#316 Julia

Dr. Julia Blanchette, PhD, Registered Nurse, Certified Diabetes Care, Education Specialist and Type 1 Diabetic.

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

+ Click for EPISODE TRANSCRIPT

---

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, and welcome to Episode 316 of the Juicebox Podcast. I'm your host, Scott Benner. And this is the type one diabetes podcast that you've been searching for. Today's episode is with Dr. Julia Blanchett, PhD. She's a registered nurse, a certified diabetes care and educational specialist and a person living with Type One Diabetes. Not only that, she may become a regular on the podcast, you'll find out why soon. Today's episode of The Juicebox Podcast is sponsored by Omni pod, the world's greatest insulin pump. It's tubeless, you know, no tubing. What does that mean to you? Well, it's easy to find out. Because you can get an absolutely free no obligation demo of the on the pod sent right to you by going to my Omni pod.com forward slash juice box. Today's show is also sponsored by the dexcom g six continuous glucose monitor, you want to be able to track your blood sugar in real time without a finger stick. Get the dexcom g six, head over to dexcom.com Ford slash juicebox. To find out more. As I said in the cold open, Julia has type one diabetes, she's also a CD even though you know they're starting not to call them CDs anymore. Julia has a PhD as well and her focuses for her dissertation are of great interest to me. And I think to you as well. To check out Julia today, I think you're gonna like her. And I think she's gonna be back. While you're listening, please remember that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, please always consult a physician before making any changes to your health care plan. Becoming bold with insulin, or you know, walking outside during this Coronavirus thing. While we're all locked up in our houses, I'm going to be holding some zoom meetings for people just to check in and chat with others. The first one's going to be March 26 at let's say 3pm. Eastern time. Okay, March 26 3pm, eastern time, you'll be able to find links, where you're gonna be able to find links on my Facebook page, and on Instagram, and Twitter 3pm you can come by and chat, just listen, you can show your face, you don't have to just going to be like a little support group for people to type one. You know, while we're all locked up in our house. First of all, you know, we're recording. And I'm gonna apologize to you for you know, you and I had a full and complete conversation that I made you wait months and months and months to actually hear. And then it turned out I had recorded my voice and not yours. The third time I've done that in five years. So not feeling too bad about it. But I did enjoy speaking with you. So I thought let's do it again.

Julia Blanchette, PhD 3:02
I mean, it was pretty fun. So

Scott Benner 3:04
fun dad will be able. And plus there's other stuff to talk about now. So we're gonna, we'll do a little a shorter thing about you. And then we're gonna talk more about what's going on in the world. Perfect. Makes sense. All right, perfect. So how old are you right now? And what is your name?

Julia Blanchette, PhD 3:23
I am almost 28 and a week, I'm 28. So I guess I'm 27 and almost 28. And my name is Julia. And oh, I was gonna say more. And she didn't ask me to say more.

Scott Benner 3:36
So, look, you don't have to follow the instructions that closely. Why? Why are you so accomplished at 28? What happened to you as a small child did someone impress upon you, you need to work really hard or something like that.

Julia Blanchette, PhD 3:49
So I was diagnosed with Type One Diabetes when I was shopping. And I had a really amazing support system. Mostly my mom who always advocated for me and helped me learn how to advocate for myself and show me that I wasn't going to let anything stop me. And I think that really has led me to become who I am. And

Scott Benner 4:12
you just got a degree right? Like, what what did you just accomplish?

Julia Blanchette, PhD 4:17
So I just finished my PhD. So I have my PhD in nursing science and my area of expertise is financial stress and psychological symptoms in young adults with type one diabetes.

Scott Benner 4:33
So hold on a second. Wait, that seems like a lot. Explain that to me. What was that?

Julia Blanchette, PhD 4:39
So it's, it's I have a PhD. So if you actually look at my degree, it just says doctor philosophy, okay. But but then people are always like, well, what's your PhD in? So then I say, well, it's nursing science that was technically my major, but then people are like, but then what is it really in in nursing? So I gave the full answer

Scott Benner 4:58
and give it to me. One more. I'm slowly.

Julia Blanchette, PhD 5:01
So I have a Doctor of Philosophy or a PhD in nursing science, and my area of expertise is in financial stress factors, psychological symptoms, and self management outcomes. And young adults with type one diabetes, the

Scott Benner 5:18
only person who has this degree in the whole world are the other people in the room with you.

Julia Blanchette, PhD 5:23
Um, so I'm the only person who's defended this dissertation and the whole world. But there's other people who have PhDs in nursing science.

Scott Benner 5:32
So when you are tasked with your dissertation, what, what led you to choose those focuses?

Julia Blanchette, PhD 5:40
Yeah, so that's an amazing question. So I'm very

Scott Benner 5:43
good at this podcasting. That's why it's

Julia Blanchette, PhD 5:46
so good at the podcasting. I'm

so I'm so when I graduated with my Bachelors of Science in Nursing, my BSN. That's what would have allowed me to take the RN exam. I worked at diabetes camp for that summer, and I was the counselor and training nurse. So I spent the whole summer with 16 year old, young girls, or young women. And it really opened my eyes. So I worked really closely with some amazing now young adults who have overcome a lot and but at the time, they I just saw all of the psychological stressors they were facing. And it really was eye opening to me to realize that I had an amazing support system. And I really haven't had a lot of barriers psychologically with managing type one diabetes, but it's not like that for everyone. So that was the first really important thing that I noticed as a clinician for the first time that I wanted to then bring research in to figure out how to solve problems. So I went into my PhD, saying, I want to figure out better support systems for adolescents and young adults with type one diabetes. And then at the same time, I was going through the transition from pediatric to adult diabetes care. And I was kind of just thrown, for lack of a better word, onto the adult side, um, I went to see my pediatric endocrinologist in a different state. And so when I was seeing my adult endocrinologist, like 500 miles away, my pediatric endocrinologist who was amazing just didn't really know who to connect me with. So I had, I was nervous to make it my first adult appointment. And when I made it, it was really discouraging. So then, I was like, Wow, so there's all of these adolescents that don't have a lot of psychosocial resources and have a lot of psychological barriers, and then they have to go into this transition. That is awful. So that was the next piece of what I wanted to look at. And so first half of my coursework during my PhD, so it was like a year and a half, I was set on trying to find better ways to smooth the transition from pediatric to adult diabetes care, by making sure that these adolescents and young adults had better psychological support. Okay. And then January 1 2017, happened.

Unknown Speaker 8:28
And

Scott Benner 8:29
that's my I painted my bedroom.

Julia Blanchette, PhD 8:32
Well, well, that's amazing. That's that that's not what happened to me. something a little different happened. So um, so January 1, that year, I was switched from a non high deductible private insurance plan paid by my father's and player, or covered by my father's employer to a high deductible plan. And young Julia had no idea. Like, I had no idea about health insurance, right. My parents were paying for it. I was, at this point, I was going to pick up all of my medications by myself. And I was paying for some of my medications and supplies by myself. But I was I was a graduate student. So I was on my parent's insurance. I was not 26 yet. So then, I'm the first week of January. So it wasn't January 1, but that was the day the insurance changed. So it was probably like the fifth or sixth. I go to Walgreens to pick up my three vials of insulin. And the farm tech looks at me and she's like, I don't know what's wrong, I can't dispense this. And I said, What's going on? And she said, your insulin is like astronomically expensive. I don't know what's wrong. I don't know why your insurance isn't covering it. And so she even applied the pharmaceutical coop on which at the time only deducted like a $100 savings for the high deductible and then, of course, I had to I called my parents crying and we figured out a way to pay the high deductible to get my insulin. But it was a shocker like I was my eyes were open again, to just another problem that a lot of people, especially young people with diabetes were likely experiencing. So,

Scott Benner 10:20
Julie, I just did something that I don't normally do. I wrote down things. Yeah. And here's what happened. Please don't feel any pressure to say yes. Okay. But what I think we've just done is outline the first three episodes of a new diabetes pro tip series, with you as the guest. Oh, that just happened? Do you feel like that just happened?

Julia Blanchette, PhD 10:41
Well, well, Jenny, get upset. I love Jenny. No,

Scott Benner 10:43
Jenny, and I have already had a conversation. I've been looking for someone to handle the psychological stuff. The questions that come up that I can talk through, but don't understand enough to be definitive about. And I just as you're speaking, I started writing down questions that I had around these ideas. And if you're up for it, we should talk about that later. If you're not just disappoint all the people who just heard me ask you that. And then you said, No,

Julia Blanchette, PhD 11:11
no, I'm down for anything. So you know,

Scott Benner 11:14
I'm sure your parents don't want to hear that. Okay, so there's, so I'm first I'm gonna say something to you, that's gonna make you laugh, and I'm gonna bleep it out. No one's ever gonna hear it. When you said on january first 19 data 2017 this amazing thing happened. I thought you're gonna say I found my

Unknown Speaker 11:35
Oh, my God.

Scott Benner 11:38
I see you understand where my brains running in 19 different directions while I'm doing this podcast, there will be one long beep through everything I just said. just wonder forever when I said to Julia,

Julia Blanchette, PhD 11:50
but and this is this is the difference between me and Scott. I'm a researcher who finds these aha moments. And Scott thinks about other things. My

Scott Benner 11:59
brain just bounce around. Okay, so write your first thing you talked about. Um, I was wondering, what are you seeing so far? Like, let's tease us this idea a little bit. When you talk about the stressors, right? Do they lessen when people have good tools? We're living in Strange Times. It seems we're all sort of in our homes now waiting out the Coronavirus are still some people of course it has to get out to work. But many people around the world are in their houses right now. And it feels strange. It might feel like life's on hold that there's a pause here, but I choose to see it as an opportunity. It's an opportunity for you to better your own health, you have this block of time now. There's less to do. So that means there's more time to focus on your health. more time to figure out a new device for instance, like beyond the pod tubeless insulin pump. There is no better time to go to my Omni pod.com forward slash juice box. Then right now, let Omni pod send you out a pod experience kit. And absolutely free, no obligation demo of the Omni pod can wear it around your house to your new dystopian life and see how you like it. And when you decide that it's for you contact on the pod and they'll get you going. Then you can use this free time, you know to get your basal rate set up and learn how your new insulin pump works. It's really kind of perfect. I mean, you know, with the exception of the Coronavirus, otherwise the free time is what I mean is perfect. My Omni pod.com Ford slash juice box. It's the world's best pop. It's an amazing device. It's tubeless nothing to be clipped to your belt or stuffed in your bra or hidden in your shirt. Right just this little self contained, beautiful pump that will deliver your insulin sleeping and awake, active inactive sitting on your sofa rewatching your favorite show for the 30th time. After you do that, reset the music. And check out the Dexcom g six continuous glucose monitor. You may not be surprised to know that that's at dexcom.com Ford slash juice box. When you get there. It's a simple trip to a better life. Get started with the dexcom g six it's a green button right on that page. You can make knowledge your superpower with the dexcom g six. It's covered by most insurance plans and it is absolutely at the center of how we make decisions about my daughter Arden's type one diabetes. It's how I can look over my shoulder right now and see that her blood sugar is 78 after today having a bowl of cereal and Apple I saw her with something else and Between think she's been snacking on chocolates, it could possibly be that time, you know, I'm saying her blood sugar has never been under 70. We're over 120. Not today. Imagine that Frosted Flakes, and a 120 blood sugar. I get to that courtesy of the information that comes back from the dexcom, continuous glucose monitor, you absolutely owe it to yourself to check it out. Zero finger sticks, customizable alerts and alarms, smart device compatibility for Android, and iPhone, you can share your data with followers, right? Your mom, your dad, your sister, your brother, your best friend, they could see what your blood sugar is. It's indicated for children two years and up. Come on dexcom.com forward slash juicebox. Get in there, get in the fight. Look at this text I'm getting right now. I swear this just happened. Hey, Dad, I'm gonna have some sherbert Look at that. No worries, just sherbert Dexcom. When you talk about the stressors, do they lessen when people have good tools?

Julia Blanchette, PhD 16:08
So that's a really good question. I'm gonna preface this by telling you so I can only talk about what I have published from my dissertation. But I can also tell you what I've seen clinically and what I know just from other researchers, so I'm with the young adult population, even young adults that have access to technology. So that's a, you know, it's a high percentage of a lot of people with diabetes. But we think that potentially a young, lower percentage of young adults than the general population are using these technologies. They're still having stressors.

Scott Benner 16:46
Okay, so so people to so if, say, I'm a person, let's make me a person with diabetes in this scenario, and I know all the stuff that you know that I know, because you listen to the podcast, I'm still going to feel stressors, even though I'm that on top of the idea of my management.

Unknown Speaker 17:05
Yeah. Okay.

Scott Benner 17:06
All right. I imagine that to be true. Are they greater when I don't understand the management?

Julia Blanchette, PhD 17:12
So from what I've seen clinically, I think when you don't understand the management, it definitely can contribute more quickly to burnout because you feel more helpless.

Scott Benner 17:24
Okay, so is in your mind? Because it's such a it's a word, right? burnout, like we throw it out? Yeah, it really does it really mean just an inability to care at some point or to or to be motivated or something along those lines?

Julia Blanchette, PhD 17:40
Yeah, so it does, I mean, it means that you've gotten to a point where you, you've physically and emotionally cannot do the tasks. And then there's other components as well, like with diabetes, distress, and other psychological factors to like depression and anxiety. But burnout itself means you do not have the ability to actually get yourself to do what you need, what you don't want to do what you need to do, because I'm trying to steer away from making people feel bad when they're unable to do what they would otherwise do.

Scott Benner 18:22
descriptive word in, in an intellectual conversation, it's the things that have to happen, you have to get your insulin in a timely way, you have to know how many carbs you're taking in for the most part, like the things that have to happen around diabetes, you just literally cannot bring yourself to, to do them to care or do them or to, to feel the and it, but it doesn't stop you from feeling the impact of not doing it.

Julia Blanchette, PhD 18:44
Correct. And I think there's a lot of guilt that I see.

Scott Benner 18:47
Okay, all right. Yeah, you're the right one. We're doing this. This is the least five episodes that could turn into more. See, it's good thing that my recording thing didn't work, because I never would have had this idea. Otherwise, it was it was the different way that you described your PhD this time than the last time that made me think oh, this is the right person

Julia Blanchette, PhD 19:08
will remember last time I didn't defend my PhD yet. Yeah. So I am I am a different person now. So when we recorded last time, I was a few weeks away from defending it.

So imagine how different of a state I was in.

Scott Benner 19:22
You were just back then you're like, I hope I get this damn thing done.

Julia Blanchette, PhD 19:25
Yeah. Yeah. And I hope I hope that they passed me like that's how I was feeling

Scott Benner 19:30
I can wonder to out about the just the pressure of like, what if I defend this thing, and I get my PhD and that's all great, but I get to the end and think to myself, Oh, this whole thing was bull. I don't even believe this. Like, Is there ever that feeling like what if I get through all this and I get to the end and I don't even agree with myself when it's over.

Julia Blanchette, PhD 19:48
So I think I'm doing a PhD in itself is a really emotionally challenging process. And I think for most of the PhD students that I've talked to And then there's quite a large support network on social media like on Twitter. Um, I think all of us just feel so burnt out by the end of it that it's like, you just want to get it done. And like, that's the main thing you're thinking about. But I was so lucky in the fact that I had this, and I'm going to be honest, like, most PhDs, you just try to get your dissertation done. But I mean, I really crafted something from what I had seen clinically what I had experienced personally, as a young adult with diabetes, and where I saw the gaps in the research. And I actually did, I will tell you, I had significant findings, which isn't always common for a dissertation. So not everyone actually finds that their hypotheses and their research design actually conclude with relevant Well, all results are relevant, sorry, so I take the relevant word back, but they're not always significant results. So I did have significant results,

Scott Benner 21:02
I have to tell you that I don't have the ability to, I would not have the ability to claim a PhD out of the world. But I do believe that this podcast has given me back significant results about the stress that you take away from people by just allowing them to make decisions that they can kind of count on. And yeah, and have repetitive occurrences and outcomes and things like that stuff that they can lay back and go I know, if I do this, this is gonna work. And that if it doesn't, there's a reason aside from the steps I've taken. And I think that's amazing. But I'm, you know, again, the dirty secret of the podcast, right? It's, it's for me, if it helps you, that's a benefit. That's awesome. Um, I'm thinking that what you and I are going to talk about, is, is going to help me and I'm already I'm already feeling more comfortable with my thought that as life progresses, there are going to be times where Arden is going to have to kind of you know, come home for the lack of a better term, to reset herself around diabetes. And that could that could happen, as a young adult in college, it could happen as a married person, it could marriage, it could be as an older single person, like whatever she ends up being, I think there's going to need to be a home base, where you can go back to people who just like are like, Oh, I know how to do this. It's okay, let me take it off here for five seconds. So you can reset. So sort of the way we talk about, yeah, when you roller coaster, right, with diabetes, or when you get high and you get stuck high. Sometimes you just got to get low, stable and start over again. I think that that the truth about life, if you're if you're really listening to the show my concept about diabetes, it's just my concept about living, well applied to insulin. So I don't want to I don't want to give the whole secret away, you know, before I'm done paying for my kids college, but Oh, God, but that's what the podcast is like, to me. Like, it's just my basic idea of being alive applied to other things, and in this case, diabetes.

Julia Blanchette, PhD 23:04
Well, and I want to take a step back and go back to what you were saying. So, you know, what we're finding is that even if parents aren't actively involved, parents or other types of caregiver support, aren't 100% actively involved in self management for young adults, just having someone who is supportive and who's there for you for your diabetes, like you just described, is that in itself helps helps prevent some of the psychological distress,

Scott Benner 23:32
right? Oh, no, I I find myself saying just as a matter of, you know, a baseline, I say, into your mid 20s. I think they need support, at the very least, and I don't know why. I mean, there have been times in my life in my 20s and 30s and 40s, where I've had the thought like, I gotta go find my mom, you know, they mean like,

Julia Blanchette, PhD 23:53
Yeah, well, and it's the same thing. So it's, it's this whole, like developmental stage of emerging adulthood. So it's not only when one's taking on diabetes, self management and experiencing how that is, but it's, you know, the typical developmental process when you do need to lay on others, especially people who you've depended on your whole life for support in certain situations.

Scott Benner 24:17
I know excuse me, the whole concept of the excuse me one second.

Julia Blanchette, PhD 24:24
Give Coronavirus Coronavirus in my throat. Yeah. Oh, no. Good thing. We're, we're not talking to each other in person right now.

Scott Benner 24:33
I'm not even six feet from this microphone. This microphone screwed to? Oh, no, but no, no, um, I think that as much as I understand the statement, how old you know, people ask me very frequently, you know, what's a good age where they can take over their own care? And I think some people ask because they don't want to infantilize the kids around diabetes. That's their fear. But I think there are some people who ask us like, you know, when can I stop? You know, being burdened with this diabetes thing, like I like kind of put it on the kid a little bit, you know. And in my mind, I don't think there's an age. You're,

Julia Blanchette, PhD 25:07
you're on it, you're on it. There's not an age, it's different for everyone in every situation, you get it. Of course,

Scott Benner 25:13
William was on the show years ago with 15, listening to the podcast, and then figuring things out as mom came on and was talking about, you know, how well, you know, she and I spoke privately and she's like you, my son, listen to your podcast, and like, put a whole plan together for himself. That's a certain person. All you know, Arden is, you know, sometimes I'll be like, Hey, what's your blood sugar? And she'll be like, isn't it on your phone?

Julia Blanchette, PhD 25:38
Well, that's what teenagers do. But I mean, I think to like, so the type of person I am, I always wanted to manage my diabetes by myself. So I was diagnosed when I was seven. And for the first year, my mom and dad gave me most of my shots. But then I can say, I think by the time I was eight, when I was on a pump, I was calculating my carb doses, I remember. So I was, my carb ratio was point seven for 15, which is actually a one to 20 to carb ratio. But the reason it was so weird is because in 2000, we were still using carb exchanges. So you did everything in 15. So that's why it was point seven units to 15 carbs. But I remember my neighbor, who's amazing, she was, she's a teacher. And she kind of did like, um, I don't know if she did special ed support or what she did, but she actually helped a lot of kids like with math and like smaller settings. That was her job. And she actually showed me how to do my carb calculations, because the pump didn't calculate it. For me at that time, we it there was no carb calculator, or calculator on the pump. So my neighbor actually showed me how to calculate my carbs. And I would I, at eight years old, I was figuring out how much insulin I needed for carbs. So but that takes a special person like not to call myself special, but what you just did. But like, I think not, it's just the person I am like, I am very motivated to do things and self motivated. And, and, you know, so with the transition and doing the independent self management, it really just depends on who the kid is, but also their situation.

Scott Benner 27:18
It just, it's who you are, right? Like, yeah, it would, it would be ridiculous. We couldn't randomly just take 10 children and tell them all, you know, you're going to be calculus majors, right? It's right for some people and not right for other people. And you do need to listen, there are some, in my opinion, some basic ideas that everyone, you know, kind of has to adhere to, and there are things you should expect from your children a baseline, but then you don't start expecting calculus from all of them. Some of them, you know, probably should be drawing a picture or write telling a story, you know, or or talking to other people. I mean, honestly, this thing I'm doing right now, this if this idea of having a microphone, and being able to speak to a person remotely about something, if that was a thing that existed in the 70s, I would have known that was right for me that,

Unknown Speaker 28:05
right, you know,

Scott Benner 28:06
and but it just didn't, it didn't exist. But imagine if someone, I was lucky enough to not get pushed into a direction that wasn't me. Right? You know, I had this, um, I don't think I've ever told this here. But I said it to somebody the other day that made me remember, as I was leaving middle school and going into high school, I was walking down the hall in the waning days of my last year, and my guidance counselor came out of a door saw me and grabbed me pulled me in, and don't worry, this doesn't end poorly. And, and, and he said to me, I'll never forget him. His name was Mr. Wiley land I but I didn't have that much, you know, interaction with him. But he said, I'm glad I found you. I wanted to let you know, I think you're going to do great. And I always thought you should be an attorney. Well, I don't know how old I was. Maybe I was in ninth grade, eighth grade, you know what I mean? Like, whatever how old you are then. And even at that age, I stopped and said, Oh, that's really nice. Thank you, but then I'd be an attorney for the rest of my life. Right. I was like, that sounds bad. Yeah. You know, like being anything for the rest of my life. sounds bad, but I don't want to. And then he asked me why. And I said, I have to be honest with you. I think I could be a good attorney. But I don't know if I have the self restraint. Not to be a bad attorney.

Julia Blanchette, PhD 29:29
And I knew that in eighth grade.

Scott Benner 29:32
I know, I know that I see the other side of I know that there's a there's a good person who I am. But I also see the other side. Like if I decided to start an online ministry and steal from people, I think I think I could do it you hundred percent wouldn't. But I also always wonder, you know how much of what we wouldn't do is because we don't have the necessity like you know, when people used to tell me like You're such a great dad, it was easy. My kids were good, easy kids. Like, I wonder if my kids were like, terrible how good of a dad I would have been, you know? Yeah.

Unknown Speaker 30:07
And I wonder

Scott Benner 30:07
if you made me an attorney, if I wouldn't end up being like the mankind? Or you don't I mean, like, so yeah. So I had those two thoughts. Like, I don't know if I can trust myself even then. And I definitely don't want to do the same thing for the rest of my life. Now, as an adult, I know I can trust myself to do the right thing. I do it over and over again, when I have the opportunity to do the wrong thing. Yeah, but but I still cringe at the idea of doing the same thing forever.

Julia Blanchette, PhD 30:36
Well, sounds like you're doing what you enjoy. And it's different all the time. So I wish to see you got that

Scott Benner 30:41
I'm at the point where I wish I could make this podcast every day. Yeah, like, I would enjoy that you and I are having a completely different conversation than we had the first time. And I think I could bring you back on every day and have a different conversation with you. Oh, don't take that. Personally, I can do it. Anybody. I'm saying it's me. I'm the skill not usually you

Unknown Speaker 31:00
stop trying. Hey,

Julia Blanchette, PhD 31:02
my spot? No, but I mean, I think like, I do think you're right about that. I think you're you have very good, real conversations with people. And you're not just interviewing them with the same types of questions and getting the same types of answers. And I think, yeah, you could you could find someone different every day. Thank you. And

Scott Benner 31:21
yes, I'm very proud of it like really am and I'm proud of how it gets better. Because Yeah, even I there are times I'm in the middle of a conversation, I think this is better than I would have done last year. like wow, while I'm talking to somebody. But But nevertheless. So. Alright, so you've had type one for quite some time. And now how do you take all of your fancy learning Julia and apply it in the real world? And by the way, did you find out your PhD made you another $5? a day? How much? How much? Is that helping?

Julia Blanchette, PhD 31:49
You want to know the real answer?

Nothing more right now. So yeah, thank you. But I can tell you know, the jobs I'm qualified for, it'll, it'll pay more. I'm just right now, since I graduated in the middle of the year, I am working not full time, but I'm working like 70% of the time as a Diabetes Care and Education Specialist formerly known as a certified diabetes educator. And I love that job. So I do have a couple of future opportunities that are potential that would Yes, they would pay me quite a bit more with the PhD. Um, but for now, I am happy on where I am. So I'm not I'm just going to things will fall into place.

Scott Benner 32:34
And I see I see that we're not saying where you work, and that's fine. But I, I want to say that Julia works in a very impressive place.

Julia Blanchette, PhD 32:42
Oh, thank you. Well, and I have a I have an awesome team. So I think I've grown a lot even since I started working with them. I've grown so much as a clinician, it's excellent. To answer your question about how do I take what I learned and apply it to myself. So I'm a very hands on learner. So what that means for me is that in order for me to fully understand things, I actually have to try them myself. So a lot of times, I find myself doing these self diabetes, self management experience experiments, before fully taking the knowledge I know about it into practice. So I think I kind of do the opposite of what you were asking, I kind of try it on myself first, and then I apply it in practice. But when I'm trying it on myself, I definitely take a lot of time to stop and look at my patterns and figure out kind of what's going on as it's happening. So I do take a lot of time to understand all the different factors that are impacting me and what changes I can make, and that I learned from working with patients, right? So I'm telling them to look at their data, and think about everything they're doing and think about all the factors and I have applied that to myself. So

Scott Benner 34:00
how many people do you meet? What's the ratio? I guess, is my question of people who you look at and think this is gonna work out for them versus people who you look at and think this isn't going to work out for them.

Julia Blanchette, PhD 34:15
So you asked me this question last time, and I have the same answer. I never look at someone and say this isn't going to work out.

Scott Benner 34:22
Okay, a more difficult road. Is that a more fair way to say it?

Julia Blanchette, PhD 34:26
So, and this is good, this is really weird timing. So I have to tell you, I've met one person in my years as a diabetes current education specialist, who really didn't want to be in my office and really didn't want to be talking to me. So that is the only example of a person where I'm like, this person is going to have a difficult time because they don't even want to learn. Um, so you know, adult learning since I work with adults is a lot. It's um, it's a lot of the person wanting to learn themselves. and applying it to what's relevant for them. So I try to shape all of my education sessions to the person and to what their needs are and to what's relevant to them. So I kind of go in with, what can we make work for them, as opposed to what what worked for them? And that's just my frame of thinking.

Scott Benner 35:20
That's the same thing we were just talking about really, with, like parenting or diabetes, or any of that stuff, just like, yeah, molding it to people. So that so then that's a, that's a great answer, and makes me realize is my question incorrectly? That's okay. How many people? Let's start here? How many people have type one diabetes in America?

Julia Blanchette, PhD 35:41
Um, you know, Dr. Julia should really know the answer to that. But it changes so frequently. It's it, I believe, isn't it one point something million 1.8 million, something like

Scott Benner 35:54
that one and a half coming up on 2 million people. So my question then is, how many of those people are significantly underserved with information and support? Like, maybe our you may be seeing the ones who have insurance who come You know what I mean? Like, like, I only try to imagine who it is we're not finding.

Julia Blanchette, PhD 36:15
So I yes, that's okay. So that's a really good question. So in my current practice, we, we do take people who are on public insurance, but we don't offer like free services to those who do not have insurance. But even that being said, I mean, I get people every day that are like, I'm so happy I met with you. No one's ever told me this before. No one's ever told me why I need to count carbs before No one's ever taken the time to explain what a carb is to me before. No one's ever taken the time to explain that. It's not necessarily my fault. My insulin might not be what's right for my body's needs, right. Now, how does that happen to them?

Scott Benner 37:02
Because they know they have no tools in their hands. Somebody saw Oh, no,

Julia Blanchette, PhD 37:07
it's an it's like, I have to say, it's, I would say with 80% of my patients, they feel like they're doing something wrong. And in the end, then I always, you know, I take the time to provide them the education they deserve. And, and it's just, it's really shot. I mean, yeah, I think now that I'm talking about it and thinking about it, it is really shocking that so many of them just don't ever get the education that they need. But I think a lot of it has to do with our healthcare system. So if you know, if you're diagnosed in the hospital, you're kind of they kind of this is nothing against inpatient diabetes management, or educators, it's very different. And they have to kind of put out the fires, and just explain to you, okay, you need insulin, you need to prevent lows, like, that's all you can, that's all a person can have the capacity to learn when they're in patients, and we're

Scott Benner 38:01
handling it wrong, then. Because the truth is, this podcast shouldn't need to be popular. Right? You know what I mean? Like, there, there is a very easy way to put it out of business, it's just have died, have people educate better at the at the at the point of contact?

Julia Blanchette, PhD 38:18
Well, so I think so just from, you know, I, I obviously didn't get my like I my whole family education at our point of contact. And I think my mom would have a lot more to say about how she felt overwhelmed opposed to me, who is running around the hospital, in hospital socks, dancing with my friends, not not feeling very sick. But I think now that I've had friends my age that have been diagnosed with diabetes, and have been in the intensive care unit in DK, like, it's really, you can't provide even if you try to provide the education needed at that point in time, people don't have the capacity because they're so overwhelmed with their diagnosis, or they're so sick. So I think the key is getting them to diabetes education when they're out of the hospital, but that doesn't happen. Because, you know, it can say that on the discharge orders. Or they might, they might be at a smaller community hospital that doesn't even have diabetes education, right. Or they might be at a hospital and live far away. And they might not have access to an educator. So I think there's still a lot of barriers. And then if you're overwhelmed, and you just went through all of this have, you know, of this new diagnosis and this hospitalization? I don't know I would show up for diabetes education, but maybe other people still feel too overwhelmed too. So there's just a lot of factors. Um, it's a really complicated,

Scott Benner 39:47
I'm gonna say something that's gonna sound pompous for a second. Okay,

Julia Blanchette, PhD 39:50
okay. Okay. Now,

Scott Benner 39:52
I think that if you could, obviously there's a lot of pie in the sky here. But yeah, if you could Bring me to your institution. And okay, and let me talk to 10 people, okay, the first three days of their diabetes diagnosis, and I would need a half an hour with them, and then a 20 minute follow up. I think I could do it.

Julia Blanchette, PhD 40:16
I think there's something about connecting with someone else who has diabetes in a light that's not medical, medical, medical, and a light that's like, I'm a real person. But I also find that that's why patients appreciate me, because part of my strategy is showing them like I do understand, or sometimes I don't understand, but if I do understand, I let them know, like, hey, like, here's what, here's what I found helps me. I'm a real person. And you know, it's interesting, a lot of my patients will come in, and they'll be like, you're gonna be so mad at me. Because I haven't been Pre-Bolus thing, or I've been, what they'll say is I've been eating bad. And I'm like, I'm not mad at you. You're a real person, like, this is how we live our lives. And we just have to find a smaller goal, and figure out how to meet it for you.

Scott Benner 41:07
I don't change what people say when they're on the podcast. Like, I don't correct them if they use terminology I don't agree with because I think it's good for people to hear how people feel. But I'm always like, shocked when someone tells me they're a bad diabetic. Like I

Julia Blanchette, PhD 41:20
know, and it's just showing how guilty people feel. Yeah,

Scott Benner 41:23
I know.

Julia Blanchette, PhD 41:24
It's a problem.

Scott Benner 41:25
It is. Okay. All right, let's do. I'm gonna hit two things, right. And because I've messed you over so badly with your episode, yours is going up very soon, so I can

Julia Blanchette, PhD 41:37
Oh, can I trust you or no, I don't know.

Scott Benner 41:44
So I want to talk to you about and you're gonna have to help me be. You're gonna have to help me with your phrasing. Okay. Okay. And I want to finish up talking with you about algorithm based pumping. Okay, and what you're talking about at your practice around Coronavirus, as it's March 17. Right now. So okay, let's start with the corona thing. So have you been in Corona meetings? Like are you got what is happening, but like, what I expect is happening in our endocrinologists offices, this is all kind of ramping up and happening.

Julia Blanchette, PhD 42:21
So I'm gonna be totally transparent. And let you know, I think it really differs based on what state you're in. And because you know, different state governments are suggesting different or implying different restrictions right now. And then I think it also depends if you're at a big practice or at a really small private practice. So I can tell you at my big practice, as of March 17, we are not closed, we are trying to limit in person contact, though. Okay, so and that's another thing. So like, if your practice doesn't have virtual visit capability, or you have state law restrictions on that, that might be a barrier. That being said, I'm saying this on the morning of March 17. Later today, there could be some sort of law passed that waives those restrictions. So it's very, it's a very fluid situation. But I think you don't expect that you can't contact your endocrinology or your diabetes practice, because we're all making arrangements, as of March 17, that you can contact us and that we can somehow get you what you need. So I've seen some practices doing just telephone console, that don't have the virtual capability. I've seen other practices that are just waiving fees for the time being, and then figuring it out later. So don't feel like we're not available. As of March 17. We are. We're just a lot of us are trying to limit the in person contact.

Scott Benner 43:53
You're further in off of the coasts, not a lot, but yeah, you still are. And it's very funny as, as I saw, like speaking engagements getting canceled. Yeah, I had one in Wisconsin. And they were like, everything's fine. I'm like, are you sure cuz I don't think my son's going to college anymore.

Unknown Speaker 44:13
Yeah, no

Scott Benner 44:15
one's talking about here. And I said to Julia in Wisconsin, I said, give it two days. Yeah, and sure enough, two days later, yeah, had bled, you know, the virus had spread towards the center of the country a little more. And so it's happening. It is interesting, how we, how we like to, like wish for what we want to happen, you know, when you start seeing what's happening in Seattle, and New York, and these other things to think it's not going to continue on is just like, that's just hopeful, in a way so it's coming towards, towards everybody what and it's so are you looking at tele med, is that an idea where you're going to be able to video, chat with people and have real life Thanks, do you have any idea which way they're gonna go?

Julia Blanchette, PhD 45:02
So I can tell you my practice. Um, we have virtual visit capabilities for my practice in my state. Not all insurance covers virtual visits, though. So there's an out of pocket costs for some situations as of March 17, that may be waived by my hospital at some point, I don't know what's going to happen. But yeah, so we're going with virtual, but then like, yesterday, I actually had a patient who doesn't have a smart device, or a computer. So like, in that situation, we would do telephone, instead of virtual. So like, we're making it work, like know that we're not trying to push you guys, at least my practice, and I would hope everyone's like this. We're not, we're not trying to limit your resources, like, we know, you need your resources. So so so don't freak out, I would always call your practice or your provider to see what they're offering at this moment.

Scott Benner 45:57
Because it's gonna change pretty readily is this it's gonna change. Yeah, and this is, my best guess is this is going to go on for a number of months, probably. So

Julia Blanchette, PhD 46:07
yeah, as a as a health care provider and a researcher. I would say, it's not we don't really know when this when it'll stop at this point. But expect, at least for the next month to two months.

Scott Benner 46:21
No, I think I think eight weeks is the is the bare minimum? We're gonna

Julia Blanchette, PhD 46:26
Yeah, that's what that's what it seems like the experts are kind of directing towards, so it's not going to be over quickly. And, you know, I think this probably is, unfortunately, I don't think this is the first time we're going to be hit by a pandemic, either. So I think we're learning a lot from this experience, especially as healthcare providers, and I think we'll be much better equipped for next time, because right now, we're just doing what we can we're just adjusting as needed.

Scott Benner 46:52
I completely agree. Yeah. So have you met or heard of anyone with type one who has Corona yet?

Julia Blanchette, PhD 47:00
I have not. I'm waiting for it to happen, since I feel like I have a million friends that all have diabetes. care. I don't know anyone who's been diagnosed with it yet. That being said, I'm sure I'm sure. Yeah, it's coming. And I'm sure someone's had it. But you know, as someone with diabetes, it is really important to know that if you have any type of complications, you and or your blood sugar's are running higher, not blaming anyone for either of those things. I know a lot of people have circumstances where that's just how you have to live. But if you're in one of those situations, know that you could be at higher risk of contracting it, if you have well managed diabetes, for lack of a better term right now. And you don't have complications, you're not necessarily at a higher risk of contracting it. But with either situation. Like with any type of illness, you are at higher risk of going into decay, or getting ketones or having dehydration, or hyperglycemia, from contracting an illness. So we all just have to be careful,

Scott Benner 48:05
right? And I just recorded an episode that I put up today, I just recorded it last night with Dr. Adam Edelman, he said the same thing, just in general, the better you the better health you are in, aside from diabetes, just in any way you can consider, you know, the more capable your body's going to be fighting off a virus or right, you know, or maybe you know, I'm not saying keeping you from getting it, but it might make it more difficult for you to get it might make it more difficult for it to thrive. And you just in general, your quality of your health has a lot to do with your quality of your ability to stay healthy.

Unknown Speaker 48:39
For sure. Yeah,

Scott Benner 48:40
I agree. Yeah, it's just it. I mean, that's, this is common sense, right? We haven't really said anything too deep there. It doesn't mean that, you know, some, you know, Olympic pole vaulter with you know, point 14% body fat isn't gonna get the Coronavirus

Julia Blanchette, PhD 48:56
will. Right. That's the other thing too is it seems that there's gonna be situations that are exceptions to the overall situation. Like there's going to be exceptions where someone randomly gets a really bad case today, and there's no logical explanation. It just happened. Like I feel like that's also something we need to be aware of. So social distancing, guys.

Scott Benner 49:19
Yeah, stay away. Stop. Yeah, stop kissing people. Yeah, that's hot. You just wait a little bit. Relax.

Julia Blanchette, PhD 49:29
Oh, that's hard right now. Well, listen, the

Scott Benner 49:31
last thing I'm gonna roll into because of just because of your, your PhD, if else is what about people who are already sort of naturally anxious or, you know, depressed or worrisome like I have. I don't want to say who it is, but there's someone that I know who you know, sort of suffers from some, you know, mental health issues and you can already see that person bubbling over trying To think their way through this in, you know,

Julia Blanchette, PhD 50:04
yeah, so I think at this time, I mean, social isolation and itself can contribute to even greater feelings of depression and anxiety and isolation, right. And then just the angst that the rest of the world has right now can also contribute. So anyone that has already has a mental health diagnosis, they're already at higher risk of being they're being put in an environment right now, that's going to exacerbate their symptoms. So keep that in mind. And I think just like with diabetes, don't assume that your mental health care provider is closing, or not available. Like I'm telling you Everyone is making resources available. I also know in general, telemedicine. And I'm like, so tell it and then virtual medicine for psychological resources are both increasing in popularity in general before this happened. So if you don't already have a mental health care provider, look and see what you can get connected with online to see what services are available to you, because it's really important to take care of your mental health during this time. It's I mean, it's just going to exacerbate things.

Scott Benner 51:13
I'm thinking of just doing like a Facebook chat just for everybody to kind of come together and chill out. And you know,

Julia Blanchette, PhD 51:19
yeah, and I think community support during this time is really vital to

Scott Benner 51:23
know. Cool. All right. So now, Julie, I want you to be really thoughtful about my ads. Okay.

Unknown Speaker 51:31
Okay. Okay.

Unknown Speaker 51:35
Oh, boy, okay. He's good

Scott Benner 51:36
at this. This is a test for you. Okay. Are you using an algorithm based pump?

Unknown Speaker 51:44
I am, how is it working for you?

Julia Blanchette, PhD 51:47
It's fantastic. So I was using a different algorithm based pump before, which was also great. But yourself? Yes, it was a little more. Yes. Um, and I now using a different algorithm based pump. And I mean, honestly, like I was achieving greater than 80% time and range on both. But with this one, I'm actually having even less variability. So my standard deviation, which shows the variability, that's one of the measures for it is very low. On this one in comparison to the last one, even though I was achieving greater than 80%, time and range on both. And on this one, my 90 day average for timing ranges over 90%,

Scott Benner 52:34
what is your time and range set out? Your range?

Julia Blanchette, PhD 52:37
So I am I am a Diabetes Care and Education Specialist. So when I read reports, I use the same time and range that we use as clinicians, because that's how my brain works when I'm assessing. So and also in the, in the clinical trials, this would also be the way they've set time and range. So it's 70 to 180 is the way that providers look at time and range and the way that we look at like ambulatory glucose profile outcomes and metrics, and then it's also how the studies for all of these devices, look at time and range seems very

Scott Benner 53:08
reasonable. Yes, excellent. I have Arden's obviously set at my goal. Not Yeah, yeah. From 70 to 120.

Julia Blanchette, PhD 53:15
Well, no, that makes sense for you guys, for me, so I actually have my highlighter on my pump. Oh, sorry, on my device. I'm so pumped. That's the pump. Okay. Okay. So sorry. So my Hyler on my pump and on my CGM of choice, um, of choice and that is integrated with the system. Um, it's actually set lower than 180. But just for my reports, I put it up one at every once in a while for my

Scott Benner 53:40
for the reports on for art and stuff, I just switch it down, I switch it back up to 182. Yeah, I'm like, Oh, my God, we're doing great. And they push it back down. It's funny how pressure serves different people differently. Like, I like to set it at 7171 20. And when I when it says I'm out of range, even if she's 130, or 140. I like to know that 40% of the time, she's not under 120. So that I can write, it helps me think about how that happened. But I'm not. I'm not impacted by it. Like, for instance, last night. So Arden was home. This was her first day yesterday, distance learning for high school because her high school got shut down. Right. So I think she was maybe a little stressed out all day, and we had her we had her bazel cranked to like 150% all day just to keep her like more stable and down around. Yeah, one focus.

Julia Blanchette, PhD 54:36
She wasn't like running around school either. Like in the

Scott Benner 54:39
hallways a lot changing and I'm trying to figure it out. Right, but I did think all day. She's gonna get lower overnight because of this. And around 1130 her blood sugar started like trending down and we turned off all the you know, the extra insulin that we have going. Yeah, but I'm like this isn't gonna stop like I just know it isn't and she ate an uncovered Banana. And I kept, I turned everything down a little more. And then right when I know I needed the insulin to go back on, I fell asleep. Oh no. And so from about 3am till 6am artists blood sugar was like 270. It showed up out of nowhere and leveled off. Yeah. And when I got up in the morning, I just looked at I went, I fell asleep. That sucks. I fix it. And I didn't think about it again. But that's a long time with diabetes, practicing not feeling guilty. Not not going down that path of like beating yourself up and everything like that.

Julia Blanchette, PhD 55:36
You can't I mean, you're a person. You have to fall asleep. You fell asleep. That's how it happened, right?

Scott Benner 55:41
Yeah, this is not going to, you know, this is not going to negatively impact Arden's existence. No, and so and so I'm like, you know, cool. But there would have been a time years ago, where I would have beaten mice, I would have got up and like, what do I do you know what I mean? Like it would have felt, but, but I like that range set where I can feel I want the feedback. It doesn't Yeah, it doesn't make me feel bad. But But it took me some time to train myself to that. So okay, so you're so your timing ranges? is really excellent. Yeah. Are you still Pre-Bolus thing with this?

Julia Blanchette, PhD 56:17
I am right. Pre-Bolus thing is key. And I will keep saying that. So until the devices do not require you to Pre-Bolus which is coming. Um, the current devices Pre-Bolus thing is still key.

Scott Benner 56:30
Yeah. 100% do you think, from what you've seen, I know what I think. But do you think from what you've seen, this is the way the future? Or do you think this is the thing that five years now? We'll all look back? No, no. Do you remember that time we thought algorithms were going to help us with our insulin?

Julia Blanchette, PhD 56:48
No, I think they're gonna keep getting more complex. So I think I mean, I know, from some research presentations, I've been to, that they're integrating even more machine based learning into these algorithms for the future ones that are in development. So, you know, soon the pumps will be able to predict like, you're moving in this way you're about to eat, and then they'll be able to change insulin based on that. So I think the algorithms are going to be great. I think we're going to look back and say, Wow, we needed, like different types of insulin to work a little more efficiently in order for these algorithms to be even better.

Scott Benner 57:27
Yeah, no, I think improving insulin canula technology like little Yeah, that's what I think about right, like, those are the those are the, the points that should be focused on right now. But I'm just gonna say that I, I am looking very forward to the on the pot horizon coming out, when it comes out. And I'm thrilled that there are other options for people in this is it to me, this is, this is it, you're, you're right there,

Julia Blanchette, PhD 57:58
you know, and I think they're just gonna keep getting better. So I think, you know, the first couple that have been out here, like, maybe we'll look back and be like, wow, that really wasn't as much of an algorithm as what's currently available in five years, you know, but I think they're helping people so much. I'm not focus so much on the little decisions that we have to make constantly. I mean, there's still, obviously some psychological involvement with diabetes, but they're really reducing it. And I think they really are helping people achieve much better time and range. I do something Pre-Bolus thing is key with the commercial ones, though. Yeah. Listen, and I think that's what's helped me so

Scott Benner 58:37
2021 and 20. And 20, the end of 2020. Here in the beginning of 2021. This is the jumping in period. Like, yeah, I'm telling you, if you if you met me on the street and asked me I'd say do it, let's go. Yeah, yeah. Right. So

Julia Blanchette, PhD 58:51
yeah, there's a saying, stop. Yeah.

Scott Benner 58:52
And and then the next step, of course, is access and affordability and getting these things to a point where they're less expensive, easier for other people to get because then maybe one day, there'll be a world where the person who is not going to understand what was told to them in the hospital or doesn't get a hold of them. Maybe they really just will get a thing. You know, here, slap this on here. Put this on here. I'm going to put an app on your phone.

Julia Blanchette, PhD 59:17
Well, that's Yeah, that's what it's coming to. I can tell you that's, it's getting there. So it's really exciting.

Scott Benner 59:23
I'm excited to know that you agree. I really am. Yeah, because you've been using it for a while, haven't you?

Julia Blanchette, PhD 59:31
Are you allowed to say that? automated? Yeah, I am. Um, so I've been using this device for over three months now.

Scott Benner 59:39
Right. Okay. Cool. Yeah. Yeah. I just been doing this for a long time at this point now, too. Yeah, yeah. We just put some episodes out about it that I think you even came up online said you learned something on one of the episodes with Kenny, didn't you? Was that you?

Julia Blanchette, PhD 59:55
I don't know if it was me. I think I'm the one that will. No offense to the listeners. I'll send you messages. I was like, I thought about this a different way.

Scott Benner 1:00:01
Yeah, no, I like that. Yeah.

Julia Blanchette, PhD 1:00:05
I don't, I can't remember if it was I don't think it was Kenny. So I think it was a different episode. Gotcha.

Scott Benner 1:00:11
I hear, I just think it's a, it's so worth having these conversations, because you're laying a blanket of understanding across the community that hopefully we'll, you know, will one day be big enough to warm everybody? Yeah. Because you're not just gonna reach every single person. Like, you know, and this is not how it's gonna work. It's there's gonna be a trickle down. There are gonna be people who, you know what, not unlike how you spread the Coronavirus. There are going to be people who use an algorithm based pump, because it's something I said on this podcast, and they're never going to have heard of this podcast. Yeah. And I think that's important for us all to be doing spreading good information out to

Julia Blanchette, PhD 1:00:50
people. No, I agree. Good. And like accurate information is really important. Yeah.

Scott Benner 1:00:54
Trust me. That's a that's not as easy to get people to do. I know, but it's getting better. And you know, what is helping? This is gonna sound crazy. Facebook pages are less and less popular now.

Unknown Speaker 1:01:07
Yeah.

Scott Benner 1:01:08
Have you seen? Have you noticed that?

Julia Blanchette, PhD 1:01:10
Yeah, I think we're moving towards Instagram. But I don't know if that's more accurate.

Scott Benner 1:01:17
What I'm saying is what you're losing is a place where let's pretend you were diagnosed a day ago, and I was diagnosed a month ago. And I found this place online, me with my one month worth of information and pontificating about what I've learned. And you come rolling in thinking, Oh, Scott knows, listen, look at how he's talking. He must know he typed a lot. Yeah, you know, and you don't realize that you're listening to a person who's three and a half weeks ahead of you. Right? And then it just blends confusion. And the information still in there, because there's also people in there who are giving you good information. But when it's all blended together, like how do you figure out what which is, which like, what do you know, is a trusted source in that situation? Right. And so, you know, and that's blurring away. It's so interesting to have watched this for as long as I have, you know, I came into it during blogging, and Oh, yeah. And there were blogs that were rock solid. Do you know what I mean? Like, wow, you could you could you could bank on what was being said there, then blogging became popular, and then all of a sudden, there were a lot of opinions. Right, which are fine, except now how do I decide which opinion blog is good? Yeah. And then they kind of drifted away, blogs drifted away. And Facebook killed blogging. Yeah, right. Because it used in the beginning, you'd write a blog piece. And you'd post it on Facebook, and someone would read it and share it on Facebook and social sharing, like that used to be really popular. And so then the Facebook was good for the blogs. But then as soon as people opened up Facebook groups, and made them private, that killed the blocks, because the guac

Unknown Speaker 1:02:57
don't want

Scott Benner 1:02:58
you to leave the group. They want you to stay in the group. And so they don't direct you out to other stuff that killed blogging. And then now, I think that being able to get information in other ways, you know, is now is now hurting Facebook. And so those groups are dwindling down. And it's so interesting to watch how it just rolls through and changes and changes and changes. Super.

Julia Blanchette, PhD 1:03:22
Yeah, you've seen all of it. So I'm very old as well. You're not old. You've just seen the internet grow. Yeah,

Scott Benner 1:03:28
it's a very weird thing to go from dial up to this. Yeah, seriously. It's like I said last night. How is it possible that my kids are bored? Like at no other time in the history of mankind? Have you had more ways to keep yourself busy or fill your mind or anything that you do right now? My son was home from college for three hours to just wander around the house go What am I gonna do? I'm like,

Unknown Speaker 1:03:52
Oh, no.

Unknown Speaker 1:03:54
Poor guy.

Scott Benner 1:03:56
Oh, man. Yeah. are just like artigos school. Thanks for gonna read for 30 minutes a day. Haha.

Unknown Speaker 1:04:03
Man.

Scott Benner 1:04:05
Oh, man, I getting Julius PhD one day, that's for sure. Oh, God, anyway. Okay, so I'm gonna say goodbye here. And we're gonna spend 30 seconds, but me asking you about setting up some other stuff. So hold on one second. Thank you so much for doing this.

Julia Blanchette, PhD 1:04:22
Yeah, thanks for having me.

Scott Benner 1:04:24
Huge thanks to Julia for coming on the show and for considering being on some diabetes pro tips about more emotional and psychological issues regarding type one diabetes, look for those in the future. Thank you also to Dexcom, makers of the G six continuous glucose monitor. I appreciate that you sponsor the show. And of course, my longest advertiser, my dearest advertising friend, the Omni pod tubeless insulin pump. You can find out more about Dexcom dexcom.com forward slash juice box, have yourself an absolutely free no obligation demo of valmy pod sent to you at my Omni pod.com forward slash juice box. And the links to all of the sponsors are in those show notes of the podcast player you're listening to right now right in that app. They're also available at Juicebox podcast.com. Now, if you're listening in an app, and you haven't already, go ahead and hit subscribe, so you don't miss the next episode of the Juicebox Podcast, and then go look back, because there's about 314 other ones that you haven't heard yet if this is your first one. Okay, don't forget on March 26, at 3pm eastern time, we're gonna have a meeting, it's just a meet up, right, it'll be through something called zoom, you'll just click on a link to get into it. You don't need any special software, you'll be able to interact with, see if you want or just listen to other people just like you who are listening to the show. I'm thinking we're going to use it as sort of a support group, while we're all kind of you know, holed up in our homes. So that's Thursday, March 26, at 3pm. Eastern Time, there'll be a link on my Facebook page, my Instagram, and my Twitter, you'll find it or if you don't send me an email, I'll hook you up. absolutely free by the way, no charge No, nothing like that. No special software needed. Just bang and look around. Don't look around. You can turn your camera on or not turn your camera on. Right. And we'll just sort of like you know, shoot this

---

Please support the sponsors

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!

Donate

#315 Jenny Smith, CDE discusses Coronavirus

Coronavirus disease (COVID-19): Juicebox Podcast conversation with Jenny Smith, CDE

Recorded March 20, 2020

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

+ Click for EPISODE TRANSCRIPT

---

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 0:07
Hello, everyone, welcome to Episode 315 of the Juicebox Podcast. Today's show was recorded on March 20. It is a conversation about Coronavirus with Jenny Smith. At the end of the episode, I've listed some important talking points from the CDC website. Make sure you get to those.

Please remember that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise. Please always consult a physician before making any changes to your health care plan, becoming bold with insulin, or anything else that might come up. You know what I mean? Jenny Smith is a registered and licensed dietitian, a certified diabetes educator, and a person who's been living with Type One Diabetes for over three decades. Jenny has the exact same person you hear on the diabetes pro tip series during the defining diabetes episodes. And of course, ask Scott and Jenny. Jenny works at integrated diabetes. And if you want to check her out, or even higher, you can do that. Jenny's email addresses right in the link of the show notes.

This episode of The Juicebox Podcast is sponsored by the Contour Next One blood glucose meter. The Contour Next One is without a doubt the finest most accurate blood glucose meter My daughter has ever used in the entire time she's had type one diabetes, go to Contour Next one.com to find out if you're eligible for an absolutely free meter today. The podcast is also sponsored by touched by type one. When you go to touch by type one.org, you're going to see an organization that is working towards a cure, supporting people with type one diabetes, and putting on maybe one of the greatest dance shows I've ever witnessed. Go find out more about them. They're supporting people with type one diabetes all over the world. You might be one of them, go check them out. And if you don't need that support, and you want to help support someone else, this is a great way. Touch by type one.org is a great way to do that. Get yourself an absolutely free no obligation demo of the Omni pod sent to your house today. Go to my Omni pod.com forward slash juice box. When you get there fill out a little bit of information. And on the pod is going to send you an absolutely free no obligation demo of the Omni pod. You'll be able to try it on wear and see what you think. And of course, find out more about the Dexcom g six continuous glucose monitor the exact same CGM that my daughter wears today. Go to dexcom.com Ford slash juice box. Let's get to the show.

Jennifer Smith, CDE 3:01
Hello. Hey, good morning.

How are you today? I'm

Scott Benner 3:06
we're hanging in there. How about you?

Jennifer Smith, CDE 3:09
Yeah, I'd call it the same. Oh, I would assume calls home from school.

Scott Benner 3:14
Yeah, we didn't even make it through. My gosh, we didn't even make it through is I'm

Jennifer Smith, CDE 3:23
sorry. I didn't realize I was all covered. A little post it notes.

Scott Benner 3:27
I don't want to know what you're doing with your computer in your private time. It's fine. So Cole was in Florida for his college tournament. He got there Friday. We got there Friday. On Sunday. He asked us for Azhar tech thinking that his allergies were coming on the runny nose. On Monday, he asked for another one. Kelly and Arden left on Monday to go home. I stayed behind Tuesday was his day off. And when I picked him up Tuesday, late Tuesday morning to take him to lunch. I was like, are you okay? And he's like now I don't feel right. And I was like, okay, so I took him out to eat. And he didn't look good. So I said hey, go back to my hotel and lay down for a while. So three hours later, he woke up. And he woke up to an email from his coach and said we're having an emergency meeting to talk about the season. So I had to hump him back like a half an hour to his hotel. He was feeling better from sleeping, but, you know, he didn't look magically better than me. Right. You know, and they announced that the season was going to be suspended. That's what they do at the time. And he definitely didn't feel well still. So now he's like ask me kind of like trying to be like, slides like I couldn't have the Coronavirus, right. And I was like, I mean you could you know I said you know what, what are your symptoms at that point he had a sore throat, a runny nose, you know Now you don't have a fever, you know. So, right. So the next day comes Wednesday, he ends up pitching his face off against the number one ranked team in the country. In Division Three, just pitches, these two amazing innings comes out of the game. The game ends, he gets on a bus and goes back to the hotel. I'm supposed to pick him up for dinner, he texts me, he goes, Hey, I'm not gonna go to dinner. But come over here. He's like, I felt like I was gonna throw up on the bus. And so I think he used every ounce of energy, everything he had, and realized that he was sick. So on the way over there, I just stopped at a like a Walgreens. I'm like, let me just get a thermometer. You know? Yeah, stuck the thermometer in his mouth. He must

Jennifer Smith, CDE 5:45
be a dad. Yeah.

Scott Benner 5:46
100.4. I took him right to urgent care. Oh, my God. Now he's an urgent care with a mask on. And they swap him for flu. He doesn't have the flu. And the guy looks at his throat and says, Listen, you have strap? I can see it. You know, he's like, I'm gonna give you a antibiotic. And I said, Are you gonna swap him for it? He goes, man, this is strep throat. And I was like, okay, you know, fingers crossed and all. But I took him out of the hotel where the kids were where the poor kid had to leave his team. Wow, I just basically like shudder, like, just yeah. And the he didn't play the rest of the week, obviously. But the antibiotics did it. That's right. He had strap. Yeah. So but you know, in the moment, it was weird. And when he went back to watch the games, like from outside of the dugout, and the last two days, people were, you know, they're like, hey, how's he doing? Like, you know, we just want to make sure it's all right. It really what they meant. No, they really meant was Hey, got strapped we took given authority has exactly what I was saying. Just like just like, oh my god, are you allowed out of your house? What's the Wisconsin thing so far?

Jennifer Smith, CDE 7:03
So the Wisconsin thing is beyond the like, multiple levels of weather we have happening, like it was raining before and now it's like, fuzzy snowing, sorry, I'm looking out my window. But being trapped in the house. No, I mean, we can go outside. Our kids are out of school. The governor originally had a timeline of like, on April 6, but just two days ago, no, two days ago, we got another email from our school district specifically stating that according to the new guidelines, school is delayed or cancelled indefinitely. We don't know which my husband and I are like, okay, that means that Oscar is just not going back to school this year. That's what I think we will be homeschooling and I mean, the The good thing is that, you know, working from home, I'm here right? But the bad thing is that working from home, I don't have a clinic to go to so I have work that continues which is very good. It's good that people can utilize this type of telemedicine to stay up especially as things change and things happen and there are more questions that come in. But it also makes navigating my day a little bit more interesting.

Scott Benner 8:22
Okay, we're talking about the Coronavirus today. So here is on the pods website if you want to know more about how they're handling Coronavirus. It's it my omnipod.com forward slash Coronavirus. So if you want to get a free no obligation demo, go to my Omni pod comm forward slash juice box but if you want to find out about the Coronavirus and how Omni pod is handling it, my omnipod.com forward slash Coronavirus there they will tell you how insulin is responding to the coronavirus outbreak. They're going to tell you if Coronavirus is impacting insolence ability to produce its products, what sterilization processes are in place to ensure the pods are safe. may talk about reordering. I'm gonna jump through it really quickly. insolate continues to be vigilant monitoring and managing the global impact of the coronavirus outbreak. So that's how they start to talk about their response. They say they also have a comprehensive plan in place to ensure the safety and well being of their employees and they are going to continue to deliver on the pods to those who depend on the product manager type one. At this time. insolate does not anticipate any product supply issues. Pretty cool here. They talk about the sterilization process. Why don't you go check it out if you're interested my omnipod.com Ford slash Coronavirus. Next thing I have to share with you is a lovely email that I got from Rick Doubleday. Rick is the chief Commercial Officer at Dexcom. rick sent me a note and said at this moment, there are not any interruptions to Dexcom his ability to produce and supply product. However, we do anticipate near term delays in both customer service and tech support as we transition more employees to a remote work environment. wait times on the phone will be much longer than usual. We ask that customers Please only contact Dexcom support for urgent requests at this time. Dexcom is committed to communicating with their customers as the situation evolves, and customers should visit dexcom.com forward slash Coronavirus for latest updates. So that's directly from Rick. Now, if you want to get an Dexcom system going go to dexcom.com, forward slash juicebox. If you're already using it, you want to know how Dexcom is reacting to the outbreak, check that out right there. Now, when you start looking around the internet for a little break from all this, go to touch by type one.org. There, you're going to find an organization with the mission to elevate awareness of type one diabetes, raise funds to find a cure and to inspire those with diabetes to thrive. They've got great programs and services, all kinds of stuff. And hopefully, I'll be there and may speaking, if you know, we're allowed to travel again and get together with people. But you know, that's a long way off, I have good feeling about that. Anyway, touched by type one.org. Check them out today. Last but not least Contour Next one.com. That's where you can check out the Contour. Next One blood glucose meter, there's a little yellow tab at the top it says get a free Contour Next One meter today, check that out, see if you're eligible. This meter also has a wonderful app that works both with Apple and Android really helps take your data to a new level. Contour Next one.com. All of these links can be found in your show notes at Juicebox. podcast.com. Alright, let's get back to Jenny.

Jennifer Smith, CDE 11:57
My husband is on medical family medical leave right now from his company. They allowed employees who have family members in home or whatnot that could be at increased risk to take their family medical leave. So he chose to do that. I mean, he sees thousands of people a day at work. And he was like, yeah, I'm

Unknown Speaker 12:16
just gonna be at home with you guys. So I'm sure companies looking for some people not

Scott Benner 12:19
to come in anyway. They're correct.

Jennifer Smith, CDE 12:21
Yeah, yeah, exactly. So you know, that kind of works out for whatever limited time he can use that for? I mean, he'll have to go back to work at some point. You know,

Scott Benner 12:34
we'll figure it out. We're gonna become a socialist nation pretty soon.

Unknown Speaker 12:37
Right? Well, yeah.

Jennifer Smith, CDE 12:39
But I mean, I'm, it's interesting, because, you know, grocery stores and everything, those things are still open. I expect for like limited time. I haven't really looked at the websites to see Are you still 24 hours? I would expect? Probably not. But yesterday, I thought, I got the brilliant idea from actually somebody I was working with. And she's like, Oh, I just, I just go online. And I just ordered all my food. And I just pick it up at the door. And I was like, why did I not think about? Oh, so I went online. And I did that, oh, the next time I could pick up groceries at the grocery store that we most often go to is Monday, March 30. Like, at 6pm. I'm like, I'm out of all of the fresh stuff that I eat every single day. I'm like, I'm not living just on like frozen broccoli. So we picked

Scott Benner 13:27
one person. So one of us goes to the grocery store. Nobody the other person's not going. Yeah, tomorrow, we're supposed to go move cold stuff out of the dorm. I don't even know if they're gonna let us do that. But wait and see. But no, I think this is going to go on for months. I don't think the kids are going back to school this year. And everybody is now seeing, you know, for all the things we talked about that are important. If you can't walk outside without getting sick, nothing else matters. You know, it's really, really something else there. I there's that one model out of England that says between 600,002 point 2 million Americans could die in the next year and a half or something like that, which is it's funny. It's a staggering number, right? And at the same time, my son said to me, because he's, you know, he's younger, and he doesn't feel like he's gonna get sick. Right? He goes, how many people die anyway. And I was like, what, just like before this and I said, about 150,000 people a day worldwide die every day. And he's like, so was 2 million a lot. And I said, it is if it's you. Yeah, you know, there's a way to look at the world personally. And there's a way to look at the world,

Jennifer Smith, CDE 14:40
you know, globally, globally. And yeah,

Scott Benner 14:42
there's two things are they're very different. So

Jennifer Smith, CDE 14:45
we are exactly I see no,

Scott Benner 14:47
I stopped my 20 year old son from going to play basketball. He's like, we're gonna go play basketball like you're not. Yeah, no, you're not PlayStation, that's your dream come true. You can play it as much as you want. So, um,

Jennifer Smith, CDE 15:01
we have everything closed. I mean, other than pharmacies and that kind of stuff. So yeah.

Scott Benner 15:06
Okay, so let me let me first talk with you about this. I think it's just important right now with the timing to put out an episode for as long as it needs to be if it's 10 minutes or half an hour or whatever it has to be talking about how to manage through a respiratory illness. Because, you know, it's gonna happen and we can at least have a baseline idea. We don't know what this you know, what do you call it? By the way, do you call it COVID-19? Or the Coronavirus when you're just chatting about it at home?

Jennifer Smith, CDE 15:35
I've just been calling it the Coronavirus because I just I feel like all of these extra like, names to things just it's confusing in my brain. So I'm like it's the Coronavirus whatever they want to call it beyond that. Fine. Right?

Scott Benner 15:48
We definitely go with Corona here. Because in the you know, in the monsters incorporated movie when the sock touches the thing, and they yell 2319 2319. So when people say COVID-19 Kelly, here's 2319. And it starts the whole comedy routine in the house. So we don't say that like that.

Jennifer Smith, CDE 16:06
That's funny.

Scott Benner 16:08
We go Coronavirus, though. So okay, so we don't see, I've seen I think two people with type one on social media who have had it so far, but haven't really heard much from them. We're starting, you know, you're you're not really hearing from people yet who have recovered from it. Because those recoveries have happened overseas, we're right, you know, we're, we're still in the spot where you're gonna see, I mean, today is the 20th of March, we had a big increase yesterday in diagnosis, and I'm gonna guess it's gonna double today, because we're now starting to see numbers from, you know, people who were tested five, 810 days ago, right. So there was

Jennifer Smith, CDE 16:50
a really good post done, and you might have read it, The Washington Post did a really good article that had graphical of dots interacting with each other, and how, like, you know, no social isolation versus minimal versus extreme socializing, isolation, and how much difference that makes, but you still get a blowout of people, it's just slower, and it decreases that, you know, that you graph essentially, of how many people will potentially get it, I think the problem will be until we have hopefully a vaccination for it at a small level, and I think this is why it draws out how many months we're going to see things closed, and social interaction minimized and things. Because until we have a vaccination, it's just going to keep floating around, just like somebody is always going to bump into somebody that bumps into somebody that bumps into somebody that hasn't had it yet. And you know, they don't, but that being new from everything that I've read, the human body doesn't know what to do with it really yet, or how to form like the antibodies and things that it would normally form for the typical cold and the typical flu and, oh, I see this again, I had this, you know, two years ago. Now I can handle it better again. Yeah. I think

Scott Benner 18:11
a lot of people mistakenly believe that it's gonna have a season like the flu. And it'll just we'll get to a date, and you just won't hear about it anymore. And that I think, listen, I don't know anything other than what I'm paying attention to. But I just had Dr. Adam Edelman on the show the other day, in this episode with us going to go up right after that. He talked, I brought up the Washington Post article, and before I could tell him, it was out of the Washington Post he was was that in the Washington Post? And I was like, yeah, we've all seen that. Right? Yeah. Because it's such a wonderful visual visualization of how you know, spread happens. But I would say, this is gonna last two full Corona seasons, whatever this time is going to be, and then I think there's going to be a break, and then I think it's gonna come around again. And then it'll probably be a normal part of life, like the flu, and, you know, write SARS and MERS, and all that other stuff. But it just spreads so much more quickly. And easily then things in the past have. And so you're just seeing it, overwhelm everything.

Jennifer Smith, CDE 19:13
Right. I think that in terms of, you know, diabetes, I think people with diabetes, or even people with other, like chronic health conditions, where they've become, it's become a habit to be more careful about things like, you know, you change your pump site, or you take an injection, you clean the site, you wash your hands, or, you know, maybe you wash your hands before you do a finger stick or you put your, your continuous monitor site on or those kinds of things. So we we already are a little bit ahead of the curve of just paying attention to hygiene is in it cautiously in that sense, you know, but then, in terms of just management, I mean, the only the only one that I read about online with type one specific was, as you mentioned a guy over In the UK, I believe he was from he had gone on a ski trip in like, December, December, early January or something with a group of friends. And a good majority of the group got have Corona or had Coronavirus. He himself got tested because others in his group, he was positive. And his symptoms actually didn't show up for several days after he was tested positive, and he has type one. And he actually, in his article, he mentioned the fact that it wasn't so much the diabetes management. That was the hard part about it. It was he described it as like uncontrollable respiratory coughing. He said it was just so unbelievable that the only thing that helped was some type of medication, his doctor prescribed him and he went and he picked up steps to stop the actual coughing, but he said otherwise. And of course, this is an end of one experience, right? Everybody's experience with an illness is a little bit different. But I think it gives, it gives good information that if you were fairly healthy outside of just your diabetes, and you have fairly good blood sugar control, which is a huge key in a lot of this, then your management strategy for the illness piece of it shouldn't be that much different. If anything, you're you're gonna likely need I mean, most people with a respiratory illness who have a fever, or an infection, you're going to increase your insulin use. So

Scott Benner 21:35
I Well, it's interesting, because obviously, we this is a new virus, you know, for us and no one's really seen it before, but I've been managing Arden's blood sugar in one way or another for I mean, over 13 years, it's probably coming up on 14 years pretty soon. Viruses don't really change her insulin needs greatly. Now, I've seen it differently for other people, you know, but I just don't see a mass difference. I have to share this somewhere. So I'm going to do it here. So Vicki's been on the show before she talked about eating. What's the thing when you don't have any carbs?

Unknown Speaker 22:15
I can't believe that we're just Oh, like ketogenic ketogenic she was she Yeah.

Scott Benner 22:18
Vicki was on to talk about that. She and I were speaking this past weekend about something different. And she said something just hilarious. She's like, I'm not afraid of this fires. She goes, my immune system has already killed my pancreas and my thyroid. It could take this, it could take this Coronavirus. No problem. I was like, oh, but I think a lot of people with type one feel that way too a little bit. Right. Like, I mean, it's not everybody, but you talked to a lot of people are like, I don't get sick that often. You know, like my immune system is really great. I'm incredibly healthy with the exception of the fact that my pancreas doesn't work,

Jennifer Smith, CDE 22:54
right. I mean, honestly, I was until I had kids who started going that well, one child who started going to school, I rarely had even the common winter cold rarely. But, you know, so and even from that standpoint, I would say when you talk about you know, Arden's insulin needs don't really change so significantly, everybody is a little bit different. And I think the other thing to consider is the severity of the illness. And what At what point you are in illness, right, because I know myself with just a typical cold like the sniffles I might feel a little under the weather. But other than that, I'm going about my normal daily I'm not laying in bed like blowing my nose like minute after minute after minute. That typical cold, I maybe need a little bit more insulin like maybe five or 10% more it's not even as significantly noticeable and if I can remain at least moderately active, I actually don't even notice a difference in my insulin needs. Whereas if I have a really nasty cold my insulin needs will go up 40% from a basal level to start with and then if my post meals still aren't I'll adjust my ratios too.

Scott Benner 24:09
And there are there are illnesses that Arden needs more insulin for sure. It's those ones that are just sort of like she's got a little cough or her throat a little sore or has a little stuffy those don't seem to hit her but when she if she gets like, you know, knocked over by an illness when the body aches stuff happens and when the right rundown thing happens then and then you start getting like you said you start moving around as much you're more dehydrated, like there's a lot of stuff that goes into that

Jennifer Smith, CDE 24:39
well and I think you bring up a good he said hydrated right? It's we've talked about hydration piece just in general before but we talked about a respiratory illness specifically. I'm sure we've all seen the mucin x commercials right it's a little like blob of like mucus like you know haha I'm like in Getting your logs in your nose, and I'm not gonna let you sleep kind of thing. One of the biggest things to do is stay hydrated more. So if you're the person who's like, I drink eight cups of water a day, or I have five water bottles or jugs of water a day, you know what double that, because that fluid will help to move things faster through the system and keep that stickiness down. From the mucus standpoint. Listen, in

Scott Benner 25:27
plain words, if you have fixed not, and you hydrate yourself more thiess not will get thinner.

Unknown Speaker 25:32
That's right.

Scott Benner 25:35
It's just, you know, it's not something that's it's hard to, it's not hard to follow, it's hard to drink the water when you don't feel well. Right. That's the whole thing. It's difficult to maintain these good practices, when you feel like a truck ran you over and then backed up to see what it hit. You know that that really is the problem.

Jennifer Smith, CDE 25:54
There are some other things that are even not like, pharmaceutical, but things. I think that the Tea Company traditional medicinals makes a tea it's called throat coat. There's another one that they make, it's called breathe easy. All of them, they work very well. I've used them in, you know, a respiratory kind of bugs. So beyond going to your local pharmacy and grabbing everything off of the shelf, some of those things to kind of have stocked in your cupboard as a backup, um, peppermint and ginger can help to ease if you've got some stomach discomfort from like, post nasal drip and that kind of stuff. So there are a lot of things that we can do chicken broth, vegetable broth, all of those. I mean, there are there's actually really good research even just into chicken noodle soup when you've got a respiratory illness and the benefit of what that actually does for the immune system. Yeah.

Scott Benner 26:46
Well, you know, it's interesting as this is also new, and I think that it's going to continue to feel new even when we get deeper into it. Just the other day. You know, there's a wash of an article about you can't take ibuprofen if you have the coronavirus, it makes it worse. And I was like Now hold on a second. What just happened here? Like Did you know I started thinking about the podcast a little bit. I was like somebody stuck a pencil in their pocket and robbed the bank and was like, I know what this pencil just made me do. You know? And so and then it didn't take long for I think who to come out and say that ibuprofen is not a problem to take with the Coronavirus, right. It is really one of the problems with with social media, is it just anybody really could say whatever they want it and you know, if a person sees it, and they're scared, you know, they go back. So it's funny, we talked I you know, I talked about having you on for this to talk about management during a respiratory illness. But I mean, what really changes in management? Not a whole lot, right?

Jennifer Smith, CDE 27:47
Not a whole lot, honestly, I mean, you it's an illness. And unless you have another background illness, such as, you know, lung diseases or you know, there are some people with type one who actually have type one because of something called cystic fibrosis, right, which is already a lung disorder. So someone like that would have much more different management needs, even outside of the blood sugar component to it. So but when we're talking just about diabetes management with a respiratory illness, there shouldn't be much that you don't know in your normal Sick Day. packet of no checkoff, I got this. I got this. I got this.

Scott Benner 28:30
So when this all started happening, I thought, I'll put let me put some information out there'll be helpful people, and it was great to talk to Adam because he really did go over what the Coronavirus is and what it is and all that stuff. But as we were talking, and as I've been thinking over the last number of days, I think the most important thing you can do about the Coronavirus whether you have type one diabetes or not is be healthy, right like just be as healthy as you can be because a healthy body does a better job of fighting off viruses, colds and all kinds of things. Rock so much like well, you know, we're all locked up inside. Go back to Episode 210 and start the pro tips over again. It means like like get your blood sugar lower, stable, take out the variability. you'll move around a little bit even though it's probably gonna be in your living room for a while. We're here

Jennifer Smith, CDE 29:24
by the way, we've got lots and lots of online videos now that are free workout options, even my gym my gym like stopped all of our memberships so that we would not like have to keep paying for something and not being able to go but they also sent out a connection link for 150 workouts online that are free for us to use, which I thought that was a really nice thing just from a gym standpoint to do for its members. Um, but their 10 minute workout their 30 minute workouts, there are a lot You've got some equipment at home, you could even use your peloton or whatever it is, you know. So

Scott Benner 30:05
I think it's it's stay moving, stay healthy don't fall into like really poor diet habits because you know, it's going to be easier. And I don't know how easy that's gonna be to maintain over time, I don't know how easy getting food is going to be weeks from now I'm sure it's gonna get a little dicey at some point. Maybe just because you're gonna be scared to go outside, I don't know. But I don't think if you're really paying attention to the day to day numbers, and not listening to political conversations around it, but actually seeing what, you know, the CDC is saying those kinds of things. We are, we are following the bend of that, that Italy was falling, like we're gonna get a really big spike. There are a lot more people here we are spread out further, we have population centers, not just one or two, like smaller countries, too. We have, you know, countless dozens of population centers. This is not ending anytime soon. You know, if I had to bet money, I'd bet my kids aren't going back to school this year. I bet that things are gonna change moving forward, even. Yeah, you might start seeing work from home days for school in the future. And, you know, I think the other thing that's gonna happen here is we're gonna learn a lot about things that we've been afraid to look at. So far, like telemedicine is such a god example, right? You guys, you guys have been, you know, who else is talking to people about their diabetes through, you know, through video interaction, except for you. And now suddenly, every doctor's office in the world is like, this is how you go to the doctor now. Right? Right. Okay, so I think you have type one. Are you doing anything differently? No,

Jennifer Smith, CDE 31:51
I really not. I mean, other than, I mean, in my diabetes management itself. No, I'm not. I mean, we have, you know, all of the Sick Day things in the cupboard that we could possibly need. I mean, we actually went about was like, two weeks ago, before any of these school cancellation and anything of that nature. I was in the aisle just picking up some band aids. And I was like, you know, let's just get some extra things. Just like I could see what was sort of like, coming down the line, right? So I got some extra, you know, like cough medicine and that kind of stuff, just to have got popsicles in the freezer. All that kind of stuff. But other than that, my normal management is it. I'm managing the same way. I'm trying to get exercise every day in my house, or going outside and taking a run with my dog or, you know, whatever. I know some communities even have some restrictions on that, but we don't right now. There are plenty of you. In fact, more people I think I've seen like, I have to get Brashear like, let me out of my house. Right. Fair.

Scott Benner 32:58
Two days ago, Colin, I went to an outdoor cage so he could hit Hmm. And afterwards, no lie. His personality was brighter. He had more energy. He was smiling. Like he just he's not a person who wants to be trapped and sitting around and you have to almost the same as you sometimes can get lulled into being like Oh, 150 is a good blood sugar. 180 is not bad. You know, 200 is not far from 150 you can start getting to the like, Well, you know, Doritos for lunch is fine. Today, three days a week with the Reno's isn't bad, you don't I mean, like I haven't moved around a month, but I've only gained six pounds like you can like

Jennifer Smith, CDE 33:35
you can write, you can sort

Scott Benner 33:37
of just know that and slide into it and not know that it's happening to you. And then by the time that happens, you know, you're having that conversation with yourself like ooh, I've let things get out of hand. And then it's harder to get back from.

Jennifer Smith, CDE 33:50
I do think too, within that. from a management standpoint, we do have to consider some some things that if and when you can get to the grocery store, right? Because you're probably not going every other day or every three days Oh, I just need to pick up the milk today or I just need to do is you're like okay, everything on my list I can get it and I hopefully this will be stockpiled for like two weeks before I have to go back you know running in and out again. So from the standpoint of diabetes management and then making sure your list is full of all those things that you know keep you in line and it might even come down to making some more soups or making some more things that do last a little bit longer. I mean I know fresh fruits and vegetables and we certainly we have to go shopping either today or tomorrow someone in our house you know myself or my husband has to go because we're out of those we've got some frozen stuff but other than that our fresh is gone and I I like living on my frat

Scott Benner 34:50
Yeah, well listen, I am so the the I'm one of those people who usually goes grocery shopping like every few days. I'd much rather like bang in and Because that's how I like to keep the food fresh in the house, you know, I don't want to grab, you know, a ton of vegetables I grab enough to get me through a couple days. That's obviously a little upside down right now and might not be going as well. The other day, we ate leftovers, that I think in a regular situation, I would have been like, you know what, let's toss these out and start over again. But I was like, No, eat this. You know, like, What's another? What's another meal? Like? Let's get another meal. And prior to all of this? I guess not really prior to it. Maybe I just paid attention to it a little sooner. I ordered everything that Arden had a refill for I refilled. I'm starting to think I should have gotten to see but to just in case. She you know, I don't know. I don't know what, just in case three months from now, you know, other stuff starts happening me Meanwhile, pump companies Dexcom they all say like, we don't see this affecting our supply. But what if it? What if it's not them? What if it's delivery? Or, you know, what if it's, what if it's FedEx or, you know, whatever it ends up being. So I got all of our supplies, restocked. And I buy these juice boxes online that come in a big flat, and I was like, I'm gonna get to them, like garden could get low, like, I don't know, 150 times that I'd be okay. Yeah, right. Right, which I don't think she'll get low because you

Jennifer Smith, CDE 36:24
also have a goose box that works very well for her. Yeah, others don't. So you know, what works. And, you know, you kind of stockpile put it away, I know, my my glucose tablets that I really like to use have been out of stock online for quite a while. And so when I went to pick up my last insulin fill at the pharmacy, I grabbed two bottles of the only kind of that pharmacy brand glucose tablet that doesn't have artificial colors or anything in it. I grabbed two of them. And I actually, if I don't hide them, my kids will eat them. Like lip height these way away. So nobody else knows where Jenny's supply. I think,

Scott Benner 37:05
you know, I am not an alarmist person at all. But and I think this is going to be fine. Like I think this is gonna be a natural, it's gonna run a natural course. People are going to die. It's not going to be pleasant. I think we're all going to know somebody who died from the coronavirus next year. But at the same time, I did say to Kelly last night, I was like, let's start thinking more long term around Arden. Like that was the only thing I've said about diabetes so far. Like, I don't know what that means. Exactly. But let's always be thinking months in advance, not days in advance about Arden. And she's like, okay, and I'm like, I'm not worried. I'm just thinking we should change our focus a little bit. Right. You know, I did my best the week or so ago, I put up on my social media. I was like, Listen, if you have refills, filled, do it now.

Jennifer Smith, CDE 37:51
Yeah, absolutely. I know. That's actually one of the things that I also went through even my husband who pretty much leaves my diabetes management to me, I mean, unless I'm like, I need help with this or, you know, can you pinch my skin back here to put the Dexcom in or whatever, for the most part, it's all my management but even came to me is like, sure you're okay, on all of your supplies. You got enough insulin, you got enough of your pods. You got enough, you know everything and I was like yeah, I'm, I'm really good for you know, he's like, how many months? Like, hi, at least four months? I'm pretty good before I'd have like even maybe more than that, quite honestly. The biggest one is sensors, because I can't get more sensors other than what my insurance will cover. Yeah, I can't. The one the one thing to my pump right now is that I'm I'm kind of training on the control like you with hand up. So right now my pads are not being used a little extra,

extra.

Scott Benner 38:58
He's like, I gotta figure this other pump out for my job. So my my pumps are sitting in a pile I'm not gonna use.

Unknown Speaker 39:03
That's right.

Jennifer Smith, CDE 39:04
My Riley link gets a little break. And

Scott Benner 39:06
it's funny. Yeah, yeah, little extra stuff here and there. You know, little stuff off to the side, if you can afford to grab it. It really does make you think about the people who can afford it who are paying cash, or just, you know, that horrible. It's got to be in the back of all of our heads somewhere, right that, you know, if I don't want to be like, I'm not a doom and gloom person. But I do think this and I thought this before Coronavirus society is a paper tiger. It really is just holding together because we all agree to let it hold together. Right? That, you know, I don't walk across the street with a bat, kick my neighbor's front door down and steal his television just because we've agreed basically not to do that. Right. Right. Right. And but you know, it's it's assumed that if you get sick you go to a doctor a doctor helps you even if you don't have insurance. Someone will help you right? Yeah. Now all of a sudden your doctors are like, Look, call us on the phone. Don't come here. You know, the grocery stores always got food right? Now, Wow, well again, but it doesn't right now. And it makes you think, like bigger picture, like would it make you realize is that 10 pretty smart people who were writers sat in a room one day and said, what would it be like if zombies came? And then they wrote what they thought would happen. And, you know, that's probably pretty close to what's gonna happen. You know, it's, it's just where human nature takes us in these situations. The toilet paper is a great example, right? People are afraid, what makes them feel better control. having enough toilet paper feels like control. It seems silly right now. But it's true, like, right, it gives you some feeling of control. I filled Arden's prescriptions and got more juice boxes, and I bought, you know, I got the G vote the kids, you know, like stuff like that, but, and that makes me feel like it's okay. And it is okay. Unless, you know, people just decide to be lunatics. And then I don't know what happens next, you know, and none of us do. And, and that's the real, that's scary for every living person. But more so for a person who has type one or has something else who is who is your ally is reliant on these things working on the on the traffic lights going on, when they say they're going to, you know that that stuff that we just take for granted. So the best thing you can do is be be prepared. And and do your best and not lose your mind. Right, you know, don't go Don't go barging through people's doors with the you know, the bat, right?

Jennifer Smith, CDE 41:45
Give me that. It's so funny.

Scott Benner 41:47
This must have been in the consciousness a month or so ago. Because Because Arden came up to me six weeks ago. And just out of the blue, she goes, Hey, the zombies come? What happens to me. And I was like, so

Jennifer Smith, CDE 42:06
just a random teenager kind of idea.

Scott Benner 42:08
And she wasn't really talking about zombies. She was like, Hey, you know, this stuff gets upside down. You know, with the diabetes, what happens? It's like the first time she ever asked, and I said, I said, well, in truth. I said, If things really got sideways, I guess I would throw my morals away, go down to the corner and overpower as many people as I could and take as much insulin as I could for you. If we're if we're into the apocalypse situation, if that's what you're talking about. I said we'd lower your carb intake, which I don't think would be trouble because I don't think we'd have food. Eventually you I tried to keep the insulin cold. you'd run out of it eventually. And she goes, how long? I'm like, you'd be dead a couple weeks, a month later, probably. And she goes, Okay, that's what I thought. And I was like, I right on. And then we just sort of like, walk around the room. Yeah, it just she she wanted to know. I don't think she'd ever said it out loud. I think she knew, but she never said out loud. Like, what happens if these mechanisms go away? For me? I was like, that's pretty much it. It's like some of the Egyptians stayed alive a really long time. I was like, Oh, yeah, I mean, if you How long do you think you could eat kale before you just gave up?

Jennifer Smith, CDE 43:23
There are lots of ways to cook kale. I like

Unknown Speaker 43:27
that, you know,

Jennifer Smith, CDE 43:28
the other. The other thing to possibly do is maybe you know, get your own pig farm started. And then directions about how to make your own insulin and your you know, pig farm out of the pigs that you're growing in your backyard. Or

Scott Benner 43:41
I'll tell you what, if that kids, if that kids hanging her hat on that on me figure that out, she's in trouble. I could maybe do a podcast about it, but I don't think anybody would care. Right? But anyway, like, I don't think of that as, like, I didn't think of that as a sad thing. She just wanted to understand her reality. She got to an age where she was like, hey, just real quick, like, you know, right? What, what is this about? And it's not something I was talking about. Maybe she was hearing something at school, or like, I don't know where it came from, honestly, but I wasn't gonna lie to her, you know, and I wasn't gonna just be like, that'll never happen. I mean,

Jennifer Smith, CDE 44:16
who knows? We don't know what the future is. in any circumstance. Even without this. We don't know what the future necessarily.

Scott Benner 44:23
And if it if it happens, you're not going to stop it. If it's happening. You know what I mean? Like, it's, you know, and I just I told her, I was like, Look, I said, She goes, do you think it'll happen? And I said, No. And she said, why I said, greed. She goes, what I'm like, we live in a capitalist society. Everybody wants things. The only way they get things is to go to work. They want to go to work, they want to make money, they want to have things. I was like, it's what keeps people chugging along. It's what keeps insulin being made. And insulin pumps being you know, people like they think there was a guy one day who was like, I could make a better insulin pump. I bet you I could do this without tubing and he made it and turn into a business. And it was like, that's what keeps society moving people's desire to do things have things be alive. You don't I mean, I was like everyone's desire to be alive is going to be why you're going to have insulin and pumps and needles and whatever else you need. And, and I said, so while I can, you know, I can think about your little scenario here that you've made up in your head. I don't believe that's gonna happen, you know? No. So we'll say even with this, it's gonna it's going to pass. There'll be a day in the future where you'll say to somebody, do you remember that Coronavirus thing? Wasn't that crazy?

Jennifer Smith, CDE 45:37
Right. Right, exactly. It's, you're right. You're right. But I you know, in terms of even like, your daughter's question, I think you also, you know, you kind of bring we've already talked about like the supply component. But the going back to like, the age old management strategy, like maybe your technology dies, and you can't get a replacement for it. Do you know what to do? To go back to an injection? Do you have pens? Do you have syringes? Do you have you know, your vials? Do you know how to use them? Do you know what your doses are? All of those things are, they should be in your marked down list of I would know how to do this. If this happened, or if this failed, I could go to this parameter. If this fail, I could go down to this like 1940s way of management.

Scott Benner 46:33
I thought about it last night, and we don't have slow acting insulin in the house. And I thought she'd get stuck a lot. But I could do it with just her pager. Like I know I could you know what I mean? Like it wouldn't be perfect. But it would be she'd be alive, he would be alive. Yeah, and in enough time to go get some slow insulin somewhere. Right. But I think I could do it, you know, it's just, you know, there's a certain I'm thinking, I would probably create layers with boluses, like rock, like like just, you know, put in a bolus. Think about where it peaks, probably right at the peak time, put in more and just keep those like dolphins like

Jennifer Smith, CDE 47:15
flying through the muck have to do your own little like graphical chart, I don't sit here it should be done here. I dusted here, it should be done here. We kind of have to keep track that way, mentally, to not drive yourself like insane with a charged brain. But in

Scott Benner 47:31
my mind, if I know when it goes in, I know when it peaks and I know when it crashes, then I can put the next one in and create them

Jennifer Smith, CDE 47:37
for next week at

Scott Benner 47:38
the crash and just keep the peaks covering the crashes. And that should make a reasonably level amount of insulin the whole time. So

Jennifer Smith, CDE 47:46
and that that would work for somebody who has looked at and truly understands the total action time of their rapid insulin. This podcast for a while you're right, you do and I would say you know Scott definitely could do that. If you've not really ever figured that out. probably

Scott Benner 48:05
thinking a lot of people might kill themselves doing it. Yeah, oh, this is definitely one of those episodes where nothing you hear on the Juicebox Podcast should be conservative. But But I was really that's what I was thinking. Right? Like, would there be a way to bump insulin and over and over again, so that she didn't find herself without insulin? Or didn't find herself with too much? Right then? I don't know. I think I could figure it out. But, you know, again, it's because I, I can be like, I can be dispassionate about it. It's not me if I had diabetes, this is what the sound sounds like, Jenny, I don't know what I would do. If I didn't have so I can answer I probably just run around the house, I hit a wall and just passed out, you know, like, so it's, it's an interesting thing when it's for someone else,

Jennifer Smith, CDE 48:48
because you can step back and you can look at it for a second.

Scott Benner 48:51
Wow. And you don't have that Panic of like that your health is on the line.

Jennifer Smith, CDE 48:55
But overall, you should run to the pharmacy. And you should get well Jenny,

Scott Benner 48:58
I'm gonna tell you what I'm gonna. I'm gonna send an email when we're done to Ardennes. And oh, and I'm going to ask for some slow acting insulin. There we go. And I guess maybe two, I don't have a backup. Yeah, that's exactly what I'm going to do. And that's what we should all be doing. Right. It's just preparing.

Jennifer Smith, CDE 49:15
Just prepare.

Scott Benner 49:17
So did we learn today that at the moment with the information that we have, that a person with type one diabetes in the Coronavirus is going to get some level of sick and they're going to manage their type on the way they would if they got any other virus and

Jennifer Smith, CDE 49:32
in a normal illness? Yes, exactly. And I would think, you know, unless you're really newly diagnosed, and you've been a fairly healthy person outside of the diabetes, and you've never really managed an illness with diabetes yet, then sure it will be very new for you, and it's going to be kind of scary, you know, but the biggest thing really is looking at the glucose levels looking where they're going and seeing Gosh, I'm you know, so 7500 points higher than I normally run. Clearly I need more insulin. So

Scott Benner 50:10
Jerry, what's your what's your level of commitment to the podcast? Are you willing to get the Coronavirus? So we can talk about what it's like to have it now.

Unknown Speaker 50:19
Can't get you to go look a couple of handrails or something like that.

Jennifer Smith, CDE 50:23
No, and I can go hang out at UW hospital. Sorry.

Scott Benner 50:28
Gosh, do you think health care workers who are in situations where they may be more susceptible? Do you think they should step back from their jobs? Like, what would you do if you are in a hospital right now working?

Jennifer Smith, CDE 50:43
So, you know, given my profession, I know that my position would have been not necessarily cut, but I would have probably been sent home because I would have been outpatient, I wouldn't have been necessary to be there. Right? If I were a nurse, or a doctor or any other profession that's absolutely needed. And you We need people I mean, what, what would happen with all the sick people, if all the doctors were like, all the nurses were like, nope, okay, I just gonna go hang out at home, I can't get sick. I can't do this, you know. I would have to say that I would, I would do my job. It's even if I had, you know, people at home as I do little kids, a husband, or if I had, you know, an elderly parent, or grandparent or something living, I guess I would just live at the hospital then. Yeah, I wouldn't come home with it.

Scott Benner 51:37
You know, yeah, we're in a situation now where everybody's got a row, the boat, whatever, where they have in their hand they need to use and it's very similar. You know, when you think about police officers, right, or emfs or firemen? What do they just gonna be like how your house gonna fire? I don't know if you have the Coronavirus or not. So we're just gonna have to burn your life. At some point, there are some a lot actually of professions that just you don't get to think about yourself first. Well, that's, you know, what ends up? Kind of,

Jennifer Smith, CDE 52:08
you're doing social good. By continuing to do what you professionally chose to do. It is. I mean,

Scott Benner 52:17
well, when I was speaking to Adam, the one thing I said that was interesting that I've kind of noticed from afar is that we have set up a society that, for the most part for most people, goes the way you want it to go. Do you know what I mean? Like there's not a lot of, like, I remember my parents, you know, talking about getting a car, and it taken them seven years to get money for a car. Do you mean like, we're gonna get a new car one day, they never got a new car, they would always get a newer car, right? But no one ever woke up and was like, I will just take out a loan, and then I will buy this car. And then I don't need the money today, I'll give it to them. Like, like, we've set up a situation where if you have any kind of income and need something, you probably can get it. And that goes for entertainment, as well. Right? Our entertainment are amazing now. Like, we're all at the point now where we're like Disney plus nothing on here. I want to watch it. Like we're a little spoiled. Right? Right. This is the first time in my generation, and definitely my children's where someone said that you're being limited and there's no alternative. Right? You just have to do this. Right? It's very interesting. And people are so far, I think doing a really good job with it. Yeah, I don't see people freaking out or anything like that.

Jennifer Smith, CDE 53:34
I think it's hard. Even from a from the from the child standpoint, though, you know, our kids have gotten so used to social interaction. Right? I mean, very minimal numbers of kids are homeschool. These days. I've got a couple of clients who have I work with Who are they do homeschool their children. And I've actually email I'm like, I bet you're glad that you've been doing the homeschooling you'll know exactly how to do this. I however, do not. So we've been after school or after I'm done with work in the afternoons. Now we've actually just been getting in the car, and going and taking a drive around the city. Just to like physically, like,

Unknown Speaker 54:16
get out, change,

Jennifer Smith, CDE 54:18
and change the visual and change and see that, you know, the world is still there. Everything is still in place. It's just that we've got limited interaction.

Scott Benner 54:28
It really is we're all just trying to stay away from each other so that we don't overwhelm the healthcare system. Right.

Jennifer Smith, CDE 54:34
And for explaining to kids it's also something for explaining to I mean, you know, with a seven and a three year old, they don't really quite understand, you know, why can't we go to the coffee shop and get a flowerless cookie? Why can't we you know, well, they're closed so we drive past the coffee shop. You have to kind of visually explain to many younger kids and well it's closed you know, we can't go and see all the chairs are up. But why Mommy, can't we get a morning muffin. Let's go home and let's make morning muffins. So now we have morning muffins sitting on the counter in the kitchen. Yesterday,

Scott Benner 55:06
I had that conversation with my 20 year old son. I was like, Listen, you can't play basketball. And here's why. Because Do you want to wonder for the rest of your life if your buddy's grandmother dropped dead because you had to go play basketball, you know, like, just go outside, you have a net play by yourself. And that's what this is gonna be for a little while. It's tough because you because it isn't. It isn't hard to look at what you're missing. Like, I watched kids on my son's baseball team and every baseball team who were seniors, who were eight, eight games into their season, be told That's it, you're never gonna play college baseball again, say goodbye to everybody and get back on the plane to go home. Wow, it was hard. It was really interesting. All these kids weren't going to graduate from high school at a ceremony maybe or from their college. You know, that's all total. But like I said, I think at one day, it will just be it'll just be a story to tell people. You know, like, remember the time I'll tell you this. And I mean, this, I said this to Kelly last night, I was like we are parenting through. Our parents never had anything like this, that I can remember that they had to be parents. And my wife's like, my parents just sent us outside anyway, we'd be dead. They'd be like, go outside and play, you know. So I really feel a feel like we're gonna be professional parents when this is over, like really good at it. Because this is just another level Jenny.

Jennifer Smith, CDE 56:22
It's really funny. I said that to Nathan, the other day, I said, this is really kind of a it's a social experiment in teaching people who've been so used to and nothing against it. This is the way that society work. Because moms and dads all have jobs now and you send your child to daycare or you send your child to school. It's teaching parents what it actually means to like spend majority of your time interacting with your child. I wonder if somebody else isn't raising your child? Yeah, somebody is else isn't teaching them. It's on you now. 100%? That's,

Unknown Speaker 57:00
that's hard. Yeah.

Scott Benner 57:01
Yeah, I listen, I've raised two kids, as a stay at home parent, right? That means you get up in the morning, and you're with them 24 hours a day. And it gets long after a while. And you really have to have the fortitude to just push through and find the good and what you're doing and not make it feel like oh my god, this is my whole life like that, that whole thing. But I'm wondering how many people will maybe I wonder how many people will try to go back to a single, like income, like how many people are gonna like this and think, Oh, this is nice, you know, right. I never thought it was possible.

Jennifer Smith, CDE 57:33
I didn't know my kid could do this. Or I didn't know I liked doing this type of thing with my child. Or look how good my child is that like reading and we can read together and we can learn all these things. I mean, I think of all the like, books that hopefully people are reading and the games that they're getting out of the closet that have cobwebs on them and like, Yeah, because especially with kids, you know, specifically, as you know, you have to entertain them up to a certain age, you kind of have to do the entertainment. Yeah, yeah.

Scott Benner 58:06
I've got my pile of books right here. I'm hoping. Yeah, really only five fingers crossed. So okay, so stay healthy. Keep your blood sugar stable. I think the other thing we didn't say that I think is really important is get sleep. And as

Jennifer Smith, CDE 58:19
bunk water.

Scott Benner 58:20
Yeah. And try not to make yourself nuts. Like stress, people don't sleep well. People don't sleep, well don't fight off colds. Well, like the really the things you can really do is, you know, take care of your health, get some sleep, keep your stress down. And you know,

Jennifer Smith, CDE 58:36
and some of that keeping your stress down ultimately is just keeping as much normal in your day as possible. Yeah, you know, you get up every day at seven o'clock, keep getting up at seven o'clock. If you always have tea at nine o'clock. Keep having your tea at nine o'clock. You know, it's just keeping some of those normal scheduled things, helps to keep the stress level down to I think, too, if you're working from home, I know everyone's interested, but don't leave like cable news on 24 hours a day in the background, because they're repeating the same thing over and over again. And it's getting into your brain. So right.

Scott Benner 59:07
Yeah, right, Jenny, I appreciate you doing this. And I hope you guys all stay healthy there. And I hope you do too. Thank you. I hope hopefully this will help some other people do the same. So I'm going to read to you from the CDC website for a second. Older adults and people who have severe underlying chronic medical conditions like heart or lung disease or diabetes seem to be at a higher risk for developing more serious complications from covid 19 illness, please consult with your health care provider about additional steps you may be able to take to protect yourself. The site goes on to remind us to stay home if you're sick. But I think at this point travel bans are starting to go into place as I'm recording this on March 20. So you know that may be that may just be a given at this point. Cover your coughs and your sneezes cover your mouth and nose with a tissue when you cough sneeze or use the inside of your elbow. Throw used tissues into the trash. Immediately wash your hands with soap and water for at least 20 seconds. If soap and water are not readily available, clean your hands with sanitizer that contains at least a 60% alcohol. If you're sick, you should wear a face mask when you're around other people, even if you're sharing a room or a vehicle with them or before entering a health care providers office. If you are not able to wear a facemask or a sample because it causes trouble with breathing, then you should do your best to cover your coughs and sneezes and people who are caring for you should wear a face mask when they enter the room with you. If you're not sick, you do not need to wear a face mask unless you are caring for someone who is sick and they are not able to wear a face mask. face masks may be in short supply and should be safe for caregivers around the home clean and disinfect. This includes tables doorknobs, light switches, countertops, handles, desks, phones, keyboards, toilets, faucets and sinks. If surfaces are dirty, clean them use detergent or soap and water prior to disinfecting. The CDC goes on to tell you about disinfecting most common EPA registered household disinfectants will work. Use disinfectants appropriate for the surface. options can include diluting your household bleach. To make a bleach solution. Mix five tablespoons or a third of a cup of bleach per gallon of water, four teaspoons of bleach to a quart of water. Don't forget the manufacturer's instructions about proper ventilation when you're using bleach. And if you're going to use an alcohol solution to kill bacteria or the virus, ensure that it has at least a 70% alcohol content. This is all available@cdc.gov there's guidance from the CDC around the 15 days to slow the spread. Listen to and follow all directions for your state and local authorities. If you feel sick, stay home Do not go to work, contact your medical provider. If your children are sick, keep them at home Do not send them to school well. Think that cats out of the bag to around most of the country contact your medical provider if someone in your household has tested positive for the coronavirus. Keep the entire household at home Do not go to work, do not go to school, contact your medical provider if you're an older person stay home and away from other people. And if you are a person with a serious underlying health condition that can put you at an increased risk, for example, a condition that impairs your lung or heart function or weakens your immune system stay home and away from other people. Okay, so here are my plans for the podcast. Next week. There'll be two episodes that are just stories from people with type one diabetes stuff that's more entertaining. We're going to do some after dark stuff, you know stuff to keep your mind off things keep you entertained. I will come back with Coronavirus information whenever it's necessary. Dr. Needleman we'll come back on Jenny and I'll talk again. But the podcast is going to be here for you. I'm trying to figure out how to do a live chat for us all. So if people just need to feel a little less alone, they can get together and talk. that'll probably happen through the Facebook page. So keep an eye there. Perhaps even Instagram and I'm looking for a way to bring everybody in. Maybe in a third party platform. I'm doing my best on that. The Juicebox Podcast will run as scheduled. It's not going to go away. And I appreciate that you guys are such supportive listeners. I hope this information has been valuable for you. Please just use your common sense. Stay well stay away from people. Don't touch things. Wash your hands. be cognizant of your surroundings. Do your best to stay safe. Do your best to stay healthy. If you feel sick in any way, please contact your physician immediately. I'm going to read you one last thing the symptoms of coronavirus. People may be sick with the virus for one to 14 days before developing symptoms. The most common symptoms of coronavirus disease, the COVID-19 virus are fever, tiredness and a dry cough. Most people about 80% recover from the disease without needing special treatment. More rarely, the disease can be serious and even fatal. Older people and people with other medical conditions such as asthma, diabetes, or heart disease may be more vulnerable to becoming severely ill. People may experience cough, fever, tiredness, difficulty breathing in severe cases. Now having that in your head. Don't forget what Jenny and I talked about today. If you're a healthy person, if your blood sugars are well maintained, you don't fall into that category just because you have type one diabetes. Be healthy, keep your routine going. Keep your mind fresh, get some fresh air. Try not to go crazy in your house a little bit. You're going to be okay. The Juicebox Podcast is sponsored by Omnipod Dexcom touched by type one and the Contour Next One blood glucose meter. You can go to Contour Next one.com touched by type one.org My Omni pod.com forward slash juice box or dexcom.com forward slash juice box to learn more about the sponsors. There are links in your show notes at Juicebox podcast.com. If you can't remember those links, now might be the perfect time to check into some new gear, the stuff you've been thinking about getting, I mean, you got a lot of time to read up, right? I genuinely meant what I said to Jenny earlier, I'm not just trying to get you to listen to the podcast more. If you want to work on your variability if you want to work on keeping your blood sugar's more stable. Go back to Episode 210 of the podcast and listen to the diabetes pro tips again, you can figure it out if you're struggling. And if you knew what you were doing in the past, but you've sort of burned out a little bit. This podcast episodes can help bring you back around again. I want to wish you all a ton of success. I'm gonna see you soon. You guys are going to be okay. I'm gonna be okay. We're all going to be okay.

---

Please support the sponsors

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!

Donate

#314 Adam Naddelman, M.D. discusses Coronavirus

Coronavirus COVID-19 discussion for 3-16-2020

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

+ Click for EPISODE TRANSCRIPT

---

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.

Adam Naddelman, MD 0:00
My name's Adam Naddelman. I'm a pediatrician at Princeton Nassau pediatrics in Central New Jersey.

Scott Benner 0:10
Hello, everyone. Welcome to Episode 314 of the Juicebox Podcast. Today, we're going to talk about the Coronavirus situation. This one's going to be an overview with one of the brightest, most thoughtful doctors that I know personally. Adam and I met. A long time ago when Arden was born. Dr. Adam Needleman joined the Princeton Nassau pediatrics group in 2001. He completed his pediatric residency from New York hospital, Cornell Medical Center, and was chief pediatric resident the following year. Dr. Edelman received his medical degree from the University of Medicine and Dentistry of New Jersey, Robert Wood Johnson medical school in New Brunswick, New Jersey. He attended the University of Pennsylvania in Philadelphia, where he received a BA in biological basis of behavior. Dr. Edelman is board certified in pediatrics, and is a fellow of the American Academy of Pediatrics. So please don't judge him. You know, because he knows me. He's a pretty smart guy. Despite his tastes and friends. I'm going to ask you to please remember that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, always consult a physician before making any changes to your health care plan. We're becoming bold with insulin. Today's episode of the podcast is sponsored by the Omni pod tubeless insulin pump, you can go to my Omni pod.com forward slash juice box or click on the links right here in the show notes of your podcast player to get an absolutely free no obligation demonstration pod sent directly to your house. Omni pod will send you a non functioning pump but otherwise it does everything else meaning it looks the same. It's the same weight you can wear it and find out if you like it in my experience wearing a demo pod. You forget that the only pods even there after a very short time then it's kind of up to your imagination what's it going to be like to live with it to shower with the to work out with it? Normally I would say go to school or something but you know right now maybe you'll just in your house what it would be like to wear the Omni pod anyway, to get an absolutely free no obligation pod experience kit. Like I said my on the pod.com forward slash juicebox. Not even the Coronavirus should stop you from making plans to take better care of your type one diabetes. Please don't tell me I was thinking of getting a pump. But oh, this whole thing happened. Don't do that. Just keep moving forward with your health. podcast is also sponsored by the dexcom g six continuous glucose monitor. That is the CGM that my daughter has been wearing for ever and ever. It's the continuous glucose monitor that we use to make decisions about ardens. dosing. Right? When does she eat the stop below? When does she give herself insulin to stop a Hi, how do we Pre-Bolus for meals? What are the trends look like? How do we set her basal rates overnight during the day while she's in school while she's at rest when she's sick when she's well. The data that comes back from the dexcom g six tells you everything that you need to know to make great decisions. And then you can make those decisions with your needles with your pens with your Omni pod, however you get your insulin dexcom.com forward slash juice box. Find out about it right now. Okay, so my Omni pod.com forward slash juice box dexcom.com forward slash juice box. And when you're all done, and this whole Corona thing is overwhelming you you need a happy place to go touch by type one.org. Go watch some little kids with Type One Diabetes living well for a little while, check out what they're doing. Find out how you maybe can even get involved. That'll be good for your soul, touched by type one.org. And now, my friend, Adam Needleman. My goal here is for people to have a really firm understanding of what's going on because I feel like the media, you know is actually I'm seeing them try really hard to do a good job. But it's all piecemeal, right? you'll flip it on, you'll hear one thing, you can't listen all day, you can't listen every time they update their thoughts. And people have been listening for two weeks now. And two weeks ago, it was, hey, there's this thing happening somewhere else in the world. And maybe it won't happen here. And I just think that everybody's got fragments of an idea. So I guess I want to start like simply by saying it's a virus, right. But Corona isn't just this thing that we're dealing with right now. Am I wrong about that?

Adam Naddelman, MD 4:43
No, that's correct. So coronavirus is just the name for the family of viruses. Like for instance, I'm sure most people have heard of SARS from a few years ago and there's another one called MERS that was a basically in the Middle East. Those are both in the same family of viruses. They're different strains of this Same virus

Scott Benner 5:00
family. Okay. And and so do viruses just appear? Do they mutate from other viruses? How do they happen?

Adam Naddelman, MD 5:10
Well, so they typically will mutate. So the thought here is that this most likely originated in an animal, the thought is perhaps probably a bat, in bohan, where they have these open air markets, where there's a, yeah, there's a lot of food, a lot of animals really, that are alive and in these markets. And the thought is that perhaps the virus was sort of native to an animal. And again, the thought is a bat. And then it mutated in some way that allowed it to jump from an animal to a person. It's similar to what happens with like, avian bird flu, where you see this in Asia every once in a while where there's a some strain of a bird flu that gets into chickens. And people get really panicked that it's going to mutate and jump to humans. So they start literally just killing off like hundreds and hundreds of chickens, in order to prevent that from happening. So this happened, it may it may have happened and jumped to multiple people at once. Nobody really knows. But the cluster clearly is the cluster of cases, that seems really seems like it started this all came from that area of China, right. And what

Scott Benner 6:16
I've been able to kind of glean about these wet markets is that they bring the animals in, and they keep them alive for freshness reasons, and then they start they slaughter them as you buy them and cook them right there. Except you have a situation where one kind of animals in a cage stacked on another kind of an animal, they would never be that close to each other in nature and,

Adam Naddelman, MD 6:36
and they wouldn't be that close to someone who was actually like preparing them for sale and for food. And they it kind of reminds me of like the old time butcher shops where you had like the animals hanging sort of in the window, but they were never alive, like you didn't go, you know, you'd go into the back and pick out your lamb or something they were hanging in the window. This is similar to that, except that the animals are alive. And they're stored, like you said, kind of in close quarters. And I don't know exactly how whether or not the those markets would meet the same kind of hygiene and sanitary requirements that we have in the US, etc. So you just don't know. But that's where the thought is that it came from.

Scott Benner 7:12
Yeah, some some of the images I've seen online, these things are being cooked on just wire grates or trash can lids and being slaughtered at the same place, they're being cooked in the same place they're being eaten. It really is. I mean, not that I know a lot about it, but it's it's overpopulation people need to eat, you know, and when there's not when there's not farm produced food, they have to go out in the, in the wilderness, and in this case, find bats and whatever else they can find to stay alive, you know.

Adam Naddelman, MD 7:38
So yeah, but the thought is that it probably jumped. So the virus must have mutated from whatever form it was in before and then jumped to a person and it was highly infectious at that point, and very efficient. So it would, it was very easy to pass from person to person, which is why it's spreading as quickly as it is. And then on top of that it unfortunately has the added characteristic of being quite a bit more dangerous than like a typical flu or a cold virus would be.

Scott Benner 8:07
So let's talk about how it transmits. It's, when they first started talking about it, it was I heard a lot of like, wash your hands, you know, but now I'm hearing more than it's airborne, or be on surfaces,

Adam Naddelman, MD 8:19
there are very few viruses that are actually airborne. measles is probably the best example of one. measles is probably the most infectious agent that we've ever encountered. Like if you take a person with measles, and you stick them in a room with 100 people that have either not had it or not been vaccinated, and you just let them kind of hang out in that room for a while 90 people in the room will get it, then so that's airborne. And that's like incredibly infectious. This is not that at least as best we can tell this looks like it's actually through droplets, which that just means you sneeze, then the virus is expelled from your mouth, your mouth and your nose. And it's on a little droplet of you know, fluid. And that either lands on a person or lands on your hand. And then I shake hands with someone and then they touch their face, and it gets passed that way. So the problem though, is with droplets, it can look like it's behaving like it's airborne, because if you sneeze on a surface, it can survive on the surface for sometimes as long as you know, several hours, then if someone else comes along and touches the surface touches their face or mouth, they can pass it to themselves that way.

Scott Benner 9:23
Is that uncommon for viruses to be able to survive like that on the surface of something

Adam Naddelman, MD 9:28
in a dry? No. I mean, the ones that are through droplets can survive. It's just this one seems to be a little bit more kind of Hardy and how long it can survive. It just it seems like it's it survived for a while. What they're saying now about this virus in particular is you really need like, this is what the guidance says it has to be more than 10 minutes of kind of face to face contact with a person that's less than six feet away. So you can see where all this social distancing stuff and I know I'm kind of getting ahead of myself a little bit but that's where a lot of this these thoughts Coming from,

Scott Benner 10:00
right. So if we just don't have those interactions, we won't pass it around. And, and I guess one of the bigger issues must be that the incubation period takes a while, right. So once I'm affected by it, I might not show symptoms for a while or at all.

Adam Naddelman, MD 10:18
Yeah, so you can be infected and be completely asymptomatic. And some of the data that's coming out from what we're seeing overseas is, looks like people who are asymptomatic are sometimes the highest shadows of the virus, which is why it's so crucial to do the 14 day thing, because the thought is, you probably can be asymptomatic for as many as four or five days before you start either showing symptoms or your body just lights it off. But once you start showing symptoms, the guidance now is that you really ought to be symptom free for a week before you put yourself around other people again, so you could see where the 14 days certified before seven after that kind of a thing. And now it's not precise. And if you're sick with the virus, and it's confirmed, it's probably a little bit different in terms of timeframe, because it depends on how sick you get, how long it takes you to recover. But that's kinda where that comes from.

Scott Benner 11:13
All right, that makes sense. So there's just, there's no end to be really when you stop and think about regular life. You don't realize when any of these situations are happening, honestly, like if somebody sneezes like, it's just you're like, oh, God bless you. You don't think right? Now I have this because even if we get sick, it's interesting, isn't it? Like we don't live, at least I don't live thinking, Oh, I'm gonna get sick. And if I do get sick, I just think, Oh, no, I got sick, and then I'll wait it out or lay down if I depending on how bad it gets. But I never think I'm sick. And this can be passed on to so many multiples of people without me knowing it's happening.

Adam Naddelman, MD 11:52
Now, it's a great point. And one of the things with this virus, too, that makes it a little bit unique, I guess are not unique, but it just makes it more dangerous is it's a little bit more infectious. We think then what the flu even is. So they talk about viruses. And they use this our number, which is basically just a, a variable that gets factored into how they do a lot of these calculations in terms of how infectious thing is, but it basically how many people are you likely to infect if you yourself get sick with that illness. So like I said, before, with measles, if you're in an unvaccinated population, you're going to infect a whole ton of people, just a ton of people, right? with the flu, the average flu and an average season, you're probably you're like, say somewhere between one and two and a half people on average. With this, this appears to be more like two to three and a half or four. Now that doesn't sound like a big difference. But imagine a class of like 30 kids. And if you're gonna if every person and there's likely to infect three other kids, the whole class is going to be sick unless you split them all apart, right? If you only get infected one other person, then you're probably it's probably not going to get to everybody before there's some level of protection within that classroom because you have kids that are now immune.

Scott Benner 13:11
So I've seen a lot of those people are making visual representations of what you're just talking about where, you know, there's like 1000 dots bouncing around in the box, and they give, you know, three of the dots the Coronavirus, and as they start banging into each other, it moves across. And it is fascinating to watch how quickly that happens, how quickly three can turn into six that can turn into 12. And it just multiplies so amazingly fast in random ways that you would just just couldn't imagine, I guess.

Adam Naddelman, MD 13:40
Yeah, I mean, that's exactly what we're talking about. I saw another good one the other day, which was like just a matchbook with four matches close to each other, and one that was further away, and you just like the first one, and then they're all gonna light. And then the fifth one that's further away, it doesn't like the same idea. But the one that I saw the same simulation you're talking about, I think was from the Washington Post. And that, to me was the best example. It was just sort of the random movement of people in a grocery store. And if, if, you know, that's really if it was airborne, like if you all if all you needed to do was sort of walk past someone and you could get it, then yeah, that really makes sense. But it's the same concept. And the more infectious it is, the more likely you're going to be in a scenario like that. I just

Scott Benner 14:19
think it's important to remember that most of the actions that are going to cause this the transfer from person to person are not things that you're aware of, you can't you know, you can you can say don't touch your face, for instance, but, you know,

Adam Naddelman, MD 14:31
it's impossible

Scott Benner 14:32
doubt yourself from doing that. Right, just the same as you when you approach somebody, it's really common to feel like you want to reach out and shake their hand or if you're closer to them, you want to give them a hug and you don't you don't imagine like, hey, that guy sneezed five minutes ago, and then I'm gonna hug him. Then his collar is going to hit my collar then later I'm going to adjust my collar and then later I'm going to pick my nose and then I've got the Coronavirus, right.

Adam Naddelman, MD 14:54
Exactly. Nobody thinks like that. And that's why I think it This has been such a challenge for so many people. Just the process. I mean, I think, you know, it's easy to say, Oh, you know, these people should all understand why they need to do this distancing. But it just doesn't. We're not, we've never been in a situation like this before, where you have to have such a high level of awareness of your personal space, and who you're letting into that space and whether or not you let your kids do certain things. It's just not normal for us to have to deal with it. And it sort of runs counter to everything that we do, like you're saying, on a regular basis. I mean, you're supposed to greet people, you're supposed to hug people that you care about, you're supposed to go visit your relatives, you're supposed to have, you know, fun with your friends at a restaurant or a bar or something like, it's to think that you have to sit in your house and spread yourself out and not get near anyone, it's just, it's really hard to fathom that we could be in this situation, but there is no doubt that we actually really are in this situation.

Scott Benner 15:48
This is not someone's imagination, this isn't media hype, it's

Adam Naddelman, MD 15:51
now is happening, I think you can make a really strong argument that we were actually pretty slow on the uptake of all of this with the knowledge that we had about what was going on to the rest of the world. And that's, I think the fear that a lot of people have, it's just that it may be too late. Like, there's a lot of people that believe once you get to, say 1% of the population, or, you know, maybe 2% of the population, once you get to numbers like that in terms of people infected, you can't contain it the way that we are trying to it. That's why now they're clamping down so hard so quickly. Because I think finally it's really sunk in. And I think the governors are the ones really leading the way on this, because they're the ones that have the costumes right in their backyards. But that's really where that all comes from. I was talking to Kelly, and she said, if this persists into a second season, I don't see how most of the population won't have had this in one way or another a year from now. Yeah, well, it's a lot like the Spanish flu, or the h1 and one from 1918. That's exactly the model of what we're talking about here. And that's exactly what happened. So you had this time of year, incredible outbreak where no one had any level of protection, there was no flu vaccine back then, like we have now. And there were no antivirals. And the conditions were not what they are now. And so a lot of people got sick, and then it kind of started to Peter out a little bit. And then when the fall came, it came roaring back. And now this is probably a little bit different than that. That particular strain of flu was just for whatever reason seemed to really kind of persist for longer than you might expect. But yeah, I mean, this virus, nobody has any native protection to it. And so we're in a similar situation where you could end up with a second wave, like we're talking about later in the fall.

Scott Benner 17:40
I think for people who can't believe that it could reach everybody, at some point, think of this, if you can, it's it's apples and oranges. But it's apples and apples in the same way, I think and you'll stop me if I'm wrong. We all have the common cold at some point during the year, nobody goes through a calendar year and doesn't have a cold, right? Like it happens eventually, which means these things get passed around in ways you don't imagine is that is that a similar way of thinking of transmission? Well, it would be if you weren't doing all the things that are happening out. So the whole goal of all this social distancing, and the you know, getting rid of all the

Adam Naddelman, MD 18:18
sports and Broadway and restaurants and all that is, the thought is that if you can get that coefficient of infection, that R value down to like under one. So if you get it, you're likely to only give it to just one other person instead of two, or three or four, that changes the whole thing. Because then you can get, like, let's say it gets into my house, just God forbid, but let's say that, and I get sick, and I give it to one of the other, you know, four people in my house, then and then the two of us both get better. After the 14 days we self quarantine, we're better in 14 days. And between the two of us we only I only give it to one person. So you can make an argument that the are like in my house was point five, right? Okay, you can see how then it died out, you know, and like my little cluster of it just stopped. I didn't go that I didn't go and give it to 10 other people, it just stopped. picture that all across the country. So if there's, you know, I don't have any cases are reported. Now it changes by the minute, but say there were 10,000 cases. If everyone did that, and only gave it to half of another person, then all of a sudden the new cases being reported that number will start to drop. And you'll get to a point where it doesn't have a way to get around enough in the community. But that's exactly why if you're going to make this these kinds of measures work, they have to be across the board across the country, you have to lock down travel you have to do all of that. Otherwise, like you're saying it what's to stop it from you know, okay, we do that we do a great job for three weeks and then a whole bunch of people come over from wherever they're from. They're where they all have it on a cruise ship and they get off they get off the cruise boat, you know, cruise ship in Miami, and boom, it just started here it starts up again. So everyone has to do it at once

Scott Benner 19:56
right so there's a way to affect there's a there's going to be a curve either up or down. And we can impact it by doing all the things that people are talking about, we're gonna talk about those things, too, so that people understand, I just think it's really important for people to hear, there's no way to just ignore this and stop it. You know, you're not gonna do that.

Adam Naddelman, MD 20:16
I mean, what I was saying earlier today, when I was talking to somebody else, just, I think you have to think of this as not so much that you don't want to get sick, it's that you don't want picture the person in your life who is the most well, most vulnerable, you know, whether that's a grandparent, or it's a relative that's fighting cancer, or it's a, you know, newborn baby that has medical issues, what whoever it is, and picture like these actions being put in place to protect that person from getting it. That's really I think, the way you have to think about it, because those are the most vulnerable people. And that's who we don't want to see all piling into emergency rooms, all at the same time.

Scott Benner 20:54
Yeah. And you have the diligence that's involved is, is extraordinary, actually, because if you think about when you're sick at home, maybe I'm just speaking for myself and about the gross people out. But you know, you make this you live in a family, you make an announcement, at some point, Hey, no one touched my drink, I don't feel well, you know, you mean or you've got kids and there'll be like, Hey, Dad, give me a drink your water that happens all the time. But you know, after a couple of days, once you're not not in anymore, you don't think to say to anybody, your kid comes by and grabs a water or you hug people or give them a kiss again, this is where I think it's going to be difficult for people not just to remember not to do it, but to be militant about the time that it takes, right, you know, now say I do that, say in your scenario, you come home, you have it, you end up only giving it to one other person your house, you wait the 14 days, you're both good. If the third person your house, gets it and brings it back in, can you get it again?

Adam Naddelman, MD 21:46
So that's a great question. It looks like I mean, again, it's just so hard because there's not enough testing to really prove all of this. But when you look at the what people are experiencing overseas, because they're ahead of us, they are not seeing reinfection at all. They're just not now, is it possible that the virus at some point mutates and there's a second strain of it, and maybe you can get the second strain? I guess it's possible. But that's not what's being reported at all at this point. Which is actually very promising, because when a vaccine does get developed, it can be against this particular strain of coronavirus. And you would hope that it would be effective. For that reason? Is there a chance that it could just morph again? Yeah, no, there's, it can mutate and change. I mean, there are lots of I that's what happens with the flu virus every year now that this is a different kind of virus. But the whole reason why you have to get a flu shot every year is that the strains will shift and change over time and turn into slightly different strains than they were the year before. And if you have just last year's flu shot, it's not going to be as effective as the one for the current season. Now, this is not the same type of virus, so it doesn't behave exactly the same way. But that's, in general, that's just a kind of a, like a

Scott Benner 22:58
kind of nonspecific or broad way to think about it. Is that in I realized this is a layman's term, example. But is that the virus or the flu in that other scenario? Is that that thing just trying to stay alive? Like, is it does it adapt? Like, is it adapting the way I think of, you know, we don't need our appendix anymore. Like,

Adam Naddelman, MD 23:19
sort of so think of it this way. It's not so much. Yeah, that I mean, that is the way to think about it. But it's, I think you have to just think about it as more like a series of random events, right? So you have these, this flow that's out there, it's probably mutating slightly over time, and the antigens that kind of get presented on the flu virus that ended up being what triggers the antibody reaction, and you, those are shifting slightly over time. And there's some, at some point, like one of them hits the jackpot and says, okay, we shifted, now we can infect people more easily now we can evade the antibodies that this person has from the flu shot they got last year. So now I can get past person a person. It's really just evolution, it's just shifting, there's little mutations that caused it to shift slightly, that at some point conferred advantage. And that advantage allows it to be passed person to person more easily or allows you to, you know, evade Tamiflu or allows the abaza to evade the the antibodies that are in your body that are from your Western flu shot like that's sets the way it works, typically. So thinking out into the future, it's completely possible that this will run through society will build up some sort of an immunity to it, it will dissipate. And as long as somebody doesn't decide to eat monkey brains next year, we should

Unknown Speaker 24:38
be like, like, don't I mean, like, is

Adam Naddelman, MD 24:39
this? No, I mean, yes, yes or no? Say it that way. I just wanted.

Scott Benner 24:45
This is our new normal, like, Have we reached a new level, like five years from now? Is there just going to be Corona season?

Adam Naddelman, MD 24:50
No, not necessarily. I mean, I think that this is probably going to look more like what happened with SARS and MERS. The difference with the with SARS especially Which is a coronavirus that was in Asia, but never really got out of Asia. And the only reason was for some reason that back that virus, when it jumped person to person, it tend to weaken a bit. So I know I'm not I'm not sure anyone really understands why this is. But by the fourth or fifth jump, it kind of petered out, it became much less infectious. So it was hard for it to get out of where it was, it infected a lot of people in those areas, a lot of people got really sick, but it never like, made the leap onto a cruise ship and ended up in the United States or ended up on an airplane. And, you know, there might have been isolated cases here and there, but it wasn't infectious enough. But ya know, it's look, I think that we're in a very connected world, it is very easy for an infectious agent like this, to jump and end up in the US or to start in the US and end up somewhere else. I mean, with the way people travel now, it's virtually impossible to expect that this wouldn't happen again, at some point down the road.

Scott Benner 25:55
Well, so then. So then I guess the question is, I think what people's there, I think fear, obviously is alive around the subject. I think most of its around the disruption of life, even more than health, at least the people I've talked to so far, I think we've done such a good job in America, at least in building a world a life for people where they get to do mainly what it is they want to do. Like, we're not used to being told no. Right? Yeah. You know, like that, that sort of thing doesn't isn't a custom. I think people don't want to get sick. But I actually think that it really, it really is more towards the people who are at risk. I think the people who feel like they're not at risk are probably like, whatever. So if I get sick, I get sick.

Adam Naddelman, MD 26:38
Well, and I think that explains why you saw so many people who thought it was a good idea to go to restaurants and go to bars and basically forced these governors to say, all right, you know what, you guys, that's it, you're done. Like, it's almost like when your kid won't get off his phone, and you have to eventually take it away from them. I mean, I think you're right, people are not used to this. And they don't believe it's a bad combination, because they're not used to it. And there's also a pretty significant level of mistrust. Among the way the population looks at authority figures and expertise and the media and the politicians and everybody else. Everyone's like, yeah, whatever, it's fine here. But this thing's all the time, no big deal. And people don't don't take it seriously. I mean, they're pictures of people at Disney World. Yesterday, it looked like any other day at Disney World, or, you know, people in restaurants or there was a data clear out Bourbon Street a couple nights ago, because people were out partying till all hours of the night, not taking it seriously. And you know, it's not their fault. I mean, this is like you said, this is the society we're in and, but you need really strong, really clear and kind of consistent messaging.

Scott Benner 27:43
explain to people why this is so important. That's why I wanted to do that's why I appreciate you doing this so much, actually, because I just I don't know, I, you look around you think this this is your reaction to this, like you know, it that Oh, I'm not in the in the group that's at risk. And by the way, too, for people listening. Watch how you say something like that out loud. Oh, it's only killing old people and sick people? Well, you know what, that's a hurtful statement to older people. And you know, people who have pre existing conditions, especially for most of the people listening this podcast, and I want to talk about that too, and find out if people with type one diabetes are at a greater risk. But I want to first find out how you're treating people. So you're a pediatrician, and are you getting massive amounts of calls from everybody now? I guess we'll go back for a second. I was with my son a few days ago, he was playing baseball, and he got sick. It started with a runny nose. And then he got kind of wiped out his throat started to hurt. He had a little bit of an intermittent cough. Looking back on it. He was in a warm weather place and he's got allergies. So the nose and the cough were probably the allergies and the sore throat ended up being most likely strep. But in that moment when it all started happening, and we were like, intermittent cough, it's not wet, his throat sore, you're like, Okay, he's got Corona. You know, like, your brain just jumps right to it. Now luckily for me, I was able to text you, but I texted you from right from urgent care because I took him right out of a situation took him right to urgent care. And I thought, Let's find out. You know, what's up with this kid. But the first thing I find out when I get there, so big sign hanging up, says, Hey, if you think you're the coronavirus, we don't have any test for that. So you know, put this mask on and wait your turn. So it turned out that gave him antibiotics. And he's of course significantly better now because he had it he had strep throat. But I'm trying to imagine all of the people in all the towns across the country calling their doctors offices that that is that your exists

Adam Naddelman, MD 29:47
right now. We're pretty much

definitely you know, my friends like you who text me and said

no, but it also is just No, it's okay. In all seriousness, yeah, I mean, everyone is concerned I mean, I'm sure, you know, for all the people that are hearing this, I'm sure there you have friends that are saying, Oh my god, I'm congested. I wonder if I have it. Or I'm coughing, I wonder if I have it, you know, and it's difficult because the numbers that we're seeing from China and from Italy, as best we can tell, at least 80% of people that get it are going to have a mild illness. Probably even more than that, it's probably a higher number than that, because we can't actually test everyone who's walking around with the symptoms like you described, but at least 80%. You know, it could be as high as 90%. But at least 80% of the people are going to have a mild illness. So what we're doing because we can't test, as you said, at least not yet, there are very strict criteria for who can actually be tested. But what we're doing is just saying, Listen, thankfully, and children, for whatever reason that it appears that the virus is actually quite mild, in general. So we feel very comfortable saying to the vast majority of our patients, if you're congested, if you're coughing a little bit, if you have a little low grade fever, you're okay to just hang tight at home, stay away from other people as best you can. And let's see what develops in the next couple days, and the vast majority of those kids are going to define as if they had a cold. Now, would it be great to be able to do a swab like we do for strep to say, hey, look, you have it, and then to prove to people that you had it, and you were fine, of course, but that doesn't exist right now. When you say in children, is there an age range you're seeing, they're saying that from all the numbers I've seen, it's really, it's really lm under 18. There are a few reported cases in overseas of, of older teenagers that got a little bit sicker than you might expect. But again, without knowing the background on them, it's hard to really say, but everything that we've seen so far is that kids under 18 are really my whole, almost our entire population other than the college age kids are, are really gonna have a mild illness. And it does look like you're the risk factors in terms of being hospitalized or ending up in an ICU. It really ages a huge part of it. So we've interpreted that to mean that if you're young and healthy, which most of our population is, those children are going to be fine. Now, you asked before about type one, there's no data yet that shows that type one is a significant risk factor for especially for the pediatric population. For severe illness with this, I would assume like any other infection, very poorly controlled type one is going to put you at a higher risk for for just getting sick in general. And the virus itself is likely to assuming Yeah, and it will also like in the way that all of you that are listening to this know that when your kids get sick, their sugars are all over the place, it's harder to manage their insulin, that is likely to happen with this too, but not to any extent any not at any greater extent than any other illness that they might get.

Scott Benner 33:01
Okay. It's It's funny, I was making a note to ask you a question, you kind of lead into it. The one thing that occurs to me while we're hearing numbers, you know, five guys found it, you know, had here and another thousand people here and you start hearing this thing? Is it? Is it your health? We don't ever think about that you don't ever get to see the person, you know, is it a person who's in poor health in other ways? Is it perfectly healthy people like it? Does it skew more one way or the other? Have you seen any data data about that yet?

Adam Naddelman, MD 33:30
Well, so there's no doubt that pre existing medical conditions are more likely to lead to more severe illness, like if you look at the population of people that ended up in the ICU in China or in Italy, like the average age of death from this in Italy is 81. Now Italy is a very as a much older population than we have in the United States. And their health care system is a little different. And there's all kinds of rules and regulations that are there. But so that's one, you know, one piece of information that I think is important that 81 for Italy. When you look at the numbers in Wuhan, China, it looks like being older than 50. And definitely being older than 60 or 70 are risk factors. Now 50 is probably I don't know how significant it is. 60 is starting to get significant. 70 definitely significant. So age is a factor. They found that men who were hypertensive with uncontrolled blood pressure that clearly was a factor. And now in that cohort, but again, without being able to do widespread testing, you really don't know these are all the sickest people they're looking at. They're not looking at every person who's sniffles and turns out the habit like some of these famous people that you're seeing in the media, right? Tom Hanks has it. Idris Elba has it now the player on the jazz that has it. Those guys got tested. Like they were sick for like five minutes and got tested and prove that they had. As far as I know, they're all doing just fine. Now if we could test every person that had that level of symptoms, it would probably be a little bit more reassuring because we could say it's About 80% that are mild, it's a higher number than that. The only thing that I think has us worried is, in some of the countries where you're getting a lot of testing now, like in China, the the rate of serious illness and the rate of like ICU admission, and even death, they haven't decreased as much as you would hope, the only place we're seeing the numbers come down in South Korea, and that they are doing an unbelievable amount of testing. And so the mortality rate there, it looks like it's significantly lower than it is in places like China, or in Milan, in Italy.

Scott Benner 35:32
I think that it's interesting, too, that you're seeing some, you know, the really well controlled places are seem to be smaller countries, that is countries that aren't as landlocked sometimes, you know, like they're having, it's just like you were talking about earlier there, it's easier to restrict people from coming in and out, which should say to you, if you're listening, it should say to you, I need to restrict people coming in out of my life, just like you need to restrict them coming in and out of your country. It's it's all the same thing. You're, you're just trying to limit contact with people,

Adam Naddelman, MD 36:03
right? To keep this from happening. And so yeah, you could see why like, going to an NBA game, going to march madness, yeah, going to a concert, or a Broadway show. All those things are tremendous, tremendously dangerous in a situation like this. So it makes sense to not be doing them now. It made me wonder

Scott Benner 36:22
from the conversation so far, if as we get further away from where this began, if you will see it impact less people at younger ages, like will it get? Will it weaken? Or will this be a virus that doesn't weaken as its past? And I guess there's no way to know that now. Really?

Adam Naddelman, MD 36:43
Yeah. So so far, it's not showing the same signs of weakening the way that SARS did like I was talking about earlier. But the hope is, like, if you look at what's going on, in Wu Han China, now, they clamp down an unbelievably crazy amount compared to what we could ever do here. And because they did that, they essentially got all of the active cases, away from everybody else, quarantine them, force them, essentially, to not even be with the people that they wanted to be around that all like they pulled him out of their houses in some cases. But by doing that the person each person fought off the virus, and then they're not contagious anymore. And so they can go back to society. And if you look on the news, now, you'll see videos of people walking around, whoo ha, and like, you know, I mean, not like nothing ever happened. But they're getting back to normal, because they took they took what we're doing here, and they turned it up about 10 more notches, and

Scott Benner 37:36
they were able to because I guess freedoms, not such a concern there.

Adam Naddelman, MD 37:40
Yes, there is a bit of a trade off, which I wouldn't I mean, there's videos of them, like spraying down the streets and crazy stuff. And pulling people out of houses like that, that will never happen in the US. But that just means it's going to take us probably a little longer than it took them.

Scott Benner 37:53
I saw something online that really made me smile The other day, some it said, your grandparents were asked to fight a World War, you're being asked to sit on your sofa.

Adam Naddelman, MD 38:00
Yeah, I mean, in all seriousness, like you, I mean, we all have like 40 hours of TV we'd like to watch and probably, you know, at least 50 hours of podcasts and books to read and all kinds of stuff. Just go and enjoy that stuff. Just go sit down and relax. My son

Scott Benner 38:14
said the most thoughtful thing about it so far. So you just said to me He's like, this is just like summer vacation. I don't really need to do anything. And I was like, yeah, hundred percent. Just go relax. I said, just take a vacation. We're just gonna take it here in the house. Yeah. Now when I when I find myself in the grocery store, are there ways to protect myself? Like when I do have to go out? What do I do?

Adam Naddelman, MD 38:35
Yeah. So I think ideally, you go at a time when perhaps it'll be less crowded. A lot of the grocery stores are doing some clever things like only every other register is open. They're putting a shopping cart between customers. So you can't get within six feet of the person in front of you or behind you. You're not going to stand in line with some guy on the line next to you and watching sneezing and coughing or whatever. So you're going to be spread out. I think you want to get in and out. It's not the time to like, you know, debate which peaches you want to buy for 10 minutes. Like, grab what you need to get out.

Scott Benner 39:08
I am we were so Kelly and I went together. And it was hard. First of all, it was very interesting for anybody that's been out. It was quiet, solemn, almost like there wasn't a lot of extra talking people were very, I think they were trying to be calm, but felt like on edge. Everybody looked at each other a little weird, you know, like when you are passing by. And I watched Kelly pick up a jar of pickles, and put them down and decided against them. And then she changed her mind and pick them up again. And I was like, well, you stop handling everything. Even though if that made sense or not. But I was like, decide if you're gonna buy the pickles by looking at them. And then that made me think about that, like you start your brain starts going. So somewhere there's a woman who's a nurse and she came home at the end of a night shift and she's got the virus on her. She kissed her husband, her husband came to this grocery Or put these pickles on the shelf? My wife touched him. Now we got it. Right. And it's hard not to do that calculus in your head while you're while you're looking at things and doing

Adam Naddelman, MD 40:08
Yeah, this is this is a difficult time for people that have any level of anxiety. And in all seriousness, I mean, you really can make yourself insane. By running those scenarios in your head about every single thing. I mean, the good, the good thing is, like I said before, over 80% of people are going to get a mild illness. So even if you were unlucky enough to pick up the pickle jar that was handled by the nurse who kissed your husband, or whatever you said before, you're likely going to be okay. I mean, even though we worry a lot about the rates being higher than what you'll see for like a typical flu season. I mean, we're not talking about like some movie, you know, some crazy like outbreak in a movie where half the people who get it end up in the hospital, that's that's not going to happen. The problem though, is we just don't have the capacity that we would need in our hospitals to deal with all these people stick at once. And that's really the point of the measures is to, is to flatten that curve that jump that spike in cases, like if you just picture like you were saying before, how fast but just look at how fast the numbers are changing. And then when you hear about it in the media, the whole goal is to get that to slow down and spread itself out so that the people who do unfortunately get more, who are more sick and need hospitalization have a place that they can go and the resources aren't being taken up by too many people all at the same time.

Scott Benner 41:25
So the basic idea is that we don't, we only have a certain amount of hospital beds, ventilators, things like that. And for people who listen to the podcast, it's actually an interesting overlap, because we talk about stopping rises in blood sugars before they happen. Because if you never get high, then you don't have to deal with the things that come with being high, you know, extra insulin crashing, getting low later. So we're really trying to stop the spike of, of infection, not because we think it's going to stop people from getting sick, but so that it spreads out illnesses over time, so that hospitals can handle people's illnesses, if everybody gets sick at once they'll overwhelm the healthcare system, right, we can spread it out a little bit, then your grandmother gets to go in and get the treatment she needs and come out alive. Instead of ending up in there with four other people's grandmothers. When there's only three ventilators and then they got to do any meenie miney. Mo to find out which grandma doesn't get a ventilator.

Adam Naddelman, MD 42:17
Right. Right. That's I mean, that's exactly what the hope is that you can let the healthcare system catch up, like, I don't know if you saw last couple of days, but some of the governor's now are starting to really ask the military as the federal government to even deploy the military and let them put up a 500 bed, you know, mobile army type hospital that they do all the time. You know, they have a lot of experience over the last 20 years doing this. And it would be incredibly helpful. I mean, there are abandoned warehouses, there are all kinds of buildings, how about taking some of the dorms that no one's living in now, and using them if you need to, there's all kinds of structures that could fulfill this. And that would just give everyone a big sense of relief that they're that, you know, the capacity is there, it's temporary. When we're done with it, you can take it all down. It's when there is a tremendous need for it.

Scott Benner 43:07
I think people think that's crazy. But it seems a little morbid, but my wife's lobby of her building was used as a mortuary during 911. Like the need to take bodies, and they just, they use the building, they did what they had to do,

Adam Naddelman, MD 43:20
right? I mean, this is this, it seems like you know, because I think part of the problem is we have a hard time with the notion of this is likely going to happen. So let's prepare for it versus, oh, no, this is happening, we need to do something now. We tend to be more reactive. And I think the governors are, to their credit to being much more proactive and trying to get ahead of this so that we don't end up in a situation like you're talking about. It's, you know, a lot of those calculations that were being done when people were talking about things like you know, rationing care. That was before all these measures were put into place and they and every study that's been done and every calculation that's been done really does show that even a day or two earlier with these measures can make a huge difference. So we're gonna have to wait and see whether or not it was enough and how and whether or not it was early enough.

Scott Benner 44:14
Yeah, we got we got to a too late by waiting that that that week in there because I know people talk about it as this has been ramping up for a few days. But I think if you really look back, it's been happening for a week or so in America.

Unknown Speaker 44:26
It's been a

Adam Naddelman, MD 44:26
week of, hey, should we be doing something about this? No, don't worry about it. Like that's been about a week. I you know, I was away. Like in the beginning or so of February and I saw in the paper an article about a novel Coronavirus in China. It was like a little blurb like on page, you know, 52 or whatever the newspaper. And I remember thinking like how that's interesting. I wonder if that's anything like SARS or MERS or these other ones. That was like six weeks ago. Yeah. And you think about where like, think about where you this was a week ago, think about two weeks ago. If I told you three weeks ago Hey, guess what in three weeks your son's cancelled, a college canceled kids are home from school all the major sports are canceled. There's nothing on TV for them to watch. It's It's amazing. And that's the worry is are we good? Three weeks from now? Are we gonna look back and go? Yeah, you know, when we were complaining about how we had the kids home from school, that's nothing compared to what's going on at hospitals. Now

Scott Benner 45:21
I got lucky. It was really lucky because I did more traveling this year than I have previously. And I've never been a hand sanitizer person. But I just thought, I've so many commitments, I can't get sick. So I bought one with a little pump. And I put in the door in my car. Every time I got in a you know, I got back in my car from a public place. I gave a little squirt. And I rubbed it around. And I even like thought, like I put it on my cell phone like dirty me like I thought, well, let me see what I can do here for myself. And so you'll find this. I hope you find this funny. But then if you do it with the kids, you know, like when Arden gets in the car, like here, and she rubs it around, and she always goes now I smell like Dr. Edelman.

Adam Naddelman, MD 45:58
That's great.

Scott Benner 46:01
And now I'm thinking looking back, I'm happy. It was random. But I'm happy it happened because I have been in a lot more public places and traveling through now. But I've just been kind of cognizant about it. I've been like, you know, like, I go through places, thoughtfully not touching things. I was on a train the other day, I just thought you know what, let me practice my skateboarding skills here. I'm not going to hold on to the bar, you know, and if I hold on to the bar when I get out of the train a little thing, is that stuff really? Is that just in my head? Or is that stuff valuable?

Adam Naddelman, MD 46:30
No, it's valuable. It definitely is valuable. You know, old fashioned soap and water is just as good. If you're worried that you can't find PRL anywhere. Now, you can't find hand sanitizer anywhere, but it No, there's no doubt that it's valuable. So yeah, I mean, practicing this hygiene all the time. Like even something as little as Hey, before you eat your dinner, Go wash your hands. Like I'm sure we're all saying that to our kids, our our parents did that to us. But you know, just like you said earlier, like you get lacs about it, oh, they're outside, they're having to catch thrown a ball around, they come in, they eat a piece of pizza, they don't always wash their hands. Now, I think people are saying, you got to really wash your hands you got to be good about and you got to really wash them, it's not enough to run them into the water for two seconds and say you washed your hands, you got to wash them with soap and you got to, you know, count to 20 at least, and really take your time and wash your hands. But no, there's definitely a value in what you're talking about. Now, for a while we used we were thinking for a while that people were getting like way overboard with the hand sanitizer and not exploiting their kids ever be exposed to any germs. There's a danger that we're going to go all the way back to that and never let kids that playdates anymore, and we're going to shut all this down. There's a value in your immune system being exposed to a wide variety of things over the course of your lifetime, especially when you're young. So there, there's going to have to at some point be a bit of a pullback from all of this, like when when the world returns to normal. But for now, you can't be too careful with this. If you want to use hand sanitizer, every five minutes, do it if you want to wash your hands 20 to 50 times a day do it.

Scott Benner 48:01
Okay, so let's recap here. And I'm gonna let you get back to life. I think, um, Adam has been talking about this a lot lately. By the way, how did you end up on crisc comos radio show talk. So

Adam Naddelman, MD 48:11
I listened to that show a decent amount just because you know, if I'm driving between offices or running home for lunch, I'll put it on and I just called it there was no nothing more than that. I called in and the guy who picks up the phones, asked me who I was I told him who I was. He said, Oh, that's great. Let me you know, I'll put you through first time I got on. He put me through, like almost right away. And then at the end of the call, Chris Cuomo said, Hey, you know, why don't you call back, you know, each day and kind of let me know what you're seeing and whatever. So I figured today that was Friday, I figured let me just see if I actually can get through I thought maybe there was like a back number. I don't know how, how it works. But I called again today. And it got right there again. So I don't know if they set my my number up now to be able to call through or what but I figured lucky. You know, he's talking about this topic. And he wasn't doing it necessarily from a political angle. It was more from the kind of conversation you and I are having. I figured let me offer a medical perspective because not not one of his callers was someone who was actually dealing with this for real and from the health care side. And it sounded like he appreciate I was on there today for I don't know, eight or nine minutes, I think. Okay,

Scott Benner 49:20
well, one day we'll get you back on here and you can tell people the story of how I called you in the middle of the night and you sat on your computer in your underwear finding a hospital to take art into while she was being bad. Yeah,

Adam Naddelman, MD 49:29
it was Virginia Beach right? What are you doing the beach?

Scott Benner 49:33
Yeah, we're on our way to the wrong hospital. And I heard you clacking away on the keys. And it was it had to be like 130 or two o'clock in the morning and you found a hospital that had a kid some kids dedicated center for for diabetes and that's it

Adam Naddelman, MD 49:48
all those kids they're all the people that were there were people that had trained I think at the Children's Hospital Philadelphia so we remember saying he like I have a feeling this might be a better option than whenever the closest place was at that point. You should Did you like turned around and drove in the other direction? But got there?

Scott Benner 50:02
Yeah, it was really. It was really something a long time ago. But uh, so I, I'm embarrassed that I didn't think of you first I for two weeks I've been like, Who am I gonna get on the show to talk about this if this really needs to be talked about. And then I got I landed coming home from Kohl's baseball thing, and I picked up Facebook and there you are talking to, you know, on on the Cuomo show about I was like, why

Adam Naddelman, MD 50:24
am I not thinking of this? So I really appreciate you doing this because I know you've been slammed, your your practice is going to go to is are you going to go to like, this kind of thing? Are you gonna start Skyping with people to see people. So we actually, about a week ago, when we started to realize where this was heading, we about as fast as we possibly could do anything put in place, the whole plan for starting to do telehealth. And so tomorrow is the morning we're going to have a couple training sessions with the people that we're doing it with. And then our hope is that by the afternoon, if not the afternoon, by definitely by Wednesday morning, we will be offering telehealth appointments for basically anyone who has I mean, we could do it for almost anything at least as a starting point. But especially for the kids who parents are worried. You know, just just like you said before, they're calling the office thing, oh my god, he's congested, he's coughing, he has this, he has that, instead of the nurses trying to just triage it without seeing him, we are going to actually do a virtual visit where we can see them and actually observed the child and talk to the parents and do a whole basically like an office visit, it's a good idea. But do it over the phone? Or do I have to do it on the computer, I genuinely think that

Scott Benner 51:37
you know, a lot of bad is going to come out of this whole thing. But a lot of good is going to come out of it too. We are going to become more agile, but we take care of things, you're going to see a lot of businesses follow suit, and maybe some of them won't go backwards again. Or maybe this is the thing you'll keep

Adam Naddelman, MD 51:52
you know, maybe we're definitely gonna keep it I mean picture like even the example you just gave about that awful night all those years ago, imagine if we had telehealth and you said to me Look at her now like you saw her a few days ago, look at her now what do you think's going on? Like, that would be a very different interaction than a cell phone at one o'clock in the morning. And I think I think you're 100%, right? I mean, look, there are times when we all think the world is changing in a way, and we're never going to get back to where we were, and it's all atrocious and good can come out of it. And I think this is one of those situations, it's just gonna take everybody thinking about it in terms of what can they do for each other and not just about themselves, you have to think about it in terms of your neighbors and your community. And if we do that, and I think businesses like you're saying are clearly going to adapt. And I've been saying for years, what in the world do we have to have all these people traveling all over the place to have these in person meetings? for like an hour that you fly to California for an hour meeting and you fly back? like that just seems so foolish? Now when you look at what people are going through, right? Yeah, I more recently?

Scott Benner 52:53
I do I do a fair amount of traveling to give these talks, right. And I just go about, I talked about how we do things on the podcast with blood sugars and stuff like that. And it's really valuable. And I see that I see the people having sometimes very instant, like significant changes in their health. But recently, someone contacted me and they were like, would you come to Japan? I was like, No, but I'll do it over the computer. And we did it. And it worked great. Yeah, I mean, there was really no difference between me not being there and being there.

Adam Naddelman, MD 53:22
Right. I mean, I could see like, for a live presentation in front of a lot of people, and especially question and answers, that can be a real value in a face to face. But, you know, these these meetings that you have some times where you have to really put yourself out in terms of travel, just to spend a couple hours in the, you know, there are certain industries where the face to face thing is still super important. And I think this was is likely going to change that for a long time. Like you're going to do a lot more of this a lot more skypes a lot more kind of video sessions, where you know, as the technology improves, and everyone's in super high def, and the cameras improved. It's not gonna be that different from sitting around a table if you have five computers set up and you can see everyone's faces.

Scott Benner 54:01
Oh, my daughter did her first day of high school from home today. She said she liked it. Is there a way I can keep doing it like this? A couple hours later, Cole got word from his school. They're going to distance learning for the rest of the semester, which is the rest of this year. And Kelly's working for him for for the foreseeable future.

Adam Naddelman, MD 54:21
Yeah, I'm in the same situation. Dana is now working from home. She's not they're not going in at all. My kids are all doing virtual learning. The boys are doing virtual learning with like, they're using zoom where you literally are watching a lecture and the kids are all on the screen at the same time and they're all participating. I think our kids generation is going to be really good at this. Like they actually in some ways, some of them probably will prefer it and may get more out of it because they can it's more condensed like that their lesson plans are right there. There. It's there's not a lot of like walking around between classes, and they're gonna find they can actually accomplish a lot this way. I think it's interesting when you think about the universities, I would I would it would be interesting to talk to people who are in that line of work. But you have to think that there's a real concern among some of these universities that someone is going to come around with a real good online platform for education. And it's going to cost like a third as much as what people are paying, now, you're going to get a degree that's actually really worthwhile, and you're going to be able to do it from your living room. I mean, there's no doubt that the social aspect of college is probably a bigger piece in some ways than the academic piece. But if you can do it for third the price, and this market,

Scott Benner 55:31
yeah, there's right. There's no reason not to try. So I, I just think it's, you know, it's not dissimilar to I say this about diabetes a lot. And sometimes people think it's odd, but, and I don't, I always say like, don't get me wrong, like I would genuinely do anything for Arden's pancreas to work, right. But because it doesn't, we've also had all of these amazing experiences, and she's become a much more resilient person than I think she would be at 13. So goods come from it, too, you can't ignore the good that comes from it, you can hate the bad, but you don't have to, you don't have to ignore the good stuff that's coming. So

Adam Naddelman, MD 56:06
I agree, I agree. And my office is about as crazy as you could ever imagine anything. Right now, there's no doubt about it that we would be life would be much easier right now for everyone who was working in my office and putting in the hours they're putting in if this wasn't going on, but I also have no doubt that when it's finally over, we will be a better practice and better physicians and better nurses. And more probably empathetic even to people like we will all be a little better. Because we worked through all this. It's hard to see it now because we're not at the end of it yet. But I really do, I really do believe that. But you got to really you got to just work it you got to you got to think about everything that's going on, you got to take the measures that the experts are recommending you got to believe the scientists, you have to you have to really think about what you can do for each other. You got to you know, all of those things, I think are critical for all

Scott Benner 57:01
you people who are always my wife said she heard you saying this earlier today. But I've seen it on Facebook a little bit for everybody's always bemoaning I don't have enough time with my kids. there's now an equal amount of people were thinking and saying out loud in some points. I don't want to be around my

Adam Naddelman, MD 57:14
kids this Oh, it's so true. And I was saying earlier that, you know, for every time you complained about all how to want to go to that practice, I really have to take into this. Now, how many people would you know, pay $1,000 to be able to have their kid just go to softball practice.

Scott Benner 57:29
I told my son tonight I said, you know, it's interesting. We live in a time, unlike any other time in history, so you have so much ability to do so many varying things. And he was home from school for three hours yesterday and told me he was bored.

Adam Naddelman, MD 57:43
They're bored out of their mind.

Scott Benner 57:44
Yeah. I said, I don't know how you're bored. You have a computer in your hand that could watch a space shuttle. You could, you know, I you just maybe you needed to dial in one time to the internet in your life to realize how amazing this is televisions that you have and contact with other people. You can speak to people if you want to face to face and all this stuff. And he's like, I don't know what to do. Like.

Adam Naddelman, MD 58:05
Yeah, I mean, it's amazing. I actually kind of hoped that maybe. And this probably isn't gonna happen. But just simple things, pick up a book, go for a walk, like go for a walk around the neighborhood, just you know, the weather's not bad. Get outside, sit outside for a while with a book like something that's just not the constant incessant, you know, in front of the screen and make you anxious and make you crazy because reading every last thing and hearing every last thing I feel

Scott Benner 58:32
I feel the worst for people who just not in the financial place for this for people who don't have a job that sends you home but just tell you can't come in, but you're not getting paid. That's a hard thing to fathom.

Adam Naddelman, MD 58:41
Oh, it's um, but it's unfathomable. I mean, imagine if you owned a coffee shop, or if you owned a restaurant or, you know, you're you're just an employee that's per diem somewhere or you just you're, you know, an hourly employee that you have no benefits, or I mean, it's just, it's unfathomable to think like what in the world is the certain industries going to do? Right? I mean, imagine being like a pilot, for instance. I mean, those guys aren't flying anywhere now. American Airlines cut 75% of their international flights yesterday,

Scott Benner 59:11
I saw that there's 75% of one of the European airlines just shut down. Yeah, they say they said we have no Scandinavian maybe I'm not sure one of them was just like, we don't have any. There's no call. Right. So you know, we're just not gonna fly planes anymore.

Adam Naddelman, MD 59:26
No, I mean, I agree with you. And I think Unfortunately, that's the next big me on top of the fact that the illnesses are going to pick up you're going to start hearing more and more about companies that are not doing well and employees getting laid off and it's going to be really, it's going to be awful for a while. That's why it has that we have to do these things now to hopefully shorten the duration of this and decrease how painful it does get.

Scott Benner 59:50
Yeah, no, I hope people believe that. Is there anything that I didn't bring up or that you didn't say that you think is important?

Adam Naddelman, MD 59:56
No. I mean, the only thing is I do just want to reiterate the social distancing thing. Think keeping yourself six feet apart, you know, with from people around you, including the kids. So no sleepovers, no birthday parties, this is not a snow day, there's a great post circulating about that too, that I saw. Don't treat this, like, you know, it's snowing, and we're gonna pile 20 kids in my basement and let them all watch a movie, you can't do stuff like that. You just have to stay apart. If you have elderly relatives, the best thing you can do is call them and talk to them, don't go visit them, stay away from them. Just because they're family, it doesn't mean that they might not have it. So you really need to take it seriously. If you are going to visit with people do it outside, you know, be outside be six to 10 feet away. Do it for a brief period of time. And but no contact like no hugs and kisses and all of that that has to stop now going to the bow.

Scott Benner 1:00:47
I'm just a genuflect a little bit. And you said that I I called my mother last night who's 76. And she lives by herself. And I just said, Mom, listen, Kelly and I talked about bringing you up here. But I think you're better off where you are by yourself. Yeah, I'm like, Well, you know, text every day and we'll call and everything but I think just you know, she's like, Oh, my card clubs not meeting anymore. And I was like, Yeah, that's good. I was like, don't do any of that stuff. I say go outside. I said the same thing to her. So it's so what I'm hearing, at least between you and I and you and I think pretty similarly about some things but common sense, right? Just use your common sense and don't get in contact with other people. You can't just decide that people look okay, it's you know, right, you know, you should

Adam Naddelman, MD 1:01:31
prompt exactly right just just and be patient because it's going to take some time this is not going to be over in two days. It's going to take some more time.

Scott Benner 1:01:39
Well listen in a world where social There are apps for dating apps that have never once warn people about like sexually transmitted diseases but those those apps are popping up now I'm hearing and telling people listen that Coronavirus blah blah blah, you know, so so I'm gonna let you go with this. What do you call it? You call it COVID-19 or do you call it the Coronavirus? I mean the medical world is calling it COVID-19 I think when we talk to patients and when I just talk about it with friends I'm always calling it the Coronavirus. I think you know COVID-19 just sounds like it just doesn't sound like a virus. I don't know. It just sounds like something different. COVID-19 is really like what they're calling the illness that people get. I'm using Coronavirus. I don't think the people at Corona are so happy that this is the Coronavirus, but it is what it is you must be out of their mind actually. Okay, so I'm going to um, I'm going to in a number of weeks when there's more to say I'm gonna force you to do this again. Just

Adam Naddelman, MD 1:02:29
you know, I'm happy to do it. I mean, look, this is changing unbelievably fast, like incredibly fast. Just thinking back to where we were a week ago. So I'm happy to do it again. If you think it's useful for you, all your listeners find out.

Scott Benner 1:02:42
So thank you very much.

Adam Naddelman, MD 1:02:43
No problem.

Scott Benner 1:02:46
This episode was recorded on March 16 2020. And Adam will be back if there's more to talk about and I think that there's going to be much more to talk about. huge thank you to Omni pod Dexcom and touched by type one for being fervent and long term sponsors of the Juicebox Podcast I appreciate your dedication to the show. Get yourself an absolutely free no obligation demo of the Omni pod sent to your house right now my Omni pod comm forward slash juice box but the links right there in your show notes. Were the ones you can find at Juicebox podcast.com. Start today with the Dexcom g six continuous glucose monitor by going to dexcom.com forward slash juice box again, where the links that you'll find all over the place. And of course touched by type one.org. Head over there, check them out. They're doing amazing work for people with type one diabetes. And you know what i guess if you're in the central New Jersey area and you're looking for a beautiful pediatric center, Princeton Nassau pediatrics, I've been taking my kids there for a very long time. So okay, everybody, listen. Let's do this together. Right, let's look out for each other like Adam was saying, to be cautious and careful. Let's try to ignore the fact that we don't want to stay in our houses for a couple of weeks. Just do the right thing here. And let's get past this as quickly as possible. And if you absolutely have to go out for any reason financial the buy food, whatever. You know, again, what Adam was telling you, keep your distance from people wash your hands. Let's not get in spitting distance, sneezing distance, will be kissing people you don't know or Come to think of it people you do know don't kiss anybody. You understand what I'm saying? Right? If you touch the handrail and something, try not to touch anything else till you handle yourself. Soap and water. Good, good, good, you know like this really get in between the fingers. I think together we can put an end to this pretty quickly and get life back to normal course. The next episode of the podcast will be out in a couple of days. Jenny Smith and I are going to talk about Sick Day management for respiratory illnesses. You know, like the Coronavirus

---

Please support the sponsors

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!

Donate