#318 Sarah has Coronavirus and Type 1 Diabetes
Working at a NYC Hospital with Type 1 Diabetes
Sarah, ACAGNP-BC CCRN CCTN. Sarah is working in a New York City hospital, she's had Covid-19, has Type 1 Diabetes and she's on the show to share her experiences.
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DISCLAIMER: This text is the output of AI based transcribing from an audio recording. Although the transcription is largely accurate, in some cases it is incomplete or inaccurate due to inaudible passages or transcription errors and should not be treated as an authoritative record. Nothing that you read here constitutes advice medical or otherwise. Always consult with a healthcare professional before making changes to a healthcare plan.
Scott Benner 0:06
Hello everyone and welcome to Episode 318 of the Juicebox Podcast. Today's show is sponsored by Omni pod Dexcom. The Contour Next One blood glucose meter and touched by type one.
Sarah 0:26
I'm Sarah. I'm a 37 year old nurse practitioner who works in New York, which is now kind of the epicenter of Coronavirus. I have two little kids, a five year old and a seven and a half year old boy and I'm married and my husband's a teacher.
Scott Benner 0:50
Sarah reached out to me just the other day wanting to share her experience as a healthcare worker in New York City who's recently been diagnosed with COVID-19. Please remember that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, always consult a physician before making any decisions about the Coronavirus becoming bold with insulin. Just about anything else. This is just a podcast. Talk to a doctor.
You can get an absolutely free no obligation demo of the Omni pod tubeless insulin pump by going to my Omni pod.com forward slash juice box. Find out today about the Dexcom g six continuous glucose monitor@dexcom.com forward slash juice box and to see if you're eligible for an absolutely free Contour Next One blood glucose meter go to Contour Next one.com to check out the world's most delightful Type One Diabetes organization and the whole of the world at least as far as I've seen. Touched by type one.org. How old were you when you were diagnosed with Type 117?
You've been doing this for a while?
Sarah 2:11
Yeah, I've been around the block a few times. 20 years? Actually, it just was my diversity this week, actually. Oh, well. Congratulations.
Unknown Speaker 2:19
Yeah. big week for you, huh?
Unknown Speaker 2:22
Yeah. Yeah.
Scott Benner 2:24
How long have you been listening to the podcast?
Sarah 2:27
Um, not that long, maybe four months ish. But I like what I tend to do with a lot of podcast is I kind of Bolus a lot of shows. I'm like, oh, wow, this is really great. He's got a lot of great ideas. And I like the way he thinks about things. And you know, I really like some of your guests and stuff. So I listened to a bunch like for a few weeks straight. So I don't know how I would say I've probably listened to about maybe 100 of your podcasts
Unknown Speaker 2:56
like you just just just a small number. Keep going.
Scott Benner 3:01
I'll tell you the the interesting thing that you're seeing around Coronavirus is that people aren't commuting as much and when they don't commute and listen to their podcasts as much. So yeah, I need this Coronavirus thing to be over just like everybody else. But not as much as you need it to be over. So I got a note from you the other day. And you said hey, I have type one diabetes, and I have the coronavirus. And I was like you're getting right on the podcast.
Sarah 3:32
I was I'm thinking about I'm saying something to you about it. And then when you I listened to your one that you talk to Jenny and you were joking with her like, Hey, can you just get Coronavirus so we can talk about it on the podcast. I was like, Oh my god, I have to message
Scott Benner 3:49
you believe she wasn't willing. Honestly. I mean, what kind of a person wouldn't just you know, risk their own death. So I can get a couple extra downloads on one, one episode of a podcast. No, I just really listen. I mean, I really was hoping to get some insight. So So let's do this first. So you you work in a hospital right? Are you in a but yes. Tell me what department is you work in? Is that?
Sarah 4:12
Yeah, yeah. transplant.
Scott Benner 4:15
Okay, so that seems like a place where you wouldn't want anybody to be sick?
Sarah 4:19
Yeah. Yeah, no, our patients are immunosuppressed. So they're actually more at risk of getting the virus. Mm hmm. Then, then even I am. So you know, obviously if you're type one, you're immunocompromised. But we give these patients medications that suppress their immune system. Right.
Scott Benner 4:40
So, so I guess the The question is, do you have a feeling for the epidemiology of like, how you like, you know how you got sick or is it just were you just waiting?
Sarah 4:51
Yes, it was either a co worker or a patient.
Scott Benner 4:58
One of your direct patients
Sarah 5:00
Yes, yeah. So I was, it was it was right before everything got really crazy with everybody being isolated and stuff. Yeah. And we were kind of doing business as normal ish. And then my coworker left work early, had a fever. And then I was going to go on vacation. My husband was going to leave the country. He was going to chaperone a trip but then that got cancelled because of coronavirus. And then so I was home and he was home. So I wasn't even scheduled to go back to work. And then I started feeling a little funny, a little sick, like I had congestion. But then he was complaining that he felt like he had the flu. Now, I've never had any flow. To my knowledge. I could have had it and just not had it. known that I had it. But I've never had like aches, I probably haven't had a fever since the 90s. Like, that's just I'm not I don't get a lot of colds.
Scott Benner 6:02
I haven't thrown up in three decades. So some point you're just like, hey, this doesn't happen to me anymore.
Sarah 6:08
Yeah, I do throw up a lot. Not a lot. But when I was pregnant, it was like, I was like, 30 something weeks pregnant. If I didn't have food on my stomach, I would drop so I do I do tend to vomit but like no fever is never anything I have had in fairness, sir. I've never been pregnant so I can't
Scott Benner 6:27
get apples to apples this with you. So you start not feeling well. Like how so? Today's March 28. How long ago was that? Do you think?
Sarah 6:37
I can give you the dates because I actually had to replicate the dates for a public health nurse called me the day after I was diagnosed. So this was um, I started feeling on well, March 15. But I thought maybe I had a cold. I was there. Last thing on my, in my brain was Coronavirus, because I wasn't really suspicious when the coworker left work. I just didn't really like oh, no, you know, he's probably just had some flu or something because it wasn't a big thing. And they we weren't allowed. I think it wasn't a big thing because nobody was allowed to test anyone. I mean, Trump had I think at that point had just come out and said, Oh, anyone could get tested. But no one could get tested. We couldn't test anyone. It was still I didn't really think people really had it. I mean, I thought it was coming. But I didn't think that it was like pervasive. So I would say Sunday night I felt sick Monday morning. I was like, wow, I have a horrible headache. It feels like I'm getting a sinus infection. I've had a couple of those like I'm over a decade ago. They required an antibiotic. So my husband goes to the pharmacy, he picks up an antibiotic, I have it at home. And I'm just feel like a little a little tired. I felt I had the headache. And then I felt like I couldn't really smell like my sinuses were blocked up hence why I thought I was getting a sinus infection. And then the next day, my husband's like, Oh, I feel worse. And he calls to try to get tested for coronavirus because he's like, I feel like I have the flu. But we all in my house, I'll get the flu shot because I'm type one. I'm a health care provider, we have little kids, we all get the flu shot like immediately when it's offered. We're very vigilant about it. So I honestly, like I'm not that you can't get the flu once you have the flu shot, but it you know, it's much, much less likely. So. So Tim was like, I think I might have it I'm like, I don't know, like maybe but that seems kind of far fetched. But it's all over the news. So like, yeah, that's what, you know, a lot of people jump to, but I'm like, I don't think so. So he calls and they're like, No way because you're too healthy to get tested. You know, he's not short of breath. He just has he had like a subjective fever, which kind of means he had chills and felt like he was you know, having trouble regulating his temperature, and just fatigue like, you know, low energy, they wouldn't test them. And then that night after he had called somebody texted me from work that a patient tested positive.
Scott Benner 9:24
And then all of a sudden it feels very real.
Unknown Speaker 9:26
And this is then I'm like
Scott Benner 9:30
well, this is all really it's so funny how quickly things have moved. So you're describing basically 13 ish days ago. And it really is the night and day difference between what we are thinking of now and what we were thinking of back then back then it was just sort of like hey, it's overseas it'll probably get here we're not sure what's going to happen yet. And and it it just really ramped up so incredibly fast and I guess you can you really at one point when we look back and and pay attention Assuming it would have been here and just not as prevalent, weeks and weeks before we really were thinking about
Sarah 10:07
Oh, yeah, I definitely was, I mean, based on like, where our numbers are now, it was definitely circulating. And I'm sure people had it and just never knew that they did.
Scott Benner 10:16
Right. Oh, hundred percent. Yeah. Do you think you had that thing where you can't smell when you lose your sense of smell or taste?
Sarah 10:22
Oh, yeah, I have that. And that's, I still have that symptom. That's with you pretty much over the other other stuff. But I still have that. And that's actually kind of how much when I cemented that I diagnosed myself as having it was so like, the day after Tim couldn't get tested. Then the next day, I was like, Can you call them back, tell them that your wife was exposed, and they still would not test him. And then later on, I call my supervisor and she's like, I'm try you can do a telehealth visit. Okay, so that's a big thing now, in order to screen people for being tested, but also to see other doctors because we're not sending anybody to see doctors, because that's like a big risk. So, um, I, I saw a doctor online, and I kind of exaggerated my symptoms a little bit, because I was like, based on what I have, I don't think she's gonna test me. But at that point, I also thought maybe my coworker had it. Yeah, maybe because they left with a high fever. But then I also was like, I had a patient who I, you know, admitted to the hospital who tested positive. Tell me,
Scott Benner 11:39
let me jump in. Tell me your thoughts about wanting to get tested at that point. I mean, you, you figure you've got it. Right. You've been in contact with people had it? What did you just want to know? Like, what changes knowing to not knowing
Sarah 11:51
part of me wants just like the public health data, yeah, like capturing a positive. But being more careful about quarantine, because at that point, I've gone to the store a few times, like I've done stuff, or being just being more careful. And also, like not wanting to expose patients, because eventually I was going to have to go back to work. Right.
Scott Benner 12:17
So just having that answer maybe gets you. I mean, it should definitely get you out of work. Is that right?
Sarah 12:23
Well, we'll get to that.
Scott Benner 12:26
Okay. things a little so upside down. It doesn't matter if, if you've got Corona as long as you know how to be a nurse.
Unknown Speaker 12:33
Not
Unknown Speaker 12:34
not Yeah.
Sarah 12:36
So, um, so they still wouldn't test them. They said, if they knew I was positive, they would test them. I did. I talked to the doctor and I kind of told her I had a cough, which wasn't a straight out lie. I probably coughed a few times, but I didn't have a persistent cough at all. Okay. Nothing like they're talking about. I never had a fever. They still want to test him. But they put in an order for me. But then I had to set an appointment. They weren't they're not accepting walkins to get tested at my at my job. So I had to wait for five more days. For once you put in the order to even get testing well. Yeah,
Scott Benner 13:14
well, there's a test at that point. Right. Like they're,
Unknown Speaker 13:16
I think they weren't prevalent.
Scott Benner 13:18
There's a rapid test. I think that's just becoming available today. Is that right? Did you hear about that?
Sarah 13:24
Um, yes, I heard that there is a rapper, I was actually more interested in the I saw there was a I don't know when the blood test is coming up, but Saturn is going to be able to Yeah, yeah, I think that's gonna be really, really useful, both for people that are taking care of the patients and for the patients themselves. If that's what again, if that becomes like,
Scott Benner 13:50
widely available? Well, I think my wife keeps talking about that. She's like, I've just one day I want to find out if I've had it or not, because she's like, I swear I had it like a while ago. And before anybody was talking about it. I am looking at an article right now. Us approves Abbott Labs, five minute rapid Coronavirus test that was six hours ago, this story went up so Oh, wow. Yeah, so this just happened.
Sarah 14:14
When I did finally get tested it only it was a quick turnaround. It was only it resulted like six hours later. Okay. Which was nice.
Scott Benner 14:22
So I guess we have to talk about it. Is that image online? True, does that because that looks like there's a swab on the end of a long wooden stick that goes in through your nose and heads back towards the center of your brain?
Sarah 14:35
Oh, yeah. It's very, extremely uncomfortable. And they really have to turn it around. And that's where some people are, are falsely getting negatives to and that's another reason that it's good to have a blood test. Is this because
Scott Benner 14:50
being done right? Because
Sarah 14:51
Yeah, exactly. But you really have to like turn it around in there and it's very uncomfortable. So if so if if The nurses been properly trained. And that's all they're doing all day long, they're probably doing it right. But we have like any and every nurse in the hospital doing it. So they're not necessarily getting good samples all the time and not and I don't not blaming them, they have a million other things to do. Like if a nurse is just doing that all day long, she's getting good at it. And she's like dealing with the patient's discomfort, because like my eyes were watering, it was very uncomfortable.
Scott Benner 15:25
Again, I just the picture online makes it and there's a description that says, it goes back to being parallel with your ear or something like that. And I'm like, wait, why? Oh, yeah. Like, I don't want that. Please, please. No, but I do like the idea of knowing, too. I mean, obviously, the way the the numbers get skewed constantly, because everybody hasn't been tested. And I mean, do you think that from what you're seeing, is the rate of death going to continue to drop as we find more people have had it? And
Sarah 15:58
oh, yeah, like, I'm sure the the Yeah, the mortality rate would be less if you could actually capture like, more accurate numbers. Yeah.
Scott Benner 16:07
Well, okay, so are you still doing transplants at this point, or have has that stuff's been I guess that's not a elective that needs to be done when it needs to be done? Right.
Sarah 16:18
Um, I think I'm going to talk about it more generally, and not about my programs specifically, right. But I think everyone else is being much more careful about who they do it too. Because you're you're massively immuno suppressing people so much. So I think most programs are are way way, like, doing a lot less only if it's really urgent.
Scott Benner 16:43
So your husband has it, you have it, how do you stay away from your kids? What do you do in that situation? I'm
Sarah 16:48
pretty sure they have to, honestly because then, um, so then and all another clue, germane to to what we're talking about is my insulin requirements went up to
Scott Benner 17:01
Okay, so
Sarah 17:02
um, so that was another reason I thought that I had it not usually when I get colds it doesn't go up.
Scott Benner 17:08
Yeah, Ardennes doesn't Arden's usually goes down a little when she gets sick. But, um, but just something obviously, with your body changed, because you saw your insulin needs change at the same time.
Sarah 17:18
Yeah, diabetes gives you a window to certain things that the layman doesn't necessarily seem to see. Yeah.
Scott Benner 17:25
Because you
Sarah 17:26
can see different changes. So Mike, Mike, that was another kind of thing that muddy the water. My younger son had been sick for weeks. So I kind of thought maybe we had what he had, yeah, maybe we just have some kind of a cold and it's affecting us differently. But his his was like a runny nose, and a cough. But during this time, his cough was getting worse. And so bad, because at that point, he had been maybe sick for three weeks, so I actually had to take them to the pediatrician, right. And at that point, I wasn't tested yet when I took them to the pediatrician. And she basically was like, Oh, I could test him for it, but only a few were positive. And I'm like, Well, I have an appointment in a few days at my job like, you know, I can only control what I can control
Scott Benner 18:22
right? But I have
Unknown Speaker 18:25
Yeah, I just
Sarah 18:28
like I've never felt like this before in my life, but you know,
Scott Benner 18:31
and so having it is like what is it just like every other virus you've ever had, or is it different? How's it been affecting you?
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Having it is like what is it just like every other virus you've ever had or
Sarah 19:48
I would say I had more fatigue
and I don't usually have a blood sugar bomb and I was definitely a little more insulin resistant and And then not being able to smell at all, even when I felt like my nose, like I was maybe congested for three days. Yeah. And then then it went, the congestion went away. But I still couldn't smell and I still can't smell now. And that was actually I have an au pair that lives with me. And actually, when I said that one day, like, I was like, if you guys want to get takeout, that's fine. I sat at home, even though we were trying to be very careful about it. And I was like, I can't smell or taste anything. And he was like, Oh my gosh, that's what they're saying is a symptom of coronaviruses. You can't smell or taste. And that was when I was like, Oh my god, I have 100% habit.
Scott Benner 20:36
That's got to be like a baby to get the test. Right? That's a bad movie, right? Where if somebody turns you slowly and says on the news, they're saying that that's one. And you're like, Oh, I have that? Yeah. Have you freaked out at all? Or like, so you've been a nurse for a really long time, right?
Sarah 20:51
Yeah, I was a nurse for nine years. I've been an NP for five years. Okay.
Scott Benner 20:55
Okay. So you've got a lot of experience in this space. Is this unlike anything you've ever seen before? Or what does it kind of match up with? from your experience?
Sarah 21:06
From what I'm feeling? Or the pandemic?
Scott Benner 21:09
From the work side? Yeah, from what you're seeing in the hospital? Oh,
Sarah 21:11
no, this is way different than I've ever experienced.
Um, yeah, this is completely different.
Scott Benner 21:20
necessary, in your opinion?
Sarah 21:22
Oh, yeah. Because Because of just the amount of Yeah, the amount of people that are that are affected? Yeah. Like, like, they, you know, that's what everyone's talking about flattening the curve, because we there's just not enough ventilators or not enough beds in the hospital to take care of all the sick people, because because no one has any immunity, because like, you know, people have immunity to the flow. There's, there's no immunity to this. And it's,
Scott Benner 21:52
we're all overwhelming new thing for the very first time all together. And yeah, it's moving, is it? It's moving more quickly than we see with other viruses. But that's, we're not sure if that's because none of us are immune to it, or if it's because it has an ability to move more quickly. But it doesn't really matter why. It's just it's spreading. so incredibly fast. Yeah. And, and so when we're all hearing in the media, we take in, that this is about spreading out people's illness so that hospitals can handle it. That really is though the entirety of the goal here, right? Like it's not, we don't think some of us aren't going to get it like we're all going to get it at some point in the next year or so. I'm imagining, you know, by all I mean, a lot of people are going to have it to varying degrees. What is the varying degrees? What are you seeing, like, what would you call your case of it? Like in the mild, mid and harsh like,
Sarah 22:49
I wouldn't say I'm a symptomatic for sure. But I would say definitely mild to very mild, because because I was feeling so low energy and I like working out. I was, you know, lifting weights and stuff at home like I was doing my normal thing I except i was i was just, I could fall asleep in the afternoon and I'm not usually like, I can't usually take naps and stuff. I just would wake up I would drink coffee and it was like I didn't drink any I didn't have any caffeine like like I was just I was very low energy. So my body was definitely fighting something. And the headache Oh, that was another thing that headache. I could Tylenol. And Advil didn't do anything for the headache.
Scott Benner 23:35
What did finally drinking?
Unknown Speaker 23:37
No, no. What did you
Scott Benner 23:40
were you able to alleviate the headache or no?
Unknown Speaker 23:43
I'm
Scott Benner 23:44
not really how long did it stay with you? Or is it still with you?
Sarah 23:49
I would say I had maybe like a two out of 10 headache today. But at the worst I probably it wasn't like severe severe because I've had migraines before this was like maybe a six seven but the fact that like normal pain medicine didn't do anything it was it was pretty obnoxious. Yeah. Luckily, I was at home for a long time.
Scott Benner 24:10
What about at work right now? Are they just using? Is it all hands on deck like Howard? How is this being staffed and and handled?
Sarah 24:19
Well, if you're too sick to work, you're too sick to work. And but you're allowed to come in if you have
seven days after your onset of symptoms,
which I was out of that window when my vacation was over. And honestly I didn't know that I had it when the first day I came back to work was when my appointment was Yeah. So I walked into work and I'm like, I'm pretty sure I have it but we have to get you know, I don't know that I have it. And I wasn't you know, I don't have the fever or the cough so I wasn't like you know having the big name symptoms. So I came back to work, I tested positive and I got the result as I'm walking in my door at night. But I was already out of the window. And the next day we like called everyone to make sure it was okay for me to work, you know, from occupational health to various doctor, you know, infectious disease experts to make sure it was okay. But their policy right now is either 72 hours after your last fever, or after seven days of when your symptoms started, you can go to work, I'm extra careful. Like I really, you know, mask and hand hygiene very, very meticulously, and I and and, and before this even happened, we were staying out of the rooms much more. Yeah, like we're limiting patient contact, worried about you know, getting whatever from them, but but actually more worried about us giving them something because there could be there. I'm sure there's many health care workers walking around with it, and they just don't have any symptoms, or their symptoms are so mild, they don't know. Sure.
Scott Benner 26:11
about you and your husband, like, it might be unfair. You've got a couple of little kids. So maybe you're not running around like smooching every time you see each other but are you like air high? fiving? Or like, what's your level of like intimacy, like, now that you cuz he's through it too, right?
Sarah 26:27
Um, yeah, yeah, he feel he feels 100% I wouldn't say I'm 100% like he had worse symptoms for a few days. But mine have symptoms have been milder, but more like, prolonged No, I didn't really, because I felt like I felt like the, the horse The, the horse was out of the gate. Like, I felt like I had given it to everyone already. Because we were all at home. I was cooking, like, you know, very cuddly with my kids. And I think also because once your, you know, your quarantine in your home. Anyway, I felt like I was more needy with like affection with my family, because I'm not seeing other human beings going anywhere Do you can't like touch anybody. So I felt like I had exposed everyone to it already. I mean, maybe like, I don't think I was sharing as much because I was, we were trying to do more like being a little more careful at home with cleaning, you know, washing things like I was having my kids do the chore of like, cleaning off the doorknobs with a Clorox wipe every day and the light switches, we were doing more like disinfecting at home. But like, honestly, after after I figured it out. Like I was like, it's it's already everybody I'm sure has been been exposed. I mean, maybe I'm being a little like blood about it. But I felt like I have already given it. So I didn't really change much. And it's very hard because my little kids are there not because we've tried to have them have better boundaries, especially the little one before, but he's very bad about it, he'll be very sick, have a cold and still want to kiss you on the lips and stuff. So I'm not very good about it's
Scott Benner 28:10
interesting because your human nature does take over. I mean, I've got two children and when they're sick, you, you do have that feeling like I'm gonna get sick, too. I guess it's okay. You know, like, you don't really stop from doing the things you'd normally do for them, like you don't like kick them into a room, like close the door and go listen, if you're still alive in five days, that'll be great. We'll come back and get a year in there helping them and you know, and doing what they do you have mountain. They're sitting on your lap and watching television. And
Sarah 28:37
well, I think also for Coronavirus, because I researched it enough to see that it doesn't seem like it's hurting children very much. And my children also, you know, they're very healthy. So I was like, I mean, parents overall aren't terribly concerned, I think about kids in general. But I think I was even like less concerned because I'm like, I'm the most immunocompromised person in my house. Like,
Scott Benner 29:02
why is the one concerned about me? Maybe Maybe I should be worried about Mila. But it's very interesting. I mean, the whole thing's really interesting. Because when you hear stuff like oh, you know, it's it's a it's a strange way to talk about it. When you hear them say, Oh, you know, it's mostly people who are older or compromised, you're like, well, that's not nice to say out loud. Because you know, there are people who are older and compromised who are listening to the news also. Yeah, that's not exciting news for them. What you just told them is 100% of you, you know, are having a hard go with this. And so I get what they're doing, trying to keep the masses to become, but then you will see like some I've seen a little kid have it and be on a ventilator already. And, you know, it's just like, I don't think this might be one of the very first times that as a nation, at the same time, we're all conscious of the idea of we don't want to get sick. And if you really look back at how you live, you don't live like that. You live knowing that you're You're gonna get a cold sometimes, or you're gonna have a virus or something's gonna happen to you. Like, I don't know that it's a reasonable expectation to live without being sick. I mean, it sounds pretty impossible to me. And so, like, where do you draw the line then? Like, you see, some people are, you know, on their boats, or there was just an arrest in New Jersey recently, where there was like, some, they somebody, like throw a house party and charged I think, admission, like turned it into a business. And and they got raided, and the guy who ran the party is being charged. And like, so, you know, don't do that, obviously. But like, Where's the line, like, we got food today, you know, like, brought in, and I broke the packaging down. You know, like, I was, like, I was on Breaking Bad. You know, I took everything out of the out of the bags of bags when the trash then you know, someone else brought me plates. You know, I put the food onto the plates. I threw away the packaging for food and everything and then wiped everything down afterwards and wash like 1000 times. And Kelly's looking at me like, what are you doing, man? Like, just relax? I'm like, I don't know, like I said, you know, we don't know where all these things came from. And I just don't want to be sick. Like it keeps for me coming back to. I don't want to end up in a hospital right now. Oh, yeah. Is that a smart thing for me to be thinking?
Sarah 31:16
No, for sure. And that's, that's the thing, even very healthy people are sick on ventilators. So it is it is reasonable for everyone to be extremely careful not only for to not spread it, but so you don't get sick because you don't know even though you have a healthy immune system, some people are just getting horribly sick. Like, yeah, my coworker that had it was way sicker than me and I'm the immunocompromised one. So it's, it's you don't know.
Scott Benner 31:44
Yeah, I think for me personally, in my mind, I'm a not wanting to end up in under medical care, while the hospitals are so taxed. Just because that just seems like you don't I mean, like, you know, if there's, if there's 10 nurses and 10 doctors and 50 patients, I don't feel like I'm gonna be getting like the hands on care I would be hoping for. Not that people wouldn't be doing your best but but it's stretched thin, you know. And then my next thought is, I don't want to be the person. Like, I don't want to live for the rest of my life knowing that like my neighbor's grandmother died and died. You know what I mean? Like for me? Yeah, like, because, because I had to what? kept Chinese food? Like, you know, you mean like that, you know, I that's the thing. And we've been, we've been in this house for like, two weeks now. And I have to be honest, I'm okay with it. Yeah, dude, but you know, and I'm lucky enough to be able to obviously do what I do from where I live, but it's not that bad. You know?
Sarah 32:45
Well, I think with the with the takeout. So for a while, I was resisting at trying to be so good. Well, it was first I felt like I was sick and like, I might have it. But then I also felt like I was scared that all these like local businesses. Were were under such duress that I'm like, oh, maybe we should order a couple.
Scott Benner 33:05
Here, right. You're also trying to support the because you're also looking at your own. But listen, you're still working. But there are people who aren't working people yeah. Backwards financially every day. And and then local businesses are anybody who's ever run a business knows that most of them are barely operating it even. You know, they have to keep moving to work. There are going to be places that don't open back up after something like this.
Unknown Speaker 33:28
Oh, yeah, for sure.
Scott Benner 33:29
It's just very, it's just it's different. I've never experienced anything like that. No,
Sarah 33:35
I yeah, I don't think this has ever been in our lives.
Scott Benner 33:38
Yeah. Now what we want Next, I'm assuming is we're hoping for inoculations for the future. But yeah, sort of similar to the to the flu vaccine? I don't know. But it's really crazy. So have you seen anything? Like, like if I said, you and I'm not asking you to but if I said you tell me a really scary story. You have one for something you've seen at work? Where what's your level of? Like, what do you
Sarah 34:06
um, well, like are specific.
Scott Benner 34:10
I'm just wondering if it's like it is.
Sarah 34:14
To me. Yeah. Yeah, it's it's sir. It's terrific. And I've seen a lot of stuff. I mean, I've seen a lot of awful awful things. You know, I've worked in an ICU I've seen some terrible things that like How can this happen to human beings, you know, people innocently going about their lives. But I yeah, I think what's most, like, hardest as like health care providers, I think sometimes is see because like, it's almost like an expectation to see older people that get really sick with something like this, or people that already have a few other conditions. Get very sick. It's I think it's the hardest when you see people like in their 20s knees, and they were completely fine. like walking around. And now they're like, in a terrible state, you know, they've got a machine for their lungs, they basically, you know, have machines working for the as their heart like, like, like, like horrible like they're next to death. And it feels that's that's the most terrific
Scott Benner 35:22
it is it is. It's how we all think. I mean, it's, you know, it's funny, it's wrong, but it is how we all think like, if you see an older guy, they've lived a pretty decent life, you know, like you, that's your brain and your brain writes
Sarah 35:34
it off. Yeah, but he's 70 something and, and passes away. Not that it's not sad. But like, oh, they've had a chance to live a life someone's in their 20s, you know, that they're just starting
Scott Benner 35:45
out. And so if that's what they're talking about, is happening to with care, right, like once we get down to rationing care. Oh, yeah. That's how those decisions then get made. Right? Is it by age? And hell? Yeah.
Sarah 35:58
Yeah, I actually read it because yeah, I had read about that happening in Italy. But I'm a co worker of mine sent an article about a new jersey hospital. Yeah. Um, I forget the name of the hospital, but it was the article was out there. But the The doctor was talking about already making the just like, the doctors were having to make the decision once the patient goes on the ventilator. Like if they don't look like they're gonna, you know, little while, like, if they don't think they're going to keep going and make it through this. They're just taking them off the ventilator to to sterilize it and give to another patient because it's not fair. You know, because in the ICU, we do incredibly extraordinary things. Every day, we have machines for almost every organ, it's requires a lot of money, a lot of personnel, but we can do and I've seen many, like people that were dead dead for like weeks come back to life. Yeah, honestly. But but there's not the time and the, the, the staff and the more importantly, the equipment to do that for everybody that you want to give a chance to. So the doctor was talking about, yeah, take it, if there's three patients that they took the ventilator away from, because they didn't think the patient was going to make it in the long run, and they couldn't give even give them in this situation now, like that's, that's the thought that you're not going to be able to give these people the chance. So, my job we're talking today about that similar kinds of things, like changing the way we make decisions, and healthcare.
Scott Benner 37:44
So it's, it's really the, it's the equivalent of a war movie, where you've seen where a medic comes along, looks at somebody and goes, he's not gonna make it. We're gonna go to the next one. But that's Yeah, but that person, you
Sarah 37:55
know, yeah. Really good synopsis. Yeah.
Scott Benner 37:57
Right. So you just sort of, you start making these decisions, and then Geez, that, then that has to weigh on, you know, that's not a decision you want to make you want to exhaust efforts. And then if someone passed, yes, right, but you don't want to exactly
Sarah 38:13
what we've been, we've been trained to do, right?
Scott Benner 38:15
Because what if you're wrong? What if you just look at somebody that one's not gonna make it will take the vent, get the vent clean, move it over to this person who we know with events going to do? Well, and, and you're wrong about that? And that's
Sarah 38:28
because you could, you could pick the other person and they might end up passing away in the end?
Scott Benner 38:33
Yeah, it's just their decisions that no one should have to make. And in, in my right to say, in the regular course of medicine, these decisions don't normally have to get made.
Sarah 38:42
Yeah, exactly. They, they don't and I actually have been talking about it, because I thought about it in the past week that like, honestly, a lot of us are going to need some mental health, like support. Because this isn't like the normal, like even the way the units are set up and stuff. Like wait because no visitors are allowed. Or the patients are lonely, if they're, you know, because not all patients are like out of it on a ventilator. There's, there's a lot of like patients that know what's going on in their family can't see them. Like it's a very, it's I want to dystopian, like the hospitals like a dystopian, like, please, because it doesn't seem like this isn't it's completely and there's so few people working they've minimized all the people working in the hospital. Like it's a very weird lonely
Scott Benner 39:34
place. Yeah, that fluorescent lighting is a little otter I would imagine today that it is normal, right? Yeah, just sort of feels like the fourth episode of a zombie television show. We're like everybody's like it's gonna be fine. Still, we're just working hard and we're gonna get past this. Except we except by the way, we are going to get past this it is going to like flattened out and it you know, people are still going to have it but it's, they're going to get to keep their event you know if they need one. Yeah, it's just this. This is the time this is the spiky time right now. And people are people are. I mean, we're not talking enough about the cases that have, you know, resolved and recovered. Yeah. And that's starting to happen. You know, we're starting to see those. I think the last numbers I saw, were like over 120,000 cases in the US, somewhere over 2000 deaths, but also somewhere over 3000 recovered. So, you know, that's hopefully the next bit of news we're going to start getting is, you know, how many of these, you know, I'd like to I'm excited for the day where it says, you know, we have 150,000 cases, and 100,000 of them have, you know, recovered already. And, yeah, so it's just a very, I don't know how you're doing it, honestly, are you? Did you say you're in a hotel right now?
Sarah 40:49
Well, um, they're doing a lot of things. I'm sure they're getting really good rates on hotels, because nobody's traveling,
Scott Benner 40:56
right.
Sarah 40:56
But they're also understanding that we, the commute, and everything is much more stressful, more difficult. And honestly, because every No, it's like, no one wants to take public transit. So the parking lot because I drove to work this past week was crazy to get it. I don't normally drive I usually take public transit. Yeah. But I think they're understanding that, you know, and also like, so then, they're also understand that people don't want to expose their family members, necessarily. So at least, like if you, you know, stay here and between and then if you want to kind of shower off, or I saw a lot of memes about like, nurses being like, I'm just gonna, you know, you're gonna see me stripped down to my underwear before I walk in my house. Just mind you're
Scott Benner 41:49
out front on the on the patio.
Sarah 41:51
Yeah, so so if that's the way you feel about it, like it's a safer place. I mean, I obviously I don't feel like I need to protect my, but it's nice to having like, to, to not have to somewhere you can
Scott Benner 42:03
go. I've heard stories of doctors sleeping in their cars at hospitals, because they don't want to go home. You know, so there's all levels of like, yeah, you don't want to like if you've got a family at home, and they're basically sheltered in place. And they're not ill, as a health care professional. You coming into the house is probably the worst thing that you can do. Yeah.
Sarah 42:24
Yeah. To expose everyone.
Scott Benner 42:26
Right? It really does make you think, doesn't it? Like what is expose everyone mean? Like, you don't mean? Like, you're just touching something like, you know, is it is it as weird as like, I touched the desk and a day and a half later, and my kid touch the desk? And
Sarah 42:40
well, yeah, this this disease is a lot of like, unknowns that everyone's scared about it, because I don't think a lot of it's not that clear. And everyone, stuff, policies and procedures keep changing. And the recommendations keep changing. So it's a very scary, it's a scary disease, because, you know, we've never dealt with this before.
Scott Benner 43:04
I'm finding it really fascinating to watch states that are, where we were two weeks ago, and how they're acting like, Oh, it's not gonna be that big of a deal. And I'm like, is it not like, you know, two weeks from now you're gonna be like, Oh, we should have done something, you know, like, just a very, because, listen, when this was all happening, I was in Florida with my son, and he was playing baseball, you know, he's a college student playing baseball, and we were like, hey, it's springtime, this is great. And then all the sudden, you know, there's these conversations about, hey, you're gonna get sent home from school, or, you know, spring breaks gonna get extended. And now he's, you know, now he's home for the rest of the semester. And my daughter's taking, you know, going to high school in my kitchen. And you know, like, that stuff two weeks ago was just things people were talking about, like, have you heard this might happen? And so I think you're right, there's just not enough. I think there's not enough top down. Leadership, like, like, somebody just needs to say like, these are the rules. Everybody follow them? You know, it seems to me that if we all just started doing the same thing two weeks ago, we'd all be a lot closer to it.
Sarah 44:13
Yeah. Yeah, we'd be in a much better place. But yeah, it didn't come it didn't come from the top because, I mean, the President had different ideas about it from long ago, right.
Scott Benner 44:24
I'm seeing here there's er workers are saying that a quote every man for themselves atmosphere, regarding their protective equipment has kind of like crept into New York City, sort of like you're on your own to protect yourself because we're out of stuff.
Sarah 44:39
Well, yeah, there there's there's a limited supply. I mean, my my hospital definitely has a good amount, but because the amount of patience and like we're going to be expected to go so far above like our normal capacity. I don't know if you saw government Cuomo talking about how we have to increase the capacity. So every hospital has to increase the capacity. So even if you were prepared for the amount of people you have, so many people are on isolation, like it's like an obscene number. So if you're taking care of the, we call them COVID patients, they have a lot of protective gear. But if you're not, you're basically in your limb, you're limited. you're limited to what? They give us some, but you're, it's it's kind of, you have to make it last.
Scott Benner 45:39
So like, if I'm delivering a baby, do I just pull my T shirt up over my nose? Is that? not quite there yet? But, but so you might. So there's a there's a descending order where the gears going?
Sarah 45:51
Yeah, for sure, though, there's, they have like a lot for the COVID patients, but for the rats, but at the same time, the problem is, sometimes you don't like, you know, we've been talking about you don't always know when people have it or not. Yeah. So like, like, you could walk into a room, you know, like I did a few weeks ago, like, not knowing that the patient had it.
Scott Benner 46:15
And that's it. And that's why the I mean, the tellement stuff for other stuff, you know, out in the world. Pediatricians visits, my wife isn't feeling well with something. It's not this. And she did. You know, she had a phone call with a doctor that ended in a prescription. And you know, a month ago, you would have been like, Really? That's weird. But that because that's not really something you ever think of is a doctor, like writing a script from your description over the phone? Yeah, but it was, I guess it's a better decision than asking her to come somewhere.
Sarah 46:43
Oh, yeah, for sure. Yeah, my endocrinologist who called me because she got routed my COVID result. And she's like, Oh, yeah, we're gonna do telemedicine and you'll just upload all your stuff and all that I'm like, Yeah. Okay. I guess. I guess it makes sense. Yeah. Although for me, it doesn't really matter.
Scott Benner 47:04
Yeah, well, for you personally, it's interesting, because you have for you personally, doesn't matter. You've had it already. Yeah. And you can't get it again. We should all get like tea. Everyone should get a T shirt who's had it? like, yo, don't worry about me. I'm good, baby.
Sarah 47:21
Well, that's what that was the other reason I want Well, my husband especially wanted to get tested because he felt like, I want to get tested. Because I want to know if in like a few weeks, I can help people if they need help, like if they need groceries or something and I don't have to worry about getting the virus. Mm hmm.
Scott Benner 47:37
I'll tell you the one thing that talking to you makes me feel exceptionally good about is it no matter what I do all these articles and I've had a doctor on already, Jenny's come on and talked about it, you know, and now having you on who has it, and obviously you're doing fine. Not that everybody's gonna have the same experience you're having with it, but it makes me feel better, because there's so many of these articles that are popping up about like, you know, COVID-19 and diabetes, like what should you do? And after you go through, you know, 2000 words, there's always an overview at the end it says so, basically, you know, wash your hands and stay away from sick people and like, clickbait more clickbait, you don't mean like, like, just what a horrible thing to do, like drive people because, I mean, you've had it now you have diabetes, you've been a nurse, you're an MP like, what should people in your opinion with diabetes be doing right now? anything different than anyone else?
Sarah 48:30
So when I was starting to like,
kind of become real, I guess sort of like the end of February when really we should have like started the lockdown. But like things were coming down that soon, you know, Italy was like, saying all kinds of stuff. Now I have like, pretty well controlled, not art and well controlled, but you know, my a one season that the six is, um, and I was like, you know, I think I'm gonna you know, step it up a little bit. Work, get myself a little tighter, and eat healthier, more fruits and vegetables. I've been kind of doing like, vegetarian since January. But I was like, you know, less dairy more fruits and veggies like I was trying because I know I'm immunocompromised and I do work in the medical field to be even more vigilant with being healthy. Right. So that was my biggest intervention. It wasn't like, I didn't buy to be fair. I'm like a mild hoarder at baseline. So in my basement, I already had like, one and a half big things of hand sanitizer. I had some wipes. I had I had enough stuff while but Well, a lot of people were starting to hoard things. I was trying to like, make myself help, like, follow a healthier diet, right? Pay more attention to my blood sugar's that's what I was trying. So while everyone
Scott Benner 49:53
else was looking for hand sanitizer, you're like, I'm gonna have an extra fruit and a sit up here. Yeah, by the way. Line mild hoarder is the T shirt, in case you're wondering. I don't have the time or energy to put that dope fact, but I feel like that is gonna be a big seller in the coming days. Yeah, it's uh, I mean, I threw a couple custom meat in the freezer, and I'm usually more of let's just waiting by it fresh kind of person. But you just thought, you know, listen, the one thing I did while you were doing a sit up is I was refilling ardens prescriptions in February, like I was I was paying attention to what was happening overseas. And I looked at all of our scripts and anything that had a refill available I sent in, I was just like, okay, I'll take more insulin, I'll take more insulin pumps, I'll take anything that you're willing to give me. I'll take right now.
Sarah 50:42
Well, let's be also because I'm a mild hoarder that I have 30 vials of insulin in my refrigerator. I have I have so much pump sites, I have like two insulin pumps. I'm wearing a Medtronic sensor, but I have a Dexcom in the basement that I need to switch over to so I have like, I have excessive diabetes supplies. I mean, I think because I've always tried to, you know, get my get prescribed more, etc, that I've just ended up with,
Scott Benner 51:14
I don't know, extras. On every time I just was like, I don't know, I thought I don't want to need this. Like, I don't know what's going to happen. Like, I didn't know how Cisco knows
Sarah 51:24
for sure. And if you don't have like a ton of stuff. Yeah, definitely. But because I i've always I've just had a CAD an excess of stuff for a while now. I don't know if it's just because I am not using as much and then you keep getting it. You know, I've I've been on an insulin pump for 17 years. So like, you know, I kind of stayed ahead of the curve. And I've had, like, you know, you guys talk about sometimes people like, you know, going between insurances, or they just don't have good coverage. But I've always and that's I think part of the reason Honestly, I went in to the nursing profession having diabetes, because I always knew that I needed really good employment to buy my supplies and good insurance and stuff.
Scott Benner 52:06
So having diabetes made you think I need a really stable job that comes with health insurance?
Sarah 52:10
Yeah, it did. Honestly, I do think it really affected the ways I was thinking about professions.
Scott Benner 52:19
I can imagine I mean it. I don't you know, I don't pressure Arden about it. But every once in a while, I'll be like, hey, see how we all have stuff for you see mom's job? You know, oh, yeah. As you know, everybody needs a job with insurance. I know you have dreams that are nice. I don't want you to not them. You know, don't forget your dreams. But don't forget, you need insulin too. And I'm looking at me, there's no way I'm gonna stay alive much longer. So I'm doing my best here. But I mean, let's be honest, I'm not going to be 95 while you're 40. So, pull it together, do your best. I think it's um, I don't think it's unreasonable to consider, you know what I mean? Like, I think it's smart to think about it. But that's what I did. I was just like, Alright, let me get these. And don't get me wrong. I wasn't hoarding stuff. I was just like, Look, we have prescriptions there up to be refilled, I'm going to refill them now. Because, you know, it's easy to be like, Oh, it's all gonna be fine. And it probably is all gonna be fine. But I just didn't want to get in the situation where Arden needed something. And that company got hit with this virus and got slowed down even, you know what I mean? Like, whatever it was gonna be. I just didn't want that to happen.
Sarah 53:30
Actually, there was an article written because a friend of mine shared it with me, it was a type one diabetic, who, I don't think they I know, I don't know what their job was, I think it was in business, but they wrote it like a, you know, an op ed piece on the wall street journal or something, but talking about how this might affect their disease, because the supply chain might be affected somehow. So it's a big thing to consider, for sure.
Scott Benner 53:57
It probably won't happen. But if it does, it does. And then what are you gonna do? Who are you going to call like, you know, world where you we all basically live a life or anything you need, you can have almost instantaneously, right? Yeah. So all the sudden, you know, what does it mean? If somebody tells you, hey, we're gonna get those to you, but it's gonna be a month from now. You know, here's a bag of needles and a vial of insulin, like good luck. You know, so a lot of us, you know, Arden definitely included. She leans heavily on, on the technology she has, and so she, you know, she needs to stuff to make it go. I don't think we could not do it the other way. I'm, you know, I'm pretty sure that what I, I think I could reverse engineer my knowledge back to MDI pretty easily. But still, it's, you know, no one's looking for that. And I'll tell you what, it would be like getting diagnosed all over again for Arden. Oh, yeah. You know, because she doesn't have any recollection of getting shots. So it would definitely be an on though and so I just thought all right. Let me let me be And, and I did the same not with food like we didn't like, you know we only have a basic refrigerator. It's I don't have like a, you know, I don't have three freezers in my basement or something. You know,
Sarah 55:13
I only I have one deep chest freezer in the basement.
Scott Benner 55:16
See? Well, you are a mild hoarder, then. Congratulations. What's
Sarah 55:21
that one? I know when I was breastfeeding my kids, and like my, my, my refrigerator freezer and my kitchen isn't very big. It can't fit like a very big refrigerator. It's like, it's okay size. But like if you're storing up a bunch of breast milk, so go back to work. This is probably TMI. Not at all.
Scott Benner 55:40
We can hear next week's episode about sex from a female perspective. This is not gonna be too much information good.
Sarah 55:46
No. So like, in a depressed freezer. Breast milk last longer. Yeah. Okay, so I think I got that. I think that my first kid. Yeah, just so I could store more breast milk longer.
Scott Benner 55:59
Gotcha. Oh, that that's a that's a good idea. I mean, now I'm trying to imagine how much breast milk you can pump. But that's a complete we're getting off topic now. Because that seems like a massive amount. But that seems like a really important reason to have one because Kelly's like, should we have one of those freezers? And I was like, I heard they use a lot of electricity. And what exactly are we going to put in it? Five seconds after this is over? You know, what the, that made me feel like and I bet a lot of people feel this way. You know, when there's like a power outage. You know, ever since you know, we've had a couple of hurricanes. Oh,
Sarah 56:31
yes. Irene killed my basement right. And I left her Sandy too. So right which was also a mild emergency, but my my house was okay,
Scott Benner 56:39
but doesn't didn't Sandy make you feel like I should have a generator?
Sarah 56:44
Oh, yeah, we got one. I think we got one after Irene, though. Okay, because that hurt my house pretty bad.
Scott Benner 56:50
And so I had that same feeling. I should have a generator. My wife's like, we need a generator. But I resisted. I was like, we don't need a generator? We don't we definitely don't, unless we need one. But I think we're not going to be able to resist that idea. But this is so do you see? Have you heard what are people talking about? About how long? Like how long is this? Are we at the apex for the New York, New Jersey? Like area? Or is this not it yet?
Sarah 57:18
I don't think it is. Honestly, I might be being a pessimist. But I would love to be proven wrong. I feel like it's gonna be like, another month or two, because the amount of people that have been diagnosed? I, I don't know, I can't imagine and some of these people need to be on ventilators for a very long time, right? I mean, if we get more ventilators honestly, if we don't get a lot of ventilator to
Scott Benner 57:45
go faster, right? Yeah, cuz
Sarah 57:48
not to be very morbid, but yeah, people won't live. But if we got a lot of ventilators, it's gonna last a long time, because some people like I have a good amount of ICU experience. Some people can exist on ventilators for a very long time,
Scott Benner 58:03
that could end up being necessary for some of them who are hit harder, because for you know, while most people are probably going to have your or your husband's experience, the people who have an opposite experience, it's an incredibly severe and dire experience.
Sarah 58:17
And it's I think it's much harder for people who have like a family member that's never been sick a day in their life to imagine like, I think, I think a lot of people who have chronic diseases or family with chronic diseases, you along the way kind of accept certain things. Like if you're like a realistic person, there's a, you know, I talked about it with people and like, like a knee jerk way, like, I could overdose on insulin someday, like, like, I have a more risk of dying than than the average person. And I think like, if you're a wise person, and you have family members with diseases, you think, oh, maybe they're, you know, they have more of a risk and I think they are more likely to be okay with the patient, you know, going passing away because they've dealt with a disease for a long time. But if you go in there and your husband's 40 years old, never been sick a day in his life, and you're like, do everything for them, like Like, there's no reason he's should be dying right now.
Scott Benner 59:26
It's the implications of your life, right? Like you have type one. So there's extra variables around your life. So yeah, sure, right. And, and 65 year old, 75 year old person in a normal everyday setting doesn't have the same implications that they do now that this virus exists. Now they're Oh, yeah, they're, you know, their context is different now. It's a very strange thing to hear. I think that's where some of this consternation is coming from right is that we don't really talk about dying like this ever. We don't talk about About mortality we don't talk about we talk about health, like it's fixable. I know for sure my kids think that whatever goes wrong with them, someone will just fix. Like, again, most of us feel that way. Right? Like, what could what could happen to me until you know, until you get one of those things that nobody can fix? And then your understanding of the world changes. And yeah, you know, so we're just hoping that everybody can stay in their understanding where Oh, it all will work out fine. Like most of us get to live like that for a while. The lucky ones at least. Yeah, yeah, that's really crazy. I really appreciate you doing this. Did we not talk about anything that we should have talked about?
Unknown Speaker 1:00:40
Um,
Sarah 1:00:43
no, I think we did it. We covered my disease.
Scott Benner 1:00:51
By the way, is it a disease? I sometimes I hear people call it a disease, but it's a virus a virus. It is the COVID. Like, I don't understand, do you? Well, I
Sarah 1:01:00
consider it like an infectious disease. Okay.
Scott Benner 1:01:04
All right. Because I always wonder like, sometimes somebody calls a disease on television, and then sometimes they don't, I'm like, well is, is everyone, right? It's no one right. So I appreciate you doing this shark. Tank. Good luck with everything. Huge thanks to Sarah for coming on the show as a type one who's had the COVID-19 virus. Please remember that Sarah's experience with COVID-19 was her own and yours very well could be different. But I thought it would be incredibly comforting to hear from someone who had the mild symptoms that you hear about, maybe not frequently enough on the news. Huge thanks to Omni pod Dexcom. The Contour Next One blood glucose meter, and of course, touched by type one for sponsoring the show. And how about a shout out to Sydney for refreshing all the music that you hear on the Juicebox Podcast. That's right, while the rest of these podcasts are circling the wagons going, Oh, I don't know what to do. Nobody's commuting anymore and listening to my podcast. I'll probably just put out some real short episodes, you know, to make it look like I'm putting out a show. But I'm really not that Juicebox Podcast is coming through with absolutely new music, all new content up to the date information. And next week, we're going to talk about working with Type One Diabetes from an adult female perspective. Please don't let your kids listen to that one. You know what, since you're here and basically the rest of your day consists of leaning on the kitchen counter wondering what time to go to bed. Why don't we listen to all the new music together uninterrupted like thank you so much Sydney, Mahler. your talents make this show amazingly better. Here's the refreshed theme.
Not all podcasts do this, but I put special music overtop of the ads so that you always know you're being sold to. You deserve to know that. And Sydney who by the way is 15 years old. I believe nine the first time she wrote the music for the show. updated the music too.
This last track was a surprise, I only asked Sydney to update the music that I had. But she even wrote a third piece that I love so much. I'm going to use it at the end of the show to use to hear the theme at the beginning of the theme at the end. Now you're gonna hear the theme at the beginning, the add music of the ads and this little ditty, as the show ends.
Okay, everybody do your best to stay. Well. I'll talk to you soon. Like I said, there's another episode coming in just a couple of days after dark episode about female sexuality. Dr. Edelman might be on pretty soon again to update us on the bigger picture around Corona. And there'll be some asks Scott and Jenny at the end of the week. Thank you so much for listening to the Juicebox Podcast, even during tough times.
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#317 Ask Scott and Jenny: Chapter Eleven
Answers to Your Diabetes Questions…
Ask Scott and Jenny, Answers to Your Diabetes Questions
When do you change basal rates? Basal versus temp basal adjustments.
What are the most meaningful measures of successful diabetes management?
What is a good standard deviation?
You can always listen to the Juicebox Podcast here but the cool kids use: Apple Podcasts/iOS - Pandora - Spotify - Amazon Alexa - Google Play/Android - iHeart Radio - Radio Public or their favorite podcast app.
+ 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 317 of the Juicebox Podcast. I'm your host Scott Benner. Today, Jenny Smith and I will be answering questions that you the listeners have sent it. Three questions today. The questions three. As you can tell, I've been locked in my house for a number of weeks now, I'm getting a little weird. This episode of The Juicebox Podcast is sponsored by the Contour Next One blood glucose meter. And by touched by type one, you can go to touched by type one.org or Contour Next one.com to find out about these wonderful sponsors. My friend Jenny Smith has had Type One Diabetes for over 30 years. She's also a certified diabetes educator. She has a bachelor's degree in human nutrition and biology from the University of Wisconsin. Jenny's a registered and licensed dietitian, a certified trainer on most makes and models of insulin pumps, and continuous glucose monitors. And as you'll find out later, very well may be a person who can talk to wildlife. But one thing Jenny definitely is, is a person who would want to to know that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, she'd want you to always consult a physician before making any changes to your health care plan. We're becoming bold with insulin, and he's just good like that. She's rock solid, you know what I mean? She wants what's best for you. In today's show, Jenny and I are going to talk about when to change bazel rates you know when to do with Temp Basal, and when to put, you know, a firm change into place. We're going to talk about the measurement for success in diabetes management. And what a good standard deviation might be not just for you. But for everybody. Bum Bum, bum bum bum, bum, bum, bum, bum, bum, bum, bum, bum bum bum. The highlight of my entire week has been that the Costco near me had paper towels.
Hey, sorry, I was moving my microphone stand a little.
Unknown Speaker 2:18
That's okay.
Jennifer Smith, CDE 2:21
I think I have a like, I think I have like a problem with like, I did a finger stick. Okay. And my finger really hurts. really hurts. Like, like, and it's kind of like, puffy. Like, can you see that? It's like puffy and red again.
Scott Benner 2:42
We're on the top. It's puffy, but you didn't stick yourself?
Jennifer Smith, CDE 2:46
No, I stuck it on the side where I always does do and yeah, like I can't see anything from it. I also need like bifocals, because I have to go like this every time I have to like see something up close. My son brings me like the directions for a game. And I'm like, like, seriously, who wrote these directions? Like, come on.
Scott Benner 3:09
You have no idea how many times because Arden's a side stick like she sticks on the sides of her fingers, too. Yeah, you have no idea how many times like in the middle of the night when I do it. I'm so close to a cuticle. I'm like, how did I miss that? Yeah, and I looked down at her and she's not awake, and I go ooh, she's never gonna know about this.
Jennifer Smith, CDE 3:30
never happened before like, and it's it like it hurts it physically. Yeah. I'm like, I can't there's like no hole. I can't tell if there's like gross underneath or anything. But who knows? I don't know. Maybe there's like an alien growing underneath
Scott Benner 3:45
there. Listen, if it's too fast for you to get an infection, obviously. So it's not that I did you maybe just hit a nerve. I just
Jennifer Smith, CDE 3:54
responding must have just hit something that was just a much more sensitive spot. Or maybe I hit a spot that I had already hit. It's wrong. It's time it's kind of a favorite thing. Like
Scott Benner 4:07
Yeah, her sleep. Right. This is fascinating. In in Arden sleep, I will try I will go to fingers that she doesn't use figuring she's asleep. She won't know in her sleep. She'll pull the finger back and give me a different finger. That I'm always impressed by because sometimes I'll be like Arden and she's not awake. Right? she just she feels you in her sleep. Take the wrong finger. She's like, No, no, no, this one. Or she'll do two of them. She'll like either one of these is fine, but not like I try to use her thumbs when she's asleep. Yanks him right back holds him up in a fist. I'm like, That's hilarious.
Jennifer Smith, CDE 4:44
That's super funny. So So how are you? How are your older older kids? I hate calling them kids because they're really not kids anymore, but like, how are they doing with everything? I've got 17 nieces in Milwaukee, and they are just like, they're like climbing the wall really learning to up brother in law says they're just like, I cannot be inside anymore. I need to be not near my parents.
Scott Benner 5:13
I'm bored. Well, we're gonna turn your question. You're very kind. How are you question into part of this episode. And here's here's why Arden's insulin needs have gone way down since she stopped going to school.
Jennifer Smith, CDE 5:27
Do they go down in the summer too?
Scott Benner 5:30
Yes, she doesn't like being at school. That's just what it is. So now this whole the the, the incarceration is actually freedom to her. She can go to bed when she wants get up when she wants handle her work when she wants to. She's much happier. I'm seeing more smiling. I don't think I should ever send her back to school.
Jennifer Smith, CDE 5:55
The reason a lot of a lot, I've got several people that I work with who homeschool their kids. One who I started working with. I was telling about her she's the pilot. Yeah. And her parents school homeschooled her. She's now like, out of college, she's actually doing an internship with one of the airlines doing wonderful, but she was homeschooled. And they didn't see the fluctuations. Like comparatively with the other kids her age that is working with who were in school. clear difference from a weekend or a holiday away to actually being physically in
Scott Benner 6:33
school. Right now. There's there's been, even the summer takes time for her to like ramp down. Sure. But this was one day, the first day, which she was unsure of how this was all gonna work, her blood sugar didn't change. And then after she got her work in on time, she was just like free and easy and really happy. So it's interesting. Now my son. He doesn't like the lack of activity. Like we were outside in the driveway throwing a baseball yesterday for half an hour. He brought us. He said, He's the my kids are both very good with money. They don't ask for a lot of stuff. And he's like, I need a squat rack. For the basement. He's like, I need to be able to like exercise. And I was like, okay, and the other end, he walked outside just sat on the front step for a while, you know, just the hate, I need to get outside, because he's also a boy. So like, he'll start playing a video game and lose a day to it if he if you let him, you know what I mean? And last night, he told me around midnight, I'm going to get a shower. And then I'm going to read for my economics class. And I was like, Oh, that's great. And he's like, it's not. I was like, why is it not? He goes, because I'm going to read for an hour to get what I could get out of a five minute explanation for my professor. And I tried to do like I did the dad thing. I was like, oh, there's nuance to the reading. You'll appreciate it later. He was looking at me like, I don't care what you're saying. And I was like, I was like, I tried not to be, you know, I just was like, you know, this is it. It's good. And, but he wants that he's also concerned about how much we pay for school. And that now he's basically learning through, you know, yeah, really fancy YouTube videos. So he's like, why are we paying for this? And I said, coal, this time is going to turn. It's one of the strange things about about the United States at least, that I've never understood. Like, why has quality distance learning not become more? I don't know, like acceptable, especially in college. Right.
Jennifer Smith, CDE 8:40
Right. Right. Yeah. I mean, I think it's getting better now. How people viewed the distance learning like the University of Phoenix or whatever it is, yeah, all the commercials for but there, there are quality programs, and my sister in law actually did an online master's degree in business management. And she she does a great job. She's a wonderful job because she did that. So there's nothing wrong with
Scott Benner 9:07
no, no, no, but why is it not more popular? Why? Why not? Yeah, it is. It just is like, his level of embarrassment. Like I went to school, like through the mail. Does it feel like that or something like that? You know what I mean? Like 1960 took a writing course from Hollywood.
Jennifer Smith, CDE 9:22
Yeah, I don't know. I think I think in today's technology world, it's getting better. Um, in fact, some colleges as I'm sure you've seen with even Cole, I'm sure he probably has some things he needs to submit online and do that way already. But I think it's such a big change from the quality of as you know, in high school and even in college. There's a lot of social networking that goes on that you you don't get that when you have it at
Scott Benner 9:53
school. You just don't and we talked about that. There's, you know, you sometimes meet guys You know, he's playing baseball with or he's met through school. He talked to them a little bit, you know, that's an impressive kid for 20. It's going to be an impressive adult. And you don't know when 10 years from now that kid or your son's going to wake up one day and go, you know, I have a position to fill, you know, who would be great for this? Yeah, yeah, that guy played baseball with 10 years ago. And so there's that piece and there's the social part of it. Like, I'm not, I'm not discounting that. But for some people, they just want their degree. They're not looking for you know,
Jennifer Smith, CDE 10:28
they could care less about sitting in class next to the guy who doodles pictures of his dog.
Scott Benner 10:32
Right? Yeah, I met the most interesting guy in college yet. No one cares. But anyway, it's just it's it's interesting that they both are, they're not happy. We spent a number of hours playing poker the other day. You know, there's, we keep talking about having a movie night, but it hasn't happened yet. Everybody said we're, I think we're kind of quietly keeping things. Activities aside for when everyone loses their mind. And we really, like need the activity. So far. Everybody's been okay. And Kelly's under the weather, but Oh, it's not um, you know, it's nothing related to all of us. Yes. Yeah. It doesn't feel well,
Jennifer Smith, CDE 11:14
just a normal thing. I know. And that's every time you hear somebody like,
Scott Benner 11:19
like, Oh, my God, get back 30 person get away.
Jennifer Smith, CDE 11:24
The cough. Maybe they were eating a granola bar that didn't go down the right way.
Scott Benner 11:28
We're doing it on purpose for comedy reasons. Oh, yeah. Yeah,
Jennifer Smith, CDE 11:31
that would be my husband.
Scott Benner 11:32
Yeah, just everybody runs out of the room. Mom's like, Don't touch her. She's like, I just I got a dry piece of wood. Like that bringing us down with you. So, and she cut caffeine out. But she did it too fast. So now she has a caffeine headache, you know, and I gave her a little tea. I'm like, here have a little that's not from soda. And this, she might
Jennifer Smith, CDE 11:55
even do better if she if she's willing to do tea. She could even do something like a matcha which has a little bit of caffeine in it and could kind of ease down
Scott Benner 12:03
help her the caffeine.
Jennifer Smith, CDE 12:05
Because it's also much smoother caffeine than coffee coffees. Like you get this big like, Whoa,
Scott Benner 12:11
yeah, we don't drink coffee. Nobody here drinks coffee. Actually, I think the truth is that I don't believe Kelly ever has, but I've never had a cup of coffee in my life. So I wouldn't even know what it is. Jenny takes a large as well.
Jennifer Smith, CDE 12:26
I drink tea every morning. Usually a couple of hops, but
Scott Benner 12:30
I'm drinking Earl Grey with a little bit of honey.
Jennifer Smith, CDE 12:32
Oh, I have a very good friend in Colorado who Earl Grey. And lady grey are like her favorite.
Scott Benner 12:38
My favorite thing? It really is. Alright, so Jenny, we have a ton of ask Scott and Jenny questions. And we are going to do like three recordings in a row over the next two weeks so that we have them all set up. Yes. Before we start, let me tell you that and there's no pressure here. But tomorrow at 3pm I'm doing a like it's just a social meetup online. And if you're free and you jumped in for a couple of minutes, I bet you these people would be very excited to catch
Jennifer Smith, CDE 13:07
up on were zooms on zoom.
Scott Benner 13:10
Yeah, you could sit like this, click on a link pop up.
Jennifer Smith, CDE 13:13
What? Yeah, we zoom for our staff meetings on Wednesdays. But
Scott Benner 13:18
what at what time, three o'clock tomorrow? Three to 430 it's gonna run. It's gonna be like a free thing. Like people can come it's your
Jennifer Smith, CDE 13:24
time. So like, two to 330 my time. I should be around. Usually I'm working on emails at that time. So send me the link. I will
Unknown Speaker 13:33
even if you just popped in and you were like, yo,
Jennifer Smith, CDE 13:35
and send me a quick text while you're doing it so that I remember you
Scott Benner 13:39
will. You're gonna find out what it was like to be Elvis in the 60s.
Unknown Speaker 13:43
Ah.
Jennifer Smith, CDE 13:46
Interestingly, um, are you recording right now? Of course. Okay.
Scott Benner 13:51
I just wanted to read you want to say something private? Hold on a second. Bye, everybody. Well, Jenny, I hope nobody finds the body. I think you're gonna be okay with where you hit it. I mean, it's Wisconsin. There's so much snow on top of it. No one's ever gonna find it.
Jennifer Smith, CDE 14:10
We've got lots of bogs, too, you know?
Scott Benner 14:11
Yeah. Should we just start at the top of this list? Or do you have a favorite in here?
Jennifer Smith, CDE 14:16
No, I the one that I think we had commented briefly the last time we talked was it last week already? Um, was about there was somebody who asked about artificial sweeteners. And that one was curious to me. But there's a good list of questions. So wherever you want to start, it's totally fine to me.
Scott Benner 14:33
Okay, well
Unknown Speaker 14:38
can you like
Scott Benner 14:41
there's so many guys first of all, Rudy was so nice to send in so many questions. Yeah, let's just roll through the top. Okay. Okay. Sarah asks, please address puberty specifically. I think Sarah wants eight question answered for her specifically, but 12 year old, pre period girl spikes and drops are insane. They're on Omnipod Dexcom. So I think the question here is when to change bazel? And just Temp Basal. Okay, so she's seeing drops and spikes. And she's looking for when is this a change I make forever? And when is this just something that's happening? Well, that's interesting.
Jennifer Smith, CDE 15:22
It is. And it's a great, I mean, given the age of the preteen and and you know, her being a female, obviously, there are going to be, as I've talked with a lot of the people I work with who have girls about this age, who have not started a cycle yet. There are often about like a six to maybe 12 month time period before a cycle actually shows up. Okay, that if you start to track these resistant and sensitive times on a month to month basis, you may find anything to answer her question, you may find that it actually flows around the same time every month. And if you can catch that, then yes, you may be able to put a pattern in, you know, Omnipod, all the pumps out there allow you to actually set up different Basal profiles to turn on at certain points. So if you can track enough to say, Okay, this cyclic nature of resistance is always coming around the 15th of the month, or whatever it is, right? If you track a couple of months, and you see that, and you say, Okay, last month, we used 50% more this month, we're using 40% more, you should be able to set up a bazel profile, then that essentially is that much more at least in bazel delivery. And then just enable it for that time of the month and the duration of days that you see it typically lasts. That's you know, that's kind of then going forward into once a cycle does start, you'll be able to utilize that same kind of pattern. And once the cycle becomes regular, which is usually it takes about a year, yeah, give or take for most girls once they start their period to have kind of a consistency to it. So you should be able to use a pattern then, rather than just always employing a temporary bazel. It does take using the temporary bazel up front though, to figure out which amount extra you need to actually create a profile from
Scott Benner 17:28
okay. So last night, I learned that Arden has a name for her period and she won't tell any of us what it is. It has a human name, apparently human
Jennifer Smith, CDE 17:35
name. Yes. Awesome.
Scott Benner 17:36
I think she likes to feel like there's a person who's inflicting this on her so that she can be focused on the person doing the problem that's on the side. Yesterday I showed Arden's friend Jani, who has not been on the show yet, but will eventually she's somebody whose blood sugar on tracking. I showed her how to see that her pod site went bad. So she's rolling along great in the 90s just kind of bouncing, you know, at 996. Like all day long, three o'clock in the morning, it shoots up and levels off at like 220. And just stays that way all night till she wakes up at like four in the morning realizes that Bolus says the Bolus takes her down a little. And then she levels off and kind of rises back up again. And so I just pulled up a 12 hour graph. I showed it to her and I said just look at this. This is a bad site. And she's like, why? And I'm like, doesn't matter. It just is like look at it. Look at it. This is what a bad site looks like all the sudden, your insulin pump is not doing what you expect of it. Mm hmm. Common sense here says bad sighs it is this the last day of your set. And she goes it is and I was like, okay, change your pump. Get yourself down and start over again. The reason I bring that up where it doesn't feel like it maybe fits here is that the way I would handle Sarah's question is I would just do it over and over again until I had that feeling of like, Oh, I know what this is. And I really believe that it's not just me. I mean, I think the podcast has proven that out right? That eventually after you do something enough, you just see it. And then all the thinking goes away Jenny's what Jenny said is all perfect do that. But I think that one day, it'll just be a situation where you go Oh, this is a Temp Basal increase or Wow, this is not giving up. This is more. Right. Sorry. Exactly. long game.
Jennifer Smith, CDE 19:33
It is a lot. It's a marathon, not a sprint. Yes. entirely. And you know, in the beginning, though, when you're really trying to figure out the difference between a temporary or a true solid adjustment. Yeah. I think you know, when you make let's say you make you decide you're going to make a profile change. Oh, sorry. Ringing it shouldn't arraign I had it turned off.
Scott Benner 19:57
I didn't hear it on the sensor. You're good.
Jennifer Smith, CDE 19:59
Oh, good. Good. Good, good. So, you know, overall, you might make a bazel change. And then you're like, well, what, what gives Three days later, you're like, that's not working anymore. And now I'm way back down that might overtime again, prove, I need to maybe make a temporary adjustment, rather than a permanent kind of an adjustment, kind of similar to growth patterns and kids, you know, where you see a temporary need, because you're now fluxing up and Okay, all of a sudden, this is gone now. And I'm staying a little higher, but I wasn't at the rate of need. Like I was for three days. Yeah, it's come back down a little bit. But now it looks more stable. It's a little higher, but not quite. So. Yeah,
Scott Benner 20:41
yeah, I think that somewhere in between, stay flexible, be and reactive, not in a negative way. But in that sort of, don't wait around way, you know, like, and there's drifts Sarah that you'll start seeing on the Dexcom line. And just by the angle of it, I don't know how to explain it to you. But you'll start to look and go, this isn't going to stop, like this shouldn't be happening here. I'm going to try a Temp Basal increase right here. With Arden's period yesterday, I used a lot of temporary increases yesterday, because she was sitting stable at 190 boluses weren't moving or, and so to me, that meant, you know, bazel jacked it up, it worked a little but not enough, it was the end of her pump. So we swapped her pump, you know, we just went through the steps of you know, what it could be and, but we didn't wait around, like once you saw it, we moved on it. Well, we all have one thing for certain. And that's an abundance of Time, time that can be used in many different ways. You could perhaps spend your time at touched by type one.org. Or maybe you'd go to Contour Next one.com to find out if you can get a free Contour Next One meter by just clicking on a link and filling out some information. So here's what we're gonna do. Touch by type one.org has a mission of elevating awareness of type one diabetes, they also want to raise funds to find a cure. But mostly they're looking to inspire people to diabetes to thrive. They have these beautiful programs and services. They're helping kids all over the world with their D box program. And they put on one heck of a dance program every year in Florida. Go check them out, touched by type one.org. And once you've done that, you know what you need. You need the best blood glucose meter My daughter has ever used. And by best I mean, the most portable the handys fits well in your palm lights up nicely at night super duper accurate. And blood sugar test strips, the little strip things you get a second chance with if you mess up, you know when you go into the blood, sometimes you're like I got it, I got it, and then it doesn't beep and you're gonna throw away the test strip, not with the Contour. Next One, he does dive back in again, beep beep looking at your blood sugar. I absolutely adore this meter as much as anyone could adore a blood glucose meter. But Contour Next One is it. So head over to Contour Next one.com and see if you're eligible today for an absolutely free no obligation meter. And if you know you need a prescription, contact your doctor. They're just sitting in their living room to no one's doing a damn thing. Just throw them an email be like Yo, what's up? Let's try this new meter. send out a prescription. I've got nothing but time. Contour Next one.com touched by type one.org. Those links are in your show notes right there in the app, right that you're listening in now. And it's Juicebox Podcast comm check them out support the sponsors.
Okay, well, it's so funny. It's another Sarah but a different Sarah.
Jennifer Smith, CDE 24:17
There are lots of stairs just like Jenny. Yeah, it was a popular name. So
Scott Benner 24:24
they're even spelled the same way. It's not even helpful. What would you consider the most meaningful metric or measure of successful diabetes management?
Jennifer Smith, CDE 24:33
Oh, that's a good one. I think we've actually got we went over that a really long time ago. Any of the of the pro tips or any of those kinds of things? I think if you're looking at measurement from a site like clarity or one of your pump upload sites that gives you all of the metrics of this is your you know your average or standard deviation. This is what your glucose management indicator showing you what not what's the best indicator is time in range. That's it, I and second to that really would be that standard deviation, right? Because the lower the standard deviation, the more smooth management is rather than the jig up and down kind of Rocky Mountain. But definitely, I would say time in range. Our goal when we work with people is always new, at least 75% time in range less than 5% of the time low. pregnancies a little bit different. But
Scott Benner 25:35
yeah, so ranges, what are the ranges you give people? But is that range?
Jennifer Smith, CDE 25:40
I work with people on their target range, because everybody is individual. Mm hmm.
Scott Benner 25:45
So okay, so if Do you feel like most people are being told at 180? Something like that? 7180 Yeah,
Jennifer Smith, CDE 25:54
70 to 180. Like, if we look just at tide pool, tide pool has automatically set up as a timing range target, as 70 to 180. You can in your settings, go in and adjust that to get it tighter or make it broader or whatever. But yeah, most most practitioners, I would say, are aiming for about an 80 to 180. That's the most common that I hear. Um, so again, if you just aiming for what the standard is. That's it? Well,
Scott Benner 26:24
I think that these companies should expand this a little bit. I've been thinking about this, I need a time in range. And a time in Nirvana, like kind of mess, right? Like, I want to know,
Jennifer Smith, CDE 26:39
I want to know, the end range, but I really wanted this sweet spot. Like I'm not I'm
Scott Benner 26:43
not, I'm not upset that Arden's blood sugar's 180 for an hour, right? I'm going to get it back down again. But I want to know when I'm 70 to one to one, or, you know, at 130, once we're in there, I want to know when I'm, I even want to know, like 65 really like because if I'm because if she's 65, for a couple of minutes after Pre-Bolus? Yeah, I'm already with that, right. And so I think that everyone needs to remember that when we talk about this stuff, there's context that you need to give it. And you see all the time there's people online, or Look, I was in range 100% of the time today, and somebody will come in and say, you know, what's your range? And then suddenly, they don't come back again? Because you know, they never went over 350. And we're never under 50. I'm in range all day. And even you know, what, if that's for them a success? I'm not taking that from them. I'm just saying that when you're trying to share it out loud in public, you need to tell people what that range is, right? It lacks, you know,
Jennifer Smith, CDE 27:45
weight. And I've even seen something that goes along with it. I've even seen people then question, well, what are you eating? Because when we're looking at sharing our own information, and kind of patting ourselves on the back, what's good for us? Absolutely, it takes work. So go ahead and pat away. But you also have to, when you're putting it out there to the public, you have to give all the information that went along with that. You can't just say look at this nice flat line. Well, people then ask, Well, what are you eating? How did you get that? Because there are so many different variables that go into meeting that.
Scott Benner 28:21
So my blood sugar has been between 82 and 86. All day, I've had four hard boiled eggs yet like, like tell somebody the whole story.
Jennifer Smith, CDE 28:28
Right? Exactly, yeah, because it feels
Scott Benner 28:30
bad. Otherwise, like, otherwise you're looking at it, you're like, Oh, my gosh, you know, this person's blood sugars like this, I try to remember as much as I can to say, you know, ardency, one sees been between five, two and six, two, by the way, coming up now on six years. And she doesn't have any diet restrictions. But I always think the important thing to add is, for all of you that are imagining that her blood sugar is just at three constantly. That is not the case. You know, we just don't look at high blood sugar's very long and she's not low. So, you know, I would say that ardens deviations never where anyone would want it. Hers is usually like 40. You know, and
Jennifer Smith, CDE 29:11
but within range,
Scott Benner 29:13
it's being measured between, it's being measured between 70 and 120. Right. So, you know, and, you know, and I know, I still don't want her to spike up, but she sort of doesn't, right, you know, so. And not that she doesn't ever she does a couple of times a month or you know, a couple times a week or whatever it ends up being, but she just doesn't jump the 300 and stare at it. So I think that while the measurements are really important, the way we talk about them are is possibly even more important. So I don't see anything wrong with a one see if it's being done correctly, meaning no protracted lows that are giving you a false sense that you're a one C is lower. But what Jenny's saying is you do not want your blood sugar bouncing up and down. That is just It's not good for you, it would probably be better for you to be steady at 150 than to go from 70 to 300.
Jennifer Smith, CDE 30:07
Correct. Exactly.
Scott Benner 30:09
Right. So there you go. Actually, the funny thing here is the next question from Nicole, is, what are your thoughts on a reasonable standard deviation for a growing five and a half year old? Hmm.
Jennifer Smith, CDE 30:22
Yeah, that's an, I think you have to have a little bit of expectation that there is going to be more variability in certain periods of life, there will be I mean, kids, I mean, she's is growing five year old kids are growing considerably from birth, I would say, honestly, until about the age of like, 10 ish, things are kind of similar and patterns of growth, they really speed up, I mean, you can see the difference. You know, we've got one of those, like tree growth charts for our boys. And I usually turn every couple of months to see where are you because I know, you look like you've grown or your pants look way too short again. And I swear, I just bought new one last month, you know, but at some point that growth slows down. And certainly the teen years are a different amount of growth, not the same as far as like height or anything, although it could be for boys differently than for girls. But hormones are a bigger impact there in the teen years. for little kids like that five year old age, you can expect that eating for a standard deviation of something like 20 might not be in the cards, because you may have a lot more variability. Even if your timing range is kept very good, you still might have a little bit more variability in there. Because if your five year old is like my who is now seven, when he was five, I mean, he could be like I want to eat, I want to eat, I want to play I want to eat Nope, I'm not going to eat all of that. So when you mix diabetes in there, and you have to bolus and strategize and Okay, now I have taken a little way. And now I have to plan for this and whatever, there's going to be a lot more variability perhaps. But aiming, that's why I said that metric of time and range would be really more what to look at. Yeah, we don't want your standard deviation to be 80. But if it is going up a little bit more, you know, up and down. That's kind of par for the course with littler kids.
Scott Benner 32:30
I think that common sense is incredibly important here too. Because as you're listening to Jenny, explain this, from a clinical standpoint, you're thinking about what is or isn't said to you by the American Diabetes Association, or by your endocrinologist, all that stuff, you have to remember that they're just trying to give, they're not with you, they're not always whispering in everybody's here, right. So they're just giving a baseline like, you know, your standard deviation should be less than blah, your agency should be here, your variability shouldn't go but like, they're just giving you a place to start. I think that it's a, it's kind of incumbent upon all of us to take what looks like the rules, I'm making little quotes with my my fingers, and realizing that that's probably not the best you should be shooting for. It's not It's not the top, they're just trying to keep people. I don't know how to say this. There's a there's a way that if your own? Well, I'm struggling here, anyone, anyone who's been in a position of power in an organization knows that you're giving common denominator advice to your employees to you know, the subjects of your kingdom to like to whom ever you're talking to. And and to hear that advice and take it as gospel, I think is a mistake. Do you know what I mean? Like, you know, yeah, you ever go around a corner and the speed limits 25. But you're in a sports car, and you're like, I could go around this corner of 45. And it would be you know, that's you you're in a different car. They put the 25 there for the guy coming through in the 1975 Datsun like do you mean like his car can't handle this curve at 25?
Jennifer Smith, CDE 34:17
He will roll the car and right yeah,
Scott Benner 34:20
so for us, for instance, my standard deviation doesn't look good on Arden compared to what people say, except those people have a range between, you know, 80 and 180. While I'm shooting for a range between 70 and 120. And so, my I, I know where our standard deviation sets when I'm happy with our blood sugar, right, and I don't care what anybody else says that works well for us, right? And then people are like, oh, but then or health or health or health is going to be great. Like if you tell me that a person growing up with diabetes, who's got an eight one C and the fives constantly eat whatever they want, doesn't spike Hi, you know, maybe sees one ad twice a day for 45 minutes. If you're telling me that's a problem, I don't believe you, you're I mean, like I were, here's this, that's the best we can do. So, you know, we keep trying to tighten it down and make it better. But at some point, that's when you get to the life versus management trade off, like I got to be alive to
Jennifer Smith, CDE 35:24
weed. Right? Exactly. Right. Yeah.
Scott Benner 35:26
And so the problem with asking these questions are and getting the answers is that no one's going to give you a real answer. They're just gonna say what feels safe. Right. And so that's the most part common topic,
Jennifer Smith, CDE 35:39
what I can kind of say about standard deviation, though, even in, let's say, your timing range of whatever range you have set. Even for a five year old, for example, you know, if you're constantly having these big old climbs, and then constantly attacking then and then having a drop that you're getting into the red zone, and then you've climbing again, because of the red zone, and then you're dropping again, even if you're in range in doing that, that standard deviation, still, it requires improvement, right? You don't want this mountain peak, you know, up, down, up, down, up down all day, because even in range, it doesn't feel good for any age person. So the smoother that is, the better the person, the child to whoever feels.
Scott Benner 36:29
And if you're looking it up and down and up and down like that and worried about time and range or standard deviation, you're missing your Miss focusing your concern, your right turn should be Pre-Bolus thing and carb ratio and understanding glycemic index and stuff like that.
Jennifer Smith, CDE 36:43
And also effective insulin right duration of insulin. Yeah, understanding how long is my insulin actually working? You know, we're under I mean, that kind of takes it a step further in that variance that you see that standard deviation, because we're kind of in the understanding that our rapid insulin is rapid. And we've talked about this before, and that it also clears very rapidly. That's not actually the case, if you follow it out, right, there's actually a lingering dribble of impact. So if you are getting that up, down, up, down, up, down, it's very likely that even with using a pump, you might unknowingly be stacking insulin because your duration of insulin has been too short. And with modern day conventional pumps, what you set it at is what it uses, it doesn't know anything else beyond that, right? So it can't say okay, there's still insulin left here, make sure you take some of this off. But yeah,
Scott Benner 37:42
Chinese talking with her hands while I can hear birds outside of her window, and she looks like Snow White. I talk with my hands a lot. I don't mind the hand talking. I'm just telling you like Snow White for a second. Listen, here's what I think. Don't worry about your algebra grade worry about understanding algebra, right? You know, the grade will come if you understand the math. And with this, if you know how insulin works, the standard deviation of calm, the time and range are commonly a one seal come like you can't, don't focus on the grading focus on the work. And, you know, I don't know how many more times I can say this, I keep thinking I'm going to sync the podcast, it's timing and amount. It's understanding how insource use the right amount of insulin at the right time. And the rest of this becomes unimportant, you know, its background all of a sudden.
Jennifer Smith, CDE 38:30
And the important thing about that timing and understanding is that it is individualized right for you not to cut and dry up here. The doctor told me that this should last three hours. So that's what it should last. That might be the case for Johnny. But for Susie over here in the corner, maybe she's figured out that three hours the doctor told me Ah, it looks like it's four hours for me. So it does have to be individualized,
Scott Benner 38:52
right? I don't know where I was where I rolled up into a talk and I told people look, here's the truth. I could have flown in here, got up in the morning, got showered, jumped up on the stage, grabbed this microphone and said, Hey, everybody, it's all about timing and amount. Just understand how insulin works and you and you're going to be fine. Thank you. Good night. I could have left. You know. Well, you know what I left out some of the details about how to get to that but that's still the truth. Correct. Jennifer Smith is available to work with you. Check her out at integrated diabetes.com Thank you very much to the sponsors. Contour Next One and touched by type one. A lot of ones in there. Two ones you know you get when you add up to ones. One on One is equals to.
Unknown Speaker 39:45
I'm completely alone in this room.
Scott Benner 39:48
I just want to go outside, touch a handrail. Don't walk past somebody who sneezes and not have a stroke. Soon, probably a couple more weeks, couple months at the most, it'll be fine. I'm still wearing pants or you don't judge me. Listen, I put this up a little early. Right? Because on March 26, at 3pm going to do a big zoom meetup. And I have an idea for that I think you guys are gonna like, so if you're hearing this in the moment, check it out. And if not, the video will be running on the Facebook page, you can go back to it. But here's what my thought is, when you get a bunch of people together. And we're all going to, you know, just chit chat, see how things are going make sure nobody's like, you know, go and do it because they've been locked in their house too long. And after we all do a little Chitty, chatty like that. We're gonna talk about getting people's bays on its own right. So like a big group thing on everyone's basal insulin. And then we're gonna come back the next week, see how people are doing and then add another step. And maybe during this whole Coronavirus thing, we can bring everyone's variability and standard deviation and a one seat down, when that'd be cool. If we just all got together in a group and did something like that. I hope you think it's cool, because I'm pretty excited about it. March 26, Thursday, 3pm Eastern time. There's links right now on Facebook, I think the links on Instagram, send me a message if you don't know how to get to it, get there gonna go through people's bays or it's just like it's a private phone call. We're all gonna be there, kind of kicking in our two cents, helping everybody out. You know, if the listeners of the Juicebox Podcast can't count on each other during a time like this, then I don't know who we can count on. So while we're all busy being stressed out watching bad Netflix shows, I figured we could spend a little bit of time doing something for everybody's health. I hope to see you there. Hey, last thing if you're not a subscriber to the show, like if you just count on remembering the shows on it would help me out a lot if you hit subscribe in your podcast app would help even more if you share the show with a friend. And if you're not up to like sharing the show, maybe just share the zoom with them get together and maybe they'll see something they like and they'll check it out on their own. The podcast is growing so quickly because of you guys. It isn't even letting down during this Coronavirus thing. I'm super impressed. I thought for sure. Like oh, downloads will slow down but they haven't. And that's really very touching. Oh, by the way, last thing next week. So the next show that comes on. Let me take a look. On the 30th of March, it's going to be an after dark episode. Sexuality from a female perspective. So if your kids usually listen, don't let them listen to that one. Because there's not a lot of bad words in it. But there's a lot of clear talk. So unless you want your kids to know exactly where the round peg in the square hole are, I think you should. I think you should make sure they skip that one. I didn't believe a lot of kids listen to until recently but apparently they do. Which I think is great, but not for this one on Monday. So there's an afterdark coming up on Monday. Make sure you kids. don't hear it.
About Jenny Smith
Jennifer holds a Bachelor’s Degree in Human Nutrition and Biology from the University of Wisconsin. She is a Registered (and Licensed) Dietitian, Certified Diabetes Educator, and Certified Trainer on most makes/models of insulin pumps and continuous glucose monitoring systems. You can reach Jenny at jennifer@integrateddiabetes.com
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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!
#316 Julia
Dr. Julia Blanchette, PhD, Registered Nurse, Certified Diabetes Care, Education Specialist and Type 1 Diabetic.
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DISCLAIMER: This text is the output of AI based transcribing from an audio recording. Although the transcription is largely accurate, in some cases it is incomplete or inaccurate due to inaudible passages or transcription errors and should not be treated as an authoritative record. Nothing that you read here constitutes advice medical or otherwise. Always consult with a healthcare professional before making changes to a healthcare plan.
Scott Benner 0:00
Hello, 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
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