#872 Go With the Flow

Jim has had type 1 diabetes for 55 years.

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

Scott Benner 0:00
Hello friends, and welcome to episode 872 of the Juicebox Podcast.

Today, I'll be speaking with Jim. He's had type one diabetes for 55 years. And I think what I want to tell you about this episode is that a number of times, Jim really surprised me. You're never gonna go wrong with that. While you're listening. Please remember that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, always consult a physician before making any changes to your health care plan, or becoming bold with insulin. If you would like to save 35% on your entire order at cosy earth.com, all you need to do is use the offer code juice box at checkout It is that simple. Don't forget to go to T one D exchange.org. Forward slash juice box and take the survey completing the survey helps type one diabetes research it helps you and it supports the podcast T one D exchange.org. Forward slash juicebox. Go complete the survey. And if you're looking for community around type one diabetes, look no further than the Juicebox Podcast private Facebook group Juicebox Podcast type one diabetes

What did you do first thing this morning. The first thing I did was drink my ag one from athletic greens. Ag one is available at athletic greens.com forward slash juicebox. And when you use my offer code, you're also gonna get five free travel packs and a year supply of vitamin D. Thank you ag one for sponsoring this episode. Today's podcast is sponsored by touched by type one, now touched by type one is out there doing the good work touched by type one.org helping people with type one diabetes through their organization of just lovely people. It's wonderful. You have to go look at it touched by type one.org. And of course find them on Facebook and Instagram. I'll be speaking at their next event. So I hope I see you there.

Jim 2:24
My name is Jim. I live in northern Georgia. I'm a retired rubber chemist. I'm a musician and a car guy. I have three children and seven grandchildren. I'm 69 years old, and I've had type one diabetes for 55 years. But it does not slow me down.

Scott Benner 2:47
Jim, you are right, you have a longer intro because I think you have a longer richer life and some of the people who come on come on at a younger age and you make condoms. Well, back when you were working. Is that right?

Jim 2:57
Well, not that kind of rubber factory. It was mostly automotive parts.

Scott Benner 3:05
Okay. All right. Well, then there's a ton to pick through here. Isn't there? Sure. 55 your 14 when you were diagnosed?

Jim 3:13
I was actually 13 Or I was diagnosed in January to 67 and I turned 14 that March.

Scott Benner 3:22
Okay. 67 Yeah. All right. We're gonna get to that for certain of your children. Anybody have autoimmune?

Jim 3:32
No, no one. Of course my I have 344 of my grandchildren are under four years old. So it may be kind of early to tell. But so far, nothing.

Scott Benner 3:49
Nobody's being tested for markers or anything like that.

Jim 3:52
No, I haven't. I think I'm gonna just let them know they can do that if they want to. But no one else in my family either my you know, none of my parents, grandparents, uncles, aunts, cousins. Nobody.

Scott Benner 4:07
How about in your back in your family line? Other stuff like celiac or? I don't know. Hashimotos? Anything like that?

Jim 4:15
No. My mother died of leukemia in 1959. And my parents died 10 to 15 years ago but no, no auto immune stuff that I was aware of.

Scott Benner 4:33
Jimmy lost your mom when you were four.

Jim 4:35
I was six it was 1959

Scott Benner 4:41
Oh, that's that's something else.

Jim 4:43
Yeah, it was. You know, and it never really. I've never really had huge effects from anyone close to me dying except for my brother. He died maybe four years ago. And he, he was. I'm not sure what his actual diagnosis was. He was from what anyone could tell he was severely autistic. He was non communicative. He never spoke. And he got sick and ended up in the hospital on life support. And my parents being dead, I was left with the decision to basically unplugged machines. That was That was rough. Yeah, younger brother,

Scott Benner 5:40
older brother.

Jim 5:42
He was two years older than me. Okay. And

Scott Benner 5:45
it's interesting, because I guess if when he was born, like, do you think he ever had like an autism diagnosis? Or was that not something they did then?

Jim 5:54
Yeah, I don't know that they really knew much about it. until many years later. I think they just the first diagnosis was probably something like brain damage. So did but as far as I know, he was like that from birth. So

Scott Benner 6:12
did he live with your parents or in a facility?

Jim 6:16
He often on he lived with, with us at times? Probably until I was oh, 10 Because my dad remarried. And my stepmom just wasn't, she was kind of high strung, loved her dearly. And we had a great relationship, but she just wasn't equipped to deal with my brother. So. So he was in a facility after that. Gotcha.

Scott Benner 6:47
There are days 30 days, Jim, when I'm high strung. I just wish people use the term still.

Jim 6:54
Yeah, I'm typically not I'm pretty laid back.

Scott Benner 6:57
I can tell from your speech pattern that you're fairly laid back. Yeah. So. Alright, so I'm gonna pick through the rest of it a little bit. You play music?

Jim 7:07
Yeah. I started playing piano when I was probably five years old. We had an old piano down in the basement. And I would go down and play songs. I mean, not just plinking around, but actually with chords. And when I was eight, my dad said, if you take piano lessons for a year, I'll buy you a new piano. So he went out and bought the piano and I took lessons for I took private lessons for probably 10 years. And then I went to Michigan State University as a piano major. And unfortunately, that was the year that Michigan lowered the drinking age to 18. My my music major, and my college career didn't didn't pan out too. Well.

Scott Benner 8:06
I was gonna say, Jim did Meister Brau waylay your music career?

Jim 8:11
No, I think it was Old Milwaukee.

Scott Benner 8:15
Because, you know, it's funny as you're telling the story. I'm like, he goes, he's off to college for his music major, but he's a chemist, I think and that. None of that makes sense. So what did you wake up and reorient yourself?

Jim 8:29
Well, I took a I think I still planned on going back. Probably not to Michigan State because they weren't too happy with me. But But I took a summer job in a rubber factory. We were molding, like I said automotive parts. Started off on the press line actually doing manual labor, which was great for my diabetes, because I was getting, you know, strenuous exercise all day long. And I ended up staying there for eight years. And then I went back to college and got a chemistry degree.

Scott Benner 9:05
Wow. So something about the job made you want to do that.

Jim 9:11
It was a it was it paid better and was a lot easier than being a music teacher.

Scott Benner 9:20
Am I like the way you make all your decisions?

Jim 9:23
Yeah. All right. It gets even better than that. I was at a company in Indiana. I grew up in Michigan, but we lived in Indiana for 20 years. And I was at another company and I was always getting calls from headhunters. And this guy calls up and says I've got a job for you in this town in Indiana. Well in and this was in. This isn't the late 80s When I got this call. Well in 1978 I had gone to this as Auburn Indiana and every day Labor Day they do the Auburn cord Duesenberg Festival, which is a cars that they made and sold back in the 30s. And so I get this call about this job and the guy says it's in Auburn, Indiana. I said, that's the place with the cars had the a great job. And we went,

Scott Benner 10:19
sir Jim, your episode is gonna be called path of least resistance. I think

Jim 10:24
I know. Yeah. So I did. I did mention I'm a car guy. So

Scott Benner 10:28
what kind of cars do you enjoy?

Jim 10:32
Right now I'm in the muscle cars. I have a I have a 93 Mustang convertible. And then I also am working on my second 67 Pontiac GTO.

Scott Benner 10:46
Do you renovate them yourself? Or do you like to buy them ready to go?

Jim 10:50
No, I buy them as projects, and then I restore them. Okay. Are you and I told my wife, this is the last one I'm doing. For this, yeah.

Scott Benner 11:05
It's the work. That's that's the work. Yeah. Plus, as we know, you're not looking for a challenge.

Jim 11:10
No, not anymore.

Scott Benner 11:14
It's funny, you you said you started to say I told my wife as I was getting ready to say, are you married?

Jim 11:19
Yeah, I've been been married 41 years. We met at the first rubber factory I worked at. And there were people there who told her not to marry me. Because at the time I was, you know, the the quintessential hippie slash Bad Boy, you know, long hair and a beard. Little little bit into drugs and alcohol. They just told her to stay away from me. And we've been married 41 years now.

Scott Benner 11:51
Wow. What do you think? Did it Why do you think she ignored them?

Jim 11:57
I think it was probably, I'm sure it is, as it is, in most cases. It's a physical attraction to begin with. And that was incredibly strong with us. But she was also a Christian. And I saw something in her that made her different from all the other girls. And once I found out what it was I adopted that philosophy as well. And I think that's probably why we've been together for so long.

Scott Benner 12:33
What was that thing? Finding Jesus. Yeah, that that really appealed to?

Jim 12:41
Well, it didn't it first. And it didn't. It wasn't like an overnight change. It's it's a long process. And it's I think it's a lifelong process. And we went through some difficult times. And it was I think it was the only thing that saved us. And I'm not a you know, I'm not a holy roller. I'm not really outspoken about it. But, you know, I'll if someone you know, brings up the topic, I'm not afraid to discuss it.

Scott Benner 13:13
No, I mean, it's not why you're on but I'm, I'm just following the thread of the conversation. So were you looking for some constant in your life that you didn't have or what do you think it gave you

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Jim 16:25
it gave me peace and purpose. Which I didn't have before. And I don't know. I guess the piece that that you know, that was a pretty that time in my life. Let's see, we're going back to like 7879. I had been married before, got divorced. Well, we had a child and then we got divorced. And I was kind of floating around wasn't quite sure where I was going to go. played in a couple of bands. And we just we hit it off. And I think it was probably more than anything I may not have realized at the time, but I think it was just my my body or something was telling me. Dude, it's time to settle down.

Scott Benner 17:29
Jim in that in that time period when you talk about drugs, you talking about acid?

Jim 17:35
No, I never did acid It was mostly just marijuana. I did some cocaine, which I never really. It never really did anything for me. It was not a huge, you know, I only did it like two or three times. Mostly just marijuana.

Scott Benner 17:52
Okay. All right. So okay, so you have a previous marriage, but when you were very young, you weren't married very long.

Jim 18:01
Yeah, we got married when I was 22. And we were only married. Let's say we were married from 73 to I guess our divorce was final and 79.

Scott Benner 18:15
And one child, are you in touch with that job? Oh,

Jim 18:19
yeah. Yeah. We're still very close. He has three. I had three sons. He has three sons. And there's a huge story behind that because my, my dad had two sons. And like I said, I had three sons, my oldest son has three sons. My middle son had a son. So in our family, for 93 years, we had not had a girl born. And my youngest son in 19, or in 2018. Had the first girl in our family in 93 years. It's crazy. And then the next two kids were girls.

Scott Benner 19:08
Maybe maybe for the next 90 some years. It'll it'll just go that way.

Jim 19:12
Yeah, could be. But I tell people we didn't have any girls in our family for 100 years. Yeah, my wife says yeah, but you hardly had any people at all.

Scott Benner 19:21
You know, we realized recently that that my my parents bloodline and now pretty much because I'm adopted, so even though I have a son that name moves forward, but not not any connection to the to the family. And then my my brother has a daughter, and my other brother's children are his wife, his wife's their stepkids. So and I don't think they're gonna have more. And I was like, well, it's just sort of it and then it's funny. It felt like a big deal for a second and then I was like, yeah, it doesn't matter.

Jim 19:59
Yeah, Uh, well, I've got there's so many boys. I don't have to worry about our family.

Scott Benner 20:03
No kidding you people are gonna take well listen to you. Hopefully not, but it's possible in the coming decades, you're gonna be respond to this family is going to be responsible for an army of type one kids at some point. Oh, yeah,

Jim 20:18
I hope not. But you never know. Yeah,

Scott Benner 20:20
I mean, and if you're saying you go back that far and you can't find any auto immune, you really become an outlier in that situation.

Jim 20:26
Yeah, I definitely am. How do you figure out

Scott Benner 20:29
in the 1960s and the 1970s in the middle of you know, free love and everything else? And no real diabetes technology? How do you figure out how to take care of yourself? Like you are? You're healthy now? Is that correct?

Jim 20:44
Oh, yeah, yeah, no complications of any kind. I think it was just getting into a routine and doing what you need to do. Unfortunately, there was probably, I'm guessing it was probably not until sometime in the mid 80s. That I had kind of settled down and gotten into, you know, not eating as many things as I shouldn't have. And I'm just, I'm thankful that after having this disease for 55 years, I've got no retinopathy, no neuropathy. The only and the only other autoimmune I have is hypothyroid. So,

Scott Benner 21:41
Jim, it's almost ridiculous. I mean, I know. Now, you know, I'm thrilled for you. But it's almost just silly. What you're saying. So you managed for, like, around 20 years, not really paying very close attention to things. So what insulin are you using? In the beginning?

Jim 21:58
In the beginning, it was 45 units of lenti. Every day, one shot in the morning. That was it.

Scott Benner 22:03
That's all you did? Did you get low ever?

Jim 22:07
Very rarely. I only actually remember. I remember one day at work. This was probably in the late 70s, early 80s. I was at work, and I was trying to I was filing some papers. And I was putting them in folders in alphabetical order. And I couldn't do it. It was just, it's like I couldn't tell, you know, I had this thing with an AE on it. And I just couldn't figure out that it went in a folder. And this thing with a C on it went in the C folder. And my boss comes in. And he knew something was up. So he calls my wife. And he says add just get him a coke. He'll be fine. So

Scott Benner 23:02
and but that's but nothing. Wow. I mean, how do you? What's my question? Even? Do you think you just got lucky?

Jim 23:12
Well, you know, I don't believe in fate and luck and stuff like that. But yeah, I can't explain it. Now. I know that my my stepmom who I never called My stepmom she was my mom. She was great. We had a great relationship. She listened to what the doctor was saying about mostly about the diet. And back then it was the exchange diet. I think I was on 2700 calories a day. So it was like, you know, this many starches and this many fruits and this many vegetables and stuff like that. And she was she was good at sticking to that. And I think that would have had a better effect had I not been going off the deep end with you know, fruit pies and milkshakes and stuff like that.

Scott Benner 24:11
So the diet, the diet really only existed in the home.

Jim 24:15
Yeah, pretty much. Yeah. I mean, it was to the point where at night, I'd be practicing my clarinet in my bedroom. And I thought I could smell ammonia. And I finally realized years later that I was probably smelling the ketones oozing out of my pores.

Scott Benner 24:32
Jim, that's not a euphemism. You play the clarinet.

Jim 24:35
Yeah, I played in addition to piano. I started playing clarinet in sixth grade. But soon in, I don't know, eighth grade saxophone in ninth grade. And I think I think that's about it. I mean, I dabbled around on guitar and stuff like that, but never you It was mostly piano and wind instruments. And I've I currently play in the church, church orchestra. And I also belong to a local community band.

Scott Benner 25:10
Is it just come naturally to the music?

Jim 25:13
Yeah, yeah. It's I know that it's in, in anyone who's a successful musician. It's just a characteristic they've probably had from birth. And oddly enough, I think it's also accompanied by a very strong very strong math skills. Really, believe it or not, because music is very precise and rhythmic, and you have long notes and short notes, and they're all mathematically related. So you'll find I think you'll find that a lot of mathematicians and scientists are also musicians.

Scott Benner 26:02
And so that's, I guess, when you went back to college that that made all that easy as well.

Jim 26:08
Yeah, yeah. It would have except for the drinking age.

Scott Benner 26:13
I meant. I meant the second time, Jim.

Jim 26:16
Oh, the second time Yeah, yeah. No, no, the first

Scott Benner 26:19
time nothing helped you you write sounds like you almost got tossed out of there on your ass actually.

Jim 26:24
Yeah, pretty much. Yeah.

Scott Benner 26:27
So what did you tell me again, what your degree ended up being?

Jim 26:30
I got an associate's degree in chemistry, okay.

Scott Benner 26:34
And that propels you through a whole an entire career.

Jim 26:38
It actually, let's see, I took the first job in 72. I got my degree in. I didn't get my degree until 96. And then, I retired three years ago and 2019. So I was in the industry for 46 years.

Scott Benner 26:59
It is that a I'm going from how you were growing up until this, you started this career, do you? I mean, you met your wife there. So she didn't draw you to the place. You just just, I mean, you don't seem like the kind of the story doesn't propel itself towards I'm gonna get like a regular job and work in a rubber plant and, you know, make dashboards.

Jim 27:23
Yeah. Well, a friend of mine told me about this place, and I was looking for a summer job. So I went there and got in and it just took off from there. I started, like I said, I started off on the production line. They apparently the Forman noticed that I had more skills than just manual labor. So I ended up in the laboratory as the lab technician, and then ended up kind of just growing into a even though I had no degree, I was basically the chemist for the organization. So

Scott Benner 28:02
we're that's a story that won't exist anymore, huh? Yeah, yeah. You kind of bounced around as a younger person. And then get a job and based off of hard work and, and your intuition for the job, you moved up and raised a family and three kids off of an associate's degree. Yeah. And in your retirement, you have cars and free time and leisure and music and even playing musics not a cheap endeavor. So you through the years, we're buying instruments, and I'm imagining everything else. Yeah, that's, that might be a might be a time we all find ourselves missing at some point.

Jim 28:42
Yeah, I don't think it's like that anymore. So

Scott Benner 28:45
nine, my son left college and the pressure to like, find a job that paid well started, it felt like it started as they handed in the diploma, you know?

Jim 28:54
Yeah. And I've I've told young people over the years that going to college, and picking a degree without knowing whether it's something you really like to do dangerous is a huge mistake. I've often told people go out and work a bunch of places and figure out what it is you like, and then then decide what kind of degree you want.

Scott Benner 29:20
Jim a coffee is $8 How are they supposed to do that? They kind of get a job. I agree with you though. I thought. I felt like in the first 18 years of my first child's life. One of the strangest things I saw happen was him go to college and be like, This is what I'm gonna get a degree in, when he didn't know which way was up or what he cared about or anything like that. He just knew he knew what he was good at. But he didn't. He doesn't know what he likes or if he likes anything to be honest with you.

Jim 29:50
Yeah. And my youngest son did it right. He he was always interested in mechanical stuff. He and I worked on the cars together and He said I'm not going to college. And he picked out a trade school in Chicago. And now he is an ASE certified master mechanic with Land Rover.

Scott Benner 30:10
Okay, that's a that's a nice clean job nowadays being a mechanic.

Jim 30:15
Yeah, sorta

Scott Benner 30:17
little rolling computers that uh,

Jim 30:20
yeah. So he is he is currently re restoring my first 67 GTO. Oh, he can do it for you. Yeah. Well, he's doing that one and I'm working on the second one. Okay. And it's funny because my granddaughter. She calls me pop pop. And every time we talk about my son's GTO, she says, It's pop ups GTO.

Scott Benner 30:50
Jim all was left in the next however long we talked for his for you to say bang. So I can call this episode Pop Pop bang. Because right now, right now I'm stuck on Jim makes rubbers and stuff like that, which I don't think is appropriate. For.

Jim 31:07
Yeah. Jim met his wife in a rubber factory.

Scott Benner 31:10
Yeah, exactly. With all that rubber around on it, all those kids. Yeah.

Jim 31:16
Well, I guess the one related to diabetes. The one bang I've had in my life CGM. I mean, I'm sure other people have told you their stories. You know, I was drinking all the time peeing all the time losing weight, blah, blah, blah. You know, I had to do the urine tests, blah, blah, blah. There is kind of a funny story on how I got the pump therapy. I've been on pumps for 16 years now.

Scott Benner 31:48
16 years. Okay.

Jim 31:50
I was back in 2007. I don't know if they still even have these but you had health savings accounts or health care spending account?

Scott Benner 32:04
is what I used mine yesterday. They definitely have them. So well,

Jim 32:07
there were there was a different one that we had. Because because there's two choices. Now. Back in that day, if you didn't, if you had any money left in it at the end of the year, it was gone. Right? You didn't. You didn't get it. So I'm looking at my I kept pretty good track of it and in a spreadsheet. And I'm looking at it going, Oh, geez, I've got $1,000 left. If I don't use that I'm going to lose it. I think I'll go on an insulin pump. So I went to talk to my Endo. And he says, Yeah, I think you know, because I had a previous endo had told me that my control was so good. He says if you want to go on a pump, fine, but you're on MDI, you really don't. It's not going to make any difference. And it hasn't, as far as my, you know, agencies or anything like that. But I think it has, I think it has helped. And then when CGA CGM came out, that was like I said, that was a game changer.

Scott Benner 33:09
So tell me a little bit about you were on MDI for how long?

Jim 33:14
Um, let's see, I was on the single injection, probably until the late 80s. So 20 years. Wow. Right? And then in that, that 8990 range was when the human insulins were coming out. And he switched my endo switched me from the single shot to I think it was NPH in the morning and evening. And then at that time, it was human log, or humulus and humulus are right, at meal meals. Yeah. And then when human log came out, it was pretty much the same routine NPH in the morning, and evening and human log with meals.

Scott Benner 34:04
When do you slip into a Basal insulin?

Jim 34:07
I went, my first pump was in 2007. And it was the Medtronic 513 G. And that was, you know, that was a good, a good run, I thought. I mean, my agencies were always in the high fives, low sixes. But a couple of months ago, I pulled up some glucometer data, and in 2000 and this is on MDI. My average blood glucose was 150. But I was running 32% under 70 and 32% over 180 and only 30% in range. Yeah, well, there's even not. Um, so So as as you know, There's a fallacy to just looking at the A one C, right?

Scott Benner 35:03
Yeah, the you didn't have any kind of stability. So you were you were low for a long periods of time high for a long period of time. 150. And the average gave you an A one C, that seemed amazing, but probably was as good as Yeah, yeah.

Jim 35:16
And I think due to running low, so much, it didn't take that long to develop hypo unawareness, which I still have to this day.

Scott Benner 35:27
How low do you get before you know you are?

Jim 35:33
I'll get down to 37 and all fall down. That's the only way I know. I don't feel a thing. Wow. So then in 2017, I pulled up some more numbers. And things were better. Averages 121. I was only running 19%, low and 68% in range. So that was you know, halfway decent without having to CGM. Oh, the other the other stat on my first ones. My standard deviation was 87. And then in 2017, it dropped to 50. And then the last 90 days. Average is a little higher 136. But my standard deviation was 43. Only 3%, low 10%. High, and 84%. And range. And this is with this last 90 days, we've been traveling a lot. I would typically run 85 to 90%. Time and range. But like I said, we've been traveling, and that just kind of you know, I'm able to manage fairly well with it. But you still still get highs more than I like restaurant

Scott Benner 36:45
after restaurant sitting in a huge drop. Are you driving around right now or flying?

Jim 36:52
It? Well. It's a combination depending on we've got kids, my middle son and his wife and two, two kids are in California. My youngest son's in Illinois, and my oldest son's in Michigan. So we just we actually we just flew back yesterday from Michigan so

Scott Benner 37:12
well, well thank you. Actually Today's my birthday.

Jim 37:16
Is it happy birthday. Thank

Scott Benner 37:17
you very much. I only bring that up because people end up on the show all the time on their birthday and they bring it up and I was like I have to take I have to say when it's mine right. So when you when you went to a CGM was when

Jim 37:35
um let's see, I went on the G five and a tandem T slim and 2019 year I retired. Because I I guess my

I have I have recall issues. My other pump.

Scott Benner 37:57
The Medtronic

Jim 37:59
thanks. Expired expect the warranty expired in 2019, which was perfect timing. I did a lot of research looking at pumps and decided I want the teat one at the T slim even though I could only get the G five on Medicare at that time. The advantage to that was I had it all dialed in before I went on to G six and control IQ in 2020. So I had basically done all my Basal testing and everything at that time. And I frequently recommend to people on the web on the Facebook pages there to go on on control IQ. Do you have any advice for me and my advice is always get it dialed in before you turn control IQ on.

Scott Benner 38:44
Yeah, run it like a regular pump? Yeah. Yeah, it's tough because some people are, are hoping that that algorithm is going to save them from something they haven't been able to figure out so far. I wondered. Good, but I have a question. But the problem

Jim 38:59
I see with that is it's kind of like driving a car that you have an erotic that erratic speedometer. Yeah. You know, it reads high. So you're compensating for that. Well, then the next day, it reads a low so you're compensating for that? Well, your pup is compensating for things that are happening because your settings aren't right.

Scott Benner 39:27
Yeah, no, it's everything is settings. Jim, like, you know, I'm gonna say that forever. So what was what was my question? Oh, was it a huge shift? Going to a CGM and a pump versus just a pump versus just MDI? Like, was there ever a spot where you thought, I can't? I can't adapt to this or have you always been interested in moving forward with things?

Jim 39:56
No, I've always been Technology addict, so, okay. And I, I guess that's one thing that I'm typically not a compassionate person. But I do feel for the people who just don't have strong math and scientific skills. I mean, let's face it not everyone's a mathematician. And I can't imagine being diagnosed today. And the doctor saying, Here's a pump, and here's CGM. Go for it. It would have to be so overwhelming.

Scott Benner 40:39
Yeah. Don't you think that that's part of what we're seeing with? Like Omnipod? Five control IQ, that kind of thing? Doesn't it seem like they're trying to develop something that if you don't know much about it, you can still have more stability at a lower number than you're going to achieve on your own?

Jim 41:01
Oh, yeah, I'm sure of it. Yeah.

Scott Benner 41:04
Yeah, it does seem to me like what they're trying for me, because I get lost sometimes in the podcast, to where I'm very accustomed to being around people who are super motivated and either get it right away, or if they don't get it really nose to the grindstone, find a way to figure it out. Whereas I believe that it's possible that the, you know, the great majority of the rest of the people don't fall into those categories. And they might they might just be bouncing around their whole life and, and not knowing.

Jim 41:34
Right, yeah. And, and I think you see it in the Facebook posts. You know, people just I've had this disease for so many years, and I just can't control it. And I do feel for those people.

Scott Benner 41:49
You know, for the first time in forever, I mean, honestly, I've been doing this a really long time. No one's ever yelled at me. I got yelled at the other night, it really Yeah. And a Facebook post by but and I saw what was happening. So I didn't find it to be off putting. But here's what this person probably meant, not what they said. I think what they meant was, I can't figure this out. I need you to tell me. And I, of course, was trying to help them figure it out. And they just kind of, I don't even know how to put what happened. They just sort of we were in the middle of talking about something and they just turned on me. And you know, you're not helpful. This isn't helpful. Like I was trying to ask leading questions. I thought we were having a dialogue. I didn't realize I didn't realize that I was speaking with a person who probably was at wit's end. Yeah, you know, and feeling a ton of pressure. He was about a child about a younger child, like I understood. I mean, I completely understood and I tried really hard to like say, Hey, listen, I think we're just having a communication problem here. But the truth is, I, from my perspective, what was happening was, they were just, they couldn't take it anymore. They were up to like, somebody needs to tell me what to do. Because I don't know what to do. And that I think is your point is that those people are, you know, they're plentiful, and it's, um, it's a shame, you know, he said something strange. You threw me off, you're not normally compassionate.

Jim 43:21
Well, yeah, like I mentioned earlier, you know, when my mother died, and my dad died, and my stepmother died, I, you know, I wasn't hugely affected now, my mom. I think I was more affected by her than my actual biological mother. Because, I mean, let's face it, I was only six years old. That's pretty young. But when my when my mom died, she had she had been an executive secretary Ford, both her and my dad worked at Ford. And they met after my mother died. And she contracted Alzheimer's. And having known that she was an executive secretary at Ford Motor Company. She was a gourmet cook. She worked in offices. She was I mean, she was smart. And to see her reduced to what she was, you know, before she died. Was was hard. It was actually seeing her deteriorate. It was harder on me than her death was. Because I think by the time she died, she was I mean, she was done with it. Finally,

Scott Benner 44:48
do you feel like you've like, walled yourself off from those feelings?

Jim 44:54
Yeah, I don't know. I I've never I've never Put any I've never tried to do any, you know, soul searching about it or never seen a psychiatrist or anything like that you're

Scott Benner 45:07
from the wrong generation for that question. I just thought I would ask it. I got I got up the next day and I paid my bills. Yeah. Well, well, but it's interesting. Hey, listen, you don't, you don't lean in that direction. But I'm still gonna ask the question because of your older brother. Do you have any, like, tendencies towards spectrum stuff? I'm not sure what you mean, Autism Spectrum stuff? Or like, Do you have any leanings that way?

Jim 45:39
I suppose in a minor sense, because as a child, I was perfectly content playing by myself. I mean, I had, I had a lot of friends. And I was popular in school. But when I was younger, you know, I could sit in the basement hours for hours by myself playing with my Legos, and stuff like that. I didn't need anyone. But I wasn't. You know, I like I said, I had friends. We played, you know, we did stuff. So I suppose you know, there is I've always been kind of a loner. But but at the same time, you get a party going and I can be the life of the party.

Scott Benner 46:27
I took it. I took that from the beginning of your story. Yeah.

Jim 46:31
I guess I guess I'm kind of schizophrenic.

Scott Benner 46:34
Jim, I think you're one joint away from just going crazy right now.

Jim 46:37
Yeah. Hey, it's not legal down here. So

Scott Benner 46:42
Oh, okay. I was gonna ask you, if you still partake once in a while.

Jim 46:46
I did one of my kids, bachelor parties. And it slipped out. My wife heard about it. And she was not too happy with me.

Scott Benner 46:56
I didn't think she did. I was just checking on you

Jim 47:00
know, she doesn't know. Didn't?

Scott Benner 47:03
That's, uh, that's pretty interesting. What else do I have here for you? I did want to ask you about your wife wanted to ask if if she has any involvement with your diabetes at all.

Jim 47:11
I'm very little actually. I mean, I've been self managed for so long. She knows that I know how to take care of it. She can tell when I'm alone. Well, she used to be able to tell when I'm low. But I have my low limit on my Dexcom set or not on the Dexcom. But on my pump. I've got my low limits set at 100. So I get advanced warning when I start to go low. And she's I mean, she's she's pretty hands off, but she's aware of it. So

Scott Benner 47:46
is that a number that has increased as you've gotten older? Is that always been where you like to treat?

Jim 47:53
Well, yeah, that's a tough one because I don't think it was until till I got the CGM and 2019. That I really knew where I was because like I said, I had developed hypo unawareness so long ago, that you know, I like I said, I was out mowing the yard one day. And I really literally my legs went out from under me. So I was able to make my way into the house and checked on my glucometer. I was 37. And that happened at work wants to my legs went out from under me and it was exactly 37. So I know that if I fall down, I'm at 37.

Scott Benner 48:40
Has that happened since you've had a CGM?

Jim 48:43
No, it has not. No, that's a big change. I mean, I've had I've had lows, but because what a lot of times when I'm working on the car, it's physical, labor, turning wrenches. And I'll frequently turn my basil completely off when I go downstairs to work on the car, and then I have to set an alarm to make sure I turn it back on later in the day.

Scott Benner 49:06
Yeah, they say Jim Temp Basal off is the way to go. So you can't forget to put it back on. Avoid your DKA that way.

Jim 49:13
Yeah, well, I haven't been in DKA. Since I think the last one I had was in 19. I'm assuming it's going to be 1981 Based on the house I was living in. And I didn't even go to the hospital for that. I knew what was going on. I went to the pharmacy got a bottle a regular insulin, just you know, gave myself probably like 10 units or something like that. But I had been hospitalized for DKA three times. From probably in the early 70s I would say yeah, I buy nonsense then

Scott Benner 49:58
go As you're harkening back to earlier management ways that you know, and obviously you were doing what you were told. And I asked you earlier, you're healthy, right? You don't have anything you said, No, I'm good. But then you said later, you have brain fog you have you have trouble recalling things sometimes.

Jim 50:14
Yeah, I just had my, the when you're on Medicare, they give you an annual. It's not a physical Well, yeah, I guess it's a physical, but they also do a memory test. And I aced the memory test every time. But I told the doc I said this, and this is my PCP, not my Endo. He says, Well, you don't have any memory issues, you have recall issues. He said, the data is there, you just can't find it. So I'm not sure what that means. But it's it's particularly it's the worst with people's names. People I've known for 20 years, you know, it'll take and then their name will just come to me later on.

Scott Benner 50:57
looking them in the face or, or, or thinking of them, whatever. You just can't find the name sometimes.

Jim 51:02
Right? Yeah. Was that he didn't seem concerned about it. So I'm not sure it's not happened

Scott Benner 51:07
to him. Yeah. Good. Well, I, there's a, it's, I've said it here before. So it's not that much of a secret. But I'm just good at, at, at moving. So whenever I can't find a word, I just find a different one. But it happens to be on the podcast constantly. I'm just I talk so quickly, you can't see it happening usually, where I find a way to like artfully pause while I collect myself. And if I if I really get caught, then you know, I'll just admit to it while I'm talking about I cannot think of what I was thinking of just now. Part of I you know, I'm I'm 51 today. So I mean, that's not young, it's not old. And I've had problems with my iron being low in the past. So I'm not certain because the iron thing just like, it knocks you out. Like it's like, it's like being on a dimmer switch and somebody just shutting you off. Right. So, but but I know what you're talking about. I've had that experience we all have. I've watched it happen to my wife recently. She you know, she's getting older and the kids are like, she can't think of her word. And I'm like, you know, you only have like, 25 years before this happens to you. So just be a little. Yeah, that's interesting. It really, Jim. Yeah.

Jim 52:21
Like I said, it's worst with names. That's the big the big thing. And I actually read somewhere. I saw it on the internet. So it has to be true, that it's a there's actually a condition for this thing about not being able to remember people's names. Or recall, I'm sorry, recall their names. Yeah.

Scott Benner 52:42
I'm terrible with names, but I always have been. And, you know, it's not because I don't care about people. I just, I don't know, like, I can't remember people's names like in Titan my life I can. But you know, you get slightly outside of my bubble. And I'm like, I remember, you start telling stories around them. Like you even said, like, I remember what house I was in, like, like you can remember all that stuff. And not the one piece, I have to tell you, I find talking to you incredibly interesting because your life goes against conventional a little bit. And, you know, in a number of different ways. And it's interesting to look back at it as a whole. I find it super interesting to hear somebody talking about like, you know, I was married in my early 20s for a number of years, and I have a child. But then, you know, and I went to college once but then I went back to get an associate's degree, I had this job here, I met a person at the job. It's very interesting to hear it to hear it all in one place. I don't I don't know why exactly. Other than I think most people expect, you know, nowadays, it's, I'm gonna grow up, I'm gonna go to school, I'll meet a person, I'll marry that person. Everybody thinks that's gonna last forever, we'll have a bunch of kids as kids will become astronauts and quarterbacks and the President? Well, well, you know, I don't know how awesome that is anymore. But but you know, like, like, in these big things. And it's just, they realized the other night, I was taking out the trash where I do a lot of my best thinking, walking to the end of the street. And it's the only time I'm alone, like, during the week, and I just thought, you know, my expectations for things versus how they went. You really get a different perspective as you get older. Sure, yeah. All the things you think, in your 20s and 30s, while you have a young family is it's all hope it's not. It's not it's not based in much reality. And for the people who you know, for the people who get to the end, and it went exactly the way they thought it was going to go. I think that's a fluke. Maybe more than, than anything else.

Jim 54:49
Yeah. And I mean, I think this is one of those things that kind of goes back to another era. You know, my dad was a He was born in 1923. He spent he was a volunteer on B seven teams in World War Two, got shot down on his second mission and spent two years in a German prisoner of war camp, came back to the US, went to college on the GI Bill, and became an engineer and finished out his career at Ford Motor Company. I mean, he had a plan and he stuck to it. People don't do that anymore. I didn't even do it. Now, Jim,

Scott Benner 55:31
you're you blow in the wind like that thing. Our dealership? Yeah, pretty much you're like, you're like, weed? Beer? Yeah, no, Jesus, I don't care. Put it in front of me. I'll follow it.

Jim 55:48
I just go with the flow. You know, you really do. But so

Scott Benner 55:53
even with the diabetes, if you didn't fight against the changes, you took the time to relearn. I'm a big fan of that. And yeah, you know, you could have got stuck somewhere and been like, Screw it. I'm just gonna do it like this.

Jim 56:07
Yeah, well talk about memory. I'm the odd one of the odd things, I think. Because when I was diagnosed, it it didn't, you know, I was like, Okay, I got to do this. Let's move on with life. I can still clearly remember the doctor coming into the examination room and telling me I had diabetes. I can picture it plain as day almost like a motion picture. And what I find so odd about that is why do I remember that? Because I don't remember it having much of an effect on me at all. You know, a couple days later, I was in the hospital for a week while they got things straightened out. And

Scott Benner 56:55
that was it. That was it just went do what you're supposed to do.

Jim 56:58
Yeah, you know, for all the changes. All the weird tracks I've taken in my life. I've always been kind of a compliant. Person, except my wife accuses me of being passive aggressive.

Scott Benner 57:15
Yes, I'm sure you're terrible. Horrible, horrible person. Yes. The way you've stayed there and raised three children for 41 years. Yeah, stop smoking your weed when you were told. So? Yeah, you just don't

Jim 57:31
know, a poor listener. But yeah, I've had I've done a few other things in my life, too. Let's see in 1984. I hiked by myself into and out of the Grand Canyon, spent a week down in there. And that was when I was on the one shot a day prep, which I probably cut in half because of the, you know, the hiking exertion. But that was a fantastic trip. And in 2014, I had open heart surgery to fix my mitral valve, which I'd had, I'd had a heart murmur since I was a kid. And the doctors always told me, you'll probably have to get that fixed someday. And when I went in for I went in for an echocardiogram every year. And I'd always positioned myself so I could watch it on the screen. And I could see that, okay, this thing is not looking good now. And then about a month after that, I started getting short of breath and told my wife, Okay, it's time I told him at work. I said, I've got to go in for open heart surgery. So I'll be I'll be off for about a month and survived that. It really, I mean, looking back on it yet. It was pretty painful for a few days. But all in all, you know, it's it's still holding in there. So that was what, eight years ago.

Scott Benner 59:07
difficult recovery?

Jim 59:11
No, actually, the only thing that bothered me. And I don't recall what my blood sugar's were doing at the time, so they probably weren't too bad. I was on the Medtronic pump at that time. So I mean, they probably ran high for a while. I know they had me on an insulin drip in the hospital. And I'm not sure how many units per hour I was getting, but it was probably a pretty hefty dose. The worst thing about it was I had to cough to make sure I was getting any junk out of my lungs. And that hurt and that hurt. And I remember the first time I sneezed I was convinced my heart my chest was going to explode. load, you know, I was gonna break open and you know, my lungs were gonna spray over here and there was gonna be blood all over the plant bathroom but didn't happen. I didn't know that I was wired shut, so I couldn't explode. So

Scott Benner 1:00:13
well, that's really crazy. I'm feeling like there's a lot more that's happened to you that we're never gonna get.

Jim 1:00:19
I guess. That's all the major stuff. But I mean, the things. I've got a list here of everything. I wanted to talk about how we got one. We're almost done. Cool.

Scott Benner 1:00:33
I'm doing all right.

Jim 1:00:34
And I think we've mostly talked about the one the one section I have labeled what I don't have. And we already talked about most of that, you know, complications. I don't have any complications. I don't feel highs or lows. I don't have as many highs or lows. But, you know, I still hit that occasional 300 Because I didn't call us right for meal, eating out or something like that. But I, you know, I 303 50 I don't feel the same.

Scott Benner 1:01:04
You just don't know. There's no, this is real.

Jim 1:01:07
Yeah, I feel perfectly fine. I have never felt other than the initial lows that I felt very early on. I don't feel a thing. I don't feel so. You know, I mean, obviously, when you're in DKA, or, you know, puking your guts out, but and then the the whole other thing about no one in my family with tea, Wendy is is kind of weird.

Unknown Speaker 1:01:33
No, it is.

Jim 1:01:35
The other thing I have listed here is horror stories. And that's not not for me. But for things I've heard and seen over the years. I remember being in my, the endos office, the one that got me started on the pump. And I gotta say he was the best endo I ever had. Because he was a type one on pump therapy. He understood he knew what was going on. You know, he's the only one I've ever had, that really had an intimate knowledge of diabetes. But I was in his in his examination room one day. And the walls weren't very soundproof. And he was in the room next to me. And there was an older fellow who I assume was a type two. He walks in and says, Well, you're a one C was 11. And the guy says, Oh, is that bad? And I'm like, Oh, dude, you're killing yourself. And I mean, I laughed at it at the I don't know that I laughed at it at the time, because obviously, it's not funny. But I had another endo Tell me about a patient of his, who was a young college educated woman who simply refused to take care of her diabetes. She was in a wheelchair by the time she was in her mid 20s. And I'm just cash. It's so sad, you know, and me being a totally uncompassionate person, you know, to feel for someone you know. But and then, this was I think, in the early, probably the mid 80s. My wife and I were canoeing on a small river near where we lived. And fellow she worked with and her husband or his wife. We ran into them on the river, not literally ran into him, but he was type one, and he was having a low. And turns out that when he was diagnosed, his parents refused to admit that there was anything wrong, because he looked fine. There's nothing wrong with him. He was already in his mid 20s Suffering from retinopathy. But the worst, the worst, one of all was a good, a good friend of my wife, her. They were never married, but her boyfriend for years, was a type one. He had had both legs amputated. He was pretty much blind. He went into kidney failure, and he died and all as a result of type one. So, you know, like I said, I don't consider I don't particularly particularly believe in luck or fate. But I guess I have to say I've been pretty lucky. Ya

Scott Benner 1:04:39
know, I don't know another way to think about it. When the when the technology the understanding is where it was in the 60s and the 70s, the 80s and part of the 90s. You know, to make it as far as you have as well as you have is there's a little bit of it doesn't matter what you call it, right but but whatever it is, Is it's there? Because like you said, look at all the other stories you have, you know, just from being in the in the office or meeting people, you know, along along the way. Was there any kind of community aspect to diabetes like like the way you describe yourself? Like, it's interesting to me that you know, this podcast or that you're involved in the Facebook group, because it doesn't seem like you would be but you are?

Jim 1:05:27
Well, I think it was probably after I got on the CGM and the tandem T slim, and control IQ. And probably it may have started when I was researching what pump I want it to go on. I started looking up Facebook pages and found found the the tandem T slim page on there was a group 30 years with type one diabetes. Adults with T one D. And then I didn't see that the Juicebox Podcast until just probably within the last year. Someone on one of the pages mentioned, I listened to this podcast and it was really good. And I'm juicebox What the heck is that? So I looked it up and listened to a couple episodes and then I saw the pro tips. So I listened to all of those and then I've gone through the list. I haven't listened to all of them. I probably listened to maybe a third of them. I usually go by the titles. Oh, this one looks interesting. But I have to admit I've gotten some good tips. I think the best one was it might have been one of the pro tips was bumping nudge. Yeah. That that was good. And then the the other one about the the CIQ ninja, the guy whose son? Yeah, was that great? Yeah, that was a good one. And this morning this morning, I just listened to the the older lady who was diagnosed at like 49 I think it was number 714. They see Scott Scott made a Scott messed up. Yeah, it's got messed up. I enjoyed that one. I do like listening to other people and just hearing their experiences. But the weird. Another weird thing about my experience with T one D is I have met in 55 years I have met so few people with type one. I have never actually seen another person. I've never run into another person with an insulin pump. Really in person. Yeah, ever. But you

Scott Benner 1:07:57
met in five years. But you did see a type one on a river once that's gotta count for like fit. Yeah, different.

Jim 1:08:04
Yeah, but my wife knew him. And she told me he was diabetic so and the odd. There were two guys that I worked with. At the last company I retired from there were two guys who were T Wendy's. And they never talked about it. I never would have known it except for one of the guys saw my pump. Because he thought it was a pager. I said no, it's an insulin pump. And it turns so he and I hit it off pretty well. And I haven't heard from him for a while I need to contact him. But he was he was on the one of the later Medtronic pumps with The Guardian sensor, I think the 617 or something like that.

Scott Benner 1:08:47
Yeah, I don't know all those Medtronic pumps for sure. Of which there are many. So there's you like this, you like being around other people who have diabetes?

Jim 1:09:00
Yeah, um, I, in the I guess I've been on the Facebook pages for a few years. And I was giving a lot of advice to people who are newly diagnosed there having this issue with the pump. And I think I probably gave more advice than I got. But there were still some valuable things I picked up. And I Yeah, so I started my own Facebook page. Because there was one out there with 30 years with type one diabetes, and I said, well 30 I got that skill. 50. Let's go 50. So I started a Facebook page called 50 years with type one diabetes. And it's interesting because I've got like 60 I haven't looked at recently but about at least 62 members last time I looked and I'm the only one that posts anything. I might not always get a lot of comments when I do post something But no one volunteers anything. I think they're just like, Yeah, you know, I've had this for so long. It's just a way of life. I got nothing to post. So

Scott Benner 1:10:08
I also think that's a generational thing. I don't think people in their 60s are, are looking to, generally speaking be part of the social media movement. Yeah. It's hard to get people to share things. I have an incredibly tough time getting type twos to share. So I try, I try and I try and every once in a while you get one who's terrific, but it's not as many people as I hoped for. Yeah, your group has 75 members in it right now, Jim? Okay. All right. Well, that's excellent. 50 years with type one diabetes in the 50s. Five hours that correct? Yeah, yeah. Very nice. My group gets 300 new members a week. Yeah. And it's not something I expected. To be perfectly honest. Most of this is not something I expected that someone would tell you that, you know, I listened to a podcast, it still freaks me out. Or when someone you know, when people come in, they answer a question about how did you find out, and I read through every one of them that pops up in front of me. And I'm, I'm just stunned, you know, how and how it's sort of permeated and spread? I just never. I mean, I hoped but I didn't. I didn't really expect it to. Sure.

Jim 1:11:21
Yeah. Well, there are so many parents out there with children with t 1d. And that that's another group that I really feel for because it's, you know, it's hard enough to manage this thing by yourself, but managing it for someone else. Well, you know, it's hard because Arden you know, it's gotta be, it's gotta take a toll on you.

Scott Benner 1:11:47
Yeah, my wife, who doesn't she's pretty stoic, most of the time about stuff like this. But the other day, she said to me, we're, you know, we're getting older, we're not like, you know, we're not, we're not drifting, it's not over or anything like that. But she said, I just didn't think there'd be so many roadblocks. And I said, No, I didn't either. And it's tiring. And if you don't have the support you need from people and you don't have the support you need financially and, you know, health insurance wise, and your earlier point, you just kind of don't have the wherewithal to think it through, you know, and, and be ready to get it wrong and try again. And, you know, sometimes, you know, talk like you're talking about go with the flow, and sometimes, you know, have to stand up and push back. It's, it's more than you expect, you know, you're you're in your 20s and your 30s. And you're having kids and you think like, Oh, this one's my astronaut, and this one's gonna be a prince, and this one's gonna be this and you don't think that you know, 25 years later, you're still going to be on the internet trying to figure out why somebody's leg hurts, or Yeah, you know, what? That kind of stuff. It's just this autoimmune stuff is that sucks.

Jim 1:13:04
Yeah, yeah. Well, like I said, it's been a part of my life for so long that it's just, it's just, it's just there. You know?

Scott Benner 1:13:12
What's your, um, your early grooming was, I got captured by the, by the Nazis. And here I am. I'm back. So I don't imagine there's like given up in you.

Jim 1:13:24
Well, I guess that I probably inherited that from my dad, you know, he's, for him. You know, spending two years in prison camp and World War Two was, you know, he's, he said at one. From one standpoint, it was the scariest time of his life. But it was also the most glamorous time of his life because he was a hero back home and he's still like, he is a hero to me. You know,

Scott Benner 1:13:48
he knew that even when he was in, in the prisoner camp. He knew that that it like the knowledge that he was there and not giving up was, was uplifting to other people. Yeah, yeah,

Jim 1:14:00
I think so. Plus, how

Scott Benner 1:14:02
the hell do you complain, Jim? Like, right, like once, like, you know, my tires flat and he's like, Nazis, leave me alone. Let me know when you let me know when they lock you up in a prisoner of war camp and tell them go clean your room. You're like, all right. I guess he's got Well,

Jim 1:14:18
yeah. Well, all that plus having grown up during the Depression, sure, sure. So he'd been through it.

Scott Benner 1:14:26
No kidding. How old was he when he passed?

Jim 1:14:28
He was 87. That's a full life. Yeah. Yeah, he got a full full honors military. funeral. It was. It was very moving. I almost I almost teared up just thinking about it because it was it's like wow, 21 gun salute and everything.

Scott Benner 1:14:52
making you cry sounds difficult. So it

Jim 1:14:55
well, you know, not as difficult as it seems because I cry more to tears of joy than anything else.

Scott Benner 1:15:02
I had 20 minutes while I was by myself last night where I was doing laundry. And I found myself thinking of a memory of one of my kids and I made myself cry by myself. Yeah, yeah, it's,

Jim 1:15:12
well, I mean, we were my, let's see this, it'd be my wife's. No, my daughter in law's father does a church in his house. And we, usually when we're up there, if we're up there on a Sunday, we'll, we'll go, and it's very informal. And we were, we were singing a couple of hymns. And one of them was talking about something about a newborn baby. And we had two that were due within weeks. And I just, I just busted out in tears. It was, it was crazy.

Scott Benner 1:15:52
I think it's good for you, Jim. I really do. It's, it's a, I found myself just thinking about. I mean, my son's 22. He's still here. He just finished college. And I kept I keep thinking he's gonna leave. You know, I don't know when it's going to be. And what am I going to say to him before he goes, and I realized that the thing I always really want to say to him in tough situations, I never say because it's, it's not it's not valuable for him to hear when he's trying to make his way or be confident or things like that. You know what I mean? Like, there's the part you see the part you say, and there's the part you don't say? And I thought boy, before he leaves, like, how am I going to stop myself from saying, you know, please don't go. Yeah, I can't. I think I'm gonna have to say it. Because I don't know how I'm gonna hold it in. And yeah, because all the other times you know, you're, you know, something tough happens to them and, and you want to, you want to be like, Look, I know this sucks and everything and you should give up. But you don't you know, you don't say that. You say, Keep fighting in your mind. You think I don't think this is going to work out. But I think there's more value in him trying and failing than there is in him. Just walking away from it. He doesn't need to hear from me. This isn't gonna work. Yeah. I don't know how I'm going to tell him. You know, just I'm gonna miss you. It doesn't seem like enough. Yeah, well, anyway,

Jim 1:17:22
when my dad dropped me off at college, I basically got out of the car with my suitcases. And he said, by

Scott Benner 1:17:30
dollar Jerry, get your gym.

Jim 1:17:34
Watch out for the Nazis.

Scott Benner 1:17:36
Listen, if they throw those big grenades at you, you've got time to throw them back. Don't worry. Gotta go?

Jim 1:17:44
Yeah, pretty much.

Scott Benner 1:17:46
Well, that's interesting. Jim, you've had a hell of a life out. I appreciate you sharing it with me very much. Well, I

Jim 1:17:52
appreciate talking to you about it. It was good.

Scott Benner 1:17:54
No, it was the eight. Did you have a good time? Yeah, yeah. Fun. Good. Good. I'm glad I really am. I mean, I don't want to wish you luck, because I don't think you I think you believe in it.

Jim 1:18:07
Well, you know, whatever it is. I'll, I'll keep it.

Scott Benner 1:18:10
Ya know, I hope you stay on the path you're on. I hope. I hope you continue on like this. It's a it's really an uplifting story. Congratulate.

Jim 1:18:19
Yeah, I have to continue because my kids want to kidnap me and 2040 to take me to the 1,000th anniversary of a brewery in Germany. So 2040 Yeah, I'll be 87

Scott Benner 1:18:31
I don't have a ton of confidence. I'm going to be alive in 20.

Jim 1:18:35
Well, I told him, I told him You do realize that's beyond my life expectancy.

Scott Benner 1:18:40
Why don't we go earlier? And you just tell me it's the anniversary? Yeah. Well, I hope I hope to see pictures of your brewery trip. Okay. Put them on, put them on whatever magical thing exists in the future where we, you know, right. It's really something it's so cool. It's so cool to talk to somebody who's kept up with things the way you have and, and I am definitely calling your episode go with the flow. Okay. That's what I figured out while we were talking. Yeah. All right. Cool. Right, man. Have a great day. Hold on for me for one second. Okay. Of course, I want to thank Jim for coming on the show and sharing his story. And then I'd like to thank touched by type one and remind you to go to touched by type one.org. And thank ag one and remind you to go to athletic greens.com forward slash juice box. Of course you can get 35% off your entire order at cozy earth.com With offer code juice box, and 10% off your first month of therapy@betterhelp.com When you go to betterhelp.com forward slash juicebox. I hope you enjoyed this episode of the podcast. I'll be back very soon with another

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#871 Best of Juicebox: Standard Deviation and her Friends

First published on Jun 8, 2020. Dexcom's John Welsh M.D. does a deep dive on Standard Deviation, Coefficient of Variation, A1c, Time in Range and more. 

You can always listen to the Juicebox Podcast here but the cool kids use: Apple Podcasts/iOS - Spotify - Amazon Music - Google Play/Android - iHeart Radio -  Radio Public, Amazon Alexa or wherever they get audio.

+ Click for EPISODE TRANSCRIPT

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

Scott Benner 0:00
Hello friends and welcome to episode 871 of the Juicebox Podcast

Welcome back to the best of the Juicebox Podcast today we're revisiting episode 343. It originally aired on June 8 2020. And it's with John Welsh, a doctor who goes into a deep dive on standard deviation, coefficient of variation, a one C, and time and range. While you're listening today, please remember that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, always consult a physician before making any changes to your health care plan, or becoming bold with insulin. Are you a US resident who has type one or the caregiver of someone with type one, please go to T one D exchange.org. Forward slash juicebox. Join the registry complete the survey. When you complete that survey. You are helping type one diabetes research to move forward right from your sofa. You also might be helping out yourself and you're supporting the podcast T one D exchange.org. Forward slash juicebox.

This episode of the podcast is sponsored by cozy earth. Now you can get 35% off your entire order at cozy earth.com Just by using the offer code juicebox at checkout, I'm wearing cozy Earth joggers and a sweatshirt right now these joggers are like the best and our sheets are super duper super, super cool. And silky and soft. Also from cozy Earth. Cozy earth.com use the offer code juice box to save 35% The podcast is sponsored today by better help better help is the world's largest therapy service and is 100% online. With better help, you can tap into a network of over 25,000 licensed and experienced therapists who can help you with a wide range of issues. Better help.com forward slash juicebox. To get started, you just answer a few questions about your needs and preferences in therapy. That way BetterHelp can match you with the right therapist from their network. And when you use my link, you'll save 10% On your first month of therapy. You can message your therapist at any time and schedule live sessions when it's convenient for you. Talk to them however you feel comfortable text chat phone or video call. If your therapist isn't the right fit, for any reason at all, you can switch to a new therapist at no additional charge. And the best part for me is that with better help you get the same professionalism and quality you expect from in office therapy. But with a therapist who is custom picked for you, and you're gonna get more scheduling flexibility, and a more affordable price. I myself have just begun using better help. Better help.com forward slash juicebox that's better help h e l p.com. Forward slash juicebox. Save 10% On your first month of therapy. All right, let's talk about John Welsh for a second. John has type one diabetes. He's a physician. And he works at Dexcom. And he's on the show today because I reached out to Dexcom and said, I want to drill down deep. I want to understand granularly the way smart people understand what is standard deviation. And I know that might be like You're like Oh my God. That's what this episode is about. But no, no, listen to me, what we're going to talk about today, standard deviation, we're really going to understand what it is and how they come to those numbers. We're also going to talk about coefficient of variation. Now there's a lot of words you don't know. But by the end of this, you're going to understand. And you're going to understand why it's so important for you living with type one diabetes. After we get all this information into our heads, I started talking to John a little bit about how does he manage what does he call success at the end of the day. And it wasn't as much about the numbers, as you might think. But he really helped me to understand what these words that you know, maybe don't make sense to us right away. Just lay people what they mean, and how they're helping. You know, it used to be all about a one C right? You just tell you tell people like keep your eye one say here, this is what you have to do. But then all of a sudden you start hearing people talk about standard deviation and variability and this is going to help you to understand that even more. I had such a good time talking to John, that it got away from me. I was supposed to talk to him for an hour and like an hour and 20 minutes into it. I was like oh my god, I gotta let you go. He was like four We're minutes away from having to go to another meeting. And I just like, I'm sorry, go, go go. I found this incredibly interesting. I hope you do too. Because I really believe that the concepts that John and I spoke about today are at the core, they're the basis the bedrock of how you should be considering your health with type one diabetes, if you're looking for data to tell you how you're doing. These three things are a huge piece, you'll see. Please remember, while you're listening, 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. I wanted to call this episode, sugar Adam. But anyway, you'll find out why. Here's my finding. And I've been at this for quite some time, being around the diabetes space, I guess. And when the powers that be whoever they be, decide that we should all be aiming for a lower agency, there's a way to disseminate that information they pull together, you know, industry people, and they give them the toxic here's why no one c should be here and not here. And here's what we've learned. And you know, you get that talk. And then those people find different stakeholders and influencers and they spread the word. And before you know it, when it's distilled out to the public, the message is simply, you know, the ADA decided that your agency should be this now. And that's what you're now going to hear your doctors, your doctors talking about. Like it's, you know, like, it's a rule handed down from my PI, though, suddenly, they have a different opinion. And if you don't pay attention, you don't realize that that's just how we get information out to people, right, there's no good way you can't call everybody in the world and say, Hey, by the way, your agency should be a little lower. Now, you do this. But often, while we're spreading that information, it lacks real context. And when this happened recently, I'm gonna guess in the last two years, when all of a sudden, you started hearing your endocrinologist tell you? Listen, it's really much more about variability, your standard deviation, and they started talking like that. There was no context with it again. And then suddenly, everyone's just, you know, they're walking around, like they learned something. And they say, you know, a one sees not as important a standard deviation, and then all the sudden the message becomes a one sees not important, and then it gets, it gets, you know what I mean? Like it gets ruined as people oversimplify things. And so I really want to leave this talk, just backwards and forwards understanding standard deviation. And when I reached out to Dexcom, I said, I need someone who can really do that, and no pressure, but they said it was you. So

John Welsh M.D. 7:50
I guess you know, if you looked around Dexcom, you would say, All right, we need somebody who can tell stories, who can talk in a straight line more or less. And my, just by way of introduction, I My job title is medical and scientific writer. So I love a good story. And I love especially those stories that have to do with numbers and stories that try to convince people that the truth is actually true. And numbers can really buttress a story, you say, hey, look, look what happens if you don't save for retirement. Here's, here's one way you could go if you spend your money in Las Vegas on that gambling table versus spending your money in an IRA or whatever. So the the idea that you can make convincing arguments with numerical data has always been attractive to me and, and that's why I did some residency training, I went to went to medical school, went to graduate school. And after medical school, I did residency training in laboratory medicine. And laboratory medicine is all about measuring things, and saying, Oh, you've got an abnormal value on one of your lab results. And here's why it matters. And here's what you should do to mitigate the risk of, for example, having a really high potassium level. So if you have good data, then you can make persuasive arguments and you can change people's behavior, hopefully, keep them out of trouble. In the case of a higher low potassium, you could save their life, if you get the doctors to intervene. In the case of some really abnormal lab value that might come up in the hospital context. The bigger question about about glucose values and standard deviation. We can get to that but you made the broader point about public health recommendations and man we are just right in the middle of public health recommendations with with the pandemic because there's there's a lot of uncertainty, which is gosh, you know, how can I go to the concert? Can I go to the restaurant? Can I go outside without wearing a mask and that the recommendations that we've been getting from public health authorities have been A little bit discombobulated maybe internally inconsistent and kind of frustrating at times. But I am with you though the idea that we can provide good evidence based recommendations with respect to goals in managing diabetes is, is a big interest of mine. I'm all about all about the numbers.

Scott Benner 10:20
Well, many, many years ago, I came to the conclusion for my daughter, that if I get what I expect is what I started thinking of it as I realized I had Arden's high line set at 200. And I always kept her under 200. So one day, I moved her to 180. And I was like, Oh, I always keep her under one ad. This is really interesting. So I kept pushing it down and pushing it down. And now my daughter's, you know, ranges 65 to 120. And mostly, we keep it in there. And when we don't, it doesn't go that far out. Right, I'm gonna go to 150. That's usually, you know, like, just now, I will use this morning as an example, two slices of toast, an avocado, butter, and an orange. And her blood sugar went to 148. And it's coming back now. And it's not over a longer yet. Beautiful. Right? And so, but her standard deviation will look bigger than someone else's. And I don't know if I'm making up things in my head, or, like, how is it possible that Arden can have a life like that, but her standard deviation could be higher than someone who's a one sees a point or two bigger than hers, and who have swings that are far higher and lasts longer. And so that's the one idea that keeps me focused on I don't understand standard deviation or not. And then when I start talking about it with the people that I that listen to the show, I come to realize that everyone's sort of got that, that confusion. So can we start very over simply. and standard deviation as an idea? Is a mathematical issue. Is that right?

John Welsh M.D. 12:01
Oh, it is it's it's a number that is used to describe a set of numbers. So for the case of folks who are using CGM, you might expect up to 288 numbers every day. And each number represents a glucose concentration. And you can use words to describe that set of numbers or you can use numbers to describe that set of numbers. The the average is a pretty simple number that it's easy to calculate, you would add up those 288 values and then divide by 288. And then you get the mean, in this case, it's the arithmetic mean. There's other flavors, there's the geometric and the harmonic mean. But we'll we'll leave those aside for now. But the arithmetic mean, tells you it's a measure of central tendency, where you might expect the average, if there is such a thing, an average value to fall. The standard deviation is is another number that's used to describe that set of numbers. And it describes the width of that distribution. So it gives you an idea of how surprised should you be when a number shows up, which is pretty far away from the main. So here's I've got a kind of wonderful document came out a couple years ago that looked at glucose concentrations in people without diabetes. And they they came out with normal values. And the normal value here for glucose was pretty close to where is it 99. And express this number 99 is the average and then they give you a plus and minus seven. That plus or minus seven refers to the standard deviation. And the standard deviation. If you imagine a bell curve that you might have seen in school, where the most popular value is right there in the middle, that's the mean value, in this case, 99. The plus or minus seven tells you how steep is the drop off on either side of that mean value. So in this case, the 99 plus or minus seven, if you were to go up to 106. In other words to the mean plus one standard deviation, you would expect to have about I'm sorry, let's go back and say 99 plus or minus 799 minus seven is 9299 plus seven is 106. So anywhere from 92 to 106. The expectation is that you would have two thirds of the values in that pretty narrow range. So if your goal is to have if your goal is to have quite a lot of stability, which in general is a good thing. You want that standard deviation to be low and normal people without diabetes, it is in fact quite low. 99 plus or minus seven is a very tight distribution. Two thirds of the values fall between 92 and 106. Okay, so Whether there's a calculation, we could walk through it if you want,

Scott Benner 15:02
please. Yeah, I was just going to tell you that when we're done. And I can say this because this won't go out until after I'm allowed to, but I'm wearing a Dexcom. Pro. I have been for a couple of days. Ah, so I can see, I'll be able to look while you're talking and figure out what mine is.

John Welsh M.D. 15:20
Oh, good. So are you able to see the real time data or not yet? No, I

Scott Benner 15:25
see it. It's not blinded. I'm looking at it on my phone.

John Welsh M.D. 15:28
Oh, okay. Well, I hope you're, I hope you're within seven points of 99. I hope you're well in the normal range.

Scott Benner 15:34
I certainly hope so too. But I am I, I was really, I have to be honest. As I put it on, I thought, I'm doing this so that I can see how a working pancreas attacks things brings them back what curves look like, I wanted to see all that because I thought it would make it easier for me to speak to people about about using insulin. But at the last second as I was about to do it, I thought am I about to find out I have like type two diabetes or pre diabetic or something like that as like maybe you know, and I just kind of was like, alright, well, if that's if that's the case, it's the case, I'm going to find out. But so far, so?

John Welsh M.D. 16:15
Well, I hope so. And when we do onboarding, we have people come work for Dexcom. And part of the onboarding process is, hey, look at, look at our product and look at what it does. And of course, it's voluntary, but we say all right, if you'd like to wear one of these, just to know what the experience is, like, we can get you set up with one of these. And our expectation is always your glucose values are going to be are going to be let me check boring. And you're going to have a really smooth ride throughout the day. You know, 99 plus or minus seven. But once once in a while we have we have people that come back and they say, you know, John, I learned something really interesting. And what's that? If I have if I have an entire pizza, I can get my sugar up to 180. And I say wow, that's, that's abnormal. And so people learn something, even if they don't have a known diabetes, they can learn something about diet and exercise that you know, I went for a long bike ride yesterday and I crashed I went pretty low. And then I had the the Coca Cola or the sugary drink. And then I saw my sugar zoom back up so you can learn a lot. And that's a general truism that you can learn a lot just by looking. But Scott, I'm pleased that you're wearing one of the CGM sensors and I hope you learned something I really

Scott Benner 17:39
am. I'll tell you already, I had two pieces, smaller pieces of homemade pizza on Sunday. And three and a half hours later, I got a push up from the protein and the fat probably holding the the crust of the pizza in my in my system longer. That was fascinating. And this morning, I had a breakfast that was just a piece of Turkey and toast. People are like oh my god so boring. But, but I smoked a turkey yesterday, it was so good. John, I want to have some sort of breakfast. So I took some turkey and I had a piece of toast this morning. And when I was done, I grabbed a navel orange. And when I ate the orange It tried really hard to push my blood sugar up. You know, not immediately but it was it was drastic, and my body attacked the drastic rise so much so that I was 74 straight down for a second before I leveled right back out at 80 It was amazing. I went from 74 straight down to 80 and stable in a fight in all my shin one five SEC five minute things. So I saw my body go oh, that's a lot of sugar from that orange. And you know, he's already put this bread in here, I guess you know, I don't obviously don't know exactly how my body's thinking but but the idea was I was I was starting to push up a little from the bread not greatly. But then I think when I added the the simple sugar, I just I got a really quick response. So I'm noticing that that every time I press with simple sugar, my body comes back more aggressively than it does with more complex carbs.

John Welsh M.D. 19:03
You know, boy, that's interesting and, and other people have described it to me where they'll, they might have some indiscretion, they'll say I'm gonna have a 24 ounce Mountain Dew and you slam the sugary beverage and you get this wonderful increase in sugar which you can feel in life is wonderful. And then what you described with the orange happens happens in a very dramatic way where they're the insulin kicks in and then the sugar plummets and then all of a sudden you have the the big crash after the sugar high comes the crash and that I think that's a manifestation of instability. And same thing. I'm going to make a quick little analogy to the cruise control on your on your car. What I hoped for when I engage the cruise control on my car is just a smooth ride. And and I don't want the car to be slamming on the throttle and slamming on the brake all the time. You I just want to be going at 65. All the way home. So I am very sympathetic to your experience with with high amplitude glycemic swings. It's it's a common thing, especially in the world of type one diabetes where we're all taking insulin.

Scott Benner 20:17
Yeah, it's it's very interesting. I'll tell you and I'll then I'm gonna let you get back to it. But the other thing that happened that I really didn't expect, but makes total sense, is that for about the first 36 hours, I wore it, every time I looked and saw my blood sugar stable, I had a horrible feeling of guilt. It was, it was really interesting, because my daughter has had type one since she was two, she's 15. Now I have interactions with 10s of 1000s of people who have diabetes, and they all would just, I don't, they would do anything to have that, you know. And it really, it really impacted me for in the beginning, I just was I felt very guilty for my pancreas working. It was a weird feeling. So, but I'm sorry, I shouldn't derail you, because we're talking about something that's, you know, you don't think it's complicated, but trust me, I do. So I shouldn't I shouldn't distract myself. But we were talking again, about about people, you know, who have a functioning pancreas. And you said, you know, let's pick 99 Is that is that that kind of center target? And you can go to 92 or up to 106? And then explain again, what I'm sorry, where were you headed with that?

John Welsh M.D. 21:23
Oh, sure. The value, I'm looking at a big article that came out a couple years ago, they looked at 153 People without without diabetes. And they put glucose monitors on him. And they they collected a bunch of data. And so the question, I guess the first question is, why would you care? Why would anybody bother? The answer is, well, we want to know what normal looks like. So we can decide if if a particular glucose profile is reassuringly normal, or if there's something going sideways on it. The 99 value from earlier is the mean, the standard deviation I gave you earlier is seven. And that tells you something about how wide the distribution is. So one standard deviation on either side of 99 would go from 92 on the low side up to one 106. on the high side, that mean plus or minus one standard deviation, the expectation is that two thirds of the values would fall in that relatively narrow range, two standard deviations 99 plus 14 is 114 113. on the high side, and then 99 minus 14, I guess is 85. Is that right? On the low side, so 85 to 113, the expectation is that you would cover an even higher percentage, I think 96% of the values would would fall in that range. And if you go out even further to plus or minus three standard deviations, the expectation is that almost all the values more than 99% of the values would fall within three standard deviations of that central value the mean. So that's, that's it in a nutshell, the calculation. It's not difficult, it's not trivial, but it's not difficult. I'm not sure if your audience would be interested in walking through it or just looking it up.

Scott Benner 23:19
Right now, John, this is very much meant to be for people who are interested in that. So I have a group of episodes, there's about 20 of them. They're called protests and they are deep dives into specific things about type one. And this is this is one so don't think of this as an interview as much as think of it is, we are really trying to pick this apart so that when someone listens through like, I'll be honest with you. In sixth grade, my guidance counselor told me I could take algebra halfway through algebra, I didn't understand algebra at all. And I thought, oh, my gosh, I'm terrible at math, I dropped out of it. A was a bad decision, because I followed a much simpler math track the rest of my time, which probably wasn't necessary. And just now, as you were talking, I, you know, you set up this scenario, and the standard deviation was plus or minus seven, and you started talking about out one, standard deviation two and three, and it just started to make sense to me. So you're doing a good job. Trust me if I understood what you just said, everyone listening has a chance to understand it as well.

John Welsh M.D. 24:20
Well, you're you're very kind and that's I'm very pleased to think that we're making progress toward the goal, then we can I can introduce the topic again and say the standard deviation is just a number that's used to describe a set of other numbers. The standard deviation, there's a calculation for it, it's a little bit involved, but involves, first of all calculating the mean for a population. The example that we used was the the mean value for people without diabetes, it's 99. You have quite a lot of values. You might have 1000s or 10s of 1000s of values. And this is where it gets a little bit tedious. For every one of those individual values in the set that you want to describe, you have to calculate the difference from the mean. And the difference from the mean is either going to be a negative number, or it's going to be a positive number, depending on whether the the individual value is higher or lower than the mean. You square that. So squaring a negative number, it gives you a positive number, squaring a positive number gives you a positive number. So you're going to get another set of numbers, which is the squared difference from the mean. And if you had 10,000 values in the set, you're going to have 10,000 squared differences from the mean, you have to add them all up, you get a sum of squared differences. And then you divide it by divided by the number of observations in the set minus one. So it's, it's a pretty complicated when you try to describe it verbally. But if you were to look at it on a sheet of paper, you would say, oh, it's, it's a series of steps. Add up all the squared differences from the mean, divided by a large number one less than the number of observations in your sample, and then take the square root. And then once you've taken the square root, bingo, there's your standard deviation. So it's, it's a few steps, but it's something that kids probably learned and then probably forget just as quickly as they learned it in, in middle school or high school algebra class.

Scott Benner 26:26
So how does clarity app like to simplify that all down? What is the clarity app looking at? When it tells me, you know, the, the standard deviation is 35? Can you like, distill it? What is it looking at to make that decision without the without the detail?

John Welsh M.D. 26:44
Oh, absolutely. So the statistics page, for the clarity app gives you some summary statistics. And just a quick little operational note, I wonder if you're able to see my page that I'm trying to share with you on the Zoom meeting? Yep. Oh, good. Okay. So maybe you should ask your question again. So we could rejoin the the post editing narrative?

Scott Benner 27:11
Oh, I just know, I was. What I'm worried. What I'm interested in is, is there's a clarity app, obviously. And it tells me, Oh, your standard deviation, or your daughter standard, if she is 35. Or some people are like, Oh, I'm struggling. And you know, my mind is 65. And I heard from a woman the other day that told me her doctor told her that anything under 100 was okay, which she very smartly was like, I don't think that sounds right. But I want to know, like, what does it look at? To tell me? My standard deviation is 34. Like, taking into account?

John Welsh M.D. 27:47
Oh, sure. Well, that's, I think I can get that one answered pretty quickly. We've got our statistics page. And if your audience wants to look at the Dexcom, clarity, web interface, there's a page all devoted to statistics. Looking right now, at my statistics for Monday, and this is every Monday for the past 30 days. So there's several Monday's in that sample, I've got a total of 1253 readings. And each one of those is estimated glucose value. And then the summary statistics, the minimum 40 Oh, that was scary, the maximum 244. So those are, those are not normal, the mean value 128. That's reassuring, and then the standard deviation 34. So to get that 34, the calculation that I just walked you through, which is look at every one of those 12 153 values, get the difference from the mean. So do the subtraction 128 Minus a particular value. You square each of those differences from the mean, add them all up, and then divide the total by 1252. And once you've done that, you take the square root of it, and it's it's 34. So there's, as I said, it's a little bit of algebra. But it's, again, the usefulness of it. 128 plus or minus 34, tells you that you would expect two thirds of those glucose readings to be within one standard deviation of the mean. So 128 minus 34 is just 90 something and then 128 plus 34 is 162. So you would you would expect most of my sugars to be in that in that range.

Scott Benner 29:41
Take for second example, I know we're going to oversimplify but describe what mean Yes.

John Welsh M.D. 29:51
Oh, sure. I mean, it's also known as the average value. So if you were to look at the NBA players As you say, Wow, NBA players are really tall. You might express that in numbers by saying the average or the mean, height of an NBA player is six feet six inches tall. So it's another word for average, it's a particular kind of average. But we don't need to talk about the other kinds of averages. Mean is usually just the arithmetic mean, you calculate it by adding up all the values, and then dividing that total by the number of values.

Scott Benner 30:31
So what I have here, what I'm looking at in front of me is 12 153 readings. There were 40 that were or is that under a certain number, those 40?

John Welsh M.D. 30:45
Oh, yeah, we're looking at these rows in the in the statistics, the number of readings, 1253 is a bottom, the minimum was 40. The maximum 244. And the mean value 128.

Scott Benner 30:59
Within within those 12 153 readings, there, the high was 244. The low was 40. But on average, this person's blood sugar was 128.

John Welsh M.D. 31:12
That's a that's a nice way to do it. And yeah, we're looking at, we're looking at my readings from the past month or so

Scott Benner 31:17
these are you Oh, my gosh, are you? Do you have type one?

John Welsh M.D. 31:21
I do. I've been living with type one for most of my life for past 45 years. And so far, so good.

Scott Benner 31:28
Show me like an example page. I didn't realize we were looking at your blood sugar. Well,

John Welsh M.D. 31:33
I yeah, you can spy on me. You can you can look at my summary statistics. Here we can we can continue with the summary statistics page. Yeah.

Scott Benner 31:43
And I'm gonna have some questions about it when you're done. But please keep keep going.

John Welsh M.D. 31:47
Oh, sure. And this is an incredibly number, it's a very useful way to get a numerical description of other numbers. And so far, so good. You know, here's, here's a guy, John Walsh, who is this clown anyway, and what is he doing talking about his glucose numbers. So John's, had a, at least one time where he went all the way down to 40. But the main value 128 is reassuring. And then we get down to some other statistics that talk about the median value, the median value is the value above, above which and below which half of the values occurred. So in my case, the median is 122. And that tells you that half of my readings were above 122, and half of my readings were below 122. So that's another measure of central tendency. The end, it's usually expressed alongside the interquartile range. And so you look at the, the value that is 75% of the way to the top, so 75% of the values are below at 25% or above it. And in my case, the the 75th percentile is 153. The 25th percentile is 103. So you can say with, with some confidence that half of my values were between 103 and 153. And those are the 25th and 75th percentiles, and the the interquartile range here has given us 50. And that's just the difference between 153 and 103.

Scott Benner 33:33
So the question here, if if Yeah, if if half of those range between 103 and 153. I'm assuming that the other half are how we arrive at the standard deviation of 34? Like, I'm assuming you need that information to to come back to the standard deviation?

John Welsh M.D. 33:49
Oh, no, no, the standard deviation, the standard deviation relies on all values. And it doesn't, it doesn't care so much about the distribution, it just cares about how far from the mean value the values are. So there's, there's there's another point that I want to make, which is the median value, in my case, 122. The mean value is 128. A lot of times those are very close together. But sometimes they're very far apart. And there's some special circumstances where the mean value is much, much different than the median value. And we can talk about those if you think it's interesting.

Scott Benner 34:32
I wonder what I do want to know is, is how much of sensor like so you know, I've my daughter has been wearing a Dexcom since seven, maybe Dexcom, seven or seven plus back then. And so, obviously, we see things at every generation, improve and improve and improve but I could still say that for Arden in the first number of hours. You know that you put on a new sensor it's not as I don't know, it's not as tight with its understanding of your blood sugars that maybe is on, you know, day two or like, you know, or there's a sweet spot through the middle where it's crazy. Arden uses a Contour Next One blood glucose meter, which is incredibly accurate. And for a large part of our sensor where the meter and the CGM are spot on with each other there within a couple of points. And when you're managing type one, there's a ton of like, good feeling about that, knowing that, you know, she wakes up in the morning, and it says her blood sugar is 96. Now whether or not her blood sugar is really 85, or it's really, you know, I don't know, 104 to me is of no real consequence. It's in that space. And I'm thrilled with that. Then I put it on, and I don't have diabetes. And I wake up and it says my blood sugar's 94. And I think, Oh, my God, I've been fasting all night. And I'm 94 and I do a finger stick. And I'm 85 It's amazing that those seven points to a person without diabetes is, it's a different impact than it is to a person. Right? And so it is seriously like, I wake up in the morning, 94 I'm like, Oh, I guess that's it, I'll just eat lettuce till I die. But you know, like, like, it's just, it feels like that immediately. And, but I take that same information coming from my daughter, I am completely comforted by it, not just comforted by it. But it leads me in my understanding of how to manage her insulin and her health and everything. My question is, is that knowing that the sensor is a little, you know, on the on the edges, it struggles a tiny bit more than it does in the middle? Is there something about my data that I can't look at to micro? Like, do I have like, how much time do I really need before? The inconsistencies in the data? And the consistencies in the data bounce out to where it doesn't matter that it's not all? Perfect? Does that make sense?

John Welsh M.D. 36:53
Oh, that's, yeah, that is a very common question. And I don't have I don't have a good answer, I can tell you how I deal with imprecise measurements in my own life. And, and I've got, I had a wonderful bike ride yesterday, here in San Diego, and I've got a fancy bike that has a built in speedometer, it's based on how many how many times the will completes a revolution. So there's a speed sensor built into the into the wheel. And based on that, you can calculate your speed. And I've got another fancy thing in my phone where you can get your speed based on satellite data from your global positioning satellite system. And and I looked at it and I found myself chugging along the road and and the the speeds, you want to guess if they were exactly the same. No, they weren't. I was going 20 miles an hour. If you look at the wheel sensor, I was going 21 miles an hour, if you look at the GPS coordinate, so measuring your blood sugar and seeing one number and then looking at your CGM and seeing another number. And and it's frustrating, because there's no good way to to know how excited or how concerned to be about discrepancies. There's always going to be discrepancies. It's a rare thing when when the blood sugar tells you you're 105. And then you get that 105 From the CGM. And I don't want to give medical advice over the phone like this. But there is the possibility that you could calibrate your your G six and based on the your confidence in a blood glucose meeting reading, you could say, oh, my GSX is reading a little bit low. I'm going to calibrate it, and then bring it back into better alignment with the with the blood glucose meter. So I know it's frustrating. I wish I had a better. I wish we had better devices for measuring glucose with even more precision.

Scott Benner 38:59
They're amazing. You've had diabetes forever. You know how amazing this stuff is. Just because you work there doesn't mean you can't say that. And it's actually been very interesting for me because of the pro doesn't allow you to calibrate or at least I just had to go with it. And it really sure it was it was it was interesting to live in the space because for my first maybe 18 hours, the glucose monitor was reading about 10 to 12 points higher than what the finger stick was was pretty consistent for those few hours. And I found myself thinking if this was my daughter, and I put a brand new CGM on her that thought she was 110 when she was 91. I'd be like, Oh my god, this is the most amazing thing ever. I love this thing. It's so amazing. Except you know, and I didn't have diabetes and I was like, Is my pancreas not working? You know, like it's very like it's a it was just such a very different thing. But beyond that initial feeling. It really did just cement my idea of how much I love this technology. And and because I can remember managing my daughter's blood sugar without a glucose monitor. And to think that she'd be stable at 110 or 91, ever for hours and hours at a time is insane, but it just never happened. But over these last few days, we've been eating the same meals. And her care is so dialed in, due to a large due in large part to the information that comes back from the Dexcom that her blood sugars and mine are largely matching before and after meals.

John Welsh M.D. 40:35
Congratulations. And that's just That's wonderful news. And, you know, it's, and I'm totally with you, we we can talk about the battle days when when you had to make a make a guest and a lot of times it was not a very good guess based on just a urine dipstick and you could say, oh, I'm spilling sugar into my urine and I need more insulin, and you would have to make a guess. And some of the highs and lows were pretty scary. And, and people you know, sad, sad to say that people are still dying from insulin overdoses, insulin, let me check, it's a poison, and it can kill you. And there's, there's a lot of downside risk to insulin, even though it's a huge blessing, we're coming up on the 100 year anniversary of the commercialization of insulin. So we're all going to celebrate and be thankful for the commercialization of insulin and the fact that we're not dead. But it's, it's a tough disease. And you wouldn't, you wouldn't wish it on anybody because it's really a lifetime burden. But I'm really pleased.

Scott Benner 41:43
I just had a conversation briefly online with a woman this morning, who even with all the technology gets incredibly low every day. So I was turning her on to the podcast as like, this doesn't need to be you're just you're not using your insulin correctly. And it's not that it's not that difficult to figure out how you know, so I turned around, I was like, Listen, I have an idea. Can I hit you with some questions and see if you have answers to them. These are questions that came from listeners. And sure, I'm not asking you now I understand you're a doctor. But I'm not asking you that way. I'm asking you based on this information, this data and how much you've seen it? Do you see? Do you see information in the data that would help people with the things that they're concerned about? So the first one simple? Do you know what a non type one standard deviation usually is? Is there a range where it usually falls?

John Welsh M.D. 42:34
For example, somebody with type two?

Scott Benner 42:36
No, no, no, just someone who doesn't have diabetes at all. Do you know where like, like, where? Oh, yeah.

John Welsh M.D. 42:42
Yeah, so we've got a we've got some data from a big study of 153 people without diabetes. Their standard deviation was was seven,

Scott Benner 42:55
seven. Okay. Okay, is there? Let's see how I want to say this here. So this is a type one question somebody is somebody's asking. If there's a lot of variability within the good range, say like, like 70 to 120, this person's kind of bouncing between 70 and 120. There what they want to know, for their health? And maybe you don't know, but would they be better off sitting at 120 than they would be from going up and down between 70 and 120?

John Welsh M.D. 43:27
Oh, I think so. And there's, this kind of leads into another number that you can get with the, the summary sheet, it's the ambulatory glucose profile is something that Dexcom has. It's, it's not exclusive to Dexcom, but it's called the AGP. The ambulatory glucose profile, what

Scott Benner 43:46
my things John, don't know, you really got to get creative in charge of in medical in general in charge of the stuff that that goes back and touches people. If you look at glucose for I'm sorry.

John Welsh M.D. 44:01
There's, there's a lot of syllables there. And there's a whole industry for you know, if you come up with a new drug, you have to hire a marketing firm to come up with a name for your for your new drug. But there's a digression for you. Anyways, is the numbers. The numbers that are on the top line of the ambulatory glucose profile, the average is there, the time and ranges there. There's another number here, which is the standard deviation, and then the coefficient of variation. And that's a number that I think has has a lot of usefulness because it tells you how big is your standard deviation compared to the mean value. And there's some clinical implications for that as high, high coefficient of variation is dangerous because it puts you at very much increased risk for dangerously low events for for hypoglycemic misadventures. So the the coefficient of very Question again looking at my own data for the past 30 days, my coefficient of variation 31.3. And is that good or bad or indifferent? It's, it's higher than I'd like it. But is it dangerous? And there was a fun article. Fun, I don't know, but useful anyways, the useful article came out a couple years ago, and some folks in France in the UK came out with an article in diabetes care. And they they said, CV coefficient of variation of 36% is the threshold to distinguish between stable and unstable sugars. Because beyond this limit, the frequency of hypoglycemia is significantly increased. And, and if this, my own CV here 31.3%, that's reassuring, it's low, which is good. And it's less than 36%, which tells you that I'm, I could still go low. But the fact that this CV is less than 36% is reassuring. I went to see my endocrinologist and he said, Hey, John, keep up the good work. You're probably not going to die of hypoglycemia before the next time I see you. And I was so alright. Yeah.

Scott Benner 46:15
John, you know, it's interesting that I see with my daughter who is, you know, a woman, a burgeoning woman, is that with our care, the same exact care we use on weeks and days where she's not impacted by hormones? Arden's standard deviation is 24 ish. But oh, my gosh, that's terrific, thank you. But that's not why I'm telling you that what I'm telling you that is because although I appreciate it, why I'm telling you is because that when she is impacted with hormones, the run up to her period, for example, her deviation jumps up to 45. and N are no holes aren't different, her meals don't vary. It just, she needs more insulin. And it sometimes takes a couple of days for you to realize that that's happening. And then once it's happening to remember, it's happening to remember, like, you know, oh, you know, my ratios are telling me this much insulin, but it's four days before I'm gonna get my period. So it needs to be more, it's difficult to recall all that, you know, constantly. But it's fantastic. It's interestingly fantastic to see because if Artem was a boy, I think I would have a son with a with a standard deviation, pretty consistently within 24. Until they hit I'm assuming puberty as well. But you as a, it's just very interesting to look at your 30 day chart here. You're I know we're talking about so you don't mind, but your standard deviations 42. And you're saying it's not where you want it, but it's also not terrible, like people are trying to understand on the outside, what's the number that keeps them healthy? And what's the number where they think, you know, something else is going to happen? It is very simple in people's minds when they think about these numbers, like what am I gonna hit? How do I get to it?

John Welsh M.D. 48:03
Oh, yeah, yeah, and I think if the the more useful number and I think the one that is very convenient to have as a as a goal, and is is the coefficient of variation. And that's just a ratio, it's the standard deviation divided by the mean. And aiming for something less than 36% would be would be a reasonable would be a terrific goal. And if I were still seeing patients, I would say, Here's your, your coefficient of variation is 40%. Let's look more carefully at the trajectories or the, this is called a modal day plot. And I'm sure your audiences has seen this, it lays out the clock time here on the bottom axis, and then the glucose values on the vertical axis. And you can see the median value here and the bold line right in the middle. And then you can see the shading here, the blue shaded area covers 50% of the values and then the area in between the dotted lines covers 90%, or I'm sorry, 80% of the values. So what what I'm looking for what I wouldn't be looking for if I were looking at somebody else's plot is a smooth ride. And sometimes you can identify parts of the day where the ride is pretty bumpy. For example, after lunch, if you're having lunch at your desk and you're not going for a walk and you're having the third slice of pizza, you might see spikes after lunch or dinner. Or you might see plummeting lows after breakfast if you gave yourself too much insulin for breakfast, and fun to go with breakfast. So I'm not the standard deviation. If you're always cruising around a relatively high number like 170 The standard deviation is going to be bigger than if you're always cruising around at a much lower number like 100 And so, um, the number that I think is more reasonable to target as a therapeutic goal is the coefficient of variation.

Scott Benner 50:09
Okay? Under 36.

John Welsh M.D. 50:13
Yeah, that's, that seems to be the magic number. And that's the consensus and, and it's, it should be achievable if you if just pay attention to parts of the day where you might be having a bumpy ride, you can look at your behaviors, look at your response to your behaviors and say, You know what, I think I will, instead of having three slices of pizza, maybe I'll just have one. So CGM can be a wonderful motivator. It can inform people it can motivate and reward good choices. So I'm you can tell I'm a huge fan. I love evangelizing this stuff, but you can learn from, you can really learn a lot from the numbers. And the numbers can tell you, if you pay attention to him, to the numbers themselves, and also to the summary statistics, like the standard deviation, you can learn quite a lot from him.

Scott Benner 51:03
I'm a huge fan, I don't understand that, obviously, nearly as well as you do, but I know what it tells me. So for instance, after Ardennes, my, my poor daughter, one day is going to listen back to this and be like how much did they talk about my period on that podcast, but after so the lead up to her period, there's like three or four days prior to it, she gets, you know, all of a sudden, she needs way more insulin. And then in the first day or two of it, it happens still, but then there's a moment where it levels like whatever happens is done. She's still the periods still happening, but the hormonal impact seems to be going out of her body. So let me give you an example. Because it just happened yesterday for the last 24 hours. Arden's estimated a one, C is five, and our standard deviation is 24. Per average, blood sugar's 98. But if I just go back seven days, through her, you know, through this lead up to this period, estimated a one C 5.8, standard deviation 43, average blood sugar 119. It's an it's just the hormones, it's the lead up to her period. And so it's fascinating and not that you don't know but and then there's another time of the month where it happens again to her for four or five days. But just those just that week, and then that other chunk. So basically what I think is about 789, probably 12 or 13 days of the month, takes what would normally be I think, an SD and like I said in the mid 20s and an A one seat closer to five than six, and it moves her agency more towards like Hurray, once he pretty much sticks at like 5.6 it doesn't move very much. Okay, it's just very, I don't know, like I don't know what I would do before this information like no lie prior to it. I wasn't a different person. And we were not good at this at all. You just diabetes in general her hurry once these were in the eights and I finally got them into the sevens just by having, you know, better tools and insulin pump and a glucose monitor. But I still didn't understand that enough to turn it into real, like success, you know, like, like the idea of knowing when to Bolus and that sort of thing. But I know all that from this data now. And it's sure incredibly beneficial.

John Welsh M.D. 53:27
Absolutely. Well, I'm, I'm with you 100% on that. And I think for my own my own experience was in the bad old days before CGM, I was poking my finger and making a lot of guesses. And it really got me interested in how the body works. And it was a great, great motivator all through college. And that was part of my story when I was applying to medical school and I'm not alone. There's a lot of a lot of physicians who specialize in in Endocrinology and Metabolism who also have type one diabetes. So my own story is, is hey, this is really interesting. I want to learn about it. And I want to go to medical school and what do you know, the medical school here in town said all right. All right. Coming to medical school, and you can learn you can learn quite a lot in medical school about about the disease itself and about how you measure how you measure sugar and measure all the other important things that we care about in metabolism. So it's for me anyway, it was not just a life changing event when I got that diagnosis but it also sort of defined my career path toward a toward becoming a physician and also to to working here at Dexcom

Scott Benner 54:40
Yeah, so that's fascinating and I'm afraid I'm gonna start talking to you and then lose track of what we're supposed to be doing because questions I almost answered ask them and I was like, No, don't do that. What cut when you when you when this data is pulled together, given that there are you know, Blood Sugar legs and meters aren't perfect and nothing's perfect. What? What's built in to deal with the error? Like, how does it come to the number and? And take the the imprecise pneus out of it? Is it like, like looking at yours? For example, your standard deviations? 42? What if if if a Dexcom was absolutely perfect if there was a you know, if it wasn't technology, but it was it was your, you know, I don't know, something organic that could know 100% For sure. What all these measurements are on your glucose all the time? How far off? Do you think that number would be? If you had perfection? Does that make sense?

John Welsh M.D. 55:41
Oh, yeah. Yeah. You're You're hypothesizing that there is some there's no real answer. Yeah, there is. There does exist some true number. And we're always trying to become more more accurate and getting closer to that true number. We are, we're never going to get there. You have to stipulate that we're always going to have some, some wiggle and some imprecision. And that's, I think true. Because nothing on this planet is perfect. And we have to, if we get to heaven, and then everything is perfect in heaven, if we ever make it there.

Scott Benner 56:17
That'd be my first question. When I get there, I'll be like, what was my kids? Really?

John Welsh M.D. 56:24
Yeah, so that's a whole nother line of inquiry. But we're probably certainly within 10%, I think I'm confident that we're within 10%, I'm less confident that we're within 5%, I wouldn't be surprised if we were within 3%. And I would be really astonished. If you told me it was within 1%, I would be astonished. So I've got some confidence, the for the 10% precision. And I've got some optimism that we can usually get within 5% of the true value. Those are just speculative numbers. Because there's no such thing as a perfect value, even if even if you use the gold standard. We could quibble about any reference instrument. And this is one of the things they drilled into us during my residency training in laboratory medicine, which is, is there such a thing as a perfect measurement? No, not until we all die and go to heaven. While we're living on this earth, you have to deal with imprecision and uncertainty. But I think we're pretty good. And just for purposes that we care about managing managing diabetes and living a long happy life, I think we're we're well within the realm of of good enough.

Scott Benner 57:40
And outcomes are good based on what we noticed. Does that mean, from what you just said, if at a 42 standard deviation? Is it possible that your standard deviation is somewhere like 36? Or possibly like, I don't know, 48 or 47? Or is it more likely it's lower? Or more likely, it's higher? If it's Is there a likelihood that it's more one way than the other?

John Welsh M.D. 58:05
Oh, yeah, the standard deviation just tells you how, how spread out the distribution is. And the the true standard deviation could be higher or lower? Because all the numbers that the standard deviation depends on could actually be incorrect. So I think, yeah, that's a tough one. Let me let me think about that. Yeah. I'm looking now at this. Looking now at the standard deviation and this famous bell curve, the you know, what the, if I'm understanding your, your question correctly, could the standard deviation be something different?

Scott Benner 58:51
You use me as an example, in my situation, right. Now, if I put on a new CGM, every 10 days, I wear three sensors a month, nine sensors over a three month period, if I look back at my 90 days, my standard deviation, if my if my sensors reading just 10 points higher for the first, I don't know, just say 36 hours of every one of those things. Am I more likely to look higher than I am? Or lower than I am? Because of that? Higher right?

John Welsh M.D. 59:19
Oh, yeah, I think I think you would have a high. It's called a high bias. But your earlier question, could the standard deviation be something other than the calculated result? I? I think the answer is no. If if you give me the numbers from one to five, could the total be something other than 15? And I would say no, the total of the integers from one to five is 15. And if you give me a set of numbers, I can calculate the mean and the standard deviation. So I think the calculation that we've done here, resulting in this standard deviation of four 32 If we did the math correctly, then the standard deviation is 42

Scott Benner 1:00:04
is the I'm sorry, there's the algorithm that's making this decision. Does it scrub anything? Like, you know, like a compression load? Does it see that and go, we're not going to take this into account, does it do any of that kind of stuff?

John Welsh M.D. 1:00:18
Oh, yeah. And that's, I think that's true. That's got to be true for Medtronic, it's got to be true for Abbott, it's got to be true for sensing Onyx. And also for Dexcom, we've got, we've got algorithms, the signal that we are measuring is actually a voltage. It's a, it's so I'm sorry, it's current. So the current is very low. Current, usually measured in amperes. And we're dealing with billions of an ampere, I think, nano ampere, or Pico amperes. So incredibly small currents. And the challenge for the engineers is to take that very small electrical current, and translate that into a number that makes sense and number of milligrams per DL. So that requires some, some engineering talent. And it requires an algorithm. And I think that's part of the secret sauce that we have here at Dexcom. Medtronic, I'm sure they have a algorithm, which is similar, but slightly different. And the same for Abbott. And the same for sensing Onyx. And that's true. Whenever you're measuring something and saying what you're measuring, you know, for the example of your oven, if you're cooking, you're making your cookies, you're measuring temperature, what you're really measuring is the height of the mercury in the thermometer. And the trust is that that's a good representation of your temperature. And then going back to the bicycle speedometer example, what it's really measuring is how fast the wheel is turning in, you're translating that revolutions per minute into a speed. So it's a challenge to take a very small electrical current and turn it into a glucose value. And but that's, that's what we do. And I think that's what all the manufacturers have to do.

Scott Benner 1:02:07
It's amazing. And listen, we're one rabbit hole away from wondering if we live in a simulation. So let me ask a more concrete question. Ready, John? John, in 30 more minutes, we're going to be like, we're probably in the matrix. So just a real quick when Canadians or people who are using other scales, did they multiply their standard deviation by 18? To get their answer? Like, this person gave me an example so that their last standard deviation in Canada was 1.62. They multiply that by 18. To get the number that the way we're talking about it right now.

John Welsh M.D. 1:02:46
They sure would, yeah, so the the units for standard deviation, the standard deviation here in the US as milligrams per deal. outside the US, the standard deviation is millimoles per liter. And the conversion factor is is 18. So the standard deviations would be less by a factor of 18. In places where they use millimoles per liter, the end and that's a good point, thank you for bringing it up. And the point is that what would not change is the coefficient of variation. So if you were to take all my numbers, or if I were lucky enough to be a Canadian, and measuring my sugars and millimoles per liter, I would still have this coefficient of variation of 31.3%. That would not change, because you're dividing milligrams per DL in the numerator, milligrams per DL in the denominator, and those units would would cancel them out coefficient of variation. There's no units for that. It's just a percentage. I'm

Scott Benner 1:03:50
glad you said that, or some person, Saskatchewan was gonna take their coefficient and multiply it by 18. And that's great to know. And thank you for knowing it. By the way, when I asked the question, I appreciate that.

John Welsh M.D. 1:04:04
That's a good one. You know, if you got to, if you were to travel to Japan, you would trade your dollars for yen and you would find yourself 100 times more wealthy. Because you can buy you can buy about 100 yen with $1. But wait, everything's 100 times more expensive so

Scott Benner 1:04:21
well, so let me make sure I'm understanding exactly. So coefficient of variance, or variation we're talking about under 36 Really lessens your possibility of low blood sugar's standard deviation shows us how much stability we have, right like by keeping our variability lower. What is the measuring?

John Welsh M.D. 1:04:45
Oh, in terms of our health Oh, yeah, a one C there's I love a one C I want to strangle it and drown it in a bathtub. i A one C has been with me for a long time. It's about biomarker, it's hemoglobin obviously is the protein that fills up your red cells, it's got the red color, because it's got iron in the middle of it, it's got an iron atom. And it's the same color as rust. The hemoglobin a one C, the a part of it refers to the a chain. There's an a chain and a B chain. The hemoglobin a one refers to the first amino acid in the a chain of hemoglobin. And the C refers to the isoform, if you want to know refers to the isoform, of altered hemoglobin that travels on chromatography. Anyway, that's that's the long answer. The short answer is that hemoglobin a one C is a abnormal form of hemoglobin that has a sugar atom stuck onto it. And having that sugar, I'm sorry, sugar atom, it's a sugar molecule stuck onto it. And it's a nice indicator of how your ambient glucose concentrations have been going over the past two or three months. The downside of having a high a one C is that hemoglobin a one C molecules behave a little bit differently. And they're also markers that things are going haywire in other parts of your body, other proteins in your vasculature in your kidneys, and your liver might be getting decorated with sugar molecules when they really shouldn't be. So having having a very high hemoglobin a one C number tells you that quite a lot of your hemoglobin molecules are traveling around with this kind of gooey sticky sugar molecules stuck onto them. As I mentioned earlier, I it's it's not my favorite biomarker. What's your favorite biomarker, John, there's there's ways that you can fool the hemoglobin a one C test, and we can talk about those. There's some some people have problems with red cell production or red cell destruction that would throw it off. So you can really be misled by an A one C number, it can be too low. And you can say, Ah, you're doing just fine. Your a one C is in the normal range, when it should be much higher. And then on the flip side, you can see in a one C, some people have a one c values that are unexpectedly high compared to what their average glucose values are. So it can it can mislead you in a couple of different ways. I'm a much, much more enthusiastic about just using the average glucose value that you get from a CGM system to assess the adequacy of your glycemic control.

Scott Benner 1:07:50
Is that okay? You know, it's interesting, you made me think of last year I suffered, I had my ferritin was very low. And it's it. You know, at first everyone, the doctors thought I had cancer and we did all these things. And it turns out, I just had low ferritin. And so I got an infusion of of whatever they call it, it's I can't think of it now sit iron and it's a it's a mix, it looks like a rusty bag of water and back up, but during that time, what I was told was we can't trust your Awan see right now, because of your low ferritin. And I was like, huh, dig too deeply into it. But it's something you just said now made me think of it again. And then it made me think about how, you know, measurements, right? And you always get, you could use anything. Here's an example. My daughter has hypothyroidism. But when we first figured it out by her symptoms, the doctor's office looked and said, well, she's low, but she's in range. We don't want to do anything. And we made them give her the hormone, then because we had an experience with my wife who was low in in range, and they would never help her and it really hurt her over time. And so it made me wonder, especially for, you know, women in the menstruation age, is it possible that they have an A one see that looks better than it is if they have lower ferritin just like,

John Welsh M.D. 1:09:14
there you go. There you go. There's that's another of all the ways that a one C could be misleading. That's, that's, that's one of them. And I'm thinking, my own experience, I used to be a really avid blood donor. And I thought, oh, you know, what if I if I were to donate two units of blood, and then wait around for a couple of weeks and then get my a one C measured, that would falsely lower the a one C because as soon as I donate two units of blood, my my bone marrow is going to wake up and say, oh my gosh, John, you did something either stupid or crazy or really altruistic. By donating those two units of blood. We have to ramp up production, and we're going to flood your system with brand new red cells. So after two weeks after donating the blood, I would have a population of red cells, which were relatively young and had not had a chance to get glommed on to by the sugar molecules. And my agency would be falsely low. And I say, Yep, I can sure game the system that way. And that's the same for people who undergo acute blood loss, the A one C would be falsely decreased within a couple of weeks, once the red cell production line kicks into gear. And then people who have shortened red cell lifespans, there's there's some conditions, a lot of syllables, but hemoglobinopathies, if your hemoglobin, if your red cells are, are not up to the task, and if they're prematurely destroyed, you would have a very low a one C, and it would be misleading if you were trying to manage diabetes based on that.

Scott Benner 1:10:55
Okay, so Okay, so you as a person who's had type one for a long time, and is a physician, and I think we didn't really dig into it. But it sounds like you used to help people with type one as well, when you were practicing, is that right?

John Welsh M.D. 1:11:09
Oh, you know, indirectly I specialized in laboratory medicine and also anatomic pathology. So I would, I would look at disease, and I would measure disease and then I and then I went to anyway, so I never directly took care of people who were who needed insulin management.

Scott Benner 1:11:27
But for yourself, then let me just ask yourself that I guess it makes more sense. With your background, and how much time you spent digging around in this data? How do you measure your success? Like which one of these? I know there's going to be a grouping of them here. But but can you tell me what you look at every time you look at your data, just when you want to look and go, oh, I need to do a little more a little less? Like, what what is it your? Where do you focus? And is there any way to put them in descending order?

John Welsh M.D. 1:11:57
Oh, um, well, I am I'm getting old, every if you wait long enough, everybody's gonna get old. I used to worry quite a lot about my agency. And now I I really don't care I what I focus on mostly is the average glucose. And the the example that we're looking at now is 133, which, which is wonderful. And beyond that, I try not to rank myself, I try not to compare myself to my peers. Here at Dexcom. We've got some, some very talented folks with type one who are even more dialed in than I am. If it if it seems like I know what I'm doing, there's people down the hall who are even better. And then there's people in the community who who are need some advice. And that's the mandate, I say, You know what I'm I'm doing fine. But let's, let's see if there's problems that I can address. So I look at my average sugar, I look at the time high and low time and range. And the example that we're looking at 85.9% is pretty good. And then I also look at the the amount of trouble and strife that it causes me and I try to minimize that. I try to settle in on a good routine. That doesn't cause me too much trouble and strife. And finally, after 45 years of I think I've found a good routine for managing my own diabetes. That's

Scott Benner 1:13:23
amazing. That's I think what people need to hear too, it's funny, as you were saying all that I was looking at, at my daughter's nine, like I went to 90 days on her information, because you said average blood sugar. And her average blood sugar has been 115 over the last 90 days within an estimated a once a 5.6. But her standard deviation over that time is like I said, it's it's 45. And is that should I be more concerned about that?

John Welsh M.D. 1:13:54
Well, here's, here's an important question. And it relates to the time that she spends really low and I wonder if there's numbers for either time less than 70 or time less than 54 because because those are those are things that can cause trouble in a hurry. Being being less than 54 is kind of dangerous.

Scott Benner 1:14:14
I have I have her range set as 65 to 120 She's 9% low 54% in range and 37% high but she does not get for the most point we don't go over about 180 ever and under 55 I don't think happens twice a month maybe for long periods of time not like under 55 and falling where people are running around the house you know looking for the will and stuff like that just you know like a dip down that you caught a little too late and and it'll go to 55 and hang and come back up but we don't let her sit under that number. But I look at her standard deviation all the time and I I'm always just like, ah, that's where I need to do better. But like I said, you know, for half of the month, that standard deviation is 24. And then during her, you know, her hormonal times throws throws that number off, like, is that number less scary? Because she's a girl than it would be if she was a boy. I know. That's a weird question. But you don't I mean,

John Welsh M.D. 1:15:25
well, I, I don't know if I'm, I'm gonna take issue with your premise. I, what you told me was, is that number scary? And I? I don't think so. I don't think that's a scary number at all. Just based on the fact that she is so dialed in, and that she has almost continuous awareness of where she is. And she's got good access to to her family and to you and good access to to Kandi if she needs it. So it doesn't sound like she's in harm's way at all. The thing that you know, there's there's some things that are absolutely dangerous. One is one is going low, and finding yourself waking up with a crowd of people trying to resuscitate you is a terrible misadventure. Because you, you went low and you ignore the symptoms. And guess what, you had a seizure, you lost consciousness, you bumped your head. And now the EMTs are out. That's a scary misadventure. So I think if you told me earlier, she's, she's had it for quite a long time,

Scott Benner 1:16:34
she was diagnosed, too, and she's going to be 16 next month. Okay.

John Welsh M.D. 1:16:39
So 14 years, 14 years into it. Hopefully all the autonomic counterregulatory hormones are intact, and I hope they stay that way. So the hypoglycemia awareness, I hope is fully intact, and the counterregulatory hormones that that would kick in to bring her sugar back toward the normal range, I hope are intact. The, the coefficient of variation, you mentioned earlier, the standard deviation for your daughter and remind me of the coefficient of variation.

Scott Benner 1:17:11
Oh, let me get it for you. It does similarly, change with, with what's happening in her I have it at 90 days as 39% in the last 139, in the last week, 36%. But if I go into just the last three days, where like I said, the impact from the hormones is gone. It's 30%.

John Welsh M.D. 1:17:35
Okay, wow. So sometimes, sometimes it gets above that arbitrary number of 36%. So there's some stretches of time where the variability is, is in excess.

Scott Benner 1:17:48
And it's, it's important to note that so my daughter now for over six years has had an A one C between five two and six, two, and we don't restrict her diet in any way. So she'll have pancakes, you know, for breakfast on a Sunday morning. Just as easily as this morning I said she had, you know, an avocado, avocado toast. And so you know, she she's all over the place with what she eats. So we'll have nights where she just has a big salad for dinner, and nothing else. Last night, she had some turkey and small amount of potatoes. But when dessert came out, she wasn't interested. And so she's I call I would call her eating healthy and varied and not excessive. She's not a sweets person, like she's, she'll Trick or treat, but that's the hangout with our friends. And she comes home and doesn't know what to do with the candy. But you don't like that. That's sort of an idea. But, you know, I'm trying to talk through her to everybody so that everybody can kind of get a feeling for how they should feel about this information for themselves personally. Sure, yeah.

John Welsh M.D. 1:18:53
Well, there's, there are some things and we've we spend a lot of time looking at data here we've got some data science, people who built our career on looking at data, there's a couple of comments that might that might be helpful and one is to to look for opportunities to lower the standard deviation lower the coefficient of variation. One is to see if there's any evidence of overtreating highs or lows. And sometimes those really jump out if you look at the, the hourly plot, we call it the modal day plot. Sometimes you'll say, Oh, here's here's something where I know I know where I went sideways on this. I know I had the the big snack after lunch. I shouldn't have oh, there were free doughnuts in the conference room. I should have said no to those doughnuts. So sometimes there's opportunities for looking at your data, not the numbers but just looking at the the image of the 24 hour stretch of daytime you say wow, there's a big spike there. In the early morning hours, maybe I had too much snack before I went to bed. Maybe I have too much my own case, I had a habit of taking too much fast acting insulin to cover breakfast, and I would always go low around nine o'clock in the morning. So being looking at the data, not just as numbers, but as a graph can be very helpful. And it can reveal opportunities for making adjustments. And if if the standard deviation is in, in the high range, if the coefficient of variability is in the high range, then it deserves some some careful consideration about Wow, this is a bumpy ride, are there any particular times of the day that you would like to address with your end might be really amenable to making thoughtful changes?

Scott Benner 1:20:51
Can I ask, given how the numbers are calculated? If? How much is that? What's my question? Are any of the numbers based off of the the range that I've set up? So keeping in mind that my daughter's range is on my phone, it's 65 to 120. On her phone, I think it's 70 to 130. And so on her phone, which is the one that you know, her clarity accounts connected to and everything, if my daughter's blood sugar is quite literally, between 75 and 110 for two thirds of the day, but she has two big meals that spike her to one ad. But she's not more she's not at that one ad for more than an hour and comes back down without getting low. Do those numbers look artificially inflated? If that's how it works for her sometimes?

John Welsh M.D. 1:21:48
The I think your question is, what are the numbers that you see in the clarity report or the clarity, summary. And the time in different ranges? You can, you can set those you can customize the ranges that you want to see for and you can do that in the daytime in the nighttime ranges.

Scott Benner 1:22:08
If I changed her range, this might be a stupid question. But if I pushed my daughter's high number up to 180, would her standard deviation fall?

John Welsh M.D. 1:22:18
Oh, no, it would not know the standard deviation doesn't care whether a number is in the range, the range that you set is pretty arbitrary. You can you can turn that dial up or down. The the range that you set within clarity just tells you when are you going to get beeped. And what are the summary statistics for time and range?

Scott Benner 1:22:40
The data is based off of those ranges. Got it?

John Welsh M.D. 1:22:44
That's right. That's right, the standard deviation coefficient of variation, those numbers are those are not subject to change by just changing the the alerts or the target ranges.

Scott Benner 1:22:57
Okay. And they're based off of what quote unquote normal would be. Is that right?

John Welsh M.D. 1:23:03
Oh, actually, not the the normal range I mentioned earlier than the normal range is no more than 120. And at the moment, I'm just leaning over and checking my sugar right now is it's 109. But for the most part, having having a sugar of 150 would not be concerning. I don't think for any endocrinologist, if you were to cruise around at 150, all day, every day. The endocrinology community would say you're doing a good job, you're a one C is likely close to 7%. And your risk of long term complications is close to baseline is close to what the non diabetic population would have. So that'd be very reassuring. Even if you're having a abnormally high glucose numbers. I got a I got a call once I did some lab tests and for a different occasion, and the nurse called me up and said, John, I've got some very concerning news. Your your glucose is 123. And I thought, well, what's concerning about that? And she said, Well, it's higher than normal. And I said, Well, I have type one diabetes. And and as soon as she heard the fact that I had type one diabetes, she said, Oh, well, you're boring. Have a nice day. Goodbye.

Scott Benner 1:24:24
You mean, my daughter had to give urine one time and I left the room or I dropped off and didn't tell the nurse she had diabetes. And I walked halfway down the hall and ran back because I was worried for the nurse and she was running out of the room at the same time. And I looked at and I went she has type one and she goes Oh, okay. And then she she goes back in the room. Let me re ask my question because I have it in my mind and maybe I might ask another dumb question here. Trust me. It's very boss. I'm ready. So So Arden's blood sugar does sit in the 80s for most of the time, but sure, and and like I said, Sometimes she'll hit one ad on a call couple of meals. What if her blood sugar always sat at 120? And sometimes hit those 180s? Would that make her standard deviation lower?

John Welsh M.D. 1:25:14
I don't think I don't know, I don't think you've given me enough information. To ask that question we could we could do some numerical simulations, which would be interesting, but maybe a quite a digression. I don't think we can tell for sure, just based on what you told me. So it's, it's a big question mark, right now, I'd have to punt and say, I don't know,

Scott Benner 1:25:39
that's fine. I'm trying to I can't wrap my head around my own question, which is frustrating, as you may imagine, and a limitation of my intelligence, but I'm trying to, I'm trying to decide how, you know, so. So you don't, I know, you've heard a couple episodes of the show, John, but you don't listen to the show. And I actually would like to send you a short list of episodes, and let you listen to them and hear what you think of them. But most of the people who listen to this podcast, I would assume having a one C in the fives, or I would think over six and a half, for somebody who's been listening more than three months would be uncommon. And the basic tenant of the podcast is that you don't, you don't stare at a high blood sugar, you get it back down, without causing a low and there's ways to use insulin, you know, with the data that that makes that work. So we, you know, we're pretty heavily talking here about make sure your Basal insulin is right Pre-Bolus Your meals, don't stare at a high blood sugar, you know, don't cause a low bumping nudge with insulin, you know, if you after a meal at a meal time, you know, 45 minutes after you eat. If you're 136, diagonal up, we bump it back down. Again, if you're 85, diagonal down, that turns into 80 that you think this is going to keep going, you don't wait to see a 60 you take in a few carbs, and nudge that that blood sugar back up again, it's like driving between two lines, you know what I mean? Like you don't want to swerve, you just want to kind of try to stay as steady as possible. And we talked about a lot about how to use insulin, temporary Basal rates, both positive and negative, and food in ways that keep those swings from being crazy. And yet, there are people who come back with amazing a onesies who don't get low very often, but have a couple of spikes with larger meals. And these numbers that everyone's telling them, they're super important, you know, standard deviation, they can't seem to get into the space that they want. And then they start thinking about limiting food to make that happen. And I, I think that I think this podcast has a lot of different goals. But one of them is for you to understand insulin enough that you can eat what you want to eat. And I'm not saying that everyone should run out and eat those doughnuts at the conference table. Like, that's not my point. My point isn't, I'm not a person who says, Oh, you have diabetes, you know, don't ever think of you know, don't ever think about your your health, just eat whatever you want, because insulin can take care of it. My point is that if you understand how to use insulin, then you can go off into the world. And with a diet of your choosing, keep your blood sugar's in a more normal range and extend your health. But I'm baffled a little by my daughter's standard deviation. All the other numbers make sense to me. But that one number, I can't wrap my head around.

John Welsh M.D. 1:28:28
Yeah, and and you mentioned, you mentioned the hormonal changes that come by every month and and sometimes the good control becomes more of a challenge, obviously. And the coefficient of variability goes up. And and then unfortunately, the having a high coefficient of variation gives you a higher risk of symptomatic or potentially dangerous lows. But but so it's it's especially important to have that awareness of misadventures on the low side, especially during that time of the month where the swings are, especially high amplitude. The but the goal is, as you said, I think the goal is to spend most of your time out of harm's way. And to live a long happy life where your retinas your retinas last your whole life and your kidneys are going to last your whole life and you're going to die with all 10 of your toes where they belong at the end of your feet. So it sounds like she's well on the way and especially the education that you've been giving her and the insights that she's been getting from from CGM. Sounds like they've been tremendously helpful.

Scott Benner 1:29:40
I appreciate John I just did something that I'm so I feel badly about that because you're sharing sharing your screen. I can't see my screen. And I just realized that I've had you on for an hour and 20 minutes I'm so sorry. I didn't even I didn't really enjoying this and I didn't I didn't recognize about the passage of time. I hope I haven't kept you from something here. not just being polite to me.

John Welsh M.D. 1:30:01
Oh, well, let me You know, I think I had something that I did have something else on the calendar and I hope I'm not. I mean, check my little outlook here. You can see my calendar, there's something coming up at noon, so maybe we ought to

Scott Benner 1:30:15
go is what I was gonna say, yeah, 100% I, I just looked at my phone to look at something about art and to save you. And I was like, Oh my gosh, they're gonna crucify me. I've been I've had you wait too long. Listen, this was incredibly interesting. And I can't really thank you enough for doing it. Because, you know, it's not something everyone jumped up to do when I say can I get somebody who really understand standard deviation talk was a long line of people with their hand up, you know, so I really, I genuinely appreciate this. And I have to tell you, it's gonna go right out tomorrow. I don't usually put stuff out this quickly. But if this fits right into my schedule, so you'll be able to hear yourself and be horrified by your own voice in probably 12 hours or so.

John Welsh M.D. 1:30:57
Well, that's great. So you can I hope you cut out the obscenities and the screaming and and the lawnmowers. And

Scott Benner 1:31:03
all that horrible stuff you did will be cut out now people will just hear you say that and wonder what it is that we

John Welsh M.D. 1:31:10
Scott, what a pleasure, I enjoyed speaking with you, thank you for thanks for reaching out, and I'm a dew point. Dexcom is great. I'm just surrounded by really smart people who love who are really bought into the mission. It's a good company, it's a good product, it's a good mission. And I it's nice hearing about your own experience and your daughter as well. I hope you have a long happy life with with this thing that nobody wants. But we're doing the best we can with type one diabetes, you're very

Scott Benner 1:31:39
nice, John, but to think that you're not going to get drunk back on this podcast at some point is, is not reasonable. I'm gonna get you back here at some point, we'll find out more about you and your diabetes one day. I really appreciate this. I'm going to be incredibly humble all day long after talking to you just so you know.

John Welsh M.D. 1:31:56
I realized you've got to You're the God of podcasts, though. You can go have some podcast swagger, and brag about having a wonderful podcast.

Scott Benner 1:32:03
I'll have to lean on that since I couldn't get out of algebra in sixth grade. So thank you very much.

John Welsh M.D. 1:32:08
Okay, cheers Have a good rest of the afternoon. You too.

Scott Benner 1:32:13
I know that was a denser episode than you're accustomed to on this podcast. But I just thought that having someone like John walk through these ideas was important. I took a ton from it. I'm going to listen back to this a couple of times, because I am I'm not as smart as I need to be sometimes about some of this stuff. But John made it understandable and complete. I was really thrilled to have him on I'm going to have him back someday and just talk about him and his diabetes and try to learn his story. I wish you could have heard the conversation I had with my Booker when I was like, hey, I need somebody from DAX calm to talk about standard deviation, like, really deep dive. Is there somebody over there that can do that? And she was like, I'll find out. And boom, John Walsh comes out of nowhere. Really lovely. Man. I want to thank you for listening. I mean, especially if you're still here, an hour and a half into this, you are a major geek about diabetes data. And I love you for it. Thanks so much to on the pod touched by type one, the Contour Next One blood glucose meter, and Dexcom for sponsoring this episode of The Juicebox Podcast. Please again, go to juicebox podcast.com. For those links, or look right into the show notes of your podcast player. You can clicky clicky on him right there. One way or the other. If you use my links, you'll let the sponsors know that you came from the Juicebox Podcast and I will of course really appreciate that. Hope you're all well, especially in these times. I'm thinking of all of you, and I'll see you soon.

I hope you enjoyed this episode of Best of data. Data. Duda data. People love diabetes data. This is a all time favorite episode of the people. Would you like to save 35% on this sweatshirt that I'm wearing here? Are these silky joggers? Am I rubbing my legs while I'm saying it? I'm not gonna tell you because it sounds creepy, but they're super soft, cozy earth.com Save 35% at checkout with the offer code juice box. And of course you can get 10% off your first month of therapy@betterhelp.com forward slash juice box just by going through that link. It's all you have to do. Thank you so much for listening. I'll be back very soon with another episode of The Juicebox Podcast. If you enjoy this conversation and you're not in my private Facebook group, it's absolutely free and I think you would love it Juicebox Podcast type one diabetes on Facebook private group 35,000 Plus members. That's over 35,000 members, tons of conversations, opinions, perspectives, and great conversation absolutely free. Go check it out.

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#870 The Alaska Principal

Molly has type 1 child with  diabetes and she is a school principal.

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

Scott Benner 0:00
Hello friends, and welcome to episode 808. And welcome to episode 870 of the Juicebox Podcast what happened to my voice there when we

Molly is the mother of a child with type one diabetes, and she's also the principal of a school. So we have this very cool kind of hybrid conversation around like 504 plans, but also being a parent, but also they live in Alaska. So, I mean, that's different, right? You're gonna love it. Just listen, you know what I do? Settle in. You're ready, you feel it? Alright. While you're listening, please remember that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, always consult a physician before making any changes to your health care plan, or becoming bold with insulin. Yeah, they're great. I just went into the Frosted Flakes rhythm there for some reason. Sorry about that. If you are a US resident who has type one diabetes, or is the caregiver of someone with type one, please go to T one D exchange.org. Forward slash juicebox and complete their survey. You're going to be helping research by doing that. It's HIPAA compliant. Anonymous, it'll take you 10 minutes, T one D exchange.org. Forward slash juicebox. Don't forget cozy earth.com. Use juice box at checkout to save 35% This episode of The Juicebox Podcast is sponsored by us med now us med is where Arden gets her Omni pods or Dexcom and a lot of her diabetes supplies us med.com forward slash juicebox head there right now to get your free benefits check. Or you can get that benefits check at 888-721-1514. Let us med bring your diabetes supplies the way they bring ours. If you've been thinking about talking to somebody and are considering online therapy, check out better help@betterhelp.com forward slash juicebox Juicebox Podcast listeners get 10% off of their first month of therapy at my link. Better help.com forward slash juice box. That's better help h e l p.com. Ford slash juice box.

Molly 2:34
My name is Molly, and I live in Alaska. And I have two kids. My daughter is 19. And my son is almost 16. And he's my type one. And I have been a teacher and I'm now a school administrator and elementary school principal.

Scott Benner 2:53
Wow. Born and raised in Alaska moved there.

Molly 2:57
moved here when I was 19.

Scott Benner 3:01
When you were 19 on your own or with your family.

Molly 3:06
Following a boyfriend

Scott Benner 3:09
I was I always wait for following a boyfriend or escaping a crazy parent. Yep, wasn't sure which are both who knows, you know?

Molly 3:18
Pretty common story. I came up here for a summer job and then stayed.

Scott Benner 3:22
So the original plan was just to hang out for the summer work to pay for your life and then head back. Yep. What kept you there?

Molly 3:31
Oh, it's just an amazing place to live. Really?

Scott Benner 3:34
That's excellent. I do know people who also said they were going to Alaska for a little while and they never came back. So yeah, I assume they have been killed by a polar bear. But I don't know a lot about geography or nature. So yes,

Molly 3:49
well, I knew there would be I knew you would talk about bears or moose. I was going to tell you as lakes how to hitch up my dog team but

Scott Benner 3:56
there's no way you don't have a husky.

Molly 3:59
I do have a dog and she is a I like to call her a reject sled dog. She is an Alaskan Husky breed, which is what they use for running the Iditarod. But she didn't make the cut. She's lazy.

Scott Benner 4:14
Molly, do you think that when I say my silly things, and then they come true that it's funny or scary because I can never tell which

Molly 4:24
it's funny. Okay,

Scott Benner 4:25
because you have a husky and I have a husky but I don't live

Molly 4:29
in an igloo. Well, you Sam, who knows

Scott Benner 4:31
what you'll lie about today? There's no way I don't know when you get embarrassed, like, oh God, we do eat raw salmon right from the river. How does he know that?

Molly 4:41
We do eat a lot of salmon.

Scott Benner 4:45
But not with your hands like Smeagol Am I correct about that?

Molly 4:48
Correct? Correct. Way to cook it.

Scott Benner 4:52
Would you eat it? On a bagel? Maybe it was a LOX? Yes, I would say well then I was pretty much right. Okay. So you have I'm sorry to children. You said 1916. Yeah. 16 year olds, the type one boy or girl, boy diagnosed how long ago? Almost two years ago. Okay. Was that a surprise?

Molly 5:15
Yep, yep, for sure. No history of type one and either of our families. No major auto immune things. There's maybe some mild allergies on my side. And he had, he's had allergies since he was small. But nothing. Nothing major.

Scott Benner 5:38
He's allergic to ice.

Molly 5:42
When he was when he was a baby, he was allergic to cow's milk. So I used to joke because he used to, I used to buy a really fancy cheese for my then what like to and three year old because he couldn't have cow's milk cheese. So he had goat's milk, cheese and sheep's milk cheese. But he kind of grew out of that. And he has hay fever now seasonal allergies. But that's it. That's about

Scott Benner 6:10
it. Hey, the boy that you fall into Alaska, the kids that are no, no. Okay. Is that? Is that kids still in Alaska? No, okay. Well, he left and you stayed. Can we not talk about diabetes and just talk about the year that you lived in Alaska with that guy, please.

Molly 6:32
That's a really long story. We don't have time for that.

Scott Benner 6:36
So far, that's what I find myself caring about. But you seem like a reasonable person. I'm gonna move in the correct direction now. But I want to hear about what I assume was, I mean, drinking and debauchery and then cheating. And then somebody got caught. And

Molly 6:52
oh, it's less, it's less dramatic than you're thinking.

Scott Benner 6:56
Trying to turn it into an after school special. That's all. Anyway, well, I'm glad that you stayed and, and made a whole life for yourself. You became an educator, obviously, did you go to college in Alaska?

Molly 7:11
I did. I was working seasonally up here for a while and then decided to go back to school and get my teaching degree. And so I did go back up here and eventually got my credential up here and started working.

Scott Benner 7:26
And so how long did you teach before you became became the man? Because you're the principal now?

Molly 7:34
I am. Yeah, I taught for six. I think about 12 or 13 years in the classroom.

Scott Benner 7:44
Okay. How old are you? Can I ask? I am 48. Do you not know or did you not want to say? No, I have to

Molly 7:53
think about it a little bit. Because, you know, you forget I understand.

Scott Benner 8:00
Okay, so it's been 29 years since you follow that stupid boy to Alaska. It looks like you met another boy. Probably stupid but nicer and you like him, and made a couple of kids with him. became a teacher taught for a while. moved into the administration side. How long? How long have you been in that side of it?

Molly 8:21
This is my fourth year.

Scott Benner 8:22
Okay, so pretty free recently, then. Yep. Yep. Okay, what made you wait a minute? Can I ask a question that's not attached before we move on? In my head? Yeah. How does the sun work in Alaska?

Molly 8:38
Well, it's summertime right now. And it's July. So we have a lot of daylight. And I think the sun is setting. Gosh, I would have to look it up. But you know, if I go to bed at midnight, it's still light out, it's maybe getting dusky. And when I get up, it's bright, bright day. So where I am, we have I think, at the height of summer, we have over 18 hours of daylight. And then in the winter, it's darker. And it's not dark all the time it gets it gets fully light in the middle of the day. But I would say in the middle of winter that you know, the darkest time in December, it's maybe starting to get light between nine and 10. And then it's starting to get dark, like between three and four in the afternoon.

Scott Benner 9:30
So just from nine or 10 in the morning till three or four in the afternoon during the wintertime. Yeah, okay. All right. Sorry. I just, I have a note here that says ask about the sun. And I know I'm gonna start asking you about diabetes and stuff. And the whole time you're talking I'd be thinking, I wonder how the sun works. And now that I know I feel I feel better about it. And I never knew if that was a television thing you understand I'm saying,

Molly 9:51
right. Yeah. Or it's real. The Land of the Midnight Sun is is the real deal.

Scott Benner 9:57
How would you get a name if it wasn't real then that's that's Okay, so there's no autoimmune in the family, some light stuff around allergies. So how does the how does the diabetes present for your son,

Molly 10:16
um, just pretty typical symptoms, although the thing that threw us is he never said he was thirsty all the time. He said his mouth was dry. And he just kept saying, my mouth is so dry, I can't figure out why my mouth is dry. I assume he was probably going to the bathroom a lot. Although he wasn't always drinking a ton, he would just swish water in his mouth and then spit it out. Because his mouth was dry. And just tired, you know, lethargy. I, he had started taking allergy medication, because his seasonal allergies had been getting worse. And so when we were trying to figure out what was wrong, I looked at his box of it's just the over the counter allergy meds, and the side effects were dry mouth and lethargy. And so I thought for sure, oh, it's the allergy meds, and we'll stop taking those and he'll be fine. So of course, that didn't work out. He just kept declining. So eventually, and it was during COVID. So this was July of 2020. Okay. So, you know, not so easy just to go to the doctor, but we had finally decided, okay, yeah, we need to take him in. So first step is to go get a COVID test. So we took him to the urgent care to get a COVID test. At that point, they were just coming out to the car to do the test. So they did that. They asked him questions, you know about how he was feeling. And basically said, Okay, we'll call you with the results. We think you should just go home. But if he gets worse, I think they were suspecting appendicitis, maybe they said, if you know, if he's if his stomach pain gets worse, go to the ER. My husband had taken him to that appointment, and I was supposed to meet him there. And then and take our son home. I got there and I looked at at our son, his name is Jack and I looked at him, I said, Oh, I'm not taking them home. There's no way he's like He had declined even more. So can we live about 45 minutes from doctors and hospitals. So I wasn't willing to take him home. So we were able to get him inside the clinic for another for another look. And then he was you know, at that point, he was vomiting. I mean, he was in DK for sure. And as soon as the doctor asked to smell his breath, I knew exactly and like, oh my gosh, it's diabetes, you know, I have a little bit of just kind of basic first aid training and stuff. And my husband is he's also a teacher, but he's also an EMT. And so we kind of knew the basics, but it just until she said, Let me smell your breath. It didn't really click

Scott Benner 13:09
is the fire chief, also the mayor? Sorry, I know, I held it. You couldn't wait for the doctor to come in on the wagon train. So I don't know how I'm supposed to hold it all in.

Molly 13:23
This isn't. This isn't a major city we're in. We're in the biggest city and Alaska says,

Scott Benner 13:27
you know, I'm just kidding. I like it when Canadians are like, I live in a city and I'm like, do you and then it's Toronto or something like that? Oh, my God. Whoa, okay. But, but okay, so but still 4045 minute drive. And you're saying that in the time? From what you saw him last just that day till when you saw him at the doctor's office, there was a noticeable change.

Molly 13:50
Yeah, you know, he just had that look, I just it he just didn't look right. I just said no, he needs to be seen. Do they keep

Scott Benner 13:59
you in the hospital? Or how did it work with COVID?

Molly 14:02
Yep, he was admitted. You know, they told me to drive to the ER. So we did. And we were in the hospital, I think maybe two and a half days. So that because he was in the pediatric unit, they allowed both parents. But there were some restrictions. I think, like we couldn't come and go during the day, we could leave once and come back, but you couldn't come and go and so we took turns spending the night but then we were both there for the diabetes education piece so we could figure out what's going on. Okay.

Scott Benner 14:44
How did he handle the news?

Molly 14:47
He handled it really well. He and I think it's because apparently he's he's pretty mellow. He's pretty even keel kind of person. But also he had A friend all growing up that had type one. And he had a pretty close, there were maybe four or five of them in this in this friend group, and she was always one. And so I think it was, it didn't seem too abnormal are weird to him. It was like, Oh, she's got, like, I have what she has.

Scott Benner 15:21
Okay. Yeah, somebody who's living well, and he sees all the time and seems

Molly 15:26
right. And she seems very normal and functional. And she does whatever she wants, and it doesn't limit her at all.

Scott Benner 15:33
And that hasn't changed over time.

Molly 15:37
No, no, but he also, I mean, it's interesting, because he's a teenage boy. So he doesn't talk much. And that's kind of how he is anyway, you know, lots of one word answers, hates talking about diabetes doesn't, doesn't even want to acknowledge really, that that's a part of his life, or that that's a big part of his life. Kind of reminded me when you were when you had art and on how she just, you know, kind of blows it off. Like, whatever. Yeah. He has that attitude.

Scott Benner 16:10
And would you say he's 16? Now?

Molly 16:13
Yeah, he'll be 16. In a couple of weeks,

Scott Benner 16:15
you might have four more hugs, you can get the next two. Right. Oh, yeah. That's where I see you.

Molly 16:24
I realized that.

Scott Benner 16:26
Can mommy get no, okay. I'll just keep paying for the house.

Molly 16:31
The least favorite thing that I say to him is, well, I heard on my podcast, or the the juicebox guy says this, that he wants zero information about diabetes from me, and most of my information comes from you. So he really dislikes you without ever having heard you.

Scott Benner 16:52
Oh, I can appreciate that. Also, there's a kid in this house with diabetes, it doesn't want to hear from the juice box guy either. So it's a pretty common thing for for that to be perfectly. And if you can use me to deflect I actually think that's a good idea. as I as I heard you saying and I thought oh, people should use me like the doctors use the nurses. You don't even they're like, Oh, the nurse is gonna come in now and give you a shot. I'll wait out in the hall. So you'd like me when this is over? Like I could be the nurse with a needle and you could just be the person who's like, I'm sorry, this has to happen. But the guy said, right. Yeah, well,

Molly 17:24
I do stay. I don't say you know, I think you should try this. I always say, you know, all my podcast guy says that you should do this.

Scott Benner 17:33
You know, I always used to take that as, as people saying that I knew, but now I'm thinking everyone's just hiding behind me. So they don't have to deal with their kids. All

Molly 17:43
right, because we know what I mean, especially as an educator. I know that. Kids don't want to hear anything from their parents. Their parents don't know anything. Yeah. So as a teacher, I can tell kids things and they'll listen. And if their parents told them the same thing they wouldn't. So

Scott Benner 17:59
do you think they actually listen to other people or they just don't have the nerve to yell at other people?

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pushback

Molly 22:11
I think it's I think it's a little about

Scott Benner 22:12
both. Yeah, Molly, you just got all serious. Molly's a principal with your answer there. Stop messing around, you're like I have a real thought on this. Hold on a second. Do you? And that is why you wanted to come on the show. Right? Because of your background education. What you see with 504 plans and and what you

Molly 22:29
Yeah, I just I saw a lot of people asking questions about five of fours. You know, I'm not a 504 expert, but I definitely have that school perspective as, as a classroom teacher, I had students with type one, before I knew anything about it before my son was diagnosed. So I, I have that perspective. And then now as a principal, and as the one at my school who is responsible for writing 504 plans and, you know, working with my son's school to write his plan. Just wanted to you know, I think like most people say when they talk to you, like we've learned a lot from from you, and from the podcast, it's really helped. And if there's a way that I can help, or give somebody some information that might smooth their path. And I want to do that, I appreciate

Scott Benner 23:17
that. And we'll we'll see what you know. So I'm just moving the last 504 plan I've ever made over to this computer, so I can pull it up while we're talking. Because I haven't looked at these or thought about them in a while. It's funny, something that I thought was so important, at one point, became a throwaway document as art and got older when we really just didn't need it anymore. And it was just right thing we kept going because that's what you do sort of want to do.

Molly 23:48
And I feel the same way. I mean, I, you know, was very involved in in creating Jack's fi before when he first went back to school. And now I you know, when he when they call for the annual review, I have to remind myself what we put in there. And yeah, and a lot more relaxed about it now.

Scott Benner 24:08
So do you have them? Do you use a template when you make them? Or do you let the people I asked because the first time I brought in my 504 plan. They were like, This is not what we do. And I was like, Well, I've already done this. So we're all good. And they said no, no, we'll take your document and put it into our document. I was like, okay, like this is a formatting thing is what I thought at the time. And they took like my, I don't know, three or four page, like thankfully typed out documents, probably actually two and a half pages when you take out headers and etc. And they turned it into like four bullet points. And they handed it to me and I said, This is it. And she was going into kindergarten at the time and they was like yeah, this is it. This is This is enough. We have other kids here they said with diabetes. And I said if you try to keep my daughter alive with these four bullet points, she He's not going to make it a month here. And then I said, I really think we should go over mine. And that was the first time I pushed back and got them to I got them to sit down with my document to see that just because it had words in it didn't mean that it was trying to trick them or put them in a bad position or anything like that. Right? Yeah, but

Molly 25:21
I don't I think he, I think every district probably has their own format. So yeah, we have a template that we use. It's, you know, specific to our district. But, you know, the 504 the rules and laws and policies that that govern fiber fours and IPs are our national laws. So we're all conforming to the same thing. But how we do it, I'm sure varies district by district. So I am by no means a 504 expert, but I, I have some familiarity with how we do it in my district. And it is, you know, it is just taking those ideas that that you bring as a parent, and fitting it into our format, and making sure it looks right. And then you know, I'm fortunate that I'm in a big district and I have people that can review those documents for me to make sure that they're just as they need to be and legally compliant. And

Scott Benner 26:19
I know that Ardennes at one point Ardens 504 plan became the, like the one that people in town used. And then I think I noticed that the school was not happy with me because it was okay if it was for one person, but then all of a sudden, people were coming and be like, we're gonna use this fiber for plant. And they couldn't argue with it, because we were using it. And that became an issue. And then of course, it went on the internet eventually. So I think people probably all over the country use it at this point,

Molly 26:45
right. And that's how it works with all 504 plans and all disabilities that, you know, if if your child is dyslexic, then you know, there's 1000s of those floating around on the internet that you can find an advocate for but you know, it's a legal document, and we're required to provide everything that's in there. And so from the school side, you know, that's why we are a little more conservative, or we're gonna question your two and a half page document and and say is do we need to have everything in here. And, and part of the trick, I think, too, is that in this probably varies district to district and state to state. But, you know, we have a medical document, the diabetes care plan in our district that outlines medically what happens. And then the 504 is really, you know, just making sure that students can access their education equally with other students. And in to me, those are two different documents. But part of that is because my son was in high school when we were doing this and he was already fully independent. One of the nice, nice things about him being diagnosed older is that he's, he was fully independent from the beginning. You know, we had to learn how to give him shots and were in the hospital, but he always did all his own shots. And now he's on a pump. And he, you know, he he's completely independent. Yeah,

Scott Benner 28:14
yeah, I am. I want to ask you something. I feel like you can't answer. But because if you can't, you're fine. But is there ever I always felt like there were things in our 504 plan. They were like, yeah, yeah, yeah, we'll do that. And then they just never did. And it was little stuff like, you know, I was like, I want the bus driver trained. And for years, they'd be like, oh, yeah, yeah. And then one year, it actually happened. And I noticed the year that it actually happened looked a lot different than the years they told me it was happening. But I think to your point, the school looks and says, We can't get this accomplished. Even like the guy that drives the bus works for a third party company. I think that was the holdup. I think it took them years to talk to the bus company into allowing one of their employees to come to the school for a training session. And is that the kind of like, is that most of the time? What the What the? I guess the trip ups are? Is that you? You don't have the ability or the staff or?

Molly 29:17
Yep, yeah, we don't have the ability or the staff or the money. You know, I'll say I originally went into my son's five before asking for the bus driver to be I don't I don't even think I use the word train. Like I just wanted the bus driver to be aware. You know, like if if he came across Jack passed out on the bus that maybe he you know, have an idea of why and and he my son has a his best ride is almost an hour both ways. So you know, there's there's a good chance something could happen on the bus. And they told me no and I didn't push back on that. And I do know it's because exactly what you're saying. They have The school district doesn't have any control over that driver. They don't train the driver, they don't employ the driver. You know, right now we have school bus driver shortages. We're lucky to have a driver. And it just I think, I think that they couldn't imagine a system where they could uphold that.

Scott Benner 30:21
Yeah. So then once you say yes to it, now you're bound to it. Right. So,

Molly 30:27
and bound to it in the in the, in the sense that just like you said, are there some years where not everything in the five before is happening? I would say that certainly could happen. And that's when parents need to advocate.

Scott Benner 30:41
Yeah, right. And how do you do that best? So when you? You know, listen, sometimes you're in a situation where people just aren't being helpful. Sometimes the parents are unreasonable, but but in a, in an apples to apples situation where, you know, everybody's doing their best, and it's not working out? How do you handle that? Like, what's the best way to approach you, I guess,

Molly 31:03
calmly without freaking out. I mean, for everything, I mean, it just general basic life rules, right, realize that everybody's trying to do their best and, and try and bring everybody together. I think that's, that's a big one. And, you know, I think it's interesting, you know, and you talk about an acknowledge, like Juicebox Podcast listeners are, you know, they're their top tier people, I think, you know, they, they understand and are really engaged in, in their own care or their kids care. And I always find it interesting that it's widely acknowledged that there are some uneducated endocrinologists, right and, and you kind of have to advocate for yourself with your Endo, and find the right person. But then I hear people when it comes to school, like they expect the school nurse to be the be all end all and know everything about type one. And they're a school nurse, you know, they had probably, I don't know, a week of diabetes training when they were in school, which could have been 2030 years ago, you know, and they're managing, I've got 350 kids at my school, and, you know, not to mention COVID, but even before COVID, there's, there are a lot of medical needs in the school. And so to expect your school nurse to, to be able to manage or to know everything that is going on in the type one space, like, like we as parents do. And there's really involved parents, and it's just totally unrealistic. So approaching, you know, an issue or your advocacy advocacy with, with that in mind that, that we're trying to do our best. And we've, we've got a lot of things on our plate. And, you know, your child is one student in our school with significant needs that we need to meet, but that, that we're trying our best, and we don't know what you know, and we don't know why you're asking us to do what we do. You know, I'm really anxious now, for I haven't had, as principal, I haven't had a type one student in my building, yet. I had one. When we were in COVID. During COVID, we were not in person. And so but I'm excited now to be able to say to a parent, like, No, I get it. Yeah, I know what you want. And let's work together and make this happen. You're making me

Scott Benner 33:41
think that like there's, you know, people have a job description. And the what you might want from them might not be their job description. So you might trip into an administrator or a nurse who's willing to go the extra mile or comfortable going the extra mile. And the you may meet some who aren't, for whatever reason, maybe they just don't have the bandwidth. Or maybe they don't, maybe they're like doing you a favor. And maybe they're like, Look, you don't want me involved in this. I'm the wrong person for this, I can do the job, but I can't do this extra stuff, or I don't have the time, or I just don't want to and it's not my job description, like whoever you run into. I think the only chance you have is to start having more private personal conversations with them and just hoping that you can come to some sort of like a human agreement, I guess, and see if you can't get them to be in love. I've always been kind of amazed at the number of people who would not be willing to be a glucagon advocate, for example. Hmm, lots and lots of teachers were like, No, I won't do that. I won't do that.

Molly 34:44
Yeah, and I will say as a as a teacher, when I had type one students in my class and we were going on a field trip and I taught fifth grade. Mostly, I think that I had two type one students that I can Think of, and we'd go on a field trip. And I think maybe one time the nurse went with us, but then another time, she didn't. And so I carried the glucagon. And I remember going through the training. And it was super overwhelming. I mean, a field trip is a super chaotic day for a teacher, and you've got, you know, 25 kids, and they're all amped up. And, and you have a variety of needs between those kids. And then you have a student who you're being told, you know, could die if you don't give them this, and you have to mix this and put it, it's super overwhelming. And there are definitely teachers that said, No, I'm not comfortable with that. And, and I get it, I understand why they would say that. It's, it's overwhelming, and you just don't know enough. And you have so many details in your head. You know, I wish I knew what numbers to be looking for. I remember like that day of the field trip. But if you asked me a week later, like what the normal range should be, or what numbers I'm looking for, I wouldn't have known. And this was before Dexcom, you know, so we weren't getting tons of data. They were supposed to do a fingerprint, and then tell me what their number was. And I had to have a little cheat sheet. And again, yeah, like a week later, I wouldn't have known

Scott Benner 36:15
Yeah, no, I understand. I mean, I do understand, I also understand when people are in that position, usually for the first time or so their kids are more newly diagnosed, they're already freaking out, they sort of don't know, either. I think that's an important piece, too, is that when you're a new parent, you're going off of the information that was given to you, which, you know, we talked about in the podcast, a lot might not have been rock solid to begin with. And now you're trying to make sense of spotty information, and then pass it on to somebody else who's probably like, either, like, I don't understand what you're saying, because I don't know anything about diabetes, or you're saying some stuff I don't think is right. And you think Well, no, it's gotta be right, I got it from the doctor. You know, but how many people come on the podcast and say, my doctor never told me to Pre-Bolus my doctor never told me fat would make my blood sugar stay high because of slow digestion, like, you know, hear all the things people have never said. Or, you know, even said to people incorrectly, so you can see where the game of telephone could get messed up pretty easily.

Molly 37:15
Oh, definitely. And that's it. I mean, even all the more reason to come in, calmly, and with, you know, with the attitude of, let's work together to figure this out. And let's build this relationship so that it can turn into something where, you know, I'm comfortable calling you and asking you to change this or do this. And, and same thing, on my end, I'm comfortable calling you and saying, Hey, we had this happen today. How should we fix this? And when people come come to me with that attitude, then it's just so much easier for me to work with people and help them get what they want. Versus the parents that come in and say, you know, you violated my 504. And I'm going to sue you and my lawyer is gonna be contacting you later today. Yeah, you know, it's like, when people do that, and I, and I understand why, and you're totally right. At the beginning, when you're first diagnosed, it's super overwhelming, and you want the best for your kid, and then that's where you're at. But when some when a parent calls me that way, then I have to react differently, right? Well, I have to be, you know, takes me probably five times as long to compose the email because I have to double check every word and I have to have somebody else read it. And I probably have to call the district office and, and double check to make sure. Versus if you just call me and say, Hey, this is going on. What do you think I can have a casual conversation, we can probably problem solve something right there.

Scott Benner 38:41
Aside of diabetes, aside of diabetes, even I've had a number of conversations with teachers over the year where I started to go, Listen, I'm not trying to cause a problem. I know your job is hard. You know, I know it's tough to, you know, some of the parents in this town are difficult. Like, that's not my goal here. I don't I'm not trying to be right. I'm just trying to make things okay for my kid. And can we work on this together? Because I think the first time I have a little nutty, you're gonna remember that. And then forever and ever, that I'm the guy that came in there and, like, seemed unhinged, and you're always gonna remember that about me. So I tried.

Molly 39:21
Unfortunately, that's yeah, I try and give everybody the benefit of the doubt. But yeah, you do remember that?

Scott Benner 39:28
Yeah, here's the lady that threw the papers across the floor. I just gonna stand here and smile and try to get through this. You just you lose your I don't know. I think you lose the ability to have a human interaction at that point. And you've now turned it into something like you said, like you have been an aggressor in the past or on reasonable and now you have to start running things past lawyers and you know, talking very carefully and it's just, I don't know, I you know, one time I think we were setting up I think it was back when Dexcom was first around. And we were setting up art and being able to have her Dexcom receiver on her desk during state mandated testing. And we were making, making our way through it. And it was going, okay. And the superintendent called my house to talk it over. And I promise you, Molly, I don't remember the context at all. But within 10 minutes, he and I were screaming and cursing at each other. And we knew each other, like, he's a person who lived in town, you know what I mean, and by the way, a lovely man. And, and we yelled at each other, like, we were about to have a bar fight. And then we stopped. And he went, I'm sorry. And I said, Me, too. I apologize. And then we just kept going. And later I said to my wife, I know this might not be the right thing to say, but I was like, only two guys could do something like that. We were just like, I mean, Bali, I swear to God, he was he was cursing at me more than I was cursing.

Molly 41:05
Well, I will say that brings up an interesting point, like with state testing. And and you asked about the template that we use, I will say that the verbiage that we use that we typically use in five oh fours, and the verbiage that comes with state testing guidelines, has not kept pace with diabetes technology. And so there's a real disconnect there. And as an educator, whether it's a teacher, or a principal or a building test coordinator, I can lose my license if I violate a state testing guideline. And so I can see where that you know, a dispute or a disagreement over an electronic device and the testing environment.

Scott Benner 41:48
And we were breaking totally go through the roof. We were totally breaking new ground, I was pressing the state, like the state was like, we can't do this. And I was like, oh, no, you can and we're gonna figure it out together. And you know, when it was all over, the then principal of the school, she moved on, but she pulled me aside afterwards, she said, You know, I really have to thank you for going through this, because now it's so much easier for us to do this with all the other kids. She's like, well, you needed one person to just make an issue of it point out a way that it could be handled. And she said the biggest piece ended up being the education part, meaning meaning me reasonably explaining to the person from the state why this was necessary. Exactly, you know, and they probably didn't,

Molly 42:37
that's where people just don't know. And, you know, the 504 coordinator is, sometimes it's a principle, sometimes it's a school counselor, we have no medical background. And so just coming in with that calm attitude, and be able being able to explain, you know, why you why you want something in the 504, I had to explain to the counselor at my son's High School about, you know, I wanted something about being able to test, I can't remember the exact wording we use, but basically, like if he's showing up for a high stakes test, and he's super high, I want him to be able to take that at a different time, because that affects him cognitively. And they didn't know that, you know, they didn't really know that there were the or the extent of the cognitive impairments of higher low blood sugar, right. And, you know, my son's a really bright kid, and he's, he's going to do well on this test. And I don't want his diabetes to impact that in any way. So taking the time to explain that to the counselor like, no, here's why I'm not just saying like, he woke up and he has a bad day. So he gets a do over. Like his medical condition could be impairing his ability to show his best effort on this assessment, one of

Scott Benner 43:59
the problems is that there are people who would use it to gain advantage. And so that there are Yeah, there are any having to defend against that, then. Yep,

Molly 44:08
yep, there are. And I will say that the one thing to do, of course, you know, most people, I think, at this point in their final fours, if their kids are on, you know, Dexcom or whatever, have the phone as an accommodation. And I will say that, I would bet that 95% of kids at some point in school, misuse their phone, and my son has done it, I know he's done it, where he pulls out his phone, you know, to, quote check his number, and then he's distracted like kids don't have the ability to not get sucked into their device. And, and that's where I think parents sometimes have a hard time understanding. You know, every every parent thinks that their kid is always You know, perfect angel in school or most parents?

Scott Benner 45:04
Their kids are little apples, right?

Molly 45:06
Well, thanks. They do things that you wouldn't expect, like your perfect diabetic Angel actually does scroll through their phone at times. You know what, they're not just checking their number. And I have gotten to Jack's teachers and said, Okay, here's the deal. If he's checking his number, he pulls out his phone, he looks at it, and he puts it away. There is no scrolling in the Dexcom app. If he's scrolling. He's, he's not using it for what it needs to be used for. And you can tell him to put it away. And, you know, I've told him that, for me, the phone is a privilege, like, yes, it makes it a lot easier to check. You don't have to pull your pump out. You know, he's on a tandem. You know, he could, he doesn't have to have his phone there. He could look at his pump to read his Dexcom. Right. So I'm allowing him the convenience of having his phone, but he has to try and manage that. Yeah. And not be a pain in the butt first teacher.

Scott Benner 46:06
If you're gonna stick all your text make sure nobody sees. That's right. That's what I was gonna I was gonna roll through Arden's 504 with you a little bit. So we haven't broken down into little, by the way, I have to just tell you first the word accommodations was misspelled on this document, not not typed by me. And I will tell you that I don't think I live in a in a dingy place, you know, where you expect the schools to not be on par. But I have never been emailed. So many misspellings, and writings that don't make sense as I have while my children are in school. Oh, I'm sorry to hear that. The amount of times that you get like you learn to not even look at the first email, because the second email was going to apologize for what they didn't do in the first email first certain. And it was just, I don't know, it didn't fill you with a ton of hope. In case you're wondering. Anyway, with that memory in my head, I pulled this document up. And in two seconds, I thought, yeah, I really think there's two M's and accommodations. And so anyway, so we had it broken down into personal right, it was sort of like all the staff will be trained. The nurse has to designate a person, it actually says the nurse shall designate in constitution with a board of education employees of the school district who volunteer to administer glucagon. So there's a there's a passage there, they eventually would find people. The teachers are trained to recognize type one, emergency indicators, and look during large group portions of the day, including recess assemblies, etc. It describes that Arden is going to be carrying a bag or a purse, and it tells what's in it, it tells you what to do in the event of a hypoglycemic event. And it actually walks through, like give her a juice, then do this, if she's not compliant. And drinking the juice, you're allowed to do this or be more forceful with this. It actually says in here, this goes back aways it says district personnel have a parent's permission to restrain Arden, if she becomes combative during the application of a glucose gel. And we put that in there so that they wouldn't feel like out. She flipped around twice. We'll wait for 911 like we were trying to think through everything that might happen. And of course, none of this ever happened. But if Arden becomes unconscious before, after the juice, the nurse will you know, and then in steps do the glucagon here's how call 911 Call the parents, you know, etc. Like it all kind of broke down that way. We added later in time to the glucose testing and insulin dosing section that Arden cellphone is considered a medical device. That is such a big one now. Yeah, you know, it's permitted to be with her at all times. Her proximity to her phone is crucial. Because some teachers in high school, remember the thing where they just used like, they'd hang a shoe tree up. Yeah. And maybe like everybody put your phone in there and go sit down. You know, Arden had to make her wait for that, to be honest. We're going to a concert, a comedy concert in a couple of days. And we had to call the venue yesterday and say, Listen, you know, it says that you're going to take our phones and lock them in bags. You can't do that. Like you know how bow but you don't start with you can't do that you start with here's our situation, is there a workaround for this? And they say, oh, yeah, sure, do this, you know, but I found it's very um it's, um, it's always interested in May, right? Like, you're working for somebody right now, Molly, right. If I come in and I start questioning the rules, I'm not questioning you. But it is hard not to feel that way if you're you so So a lot of times employees will start defending the institution as if the institution is themselves, which is why you call the comedy venue and say, Hey, here's something we have going on, can you please tell me what to do about it, not start telling them what to do, because they're like, it's not your job. It's easy to get kind of like, I guess the bras go up against people.

Molly 50:20
Anyway. Yeah. And I think, you know, I was just listening, you just put up an episode with a teacher, mom. And she was talking about that, that I think, as parents, you know, we get used to having to fight for things. You know, I think of insurance companies, I would say, if I didn't have to work, maybe I would just spend my time fighting with insurance companies and trying to make a change there. Because that's, to me, the most frustrating piece of the whole diabetes spaces is health insurance, but we're just kind of programmed that we're gonna have to fight for our kids and fight for what they need. And every little thing, like, you just want to go to a concert, or you just want to go to do this. But you're gonna have to make the phone call and explain the situation and, and we're just kind of programmed to do that. It's just, it's just the way you go about doing it. And again, when you're calling the venue, you know, that person answering the phone doesn't know about type one, they don't they have no idea that your phone is your, you know, your link to your glucose monitor.

Scott Benner 51:23
It sounds insane. If you don't know what it sounds like, is you want to keep your phone so you can record this concert for an excuse to why to do it. Ya know, it's the whole thing is communication. I don't like Mali, I don't want to give it away. But most of life is communication. So yeah. You know, it's funny, we have one in here, really interesting. And it's something we figured out a couple of years in, that they'll do their best in conjunction with the Transportation Director to make the bus route beneficial to Arden. And that was a thing where she used to get picked up first in the morning, and then in the afternoon was dropped off last. So it was always maximizing the amount of time she was on the bus. So one time we explained to him like, listen, here's what could happen. I think if you minimize the time she's on the bus, everybody be happier. And they came back a couple of days later, they said, Hey, we were able to rework the bus route. And now Arden gets picked up. Like she was like picked up three from last before getting to the school and dropped off. Again, three from you know, she was the third drop off. And it wasn't fun for anybody. And I don't think the person who had to rework the route was thrilled. But they figured it out. And you know, and it ended up being I thought beneficial to everybody. And I did point out how it would benefit them as well. Which is a is a big point of all this because when we went to texting, the school didn't really like that idea at first. And the way I sold it to them was like, Look, if I'm texting with her, and she and I are making decisions together, I really think there's no legal, like, legally, we made the decision. Like, it kind of gets you off the hook. And at that idea they lit up about. Yeah, and I kind of like since it didn't happen to you. I want you to if you're comfortable to talk a little bit about how exciting that must have been for them when I said, Look, you know, let's get you off the hook here on these insulin decisions. Do you think they were thrilled when they heard that?

Molly 53:25
Oh, sure. I mean, I mean, we have people threatening to sue us every day. So so I'd be lying if I said that wasn't a consideration. Yeah. So yeah, definitely. No, no. And I totally agree. I mean, and that's again, where the education, taking the time to explain how you're managing and how this is going to make it easier for the school. Not to mention less liability, but just easier. Because your indirect communication. Yeah, you need to explain how that works. I felt like 504 for Arden is interesting because it's it's definitely more on the medical side than then I would have in my school or in our district. I think just because we do have that diabetes care plan as a separate piece, so. So like my son's 504 In high school has a lot less medical and more about what he's able to do in the classroom. My big thing was, I don't want them leaving the classroom. Right. You know, there's a lot of content. I know you had mentioned one time about, you're worried about Arden's math, and then it was just that she was going to the nurse every day at that time. Yeah. And and that's a big thing. We talked about, you know, engagement in the classroom and, and that's, that's key. And so if you're leaving the room every hour, or even if it's just a couple times a day, that's that's missed instruction. And so for me, I want for my own child and for my students in my school I want every student in the classroom all the time. Yeah. If that means the nurse comes down or if, you know if kids on the Dexcom and the nurse can follow. I just I just want kids in classrooms.

Scott Benner 55:14
No, I mean, it was it happened in second grade. And it's so impacted her. It stayed with her for years, it took her years to rebound from that, from basically not being at the math, the math direction part of the day, every day, she'd she'd see a couple of minutes of it, then miss the middle chunk, and then come back when it was time to do the work. And she was significantly behind, like to the point I've said it on here before where she thought she thought she was just not adept at all. And I mean, there were times where we were like, well, at least we won't have to pay for college. You know, like because she's she seemed really dopey you know about that. And, and it turned out she just wasn't getting the direction. Yeah, you know that people underestimate

Molly 55:57
the impact of missed time. Yeah, because there was a missed instruction. We have, you know, the kids that come 15 minutes late every day, like while you add that up, they're missing days upon days of of instruction. And yeah, they're not reading well, because we do phonics first thing, and they're missing that, you know, and that's exactly the impact. Yeah,

Scott Benner 56:19
no, it's exactly what ended up happening. And she rebounded from it. Luckily, I guess. But it was hard for and nobody knew what happened, right? Like, no, like, we weren't there. Like how would I know they do the exact same thing at the exact same time every day? Like I didn't, it stands to reason now that you say it, but at the time, they were in second grade, like in my mind, they're just like, they're just like little ferrets running around in a cage. And every once in a while, you get them to look at you and you say letters at them. And then they run around again, like I didn't know what they were doing, you know. But But I think that's a big deal. Like not missing class time. But I was going to tell you like your 504 plan is is a pretty complete document. We used to do an IEP, I think they call them IEPs. individualized, something plan. Yeah. Education Plan. Yeah. And we just at one point, I was like, can we just leave this on this document, and they were like, sure, and we just sort of left it there. Because then there's a breakdown of how to handle snacks and meals for Arden. And it's little stuff like Arden gets to finish her lunch. You know, she eats at the same time every day, if there's an unforeseen change in the schedule, you tell us as soon as possible. Like that kind of stuff, you know, she has unfettered access to the bathroom, you know, stuff about environment around her like, you know that she's going to have to have access to her bag, you know, to her CGM. At that time to her on the pod controller, glucose, food etc. We double down on the cell phone, it's mentioned twice in there so that it can't be lost. And then testing which you brought up. You know, we we started to put a plan into place when she was younger, where when a test would start, she would write her blood sugar on the top corner of the test. And if the test came back differently than you would expect for Arden's you know understanding of the material, you could point to that and say hey, your blood sugar was pretty high can we do it again? And the truth is it never really came to fruition because it soon after we put it in I guess soon after we put it in index calm became really like a viable part of how we managed her blood sugar's just didn't get that high that frequently. And so it became but I still think it's a great idea for people just getting I

Molly 58:39
think, I think that a 504 Just in general in an IEP. It's just like the insurance policy for parents, right. I want it to have everything in there just in case and and hopefully you never have to deal with with something like that. You know, I hope that my son never shows up for a test and he's high and we have to think about should he should he redo it or, or any of that. But if it happens, I want something in that document that says we have the right to do this at a different time.

Scott Benner 59:11
Yeah, right. We can we can just call do over and do it again. She had during her art it took her SATs in a room privately with a teacher that she knew. And there was a time where I texted so the way we had it set up actually I can read it to you that I can tell you that it says allow for medical induced breaks if art needs to check her blood sugar per that and then that's all we asked for. And then the state testing coordinator added that art and cell phone may be on and present in the testing site but must be in the Proctor's possession. So the way we handle that was art and would give the phone to the teacher and say, Look, if there's a problem, my dad's watching, he'll text this phone, you can answer the text and then like decide what to do next. So we did that that way. That worked fine. It says they all the tests, excuse me, the state also added during a medically induced break art and may be given her testing materials too. So Arden has to give her testing materials to the proctor to hold. Then she can text about her blood sugar information to a parent. The proctor will look over our shoulder as she texts to ensure only medical information is being shared. Yeah, and the state also added if Arden needs to share medical information via her cell phone either due to an incoming text prompting her to do so not feeling well, or monitoring alerts, she must close her test booklet and answer sheet move away from the desk and retrieve her cell phone from the proctor again, the proctor will watch over our shoulder. So clearly what the state is worried about is cheating or taking pictures of the test. Yes, that's what they're worried about. Right? Because there are people who sell like they get a whole picture. So those tests and you sell them? Oh, yeah. Right. Because that's the business. Yeah, it's great because your kids not gonna get to college and then still be the same dummy that couldn't do well on the you know what I mean? Like, what's the point? Exactly, I got into a better school. Now, I don't understand what's happening here. So anyway, I mean, unless I could lead could Photoshop me in like a rowboat right or something like that, then I could just get any college I want. But, but um, this worked really well. And if I'm being honest and Arden's out of school. Now, I don't want to out anybody. If you asked Arden, if anybody ever looked over her shoulder while she was texting about our blood sugar? She would tell you, they probably did it, because it's a very human thing once you're in the room and the door is closed.

Molly 1:01:32
Right? Yeah. Right. But again, it's it's in place, and all those safeguards are in place. And so everybody can feel good about it and sign off on the plan and know that the integrity of the test is secure, and that she's going to be safe. Yeah, yeah, that's interesting. I have some similar statements in my son's 504 for testing, but he, you know, kind of goes along with, he just doesn't really want to make diabetes, a topic at all, he doesn't, he doesn't want to be in that separate room. He wants to be in the same room with everybody else. So I had to work with the counselor to say what, you know, what can we provide in the same room? Yeah. So we know, the big one is usually just food and drink, like I just want him to have, you know, he doesn't. Like I said, he doesn't need his phone. But that's partly because he's on a tandem pump. And so he can look at the pump. Yeah. And I had, but I had to clarify with them that the pump is not an electronic device, because you know, the rules say no electronic devices. The pump is a medical device that has electronics. And if he's looking at it, it looks like this. And this is what he's going to do. There's no, you know, it's not connected to the internet. He can't take a picture with it. But we had to go through all of that to make sure that they were going to feel comfortable having him in, you know, the general ed setting, right? Because it was important to him. He doesn't he doesn't want to feel like he has to go to this special room.

Scott Benner 1:03:04
Arden went back and forth on that show, there were times where she's like, I just want to stay in my room. And we've done that. And there are times where she's like, Hey, they set me up with a proctor. And I was like, Oh, they're not supposed to do that. And she's like, I don't care. And that was it. Just like, I'll never forget the time it happened. She's like, you know, she texted me. She goes, I just took a test with a proctor. I thought that wasn't supposed to happen. I said, it's not. I said, Do you want me to fix it? She goes, No, you know, it was nice. And I said, Okay, that's nice and quiet. Nobody was talking, I got in and I got out. Plus, like little things like, you know, once you finish this part of the tasks, you're supposed to wait till the next time to start. And and the teacher would inevitably go, Hey, listen, if you want to start now it's good with me. Can we get out of here? And I'd be like, Yeah, sure. Let's go. And so you know, again, it's funny, isn't it? We write it down so that you said it earlier, so everybody can feel comfortable. But then we all just coach whatever the hell we want to do anyway. Yeah.

Molly 1:04:00
Well, and it's important for me to know, like, even though Jack wants to downplay his diabetes right now, I just want him to understand that he will have to advocate for himself, you know, and you do it before the fact you know, you don't do it. When you get your test scores back and you bombed it because you were, you know, high the whole time or whatever. You make sure that that people understand the situation beforehand, on the off chance that that you might need to call called out into play. We've always

Scott Benner 1:04:32
been very careful not to use diabetes as an excuse, or to even have the appearance of using it as an excuse. And we did a really I'll tell you, we were really just like boyscout honest about it the entire time. Like the last I think the last two weeks of Arden senior year, she had she just I don't know pretty she got behind on something. She was up late working on something and she says to me in the morning, can you just call and say my blood sugar's low. And I said, she goes just one time. I don't want to go in. And I was like, Yeah, all right, whatever. So, and she was only late like she was late. And it was one of the I don't know if people like get this. But in Arden's senior year, the last couple of weeks, they were just, I don't even understand you guys sometimes what? Maybe it doesn't happen at your school. But what passes for instruction. Sometimes she's like, well, we're just sitting in the common area, because that was the weirdest thing I've brought up on the podcast recently. But the weirdest thing that changed from when I was in school to when she was in school, if your teacher calls out sick, you just don't have class that day.

Molly 1:05:42
Yeah, I heard you say that, that. That doesn't happen in our district. But I can only imagine that it's because there's a shortage of subs. I mean, I had a lot of days during COVID That I could, there was no sub available, right? But I'm Elementary School. I can't tell kids to just go to the comments and entertain themselves

Scott Benner 1:06:02
make talks because I think that's what happened. No,

Molly 1:06:06
I have to provide an adult, they might not be getting the instruction. They'd be getting in there with their regular teacher, but you know, they are supervised and they're doing something.

Scott Benner 1:06:17
Well, I'm sure there was an adult with them, but I'm making air quotes. She just like she'd come home. She'd be like, hey, check out these pictures. And I'm like, what was there a dance party? She goes, Hey, this was during, you know, English, the guy didn't show up. And there's 40 kids there. And they're just like voguing and like, I don't know what they're doing. You don't even like, Okay, I was like, well, good luck in life. Yeah, I hope you understand English. Anyway, did you? I'm so sorry. Because we're like talking for an hour already. And I has this gone any way that you considered? Or did we not cover things that you wanted to talk about? I

Molly 1:06:56
want to make sure I know, I think it's, it's gone? Fine. I, like I said, I just I hope I can provide something that's useful for people and dealing with their schools. And yeah, I hope I've done that.

Scott Benner 1:07:10
So come to them. So come ahead of time. Right. Be don't yell. seems like an obvious so I'm very Reasonable. Reasonable can even be angry, just reasonably angry, please. Sure.

Molly 1:07:24
I mean, I think one thing I've learned as a principal is that, you know, I get I get complaints all the time, you know, people have issues with what's going on. And, and usually, it has not a lot to do with, with what people are actually complaining about, you know, usually it's, it's something else that you're frustrated about, or, but but we're dealing with people's kids and, you know, people send us their very best product. You know, nobody's purposely not trying to do the best for their kids, including us on the school side, you know, we are, we are trying to do the best for your child and and every other student in the school. And, you know, with diabetes, I think as parents, we can sometimes put our blinders up. And because there are life and death situations. And

Scott Benner 1:08:15
where you say, Well, is there a time though, when you go, Look, I don't care about reasonable, I don't care what you have the ability to do? Like there are some things like this has to happen. And those things, they do end up happening, right?

Molly 1:08:27
Yes, yes, I think for the most part, you know, I think the part where maybe, maybe you and I would disagree is the extent of the tight control that we can have now, because of the technology. You know, at what point is that still reasonable that that your that your child has, has the same control every minute of the school day that they would have if they were at home with you every minute, right?

Scott Benner 1:09:03
Well, that's why the texting, I think texting is the unsung hero of diabetes, kids. And you know, because you can take other steps out, you can remove people who don't really know what they're doing to begin with, or don't have the time, you know, even if they didn't know. And I think that direct communication also allows insulin to be used more effectively to because you're not saying not waiting for a beep and then walking into a room and then waiting in line behind three kids with bruised knees and don't eat meat and then find right bolusing for your meal or whatever. Right Yeah, I but I see both sides like I really do like I I love that you're presenting your side of it. And I also think that it is not unreasonable for a person to want their kid to be healthy or for a newer diagnosed family who really doesn't know what they're doing to just be like, frazzled, get right and everything and everything seems out of control. Roll. It's interesting, though, isn't it that I guess there's not enough kids? I guess, thankfully, in places where people just know where there's a system where they're like, Oh, no diabetes, sure that happens here all the time, or even with the state like that. You don't you don't have to explain to the state, this is an insulin pump. It's not a you know, it's not a handheld, you know, gaming system. Like, your son can't be the first person to take an SAP and, you know, in Alaska with an insulin pump on, right, like how right

Molly 1:10:28
I just think it's just changing so fast. And everybody's different, right? I mean, I don't feel I mean, I guess I have been teaching a while. But, you know, when I had students in my classroom, the technology was totally different. Right? You know, and then and even now, it's changing fast. And it depends on what system you're using, you know, if you're, you know, tandems different than Omnipod are different than emanate MDI, en, and what you need is going to be different based on that. So it's so individualized and how people manage and and how parents manage versus how much kids manage and at what age there's just so many variables that it's it's unreasonable I think for for school officials who aren't medical professionals to have any idea about what what you want as a parent, or how best to manage your child because it's all individual.

Scott Benner 1:11:23
Molly over under, let's set the number at 10. How many day drinking parents have you had to deal with in your career? Over Under 10?

Molly 1:11:33
Over Under 10 individuals over 10?

Scott Benner 1:11:38
Oh, definitely. I'm here to give Billy his lunch. It's a bottle of vodka Do you want to do? Was there another bag in the car? Did you want to get the other bag? I just I don't know.

Molly 1:11:52
We we see lots of things in school, I would say the one thing that maybe parents don't realize in elementary school is is how much their their little kids talk. And you know, everybody, you know, if you're six, whatever happens in your house, you think that happens in everybody's house. And so you just talk about it as if it's, you know, a typical everyday thing. So,

Scott Benner 1:12:17
you know, all the dirt like the infidelity and the town and like everything, it comes to the kids, right?

Molly 1:12:22
They I mean, they just tell you, in the same way that your child might say I had Cheerios for breakfast, somebody else's child may say something, you know?

Scott Benner 1:12:33
My, my neighbor comes over on Wednesday nights and my dad goes to their house. Really? That happens. Okay.

Molly 1:12:41
So let's just say whatever whatever happens.

Scott Benner 1:12:45
I feel like you have a book. I feel like every teacher has a book in them of just things that they've seen or heard. Oh, I'm

Molly 1:12:51
sure they could. There weren't, you know, last potentialities.

Scott Benner 1:12:56
They rattled each other these kids to in there just the openness. Like you learn about the other kids through kids, the way you learn about like home stuff, is it? Oh, yeah.

Molly 1:13:06
Well, and I always tell, you know, if I'm dealing with discipline issues, and I have to call a parent, I can't name you know, other students that were involved. But I usually just tell them, I said, just ask your child what happened? They'll they'll give you lots more details than I can I have to tell you, they'll tell you exactly who said what, I have a

Scott Benner 1:13:27
completely different in the age of the internet feeling for what teachers must go through. When more recently I saw an educator educators like physical appearance attacked on a public Facebook page by a parent who had just, I guess, been frustrated, and decided that, you know, they were gonna vent like a five year old online, and then started attacking the guy personally. And I was like, what is happening? Like,

Molly 1:13:56
yeah, that would be my other piece of advice is come talk to your school first before you post things online.

Scott Benner 1:14:04
You don't think go into your the Facebook page is the way to take care of it. I've seen so many reasonable things worked out that way though.

Molly 1:14:11
Right? I know it always it always de escalates.

Scott Benner 1:14:15
Fine, absolutely fine. My wife says to me the other day, it doesn't matter what side of the perspective is on she goes. There's the woman in town explaining January 6 to everybody in the Facebook group for the town right now. And I was like, What's that now? And and she's like, Yeah, she's she's explaining all of her theories and things she knows for sure. And blah, blah. And I was like, and this person if you met them, like, like, and you bumped into them, you think like this normal person. And by the way, I didn't say I don't mean that her opinions were abnormal. I mean, the idea that she felt compelled to like, go on Facebook and explain it to everybody, right my mind. And then when something happens at this or, and someone else agrees that Oh, this one isn't good or this one is like that, then it just turns into a free for all. Yes, fascinating. Anyway, I don't know. It lowers my expectations for adults when I see that stuff. It's really, it really does. And if you're listening right now, you've done some of that. Stop yourself. I mean, honestly,

Molly 1:15:23
just I mean, like you said, it's just communication, just talk, talk to the people

Scott Benner 1:15:27
directly step away, step away. It's okay. Just just go take a break somewhere before you start bad mouthing a guy who makes $45,000 on the internet for what he looks like, just like, how about he's trying to get an amen. And you don't know his life. But anyway, Molly, this was terrific. I appreciate you doing this very much. Well, thanks for having me. Yeah, of course. And we didn't make fun of Alaska at all. Almost.

Molly 1:15:50
I know. There weren't I thought for sure. Yeah. You know,

Scott Benner 1:15:53
Yeah, but you're not more on there. You bring a you bring a different like you have an East Coast feeling to you.

Molly 1:15:58
Oh, an East Coast. Wow. I grew up on the West Coast. You really interesting. I don't know if that's a compliment.

Scott Benner 1:16:04
I feel like you're like a no bullshit person, Molly.

Molly 1:16:07
Oh, well, I would. Yeah, I would maybe describe myself that way. Okay.

Scott Benner 1:16:11
Yeah, that's just what I mean. Like, I don't think there's a lot of room for shenanigans with you. Anyway, you probably have to go kill a beaver for dinner. So I'm gonna let you go. I know you don't live in a place where there are other people. Your kid is on that bus for an hour.

Molly 1:16:30
Yeah, we are. One of the we're kind of in a 45 minutes from the major city. So is that

Scott Benner 1:16:39
city where Santa lives like what are we?

Molly 1:16:43
Well, Anchorage is the largest city in Alaska. We are 45 minutes outside of Anchorage. So for a long time, the school in my town is a K through eight school. So my son had a like two minute commute to school and it was the school that I worked at. So that was super convenient. But the High School is in Anchorage. Alright, so for high school, he hasn't when your long bus ride when

Scott Benner 1:17:09
you grow up in Anchorage? What, what is it? Like if you want to stay local? What do you expect to do for work? Is just anything like Yeah,

Molly 1:17:19
I mean, I think anything you would do in a typical city, we have an anchorage. I mean, we have a lot of, I mean, in addition, I guess the Alaska specific things would be maybe, you know, resource development oil industry. There's a there's a lot of jobs in that sector.

Scott Benner 1:17:36
I just imagined canning or bartender like I don't have everything. It's that stupid TV shows. The only thing I've ever seen a fan of Lascaux. What does that?

Molly 1:17:46
Right? Yeah, I don't think well, there's all sorts of TV shows about Alaska. Now. We got the crabbing ones and the Alaska State Troopers and the survival.

Scott Benner 1:17:57
I met Northern Exposure.

Molly 1:17:59
Right. Yeah. Well, that's that's probably more realistic for a small town. I don't think that I think that show was you know, not for a big place like where you live but not Anchorage. Anchorage is a city like any other city and we have

Scott Benner 1:18:12
tell everybody a professional football team you have and the baseball and the hockey.

Molly 1:18:18
Well, we don't have any of them. I mean, we do have hockey, but a lot of people

Scott Benner 1:18:23
that's walking Molly You can't count on people have to go from place to place on ice skates. A

Molly 1:18:30
lot of people go to Seattle or things that you know, other places for their professional sports for $20.

Scott Benner 1:18:36
I couldn't point to Atlanta to Anchorage right now. Like, if you just show me like, in fairness, I probably couldn't point to where I live either. But I have no idea where you're at. I mean, I know Alaska is like that like little like nubby thing at the top next to Canada.

Molly 1:18:53
Well, it's just you know, floating down. It's by Hawaii in that little box. Okay, I thought the west coast

Scott Benner 1:18:58
and you can see Russia from Alaska. I've heard Yes, yes. Yes. Yeah. So that's what I know. It's all true. Yeah, exactly. Well, thank you very much. I do appreciate it. Hold on one second. Okay.

A huge thank you to Molly for coming on the show and sharing what she knows with us. I also want to thank us Med and remind you that you can get your free benefits check at us med.com forward slash juice box are by calling 888-721-1514 And of course our newest sponsor, better help better help.com forward slash juice box use that link to get 10% off your first month of therapy. I want to thank you so much for listening. remind you to check out the private Facebook group Juicebox Podcast type one diabetes with over 35,000 members in it. That's pretty budget I hope you have a good day I'll be back very soon with another episode of The Juicebox Podcast

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