wondered with somebody who has newer diagnosis, such a baby, like, you know, as far as size and age, was there, some honeymooning going on and so you think there was, but yeah, it's gone away, and your results don't look any different?

Tori 11:36
Well, so basically, when we were hunting, meaning I would time it out really perfectly, where I would give him his insulin, and I knew that he would go low. And because I was being pretty bold with the insulin, um, I would make sure that he didn't have a spike. And then right when I knew that he probably go low, it would be snack time anyway, so he would get a fruit stack or pieces of Apple, and just like, you know, typical things that a toddler would eat. And he was able to eat that to fix a 75 blood sugar and bring it up to like, 100. So,

Scott Benner 12:14
so you were doing something that I think is, is brilliant, and I've done it myself, and I didn't just call it brilliant, because I've done it too. But I think it's it's a longer look at things, I guess, step back look. So you're, you're putting in enough insulin at a meal to not only keep the meal from spiking, but you're in some strange way with the tail of the insulin Pre-Bolus in his snack.

Unknown Speaker 12:37
Yeah,

Scott Benner 12:39
yeah. Yeah, that's good. Good job. Right? Because, because he's a little kid. And so he is snacky throughout the day. Mm

Unknown Speaker 12:47
hmm. Right?

Tori 12:48
Oh, for sure. I mean, he, the whole thing too, with them not wanting me to Pre-Bolus was because he is a baby. And a lot of toddlers have a problem with finishing a meal. But we did this thing called baby led weaning where I never did pre race with him. I literally just fed him what was on my table from six months on. And so he doesn't have texture issues, he can eat an adult sized meal so easily. So he gets his own meal, and we Pre-Bolus it at a restaurant, and he eats the whole thing. So it's very, I mean, hopefully that sticks because he's not verbal yet. And so he can't tell me what he wants and what he doesn't want. And I just kind of feed him and I go quick, you have to eat this i Pre-Bolus. Um, but he he's so good about food. So when the hospital was telling me like, No, you literally cannot Pre-Bolus until he can tell you like, I'm gonna eat half that sandwich. And I'm sitting there like, Okay, then

Scott Benner 13:43
even that seems strange, because my daughter, like you said, is 15 and she'll tell me sometimes super hungry, man, let's go for it. And then we put the insulin in and eight minutes in, she gets this look on her face. She's like, I'm just not as hungry as I thought I was. And, you know, so you find ways to trade insulin around and stuff like that, you know, I've definitely been in that situation where, you know, you put in enough insulin for 40 or 50 carbs. And it's, I don't know, four or five units when she was smaller. And her basal rate was like a unit an hour and you know, she'd have some of the food and then just be like, Oh, I can't do this anymore. And you're like, Alright, well, I'm just gonna shut your bazel off for an hour or two and see if trade just do what you just did. Right? Like trade the tail of the meal bolus for the for the bazel out in the future. Yeah, like how did you come? How did what led you to be able to think about the, the insulin like time travel for the lack of a better word, like like, because I'm always telling people, everything you're doing with insulin now is for later sometimes it's for five minutes, or 20 minutes later, sometimes it's for an hour later, sometimes two hours later. Nothing that's happening to you right now is happening because of the insulin that's going in right now. absorbed it really quickly and and to your credit, and I want to get too far away from this before. I say you've described yourself as very emotionally unstable. And I want to, I want to point out to people listening that emotionally unstable in first very. So when you're adding very to it, you're saying you're whacked out of your ever loving skull on the hormones, is that what was going on?

Tori 15:18
Yeah, I was very upset. But my little baby that had even turned a year old was, you know, diagnosed with something that was going to be for life. And when going through the pregnancy at 20 weeks pregnant, I also had a dog that was probably gonna have to put down soon, and that did happen. And my grandma was living with us who has Alzheimer's, and she passed away. So all dramatic things are happening while I'm growing a baby inside of me. And so when this happened, I'm a perfectionist. And I joke around that this was like, you know, life's a slap in my face, like, haha, perfectionist. Yeah. And so there was no other option to be better than to be perfect at this. And so obviously, you can't be perfect every day. But I tried my very best. Yeah. And so when, when they're telling me Oh, it's okay, if he's had 200. And he's staying there. Like, that's okay. He's a, he's a kid. listening to everything and reading when I was reading, I was like, that's actually not okay. Because why am I going to let him hang out at at 200 250. And that still be okay, and not that high. For, I don't know, 18 years of his life, like I, I'm not going to do that. And so while I, while he's under my roof, I want to make sure that he has all the same, you know, the same health as a non diabetic,

Scott Benner 16:55
right? And the best chance to sort of absorb the way of living that you're doing and hope that he takes it off with it. Yeah.

Tori 17:01
And then people are telling me Well, in order to have him be stable with blood sugars that a non diabetic would have, you have to go low carb, and I was like, well,

and I've ranted about this before, but

I don't want him to grow up with food issues, either, because he is diagnosed so young, that I don't want him being five years old at a birthday party having to eat, you know, stuff that I brought, when he can't, and he can't enjoy stuff that the other kids are eating. So it was such a big thing when I found your podcast that I was able to let him pretty much eat whatever everyone else is having, and, and just learn how to do it. Because one day he's going to be an adult at college, and I don't want him one afraid to tell me, Hey, I'm going out to eat with pizza, what do I need to do? And to not know how to do it themselves? Right.

Scott Benner 17:56
Now, listen, first of all, I think that, in my mind, the podcast is about using insulin when we're talking about management stuff. And so I don't care what you use the insulin on afterwards, it could be on a low carb lifestyle or a keto lifestyle, or just eating carbs or what anywhere in between, I just generally don't care. I just think that people should understand how it works so that they effect what they want to affect. I mean, they're, you know, I mean, listen, people have come on here who are low carb or keto, and they still talk about where they need their insulin for their fat and protein rises. And that means understanding how insulin works. And but at the same time, I understand what you're saying, like you don't want to, you're not trying to set up a scenario where your son is in a room with 25 people. And he's the odd man out although, yeah, like, that's just not cool. Absolutely should probably not say this, but my daughter grew up tangentially around a girl who was super fit, her whole family was really into fitness.

Unknown Speaker 18:58
And I don't

Scott Benner 18:59
find anything to be wrong with that. I wish I was fitter than I am. But when you stop and look back, she's a little weird. And she's probably she's probably not like, don't get me wrong. She's just, it's, and I'm not saying the difference bad. I'm just saying that they've gone over the ridge to the other side, like so I think there'd be a way to like, be fit and cool without being like somebody who, you know, if I get up at four o'clock in the morning, because I hear a sound outside, it's your mom running by in the dark with a little light on her head, like, you know what I mean? Like it's I don't know, like, I don't know, that might be judgmental. I'm just telling you that the way I've seen it shake out in front of them is that she's always more available to spotlight, if that makes sense. Like I'm joking in there and what I'm saying but this is the part I mean, like I don't care how fit they want to be again, I don't care if he keto or if you want to go for a run at four o'clock the morning doesn't mean anything but you might want to be prepared for the fact that the masses, whether they're right or wrong, We are going to look at your little side while you're doing that. And so you know, and so that's just the truth. It doesn't matter if it's right or wrong, it just is what's going on.

Tori 20:08
I have fitness background, and I used to do bodybuilding competitions. So that's also really funny because when they were teaching me about carbs and how insulin works, I already knew a lot about that not, you know, not the insulin itself, but how my body myself makes insulin. And so it was it was super interesting, because when he was diagnosed, people were messaging me like, of course, you would have a diabetic kid, you counted carbs, like 10 years long.

Scott Benner 20:36
Did you text them back? And you're like, this is not helpful or supportive at all?

Tori 20:39
Yeah, no, it was not helpful. I was like, oh, but like I said, my subconscious knew that I would have a diabetic child. So I've been training for it my whole life.

Unknown Speaker 20:52
So I was ready.

Scott Benner 20:54
So are you do you think that you're having the success you're having? Because he's such a good eater? Or do you think you could do it? Even if he was a little more pig? Like, can you imagine what you would do? In a scenario where you weren't certain what he was going to eat?

There is nothing like having a blood glucose meter that you can count on and trust. That's why I would like you to go to Contour. Next one.com forward slash juice box. And when you get there, take your time. And poke around. Sure, you're gonna see right away Arden's meter, the Contour, Next One meter, right there, big sticker on, it's like value pack, 40% more talks all about the test strips and everything. Here's some stuff that I can tell you from personal experience. The light at night is great. It's very holdable. It's just not a word, but it's small, but yet not difficult to hold on to is probably what I should have said instead of making the word pool holdable. Yeah, that's what I should have done. But you know what, let's just soldier on, shall we? Great light, very holdable, I'm sticking with that. test strips offers a second chance. So if you touch it in the blood, don't get it right the first time you can go back in without impacting the quality of the test. And speaking of the quality of the test, this thing is gold standard, accurate. Understand i'm saying is right up there. There's like good, better best, this one's best. Contour Next one.com forward slash juice box. This link is more than just a pretty face, there's real information here, you can go to the resource tab and find out about the contour diabetes app that by the way, pairs with your meter, you can find other products, there's other meters that contour makes you can looky loo through them if you want to. Personally, I like the next one. Contour. Next One. Also, it's possible you could be eligible for a free meter, that's under the meters and trips tab, there's even a choice card to see if you can save on test trips, there's a lot here, it's worth knowing, check it out. Even even even possible that you could buy this meter and the test trips, cash out of your pocket. And it might cost less than you're paying through your insurance company. I can't say for sure if that's gonna be you, but it's gonna be somebody. So head on over there and figure it out. One way or the other. This is the meter you want, in my opinion, Contour Next one.com Ford slash juicebox. I don't know if you remember the CEO of the T one D exchange was on the show a number of months ago, I had a very good feeling about him. And then they came back to me a few weeks or months later. I don't remember time, you know what I mean? And COVID I don't even know like what today is. But anyway, they came back to me sometime after that. And said, Hey, can you help us get the word out about our registry? And I was like, you want to buy an ad? And they're like, No, we don't buy ads. And I was like, ah, I don't know what to do that. They said, Well, what about we'll give you a little bit of money every time somebody signs up for the registry if they come through your link, and I thought, No, I'll try that. So I did T one d exchange.org. forward slash juicebox. Here's why I said yes to that. I know what your thing is for the money, but that's only part of it. The other part is there using this research to make real improvements in people's lives. People living with type one diabetes, and it's simple to do. It's 100% HIPAA compliant. It's absolutely anonymous. You can do it from your phone or your PC. I guess even if you had a Mac, you could do it from your Mac. In just a couple of minutes. I did it. Now you have to be from the US. So you either have to be the parent of a child with type one and live in the US you need to be an adult living with type one and before To us, but it's super easy to do. And it's worth it. A lot of goods come from it, I think a lot more coming. T one d exchange.org. forward slash juicebox. Contour Next one.com forward slash juice box. Links in your show notes. Links at Juicebox podcast.com. Okay, now let's find out the answer to this question. Can you imagine what you would do in a scenario where you weren't certain what he was going to eat?

Tori 25:27
Yeah, because we do have some days he's been dealing with typical toddler sickness for the last few months. I'm getting cold and coughs and so he's been a little bit on the pickier side. And so what I've done to combat any picky behavior is I have his fake foods, and every toddler has a safe food. And I will Pre-Bolus like half of what I think he's gonna eat. And if he does eat all of it, I'll do like a really aggressive, like post Bolus.

Scott Benner 26:05
No, no, I I this morning, right before you and I spoke Arden's blood sugar started drifting up. And I was like, Huh, what is this about? Because she was so super stable at 94. And I was just, this is working, I'd made a small adjustment to our baseline some the other day and I thought, Oh, my adjustment is so good. And you know, I was just like, right on, this is working. Then all of a sudden those 94 turned into like, one to one. And then she jerked. She was drifting off. And I'm like, What is happening? So finally, I texted her, I was like, Did you eat something? And she's like, she goes, Yeah, don't worry, I bolus for it. And I was like, Well, what was it and she goes, a Munchkin. And I was like, did you Pre-Bolus for and she goes, No, I was like, it's not enough insulin. So let's just put some more in, you know, and, and we're gonna find level here around 155 before she comes back down, which is cool, because she really tried something on her own to try to take care of it. That's I'm not like, I'm not. I'm not I don't that's great. Like, I don't care about that.

Tori 27:04
Yeah. I mean, that's probably been my biggest, my biggest like, fear grow. As he ages. I love that he's a baby. And I I've said before to people, I'm actually very happy that this happened, when it did. And, and it's crazy to think like, why would you want your baby be diagnosed, but, um, it just, I was talking to a friend of mine, whose kid I used to actually teach ice skating to. I used to be a figure skater. And he came over. Yeah, I was. And, and so she, her 10 year old kid is at the house. And she knows this all of axes here. will just the Dexcom and all of my, my needle stash. And he she's like, Oh my God, if I was diabetic, like, Oh my god, I would never eat again. Little 10 year old saying that. And I just thought to myself, like, Ha, that would be so traumatic to have, you know, him be so much older and him have to mentally go through that.

Scott Benner 28:09
And so I was like, these thoughts.

Tori 28:11
Yeah. And so I've thought to myself, like, wow, it's actually kind of a good thing. If he was going to get diagnosed at some point in this life that it got done when he was a baby. And it kind of scares me for when he gets older and has to manage it a little bit on his own when he's out and about and I'm listening to your podcast, I've kind of been like, okay, like Arden's doing awesome. She's, you know, she listens to her dad, like, baby ducks will do the same.

Scott Benner 28:39
Well, you know, it's, it's all you can sort of hope for, I think, it's sort of funny. I've been listening to a lot of physicists talking lately, so I'm gonna probably sound a little weirder than I usually do. But you know, we're all really just sort of really evolved ants, you know what I mean? Running around you know, one of you goes and gets the food one of you stays and builds the hill you know, some of you dig the holes like we all are doing like a different job. And we have life cycles. And you know, every once in a while you look down one of the answers going crazy right is running in 16 different directions and then it disappears away and probably wanders off and dies. And so there's just we're not all going to have the same level of success in life in in so many varied avenues of our life, right? Like you know, your health, your fitness, some of us are gonna lose our hair, some of us are going to do better at keeping a job. Some people are those people who are always an HR going I have a problem this is a problem you don't realize but you end up being a person who people go Yeah, we don't really want to hire you. And like and but you don't think that because on your side you have a problem. Like it's it's just we all end up being different types of people. Some people become addicts. Some people become addicts, not of their own. No issue like some people become alcoholics, some people never drink. There's all kinds of different ways people's lives are gonna go. And that's going to happen for people who have Type One Diabetes too. And so the best you can do is lay in Foundation, and tools, and reason. And then do your best to sort of Shepherd them towards that being something that's important in their life. Listen, I very well could end up at the end of this being the guy who had a podcast to help the whole bunch of people, and it didn't help his daughter. There's no, there's no way to know that, right? Like, there's absolutely no way to know if this is gonna work out for my kid any differently than it's gonna work out for somebody else's just because I understand it might not be the reason she understands it. I just don't I just do my best to see who she is, how she absorbs things, what she cares about where she gets lazy, all these things about her, and I'm just trying to take what I know and retrofit it to her. And that takes time. And that takes a lot of time. Right? I shouldn't I should not be listening to physicists talk about the nature of messing me up. Let me say something stupid instead? No, no. But the point is, is that some of you listening aren't going to end the way you want to end. But, but that doesn't mean you're not going to end the one the way you want to end because of the decisions you're making today. But that doesn't mean you can't change the decisions you're making and find a different ending. It's just more difficult. Boy, I don't know I there's part of me that wants to say it's more difficult when you're parenting because you're trying to infer what another person needs. And then there's also a part of me that thinks it's hard to do for yourself too. It's me, it's difficult one way or the other. But I think what's really interesting, what needs to be paid attention to when you're caregiving for someone else, is how often you take your feelings or interpretations of a moment and put them on someone else. Just because I feel like this in this moment. That must mean everyone around me is feeling this too. That's never right. You know what I mean? Like, like, see, you really have to want to dissect understanding the person across from you like, like, just, you know, it's, you think this is super important, this Pre-Bolus thing thing, and your kid just goes out, you know what, I don't care. And, and so, right. So and so you have to figure out, how do you make what you care about? Something they can care about? I don't know. It's just It's very, uh, I didn't think this was gonna go this way. Tory, I apologize. I just like Tories on Instagram. She's got this rad graph all the time. You You basically. So you know, when some people say like, Oh, yeah, people have flat graphs once in a while. That's the only time they share them. I feel like you send me a rock ass amazing graph. Almost every day.

Tori 33:02
He doesn't have spikes. I mean,

I today, for example, I'm looking at his graph right now. And he started his meal at 118 got ups like 150. And now he's back at 130. And you know, that's, that's high for us. nice and gentle.

Scott Benner 33:17
And listen to the second baby boy or girl? Boy, again, boy, you see? So here's what I don't understand. How is that kid's name? Not Scott, How did this get away from me? Exactly. I was counting on you being the one you know. You mean? Yeah, yeah.

Tori 33:32
After the first one that saved my first baby.

Scott Benner 33:36
I didn't save your baby. But I've just That's very kind of just saying like, I want to you eventually is going to be you know, I'm going to catch you in. What did you call yourself? very emotionally unstable. I'm going to catch someone in a very emotionally unstable moment. It's like the podcast guy. And and I'm going to get a kid named Scott one day, even though it's not a great name. But um, but anyway, I'm kidding. I had to make up for the physicists talk. And we're all just sort of evolved dance and etc.

Unknown Speaker 34:02
So yeah.

Scott Benner 34:04
Just say something stupid to keep this moving. Are you pumping or injecting? Or how do you get me

Tori 34:10
We are MDI stuff. Ah, see. And we had spoken right after he was diagnosed pretty much and I know you were telling me about the AMI pod, and I want to get it on him. As soon as possible. We're going through a little I'm trying to figure out a job change on that slide. And so we're not sure if we're wanting to spend all our money on our deductible just to start with a new insurance and then, you know, but I'm also very comfortable with them to get right now. And yeah, and so right now, it's just not been something that we are in dire need of um, I do see that we would have even more stable lines and it would become Even even better blood sugars, but right now he's doing really well. And he has been starting to pull on his Dexcom. And that's been very irritating. And I'm just afraid. Yeah, yeah. irritating to me. And so I don't want him to pull off the only pod so I'm just like a little little weary right now and being like discovering things on his body and his age.

Scott Benner 35:27
Hey, so what slow acting insulin are you using?

Tori 35:31
Basic bar? Ah,

Scott Benner 35:32
see people talk very well about those two new ones, which is what are they basically? I can't even say basic glar. We did. I did say it is the other one. To Seba. No. Yeah, there is that one. But I'm right. Those two that are kind of the newer fancier ones that don't. Yes, they seem to actually last more than 24 hours, not less than 24 hours.

Tori 35:54
Yeah, I believe so.

Scott Benner 35:57
Yeah. And so you're so you're getting a stability? A good base from your bazel to begin with? How much? Are we talking about? How much bazel does he get a day? two units?

Tori 36:12
He weighs 35 pounds.

Scott Benner 36:14
Yeah, he's a he's but are both your Is it fair to say that both of your kids are pleasingly plump. Is that a nice way of saying

Unknown Speaker 36:24
Yeah, yes.

Tori 36:27
Yeah, they both are like 99th percentile. Like, I mean, when that was the whole thing with Jack's like, we started seeing him lose weight. We were like, holy cow. Like this is a chubby baby like, this is something's wrong.

Scott Benner 36:40
Like he did someone put this kid on to CrossFit and I didn't realize it.

Tori 36:44
Yeah, like he was always eating. So I was like, I don't get it.

Scott Benner 36:47
How tall are you?

Tori 36:48
But yes, I am only five feet tall.

Scott Benner 36:51
Wait a minute. And how tall Jasmine?

Tori 36:55
Evelyn really skinny.

Scott Benner 36:57
Are the kids like 90 whatever percentile for height two or four? Wait.

Tori 37:02
Yeah, yeah. They're just big. Any, any giants

Scott Benner 37:05
in the extended family?

Tori 37:07
No, no.

That was that was a big baby, though. I was not. So I think that, okay, they're just big babies.

Scott Benner 37:17
Yeah, no kidding. That'd be interesting. I'm imagining, you know, when you're, you're like, 45. And you're out somewhere and the kids just like three feet taller than you and you just think you adopted them. You know what I mean?

Tori 37:29
Oh, for sure.

Scott Benner 37:30
Yeah. Oh, yeah. I have. I have a friend who's so short. She's just the shortest person I've ever met in my entire life, but her whole family is. And so with. Yeah,

Tori 37:39
my whole family is pretty sure. Yeah,

Scott Benner 37:41
that's uh, that's interesting. So how about diabetes in the background of either side? Do

Tori 37:46
Did you find any? No, buddy. Not a single person. I didn't even know about type one. I was bad. oblivia

Scott Benner 37:54
any other endo problems that you could find anything?

Tori 37:57
No, he was. He was so healthy. We had a perfect you know, hospital stay when he was born. He was born at 40 weeks and five days or six days. I was in do some four and five. So I was you know, full term. And then son. He was eight pounds, six ounces, very healthy. breastfed ate everything. No allergies, no health concerns and nothing. At 10 and a half months old, I noticed that he was a little constipated. And that was that was the sign that kind of started getting me thinking about things. So at a week before his birthday, I remember on a Monday or on a Friday, I called a pediatrician. I was like, Hey, can I get in the office on Monday? Cuz he hasn't pooped? So they're like, yeah, I mean, we can check and see if his stomach's hard and, and whatnot. So then I go in there and they go, Oh, he's just you know, a little blocked up I think just get him some prune juice and pure and puree now mind you, I'd never given this kid juice or even pureed food. So this was what got him into DK, I believe. So then

Scott Benner 39:18
you think the the the sugar from the burns is what pushed him away?

Tori 39:22
I think so. So well, that and on Tuesday, so the day after the appointment he was he weighed men on Monday, 29 pounds. The day after the appointment we went to do you have a Rita's Italian ice scenario? Let me know what that is. I love Rita's.

Scott Benner 39:39
So Rita's originated in Philadelphia, right where I grew up. My wife actually knew the family that started the company.

Tori 39:46
Yeah. So that morning, he'd been a little groggy and I remember telling my dad and like, I just needed to get out of this house. I'm way too pregnant to be dealing with this fussy baby. That's turning one Soon and I guess he's teething. But he's just he won't stop crying. So I'm going to go to the splash pad. It's really hot. It was a nice 90 something degrees and mid end of May. So we go to a splash pad and my baby's always been very, very happy. Just a hyper happy baby and he just wanted to stand there. He wasn't walking yet, but he was crawling and he would stand independently. So he's just standing there like, I don't like pie in the water and he just cried. So that I'm like, okay, whatever. We'll go to breeders and get some to Lottie and I'm giving him spoonfuls of that and I have a picture of me spoon feeding him in the stroller and looking back now I'm like, how did I not know? Because his eyes were sunken. And he had like these darks, super dark circles, and he just looked really emaciated. And I was like, something's wrong. I think he's just tired. Maybe he's not sleeping well. And then that night, he threw up is the first time ever if he had grown up. And so that goes, I don't I don't get it. Why is he? Why is he throwing out? What do you feed him? I was like, I mean, he had sugar today.

Scott Benner 41:17
Like how that immediately goes like, Hey, would you do to my kid? Do you give him some? Yeah. You're like, I did give him sugar. I actually gave him like soft serve mixed with water ice. So

Unknown Speaker 41:27
yeah, I

Scott Benner 41:28
mean, if I'm being honest, I'm really pregnant. I wanted him to stop.

Tori 41:32
Yeah, I wanted to give him a nice little tree feed. I felt like the slicker and the ice like it would move his gums.

Scott Benner 41:39
You're the only one that has to be pregnant, or excuse me constipated. You're

Tori 41:43
like, yeah, I'm pregnant.

I'm mind you. We still like he had prune juice and his sippy cup, and he wouldn't drink it much. But he then he started to like, get super thirsty and wanting to drink all of it. And so I'm like, That's weird. You didn't like it earlier today. But then on Wednesday, I'm doing I'm sitting on the ground playing with him. And he crawls over to me and he starts breathing really, really heavy. So I call the pediatrician. I'm like, something's wrong. He's throwing up. He's breathing really heavy. And he's very lethargic. And he doesn't even want to crawl now. And he just wants to sleep all day. And so she's like, Okay, come back tomorrow. And we'll see what's going on. And they didn't actually wait a minute or anything they just said. Let's have you scheduled to go to a gastroenterologist at Children's Hospital on Friday. So now we've gone Monday through Friday. With this, you know, baby that still hasn't pooped. He's now getting way sicker. And Friday morning at the gastro they weigh him. And he is and mind you like all throughout those. When Tuesday, Wednesday, Thursday, Friday morning. He's throwing up everything he eats. And so we're getting very concerned. And he goes, Well, there's nothing blocked in there. Let's weigh him. And he's 21 pounds. I lost eight

Scott Benner 43:09
pounds.

Tori 43:11
Yeah. And I remember holding him being like, this is this is scary. Like I was crying now. And unlike I don't know what's going on with my baby. And he goes, does he always look so his skin so modeled? And I was like no. And they go well, he's very, he looks very hydrated. I said, Well, that's impossible. He's always drinking water. And he's always being like he pees through snipers nonstop. So he's like, you just looked at me. At that point.

Scott Benner 43:38
Can I ask you do you have the it's a recent thing. So you might have the memory? Did it? Was there ever a voice in your head that thought my kid is dying? Or did you did you actually think that?

Tori 43:52
Yeah, on like Thursday, because he was just falling asleep in the highchair. I was feeding him some more Korean puree. Nothing ever said diabetes. I just thought he was dying. And so on that Thursday, I remember feeding him and he just fell asleep eating. And I walked over to my husband and he was like, um, I think we need to go to the hospital. And he was and he's very, no, no, no, he's fine. He just has a stomach. And I'm like, this is not a stomach bug. And, and so he kept on trying to reassure me like, everything's fine. But we're going to the hospital, you know, we're going to go see the gastro, they're going to figure it out. And I was like, Okay, well, that whole night, that Thursday night, he was just waking up full of pee full of thermoweb. And I was like, I don't get it. So then Friday morning. They tell us he's very dehydrated, and you need to go next door and get good the emergency room and get hooked up with IV fluids. So now we're like getting the runaround and we're like, oh my god. Like, what are you gonna find out what's wrong? And so I'm like, I'm not leaving this hospital until we know exactly why he's not having a bowel movement. And why he's, you know, so dehydrated, so to speak, because I didn't think he was dehydrated. Like first time Mom, I didn't realize this scan wasn't supposed to be modeled all the sudden. So then we get hooked up with the emergency room and they're trying to find a vein and his veins keep collapsing because he's so dehydrated. And there they have the whole IV team, pinning him down, he's crying, then he's passing out and then he's crying some more. And we're crying. And someone rushes in after they did a blood test. And they go, either of you diabetic. And we just looked at each other. We're like, no. And they go, well, his blood sugar is 360. we're transferring up to 50 right now. And they didn't tell me. They didn't say it in a very, like, bedside manner. They were just like, he's pretty sexy. We're going to pick you up. Okay. And then he just runs out. And I was like, What?

Scott Benner 46:00
What does that mean? Quick? I'm sorry to do this. Because Arden's text me Never mind the abbreviations. nvm, right. Yeah, all right. Sorry. Just got old there for a second. Like, it's an N and there's a V, and I forgot, it feels like there should be an M in it. Sorry about that. That is stupidly, like my daughter's diagnosis. Like your details are different. But the the salient points are the same. And so I'm assuming for many, many people, but yours went on for a while, like you didn't know and you kept taking him to places and they were just like, Oh, you know this that this that? What's that? When you go back home right after the fight, you want another thing? And another thing that isn't correct. I don't like that's a weird feeling. Right? Like that. Like it's gonna be okay. Like person in charge said don't worry. And and Whoa, but everything in you is kind of yelling like, no worry, this is wrong. It just there's nothing right about it's fascinating that they didn't see that I mean, a nine pound weight loss for 30 pounds is a third of their body weight. And born that that, in general, you would think that would put a person right into a hospital for a battery of tests. On that doesn't make that mistake. It just, it's unmistakable that like that. That's what should happen. And I like that your husband recognized Hey, it's hospital time, but it's gonna be fine. It's interesting. Yeah, he went into like, hey, Tori, don't worry. Just because the guy who's never once wanted to go to the hospital thinks we should go to the hospital. That's not a reason to get upset. But he was panicked, obviously, if that's what that's what he was considering to. So veins are collapsing. Nothing's working. He's completely dehydrated. What was his blood sugar when they figured it out? You know?

Unknown Speaker 48:01
360?

Scott Benner 48:04
oddly, not that high. Unless, unless it's been 360. For how long? How long do you think that have been going on?

Tori 48:10
Well, his a one C at diagnosis was 11.9. Okay,

Scott Benner 48:15
so quite a while.

Tori 48:17
Yes. So I try and go back and I try not to like get myself worked up over it. But I try and go back in pictures and try and see when it might have started. And I just can't tell because he'd always been such a happy plump baby.

Scott Benner 48:33
possible to that his blood sugar was bouncing around, maybe it would jump up stay up for a while. And then it may be his you know, his pancreas would be like, you know, come back online for a little while, bring him back down. Because the one thing I don't know. And I wonder how we could find out but in a in a if you could get a healthy pancreas, BOD in the body of a healthy pancreas up to 360. And I don't know like somehow like turn off the pancreas for a little while bring it up to 360 let it stay stable there. When you turn the pancreas back on. How long would it take a healthy body to bring a 360 back to you know at because that really is what you're talking about? You're talking about a body that doesn't have diabetes, that all of a sudden has it and then all of a sudden doesn't have it again while this pancreas is sputtering you know, to its demise. And and that's just very um, that's a weird thought I've never had before. But that didn't mean like I went because maybe he would bounce and stay there for a few hours and then come right back to normal again. Like maybe there'd be no way for you to notice. Really?

Tori 49:40
Absolutely. I believe so too. Yeah, I don't know. He never had a healthy diet or an unhealthy diet either. So I was very I didn't feed him. A lot of you know, snacks. Um, it was I was that mom that was like, Oh no, my kid will never have juice. That's horrible. So then when he was diagnosed, I was like, Well, I mean, I think he'll drink juice. And it's like, Well,

Scott Benner 50:11
turns out he's very sweet. And most people like it Arden, you know, interestingly doesn't like sweet things. Yeah,

Tori 50:17
yeah. So Oh no. Now Jax loves them because it's a hot commodity, and

Scott Benner 50:23
you're able to turn them around pretty easily.

Tori 50:25
Yeah, now now. He's all about it.

Unknown Speaker 50:29
Okay,

Tori 50:30
so horrible. I can't even eat in front of him.

Scott Benner 50:33
Do you ever do wonder about the baby? Do you?

Tori 50:37
I do a lot. Because, yes, we did not have diabetes in either side of our family that we know of.

And so we're very

uneducated on like, what type one totally means. And when he's diagnosed before he's even a year old. I'm like, Well, what does that mean for my, my other baby that I'm having? So throughout this whole training period at the hospital, I'm going What about this one? in me? It's gonna. And so they're telling me the percentages and stuff and they're like, you might not even have anything to worry about what the next one? This is just, you know, an anomaly. And I'm just thinking to myself, but why one years old?

Scott Benner 51:24
Did you? Did you try to like buy like extended warranty on the back? Like, listen, I usually I don't buy the warranty. I just figured, like, if I dropped my iPhone, I'll buy another one. You know, I never dropped my phone. I'll be okay, but I'm gonna get it on this one. If you don't mind. Where do I

Unknown Speaker 51:41
sign up for?

Scott Benner 51:44
Now, it's it's the, it's the so early in life thing that's shocking. Oh, I can tell you that. In the middle of July of 2004, my wife and I had bought a house. Maybe two years prior, we lived in a condo we were we lived in an apartment. She got pregnant, we moved into a condo, the condo like appreciated out of nowhere. So we ran away and sold it really quickly and bought what I kind of lovingly referred to as this East house in my town. Like just it was the only one we could really afford, right. But it was on an acre of ground, which is which is incredibly uncommon in my town. So our goal was always just keep doing better. And one day, we'll knock that house over and we'll build another house on this piece of property. But in the meantime, we were making babies and trying to make money and you know, all the stuff you do. And we had gotten, you know, we made Arden on purpose in October so her birthday would be in the summer, you've probably heard me tell that story. So we've got a summertime baby. We're gonna do a summertime birthday party, and we get her a pony for not not like we didn't buy her a pony. We got a pony came to the house and gave pony rides all through the party that was outside. And we were ruining our lawn, and we didn't care. And we were just like, this is like we got a house. It's outside, we got a summer baby. Boom. So I have pictures in my head and on my computer of my daughter in a dress, looking really excited and kind of scared riding around on a pony in the backyard. And maybe a couple of weeks later, she's standing on a, you know, at a beach vacation. He looks like she looks like an extra on the walking dead. Like, she just it looks like somebody's greater skin, took the weight out of her face, found the way to take the life out of her eyes. She could barely lift her limbs or walk around. And she was like quite literally dying right in front of me like your son was and I never thought of it that way. I never looked at her and thought kid seems like she's dying. I just thought, um, it's weird. She's losing weight or she's tired or she's sick or all the reasonable things that bounced around in your head. But then once that's over, it is one of the very next thoughts you have once you've got the diagnosis of like, no, that's not fair. She's so young. Or you know that that shouldn't happen to a young person, but stuff like that happens to people of all ages.

Unknown Speaker 54:28
Absolutely.

Scott Benner 54:28
Yeah. And I agree with your your assertion by the way that you know, while a person who's diagnosed that your son's age, who doesn't receive the care that you're giving him, that might not be a great thing that he has diabetes at such a young age because then if there are complications, they're going to happen sooner in his life, but but but to your assertion that he might grow up very well, not knowing a difference, and therefore unlike the people who you met, you know Maybe won't have a horrible version. That's your hope like and that that's a reasonable hope. It really is. I think you're doing such a good job. It's fascinating. Okay, no, that's fascinating because like, I can't believe you're doing it but fascinating because of how many people I hear talk about. I have a baby. This is so difficult, you don't understand. And I'm like, No, I do understand because I had a baby a diabetes, too. But But like, not a not a, you know, not one that you were counting their age still in months, but pretty close. Like, so I know. I know what it's

Tori 55:33
like to to makes me even, like more afraid because I have a niece who is newly too and she is so choosy.

Unknown Speaker 55:46
Yeah. And I just could not

Tori 55:48
imagine if she was diagnosed at at the age she sat down.

Scott Benner 55:52
Right? I please Do you have any idea how many times like I tried to make like a joke out of the fact that Arden was getting a shot like I'm like a it'll be okay. Like big smile on my heart, my heart inside completely broken. And I'm just like, it's gonna be fine, big smile. And then she'd be like, look at me and laugh and then just take off.

Tori 56:11
You know, he's starting to do that. Now. You're starting to do that, where he sees me prepping the needles. And I I'll get the pen in my hand. I go, you ready? You ready to eat? And he he smirks at me? And then he runs around the Capitol quick. And I'm like, no, no. And I throw him over my shoulder and I pull the diaper down the shot on the butt. I'm like, well, when he you know, is too heavy to get thrown over my shoulder, you probably need to get that point

Scott Benner 56:35
there. So that hit so there by the way, is a is an experience. A lot of people don't have the one of like actually being able to hold a person while you're giving them a shot. Yeah. Or, you know, as Arden got bigger, there were times like she'd run up on the sofa. And like, you know, and she tried to get away and I'd like, you know, crawl after, and then I'd like get her. And then there's then then reality comes into play. You're holding a needle. And yeah, and they're swatting around like, like no, and and you think it for me, at least one of my most panicked thoughts was, what if the amount of insulin I intend to go into her isn't what goes in, what if she bumps the plunger while I'm trying to get near or she pulls away sooner. And now the next what I felt like was like, now the next three hours of my life are going to be wrapped in even more uncertainty. Because

Tori 57:28
so happens a few times. We were trying to train my parents to be able to do all the diabetes care while I was in the hospital with the baby, the new baby. And so I'm 38 weeks telling my parents, hey, you need to know what to do so that we can be at the hospital giving birth. Yeah. And and not being wondering, you know, hey, how much do I go for? And so so I have my mom, giving him a shot. And she first off doesn't take the cap off the needle and she like goes to give it to them and like what are you doing? And and now now I'm holding taxes are like, you know, strong and and, and Jax is trying to whittle away from me and I'm like, take the cap off and she's like, okay, okay, am I gonna poke myself and I was like, take it off. And then she doesn't dial it. And I'm like, Oh my god, you have to dial it. She's like, You're making me nervous. But I was like,

Unknown Speaker 58:36
You're making me nervous.

Tori 58:37
You're making me extremely nervous because I'm gonna be giving birth and you're gonna be texting me. Hey, how do I do this?

Unknown Speaker 58:43
Look at the killer.

Tori 58:45
Yeah, I'm like, you have to listen to me. So I she finally got it. But then she took it out right after she did it. So then like a little bit squirts out. So and I'm like, now what you do? Yeah, you just did half a shot and I gave him like one unit. So I don't even know if he got anything. He's like sat there staring at the Dexcom like, Did anything go in nap Jackson's like, he like get some eggs here. So let's get any strawberries. Now,

Scott Benner 59:15
the cool thing about that experience that I had you had is that in the moment, it's ridiculous. And you know, frustrating. But But last night, so you guys listening? Haven't heard this yet? Or maybe you have, um, you know, I don't know, I record a lot of these things. So Arden has a friend named Jani, who's 15 and also has type one diabetes for six years. And Johnny's control was not great. She'd be over 400 a couple of times a day for extended periods of time, even though she had an insulin pump and a glucose monitor. And, and she was really trying to and that's the other thing that's really important. She was not passive. She was doing what she was told. So you'll hear this on her episode because I've been recording with her little bits at a time as we move forward. But I met with her one time over FaceTime, we made changes to her settings, got our blood sugar down, talk to her about Pre-Bolus saying, you know, didn't, I walked her through the steps it was, it was weird, it was almost like I was like giving the talk that I'm going to give on Saturday when you see me, except I would give one part of the talk. And then she'd go live a day. And then I'd give another part of the talk. And she'd go live a day. And we were sort of doing it like that. So anyway, in four weeks, four weeks, I'm going to her episode of go up before this, so people should go back and find it. In four weeks, her a one c needed to be tested again. So she had had an A one c done live for two months, spoke to me live for one more month had a one seat on again. The day I started talking to her, her blood sugar was no lie constantly over 250 frequently over 400. And she went from an 8981 C to a 6981 thing. He is so good at taking care of her diabetes, right? So it turns out that all the she was very willing to make the effort she just kept, you know, making the effort with the wrong with the wrong ideas. She was she was looking at multiplication and trying to apply Division Two it like it was just you know, she was just all in the you know, right church wrong pew. And so yesterday, and I'm following her DAX calm, but I never really pay attention to it, because she's just doing a really good job. And I'm just following it till we're done recording. So I have contacts more than anything while we're speaking. But she she has not needed my help in a long time in weeks. And I don't offer her any advice, usually. But last night, I finally looked, and her blood sugar had been over 304 hours. And so I just texted her I was like, hey, okay. And she said, I'm not feeling well. I mean, I said, you mean you're sick? She goes, I don't feel good. No, I don't feel good, because my blood sugar is high. And, and I'm just not used to this anymore. And previously, she talked about how great she felt now, and her focus was different, just that her attitude, like everything about her life had changed, you know, or just for the better. And so I said, Okay, and I was able to like in a split second, figure out what was going on and fix it. Because I've lived through that moment of like, Is there something there isn't there and like, I can finally see that there isn't without knowing. And so I just said to her, I'm like, you know, your your pump sites bad. I said, so she had described making a large bolus that didn't work. And I was like I said, change the pump, double your bazel for a couple of hours. Let's Bolus a little bit of insulin. And I think it took us about four more hours to get her back down to being level again. But but it's that experience that lets me see bad pump sites now. Do you know what I mean? Like Like,

I don't need to know what you did before. Exactly. To know if what's happening is what should be happening. I hope that makes sense. Right? So she said she put in seven units, where a lot of people would be like, Listen, I can't bolus more. I'm like, I get that we change the pump. But I can't bolus more because I put in seven units. I looked at like that seven units is not working. I don't I don't care about that seven years, I'm pretending that doesn't exist. And that most people would get involved in like, oh, there's insulin on board, I can't do anything. And then suddenly that 300 blood sugar would be go from a few hours to a day. And then it would just keep running and she'd go to sleep and it would go up and see how you get out of rhythm really simply. Anyway. Oh, yeah. Anyway, I get her down and I get her stable. And I told her I said I'm not going to text just like let's talk for a second. So we FaceTime. And I looked at her and I said I want you to remember something. Those 300 blood sugars, that doesn't happen to you anymore. So when so when it does, it's not you, it's something else, you have to start looking beyond you you made the right decisions. If the insulin went where it was supposed to go, this would not happen, right? And she's like, okay, and she looked at me and she's still 15 you know, and I'm like, this is not what happens to you anymore. Because what had happened was she saw her blood sugar go up and even though she had this great success for these four weeks, what she thought was okay, like she just got she was logged into it right away in two seconds again, like they're just I must just not be doing the right thing. And, and it was I was eye opening for her. And I think for me to see that happen to her how quickly she snapped back into believing. This is just my life. It was was really interesting. But anyway, I think you have to have those experiences. Your mom has to go through that so that you know you She better at it now your mother?

Tori 1:05:02
Yeah, well, so when, when I had the newborn, his name's Brolin and I had bro in. Jack's had been, he had 300 blood sugar's the day that Rowan was born. And I said, You must have not done basically this morning, you must have not dosed him right for his breakfast, something went wrong. And I'm sitting there holding my newborn at the hospital saying this. Well, he had hand foot mouth. Little did we know. And so he was sick. And they're like, I had to give him an insulin shot again at the hospital and like, they're like, well, we just gave him some insulin that morning. And I'm like, maybe it's more. So

Scott Benner 1:05:41
that's what Arden got right before she was diagnosed.

Tori 1:05:44
Oh, it's horrible. And so he didn't have a rash yet. But the next day, they call me and they go, Well, he has some, you know, a rash on his butt, and like around his mouth and on his hands. And then dad's home with him on Friday morning, he calls me and we're about to get discharged. And they go, he's like, well, that rash. It's, it's worse. And I'm like, oh my god. Well, so they took him to Florida to my uncle's. He has like a huge 30 acre lot on his home, his homes on 30 acres. And so he just got to run around and play. And they took care of the diabetes management. So well. They just had to kind of

Unknown Speaker 1:06:24
live get thrown into it. Yep.

Scott Benner 1:06:26
Yeah. Yeah, there's a person on line right now, who posted in the private Facebook group, and they're like, I don't understand I'm not having the same success as everybody else, then when you really stop and look, they hadn't been at it for very long. So I just said to him, like, Listen, it's not a great answer. But you're gonna have to do this a few times before you get it right. Like you don't just, I don't mean, it's not paint by numbers. It's not like,

Tori 1:06:47
I haven't been in it very long, either. Um, but I think having the strength to just like, let go of the fear around diabetes helps a lot.

Scott Benner 1:07:01
What was that one of the things that really moved you in the right direction is just not being afraid.

Tori 1:07:05
Yeah. Because he's a kid. Lowe's actually worked in our favor. Because he's always hungry. So when he goes to, you know, if he's coasting down at 7970 a, I'm like, perfect. Here's some fruit. Bite of my feet. Yeah.

Scott Benner 1:07:26
But for clarity, you're not constantly feeding lows. You're just sort of, right. Yeah, your graphs are way too smooth for that to be the truth.

Tori 1:07:35
Yeah, I got to a point where I wasn't afraid of that happened. And, and we don't have like, double arrows down. Unless I totally flipped on dinner. Um, but he, he's to a point now where I mean, if, if it's been three hours since he ate, and I want to give him something, I'm, I'm not afraid to give him a little bit of extra insulin, half a unit to a unit and let him eat a snack with carbs. And the hospital still to this day is very, three shots a day. That's it. Breakfast, lunch and dinner. I'm like,

Unknown Speaker 1:08:11
oh, what

Scott Benner 1:08:12
do they say to you for how you are doing things? Do they give you any trouble?

Tori 1:08:16
No, no. They asked me what is what are his ratios. And that happened maybe the the third month when we went again. And they saw just how well we're doing. And they're like, so what are you doing? I'm like, well, so his ratios are this but sometimes they're that if he's really activates this. And they're like, Okay,

Scott Benner 1:08:40
good. No, yeah, you're paying attention. It's uh, yeah, but it's also nice to hear that they didn't you know, because too many people report back that, you know, they have this the kind of success that you're talking about, and then doctors are like, no, you're using too much insulin. They take it away from you. Like, you know, yeah, I get scared of it.

Tori 1:08:56
Yeah. Anyway. Well, so because like I said, they they don't like me giving him extra shots for snacks and stuff. But I I made them aware that I'm watching the back phone all day long. And I'm he's always he's a growing baby. And he wants to eat and he's getting really tired of cheese sticks.

Scott Benner 1:09:18
Exactly. And it's and that's important. We don't bring that up enough Is this your children need to eat? You know, like they're trying to grow their bodies are trying to get bigger and if you're having to restrict certain foods or foods at all, because you're not able to manage the insulin well, then there's another day now you have a different problem is the kid you know, not saying is malnourished, but definitely not nourished the way you're you were hoping to or that you would have if you weren't worried about the insulin.

Tori 1:09:44
Absolutely. Yeah. That's so cool.

Scott Benner 1:09:46
I'm glad for you that the podcast was helpful. It really is nice.

Tori 1:09:50
And I mentioned at my last, his last endo appointment. They were telling me about the Atlanta summit and I said, Oh yeah, I definitely want to go I listened to Juicebox Podcast and they're like, oh, That makes sense.

So they were aware.

Scott Benner 1:10:04
So the hospital. So this happens more and more, which is really kind of kind. I was told recently by somebody that they went to their endos appointment. And the person just said, Listen, I just let me just ask you, do you listen to the Juicebox Podcast? And the woman said, Yes. Why? And she was, I can just tell by your graphs. And I was, I was so touched by that. I thought, that's really, that's really cool. You know,

Tori 1:10:31
they told me as his last appointment when we were discussing you. This is the best graph that I have ever seen. From one someone that's not been diagnosed more than a year and to just his age in general.

Scott Benner 1:10:47
So in seriousness, then, don't don't just say the podcast, but like, what do you attribute that to? Do you tribute it to knowledge? Or comfort? Or is it a blend? Like I want people who are listening? who are, who are healthcare professionals to understand what I believe, which is that if you tell people the right thing, it doesn't matter how early you tell them, but I want to know what impact before I let you go like, I want to know how, how it shaped you.

Tori 1:11:17
Like, what your podcast has done for me, just in general? Yeah, like, What does

Scott Benner 1:11:21
you know, what does the information like so so here's the thing, you really haven't been around diabetes that long. So he wouldn't know. There's a an old school idea that you don't tell people too much too soon, you get a you get a little bit of information, and then you get a little more in three months, then you get a tiny bit more than three months, and in a couple of years, then we can start talking about you know about and by then my contention is, what that builds is fear and a lot of psychological angst. And so it's hard to get you back from that, then I I'm a bigger fan of getting the information out in front with good explanation about how to use it. Not technical explanation or mathematical explanation, but like real like real world ways, because I even I sat next to a physician recently, who loves the podcast, and wants to move the information from the podcast to people at his hospital, and even doctors that are training at his hospital, which I was really overwhelmingly touched by. But still in that conversation, there was an assertion that the information that I'm sharing with people about how I manage my daughter, that's not something everybody can understand. And I don't I don't know if I agree with that or not.

Tori 1:12:38
Like I had to keep on listening. And and you had mentioned in a podcast that you just put up the other day like you just have to listen and listen and listen and something's gonna you know, pay you and i think i think it really helped me to want to live day to day and really look at the grass Dexcom but I need information from the get go. I need to know exactly what to do. I am very type A personality. There's like this big thing about like Enoch grams and I'm a type one in a gram. And

Scott Benner 1:13:19
Bruce past that. What the hell is that?

Tori 1:13:22
It's like personality. I'm on

Scott Benner 1:13:24
the internet. Don't worry. Hold on a second. Type. I found that already. Hold on. Oh, I see. The Nine intagram type descriptions reformer helper achiever, individualist investigator, loyalist enthusiast, challenger Peacemaker. Which one are you

Tori 1:13:44
a performer? So type one.

Scott Benner 1:13:46
I got it the rational idealistic type, principled, purposeful, self controlled and perfectionist. Whoo, I wonder which one of these you tell me about that one? Yeah. decide which one of these.

Tori 1:13:58
Yeah, so with with that personality when, when he was diagnosed, and I would see that the blood sugar is where I wanted it. And especially after I got the dexcom and I'm trying to figure out his ratios and the hospitals just telling me to hundreds, okay. 180s Okay. And, and I'm like, that's not okay. It's not and so I'm racking my brain around how do I get these ratios to where I want them to be? And by listening to your podcast, it's little bits of information from other people and what they do and how, how their day to day goes. It's one made me feel like there's

people going through the same thing that I'm going through and people that

had the same frustrations. Does that make it a little doable,

Scott Benner 1:14:52
either? Yeah. Okay.

Tori 1:14:54
For sure. And so I was like, there's like, just because he's a baby doesn't mean that I can't have a great alien. See. And so

I don't like to be frustrated. And

my husband would see me sitting there racking my brain, looking at every single graph and going through the clarity reports, and he's like, just it's diabetes, just get over it. Things are gonna get out of your control. Sometimes I was like, Well, no, no,

Scott Benner 1:15:24
no, they won't. And by the way, you're under my control. You don't even realize it.

Tori 1:15:29
Like, I tell you what, I'm not home, when to give him the insulin. And then as I'm watching, I say, Now feed him. And so like I do,

Scott Benner 1:15:36
I'm in bigger picture to not just the diabetes, but yeah, hey, listen, this, this intagram thing. I'm concerned that I might have multiple personalities, I'm alone. things is that is the Does that ever happen?

Tori 1:15:48
Yeah. No, it does. It does. You can be a couple different things. Okay. But there's like a primary one that you gravitate to best. So I would totally take a test

Scott Benner 1:15:59
because as the reformer, I am not a perfectionist. I am self controlled. I'm sometimes sometimes personal, purposeful. I'm actually a very principled person. But I am. But I have my limits. So I always tell people, I've definitely never said this here before I live my life under like, very basic rules. Like I don't I don't treat people the way I don't want to be treated. And I don't lie. If I can absolutely help it. That's those are pretty much my life rules. But now the helper caring, I am caring. Let's see, demonstrative. I'm super emotional, generous. I don't know people pleasing. I definitely am possessive. I don't know what that means exactly. Like of people or things I don't care to. I mean, I, the people around me that I care about, I want to be close the achiever pragmatic type, adaptive, excelling, driven, and image conscious. I'm not image conscious, which you'll see this weekend when I allow you to take a picture with me, and I look terrible in the photograph, and you're still allowed to keep but I'm driven about things I care about. And things like things I don't care about. I don't care about law. Am I adaptive? I don't know. individualist. traumatic. Oh, I'm so dramatic, self absorbed at times. And temperamental, super temperamental. I'm all of these things. I have a mental illness is what I'm learning here. Isolated, secretive. I'm not isolated or secretive, innovative. It's funny because of the podcast being innovative, but I don't think of myself as innovative, engaging, responsible. I'm responsible. I think I'm delightful. It's delightful, engaging the same thing. anxious and suspicious. Hmm. I'm not anxious. And I'm not suspicious. I know you people are out there trying to screw me. So don't think I'm scattered or distractible. I love to the enthusiasts. Now you guys should check this out. You can definitely distract me. And I'm not very versatile, spontaneous. I think I pretend to be spontaneous. That makes sense. I do it down here. self confidence. I project self confidence. But I don't personally feel self confident. I'm not decisive. I need to think things through from like, 9000 different angles. will fold no confrontational, less as I get older. And Peacemaker. agreeable or not agreeable? complacent. I'm not complacent, reassuring. I'm not necessarily Oh, so the peacemaker is Peacemaker for other people. Like how does your how does how you are impacted people around you? Is that kind of the idea that?

Tori 1:18:54
Yeah, I took it that way. Yeah.

Scott Benner 1:18:56
Yeah, you took it. So you didn't seem insane. You took it that way.

Tori 1:19:02
I mean, the cool thing about these is that you can take it with your partner and like, understand each other better, because when they do something like when I'm a perfectionist, next we like Well, that's just her just gonna stare at that clarity or for for days, and so she figures it

Scott Benner 1:19:18
out. How long have you been married?

Tori 1:19:20
We? Well, we we say that we're husband and wife, but we're getting married finally. All right.

Scott Benner 1:19:25
Don't worry about that. How long have you been together?

Tori 1:19:29
It'll be four years. Okay. Yeah.

Scott Benner 1:19:31
So when you're together longer, you might have this experience if I brought Kelly up here right now, and told her for instance, that I am. Let's see, hold on. Let's pick one that, you know, there was one

Unknown Speaker 1:19:46
how I

Scott Benner 1:19:46
know. Yeah, but no, if I if I said that I'm driven, exempt, for example, she would completely disagree with that. And she would not let me have my belief that I'm driven. She would stay here. beat out the idea from me that I'm driven. She's like, No, you're not. And then she'd give me examples of why not. And then I'd give her examples of why I am. And she'd say, Ah, don't argue. And so then she just she's, you know, she's a different view of me than other people do. Which I think I think is good. Sometimes it's grounding to not Yeah, somebody agree with you all the time. All right. Is there anything we have not said that you want to say?

Tori 1:20:25
Um, well, is a one C was 11.9. diagnosis and three months in, and having the dexcom for only two months, we brought it down to 6%.

Scott Benner 1:20:36
That's amazing. What is it now?

Tori 1:20:39
Is next I know, appointments next week, and I have a feeling it'll be there. 6% still, because we have been dealing with a lot of toddler sticky. Um, so the, you know, gas has been a little wonky. But I think it'll be around 5.7 to 6%. On sugar main, it tells me like it might be around 5.7. And the clarity report says 6%. So I mean, we've been really steady right around there. I think

Scott Benner 1:21:07
that's lovely. I also think it's amazing that people who listen to this podcast are like, you can hear in your voice, the disappointment of saying 6% just, I don't know, things have been going wrong. So

Tori 1:21:21
blood sugar, it's been like around 150 or a few days and

Scott Benner 1:21:27
Arden's last day one, see that they now they play that game that, you know, I don't think they do it with everybody, but they're like, what do you think it's gonna be? And I said, five, seven. And she goes, she goes, why? I said, we were five, five last time. And yeah, and I said, and I don't, I'm being genuine from it. I don't really see the difference between five, five and five, seven, I'm, I'm in that space. I'm more concerned about variability and like limiting spikes and lows and things like that.

Tori 1:21:53
Yes. And I was looking at that as well, and our standard deviations around 30.

Scott Benner 1:21:59
But the thing is, is when she said, Why do you think it's gone up? I said, God, we've had a lot of problems this time. And she laughed at me. She goes, so you've had a lot of problems, have you? And I said, Yes. And she goes, and you believe that you're a one hurry once he's gonna go up point two. And I was like, Yeah, but I think that, you can look at that and think of me and you as crazy. Or you can look at that and see it for what it is, which is that we're, I can speak for myself. I'm so confident in what I'm doing, then that I Arden's a one sees not going to just jump up if we continue to do what we do. And so we're talking about tighter tolerances, because that's where the tools we use live, you know what I mean? Like, I, there's there, it would be inconceivable of me, for me to believe that her agency could, for instance, go from five, seven, this time, to six, five next time, like I don't, yeah, that couldn't happen. Unless something catastrophic happened to our insulin delivery, or her health or something like that, like in a normal regular situation, it's not going to move around like that. And No, you don't. I mean, like, it's sort of like, when you get in a car with somebody who's been driving for 30 years, you're just like, this rides gonna be fine. Like, you know, like, they've just, they, this is how he does, you know, like this

Tori 1:23:22
happened, the hospital told me, they were like, well, you might not always have such a tight range, because he is going to keep growing, he's going to keep, you know, going through growth spurts, and eventually puberty. And I do understand that and right now we're in a very blissful stage. But with the honeymoon ending, we're on like, a one to 50 ratio just like a few months ago, I'm gonna get,

Scott Benner 1:23:44
I'm gonna tell you with your understanding of how the insulin works. I would say that, from a, from an emotional standpoint, I think that's good advice for you that it could fluctuate around, that's not gonna be for sure. And, and I will also tell you that on the hopeful side of my betting, I don't think that's gonna happen to you. So I think you know what you're doing. And so, so when insulin needs increase, I see it right away. Yeah. And you'll increase with it. What, that's what we did. What happens to most people is their insulin needs increase, and they spend a good three to six weeks really trying to pick the situation apart.

Tori 1:24:21
Yeah, no, it happened like like, two days, I saw that we weren't doing the same like we were giving the same dinner I some days, I'll get the same dinner and over and over again until I get it right. Do exactly what I did except add another unit. And so that's what I did. And so I I noticed that last night, it worked out in my favor, except he had like a little bit of a protein and fat spike three to four hours afterwards that went in and took down right away. And then this morning, for example, it was like a one to eight ratio. And I was like, that's because I didn't give him 10 extra cards. Like I would have and I just did an extra unit and, and I said, Well, Mom, here's a fruit pouch while I do this podcast, he goes low.

Unknown Speaker 1:25:10
He didn't

Tori 1:25:11
study at what a weight right now,

Scott Benner 1:25:12
that is great for people to hear you made me feel like I've let you go after this because I actually have to record another one today. But that what you just made me feel like was I've been watching for all mankind on Apple plus. And it's sort of a fictional retelling of the space race. And you made me feel like we that you were in the capsule, running a test. And you got outside of preference out of parameters. And you just were like, do it again, like to like with the with the same meal over and over again? You're like, that didn't go right. We'll do it again. tomorrow. We'll do it again tomorrow. And and it works. Like I mean, can't do everybody can't do exactly that. But yeah, but just the idea that you realized, like, I just there's something there's a small adjustment in here. Let me make it again. And then you figure it out. And then those adjustments work for other meals. Am I right about that?

Unknown Speaker 1:25:57
Oh, yeah, well, yeah.

Scott Benner 1:25:59
Okay, cool. All right. Sorry, listen, you're chatty. So obviously, we can do this forever. But

Unknown Speaker 1:26:05
I'm gonna go interview

Scott Benner 1:26:06
the hold on a second,

Unknown Speaker 1:26:09
I am gonna interview

Scott Benner 1:26:13
Rick Doubleday, he's the chief, something officer from Dexcom. And that'll actually be out tonight. So there's gonna be a an episode with him. And they got a guy from on the pod. And they're going to talk about the agreements, they all just signed together, about working together for the horizon closed loop system. And, and I guess the Dexcom guy will probably talk about the, the other companies that they have agreements with in place for G six and G seven for people to be continuing to develop, you know, closed loop algorithms for the different pumps. So cool stuff. All right. I really appreciate you doing this. Thank you so much for coming on.

Tori 1:26:54
Thank you. See you in two days. Yeah.

Unknown Speaker 1:26:56
Oh, that's right. Oh, I'll see you then. All right. All right.

Scott Benner 1:27:01
Little did I know that would be the last time I'd ever speak in public. Anyway. Oh, thanks so much to the Contour Next One blood glucose meter go to Contour Next one.com forward slash juice box to get that rockin meter. And of course the T one D exchange. Absolutely anonymous, super safe. HIPAA compliant. worth your time. T one d exchange.org. forward slash juice box. Guys, do you have a great doctor that you'd like to share with someone else? Or are you looking for one I am in the middle of building an amazing list at juice box docs.com you can take a doc or leave one just like that little Penny thing. You know, at the gas station. Take a penny leave a penny. This is the same thing except with doctors juicebox Doc's calm.

#387 Somebody Call 911

Handling a type 1 diabetes emergency

Ginger Locke is paramedic and the host of the Medic Mindset podcast. She's here to talk about handling type 1 diabetes emergencies, medical tattoos and much more.

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Scott Benner 0:10
Hello, friends, and welcome to Episode 387 of the Juicebox Podcast. Today on the show, we're gonna dig deep into an issue that I see people talking about a lot. It's their concern about what happens if they should have to call 911. And moreover, what happens if emergency services arrives, and they can't figure out that you have diabetes, or they don't know. This is such a concern for people that I wanted to get a very learned response on it. So I have a special guest for you today. My guest today is ginger lock. Now besides being the host of the medic mindset podcast, Ginger is a paramedic, and an associate professor of MS professions at Austin Community College. In other words, Ginger can do it and teach it. And she's had the experience of helping people with type one diabetes over and over again. So we're gonna get your answers for you, you're ready, you're gonna like ginger. Please remember that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise. The Juicebox Podcast is sponsored by touched by type one, visit them at touched by type one.org. We're also sponsored today by dexcom, makers of the G six continuous glucose monitor, you can find out more and get started with dexcom@dexcom.com Ford slash juice box, how would you like a tubeless insulin pump, you can get it the same one in fact that my daughter has been wearing since she was four. It's called the Omni pod. And to get a free, no obligation demo sent directly to your door, all you have to do is go to my Omni pod.com forward slash juice box. After a couple of quick clicks and a little bit of typing on the pod is going to put that pod experience kit in the mail. And then you're going to be able to wear it and see what you think. Both people want to understand this topic. But it's it's two different reasons. The parents want to put something on their kids so that you know, emergency emergency situations they can see they have diabetes. And adults mainly want to know if tattoos are a good way to to signal. And I started thinking about the topic and I just thought why don't we just like why don't we find somebody who has probably had this experience a billion times right? I did my research and you seem to have the most popular well liked podcasts on the subject. So

Ginger Locke 2:49
Oh, thank you for saying that. Oh, of course, um, introduce yourself. Sure. My name is ginger Lok and I have a podcast for especially for paramedic students. That was the original idea and but paramedics that are in the field, listen as well. And it's called medic mindset. And so most of what I dig into is the psychology of paramedics. And a lot of people think when I say psychology of paramedics, I think that means I'm talking about PTSD and anxiety and all that mental health issues. And we do you know, that does come up occasionally but more I'm interested in how they make clinical decisions and their thought process under what's usually a stressful environment. But but but not always how they continue to kind of show up emotionally for their patience even after like long hours of exhaustion or, you know, you flip flop back from like one a really acute patient and then the next call, maybe something very kind of low acuity kind of Monday, and if someone just needs help, you know, standing up right in they live alone or something like that. Yeah.

Scott Benner 3:57
How long does shifts usually run? And are you there throughout the country? My expectation is that there are some who volunteer and do this work. Right. And there are some who are paid, depending on your municipality, is that right?

Ginger Locke 4:09
Yeah, yeah, I think most cities, we are paid kind of paid services, sometimes embedded within the fire department. But sometimes like, for example, I'm in Austin, Texas. It's a third city service. So you have police fire and emfs. And they're three separate kind of independent things. But then for sure, there's small communities that have volunteer based system. Yeah. It doesn't mean they're lower standard or anything like that. It just means that there's people are sometimes there's a longer response time because people are responding from home, right. So.

Scott Benner 4:47
But well, we used to where I where I grew up. So when I was when I was growing up the entire time. My father was always involved in a local volunteer fire department, which I've sometimes come to think of as a way to get away from my mom. I used to drink beer that wasn't our house. But they but they also, you know, I saw him while I was growing up, there were a number of like significant emergencies in our town, from car accidents to people, you know, trapped in buildings and serious fire some there were some pretty big fires as I was growing up, and my dad was the guy who ran out of my house and went to the other place and got changed and got on a truck and went and took care of it. So I tried it a little bit in my late teens from when I was 16 till I was 19, or 20. And I did hundreds of hours of training, just to be a volunteer fireman. Oh, yeah. And then we had, you know, an ambulance service in the town that was partially paid and partially volunteered. And they would even the volunteers would spend their time, you know, in the house waiting for calls. And it was really fascinating. We really dedicated people, oftentimes not making a ton of money doing something really difficult. You know, it was, so what about you? How did you get involved? And how do you practice?

Ginger Locke 6:06
Yes. So I'm a full time faculty now at Austin Community College, I teach future paramedics now. I still get to be around patients, because we do clinical rotations in the ers that are precepted by the faculty. So we go with the students, and we, you know, do patient assessments and start IVs. And rounds is probably the common term that people have heard clinical rounds. But prior to that I was in the field for about five years working as a paramedic, and I still where I teach is in the same kind of area where I work. So just kind of networked within the MS community here and, and thinking about your question about the tattoos, I actually talked to some medics, some friends of mine to make sure you know that my my experience and what I thought was the answer. I didn't want to make sure it wasn't unique. Just to me that it was it was kind of the common thought process about tattoos or markers. Right, you know?

Scott Benner 7:05
Yeah, that's cool. So all right, so we have your INSIGHT Plus some other people's. What's the steps to becoming a producer, isn't it? Our paramedics and EMTs are two different levels of qualification? Is that right?

Ginger Locke 7:17
Correct. So an EMT. Generally, if you think of it in terms of college based programs, and you can become an EMT, in one semester, it's a certification course. Whereas a paramedic is often an associate degreed person much like this, the similar links of training as a Rn, for example, who became an associate degree nurse, so two years to become a medic,

Scott Benner 7:43
I remember listening, I'm older than you, obviously, I'm looking at you and you have here but younger than I am, but I am I'm, we used to have these little squawk boxes in our houses that they gave to us that just kind of like alerted this high pitched alarm to tell you there was a fire, and then you could kind of scratch easily here, the dispatcher, and it must have all been like FM or UHF, or I don't know how it worked back then. Because there was no internet, you know. And you could hear as you were kind of running out the door of your house, you could hear the dispatcher talking. And I always knew if it was an accident, that it was going to be bad because the police on the scene would always want to skip over the medic or over the paramedic and go right to the EMT, they'd ask for the EMTs like to be so there was not I always felt like there were two different rigs that were kind of, you know, stocks are

Ginger Locke 8:38
right, sorry to cut you off. EMT EMT. We classifies basic life support and then a paramedic is advanced life support.

Scott Benner 8:45
I have a backwards. Okay,

Ginger Locke 8:47
yeah, the way you said it was was reversed.

So EMT might, you know, most firefighters are EMTs they come and they can do these basic life support things. But then often a paramedic arrives in an ambulance for the for the transport, and they've got a higher level of medical care IVs cardiac medications EKGs ultrasound, more toys. Yeah. And, and additional schooling, additional education. So they think in a more complex way about you know, what could be wrong with the patient, they do get what's called differential diagnosis, they think about what disease could be causing this problem. Obviously, if it's correct, it's trauma, it's pretty straightforward. But in thinking about diabetes, you know, we've got to differentiate things like diabetic ketoacidosis, from sepsis, and those two can look a lot alike or maybe it's both and, and so a lot of our education is teaching medics how to think about diseases and how to sort them without all of the benefits of things like blood labs in the hospital, we do have glucometer so we do know blood glucose levels, but we don't have things like lactate ions and some of the advanced stuff that's in the hospital.

Scott Benner 9:58
So after I I decided that I was going to ask you, I put it out to the community that listens to the show. And I got a lot of questions here for here. So I apologize, but I'm gonna probably hit you with some rapid questions at some point and see if we can't give people a full idea of what they can expect from the emergency response if they have a problem. So a lot of people just want to know, do you open up the health apps on people's phones to look for the information that they put in there?

Ginger Locke 10:25
Yes, we would if they were unresponsive. I think if someone is obviously talking, we would never do that, you know, they're kind of in full consenting ability to just have a dialogue. But when people are unresponsive or in cardiac arrest,

yes, but

it's not the first thing we do. It often comes into play a little later into the call. So the one mindset of medics is a find it fix it approach, right. So if, if the person is on their back, unresponsive and they're snoring or they're gurgling, right, we just open the airway, we do some suctioning. So it's just we find this we fix it, we're not yet thinking what caused all of this. It's just some if they're bleeding, we stopped the bleeding a lot then minutes into the call when you start thinking, what caused this? And is there anything any additional treatments than Yes, we start, we start looking through you know, looking for insulin in the in the refrigerator looking for papers that look like they might be prescription, you know, papers from the pharmacy or things like that,

Scott Benner 11:36
go through purses and stuff like that look at your possessions.

Ginger Locke 11:40
But on the iPhone, there's this functionality to get into someone's medical ID and I teach that I teach that to paramedic students of how to get in there that different iOS is and talking specifically about the iPhone. Sorry to just be talking about Apple but there for a while there was a functionality where you just tap I don't know what button that is. This is volume. I guess it's one of the menu buttons right on the side. You do it five times. I think it opened up the medical info. That's interesting. Don't do it. I don't know. Sometimes it does.

Scott Benner 12:15
Let me try. Don't try to now pay with my credit card.

Ginger Locke 12:21
Doing an emergency SOS right now

Scott Benner 12:23
versus calling for help. I they just added these tap functions to the back. But that's

Unknown Speaker 12:29
that's bad calling 911 Are you really cheap?

Scott Benner 12:34
At least they'll know it's you. Right? Are you gonna say hey, it's ginger. I'm sorry.

Unknown Speaker 12:40
Oh, my gosh.

Scott Benner 12:42
She says

Ginger Locke 12:44
I'm sorry. It was a missed call. I hit my phone five times on the site, because I thought it opened up the medical alert. info. All right. Thank you.

Scott Benner 12:57
Oh, my gosh.

Unknown Speaker 12:59
Okay. Well, we won't sprint. That was great. Please leave that in the podcast.

Scott Benner 13:03
Oh, I'm not taking anything out of the podcast. Don't worry.

Ginger Locke 13:05
Now it did open up my medical ID it was the third step apparently

Scott Benner 13:09
123 opens it? I don't know. But let's go again. Hold on. No, no, don't do it. I so I know two clicks is to open up an app like Apple Pay. And so I keep running into that. But I will figure it out. I'll tell you what, I will figure it out. And I'll put it in here. But, but I think it's gonna be of great comfort to the people who asked the questions that you do look, because I I mean, listen, especially for not, you know, it doesn't matter. I should say whether you're a parent or a person living with Type One Diabetes, your thought is Oh, my God, if my kids alone, is someone going to know if I'm alone? Is someone going to know? And and that kind of brings me to what should someone do when you arrive? And there's a person with diabetes who's struggling? What should I be telling you? Hey, they have type one diabetes, like what do you want to hear from people? That's, that's helpful and actionable. And what's too much? You know what I mean, when people start telling you their life story in a weird situation?

Ginger Locke 14:08
I, of course, yeah. Um,

Unknown Speaker 14:12
so generally,

Ginger Locke 14:14
we want to listen.

And that's called the ope that, that what you just said this telling them the life story that's called the opening monologue. And we, it's actually part of training to try not to interrupt that initial what's called the chief complaint. It's like, why are we here? What are what is, what is your need, and what are we trying to address? But I think of you, for example, being a parent of someone or having a family member who has type one diabetes, and let's say they were critically ill, I think because you've lived with the disease for quite some time. Now you would know to say they have diabetes, they're unresponsive. And then we're gonna do a little bit of work, you know, for a couple of minutes, but then also That additional info is going to be port important. Like when were they last seen, okay. And it's helpful to tell us that they have diabetes, but that that can also do something called I think it's called triage cueing where you're basically sitting us down a path. Accidentally. Yeah. So it's, it's good that we know, but we don't want to only think, is this just diabetes? Could this be also could this be something else? Could this be a stroke or something else? So

Scott Benner 15:29
it's funny, I employ a similar idea, when I'm interviewing people on the podcast, you don't want to say something that takes them away from their thought, or leads them to, you know, believe that they've come to some conclusion. And they might be false, you know, like, so. This person has type one diabetes, they use insulin, we just ate and now she's unresponsive. I think she had too much insulin, or she's generally like, would it help to know this is a generally healthy person versus someone who's struggling? But yeah,

Ginger Locke 16:00
if we know this is out of norm, normally, this is well managed diabetes, this never happens. This is something and then then we think, oh, that it's important that we know that the patient has diabetes, but maybe I don't want to get tunnel vision on that one possibility. I want to remember Oh, just because they have diabetes, doesn't mean they can have all these other health problems, right?

Scott Benner 16:23
And and indicate quickly, type one to type two as well. I'm using insulin not using insulin.

Ginger Locke 16:30
I think knowing that someone uses insulin helps because that means that they're at higher risk for sudden drop in their blood glucose levels, right hypoglycemia,

Scott Benner 16:40
so in an emergency situation that the person is not expecting. The difference between type one and type two is not as important as they use insulin or they don't use insulin because Metformin is not going to make you pass out for instance, like that. I get that. Okay. Do you guys use glucagon do you carry it? will use the person's How does that work? Yes,

Ginger Locke 17:00
I have when I was in the field, we had glucagon, we used it. And then I also had patients who had it at home and what could give it to themselves and they had already used like an auto injector to give themselves glucagon. And when I got there, they were starting to get a little better, right? It takes some time. So glucagon is, as your listeners, I'm sure now releases glycogen stores from the liver. But yes, we have glucagon for that. And then also for

some other things to look at actually

has indications for other non diabetic emergency close down

Scott Benner 17:35
GI tract, right. Is that one of the things that does I had somebody told me they use it in some surgeries to keep people to slow people's gi tracks down and oh, it's interesting. I guess it does a lot of different things.

Ginger Locke 17:46
Yeah, it very well could, as I'm thinking about kind of its mechanism of action. Yeah.

Scott Benner 17:51
Okay, so do you have any stories that stick out because I'm thinking about a close friend of mine who lived his whole life with type one and you know, fell out of bed because his blood sugar was low and broke his arm, you know, got so low that his family couldn't help him? I'm wondering if you have any that that stick in your mind?

Ginger Locke 18:10
I think the the extremes, right, the hypoglycemia is and the hyperglycemia. I think they all stick in my mind because they're pretty extreme presentations. Okay. Right. The DK a patient, that's a perfect, they're profoundly ill, those are ICU Intensive Care Unit, they're going to end up in the ICU. And so they're very obviously, profoundly sick. And same for hypoglycemia, right? When they're unresponsive or altered. They're those two decay and hypoglycemia are not very quiet presentations, right? They're very in your face. The one that's sneaky, is the hyper molar hyperglycemic nonketotic syndrome.

Scott Benner 18:55
We all know that one Tell me,

Ginger Locke 18:56
well, you don't know it, because type one usually results in DK whereas type two diabetes can result in this other hyperglycaemic condition when they're not. p todich. They're No, they're they don't have keto acidosis.

Scott Benner 19:10
But their blood sugar still super high.

Ginger Locke 19:13
Well, yeah. And so they're just sitting there actually, not looking particularly sick, because there's no acidosis but their blood sugar is very, very high, and they're very dehydrated, and all that.

Scott Benner 19:22
Wow. I know, I just had somebody on recently who talked about as they were going to decay. He described it as it felt like the devil was inside of them, just a burning chest and I thought he was gonna die just kept telling people when he got to the hospital, I feel like I'm gonna die. So that's crazy. So you guys have to show up in all of these situations. It really did strike me when you said earlier and I let it get by and I shouldn't have that you could go from a situation that's, you know, an overdose and get back in a rig and drive somewhere else and somebody cut their finger making you making dinner, and you're probably still all like, like, how do you how do you do level? Or is it not possible all the time?

Ginger Locke 20:04
I think the fact that it's work helps a little bit of you can be more objective right then if it's your family member, so that what you know what you just said that we, it's our goal to not really get to maintain just a little tiny bit of emotional or professional detachment, right? We don't get quite that we have empathy. But empathy can get so deep that you're actually experiencing the other person's trauma. You know, it's, that would be terrible. If you kind of went down that Yeah,

Scott Benner 20:34
you're there to help so far not to forget that right? Yeah, I have to say that

Ginger Locke 20:37
I think I think we have it tough, but we get a little bit of wind down and wind up time. So we get to, you know, clean up the truck and do a kind of tidying up and then wait for the next call. I think I've also I've watched er, Doc's that we'll be doing cardiac arrest in one room. And then minutes later, I'll see him in another room, just sit and talk him with a family member about something kind of mundane. And I'm like, that seems like a lot of whiplash.

Scott Benner 21:04
There's definitely a scope. We we came up on a car accident one time that seemed kind of benign. And we were told to, we were going to we're gonna have to extricate, they told us and as we were getting stuff together, I sneaked. I looked in the car, to kind of try to get my vibe for what it is we were going to do. And there was no one in the car. And so I turned back to the the officer on the scene, I was like, there's no one in the car. And he pulled me aside and said, it's an older woman, she was like, in her 70s. And she had not been wearing a seatbelt. The force took her into the footwell, and she was under the dash, like, folded in half under the dash alive. And I was I just that that was the moment for me, where I realized I actually did have it in me to hold it together and still do a thing. Because I feel like, if I didn't, I would have found out that one day, you know, I mean, like, I'd seen dead people dead people wasn't too bad. I've smelled burning bodies like that. That didn't get me too bad. But this one for some reason. Like as I as I was living through it, and then look back at it later, I was like, Oh, my God, she was she was broken in half, you know? And, and I still did my job. So that's like, cool. I might I might be okay at this, you know? Because was it that exact same thing? Because if anyone was going to go running and screaming, that would have been the time it was horrific, you know, really crazy. When a persons with another person with diabetes, say they've had or they're having a seizure? Is there a way to articulate this without you believing that they've odede? Like, are there words to use or not use so you don't get confused?

Ginger Locke 22:41
Hmm. So you're saying you're you're the person you're with is having a seizure? And you believe it's because of a diabetic origin right? hypo hyper hypoglycemia is what we call hypo. Right?

Scott Benner 22:54
Yes. Where they're unresponsive, or they're, you know,

Ginger Locke 22:59
yeah. You want to quickly communicate, hey, we're not doing opiates here. This is a part of the

opioid epidemic.

Scott Benner 23:06
Right? Right. How do you start with this is not narcotics, this is diabetes in a way that we'll believe it, because people will lie about drugs thinking that there's legal ramifications on the way right. Okay. Uh, no, yes, sure. I'm sure

Ginger Locke 23:20
they do. We try to get that you know, across to them that we would never end it's in fact illegal for us to as healthcare professionals to that's your protected health information. We try to communicate that but sometimes we arrive in uniforms that look a lot like cops and it's it gets real messy and confusing, or the cops show up also. Right.

Scott Benner 23:37
So they're there at the same time. Yeah,

Ginger Locke 23:39
um, I think, you know, saying that you know, the person that they have diabetes that this sometimes happens when they have hypoglycemia, and probably just saying if you're concerned about you know, recreational drugs we we don't use or we don't use anymore we haven't used today are just directly saying it. I think medics are incredibly non judgmental about recreational drug use. And they really just want to know what they're dealing with. They're not it's not zero judgment. And it's understandable that the general public wouldn't know that right? So clarity, just

Scott Benner 24:17
just just throw it out there. Yes, I'm, we're, we're This is not drugs. This is diabetes. Please think about that as you're going towards it. Or I know this could look like something else, but it's not. Does DK look like intoxication.

Ginger Locke 24:30
It can smell like it unfortunately. So you breathe off ketones. It has an acetone smell that to some people, it can smell like metabolites of metabolizing alcohol,

Scott Benner 24:44
okay, like fermentation almost.

Ginger Locke 24:46
Yeah, just kind of smells sickly sweet. Yeah, the way

Scott Benner 24:50
sweet breath is one of the ways we figured out my daughter had diabetes all those years ago. And then again, she was too so I guess I wasn't thinking maybe she had too much right brandy or something like that. That Okay, so there can be that. What about the combativeness with those low blood sugars? Like I've heard stories of grown adults whose blood sugars get low, not so low that they're unconscious, but then all of a sudden, they're like the Hulk and about half the weight of they can't think either and that situation.

Ginger Locke 25:19
Yeah, I've, I've run those calls.

Scott Benner 25:20
Yeah, what do you do?

Ginger Locke 25:22
Um, so often they're sweaty to a lot of

pale and sweaty and so

it kind of be I can kind of be a handful.

We have general approaches to what you might call an agitated patient or combative patient. I don't really like to use the word combative, I think of it as more agitated, like, it's often in fear, yeah, that people become so non, you know, not able to kind of follow along with the sequence of events that a normal person would

Scott Benner 25:56
lose the society, you know, I guess combative. I get your feeling. I didn't mean to cut you off. But combative gives the overtone that they're purposefully not Yeah, doing it. Right.

Ginger Locke 26:07
Yeah, I hate that word. Yeah, I prefer more agitated, because it gives you a sense of what's going on in their head, right, they're going through anxiety and

confusion. So

we basically have two, two approaches. One is physical, like if someone were truly combative, like swinging at you, there's basically two approaches. One is physical restraint. And the other is chemical restraint. And both can be used in conjunction as well. I think chemical kind of sedation is the humane thing to do, you wouldn't want to physically hold someone down, right? Because that could be dangerous for them. But then also just like, psychologically

terrible.

We usually try to give them glucagon or some dextrose, you know, we try to first discover that their blood glucose is level. So that means we have to stick them to get a little bit of blood. So that's sometimes exhausting. Just even get a little blood there. They're not liking that.

Scott Benner 27:05
I can tell you that even at a reason there's a spot in my daughter's blood sugar, will she'll stop caring, like the kids like in you know, I'll say hey, test your blood sugar shekel, I will. And then it say keeps falling. And it gets to a certain level. And you'll say like, Hey, this is becoming a problem. Like you really need to check and eat something at this point. And she'll get like, it's it for her. It's very jokey still, but she's like, well, if I die, I die. Like she and she's not being funny anymore. But she just gets into kind of like a it's like a twilight almost where she's just like, hey, whatever happens happens. Yeah, a little detached is a great way to put it or dissociate. And you kind of have to keep pushing her towards it or kind of, you know, take something to her and say, Look, do it now. It doesn't happen a lot. But I've seen it happen enough to to recognize the repetitiveness of it. Mm hmm. Let me ask you a couple of questions about about how people can help you if they're by themselves. So people want to know about tattoos, IDs, you know, watch bands, people now have like, you know, Apple watches and there's they make these little snap on things on the bands that people put stuff on there. a QR code bracelets, do you guys scan QR codes. If you're using an insulin pump with tubing, or you're on multiple daily injections, and you'd like to be on a pump, this little bit here is for you. The Omni pod tubeless insulin pump has been a mainstay in my daughter's life. Since she was four years old, she's been wearing it on the pod every day for I think about 13 years now. And it's been a friend in her life with Type One Diabetes. Not only is it tubeless, which is amazing, because you can wear it anywhere you can keep it on while you're swimming or bathing or playing soccer. You know, are you whatever you're doing with like friends or acquaintances, you get what I'm saying? adults, right? Like you can just keep it on. So you're getting your insulin the way you're meant to be while you're doing everything. But for those of you who are still MDI and you're like, I don't know, it's going pretty great. I'm sure it is. And I'm not pressuring you, you don't need an insulin pump. But I want you to think about do you get low, like at the same time every day, like three o'clock in the morning or something like that? Or do you rise up at the same time every day? How cool would it be to be in charge of your basal insulin to be able to make it stronger or weaker. So that things like that don't just, you know, quote unquote, happen to you. If you're always getting low at 1am you could set a basal rate that begins you know, like an hour or so before that would impact that. Same thing for rises that happened in the morning. All kinds of stuff. Being able to manipulate your basal insulin with a pump is next level stuff, being able to do it tubeless Lee, that's even better. But here's the greatest thing about on the pod In my opinion, I mean this, you don't have to listen to me. Because they'll send you a free, no obligation demo, you can try it on to see what you think. And then if you like it, you move forward with the process. And if you don't, it's no big deal. It's up to you. That's how it should be my Omni pod.com forward slash juicebox. Get that pod experience kit coming to you in the mail right now.

Guys, the dexcom g six continuous glucose monitor is maybe one of the most important tools you can have while you're managing insulin. Why? Because you can see the speed and direction that blood sugar is moving when you were the dexcom g six, you can see it right there in real time. And it's not just I'm rising, or I'm falling. It's I'm rising. And this is how fast I'm rising, or this is how slow you're falling. It's spectacular technology. Imagine you're just doing a finger stick and you find oh mama, my daughter's blood sugar. It's 135. He's at 135. And stable, is it going up? Is it going down? There's no way to know where the finger stick. But with dexcom. There is. And you can see it right there on your cell phone. They're saying I'm saying you can follow a loved one a child or a spouse, brother or sister on your Android or iPhone device. Not only can you follow them, but look at nine other people because the user can have 10 followers if they want to. That could be a school nurse, a babysitter, so many options. So many people who are able to help you with your blood sugar, hold on a second, my wife's walking in, okay, I got rid of her so that I could tell you dexcom.com forward slash juice box Dexcom is going to give you an honest chance to keep your stability where you want it, you're a one seat down. So the time that your blood sugar spends in range is greater. How's it going to do that? Well, it's gonna tell you what your blood sugar is, and how fast it's moving. And that's going to give you an honest chance to use your insulin. Trust me, it's how I do it with my daughter. And her a one C has been between five, two, and six to four coming up on seven years. There are links to all of the sponsors at Juicebox podcast.com. And right there in your podcast player. But for today you're looking for dexcom.com Ford slash juice box and my omnipod.com Ford slash juice box. So people want to know about tattoos, IDs, you know, watch bands, people now have like, you know, Apple watches and there's they make these little snap on things on the bands that people put stuff on there. a QR code bracelets, do you guys scan QR codes? Like what what's the good thing to do here? Or should I just put something on my wrist that says I have diabetes and tattooed right?

Ginger Locke 33:03
The main thing you want to communicate is that their blood glucose level should be checked, right? And so just saying diabetes even not even getting into the type, just saying that the patient is diabetic means we will. And honestly, even if someone's just has altered mental status, we check the blood glucose level. It's a screening tool, it's a very low risk high benefit screening tool to just take a little tiny bit of blood it's very inexpensive test to know and so even patients where we have very low suspicion that the blood glucose level is off.

We'll do your take that as readily as we would take someone's temperature

Scott Benner 33:40
for example on a glucometer and you test somebody's blood sugar. It's it's one of the basic tools.

Ginger Locke 33:44
It is a very basic vital sign. Yes. Okay. But to your question, I think it's a good one of you know, maybe how do you get that medic to check the blood glucose earlier in the call instead of I think of a call I had once where there was this older gentleman and he was having unilateral neuro deficits that kind of droopy on one side and we were so certain that it was a stroke. But then finally very late into the call we got a blood glucose levels very, very low. He was hypoglycemia and apparently hypoglycemia can cause unilateral neuro deficits which is bizarre to me. I don't know how that would happen. But it can and so we we miss understood what was going on with him till pretty late in the call. But the way to communicate that information to medics would be to me a necklace or a bracelet that is the universal way all the fancy tech stuff is nice and probably more aesthetically pleasing to the typical person that has diabetes is want to be walking around with those bracelets and necklaces on. But it's just it's quicker. When we see a necklace or bracelet that's got the little engraving on it that says

Scott Benner 34:58
yes, just say it's a bracelet sandwich Girl, you're looking at me now you're probably having such an easy time imagining that. But say I'm a girl and I'm wearing a bracelet that has charms on it. I can't just throw one charm on that's for diagnostic, you're not gonna sit and pick through my

Ginger Locke 35:10
I will never notice that. Right, right. And actually same with tattoos. So this was a conversation I had with other paramedics about do you ask them? Do you look at people's tattoos? And they said the general response was, yes, we noticed people have tattoos, we would not be looking at the content of what the actual image is until later in the call with a stable patient as a conversation starter. But it would never be I'm scanning this for data that can help me take care of this person. Right. So you're looking at it in a very with a different filter. So do you I mean, if it was tattooed right across the chest? That's what

Scott Benner 35:47
I was gonna say, right? Yeah,

Ginger Locke 35:49
it's pretty obvious. But if it were something subtle or small, it could very easily be missed. It's just

Scott Benner 35:54
right are acronyms in a sleeve of tattoos? You know, you're not picking through. But if someone had no tattoos, and tattooed around their wrist where you were looking for the bracelet, it's a type one diabetic, that's as good as a bracelet, you would think, right?

Ginger Locke 36:06
I don't think it's as good as a bracelet.

Scott Benner 36:08
Wow, because you're looking for the bracelet.

Ginger Locke 36:10
Because I'm looking at tattoos and thinking that's a tattoo. And I don't, there's no data in that for me, other than this is just a person that has a tattoo. Okay, but it I'm not looking at it for. I mean, sure, I may see it. And it may be helpful. But a bracelet is it's, you know, those really ugly bracelets that have the terrible chain and the rectangle, and they're just so uniform. And so kind of institutional looking. Those are the ones I'm used to seeing. Do you know the ones

Scott Benner 36:39
I do? See, what you're saying is the classic medical ID is what you're looking for, because that's just, it's what you're trained to do. It's what happens more over than not. And you're also in a heightened situation, at that moment to

Ginger Locke 36:55
correct. So you're, you're working on a little less cognitive bandwidth and somebody who's relaxed, and you may get there, it just wouldn't be as quick you. So you'll get there after you've done a couple of things and you're kind of your physiology is calming down and your field of vision expands a little bit, then you'll start noticing those little things. I've talked to people about their tattoos a million times, but it's when everything has stabilized afterwards.

Scott Benner 37:20
So if mike tyson got a face tattoo that said, type one diabetes, and you rolled into the room, and he looked low, you might just look at him and go, I don't see that and keep going, I get that I really do. And there's this extra thing that doesn't belong on the body. And that draws attention. It looks like all of the other things that sit do that job. And so that makes your brain stop and go that's a medical ID.

Ginger Locke 37:43
Yeah, right. It's about picking a lot of what we do is pattern recognition, because we're moving so quickly and thinking so quickly. And there was a study done for radiologists to find. They were told to find basically cancer on all these CT scans right in their black and white images. They're told to find cancer to screen these CT scans quickly for Do you see anything it looks like a mass chest CTS and because masses are cancer usually shows up as white on a CT, they missed. There are all these little black tiny, they place a tiny black gorilla and all the CTS and they did not see the little thin outline of a little black gorilla on a CT scan. Because they weren't looking for that they were looking for White. Okay, and so it's just what your body your brain kind of selectively notices and and the way a medic thinks is not to go hunting through tattoos, they're looking for other stuff.

Scott Benner 38:46
So I have a tattoo on my shoulder or my forearm and I'm wearing sleeves and nobody's finding that. Not until later from your

Ginger Locke 38:53
you know, you point to your forum. I think about that where we might put a blood pressure cuff or start an IV I mean, those arms are better than legs. If you're Yeah,

Scott Benner 39:03
you're not gonna get away not you're definitely not taking my pants off during this situation.

Ginger Locke 39:08
Sometimes Actually, we do make patients all the way naked. Just go hunting for what do you think? Yeah, injuries and stuff like that. But

Scott Benner 39:16
But okay, but but I hear what you're saying. How about in the car? seat belt? How about those things that go on the seat belts are stickers on the window? Do they kind of fall in this? How do I how do I brand my car say I've got a 17 year old driving with Type One Diabetes? How do I make it so that when you come to the door, you know, this person has diabetes?

Ginger Locke 39:34
I think even if it's on the car, I don't know that that person that is that person's car. Right? So we're often the way our mindset is we're thinking I want to keep all the possibilities open. So yes, I have this piece of data that says somebody put that sticker on there, but I don't know it's specific to this patient. So I don't know for sure that conclusively that that patient has diabetes.

Scott Benner 40:00
When we're buying when we are branding things is the caduceus the most like thing that makes you think medicine. It's that set the snake thing with the rod. I like that you said it like that. Yes, it is.

Ginger Locke 40:12
Yeah, yeah, that's the one in red. Oh, am I so

Scott Benner 40:14
old that I know words for things people don't use anymore? Is what I just started one.

Ginger Locke 40:19
Well, I was just kind of is, is is a good word I forgotten

Scott Benner 40:23
now I'm wondering why I know it. So, okay, so I mean, it's just like this add to that you can do as much as you want to hopefully trigger that emergency person's thought to like, oh, diabetes, but until they go through their process and do their things, there, they're not going to know for sure. Without that, that jewelry around the neck

Ginger Locke 40:46
around the wrist, or something in a wallet of someone

will help as well. So we

typically will look through a wallet looking for prescription, you know, medication lists, or names of, you know, some people have that they've had surgeries, certain type of implants and stuff in their body, they'll have little cards in their wallet that will find

Scott Benner 41:06
what about a lockscreen image? What about I push the button once the lock screen pops up? But it says Great,

Ginger Locke 41:10
well, that actually, this is pretty genius.

Scott Benner 41:14
Okay,

Ginger Locke 41:15
that's, that's pretty smart, because we will go to the phone pretty quickly. And I've watched at the hospital social workers really just the phone is the lifeline to getting to the family and trying to figure out who people are and kind of doing all that detective work.

Scott Benner 41:29
Okay. All right. Well, there you go. Finally, the cell phone, not ruining lives saving. I don't know if anybody's seen the there's that Netflix documentary about social media right now, that tells you everything about your phone that you already know is wrong, and how it's trying to kill you that you choose to ignore it because you love it. And it's not, it's not killing you immediately. So you're just like, I love my phone. Please stop saying bad stuff about it. Okay, let's see, well, while people are waiting for you to get there. Mm hmm. What do you think people fail to do in that time when they're panicking, like what could they be doing? Does that make sense? Is there something to talk about,

Ginger Locke 42:11
rather than saying what they've failed to do, I could just kind of list off some useful things to do. clearing a pathway between the road and where the patient is. So if they're in a back room, right, moving things out of the way just to get a stretcher through or even be able to walk through with bags, clearing that pathway. As far as sick and unresponsive patients that many have religious may have heard of what's called the recovery position, right? This is laying on the side that allows and if they were to have any vomitus or spit to kind of drain out of their mouth with gravity towards the floor, rather than back into their their airway. coming outside to meet the fire truck or ambulance is very helpful as well. Sometimes, homes aren't very well marked, or an apartment complex, it's may be hard to figure out exactly where you are as quickly. It could save, you know, a minute or two. Right? If you were to come out and be what's called a flagger where you kind of wave down the the

responding. It's a good

Scott Benner 43:14
idea. There really is no lights on on the outside of your house, stuff like that.

Ginger Locke 43:18
Yeah, turning lights on. That's that's a great way, especially at night when the lights are on. I'm like, Oh, I know. What's that house? Yeah. Because ever all the other houses look asleep at 330.

Scott Benner 43:24
In the morning, this house is lit up like I bet you they're the ones that called us.

Ginger Locke 43:30
That's a good one. Yeah. And then just then assembling medication lists, putting all the meds in a little baggie that we could take with us. Just kind of assembling some key stuff that if we needed to leave quickly, that stuff is all together.

Scott Benner 43:43
I guess too. If you're you're likely going to take this person with you. If they have some personal stuff that they use to manage their type one, they're going to want to make sure that gets in the rig with them and or somebody goes with them too, if possible. Do you like to take a family member if you can?

Ginger Locke 43:59
We do so COVID times is messed up all taken all the family members and things like that. But yes, let's talk non pandemic times. It's great to take a family member, especially with patients who are unresponsive because they're there all the info there. The patient's history. So we talked about when we do assessments, there's a history and a physical exam. And when a patient's not talking, you have zero history, and you only have your physical exam to rely upon. So they become the surrogate historian. Okay,

Scott Benner 44:27
yeah, no, that makes sense. Hey, when I call 911, can I say I need an EMT? Not just a paramedic? Will they take me seriously if I do that? Well, well, they'd be like, Hey, who are you buddy? I know you've seen ER and everything but you know.

Ginger Locke 44:43
So you said in reverse again.

Scott Benner 44:48
Alright, can I okay. So,

Ginger Locke 44:50
here is when you call 911. They will have already a pre planned response, right that is appropriate for whatever it is. Your job is to report what's going on where you are as best as you can, right as a patient breathing as a, are they breathing? strangely? Are they bleeding? Do they have a pulse? Are they talking? Those are the types of questions, very simplistic questions. And then the response will be kind of triage through dispatch about what resources should be sent.

Scott Benner 45:22
So I shouldn't get all obviously I definitely shouldn't. Because I'd end up asking for the wrong thing. I'd be like, I need the guy that went to more school and then I say it backwards. They'd be like, Oh, he only wants this. They send over for band aids and a nice cages on his first bag. Alright, so yeah, don't don't think this situation because obviously you're gonna do it wrong. And and be very clear about what's going on in that assessment when you're talking to 911. All right, that makes more sense.

Ginger Locke 45:51
And the first question that's usually asked is not what's going on, but where are you?

Scott Benner 45:57
Okay.

Ginger Locke 45:58
Like, are usually your location

knocked what's your we think they answer with what's your emergency? But it's not they want to know where you are? And then once they start hearing What's wrong, then they'll start sending people to that location? Gotcha. Because it mean, no one can do anything until we know where you are. Everything's on pause. Well, we know that

Scott Benner 46:21
you're in a medical crisis. I'm as if I'm the responder, my first crisis for me is getting to you. And then figuring out what's like you said, going through those checklists and getting to let's not let you die before we can figure out the bigger problem, and then stabilize you and get you to the hospital if that's necessary. Mm hmm. How many people? Have you treated with the diabetes situation and left behind versus take them with you? How often do people have to go to the hospitals that

Ginger Locke 46:51
for the hypoglycemic patients that are awake and talking and breathing when we get there? It's rare that we would transport them because what they need is food.

Scott Benner 47:01
They need to have it there.

Ginger Locke 47:03
Yeah. We will discuss you know, what may have caused the hypoglycemia? Was it too much insulin? Was it that you have an underlying infection that you didn't even realize? Or you know, and that maybe there's something more going on today? So it's not just a simple we fix your blood glucose level and lead? It's okay, let's explore why you became hypoglycemic. And are we all confident today, you just took your insulin and forgot to eat? Okay, that's the story.

Scott Benner 47:27
All right. No reason to pay for the, for the, for the taxi ride and going to the hospital and all that other stuff, because it's over. It's one of those medical things that once it's over, it's over, right. I know, my daughter had a seizure once when she was first diagnosed. And we, it was a Sunday afternoon. And we just gotten back from somewhere and put her in a crib. And she was she was napping after a car ride. And she just started grunting. And you know, it was clear she was having a seizure. We're trying to figure out how to use the glucagon. She'd only had diabetes for a short time, we didn't know what we're doing. We got our son who I think at the time was like seven, we got him to call 911. And we were messing with him the next day. I know there were a couple police officers in the house and and then you know, the emergency services were right behind them. And once we got her stabilized, we went to the hospital. And I think we were there for five minutes before my wife looked at me and when we didn't need to come here. And I was like, No, we didn't, did we and then by then it was too late. They had our insurance card already. And we already took the ride. So we just went over and and it was fascinating how little actually happened at the hospital where they were just like, well, she looks good now. So yeah, you don't want to do that. Again, it was sort of like that.

Ginger Locke 48:36
Well, that's a big trend in EMF not to go too far down the MS. Tangent, but I do want to say that emf is evolving and that the more education that paramedics are getting, the more independent they can be in making those decisions about where's the right what's where's the right paid place for the patient. Right. We used to be there's kind of a saying you call we haul, right? You just call us we're going to the hospital because we can't think for ourselves now. With more education really good physician oversight, we can have longer discussion about what's going on and create a plan that's right for you today. And not just this prescriptive, like everybody goes to the ER thing got it.

Scott Benner 49:13
Hey, um, a lot of people asked this question when someone has a low blood sugar you figured out they have a low blood sugar and they need food. Is it common to over carbohydrate them like to jam them up and make them super high because the people who are normally pretty cognizant about keeping their blood sugar stable in a lower range who've just had what they consider to be a you know, an emergency situation? They are not looking for you to make their blood sugar 450 but are you are you

Unknown Speaker 49:40
Why?

Ginger Locke 49:42
I love your question. I love the way you asked it. Yes, we are thrilled that you're no longer hypoglycemic. But, so if we're going to air we're going to err on the side of you maintaining consciousness and not becoming hypoglycemic. So sometimes Yes, that means we overshoot it,

Scott Benner 49:59
but you're not going to show up Go, hey, try these three Skittles and wait 15 minutes. So let's see what's happens you're gonna write,

Ginger Locke 50:03
you're gonna usually it's like poor, I, you know, can bring some orange juice, put some sugar in it, you know, it's like, it gets ridiculous. But we also give intravenous dextrose. Okay, right. So for patients that can't eat can't swallow.

Scott Benner 50:22
I know, it's something that

Ginger Locke 50:23
you haven't talked about yet, which is you've talked about glucagon, you've talked about oral kind of sugar. But then there's also intravenous, what we call d 50. It's 50%, water, 50% sugar, it's a lot of talking about carb load. So we used to just give like the whole thing. Now we've started kind of giving half of it, and then wait and see how that does not we do we are cognizant of the fact of trying not to overshoot them so so much, because that's, that's rough on you guys. Yeah,

Scott Benner 50:51
it's terrible. And then I wonder, too, with all the new technology that people with diabetes are wearing. It's a lot of people have continuous glucose monitors. So an ability to see their blood sugar in real time and how it's moving. Do you will you employ those once you're aware, and things have calmed down a little bit where you say, hey, let me see your blood sugar on that you would, okay.

Ginger Locke 51:12
And we're gonna double check it with our educational course. Yeah.

Scott Benner 51:15
But I mean, in easy way to say that, like this dextrose has gotten you to like 125. And it seems pretty stable. We don't have to push the rest of this. Yep, I got it. Okay.

Ginger Locke 51:25
And going along with the clinical presentation, too. So it's like, with the number looks good. And you are looking better.

Scott Benner 51:31
Right. So yeah, so the stuff that you would normally do visual check over. It's not just these numbers. Okay.

Unknown Speaker 51:37
Right. Do you

Scott Benner 51:38
have, like at one, obviously, I think you do. But when you're teaching your course, what do you tell people about assessing diabetes?

Ginger Locke 51:49
Um, we tell tell the many things. It's a whole module. But, you know, some of the teaching points are that this may be the first day that they've realized they have diabetes that they may not have known. Often it results in some emergency to for them to even become aware. Right. And so that's, that's an important thing for paramedics, I think, to understand that. People can be having a diabetic emergency and not even know they have diabetes. Wow.

Scott Benner 52:21
Yeah. I never thought of that. Like they're everybody's first time is somebody who is Yeah, everybody has a first time and not everybody ends up in the hospital, passed out their first time, they might just have some of the symptoms of high blood sugars. Yeah, it's funny, I think so much about the problems we that people have when they're being diagnosed because doctors offices, it's, it's almost disturbing to hear you talk about how obvious it is to do a finger stick to check on somebody's general health because they don't do that doctors offices. So a lot of kids get treated for the flu or other stuff like that for a long time, then end up in DK because no one took the time to just, you know, check their blood sugar very quickly.

Ginger Locke 53:02
You know, what's interesting about that is I I've thought about that same thing, because I've got two kids. And it bugged me that they weren't they didn't know my kids blood glucose level at any point in their life until I think maybe they check there's a there's a routine, routine screening age, I think they finally do check. I don't remember for eight or what, but it did bug me.

Scott Benner 53:23
Yeah, it's a huge problem. There's a lot of different organizations that try to help you there's these letter writing campaigns that go to like pediatricians offices and all these things, because a lot of kids you know, there are people who die every year from undiagnosed type one diabetes. And really, you know, when you look back on it, you realize that for whatever a test trip costs $1, maybe, you know that somebody just kept treating the flu, the flu, the flu, the flu and never looked that next step is it's disturbing. And that's why I felt I found it really comforting and interesting that you were like, Oh, we would just do that all the time. That's a great way to

Ginger Locke 53:54
find out routine. It is. I mean, it's not only our paramedics educated to do that is very routine, we work under kind of standards of care or protocols that are written and it is a very standard thing that any altered mental status patient, right, even if they're just a little confused, little grumpy, sleepy, lethargic, and so not just unresponsive, but altered mental status, that is a very routine test. And, you know, you said it's inexpensive, it's also low risk, there's very little risk. It's not it is very hard to hurt someone with a lens set.

Scott Benner 54:31
Right, right. Yeah, you're gonna be okay. That's

Unknown Speaker 54:36
the high yield low risk test to make sense.

Scott Benner 54:38
So when people have a higher blood sugar, so you get there and you assess them and they're not DK but their blood sugar's 500. Do you help them? Like do you want them to have insulin? Or do you leave it to them? Or do you just say, hey, look, you don't have enough insulin? What if you get them What if you have to transport them do you carry you don't have to carry insulin with you.

Ginger Locke 55:00
It's a great question. We generally in the outer hospital setting, paramedics are not using insulin No. And it's because it's a very strong drug that does other things besides move glucose into the cell, it also affects other electrolytes and things like that. So abrupt changes, someone's really hypoglycemic and they take a ton of insulin that can do a lot of other things to their body, besides just fixing their blood glucose level. As I said earlier, and you guys who are listening know it's a these are very critical care, very fragile, sick patients. And so insulin is not a very common out of hospital. medication. Yes, yes. I can think of a few maybe remote places where it's used, but nope, not on the trucks in. In Central Texas,

Scott Benner 55:44
would you turn to the verse and say, Look, you have insulin here? You should probably take it as your doctor has instructed? Or do you don't mean like, you're obviously not going to give it to them? I guess? Because you don't know any other way.

Ginger Locke 55:56
I wouldn't even know I don't even know all the scales and all that stuff. I don't know how to do it. Yeah, I would be because of kind of my lack of knowledge about, you know how much insulin it takes to get someone's blood glucose level? To me. 500 is the number use is a pretty scary one. And I would be afraid it's not just simple hyperglycemia? I'd be worried is there more going on. And I would not be comfortable if they if they? So usually, if someone's quality msmes are sick, they don't feel well. Right. So to also see a blood glucose level of 500. It's like, okay, I want to make sure you get screened for many things at the hospital that I don't I feel a little out of out of my

Scott Benner 56:38
zone on that the word purview kept coming into my head, like that's outside of your purview. What?

Ginger Locke 56:42
A little bit, just because it's like 500, or you're pretty sick? And if, depending on your clinical presentation, right? If you look really sick, yeah. And there may be more,

Scott Benner 56:53
I guess, you have one problem you're dealing with, you don't need to add a secondary problem before you get somebody to help, right. But let's just interesting, like, you really are there for an emergency situation. So if somebody called you in that scenario, you got there and said, Look, you know, this is what your blood sugar is, it looks like you probably need to be checked for a number of different things. I can take you to the hospital if you want, or you should make your way to your own physician, or I guess there's a lot of different. It's interesting, your job is very specific. Yeah, we

Ginger Locke 57:22
we talk about paramedics, our healthcare navigators, so they're not just responding to emergencies. They're responding to people that aren't sure what to do next, with wherever, however, they found their condition to be and so maybe they're new, newly diagnosed, and they're not very good at taking their insulin, if it's daytime, and we can call their doctor and talk through all of that, then sure, but if it's the middle of the night and

Scott Benner 57:46
can't get a hold of people, then maybe then the hospital becomes the way

Ginger Locke 57:49
Yeah, and you you know, maybe they have a headache to go along with it. Well, headache can be a lot of things that I can't test for, like meningitis or strokes, right. So there's so many things in that hospital setting that we can't test for that we do end up taking a lot of people to the hospital for additional testing, when, you know, we can't really get in touch with their primary care physician.

Scott Benner 58:10
Do people try to use you improperly? Meaning Do you ever get to people and this is away from diabetes, I'm wondering this, and they clearly need a hospital but don't want to go to the hospital, you have no power over that. Right? If I refuse to go I just that's it.

Ginger Locke 58:25
Correct. If you don't want to go to the hospital, I'm not kidnapping you and taking you anywhere you don't want to go as long as you have mental capacity, right? So as long as you aren't incredibly intoxicated, or unresponsive, or something's in a way that you like you're not making your judgments impaired.

Scott Benner 58:43
So you can make medical judgments about their ability to make judgments for themselves.

Ginger Locke 58:48
So if I say we do it a directively with tests like Do you know what day it is? Right? Do you can you explain to me what's wrong with you today, and that you're preferring to stay home? And you understand that you might become worse and die here in your home? Or you if they can explain it back to me then.

Scott Benner 59:05
Then that side everybody's got their own freedom. But now if I say I don't want to go to the hospital, then I pass out are you allowed to go ups? Oh, well, I've been put them in the truck

Ginger Locke 59:13
is called it's that it's called implied consent. And the idea is that a reasonable person would want to go to the hospital if they had known they were about to become unresponsive, right?

Scott Benner 59:22
Oh, that all makes sense to me. Okay. Is there anything I didn't ask you or that we didn't talk about that I should have to answer these questions for people, which by the way, started out with our medical tattoos, okay, and then turned into all these great questions from everyone.

Unknown Speaker 59:40
Um,

Ginger Locke 59:45
I think you know, you're asking how does how do you signal to somebody come into your home that someone in the house has diabetes? I think the probably the top places are a bracelet in your wallet, the refrigerator Another place we go look on the front of the refrigerator, people will put lists of medications and stuff. Yeah.

Scott Benner 1:00:07
So my last question, which a lot of people ask, because of the timing of when I put this out into the community, and when everybody started asking the questions, there had been something in the news recently, where a gentleman had a very low blood sugar. And the, I guess the people who showed up his house, were just certain he had odede. And would not listen to the other people in the House about it. What do I like? What do I do? If if like, really like, Is there something you can think of that would snap you out of that mentality? If you were thinking this is drugs? This is drugs, and I knew for certain it wasn't like, what do I do to get you to stop thinking that way? Because timings of real issue at that point.

Ginger Locke 1:00:44
Yeah, I love the question. Because you're talking about cognitive pitfalls. It's not that these people are jerks, right? The medics that come to your home, they got into ms because they want to help people. And they're not just jerks. But they can if they've run, you know, maybe they're in a community with an opioid epidemic. And they're, you know, that's 2020 calls back to back to back to back, they kind of get their brain gets stuck, as you said, So what can you do to get them unstuck? There's this really great book called how doctors think, and it might be something you know, and your listeners are interested how doctors think is really neat, because it talks about how clinical decisions are made. And it's recommended to ask of your doctor. What else could this be?

Scott Benner 1:01:30
Okay, that's that's phrasing that gets them to start thinking a different way.

Ginger Locke 1:01:34
It's like, okay, right now you're thinking overdose. But what else could this be? And it just opens up their brain to

the possibility and a reminder of the

fact that other conditions can look just like this. Ah, so you're

Scott Benner 1:01:48
tricking them into doing their job that they are somehow stuck in can't figure out how to do I love language? I really do. I think sometimes I get done an episode of this show. And I'll listen back when I'm editing and think, like, I'm proud of myself how I got someone to something without telling them to go to it or, or fooling them into understanding it, but just sort of asking a question that makes them then think about something different, and then see where it leads them. And that's really what you're saying, you're somebody gets stuck on this idea. This guy, he odd, odd, odd drunk or whatever. And you start, you just kind of break that you break that, that pattern he stuck in, or he or she or stuck in, and then you you get them thinking about something different. That's kind of brilliant, and simple, isn't it?

Ginger Locke 1:02:36
Another pitfall is that we forget, it can sometimes be two things. And so it could be opiates in this case and diabetes the patient could be having experiencing both, right? And that's probably one of the harder things because we love the binary, it's this or that. And

Scott Benner 1:02:55
it's like the most human thing. Pick one who wins either or black or white. Be both. Can I not be high? And my blood sugar be low? No, he's a good guy. It's his blood sugar.

Ginger Locke 1:03:07
Yeah, yeah, no, no, I hear that. Once we once we find the cause that there's something called the I think it's called the second fracture phenomenon where, let's say you, your arm hurts, and you've been in some type of car wreck and they find a fracture in the arm. They're like we've done testing, we found the cause, well, sometimes there's a second fracture that gets missed on the X ray, that they just don't see because they think they found the cause. So same for

Scott Benner 1:03:33
this. No, it's almost like anecdotal evidence, like you feel like you've got the answer. So you stop wondering, gotcha. This is excellent. And now it's making me if I can make me wonder if I can get Jerome groopman, the author of How doctors think they come on the show. Because that's, I think, this that this specific thought translates into people's personal doctor's visits. Oh, yeah. You know, when you get into the room, and you realize, like, you've got this whole thing figured out, and they don't see it that way. And then you just sit there feeling defeated. And instead of another one,

Ginger Locke 1:04:02
as you're saying that another one I've used with my own doctor, is I'll say, How do we know it's not x? Right? So I have asthma sometimes. And I'll say to my doctor, how do I how do we know it's not pneumonia? Or how do we know this isn't?

whatever other respiratory disease? Yeah, and

Scott Benner 1:04:21
you're not asking so much for him to tell you how he doesn't know you're asking him so he'll think it through again.

Ginger Locke 1:04:27
Think of all the tests that might need to be done or not done.

Scott Benner 1:04:30
Yeah. Damn, ginger, you're pretty smart.

Ginger Locke 1:04:32
This sneaky.

Scott Benner 1:04:35
By the way, you live in the part of the country that I often tell my wife, we should run away and go live there. But I guess other people think that too. And you're probably all very sick of us coming there. So I won't say it out loud.

Ginger Locke 1:04:45
But well, you're very welcome to come.

Scott Benner 1:04:48
Thank you. I'm looking for lower humidity. Not so much snow. Is this the place or no,

Ginger Locke 1:04:52
there is pretty low humidity and definitely no snow. I'm

Scott Benner 1:04:55
on my wife's. Alright, just give me your address. And I'll just I'm gonna pack up right now and go Because I am tired of the snow, and I am tired of sweating just because it's June. So I'm done with it. Now, I don't mind a dry heat. I just don't want to be wet. While it's happening, you understand? Hey, tell everybody about your podcast.

Ginger Locke 1:05:14
Sure. It's called medic mindset. And what's neat is it started as a podcast for paramedic students, but the paramedic started listening. And then I got some medical directors who are emergency medicine, physicians listening. And so suddenly, emergency medicine kind of residents or med students started listening. So it's, it's expanded to, to reach beyond kind of its original intention. And it's, it's, I really spot one episode a month, something I really enjoy just talking to paramedics or people that work in emergency medicine about how they think through problems, errors they've made, why we you know, kind of the cognitive theory about why they may have made that error.

Scott Benner 1:05:54
That's very cool. Isn't it interesting how you start something like that, and then it grows, and it finds other avenues to help people. And like I told you at the very beginning, I started this podcast because I thought my blog was kind of dwindling, because people stop reading. And it's got millions of downloads now. I love that crazy, isn't it? Like I just I love that it helps people and it was just a very unexpected treat, I guess at how well it worked out. Um, so I'm really glad for you. And I'm gonna I'll put a link in the show notes. And and hopefully there's some people listening to this that that might come over and check you out too.

Ginger Locke 1:06:28
Nice. Yeah. Thank you so much. You're welcome. Thank

Scott Benner 1:06:30
you for being By the way, as we're as we're wrapping up here, thank you for being how you are, because I just was at my son's baseball game one day. And I decided, like, I'm going to get somebody on to talk about this who, who's got a podcast that talks about this stuff all the time. And so I'm have my headphones in, and I'm sitting in a chair under some shade, because like I said it was human. And I'm like, like, oh, here's one I tried listening a couple of people in there, you know, but I got to you and you were measured and thoughtful. And you had a nice clean microphone, I could understand you and then I started reading like reviews. And then I just started listening to an episode and I was like I would like it if this person was on my show. So you want out I didn't just like I didn't throw a dart at podcasts about this I really listened and I think you're doing a really great job not that what I think means much But

Ginger Locke 1:07:20
no, I appreciate that. It actually means a ton because

your podcasts yourself so you know kind of what you value in and talking to you what this has done. I was hoping to get to hear more about your daughter and your journey. So what this has done is made me now I want to go back and and hear your previous episodes.

Scott Benner 1:07:37
Oh, cool. Yeah, I do everything so that people will listen, everything's just a carrot on a stick to get you to download my show. I need listeners dammit. Keep listening. Tell people. No. But But seriously, I appreciate that. I'd be happy to tell you more about it. But I know we're up on time. And I you have children who I think at one point I heard outside going Hey, when's this over? So go live your life. And thank you very much. And I really I can't thank you enough. This was wonderful.

Ginger Locke 1:08:05
Thanks, guys. I appreciate you

Scott Benner 1:08:06
having me on. Oh, absolutely. Hey, huge thank you to ginger for coming on the show. And thanks so much to Dexcom and Omni pod for sponsoring this episode of the Juicebox Podcast. You can go to my Omni pod.com Ford slash juice box to get a free no obligation demo of the Omni pod tubeless insulin pump. And to learn more and get started with the Dexcom g six go to dexcom.com Ford slash juice box. And please don't forget to visit touched by type one.org there are links to all of the sponsors in the show notes of your podcast player and at Juicebox podcast.com.

Would you like to hear more from Ginger? Check out medic mindset wherever podcasts are available. Or go to medic mindset.com her shows available on Apple podcast Spotify everywhere that you listen to this show. You can listen to ginger and medic mindset