Scott Benner 4/16/23 Scott Benner 4/16/23

#890 Best of Juicebox: Dexcom Calibration Practices

Originally aired on Sept 4, 2020. Jenny, Scott and the members of the Juicebox Podcast Facebook group compare their calibration ideas. Come along as we compare the Dexcom calibration practices of many people living with type 1 diabetes.

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

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 890 of the Juicebox Podcast

Welcome back everyone to the best of the Juicebox Podcast series. Today we're going to revisit episode 375 Dexcom calibration practices. This episode originally aired on September 4 2020. And it features Jenny Smith and I talking about when we calibrate our Dexcom G sixes. It's still something I see people ask every day. So here it is. 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 juice box at checkout. I am 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% My daughter Arden began wearing the Omni pod tubeless insulin pump on February 4 2009. That was 5093 days ago. Were another way to think of it 1697 pods ago. At that time she was four years old. Hang out with me for a moment while I tell you more about the Omni pod Omni pod.com forward slash juice box. Today Arden is 18 and still wearing Omni pod back then there was one choice just one pod but today you have a decision to make. Do you want the Omni pod five, the first and only tubeless automated insulin delivery system to integrate with the Dexcom G six because if you do, it's available right now for people with type one diabetes ages two years and older. The Omni pod five is an algorithm based pump that features smart adjust technology. That means that the Omni pod five is adjusting insulin delivery based on your customized target glucose that's helping you to protect against high and low blood sugars, both day and night. Automatically. Both the Omni pod five and the Omni pod dash are waterproof, you can wear them while you're playing sports swimming in the shower, the bathtub, anywhere really. That kind of freedom. Coupled with tubeless a tubeless pump, you understand it's not connected to anything. The controller is not connected to the pod, the pod is not connected to anything, you're wearing it on the body tube lessly no tubing to get caught on doorknobs or anywhere else that tubing with those other insulin pumps can get caught Omni pod.com forward slash juice box that's where you go to find out more, you may be eligible for a free 30 day trial of the Omni pod dash. You should check that out too, when you get to my link Omni pod.com forward slash juicebox. So if you're looking for an insulin pump that is tubeless waterproof, and automated. You're looking for the Omni pod five, if you want to do it on your own, or you're not looking for the automation, Omni pod dash for full safety risk information and free trial Terms and Conditions. Please also visit omnipod.com forward slash juicebox.

fellow friends and welcome to episode 375 of the Juicebox Podcast. On today's show, Jenny Smith and I will discuss different ideas around calibrating continuous glucose monitors. My perspective of course will come from the Dexcom G six because that's what Arden uses. Jenny also wears the G six but she has worn the Medtronic CGM and many of you have added your thoughts to this episode through the private Facebook group. For the podcast I asked this quite Question Hey, calibrating your CGM, yes or no. And we got a lot of answers. They're all woven into this episode. At the end, I will read directly to you from Dex coms website. And of course while you're listening, I'd love it. If you'd remember that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, please Always consult a physician before making changes to your health care plan. We're becoming bold with insulin. I also took a few minutes from the conversation while Jenny was setting up her microphone and everything and she was admitting to not being able to do something around her house and I put it at the end of the episode so you can enjoy it. Jenny is delightful. You want to know something else about Jenny. You can hire her just go to integrated diabetes.com. Jenny Smith has been living with type one diabetes for 31 years. She holds a bachelor's degree in Human Nutrition and biology from the University of Wisconsin. She is a registered and licensed dietitian, a certified diabetes educator and certified trainer on most makes and models of insulin pumps, and continuous glucose monitors. She is also a very good friend of the podcast. So check her out. And while you're looking, check out the Contour Next One blood glucose meter go to contour next one.com Ford slash juice box to find what I believe to be the greatest blood glucose meter available. Second Chance test strips. Super bright light for nighttime viewing. It fits easily in your hand, but doesn't slip away. Well, if that makes sense or not. But it's easy to hold. You don't drop it. I like the shape. I like how portable it is. I can find it in a bag at night without the lights on. I've never told you that before but it's easy to find in a bag. And it's testing ability is just first class. Contour next.com forward slash juice box are the links in your show notes are the ones available at juicebox podcast.com. If you have time I'd also loved if you check out touched by type one.org and T one D exchange.org. Ford slash juice box touched by type one is my favorite diabetes organization. And T one D exchange. They're doing research to help people living with type one diabetes. And every one of you that completes the research. You just need to be from the United States have type one diabetes, or be the guardian or parent of someone with type one diabetes. Anyway, when you finish the research, the podcast gets a little help you don't I mean a little cha ching, and you're helping people live better with type one diabetes. It's a great organization 100% HIPAA compliant, absolutely anonymous. You can take your information out at any time, just tell them look, I don't want to be a part of this anymore. If you want to write so there's no pressure, you'll never have to go to a doctor's office never have to go to a testing site. And once a year, they'll ask you a couple of questions to keep your information updated. And your answers help shape type one diabetes care. It's pretty cool. Being Arden's parent, I was able to fill out the survey, it took me less than 10 minutes. And I did not find any of the questions to be like I was I was never like, oh god, why they asked me that was all very pretty simple actually. was easy to do. I think we're going to record an episode today that has the opportunity to be very controversial. Oh, great, but not in a way that I think I don't think it's gonna get us in too much trouble. So I this is gonna sound crazy, right? But I want to talk about how you manage your G six. As far as calibrating we're not calibrating it goes. And I asked online and got 77 replies. I just said to people

Jennifer Smith, CDE 8:53
and are all they are they're all different.

Scott Benner 8:55
Oh my god, all of them are so different. So it says I said Dexcom calibration thread share what works for you. And I did say your tips may be used in an upcoming episode of the podcast. So first, I guess we'll talk about what we do and then we'll dig through all of this now for clarity right that I mean Dexcom you know their I guess their public statement is that the Dexcom G six does not need to be calibrated.

Jennifer Smith, CDE 9:25
It doesn't need to be unless it's unless the system asks for a calibration Okay, in my year and a half of use of G six now I've I think I've seen it asked for a calibration maybe twice on its own like you know, like a this is not right or I think one of them might have been you're not right I'm gonna give you a calibration then the system was like no, no, no, no, no. I'm going to ask for calibration again in like 30 minutes or something. I think what kind of did that Yeah, technically G six isn't supposed to require a calibration through the whole 10 days of life, right? Unless it requests

Scott Benner 10:09
one. Okay. All right. So there's a whole bunch of information on the website about it. I'll probably read it at the end, just so that it's in here. By the way, keep in mind, I did not tell Dexcom I was making this, I don't do that. So I didn't, I wasn't like, we're gonna do a calibration episode. It's just something people talk about all the time. And every time someone talks about it, it's like religion or politics. Do you know what I mean? Like, someone will come in and say, well, here's what I do. And 30 people be like, that's wrong. Don't do that. I was like, wow, everyone has such feelings about this, you know? Yes. So obviously, I think whatever works for you is what works for you. But Jenny, do you do you have like a, like a way like, when you start a new sensors, or a thing you do?

Jennifer Smith, CDE 10:55
You just start a new sensor. I pop it in, I expect. It's funny. I, I see a lot of people you know, work with a lot of people are like, it always kind of like you just said it is always low for a one hour for five hours, six hours after I started up, I know that it's just going to read me low. And whatever. I'm kind of, I think I'm sort of odd in that. Sometimes when it gets going. It is spot on. And I always do a finger stick because I always want to verify where it is. That's just my habit. Yeah. Sometimes it stays completely reliable. From the get go. It's great, right? Sometimes it's a little bit off. But then as it kind of keeps going. It gets right on with a finger stick. Yeah. And sometimes it has that weird. Low. The fun thing about that low is, it always seems to be if I have to change the sensor at night. It's gonna be low. And then I'm gonna be fighting the annoying alerts. All night

Scott Benner 12:08
long. All right. Okay. So is the time that I can relate to what you're saying. I might take a detour for a second here. But before I do your, uh, your your spotty on your end. You plugged in the Ethernet, right?

Jennifer Smith, CDE 12:22
I did plug it in. Yeah. All right.

Scott Benner 12:24
Make that mic a little closer to you, please. So I better i Yes, I do think that. What's that old cartoon with a round head? And do you know what I mean? It's like, if something's gonna go wrong, it will and it's attributed. How is it possible? I can't remember Murphy's Law. Okay, was it a cartoon?

Jennifer Smith, CDE 12:46
cartoon? I think it's actually, I don't know that it's necessarily a is maybe it is a cartoon. I don't know. What am I kidding? No, no, it's like rule of thumb.

Scott Benner 12:55
My thinking of I think I may have had a mini stroke just now because I don't think there's any cartoon associated with Murphy's Law. Okay, let's get away from that thought. I

Jennifer Smith, CDE 13:04
think that this might also be the issue between my voice. I, well, it came with the mic. And I always try to be very protective of the mics. I always put the little Styrofoam thing she's

Scott Benner 13:20
talking Styrofoam between the microphone and her mouth when you throw that out. Please. No wonder you can't change that light bulb. Everything you said about the light bulbs thing in the episode now just

so yeah, so I said at the beginning, but just to reiterate, Arden CGM is usually go on. And then they read perfectly. And then sometime in the first hour, it just decides that she's low, like, you know, way lower than she is. And if you let it ride out, it comes back up. Now

Jennifer Smith, CDE 13:56
hit a particular time. Do you have like a defined time that usually

Scott Benner 14:00
Yeah, I think in like, if I don't see it in like three or four hours, then here I go. I calibrate it. If it's not that now I don't calibrate low to 90. Right. So we'll talk about that. Like you can confuse the CGM. If the reality is, if the reality is too far from where the CGM thinks it is. Right? You can't calibrate it because it just goes does not compute and you know it, you fry its mind. And it takes forever for it to come back from that. But know if she's, if she's 100. And for clarity, too, I think this makes sense to say obviously, we're using the Contour Next One blood glucose meter. If you have like an old Genki blood glucose meter, you know, the G six is probably way more reliable than your old meter is right but I'm very comfortable that this meter is is pretty spot on. And so if the meter tells me she's 100 But it says she's 60 Well, then that's too far apart, obviously. And so I'll calibrate it, but I'll tell it like she's 75 and kind of coax it up, and then test her again a little while later and coax it the rest of the way. So that's one of the ways I sort of, if it's too far apart, I calibrate but I don't you have no

Jennifer Smith, CDE 15:25
timeframe to calibration, coaxing kind of way, like you said, and if it gets up to par quicker, you probably don't calibrate again, or at all it does. Then you'll calibrate again. But that's not like a defined time period after that initial coaxing.

Scott Benner 15:43
Yeah, yeah, I don't have like, I don't have like a magic number to it, like, like everyone else does. Like, here's a person who said, over 50 Points off, I wait an hour for blood sugars to stabilize. And if it's still off, I pull it and get a replacement. Well, that seems aggressive. And I wouldn't do that. Because last night, like I said, Arden's sensor went on. Around seven, came online, around nine was great. Said she was low, around 10. She was in the shower, but I don't think that has anything to do with it. She gets out. It's wrong for a while. And then it just is right again. And then it just shuts off for like, two hours. It's what last night was that was last night was an uncommon occurrence for us, we don't usually lose a signal during it. But as it came back on, I calibrated it probably two times overnight. And then it's now it's it's beautiful. Like if I use this person's theory, I would have pulled it off. And I knew not to pull it off less than I was like, No, this one's going to come around. Right? You know, and it did. Tina says that I calibrate if it's way off after warm up. But only if it's a stable arrow. I didn't do it once and waited for it to catch up and that sensor ended up being not good. So there's so much anecdotal conversation in this thread. Everybody knows, I bet you if Dexcom was here, they would just tell you like, Don't calibrate it. It'll it'll figure it out. Right? But what do you do when it doesn't figure it out?

Jennifer Smith, CDE 17:29
Yeah, that's when people get frustrated like this. They're like, well, it's clearly not doing what I want it to do. I haven't calibrated so either I'm just frustrated enough to pull it off and start a new one up. Or they calibrate and then they calibrate and then they calibrate and then calibrate and you know, I think Dexcom in the first 24 hours tells you not to calibrate leave it alone, the system should write itself after that. If the system is off compared to finger stick, then if your glucose is less than 70, you can calibrate if there's more than a 30% difference between finger stick and CGM. If your glucose is more than 70, and finger stick to CGM is off by more than 30 points, then you can calibrate. Okay, so those are the rules of thumb that at least used to be a piece for Dexcom in terms of when they would say, okay, it's okay. Now to go ahead and calibrate. Yes, the system technically doesn't require them. But if it's this much off, you could calibrate because clearly, it's not keeping you where your finger sticks are. And again, I you know, the fact of using an accurate blood glucose monitor. That's huge. That's huge.

Scott Benner 18:52
You definitely can't use an old technology. Now. There's a Listen, I'll make this argument all day long. If you've got a 10 year old meter, and you've got a Dexcom G six, you trust the Dexcom G six, not the meter, and you don't tell the Dexcom who might really know that your blood sugar is 90 that Oh, no, no, it's not it's 120 This old busted up meter I have here says so you know, because then then you're then you're literally telling the CGM what you're really 120 and it's going no, we're not. We're 90. And that causes confusion. You know, the next person in here. So Stacy goes. Don't calibrate. Install the sensor. When the BG is most stable, like right before bed, stay hydrated. Learn what the trends are for you or your child because everyone is different. Thanks again for the pakoda it's not about that. But so her explanation is she doesn't like to put on a new sensor in a time of blood sugar turmoil, correct up or down or anything like that. Is that also something that helps do you think

Jennifer Smith, CDE 19:54
I would expect that it would help? Yes, I mean, I don't. My personal Do I pay attention to that? No. I mean, when my sensor dies, I replace it and I started up. But it for those who do have more issue with sensor accuracy from the get go, it could be a very good rule of thumb because it used to be, I mean eons ago, when sensors first came out, that was the rule with the calibrations, make sure that you have a stable horizontal line or a horizontal arrow. Or there's there's not a very large rate of change happening, so that the system can kind of get on par with what it's sensing in a more stable setting.

Scott Benner 20:38
That to me makes sense. Because if you're rising quickly, and at the moment, you're 71, and you tell the thing, you're 71, it's aware that you're rising your meters not. And so by the time you put the number in, you might be 80. And then that's also well, so. So it's interesting here, because the next Lisa comes in and says, in these books, these two people are parents, it's interesting the difference between parents and maybe this is where we really give parents and people with type one a little extra, because you know, they're paying attention a little extra, right? Like you just said, like, I'll put my damn thing on whenever I need to. And that's the end of it. But Lisa said new sensor inserted and warm during stable time, she says the same thing. And then she says when it works for her stay hydrated, avoid rapid blood glucose changes during the warmup. And the first hours. For example, that looks like they exercise physical exercise be suspicious of unexpected values in the first evening, I 100%. Believe in that I you know, first day of a Dexcom. If I don't trust what I'm seeing I check, right. She says she gives a little rule of thumb here. If way off from a finger stick and a flat arrow. I calibrate a value in between but never more than too many miles. Or 36. Oh, she's from? Oh, yeah, at least I think is Australian at a time. Normally given one, the sensor gets a brain normally given one a sensor gets around. I don't know what she means by that. But so that's it for her right? It's way off from a finger stick. And you have a flat our all calibrated value in between but never more than the 36 points off for Americans. So I think what she's saying is, if the if the things that if the sensor says she's 100. And the meter says she's 136 She picks a midpoint and tells it oh, I'm really 118. That's what I say

Jennifer Smith, CDE 22:33
sounds like yeah, that sounds like what you're doing

Scott Benner 22:35
to coaxing it towards the truth. Right? Yeah. It's like the first hour of interrogation after you've been arrested. We don't go right. We don't go right for the for the idea that we start off with. So are you there?

Jennifer Smith, CDE 22:50
I do have to say, you know, I guess I didn't, I guess I didn't really think about it in in terms. Maybe subconsciously. I was thinking about it. But in terms of like the comment about starting a new sensor before exercise, I don't do that. Okay. I will, I guess, again, subconscious level, I will start it when I'm not going to be moving so that things are moving quicker. I just do finger sticks. If I have a sensor that dies before I plan to go out, I just do some finger sticks and go about my exercise plan.

Scott Benner 23:25
Yeah, well, we, you know, we've run into situations before where we're, you know, throwing on new equipment. Honestly, whether it's a pump or a CGM, and we're running out of the house or Arden's leaving, but we're going to split up. And I think I must always say, hey, look, that's a new pump. So, you know, let's be extra careful. That's a new CGM. Pay attention to how you feel you should probably test in an hour. Right? You know, I think we all have feelings around technology, like, you know, a continuous glucose monitor, or even an insulin pump site isn't a television, it's not just like it works. This thing should do exactly what it's supposed to do every time this. There's also a dance it's doing with your physiology. And that's different for many, many of us, and not always repeatable in the same ways. So,

Jennifer Smith, CDE 24:17
right, like, I think there are some people to someone who is a very true listener to your podcasts, who I've been working with for a bit and he actually wears two sensors, he wears G six, and he wears a libre, at the same time interesting. And, you know, a piece of it is the benefit with the pumping system that he uses when it's when he has a new sensor. He wants to be able to continue to feed glucose values to the system in order to keep it running right and doing what it's supposed to do. So he uses the libre data then to plug in the glucose values in order to not have to do finger sticks in that time period. I'd like to be able to still give it glucose values, which I think is, you know, if you're not, if you don't really care about wearing more robotic parts, that's a great idea, you know, those time periods too, and I've had them. G six for me has been kind of funny I have, I would say I have really good accuracy with it. But by about day eight on 90% of my sensors thus far, day eight, I start to get sensor error, wait three hours, and then it'll come back. And I'll get a little data and then it'll give me another sensor error, wait three hours. And at this point, if I get it twice, on day eight, I'm like, kaput, the air the sensors done, I take off, I call it in Dexcom is great. They've send me new ones. They always ask the same darn questions. I'm like, I don't know why it's dying on day eight for me, but it is. So. But I mean, in terms of units, and just the time periods when you get those errors, having a backup, like wearing a libre, which again, also doesn't require any calibration, kind of can give you a back up in terms of your initial system

Scott Benner 26:08
overlap it, you're

Jennifer Smith, CDE 26:09
right, it's a little overlap.

Scott Benner 26:11
Well, you know, and we do testing in that time, like I, I don't I agree with you, when when I see people who are like, Oh my god, the worst time in my life is the two hour warm up when I don't have Dexcom. Right. And I think those people must be newer to diabetes, or to decks or in general, because I've never once thought, Oh, my God, we've lost the CGM for two hours like this thing. Like last night it you know, it, um, it lasted the full 10 days, like right up till to the hard stop. And it wasn't a problem once during the thing. And then the next two hours, I just hold our nose, like they get an hour, just test. And if you need insulin, give it to yourself, like, you know, the way we did it for years and years and years before this technology exists.

Jennifer Smith, CDE 26:55
I feel like that's probably the case. And it's, I sort of have, I compare it to kind of being like, you're on the mothership, and all of a sudden, you get like, spit out the back door, and now you're like, Lost in Space? Where am I traveling to? What's going on? I mean, quite honestly. fingerstick I mean, it's I know that and for many parents, I think it's hard when you've gotten so used to a system that you feel like you're saving your little ones fingers. Yeah, you know what? They're going to be okay. It'll be alright, if you stick their finger, you know, they'll be okay. If you get information that's going to help in the short term,

Scott Benner 27:37
right? I'm helping a person right now. And I said, Hey, why don't you check with the meter, and they have the contour. So I was like, I'm pretty comfortable with this. And they responded back and we're like, we don't we didn't ever test. And I said you probably should have a little bit. And you know, and so and now is one of those questions. Why do you want me to test right now? I said, because we're about to do something. And I want to be 100% sure we're doing the right thing. And I don't know you. And you know, I don't know when you put the CGM on, I don't know how you've managed it. Like I just want. I want a little peace of mind here. Right? Don't take your peace of mind from an old meter. But you know, at the same time, okay, ready? What do we have here? Dana's got some solid advice. I think I've probably calibrated every sensor a few times, but it has to be a flat arrow. I use decks, comps for trends, and a finger pick through a finger poke throughout the day. So if it's consistently off by 10, or 20 points, over two and three or two or three checks, then I'll calibrate. So if she's off by more like between 10 and 20 points, two or three times, then she brings the CGM back. I have to admit, I would do that too. I don't know that, that she's saying she does it consistently through every sensor. We don't do that. But if I saw that, I agree I would do it. You know, and Arden's a one see very closely matches her Dexcom data. Right, so I'm comfortable that I'm doing the right thing.

Jennifer Smith, CDE 29:11
Yeah, mine does too. And that's a lot of people do some comparison. I mean, I'll usually get emails from people and they're like, Well, my my GMI from tax calm was telling me this, but my agency came back at this what's what is the deal? You know, and I know that we've talked about that before on a couple of other episodes, but I mean, you have to understand the difference you know, blood glucose versus interstitial glucose, a little bit of variance there. Could be I myself also have very good comparison between the Dexcom average and my actual Awan See, they're they're close. I think that the last one was within like, one point or point one.

Scott Benner 29:54
Well, that is that is definitely how I, in the end, assess whether or not I I'm managing that sensor Well, right. And it's funny too, because, you know, back in the day when people were rampid for information back when information used to go really slow, like a new CGM, you know, the G five would come out and people right away is I get the notes. Scott doesn't work review it, Bob a lot. I'm like, I'm not going to know for three months. Like, why do you?

Jennifer Smith, CDE 30:20
What are you talking about? Ask me two days after, right?

Scott Benner 30:23
Here's how we'll know three months from now I'll look at Arden's data. Somebody sent me an email and said, Please say data for me. So I'll look at Arden's data. And then I'll look at her agency. And if they match, I'll say Hmm, that CGM must have been pretty good. Because there's no other way to tell. And so I do think that this is kind of crazy, because it's user error. A lot of the times right and not error, like, oh, you screwed up, I think, Oh, you don't know how, which is why I want to put this this episode together. Because it just it is like sometimes this thing needs a little massaging. Chelsea said, we calibrate only if the arrow is stable. Usually first thing in the morning, and before I go to bed, keep hydrated. Never calibrate when there is no arrow? Because she believes rackets that means the sensor is confused in general, right?

Jennifer Smith, CDE 31:19
Correct. That means the sensor is it's still giving you data, but it's it's making sure like all of its little algorithm, whatever it's doing internally there, it's not giving you an error, an arrow of direction, because it's seeing a glucose value. But there's there's make sense for them. Yeah, it's kind of confused, I guess. Yeah.

Scott Benner 31:41
She goes on to say try to calibrate when food or rapid insulin is on board. And some people say this is her gleaming I think what other people said to her that works for her, insert it let it marinate overnight and then calibrate in the morning and in fairness, Jeanette came in and said this and put arrows to it. Like she was like, I completely agree with this one. Next person says we rarely calibrate. We know that the de Dexcom will oftentimes be off a bit in the first 12 hours. If you do calibrate, do so when numbers are stable and not dropping increasing quickly. Right? Yeah, see people are starting to hear

Jennifer Smith, CDE 32:21
idea is not, it's not I guess, proprietary to Dexcom. A lot of people with Medtronic do exactly that as well, because of I think their sensor has long term been a little bit more wonky, kind of in the get go kind of stage. So there are a lot of people who even with the older Medtronic sensors would let it do that, like marination, they'd sort of inserted at night, they'd start it up first thing in the morning, still get another two hours of wait time period, but it was enough that they got rid of that sink in period.

Scott Benner 32:57
Have you ever seen people put a sensor on but and then cover it? Yeah. And not not at all, like put a transmitter in it or anything like that. I've seen people do that. In fact, I've

Jennifer Smith, CDE 33:09
had a couple of parents who do that with their kids kind of this marinate idea. They'll use that. Whatever it's called caveman. It's like the the sticky wrap. It doesn't really

Scott Benner 33:17
stick stick. Like if they give blood now they wrap it around your cotton, right? Yeah,

Jennifer Smith, CDE 33:22
exactly. So what they'll do is they'll put the Dexcom on, not put anything in it like meaning like a transmitter. And then they just wrap that around, let it sit and then they started up when the actual old the old sensor dies.

Scott Benner 33:36
Because and Dexcom has been on and in the past obviously a lot and they've they've you know, I've been told more than once. Right? There's this there's this wire that goes in and it needs time to I mean, let's say acclimate to the interstitial fluid get wet. Yeah, I think it's soaking in right I think is the idea. It's I guess it's like, you know, it's it's like taking a log and dipping it in water and pulling it back out right away. The logs not wet in the middle from that, but if you throw it in there for a few hours, it'll soak through. Gabriella, I only calibrate within plus or minus 30% of Dexcom readings directionally towards my readings directionally towards my meter, I don't get into calibration loops as a result. Have you ever seen a calibration loop personally? Where it asks you to calibrate you calibrate and then it tells you to calibrate again?

Jennifer Smith, CDE 34:28
I have not not with G six. I have had that with G five. But again, not often either with that,

Scott Benner 34:34
I think I've seen it. I honestly have to say maybe twice. And we've gotten out of both of them by being persistent and and doing it. Here's a question for you. Let's say you calibrate and let's I'm gonna try to make up a number here. So let's just say your blood sugar's really 90. The Dexcom says Is your 120 and you put in 90, and it says 110. You know, if you put in 90 Again, it will agree with you, right?

Jennifer Smith, CDE 35:11
It did not done that a

Scott Benner 35:13
double calibration on close numbers, forces it to agree. Now, the question my head always is, does it stick then is that right to do? Or is it just making me feel better? And all I can say is that when I do that, things go okay afterwards, but I don't know if that's right or wrong. This is probably right, where I'm thinking right now people are listening. And they're just like, they're pulling their hair out and punching the dashboard of their car. And they're like, such bad information. Let's keep this in mind. I'm just telling you what I've done in the past. I'm not telling you to roll. I'm certainly not saying Dexcom says to do it. We're having a long conversation here about what other people do because it's such a varied thing. Don't do it if you don't like it, like, you know, or try it once and see what happens. I don't know. But I don't even know if the outcomes right or not. I do know that it makes me comfortable that you've

Jennifer Smith, CDE 36:07
done it a couple of times. So it's Yeah, seems like it works when you've done it.

Scott Benner 36:12
Well I've done it enough to say it out loud and let my voice be recorded while I'm doing it. Yeah, I willy nilly on here yelling about diabetes stuff.

Jennifer Smith, CDE 36:19
Right? Right. Yeah, I I've never tried that. I guess the next time that I feel like it warrants a give it a whirl. See what happens. Mike, give that a whirl and see how that works out especially at two o'clock in the morning. I'm like, I'm not Oh.

Scott Benner 36:36
Elena says I don't calibrate I find that calibrating leads to far more inaccuracy than just letting it go. With that said, I do think the first 24 hours or so of a new sensor can be rough. And it eventually works itself out. Tarot, we check on the first day. If it is 20 Points off. We calibrate. And if it helps, and if it helps it not to be so wonky that day. Any other time we spot check it, it's right on. That'll stop it. She's saying okay. Molly, I have never had to calibrate. And when I test as long as my arrow is stable on my Dexcom they match within three to eight points. Wow.

Jennifer Smith, CDE 37:17
That's great. Oh, God, I think you know, and I think a big piece of this too, which has now been commented a couple of times by people is hydration. That is a and I know we've talked about it before I've mentioned it before that is just enormously important. And I think especially for for kids, little kids who you kind of have to coax them to drink more, right? And remind them I mean, kids without diabetes, I don't even think parents pay attention, honestly, to how much their kid is drinking through the course of the day. But kids with diabetes, certainly, especially with the fluxes that they have in their blood sugar. Hydration is huge. And then you've got kids who are very into sport. I mean, they might be doing something for four hours, you know, four times a week. Make sure they're drinking. Yeah, absolutely. So but for sensor specific, though hydration is so important.

Scott Benner 38:17
Well, you know, your point is well taken because today in the in the private Facebook group for the podcast it somebody asked about their creatine been been creatine or something like that, like yeah, they're

Jennifer Smith, CDE 38:29
creatine been is. Yeah, blood urea nitrogen is what it stands. Thank

Scott Benner 38:33
you, Jenny. And everyone who came in who had any kind of a medical background was like, Look, if I was you, I would just make sure I'm hydrated. You know, Natasha says, we used to try to calibrate after the first 24 hours if Dex was still over 20% off for the last sensor change. We did a pre soak Oh, see that? The new sensor, they soak their sensor overnight, and then snapped in the transmitter in the morning. And it worked without calibrating the x was very close to the Contour. Next One, thank you for the plug once the 24 hours past nice X was also less jumpy during the 24 hours. And

Jennifer Smith, CDE 39:11
I've seen that too. That's actually an interesting comment. You know, with G six, the the system has smoothed the data, right? So you get this smoother trendline with less jagged down, but a lot of people have questioned in that first like Let's even say 12 hours. Some people do get that like that little object where you can see that the numbers those little dots every five minutes they are more up down up down versus this nice smooth into each other. So that's interesting that somebody kind of commented on that.

Scott Benner 39:50
Well someone comes in and asks Do you can you explain pre soaking and she Natasha went on and said before the current sensor expires, apply the new sensor but not but do not move the transmitter. So the type, so the type one will still be wearing two sensors one active one inactive for a period of time, this gives the new sensor a chance to acclimate for longer than the standard two hour warm up period. If you do this, be sure to cover the new sensor to protect the delicate electronics. We use a band aid Oh, a band aid i Yeah, this is completely off label. Obviously, most of our base of the podcast is off label right?

Jennifer Smith, CDE 40:25
I would expect that a band aid that's one of those like larger band aids would probably be the better option just to really protect that internal part of the sensor. Because you know, the funny thing about G six, and I didn't realize it initially after I started to wear it, but G six has this like sticky stuff. Like inside. And when you remove your transmitter, you can see it on there. And that's why you have to clean the transmitter off every time you take it off. Does

Scott Benner 40:53
it remind you of like petroleum jelly or something? I don't know what it is, though.

Jennifer Smith, CDE 40:56
Yeah, it's like Carmex or like, you know, like, yeah, like petroleum jelly gynae.

Scott Benner 41:03
I, I definitely know what you're talking about. Yeah, it. Listen, Linda, we never calibrate. And I have to say to their sensors for weeks in a row that we don't calibrate. Like, I don't need most like, this is interesting to do. But I'm not a person who's in a position of saying, Oh, wow, we really need to figure out what works. Because what works for us is, you know, like,

Jennifer Smith, CDE 41:28
do what works for you. And you might have censored a sensor that one. One, I guess, idea of what to do with this particular issue. It could be different three months down the road when you've got another sensor.

Scott Benner 41:42
Oh, can you get sorry?

Jennifer Smith, CDE 41:45
I thought I had it turned off. But yeah, it might be three months down the road that it's a completely different calibration need, right that you do something completely different this time versus the last time that you needed to calibrate.

Scott Benner 42:00
Yeah, there's three people here, Irene, Jeanette, and Jolie. And they all say the same thing. Like, once in a while, like I put along that works great. But sometimes I get it where it asks me to calibrate twice after a warm up, even though it's not supposed like, have you seen that. And if

Jennifer Smith, CDE 42:14
I have and I didn't see that until Gosh, a cup, maybe it was the beginning of this summer that I put a sensor on. I gave it the code and accepted the code. And after the two hours, it was like, You need to calibrate with it with two finger sticks. And I was like, but I fed you a code and then it I believe it's every 24 hours then if it didn't, for some reason register the code even though it told you you did, you'll get the two hour warm up two finger stick and after that once a day, you'll get a request for another calibration every 24 hours with a new sensor.

Scott Benner 42:48
Okay, how amazing is all this by the way for it? Listen, for those of you who have walked into diabetes during the time of glucose monitoring, you're probably thinking, you know, oh, that sounds like a problem. And for anyone, Jenny or me with Arden, who were around before this, I think this is all like astonishingly amazing and just magical. You know? Danielle, we rarely check with a finger poke. We only check when we are surprised by what Dexcom is telling us. I think that's important to remember. That is exactly how I feel about it. It's that like when I don't know how to I don't know how I know. But when I don't trust it, I don't trust it. And right, you get that over time. I think

Jennifer Smith, CDE 43:30
it's kind of like with the ones that as you said they start up and it just reads like ello W Yeah, your low your blood sugar is like 39 I'm like, Yeah, I don't feel 39 I know. I mean, I have you know symptoms, thankfully for low blood sugar still. And I would know a 39 I mean, I really would. And so I can be like yeah, that's totally wrong. I'm gonna do a finger stick and it's going to come back at like 78 or like maybe 90 or something you know. So symptoms are another piece to it as well if you are feeling very differently than what the CGM is telling you. Even if you haven't done a finger stick in three months. Yep, figure out where your glucometer is.

Scott Benner 44:10
Go find that first. Megan says I don't calibrate if it's an accurate we go off finger sticks. Excuse me, why can't I say finger sticks until Dexcom becomes accurate? My daughter has been wearing Dexcom for two years. I only calibrate if it's off by more than 50 points which is rare. And I only calibrate when the the error was level was he says I've never calibrated a Dexcom CGM. Wow, yeah.

Jennifer Smith, CDE 44:40
That's amazing. Yeah. Must have been must be somebody then who's never been on G five because that required

Scott Benner 44:45
you to have calibration, right? Yeah.

Jennifer Smith, CDE 44:48
Although interestingly, I have had people who've worn GE five who have said they want it back calibrate. I just don't calibrate it. I've just let it and honestly the system will All, it will keep running unlike G four, and the previous, if you didn't calibrate it, it would just stop giving you information. G five would keep giving you data. Okay, it would keep asking for calibrations, but it wouldn't. It wouldn't stop giving you data. Well,

Scott Benner 45:16
you're right. You're 100%, right. Oh, I remember that too. Yeah. Okay. Sara in the morning with no carbs or insulin on board with a level arrow. So we're starting to see some similarities with people's answers that are that are repeating over

Jennifer Smith, CDE 45:31
I mean, I think if you could put it together in a simple, it would probably be one be hydrated, yep. To make sure that the glucose value is stable, or that you're in a stable time period, meaning you haven't eaten like the whole basket of like, chicken fries, and like ice cream, and now you're waiting for your sensor to give you good data. Right? Well,

Scott Benner 45:50
I'll tell you what, there's a couple of there's a couple of statements in here that really does shine a light on what anecdotal information is, because there's a person and they're even putting a laughy face in it, who says, I usually only need it during the first sensor session with a new transmitter. I feel like the new transmitter needs a few days to learn me, the transmitter has nothing to do with the measurement of your blood sugar. It's just sending the signal right to but even so that's it right? Like you see something over and over again. And if you misconstrue it, all of a sudden you feel like it's a roll. You know? It's like when people's likes Murphy's Law. Oh, that thing? Always. I love it. When people say this about diabetes, this stuff always goes wrong at the worst times. And to that I always respond, what would a good time be for it to go wrong? Right? Every time feels like a bad time. Exactly. Yeah. Going along and living your life and then all of a sudden, something you're counting on stops working. There's a good time for that.

Jennifer Smith, CDE 46:53
You're always stinks no matter if it's two o'clock in the morning or when you're on the beach vacation or your whatever, in the middle of a basketball tournament. It's never a good time.

Scott Benner 47:05
Jeff Brent and Jaya, I don't calibrate.

Jennifer Smith, CDE 47:11
If I'm curious for those who are not calibrating

Scott Benner 47:14
how close they're a once the match is there?

Jennifer Smith, CDE 47:17
I'd be curious about that. But I'd also be curious if they're also people that may not be doing finger sticks. So they may not really know if their sensor is really off. Yeah, I mean, because, you know, having had diabetes as long as I have. I didn't have sensors for a good majority of my life with diabetes. It didn't. And I mean, my first sensor was in 2006. That's when I first started using them. And so I was always, I still am, I still do finger sticks during the day, even if it's not to check my CGM. It's because it's time to eat. And I'm so programmed. I'm just programmed to do a finger stick, I can do a finger stick when I wake up in the morning, I do a finger stick at lunchtime. I do a finger stick at dinnertime. I always do it before I go to bed. And I'll even do more than that during the day with exercise, right? And I just it's just a routine. It's like brushing my teeth. It's not something I think about anymore. So I think that I'm also a little bit more in tune then with Oh, my CGM is reading this. My finger stick was this, you know, and for those who pump especially if you're relying on the CGM, but you've not really been doing finger sticks, and you're kind of wondering Why will my GMI from Dexcom is telling me this is my average. But every time I get my a one C done, Gosh, it looks like I'm a lot higher. Yeah, well, it. It could just be that CGM just isn't reading you, as accurately. Do you remember

Scott Benner 48:53
a long time ago in the original Omni pod? PDM. There was the meter. Yeah. And that the meter wasn't it wasn't great. And so that's how I figured it out. Right. So how did I figure out the meter wasn't great, because Ardens a one C kept coming back higher than it should and it didn't matter. This is before CGM. And it didn't match what the finger sticks. Were telling me. And that's when

Jennifer Smith, CDE 49:20
I figure out how to play with the kalam Yeah, then you change

Scott Benner 49:22
the calibration code and the meter works better. And so I used to it was 17 or 18 Right? All the all the test strips for the Omnipod PDM are code 1616 And some people change the meter to code 17 And some people change the meter to code 18 depending on which ends up being more accurate for them. We were 18 I know a lot of people were 17 Yes, I was 18 Yes. And then Ardens a once he started matching my expectations just like that, so you can be mad about it if you want but at this point now that meters a decade old, and you know and so the people were like I can't believe that the new dash doesn't have a meter on it. You You don't want a meter in your technology because the meter keeps getting older. All of our new technology now is updatable, right? It's like your iPhone, you want to put a new operating system on it, you can a new app. But if you stick a physical piece of equipment into it like a meter, now suddenly you're stuck with that meter forever. And that's, that's I don't think that's a good play. And I think that's why if I had to guess why on the pod took it out, I think that's one of the reasons. It could be. Yeah,

Jennifer Smith, CDE 50:29
I mean, it's also the reason I think that they've decided, you know, now when you get Omnipod, the dash system, you get the Contour. Next One, right.

Scott Benner 50:37
And the PDM is now really just sort of like a lockdown Android device. Right? Right, exactly. But it's it. But the point is, is that I saw that as far as moving on, I kept thinking like, Oh, my God, this meters Old, old, old, and I felt tied to it at that point. You know, I am. I hate to say this, but I am so much more happy with the Contour Next One than I was with the PDM meter. Back in the day, I'm thrilled with it. And I think that to people listening probably were like, Oh, my God, Scott's taking a meter ad. We know he uses Dexcom, he probably doesn't even use a meter, we use a meter every time we need a meter. And it's a lot more than you think it is. And it's not because Dexcom is not great. It's for the reasons Jenny just said. So I was actually kind of

Jennifer Smith, CDE 51:21
curious, you know, I my insurance doesn't cover the Contour. Next One I wish it did. It covers the accucheck Guide me, which is another very similar to the contour its accuracy kind of parallels, right. But the interesting thing is, I do have a Contour Next One. And I had like the sample bottle of test strips that kind of comes with it. And so I played once I got my accucheck I was like, I'm just curious. And they were pretty spot on with each other, quite honestly, which was nice to see. But also then went back to my old school PDM and my freestyle light test strips and and I figured out that actually that code 18 is the one if it was the code 18 It was within like two to five points of the Contour. Next One, the accucheck. Yep. So that's old school as it is. Code. I

Scott Benner 52:11
know. I know. That doesn't make sense to a lot of people. But code 18 for code 16 strips in the old PDM perfect for Arden was the way to go. You know what's interesting here, here, I have three people in a row who I know are not old school diabetes people but been added a long time right people whose comments that I'll pay attention to when I see them roll by Jen, a big note a calibration, Shawn, personally, I would never use the G six without calibrating. And then the third person reads as we calibrate if readings are off by more than 20%. But it doesn't happen that often. These are three people whose opinion, I think are probably pretty good. And they said three different things.

Jennifer Smith, CDE 52:52
And they all do it differently. And I think it's also kind of as I commented earlier about mice a good number of my sensors, like just being done on day eight. I think it goes back to the the truth in that the sensor filament interacts with everybody's body system, body tissue, interstitial fluid, whatever you're going to call it a bit differently. I think that's the reason some sensor systems work beautifully for some people, and not so beautiful. For others. I've got friends who love their Medtronic sensors get really awesome accuracy finger stick CGM. It's always on they don't have any problems with their systems. I could not get that thing to work for me. For the life of me and I wore both my sensors. I wore Medtronic and Dexcom. And it just never want to work

Scott Benner 53:45
for as good. You know, here's another name that I Kristen who I know. And she says I've never calibrated I do not believe my blood. Here's why. I do not believe my blood glucose meter to be more accurate than my Dexcom. So she just doesn't have probably that she can confidence in her meter. And some people don't think about that. They're just like, yeah, I checked it. So the meter the meter is like God, you know, the meter said, so the meters right? Well, you know, some of those meters. If you've seen the testing, I brought it up recently on an episode. There's I think the last one was like 2018, right? And it kind of ranked them only like six meters even ranked in like I would use this if I was you. All the other ones were like don't buy this meter. Right. The variance was way off. Yeah, right. Well, okay, we're out of time, aren't we? Because we're also at the end of the list, and I only had you for an hour today. So I actually got down to the list. There's people's I'm sorry, I skipped some that obviously were repetitive. But yeah, like Jenny said in the middle. I think that what works for you is important that checking with a quality meter is important. And it seems that you know the consensus seems to be if you're going to calibrate make sure you're high hydrated at a stable blood sugar before exercise, no active insulin, that kind of stuff. So the thing has a chance to

Jennifer Smith, CDE 55:09
get a lead correctly from the beginning. Yeah.

Scott Benner 55:12
I wonder if we'll get yelled out about this? I don't think so. We were very clear. Yeah,

Jennifer Smith, CDE 55:17
I don't think I mean, it's not like we're saying, This is what you should definitely be doing. 100% to make. I mean, that's not this is not medical advice. This is just discussion.

Scott Benner 55:26
Jennifer, this is a work culture. Okay, if you say something out loud that somebody doesn't agree with. You're trying to ruin the world, don't you understand? All right. Listen, I want to wish you a lot of luck changing your light bulb. And I really wish I knew your husband, because I would go behind your back and tell him that you don't change.

Jennifer Smith, CDE 55:46
Like I will, he will laugh at me. He'll be like, Who do you see this little like thing on the side? This is very, like, pull it off. And so I'm like, scouring.

Scott Benner 55:54
Well, listen, I'm gonna help you for a little bit before you go. He's get up on a ladder and look around the ridge at the ceiling to see if there's little set screws that are holding the whole thing

Jennifer Smith, CDE 56:03
or not. There are no screws, there's nothing. So then it's

Scott Benner 56:07
got to be. Did you twist it for? I don't want you to twist it out of the ceiling.

Jennifer Smith, CDE 56:12
Yeah, I twisted the glass part of it, which is would be the next option. Because I've seen the glass bulbs that just twist off, right? This one is either really screwed in unbelievably tight, which I guess might be the case. Or maybe I'm just too worried to try to unscrew it or like, heavier because I don't want it to crack in my hand. Here are my

Scott Benner 56:32
two thoughts. When you're trying to turn it is the base the metal base turning with it? No. Okay. So maybe you have I don't think you have to turn the base. But what I am thinking is, is it possible that it's a reverse

Jennifer Smith, CDE 56:45
thread? Oh, counterclockwise?

Scott Benner 56:49
Do you have to turn it the other way opposite. I wish you had enough time I would like to make you go up right now and turn it and see if it comes off. But instead I will just wait for your text message later. And

Jennifer Smith, CDE 56:58
I will let you know whether I required help to change the light bulb or not.

Scott Benner 57:02
I 100% agree you shouldn't tell anybody about this. That's all. Yeah, all right. Well, thanks for doing this. I really appreciate it. Yeah,

Jennifer Smith, CDE 57:09
absolutely. Have a good weekend. Okay, bye.

Scott Benner 57:14
Hey, everybody, Jenny's gone. I'm still here. We're gonna do everybody's favorite podcast thing I'm gonna read to you for a second this is from dexcom.com. In their frequently asked questions. The question is, is my Dexcom sensor accurate heading Dexcom G six continuous glucose monitoring system reading and meter value. Whether you're new to Dexcom, or experience, review product instructions before using the Dexcom G six. Keep using your blood glucose meter to make treatment decisions until you know how Dexcom works for you. Your meter gives you one number if you test twice, using the same or even different meter, it gives you another number and your Dexcom G six gives you a third. What do you do with all those numbers? Next heading is the test. The test your doctor does is considered a more accurate glucose number than any products you use at home. Both meters and Dexcom G six are compared to that doctors test to measure accuracy in clinical studies. They aren't compared to each other. Because of this, the Dexcom G sex reading and meter value are unlikely to be exactly the same number, but they should be close. Compare the meter and your Dexcom G six to see how closely the numbers match each other. If your G six reading and meter value are within what we call the 20 rule, also known as the 20% 20 rule, they match closely. Here's the rule. To use the 20 rule follow the steps using the table below my gosh there's a Table Lookup your meter value in the green middle column. The left G six column shows the low range for G six reading that okay, you're gonna have to go look at this yourself. I'll put a link in the show notes for this 2020 rule goes on to talk about good fingerstick practices. When you're using your meter. Make sure your test strips are stored as directed and not expired. Your hands are clean for finger sticks. Wash your hands thoroughly with soap and water, not hand gel and dry them then test. There are times when the numbers temporarily don't match, but are likely to become closer over time. For example, the sensors first day. With newly inserted sensors the difference between your meter value and your G six reading may be greater. Generally the match gets closer over the first 24 hours. Glucose changes quickly. When your glucose is changing quickly. It is more difficult to compare numbers. The meter and Dexcom G six measure glucose from different sources. They are blood in interstitial fluid and blood glucose changes a little before interstitial fluid. The match gets closer and easier to compare. When your glucose stabilizes pressure on the sensor when something is pressing on your sensor it can affect 36 readings the match should get closer after the pressure is relieved. That of course is what people call a compression low. So everything they're saying here matches pretty much everything that we found talking to Jenny, my experiences and what everybody in the Facebook page was saying. To determine what to do watch a G six readings over several hours. If the readings are always higher or always lower than your meter values, and always outside of the 20 rule, consider calibrating. Also consider calibrating if your Dexcom G six and meter numbers don't match, and your expectations or symptoms fit the meter value, not the G six reading calibration. Calibrating your G six with your meter is never required, it can make the Dexcom G six more accurate or less accurate compared to lab results, but it should bring the G six reading closer to the meter. When calibrating make sure you enter the calibration within five minutes of taking the finger stick. You don't calibrate during a sensor error. If you like you can calculate the 20 rule on your own. The Dexcom G six reading must be within 20% of the meter value when the meter value is 80 MG DL or higher 20 MG dl of the meter value when the meter value is under 80. Please note that the information listed here is applicable to the Dexcom CGM user within the US only. I cannot just read you this link. Because it is it looks very maybe I can hold on one second. So it's dexcom.com forward slash FAQ s forward slash is dash my dash Dexcom dash sensor dash accurate. Like I said I'll put a link in the show notes huge thanks to the Contour Next One blood glucose meter for sponsoring this episode. Go to contour next one.com Ford slash juicebox To learn more, and thanks to touch by type one.org For being such a wonderful long term friend of the show. Check them out touched by type one.org. Of course if you'd like to get a Dexcom CGM dexcom.com forward slash juice box you can get a free no obligation demo of the Omni pod tubeless insulin pump my Omni pod.com forward slash juice box take the survey AT T one D exchange.org forward slash juice box guys ready to hear Jenny admit the not being able to do something that I think she's kind of embarrassed about and some other chitter chatter. If you're looking for bonus material, I got you covered.

Jennifer Smith, CDE 1:02:44
I'm fed children I've gotten them changed. I've wiped but I have washed my hands and then I picked my tomato isn't my peppers from my garden and

Scott Benner 1:02:56
it was how did you get up? Six o'clock. Oh, so last night. That was seven o'clock your time. Last night. Last night as Arden's pump was winding down. I was like it'll make it overnight. Then her CGM and her CGM men, right. And we changed our CGM around seven o'clock and it was done. It lasted the entire, you know, 10 days. It was working great right when it shut off. And we hit like a little bit of a bleeder I was like, ah, that'll probably be okay. So it comes on in two hours. And Arden's CGM starts are all exactly the same. It comes on, knows her blood sugar perfectly. And within an hour tells me she's low and she's not. And then we we coax it along and get it going, and it's fine. So this happens. Around midnight, I go to sleep. And at 2am Kelly wakes me up and she goes, Hey, I need help we changed Arden's pump, because her blood sugar was going up. And her CGM has lost that signal. And I was like, Okay, no problem. I'll take care, but you go back to sleep. And I did take care of a Jenny. And then I went back to sleep at 6am. I was up for four hours in the middle of the night. And no, and it just, it would come back and it would go away and it would come back and it would go away. But I'm I know it's gonna be all right. And if this would have happened in the middle of the day, I want to be clear that this doesn't happen often. Does it just happen this time at a really bad time? But since it did happen, I know what I want to talk about today.

Speaker 2 1:04:43
Oh, great. And while we're doing that, I'm going to actually I've got like I have so many chords.

Unknown Speaker 1:04:52
What was going on? What

Jennifer Smith, CDE 1:04:52
is the deal with chords?

Scott Benner 1:04:55
The room is cleaned up though it's different.

Jennifer Smith, CDE 1:04:57
Oh, oh because we are are putting in new floors. Oh, this room, no campus. This is the bigger of we put a new floors in our living room. They're like, we are purging our home of carpet.

Scott Benner 1:05:12
Okay, blah.

Jennifer Smith, CDE 1:05:16
So living room got done. Now we're moving on to the space that has been my office which interestingly has been, it's the bigger of the two like spare bedrooms, right? Okay. And so we're going to put new floors in here. And then we're going to put new floors in what is now the room that the boys technically share. Okay, we're gonna then transition rooms. I'm gonna take that room, which is actually the smaller they're gonna we're gonna move their stuff in this room and this is the bigger of soap.

Scott Benner 1:05:50
You're under. Well, listen, we your fun stuff. To me. I know there's nothing like being an adult is there? We just ordered a folding state floor for Arden's room. And she very Arden just picked this floor that wasn't very expensive. So we were like, okay, yeah, you can have she's like, Can I do this? And when she picked that one, we're like, yes, you can. And you absolutely can. But we're replacing we. It's funny, you said this we wanted to replace, we have hardwood through most of our house. So the kids bedrooms and this room, amen. is carpeted. And then our living room is carpeted. But everything else has Tyler or wood. And we wanted to make the living room, tile or wood or something. We weren't really sure what. Because the one one of the bonehead mistakes we made when we put the house together was we bought this carpeting and didn't realize and dog owners will know right away, you don't buy looped carpeting with a dog right. And we didn't know that our carpet cats or I think the over under on poles that I fixed in that carpet have to be in the 1000s you know, or sometimes the dog's leash or something gets caught on he runs away and just yanks out like six inches of carpet and I actually get back down on my hands knees with a hot glue gun and toothpicks and put each one back in again. Right.

Jennifer Smith, CDE 1:07:16
Hi, God, you have so much more time than me.

Scott Benner 1:07:18
Oh my god. The other option was the other option would have been to burn the house down. It was like right in the middle of the room. You know, like I was like we got to get out of here. It was just really bad. And so we can afford to put wood down or what we wanted to put down in there right now. So we just went out and bought like a really inexpensive piece of carpet and it's being delivered in a couple of days. I can't believe we're doing flooring at the same time. At same

Jennifer Smith, CDE 1:07:42
time. Yeah, I don't think I've ever seen the floor in that room. Usually there's like a nice couch behind you. And that's all I see besides like,

Scott Benner 1:07:51
yeah, well my son stole the couch, just so you know. So that's gone now. He's like, I'm gonna take this sofa into my room because and he's home forever. So we're like, Alright, he's gonna take the candles, you know? So he's got that. And I have all of Arden's junk in here because we're waiting for the flooring to be put in her room so it's a bit of a disaster. Anyway,

Jennifer Smith, CDE 1:08:12
but I was gonna say I'm gonna get yet another cord totally forgot to plug the cord for the computer like direct connect in so give me a sec yeah sure

Scott Benner 1:08:29
I make Jenny plug her I don't let her use Wi Fi while we're doing this. So she's dragging an Ethernet cable across the room.

Jennifer Smith, CDE 1:08:37
And I also realized that I have no clue how to change the lights.

Scott Benner 1:08:42
What do you want to change in there? What do you mean we want

Jennifer Smith, CDE 1:08:45
I want light bulbs in the ceiling died I cannot figure out how to get

Scott Benner 1:08:54
What are you talking about? Let me say

Jennifer Smith, CDE 1:08:57
I don't know how to get it off. I have no idea

Scott Benner 1:09:01
is there no screw in the middle of it?

Jennifer Smith, CDE 1:09:03
There's no screws I've tried to turn in the glass doesn't unscrew. I don't know what to do with still. I have a big ol like floor lamp in here now. So like actually have Why have you

Scott Benner 1:09:19
brought anyone else into? Try to figure it out?

Jennifer Smith, CDE 1:09:23
No. I should ask. I know I should ask my husband. Do

Scott Benner 1:09:28
you not want to tell your husband you can't figure out how to change the light bulbs. Right?

Jennifer Smith, CDE 1:09:34
Like I'm not this dumb. Like I don't know what the deal is. So

Scott Benner 1:09:37
you're not wrong. It's isn't glass. It's a dome right?

Jennifer Smith, CDE 1:09:42
And it's glass right so it's like the wrong move. Like I just I think I also need to get like a taller.

Scott Benner 1:09:48
Are you reaching this? Yeah,

Jennifer Smith, CDE 1:09:50
because I've got just the basic level, which this stool has worked fine for all of the other like ceiling things right? So why wouldn't it work for this

Scott Benner 1:09:59
long Has the light bulb in that light been working for you? This is the first time you tried to change it is

Jennifer Smith, CDE 1:10:05
we moved in. It'll be October 1 will be two years in this house. And we've not changed the light bulbs in this light since

Scott Benner 1:10:17
because that's good run.

Jennifer Smith, CDE 1:10:19
Right? Good lights, I guess you know, but I also don't get used that very that often. Because I'm really on this in this room during the daytime. Okay, and so unless it's really dark in here, I typically don't usually use them. But anyway, yeah, cool.

Scott Benner 1:10:39
All right, listen, let's try to bring your yes, your bring your microphone a little closer. Do you know sir, to me, is that better? Try again. Better. Yes. That's okay. There's the spot. So hopefully we've answered some of your questions today about how to calibrate or not calibrate your Dexcom G six and the other burning question. How many people does it take to change a light bulb in Jenny's house? As of now we know the answer to be more than one. If Jenny's involved in it's in her office. Thanks so much for listening to the Juicebox Podcast. Please take the time to share the show with a friend. And leave a wonderful five star review on Apple podcasts if you're so inclined. Thank you so much for listening to this episode of the Best of the Juicebox Podcast. I hope you understand better now the process of calibrating your Dexcom G six. And I also hope that you're interested in learning more about the Omni pod five, or the Omni pod dash? Don't forget to use my link Omni pod.com forward slash juicebox 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 juicebox. And of course, you can get 10% off your first month of therapy at better help.com forward slash juicebox. Just by going through that link. It's all you have to do. If you'd like to know more about better help, there's going to be a short explanation at the end of this episode. Thank you so much for listening. I'll be back very soon with another episode of The Juicebox Podcast. If you enjoyed 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. If you enjoy the Juicebox Podcast or this episode or any episode, please go into the audio app you're listening in and leave a five star rating and a thoughtful review that will help someone else to understand why you love the podcast. 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. betterhelp.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 BetterHelp betterhelp.com forward slash juicebox that's better help h e l p.com. Forward slash juice box save 10% On your first month of therapy

#889 Type 2 Diabetes Pro Tip: Movement

A series for people with pre and Type 2 diabetes.

+ Click for EPISODE TRANSCRIPT

00:00:21 Importance of exercise for diabetes.
00:09:52 Start exercising gradually and safely.
00:11:36 Walking is beneficial for health.
00:21:59 Exercise regularly for better health.
00:22:32 Regular exercise benefits diabetes management.
00:32:30 Stay active and find enjoyable exercise.
00:34:57 Exercise for increased heart rate.
00:40:43 Involving others boosts exercise motivation.
00:45:50 Take time to enjoy life.

Scott Benner 0:00
Hello friends, and welcome to episode 889 of the Juicebox Podcast.

On today's episode Jenny and I will be adding to the Type Two diabetes Pro Tip series. And we'll be speaking today about getting moving. There are easy ways to get yourself going again, Jenny and I are going to talk about just a few of them and why they are so important. 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. And I have a couple things here for you just for Juicebox Podcast listeners if you want to try ag one that green drink from athletic greens, I actually drink it every day you can and if you use my link athletic greens.com forward slash juice box you will get a free year supply of vitamin D and five free travel packs with your first order. Now if you're looking for joggers, sweatshirts, sheets, towels, pajamas, that kind of stuff, you can go to cozy earth.com And when you use the offer code juice box at checkout, you will save 35% off your entire order cosy earth.com Use juice box at checkout

friends My daughter has been using the Contour Next One blood glucose meter for some years now. And it is my personal favorite meter. Contour next one.com forward slash juice box. Why is it my favorite meter, it is easy to carry to hold as a bright light for nighttime viewing and features Second Chance test strips. On top of all that it's incredibly accurate. And isn't that the most important part? It is. But let me tell you about those Second Chance test strips say you, you get some blood out and you touch the strip to it but it's not quite enough. Now this is not to say that the strip requires a lot of blood because the sample really does not need to be very large at all. But for some reason, like you touched a little and I don't know you you sneeze now you have to go back and get more well with most meters you'd have to throw away that expensive strip and go again but not with the Contour. Next One with the Contour Next One, you just get a little more blood touch that shirt back to it and you get the same accurate result as you would have if you got all the blood the first time Second Chance test trip. On top of all this if you go to my link contour next one.com forward slash juice box you'll see a big yellow button that says buy now. You can actually get your supplies online often for cheaper than it costs you through your insurance. You can buy a meter at Amazon walmart.com Walgreens CVS, Meijer Kroger target Rite Aid all at my link. Check it out, won't you contour next one.com forward slash juice box is a great website has a ton of information about a ton of their products. I'm here to tell you about the Contour Next One, but the website will tell you much more. I am not kidding. I am not gilding the lily. I am not making this up. The Contour. Next One is hands down the best meter I've ever used. And it could be cheaper in cash than you're paying right now through your insurance. You owe it to yourself to check it out. There are links to contour and all the sponsors in the show notes of the podcast or audio player you're listening in right now. And there are links at juicebox podcast.com. If you can't remember contour next.com forward slash Juicebox 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 therapist who can help you with a wide range of issues betterhelp.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 lp.com forward slash juicebox, save 10% On your first month of therapy.

Jennifer Smith, CDE 5:08
I was gonna say before, with your use of the word go v. And as we've like, texted about some things to, you have taken it to a degree to the route that really should be, along with anything that's supposed to impact health and weight and all that, like, you're not just sitting back eating a bag of Doritos expecting that this is going to be the magic trick, right? You know, you're really, you're conscious, you're being more aware than maybe you were before you're making sure that you're eating, you're not not eating because this med can take away appetite or reduce or increase satiety, right. Yeah. So you're I was just going to, I meant to say that that's a good thing that you're doing well, good lifestyle.

Scott Benner 5:56
I appreciate that. Actually, I started recording right before you said that, and I'm gonna keep talking. And I might, I might keep this in. I took my own advice. That's basically what I did was I looked at myself, and I thought, what would I tell other people to do? I'm going to do that. And, and that's, that's what I've done. So I, and the medication, like the specter of the medication, when the doctor gives it to you, it kind of helps you because they're like, Look, if you eat the wrong things, you could end up with, like, some horrible nausea and like, I don't want that. So, you know, but then the doctor is like, but in this first injection, if we go over, you probably won't experience that. I'm like, Well, I'm gonna start eating that way. Now. Just to get myself ready. Like because I don't, I don't want to be in a panic situation where I'm like, I don't know, tossing candies back. And this medication gets ramped up, and I'm like, oh, plus, plus, if there was any value to just wait, I wanted the weight loss value. Yes. And so the one thing I can for sure, say is that I don't, there's no hunger on this at all. Like, the first four days, I was getting hunger in my head. Like I was getting woozy,

Jennifer Smith, CDE 7:06
right, like shouldn't I should be eating something but your stomach wasn't telling it to you. It was more your brain recognizing that your body was giving you some signals of lack of enough intake. But you really weren't, like physically hung. That's not the right way to say it. It's not like you've got this signal from a rumbling belly,

Scott Benner 7:27
let's say Oh, my God. No, it's bizarre, because the only way I knew I was the only way I knew I was hungry is that I was like, am I gonna like, like, pass out? Like, why am I weak and dizzy? Like, do you know what I mean? Like, Oh, I haven't eaten anything. Oh, goodness. And so for the first couple days, I just put timers on my phone. And I was like, eat here. Eat here. Yes, because I didn't know what else to do. I'm back. I have a better flow now. And after I've been on it for a few days, I I am, I have a little bit of it's not hunger the way you would think of it. But it's not like a mask like hypnosis. Like it was the first time when when it first I don't know what's going to happen when I ramp up to a new dosage. But for now, I took my own advice I'm eating carefully cleaner. When I'm, if I have a sweet tooth, I go to fruit. Yeah, you know, like little stuff like that. I'm eating a lot of like chicken and turkey and like some lean beef and stuff. So

Jennifer Smith, CDE 8:31
I'm very proud of you. That's super awesome. Honestly. I think I mean, that's right or wrong long with like, lifestyle things, right? I mean, lifestyle, including while a medication might help lifestyle in many health conditions, is a piece that needs to be included. If the med is really going to help you the way it's supposed to,

Scott Benner 8:53
also wasn't going to waste the opportunity. Like I just thought like, it's not going to happen. What am I going to go back to a doctor six months ago, I'm really ready this time, you know, so I'm just like, I'm gonna go for it here. And, you know, and actually making the series if I'm being honest, has helped me too. Because, you know, telling people, this is how you can help yourself. It would be pretty hypocritical if I didn't do the same thing. Yes, yeah, I will say for the recording that I have eaten like this in the past and not experienced weight loss like this. So um, this stuff's gotta be doing something, I am gonna go I'm gonna get up a hill, a monster to spit on me. That's what I'm gonna do. Listening, you don't get that you gotta go back and listen to the episode before this. But today, today, we're going to talk about something that I think a lot of people need help with. And I'm going to be a great person to talk to you with about it because I easily could be asking these questions. So cool. How do I start to exercise when I'm not a person who's exercised because I don't want to get hurt. And I don't want to I don't want to like break down right away. I think that's got to be the biggest goal, right? The focus in the beginning?

Jennifer Smith, CDE 10:06
I do. And if you I think the majority of people that are listening are also listening because they're ready for a change. And I think that's a step two, any lifestyle change inclusive of adding activity is you have to have this, this motivation of something needs to give here, right? I've got to put some some in some effort in. Does that mean? Oh, gosh, I want to start exercising, so I'm going to buy the new shoes, I'm gonna head out the door, and I'm gonna go run 20 miles, because that's clearly what I have to start to do. That's, you're gonna come back and not want to do anything anymore.

Scott Benner 10:47
Yeah, right. You don't want to beat like you want to. I always say to people around me when they're starting up. Like, don't just go like that, like, let your hair on fire and run forward, because you'll burn out too quickly, and you'll get sore, and you'll skip and then you'll go right back into old things. Listen, this is old timey thinking. But I remember being 1011 years old, and my aunt and my cousin saying that they wanted to lose weight. And they just started walking after dinner. Yeah, it was literally all they did. It was one summer they started walking after dinner. I was stunned even as a child at how much weight they lost doing that.

Jennifer Smith, CDE 11:26
Yes. There are some some really good studies that have been done over a number of years for people, elderly people now who are in there, like, like 90 year old people who have had longevity, obviously, and health during that long life. And what are some of the biggest takeaways? These are people who they may not have done marathon runners, or crazy swimmers or they played tennis like a fiend every week. These were people that walked Yeah, walking was the most common thing for these people who were interviewed to have included long term. And if you're going to start with any kind of even the word exercise, I think, to some people is a turn off. If you think about it by of just increasing movement in your day, right? You might, I mean, most people have heard parked the car farther away. That's something you can do. And if the three trips to whatever store grocer that you're going to a week means that you're parking way in the back of the lot, and you're walking farther in, and you're not having somebody help you all the way out and cart, your groceries, you are increasing your movement. It may not sound like exercise, but you're changing and you're creating a new habit to include more steps than you were likely getting. Right. Yes,

Scott Benner 13:00
I laughed to myself because I do that because I don't trust people near my car.

Unknown Speaker 13:07
But sounds like my husband.

Scott Benner 13:09
I'm like these sons of bitches. And it's windy, they're not paying attention. Don't park

Jennifer Smith, CDE 13:16
next to the car that has car seats. Don't right,

Scott Benner 13:19
Jenny, I will only park if one side is on a curb. If there's a hill, I'll only park on the top side of it. I have a lot of rules about not I can't. If I see a little ding in my car. It ruins it for me. Anyway. So I do that. And I also take my cart back to Yes, like just until you get a little extra and it is it is helpful. I mean, it's safe, more walking than I get otherwise when I'm down marking.

Jennifer Smith, CDE 13:45
And if you're you know, if you're somebody who lives in one of the like, let's say a bigger city that might have some more public transport, whether it's a subway, a metro, a bus or whatnot. Let's say you take your car and you park in a lot and you get on a bus, park your car way to the back and walk farther in to where you get on. If you're standing and waiting for your subway, you could be marching in place. I guarantee you nobody's gonna care. Honestly, if you live someplace that there's a subway that most people take for public transportation. I promise nobody's going to look at you sideways. If you're walking in place, or walk up and down. Don't just stand there looking at your phone. Sorry, calling out people, right? It's the thing that people do, but you could be getting in more steps by just walking back and forth waiting, right? Going up and down on an escalator instead of standing. Walk on the left stand on the right. Be the Walker on the left.

Scott Benner 14:45
I will have an episode coming out a few weeks after this one goes up and it's with this person. We were just talking through ways that people can like lower their glucose values not and it wasn't about people with that. Diabetes, this person who comes on as a guest, she's talking about just everyday average people. And I thought, Oh, I'll have her on and see how what she's talking about might relate back to people with diabetes. And she was talking about calf raises, and how working your calves like just sitting in your seat, like lifting your heels and bending. And she's like that could actually lower your blood glucose. And I was like, oh, Jen, I forget her all explanation off the find it. Yeah. But yeah,

Jennifer Smith, CDE 15:29
there are whole bunches of things like that, even if you have a desk, get and you have the opportunity within wherever you work, get a standing desk, one that you can raise up and down, stand part of your day versus sitting, you actually burn more calories standing than you do sitting all day long. Even if you're just standing in one position. If you have, you know, an underneath of a desk that allows enough space for one of those, it's, it's like a tiny, little pedaling. Like I can't remember what they're called, right. But you could be getting in some movement by doing that, and you're building it into your day where you're already continuing to do then what you need to do. But you're adding it in, which is extra. You know, if you got kids go walk to the bus stop and go and pick them up there in back. These are just, it's not what we would call exercise session, like 30 minutes at the gym with the trainer, right? Yeah. But this may be adding more than what you were doing. And it could start to add up,

Scott Benner 16:38
you know, a pet a desk pedal is what I guess they call it a portable under desk, or you know, you can get them for as low as like $35. Yes. So you all have Amazon, it can be at your house tomorrow, and you don't and you don't need the one that's like 200 bucks. So they that's a great, I mean, that's just that's what we're that's what I'm talking about here, because getting started has got to be the most difficult part. Yeah, I mean, just honestly, with this whole series, I keep thinking that, you know, whether it's going to the doctor, asking speaking up getting a blood test, like the Getting Started part is, is just always kind of the biggest leap. And that's why I'm excited to talk about it.

Jennifer Smith, CDE 17:17
Another one is if you do have some of even news, if you watch the news every single night, or you always sit down to a favorite program that you've recorded, and now you're going to catch up on it either during the commercial breaks, get up, move around, maybe get some simple five pound hand weights, lift them up and down while you're sitting on the couch or your your your favorite chair, or stand up during the commercials. Again, walk in place, do some squats, squats, kind of like the leg raises are, they're a great way to drop your blood sugar honestly, like crazy. So they can these, they could all be added in again, as examples to your day to day normal stuff that you're trying to get done. Without creating too much change in your, I guess what you're trying to do?

Scott Benner 18:09
Yeah, I also think that it can be scary, like the idea of like, we have to start exercising I imagine people think about, Oh, I gotta get a gym membership. I gotta go to the gym, they're gonna be people that are in better shape than me, I'm gonna be embarrassed. I don't want to do that.

Jennifer Smith, CDE 18:20
I don't know how to write that cost.

Scott Benner 18:22
It's a cost. I don't know how to do the exercises. Like I don't think you have to start with that even just like little tiny five pound dumbbells that you could I'm sure grab anywhere you could probably probably things in your house you could use just to just do some current like easy curls to like help the muscle tone come back and other ways to burn calories. You know? Yeah. It just make yourself stronger overall, like your whole body like it doesn't have to start with you know, military style push ups and

Jennifer Smith, CDE 18:53
not at all. And today in today's world, even something like a gym membership doesn't it's not necessary because we have so many tools that are free. YouTube is full of stuff that you can get started with. So again, as you mentioned, if you're if you are worried about how you might look or that you don't have the right clothes to wear or whatever it might be or that the gym membership is just, it's too pricey. It doesn't fit into your budget. Online. There are a number of they you close the windows in your house. Nobody has to see you. You could do it at two o'clock in the morning if that's what your schedule, you know, permits. There's a there's a wonderful it's it's walked down your blood sugar, it's by Lesley sandstone. She does she's fantastic. All of the people actually, in her online videos have diabetes, most of them with type two diabetes, and she has anywhere from 15 minute walks all the way to 45 minute walks going a mile all the way up to three miles And she's she's funny and she's fun to listen to. So that's one that I used to recommend a lot, actually, when I was working with the education

Scott Benner 20:11
when we want people to listen to the podcast while they're working, though, no, no, my I mean, my podcast, that's one. I want to I want to say something kind of like, odd that I make your point. I don't know how many people know Joelle and bead. He's a basketball player for the Sixers. And I read an interview with him recently. And they asked like, because he lived in Cameroon, he you don't think he came here until he was 16. He wasn't a like a basketball player. They asked him how he learned to play. And he said on YouTube. He learned to shoot on YouTube. He said, he said, I went to YouTube, I watched a bunch of videos and I went to the gym and practice. So I don't know what isn't on YouTube at this point. Correct. You know, go find something that will help and stretching to Right. Like I wanted to bring this up, like just getting your body stretched out is such a big deal. Yeah. And again, I think you can you can go to YouTube for that as well.

Jennifer Smith, CDE 21:10
Absolutely. There's even some really good flexibility, yoga, there are a number of different people who have really good free programs, some of them are even like 30 day, and you can start them and each day kind of builds on itself. And they're short enough to fit into a schedule that may not permit a lot of time. So yes, there. I don't, I don't think there's anything you can't find on YouTube.

Scott Benner 21:35
And there's no shortage of people on social media who are sharing their journey as well and throwing a camera in front of themselves and saying, Look, this is where I started. And here's how I've been going. Whatever you need for motivation, but the the movement itself. So how much? How much actual movement? Do I want to start with? Is it a certain amount of day? Is it a certain amount of week? How do I count it a

Jennifer Smith, CDE 21:59
certain amount of minutes, about 150 minutes a week is the goal. And that's a little bit more maintenance, right? If you're really looking for your activity increase, or your addition of activity that wasn't there to benefit loss, we're looking at around like 200 plus minutes a week kind of give or take. And the average recommendation is about 30 minutes of exercise a day, right or five days a week. So

Scott Benner 22:32
and should it be spread out? Like I don't want to, like get up one day and try to put two hours in or something like that. Right? Correct.

Jennifer Smith, CDE 22:38
And I think that's an important point to make more talking. Specifically, in the realm of people who have diabetes, the more regular your activity is, especially around medication use, the more likely it is you're going to have a sort of an overlapping effect on a day to day basis. If you get consistent every morning, I get up I take a 20 minute walk Great. That rolls into the next 24 hours and that day rolls into the next day. So we really do want regularity and not just saving it all up and saying Saturday morning that's when I'm gonna get this 150 minutes it

Scott Benner 23:18
well type to see the same benefit that type one see from consistent Okay, not Jenny's

Jennifer Smith, CDE 23:24
Absolutely, yes, I mean muscles, muscles that build and you build muscles by exercise multiple different kinds, right cardio as well as your weight bearing flexibility. those muscle cells are what respond to insulin and allow them the glucose to be shifted into the places that it's supposed to. So exercise is it's like free insulin, essentially, it Prime's, those receptors on your cells to open up. Because when you move your muscles, they need energy. Where's the energy going to come from? It's going to come from the glucose levels in your body, right or some of it. And so then that decreases your blood sugar levels, which is great. Yeah.

Scott Benner 24:08
So I'm going to ask you a question. I might not be right about with a type two. It's not that they're not making insulin, their body's not using it correctly, and doctors are going to call that insulin resistance. Does exercise help with that? Or can exercise help?

Jennifer Smith, CDE 24:23
Yes, absolutely. That's a big reason for adding exercise is decreasing the amount of resistance that's in the picture? Yes.

Scott Benner 24:32
So the exercise works exactly the way it does and type ones and type twos, like exercise helps your insulin be more productive, you'll need I say, yes. My daughter who has type one is at college. And she had she's decided to start driving to class. And I thought, Oh, I wonder if she's gonna need more insulin like that? Because she because she was walking getting on a bus getting off the bus and humping her ass one way and the other and then all of a sudden she wasn't it And then she got and then you know, the the new semester started up. It's a quarter, the new quarter started up. And she got a lot of desk work again. Oh, so this week, she's like, I'm using so much insulin this week. And I was like, yeah, like you're driving to school, and you're sitting at your desk, and still eating that horrible college food. We have one more quarter to go. Arden requested. She used her accommodation. So I know this isn't for type two so much. But she used an accommodation to ask for a dorm room that had a kitchen in it. Because she's like, I have to start cooking for myself. I have to stop eating this food. Good for her. Yeah. So it was really, really kind of cool. But anyway, they gotta move. Do you remember? What was it the Big Blue Test?

Jennifer Smith, CDE 25:46
Remember? Yes, absolutely. That was where during November diabetes Awareness Month, the Big Blue Test was check your blood sugar, get up and move for 15 minutes, right? 10 or 15 minutes, I think it was and then check your blood sugar again. And post it was really the idea of getting people to see that movement, even if you've got only 10 or 15 minutes, really did have a very quick impact on blood sugar.

Scott Benner 26:10
Yeah, I just remember that. That's something that that had to be 15 years ago and the type one community Right? A long time ago. Yes. Yes. I'm gonna say again, I'm all for one of you listening to like, jump on social media and share improvements with your type two diabetes, the way people share improvements with their weight, the way people share improvements with all kinds of other things, exercise improvement, like just show people, Hey, I did this today in my agency, you know, especially if you have a CGM, you'll you'll be able to go into their the clarity app, if you have a Dexcom. And say, Look, my my agency estimated last week was this and this week, it's it looks lower. And, you know, try to be I mean, if you need that to motivate yourself, great. If you think you can help somebody else is terrific as well. Right? Yeah.

Jennifer Smith, CDE 26:58
And, you know, I think the other thing in the realm of adding activity is people stay motivated when they've got somebody else that is working with them to their goal, right? So if you're somebody who says, I've got this 30 minutes after I finish work, and I want to get out and exercise, maybe there's a friend that will walk with you, right? Because now you're also tying in a scheduling, which makes it more it makes it more like an appointment that you've made. Yeah. And you don't want to let your friend down because you've made this appointment. So you guys, you keep your each other sort of on track with this plan of action. And it's kind of nice.

Scott Benner 27:45
It's a great idea. It really, it really is like a gym buddy, but a walking buddy, or

Jennifer Smith, CDE 27:49
Yes, exactly. Right. Or a pickle, buddy. I mean, I don't know how many people have like, we've got a park right across the street with tennis courts. And last summer, they actually because so many people were playing pickle, or pickleball, or whatever it's called, right? They drew the cord for the pickleball lines, right? All on the tennis courts. Because people were playing it anyway. Right. So you know, maybe somebody has said to you, hey, you know, come play pickleball with me or whatever. And add that in. That's a fun form of exercise.

Scott Benner 28:22
Right? I think back to when I was in my early 20s. I was working with this bunch of guys. And they were playing, I forget what they call it. But it was a it was a game you played with a ball, but it was in a racquetball court. And there was a net, some people on either side, and we would get together and do it like once a week. And that was probably the best time of my life as far as being in shape. And I didn't even think of it that way. It was just moving. It's just fun. Yeah, right. And it was fun. And like, it wasn't difficult either. Meaning it was after work. I used to have a terrible job. So I worked very hard all day, like we were beat up at the end of the day. And we still all showed up and did it. You know,

Jennifer Smith, CDE 29:01
and it was probably that type of activity, you bring in a good point, maybe there's an activity that you can get into that is a it's a release of everything that you've put into your day, that's not been the greatest or that has been really difficult to maybe you can find an activity that's just like a, maybe you go in you box, oh, you take a kickboxing like something or

Scott Benner 29:27
I visited my son recently, and he just, you know, in the last year, graduated from college and stopped playing baseball. And he just one day, he said to me, he's like, I can't talk. I'm gonna go play basketball. And I was like, where he goes, I'm going to the park. There's got to be a game there. Right? He's in a city by himself right now. And he's like, I cannot sit still like this, but it's he's got the mind of an athlete. Like, like, I can't just sit here. And so he went to play basketball. And he's like, Oh, I met some guys like Applying now this is terrific. And then he said to me, I might try to find a boxing gym. Even like he's like that looks like good exercise. And it's just interesting the difference between. And I made this point in another episode, and I hope people are tying this all together. We all drag our five, six year olds to some sport, and they're all able to do it. And some kids keep doing it. And they're not all like, don't get me wrong, right? They're not all like pros, but they can get up and they can go and they can do it. And they're, they're healthy and they're moving. And then some people make a decision to stop moving, and some people make a decision to keep moving. There's no reason you can't make a decision to go back to moving like that correct? You know, there's just no reason you can't do that. So

Jennifer Smith, CDE 30:44
and I think the more that you do that, especially if you have children at home, the more that you do that, the more likely it is that you're by show teaching them that, just because mom and dad are adults, and they're doing all these other things. They're still taking care of themselves, right. I mean, my kids see me exercise all the time, especially now that I have actually gotten nice outside, like temperature. And when I take my kids to take one dough Now, there's another mom I've been talking to. And last week, I got to class I dropped my kids off, I was like, you have fun in class, I'm gonna go take a walk. Because of right I just otherwise sit there and watch them and what's the purpose for me, then I could be doing something for myself. So she looks at me. She's like, I didn't touch that. Can I walk with you? It's like, great. Come on. There was

Scott Benner 31:38
a father on Arden softball team, and we'd get to a practice. And the kids would get settled. And he'd put on different shoes and just take off and run. Yeah, and that's it. He did it every time he used the practice as his time to exercise time, exactly home, and I'm not doing other things. I'm not just gonna sit here and stare these kids practice and softball. So I'm gonna go through this now.

Jennifer Smith, CDE 32:04
Right? I mean it unless you have to be an interactive part of your child's participation in a sport or whatnot. Obviously, it's important for them to see you there and paying attention and cheering them on and all of that kind of stuff. But if there are points at which, clearly they don't even care until you pick them up. Go be busy yourself.

Scott Benner 32:28
There's a list here I found that I'm going to run through real quickly just because I can imagine people are like, I don't want to go for a walk. So ride a bike, walk your dog, which I thought we should like, you know, maybe your dogs like the guy never takes me anywhere. Skipping rope. Please don't do that. If you're on a high floor and an apartment building Frisbee. The gym swimming this hokey hosted dance party. If you do that, please let me know. You This is akin to what Jenny was talking about earlier, use the stairs instead of using an elevator, carry out household chores things need to get done anyway. Just even moving around the house and bending over and reaching around the back of the toilet. And like at least you're moving right? Yoga is brought up here. Again, that's something you could do through YouTube. This is a temporary rock climbing. I'm not doing that. Go for a hike, hula hoop. Join a sport. There are some parks have circuits already set up? Yes. Like if you don't know what they do, you can

Jennifer Smith, CDE 33:31
they're typically like called Vita courses. Essentially, they have you walk a little bit and then you do like a pull up. They have you walk a little bit. And you might do a couple sit ups on like a park bench or something like that. But they've got a visual of how to do the exercise, how many reps to maybe do. And then hey, proceed on down the path from here.

Scott Benner 33:49
This one's interesting. If you bowl three games, you'll walk an average of a half a mile. Now, who would know? I'll say one i i used to love like photography. And then that love of photography. I kind of pointed at my children and now I have way too many pictures of my kids. But when you go out to take pictures, you wander around looking for things to take pictures of it's another good way to keep your mind busy. And not tell yourself oh, I'm out here moving around because I gotta get moving and you know, and spin class at the end. But that sounds horrible.

Jennifer Smith, CDE 34:31
I used to love my spin class. I don't belong to a gym anymore. But I I really loved my spin classes. They were a lot of fun.

Scott Benner 34:38
So what are we looking for out of exercise? Like because this I mean, obviously we're not talking about, you know, we're not talking about lifting weights. We're not talking about doing anything really intense. So what's the feedback I'm looking for from my body to tell me this is worthwhile and valuable for me.

Jennifer Smith, CDE 34:57
Right So one big thing as I would recommend And for anybody starting something they haven't been doing is make sure that you are okay to start it right, your doctor visit, make sure everything's fine. As long as that's the case, then out of exercise you're looking for an increase in your heart rate above sitting down. And right. So you mentioned dog walking before. dog walking is fantastic. But if you take your dog for a half mile walk, and every three steps is a sniff and pee and grab and chew on the stick. You're probably getting a little more movement than you might have been sitting at home, but you're really not getting like, like, walk the dog

Scott Benner 35:47
sense of wandering around the kitchen with trees.

Jennifer Smith, CDE 35:50
Yes, exactly. So you're looking at us an increase in your heart rate. You don't have to be out of breath. In fact, some of the most beneficial for weight loss type of movement is honestly being able to carry on an easy conversation, not like we're having now. But you should be a little out of breath, but not terribly out of breath that you can't actually get words out, right. So thus, the reason bring a friend along, you can have a nice conversation about something but Yes, a bit of an increase in heart rate. A warm if you're moving and we're talking about cardiovascular exercise here. You are going to warm up if you're getting enough movement in.

Scott Benner 36:36
I'm going to bring up something from the podcast. Let me see if I can find it. Oh, there was a guy on episode 713. His name's Adam, he had type one diabetes, the episodes called a rage rocking, because I thought that was funny because I thought that was funny not because that's because not because it has a lot to do with anything. But he he lost weight rocking, which is walking with a backpack that's weighted. And apparently, Jennifer apparently this is Inc reasonably popular. So if you're if you're a person who wants to go on a hike, or you know, just go for a walk and add a little more to it, apparently rucking is a terrific way it's worth googling or looking at or listening to Adam story in the episode because his experience was, I remember being pretty like blown away by what he was able to accomplish.

Jennifer Smith, CDE 37:34
I wonder if rucking came? You know rucksack is actually the term for a military attack.

Scott Benner 37:40
Yeah, somebody, somebody, somebody looked at a bunch of guys who were, you know, overseas, they're like, those guys are all in great shape. Yeah,

Jennifer Smith, CDE 37:47
well, and that's I mean, that's essentially what they do is they go out, and they, they hike with a lot of all of their stuff in their backpack, and it's training,

Scott Benner 37:56
they're carrying their life with them, and they have to carry it. And apparently, it's apparently it's an insanely beneficial. So a thing that from his description, and when I remember looking into it is something that does have easy entry for you. Like, it's, you know, you just grab a backpack at home and put 10 pounds in and go for a walk. And then when it gets easy, add more, you know,

Jennifer Smith, CDE 38:20
and what comes up to me as a another good suggestion for a parent who has a child that is of the size that you can put in one of those carrying or the right, carry your child, if you're gonna go out and take a walk, while pushing a stroller is also something to be said of extra. Carrying that child on your person and walking adds more just like this idea of a weighted backpack. Yeah,

Scott Benner 38:48
yeah. You know, it's funny, it just made me think of something. I went to high school with a guy who's like a land management personnel. And he's one of those guys. he's outside all the time. He carries his gear with him. I stop and think about that guy. He's absolutely chiseled. Yeah, he's just he's got little Ripley muscles on top, a little Ripley muscles. He's outside. He's moving. He's carrying things. I don't think he's setting up a gourmet meal that has cheesecake at the end, probably, you know what I mean, outfield so he's living that lifestyle he's getting and I think that really is what we're talking about. Right? Like there's, there's a lifestyle that leads to an end, just like, just like sitting around leads to an end. Moving around, leads to an end. Yes, I did. Really. I loved your idea of like, including someone else too. I mean, going all the way back to my story of when we were kids. It's my aunt grabbed her daughter. And I want to be clear, like I did not grow up in a family full of people like exercising. Right. There were two exercises I saw done in front of me in that time. It was those walks. And my cousin doing something that involved her going I must I must I must increase my and these are the only the only exercises I was ever witnessed. Oh, that's so fine. Second one did not work for her. If you're wondering,

Jennifer Smith, CDE 40:11
no, it won't work, although it's funny that we're both in the same category of having I totally remember that as well. Yeah.

Scott Benner 40:18
There was this thing with a spring, right? It was Yeah. And you were trying to make your I don't want to be in delicate. You're trying to make your boobs bigger. But that's not how that works.

Jennifer Smith, CDE 40:26
That's not how that works.

Scott Benner 40:30
out, you could have just had a little more milk as you were growing up and that might have done it. Yeah.

Jennifer Smith, CDE 40:36
No, but But yeah, definitely in involving someone else in your plan. keeps you motivated. Because again, you may be even checking in with them. Right. And if you wanted to go a little bit deeper, there are there even, you know, some some tracking apps, things like many of the tracking devices, the tracking watches and those kinds of things. They've got motivational things on them that will even tell you, hey, you know, like my watch, it tells me Hey, get up, you've got 250 steps to get in yet this hour, like you've clearly been sitting on your bottom. So get up and move some

Scott Benner 41:14
right say to like, for a lot of you. I mean, you might have a little natural anxiety to begin with pointed at something valuable. You know, like, if that's a great point, if that app is like, look, walk this many steps, or a lot of you whose personalities you're gonna go, Okay, well, I need to do this now. So sometimes just asking it of yourself is going to make it happen, because it's kind of how you're wired. You could be doing that with, with things that are not beneficial in your life and not realizing it. Like, it's interesting how we can turn things into tasks. Yeah, do you know the mean, and some of them are not always good, but they become repetitive and you do them anyway. Right? Okay. Well, I love the way you just said it now, like involve someone else in your plan. And I thought, if you're robbing a bank don't involve any exercising, tell people tell people? That's exactly right. I say that more than two people can't keep a secret. So eventually, someone's gonna snitch. In this situation, that'd be a great thing.

Jennifer Smith, CDE 42:15
That would be a good thing.

Scott Benner 42:15
What are we? Are we not saying anything that we should be here?

Jennifer Smith, CDE 42:19
Oh, I know, I'm trying to think. Well, I think it goes along with involve someone else, if you are the type of person who really needs some direction. And if you have the means, it may not be a bad idea, with motivation in the picture to just call a gym and see what it would be like to get a month's worth of a trainer. Right? Somebody who can give you a starting place where you are, and give you an idea of how to progress out of that. Even if you're not going to stick with them longer than a month, you've got an idea. Now you've got a base to continue to build on. And it may very well be money well spent.

Scott Benner 43:04
Yeah. Also, if you're looking for another reason to do that, it's a great place to meet people too. It is, you know, in a world where it's hard to meet other people, we were talking about this somewhere the other day. It's hard to date. It's hard to like it's hard to even, it's hard to meet people you're working. You know, some of us are working in our homes. There are days I just go out to go out, because I'm like, I gotta leave here. Now, you know, middle of the day yesterday, my mom was asking for something. I was like, I'll go to the store and see and my brother's like you don't live here. I'm like, I'll mail it to her. I just gotta get out of the house.

Jennifer Smith, CDE 43:39
So you need to see other people in real person

Scott Benner 43:43
fresh air. I got my car I drove I walked around a little bit. I was like, Thank You know, I needed to get away and you don't, it just becomes I don't know, like, the whole COVID locked down. It really shone a light on that for me that if I'm not careful. I could do this forever and ever and ever and ever and ever again and never break this cycle whatsoever. It's you know, it's there's always work to do. There's always something to do around the house like I could, you know, can easily become a shut in no problem. Right, you know, don't be a hermit. Yeah, Herman's Hermits, it's okay, but not like a regular hermit.

Jennifer Smith, CDE 44:21
Find your dog and you've got a dog. Yeah, find your dog. Take the dog to the dog park. You will see people there.

Scott Benner 44:27
I got a great walk the other day because my dog just wandered away. I'm trying to talk to my wife at the back door and we're having this conversation about something and I turned around I was like, where Where's where's the dog? So now I'm like, Oh, I know which way he likes to go and walk in that direction. Also, I stopped to get a sweatshirt because I'm delicate and it was chilly. So

Jennifer Smith, CDE 44:50
you can see your delicate Scott. You're not delicate. Got a

Scott Benner 44:54
little distance on me because I was like, I'm not going out with that sweatshirt. And then he's just five doors down standing in someone's backyard. And he's like, He's so old. And I was like, Andy, what are you doing buddy? And he looked up, he goes, Oh, hey, he looked at me like, I'm lost.

Jennifer Smith, CDE 45:11
I don't smell right anymore. So I don't know exactly which way to sniff back to where I'm really supposed to be. He looked

Scott Benner 45:17
at me like I was standing here waiting for you to come find me. And he's looked at me. He's like, and then he starts like, he forgets he's old. He starts to run. And then he's like, Oh, can we walk? And he looks at me like, let's let's not go too fast. I'm like,

Jennifer Smith, CDE 45:30
Can you pick me up? In fact,

Scott Benner 45:31
he's too big for that. But I hope that doesn't come to that. Oh, gosh. Anyway, Jennifer, I really appreciate you doing this very much course. Yes, thank you. I'll talk to you soon. Hi.

If you're enjoying the type two Pro Tip series, please share it with someone else who you think might also enjoy it. Let me thank better help for sponsoring this episode of the podcast and remind you that if you go to better help.com forward slash juice box you will save 10% off your first month of therapy. And don't forget that full line of contour meters at contour next.com forward slash juice box they are really accurate and very worth checking out. Contour next one.com forward slash juice box. Hey guys, if you're looking for community around your diabetes, check out the private Facebook group for the Juicebox Podcast. There's links in the show notes of your audio player. And if you'd like to hire Jenny, she works at integrated diabetes.com. Just head over there and ask for Jenny

#888 Iron Deficiency Anemia with Dr. Pelcovits

Ari R. Pelcovits, MD has type 1 diabetes and is on the show to talk about iron deficiency and ferritin.

+ Click for EPISODE TRANSCRIPT

Scott Benner 0:00
Hello friends. Welcome back to the Juicebox Podcast. Today, we're going to be listening to Episode 888.

I was so excited to make this episode. I've got a doctor on, he's got type one diabetes, that's how I found him. But that's not why he's here. Today we're gonna be talking about anemia, and low ferritin. Now before you say, Oh, I don't have anemia, I don't have to listen, please trust me, just check this episode out. Anemia low ferritin. And its impacts are very, very, very much under diagnosed. 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. We're becoming bold with insulin. Couple quick things. If you have type one diabetes, and you're a US resident, or you're the caregiver of someone with type one, please complete the survey AT T one D exchange.org. Forward slash juice box. It will help diabetes research to help you and it'll help me t one D exchange.org. Forward slash juice box. If you'd like to get 35% off your entire order at cozy earth.com. Just use the offer code juice box at checkout. And to save 10% On your first month of therapy. Go to betterhelp.com forward slash juicebox. This episode of The Juicebox Podcast is sponsored by touched by type one touched by type one wants to elevate awareness of type one diabetes by raising funds to find a cure and inspire those with diabetes to thrive, touched by type one.org. And I'm going to take this opportunity to talk about the podcast just for a second before we start. So sort of an ad for the podcast. A lot of the management stuff is broken up into series defining diabetes defining thyroid, the diabetes Pro Tip series, the bold beginning series, there's an entire collection of algorithm pumping episodes, ask Scott and Jenny, just episode upon episode of listener questions answered by myself and Jenny Smith. There's the diabetes variable series, the mental wellness collection, how we eat, and very new to the podcast, a type two series for people who are struggling to understand what their Type Two diabetes means or how they can get started with helping themselves. And of course, the after dark series, which has a long list of interviews with people living with diabetes, and their stories that let's just say don't usually see the light of day, you can search for the series within your podcast app, like you could say defining diabetes juice box and it would come right up. Or you can go to juicebox podcast.com. And there's links at the top of the page in the menu section that will allow you to see every episode that's in every series and collection and then you can just go to that episode as you please. And if you're in the private Facebook group, and please I hope you are in the featured tab. There's a tab at the top that's called featured. There's lists of all of these series and collections there for you as well.

Ari R. Pelcovits, MD 3:29
I'm already Palca that recently diagnosed type one diabetic and also a Hematologist Oncologist in Rhode Island. And happy to be here today.

Scott Benner 3:40
Good morning. How are you? I'm doing well. This is one of these odd situations. You ever hear somebody say I have x disorder and I can't wait for someone famous to get it so that they pay attention.

Ari R. Pelcovits, MD 3:54
Yeah, no. Yes. Yes. That is sometimes the best thing that can happen to any disease and someone famous getting that.

Scott Benner 3:59
So for my situation and what I'm trying to accomplish a hematologist getting type one is perfect. Sorry for your trouble, but I'm looking forward to picking your Yeah. Well tell me first How old were you when you were diagnosed?

Ari R. Pelcovits, MD 4:16
So I just got diagnosed about five months ago, and I'm 36 now so I was 35. Okay,

Scott Benner 4:22
is there a history of autoimmune in your family?

Ari R. Pelcovits, MD 4:24
You know, really little, my mom has Hashimotos which I feel like, you know, a lot of people too, but outside of that, I was sure I was gonna get cancer. I mean, that's kind of why I wanted to be in hematology oncology. And so it was it was a nice surprise. When I got this diagnosis.

Scott Benner 4:39
We wait You thought you're gonna get cancer. So you became a hematologist? Tell me about that. Exactly.

Ari R. Pelcovits, MD 4:43
Yeah. Well, you know, my mom have had breast cancer, which he's doing great from, and my brother when I was a kid had lymphoma, also, he's doing great. So just a lot of life experiences that I think led me down the path towards oncology, and then always in the back. I mean, I don't know if it's true every doctor but I think a lot of doctors are hypochondriacs and assume they're gonna get almost every disease, but most likely also assume the ones they treat they're gonna get because they see it all the time.

Scott Benner 5:13
Well, I can tell you this, that a lot of people who need therapy become therapists. I don't know why that

Ari R. Pelcovits, MD 5:20
Exactly, exactly. Yeah. Although my endocrinologist told me other day that maybe I should take my endocrinology boards now just for fun.

Scott Benner 5:28
Well, you're a, you're a well educated man, you certainly went to a good medical school and tell people where you went and what you're doing now.

Ari R. Pelcovits, MD 5:36
I went to medical school at the University of Maryland where I grew up. And then I came up to Rhode Island and did my residency and fellowship at Brown University. And now I've stayed on and I treat patients with both cancerous and non cancerous blood conditions.

Scott Benner 5:51
And that explains why your internet stinks. Okay.

Ari R. Pelcovits, MD 5:55
That's exactly.

Scott Benner 5:57
Alright, well, I will not go down the rabbit hole of Rhode Island. I'll skip right over that. That's fine. And, and just say how long you've been practicing?

Ari R. Pelcovits, MD 6:07
Well, so actually, I'm just out of out of training. So you know, medical training, just to be fun takes forever. So my training was seven years, and now I'm about six months or no longer nine months out of training. So I'm almost finishing my first year in training.

Scott Benner 6:20
Wow, that's insane. Well, I appreciate all the effort you put into it. It's really, really something honestly, may you live long enough to pay off your debt?

Ari R. Pelcovits, MD 6:32
Make it worth it? Yeah. Okay.

Scott Benner 6:33
So tell me a little bit about how you manage your type on. Yeah, so

Ari R. Pelcovits, MD 6:37
I currently am on a pump. I'm on the tandem T slim. And I have Dexcom, which I was able to get pretty quickly, I think, was on MDI just for a couple months after diagnosis, and then got on a pump, maybe about two months ago or so. And it's been pretty awesome with the pump since then.

Scott Benner 6:57
Are you using control? Like you? Yeah. How do you find it?

Ari R. Pelcovits, MD 7:03
You know, I find it overall good. I eat I wouldn't call myself like a low carb person. But I definitely changed my diet since diagnosis and much more of a low carb on the end of the low carb things. So I think, you know, I stay pretty steady from that perspective. And I don't think control IQ has to do a ton of work. It is interesting where I didn't notice, like I think with Lantis you know, I kind of knew what was on board always. And with the control IQ the way it's kind of adjusting things. It can have some impacts where you know, some days I have more insulin on board than others just because for whatever I've been doing, it's decided

Scott Benner 7:40
I needed more. Yeah, you're using Lantis out the box. Yeah,

Ari R. Pelcovits, MD 7:44
I started on Lantus and fast acting with with males.

Scott Benner 7:48
Okay. Hey, are you did you put on a headset with a microphone? I did you just move it a little farther away from now from your popping a little bit? Yeah. Is that better? Yeah, we'll find out. So okay, all right. Well, I don't want to skip over your diabetes, but I have a lot to ask you. So yeah, that's fine. We can come back to my diabetes. Okay. Where does this begin? Where does my obsession with understanding people's iron and ferritin levels begin? I guess, if I look back over my life, I was a person who was tired all the time. I didn't know it. If I came to your house to watch a movie, you know, back when people rented videotape, so if you remember that. Yeah. I would be asleep halfway through the film. It was a joke. We go to a theater. Scott be asleep. Come to the house. Scott's gonna fall asleep. I have fallen asleep. Driving a car. Oh, gosh. Okay. I mean, in in moments when you probably shouldn't just, it just became a thing. Sort of just like, and it was always put on me. By the way, there it was. It always was. I was always treated sort of like, oh, like he can't even stay awake. Like it was nobody ever thought anything medical. They were just, you know, anyway, 80s 90s. I don't know if people realize how much more the world's come along because of the internet and things like that. But back then somebody made a snap decision about you. And that was it for the rest of your life. Right? You were sleepy. So I'd go through bouts of it where it was terrible. And then it would get a little better go back. I'd get used to it. I was good at pushing through it. I guess one day, I just said to my wife. I feel like I'm going to die. And I didn't know another way to put it. I was like, I'm like if if this isn't what dying feels like then you know, I don't know. So I went to a battery of different doctors. And my ferritin level comes back very low. I think like 13 Maybe. And, of course, like I didn't realize it at the time, but everybody in the room looked at me like oh poor guys got cancer. like that, that's now I look back. I know that was the look I was. Yeah. And how old were you then? Oh God in my 40s, my mid 40s Okay, you know, and then the battery of tests, we're gonna put it through, we're gonna put a camera up your ass, we're gonna put a camera down your throat here swallow this giant pill, it's got a camera in it, like, like, all that stuff. Come back. And the answer is, huh, there's nothing wrong. I was like, okay, so any reason you can think that you would have blood loss? And I said, I've had one pesky hemorrhoid my whole life, but I don't know that it's bleeding that much. You know, like, meanwhile? I don't know. Like already. I don't know. Like how much blood loss is blood loss? Right? You know? No, yeah,

Ari R. Pelcovits, MD 10:49
you what looks what looks terrifying to you sometimes in a toilet bowl is actually kind of mild compared to what will really drive your numbers down.

Scott Benner 10:56
What a nice thing to say. And it's so anyway, then some tests come back. I have something called Berets. Okay, and maybe you're not absorbing iron correctly, Scott. You know, I don't have celiac. I don't have like, you know, like that. All that. So I'm like, Okay, so what's this Berets? And then you might be able to explain it better than it was explained to me. But it's been. I kind of assume it's like a precursor to a can a soft to cancer. But

Ari R. Pelcovits, MD 11:28
yeah, doesn't necessarily have a GL was the word I think you were holding back on.

Scott Benner 11:32
Thank you. Because I wasn't certain. So cursor, esophageal cancer, but doesn't have to be that and, and take this thing and keep, you know, keep your stomach acid down? Well, at that moment, I was like, Well, I'm just going to change the way I eat. If, if that's it, because I didn't, I did have heartburn, like throughout, maybe not throughout my life, but it was getting worse. So I cut out like oils. It's a strange thing. But I cut all oils out. I stopped eating later at night, like little things like that. And I was actually able to deal with it on my own.

Ari R. Pelcovits, MD 12:06
Without any sort of medicine for the heartburn. Yeah, I

Scott Benner 12:08
used the medication in the beginning, but then I got away from it. And I still keep like a, I don't know, like an acid like a chewable by my bed in case something happens, because I've learned not to ignore it. But I mean, I might be used those. I don't know, once every six weeks, something like that. So and that's and

Ari R. Pelcovits, MD 12:27
you're still getting iron infusions now or you sort of got it and you're done. Oh, no,

Scott Benner 12:31
I get the iron infusion. I feel like a million bucks. Six, eight months later, I start tailing off again. And then I gotta get him again. Yeah, I've had iron infusions. I've lost track. Now. Honestly, over the last couple of years, I've probably had 10 of them. And I, you know, I take my biggest my biggest leap was that the doctor kept saying, Well, maybe it'll hold on. And then one time after an infusion, he retested my iron in my heart and was so high that he was like, Oh, good, you don't need to take a supplement anymore. And then I was like, Oh, I'm good. And then I didn't take the supplement. And then of course, eventually, it dropped back. Right?

Ari R. Pelcovits, MD 13:12
I mean, your story that your story is so classic for the type of patient I see with iron deficiency. It just the number of people I see who go down that same path of, you know, where's the blood going? Where's the iron going? We can't find it. But clearly, something's going on here. And they need iron to feel better. Yeah, I'd be happy to kind of run through, you know, why we think that process and you know, what are sort of when someone comes in with low iron, what we're thinking about and why they thought you had cancer? If that would be helpful, please do. Yeah. Yeah. So you know, well, the main thing is that we need iron to make make our blood and that's why we care about it. And so oftentimes, if you don't have enough iron, you also then won't be able to make make enough red blood cells. And that's when we use the word anemia, so become anemic. And I think for a long time, people thought that it was only if you became anemic, that you would start feeling crummy. But clearly, there's tons of people like yourself who just having low iron makes them feel awful, tired fatigue, no energy. And the way we can sort of not have enough iron in our bodies is usually one of two mechanisms, which is either we're losing it in the blood, because the iron that's in our body is mostly in blood. So whenever we bleed the iron in there, it gets lost. And then our body uses up whatever sort of iron stores we have. Or we're not absorbing enough iron. And so and someone who's over the age of you know, we used to say 50. But now with this happening younger, probably even over the age of 40. If you come in and especially if you're a man and don't have any other reason to be losing blood, we certainly worry could this be a cancer in the GI tract or colon cancer, cancer higher up that's causing you to lose blood and that's why you have low iron

Scott Benner 15:00
Oh, to say that I don't feel well. By the time I was able to tuck a hematologist into giving me an infusion. And it was really like I had to bang on people's heads, because the last thing they made me do was eat. Even though I didn't have any signs from testing of celiac, they made me eat a gluten free diet for a month. Oh, interesting. And so I'm eating a gluten free diet. And one day, I'm in my kitchen, and I just bend over to pick something off the floor. And I almost went headfirst into the floor. Like I was diving into the floor on purpose. I just couldn't hold myself up anymore. I was at the point that no matter how long I slept, and when I got up by 1pm, I couldn't function anymore. And I took myself to the emergency room.

Ari R. Pelcovits, MD 15:53
And were you were you? Did they make you go on iron pills first?

Scott Benner 15:56
Oh, I had to do everything. Everything that everyone knew wasn't going to work I had to

Ari R. Pelcovits, MD 16:01
write did you get the bad constipation from the iron pills? No, because

Scott Benner 16:04
I used a really good formulation to do it. I used I use the thorn labs iron I mixed it with a their vitamin C brand and I didn't have any trouble with that. I've also learned by trial and see works really well. Okay, but point being I wasn't just didn't feel well, like I was shutting off. And, and so I went to I went to the emergency room. I because the doctor still wouldn't give it to me I hadn't completed all the things I had to do. I told my wife, I'm like, I'm not gonna make it to the end of what he needs to do. And I explained everything to the ER and some lovely doctor in the ER gave me a small iron infusion not nearly enough, right? And it was that enough to like, Let me hold on until until the doctor was fine. Then they put in that first infusion waited a week gave me a second one. And I'm gonna say that in a month, maybe six weeks? i It changed my life, like I was just met. And is that because you have to remake red blood cells with the new iron in your system? Is that right? Yeah. So

Ari R. Pelcovits, MD 17:15
it depends. So if you if you're also anemic, so we sometimes use these words interchangeably, and it can get kind of confusing. And I think especially if people go and donate blood a lot, they'll sort of say things like oh, your your iron is good today when they're actually not testing your iron. So you know, you have your your hemoglobin and your red blood cells. And when those are low, really the word is anemic or anemia. And then you have your iron. And you can have low iron and ferritin is a what we use to measure sort of how much iron you've got kind of stored up in your body that's available for use, if you have or

Scott Benner 17:55
just a quick reminder to go to touched by type one.org. And to find them on Instagram and Facebook. At touched by type one.org You go to programs. And then you can scroll down to see everything that's going on the annual conference, an awareness campaign, a dance program, dancing for diabetes, they have a D box program, a golfing event, and other stuff, videos and pictures what they're doing links to get started. And by the way, that annual conference, let me click on it and see if there's a date listed yet. Because I'm going to be speaking at it. Oh, it still says Stay tuned for 2023 announcement date. What we're getting close. And I think I know the date. So go check it out. It's a great event in Orlando. And by the way to say it's a great event is an understatement. Beautiful facility, wonderful staff, great speakers. And I mean, I'm going to be there so touched by type one. dotwork Hey, if you're feeling overwhelmed, and you'd like to have some talk therapy, you can get 10% off your first month of therapy at better help.com forward slash juicebox just signing up at that link saves you 10% off your first month. Again, you can save 35% off your entire order at cozy earth.com By using the offer code juice box at checkout and athletic greens athletic greens.com forward slash juice box I think you get free. Yeah, vitamin D for a year and five free travel packs with your first order at my link athletic greens.com forward slash juicebox. And don't forget juicebox podcast.com To find the series and the collections. And please subscribe and follow in an audio app like Apple podcasts Spotify or wherever you get your audio I hate to say that

Ari R. Pelcovits, MD 19:54
you disagree. First thing that has to happen is you've got to make my red blood cell sorry

Scott Benner 19:57
I'm sorry you disappeared again but we're on a good day. Yeah, so let's keep going ferritin from there,

Ari R. Pelcovits, MD 20:03
yeah, so ferritin is a measure of how much iron you have left in your body sort of leftover for you to use. And so if you also have anemia, if you don't have enough red blood cells, when you get an iron infusion, your body first sort of takes that iron to make new red blood cells. And so if part of the reason you're feeling so crummy and fatigued is because of the low red blood cells, then it's going to take a little time for those to get made. But then you're also going to need to sort of replenish those iron stores. And sometimes it's just redistribution of what's been put in your body, and everyone's going to be different. And I know I think you're like the ideal patient your response. And you know, when I see people for this reason, I often try to caution them and say, Look, you know, lots of different things can cause people to feel terrible. Clearly, the only thing we found right now that's doing it is low iron. And so I'm gonna give you this IV iron, and my hope is that you have the Scot response. And, you know, four to six weeks from now you feel like a different person. Yeah. It doesn't work that way for everyone. You know, some people will get okay, I feel a little better, but something else is happening. Some people, especially when it's just low iron, and they're not anemic, I give them the iron and they really don't feel any different. But and not not the question, sort of the care you are getting, you know, IV iron is a pretty safe medicine, they probably talk to you about this, the sort of the main side effect we worry about is very few number of people can have an allergic reaction to it. Yeah. Outside of that, you know, cost and things like that you certainly want to think about but I'm pretty liberal and who will at least give it a shot with it too. You know, and if you're someone where I give you the IV iron and you have no response, you know, you don't feel any better. And there's nothing dangerous about your numbers. Well, then sometimes I'll say okay, we'll give it a try. And clearly this is something else.

Scott Benner 21:53
No, for sure. i And to your point about perhaps having a reaction. I think the first two times they gave it to me, they gave me IV Benadryl to and then after you don't have a reaction a couple times, I'm like, I'm gonna say no to the Benadryl.

Ari R. Pelcovits, MD 22:09
Yeah, that was the right thing to do.

Scott Benner 22:12
This is ruining an entire day of my life. And I don't use the Benadryl anymore. As a matter of fact, I go in there, I'll tell you, one of the most difficult things about getting an iron infusion for me, is that I walk into an infusion center, where everyone has cancer. Yes, and I I roll in 20 years younger than them, probably looking like a million bucks. And I'm like, What's up everybody, I'm here for my butt. So I keep it very, I keep my head down, I walk in very solemnly, it seems like a very, it's almost seems like a religious setting. I don't know another way to say it, you know, and, and I walk in, I keep my head down, I get my iron and I keep my mouth shut. And I leave, just try to be respectful to everybody. But the, the response I have is insane. Like, like, it just happened again, where it was four weeks ago. And I said to Kelly, I'm like, Oh my God, my iron slow. And we were getting ready to go on a trip where I was gonna have to drive to, you know, the East Coast, I was going to drive from Jersey to Atlanta. And then in like, and then back again, like 10 days later. And so and so I got went through the whole process, I knew my insurance company was going to say, okay, because you know, we've gone through it before, and I just got on the phone with them, like, I need this before I leave, I grow my iron won't kill me, I'm gonna have a car accident, you know. So I'm like, I have to go on this trip. So they were able to sneak one in before I left. And about three days into my trip, I said to Kelly, I'm like, I'm starting to feel a little better, like, and then it progressively got better. I got back, I took another infusion. Now it's been maybe two weeks since the second infusion. And then so many things like little things in my body get better my muscle tone picks up. My GI tract works better. You know, energy all that's right back again, my mental clarity is back. Like there are episodes of this podcast where you guys won't know it. But I'll think around words, like I'll be making the podcast. And I don't know how other people's brains work when they're, I can I can feel what I'm going to say before I'm saying it. And I can look ahead at my sentence and go I can't find that word. And then I'll talk around needing the word. And that happens when my arms lower too.

Ari R. Pelcovits, MD 24:32
So not not to talk too much about diabetes. But what I will say is that since getting diagnosed, I think one of the lessons as a as a doctor I've tried to take from my experience is listening to the patient. And this has been true both from my own experience, but also kind of listening to the podcasts and on the Facebook group. And just, you know we have our textbooks and we have what we're taught. And certainly you don't want to just run away from those and start practice. The same, you know, crazy medicine just for the fun of it. But it's clear that that's not going to capture every patient experience. And the people, you know, and this has been said over and over again. But the the people who are the best experts in any condition are the people who have it. And so kind of what you're describing with this, you know, your response to IV iron is, I mean, could I find every every symptom? You just said in a textbook? No, but but why would I deny what you're?

Scott Benner 25:31
I'm assuming you're just going to come back in a second.

Ari R. Pelcovits, MD 25:33
Iron? And could you give me an iron infusion? Well, I'm not going to go kind of try to do that, because that wouldn't make any sense. But, but listening to people and sort of saying, Look, you're having this experience, I have a medicine that can make you better that I think within the risks and benefits of what's safe and appropriate, and within sort of what we consider appropriate medical practice, you know, listening to the patient is really important.

Scott Benner 25:55
Is it? Or is it that? Is that that low iron can't cause some of the things? Or is it that just historically, and traditionally, you don't attach? Like muscle tone to that as an insult? Yeah, I

Ari R. Pelcovits, MD 26:12
mean, I think it would probably be that, well, here's what I would say, taking a step back, I think the reason anemia, the reason when your red blood cells, your hemoglobin gets a low, you feel tired, kind of makes sense from a scientific perspective. So your red blood cells carry the oxygen all around your body. So when that gets low, you know, on some level, you kind of, you know, make sense that you're probably not delivering enough oxygen to all the tissues, and so you're going to feel tired, weak, etc. The reason that when your iron is low, you also feel that way is not quite as clear. Because you would think that if your red blood cells are high enough, then okay, so you don't have enough iron in your bank. But I'm still getting all the oxygen I need everywhere it needs to go. But again, it's so clear, and this is not controversial, that there are people who have these symptoms when their iron is low, yeah, without anemia.

Scott Benner 27:05
And I'll tell you that I've now met so many people because of the podcast. And that, and I, and I'm thinking too, because all is this? I mean, can you step back and imagine that this isn't crazy that my daughter has type one diabetes, my son has Hashimotos and I have trouble with iron. Is that is that somehow connected? Because why am I meeting so many people who either have type one, or kids have Type One, who are also talking about the same symptoms, and have the same test lab results around their iron in their ferritin?

Ari R. Pelcovits, MD 27:41
Yeah, I mean, I think the main way you would want to tie it all together would be celiac, because that would be the sort of other autoimmune condition that you know, would run in the family and would cause low iron. So outside of celiac or Crohn's disease, ulcerative colitis, these other autoimmune conditions that impact your gut absorption, I can't say there's a clear way I can connect it probably it's more coincidence than just that iron deficiency is really common. But I mean, you know, maybe there's something there that

Scott Benner 28:12
we need to investigate. Why do you think iron deficiency is very common?

Ari R. Pelcovits, MD 28:16
Well, so when, in young women, almost any woman who's having her period will have some amount of iron deficiency. So, you know, you test that anyone, you know, between the ages of, you know, when they have their first period until their last, they're gonna be probably, you know, a good chunk of those people are gonna be iron deficient. And then we have, you know, again, I think it's more that is symptomatic iron deficiency as common as just iron deficiency. So sometimes we end things in medicine, we go looking for them, and we find them. And it's, but does that necessarily mean there's a problem there? And some of that is sort of the test with treatment. So do we give a treatment? And do people feel better? And there's a lot of people who, who aren't like you who like I said, Well, we'll only have a little bit of low iron there, you know, hemoglobin will be normal, and I give them some IV iron, and they really don't feel any better. And so those are the people where I say, Look, we found this by accident on bloodwork, I don't want to sort of give you extra medical bills, extra visits, just to sort of solve a number, if it's not really making you feel any better.

Scott Benner 29:11
Well, I know it makes me feel better. There was a day where I needed an infusion. And they're like, we can't we don't have a chair and I said, I'll drink it. And she said, and she laughed, I said, I'll do it in the parking lot. And she laughed again. I said, if you think it'll help, you can stick it up my ass. Because I need this future. And, and they laughed and found a way and I'll tell you this too, a number of years ago, probably four years ago now. My son had a lot of the symptoms. And he was a college athlete. He was like killing himself, you know, and we got him some blood work in his part and came back very low. And we got him an infusion and it changed things for him but now he just takes a supplement. And it's he seems to be fine

Ari R. Pelcovits, MD 29:59
and they never found because in his case, well, no,

Scott Benner 30:01
but about two years later, he was diagnosed with Hashimotos.

Ari R. Pelcovits, MD 30:05
Okay. Okay, so that definitely could have been playing a role. Yeah. So

Scott Benner 30:08
now he just takes a supplement, you know. And I'm actually I don't know the name of it, but I just started seeing an endocrinologist. So I went into the doctor, I was like, Look, I and I'm telling you this to see if you see a connection to my body is always carried extra weight. I say all the time on here, and anybody who will listen, I am the fattest guy who doesn't eat that you'll ever meet in your life. And so I do not consume food, commiserate to my body. And so I went to this Endo, and I'm like, Alright, look, the kids are gone. Like God bless them. Hopefully, they'll live but it's time for me to try to stay alive. You know what I mean? And battery of tests, and she comes back and says people would kill for your bloodwork. And I was like, I wanted to be happy. And I was like, Alright, great, but no answer there. You know, like, Why does my arm keep falling? So she wants to put me on something a little stronger as far as iron goes than what I'm taking now. And I said, Well, what about the weight? And and to give you some context already, like I stood in front, I've known this woman a long time. She's been on the podcast, actually. And I'm going to bring up something that she told me in a second to see what you think about it. But I so I know her. You know what I mean? Like, we're not we're not friendly. But we know each other very well. I stood up in her office, and I said, How much do you think I weigh? I was like, be honest. Just I mean, you look at people all the time, what do I weigh? And she goes, I think about 175 pounds. And I said, Yeah, I'm 233. I'm like, I'm like, what, like, so that's part of the problem, too, is I carry it well enough. That like, I don't personally look at myself and go, I have to lose weight. Like, do you know what I mean? Like, it's that kind of feeling. So she's like, What do you really? And I was like, yes, she examined me. And she goes, I'm gonna put you on Wigo v. And I said, okay, like, right on. So yesterday was my second injection, I'm still not on a therapeutic level of it yet. I'm taking, I don't know, whatever. This is, like point two, five milligrams, I'm down seven pounds. Wow. And so I got to the point where I'm like, I'm 51. I don't even care why anymore. I just, I don't want to have a heart attack. You know, like, like that. That's that, like, you know, so I'm, I'm getting out of this anyway. I can.

Ari R. Pelcovits, MD 32:32
Yeah. But so. So yeah, so obesity? And weight? Oh, man, you know, you could do and you maybe already have, and I haven't seen it, but you could, you could do, you know, podcast upon podcast about that. And it's certainly not my area of expertise. But, you know, what I would share is sort of a few things. I think, like many things in life, you know, I think there's probably extremes, and then there's the truth somewhere in the middle. So, you know, there clearly is, you know, we call it sort of, you know, an obesity epidemic, or whatever term you want to use it, there has been a rise over the last several decades in, you know, people's weight and obesity. There's also clearly, you know, some link between weight and bad outcomes in healthcare. So, as your weight increases your risk of certain things like heart attacks, and some cancers goes up. But, you know, at what point that happens, exactly. So, you know, at what point do you cross the threshold where, you know, if I weigh this amount, now I'm at risk for a heart attack is is a bit unclear. And, you know, there's probably some amount of being slightly overweight, that's not quite as bad for you, as maybe we've been sort of led to believe in our general culture of thinness. Sure. It doesn't mean that, you know, living a healthy lifestyle isn't important. But I think it's like, how do we focus on the numbers? The other thing is, there's certainly some data about where your weight is as important. So probably carrying your weight in different places in your body can lead to different outcomes. And that's not a choice you can make. That's just the way your body is

Scott Benner 34:05
right. Yeah. And I'm carrying it in the wrong places because it my arms, my legs, my ass, I looked like I weigh 175 pounds. So not great. And, and so, you know, that's but do you see any? Is there any relationship to carrying extra weight and anemia or low iron or low ferritin?

Ari R. Pelcovits, MD 34:27
No, not particularly. I wouldn't think I mean, again, you know, maybe you could, you could sort of try to connect things where, you know, the low ferritin the anemia is making you, you know, more tired and weak and so you're living a less active lifestyle. But again, the sort of science of weight loss and weight gain is, I think, so complex. And, you know, I think what these medicines like what Goby have taught us is, every everything before this where we've tried to get people to lose weight by restricting what they eat and you know, putting them on intensive exercise regimens, never works, and the majority of people can't keep that weight off, or a lot To people doesn't even work. And so there's something about these medicines that are working in an entirely different way. But yeah, I couldn't I couldn't say that just being overweight is going to lead to low iron.

Scott Benner 35:10
No, no, but could low iron lead to weight retention?

Ari R. Pelcovits, MD 35:14
I think the only way I would imagine is sort of through a sort of decreased exercise type of situation where you're just a less, you're being less active because you have less energy. Well, I'm sharing

Scott Benner 35:24
it and bringing it up, because I don't know I just, if it helps somebody just to put, you know, connect some dots for themselves, then that's it. I mean, the amount of people who after I, I talked on the podcast about having my iron below, the amount of people that reached out is stunning. Like, like, really, really stunning. It's almost like thyroid and you know, oh, you're in range. So we won't give you the hormone. But but, you know, once they heard me say, I, you know, we manage Arden's thyroid, to under two, like, that's the goal, like her TSH needs to be under two, that's how we're managing. They're like, Oh, but mine's four, and I have all the symptoms, and my doctor won't blah, blah, blah, and like, that just happens over and over and over again, there's got to be some sort of a metabolic balance to your body. And that if it's too far out of whack, I just, I think things just can't work. And, you know, I have no medical experience, but I can tell you that I have a number of little things wrong with me. And once I, once I put them in a better situation, things improve that there's no connection to I mean, because of Arden's trouble with food, and digestion, probably from type one, I started taking a digestive enzyme with my meals, and it's really improved my life. So what the hell who cares? Why I don't even

Ari R. Pelcovits, MD 36:49
exactly know. I mean, I think that goes back to this sort of what I was saying before about, you know, listening to patients, but also the humility of practicing medicine. So, you know, don't try not to come into, you know, when I meet a new patient, not trying to come in thinking I have this ego that I know more than them, but really listening. And like you said, when you encounter something that's making someone feel better, you know, make sure you don't harm someone, don't tell someone to do something that's going to hurt them. But listen to people and believe them when they're feeling better. And like you said, if we can't explain it, but it's it's overall leading to better outcomes. And sometimes that's what's most important.

Scott Benner 37:22
Yeah. Okay. So Dr. BENITO came on did a long episode about thyroid. And in the middle of it, we talked about iron on ferritin, a little bit. And she said, her patients, a woman of a menstruating age, she thinks of a ferritin of 70, as absolutely minimum. And I wondered what you thought about that?

Ari R. Pelcovits, MD 37:48
You know, that's a little higher than I would, again, well, that means taking a step back again, I think it's what do we mean by by low and not just treating the numbers? So, you know, going back to this concept of iron deficiency and anemia? I think it depends on what's going on, and why the I'm seeing the person. So if someone's been referred to me, because someone checked the ferritin level, and it came back at 25. But this person feels fantastic. They're not anemic, you know, they're running marathons, then I say, just look, just watch it. Right, I don't think there's been any clear evidence that simply pushing that number higher necessarily is going to, you know, make things better for them, right, where simply that same person could walk in with that ferritin. But if they're feeling crummy, then I might say, let's give this a shot and treat it. So I think the number itself, although certainly, you know, there are going to be normal values. It's going to depend a little bit also on how that person is feeling. Yeah.

Scott Benner 38:48
No, I agree. And I don't think she meant, you know, if everything's happy, go lucky. And you're 70 I need to give you more iron. But I but I think she means for people who are, are complaining of these issues, that she still thinks of 70 is as lower. And I mean, I don't know, this woman is an integrative endocrinologist. She's helped my family significantly. She's managed thyroid levels when other people wouldn't have touched them. She's just been like, she's just a little. She's not crunchy. Like, it's all very scientific. But right, but, but she's just seems to be on the bleeding edge of what she's doing. Right. Right. And

Ari R. Pelcovits, MD 39:32
yeah, I mean, again, I think that I would, you probably have to twist my arm a little bit to get me to treat someone just for Farrington. You know, if you came in and you were labs look pristine otherwise, and you're feeling crummy, but your ferritin was 60. I don't think I would be rushed into to give that person you know, IV iron.

Scott Benner 39:50
So when you give it to them orally, though, is there really a chance of it helping? And do you think this is going to be a two prong question? Like, is, is the state of our food? The reason for this? Like, are we just not eating iron rich foods?

Ari R. Pelcovits, MD 40:09
That's a good question. You know, I don't, the what we can absorb through food is somewhat limited. So if you get into an iron deficient state, so if you have some sort of bleeding event, right, let's say you've never had iron deficiency before, but you get an ulcer in your stomach and it gushes out blood, it's hard to get your numbers back to normal without some amount of supplementation through pills, or IV, you know, just eating a lot of steak isn't going to always do it. So but on the other side, it's a little not impossible, it's hard to become iron deficient, just by you know, being a vegetarian. Again, oftentimes, when I see people probably like yourself, where we can't find the exact reason, it's probably a combination of things. So it's, you know, they've not been eating a lot of iron rich foods, maybe they've got a little bit of bleeding, we can't find, or I have more that's been bothering them for 30 years, they might be on a medication that's blocking some amount of iron absorption. So it's maybe not one thing alone. But all of these things added together. To be honest, we probably eat too much red meat as a society. So I can't say that we're not eating quite enough iron, although, you know, we have iron and a lot of other foods as well.

Scott Benner 41:20
I do my part on red meat and helped me at all. And so is it. Does it make sense to you that about every eight months I, I just deplete?

Ari R. Pelcovits, MD 41:31
Yeah, so you're probably having my guests if you know, is you're probably having some amount of small amount of bleeding. That's ongoing. And so it's, it's slow, and it's small. So it's not enough that they're going to catch it on any sort of colonoscopy or endoscopy or any camera looking anywhere. But it's persistent enough that every eight months you kind of start running out a little bit.

Scott Benner 41:55
And stuff. Do you think supplementing could stay ahead of it? Like, should I like, double down on supplementing? And do it?

Ari R. Pelcovits, MD 42:02
Like you mean with like taking pills orally? Yes. Yeah. So it depends, it depends on the dose you're at, there's actually a point where the oral medication can kind of start backfiring if you take too much. So we used to recommend people take these like massive loads of oral iron, you know, they would take pills three times a day. And what we found was that it was it was probably confusing the body. And the body's sensors in the gut would see all this iron coming in, and would start being like, Oh, God, we must be getting too much iron. And we'd really shut things down, and it would stop working. And so that's why we now recommend you take it every day or even every other day. So there's sort of a limit to what you're gonna be able to accomplish through pills.

Scott Benner 42:43
Do you talk much about gut health? It's such a weird thing to talk about with doctors, because I feel like it's unknown, to a large extent, but absorption happens there. Right? So yeah. Are there things people can do to make their stomach a more hospitable place to absorb things?

Ari R. Pelcovits, MD 43:02
I mean, you know, I think certainly there are going to be some medications that get in the way of absorption. There are some really good doctors actually at our hospital who do a lot on sort of Gi you know, the biodiversity of your GI system and gi health. I will plead guilty that I probably don't do a good enough job like all doctors and talking about nutrition and what's going on in your gut. But but they exist out there.

Scott Benner 43:28
I'm suffering for the word, I can't come up with it. When I take a medication like keep stomach acid down, what is that? It's a something inhibitor, h2 blocker or a proton pump inhibitor, proton pump inhibitor, they also slow down iron.

Ari R. Pelcovits, MD 43:43
They do. Yeah. So there's a little bit of controversy about exactly how much but I think they certainly, again on that sort of, you've got a couple things on the scale. You know, that alone probably isn't enough to make you iron deficient. But it's certainly in combination with other things. Well,

Scott Benner 43:57
yeah, but when you're me, and they're like, Hey, take iron and take this for stomach acid. I was like, wait a minute how I know. Yeah. They gotta fight with each other. And but anyway, okay, so let's talk a little bit about how to get people help. So they have first of all, what do you see as the classic signs, signs of low iron? Losartan?

Ari R. Pelcovits, MD 44:19
Yeah, so I think there's the ones that are the most generic and then can be anything. So that's the fatigue, tired, low energy, just feeling kind of off and not not quite like yourself, but that can be 100 million different things. The one that's the most classic that we have a fun medical term for is called pica, which technically meets eating things that are sort of not foods. So the classic example in the old textbooks would be like eating dirt or clay, but the way it typically manifests is ice craving. So my wife who had low iron this was like her most classic symptoms, she would just chew and listen mounds of ice that drove me insane. And then she finally got an iron infusion once and it was like, you know, within a few weeks, she just like, suddenly one day was drinking a glass of iced water and went, Oh my God, I don't want to eat this ice anymore. Yeah. So that's almost, we have a fun word for that. pathognomonic which is, you know, if you're sitting there chowing down on ice, and you can't stop, it's almost certain that you're gonna go find your, your irons low. The problem is a lot of these other symptoms are really nonspecific. And so it takes, you know, your doctor as part of their battery of tests, including that iron level to check.

Scott Benner 45:32
So I, before I realized I had a problem with my iron, I actually bought my own icemaker because it was, I had to chew the ice. I was hydrating myself through ice, I believe. Yeah. And my hydration has gotten worse since my irons gotten better.

Ari R. Pelcovits, MD 45:51
Yeah, no, no, that's literally my wife said the exact same thing. Yeah, like, I don't drink water anymore.

Scott Benner 45:55
And then when my iron came up, not only did I not want to chew ice, but chewing ice, like turned me off. Like it almost sicken me a little bit. I was like, Oh, I don't want like, this is not a thing I would do if I wasn't getting that drive. Do you understand the? Like, what's the functionality behind that?

Ari R. Pelcovits, MD 46:13
very unclear. You know, one of these things go it's funny, right? When when we feel like something's unclear. We're okay with it if it's coming from the doctor side, but yeah, so So, so, so pretty unclear why you got this craving whether, you know, I think there's probably if I remember back to what I was taught that the thought about like, these, like clay, your dirt cravings was like you literally were trying to search out the iron there. But certainly that makes no sense with ice. So who knows?

Scott Benner 46:38
Yeah, it's I can tell you it's as real as could be, though. I know. Yeah. It was for me. Alright, so if people are having the symptoms, right, they're there, they can't get rested, no matter how much they sleep, they're weak. They are dizzy. Brain fog, chewing ice. I mean, if you please, if you're out there chewing dirt in your backyard, please give us

Ari R. Pelcovits, MD 46:59
a lot of maybe a few other things we did to work.

Scott Benner 47:01
Yeah, go see a doctor. And, but And so anyway, I go to the doctor and they run. The first thing I've learned that you have to be careful is you have to ask for a full iron panel. Is that right? And?

Ari R. Pelcovits, MD 47:13
Yeah, so there's lots of different values, there's sort of five and particularly we look at and I would say the ferritin is by far the most important. So if they're going to take check one thing, it would be the burden. But all of them together can be helpful to sort of really make sure we have a full picture.

Scott Benner 47:27
What is iron binding capacity?

Ari R. Pelcovits, MD 47:30
Yeah. So that is a way for us to measure sort of how hungry your body is for iron. So typically, when you're when your iron is low, your iron binding capacity is going to be high. So it means you know, your your capacity to have more iron, your desire for more iron is hot, you want more,

Scott Benner 47:48
okay? Because I because that always confused me. They're like your iron binding capacity is high. And I'm like, Well, hi. Seems good, don't we? Right? Right. Right, right, right.

Ari R. Pelcovits, MD 47:57
Where these things can be helpful is sort of your ferritin. Other things can impact it. And the most common thing is sort of inflammation. So some people's ferritin might be what we call falsely elevated. So it looks it looks normal, or it's even a little high. But really, they are iron deficient. And so these other numbers can help us sort of tease that

Scott Benner 48:16
out. I think that's a another thing, especially for people with auto immune, that's important for, for your doctor to understand. Because if you're sitting there at a fair ton of 25, and it may be higher than it actually is, you probably are in trouble as far as needing more. And I'll tell you, mine has been as low as seven. Like that's when I was falling over. It's seven. Yeah, yeah. The last one, I think was 13. And I was I was on my way to not doing well. But it's funny how it's almost like it's almost like driving a car and running out of gas. Meaning your tank can be completely low. But as long as the hose leading to the motor still full, you're running like everything's great. And then when it's gone, it's gone. And that's that's how I feel like I imagined if I looked back, and I very carefully looked, I might see it coming on, but it doesn't, but it comes on so creeping really slow. That is just like I'm fine. You know, I feel a little tired. And you know what, for me, it's like, why are my nails breaking? And then boom, I'm shutting off what they see the nails breaking. I'm calling the doctor like, hell do

Ari R. Pelcovits, MD 49:27
you have do you have like scheduled lab work that you do? Or is it you just wait until you're feeling this way? Yeah,

Scott Benner 49:32
so we just started talking about that. Because it looked like it was gonna you know, at one point he was very hopeful that you know, supplementing was going to be okay, but at this point now, I'm just gonna get it drawn every six months. Yeah, and see where I am at the problem ends up being his insurance. So you know, you want to be again the people say this about the American healthcare system all the time, right, like, like you want to be pre emptive but the insurance is like no, get the lab values lower and then we can do it. Right So after I feel like I'm gonna fall on my head, then we'll get right to it. Thanks a lot. But we are going to, we are trying to push them in that direction. So we'll see what happens with that.

Ari R. Pelcovits, MD 50:13
Yeah, that's good. That's what I try to do. I try to keep you know, especially people early on where I'm not sure was this sort of like a one off bleeding event or something happened that decreased your absorption, and then we're going to be fine. After we take you up. You know, let's check bloodwork every three to six months. And then we can see how you're starting to drift. You know, let's get ahead of this. Because I know how bad you felt. Let me let you get all the way down. Yeah.

Scott Benner 50:33
Oh, it is my goal not to feel that way ever again. Like I tried to stay ahead of it. Because I also don't know what else it's impacting. And yeah, there should be other stuff. And you know, you brought up I brought up earlier, like I said, like, I don't want to have a heart attack. But I am adopted, but I know very little about my birth mother. But here's something I know about her. became depressed after she was kind of forced to give me away by her family was morbidly obese after a number of maybe 1520 years and died of a heart attack trying to have bariatric surgery. Oh, God. So terrible outcome, obviously. But I just like I'm not, I am trying to avoid that, you know, and by the way, I'm not. I guess by the charts, my BMI is high enough that my insurance company was like we go over. Sure. No problem. But But visually, I don't think you'd see me that way. Yeah, and I am. So I don't know if I'm carrying it, some of it under my muscle. Like, I don't know what it is. But I just I'm not doing that. Like, I don't know, I've worked too hard to get this far. Like, I'd like to get to the end where I get to poop on like nurses in a home. And that's your goal. They have to smile and be like, It's okay, Mr. Banner, and so that they have a story to tell when they're 30. They're like, Oh, my God, I had a job when I was 18. Holy Hell, let me tell you about it. I'm trying to build resistance in the younger people already. That's but But seriously, like, I'm just trying to, you know, I've had a real, like, kind of renaissance in my thinking about age, because my mom got cancer. And she's doing well, but she got it at 79 years old. And some will argue that 79 is pretty old to begin with. But I've seen it, I saw how it kind of added 10 years to her, you know, name Yeah. Oh, yeah. And, and I just started thinking, like, you know, when we, at our age, think about living forever. I'm like, I'll probably lived on 8590 years old. But you imagine yourself as 85 now, like how you are now but that is not how it goes. And so what I told my wife is after I watched my mom with her cancer, I said, I'm going to I'm going to live like these next 15 years for the last 15 years I'm getting. And I don't imagine I'm dying at 65. I hope I don't. But I don't know where I'm going to start declining after that. And I'm like, I'm not going to just, I'm not just going to keep living now, like these other years are promised to me. But in the shape I'm in now, which by the way, I think we've just discussed for the last hour, it's not. It's not optimal. Right? So I don't know, I'm just trying to I raise my No, I

Ari R. Pelcovits, MD 53:22
think the privilege of being a doctor is that even at a young age, you get exposed to a lot of morbidity and mortality, you see a lot of people who are sick, and a lot of people die. And a lot of people who who gets to be you know, old and live well. And in it, it forces you to think about a lot of this and try to prepare yourself in different ways for that sort of, you know, outcome because I think some of it, like you're saying is, is how can I live the best I can now to be as healthy as I can at that point in my life. But the other is that, you know, it's an inevitability and not to be too depressing, but it's how do I psychologically come to terms with the fact that no matter what I do and how well I live, even if I get to 95 or 105, there's going to be a moment where my body will give up on me. And what do you do with that knowledge?

Scott Benner 54:12
I'm some days I'm stunned. I'm this old. I mean, seriously, you know? And yet, it's funny. As ridiculous as this sounds, aside of the things that I've shared here today, my vitality is like terrific. And like my mic when my iron is fine. My clarity is crazy. I am one of those people I wake up I am me from the second I opened my eyes to the second I go to sleep, like I don't know, you know what I mean? Like

Ari R. Pelcovits, MD 54:39
and you know, and I think that's the other thing that's important when you're going to the doctor and you're kind of trying to figure out you know, how to how to get worked up for these symptoms and treated you know, the other thing we sometimes do that's not great is you know, when I meet someone, this is the only time I'm ever gonna see them that are that first time is that first moment in their life. I'm meeting them and so you know, I sort of trying to make it clear what your sort of normal baseline is like you're coming in and you're saying you're sick, but I don't know what a good day is. And sort of highlighting like, no, look, I can I can be running constantly, when I'm feeling well, like this is abnormal for me. And trying to make that clear, can I think help sort of get some urgency or make people think like, well, we got to figure out what's going on. I don't want to just sort of blame this on, you know, you're just getting older or, you know, yep, some days, you know, you feel kind of down. Because I think it's easy to do that and harder to maybe think a little more and try to figure out what could be happening.

Scott Benner 55:33
Well, I'm very glad you brought this up, because it was going to be my next question. So how do people come to there? First of all, you're gonna end up at your GP first with these complaints, right? And then you're gonna see, you're gonna see the iron, or the ferritin, or the iron binding capacity, you're gonna know a little bit because you listen to this journey back. Oh, that's not right. Your GP is going to be like, that's fine. Because you don't know, or she don't know, doesn't matter. And so I tell people all the time, I'm like, stop banging your head against the wall with your general practitioner and find a hematologist. Now, it's hard to get in with a hematologist. Yeah, you know, and so don't delay. But then once I finally get in that office, what do I tell them so that we actually start moving forward from there? And I don't get ignored? Like, what would? What would really pique your interest?

Ari R. Pelcovits, MD 56:24
Yeah, so I think that what would make me convinced that we should try something is, if I can be, if I can hear that, you went from feeling good to not feeling good. So there was a change in your symptoms. And that the only thing we now can ascribe this to is this lab finding that your iron is low, or you're anemic? You know, I think what makes people sometimes they'd be hesitant is, you know, you know, I've kind of felt this way for 40 years now, certainly, it could be because your iron has been over 40 years, and nothing's happened to it. But usually, what's going to push them over the edge is that this is new, you know, in different than what I felt like before, how can I now kind of try to feel better?

Scott Benner 57:05
Yeah, I also think that there's more light bulb moments for people because of the way information is getting shared now, like, you know, because of something like this, like, somebody's gonna listen to this and be like, Oh, holy hell, I felt like Scott my whole life, I didn't know, you know, what you mean, like that is going to happen, and you have to just be able to come in to the doctor, you know, my finding is, you come in, you'll lay yourself out, you know what happened, I like to write it down. Because you can get in there and start telling stories. And that's not helpful. And the doctors looking at you, like, you got eight minutes to get to this, because I'm out of here, you know, and like, you need to be able to come in and say things, like, you know, I'm noticing this and this and this, and this and this, and then let them ask you a question. Because if you lay it out, well, then you've laid out, Hey, I think I'm anemic. Or I think my heart is low. And it's really, it's impacting me, then let them ask a couple of questions, answer them. And, and then for my money. I think you say it out loud. You say, I have been supplementing orally and it's not working. I really would like you to consider an iron fusion for me.

Ari R. Pelcovits, MD 58:19
Yeah. No, no, I think that's key. Also, sort of, if you've done the work of I've been on an iron pill for, you know, 234 or five months and look, my numbers haven't changed. This isn't working. You know, I will say there are some general practitioners who can schedule iron infusions. So we do see that sometimes. And unfortunately, probably, although I know you were just supportive of getting us over to specialists and as a hematologist, I should support that. But you know, I think you know, some more you know, well versed primary care doctors probably feel comfortable doing this themselves saying, you know, let's try the oral iron for a little bit. Let's refer you to the gastroenterologist to make sure you're not bleeding. And then you know, this isn't working let's try IV iron I can find the clinic and get get the order in for you.

Scott Benner 59:03
Oh, listen, I first of all, I would take that I would take that order from any doctor who was my dentist would write it for me I would have been like, that's cool. Let's go you know, I am I am interested by the progression though. Because I come in like and I tell you, hey, my iron bla bla bla bla bla, especially for me, this has been happening my whole life. Like, you think I've got the kind of cancer that doesn't kill you in 25 years. You know what I mean? Like, just give me a I look back on that initial situation. They could have turned me around in two weeks with an iron infusion and then gone and looked up my ass if they wanted to. But like Why leave me on death's door to do it. That I never

Ari R. Pelcovits, MD 59:48
again not knowing the specific not not not wanting to you know, totally speak speak ill of my colleagues. But I think you're right. There's no reason those things can't happen simultaneously. So if I see someone for low iron, you know, anemia And they haven't seen a gastroenterologist yet. We'll do that. But it doesn't mean I won't give them IV iron. In the meantime, well,

Scott Benner 1:00:06
I got a little I stopped seeing the the one gastro doctor because I was like, just give me an infusion. Like, I figured this out already. I tried to explain to him, I'm a very, very popular podcaster. And I've already picked I've already picked through this, and I know what's wrong. But there's part of me that thought like, hey, oh, man, I can't bill you. For an iron infusion. The way I can bill you for a scope. So like, I didn't get that feeling a little bit. I was like, Yeah,

Ari R. Pelcovits, MD 1:00:32
I think that. Luckily, for the most part, we're sort of a lot of doctors are shielded from those sort of financial outcomes. So like, for me, for instance, like, I don't get paid more if I give you IV iron or iron pills, or refer you to 10 doctors or one doctor, like I get a salary. And you know, that that's so whatever I do in my clinic doesn't matter. And more people are moving towards that. Which is by far the best on some level to avoid these sorts of conflicts of interest.

Scott Benner 1:01:00
I hope so. I hope so. Because in my mind, there's a boardroom full of guys smoking cigars going our recent murder.

Ari R. Pelcovits, MD 1:01:07
Well, listen, I'm not going to be naive, there was a lot of financial overlap in the practice of medicine that leads to some just some bad bad choices from different parties. So you know, money, money plays a big role in medicine. Let's not pretend that

Scott Benner 1:01:22
isn't the case. No, of course. And I just think from a personal level, and by the way, because the audio problems, we had your overtime, are you okay?

Ari R. Pelcovits, MD 1:01:30
Yeah, I have a patient at a lab, and I just make sure they didn't decide to come early. Well, they did. But they're okay. They haven't got.

Scott Benner 1:01:39
Alright, we'll just let them sit out there a little longer, though. Because I just wanted to ask you like one last question. Well, first, I'll say what I was gonna say, they'll ask you the question. So what I was gonna say is that, you know, all these technical things, and insurance and everything aside, like, I felt terrible, I lost a significant time and quality of my life feeling like this. So anytime, as a doctor, you're letting somebody feel like that longer than they should. It kind of sucks, you know. But So my last question is, what did I not ask you that I should have asked you about that people should be hearing about this.

Ari R. Pelcovits, MD 1:02:15
You know, I think that you sort of, I think hit it right there, which is I think the job of a doctor is to help you live longer and live better. And so I think that what you have to try to hope is that you and your physician or your you know, PA or NPU, or nurse, whoever you're seeing are on the same team to accomplish that, and aren't working against each other. I think when you have a good relationship with your practitioner, that's what it feels like. And so it shouldn't be that, you know, you're fighting against each other to kind of get to these outcomes, like you said, like losing that time. I think, on some level, part of it is I think we practice a bit of defensive medicine or, you know, we're thinking like, we don't want to cause harm. So let's avoid all these things, which which is important. But we can end up causing harm by not providing people the things they need. Yeah. Not not to leave you just to I guess, you know, I will say to just sort of err the other side of why do we maybe sometimes want to avoid IV iron and probably some of my colleagues who are a bit older than me, and I've been doing this for longer, but I have seen someone have a bad outcome, like get IV iron and actually have such a bad reaction that they needed CPR. So you can you can cut them out if you want. So if you don't want to scare your listeners, no,

Scott Benner 1:03:35
I understand why you that's why they give you the Benadryl right, because you have a reaction to it, it's gonna be a bad reaction. I gotta be honest with you, though, I was gonna need CPR and a couple more weeks anyway.

Ari R. Pelcovits, MD 1:03:45
But I will say when I when I when I saw that happen, it definitely scared me for a little bit. And I am sure that after, after experiencing that, you know, I then was probably too hesitant and giving more people iron. And I think I've now come back to a better place realizing, hey, look, that was a really rare situation. And it doesn't mean that I should be letting other people suffer because

Scott Benner 1:04:06
of Yeah, listen, I would have shoved a rusty nail under my skin. If you would have told me it would have helped. Like, that's how bad off I was. I was just like, I was lost. You know, and, and I want to be clear, not just fading, like I admitted myself to an emergency room. Like, like, I was done. I was like, This is it. Here we go. Like give me iron or like it felt like my heart was gonna stop. Like when it got low enough. It was just really I don't know how to put that feeling. But I was I'm not a panicky person. I wrote it forever. I did all the things I was supposed to do. You know, I took all the steps and I was just like, my body's shutting off.

Ari R. Pelcovits, MD 1:04:43
So I wouldn't what I'd also say, though, I guess is to add and I think we did cover this before but you know, having not everyone's gonna have that dramatic response like you did. And so I think so but I think just being ready for anything, right? Like saying like, I'm going to try this. I'm hoping it's all was my problems? And if it doesn't, the answer doesn't necessarily mean you know, give me another another dose. It means that look for what else could be causing Oh, for

Scott Benner 1:05:09
sure. I mean, if you were to get an iron infusion and nothing changed in, I'm saying six weeks, what do you think the longest is this?

Ari R. Pelcovits, MD 1:05:16
Yeah, I would say it depends on the type of irons. I don't know, if you've gotten sort of these, you know, what's called in fed this sort of big large dose at once. Or the sort of other common one we use is venofer, which is smaller doses, and you got to come like once a week for four or five weeks. I

Scott Benner 1:05:29
don't I don't play them better for bullshit. I do. I do injector for twice.

Ari R. Pelcovits, MD 1:05:35
Okay. Okay. So, so yeah, so so if you get, you know, a pretty hefty dose, but you're only needing it once or twice. And when by six weeks, you should be feeling feeling the effects of it.

Scott Benner 1:05:45
Yeah, I was once on the phone with insurance company. And they were like, We're gonna give you a benefit because it's cheaper. And I'm like, No, you're not.

Ari R. Pelcovits, MD 1:05:52
Well, right now we're actually having a problem. We're having a shortage of some of the what, in fact, is what we use, which is the big dose and so we're stuck with menopur. For a lot of people.

Scott Benner 1:05:59
I have it here in the house. It's my closet full of it. That's why I can't find any of it. But yeah, just I didn't like they I think it was like six weeks and like you want me to get an infusion six weeks in a row. And I was like, come on. Yeah, I know. I pulled out of it. But anyway, this was terrific. I can't tell you how excited I was to talk to you.

Ari R. Pelcovits, MD 1:06:22
And you know what, it's not a topic that people always are super excited about talking about. So it's great to find someone who is

Scott Benner 1:06:27
you kidding me? I'm gonna have you back someday. Amazing. I again, I can't thank you enough for doing this. I really do appreciate it.

Ari R. Pelcovits, MD 1:06:35
Yeah, no, thank you so much for having me. And thanks for everything you do. It's been it's been a huge resource for me for this new diagnosis. So Oh, my appreciate it. Oh, yeah.

Scott Benner 1:06:43
If you want to say something nice about me. You can do that at the end.

Ari R. Pelcovits, MD 1:06:46
There you go. I think I think you got it. You've helped you. Yeah, yeah.

Scott Benner 1:06:50
Hold on one second for me. Okay. Sure.

Hey, how about a huge thanks to Ari for coming on the show and sharing so much great information with us about anemia and ferritin. And thanks also to touched by type one.org. Head over there and check them out touched by type one.org 10% off your first month of therapy@betterhelp.com forward slash juice box 35% off your entire order at cozy earth.com with the offer code juice box at checkout, and a free year supply of vitamin D and five free travel packs comes with your first order of ag one from athletic greens at my link athletic greens.com forward slash juice box. Go check out the private Facebook group. Thank you so much for listening. I'll be back again very soon with another episode of The Juicebox Podcast.