Scott Benner 5/23/23 Scott Benner 5/23/23

#917 Diabetes Myths: Reversing Your Diabetes

A brand new series examining the myths surrounding 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.

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

Scott Benner 00:00 Hello friends and welcome to episode 917 of the Juicebox Podcast. Well welcome back everybody, this is the third in the diabetes myth series. Today Jenny Smith and I are going to be talking about that old chestnut reversing your diabetes. 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. Speaking of being bold, take care of your health better. health.com forward slash juicebox when you get therapy at my link, you'll save 10% off your first month of therapy betterhelp.com forward slash juicebox speaking of saving money, how about 35% off your entire order at cozy earth.com incredibly comfortable sheets, towels and clothing. I love it all. I'm not kidding. It's incredibly, incredibly soft and luxurious. I can't believe I'm using the word luxurious but save 35% off your order at cozy earth.com And of course athletic greens.com forward slash juice box, a free five travel packs and a year supply of vitamin D with your first order. I asked Chet GPT to write me an ad for the Omni pod five. And it tells me even puts in where I'm supposed to put music this is interesting. Here's what I'm supposed to say. This episode is brought to you by Omni pod makers of the Omni pod five insulin pump. If you're living with diabetes, managing your insulin levels is a crucial part of your daily routine. That's why Omni pod has designed the Omni pod five, a device that's transforming the way people with diabetes live their lives. But this isn't bad. I'm sorry. Back to the deep voice. The AMI pod five is a tubeless wearable insulin pump that adapts to your lifestyle. Its discreet, waterproof, and designed for ultimate comfort. The state of the art pump automatically adjusts insulin delivery based on your glucose levels and trends. taking the guesswork out of diabetes management once it's good, it should say we used with a Dexcom G six. We've oh my gosh, safety is always a priority. But it's time to experience the freedom and flexibility that comes with the Omni pod five insulin pump, visit Omni pod.com forward slash juice box to learn more and take the first step towards a better life with diabetes. That's Omni pod.com forward slash juice box make the switch Dami pod Vive and discover the difference for yourself. That's amazing. The machines are taking over people. That's pretty cool, huh? Anyway, Omni pod.com forward slash juicebox, check out the Omni pod five, if you want that algorithm with the Dexcom G six. Or if you want the Omni pod dash and you're not looking for the algorithm, you can get started with that as well. At my link, we use the links here supporting the show. Those links are available at juicebox podcast.com by typing them into a browser or in the show notes of the podcast player you're listening to now. Now let me say just write me an ad for athletic greens. Hold on a second. I might be onto something here. Alright, everybody, we are back for the third installment of the diabetes myth series. I am now artfully talking around vs at the end of the word. And Jenny has a head cold. So Jenny sounds like a waitress in a diner on the road. Nobody drives on so hi.

Unknown Speaker 03:51 I do. Yes.

Scott Benner 03:53 But she she promises me that her voice doesn't hurt. So we we press on for you, the good people who are waiting for the diabetes myth series. Today, Jenny, we are going to tackle the myth that diabetes can be reversed. So if you have type one, and you hear this to two possible things happen, either you get very angry because that's not true. Or you're newer diagnosed and you think oh maybe that is true. And then you see the people who are like, what if I just What if we just could I just eat like and then that conversation starts up. The first thing I have from from the listener here says they were told to quote just lose weight, eat healthy and exercise and that's it, their diabetes will be reversed. Where do you think that comes from?

Jennifer Smith, CDE 04:54 I think it's kind of relative to the sugar one right? If you just stop eating sugar or You got diabetes because you ate too much sugar or whatever. I think it starts with type two diabetes knowledge. Because while no diabetes is reversible, type two, if you start out managing with certain lifestyle changes, you can reverse is not the right word, you can bring your Sure, yes, you can bring your numbers down to that target range that is in the range we are all aiming for, right? The range for people without diabetes. And you can successfully keep it there for a certain amount of time potentially without any medications. That's not reversal. That's not curing your diabetes, that just really means that you're doing something to keep your numbers in a range of normal in a range where they would be without diabetes. But if you go back to your lifestyle habits, your blood sugars will go back up. And they will now be out of range. Again, we know that that's not the case with type one, obviously, is there a potentially a time period where it looks like? Well, goodness, my blood sugar's all nice and stable. Now it's soon after diagnosis. It's that what we've talked about before called the honeymoon, right? Where your needs could drastically be reduced. For some people, they may not use any Basal insulin, and they might use small doses of Bolus, it might be the opposite, where they just use a Basal insulin, and they don't have to take boluses for a while. That's not your diabetes reversing itself. Yeah,

Scott Benner 06:50 I don't I just opened up Amazon. And I typed reverse your that's all I typed in. Apparently, you can reverse your fatty liver, your diabetes, your type two diabetes, or your PCOS with Coach Nikki? So I think it's a marketing word. Yes. Yeah. And I think that it's very steeped in type two. And exactly what you just said that, and but how to, like, how do you put context to it? You know, I just recently this will seem disconnected for a second. But I have become very focused on people saying, like, Omnipod, five learns, or this causes diabetes, or blah, blah, blah, can reverse there. It's like, right church, wrong pew, kind of thinking, you know, like, you almost have it right. But you've chosen a specific word, and it makes what you're saying. Incorrect. I understand that. Yeah. I understand what you're getting at. And, and I just think that that's, I mean, obviously, again, people don't understand, but where it becomes, I mean, potentially dangerous, is when you get it into the head of somebody who has type one diabetes, specifically. Correct. Because here's from another listener, I almost died in decay. My expert Father said something clearly went wrong on your end, and then sent her a ton of videos about reversing diabetes. Yes, you know,

Jennifer Smith, CDE 08:22 well, there are you know, in this it's a, it's a painful thing to see. But it not too long ago. I mean, in the past, probably 15 years, I've seen several kids who were diagnosed and their parents went about it in terms of prayer. Right? If I pray enough, if I do this, it will go away. And clearly that did not end well.

Scott Benner 08:47 I've been around this space long enough that I can tell you that about every four years, some poor kid dies because somebody tries to cure their diabetes with religion. I've seen it over and over again. Well, well, here's a great example of what I was talking about about marketing. This person says, I was told that type one diabetes might be reversible through chiropractic care. Not surprisingly, she was told this by the spouse of anybody want to guess? Chiropractor? Yeah, it was a chiropractors wife who said, You know what, what might get this for you? And there's a lady who's got a car payment. I respect her. She's like, Let's go let him yank on your head a little bit. See if your pancreas starts working again. Nice idea, but you know, not gonna work. But, again, I think it's the it's the reverse thing. Like yes, you can, you can your body, you know, speaking specifically about type two diabetes. If you start becoming pre diabetic, your body can't keep up with the need and your your blood sugars are rising. And if you can about certain foods, you very well may see a decrease in that, like you're taking the the fight away. Like you know it's you know right now your body is one person and pre diabetes is 100 army men come on over the hill, and then suddenly you tell 90 of those army men not to attack you and you're like, Oh, well, it turns out I can fight off 10 of them. I just can't fight off. 100 Awesome, right. So when they say reverse, they mean, you know, stop doing the things that make your body that make your body

Unknown Speaker 10:36 able to keep up on its own?

Scott Benner 10:37 Yeah, yeah, that I almost wanted to say that reveal the fact that your body's gonna have a tough time fighting off the way you've been eating prior to this. And right. Yeah, so I mean, and then it just gets, it just gets translated over to type one because they don't hear type one, they hear diabetes. And yes, we're off to the races. I'm only I think

Jennifer Smith, CDE 10:59 that's where a lot of I think that's honestly where a lot of the myths that we'll go through. kind of come from Yeah, it's what somebody knows about one side of diabetes are what they know, because they knew a friend whose mother's uncle's brother, whatever, right? And they're in it all goes back in terms of what I think is that people should just pay attention to what they're going to say before they say,

Scott Benner 11:27 Jennifer, I got a note. I got a note today that said that I walked around all day yesterday saying Zipit lock it, put it in your pocket. So you impacted somebody with the last episode. Shut up if you don't know what you're talking about. Let me see this one here. years ago, a female coworker of my husband told him that maybe her type one though, meaning the person writing this, my type one would be reversed when I got pregnant. Because pregnancy. This is a quote pregnancy causes crazy changes in your body.

Jennifer Smith, CDE 12:07 They should go read my book, make sure that they learn correctly. Yeah, that's Oh, that's so sad.

Scott Benner 12:15 But But do you do? Do you? I hear that. I hear it like, right. You have heard pregnant women say, I never felt better than I was pregnant. My allergies went away. Like I bought like you hear them say like stuff like that. And correct.

Jennifer Smith, CDE 12:29 And there are some autoimmune conditions that do. They don't reverse but they take almost a hibernation, if you will. Many people who have other things like lupus, or arthritis or other conditions that are definitely those autoimmune and there are many of them. They can take a backseat while the body is pregnant, then there are a whole bunch of physiologic reasons for that, obviously. But type one diabetes is not one of those things that gets to take a backseat to

Scott Benner 13:05 the apples to apples comparison there is if I get cancer and I'm a woman, I should just get pregnant, because that fixes that fix. Yeah, yeah. Like that's Isn't that fascinating? I mean, honestly, isn't that fascinating. By the way, the lady said she's had four babies, but she still has type one diabetes? Yes. Clearly, maybe the fifth one will be the church. She said to that I say, I think I think your uterus has had an effect. That's a lot. Keeping track of your kids. I'm always very impressed when people can handle that many children. I don't know how they do that. Okay, so now, Jenny, the real question here is I gotta wait for this kid to leave high school everyday this time, all right past my house. Now the real question is, is this a nice little 15 minute episode about the fact that you can't reverse diabetes? Or do we keep going into the next thing and couple them together? So since it's the next thing, does it fit, diabetes will disappear, stabilize or get better? But this is a longer this is a longer it's got a lot of feedback. So part of me wants to

Unknown Speaker 14:23 snip it and move on. Yeah.

Scott Benner 14:26 I kind of want to make it a second one. So okay, so before we do that, I just want to go over it one more time. I have type two diabetes. I drastically changed my diet. I don't know I start exercising. I'm running up the side of mountains now with a rucksack on. I don't need any medication and my blood sugars are healthy and stable and where my doctor wants them. Do I still have type two diabetes?

Jennifer Smith, CDE 14:55 You still have type two diabetes. That's what it is being man imaged with the lifestyle changes you have put into action. That is what is your that's what your medication is, if you want to think about it that way, right? You are not picking up a prescription at the pharmacy. What instead, what you're doing is you're making really awesome changes to your life. And that's what's making the difference in terms of blood sugar management, getting things into that non diabetic, let's call it range. And if you reverse that, if you stop running, walking, going to the gym, eating well and choosing healthy, you know, your diabetes is going to be like beer i Oh, my God, I was just wait.

Scott Benner 15:44 You don't make type two diabetes go away. You stop, you stop the impacts of it from having poor health outcomes for yourself. That's it. All right. I think I understand that. Good. Okay. I don't know why. It's. It's interesting, but it's the word right? Again, it's the word you can reverse your diabetes, you can just lazy talking. And I

Jennifer Smith, CDE 16:07 say, Well, I think they're reverse is. It goes along with that cure. I think people think reverse and they think I'm cured. Like, I'm really That's it? I'm done. I don't ever have to worry about this again. So are you reversing having diabetes? You're bringing yourself back to a state of health where you should have probably been in we're talking about, you know, type two here, obviously. But I think reverse is such a hard word. Because it could be understood multiple different ways.

Scott Benner 16:44 Yeah. Yeah. And I think the implication is that there's not a ton of effort anymore, right? And so that's it. Because if I said, it's funny, if I said to you, you have type two diabetes, but you need insulin, and somehow I don't know, you just perfected your insulin delivery. And you literally were just your blood sugar was 96. All the time. You never got high, you never got low, and it was that way your whole life. You wouldn't say that you reverse your diabetes, you'd say you are treating your diabetes with insulin. Yes, yes. So if you do it with exercise and diet, you're treating your diabetes with exercise and diet. Yes. I'm good. I'm stopping right there. Thank you very much. You're welcome. First and foremost, we always want to thank Jennifer Jenny Smith is a lovely person who's also a CD and she works at integrated diabetes.com. If you want to hire her, that's where you go. Let's also thank the pod makers of the Omni pod five and the Omni pod dash for sponsoring this episode of The Juicebox Podcast and so many others. They're a great supporter. The podcast is supported by a ton of great sponsors, you can find all of them at juicebox podcast.com, or in the shownotes of the audio app you're listening in right now. When you use those links, when you click on them, or type them into a browser, you are supporting the production of this podcast. I cannot thank you enough for doing that. If you're looking for community around your diabetes, check out Juicebox Podcast type one diabetes. On Facebook, it's a private group with about 40,000 people in it. Actually, most of the stuff that's in the diabetes myth series is from the people in that group listeners just like you. If you're enjoying the podcast, please share it with someone else who you think might also enjoy it. And please, if you're listening, but not subscribed, hit the subscribe or follow button in your audio app like Amazon music, Apple podcasts, Spotify, something like that. It really helps the show. Thank you so much for listening. I'll be back very soon with another episode of The Juicebox Podcast.

#916 You've Got The Right

Michelle's son has type 1 diabetes and Michelle is an HR professional here to talk about FMLA, Leave of Absense, Americans with Disabilities Act, Insurance & emplyee resources.

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Scott Benner 00:00 Hello friends, and welcome to episode 916 of the Juicebox Podcast. Welcome back everybody on today's episode of The Juicebox Podcast I'm going to be speaking with Michelle. Michelle is the mother of a child with type one diabetes, but she's also an HR professional. Today we're going to talk about FMLA leave of absence, the Americans with Disabilities Act for adults, insurance, employee resources, and so much more. Do not miss it. While you're listening. Please remember that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, always consult a physician before making any changes to your health care plan, or becoming bold with insulin. Hey, would you like to save 35% off your entire order at cozy earth.com? Well, if you're looking for great sheets or clothing, you might and you can do that by using the offer code juice box at checkout. Cozy earth.com juice box at checkout saves 35% If you sign up for therapy@betterhelp.com forward slash juice box, you'll save 10% On your first month of therapy. And when you use my link athletic greens.com forward slash juice box, you'll get five free travel packs and a year supply of vitamin D with your first order athletic greens.com forward slash juice box. This episode of The Juicebox Podcast is sponsored by Dexcom, makers of the Dexcom G six and Dexcom G seven continuous glucose monitoring systems. Honestly, if you have diabetes, you really want to look at it Dexcom dexcom.com, forward slash juicebox. The Juicebox Podcast is sponsored and supported by a number of great companies, all of them are listed in the show notes of the audio app you're listening in right now. And at juicebox podcast.com. When you click on those links or type them into a browser, you are supporting the production of the podcast and keeping it free for everyone. And today's sponsor, of course is Dexcom who you can reach@dexcom.com forward slash juice box.

Michelle Mata 02:17 My name is Michelle Mata. I am an HR learning and development professional. And I am also the parent of a child with type one diabetes.

Scott Benner 02:27 And HR Say that again. HR learning,

Michelle Mata 02:32 HR and learning and development professional

Scott Benner 02:34 learning and development. Yes. All right. What does that mean?

Michelle Mata 02:40 So if we look at it from the HR management side, it's the part that deals a compensation recruitment, employee relations, all the policy and administration type things that people deal with on the daily at work. And when we look at HR development, it's the training and development of employees, strategic planning, organizational development, change management, all the things that help people get better at what they do, or help the organization move forward, especially in times of change.

Scott Benner 03:14 Do you what is learning? Is that not the same thing? Is learning when you pull them into a room and you scold them and you're like like and severance. Did you ever watch severance on Apple? Plus, I've got yet Alright, well, then you're not gonna get this reference. But do you torture people until they do what they're supposed to do? Like, this is what I think learning means.

Michelle Mata 03:35 I try not to I try to make it fun. I try to make it less mundane, in what I do. So in what I do now is I do a lot of ELearning Development. So actually the Omni pod courses that all of us are having to take right now for the Omni pod five, I build a lot of those type of things.

Scott Benner 03:54 Okay. Oh, I see. Yeah. Do you direct courses? Or do people do that on their own time by themselves normally.

Michelle Mata 04:03 If it's an elearning people typically take it on their own. But sometimes I've also developed courses where we call it like a hybrid or flipped learning where they've got to do some of it online. But then they come into a classroom or virtual space and apply what they learned or use it in case scenarios, things like that.

Scott Benner 04:24 What do you think the the, the percentage breakdown is on, on materials like that, that are given to employees that are meant to actually like help them with their job versus are meant to safeguard the company from legal action later, like, like I've seen my wife take some of these words, just it's common sense about like how to treat people at work, for example. And then I always think I'm like, Oh, the company gives this not because they want you not to treat people poorly, although I hope that I assume they hope that you don't. But in case that you do, they can go hey, this isn't our All we told her in the training, is that part of it, too.

Michelle Mata 05:03 That is part of it. There's this thing called vicarious liability. And so basically, it's on the company to train the employee to say that I've trained you on this. So the liability is now off of us, sort of, and now on the employee to be able to do the right thing. But if they train everybody and forget two random people over here, then they're still liable for the actions of those two random people because they never train them. And then it even goes down the road of is that a training issue? Or is it a performance issue? Do they know what to do? But are they just not doing it?

Scott Benner 05:41 Oh, okay. Lazy. You're saying shiftless. Yes. And so this is interesting. Michelle, do you mind me asking you questions about your job like this?

Michelle Mata 05:52 In generalities? Yes, good.

Scott Benner 05:53 I'll stay. I'll stay General. People. So I'm a hard working person, I married a hardworking person. And I get up in the morning, I do my job, like, and I do it. Like, I don't have like a baseball game on and another monitor, I'm not, you know, talking to somebody on the phone while I'm working, that kind of stuff. And it is my intention to get my work done. I watched my wife work the same way. But I have a feeling that some people are not as driven. And is that more difficult to manage now that people are so remote? Or is there a way to manage it? I'm interested in in what happened through COVID? I mean, because you can walk past a cube and see somebody asleep on their hand, right? But sure, how do you see it at work at home,

Michelle Mata 06:38 I want to go back to it depends on the person. So pre COVID, everybody was in the workplace, for the most part, except for companies that were already ahead of the curve and had people remote. But for those that were working in brick and mortar places, if you were having a bad day, it was pretty much on display for everybody to know. And when COVID happened, and that whole transition to remote work started happening, some people became more productive, because they didn't have to walk down the hall and say hello to 20 people that they were going to pass by with small talk, because they could focus on what they needed to focus on at work. But then you have others who thrive on that interaction, and need it and needed to bounce ideas off of each other. And so it's actually affected their productivity negatively. So I don't want to say in a blanket statement, you know, it's good or bad. It just depends on the type of person and what drives them internally.

Scott Benner 07:39 That's interesting. Is there a percentage of new hires you expect to lose?

Michelle Mata 07:47 So let me preface this by saying I'm not currently in an HR department, but I do support HR training. My past life has been in HR roles. And this is actually the first role where I'm not in an HR department. So this is a little different, right? As far as people we tend to lose at the start. So HR departments have they're doing the right thing. They're checking with new employees that 30 day, 60 day, 90 day, six month mark, even the year mark, and trying to figure out, is this person happy? Are they getting the resources they need in order to do a great job? And you know, just overall, is there a sense of worth also being fulfilled when they're at this job? And if it's not, well, can we move them to a role that might be better for them?

Scott Benner 08:38 Because you like the person on the onset, you think you have a good quality person, and then you put them into a setting and it's not quite right for them, you don't want to lose the person. So you have to find the thing that they're better at that maybe you still have somewhere else that needs to be filled? Is that kind of

Michelle Mata 08:54 exactly. And it may not even be the person it might be that that person and their manager are just not a good fit for each other. I've seen that happen at times.

Scott Benner 09:02 Yeah. How does it how, how is it that the qualities, this is generalization? The qualities that make a good employee are very infrequently the qualities that get you into management?

Michelle Mata 09:17 Does that make more time?

Scott Benner 09:19 How come? How come? How come we've all worked for a manager where we're like, how did this person get this job and why is it not bill over here? Who is obviously the right person for this like, like how does that happen? Like how much networking and politics exists? When people are ladder climbing? Do you think it's a lot?

Michelle Mata 09:42 I think people who know how to politic well, right tend to get those promotions, extroverts. You tend to see a large percentage of extroverts get those promotions and people who take risk at times and are willing to say yes, you Even though it might be detrimental to the rest of the team to try to get that work done. And so I know in my experience, I've definitely tend to see a certain type of personality get promoted versus others. So I would almost agree with you there. But it's not always the case.

Scott Benner 10:18 I always wonder why the business doesn't? Well, actually, I used to wonder why the business doesn't just say, Look, I know what it looks like, person A, but it's clearly Person B. And we're just going to even though they're not going to push themselves or put themselves in a position, why don't we help them move up. But then what I noticed was that as people move up, the skills that help you move up are not always the skills that help you do the job. And then those people tend to want to surround themselves with other people who aren't, say, as good at the job as they might be. Because nobody wants to be outshine. It's sort of how the mediocrity rises. And I don't know, it is a huge generalization. I'm sure people listening are like my managers amazing. And they know everything about your business inside and out. But I've just, I don't know, I've seen it a lot. And I've seen and I'm always weirded out by the idea that, that I'm, frequently I've seen people put more effort into keeping their job than it would take to do their job in a way that would guarantee that they would stay. Does that make sense? No,

Michelle Mata 11:22 that totally makes sense. And there's a phenomenon right now called Silent leak, or quiet, quitting, that actually discusses just that it's actually a thing right now, where people are kind of doing that office space, bare minimum thing, and just doing enough to keep the jobs. There are situations though, and I've seen this in practice as well, where somebody does really well on their job. And they get pegged for the promotion. And they get promoted. And they're terrible as a manager. Yeah. But they performed well as an individual contributor. Because no, they enjoy doing, they don't have the contact that they had maybe with their salespeople, or with the students that they were working with. It just kind of depends on you know, what was their thing. And if they're things suddenly taken away from them, because they're now in this role that less than their forte, there's, they're going to have performance issues.

Scott Benner 12:15 Yeah. My wife has a great manager of people. And everyone that she's ever worked for has, you know, sent a Christmas card to my house years after they hadn't worked for any more, she gets notes all the time from people like you made my whole career. It just happened the other day, a guy contacted her through LinkedIn and said, You know, I don't know if you remember me, but 20 years ago, you on boarded me at this job at a low level, and you helped me and you helped develop me. And now I just want to share with you that I have a family and I bought a house. And I think it's all because of how you helped me to be in my career. And over and over and over again, Michelle, enough that I'm comfortable saying it out loud and being recorded saying it right, like it happens. But there are times that her her superiors, will say one thing and then do another and this isn't at the company she's with now, but I've seen frequently in the past, they get you in a room and they say, look, build good relationships with your employees, they say all the right things. And then when you do those things, they pull you into a room and it's more like just crack the whip. Like just who cares if they're happy? Like it, like what gets said publicly is not how it gets managed sometimes, and I don't think my wife has that self promoting in her. So she's, she's learning that still in her late 40s. But she just likes to do a good job and help people to do a good job too. But anyway, I've just, this is fascinating to me. We should probably dial this in the diabetes at some point. Tell me a little bit about that. Your child has type one how many kids you have? I have one perfect stop there. It's great. College is expensive. And how old

Michelle Mata 14:00 and he is five years old. And he was diagnosed just before his fourth birthday.

Scott Benner 14:05 Oh, this is just a little over a year then.

Michelle Mata 14:07 We're a little over a year in

Scott Benner 14:09 okay. Did I by the chance just joke about not having more children and you're pregnant? I apologize if I did.

Michelle Mata 14:14 So surprisingly, I'm not okay. And if we go that direction, it's going to be because we would be adopting a second child. So my son, Ben is his name, man. Ben's adopted.

Scott Benner 14:27 Ben is adopted. Yes. Oh, my dad's name was Ben.

Michelle Mata 14:31 Actually the name actually,

Scott Benner 14:33 you want to hear something bizarre. I don't. I've definitely never said this before. My last name is Benner. My dad's name has not been that was his nickname. And then the first question is, why would someone give you a nickname? That's the same as your last name. I don't understand that. But here's why my father's nickname was Ben. Oh, this is hilarious. I noticed that this out loud before. My dad's real name was Laverne and he was a big straw Long kind of hulking guy whose name was Laverne. I don't think he enjoyed it. So he took a nickname. But my grandmother would call him that all the time, which would freak me out because no one called him that. And then then my little tiny grandmother would walk by and be like, Laverne come here, I'd be like, who she talking to? But then so much better. So much better. Okay, so you, you

Michelle Mata 15:25 sounds like a Marvel character, Ben banner.

Scott Benner 15:27 It does write all that alliteration. And you know, yes, yeah. Anyway, he was a mostly decent person. You so you adopted, because this was I'm sorry, this is too personal. You weren't able to have children or you just always wanted to adopt? Or how did that work out?

Michelle Mata 15:47 It was always in the cards. So my husband and I were both adopted by Ken, when we were young. And we were raised by our grandparents, in a very loving environment. And just because of our past, it was always part of our future.

Scott Benner 16:04 So that's very nice.

Michelle Mata 16:06 Do you notice how he led to Ben,

Scott Benner 16:07 do you know I'm adopted?

Michelle Mata 16:10 I didn't know. Oh,

Scott Benner 16:11 I there was so much silence on like, I thought you were like, Oh, is he being sarcastic about my adoption? Because no, no, I've tried to

Michelle Mata 16:17 remember. Listen to so many of your podcasts and like, Did I miss something?

Scott Benner 16:21 You did? I was adopted as an infant. So by by liver Hernan my mom yeah, it's, it's a it's a wonderful thing to do. Okay, so you and by the way, what part of the country you're from because you said you were adopted by kin. I'm in the South. I was gonna say, that is not a word that is used frequently where I live. But you just you just ripped out Ken Like, it was nothing. I was like, she's so. Okay. All right. So adopted Ben. Four years later diabetes. So obviously, you didn't know that it was coming or have any idea about it? Were you able to get into his record? Is there anything to learn more about that?

Michelle Mata 17:02 No, we have very limited knowledge on his background.

Scott Benner 17:05 Okay. Okay. All right. So that's the new thing. So you don't know if there's other autoimmune in his past? Had does he have anything else that's totally immune?

Michelle Mata 17:15 Not that we're aware of. That's autoimmune. But he does have sensory processing disorder. And in him that manifests looking like ADHD. And then he also has a unilateral hearing loss. So he was a hearing aid. And one year,

Scott Benner 17:30 oh, my gosh, you knew all this when he was when he was born.

Michelle Mata 17:34 We knew about the hearing loss. We got the diagnosis, of course, for diabetes years later. And for the sensory processing, we actually got that diagnosis a week before he was diagnosed with diabetes. And that's what actually led me to contacting the pediatrician about the possible type one diagnosis

Scott Benner 17:54 now, Michelle, wait to use up your copay. You're over what is that called? your out of pocket all in one week?

Michelle Mata 18:01 No kidding. I guess we were due.

Scott Benner 18:05 I'm interested in what it's like to deal with and help him learn and grow with the hearing.

Michelle Mata 18:12 We jumped on that quickly. We're blessed to be in an environment where we had access to a nonprofit that gave us a loaner hearing aid. So he's had access to hearing aid. When he became eligible around seven or eight months, I think was eight months he was wearing a hearing aid. And so we've worked really hard to make sure he had speech therapy to make up for the lack of sound that he didn't have in the first couple of months of his life. And if you met him now, and if he didn't have his hearing aid on, you would never imagine that he had hearing loss, because he will talk your ear off.

Scott Benner 18:51 Does he read lips? No, no. Does he know any sign language?

Michelle Mata 18:57 He knows well, he's no little more when he was younger, he could tell you more and all dead now.

Scott Benner 19:04 Because he doesn't. So because of the hearing aids, it's sort of like a skill he doesn't need

Michelle Mata 19:09 yes and no. So there's times where he'll take the hearing, hearing aid off because he's got audio fatigue. The sound for the hearing aid, there's this little device that we're able to use to to mimic what he hears. And actually the sound that you heard earlier, hearing through a tin can kind of mimics that except add some robotic elements to that. And that's kind of what it is. And so after, after so many hours, he decides he wants to take it off and just kind of give his mind to rest.

Scott Benner 19:40 That's interesting. That's really interesting. Okay, and is that both years? I'm sorry, just one year. And then the sensory stuff. Is that like, autism spectrum or how does that work?

Michelle Mata 19:55 We're going to be diving into that in the next few months to find out.

Scott Benner 19:58 Okay, how did it go? isn't

Michelle Mata 20:01 like ADHD, he's impulsive, and he's hyper. And he, he's really into Sonic the Hedgehog right now. And that is a great description of his personality.

Scott Benner 20:14 Just balls up and, and runs forward spinning in a circle.

Michelle Mata 20:19 Gotta go fast.

Scott Benner 20:21 Okay, so that's how you saw that. diabetes presents, how and how do you figure it out?

Michelle Mata 20:29 So his diabetes? I don't know, it's diabetes. You know? What was that?

Scott Benner 20:37 Like? What's the first thing that made you say, hey, something's wrong.

Michelle Mata 20:42 Okay, so So being in the south, and being that we were in the potty training aid area, we didn't realize the first two signs were actually signs. The first one was the bedwetting but we are potty training. So you know, what, three year old doesn't wet the bed. And then we're in the south, and who doesn't drink an excessive amount of water because it's hot all the time, usually nine to 10 months out of the year. So we didn't really think much about those two. What really kind of started setting us off is when closer towards his diagnosis. We started getting reports at daycare that he was getting fatigued. So we didn't know why. And when we had taken him to the doctor the week before, for the sensory processing diagnosis, I noticed that he had lost weight. And so I didn't really understand why because he was eating everything under the sun. But then I started pressing him more about that and asking questions. And he mentioned that his stomach hurt. So that day, we caught the pediatrician said we need to make an appointment. They said come on the next day. And and sure enough, they it was going to be type one. And they didn't tell us right then in there that it was type one what they told us was we call it the hospital. We've already talked to the ER doctor, they're waiting for you. But you've got to go right now.

Scott Benner 22:10 Great, okay, thanks. Because the stomach hurt? What did you think when his stomach hurt?

Michelle Mata 22:18 That is what wanted me to call immediately to the pediatrician. So my husband actually picked figured it out quicker than I did. We both come from families that have type two diabetes. So he kind of clued into that and thought, okay, the weight loss, and you know, all these all these five things together. Yeah. Made sense on diabetes. And that's, that's why we made the call.

Scott Benner 22:43 Okay. Well, it's excellent, good job. And that's about a year ago. So he leaves the hospital with what kind of gear

Michelle Mata 22:52 needles,

Scott Benner 22:53 just like regular syringes,

Michelle Mata 22:55 just regular syringes and lancets and a meter. And a meter.

Scott Benner 23:00 It's like you got diagnosed when, when Arvind was diagnosed? And then how do you like, why do you know about the podcast, like what leads you to try to find other things out?

Michelle Mata 23:13 So the moment that he got diagnosed, of course, we're staying in the hospital. And my husband and I start deep diving into everything. And he finds podcast, I think maybe within a day or two. And so we start reading, and reading and reading. And I just finished up a graduate degree a couple of months before. And I start diving into this, just like I would have studied for any of my courses. And so we're learning everything. And anything we can to figure out what does type one mean? Because we already know what type two means. But this is so different than that. And so, one of the resources that came up was your podcast. Wow.

Scott Benner 23:54 That's cool. I was just thinking, I mean, how old are you? Michelle? You look like you're 34 for some reason. I'll say thank you. Is that not? Is that not the case?

Michelle Mata 24:07 That is not the case. But I will take it,

Scott Benner 24:09 I think you're not gonna answer.

Michelle Mata 24:12 But I'm an older parent. Okay.

Scott Benner 24:14 All right. But so your life prior to this, would you describe it as fairly smooth flowing?

Michelle Mata 24:22 Um, as smooth as it can be? Yeah. Yeah.

Scott Benner 24:25 It's just, um, it's, I'm struck by the fact that you adopted a baby, which was lovely. And you took a baby that you knew had, you know, a medical issue to begin with, which is even more lovely. And then so many things have happened in the past year or so. That? I don't know. It seems to me, like it could feel unfair to you. And you don't come off that way. So I think that's really great. I was wondering, how you how you find yourself thinking about it when one thing After another goes, not the way you expect.

Michelle Mata 25:03 You know, we know his situation. And had he remained in that original situation. And as not adopting him, he wouldn't have had all the resources that we would he would have now to be able to thrive. I don't think he would have had access to sound as early as we gave it to him. I don't think that the sensory processing would have been seen, the way that we look at it in the sense that, okay, we this is a condition, and we need to find the tools and the resources and therapists to be able to help them with it. And then even the diabetes, how do we manage it in a way that allows him to be able to have a good childhood? Because when his numbers are out of range, that intensifies, is his impulsivity and his hyper activeness? Okay, yeah. And so I mean, I won't lie, there's challenging days, there are days that we are flat out exhausted. Because he's like a solar powered Energizer Bunny, that just never turns off until he goes to sleep. But at the same time, we also know that, you know, he's in our life, we 100% committed to making sure that he had a great life.

Scott Benner 26:12 How long? This is my last question about you and your family size, and I want to get into your profession and how the things you understand will help people living with IBD. So so you're adopted, so you know what that feels like your husband's adopted, he knows what that feels like. So my question for you is, and this is basically I think, a question I wish I would have asked my mom years ago, does he feel like your son yet? Or does it take time? Was it immediate? Is it a growing thing? Are you having trouble with it?

Michelle Mata 26:44 I think, for my husband and I, he's always felt like our son, we brought him home from the hospital. So at least we've known him since, you know, since he was an infant. And for him, we we've had the discussion already that he's adopted, and we talked about his adopted, and that even our dogs adopted, and he still sees us as mom and dad, he doesn't see that as anything different just yet. He may later on, I'm pretty sure he will. But at the moment, where Mom and Dad

Scott Benner 27:15 Yeah, I never thought about that way. I never considered that my parents who raised me aren't my parents didn't, it never struck me that way. But I've known a number of adopted people, and they always seem to just fall on one side of it either. Hey, these are my parents, and I don't care that they didn't give birth to me. Or the other side of it is I think people were sometimes burdened by it as they're growing up. And anyway, I just want to know how you felt, but that's definitely wonderful.

Michelle Mata 27:43 No, sure. And I've seen both sides of that, especially in the adoption forums. Just depending on which one you're in, tend to lean more towards a certain way. Yeah.

Scott Benner 27:55 I just always imagine when I was messing up as a kid that somebody must have been looking at me and thinking, that's not even my kid. Why am I going through all this? Let's give it back. Just speaking about me specifically. So okay, so you reached out for a great reason you and I'm gonna list some of the things you put in your note that we could talk about family medical leave, which people might notice FMLA leave of absence, reasonable accommodations under the Americans with Disabilities Act for adults with type one and parents and caregivers of children. So this is, I think this is amazing. So you have all this knowledge. Now you have a kid with diabetes. Let's share it with everybody else. How do you think we should attack these topics? You can make better decisions in the moment with the most accurate CGM on the market, the Dexcom G seven dexcom.com. Forward slash juicebox. My daughter just moved to the g7 from the G six and she already loves the new smaller size and ease of use. You can learn more and get started today@dexcom.com forward slash juicebox. Due to recent Medicare changes, millions more people are now covered for the Dexcom CGM. The G seven is the smallest most accurate CGM system covered by Medicare and it is easy to use and to get started with no other CGM system is more affordable than the Dexcom G seven for Medicare patients. The G seven is a simple to use system it delivers real time glucose numbers to your smartphone or your smartwatch. With no finger sticks required. Effortlessly see your glucose levels and where they're headed. So you can make smarter decisions about food and activity in the moment. This amazing tool is going to help you to take better control of your diabetes dexcom.com forward slash juicebox whether you're looking for a brand new system, changing from another company, or looking to upgrade that G six dexcom.com Ford slash juice box, the new G seven comes with a refreshed app that is just a delight to use. My daughter is 19 years old, she's been using index comm for well over a decade. It is at the core of how we make decisions about insulin, food activity. All of the variables that impact diabetes, check it out@dexcom.com forward slash juicebox. There are links in the show notes of your podcast player, and links at juicebox podcast.com. To Dexcom. And all the sponsors, when you click the links, you're supporting the podcast. I'm sure you know better than I do.

Michelle Mata 30:43 So I kind of made a checklist because I had to get my frame of reference back into making sure that I am noting the law appropriately or at least the the requirements of it. And so let's start with FMLA for a second. Okay. Okay, so most people no FMLA, people who are working with a covered employer are eligible for FMLA. So it's not everybody. If you work for a public agency, if you work for government or local law public school, you're covered. If you work for a private sector employee that has at least 50 or more employees, for at least 20 weeks, work weeks, during the year, they're considered a covered employer. But that employer also has to have a location where the do more employers are within 75 miles of each other. And that employee has to have worked for that company for 1250 hours, or roughly 25 hours a week for a year. Okay. So you're just not instantly eligible, right, you have to wait for a year. But then there's a few other things. So that's the first event. What makes it tricky is that if you're in your first year of work, you might be working for an employer that doesn't have any type of extended leave of absence policy. So I work for one employer that in addition to FMLA, if somebody was sick during the first year and didn't qualify for FMLA, they would have six months, or rather six weeks of FMLA. Light to call it, but it's a leave of absence. And so they would have to use it all at one time. So if they got into a car accident, they hadn't met a medical condition, if they were giving birth to a child, and didn't qualify for FMLA, they could take a leave of absence for that. That's a generous employer. Not all employers do that. I have definitely worked for employers that did not have this hyper provisions. There's also the thing where, and some people may not be aware of this. But if you work for a company that was a covered employer and you qualified for FMLA, left that employer and came back, you will still be covered under FMLA.

Scott Benner 33:03 You don't have to redo the 1000 some hours and all that other stuff. Exactly.

Michelle Mata 33:07 If you already have the year and you were eligible. Otherwise, you just pick up right where you left off.

Scott Benner 33:12 Okay. Yeah. So give me some examples of when people use, you know, leave or FMLA like is like injuries can it be for other people in your family.

Michelle Mata 33:24 So the law says that you can use FMLA. And I'll talk about how it applies specifically to diabetes. So most people know it for adoption or pregnancy. But in terms of diabetes, it's for the care of an immediate family member. So this includes your spouse, your child or your parent, but not your loss, who have a serious health condition. And if you have to take leave for yourself because of your serious health condition. And it can be applied in different ways. So the law is kind of vague in the way that it's applied, because every company can apply it differently. And what I mean by that is, so it gives you 12 months of eligible leave, that 12 months can be on a rolling calendar year. So let's say today is I just say hypothetically, just so I can be able to think of dates. So let's say that today is hypothetically April 16. So your leave day would start today, and would end April 15 2023. That's a rolling calendar year it moves every day. Some apply it based on the calendar year, and some apply it based on the fiscal year. But what I've seen more common than anything else is a rolling calendar year. And the way that I tell people to think about FMLA is kind like a pizza. You might take a slice that you need for yourself, you might take a slice that you need for your child. And then as time passes, the slices are put back or you might need a few hours here. Have pepperoni slice, to take your child over to their appointment to go get there, he wants to be checked, right? And then time passes, and that pepperoni piece is put back. But this particular pool of hours, the 12 weeks that you're eligible to take is for any FMLA related condition. So you don't get 12 for your parent, you don't get 12 for your spouse, you don't get 12 for your child, and 12 for you. It's 12 weeks for everybody.

Scott Benner 35:29 I see. Okay, so if, yeah, so my I can't, if I use a month up, because my wife is sick, I'm down to 11 months, it doesn't matter if the next time somebody gets sick, it's my child.

Michelle Mata 35:43 Well, so I say in the 12 month period, so in the 12 month period, you're allowed to take 480 hours, the 12 weeks. So if you take a month, right now you have roughly two months remaining for anything else that comes up during the year.

Scott Benner 36:02 Is it is it purposely confusing? Do you think?

Michelle Mata 36:07 I think it is. I've had to create trainings for both employees and managers on how to administer FMLA or understand it for themselves. And yeah, it can it can be really confusing. Those that use it on a regular basis. Definitely know it. Well. But I think it's intentionally confusing. unnecessarily.

Scott Benner 36:29 Yeah, I think that about medical insurance, so I think they don't want you to use it. So they make it hard to use.

Michelle Mata 36:35 Oh, so yeah, I have I have thoughts about that, too. Yeah. So yeah, and you know, that thing with FMLA, it can be used on short term basis. So you might only need it for a week. So in this case, if you had a parent who had a child who was newly diagnosed with type one, right, they might need it for the week or two as they're getting adjusted into this new lifestyle. Because, I mean, it's exhausting when you have the new diagnosis, and then it can be used intermittently, intermittently. For your doctor appointments here, there. Let's say that you have an episode where you've got low blood sugar, and it leaves you feeling sluggish for a few days, you know, that's a situation that you might need it. Or it might be on a long term basis, just depending on what's happening. And so we saw a lot of people needing it, you know, a COVID, for example, although that's a whole nother situation. But for long term, people typically use it when they're having a surgery or something like that. I.

Scott Benner 37:37 So I think this is wonderful, this exists. And yet I have personal perspective, where I've seen people just abused the hell out of this. And they know how to get the right doctor's note, and they know how to do things like that. And they end up taking off the summer and saying something like, I'm tired and my something hurts, you're like, okay, and then they're there, that person goes for two months, three months looks something like that, while you're busy at work. And it's um, I don't know, like, I know, you can't police everything perfectly and make sure that only the people who really deserve it are using it. But I don't know. It's, you know what I mean? It's nice to see that happen do when that's happening. Was that do employers generally know when they're being taken advantage of versus when

Michelle Mata 38:25 we start to see trends? I mean, obviously, if somebody is always taking FMLA, on a Monday and a Friday, that starts to show a pattern, or after any major holiday or Super Bowl. And then we might see situations where if there's certain things happening at work, and we noticed that the FMLA falls frequently, during those particular things at work, oh, oh, I see might start to ask questions. So there's that. But yeah, it does come down to what the doctor list on the FMLA paperwork. There, there's a set of federal paperwork that can be given to the employee, they take it to their doctor, or their doctor completes it. And based on what the doctor says on that paperwork, specifies how much leave that employee can expect to take. And then what

Scott Benner 39:21 is leave? Is it paid leave? Or is it just you can miss work without us being able to fire you?

Michelle Mata 39:28 It depends on the company. So most everywhere is it's unpaid leave, but if you have vacation time, if you have sick time, if you have general PTO bank, that company will specify how leave should be used at their company. So one place that I was at, if I remember, right, you had to use your stick time first. And then you would use any floating holidays, and then you would use vacation time.

Scott Benner 39:56 And if that was all gone, then you could dip into family medical leave.

Michelle Mata 40:02 So at one place, it was used in combination of so you could be paid while you're on FMLA. At other places, they would make you use all that before you take FMLA,

Scott Benner 40:13 which is then unpaid after you, because you've used up all your other time.

Michelle Mata 40:17 Right, right. Which leads into discussions about short term disability and long term disability.

Scott Benner 40:22 Yeah, at what point do you have to assess that and say, This is not just a short term thing, I have to protect myself in other ways, because long term disability would be covered, right? Like some percentage of your income. It Yes,

Michelle Mata 40:37 it's usually a percentage of the income, it's, it's definitely not 100%. Generally, I see anywhere from 60 to 80%, depending on what the policy is,

Scott Benner 40:45 okay. And those policies vary by state or by company or by insurance company that the company uses.

Michelle Mata 40:52 They vary by company, and they do vary per year based on the broker that that company is using. I see.

Scott Benner 40:58 Now, just just bare bones, like human interaction, in the HR department, somebody's using FMLA over and over and over again, or they're always taking leave, even if they don't even want to designate whether they actually need it or not. It's just it's being used a lot. At what point does the company say listen, I feel bad for you, but I have a job to get done here. And it's not getting done.

Michelle Mata 41:23 If they're covered under FMLA federally protected.

Scott Benner 41:26 You can't say I know that Michelle, but I'm saying in the coffee room. Yeah, we gotta get the hell out of here. Like it like, you know, like, how does that? I mean, that happens, right?

Michelle Mata 41:37 It does happen in I'm gonna say questionable companies. It's usually I call it a constructive discharge where the environment is made so intolerable, that the employee feels that they have to leave because it's just a hostile condition. So if you

Scott Benner 41:54 come back to work, if you come back from work, Becky, and now Jim is over here, and he's got your job, and you're now in charge of emptying the wastepaper baskets. They are done with you. That's kind of it.

Michelle Mata 42:08 Not quite. Okay. So you take leave. Okay, your jobs protected. But it doesn't have to be the same job. It does have to be a similar job. So if you were an account manager, but you come back and they're making you clean out wastebaskets, right. Obviously, there's gonna be some discussion.

Scott Benner 42:28 I have to say, Michelle, at the same pay, maybe I just clean out the wastepaper baskets.

Michelle Mata 42:31 I mean, if they're gonna pay you the same amount, wastebaskets may not be a bad kid.

Scott Benner 42:37 I might agree. I'm just saying that there's a human aspect of this. And there's also I mean, there really is the there is the the simple truth that there's a job needs to be done. So if you're going to be gone for six months, okay, you're federally protected, I get to hire somebody else to do this job. And when you come back, I can't afford to pay both you so something's got to give like, I think it's the difference between not that you shouldn't use it if you need it. You absolutely should. But I've just seen people turn what I think what should have been a week and a half into three months, and feel like, Oh, I'm on vacation. Now. It's all cool. I have some money saved, I'm gonna go back. And I just don't think it's reasonable to expect that people stopped being people because you're federally protected by FMLA. I don't know why.

Michelle Mata 43:22 I mean, no, I mean, there certainly are going to be people who take advantage of it. Hopefully, I'm not having to interact with those type of people. But yeah, I mean, there's definitely that human component where if somebody is given the opportunity to take advantage of a situation, they might milk it.

Scott Benner 43:38 Yeah. Yeah, no kidding. Alright, so family medical leave, we would use it for anything, my kid got diagnosed, and we're going to, I need to spend two weeks figuring this out, you know, before I go back to work, that's a great example why you might use that for diabetes. Getting to adults, though, I want to talk a lot actually, about the American with Disabilities Act. This is something that is asked in the forums about constantly, it's something I don't know enough about. And, and the way I usually see it brought up in conversation is simple. It's an adult with type one diabetes, who's gonna go to a job interview. And the first question they ask somebody is, hey, do I go into this interview and tell them I have diabetes? Or do I keep it private?

Michelle Mata 44:23 So the equal opportunity, Employment Commission EEOC is the federal agency charged with the enforcement of these type of things? And so they have a page, all related to diabetes. I'll send it to you. So you have it for the show notes. You're welcome. And so what they recommend is don't talk about it until you get the job. And even when you get the job, don't talk about it until you start your job.

Scott Benner 44:55 That's written by somebody who understands people. That's perfect.

Michelle Mata 44:58 Yeah, yes, yes. And the reason for that is, you know, even if you were in the interview, and you brought it up on your own, and said, I have type one diabetes, at that point, a professional HR Recruiter right and or hiring, the interviewer should not be asking you any other questions, aside from will this require a reasonable accommodation? That's it, that's all they should be asking. Now, if you're offered the job, and you decide to disclose it, before you start the job, they may be able to require you to take a medical exam, to find out if your condition is in a in a place where it would put them at risk. So if you're in a in a, let's say, manufacturing, let's say that you're about to take a manufacturing job, and it requires you to be on an automated line. And you know, you're constantly back and forth and back and forth. But you get confused, often, because you've been having lows for the last three to six months because of uncontrolled Beegees. Right, that could be a risk to the employer. Right? And you right? Yeah, yeah, yeah, yeah. And that person themselves, but let's say that the person is type one, and they're going for a law enforcement job. And they have very well controlled Beegees and have not had any major episodes in quite some time. Would that pose a risk of the employer? Probably not.

Scott Benner 46:31 So if I'm coming in, because I think the way I hear people ask the question is, is this going to stop me from getting this job? Is it going to hurt me, you know, getting the job. So the difference between what you're saying, which is, hey, just don't say anything till you're at work. But once that happens, doesn't? Doesn't the employer looking at you and go, Oh, well played? Well, or do they look at you and go, you son of a bitch? Like, like, do you don't? I mean, like, what happens? It's almost like you get married? And

Michelle Mata 47:00 I don't know. And you're like, boom, guess how much student loans

Scott Benner 47:04 threw off my wooden leg three months into our marriage? Like, how did you hide that from me the whole time? Like, you know, like, it's something that it's gonna seem big to the other person. And you, you kept it quiet, like it feels distrustful? And does the employer respond differently? Because of that, and so there's no win, right? Because if I mentioned it earlier, I might not get the job, I might taint myself in the eyes of these people. And if I wait until afterwards, I'm the person that lied to them to get the job, I think is that the, here's the rub,

Michelle Mata 47:37 your your condition, right? In this case, type one. But it could be anything. It could be migraines, it could be asthma, it could be psoriasis, it could be any condition, right? They can't hold that against you in the hiring process. It's not a condition of your employment. And it should you know, that condition shouldn't affect your ability to perform well, on the job.

Scott Benner 47:57 So I'm going to tell you a story here. Tell me because I hear what you're saying. And I appreciate your professional opinion. But one time when I was 21 years old, I was awoken by some loud knocking on a door I might have been 20. It was a rap rap app on my door. And I was asleep and I sprung up to see what happened and I opened the curtain and there stood my girlfriend who is not my wife right now, just you know, this is not a story about Kelly. And this girl is in a T shirt, no bra with a sweatshirt pullover hair going in six directions, and she's pissed. Okay, Misha, opened the door, and I go, Hey, you okay? And she says, and I'm quoting, you cheated on me in my dream. So my point is. My point is, is that you can't always count on people to be reasonable in a situation.

Michelle Mata 48:47 No, sure. And here and here's the thing, there's, I'm gonna say there's two types of HR people, right? You've got one type that went to school for it studied it has has learned, you know, all the legalities of it. For my employment law course. For example, my professor was, was an employment law attorney. All right. So you've got that grip, right? Whether they're studying it at undergraduate or graduate level and seeking certifications, then you have another group that just falls into it. And the kind of trying to figure out their way. They might know, the most recognizable laws, but they're definitely having to seek additional resources to figure out oh, well, what does this really mean? And I want to say to certain extent, HR is interesting because we're required to interpret the law without being lawyers. So it makes things really tricky at times.

Scott Benner 49:46 Yeah. I just, I'm just wondering about how often you can reasonably expect people to do what they're supposed to do without being be impacted by some. I don't know, I don't know what I'm trying to say,

Michelle Mata 50:05 No, I mean, you're gonna have some people that look at a condition and say, Oh, well, I don't want this person working on my team. I mean, this is, this is gonna

Scott Benner 50:13 affect and their response is not going to make sense that it's just gonna be like, Oh, you have diabetes like like how many people we all know this, right? Don't understand diabetes fundamentally at all it type one or type two, they definitely don't understand the difference between the two of them most of the time. And so now I'm in this, I'm in this interview, and I go, by the way, I have diabetes. And now the person interviewing me is imagining their 79 year old grandmother who has type two, or they had a friend and college that passed out all the time. And now suddenly, they're looking at me, like, Oh, this guy is gonna pass out all the time. Or, you know, he's gonna get dizzy, or this is gonna happen, and they can't ask the questions, because the ADA stops them from asking the other than what you just said, right? Well, will this require any accommodations? Right? But even if you say, Look, I'm very well managed, you know, blah, blah, blah, here's how it's gonna go, it's going to be fine, I still think they look at you and think that's both you're gonna pass out like my grandma. And you don't I mean,

Michelle Mata 51:11 yeah, you're gonna, you're gonna have some employers that get hyper cautious about it, and start taking away what's called tangible benefits. And so those are promotions, transfers, incentives, right, they start impacting you negatively at the workplace. Okay, companies get in trouble for this. So I've got a couple of examples that I pulled actually from the the EEOC, and how companies got in trouble for doing bad things to type addicts basically. And so there was one case this. And this got resolved. But it was a company that had unlawfully discriminated against two employees after they discovered through a questionnaire that their employees health conditions and medical or other learned about their employees, health conditions and medications, and learned that they had diabetes and hypertension. So that particular company had to pay $77,000, which is not enough, but then also furnish or other remedial relief, right to the people that they fired, another company had laid off and a supervisor who had been with the company for 38 years, based on having disabilities, diabetes, and kidney disease, and this person was laid off shortly after telling their employer that they would need dialysis. And then there's another one where the company got in trouble because the employee asked for a different schedule to be able to accommodate being able to stay in range better, and even had a doctor's note asking for this. And the company said, let's

Scott Benner 52:56 give you all 24 hours of every day at your house.

Michelle Mata 52:59 Pretty much. Yeah. And that constructive? discharge, right. So yeah, basically made the work environment so terrible that this employee felt that they had no other choice than to leave it. So companies do get in trouble for it.

Scott Benner 53:16 Yeah, I know. But, and I appreciate that. And that should be. And I agree with you that the number was too small, even. But my point is, is that I just want a job. I don't want to be in a lawsuit. I'm not trying to like change the world. Like you don't even want to go to work, I want to get paid. I like you to like, treat me fairly, I want to do something I enjoy. I like to go home. That's pretty much it. And and I'm trying to think about how do we tell people I guess they need to understand this side of it, so that they can understand what they're going to make available to people. Like I just wouldn't want people to believe that it's so cut and dry that it's perfect. You know, I mean, like, don't worry, you're

Michelle Mata 53:56 not, you're gonna you're gonna have even HR people, you're gonna have some HR people that are not doing the right thing.

Scott Benner 54:03 Yeah. Well, because they see their problems coming down the pike too. Like, if you come in for an interview, and you even remind me of a person I had to fire six months ago, that's gonna make me think, well, I don't want to go through this again, with you know, they said the same things in their interview or whatever. If people get biased by by all kinds of things that they see. And yep, see, you know, and I also don't like the idea of being dishonest coming through the door. But I mean, do you are you like you can't know, right? It's like a blind date. How do you know how the person is going to react when you say to them? Look, I have an insulin pump on and I might have though, we just went through this with Arden going to college. They wanted her to have a disability meeting. So we're like, Alright, so we get on the, you know, on the call with a person and it's very strange for the first couple of minutes. And then we stopped, stomp the person here. It's on Zoom, everything's on Zoom. And, and we said, Listen, we want to be clear. We don't One anything, we have no real ideas that Arden is going to need anything, we just need you to understand what this is in case something happens. I said because something is going to happen at some point. And when that does, we don't want her to be, you know, I don't know, given a given a an absence because her insulin pump fell off while she was on her way to class, she had to turn around and go back and get another one or something like that. Like, we just want you to understand that. But it's our expectation that she's never going to use any of the accommodations that we say might be necessary. And the conversation got more real after that. And it became obvious that the person who came to the meeting came to the meeting expecting to be met with let me see what I can wring out of you. Do you know what I mean? Like how many ways I can take advantage like that? They their expectation was that we were going to try to take advantage of Arden's diabetes and get Arden I don't know a puppy or something like that, you know, a pony that she could ride to class. And we were like, look, we don't want anything like we just Is it cool if we put an insulin refrigerator in our dorm room? Like it's just a little one, you know? Like, that's what we cared about. Like, could you you know, one of our classes his way across town, do you think you could find out if there's a refrigerator over there that we could keep a vial of insulin in so she doesn't have to hump insulin around with her everywhere she goes, because Arden's college is spread out over a town. And, and she was like, oh, that's all you want. Or like, yeah, she was, that's no problem. I was like, Oh, okay. So at the end of the call, I'm like, What were you expecting? And she said, Oh, you have no idea what people come on these calls asking for. And I was like, oh, and she goes in half the time. I don't think they really need them. And I was like, oh, okay, that to me seemed like the real kind of backroom dealing with that scenario. You don't I mean, I think it's why you see, adults. You know, what, one of the biggest, if you want to start an argument online about diabetes, you know what you can do Michelle, go online right now and ask for accommodations at Disney. Yes. I know that das pass. We call it the pancreas pass here. But you asked that question online. Hey, guys, I'm worried about my kid being in the heat. This is our first time going to Disney with diabetes, blah, blah. Is there a past that Bo, here's what happened next parents will come in and say, Oh, I didn't know that was something and other parents will come in and say, Oh, we've done that. Here's how you get it. And then adults with diabetes will come in and be like, You are not disabled. Stop it. Don't do this stand in line, you can blah, blah, blah. And I'm like, I always wonder like, where does that come from? And I used to think it was just that they didn't that these adults who, by the way, not every adult with diabetes says this, but there's enough of them. And I'm telling you, I've seen it over and over again. I always thought oh, they just don't want to be considered disabled. Like it's a it's kind of like, you know, a headspace idea. But now, I think

Michelle Mata 57:58 I think you're right on that. Because I mean, that's that's the other argument that you could start really quickly by saying diabetes, or type one diabetes is a disability. And some people who say flat out No, it has not disabled me in any way form matter whatsoever. Right?

Scott Benner 58:11 Yeah, there's such a difference between the legal distinction between disability and what you might personally believe is a disability. And that I know people get confused, not confused. But some people are coming from one perspective, and some people are coming from another perspective when they're online. But it's funny that while you've been talking about this, I started thinking about those adults thinking, Oh, this isn't about them all the time. Just I don't want to be disabled. It's maybe it's because they've been through the hiring process. Maybe it's because in their heart, they're like, don't tell people you're disabled. And and I don't know, I think there's so many different perspectives around that argument. I just know that if you want to start an argument, just say that out loud, it gets very riled up. And so I don't know that there's an answer, right? Because you're not going to know who you're talking to.

Michelle Mata 58:59 No, I mean, here's the thing, who's to say that you don't hire somebody and three months down the line, they go skiing and have a traumatic accident, which prevents them from working for the next three months? Yeah. I mean, you never know. You never know. I

Scott Benner 59:12 would never see Michelle. I've not tried it. I'm not ending my life, crashing into a tree with my face. That's all I know, about. That's what I imagined skiing is and I will not do it. I'm sure that's not what it is. But it's too late, that skiing and sharks. That's not how I'm going out, Michelle. But yeah, but I take your point, like, you could hire a perfectly healthy person who doesn't have one problem in the entire world and they could, you know, snap their legs stepping off a step, and now they're looking for FMLA or they need a disability or they need a some sort of an accommodation. So, do you think so what would you do? You're gonna have Ben one day, and you're gonna send Ben off to a job interview. What are you going to tell him? to do, how are you going to ask him to handle it?

Michelle Mata 1:00:03 I mean, I would give him my professional recommendation, which, which would be, you don't have to disclose anything until your first day.

Scott Benner 1:00:09 Okay, that's your that's the that's what I thought you were gonna say,

Michelle Mata 1:00:13 yeah, that's gonna be my recommendation. In the meantime, though, I would recommend that somebody do their homework. So here's, you know, I think the most people that listen to your podcast know that the American diabetes Association has a page that's dedicated to reasonable accommodations. Another resource that they can use, it's called Ask Jan. And Jan stands for the job accommodation network. So you could look up accommodations that have been recommended for diabetes, or any other condition under the sun.

Scott Benner 1:00:43 Okay. And these will answer a lot of your wonder mints about how things work. how the process works in the laws work will will that make me feel good about that? Or is it more of a how to? It's more of a how to Oh, okay. Okay. Yeah. All right. Yeah, less of an FAQ more of a, do these things, and this will go in your direction. Okay. Oh, that's, that's terrific. Yeah. Or

Michelle Mata 1:01:05 if you're thinking about asking this, here's, here's how it's been applied in XYZ organization, or how others have been advised to ask for it.

Scott Benner 1:01:15 Interesting. In your note to me, you said that you could also discuss employee resource groups and employee assistance programs. I've wondered what those were.

Michelle Mata 1:01:26 Okay, so, I happen to work for an employer, that is considered a best place to work for disability inclusion.

Scott Benner 1:01:37 And global, unlike the Emmys, how do you how did you get that? How does that work?

Michelle Mata 1:01:41 Sure. So if you think about, like, the Chamber of Commerce type organization, right, it's, it's a nonprofit, that's, that's similar to that, except that they focus strictly on disabilities, it's called Disability in. And every year, they have companies voluntarily go through the disability Equity Index report. And so they're rated on a number of things, it could be, you know, how they support teammates, how they support disability organizations that their teammates might refer to. If there's advocacy within the organization, just a number of different points. And so in 2020, to 415 companies participated, the organization I work for is one of them. And we scored a 90 out of 100. So next year, we're hoping for 100. And so some of the themes that they look for, and they kind of gathered as a result of this report is that accommodations are still a foundational practice. Inclusion is an emerging trend. And the sense of belonging is imperative for success at companies. So these are considered disability friendly companies. And so the other thing is that organizations that are certified disability workplaces might be eligible for certain federal grants or contracts. So they might be able to do work that other companies don't get to do.

Scott Benner 1:03:14 Oh, yeah. So when you're nice to people who have a disability is to do more things that makes them more money. I see what you're saying. Are there companies who are being nice to people with disabilities just to get contracts with things? Probably. Michelle, I always see the bad part of you. By the way, funniest thing has happened last hour, is you said E OC.

Michelle Mata 1:03:40 What does that stand for? Equal Employment Opportunity Commission?

Scott Benner 1:03:43 And all I heard was those turtles in Finding Nemo saying that they were writing the EOC. Is that what it was called? I'm gonna answer that with Whoa. It was like, I was even proud of myself for not bringing it up while you were talking. I don't know what that says. But yeah, a couple of times. I'm like, please stop using that acronym. You're breaking my brain.

Michelle Mata 1:04:11 I'm surprised that I haven't gone there yet. Because I am pretty random at times. So okay, good back on track. Okay, no, it's okay. Because I guess I don't want to forget this. So okay, in addition to disability in and you can look at the different companies that are disability friendly, and there's even a disability recruitment, Virtual Job Fair, during the year two, so things you could take a look at. A company might also have a employee resource group. And so again, the organization I work for, we have one and we have one focused on different things. There's one for women, there's one for Hispanics, one for veterans, and I'm on the advisory committee for our disability group. And so what we do is we support our teammates and their loved ones who have disabilities, through educational webinars, allowing them to write blogs, spotlighting them on social media and supporting each other through our discussion boards.

Scott Benner 1:05:17 That's interesting. And is this something that if my company doesn't have this? How would I start something like this? How would I, you know, is that something you can spearhead with, with a company to walk in HR and say, Hey, I really wish we had an employee assistance program. And here's why. And there's seven of us here have diabetes. So I think it would be great. And there's a girl over there has something going on. And there's I think there's enough of us that this would be helpful, do you think they'd be open to hearing about that?

Michelle Mata 1:05:43 I'm gonna go with it depends on the company. So I know some organizations that they're just kind of starting to look at that. And so they might start with one group, versus doing a ton of them, right. And so usually, what's happening behind the scenes is either in HR, or somewhere and leadership. They have located a dei champion, to be able to move those type of things forward. So if it's coming from the employee, yes, that does mean a lot. But it also means that you have to have somebody at the top or somebody in HR who's willing to say, this is important.

Scott Benner 1:06:19 Do you think when I guess maybe when that happens at places, maybe people know someone personally and it brings it top of mind to them? And as a thing that would be valuable to do? Is there a reef resource online? Like if I was gonna go to HR and say, Look, no pressure, but I wish you guys would check into this. Can I take them a link to something?

Michelle Mata 1:06:38 I would start with a disability and website.

Scott Benner 1:06:42 Okay. Well, you know what that is off top your head again?

Michelle Mata 1:06:46 Disability in.org?

Scott Benner 1:06:48 Yes, a billet. I see what you're done to me. Is it i n?

Michelle Mata 1:06:54 I n dot o RG?

Scott Benner 1:07:00 Hey, I spell disability, right. So proud of myself. It's Monday, disability in.org. We empower businesses to achieve disability inclusion and equality. Are you in Oh, I see the pun. Okay. So, um, so maybe I would just like drop this on somebody and be like, Could you check into this? I, it'd be great if blah, blah,

Michelle Mata 1:07:20 blah. Right. We could do this to support the employees.

Scott Benner 1:07:23 Yeah. Okay. Yeah, well, because expecting someone to do it just on their own is random. You know what I mean? Like people are busy at work. I don't think there's anybody right now in an HR office, whose head down doing the work and in the back of their mind thinking, I really do want to get that disability and thing going here, like you don't mean like, if somebody doesn't spearhead something, or bring it to light, it's hard to expect it to get started. It's funny to how much this conversation mimics the conversations about going to school as a child with diabetes. You don't mean like, like, like, heading into school, expecting people to understand. There's things they legally have to do for you. But But at the same time, some people may be great at it. And some people may not be meaning some people may be supportive, and some people may be less. So some people may see it as an annoyance while other people are happy to accommodate. It really is. I don't I don't see it as being much different to be perfectly

Michelle Mata 1:08:21 No, I mean, the reasonable accommodation process is a lot like the 504 and IEP meetings.

Scott Benner 1:08:27 Yeah, that's exactly what I was. That's how I was thinking about it. While you've been talking. Is there anything I haven't asked you or that you haven't gotten to that you think is important?

Michelle Mata 1:08:35 Um, let me let me talk about insurance benefits for a second. Yeah. Yeah. So people like getting paid? I do. Yeah. So when somebody's whether it's the parent or the individual with type one, you definitely want to consider the entire compensation package, you might hear this as total reward sometimes. And so some people might think, Oh, I'm gonna get paid buku dollars. So it doesn't matter what my insurance is, well, if you're getting paid, like booze, but your insurance plan is a high deductible plan, and you're gonna have to pay out of pocket for all your decks comms and all your Omni pods and all your insulin and everything. Until you meet that deductible. Well, how much in compensation? Are you really getting? Because your money is obviously going over there? Yeah. So So just because you get paid just because you're going to take a job that pays you a lot of money, but has a terrible, high deductible plan may not be great, especially if you have type one, right? Because because of what you're having to spend. Yeah, so I'm not I'm not saying take take the high paying job, right. It's all a balance. What I am saying is do your homework. So if you're going up for a job or you're considering changing jobs, and you're in the interview process, ass asked the recruiter for a copy of the medical insurance information once you get into once you get into that role where they're starting to Seriously, considering you for, you know, for a job. I mean, this is not every job right? If you're going for a job, if you're going for a job at the movie theaters, this is overkill.

Scott Benner 1:10:07 Yeah. Michelle's trying to stop you from in the first. What did they tell you? In your first interview? Your question is not how much does this pay? You're gonna you want to you want to get past that part.

Michelle Mata 1:10:17 Exactly, exactly. Yeah. So this medical question would come up along the question of like, Okay, what does this job pay? Ask for the the Summary of Benefits plan. This is a list that tells you like, what all the co pays are for in network out of network, what's covered what's not covered, and just kind of like a cute little summarized plan. And so you definitely want to take a look at that. So so know what your deductible is going to be. And then I remember I had post some questions out, actually on your facebook group on Reddit and a couple places. And so one of the questions that came up is, can I continue to cover my child who's in college after they turn 26? And the answer is no, because that's a provision of the Affordable Care Act, that children can be covered to 26. And once they're 27, they've got to be able to cover their own.

Scott Benner 1:11:13 Yeah, okay. Yeah, that comes up a lot. And by the way, my son just graduated from college. So it's in my head, too, that I have four more years where I can cover his health insurance. But But your point, I just want to go over it real quickly, as you're going for a job that pays $70,000 a year. Congratulations. And it's got a great insurance plan that's going to end up costing you $5,000 out of pocket for your whole family. So you're making $65,000 Or you're you know, you're making $5,000 less, but you get that same job. And somebody's like, Oh, don't worry like this take us because we pay 80 We're going to your but then you learn that they have no insurance, and you're out of pocket. Now you're 1520 grand a year for your for your medical stuff. You're better off taking the other job lower paying but the insurance. Yeah, right. Yeah. And I guess people don't think about that readily. Maybe people with diabetes do but

Michelle Mata 1:12:08 I mean, I've seen situations where and this is back in my recruiting days where people would jump ship for $1 or even 50 cents, and not consider what that meant for insurance.

Scott Benner 1:12:18 I don't understand people's brains work like that. I wish I wish I could have the same job my whole life.

Michelle Mata 1:12:24 Well, you've kind of done that for yourself. I mean, yeah,

Scott Benner 1:12:27 I've had two jobs. Basically, I've been somebody's parent, and I've made this podcast. The other jobs before that. I don't remember anymore. So I tend not to think about them as much. Wow. Okay. Thank you. So what? I don't want to I'm we're not done. But I really appreciate this because I I don't hear anybody talking about this, to be perfectly honest. You know,

Michelle Mata 1:12:47 no, sure. And I see this questions every once in a while. I mean, they're not always top of mind. And they're not the fun things to talk about, or they're not the annoying things to talk about. They're just the things to talk about.

Scott Benner 1:13:00 I'm the one, I'm the one on my house, Michelle, when when Kelly's like, it's time to go around insurance coverage again this year. And I'm like, Ah, I feel like a child and like, I don't want to do just take what we had last time. Why don't we have to think about this?

Michelle Mata 1:13:12 And no, it's not. I mean, this is as fun as trying to shop for home insurance or car insurance. Yeah, but But you know, for type one, I mean, this is everything

Scott Benner 1:13:21 super important. It just really Yeah.

Michelle Mata 1:13:25 So another thing that comes up,

Scott Benner 1:13:27 I'm gonna last for a moment. So please just keep talking. Okay. So

Michelle Mata 1:13:31 another thing that I see that comes up is life insurance and how people get denied for life insurance. And so one thing that they might want to find out if they do plan to leave another job is to find out if the life insurance that they have with their current employer is portable. And what that means is if they leave the organization, as long as they pay for the entire premium, the amount that they paid, and the amount that the company paid for them, they can continue to have the life insurance, because what happens when a type one applies for life insurance? You're getting denied.

Scott Benner 1:14:04 Yeah, so that happens, even if you if can that happen to me if I take a job, and the job is like, oh, it comes with life insurance, but not for you. Arden so

Michelle Mata 1:14:12 So typically, what happens is you can get a set amount of life insurance without having to go through a medical examination. Right? Right. And you can max that out. But if you want more than that, then you would have to go through the medical exam. And at that point, you could get denied because a type one diagnosis.

Scott Benner 1:14:31 And if you're not denied, there could be a larger premium for a lesser payout.

Michelle Mata 1:14:37 If you're not denied, yeah, it'll be it'll be a larger premium.

Scott Benner 1:14:40 Yeah. Okay. I have to admit, that's one of those things like we've always been lucky that my wife jobs offered some life insurance. And we talked about like, should we get more? And then it's like term and then there's other kinds and we're like, we don't know what we're talking about. And then before you know it, you're just like, I'm not doing this, because I don't know what it is. I Don't want to get ripped off, get any mean. But I would like to understand it better, but it's just I don't know, IT companies then put you on a web portal where you click through a couple things that are talking Turtles explaining diabetes to your life insurance to you. And you just think I know this. I don't know what this means, then I'm out. Yeah.

Michelle Mata 1:15:20 Yeah. And the gist of it with life insurance is this like, is the amount that you can that you make, right? If something were to happen to you today, and you don't exist, but you have dependents that are that are living off your income, right? Because their children or it's your spouse who doesn't work, you know, G have a way of being able to replace your income for the next, you know, set amount of years, next set amount of time. Should for whatever reason, you leave this planet?

Scott Benner 1:15:50 Yeah, that's how we have enough. hate, I hate that we have this, we have enough on the kids, that if they were to pass away, we could take care of their funeral arrangements and things like that without digging into money that we have. And I'm covered lesser than my wife is because my wife, you know, makes more money than I do. And I think if I died, she'd be like, Yeah, well, that's inconvenient, because I have to wash the dishes now, but I can still pay the bills. And whereas if she died, I'd be like, I need to do some sit ups and queued the kids up because I need some lady to come in here and make some more money. You don't I mean?

Michelle Mata 1:16:28 Yeah, I mean, you see situations like that. I've even seen it where, let's say that you have, you know, one spouse who is, you know, the breadwinner for the family. And the other spouse is at home and they have five kids will if that stay at home spouse passes away. And those kids are school age, like somebody's still having to take care of them during the day. Yeah. So and that, you know that that takes resources that takes income. And even though that family wasn't paying anybody for child care, right, there was, there's still a value to the work that was done at the home.

Scott Benner 1:17:02 You don't have to count on the guy in high school that liked you that you didn't like that much. But he's still single. So yeah, yeah. Do you remember me from from college? Yeah, you don't

Michelle Mata 1:17:13 want to have to depend on the Hey, remember, when we were 20? We said we would marry if?

Scott Benner 1:17:18 Well, my husband just got hit by a tractor trailer, and I need you to be interested in me again, or vice versa, like I, my wife would be at a loss. She doesn't know when the garbage goes out. You don't I mean? Like, I'm sure she kind of does, but she wouldn't remember. You know, there's just some things people do when and, you know, when it's financial, you need coverage, it because it just goes away. It's not like, you know, if you don't have that life insurance, your company's not going to keep sending a check. So, so fight through the pain of how annoying and adult it is to have to learn about life insurance. Is that what you're telling me? I'm supposed to do? Michelle?

Michelle Mata 1:17:53 That's exactly what I'm saying. It's not pretty. It's a little ugly, but it's important.

Scott Benner 1:17:58 Getting old, probably should do. You know, I mean, how much longer can I make it? Michelle? It can't be?

Michelle Mata 1:18:03 Um, I don't know. I mean, you could take out insurance policy on your voice. So that way, if for some reason anything ever happened to your throat, and you couldn't do the podcast anymore?

Scott Benner 1:18:11 Could I legally? Is that a true thing? Are you making that up? Michelle trying to be funny. You're no,

Michelle Mata 1:18:16 no. I mean, there are some people that because of whatever work they do, they they insure certain things. I mean, years ago, JLo insured her booty?

Scott Benner 1:18:30 Did she? I think Ben Affleck just bought that policy out. It's okay, well, I'm going to do that, then. I'm not gonna get life insurance, but I'm gonna get insurance on my voice. That would be ridiculous. That's amazing. I appreciate you doing this. Did I miss anything? Did you miss anything? Are we good?

Michelle Mata 1:18:52 Um, oh, one other thing to look into, as you're looking into the the employee benefits is also check out the short term and long term disability plants, your company, some companies pay for those for the employees. And short term disability is considered WHERE condition might last like seven days to 30 days, whereas the long term is going to be anything from 30 days, maybe up to two years. And so there's always an elimination periods. It's weird that they call an elimination period. But they may not start the disability payments until seven days later, or 14 days later, right?

Scott Benner 1:19:34 I see. Yeah, I see. I'm so cynical that every time you say something like this, I put myself in the HR person's position. And I think I'm interviewing you and you say, Hey, tell me when does your long term and short term disability kick in? And in my mind, I'm just putting an X on the paper. I'm like, No, like you. I don't know why I'm just I am I is this like an East Coast cynicism thing, Michelle, like do you not think that way?

Michelle Mata 1:19:58 It could be I tried I'd be optimistic. But I try to also be an optimistic realist about things, too. I mean, I mean, I've seen some questionable things, you know, when I've interviewed people.

Scott Benner 1:20:10 To me, it's like, it's like, it's like, if I'm in an interview, and I'm like, Hey, I have a question about the company. Sure. What closet? Can I shoot heroin? Like, like, like, I'd be Oh, I'm sorry. You're, uh, no, like, right? Like that kind of thing? Like, tell me, how long does it take for the short term disability to kick in makes me feel like you're planning on taking short term disability. But I know that, but I know that for a person who has a real issue, it's just fact finding. But how do you relay that to the person you're speaking to? Without saying, I know this sounds janky. That I'm asking about this?

Michelle Mata 1:20:46 No, I mean, sure. I mean, you know, the whole idea about this is the, these should be normal questions anybody should be asking. So that way, it doesn't feel like you're the oddball asking this particular type of question. It also depends on the type of organization too. And I've certainly been a part of, you know, job interviews in the past where I never even had to ask for this information, because they just said, here's the benefits book. And if you have any questions, let us know. And they gave me everything.

Scott Benner 1:21:16 Excellent. And then then you don't have to ask the questions. But you can get the answers. Exactly. Yeah. That See, Michelle, that that I can't believe I'm saying it like this, because I don't mean it like this. That's a really valuable piece of information, not to say that other things you've said haven't. But instead of sitting there and asking all these questions, it's going to lead somebody to think I think this person's like, not going to work. You know, like, is there a place where I can get all my questions answered in a booklet or online? I don't want to bother you with it right now. And that way, you can dig into it without looking like your pre planning a vacation?

Michelle Mata 1:21:51 No, sure. And some other things that somebody could do to kind of do some, some fact finding and digging about the company is they could go to Glassdoor. And they can look at the reviews and see what other people have posted about their interview experience. Indeed, also has some reviews that people could look at as well. There's another try remember what the name of it is right now. I think it's blind.com. Where you can go in and anonymously post about your company experience. And again, just do some fact finding. Yeah, to find out like, Okay, I know what they're offering me. I know, this is the job title that said, but is it legitimate? Like, are they gonna pull? You know, they're gonna pull a rug under me

Scott Benner 1:22:38 by right? Yeah, yeah, it pays a lot of money. But we also don't let you leave, you're going to work 18 hours a day, you know, and you, we don't make you but you're gonna see someone else do it, and that person is gonna get compensated, and you're gonna start thinking, Well, I got to stay longer. And like those things that kind of pressure you into, it's bait and switch, as well as Michelle Yeah, then and if you can find a reliable place, where you see, you know, 50% of the people are like, Look, don't go there. Because this is what's going to happen that you can kind of trust that that's what's gonna happen.

Michelle Mata 1:23:08 No, absolutely. Oh, you know, it was blind and another one fishbowl that they can check,

Scott Benner 1:23:12 fishbowl and and Glassdoor and what's the other? Indeed? Indeed? Okay.

Michelle Mata 1:23:18 Yeah. All right. I'm blind. I'm blind.com. Blind. It's an app. Oh,

Scott Benner 1:23:23 that's excellent. That's all good information. I really appreciate it. Do you like your the work you do?

Michelle Mata 1:23:28 I do. Like the work I do. I like if I'm less, I'm less than HR. These days. I'm doing more creative things where I get to build elearning trainings and animated videos, and help people generally just get better at what they do some more creative side of it.

Scott Benner 1:23:43 Yeah. firing people very difficult.

Michelle Mata 1:23:46 Yes. And I am glad that I was not having to do Employee Relations during the pandemic.

Scott Benner 1:23:51 Oh, yeah. On top of everything, You're firing me during COVID use. Yeah, like that would be terrible.

Michelle Mata 1:23:58 I just vaccination, but

Scott Benner 1:24:01 also, we got you this lovely bouquet of oranges and apples to take with you. Please don't please, please don't crash into our cars as you leave it. I just can't imagine having to take someone's job from it seems. I mean, even if they deserve it, it seems that something I don't want my soul connected. So I think

Michelle Mata 1:24:20 yeah, I mean, it was even hard as a recruiter to tell people like you didn't get the job. Because some people overshare right. And so I knew what this job meant for them. But if they weren't the most qualified candidate, they weren't the most qualified candidate who's

Scott Benner 1:24:35 the oversharing ever get them out of the getting the job?

Michelle Mata 1:24:38 Um I think you can tell I try to stay like even if I hear something I still try very, very down the middle. Yeah, you really aren't. Yeah. And you know, in, in my world, I try to find that good balance between you know, I need to apply all of the organization's policies and procedures, but yet also make sure that, that the employee is having a good experience. Yeah, where they're out to. So I tried really hard to kind of be in the middle. But, I mean, there's a lot of people on both sides and, and I've seen it get really ugly at times too.

Scott Benner 1:25:15 Wow. Okay. All right. Well, I appreciate you doing this. I appreciate it very much. Thank you. I I didn't know where else to get this information from. So it's amazing that you had it.

Michelle Mata 1:25:25 You're welcome. Glad I could help. Oh, no, you

Scott Benner 1:25:28 really have. Hold on one second. I'm gonna talk to you when we're done. Sure. Hey, how about a huge thanks for Michelle for sharing all that knowledge with us. And while we're thanking people, let's thank Dexcom makers of the Dexcom G six and Dexcom G seven continuous glucose monitoring systems. Learn more Get started today use my link dexcom.com forward slash juicebox. Are you looking for community around your diabetes? Check out Juicebox Podcast type one diabetes on Facebook, a wonderful, seriously wonderful community with nearly 40,000 people in it. Type one type two lot of gestational doesn't matter what kind of diabetes you have. Doesn't matter how you eat. You're welcome my group Juicebox Podcast, type one diabetes, absolutely free on Facebook. I hope you're enjoying the podcast. If you are please share it with someone else who might also enjoy it. And of course, subscribe or follow in a podcast or audio app. It's a big help, Spotify, Apple podcast, Amazon music, stuff like that. Thank you so much for listening. I'll be back very soon with another episode of The Juicebox Podcast.

#915 Best of Juicebox: Diabetes Pro Tip: Pre Bolus

Originally posted on Mar 25, 2019.

+ Click for EPISODE TRANSCRIPT

Scott Benner 0:00
Hello friends and welcome to episode 915 of the Juicebox Podcast.

Today, we're gonna be revisiting episode 217 From March 25 2019. This is the Pre-Bolus episode of the diabetes Pro Tip series. Today, Jenny Smith and I talked about Pre-Bolus thing. I mean not today, but I don't know, like four years ago, but for years has not made this one any less of a fan favorite. While you're listening, please remember that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, always consult a physician before making any changes to your healthcare plan or becoming bold with insulin. If you head to cozy earth.com You will save 35% off your entire order with the offer code juice box at checkout one word juice box at checkout at cozy earth.com to get 35% off everything they have joggers, sheets, towels, pajamas, I mean they've got so much great stuff, check them out cozy earth.com Use juicebox at checkout to save 35%.

The podcast is sponsored today by better help better help is the world's largest therapy service and is 100% online. With better help, you can tap into a network of over 25,000 licensed and experienced therapists who can help you with a wide range of issues better help.com forward slash juicebox. To get started, you just answer a few questions about your needs and preferences in therapy. That way BetterHelp can match you with the right therapist from their network. And when you use my link, you'll save 10% On your first month of therapy. You can message your therapist at any time and schedule live sessions when it's convenient for you. Talk to them however you feel comfortable text chat phone or video call. If your therapist isn't the right fit, for any reason at all, you can switch to a new therapist at no additional charge. And the best part for me is that with better help you get the same professionalism and quality you expect from in office therapy. But with a therapist who is custom picked for you, and you're gonna get more scheduling flexibility, and a more affordable price betterhelp.com forward slash juicebox that's better help h e l p.com. Forward slash juicebox save 10% On your first month of therapy. In the episode about insulin, I told you that, that my nurse practitioner CDE told us that fear of insulin was the biggest sticking point for people making good decisions with their diabetes, right. And after I got past my fear of insulin, the next hurdle I had to get past was Pre-Bolus. And I am now years and years later at a time where I will tell you that if you do not Pre-Bolus a meal, the likelihood of success is near zero. And if you have success without Pre-Bolus saying.

All that means is that you gave yourself too much insulin prior to that. And it's just catching up now. And so this is it. We're going to talk about Pre-Bolus And then we're going to talk about how about insulin action, right the action of the insulin and how to balance it against the impact of the carbs or your body function. So tell me, let's go over the part that people aren't gonna find comforting at first, right which is the amount of time it takes insulin to begin working in a person varies person to person and insulin to insulin. Is that pretty fair to say?

Jennifer Smith, CDE 4:07
It's pretty fair to say yes. And insulin to insulin. I would definitely say most of the the rapids on the market should be fairly similar. The rapid acting influence on the market and their time of action should be fairly similar now. Person to person. Yes, that may vary

Scott Benner 4:30
situation to situation as well

Jennifer Smith, CDE 4:32
as situation it may vary. But again, that's the learning part of it. Okay,

Scott Benner 4:37
so person, the person could end up meaning just your body chemistry could mean where your infusion set is right, you know, or your injection site. Absolutely. Say you're a person who gets stuck on I always injected my belly in the same place that spot might not be as reactive to the insulin as if you would just try a new spot. If you went to a new spot it might work quicker than it has been in your old spot. Right? If you're wearing infusion set it could we alluded to it before you could get better action from your insulin on day one than you do on day three or better on day two, then you know, two hours after you've put it on, there's a lot of different variables. But we're speaking generally here to you'll apply them to your variables later. Now, if you've heard this podcast before, you'll know that I have alluded to how insulin works in a number of different ways. So I'm gonna give my kind of cartoony description of it, and then we're gonna let Jenny talk about it for real.

Jennifer Smith, CDE 5:32
Her acuity might be better, as we'll see.

Scott Benner 5:34
So here's how I pictured in my head a couple of different ways. The first way is I think of a tug of war. And I imagine a rope with a with a flag hanging in the middle of it. And on one side of this tug of war rope is insulin. And on the other side is your carbs and your body function. It could be adrenaline, it could be fear, could be anxiety, whatever it helps to drive your blood sugar up. That stuff's on one side of the rope. The insolence on the other side, unlike a tug of war in a schoolyard, our goal is not for one side to win, our goal is for them both to pull and pull and pull until they get exhausted, and they both go, I can't do this anymore, and they dropped the rope and our flags still in the center. That flag represents the blood sugar. You start at when the impact of the carbs begins in my mind. So I'll explain a little more. If you let them both start pulling at the same time, the carbs are generally speaking, going to gain power and momentum before the insulin begins to work. So now your rope is going towards a high blood sugar and you're you're starting to head up. Now suddenly, you're 50 points higher. And what if you started with 150 blood sugar, now you're 200. And now these carbs have momentum. They have speed, they're pulling your blood sugar up. Now all the sudden, 1520 30 minutes later, the insulin is like, oh, no, no, wait, I have a job to do. I remember and it kind of comes online. But now it's pulling, it can overpower the the momentum that the carbs have created. Plus, you now have another 100 points of blood sugar to contend with. And all you have is the insulin that you counted your carbs for. So even if you counted your carbs perfectly, and realize that this meal is five units, once the momentum of the carbs is rocketing your blood sugar up, once you have a number that is higher than you started with those five units are not even going to begin to cover what's happening, let alone the food that you've put in. But if you put the insulin in first, and let the insulin come online slowly and begin to pull down and create the momentum in the other way, then you flip the script. And now the carbs are fighting. So instead of having a fight at 180, blood sugar, you're having a fight at an 80 blood sugar. And instead of your blood sugar falling at 80 It's being the attempt is that it's now trying to be pulled up by the carbs. And that's how when you see people with a stable graph, that's how they're doing it. And so for me, in a perfect situation for me, my daughter's blood sugar is diagonal down when I give her most foods. There's differences you know, food to food, situation to situation, but in a perfect world. To me, that's it, you want your insulin working, your blood sugar trending down, creating some momentum down, when you allow the carbs to begin to pull up. Right now, you'd explain that in a technical way that sounds

Jennifer Smith, CDE 8:37
and most in most settings, yes, that's 100% I mean, insulin, our rapid I've always thought that rapid is such a misnomer. Honestly, rapid indicates like now rapid is like sweating out, click, click, click lights with design, it's working. And it's, you know, still education is take your insulin and start to eat. I mean, even from most endo offices, it's take your insulin and start to eat, it's going to be working very, very quickly. That's not the case. And anybody who has been taking insulin long enough, and you've seen the spikes, and you've seen the issues, despite counting your carbs as precisely and weighing them and everything and you're still seeing these issues. It's the mismatch of insulin timing, it is so rapid take anywhere between about 15 to 30 minutes to really get that active peak, not peak, but that active phase where then when you start putting your carbs in. They will match as you said that carb digestion will start to match with the insulin you'll get a nice gentle curve up and it should then start to curve back down. And there is a lot of there's a lot of education that also focuses On, as you mentioned, watching for that curve down, watching for the curve down to start so that you know the insulin is already moving things.

Scott Benner 10:12
Yeah. And to give you some context that a person I spoke about in a previous episode, who was having trouble, told me, but what am I gonna do, I'm gonna be scared. I said, well try it a little bit this time and then a little more next time and a little more next time and go for it. And, and so I always tell this story somewhere. And I think here's the right place to tell it. Prior to glucose sensing technology being a thing that anyone knew about prior to Dexcom, I was again in the office and the CD says to me, Hey, you're gonna get one of those Dexcom things. And I thought, I don't know what that is, you know, and she starts telling me it's, it's, it's a continuous glucose monitor. And I'm like, Yeah, I again, don't know. And then she tells me this simple story. There's a 17 year old boy in her practice, who loves candy, certain kinds of candy, and he can't figure out how to Bolus it. So he gets a Dexcom, whatever the first one was, I don't even remember anymore. His whole goal was to eat this candy without a spike. So he goes out to the store. And he buys like little grab bags of these candies, and a number of them enough for a week and every day starts on this experiment first day, just like you said, eats, gives himself as his insulin, just like he had been told his whole life, blood sugar goes up to 20, something like that sits there forever. Eventually, he has to give himself more insulin to bring it back down again. Next day, he tries a little sooner, give himself a few minutes, 510 minutes gets a little less of a rise. So the next day, he goes even sooner. And then before you know it, it's a little sooner, a little more, and he starts adjusting it back and forth a little more a little sooner, a little later, until one day, he eats the candy. And his blood sugar never moves. And she tells me that story. And I thought immediately Wow, that means it's possible. Yeah, that was the first time I thought I was like, if that kid can do it with candy. I can do it with anything. Like anything, right? And so yes, give me that CGM place. And I got it. And I and I started dispense with my fear. And I started learning about it. There were hiccups along the way, right? I've given her insulin, and she's gotten lower than I meant to for two when she's eating. But you know, once twice, I'll go back to this over and over again, when something goes wrong. It's not a mistake. It's a learning experience. It's data for next time, right? Right. So I put the insulin in, and she goes down to 70 and sits at 70. While she's eating. It's beautiful. You know, like, there she goes. And then and then then a spike. Even if I really messed up on the amount of insulin, I used a spike takes you to 120. Right, right. Right. Right. It's just, it's all about that timing and amount. And I repeat it over and over again, that you all the things you and I are going to speak about all the things that people hear about on this podcast, if you want to know how to use your insulin, at its core, the very first step is timing and amount. If you get you can use the right amount at the wrong time, you can use the wrong amount at the right time, that it's too much, you have to have the right amount of insulin at the right time, you have to balance the action of the insulin against the impact of the carbs. If I do that, I don't want to say it's easy, because that's insulting to people. But let me just say I don't think about diabetes that much anymore.

Jennifer Smith, CDE 13:27
It's easier, it's much easier if you do that. It is easier. Absolutely. And it's a lot more. It gives you a lot more visual than to understand. Because it's not so much of an unknown Well, gosh, I counted the carbs, I took the right amount of insulin and this is always happening to me. Why. And if you can start to put those pieces together, it's not a wi anymore. It's like turning the light bulb on.

Scott Benner 13:58
Here's how I explain what Jenny just said. The Dexcom G six continuous glucose monitor gives you a complete picture of your glucose showing you where it's going and how fast it's getting there. There can be nothing more important. The Dexcom GS six also eliminates finger sticks for calibration, diabetes treatment decisions, and diabetes management. It also has an automatic inserter. Like it just you know, you stick it on and you push the button and the next thing you know you're wearing it. Now you can use the Dexcom receiver to get the information from your transmitter. But for those of you who enjoy using your cell phone, it works great with iPhone and Android as well. The last little thing about Dexcom isn't so little. How about the share and follow features also for Android and iPhone. Your loved ones can follow your blood sugar anywhere in the world. And if you're the parent or caregiver of someone with type one diabetes, you can be watching their blood sugar as well. You want to know what Arden's blood sugar is right now. It's 82 just glanced up and saw Just like that. Now my results are mine and yours may vary, but my daughter's a one C has been between 5.2 and 6.2. For over five solid years, the decisions we make about how to give my daughter insulin and when to give it to her, come directly from the data that comes from the Dexcom G six. And I don't know if you know this or not, but my daughter does not have one dietary restriction. Those numbers are accomplished through waffles, just as well as through salads, through burgers, just as well as through zucchini, it doesn't matter anything that impacts my daughter's blood sugar, that impact is shown to me by the Dexcom JSX. And then I make good decisions. You want to make some good decisions, go to dexcom.com forward slash juice box and get started today. That's the best decision you're ever going to make. This is a short episode, and I don't want you to have to have to add breaks. So hang on for me for one more second, let's talk about Omni pod. This past week, I visited the Omni pod headquarters in Massachusetts, where they've just moved their production facility. It's about to go live. And I got the tour of the floor where you're on the pods are going to be made from now on right here in America, right in Massachusetts, I want you to know that what I witnessed in Massachusetts on that assembly line, it didn't just renew my excitement about Omni pod, it shot me over the moon, the accomplishment of bringing a production like that into one facility, putting it under your roof that showed me a real commitment to the people living with type one diabetes. Right? This isn't being made overseas somewhere, you know, a bunch of different factories. It's all right there at the Omnipod headquarters, and its state of the art an absolutely stunning. This is a company who is behind you for the long haul. I believe that before but I believe it even more. Now, here's what you want to do go to my Omni pod.com Ford slash juice box or click on the links in your show notes or juicebox podcast.com. When you get there request a free experience kit. That's right, a pack a pod experience kit on the pod is gonna send you a pod that is an exact replica of the one you'll get when you start using the product for real, but this one's non functioning. And so it's safe to wear for you to try out, you'll be able to find out if you like it, where you want to wear it. And you'll notice how after you've had it on for a little while you don't even remember that it's there. Miami pod.com forward slash juicebox. The links in your show notes or juicebox podcast.com.

Last thing, don't forget dancing for diabetes that's dancing the number four diabetes.com. It's the little organization that does a ton of good for a lot of people living with type one, they're on Facebook and Instagram. And at dancing the number four diabetes.com Check them out. Here's how I explain what Jenny just said. I think of it as this equation that it's a mathematical equation that doesn't have any math in it. I did this that happen. So next time I'll do more or less sooner, you know, little less little more, that kind of thing. And I always just I always just keep looking at it like that. I did this and that happen. It's the idea of being in a fistfight and you want to hit first because now you have caused an effect. Right? And if you and so now, you know I've done something. And that's what happened next. Now I can make a good decision about what what I do next, instead of waiting for diabetes to do something to you. And then you're just covering up your face hoping not to get knocked out. Right? Like because you don't know what's happening. You don't know why it's happening. I have no context for what's going on. But when you make the first move, you can be sure that what happens next was impacted by what you did. I put insulin in 10 minutes before you ate 10 minutes before I ate. And my blood sugar went to 150. So the next time I'm going to try 15 minutes. And if it goes to 130 I might try 20 minutes. And you know if I get low then later I might say okay, I might need a little more a little less. Now here's where people always say well, how much Scott How long? You know, give me the time give me the amount? That answer for me. It's always going to be I don't know figure it out for yourself. Okay, you have to

Jennifer Smith, CDE 19:22
this is the starting place. Yes. This is where to start. This is how to start. You have to do your own. I mean, diabetes is a science experiment. It's a daily I feel like every day you're almost given like this new petri dish and you're told, keep the dots growing purple today. Okay, let's work on keeping the dots growing problem is that something green pops in and then these like little horny pink things pop on. You're like, oh, no, but it is it's like it's a science experiment that for the most part when you figure out what does work the timing around the most typical foods that you Eat and whatnot, it takes a lot less thinking out of the equation.

Scott Benner 20:04
Yeah. And while this isn't about Pre-Bolus, and it will come up later, but it's important for me to say, because I think this is impactful when you really stop and think about your, your habits around food. They're pretty similar. Right? So, you know, you're not I always say like this, like, if you're a person who gets a pizza on a Friday night and has two slices, you don't suddenly next Friday have seven slices, you don't go from being a two slice person to a seven slice person, right? Like, and so, so you can start making these decisions about how much insulin and when, and you can make them based on historical knowledge about what's going

Jennifer Smith, CDE 20:41
on? Yeah, I usually tell people as the Pre-Bolus piece, you've got, most people have about 20 to 25 foods that are the most common for you to eat regularly. Yeah, that's at least 80% of your control there, at least. So if you can nail the Bolus timing around those and figure it out, for the most part, you know, variations in setting will happen, whatever, yeah, but for the most part, if you've figured that out, you're also much more likely to be able to figure out food that isn't your norm, because of the similarities to what you've chosen. And what you're usually eating,

Scott Benner 21:27
because you can stay flexible. I call it saying stay fluid, right? So here's, here's where I'll tell people this, don't get mad. I don't count carbs. I actually think about it a little backwards from the VB how most of you think about it, I don't look at the food and say eat away at or measured and say okay, well, that's 25 carbs. And my pump says that, I get one unit for every 10. So that's two and a half units. In honesty, there is no accurate insulin to carb ratio set up in Ardens pump. We don't even I don't even pay attention to that. I look at a plate and I say to myself, that's seven units. I think that if she's going to sit down and gorge herself on nachos and cheese, the last time that happened, it took 10 units. But I think of it as insulin, not as carbs. And of course that takes a little practice, right? It does, it does. And it is a little contingent on you having a CGM. I'm not going to lie about that, right, because I start with a healthy Pre-Bolus. And healthy would mean in amount and time. And then I watch her CGM, and I don't really watch it, I have her tolerances set tightly enough that if she leaves that range, I find out about it. So as an example, if I were to give art in something incredibly carb heavy, I might use a Temp Basal increase, and a Pre-Bolus to try to spread out the action of the insulin across this timeline where there's going to be these carbs, right? If I make a Bolus, and 30 minutes after I do it, she's 121 30 Diagonal up. I look at that line. And it tells me something based on my previous knowledge, it's that I say to myself, ooh, this I missed, like, this isn't enough insulin. And I will give her more I will bump it and nudge it back. It's not a ton more, it's enough to stop the arrows,

Jennifer Smith, CDE 23:25
right. And the arrows are very important to bring up in this in this as well. Because if you are using a CGM, those arrows do indicate a rate of change. And again, that's not something that most people realize. They don't understand that and not understand that it's that they've not been told they've not been told, Hey, these arrows tell you that you're increasing by 30 to 60 points in the next 30 minutes. Okay, if that's the case, and I know what my plan of correction factor is, or whatever, I can say, Okay, I'm going to need this much more insulin because if I don't correct my rising 130 blood sugar in the next 30 minutes, I could be 30 to 60 points higher. I could be as high as 190. I don't want to be 190 I've obviously miscalculated someplace, I can throw in a bit more insulin to counter that expected and stabilize it. Yes.

Scott Benner 24:20
Yeah. It very much. It very much is remembering to like I guess the way I usually say it is that you have to trust that what you know is going to happen is going to happen, right? Yeah, you see, and I think that the least important aspect of what the Dexcom does is the number. It's the direction and the speed, direction and

Jennifer Smith, CDE 24:48
100% I wish more please say that again, is the direction it's the trend. It is not just the number

Scott Benner 24:56
the numbers nice like don't get me wrong. It's a starting point, but You know, if you're 60 and stable, and you haven't had insulin for three hours and you haven't had food for three hours, well, maybe you could get away with like a Temp Basal decrease of 100% for half an hour, maybe you'll rise to 90, right. But if you're 60, and you're falling, well, then you don't have enough time, because as we've now discussed over and over again, insulin doesn't begin working right away. Also, Temp Basal is our insulin. It's funny how people think of bolusing and basil is different. But once you're on a pump, it's the same thing. You can't just turn your basil off, and it starts happening right away,

Jennifer Smith, CDE 25:34
takes about 60 minutes for circulating insulin level to be different.

Scott Benner 25:38
I always write and I always try to think of it a little bit as like Ardens Pre-Bolus time like if Ardens Pre-Bolus time is 20 minutes, well then setting a Temp Basal is not really going to start working for at least 20 minutes. Plus, it's a fraction of the Basal rate if, if you're getting a unit an hour, and I say to her, okay, let's double it, let's double it to two units an hour, that impact of that doesn't begin for 20 minutes or so plus, it's not the whole unit. Actually, it's the it's the fraction of it. So when we talk about basil, we'll get to that. But so Pre-Bolus Singh is really just the idea of balancing, again, the action of the insulin against the impact of the carbs, giving yourself a chance not letting the carbs wash you away. Because here's what happens when the carbs wash you like, count your carbs exactly right. You put your insulin in, you spike up the 200. When that happens, that insulin was only for the food. It wasn't for the 200 blood sugar, and it wasn't for the momentum of the rise. And so when I see that, like, I guess an easier way to say this when when I don't have time for a Pre-Bolus and Pre-Bolus thing to me is never about the number, you can Pre-Bolus a 65 blood sugar, you know, you can Pre-Bolus a 90 blood sugar because still no matter what, if you're stable at 65, the insulin you put in is not going to start working until it starts working. So you have and so don't get me wrong if I see a 65 blood sugar and an artist needs 10 units for what she's eating. I don't put all 10 units in at a 65. I might do an extended Bolus which we'll talk about and extended Bolus but I get some insulin moving, I make sure the insulin is on the winning side of this tug of war to start. But in a situation where I can't Pre-Bolus Let's say I know the meal is five units. 100% certain it's five units. But for whatever reason life, let's call it I can't Pre-Bolus and Ardens. You know, I'm going to start eating right now. I'll give her seven units. Because I Bolus for the food, the five units for the food I knew. And I probe and I'm Pre-Bolus Singh. The rise I know is coming and the end the number I know is coming. So I'm already treating a high blood sugar that hasn't happened yet. Because I know what's going to happen because I didn't Pre-Bolus

Jennifer Smith, CDE 28:03
Right. John Walsh goes into detail about what you're doing in a little bit of a different way. He calls it super Bolus, I call it an over Bolus thing. Yeah. And he calls it super Bolus in the way that you take that five units, let's say in your example. And let's say your basil behind that meal for the next two hours is one unit an hour, you actually take your basil running for the next two hours, and you add it into the Bolus for the meal and you take it all upfront. And then to decrease the chance of being too low later. Because of so much upfront action and the blood sugar staying normal, you actually set a temporary Basal decrease, he recommends starting with 100% Because you've loaded that onto the front to avoid a low but on the back end. Some people find though that a Temp Basal 100% off is too much. They only need a 50% they still call the spike and prevent it. But in the back end, they're not having a low then. So similar kind of concept. Yeah,

Scott Benner 29:07
I consider that trading Bolus for Basal. So So you know, say 120 Diagonal up 3040 minutes after a meal and I go, Oh, geez, I got to stop that arrow. How much do I Bolus to stop the arrow? I usually Bolus an hour's worth of a base of Basal insulin. That way if the arrow stops and I stay steady, and she doesn't go down, I say okay, well obviously I was just wrong on the initial amount. But in those situations where you push the button, you know the unit and a half goes in, and five seconds later the error goes from one to 22 Diagonal out the flat you go oh, I didn't need that. Right Temp Basal off. Half hour. All I've done is trade the Basal for the Bolus. Absolutely. Here's a good place to say this and we'll say this in each of these little vignettes. Never suspend your Basal. It's always temporary basals when you suspend you're shutting your pump off when you shut your Jump off. It does not. You have to remember to turn it back on. Yes. Yep. It's always temporary because you can set a Temp Basal for a half an hour, an hour, two hours, but at the end of that time, it was bad. And I'll go back on and start delivering your Basal. It's always temporary Basil is not not don't suspend your pump. Okay, so I think Do you think we covered Pre-Bolus? There?

Jennifer Smith, CDE 30:20
I think that's pretty good. Good. Yeah, that's awesome.

Scott Benner 30:25
Don't forget that you can work with Jenny yourself. If you want just go to integrated diabetes.com To find out how. Let's also take a moment to thank our sponsors Dexcom on the pod and dancing for diabetes. There are links in the show notes of your podcast player app, or at juicebox podcast.com. But you can always go to dexcom.com forward slash juicebox. My omnipod.com forward slash choose bucks or dancing the number four diabetes.com. I hope you're enjoying the Pro Tip series. This was episode four, where we talked about Pre-Bolus. And don't forget that episode one is for those starting over, or just being diagnosed. Episode Two was all about multiple daily injections. Episode Three, we talked all about insulin. Today, of course Pre-Bolus Singh in the next episode, Temp Basal rates huge and important. And then after that insulin pumping, they're designed to be listened to in order to trust me listen to them in order. I have just a little bit of music left here. So let me thank everyone for the great reviews and ratings on iTunes. Very much appreciated. A huge thank you to one of today's sponsors better help, you can get 10% off your first month of therapy with my link better help.com forward slash juice box that's better. H e l p.com. Forward slash juice box. If you've been thinking about speaking with someone, this is a great way to do it on your terms. betterhelp.com forward slash juicebox. All right, I want to thank you for listening to this episode of the Best of the Juicebox Podcast. And I'd also like to thank people who made better microphones since this was made. Those people should be lauded. And I think we're all very, very grateful. Thanks again for listening. I'll be back very soon with another episode of The Juicebox Podcast made on this microphone. The one that sounds amazing