Scott Benner 11/4/19 Scott Benner 11/4/19

#276 Because Carbs Man

Kelsie takes the cake.…

Kelsie is a cake decorator and flower artist who has type 1 diabetes. Kelsie is feeling better about having a baby since finding the Juicebox Podcast..

You can always listen to the Juicebox Podcast here but the cool kids use: Apple Podcasts/iOS - Pandora - Spotify - Amazon Alexa - Google Play/Android - iHeart Radio - Radio Public or their favorite podcast app.

KelsieCakes.com < check out her work!

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

Scott Benner 0:00
Hello everyone and welcome to Episode 276 of the Juicebox Podcast. Today's show is sponsored by Dexcom Omni pod and dancing for diabetes, you can find out more@dexcom.com forward slash juice box, my Omni pod.com forward slash juice box or dancing the number for diabetes.com. There are also links in the show notes of your podcast player and at Juicebox podcast.com. This week on the podcast we'll be talking with Kelsey. Kelsey has type one diabetes. She is a cake decorator, and she sent me a really wonderful email. Now Kelsey starts off a little nervous, but give her time because she warms right up. We almost call this episode because carbs man but instead I'm going to call this one

Unknown Speaker 0:58
I want to be like

Scott Benner 1:01
cake Daya. Boss Daya Cake Boss Daya. But I like because carbs man. Maybe I will call it because carbs man. Alright, I'll figure it out. Please remember that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise. And to always consult a physician before making any changes to your health care plan, or becoming bold with insulin. Quick note, for those of you in the Pennsylvania area, more specifically Valley Forge, or even more specifically track PA, I'm going to be doing a pop up podcast there. It's going to be a live event. We're not recording it just getting together and talking about being bold with insulin. I think there's about 40 tickets out so far the place holds 100. It's happening this Sunday, November 10 2019. And you can reserve your spot absolutely for free. on my Facebook page, find us bold with insulin, then look for the events.

Kelsey 1:59
My name is Kelsey and I've been diabetic since I was 10. On and ready to

Scott Benner 2:06
look after the Oh, there we go. So you he was like so just you know, introduce myself. That's easy. And there was a pause. I'm like, well, maybe it's not that easy.

Unknown Speaker 2:16
Maybe you know,

Scott Benner 2:19
first of all, there's nothing to be nervous about. I appreciate that. Some people are well, we'll get to a point where you won't be I promise. I'll start right. Okay. Take it up for you. You were diagnosed when you were 10 years old. But how old are you now?

Unknown Speaker 2:34
I am 27 Okay, so you were diagnosed?

Scott Benner 2:37
17 years ago?

Kelsey 2:39
Yeah. Can you do?

Scott Benner 2:40
Math makes people comfortable? 10 years old. 17 years ago, it's 2019. Now you were diagnosed in 2002. Am I right? So yeah. Oh my god, right. 10 years old. What were you middle school like sixth grades?

Kelsey 2:57
Yeah, it was right before Middle School is the summer between fifth and sixth grade. People are probably pretty impressed now with my ability to manipulate time and distance and

Scott Benner 3:08
weird little time, right? Like you're pretty young siblings, siblings, any brothers or sisters?

Kelsey 3:14
Yes. I am the oldest of five. So I have two brothers and two sisters.

Scott Benner 3:18
Parents together. Yeah. Okay. They have to be they're busy making babies all the time. Right? How would they?

Kelsey 3:24
Yeah, that big crazy family.

Scott Benner 3:26
Kidding. So there's so there's five of you. You're the oldest your mom and dad have a lot of younger children. Yep, their oldest one who they're probably starting to think oh, that that Kelsey kids she could probably start cooking for us soon. You take some of the burden away. Right? And and then you're screwing around in the summertime watching cartoons running around outside What happened?

Kelsey 3:48
It was actually a, like a normal doctor's appointment before you change schools like make sure my vaccinations are all in order and all this fun stuff. Um,

Scott Benner 3:59
so that's when I was diagnosed. showing any signs or did they just do a finger stick?

Kelsey 4:05
Ah, yeah, so I'd been like really tired all the time. I'd lost a bunch of weight and going to the bathroom all the time. All the classic science. Um, I think my parents kind of suspected but it was like, Oh, I don't know, maybe it could be diabetes, but it wasn't like something they were really thinking about. Until they went to the doctor.

Scott Benner 4:26
A lot of strange things going on with you and they bring it up. Do you remember the doctor? They say hey, Kelsey is like weird. Like, can you look at her? Or was it? Like you don't mean like they were they worried enough to say something? Or do you not know?

Kelsey 4:41
I honestly don't remember how that went.

Scott Benner 4:44
Listen, as I'm asking you I have to be perfectly honest. I remember nothing from what I'm 10 nothing at all. And 17 years ago, I was 30. And I don't remember anything from that either. As a matter of fact, I don't remember much from last week. So I just wanted to know if it was a good like a kind of like a landmark in your life. Can you really remember? Not so not so much like so the diagnosis is what it is. You're off. I'm assuming you started with needles or pens. But how did you start? I

Kelsey 5:09
started with the syringes.

Scott Benner 5:11
And just a meter, right? There was nothing else to it. Yep. Okay. Now, were you like, how do you remember management back then? Was it about food restriction? Was it about counting carbs? Did you not really pay close attention to it? Like, what was the vibe around your house?

Kelsey 5:29
Yeah. So when I first started, we were doing exchanges. So it was like, I had to count my carbs and you have 15. Okay, like for breakfast, I would have 45 grams of carbs. And for dinner, it would be 60. And for snack, it would be 15. So it was like, very, like, regimented at first,

Scott Benner 5:49
and that is that associated itself with how much insulin they were giving you. So were you on regular an MPH? I think it was human login, mph. humalog. An mph. Okay. And so I don't know how many people nowadays realize that. But it's very interesting that not that long ago, the idea was you had to count up a certain amount of carbs. And those were your meals. Did you feel a lot of pressure to finish your food?

Kelsey 6:13
Oh, I guess I did. I haven't really thought about this in a while. But well, yeah. Like, if you don't finish this, then there's apple juice.

Scott Benner 6:23
Because I mean, what I'm learning right away is that you didn't grow up in a lot of with a lot of pressure.

Kelsey 6:29
No, not really.

Scott Benner 6:30
No. Did that management lead to outcomes that you were hopeful for? Like as you got older? became like a teenager? Where Yeah, what was your a one see like, Hey, hurry, onesies? Fine. This is all going great. Are you a person who was in the doctor's office? struggling? or How did it go as you got older?

Kelsey 6:48
Um, I want to use usually seven something. So everybody was like, that's good enough. So that's kind of how things went. It wasn't super drugs or regimented. It was like, you're doing all right. See

Scott Benner 7:01
any big problems, seizures passing out? Like, nothing like that?

Kelsey 7:06
After the original diagnosis? I hadn't been to the hospital sense. Knock on wood. So everything just was kind of tripping along

Scott Benner 7:16
sort of the way they described, it was going to like, Look, you'll count this up, you'll shoot this in and everything will be fine. We need your agency to be somewhere below this. And it always was everything just sort of worked for you.

Kelsey 7:26
Yeah, it was like he said, it wasn't like amazing. Nine, it was just kind of like, this is good enough. Well, that's kind of how I always looked at it.

Scott Benner 7:35
And now today as an adult, do you live on your own? Yes. Okay, and what technology you're using now? Are you still using pens and a meter?

Kelsey 7:44
I have a Omnipod index. com now.

Scott Benner 7:46
So you've, you've upgraded. Now, when did that happen? And what came first?

Kelsey 7:51
Omnipod came first. I got that in 2011. I had a mini med before that. And then the Dexcom I got it. Three years ago, I think.

Scott Benner 8:01
Okay, so let's go back to when you went to, you know, when you first had your insulin pump, or the mini Mater, whenever? Did that change your management? Or did that just sort of eliminate? Like, injections? How did you think of it?

Kelsey 8:15
Um, it definitely changed how I ate because I wasn't like restricted to that.

15 gram type mm regimen.

Scott Benner 8:26
Hey, when's the last time you checked out dancing for diabetes.com. If you haven't in a while, I'm telling you, now's the time. They're just about to put on their yearly extravaganza, a huge dance event, you're not going to want to miss it. There may still be time to get tickets, I'm not sure. But if there isn't, you're at least going to be able to see plenty of photos and video from an amazing day. Dancing the number four diabetes.com getting a pump back then the idea was, Oh, this is great. Now you can count your carbs and push on this button on this pump and then eat and you can you can stop doing this this exchange program for carbs for insulin.

Kelsey 9:06
Right? Yeah, it was like you can eat whenever you want now. So

Scott Benner 9:11
was that exciting? It was pretty awesome. Right? Like and so but so that was the unit hold. Were you when that was I'm sorry? around?

Kelsey 9:18
Oh, it was 11 when I got the pump. So I had been diagnosed for a year.

Scott Benner 9:22
Okay, she did the exchange for a year then you went to a pump pump for a while. When do you add a glucose monitor?

Kelsey 9:28
That one was three years or the continuous glucose monitor was three years ago.

Scott Benner 9:32
So more recently?

Kelsey 9:34
Yes, very recently. Did that change things for you and changed everything? Yeah.

Scott Benner 9:39
How so?

Kelsey 9:41
Well, before I would like, you know, test when I ate and then if I remember to i'd test after, you know, two hours later, but I never really paid attention to my blood sugars in between mealtimes unless I felt bad. So I got the CGM and I'm like, Oh my gosh, look at all this information. I didn't even know So I actually started paying more attention.

Scott Benner 10:03
Okay, and so that having more information made you think like, wow, there's more here for me to understand. I'll dig down into this a little further, did that right immediately exchange or exchange that immediately? Create a lower frequency or less spikes? Or like, what was the first thing you saw? When you saw? I guess my question should be, what's the first thing you saw when you had a glucose monitor? Was that Wow, my blood sugar goes way high or goes way lower. What struck you?

Kelsey 10:29
Oh, yeah, I think it was just I didn't realize all the ups and downs that were happening in the background.

Scott Benner 10:37
Have you mainly been able to get rid of those?

Kelsey 10:40
For the most part, I still have my off days, but it's a lot better.

Scott Benner 10:45
Okay. Oh, that's interesting. So now, I would tell you that with Arden, we see a spike once or twice a day, but we get them back quickly. But yeah, but we don't have days where like, everything just goes to like hell. And then we get back. But I do know some people say that, like, it's just like, you know, I'm going along great. And then something doesn't match up my I hit the roller coaster, and then I'm just on it. And right, is that what happens?

Kelsey 11:13
That definitely still happened?

Scott Benner 11:15
I would understand that I would imagine to it's wrapped around your day, right? Like you're at work, right? Like what kind of, you know, tell me where you work. But what kind of work do you do?

Kelsey 11:23
I am a cake decorator?

Scott Benner 11:25
No kidding. Oh, that's so cool. I can't believe you just said that. All right here. Alright. It only took us 10 minutes. Now we're going in a different direction. I can't believe you just said that. Because yesterday, driving home, my wife, my wife was like, look at this video of people decorating cakes online. So I'm driving Yes, holding a phone up in front of me. And and she's like, it's amazing. And they she starts talking about how they put the icing on. And she's like, I wish I could do that. I think I could do that. And I was like, you think you could do what and she's like, you know, they take that metal spatula, they make it really smooth. She's like, I feel like I could do that. So, but you don't know about me, Kelsey, is that going from middle school to high school, I was not maybe a very dedicated student. That'd be I think that's a nice way to say it. I didn't love school a whole lot. And there was this assembly one day, this person comes over and says I'm the principal, the technical school. Oh, and I was like, there's a tech what I don't even understand what he was saying, you know. So it turned out that back then, in like the 80s, you could go two weeks a month to regular high school, and then two weeks a month to learn a trade. I thought, well, I don't really want to learn a trade. But I definitely don't want to go to high school for three solid years. So let me look into this. So So I go on the tour. And it's like small engine repair. And like all these things that I'm just like, I don't care about that. I don't want to learn how to weld. I don't care about this. And I was like what's in here, and I walked through this door. And Kelsey, I'm not gonna lie to you. It was the room that I had been in that day with the most pretty girls. So like, I was like, What is this place? This is the place Scott's going to come in high school. And it was the bakery. So hey, I learned to bake. I can make bread, you know, 150 pounds at a time, not a low for the time. And like I can run an oven the size of two of your cars and things like that. But the one thing I couldn't do, Kelsey. Yeah, I couldn't decorate anything. I have the I'm like so heavy handed. And I could just never make it right. I would try and try. So I want to like how long have you been doing that? Like, how did you get started with that?

Kelsey 13:30
So I started in high school, I taught myself and then all the jobs I had like in college and everything were in bakeries. And after I graduated college, I just stuck with the bakeries

been doing this for

10 years.

Scott Benner 13:50
And so you just and so you and it's not like the overnight thing cuz I tried to get a job in a bakery after school. I was incredibly qualified, but they wanted you to start working at like 130 in the morning.

Kelsey 14:00
Yeah, so I definitely did that for a while. did not love

Scott Benner 14:04
that part. Yeah, that's not good. So you just come in at like a regular time and you and you sit and you look at the orders and you and you decorate cakes. Yeah, that's very cool. How do you keep from eating the icing? I know the trick is that after you're around it for a while, you really don't want it anymore, but

Kelsey 14:19
exactly the same as it is to it.

Scott Benner 14:23
So here's the thing I learned in the bakery that is that seems to skeeve people the most when you're making cinnamon buns. Take the dough before it's cooked. and dip it in the melted butter and then in the cinnamon sugar and eat it raw. It's so good. So good. It's amazing. Anyway, I that's what I know about bakeries. But okay, so you're sort of working independently most of the day, right? You're not probably around a bunch of people. Are you probably in charge of your time and everything like

Kelsey 14:54
yeah, I work in a pretty small shop. So there's only three of us and they're

Scott Benner 14:58
cool. That's right. I'm gonna have to get you to decorate a cake for me. Where are you at what? country?

Kelsey 15:03
I am in Tampa, Florida.

Scott Benner 15:06
I was just in Tampa. Oh, no way. A week ago, I was down there to watch my son play baseball. Oh, that's cool. Oh my gosh, that airport is nice. I have to tell you. Yeah, I fly out of Newark and not a nice airport. Yeah, yours is much nice Pampas is it's a nice place. Like it was a little, little on the cloudy side when I was there, but I had a good time. Okay, so. So you and I are talking right now, because we tell a little bit of a story. My daughter's diagnosed a very long time ago, probably around the time you were you were 2002. She was like 2006. And when our son was diagnosed, she was two years old, literally just had had her second birthday. We're in the hospital for a couple of days. And I think on the second or third day, they make us go to a carb counting class, which is ironic because I don't count carbs anymore. in there and freaking out, you know, with like seven other families who'd all been diagnosed around this couple of days. We come out of that class. And it had been enough time had passed since Arden's diagnosis that things started sinking in, he started having different thoughts. So we're walking out of that class pretty dazed. And I'm pretty sure I was dazed because I was like, I'm not gonna I don't want to count her carbs for the rest of her life. That sounds horrible, you know? And, and I looked at my wife, and I said, Do you think we're going to end up getting divorced because of this? Because that's how it was starting to strike me that this was difficult, and, you know, anxiety ridden? And that, Oh, my gosh, I wonder if this will impact our marriage. And my wife says, I don't think that's gonna be a problem. But I could tell by looking her face, she was thinking about something else. I'm like, Well, what do you think the problem is gonna be? And my wife who does not get emotional, because of her Irish and Catholic background, does not allow her to access her feelings. She looks at me and kind of swells up and starts crying and she goes, do you think Arden's going to be able to have a baby? And I was like, I don't know. I never thought of that. I'm like, Why are you bringing up other stuff? You know, like, like, stop saying horrible things. I just said a horrible thing. Let's talk about my heart for a second. But that was my wife's concern in the moment, right? Yeah. And so, Kelsey, I don't know that it may come to a surprise to people. But I receive a lot of correspondence from you guys, which is always fantastic. I get it a number of different ways, emails, social media, all this stuff. But you sent me a note in like October of 2018. That hit me in so many, like, places in my chest, heart and mind that I stood in my house and started to cry a little bit. And so I read your note, and I got all like, kind of filled up. And I was like, This is so nice. And I felt good about myself. And I was like this podcast is really helping people. And like, it was very overwhelming. And sometimes I'll like, just get a note and it makes me smile. I sometimes I'll get a note. And I'll be like, Oh, I never thought of that. Like, they all take me in a different way. Yours took me in all the directions at the same time. And I read it on the podcast at some point, but I'm gonna read it again here. And then we're gonna start talking about the core of it. Right? All right, so you said, Hey, Scott, I just want to say thank you for the podcast and making diabetes management actually seemed manageable. I found your podcast that summer when I was looking for details about the future on the pod products. And your interview with them was the only information I could find. Then I dove into the older episodes. And of course, listen to the classic Episode 11, which is bold with insulin. I honestly never looked at diabetes management that way before. But I changed my mindset completely, as corny as that sounds and tweaked my basal rates and my ratios and changed my dexcom alarms and started treating highs aggressively. And here I am three months later, with my agency down for 7.1 to 5.5. You're like holy crap. I don't know. If it's been that low in 16 years that I've had diabetes. Now. That's all really well and good. And had you stopped writing there? We wouldn't. I would have just been like, Oh, this is nice. Kelsey is having success. The podcast is doing what I want. I would have went on with my date. But then, Kelsey, you kept writing. Again, this is right. This is what you made me cry. I'm getting married this December and thinking about having kids. And before I found your podcast, I don't know how I would have ever felt comfortable enough to try to get pregnant with an A one see around seven all the time. But going to the doctor's today and seeing the 5.5 was so exciting. It was just a relief. I can do this. So thank you for showing me what is possible and giving me the confidence to do something about it and thank you for keeping me bla bla bla bla bla and now I'm standing in my kitchen thinking Kelsey, Kelsey is gonna get to have a baby and I kind of jello it up a little bit. I was like shaky and everything for a half a second. I was like this is amazing. And I think this is just your note is a big idea, right? It's all the things that we don't really talk about around diabetes, that, that you had a seven, seven was good. But you didn't imagine that there was better, you couldn't have imagined it, no one was telling you how to get to it. And that quietly and privately in your head, you were thinking, I probably can't have children. And I want to talk first about that, like with you and your fiance. Do we say his name? What's his name? Is Ryan Ryan. So you and Ryan, have been dating for how long?

Kelsey 20:34
We dated for four years.

Scott Benner 20:39
And at some point in those four years, you're like, I'm gonna let this Ryan guy marry me at some point. You didn't tell it? You didn't tell him but you know, I'm assuming. Right.

Unknown Speaker 20:47
Right.

Scott Benner 20:48
And, and you gotta keep him working. He can he can, of course. So you're thinking about that. And you think I Brian probably wants to have a family. I want to have a family, but I don't think I can. Can you talk about the anxiety and the kind of stress that comes with having private thoughts like that?

Kelsey 21:05
Yeah, it's very stressful. Because it's a conversation we had talked about, um, it was like, we were kids. We gotta get this diabetes thing locked down. Um, but, you know, even when he was so supportive about it, it's still like, this is on me. I don't know. It's gonna be really hard. I'm just gonna have to eat like, eggs and cheese for nine months. Because barbs man,

Scott Benner 21:37
I have to tell you, strong chance this episode's gonna be called because carbs, man. And so that's my, that's what I was getting at, like. So the first things first is you guys are in this together, but it feels like it's on you. Right? Well, absolutely. And if you can't accomplish this thing, if you can't figure out how to just eat, you know, eggs for free. I can't believe that was your that was your fallback plan.

Kelsey 22:05
That was it. That was like eggs don't affect my blood sugar. I can eat.

Scott Benner 22:11
Hold on a second. I'm laughing. It's

cold. So if I start laughing, I'm gonna cough. So when when that was your plan, that didn't seem like a really, like, something you were really excited to do? I would imagine the same time you probably weren't sure if you could do it. Like, but did it ever occur to you? Like, what if I get three months into my egg plan? And this baby grown inside of me? And suddenly I'm like, Oh my god, I can't eat eggs anymore. Right? And then it feels like what? Like you're letting the baby down? Or what?

Kelsey 22:42
Exactly, yeah, that's a lot of pressure. Yes, right. Oh, yeah.

Scott Benner 22:46
what's already hard enough to be a person. I think it's harder to be a woman. You guys have the deck stacked against you in a lot of different ways. Mostly it's imposed by men. And and so all this is going so you have this feeling like oh my gosh, this is on me. Right? I have to do this for the health of the baby. Not just the health of the baby. But for the idea of building a family for you and Ryan. So you could you could let yourself down with the baby down. Let Ryan down. Let the egg market down in Tampa, which is probably relying on you for some some heavy funds coming in. And so there's a lot there. Did it make you feel like maybe I shouldn't try to have a baby.

Kelsey 23:29
I don't think I ever thought I'm not gonna do this. But it was kind of like a, I'll just keep putting this off. And feeling.

Scott Benner 23:38
Oh, no kidding. Oh, that's interesting. So if if so, are you married now?

Kelsey 23:43
Yes, we got married in December. Congratulations.

Scott Benner 23:46
Well, how are you finding it so far? Has Ryan become annoying? And you realize now you don't have a baby with him?

Kelsey 23:52
No, we're still in the honeymoon phase. So

Scott Benner 23:56
your your marriage pancreas is still working? Is that right? Exactly?

Kelsey 23:59
Yeah.

Scott Benner 24:02
I always tell people that honeymoon phase and diabetes is called the honeymoon phase for a reason. And it was named by people who have been married for longer than a year and a half. So that's great. So congratulations. You guys are on your own and you're you know you're you're doing your thing. Is that noise? Can you tell me what that noise is? Because I'm just gonna wander.

Kelsey 24:23
Somebody is blowing leaves

Scott Benner 24:26
outside the window, or something like that. That's fantastic. Why are their leaves in Tampa?

Kelsey 24:31
I don't know. I mean, we got

Scott Benner 24:33
we got trees of trees. It's not like a paradise down there. Just cactuses and palm trees and everything right?

Kelsey 24:40
I mean, at the beach, but not

Scott Benner 24:41
downtown. Are you like right in the city?

Kelsey 24:45
I am like right outside the city. Gotcha. Gotcha.

Scott Benner 24:49
Okay, so now, by the way, first of all, I shouldn't tell you what to do. But please don't have a baby too soon. It's not good for you. There's A lot of great things to do, and all that stuff. But now at a 5581 C, can you tell me like, what would? What changes do you think got you from seven to five, five? You're gonna want to check out the Dexcom g six continuous glucose monitor, and you're gonna want to do it. As soon as I'm done talking, or you know what, at the end of the episode, go to the links in the show notes or Juicebox podcast.com. Get yourself to dexcom.com forward slash juicebox. And here's why you want to do that. today. It is right now I'm recording this noon on a school day. Arden left for school this morning. Her blood sugar was on the lower side. Low 7071 72 and it's kind of laying there. But she wasn't hungry. So what would you do in that situation? You probably give him food. What we did was nada. We watched Arden's blood sugar, and we got four hours, excuse me, four and a half hours of a 72 to 75 blood sugar. Now how are we confidence thing there? Dexcom right, because the G six is sending back constant updates about what Arden's blood sugar is doing. Is it going up? Is it going down? Is this thing steady? And it seemed that today it was staying steady. Even without food, too. We wrote it out. And she got four and a half beautiful hours. We were able to then Pre-Bolus for lunch. And right now, an hour after her lunch. Arden's blood sugar's 121. And super stable. Partly because Dexcom showed me that we missed a little bit on Arden's meal bowls, we were able to add a little more insulin after she began to eat. That's how you bump and nudge. That's how you use the Dexcom to your advantage. Let's I mean, we didn't even talk about the share and follow features. I mean, obviously, I'm seeing Arden's blood sugar, and she's not with me, where the fact that there's zero finger sticks required none of that. I mean, there's just so much to say, two minutes isn't long enough dexcom.com forward slash juice box. So links in your show notes or Juicebox podcast.com. What changes do you think got you from seven to five, five?

Kelsey 27:05
First thing I did was changed my basal rates. Um, because I don't think they were high enough. Okay. And then the other thing I did was I started Pre-Bolus thing. And then I also was more aggressive about correcting highs, whereas before, I'd be like, Oh, I don't want a second slim. So I'm just gonna wait and see what happens. But now like, I'm getting this thing down. Nice. That's excellent. So you've, you've outed the fact that the podcast is really just a few very simple ideas put together in my mind.

Scott Benner 27:41
And and look how well it worked out for you. I mean, honestly, 71255 is an incredible like, like, change. So my question is, you're pretty expected. So but so that's interesting, right? So when I, when I talk to a lot of people privately, they'll they'll say, like, you know, I don't know where to start, and they show me their graph. And look at the graph. And the first thing I think, is you your Basil's wrong, because because, you know, because if your blood sugar is not sitting at 85, constantly when you're not eating, then your bazel is not as high as it could be, right? Like talking about getting low and everything like that. But I'm just saying if you're sitting at 150, you're, you know, 150 because you don't have enough insulin at the right time, and that that, you know, counts for bazel as well as boluses. So, it's an adjustment for bazel. I think always kind of the first step. Yeah. Right. And you have to make sure your basal insulins, right, if your basal insulins wrong, nothing else is really going to work. At the very least you're not going to be able to kind of like diagnose what's going on. Like you can't figure out what's wrong with a bolus, if you're Basil's that far off. So okay, so then you move your alarms on your Dexcom. I want to right, yeah.

Kelsey 28:55
So I didn't have the high alarm on my Dexcom at all, like I turned it off, because it beeped all the time. And it annoyed me, which I know is not like kind of not the point. But I set it to 130 I'm actually you know, keep it under there now.

Scott Benner 29:14
Nice. And just you just bump it a notch and you're just hitting that 130 and bumping it back. Exactly. People listen, listen to what Kelsey is telling you the podcasts where you have to you can't just listen and think that guy's full of crap. I don't want my thing to be all the time. I mean, does it really beep that often? No. It doesn't now No. Yeah. How long did it take you to get from? I don't think I can keep this under 132. Wow, I can't believe how long this stays under 130 during the day.

Kelsey 29:42
I think it was like within the first week that I was like, Oh my gosh, this was working. Remember going out to dinner with Ryan and being like, Oh my gosh, look at this graph. Can you believe this?

Scott Benner 29:55
Did that immediately make him think he was gonna get that sex cuz he was like, oh my god. She's ready to have it. Baby like I would have been like, this does not mean you can give me a baby. So

Kelsey 30:06
I'm just gonna quite make that leap.

Scott Benner 30:08
Yeah. That's what I'm glad that Ryan's got his head on straight and he's not like apparently I am. That that's really cool. So I don't October, November, December, January, February, March, April, we're like you're six months into this idea. And it's going along pretty well. Have you had a second a one? See since then.

Kelsey 30:29
I actually haven't I had a doctor's appointment scheduled. And then I was going to be out of town and they couldn't fit me in April. So I have it

Scott Benner 30:38
set up. Okay. So I'm going to ask you to do something for me. It's March now. We can get that doctor's appointment. Would you send me your next day Wednesday, because when I added this, I'll put it in. Okay. So true to her word, Kelsey sent me that email that says this, Drumroll, please. Because I just got my latest a one C and it was a five, five again. I know it's just a number. And then she put some parentheses. And I did have an after breakfast bike of 210 today. So thank you diabetes, for keeping me humble. But I'm really proud of myself. We looked at all my past agencies, and they were all in the sixes and sevens, and an eight even. So I felt like I could let this big breath out that I've been holding in for years. Plus, I just feel better without the constant up and down rollercoaster. You're a shining example of what we talked podcast like seriously, study your, your website again. A case study case. Yes. A case study in cake decorating and bow and bolusing at the same time. Do you agree with me? Just to go off for a second? That icing shouldn't be too sweet? Oh, yes. Right. Yeah. And it can't it can't be greasy.

It needs to be right.

Kelsey 31:48
Yeah, I don't know. My favorite, I think is called Italian marine. And it's very, like creamy and smooth and buttery, but not too sweet. That's

Unknown Speaker 31:57
the best icing sounds amazing.

Scott Benner 32:00
I just think that some people make icing too greasy. Okay, it's not good. And then some people use way too much sugar. I don't like that either. So see, everything's about balances. Your boluses That's right. Everything really is. Okay. So I like this. So you're you're moving along the idea. You figured out the the alarms on the Dexcom. You figured out bumping and nudging you figured out your basal rates? Do you eat a fairly regular what we would consider regular diet?

Kelsey 32:32
Oh, I think for the most part,

Scott Benner 32:33
yeah. So you're not like very low carb or something like that?

Unknown Speaker 32:37
Yeah. Okay.

Scott Benner 32:40
Kelsey, I'm so proud of you. I really don't even know each other. And I'm so incredibly proud of you. I'm over being mad at you for making me cry. And I'm up to being proud. It's astonishing. So tell me a little more about like your debt.

Unknown Speaker 32:54
You work every day?

Scott Benner 32:56
Um, yes, pretty much you get up in the morning Do you eat before you go to work? Or how do you handle your life?

Kelsey 33:01
Yeah, get up, have a cup of coffee, eat breakfast, and then head out the door.

Scott Benner 33:05
Would you eat today?

Kelsey 33:07
Today I had a slice of toast. That was it. I was gonna eat a banana. But then right at the last one.

Scott Benner 33:16
Ryan, you can't eat the last banana man. Like, do you need me to talk to Ryan? You can't empty the trash and I put another bag back in it. Yeah, eat the last day food. You can't insinuate that anything that Kelsey said is in any way crazy. Never use the word crazy. You never want to say that. I could tell the kid what to do. If you haven't called me but. But he'll figure it out along the way. The The trick is Kelsey, will he figure it out? Before you want to throw him off of an overpass? That's really the whole trick. I'm sure he will. So you had a piece of toast to do Pre-Bolus for the toaster. How did you handle that? Was your blood sugar? Yes.

Unknown Speaker 33:53
Nice. Hello.

Kelsey 33:54
115 before breakfast?

Scott Benner 33:59
How long before?

Kelsey 34:02
How long? Um, 15 minutes before?

Scott Benner 34:06
It's your Do you remember what your blood sugar was before you? Pre-Bolus?

Kelsey 34:09
I think it was like 112 115.

Scott Benner 34:11
Nice for you nice and steady overnight. I think I was excellent. Now tell me about this. If you don't mind, we've already talked about other things that are private to you. How can you find managing your period?

Kelsey 34:24
Um, it? Well, very interesting. Um, I have had an IUD for the past year. So I haven't really gotten a period. So as far as this new style of management, I don't know. But before it was kind of all over the place. Okay. Um,

Scott Benner 34:42
I was just wondering because I that's a question. I get a lot from people. I go, yeah, okay, this is all well and good. But what do I do when I get my period and I always give them the same advice or I don't give anybody advice. Kelsey, actually nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise and always consult a physician before making any changes to your medical plan or because But with insulin, but when people bring that up about their periods, I say, look, in my world, when this happens to my daughter, we just you know, all I look at it as is the diabetes as being more aggressive, it's it has bigger insulin needs and you have to be aggressive back with the insulin you use. fluctuates a little more, but in the end, it's you know, it's hitting harder, you need to hit harder back. You have an IUD, which I'm assuming Ryan takes personally, he's like, I knew she didn't really want to baby this whole. anyone see thing was a smokescreen. And now she's got a one seat down says you have to do something else. I'm joking. We're Ryan taking shots in this for no reason whatsoever. Again, it's fine. He'll deal with it.

Unknown Speaker 35:45
It's a good point.

Scott Benner 35:46
That's excellent. Good for you. That's really cool. What does he work? You guys work together? What does he do?

Kelsey 35:52
He was an engineer. So he's like the opposite of a cake decorator.

Scott Benner 35:55
Not really your engineering a cake cakes are symmetrical. It's the same thing.

Kelsey 36:00
That's true. You got to stack them and make sure they don't fall over. And yeah, there's a little bit of engineering.

Scott Benner 36:04
So what are you what what do you put in on your, on your LinkedIn? Now? You should say that you're a confection engineer.

Kelsey 36:13
There you go. I like that. I

Scott Benner 36:14
got write that down. Yeah, that's it. Kelsey, your infection engineer. That's exactly what you are. You can't tilt it can't be. It's got to be symmetrical. It can't fall over needs to support its own weight. You have to be able to add other things to it without changing its its integrity. Are you kidding me? You're an engineer. I bet you I bet you Ryan can't decorate a cake.

Kelsey 36:34
He's done before. He's uh, he's alright.

Scott Benner 36:38
He's alright. I was so bad. Maybe some birthday cakes. I have. I have decorated cakes in ways that made me not want to eat them when they were over even knowing that they would still taste Okay, you look at them. Or something wrong with it. Now. It's not easy is what I'm getting at. It's a little practice. You use a spinner like when you're like, initially like do you like spin a like you put a cake on something? flop? Somebody? turntable? Yeah. Why would I advise I never able to do that. Do you think?

Kelsey 37:12
Like it's just practice, but

Scott Benner 37:15
I have no patience. If I had patience and accounting, yeah. If I had patient scelzi, this podcast wouldn't exist. And I would have no idea how to get my daughter's a one seat on anything. Because if I was patient, I would have listened to the doctor stayed patient and continued to try to know what he was telling me to do. Instead, I was just like, Oh, this is stupid. I'll figure this out myself. Like a better approach. So far. So good, right? Yeah. Okay. All right. Um, what are you excited about moving forward? Are you thinking about new technology? Or are you pretty happy with where you are. Usually, I like there to be a little more space in between the ads, but this is a good spot for this one. And then we can roll right through and talk to Kelsey the rest of the way better diabetes, as the story unfolds, and she gets a little more comfortable. Okay, that took 20 seconds, sorry, on the pod, go to my omnipod.com forward slash juicebox. Do it today because when you do, you're going to be able to get a free absolutely no obligation trial of the Omnipod. That's right, they will send you a demo directly to your home. They call it the pod experience kit. It's a pack like a kiss from Omnipod that comes through the mail. Absolutely for Free. That does not oblige you to do anything after that. I'll tell you why this is amazing because then you can try the on the pod on for yourself. You can find a spot that you like you can put it on you can see what it's like to put on a shirt or pants, some undergarments, get in the shower, go for a run all with the on the pot on how well you don't have to make an educated guess when you're choosing an insulin pump. When you wear it, you're going to notice there's no tubing involved. You're not going to be tethered to anything and I think you're going to see that as a real bonus. On top of that, like I just said you can shower with it. It is the only insulin pump that you can get into the shower with so that makes it the only insulin pump that you can get into the ocean with we're swimming pool. I know a lot of people who disconnect their pumps to play sports or workout with the only pod you don't have to you stay in control of your boluses and your basal insulin the entire time. Check it out at my Omni pod.com forward slash juicebox are the links in your show notes or at Juicebox podcast.com get that free pod experience get today the pod doesn't have any tubing to get caught on your clothes. It'll never wrapped around the doorknob worried like that thing in your countertop drawer that you know Yanks all your stuff off.

Unknown Speaker 39:37
ami fine.

Kelsey 39:40
Yeah, I think he like the horizon and all the like artificial Pinker's type systems are super exciting. I've been like reading about that for years. I'm like Hurry up. Why 90?

Scott Benner 39:55
Like right like just just to take any I guess any extra stuff. out of your day would, would be great, right? So you, even though you're rocking a five, five on your own, you'd be willing to hand it off to something else if it if it meant you're not thinking about it as often. Oh, for sure. Cool. I agree with you. By the way, I'm, uh, I'm looking to get out of this. Although I got a lovely note from someone the other day who said, Please stop saying that it makes me nervous when you say the podcast doesn't have to go on forever, don't worry. podcast is gonna go on. Plenty long. But But I still, I'm interested to get into the next part about diabetes like to find out, like what happens next, you know, and because there's going to be management ideas around all that there was actually there was actually an article that came out the other day, that over the third, please make sure you listen closely to everybody. Everybody listening. over a third of people who started on the Medtronic artificial pancreas, left it because it, it didn't work very well, is what they said. So I, I look at that. And I think you know what, it was exciting to be first. But wouldn't you rather be right than first? You know what I mean? Like, we have an artificial pancreas. It only makes over one in every three people we give it to run away from it's screaming. Maybe it's not ready to put on the market that in that situation, right. And so while I do hear people complain, and I have those thoughts, too, sometimes, like about Omnipod, I'm like, Oh, they were a little late to the game. And they didn't quite figure it like, but it ends up being in my opinion, it's a good thing, because you get to see, you get to take your time now. Like there's no expectation to be first so be right, that that's how I say it. So I'm very hopeful I would knock on some wood. I'm very hopeful that horizon is going to be something that people don't, you know, treat the way they treated the Medtronic one like I hope I hope it does what they say it's gonna do and and that's worth waiting for. It. Just you know what it is? So it really is are you from the Tampa area originally?

Unknown Speaker 42:04
I'm from Atlanta.

Scott Benner 42:07
How'd you make Tampa that's where Ryan was?

Kelsey 42:10
Well, no, I went to school down here. Um, so I met him after I moved.

Scott Benner 42:14
Okay, and just ended up staying. Yep. So what school What What school did you go to? You went you said college you went to?

Kelsey 42:20
Yeah, I went to St. Louis University. It's a pretty small school down here but

Scott Benner 42:26
major businessman events? Are you going to try to buy the bakery at some point?

Kelsey 42:32
No, I'm my original plan was to open my own bakery. Um, but when I started this job, I'm like, I want to stick around this place is good. Um, but actually own a side business. So I can still get my management in over there.

Scott Benner 42:45
Nice. Is that something you want to share what your side businesses are? You

Kelsey 42:50
know, if I sell sugar flowers on line, the decorations for the wedding cake for other bakeries and stuff.

Scott Benner 42:58
That's brilliant. So you make the flowers and then other people use them during their decorating?

Unknown Speaker 43:03
Yes.

Scott Benner 43:04
Hmm. That's really cool. Is that something I can look out while we're talking? Sure. How do I do that?

Kelsey 43:11
All right. My website is a Kelsey cakes calm.

Scott Benner 43:15
I'll see you next.

Unknown Speaker 43:19
Time look the other beautiful.

Unknown Speaker 43:22
Oh, my God, Kelsey, you're really talented. Thank you. No kidding.

Scott Benner 43:27
I you guys have to look at this. I don't know if anybody listening would need these. Some of them look real.

Kelsey 43:34
Can I? Technically, tactics don't taste very good. They're very crunchy.

Scott Benner 43:40
Technically, it won't kill you, Scott. If that's what you're asking. That's really seriously, I'm gonna put a link in the show notes to this. I have no idea if anybody would. But it is really astonishing. Like you're an artist. Oh, absolutely. That's really cool. Is this taken off for you? is this doing the thing

Kelsey 44:01
you said is a

Unknown Speaker 44:02
nice Oh, Oh, nice. Oh, listen, you stay busy enough. You won't need that IUD anymore.

Scott Benner 44:13
You're so young. It's inappropriate for you to make that joke. Get married that long and you're like, oh, he doesn't know what he's talking. like three months later, like 10 years from now. You'll be like, Oh, I get what that podcast guy was. There's one here there's a featured item it says blush and burgundy sugar flower arrangement cake topper, including dahlias. Roses, Fern leaves. It really is it's astonishing. It really I hope everybody takes a look at I don't know what the heck they would do with

Unknown Speaker 44:44
them from you but they're not again.

Unknown Speaker 44:48
A cake I guess there really is a limited use for them right.

Unknown Speaker 44:54
What else would

Kelsey 44:55
put them in phases so

Scott Benner 44:56
that she wrote what she's very proud of you? I imagine.

Kelsey 44:58
Yeah. Awesome. template my first flowers from like high school and I'm like, Why do you still have these there's,

Unknown Speaker 45:05
um, your mom loves you. That's so nice.

Scott Benner 45:10
Later you have that baby and you love that baby like that. You end up saying stupid things to it. Like, my son FaceTime the other day from school. And my wife just turns into like, she's just like, Hi, buddy. Like, she gets real life. And then my daughter stands behind our mock sir. I'm like, stop making fun of Mom, where she can't see you. Because I'm laughing and now she doesn't know why I'm laughing. I was like, you should at least have to make fun of her to her face. But she turns into mom pretty quick when she sees my kids. So sounds like your mom does, too. That's really cool. Okay. Give me a message for people who were where you are, who thought seven was good. And they were doing okay. And like, what what would you tell somebody like, like, if I came up to you and said, bumped into you in the street, and I was like, Hey, I heard you on this podcast. Kelsey, and can you tell me like what what to do?

Kelsey 46:04
Or that's a tall order.

Scott Benner 46:06
It is right. But what would you say if I if I came up to you? And I said that?

Unknown Speaker 46:10
Oh,

Kelsey 46:12
yes, I would say, you know, take a deeper look at it.

You know, don't don't take it as being good enough.

Unknown Speaker 46:22
Yeah, um,

Scott Benner 46:24
yeah. Did your doctor tell you? It's possible your doctor looked at that seven was always like, Hey, this is great. You're doing great.

Kelsey 46:31
Yeah, she was like, you know, you're doing all right. She didn't think great. But, you know, not like, we got to change everything or

Scott Benner 46:42
right, and not that seven. Let me say this. I don't think seven is a bad one. See? And if you have one, I'm not coming down on you. I'm saying that when we set an expectation that sevens good.

Kelsey 46:52
Exactly.

Scott Benner 46:54
Just that right? Yeah. It's all about expectations. The Dexcom alarm is expectation. Yeah, it really is. If you set it, so it never goes off, then your expectation is your blood sugar's gonna get high, that's what happens. And you're okay with it. If you set it at 130, then 130 is your expectation, you try to meet that expectation? Eventually, you start building on tools that keep you under 130. And you don't even find 130 that often. And then when you do, you have an expectation that you're going to fix it, you don't just look at it and go, Oh, that's what this whole thing is about that. And so, you know, it's, you try to teach this to kids when you're when they're growing up, right, which is that you should expect something from yourself every day, like, you don't just get up going, whatever happens happens. You know, I'll go with what that guy says, you know, let me see it, you should look at yourself and say, here's my hope for myself today and take steps towards that. You know, like, I mean, those flowers, you just, I just looked at, like, how long have you been working to? To perfect that?

Kelsey 48:05
gear? I don't even know. Um,

yeah, I mean, I mean, my first ones in high school, but I've been doing this continuously for like, four years. So I mean, they definitely didn't look like that when I started.

Scott Benner 48:18
But you expected that they would? Yeah, right. With enough practice and enough desire, you thought you could get to it?

Kelsey 48:25
Right? Like, gotta build towards it.

Scott Benner 48:28
And you had the tools like you had the basic tools, and you knew, like, Oh, I could, I can hone this.

Kelsey 48:34
Exactly. Right. I took classes, and I hope to and learning from others and watching YouTube videos.

Scott Benner 48:41
Okay, so now let's translate that to diabetes, right? Maybe, maybe you don't have the tools. But you checked out the podcast, you found the tools, and now you're practicing. Right, and you're getting pretty flowers.

Kelsey 48:55
Exactly.

Scott Benner 48:56
I love this down here. You want to see something interesting?

Unknown Speaker 48:59
Yeah, I

Scott Benner 49:00
just got a text message from someone who did not say that I can use their name on the podcast, so I'm not going to do that. But I've been talking to this person for a week maybe. And they started right where you and so many other people describe just blood sugars all over the place. They don't know what to do, this person is still doing shots. So they're doing like a slow acting insulin shot, long acting and we still started with basal rates, we got their basal insulin together. And you know, blood sugar's came down overall. Then talked about you know, Pre-Bolus saying and you know, getting the timing right and in just a couple of days. This is a mom of a 14 year old girl like they started like seeing better results, and and less spikes and less lows and it's all just, it's coming together for the middle week. And I'll be Get into her text when you and I are done talking, and I guarantee you what I'm going to hear is she hit a roadblock. It's gonna be something, right? It always is when they follow up, right? I'm gonna pull them up. Let me see my test myself. Let me open on my phone.

Unknown Speaker 50:14
And question for you.

Scott Benner 50:17
Yep. Okay, she's having trouble. And the trouble is I'm gonna get period related, this is the first day of the right. So it's all I'm going to do is reinforce to her is that what you've been doing? You need to do stronger, like, be just go back and be more aggressive, it's going to be more difficult because no pump, right? So you can't just go to like Temp Basal rates that are jacked up. But it's still gonna be doable, she's gonna have to Bolus a little more get it down. This is a person who's looking for a pump, and we'll be getting one soon. But it's, it's all doable. And now the questions that they're asking, and their texts are so much more thoughtful than the the questions they were asking last week. That interesting, like, do you feel like you're diagnosing things quicker when you look at them now?

Kelsey 51:12
Yeah, I think so. Um, and I'm definitely actually sitting there and thinking about instead of just going oh, well, I guess.

Scott Benner 51:22
Oh, well, that's it. And so is that what happened in the past? You just, it would go up? And you'd be like, yeah, I guess that's just part of what happens.

Kelsey 51:29
Pretty much. Yeah. I just thought that was part of the package.

Scott Benner 51:32
No kidding. And what set that expectation for you to think

Kelsey 51:36
just, oh, yeah, I just think it was all the years of not having the CGM and not knowing and not knowing how to fix it and think everyone was crazy. And then when you're told you're a one sees good, and you're like, I mean, this is good. What else can you do?

Scott Benner 51:55
Do you feel overall better now than you did six months ago?

Kelsey 51:59
I do I feel less like overwhelmed. Like, it's less of a thing that I'm constantly thinking about.

Scott Benner 52:08
That's really cool. I try to make that point to people. I don't know if they believe me or not. But like, they're like, oh, you're talking about more work? I can't do more. And I'm like, no more work upfront, less work

Kelsey 52:20
forever. Right. Exactly. It was only more work at first, but now it's like, Okay, I know how to deal with this. Because you're learning something.

Scott Benner 52:27
It's just something new. And you have to give away all the notions about diabetes that you had prior.

Unknown Speaker 52:33
Right, right.

Scott Benner 52:34
Exactly. Yeah. And isn't it? Is it? Do you find it true that what you're doing now doesn't really resemble what you were doing before? Almost at all? Right? Yeah, completely. See, Kelsey, and I really, I'm onto something here with this podcast. I have to tell you, it's really working out. Is there a podcast idea for decorating cakes? No, right? It's a visual medium, you need to do a YouTube channel. Right now, Kelsey, would you do a YouTube channel? Have you decorating cakes and making those flowers? Because I think I think time lapse footage of you, of you making those flowers would be amazing.

Kelsey 53:12
Yeah, I'm a video like kind of complicated. Get the lighting right and all that stuff. But something I've thought about but I only have one video I've ever made and that was like to help a customer figure out how to use their flower.

Scott Benner 53:27
Where's this Ryan in this? What's he busy? He can't figure the rest out of this. I'm making the flowers. You figure out how to video the flowers. Like we got to do get into the fight a little bit. Ryan Come on. And so this those flowers are like does he know they're amazing? Has he ever told you how many

Unknown Speaker 53:45
days before? I bet you he

Kelsey 53:46
helped me make a couple of them. Maybe? Yeah, cut this. This is trying to teach him more but

Scott Benner 53:52
you need to get a production line up. Exactly. Yeah, actually, you start rolling those babies out and teach them how to make those. Hey, you

Kelsey 54:00
go both an intern you imagine if you just

Unknown Speaker 54:04
like a little sweatshop of your children and making like flowers for

Scott Benner 54:09
their make the purple ones don't get up there's no ping until they're done. And But seriously, like I when I looked at them I thought the process of making them would be an incredibly interesting like, you know Instagram video or something like that. I we could get you to a spot where you had so many orders for those flowers. You couldn't keep up with them. Oh, yeah, you know what I mean? Have to quit that job.

Kelsey 54:35
Well, I'd have to get some interns or something.

Unknown Speaker 54:36
Do you sell them to the bakery?

Kelsey 54:40
Um, no, I make the flowers there for them. So it's not good.

Scott Benner 54:43
I don't like that. No, no, I don't like that because you're making a flower for an hour long rate and you're probably not making as much now as you charge for the flower.

Kelsey 54:54
Rebel I've never actually done like an apples to apples comparison. But time to shine up as I like to draw So I'm pretty happy. They're

Scott Benner 55:02
looking at me. I'm trying to get you fired. I'm

Kelsey 55:05
not gonna let them listen to this podcast.

Unknown Speaker 55:08
He's like, Listen,

Unknown Speaker 55:09
I like my job. Why are you trying to talk to me?

Kelsey 55:12
Cuz I get home I just do the flowers. But then here I get to like actually decorate the cake and do the weddings and all that stuff that I don't get to do

Scott Benner 55:20
with the flowers. You take the cakes to the, to the weddings. Yeah. And then do you put them together there or tell me about sometimes.

Kelsey 55:27
So if it's a small cake, we can just put it in the car and deliver it. But for like a really big like a two foot three foot tall cake. We got to assemble it there because it's just too heavy.

Scott Benner 55:38
So you take everything you need icing, like because I don't think do people. I don't know if anybody listening. Thanks. And I but when you assemble a larger cake, there's icing in between the cheese like mortar, like you're like you're building a brick wall. Right? Right. Right. And so you take all that to the site. How long do you think you can spend at a site like putting a cake together for a wedding?

Kelsey 55:58
Um, it depends on what the timeline is sometimes like it was an hour to set up sometimes they give us 10 minutes. So

Scott Benner 56:05
have you seen Have you seen those videos of the one My wife has shown me actually where you sort of build a cake stack? And then use a bread knife to shave it down into a shape?

Kelsey 56:19
Yes, like a bolton type thing? Yeah, like

Scott Benner 56:22
they're like you're making like a like an ice sculpture but out of out of like, Uh huh. Isn't that amazing? Yeah, that's pretty cool. You should try that too.

Kelsey 56:31
Thank you. My favorite thing to do?

Scott Benner 56:32
No, listen. That's what we'll teach. Right. Right. I'll do the shaving part. Yeah, I don't know. And do you? Here's me from the bakery. As she's cutting it down and shaving it in the video. All I can think is isn't that gonna create like a lot of crumbs when I tried to like Yeah. Well, yeah, what I mean, right? Because if the icing is too thick, it grabs the cake and pulls up like little pockmarks get crumbs, the icing, the whole thing's just a disaster. And I find that very,

Kelsey 56:58
like, do a crumb layer of icing first and then do the smooth layer on top of it.

Scott Benner 57:03
Is that what I was doing wrong? Maybe late now, I'm older.

Kelsey 57:09
That's definitely a helpful hint there.

Scott Benner 57:12
I don't even think I'm allowed to eat cake anymore. Like so hit that age where they're like, Can you just like rice cakes? Like light salt, maybe have a glass of water? And yeah, it'll eventually it sucks, honestly. But actually, I guess if you're lucky, you'll get old enough to where someone says, Hey, don't eat that anymore.

But anyway, so Okay, kills? Have we covered everything? Or is there anything we've left out or anything you want to talk about? That? I didn't know, I know, I basically forced you don't have on this podcast because of your butt.

Kelsey 57:45
Right. I was like, I have no idea what we're gonna talk about. Let's just see how this goes. And I think it's gone. Well.

Scott Benner 57:51
Yeah. See? And are you still nervous the way you were in the beginning?

Kelsey 57:55
Oh, not as much. I'm still a little nervous. But

Unknown Speaker 57:57
I can tell like i think

Scott Benner 57:59
i think we'd have to do like three hours before I think there's a whole other person side of you. I didn't meet today.

Kelsey 58:05
There might be

Scott Benner 58:06
there might be who is that person?

Kelsey 58:08
I'm a little shy at first, take some take some time getting used to

Scott Benner 58:13
it. Well, listen, it's very, it was very nice to be to do this. Because if you are a shy person to begin with, plus, you weren't like, I want to be on the podcast. I was like, Kelsey, you have to come on the podcast. Now. So here's how we're going to end up that if we if we've covered everything you were hoping to cover. I want the baby to be named after me somehow. I don't know how reasonable that is or not, but I'm making a real plea to you here. Okay, now I realize my name is kind of boring. And you're probably not gonna want to go with Scott. But maybe an initial some sort of a shout out in the in the middle name somewhere. Where do you think we can make this work?

Kelsey 58:46
Oh, no, no, I feel like names are a little bit further down the road. But

Scott Benner 58:52
Alright, so let's start thinking about it now that like, maybe we don't have an answer yet. But if it's just an initial, something to that effect, I mean, I'm not asking you to name Okay, like juicebox or something like that. Like, that's ridiculous. But, uh, if we could get an S in there somewhere, even if there's an s still there. Yeah. Can you hear me?

Unknown Speaker 59:10
Okay, yeah,

Scott Benner 59:12
no, even if there's an s in the name, and you didn't put it there, because of me. It wouldn't hurt to set a note and say you did you know what I mean? Like, like, yeah, like here. Here's an example. It took my daughter off to school this morning, and my wife was packing up her bags to leave for work. When I came back, my wife was still there. And I said, Oh, did you wait around to see me? And she said, No, my computer's just shutting down. And I said, Kelly, How hard would it have been to just say yes, like, just go Yeah, I wonder wait around, say goodbye. Like, you know what, I mean, caution, nothing kind of a situation. So I'm saying if you if you come up with a name with an S or a B, like anything, just lie to me later and tell me it's for me.

Unknown Speaker 59:53
Okay, I think I can

Scott Benner 59:54
handle that you'd be willing to lie to me. I'll see. Thank you. This is very sweet. Have you

Kelsey 1:00:01
know anything for a friend?

Scott Benner 1:00:04
I really do appreciate. I wish I would have known that. That you were in Tampa. I think I totally would have stopped by down there at one point. And do you want to say the name of the bakery?

Kelsey 1:00:14
And the bakery is called hands on sweets?

Scott Benner 1:00:17
Hands on sweets, and it's right outside of Tampa.

Kelsey 1:00:20
Yep. Right. Right in South Tampa.

Scott Benner 1:00:22
Okay, so if a lot of people with diabetes are coming in to say hi to you, I apologize for that up front. And if you guys are weird, don't go see Kelsey. But if you're nice, you can go sad or okay. And you know which one of you are weird look in the mirror. You can figure it out. Okay. Right. Like me, I would be like, I would scare you. So I would never come. But But somebody else might. Alright, Kelsey, listen, I want to wish you and Ryan Absolutely. Like, you know, happy marriage. Congratulations. It's still very new thing. So very well done. Did you did your wedding do everything? Was it what you hope? Did you have a great day?

Kelsey 1:00:56
Yeah, it was awesome. We had so much fun. That's excellent.

Unknown Speaker 1:00:59
Did you make the cake?

Kelsey 1:01:01
I made the flowers for the cake.

Scott Benner 1:01:04
That's really nice. It really is. If you have a picture of your wedding cake, and you want to share it, I will put it up on this episode.

Kelsey 1:01:11
Sure I can email you a picture.

Scott Benner 1:01:12
Seriously. I would love that. Yeah, I just was really taken when I went look at your flowers. I was like that. They're really, they're astonishing. So thank you. I see that web address one more time.

Kelsey 1:01:23
Ah, Kelsey cakes.

Scott Benner 1:01:24
calm. Cool. All right, Kelsey, thank you so much. You have no idea how nervous Kelsey actually was. The stuff I cut out in the beginning was hilarious. I asked her to introduce herself and it was like she did not know who she was. But she definitely knows how to make cakes and the gorgeous flowers that go on top of them. She wasn't asking for a plug when she came on. But I think it's worth five minutes of your time to look at it. KL si e cakes, calm Kelsey cakes calm. Her flowers are stunning. As always my great appreciation to on the pod decks calm and dancing for diabetes for their continued and longtime support of the podcast. Check them out dancing for diabetes.com my omnipod.com forward slash juice box dexcom.com forward slash juice box. There's always links in the show notes or at Juicebox podcast.com. If you can't remember them. Don't forget to check out my Facebook page where there's now a private group where over 1500 people are discussing their diabetes together. It's possibly the most civil place on the internet. I don't say that lightly. These conversations are wonderful. They're helpful, warm, not judgmental. A really good group of people. If you think you fit in, go check it out. I'll leave you this week with what it sounds like when a leaf blower goes past the window of the person you're interviewing. Over if you

Kelsey 1:02:55
like right there.

All right. Can you hear me now?

Scott Benner 1:03:06
I can hear you fine. Don't worry. I edit that out or leave it in for humor purposes. I can't decide

Kelsey 1:03:11
All right. I mean he was like right there. Okay, so

The Juicebox Podcast is a free show, but if you'd like to support the podcast directly, you can make a gift here. Recent donations were used to pay for podcast hosting fees. Thank you to all who have sent 5, 10 and 20 dollars!

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Scott Benner 11/1/19 Scott Benner 11/1/19

#275 Dexcom Pro and COMISAIR

Dexcom Pro and the COMISAIR study…

Dexcom's Senior Medical Director Tomas Walker is back to explain Dexcom Pro and the COMISAIR study.

+ Click for EPISODE TRANSCRIPT

Scott Benner 0:00
Hello, everyone, and welcome to Episode 275 of the Juicebox Podcast. Today, you're probably expecting an ask Scott and Jenny are defining diabetes. But instead, they're bringing something that I think is just as valuable. Every once in a while there's research done around diabetes, that when you stop and listen to it helps you do better. And this falls under that category. This is just going to be a quick 20 minutes, but it's packed with good information. Today's episode of The Juicebox Podcast is sponsored by companion medical makers of the in pen, go to companion medical.com. To find out more.

Please remember that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise. And always consult a physician before making any changes to your health care plan. or becoming bold within quick announcement for those of you living in Pennsylvania, particularly in the Valley Forge, or more specifically trap PA Area on November 10 2019, it's a Sunday, but don't worry, the Eagles are in Dubai. I recently shared all my speaking engagements online and somebody came to me and said privately, I wish you would come to this area. And I said I you know, I can't control who invites me to come where. And this person told me well I can find a space for you to speak. Will you come if I do that? And I was like, Yeah, sure. So this isn't sponsored by anybody. It's not for the jdrf or anything, just gonna be me showing up at a church that was nice enough to donate some space for us. We're going to talk about being bold with insulin go over the tenants of the podcast, the protests kind of stuff. And then there's going to be huge q&a, where we're just going to chat and try to figure out people's problems. So if you're in the area, and you're interested, I think there's about 20 people coming now I think the space holds about 100. Go to the Events tab on my Facebook page, and RSVP.

Tomas Walker 2:04
I'm Tomas Walker, I am the senior us medical director with Dexcom.

Scott Benner 2:09
Those of you who love data and understand how it helps people will remember Tomas from Episode 66, which is still relevant to this day, and you should listen to. So when I heard that Tomas had some data, some new data from a really incredible study from the Czech Republic that he thought was important enough to share. I booked him on the show immediately. And as a bonus, there's a little something called Dexcom Pro that he's here to tell us about as well, that may help a lot of you at your doctor's office. You're ready. Let's do this. So there's two things going on right now with Dexcom. One is the Dexcom. Is it called pro?

Tomas Walker 2:48
Yeah, the Dexcom g six Pro has just been just received FDA approval. All right.

Scott Benner 2:52
And then the other thing is like an acronym that I don't know, am I right?

Tomas Walker 2:57
The commissar study

Scott Benner 2:58
is that with this, I think of it as an acronym, because there's a lot of capital letters. But that may be

Tomas Walker 3:02
the comments or study. Yeah. So yeah, which was a study on the impact of sensor augmented insulin regimens, which essentially looked at the benefit of using CGM compared to multiple daily injections and finger sticks, insulin pumps and finger sticks and then insulin pumps and CGM and multiple daily injections and CGM. So wanted to see the benefit of adding continuous glucose monitoring to the classic regimens of diabetes therapy and compare them to each other.

Scott Benner 3:32
Okay. And that was something you would like to share. I guess it's a must. It must be interesting. If you're assuming if it wasn't interesting. You guys wouldn't be interested in sharing it. You feel like nothing happened? Just a big waste of time. Nevermind. Yeah. going on.

Tomas Walker 3:49
Everybody.

Know that. So either. It's a fun study that came out of the Czech Republic by Dr. Yan Schauble and Dr. Martin progeny. And what the study actually did was recruit 90 some patients who were coming into their diabetes clinic training sessions, and they put them all into a three four day intensive clinic training session at the end of it, they essentially pick the treatment option they want for the next four years of therapy. Okay, so the patients could choose I want to stay on MDI and finger sticks. I want to go on a pump, but I'm going to stick with finger sticks. I want to go on a pump, but I want to use a CGM, or I want to stay on MDI. But I'd like to use a CGM. So the patients were allowed to self select for which therapy option they want it. They were then enrolled in this study, which was really just more of an observational study. And they were followed out three years now, which makes this the longest study of people using diabetes technology ever completed. So that's what's really exciting to me is prior to this the longest studies we had of people using CGM were six or 12 months We have completely blown that out of the water now and pushed it out three years. And I'm very pleased to tell you that they actually have the funding to complete the fourth year of study. So you know, most of the time you get an insulin pump. It's a warranty for four or five years. So now we're going to be able to say this is the entire life cycle of someone using CGM technology out four years,

Scott Benner 5:19
and the CGM you're talking about is I'm assuming that GE six,

Tomas Walker 5:22
they've No Actually this study was based around the Dexcom, g4 this was in Europe at some of the patients did have G five, none of these patients were using Gen six.

Scott Benner 5:31
Okay. Okay. And, and varying pumps. Not though, do they give them all one, sir?

Tomas Walker 5:36
It was, my understanding was that they had a choice of two pumps in the Czech Republic, they could use the Medtronic pumps, or they could use the Animas pumps with the g4 centers. But

Scott Benner 5:46
see, you know, you start looking back a couple of years you start hearing words you don't hear anymore,

like Exactly.

That so far, that's amazing. And who put the study together again.

Tomas Walker 5:57
So this was done by Dr. Leon Schauble and Dr. Martin prizemoney, who are two endocrinologists out of the Czech Republic, and this was funded by the Czech health ministry. So people ask me, what's my favorite part of this study? My favorite part of this study is, is nobody in industry had anything to do with this. This was done entirely by this group of clinicians and the Czech government to look at the impact of these technologies on diabetes care.

Scott Benner 6:22
That's very cool. That's great that people are thinking that way stolen? Yeah. Because it's and so how did you get involved in I mean, other than I'm assuming they had to come to Dexcom. And say, we want to use the G for for the study, or

Tomas Walker 6:32
no, no, actually, we didn't get involved with it at all. There is no Dexcom sponsorship of this study. That's why we didn't actually know about this study until we saw the first poster regarding it a few years ago and saw that the protocol had been submitted to the NCT trials database. So again, this is this is a study that was done without the contributions of Dexcom, or Medtronic or anyone in industry, it was done entirely by the Czech government and the the Charles University and in the Czech Republic. So three years

Scott Benner 7:04
worth of data, Is it broken down by how you chose like, or what is it? What is it telling you?

Tomas Walker 7:11
It is broken down by how you by how by this by the approach you chose, basically, it wasn't quite equal groups, but it was almost equal between the the subjects of 25 subjects in each group in MBI, excuse me an MBI and finger sticks, pump and finger sticks. MBI and CGM are pump and CGM. And then they were tracked out every three months for four years. And at the end of this three year period, they have 88 of these 94 subjects still active in the trial. So great, a great retention, great follow through. And what they've been able to show is that the patients who went on pump and CGM or MDI and CGM have a 0.1% difference in their a one C, out three years later. And this has been consistent since six months after starting the therapies. And the interesting thing is this is mirrored almost exactly in the patients who stuck with finger sticks. So the patients who are on MDA finger sticks and pump and finger sticks also have a difference of about point 1%. And they're a one see out three years. Now they're a one C is about 1% higher than the patients who were using CGM. So that's also a strong message that the insulin delivery method doesn't matter. What matters is using CGM is what improves diabetes care, because patients are able to make those real time decisions they need to manage their disease.

Scott Benner 8:36
What do you have an idea for the range? So people pumping with CGM and people shooting with CGM? You said they're about a percentage off. But what where does the range fall? Like? Are they a seven and an eight or a six and a seven? Yeah,

Tomas Walker 8:51
you're looking at 6.9 to 7.1. That's where everybody was CGM was falling. Okay.

Scott Benner 8:57
Okay. People using finger sticks were more like 8.1.

Tomas Walker 9:02
Like in that video. They were sitting around 8%. Yeah.

Scott Benner 9:05
Wow. So if you so if you see. So I guess the other thing is that it has to show that the people who are injecting, not afraid to inject more like they

Tomas Walker 9:17
sold. So that that's one of the interesting, one of the interesting findings of the study was when they looked at the data, we assumed that the patients on the pumps would be more likely to take multiple boluses. Right, there was an old study done called the switch study, which showed that when you gave patients on pumps, CGM, they were more inclined to take an extra bonus. Like I'm so high after lunch, I'm going to take an extra unit. They were willing to take more injections, and that was part of what improved their control. Well, when you look at the commissar data, they actually they actually track the number of injections per day. And the number of injections per day was like 6.6 of fast acting insulin per day, which matched like 6.8 micro boluses per day using insulin pump two extra against that. There's no difference. This, there was no statistically significant difference between the number of bonuses the pumpers, were giving, versus the patients on multiple daily injections. I actually thought that was kind of interesting, because if I had had to make a guess and predict, I would have said that people injecting were probably going to be taking a little bit less injections in the patients on the pumps. But it wasn't what was shown what it showed was up, the patients were on multiple daily injections. And they were doing just as inclined to do an extra bolus of insulin as a patient using an insulin pump. It's something I

Scott Benner 10:27
I thought, what you would probably find you are finding, which is that when you get the data, you can start making better decisions. And those decisions then lead to not needing to make more decisions later. You know what I mean? Like, once you've seen a meal, go, you know what I did an episode Tomas, the other day there will be cursed on it. I almost said something that I shouldn't say. So let me start over again, when after you see a meal go the wrong way, a couple of times, you can make the decision. You know what I keep Bolus and four units for this. But obviously, it's five. So why don't I just do five and you can start injecting more thoughtfully after you've seen it once or twice. I listen, I can't agree more. I wanted to have you on to talk about this, because I'm a huge believer, obviously. So that is really something and and that they didn't. Now they're adults, too. I guess that's important to keep in mind, right? Are these all adults?

Tomas Walker 11:21
These are all adults, this is entirely adult population.

Scott Benner 11:23
And I would say to an adult population have probably motivated people or they wouldn't be involved to they're not a passive group, I would imagine.

Tomas Walker 11:32
You know, if they were following through on their routine care every three months, but the fact that they had 88 of the 94 that enrolled still present in three years tell you tells you that this group was really at least committed at some level to this care.

Scott Benner 11:46
Yeah, yeah, they were not cherry picked. But they were people who were interested enough to follow through. My point is, then they're interested enough to pay attention to the data and make adjustments to Sure. Yeah, that's excellent. That's really cool. Oh, my God. So now where do you go from here with that? What do you do with this data?

Tomas Walker 12:03
So where this goes from here is this goes to four years now. So they're going to finish getting the fourth year of data. And then they were discussing the group running the study how they want to take the next, the next study forward, they really raised the bar here, you know, bringing in four years of data on 100 patients with type one diabetes, like Stand back, this is groundbreaking. No one has done this sort of diabetes technology study before. I'm glad to see they've done it, they've really raised the bar. I think that they're discussing themselves the best way to go forward. Yeah, I wonder if this isn't something you can use to pressure health agencies or insurance coverage or that sort of thing? I mean, it would you would think that saying to them, putting putting this person on this should lower their a one c appoint that would be a big motivator, I would think for them. So you know, one of one of the comments I make when I talk about this study when I talk to payers is I don't want to hear any more griping about not enough longitudinal data. Okay, know what else is coming in with three and four years worth of data if you you have to look at this and recognize the uniqueness of this data set?

Scott Benner 13:10
Yeah, I appreciate that. Because I just I just heard the other day from a person an adult who was flat told him in America you're a one sees too good. We're not gonna let you have it CGM. Like I don't even know what that means. You don't even but but it's it's too so your your health isn't poor enough for us to cover this the the CGM for you is something it's fascinating.

Tomas Walker 13:33
got an A anyone see is is not a perfect marker. I mean, all you have to do is look at what some of the work from right back in the djabe Center to say that, you know, a one C, it doesn't always correlate as closely to time and range as we think it might.

Scott Benner 13:45
Yeah. Did this data show anything around variability of time and range?

Tomas Walker 13:49
Yeah, they showed this the patients with CGM had significantly less glucose variability and significantly more time and range regardless of the insulin delivery method.

Scott Benner 13:58
What's the range they used, you know, off the top of your head? And I'm sorry to have to go back and look at the paper again, I don't remember that one. I'm on top of my head is pretty specific. I just took a swing there that wasn't sure if you would know I am I joke sometimes for the people listening that you can't, you can't set your your Dexcom at 65 and 400. And then get online and tell me you were in range haltech. I you know, you get to pick something reasonable.

Tomas Walker 14:23
I'm pretty sure that the range they looked at was 70 to 180 milligrams per deciliter would have been my guess I think that's pretty widely accepted

Scott Benner 14:33
range for people. I know. We keep ours incredibly tight for reaction purposes. So when when I look at some of our data is skewed because ours is 7120. And so I you have to kind of look through some of the numbers, you know what I mean, and figure out what they really mean. And then you can kind of reset that out to 150 and you Oh, okay, this is this is very reasonable. Tomas. We'll be back in a second to talk about that. compro. But first, I'd like to tell you about the in pen from companion medical. So try to imagine that your CGM, your insulin pen, and an app on your phone all connect to each other, creating a sort of triumphant of diabetes care. What is this do? You may be wondering, Scott, why do I care about this? Well, if you're an MDI user, a person using multiple daily injections, and you're just using a regular old dumb pen, this smart pen is a game changer. What it does is it gives you a lot, if not almost all, of the options that you gain with an insulin pump options like understanding insulin on board, which is incredibly important. How do we do that? Well, that's for you to find out. And for me to know, my heart knows, I'm just kidding, I'll tell you. So the intent is like any other injector pen, except it tracks each dose and delivers your data to a secure app on your smartphone. So really, it's not really like every other pen is it way better. The pen app displays your active insulin, blood glucose and the last dose of insulin that you've taken. It also can remind you when to take your insulin, it helps you calculate and recommends your next dose, and it'll warn you if your insulin is expired, or has been stored outside of the recommended temperature range. So if you'd like to eliminate the guesswork, that often comes with injecting the pen is probably for you. There are links in your show notes at Juicebox Podcast COMM But in the end, you just need to go to companion medical.com. To get started. I think that you'll be pleasantly surprised at what you learn when you get there.

Tomas Walker 16:45
The Dexcom Pro is ducks coms most recent professional CGM offering, what places us in a unique position in the market with our professional system is we are offering patients and clinicians the opportunity to have this as either a blinded data gathering system. So you come in to the clinic and you start the system up. And it begins to gather glucose data every five minutes 280 glucose readings a day for 10 days in a completely blinded data logger mode. So there's no interaction from the patient with the device or the clinician with the device, then they can return to the clinic and download it. Or we give you the option of having the patient download an app and have a real time CGM experience with this 10 day professional system also. So the benefit as speaking as a clinician is that in those patients who are maybe they may not want to engage in it, or maybe I don't want them to engage in the data, I have the option of doing that. But the same system can be turned around and use in a real time mode to benefit both the patient and myself by giving them that real time feedback. You know, as someone who lives with Type One Diabetes, you understand that this is a disease of self management, there's 1760 hours in a year, and you might see your doctor for two or three hours a year. The rest of the time you got to figure this out and giving people CGM gives them the ability to do this. And this is the approach we took was that there are there are times when a professional CGM should be real time because it will benefit both the patient and the clinician

Scott Benner 18:21
is one of the uses here. I don't have a CGM, but I can get on one for 10 days. So we can try to figure something out. Is that one of the ideas behind it?

Tomas Walker 18:29
Sure. That's one of the potential is you know, if you come in to see me in the clinic, and I don't know why you're having these high a one sees and your logbooks look good, and maybe we're missing the nocturnal hyperglycemia, maybe you're really high postprandial than we realized. And this gives us the opportunity to get a lot more data instead of bringing me six finger sticks a day, we're going to get 288 readings a day, we're going to get a much better data density.

Scott Benner 18:52
Is it also like a test drive to? I mean, is that one way to think of it or like for somebody who can get covered for it no full coverage for Dexcom. But they not sure if they want it they can try before they drive is that there? Was that not what the thought is?

Tomas Walker 19:08
It could potentially be used as a test drive platform also for patients who are maybe not sure they want to they want to engage in this technology. I'm I'm always kind of surprised that there are a lot of patients who still don't want to engage fully in these technologies. I think it's important as clinicians that we recognize that patients have individual expectations and individual needs, and giving clinicians the flexibility with the our professional systems is something that's really unique in the marketplace.

Scott Benner 19:33
So if if someone mentions Dexcom prior to me, it's likely going to be my doctor, not me, or should I walk in and mention it if it's something I'm hearing about now,

Tomas Walker 19:42
the way you know, I strongly believe in educated patients is educated patients have better outcomes. So but never hurts to poke your clinician for what you want or what you think might help you. But if this is really this will be a device that is going to be accessible through health care providers. Okay.

Scott Benner 19:58
All right. So Okay, and it, like, tried to help me for a second. There's a pile of them in an office, I did no office or I go into my endo. And I say, hey, look, we can't figure this out. You and I don't seem to be getting anywhere. I heard about the Dexcom. Pro, I want to give it a try for 10 days to see if we can get some data that'll help us, then I get a script

Tomas Walker 20:19
for that, no, this, this will be this will be access to the healthcare providers office. So you won't be you won't be filling this in the pharmacy. You'll be getting through your health care provider.

Scott Benner 20:27
Gotcha. That's what I thought I just wanted to be certainly as I have to tell you, Arden did this a long time ago, and probably with a GE, for what and it was a blinded sensor. And what had happened was, we were asking for CGM. And Arden was having like these crazy lows overnight, but you couldn't like you said, you know, with a finger stick, you don't know what's happening. Like you just you just think this is what's going on. So they put this blind went on or took it off, the insurance company looked at the data and said, okay, you can have a glucose monitor. And it turned out that what was happening was, we were putting art into bed, you know, like you hear a lot of people doing especially in the beginning, when you really don't know how to manage your insulin. Well, we're putting her to bed at like 181 90. And She'd wake up in the morning at like 85 or 90. And I just thought like, wow, we're so good at this, like we've really figured this out. And then you know, then the blind data came back. And it turned out she was going from 192 50 and sitting at 54 hours before she would drift back up to 90 in the morning. And that was happening. Like every night. Yeah, that was very scary. It was frightening. It was like, wow, not only was I not doing a good job, like I thought I was but I don't know what's happening. And she was incredibly low. And you know, so and, and her 81 C, by the way, was still like eight and a half. Like that's how bad we were at it. Like, you know, in the beginning. It's just it's good to have that information. It's

Tomas Walker 21:51
also a strong story there that a one sees only part of the story when you're looking at managing someone's diabetes. It's it gives you one piece of the puzzle, it is not telling you everything that is going on, right? I think getting people access to real time systems in a professional manner is going to help a lot of patients, it's going to really open a lot of eyes. Something I constantly heard from patients in practice when you put them on a professional CGM, and they can see the data is when they used to come back to the clinic to me, the first thing I would ask them is what did you learn? Before I tell you anything that I've discussed? What did you learn? Because people would always have something to tell you, they would say there is no way I can eat Chinese food that white rice just drives my sugar bonkers. You know,

Scott Benner 22:31
it's eye opening for what your insulin needs are for certain a guy something just went out of my head? Do you hope that the pro can maybe also take steps to showing what CGM does to the clinicians? Like there are still plenty who don't? I don't want to say believe in it. But they don't care about it. You don't hear them talking about it with their patients like is that also the hope that maybe they'll see something that they go, Well, why am I not? Why am I not prescribing this?

Tomas Walker 23:00
Yeah, and there's a strong hope that we can get more clinicians engaging more patients with CGM by offering another professional platform and a pathway towards patients, giving them the ability to have this retrospective or this real time data, combining it with our clarity system, which I actually think is pretty good, where we can give patients these great reports. And we can give these reports to clinicians also, and kind of help the clinician to recognize the patterns that patients are having, and see what we can do to help improve them.

Scott Benner 23:27
Is that is the biggest, what is the biggest stumbling block I mean, taking insurance out of it for a second. Is it it? Do you think it's people not wanting more information? Because they're scared of it? They don't know what to do with it? Or do you think it's the doctors who are maybe a little older, I don't want to say out of touch, but maybe just haven't been brought up in this space? where CGM is so prevalent now? No, I,

Tomas Walker 23:48
I don't think we can reduce it to one factor. I think that there's a lot of issues at play here. You know, one of the things that we always struggle with clinically is momentum, there's a momentum on the patient's part, there's momentum on the clinicians part. Because every time you stop and start trying to adjust therapies, it takes time, but it's the right thing to do. And we can give people tools to make that limited time visit because you have a limited time with his clinician, if we can take that visit and make it more efficient and more impactful than we've done something good for everybody.

Scott Benner 24:18
I agree. I tell people all the time, like don't wait till the next appointment. Don't do that thing of like, like, you know, it'd be easier in the summer to do this or it'd be easier. Like everyone always thinks there's gonna be a magical time we're making an adjustment easier. It's just not like you just have to do it and, and get through it. And then it's over. It usually takes a couple weeks to a month, whether you're moving from injection to a pump, or you're moving into a CGM, like you know, it takes it's about a month before you can start making sense of it. And there's not going to be any perfect time. You know, I mean, unless you're a person who could take off for a month and go sit on an island with your new CGM and figure it out. But I don't think that's most of us, you know, most of us, right, right. I just think I'm a I'm a proponent of you know, Don't think you should switch, just a switch. But when the technology is so much better than what you have, it doesn't make a lot of sense to stay in the past. I don't think, you know, this is really great. Thomas, thank you so much. I appreciate you coming on and doing this.

Tomas Walker 25:13
No, I appreciate the chance to talk to you. And it's an exciting time. And we continue to push the envelope and try and improve the lives of people living with Type One Diabetes.

Unknown Speaker 25:21
Thank you so much.

Scott Benner 25:25
Thank you, Tomas for coming on and sharing this exciting stuff. And I mean that I know that often data doesn't sound exciting to people. But what you learned about that study is important. It's impactful. It can change the way you think about your type one diabetes index compro. That's how my daughter found out about Dexcom that so that was our first look into it. Right? We were having trouble way back before people understood what CGM is we're talked about in the community like this just didn't happen. And, you know, doctors like we can put you on this CGM thing and see if we can figure out the problem and look where it's led us. All these years later, it's the core of how we handle things. You never know what's going to be a big benefit to you in the future. So it's good to know about all of it. You know, it's November and that means diabetes Awareness Month is here, right now at the Juicebox Podcast store, the merchandise place where I sell the, you know, its shirts and stuff, but good stuff, I promise. Actually, I just got this from one of you. Thank you. I love my shirt. I ordered yours and another company's November diabetes awareness shirts. Yours is great. Theirs was made horribly. Haha. I'm just kidding. I'm sorry that this person, actually, here's what I responded, hey, I'm glad to know this. Not that you bought a crappy shirt, but that it makes a difference to you. I spent a lot of time researching the company that I'm using. So I'm really happy to hear that you're happy. Anyway, I've got some pretty great merchandise, if you want to go to Juicebox podcast.com. Scroll down to merge. Right now, the know the signed sweatshirts are on sale, I took as much of the cost as I could, there's not a ton of there's not a ton of money to be made in selling quality t shirts, you can sell cheap t shirts to people and make a bunch of money. But a shirt they're gonna love that's gonna hold up, there's not so much there. So I cut a couple dollars out of the sweatshirts, you'll see the sale there. And right now in November of 2019. If you use the code JBP fa n Juicebox Podcast fan at checkout, you'll save even a little more money. So I hope you like that. Also, the Facebook group is really growing. It's like up to 1500 people and I know some people might be like, that's not a lot. But you should see. I guess if you're really interested in talking like nuts and bolts about diabetes with people, it's a great place to be. You can find that on my Facebook page at bold with insulin, you just find the juice box discussion group and you know, try to get in there. Yeah, answer a couple quick questions. So I make sure you're not like you know, a monster. You're a real person. Then you're in what else? Are there kind of stuff can we do? Seriously the thing from November 10. The talk I'm going to do if you're in that area around Valley Forge, Pennsylvania. I'd love to see you there be really great actually, I think you'll find it really beneficial. We'll talk about a lot of stuff in the podcast, q&a, bring your decks calm graphs. We'll do our best to help everybody that's there. Hmm. Is that it? Just say Have a good weekend? No, probably.

Unknown Speaker 28:16
Yeah, that's it. Have a good weekend.

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Scott Benner 10/28/19 Scott Benner 10/28/19

#274 After Dark: Drinking Edition

ADULT TOPIC WARNING. Frank discussions about drinking that includes words like F@#*, $%it, and more… (bleeped)

Maia shares her real-world knowledge of drinking with type 1 diabetes.

+ Click for EPISODE TRANSCRIPT

Scott Benner 0:00
this episode of the Juicebox Podcast contains frank discussion about alcohol. We also curse a lot, but it's beeped out. But I mean, it's still cursing, like, you know if I say, but it's beeped out like it just was, you can still tell I was saying. So, you know, consider that before you let your kids Listen, we're, if you're a little squeamish about stuff like that, consider it before you listen, but just know you're going to miss a fantastic conversation about real life issues surrounding type one diabetes. And I think if you're the parent of a child with type one, this is the kind of stuff you're going to want to know for the future. If you're a kid right now, experimenting with drinking, you definitely need to know this. And if you're just an adult who likes to get a little boozy, might as well learn from a pro. And this episode isn't completely about drinking, we still learn about the guests and their upbringing and where they're from and how they got to where they are not a monster. I didn't just start yelling booze and talk for an hour. Actually, this one's like an hour and a half. But that's not what happened. It's still the Juicebox Podcast, you know, and love. Nothing's different. For instance, you still shouldn't take anything you hear on the Juicebox Podcast is advice, medical or otherwise, you should of course, always consult a physician before making any changes to your health care plan for becoming bold with insulin.

I'll tell you what, though, we curse a lot, Sofia, like the cursing really starts to kick in around halfway, and then it's just much quicker this year. Actually, it's not a lot of that. It's just a couple curses. Sorry, guys. You ready? Here's what I was thinking my and you tell me if you're comfortable with it. And if you're not, I'll revert to my original idea. Okay. Are you comfortable doing like a, a looser adult version of this conversation? And I can just mark it for adults and bleep out cursing if we curse.

Maia 2:00
Yeah, for sure. Okay.

Scott Benner 2:03
You just did something just now. And whatever it was, it's louder than you expect it to be. So

Maia 2:09
okay. I have let me just check something. Because the headphones I'm using. If I'm not moving around, is it good? Or

Scott Benner 2:22
I don't know what you're doing because I can't see you. But

Maia 2:24
I'm actually changing my pod right now.

Do that I can hold when I'm not changing my pod. I can just hold my speaker or my receiver thing away from away from my jacket.

Scott Benner 2:39
Yeah, that's all sometimes if you're wearing a corded headset with like, just an apple headset. If you start moving in that mic, hit your shirt hits your hair or something like that. It just makes a sound that I hear that you don't hear.

Maia 2:52
Yeah, for sure. Okay, cool. Okay. Great. Riley. Link sounds the pod.

Okay.

Well, if we can hang on for just a second so I can get this pod on and then we should be good to go.

Scott Benner 3:09
My I think this is the absolute perfect podcast for you to be changing your insulin pump as it starts. And by the way, I'm recording so we're good. Okay, great. You're absolutely fine. This is it's actually kind of nice. It probably in a few minutes, we're gonna stop and do Arden's insulin for her lunch too.

Maia 3:25
Okay, great. It's perfect. Yeah. Yeah. And I'm I'm cruising a little low, too. So you'll probably hear me eat a date here.

Scott Benner 3:34
That's excellent. I think that's actually Arden. 71. And her blood sugar just shifted to, like a diagonal down arrow. Yeah. And so I'm, like, wondering what's about to happen. I really think she's about to go to lunch, which then I just love. I love the low as a Pre-Bolus. It's perfect, but

Maia 3:53
it really works the best. You can't. You can never make it happen when you want it to. And then, you know, when it does, you're like, yeah,

Scott Benner 4:02
I'm winning. Listen, can you talk while you're while you're swapping your body? Oh, yeah. Yeah, for sure. So I'll just I'll lightly start chatting with you here but and I don't want to take your focus away too much from what you're doing.

Maia 4:14
Oh, no, you're good. You're good.

Scott Benner 4:16
I loved the way you reached out to me. idea that somebody you know, eight was your husband? Is that who you're talking about? or boyfriend?

Maia 4:25
Yeah. What my husband and one of my friends two people told me that this was my moment

Scott Benner 4:31
to people in your life after hearing me on the podcast say well, I'm looking for a professional drunk said oh my god, my it's your turn to be on the jukebox back.

Maia 4:42
I know. made me a little nervous.

Scott Benner 4:47
You know, was there any self reflection after this happened?

Maia 4:51
You know, there, there wasn't a little but I think the reason that that might husband said that it was my moment was because he's, we've been together like the whole time that I've been diabetic. And so, you know, we were together in college when I was figuring out how to drink. And so I think, you know, you know, is that I actually put some thought into it. But my other friend, that that's the one that makes me nervous.

Scott Benner 5:23
So, okay, so your husband had some perspective, and he's like, I've actually seen my work really hard at understanding how alcohol affects her with her blood sugar. And your friend just went my drinks a lot, and she has diabetes. Is that?

Maia 5:40
That is, that is how it went.

Scott Benner 5:43
Yeah, yeah, I can see you thinking, Oh, damn. So my, I'll say it here, because people won't know this before I this is gonna be part of sort of an after dark series, we're going to talk to you about drinking today. Later, we're going to talk to a professional pot smoker. And since we're gonna call you a pro drinker, and, and also going to get a male and female adult, on two separately to talk about what it's like to have sex when you have diabetes, too. So I do this whole little trifecta of, of adult activities and diabetes. But you and I are going to be a little looser, while we're talking about this today. So there's going to be cursing in this episode will all be beeped out. But if you're one of those people who normally lives a life where your kids are listening along with you, or, or for the the few people who tell me that they're like, really young kids listen by themselves, which I think is awesome. This is probably not the episode, but for your kids to listen to it. It'll be you know, Mark, Mark, dwell on the title and everybody will know ahead of time. Oh, here we go. I just said to my daughter is lunch. And she said, What? And then I wrote when is sex? So is lunch? Sorry? I didn't do that. Did I do that? subconsciously while I was talking about the podcast, maybe? I mean, there are three letters and sex and five letters in lunch. So

Maia 7:20
like, you know,

Scott Benner 7:22
I don't know. She's so helpful. I don't know, because they did this award thing this morning.

So she's not heading to lunch that like I thought she was. So she needs to take carbs here.

Maia 7:44
I'm drinking my juice box as we speak.

Scott Benner 7:46
Apparently, it's going to be too because she's not to lunch also. All right. Have you hopped the rails? Are you running away from home on the train?

Maia 7:56
No, I am. I'm sitting in my car. I teach yoga. Okay, so I'm sitting in my car outside my yoga studio, which is right by the train tracks. But that should be the only train that passes us during our podcast app, so that will be good. That's totally

Scott Benner 8:13
fine. I feel like it adds flavor. Cool.

Maia 8:20
Yeah, I got I actually have a great view. I'm right on the water. I'm on the waterfront, I'm in this nice park. It's really not

Scott Benner 8:26
part of the country.

Maia 8:28
I live in Washington State,

north of Seattle. So I'm up in Bellingham, which is, you know, right in between Vancouver, British Columbia, and Seattle.

Scott Benner 8:39
And so to start slow, because we're gonna get into you and your diabetes for a second before we get to, you know, the other stuff. But any pause at all on your part? Like, I'm looking for stigma? Like, is there any concern? Like, I really can't go on a podcast that people get here and talk about how much I drink? Or do you not

Maia 8:57
know about it? No, not at all. Good. I don't

Scott Benner 9:00
think you should. I mean, you know, I don't, I don't think anybody should feel self conscious about who they are. But I just didn't know if it was something that gave you pause. If you thought, I don't know if I want to say that out loud. Would you have more more reservation? Saying something private about diabetes or another part of your life? Or do you feel like you're just an open person in general?

Maia 9:20
I think I'm a pretty open person, I think, I don't know. I called my dad when you responded back and I had a chuckle about how you saved all your funny questions for the podcast. And I called my dad and I was like, Dad, I'm gonna be on on a podcast and when it's gonna be about how much I drink, I'll see you there was my low glucose alert. But uh, yeah, no, I, I really don't and i think i think the reason is that if you know me, you you should probably know, most of me, you know? But that's always just been kind of my opinion cool.

Scott Benner 10:01
But Maia is referring was that when she and I went back and forth a couple times, because, you know, normally I'm just like, hey, would somebody like to come on and talk about whatever they want. But when you were coming on to talk about something specific, I soon as we started chatting back and forth the the question started popping into my head, and I stopped myself and I'm like, I'm not gonna do the podcast over like, messenger, you know, where I'm like, what's this? Like, and that kind of thing. So. So how's your blood sugar? Are you okay?

Maia 10:29
I'm good. I got I had a, I had like, 20 carbs. And I should be all good to go.

Scott Benner 10:34
Nice. So you changed your pump had stopped the low end of doing a podcast on your car? That's excellent. Yeah, yeah, people. This is for the newer diagnosed people who are just like, I don't understand. It's so overwhelming. My it's just like, if I had another hand, I could be brushing my hair.

Maia 10:52
So actually, you know, I just got out of the shower, I'll probably put on mascara while we talk to.

Scott Benner 10:57
Excellent. All right, so my welcome to the show. One of the longer preambles of any show is gonna have How old are you now? How old were you when you're diagnosed? I am 28. And I was diagnosed at 17.

Maia 11:15
So I just celebrated my 10 year anniversary in June gratulations. Wow, I made it.

Scott Benner 11:23
I'm still here. You are the perfect person for this, as I didn't know your age range from diagnosis to now until just now. But you're perfect because you're in your later 20s. So any of the incredibly stupid things you were going to do? You've probably done already. you've figured out which one of those things you're probably never going to do again, which one of those things didn't, you know, wasn't so bad? And yeah, and you were diagnosed right in, you know, write in a really kind of pivotal age. So, alright, let's talk about that. Were you a senior in high school or a junior?

Maia 11:56
So I had actually just graduated from high school. I was diagnosed like, two, three weeks after high school graduation.

Scott Benner 12:04
Okay, were you almost 18?

Maia 12:07
It was a couple months before I was 18. I'm an August, baby.

Scott Benner 12:11
And so yeah, so Okay, so you just graduated from high school? Were you planning on going to college? or What was your next step? In your mind?

Maia 12:18
Yeah. So it's a little, it's a little bit of an interesting situation. So I actually grew up overseas, and I lived in New Delhi, India, for all of my childhood, I moved there. When I was six, I lived there for my whole life. And I had just moved back to the US to go to college. And my parents were going to be staying in India. And I had, you know, like, classic diagnosis of weight loss and everything, but kind of stacked on top of that was that I was in the fashion industry, and I was working as a model. So I wasn't in school, I was exercising a lot. I was losing a little bit of weight and toning up. And I was like, Man, this is awesome. Like, I never dieted and, and always was really pretty proud of myself for that. And, and I just tried to take good care of myself. And so I was like, Wow, this is great. You know, they're gonna be so happy at my agency that I'm a little bit thinner. And then it just kind of kept going. And I was like, well, this isn't super great. And, and I knew I had a problem, because my aunt threw me a graduation party, and I peed my pants at the graduation party. And I was like, because I just had, so I was drinking and peeing so much, and I was like, Oh, my God, this is not good.

Scott Benner 13:40
For clarity. Not like, I got drunk. I peed my pants or I get excited. No, my pants. It just happened. Like, you're like, I have to pee so bad. I can't stop it.

Maia 13:47
Yeah, like and I just, I, you know, I wasn't drinking that night. I maybe have like a glass of champagne or something, you know? And we were having this like family event. And I was like, Okay, this has gone far enough. And I've been dating my boyfriend for a while. And he actually lived where I was moving. And he was part of the reason that I was moving there. And I was planning on going to visit him and and my mom was like, You can't go until you go to the doctor. I was like, Yeah, I probably have like a urinary tract infection. Or, you know, I'm taking supplements that are messing with, you know, other medication that I'm taking or whatever. And I walked in and they were like, yeah, the nurse like the doctor wasn't even though she's like, Yeah, you got type one diabetes. She just

Scott Benner 14:30
knew right away,

Maia 14:32
right away. And my grandmother actually knew which is so unfair. She goes, Oh, you go into the doctor. Have your HBU and z check. I'm like, Oh, okay. Yeah, I know seriously. So so they're like you're gonna go drive we were out in that we live out my cat ruled at that time. My folks had a place out in the county and, and so we like you're going to go into the city and go to the hospital and and I called my boy friend who's not my husband and, and I was like, Hey babe, I think I have diabetes, I'm going to the hospital. And I was in a kind of unique situation because my best friend in high school was type one diabetic is type one diabetic. And, and my, my, one of my first boyfriends was type one too. And so I had known both of them at the time that they were diagnosed. Well, maybe I didn't know Brendon when he was diagnosed. But I was I was friends with Audrey when she was diagnosed. And, and so I remember what happened. It was like, one day she was there. And then she was gone. And she was like, missing for a week. And then she came back and everything was different. And, and so I was just really like, Oh, my gosh, what is about to happen to me. But I also have these examples of two humans who like, lived pretty normal lives. So that gave me enough perspective to not totally panic. And I was in that weird space of like, Mom and Dad are not going to be in my life in a month, you know, they're going to be across the world. So I got to figure this out on my own. And I thought I was in the hospital for for two days. And kind of figured everything out. My parents are like, how much do you want me to be involved? And, and the people at the hospital are like you're turning 18? And a couple months? Do you want to go through peed? Were your parents have to be involved? Or do you want to go through this as an adult? And I was like, I want to go through this as an adult. So I'm in a unique situation where if my I asked my mom how much insulin I needed to take for a meal, she would have no idea she would she would not change a pod or, or do any of that stuff. So

Scott Benner 16:54
yeah, her perspective is as an adult, as the parent of an adult person who was diagnosed.

Maia 16:59
Yeah, yeah, for sure. I wonder

Scott Benner 17:01
was six months earlier, what you would have said, like, right before you graduated, like if you would have still felt? It's interesting. Like, it's such an I mean, it's really cool that you chose I'll do it on my own. Did they come with you, even though you went through the adult path,

Maia 17:15
they never went to an endo appointment with me. They were there at the hospital and you know, being good parents about it, but they, they never really went with me. But my boyfriend did. So for the first probably three years after I was diagnosed, he was at every endo appointment. Every every CD appointment pump training, and everything with me, which was super cool. See?

Scott Benner 17:41
Lucky guy really, cuz, you know, the secret is, is that guys are always looking for something to be involved in where you look sweet. And so he was like, This is perfect for me. I could just go to these. I'm just kidding.

Maia 17:52
I know what,

Scott Benner 17:53
but that's really that's excellent. Because I I'm even like, was he much older than he much older

Maia 17:58
than you? Are? You guys say four years older than me, okay? Because that's

Scott Benner 18:02
the other thing. Like when you at 17 you're like, Hey, I have, you know, almost 18 Hey, I have diabetes, that he didn't go I'm sorry, you have the wrong number. And then, you know, and, and was like, Oh, I wasn't up for this, but he's got enough. Just enough adult life in him to not panic when you hear something like that?

Maia 18:19
Yeah, yeah, for sure. And I think, you know, I've always been a person where if something didn't matter, I just didn't put any effort into it. You know, like, I, if I, I was in when I was in high school, you know, like, if a class I didn't find in an application to what I was learning. I was just like, Yeah, whatever. And, and I always did, okay. But, you know, I think that really suited my personality that diabetes really suited my personality, because then suddenly, this stuff mattered and, and I could apply myself to it. And I was like, Okay, so the American Diabetes Association and their pamphlet that they give new, newly diagnosed type one says that you need a support network. And I'm like, okay, building support network, you know, and so I think that that was really helpful. And I'm also super lucky because I had been with trained in the shop and, and at the time that I was diagnosed, he was a chef, and he had a restaurant and we went to the restaurant. And we carb counted every meal, every menu item, so I could go and Bolus for it. And so like the first I don't know, I didn't eat anything else, except for there for a little bit because I could reliably bolus

Scott Benner 19:38
Yeah, it was great. probably helped you put some weight back on to nothing like eating Oh, yeah. Nothing like

Maia 19:44
a couple of pounds. I know. And it was all Italian food too. So I feel like everyone talks about this struggle with like pizza and pasta and whatever. But that was the first stuff I learned to Bolus for. So I kind of dialed that in quick and then you know, went back and was like, Wait, how do I get it done?

Scott Benner 20:00
He did the hard the hard stuff first. And by the way, I bet going backwards from more like carbon intensive foods to less you probably had a similar struggle adjusting from one to the others, somebody would going from salad to pizza. I don't think it's much different. It's a it's a big adjustment one way or the other, right?

Maia 20:17
Oh, yeah, yeah, I was still learning a different way, you know, of giving myself insulin for sure.

Scott Benner 20:25
You've done a very unfair thing to me here, you've said a lot of really interesting things that don't have anything to do with drinking. So I have to I'd be, you know, completely remiss if I didn't ask you why you were living in India.

Maia 20:40
So my parents are teachers, and they taught at an international school there. And you know, when I was born, they were teaching at a at an international school in Taiwan. And then later on, they moved to India, we lived in the states for a couple years in between, but they taught at the American school, they're

Scott Benner 20:57
very cool. And they're not like international jewel thieves who are hiding out overseas or something like that. They're just really teachers, as far as you know, I'm not to my knowledge. But if they were, that would be cool. As long as they leave you the jewels, I guess at the end, I know, one guy got up. And I have to say to again, I can't spend too much time on this, which is hurting me inside. But I am going to go back to India for a second before I ask him my second question. How did you find living there? Mom, I have friends who have lived there. My wife's visited kind of extensively for work a couple of times. And I'm interested.

Maia 21:29
I mean, it's a kind of an unfair question, because I don't know what it was like to grow up where you grew up, I live there, I moved there when I was six. And, you know, like, it was super cool. One year, my parents got like an elephant to come to my birthday party. You know, like, people would get a pony or whatever, and I got an elephant. And that was super rad. But I, I don't really know, because it was my whole life. I know that it was vastly different than my experience here. And

and so I think that was

an incredible, you know, asset to me, coming back to the states and having this global perspective. And I traveled back to the US frequently as a kid. So I didn't have that, like, big culture shock when I moved back. But I definitely think that it gave me a global perspective and, and a lot of gratitude for what I do have, you know, like, just on a basic level access to influence. Because I, I definitely did get to see a lot of hardship in my life. But I also got to meet incredible human beings and travel so much as a little kid. And anyone who says that, that traveling with kids is not worth their time or money is just needs to reevaluate because I've had so many, I had so many experiences when I was a little kid that really changed me, you know, getting to see the world.

Scott Benner 22:58
Well, I ever, I guess I have some follow up questions. And they're not about drinking yet. But hold on. Trust me.

Maia 23:05
I promise. Right. Yeah.

Scott Benner 23:07
So I guess what is, you know, what's one thing that sticks out to you about India that you don't miss? And something about here that you wish didn't exist?

Maia 23:22
Well, we'll just start with something that I wish didn't exist, which is the price of insulin because my parents are still living in India for a few years after my diagnosis, and I would go back and visit them and get my annual supply of insulin, or $150.

Scott Benner 23:38
Wow, for the for like, as long as you need it. For a year a year. Geez, that's amazing. Yeah.

Maia 23:44
Okay. It wasn't, it was the same insulin made in the same factory in the same vial. You know, it was not.

Scott Benner 23:50
That's something. What about India, like, so I'll give you a little perspective. My, one of my daughter's best friends, is Indian. She goes home, but she doesn't go home. She goes to her parents home a couple of times a year. Sometimes they go for visits, sometimes it's amazing. They go to shop for clothes, and, you know, people and I said to her one day, I was like, Sandra, what's the, what's the worst part about India is a bad part. And she goes, I have to poop in a hole when I stay at my grandmother. Say again, and she was he go outside and you know, dig a hole and poop in it. And I was like, Oh, yeah, that doesn't sound good at all. And she was it really isn't. And so and then my, my wife, when she visited for work the first time, I don't know where she was in fairness and what city she was in. But she sends me a message one day, and it just says, I have never seen so many penises in my entire life. I texted her back and I was like, hey, two things. I think you sent this to the wrong person. And I'd like to get divorced. And you know, and she was like, No, no, she's like, everyone pees on the street.

Maia 24:57
Mm hmm. I'm

Scott Benner 24:58
like what she goes when men are walking If they have to pee, they turn to the curb and they pee and then they keep going. She's like, it is so pervasive that written on the walls of buildings, you know, it doesn't say no loitering, it says like, nope, no urinating, and I was like, Oh, that is different. Well, something that does that surprise you?

Maia 25:20
Well, I mean, this is the thing. I grew up with it. I mean, I started you know, pooping in a hole. I don't, I don't, I mean, I, I remember not doing it. I we had we had a toilet at our house, but we, you know, like, I don't know, I was just always there didn't seem that that was hard for me when I came back was like, you know, there was a lot more like, Oh, you you can't just use the restroom, wherever you want or whatever. There's, there's a culture shock, but I always explain it, you know, with this with this cereal aisle. Okay. So when I was growing up, you could go to this one little store in this big market, and they had American food. And, and so you could go to the store and they had Cheerios, you could go buy stale super sale, expired Cheerios for, you know, like double the price that you'd buy them at a Safeway. And, and when I come back to the state, every year, there was like a new flavor of Cheerios. And by the time that I graduated from high school, there were 13 different kinds of Cheerios. And I just thought that there were Cheerios.

You know, I didn't know that. Like, I was like, What is this

Scott Benner 26:38
world had grown without you?

Maia 26:40
Can I? Yeah. And that was, that was the rest of the world.

Scott Benner 26:42
Have you ever, almost mistakenly back here in America, a flowerbed outside of McDonald's or something like that? Or does that never happens?

Maia 26:52
Luckily, that never happened. No matter how much alcohol I couldn't do

Scott Benner 26:57
it I'm like, it's completely possible that my it could be drunk in public think she's in India and just be like, I know what I need to do.

Maia 27:07
Oh, that's funny.

Scott Benner 27:11
There's a good time for a break Arden saying lunch soon. So we're going to Bolus for Arden's lunch together, chips. She's asked me what's in there. So I've eliminated some processed foods from Arden's life this week, because we're trying to figure something out. And not being exactly fun about it. I'm trying to think she's gonna be so personal I Tara Watson, so she has a sandwich and chips, bell pepper, carrots, a little chocolate and a banana. And I'm so hungry. And I said, She goes, did you give me real food? I'm so hungry. And I said yes. Um, and she goes, like, what? And I told her and she goes, so then No.

Maia 28:00
Oh.

Scott Benner 28:03
I'll tell you what. She eats all that. Combine one thing from school. So for now, I think we'll do try to thank chips 18 sandwich 24 What's up 4050 6070? Let's do 40 carbs, two hours and 30 carbs three hours. Tell me if you buy something else. Sorry about this. It's a little different than it has been. She gets she's getting like muscle. She's like muscle cramps a lot and our shoulders and her neck. And you know, we've done all of the conventional things that we can think of. It doesn't seem to alleviate it. So sort of in a wild swing I just removed like processed stuff for a couple days from or like not a lot like she still has some like natural potato chips. I know people are like what a natural potato chips. But there are potato chips that have like very,

Maia 29:23
very few additives. Oh, yeah. You know, and I live in granola land. Okay, so you're in. Yeah,

Scott Benner 29:30
you've probably eaten a raw potato and somebody's like, it's a potato chip. And you're like, No, it's not. Don't Don't tell me it's a toilet. Seriously. So diet and

she said, I'm glad we're cursing. Let's see. She goes No, I can't because there's nothing here that fits in in diet. So I said that I didn't say she was so can I get a cookie? And I said, Yes. Let's see what the answer is gonna be to that cuz I'm starving the garden zero carb kind of girl hit on a man. You just need a cookie. No, but No kidding. She did really well actually. My stomach is eating itself. Oh, just polish. She just loves to. She said, Okay. So anyway, she just she's just me and like a smaller female body. So she's just been sick. Finally, some people listening in to be like, I knew that guy. Now he's at one time joke.

Maia 30:50
Yeah, but you? Do you admitted it by calling your daughter? And

Scott Benner 30:54
did I? It's hard to know what I did right there. I hear what you're saying. Myself. One time I joke. I joke about an episode of mine. My ego really got away from me today. And I was so clearly joking around. And somebody left a review that's like, see, he even admitted it.

Maia 31:14
Oh, that's funny.

Unknown Speaker 31:17
India,

Scott Benner 31:19
a different place to live first. Yeah, for certain.

Maia 31:23
If we want to loop it back to drinking, okay, one of the crazy things about my knee growing up was that I could go out to a bar. And so I mean, I don't think I don't even know what the drinking age was. But there was no restriction on drinking. And so you know, people had birthday parties at at, you know, nightclubs. And, and in high school, we would go out to the bar. And my rule for my family was always that I could have a beer, I could drink a little, but I couldn't ever come home, drunk. And so that was already like, part of my life. Coming to the States, I would like walk up to the counter at the grocery store at 18 years old, try to buy a bottle of wine. And I'm like, I can't do that here.

Scott Benner 32:11
I'm imagining your parents having a parenting talk off to the side. And they're like, you know, my look says she asked if she could get a beer. And I don't know what to say. And one of them said, we make the whole we should probably let her have a beer if she wants.

Maia 32:25
She's earned it.

Scott Benner 32:26
Yeah, you need to be a little drunk to plant your feet firmly and kind of squat. Hey, you know what, while we're doing this man, can you describe how you do poop in the hole? How does it go? Exactly?

Maia 32:37
Well, um, I think the big thing is, is that you develop special muscles, and a little more hip flexibility. But you just you just pop a squat, you know? I mean, imagine just a little bear. I mean, I think they're, I mean, they're ergonomically laid out holes. There's normally like a foot pad on each side. A lot of them are like porcelain. Yeah. And there's like a little foot pad on each side. And, and the whole, the little, you know, behind you, and they just do your business. But a lot of places don't have toilet paper, and they have like a little sprayer. So you use of the day instead of toilet paper, which I know that for sure.

Scott Benner 33:24
Well, first of all, people who love the day, speak highly of them. And my other question is, there's a custom in India, right? Like you don't shake hands with a certain hand because of the wiping, right?

Maia 33:34
Yeah, because you use the one hand to clean yourself. And the other hand is for eating and greeting.

Scott Benner 33:40
It's so. So basically, there's so much good that's come in this podcast already. We have not even talked about drinking yet. I am, in my mind, what the subtext of this podcast episode to be. Does my the woods? Yes, she does. And

Maia 33:58
I do that too.

Scott Benner 34:00
I'm right now picturing the people listening to this at home going, wait, did she say clean their self with their hand and that's why they don't shake with a certain hand. And like, everyone who didn't know that I'm watching like in my mind right now then the process all that? But yeah, that's, that's 100% how that goes.

Maia 34:21
Oh, yeah, for sure.

Scott Benner 34:22
So I have to ask one. I have to preface before I ask. Right. So my I'm not a drinker. And I don't just mean I'm not a drinker. I mean, and I've said on the podcast a couple of times I don't drink it's not for moral reason. I haven't had a problem that I you know that I'm staying away from it. It's just never really occurred to me to drink in my life. To the point well, I always say that I definitely have not had the, the, you know, a case of beer in total in my entire life, like not even that much. And I think I've had hard liquor a few times, you know, which people would consider like a whiskey or something like that. I don't particularly dislike it. I just, it just doesn't occur to me. So I am going to be a complete neophyte on this in a lot of ways, but, but having said that, and please understand, like, you're not going to get a judgment out of me. But I am asking the question, right. Oh, as an adult now, do having the experience you would have had, if you were in the same situation, would you say to your kids, hey, it's cool. Just have a beer when you go out? Or would you? Yeah, you would be? Yeah. So you don't you haven't had any, like, there's no scenario in your life where you're like, wow, someone should have kept that away from me for a little longer?

Maia 35:40
I don't think so. I mean, I think my mom had the best torture mechanism ever, if I would come home having too much to drink, which was that she would talk to me until I was sober. So it would be like 430 in the morning, and she's still chatting away and making me engage in conversation about my latest essay that I wrote for school, and it was just torture. So I didn't wish she

Scott Benner 36:03
was she just tried. Oh, yeah, she was.

Maia 36:05
Oh, yeah, she was just trying to make my life you know, not so fun. But, uh, but no, she. That was a really good waiter.

Scott Benner 36:16
I don't want to drink too much and be forced to speak to my mom about current events. Yeah, that doesn't make sense. I again, I haven't I have no, like, no perspective on it. Like, my son doesn't drink at all. And when we talk about it, I do see that I don't think it's because I told him not to. I think it's because it's just who he is. Like, I look back now. And I realized No one told me not to drink. Yeah, that never happened in my life. Like no one ever said to me, you're going out? Don't forget you're under age. You can't like it just never. I just went my way. And you went yours. And he like everybody goes in their own, I guess.

Maia 36:51
Yeah. I think that really, if you want to be a responsible about drinking, you need, you need to start to drink in places that are safe, and not be afraid to ask questions. Because I mean, I can't imagine being a teenager and getting drunk for the first time. And already having diabetes, I already had had that experience by the time that I was diagnosed. And I can only fathom that if you had, you know, a parent helping you manage, like really helping you manage your diabetes, that would be a really challenging experience. So I can only like, hope that people and parents feel comfortable having that conversation with their kids, and maybe even helping them figure it out. If you know, it's like, Okay, so how many carbs are in this beer? They don't have carb counts on them. You know, you've got to figure that stuff out on your own. There's no nutritional facts for alcohol. So. So I think, you know, being in that space where you have someone to help you figure it out, is so helpful. Yeah,

Scott Benner 38:01
no, well, I so as you're talking, you know, the, the serious side of parenting is coming up in my mind, right, which is you don't we do this a lot is we throw kids into situations that they're not prepared for, because we don't want to talk about one of the things they need for preparation. And whether that's around sex, or drinking or drugs or anything like that. You can't just pretend someone's not going to do something. You know, like, my, my son drove back to school the other day. And I didn't say, you know, Hey, be careful driving, you know, cuz I love you, buddy. I said, Look, it's raining out. And you drive fast. And everyone drives fast. And please don't follow closely. I don't think you do. But please don't. And here's why. And, you know, like, like, a little more context around it not just be careful. You know what I mean? Like, you can't just look somebody I remember, um, my wife would say, when she would go out on a date, her mom would say, respect yourself. And that's, that's not direction. Do you know what I mean? That's like, your mom's like, afraid to say to you, Hey, you know? What? Actually, I guess we are talking pretty freely on this as I think that's your mom. Yeah, use protection. Don't every guy that smiles at you, like like, you don't mean like that kind of stuff. Like really be respect. But wouldn't it be nice if there was context to that? Like from

Maia 39:21
Yeah,

Scott Benner 39:22
from a parenting person, like a real person who would sit down. I always have this kind of regret that my mom would talk to me in platitudes. And I wrote a parenting book, and I spoke about a little bit in there. But like, Here was a woman who had the benefit of a life's worth of information and experiences. And then she would just tell me this surface, that wasn't helpful. Like, why not? Tell me your one time when I was 35. Here's what happened to me. And it was terrible. And here's why. And I think you could avoid it if you paid attention to this. Like Wouldn't that be great to get the benefit of someone's experience? Yeah, You know, and so I think I like what your parents did. And I think that if my son didn't have the vibe about him that he had, I would have stepped in and been like, Alright, look, I'm not, you know, I don't know a lot about this, but we're gonna help you because I feel like you're gonna leave this house today and you're gonna drink. I don't want to just cross my fingers. And hope that all goes well.

Maia 40:20
Yeah, and I mean, I think worst case scenario, is that your, your, you know, I think it would have been way worse if I was hiding from my parents, you know, if I was, instead of coming home being like, Oh, I'm going to stay out. And, you know, do you know, go sleep at someone else's house? So no one knows. I think that's a

trickier path. Right? Yeah.

Scott Benner 40:44
I hear what you're saying. And I also hear what you're saying about like, having drank before. Maybe you were diagnosed. So you had a tiny bit of expectation about what it was. And you knew how to maintain yourself a little bit. And did you when you were earlier? Like you weren't just a blackout drunk, right? You didn't just like every time you drank, it wasn't till you couldn't see yourself anymore?

Maia 41:03
No, I mean, I had to talk to my mom, if I got that drunk.

Scott Benner 41:06
Do you think you would have had your mom not done what she did?

Maia 41:09
You know, I would definitely happen. I think like, there were those moments when you're young, and you don't know if you know what you're drinking or not paying attention to how much I mean, it happens where you get really drunk. And of course, now that's like the equivalent of one cocktail and drink that because you know, I have way more and I'm a, you know, adult who drinks a glass of wine with dinner every night. So, two glasses of wine isn't going to make me Blotto. But, but, yeah, it happened for sure. And I think that, you know, I think that just setting the expectation, you know, the other thing that my parents would do is if I did come home drunk, in the morning, my dad would put on Formula One, which is you you've never had a hangover, Scott. But if you've had ever had a hangover, the sound of the racecars, like droning on for hours, is like the worst hangover exacerbate, or on the planet

Scott Benner 42:07
will get a great job in hell one day torturing people. Yeah, I have all kinds of good ideas.

Maia 42:13
They're great at it. I mean, they're awesome people. And I think those were really good, you know, kind of passive torture techniques.

Scott Benner 42:21
Yeah, no kidding. That's, I see what you're saying. So they were kind of digging you along the way, like making sure that you knew what was happening and that they were aware. It's just, I think that it's incredibly important for people to hear, you know, we'll get to the how you manage the, the alcohol with with insulin and everything. But I think it's incredibly important for people to hear who have younger children. Because when you have younger kids, most people's expectations are like yours gonna be the one that comes out just perfect. You know what I mean? Like, some people, listen, some of your kids are such like monsters that you're like, No, no, but it's not gonna be like it. I know my kids. But, but a lot of people have that feeling right? Like you have this, like, I have a good plan, you know, we're putting effort in, it's going to work out. But you know, when kids go to a party, and there are 40 and 50, high school kids at a party, 98% of them are drinking. You know, it's not, it's not like a few of them are like if your kids wants like, Oh, it's not me. And I'm like, now you're like, oh, but Scott says his kid doesn't like I get that like, but there's going to be my kid there. And he's going to have a couple friends with him. And they're all going to be off in a corner, just not understanding drinking at all. And they'll hang out for a little bit, and then they'll leave. And the rest of them are some level of drinking out of control. Because they don't have any expectation for what that means. Yeah, yeah. And so you, you're going to need to be ready for this. Like if your 16 year old has diabetes right now is going out on the weekend. They're like, Don't worry, we don't drink. I think it's probably still important for them to hear what my has to say about how to manage it. So

Maia 43:54
I mean, I'll tell you, my best friend in high school had type one and she was out there drinking right next to me. My, you know, my boyfriend in high school had type one. And and he would party way harder than me do. And, you know, they're okay. It's gonna be

Scott Benner 44:12
okay lived through it. Yeah. And and so, did they know what they were doing back then? Like, were those people who had had diabetes for a long time? Or were they figuring out drinking with diabetes at the same time, too?

Maia 44:23
I don't know if either of them listen to the podcast, and I don't want to like, gotcha. Oh, make them feel bad. But I would say that. Now, I would guess both of them have a pretty good handle on it. But back then, I don't think that they did. But I also think, you know, we didn't have the tools that we have now. Right? Like we didn't have continuous glucose monitoring. So, you know, I think on a baseline level, like, just, you didn't, you couldn't look at your phone and see what your blood glucose was. Or set your phone alarms super loud so that you know if you did get low, you You'd wake up. So I think that that changed a lot, especially when it comes to drinking, you know, it used to be kind of a, you want to ride a little higher going, you know, going to bed at night, because you didn't have any alarm that was going to wake you up if you went low. And now you can play it a little bit closer, you know, and instead of Temp Basal and not stress about it too much. But I think, yeah, so I don't think that that they necessarily had it figured out. And neither of them ever had a major issue while I was there, you know, they, they did well enough,

Scott Benner 45:42
let's you're talking even 10 years ago, you really are still speaking about a time with diabetes where the goal was don't feel dizzy, don't pass out, right? Like, oh, yeah, that's what it looked like back then. I just don't Yeah, I don't want to lose control of myself and pass. I don't want to get too low. And yeah, yeah. And so staying higher. I mean, if even today, people are being diagnosed, they're being told, like better high than low, like all that stuff. And that's still leftover from that was the way like you just better high than low. And you know, we'll trade you know, trade tomorrow just

Maia 46:15
bought two because how you feel is so like, I can tell you that without ever, like, I have no knowledge of any blood glucose value from either of the two type ones that I interacted with every single day for years of my life. But I can tell you that they were not running, you know, good Awan deeds, they weren't feeling good every day, the amount of water that they drank, and then the amount of you know, times they use the restroom in the day compared to me as a non diabetic at the time. Like, I know, that was not, those weren't good glucose values. And I don't begrudge them for that. Because it was such a, it was what they were told and what they were taught, you know, and even, like, when I was diagnosed, I think I did the math, and I think I might have started the AMI pod around the same time as Arden and it was the old bigger pods and and I would still I mean it was like right when they were released pretty much and I loved the pod but the text just was not like that original PDM was like it was like a brick

Scott Benner 47:34
made out of like hard plastic even right like it did it was gonna break and like the Oh

Maia 47:39
no, I did drop it and it did break.

Scott Benner 47:43
It was made out of that kind of plastic like, like when you go to a bubblegum machine and get a ring out. You're like if I squeezed this bubble too hard this this, it felt like that. shatter. Yeah. No, I hear you.

Maia 47:56
Yeah. And then I got that original, the first Dexcom that I only wore that thing for like, maybe a month and was like, nope, that was a waste of $1,000. Right.

Scott Benner 48:08
And now what? What do you use now?

Maia 48:10
I'm on the G 66. And I have the Omni pod.

Scott Benner 48:13
Right? Complete night and day from those things till now.

Maia 48:16
Oh, yeah, for sure. Yeah, for sure. And I think, um, you know, with those tools, like you can look at your yourself or your kid and be like, Okay, if you're drinking, like let's shoot for you know, you want to be at the high higher end of your range. Well for me for me, which would be around like 140 if I'm going to bed and I'm not setting attempt bazel. But honestly, the biggest thing for me in the last year has been starting to look, if you think about my best blog Lucozade This is hilarious. I love this. My best blood glucose day, this diagnosis

was the fourth of July this year on loop.

Scott Benner 49:01
And you were and I think had a drink or two maybe?

Maia 49:04
Oh yeah, I was drinking. I had jello shots. I had, we had a couple bottles of champagne. It was great. But the thing was, is that what loop enabled me to do on that day versus on a regular day was I'd already got done a lot of deep like, settings testing. And so my settings are really dialed in. And and I just input my carbs. And I didn't touch it. And it was the first time where I never like since I started living because I started in June. And it was the first time where I didn't fuss with it because I was so used to like, you know, oh, like little Temp Basal here, a little extra insulin there, whatever. And I just input my carbs and let loop loop and it was amazing.

Scott Benner 50:00
Your, your settings are very like right on then.

Maia 50:04
Yeah, you're doing pretty good. I did a lot of testing though. Like, I think my husband would tell you that I was just the biggest Pan iapp. Because I basically, you know, only ate every other day for like, three weeks trying to figure out what my settings were.

Scott Benner 50:20
So you get a setting right without eating like, like a bazel testing situation. And then you would like, right, tomorrow, I'm going to try it and you tried that didn't work, you'd make an adjustment, get it straight again, and then go back and try again.

Maia 50:30
Yeah, that's really cool. That's Yeah,

Scott Benner 50:34
I like that a lot. All right. So listen, for so far into this now. How do you handle like, like, take the take, you know, an algorithm out of this scenario for a second and you know, just be a regular person with diabetes? When do you start thinking about drinking and your blood sugar? Like if you're going to be at dinner at six with a glass of wine? Is that something you have to think about ahead of time? Or is that different than I'm going to go to a party at eight and when I walk in, I'm grabbing a glass and I'll probably have a glass in my hand of something all night long.

Maia 51:07
Um, I think honestly, I think one of the gifts of alcohol is that the thought can happen when you're holding your first drink in your hand. You don't I most of the impact. When we're talking about drinking and blood glucose, it's all after the fact right? It's that you talked about this as Jenny and your recent episode, you can go back in and listen to some of the science about why this happens, but you get low later. So unless you're drinking something where you know you need to Pre-Bolus or if you're starting out of range, you know, getting yourself in to your desired range is helpful. But I really think the nice part about alcohol is that the tricky part is delayed. So you can say okay, so I'm going to have this drink. I'm gonna give myself my insulin for whatever I'm drinking. And if it has carbs in it, and sometimes you don't you know, I think for me, a light beer I'm not bolusing for now everyone drinks those spike scalpers. I don't Bolus for those they only have, you know, one to two carbs in them. A red wine I don't normally Bolus for dark beers don't have a ton of carbs. But some of those like lagers, and, and a lot be a little bit curvier. So I might get myself, you know, a unit here, unit there. But what I'm really looking at is like, what time do I start drinking? And how much do I drink, if I'm only having one drink, my liver is not going to be overwhelmed, I'm not going to need to set a Temp Basal later, I'll probably just if it's not, you know, like a rum and coke with however many carbs for your coke. I'm not gonna give myself any insulin for it. And I'm not gonna change my, my thought process later in the day, if, if I am drinking a little bit heavier, let's say I'm drinking hard alcohol with a no carb mixer. So that's no insulin in but a potential negative effect on my blood glucose, or decrease in my blood glucose later on. Then I'm saying okay, well, I started I had my first drink at 923. And, and four hours from there, I'll see start to see a little decrease in my blood glucose. And I actually, so because I was diagnosed between high school and college, one of the big things for me, was I wanted to figure out how to be a college kid, I wanted to figure out how to just be like any other kid. And if that meant I wanted to go out and party or go on a weekend trip to Lake Tahoe, or whatever it was, I wanted to be able to do that. And we didn't really have the Dexcom back then, until I sat down on this big party weekend, everyone like four days of like, drinking and waterskiing and, you know, playing on the lake and, and I was trying, I was kind of running a little low on insulin and I didn't want to be like giving myself too much insulin and then then, you know, correcting lows, and using more insulin than I needed. So I was like, I'm gonna figure this out. So I took a shot of vodka, check my blood sugar every, you know, 15 minutes for four hours and saw what it did. I was like, okay, so at the end of that experiment, I said, Hey, if I take four shots of vodka, I get a free pb&j in four hours.

Scott Benner 54:46
Okay. I like your Pre-Bolus thing for a meal for a snack later.

Unknown Speaker 54:52
But yeah, yeah.

Maia 54:54
So set the alarm on your phone and be like, Hey, if you're not running to CGM set an alarm. on your phone and say I had five drinks. And I'm probably going to be tipsy or asleep. So I, I need to have a snack. And I think now it's easy because just like your bazel testing, you can test what different drinks do to your blood glucose, right? Like, you can say, happy hour is the perfect place to do this. It starts at 2:30pm, you have a drink an hour before you're going to eat, you can have one beer and look and see what it does to your blood glucose. And and learn from it. And I think that is it's just like everything else, right? It's like don't beat yourself up if you don't get it right. But take what you learned. And this is the tricky part about drinking is that you have to remember that you learned something because your inhibitions are down and you're not paying attention.

Scott Benner 55:51
Now what did I learn from what could I learn with the vodka? I can't

Maia 55:57
remember, so I went, I upped it from four shots to 10 shots, and now it's all getting fuzzy.

Scott Benner 56:05
Well, you know what, it's interesting what you just said, let me jump in for a second. It occurs to me that what you did was just perfect. And it would work too with food. If food didn't keep you high for so long afterwards, like, was realized that if food impacted is quickly and went away, like alcohol did, it would take us all like a week to sit down, have a great snack every night and figure out every one of our favorite foods. But it's Yeah, it's the fact that food keeps you high afterwards, it stops you from doing that experiment.

Maia 56:36
Yeah, you don't get the low. Right, right. And then you know, you can't test it with with, like, with vodka, you don't have any carbs. So there is no initial spike. Right? If you don't have a mixer, it's just that drop later.

Scott Benner 56:52
And so even without insulin for vaca, there's a drop later. Yeah. And so can you Temp Basal back earlier to try to avoid it, or is it unavoidable?

Maia 57:03
It's just a little far out. So like, what I found is that, if I can't bazel in advance, I wind up high, because I'm too aggressive, it's too soon. And it's not like a, there's not everything you drink is different too. So if you have, you know, you might have two different kinds of cocktails or whatever. And then that's going to impact you a little bit differently. So I haven't found a lot, I've had a lot of luck with that. However, what I have had a lot of luck with is just decreasing my Basal a little bit overnight when I'm going to bed. So if I just decrease my bazel, if I know I've got some insulin on board, and I've got some alcohol on board, I'll just decrease my bazel a little bit overnight, and I normally wake up in range.

Scott Benner 57:57
So two questions around that is that is the biggest concern that you'll get really low and be drunk at the same time and can't help yourself. Is that like the if you if there was a thing that you're worried about? Would that be the worry?

Maia 58:13
I think that's honestly, for me, my biggest concern is impaired decision making of like, do I input my carbs correctly for the Wendy's burger and frosty that I'm getting as my drunk monkey food on the way home, you know, when I make the Uber pullover and my bowl thing right for that, and and the only times I've gotten myself into any sort of trouble has been when I gave myself like way too much or not enough influence. Except for there's this one story that I will tell you. So this is a great diabetic in the wild story. I was at a water ski tournament, which are if there's any water ski skiers out there, crazy parties, they're just huge parties with like a side of waterskiing. So those waters de tournament, and my army pod PDM I dropped it and that shattered and it like exploded. And I was like I don't know what to do. I don't have any bolus insulin. I have nothing. I was talking to my husband and well then boyfriend now husband, and like, what do we do? You know, and he's like, well, none of us can drive.

You know.

We're all drunk. Like we could call a cab, it's gonna cost you know, 100 bucks to get a cab out here and get you home. But we can do that. Or you can not drink or, you know, or, you know, not eat anything until someone's sober enough to drive like maybe we can find someone who's planning on going home. And we're sitting there chatting and this kid comes up, Connor, and he's like, uh, you know, I'm type one, right? Like, what do you need? Did your meter break and I was like, No, my pump broke. And he's like, I have an idea. So he gave me he had an extra infusion site. And my blood glucose was high. It was I mean, I was like probably like 250 or something. And he had an extra infusion. But he just had his one pump. We popped to the infusion site on me, which I do not medically recommended us and gave me a bolus with

Scott Benner 1:00:19
wishes. Don't worry. At the beginning, we're gonna say that nothing you hear on the podcast is advice.

Maia 1:00:24
Not advice. Yeah. We're also gonna say that we're gonna swear, but that was cool. Like, that was so cool. We're still friends. And it was like this great moment of camaraderie, you know. And then in the morning, he you know, he gave me a little extra hit for breakfast. And it was, it was really great. I still have my basal insulin from my pod, I just couldn't bolus,

Scott Benner 1:00:48
you basically did the the diabetes version of like, guy in the action movies mask gets knocked off underwater, and they share like a scuba mask on the way back up again. That is exactly what we did was very cool. I love that i'm used, we're able to think of a drunk. So you are a professional drunk.

Maia 1:01:07
I told you.

Scott Benner 1:01:10
How did you find Jenny's conversation about alcohol in that? In that episode? Did you find it pretty accurate to your experiences?

Maia 1:01:18
Yeah, I did. I think, you know, I think there's this thing that happens where you know, as we age, we become more reasonable. And, and you're not going to drink like you did when you were young. And I think you can blame that on diabetes. Or you could start that sooner because of diabetes. I think generally, being type one just makes you slightly more responsible than the average human and take a little bit more personal responsibility. But I also think that it doesn't have to get in your way. And my number one advice for anyone ever, especially if you aren't familiar with alcohol and diabetes, is I make my DD my designated driver, my designated diabetic, and I give them glucagon, I give them a bottle of a tube of frosty and to put in the glove compartment of their car. And I let them know that they're responsible if something happens to me, just like if something were to happen to anyone else that night, you know, but if something happens to me, this is what you need to look out for. And I'm probably not too drunk, I'm probably low. So

Scott Benner 1:02:27
that was in college was a game changer for me. Always having someone who knew what was going on, where if something happened, they could help me and I rarely use it. But I definitely did. Hand my CGM off to people and was like, hey, if this alarm, I am not hearing it right now, like I am in some other universe. And I need you to like, come get me. You know, I was wondering, is there a difference that someone's ever said to you between like, hey, low looks dip, like how does low look different from drunk or vice versa? Or is it hard to distinguish between?

Maia 1:03:05
If you don't know what you're looking for? It's really hard to tell. And I will liken it to this. If you are not diabetic, you probably have experienced global glucose before and thought you were just starving.

Scott Benner 1:03:21
Yeah, we're pissed, right? or angry sometimes here.

Maia 1:03:24
Yeah, the minute you have type one, you begin to distinguish between the feeling of low and the feeling of hunger. Right, there are two separate feelings, and they have a lot in common. But for most people, they're the same feeling. And I think for most people, if you look at a drunk person, you know, you know, though they're drunk, but it's gonna look really similar to type ones. I think, like a lot of times in the news, if someone the type one have a seizure while they're driving, and they get into an accident, they get characterized, like a drunk driver, you know, and I think it's that, that like, cognitive mismatch, if my husband looked at me, he can tell you if I'm drunk or low, you know, mostly because he had and, and mostly because if I'm low, I am sweating profusely, and I'm shaky and my voice is, you know, wobbly. And if I'm just drunk, I'm just, you know, like slurring and and having fun.

But I don't have that like, core shakiness.

That comes with a low Yeah. So I also think for me, it's, I can tell I don't lose hypo awareness when I'm drunk. I can normally tell.

That's tricky.

But normally, I can treat a low when I'm drunk. Sometimes I can't catch a high a lot of times I can feel when my blood glucose is is trending upwards and I can't feel that Not so much when I'm drinking. But where I struggle is in the morning, especially now as I'm aging and my hangovers are getting worse. In the morning when I have a hangover, which is when I'm most likely to be low, I have a hard time distinguishing my hangover from a low. Because, you know, you think about, you're like, I'm shaky, I'm nauseous, My vision is blurry. My head hurts. I don't even want to look at any food or anything to drink right now. I just feel terrible, you know, and that's how I feel when I'm on over. So it's really the same. That's something where I start to lose a little bit of my awareness. But at that point, I'm sober. So I can make a decision. Do you have any tips not

Scott Benner 1:05:49
being hung over?

Maia 1:05:51
Ah, I always just stick with one thing when I drink, you know, like, and it also makes it easier to Bolus if I can stick with the same type of alcohol, similar type of mixer that normally works really well. I think if you don't want to be hung over, you just shouldn't drink that much, traditionally. But I also just think that's a good guideline. And they always say, you know, beer before liquor never been sicker. So, liquor before beer, you're in the clear.

Scott Benner 1:06:25
I bet you a drunk person thought of that. Now, I bet. I have to tell you, it's again, I genuinely mean absolutely no judgment, as you've been describing all this, and I listened to the joy in your voice. I, I can't imagine like everything you've said. I think Oh, God, I can't, I would never want to do that. Like that. Like, the biggest thing I could come up with, and I was like, oh, wow, drunk girls in bikinis in a lake sounds fun. But like, that was the that was the best part, I could come up with anything. I wonder what it is in me because I really am not an uptight person at all. As a matter of fact, I do a pretty good job on this podcast of reining myself in, in, you know, in ways you guys might not really know. I just, I just can't like, I can't imagine like, I don't like the idea of being out of control of myself, I already think I say enough stupid stuff. When I'm not like, not like not drunk like I don't, I always feel relaxed, like I'm happy most of the time, like, I'm

Maia 1:07:27
trying, that's just it. That's it, people drink because they want to drop their guard. And if you're a person who walks around with your guard down and you're relaxed, and you're happy, and you don't need to, like get your brain out of work mode, you know, I think for so many of us, we are so plugged in to school or work or life and you we have a hard time unplugging. So to at the end of the day, be able to sit down and have a glass of wine and just make that go away. I think that's the drive, right. And I find people who are really relaxed and easygoing, like you, they tend to just not need a drink at the end of the day because they can choose to not be stressed about their work day, it makes so much sense. I was I was listening

Scott Benner 1:08:18
the other day to the Howard Stern Show. And it was out in Los Angeles for some special show and in studio with Snoop Dogg and Seth Rogen together. And they made smoking weed sound like the best thing on the planet. To the point where as you're listening to them, you're going I should try this. Like this seems like such a good idea. You don't need me like no differently than when like somebody is telling you like, oh, gosh, you know, I, I used to have a problem with this. But now I take vitamin D all the time. And it's trading, right? I'm like, Damn, but I'm gonna get some vitamin D. This is like that's that was like the vibe it had when it was over. And then when it ended, and they weren't there talking in my ear anymore. I thought I don't want to be high. It was so funny how quickly I went from like, Oh, that sounds like such a great idea. Because it really, they just described it in such a wonderful way. Like when you're talking about drinking. I'm like, this sounds wonderful. And then the minute you kind of wind down I'm like, all those drunk people, like like this.

Maia 1:09:17
But here's the other reason to drink. Because if you're drinking, you can't tell that everyone around you is also drunk

Scott Benner 1:09:24
that I believe Yeah, no, I know that you

Maia 1:09:26
don't get that like deep frustration with the drug people around you.

Scott Benner 1:09:31
Yeah. And that's amazing, because I have an amazing tolerance for people. But when I get when when you lose that much of yourself, I'm just like, Oh, stop talking. Or sometimes you can get somebody right in the right space. And you can chat with them and they're just, like, endlessly entertaining to me. Because it's so gone, that they can't keep their thoughts together, but they're just doing so many silly things like oh, it's like having a it's like having a puppet show in front of me.

Maia 1:09:59
For sure.

Scott Benner 1:10:00
Do you see a time in your life where it stops? Or do you think it's just a part of who like, do you? Can you imagine like a 68 year old Maya at the lake? Just like drinking and waterskiing? Like, do you know what I mean? Like, is there?

Maia 1:10:12
Oh, yeah, that's the goal. That's the dream. It's excellent. It really is. I mean, that's a dream. And I don't think, you know, like, every year, I probably drink less than I did the year before. But I'm a social drinker, my husband and I love to cook and, and eat and drink. And, you know, I, it's nice to have a glass of wine at dinner, it's nice to last night, we were we got elected to the Board of our neighborhood association. And so we, you know, we all sat around everyone who, who got elected, and we had a beer together. And it was like, you know, that's just great. And it's fun, and it has camaraderie with it. And, and I also don't have to drink I right now. My husband and I are getting ready to have a baby and, and so I'm emotionally preparing myself to not drink for, you know, an extended period of time. And, and so I think, you know, it doesn't have to be a part of your life for you to have fun, but, but for us, it just is part of the way that we live our lives. And I love sitting down with my parents and having a glass of wine. I love you know, going in floating the river with my dad and drinking a case of beer. It's super fun. It's wonderful. It feels communal to you, I guess.

Scott Benner 1:11:35
Right? Do I seem uptight? Do I seem uptight to you? When I say oh, my God, water and beer seems like you're trying to drown yourself to me. And I it's funny, because I really am two different people inside, like, very uptight feelings about some things. And that there is some things I'm just like, Oh, I don't care. Like I don't care that you drink and float on a tube. I have no like problem with it. I would never try to talk you out of it. But for my personal self, I'm thinking, that sounds like a recipe for disaster. And it's just, obviously it's not, you're doing very well. And everything's fine. You figured it out. You know, and you know what you're doing? Obviously, I just like, there's weird things like I just have very, I don't know what it is. I have no bad stories. My parents weren't alcoholics like like, nothing weird. Like, I've never have never had one reason for me to tell you this. But I was God, I was 13. The first time I went to a party where there was drinking. And I went into this party. And I was milling around a little bit. And I'm trying to talk and I realized nobody's here to talk. And I'm like, okay, and they were drinking and I swear to you, 15 minutes later, I found my way upstairs, I found a telephone. I called my dad, I was like, you got to come get me. I'm like, I I just I don't belong here. Like, that's how it felt to me. I was like, I this is not the right place for me. And I left and I think that was probably like, one of the few times I've ever been in that scenario ever. And I yeah, it's just very strange how, because what you're saying again, to me right now, you're Seth Rogen and Snoop Dogg rolled up into one. I'm like, my is making a strong case for me to have a glass of wine at dinner tonight. And I'm feeling like, it's such a great idea. But I know if I went I have wine in my house. It's so that I can hand it to other people when they're here. But I always go, I don't know. Take one. Just take the one out you think is right. But I know that I won't do it. It's so weird. I'm now wondering what's wrong with me? To be perfectly honest, in case you're wondering where my brain is at the moment?

Maia 1:13:39
I mean, I know plenty of people who don't drink and I think it just you just have to be the person who is the relaxed person who's not, you know? Doesn't if you don't need it, you don't need it. And if and, and if you had it, then maybe you might know that you would like to have like the feeling of having had a few drinks. But I just think, you know, at the end of the day, you know yourself and if you're listening to your body, I think that's another thing about diabetes and drinking, specifically, is that as a type one, you learn your bodies so much better than like a muggle

Unknown Speaker 1:14:23
right now for sure.

Maia 1:14:24
And so, I think you develop these spidey senses for when things are going wrong and your body and things aren't right. And it makes it really easy to be like, okay, that's my last drink. You know, and, and, and that comes from self awareness, right? People who aren't type one, they develop that too. But I think we just innately have it because we spend so much time asking ourselves how we feel.

I think that that part of it

Scott Benner 1:14:57
is important. I would say two more things and I know you're gonna have to go But I got I got time It feels incredibly important me to point out the difference between like you just said something like, I know when it's time to stop and I just stop, which is a great indication that you're you know, you're drinking the way you mean to be that you're not you know that you don't have I guess they're people probably go back and forth on it for me alcoholism seems like a disease and, and ya know, alcoholics who they could their face could be on fire, but they would still just keep drinking. Like if it was there, they wouldn't stop. But you you have the ability to just say like, oh, cool, I'm done now and I'm done. And that's it. That's even that's a comfort to you like that You don't? Like I guess if you were an alcoholic, you would just, you'd be in a different scenario, you wouldn't be having this conversation like this. So but it is, you know, because I can I can feel people in my minds listening and going. You know, drinking is not funny because my dad's an alcoholic, or I'm an alcoholic or something. I want to be clear. That's not what we're talking about right now. I don't mean like, I am not. Yeah, I'm not talking about that. And so I do feel like some people could kind of commingle those two ideas. I to me, they're these are they would be two completely different conversations.

Maia 1:16:13
Yeah, for sure. And, and I definitely, my grandfather was an alcoholic, and my mom never really drank so because her dad had a drinking problem. And it's been really interesting to see, as, you know, me and my sister have gotten older and, and we're both social drinkers. You know, my mom was always the person who would like open a beer, she liked it, but she would never finish it. And now to watch her, like have two glasses of wine, or have a, you know, make a Moscow Mule for herself at the house, because she is interacting with social drinkers, because that was never on the table for her. Right? She didn't know that that was a way that you could

Scott Benner 1:16:59
do it. She was afraid she was afraid to drink. She thought she'd end up being an

Maia 1:17:02
alcoholic. Yeah, because the only example she had was somebody who did drink had a problem. And that doesn't mean that everyone who has alcoholic parents should go out and start socially drinking. But I

Scott Benner 1:17:14
wonder, I wonder if I've been avoiding this for no reason. It's not my goal to like, create a whole bunch of alcoholics out of people who've been holding really tight their whole life. But that's a great, that's a great point, though.

Maia 1:17:27
But if you know like, you don't have to go have a bottle of whiskey, you can have a Manhattan and see what happens. And set yourself up for success. Like, okay, we're gonna try and figure this out. It's the same as anything else. And if you go slow, you'll figure out what works for you. And maybe that's having one drink at a time. Yeah, I know where the risks are low.

Scott Benner 1:17:52
Right? If you would have just said to me, do you know what a Moscow Mule is? I think I would have guessed, a sexual position you saw on a weird old porno. I don't think I would have guessed that drink. Just in case you're wondering. I was like, fascinating. No, I'm just sitting here listening to you.

Maia 1:18:12
Ginger, beer and vodka with lime.

Unknown Speaker 1:18:15
Okay,

Scott Benner 1:18:16
I if, if this this, it's a shame, because the title of this episode is gonna have to be more descriptive. Because if it didn't have to be, it would totally be called Moscow meal, just so you know. I would have 100% go with that. I appreciate this, by the way, like you seriously are, this is a void in this space, that I can tell from the position I'm in that no one ever This is the kind of stuff no one ever speaks about? And and if they do they do it in tight circles. You know what I mean? So then everyone else doesn't get to hear about it. I think that what I learned here from you today is that I need to be clear with Arden that if she's going to drink, we need to talk about it. First, I'm not just going to pretend she's going to end up being like my son or like me or something like that. Because of the of all the reasons that you outlined. And that we're going to have to sit down and figure out how to make these different alcohols work with insulin and that because even as you were I asked you earlier, I said something that was so like, oh, couldn't you just set a Temp Basal. But that was me not realizing that that Temp Basal would need to be three hours into you drinking and how are you really going to be like, cognitive about it at that point. Like you don't even like for for drinks into your party. You're not going to be like you know what I need? I need a Temp Basal decrease of about 50% for I'm going to save up

Maia 1:19:35
where Arden is lucky right? If she wants to go have a beer. She can be like, Hey, Dad had my first beer set my Temp Basal in three hours.

Scott Benner 1:19:43
Yeah, right. override Jojo. You're like my Snoop Dogg was drinking at this point is what I'm realizing. Seriously. So what do you What's the rest of your day look like? Are you you haven't been drinking while we're talking. You're going to work?

Maia 1:19:57
No, no. It is a it's It's like nine in the morning here. So no, no drinks yet. I had a cup of Chai this morning, I'm going to go teach a couple yoga classes. And that's kind of what the rest of my day has in store. So, yeah.

Scott Benner 1:20:14
I have a question about that if I could. It's nowhere near drinking. And I actually have two questions. Did you hear the episode that I'm doing where it's gonna be four times with a person who's pregnant? We did their first show after their first trimester. We're gonna do after the second. Yes.

Maia 1:20:28
Do you like that? Oh, exciting. I love it. Good. I'm glad.

Scott Benner 1:20:33
Yeah, Arden is supposed to be starting up yoga. But she start in the house. Is there Okay, wait for her to do that, like sort of get into it on her own.

Maia 1:20:44
Yeah, there's a lot of like, different kinds of apps, YouTube is a really good resource. And especially if she's working on something specific, you can hop on YouTube and search like, you know, yoga for shoulder mobility, or yoga for back pain, or whatever. And there's a million options. There are also like subscription services that you can do online that have you know, series that you can follow where you have lots of different classes to try. But you can definitely, you know, find a great, great yoga practice at home. I think it's a really wonderful way to start because it can be intimidating to walk into a room with a whole bunch of other people who know what they're doing. And you're like, What?

Scott Benner 1:21:33
You told me That's great. Yeah. Yeah, you want

Maia 1:21:36
me to put my leg behind my head? And

Scott Benner 1:21:38
I can't do that. You know, I can't do that. I don't know any of you. And no, thank you. Yeah, no, I wouldn't. I would completely agree it's hard enough to walk into a gym and start doing something that you're on your, on your feet for see it on something that looks like it means to be sat on to done like, you know, on the floor on a mat. Having never done it before. I think that's kind of her, her, her impediment with it right now. She's I think she might be embarrassed. But that's why I was asking if there was a good way that you thought, Oh, yeah, but

Maia 1:22:07
I also would say like most yoga instructors, any yoga instructor who's, you know, worth going to, is going to be so excited to have her in class, right? I think I love having new students, I love working through their injuries and figuring out how their body works and moves and how we need to accommodate for their individual body. And that's something you can't get when you hop online, you can get the poses, right and figure out what down dog what, you know, Chaturanga, but you know, having someone to work with you and and figure out your body, especially since she's an athlete is so helpful.

Scott Benner 1:22:44
Thank you very much. I really appreciate that. Yeah, yeah, you were terrific. I really, first of all, tell your friend and your husband, they're 100%. Right? You were the right person, you were the right person for this. Not just because of your, you know, your drinking, but because of your ability to talk about it and how open and clear you were, really, really appreciate this, you took something that I have absolutely no context for and gave me context around it. And I think you did that for a lot of other people to really well done. Thank you. After every episode, I take a moment to thank the person that I've spoken with, but maybe no more big, what am I saying? It might be? How come I can't talk mother. In this situation, I mean, at times 100, Maya came on talk about something that some people might judge her about. And she knew that going into this and that really is brave, because she's trying to bring good information to the people living with Type One Diabetes. So I commend Maya for coming on. And I want her to know how much I appreciate it. Last couple things. If you're looking for Juicebox Podcast merchandise, or something to wear for diabetes Awareness Month, it'll start a conversation about type one diabetes, check out Juicebox podcast.com. Scroll down to merge. And as you heard me say earlier, I would like to keep this after dark series going a little longer. I'm looking for a smoker to come on and talk about balancing Type One Diabetes with pot weed. ganja grass, what do you kids call it nowadays? Anyway, looking for somebody who has type one who smokes regularly who can kind of you know talk about it in an open way. And I'm looking for two adults, one male and one female so we can get both perspectives who are comfortable coming onto the show. And talking about working with Type One Diabetes. I want to know all about the psychological part and the mechanical part and everything in between the stuff that maybe people don't think about, that you know about, you know, like, what's it like to bump your nose into a CGM when you think you're gonna bump it into a? Yes. Okay. That's pretty much it. See you next week.

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