Scott Benner 1/3/24 Scott Benner 1/3/24

#1098 Cold Wind: Healthcare Whistleblower, Clinical Pharmacist

Today's anonomous guest is a clinical pharmacist working with patients in the hospital.

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Scott Benner 0:00
Hello friends, welcome to episode 1098 of the Juicebox Podcast.

Today I'm introducing a brand new series called cold wind. The long title is cold wind health care whistleblowers. On today's show, we'll be speaking anonymously to a person we'll be calling Valerie. Valerie is an inpatient clinical pharmacist working with patients in the hospital. She has a five year old son who has type one diabetes. And she's here on the show today to give a behind the scenes look at what happens at her place of work. We're going to learn about Valerie's comfort level with taking her own son to the hospital she works at and so much more. Each episode of cold wind will feature an anonymous guest whose voice has been changed to protect their identity. The voice altering process we're using feels natural. You'll never know what they actually sound like. Just listen to how well the voice alternative works.

Speaker 1 1:18
My name is Beth and my oldest child has type one diabetes diagnosed in October 2020. My name is Beth and my oldest child has type one diabetes diagnosed in October 2020.

Scott Benner 1:33
When you place your first order for ag one with my link, you'll get five free travel packs and a free year supply of vitamin D. Drink ag one.com/juice box. This episode of The Juicebox Podcast is sponsored by us med U S med.com/juice box or call 888721151 for us med is where my daughter gets her diabetes supplies from and you could to use the link or number to get your free benefits check and get started today with us met.

"Valerie" 2:10
My name is Valerie I am inpatient clinical pharmacist, which means that I work in a hospital with patients who are in the hospital as opposed to like a retail pharmacist who would work at say a CVS or Walgreens. I have been doing this for about 10 years now. Well, I currently work at a pretty large hospital in an urban setting. So it's like an 800 Plus bed hospital. It's part of a larger healthcare system with Sister hospitals and other locations. Excellent.

Scott Benner 2:39
And you're so you're a pharmacist by trade though?

"Valerie" 2:41
Yes. Okay.

Scott Benner 2:42
went to undergrad, then how does all that work? How do you get that degree? Yeah,

"Valerie" 2:47
so, pharmacy has changed a lot over the years that used to be able to practice with just an undergraduate degree basically with like an extra two years. And then they made pharmacy a doctorate degree program. So most people have an undergraduate degree and then they go to four years of pharmacy school. I have my undergrad degree in biochemistry. And then I attended pharmacy school and I actually did a joint degree programs. So I have a master's in clinical research and an MBA as well as my doctor of pharmacy.

Scott Benner 3:20
Valerie, that is a lot and thank you for explaining it. Do you have a connection to type one diabetes? Yes.

"Valerie" 3:27
And so my son is five years old, he was diagnosed type one when he was one.

Scott Benner 3:33
Any other autoimmune in your family? No, no. Okay, so you have a five year old who's had type one diabetes for four years? Correct. Okay. Do you have any other kids?

"Valerie" 3:45
I have a seven year old also seven year old as well. Okay.

Scott Benner 3:48
Now you're on the show today, because I reached out into the world and said that I was looking for people working in hospitals, nurses, doctors, pharmacists, anybody at all? Who would be willing to talk about why the treatment of diabetes in a hospital setting is the way it is. That's what got you to come on. Is that correct? Correct.

"Valerie" 4:13
Okay, yes. And my specific role in my health system now is unique, and we are trying to improve our treatment of diabetes in the hospital. So we are implementing a lot of things within our healthcare system, which has included the role of the pharmacist being part of the diabetes management team, and patient as well as inpatient diabetes educators. That is something that our health system used to outsource to a third party without the pharmacist component. And now it's a more of an internal program and it's been going on for about a year now and our health system so you've

Scott Benner 4:52
been doing it for a little while. So what did What job did this give you? How are you helping in the process?

"Valerie" 4:58
So what my job is tells now is every patient who is in our hospital, we can run a report and look at if they have had glycemic excursions. And so we sort of prioritize looking at those and look at the hyperglycemia. First, anyone who had a blood sugar less than 70 in the last 24 hours, then we try to look at all the patients who've had a blood sugar over 300. And then we'll look at patients that have had at least two blood sugar's over 180. And we do this on a continual basis. So it's always just looking back at the last 24 hours to patients in the hospital. Is

Scott Benner 5:33
that happening for every patient that's in the hospital or just people who are flagged,

"Valerie" 5:37
it is happening, the report is run for every patient in the hospital. Our team, as it exists currently cannot address every patient that shows up on that report. So that's why we try to prioritize the way that we deal with the extreme like the hypoglycemia is first and then the extreme hyperglycemia.

Scott Benner 5:56
If this is seen, if if hyper or hypose are seen what happens then do you contact the physician? What do they do?

"Valerie" 6:05
Yeah, so as the pharmacist, there are certain things that we can do now within our scope. And that sort of as we're expanding the program, there are more things that we can do. So we can modify their sliding scale or their nutritional insulin orders, kind of going back and forth about modifying their Basal regimens. And with or without provider approval, depending on which particular physician is covering the patient's determines a lot about what we will do automatically. Or if we want to ask that provider first. And then as far as the, the nurses who serve as the diabetes educators, they try to meet with all of the patients who they have a little bit different report. So they're looking at agency mostly and trying to meet with all the patients that have the agency greater than mine. So

Scott Benner 6:52
if there's someone being treated in the hospital, and your system flags them as having higher blood sugars, you can make an adjustment to their dose for their meal, for example, and then the nurse that comes in the room with the actual insulin, they're not making that decision, it would be the pharmacy in your situation.

"Valerie" 7:11
Yes, a bedside nurse has no autonomy to make any decisions about the orders. Okay, and the computer

Scott Benner 7:19
from the gecko. I bet that surprises a lot of people. Don't you imagine the wind you think that people think like the nurse must be the one making decision about this or the doctors making like there's a doctor outside the door somewhere he's making or she's making the decision? I

"Valerie" 7:33
think that people with children with type one that have dealt with this school nurse will have some kind of understanding of this, because that's a lot of the conflict that comes up with school nursing, right? It's like the nurses saying, Well, I have to follow what's in the doctor's orders right here. And the parent is saying like, well, they're sick, or well, this happened, like I know that they need more insulin today. And the nurses kind of saying, well, that's not what the orders say. So that is also how it works in the hospital,

Scott Benner 7:59
your health system, or at least the hospital you're working in. What did they see that made this program come about? What do you think got it started? Well,

"Valerie" 8:09
there's, there's more kind of a push from the accrediting bodies. So Joint Commission and CMS to say that we need better glycemic management, in hospitals. So that was sort of the pitch behind it. So this is one initiative that our health system has chosen based on like kind of initiatives that were put out there saying like, we need hospitals to do better at these things. This is one thing that our health system decided to focus on. Okay.

Scott Benner 8:36
Did you have anything to do with this? Or were you just happily surprised when you heard about it?

"Valerie" 8:41
No, it just happened to coincide with my son having recently been diagnosed with diabetes, I have always worked in an inpatient hospital setting. So I have not really as a person, like, I don't know, as a health care professional, I would say, I don't really like like the ambulatory care setting as much the diabetes that was never a disease state that really interested me, it was always like, oh, diabetes is boring, until my son was diagnosed. And then it's like, oh, you know, all of that changed for me, I have a completely different perspective on it. So then, as this program happened to me implemented, you know, right after that, and that was why I, you know, got involved in it and applied prior to that I was working on overnights,

Scott Benner 9:25
can you maybe try to tell me something that maybe you haven't thought of before, I'm going to ask you to think about something prior to your son's diagnosis. If this new thing would have happened at your hospital, do you think you would have been met by you with like, oh, I don't know why we're doing this or this is more work. Like you see the value in it now because you know about type one from a personal perspective, but do you think you would have seen the value in it prior to that?

"Valerie" 9:54
No, not at all.

Scott Benner 9:56
How would it have struck you if if it came back that came across here? desk. It was 10 years ago except for example,

"Valerie" 10:03
you know, I think that we tend to think about things in that way as okay, like this isn't an inpatient issue or an outpatient issue. This is like an acute care setting or an ambulatory care setting. And it's like diabetes, other than if a person is newly diagnosed or in DKA is sort of like an ambulatory care disease state, like a chronic care, you know, something that you work with outpatient. And so that just has never been my thing that I've enjoyed. I've preferred working in a more acute care setting, inpatient setting. So that is primarily why I would have been like, Oh, this isn't, you know, this is more applicable to outpatient and even trying to recruit pharmacists to the position that is the responsible on IT people with like, Oh, this is really like an outpatient issue, even though we know we know, in our clinical care setting that having good glycemic management can improve outcomes for patients in the ICU and things like that. That's kind of the extent of it there, right? It's like, well, yeah, but we don't want to monitor all the like oral diabetes meds and that kind of stuff.

Scott Benner 11:10
But is it fair to say that even though we know outcomes are better if blood sugars are tightly managed in a hospital setting that that doesn't make it exactly a top of the line concern. I used to hate ordering my daughter's diabetes supplies, and never had a good experience. And it was frustrating. But it hasn't been that way for a while, actually for about three years now. Because that's how long we've been using us med us med.com/juice box or call 888721151 for us med is the number one distributor for FreeStyle Libre systems nationwide. They are the number one specialty distributor for Omni pod dash, the number one fastest growing tandem distributor nationwide, the number one rated distributor in Dexcom customer satisfaction surveys. They have served over 1 million people with diabetes since 1996. They always provide 90 days worth of supplies and fast and free shipping. US med carries everything from insulin pumps, and diabetes testing supplies to the latest CGM like the libre three and Dexcom G seven. They accept Medicare nationwide and over 800 private insurers find out why us med has an A plus rating with a better business bureau at us med.com/juice box or just call them at 888-721-1514 get started right now. And you'll be getting your supplies the same way we do.

"Valerie" 12:48
Right? Yeah, I mean, because it's it's not because it's not like an acute thing, right? I mean, hyperglycemia is, but if your sugar's sitting at 210 While you're in the hospital, but you're here because you just had a stroke, and you can't eat food anymore, because you have you know, aphasia and dysphasia. And you can't swallow, we're more worried about that right than the fact that your sugar's sitting at 210. Or that you just had a heart attack or you know, whatever it is that you're here for. That's always the priority. And then it's like, well, your blood sugar is a secondary kind of thing that we're looking at.

Scott Benner 13:25
Yeah, they focus on the thing that they think is going to kill you first. Correct? Yeah, by the way, because I only knew the word ambulatory from Grey's Anatomy, I actually looked it up, it actually means able to walk about and not bedridden. That's what it means.

"Valerie" 13:42
So yeah, I guess that is what the word at face value means. But then that makes sense why we call it like ambulatory care. So yeah, like ambulatory care setting is an outpatient setting. I think we kind of use those terms interchangeably in health care, outpatient ambulatory care. But yeah, inpatient doesn't necessarily mean that you can't get out of bed. But you are assigned to a hospital bed. So Oh, okay.

Scott Benner 14:06
That's interesting. That's such a word that you just hear all the time. And then when I looked at what it meant, I was like, that seems random. But, but, yeah,

"Valerie" 14:14
well, and then when you're talking about like patient care, like and the patient ambulating, like, can they walk around? It's used in that context, too. So

Scott Benner 14:20
earlier, you said we may or may not adjust the doses? It depends on the doctor. And then you giggled. Why did you why did you have that reaction? So

"Valerie" 14:31
yeah, I mean, in preparation for this, I listened to you know, I tried to get caught up on some of your podcasts more recently having to do with, you know, healthcare, healthcare system, health care providers. And I think so I think that people who don't work in hospitals sometimes forget that, like doctors are people too, and they come with their own personalities and their own like inclinations and their own ways that they were trained and Like, just like any other place that you work, you know, there's some co workers that you love and that you're easy to get along with and very collaborative. And then there's some co workers that are like not team players, and very much like, this is the way I do it. And I mean, their personalities come into play. So like, physicians, you know, pas, rnps, any everybody is that way, we're all people at the end of the day. So some are more receptive to interventions from pharmacy or from, you know, other specialties, and some are less receptive to that.

Scott Benner 15:36
So you're saying that it's possible that some doctors might have an ego that doesn't allow them to take direction from a pharmacist?

"Valerie" 15:42
That's possible.

Scott Benner 15:45
I like that it makes you giggle every time. Okay, so working where you work, knowing what you know, having had the experience for four years of taking care of a human being with type one diabetes, what is your comfort level, with your child going into a hospital system through the ER, zero,

"Valerie" 16:03
I am not at all comfortable with my child going. So I mean, so for example, when my son was diagnosed was during the height of COVID. He was diagnosed March 27 2020, we kind of realized that you knew he was sick from the pediatrician. And so our our pediatrician diagnosed him, which is different than a lot of people's stories, and it was a Friday afternoon. And most kids, he wasn't sick enough to be in full blown DKA. But his sugar was high on the meter, you know, over 500. And my first thought was like, he cannot go to the hospital because they weren't allowing parents to come in when their kids were admitted, like that had just happened that week, where it was like we parents, like we don't know, you know, and my pediatrician is part of the same health system. And that was what I was kind of saying to her was like, if he has to go in the hospital, like, I can't be there with him. So this is even before like, knowing anything about diabetes, it's just the hospital for someone who can't advocate for themselves can be a scary place. Yeah. And then when you add in a very specific disease state like diabetes, where it's very misunderstood, it's very different, like what diabetes means to one person can be vastly different. Even if you are a healthcare professional, that it's like, yeah, you need someone there to advocate for you. So actually, my son at diagnosis was never even admitted to the hospital. We managed him outpatient. The only time we have been in the hospital was where I work and the ER and it was because he was he was throwing up, I don't even check him for ketones at home, right? It's like, but if you if you're sick enough to where you can't keep fluids down, that's where I get worried. We need to go get you IV fluids. And they really weren't hearing me, like they were worried about he had a little congestion like, oh, let's get a chest X ray. And I'm like, you know, I could have done that other urgent care, like, I'm here because he's been throwing up and they're like, well, it's sugars only, you know, at the time, I think when they first stuck on when he came in, it's like, Oh, it's 130. And it's like, well, you glycemic decay as a thing. You know, I'm worried like, can we get Can we look at as bicarb? Like, can we look at it as the anion gap. And they just weren't receptive to hearing me even though I it's like, I work here, you know, in the meantime, you know, they have it's the children's er, so they have someone come in, and it's like, Oh, does he want a popsicle? And I'm like, Well, is it a sugar free popsicle? How many carbs are in it? They're like, I don't know. And it's like, what do you know that he's diabetic? Like, has anyone Wait, do you do this? Do you know, with all the patients, I'm starting to ask these questions that it's like, how much awareness is there among all of you about like, type one and what that means and like, you know, everyone keeps coming in and saying, Well, it's sugar is this, whatever it was when he was first admitted? It's like, well, we've been here for five hours, and we have a CGM. And like, I've been giving him insulin during this time as his sugar is gone up. Like, you know, you're not supposed to do that in the hospital. But that is what I'm gonna do with my son and Sarah because otherwise you're you're waiting. You're just sitting there and you can't do anything. Yeah,

Scott Benner 19:06
the process in the ER at this point takes forever so my daughter has had, she had some pain that we couldn't figure out at while she was away at college, and she spent 12 hours in an ER twice in three days. Then I'm going to ask you, Valerie, how many times was Arden's blood sugar checked by the hospital staff in a 24 hour stay over three over three days to different stays. We

"Valerie" 19:35
typically check blood sugar every six hours. So

Scott Benner 19:39
so if I told you Arden's blood sugar was never checked while she was in the ER would that surprise you? Know, if I told you she was 19 in there with a roommate from college, obviously scared in pain, put on morphine, and no one ever wants asked her what her blood sugar was, or check to see But it was it wouldn't surprise me that's not surprising to you. Okay? So aside from the idea of your, your child being diagnosed during COVID, you now have this experience of going in for vomiting. And even though you're in there saying I'm a pharmacist, by the way, a pretty well credentialed pharmacist, not just like, you didn't just get out and be like, I'm gonna go push pills, you really put your eggs into your education, if you don't mind me saying, Yeah, and you work there. So you're standing in front of somebody going Hi, I work here. I'm a pharmacist. I'm worried about my kids blood gases. I'm worried about this kind of stuff because I'm concerned about DKA. They don't even know that you could have DKA with a lower blood sugar. Today's episode is sponsored by ag one and I drink ag one every morning. I originally heard about ag one on a different podcasts. I had been using other drinks and not enjoying them. So I decided to try each one and loved it. I was using it every day when they approached me. And I was like, wait, you want to sponsor my podcast? I heard about this on another podcast. Alright, cool. So here we are. When you use my link, drink, ag one.com/juice box. Your first order will include a welcome kit. That's an ag one shaker scooping canister, the Ag one itself, five free travel packs, and a year supply of vitamin D. I drink ag one in the morning before I start my day, ag one makes me feel like I'm giving my body the nutrients that it needs to get through a hard day of podcasting. I'm just kidding. It's not that hard to podcast. But still, I feel great when I drink age one. Ag one is my foundational nutritional supplement. It helps me start my day, it helps me to support my immune system. And I think you're going to enjoy it. So if you want to take ownership of your health, it starts with ag one drink ag one and get a free one year supply of vitamin D and five free ag one travel packs with your first purchase. Go to my link drink ag one.com/juice box that's drink ag one.com/juicebox Check it out.

"Valerie" 22:08
No. And it's like, I'm not even gonna get into that argument with you right now. Just please, like, draw his blood. Because they're kind of like, you know, do we even want to get IV access? And it's like, yeah, yes. That's the whole reason why we're here right now. Like, I'm not no, don't send us for a chest X ray, like give him fluids first, and then you can do whatever else workup you want. Um, but yeah, I mean, me advocating for that it still took several hours and going to do the chest X ray first before anybody did what I was even there to do.

Scott Benner 22:39
Is there any validity to me saying with the complaints you came in the door with, they know they can do a chest X ray and Bill for an insurance won't be upset. So it's a thing they do to make money? Because you're there now. So

"Valerie" 22:53
no. So I think that a lot of people have that concept of it was interesting, because so let me answer your question. And then I'll say that the care is directed poor, you know, what can be billed for? That comes into play and in a lot larger scope than the individual, like health care providers standing in front of you. We don't care about that. Like as the clinician trying to help you as a patient, like, I am not ever thinking about billing, because that's I work for a large healthcare system. That's their job to figure that stuff out. Now, they might implement policies or things that I have to abide by that correlate back to billing, but it doesn't influence how I'm like directing my care right now with you as a patient. Okay,

Scott Benner 23:40
so the clinicians not thinking, hey, chi Ching, chest X ray, because they said this, but the policy could be set up so that even in the situation where you don't need a chest X ray, if you present a certain way, we're definitely going to do it anyway. Yes.

"Valerie" 23:54
And I would say even more so than billing. I think what drives maybe unnecessary testing is a concern about the liability if you didn't do it.

Scott Benner 24:05
Yeah, that's fascinating. Because Artem presented with initially she presented with appendicitis, it was pretty classic presentation. And they gave her a CAT scan. And then they came back hours later and said, your appendix is fine. But we see cysts all over your ovary. And we have to go do a another test now to see if they're twisted because they could require surgery like so this is what 19 year old Arden was told by herself in a hospital 700 miles away from my house with just a roommate sitting with her who by the way, had never had a medical issue and had literally never been in the hospital before. Try to imagine I'm managing Arden's blood sugar remotely through a roommate because Arden's high as on morphine, right, so we're doing all that. And you know, they said okay, we're taking you back For an ultrasound now she gets on the phone with me she's faced she's clearly scared. She's loaded on the morphine Arden's not a drinker or a drug user. So the morphine hit her really hard. And she's like, Dad, like, I have to go get a thing because if these cysts are twisted, then they might burst and I might need surgery. And I'm like, Okay, well go get the test, then call me when you get back from the test. So she calls me back a couple of hours later, the doctors here he's gonna give me the results from the ultrasound. And he literally gets on Arden's phone puts a smile on his face, because Hi, and I'm like, is she okay? She doesn't have any cyst on her ovary. And I went, what? You're the guy that four hours ago said that you took a CAT scan and saw cysts all over her ovary. And he goes, CAT scans, not a good way to tell if they're cysts on an ovary. I said, But you're the one who said that based on the CAT scan. She needed this other tests because this was a definite problem. It was clearly there. And now we just have to make sure that she's not in an emergent situation. And now you're telling me up, see. And he's like, yeah, good news. She doesn't have those tests. The good news, you're the only one who presented the bad news. I said, Okay, what's next? He goes, We're gonna send her home. I go Arden, are you still in pain? Yes, Mike, you're just gonna send her home? Well, she doesn't have an appendix. And I was like, could it be something else? He goes, Well, we're gonna have her follow up with her. OB. I said based on what? No answer. And then he treated her after 12 hours and let her go. So she spent the entire next day in a bad situation. And like not feeling well was not getting better. There's she had this low abdominal pain that had stabbing. The stabbing eventually went up into her. What would you call it? That kind of the center of your stomach your why is this basic word escaping me? Helped me a bottom my ribcage in the middle.

"Valerie" 26:56
I don't know what's in the anatomical word for that. Or even write about them. But for unknown, yes. Right away.

Scott Benner 27:03
Thank you right about there. And then the day goes on. She's able to eat and then she's like, you know, maybe it's gonna get better. And then all of a sudden around midnight. She's texting me dad the stabbings in my chest. It's going through the left side of my chest into my shoulder. Yeah, that's scary. Right. And so now you you do a little more looking at points. The gallbladder makes sense, right? They didn't check her gallbladder when she was there. Last time. I sent her back to the ER at two o'clock in the morning. And then I get on a plane and arrive where she is at 10am. When I get there at 10am They've done nothing for her except put her on more morphine. They have not checked her blood sugar in the now eight hours that she's been there. And as I walk in the door, there is a burly man standing over her in a raised voice demanding that she leave because she's been. He told her, we straight at you, you have to go. her roommates crying. Arden who does not cry about anything has puddles of tears in her clavicle. And she is telling him I am not leaving here until you tell me what's wrong with me. And you have to admit me. If you can't figure it out in the ER, that's the sentence I gave her before I got on the airplane. Yeah, if it wasn't for that sentence, he would have kicked her back out again without ever testing her gallbladder. Which by the way, it didn't end up being. But literally when I walked in, a jacked guy in his 50s was yelling at my 19 year old daughter to get up and leave the emergency room. And again, he had never touched her, checked her blood sugar, didn't check her for anything. She had had any testing. They ran some blood work, the same blood work. They ran 24 hours earlier. In that same room. There were four other sick people cordoned off into corners. And I often said that woman's been vomiting for six hours and no one has helped her. And then she pointed to the other lady and said, Wait, do you hear how they talked to her? And I stood there for a little bit. I was able to strong arm them into checking Arden's gallbladder within the proper test. And while I was there, I watched the doctor walk in to this woman who had Ms. And no no excuse me. Cystic fibrosis. And he walks in he goes Hey, so cystic fibrosis. Tough call. I was like what what just happened? Did he just look at her and go wow, cystic fibrosis tough roll the dice, honey, because that's what he did. I looked over and she had a look on her face like, ah, yeah, it's a terrible thing that has happened to me. Like this is your bedside manner right here. It was fascinating. Right? Yeah, I gotta go back and tell you Arden would have been better off laying in her bed and hoping it went away. Then what ended up happening to her that hospital? Fascinating. I'm sorry. Good night. No,

"Valerie" 30:00
I mean, that is a very so and that is a very nothing that you just said about that surprises me, unfortunately, I guess because I work in health. So it's hard for me to see them. So well, you know, I read a lot of this stuff on the on the juice box group and see and it's like, oh, yeah, I'm always, you know, people are rightfully so because they have a different expectation of what's going to happen when you show up to the ER, like, very offended and surprised. And I'm usually like, yeah, that doesn't surprise me. And some of it goes back to what I was saying as far as like inpatient versus outpatient, like, do you like to work in an acute care setting? Or do you like to work in an ambulatory care setting, so somebody with good bedside manner, who likes talking to their patients and is very sensitive, they are going to likely want to work in an insecure setting, like as a primary care provider or pediatrician, the type of people who, like the environment of an emergency room, are not the type of people that like, take your feelings as a patient into consideration. Because you can't because your career is dealing with traumas. And you know, the worst possible things that have happened to people, they roll into the ER. And that's what you don't see when you're in the ER waiting room, because you're seeing the people that physically got themselves there. You don't see the ambulance bay and all of the like five gunshot wounds and car accidents and everything coming into the back of the ER through the ambulance. And so you're thinking like, well, there's five people here, but it's like, no, they just brought 20 people and you know, what's the explanation

Scott Benner 31:42
for not doing a gallbladder test in eight hours with classic gallbladder symptoms? That I

"Valerie" 31:49
mean that that would be the only thing is that you triage, you triage your patient like ers work through a triage system. And it's like, every time someone more urgent comes in, you just bumped ahead of you. Yeah, so

Scott Benner 32:05
they weren't literally trying to make her leave. Without doing the test. I basically had to bring New Jersey to the, to where she was to the south, which straightened everybody up pretty quickly. And then got me a physician to speak to who assessed her and said, Yeah, it's very appropriate for us to test for gallbladder. I'm not sure why that hasn't happened. We'll do it right now, eight hours later. But the other guy, the other person was trying to kick her out

"Valerie" 32:29
someone telling her to leave when she's there for that. But that, unfortunately, I mean, that is whatever individual made that decision, right? That was like, I just need to clear out this, er, I'm tired of this person asking me and they're like, Oh, I'm gonna bully them into leaving, instead of like staying here and advocating for themselves. That's not necessarily a system thing. I mean, that's that, that individual deciding to deal with it that way. But

Scott Benner 32:58
I'm completely convinced that what happened was, is he needed to move somebody out of that building. And she was young, and he thought he could lean on her a little bit, and she just go, that's what I think. Except I, well, she's my kid. And I armed her with the right words before I got on the airplane. Yeah, yeah. So but who would know that? Like what regular? You know what it always always, here's what scares me. People on the Facebook group, you know, people get ketones, right? They get sick, they come on, they're like, I don't know what to do here. Hey, my ketones are really high as my blood sugar. I'm not sure what to do. And a flood of people go to the hospital, go to the ER, go to the ER and others. Pardon me? It's like, oh, I don't want to say something that puts you in a bad way. Like, you know, I mean, if you need an ER, you need an ER, but have you tried drinking a lot of water and giving yourself some more insulin? Like, is it maybe a bent cannula? Did you like you know, have you been sick? Do you think you can get this down on your own? Because you're gonna get to that er, and then all the stuff that we've talked about in the last half an hour is all going to exist? Maybe? And that's the thing I don't it's a coin flip? Like, am I going to show up and find a nurse who understands DKA? Or am I not? And then if I don't more than likely not? More than likely not. So. All right. But you also see people who are admitted, correct? Like, yes, yes,

"Valerie" 34:20
yes. So only I only we only looked at the patients that are admitted, right?

Scott Benner 34:24
So I'm gonna move away from this er idea and talk about somebody who's admitted for kind of like long term care, which could mean a couple of days to longer. I imagine. I'm in there with type two. They're feeding me. I've seen the type two diet at some pretty big hospitals. And it's fascinating how many carbs and crappy food are in it. Correct. It's not even it's not a type two diet. It's just you don't get to pick off as many portions of the menu. They only give you one dessert, but they'll still give you what we

"Valerie" 34:56
do with people on a carb controlled diet. Yeah, and there's a standard, and it's 45 grams for women, 60 grams for men.

Scott Benner 35:05
But on that list is grapefruit juice, apple juice, stuff like that stuff that's going to drive your blood sugar up in a split second. Right,

"Valerie" 35:13
the glycemic index of those foods is not taken into consideration at all. But we actually go back and forth about whether patients and even you know, we're kind of told to it's, you know, the nutrition services, it's a whole nother department kind of, of the hospital. And like whether or not patients are allowed to order more than their carb control, because it's like, okay, if I'm assuming this person is eating 60 grams of carbs with each meal when I'm dosing their insulin, but they're not, because maybe a relative is bringing them food, that's one thing, but they can actually order more than what their diet should be. And, you know, trying to like, figure that out and work with these other departments. And like, you know, we get information from one person versus another person has been a challenge that we that's one of the biggest challenges we found with our program, as it is currently is, is the diet. And then of course, as a type one parent, I'm like, oh, you know, and a lot of you I mean, you don't if you're insulin dependent, the type two diet is meaningless, kind of at that point. I mean, like, we're not trying to control you through your diet anymore. Like you need insulin, and we but but we do need to be able to dose that insulin with some concept of what you're eating at each meal. The diet is really, it's really tricky. No,

Scott Benner 36:35
I mean, that seems you just said something that didn't, it never occurred to me that people would just bring in outside food, of course, right. I'm not saying that the patients in certain settings and situations are not culpable in some of the problems that we're having. I'm certainly not saying that. I'm not saying that the people working in hospitals are ill intended. I don't think that either. I think that what you're describing is a system that is basically not set up to understand or control blood sugar. No, the understanding is just not there.

"Valerie" 37:07
The understanding 100% is not there. So the whole the whole thing about type one versus type two, I have tried very hard in this role to like get rid of those labels and just refer to patients as insulin dependent or non insulin dependent, that's a lot more useful way to describe someone's diabetes, if they are insulin dependent, they need Basal insulin every day, they've got to have some insulin on board. If they're diabetic, they may or may not need Basal insulin to avoid going into DKA. I mean, their sugars can be high and uncontrolled, but they're not going to become acidotic. You know, it's still a the terminology and talking to other like talking to the nurses is hard and other providers and using that terminology I find brings a lot of clarity to it. So if we could get rid of the type one, type two, that would be very helpful. Yeah. And then also just the idea of, of Yeah, like, what, what is this patient doing on their own, like the autonomy of the patient. So you have like this, some patients that are doing you know, all of like the podcast listeners, like doing their best to really like get a handle on their management. And then you have patients that just lie to you. And it's like, yeah, I take 80 units of love me or twice a day, and then we give them 80 units and their sugar's 20. And it's like, no, you don't. So but but they don't know, they think that they will be in trouble, I guess or like, you know, they say that they're doing it, which is what they've been saying to their doctor outpatient, which is why they're on that huge dose. But it's like, they don't understand the ramifications of saying that they're compliant, and then we give them that and it's like, no, we don't find out until we give it to you that you don't really take that out.

Scott Benner 38:56
Yeah. Is it possible that there are maybe two distinct, I don't know societies and diabetes, people who are steadfastly trying to understand trying to pull their education together and and to do a, you know, a better job, and that there are a group of people who have maybe just sort of, for whatever number of reasons bad direction bad, you know, education, intellect, not being desirous of caring, whatever, whatever. They're just not they have a onesies that are in the 10s elevens twelves. And that hospital employees see sick people more frequently than well people so they're accustomed to seeing diabetics who are higher a one sees higher variability don't have as much idea about how to handle themselves is and then you come in there with your kid, because he got a little stomach flu or whatever. And you actually know how to keep his a one to where she gets a one to 6.8 on our loss. Yeah. So you know how to keep it a one Seeing the sixth is you have a better understanding coupled with expectations. And that's why the hospital system looks roughshod to you and to me, but to most people, they probably don't even care or think about it when they're in there. Is that fair? Oh,

"Valerie" 40:18
100%. I mean, that's. So that's kind of the difficulty that I was listening to your podcast, like leading up to this, some of the more recent ones, you had one with Jenny, where you kind of went over, like the things that people were saying that like health care providers had ever said to them. That was very offensive. And they're like, there was one where the mom was like, Oh, the kids sugars 400. And they said to them, well, it's okay. As long as you get it down. There is a real, it's not like, Oh, that was stupid advice. Because, and that kind of the response, right? That's all the parents responses. Like, That's so dumb. It's not okay to be four, seven? Yes. And no, right? I mean, it is, it is what it is, you're 47. And you talked about that, like, you know, you just have to work with what you have get it down. So I think that they're coming from the perspective of like, it's okay, you don't have to freak out and go to the hospital, just because you hit four, seven, you can as long as it comes down, it will be okay. Right? That's a different conversation than like, is it okay to be for someone every day? Exactly. And so what we're looking at in an acute care setting is like, Yeah, are you going to immediately die from this, and most things diabetes related, as long as it's not hyperglycemia, no one's going to immediately die from it. Yeah. And so you have these different levels of education. I mean, you're taught as a health care provider, that everything should be communicated to patients at no higher than eighth grade literacy level, where I work at the large hospital on urban setting, the majority of our patients don't, they're indigent care, meaning they don't have private insurance, they don't have government insurance, they are not insured at all. They're typically, you know, homeless, a lot of mental health issues, substance abuse issues. So the idea that you could even provide education, or the patient's going to do anything that you you say they should do, I mean, they don't even have somewhere to sleep, much less like a way to get to the pharmacy to pick up their insulin. And so we have, you know, these frequent fliers where it's like, especially people who are type one, that are insulin dependent on that have all these psychosocial barriers to being able to manage their disease state. And that's the majority of the patients that we see. So it's a completely different perspective than, like the outpatient, Endo, who's seeing you know, you.

Scott Benner 42:43
So, yes. And so what you're telling me, I feel like this is what you're saying to me. You're saying, look, there are a lot of people who have a lot of things trying to kill them. And they come to a hospital. And their blood sugar is not nearly on the top of our list about what we need to do for them. Even when they're admitted. You're still trying to get them through this thing that's happening. And because that's overwhelming, Lee, what happens in a hospital setting that kind of, I don't know, rinses through the staff. And so when someone comes in there who's like, Hey, I've had type one diabetes for 40 years, my one sees five and a half. I know what I'm doing. That's completely foreign to people. No, that's

"Valerie" 43:28
where you get the comments like, Are you sure you have diabetes? Oh, wait, that's where that comes from. Because it's, you'd never see someone with diabetes, like you're taught, like, you have a very basic understanding of diabetes, and it's all taught from a diagnosis perspective, right? So like, your concept of diabetes is someone's a one sees higher than seven. And it's like, you come in with a 5.5. They're like, Are you sure you have diabetes? And it's like, you know, we know like, Yeah, I'm insulin dependent. Not like, but you know, if all you see is type two diabetics, then that that's not diabetic, you know,

Scott Benner 44:06
insane that somebody would even have anyone seen the fives and be using the word diabetes.

"Valerie" 44:11
Right? That's, that's foreign to Well, I mean, that's what people say, Oh, aren't you a nurse? Aren't you a nurse? And it's like, Yeah, but that this is a nurse that has been working for 20 years now in a huge hospital where all of her patients are type two. And so she doesn't see type ones unless she's maybe on like a med surg floor like saw someone after impact you or something or like the type one that said you have a onesie and the fives you're not going to decay all the time. So you're not in the hospital. Yeah,

Scott Benner 44:42
it feels like what you're saying. Seriously? Interesting, right? That it's commonly known that people who are law enforcement for over there's this scale that they go up as the longer they're in law enforcement. And by the time they get I think it's to a decade if I remember correctly. Their ability to trust people, even people that they're not intersecting at their work, it gets lower and lower and lower, because that's the experience they're having all day long, because they are seeing criminals, mostly. And then they run into a nice person. And they're like, I don't know, like, you know, are you going to shoot me? Are you going to like, flip out and bite me? And are you going to do this kind of thing? Because that's what gets. That's how they're colored. As as the time goes on, I was pulled over once. I want you to try to picture this. I'm a young man in my 20s, maybe in my late, mid to late 20s. I'm driving I think at the time, a Volkswagen Passat. I mean, it's a lady's car. I'm wearing a tie. And I'm going to my job. I get pulled over speeding to work because I'm late. And I watched the police officer in my I just want to be clear with you, lily white town where nothing happens ever come down my side of my car, one hand on the car, one hand on an unbuckled gun to come get my driver's license from me. And I'm looking in the rearview mirror going, what is happening here, and no lie when that person turns the corner. It's an older police officer, somebody who's been at it for 20 years, who doesn't want this day to be the day that they get. They get it. And meanwhile, nothing they're looking at indicates that I'm going to jump out with my GAC and start popping off. Do you see what I'm saying? And so like it, but I understood, I understood what they were doing, because I have a friend who's a cop. But if it was just me, I'd be like, wait on me. Like, I'm just going to work at a credit union right now. Like,

"Valerie" 46:42
I'm the least, that is that is so interesting, because that happened to me also when I was in undergrad. And I mean, my car was maybe a little more sketchy because I had a lot of stickers on it. You know, what a college student. But I'm still, you know, like a young, white female, I wouldn't think I would look like a threat. And I realized when he pulled me over, I had left my wallet and like the way back, I was like a Ford Explorer. So it was very bad. And so I just started to open the door once I realized, and he pulled his gun on me. Yeah. And I was like, Oh, my God, you know, like, and it's but yeah, it's like, Oh, you thought I was gonna like, do you know? Okay, I see that. But I was the one of course, like, scared. It's like, Oh, my God. And he's like, ma'am, stay in your vehicle, like, oh,

Scott Benner 47:28
yeah, the worst thing I've done is not told my parents where I was last night. But so taking that idea that you can be in a high pressure situation over and over again, where you see a specific scenario over and over again. And then suddenly someone comes into it, who doesn't fit it, you're not going to get the service that you expect in that hospital? And so the answer really has to be, you need to understand your diabetes care backwards and forwards, go in there and immediately begin to explain it in a way that lets the people listening know, I know this better than you do. Here's what we're going to do this is what's going to work for us. But you tried that and you couldn't even get them to listen. So what luck Am I gonna have, I'm not a pharmacist, but I don't work at the hospital.

"Valerie" 48:17
They did listen, eventually, it's just you know, don't be a Don't be surprised at how long it takes you to get your point across. Be Don't be surprised at how many people you have to keep repeating that too, because the healthcare is so specialized. And now you are going to have so many different people in and out and it's like, you know, the nurse assistant or the patient care technician, they don't necessarily need to understand your diabetes, but that's typically the person in the hospital who's doing the blood thing or, you know, if your checks your finger sticks, so if you have just drinking apple juice, and this is what we're assuming it's like a pre premium blood glucose, like you should probably tell that patient care technician I just drank an apple juice, but like, they don't necessarily know what that means. Is

Scott Benner 49:11
it my real goal to separate myself from what they normally see. Like to let them know if I am in fact a person who understands this on a greater level to like, get out in front of it and go look, I recognize what you normally see in this setting, but this isn't us. And and here are some examples of why that is like is it is just as easy as saying I have a glucose monitor and a pump and I know what I'm doing my one season the four in the fives, it's in the sixes like don't worry, we can help like, I'll help you with this. I know how to Bolus for food. Like we want to keep our pump on while we're here. Like that kind of

"Valerie" 49:42
stuff. And you and you need to lead with that. And that's like it was interesting because you had a conversation with that same Look Jimmy about the things and she was talking about her prescription for her test strip and the pharmacy technician saying like, Oh, why would you need like eight to 10 a day and I I did that. I did that as an intern when I was in pharmacy school, and I was an intern in a retail setting. And I had a woman come in who was newly diagnosed type two starting on insulin, and the inch, because so what we see is, oh, look, here's a prescription for 10 test strips a day. Medicare doesn't pay for that, I can tell you right now, it's not gonna go through your insurance. And it's gonna be a problem, because you're not gonna want to pay cash for it, where you need a prior authorization from your doctor. It's like a whole that sets off a whole chain of events. And it's like I said to her, you know, you shouldn't need to test your sugar this many times a day. And no, I didn't, I didn't say it in a rude way, like, Oh, this is a problem. I also did it, you know, she was also very nervous. And it's like, Oh, my God, like, it's overwhelming, right? Like, I've got to do this many fingers six in this many injections. And so part of it was me trying to say like, let's start with what insurance will cover. And if you find that you're needing to test more than that, then there's a process to get them to cover more. But it's not like an immediate thing that can happen. And part of it was kind of trying to reassure her that it's like, Hey, you're not going to have to be sticking yourself every two hours, indefinitely. Like you might feel like you need to do that now to get really tight control. And the reality is like, yeah, we aren't like my son's on Omnipod and Dexcom. And it's like, we still have a prescription that says eight to 10 times a day, but I'm not sticking a stinger eight to 10 times a day. But like everyone, I like to work supplies. And I mean, that that poses a bigger question of like, what what are the ramifications of that on the healthcare system at large? Like, you know, certain people aren't like, the idea is that, you know, there's someone at that insurance company whose job is for it to be profitable. And it's like, you know, giving, like, people getting more supplies than they need, is that somehow taking away from people that, aren't you? No, not really, because we don't have socialized medicine? But

Scott Benner 51:52
are you saying, Valerie that if I worked at that hospital, or somebody like me with the understanding that I have, at my level, my job would not allow me to take as good of care if somebody is I even would know how to do?

"Valerie" 52:03
In some ways. Yeah, there are constraints within the healthcare system that come down to billing like that with the insurance with the outpatient stuff, for example. I mean, everyone, that's the, like a diabetic or a parent of a diabetic kind of knows that with insurance, you're restricted to what's on your formulary, unless you go through a process to try to get her authorization. And so it's kind of that same concept. It's like, well, there's certain protocols and policies in place, like like with the nurse, and what the order says, say, you are type one, and you have your orders in the computer for you know, your insulin, and you get your meal tray. And it's like, okay, you know, that nurse has this order to give you four units, and you're like, why would normally take six units to cover this? She can't just give you six units, right? Like she has to give what's ordered, or she has to try to call and get that order changed, which is, there's policies in place to let them do I mean, there's not most hospitals, most health systems don't have that. So

Scott Benner 53:06
that's where you're stuck with like, go ask the doctor. And then even in your situation, I might have to go ask the pharmacist and then those people are busy with 1000 other things. And just getting to this like idea of like, changing my dose by two units, which seems so important to me, and is important to me. It's not important in the grand scheme of things in this ecosystem that I'm now in because I've gone to the hospital.

"Valerie" 53:27
Oh, yeah, not at all. I mean, there would be providers who would be annoyed that you would call them about that, and like really like, and they're just gonna say, no big try to teach you a lesson. I'm like, don't call me about stupid stuff like this anymore. Because if that person sugar goes up to 250, after this meal, when normally at home, they never get over 150. Like, it doesn't matter in the grand scheme of things. It matters to you as an individual. It matters to me as a parent of type one, but like, it doesn't matter as far as like the clinical outcome of that patient's hospital stay.

Scott Benner 54:00
So I only got art in the test for the gallbladder because I had the nerve to stand up to the male nurse, push him back, force him to the doctor force the doctor into the room, remake my concerns to the doctor. And I reached the doctor who was older and seemed more reasonable. And heard what I said and agreed with me. So the test happened. But if I don't do all of that, eventually we would have gotten kicked out of that hospital. If I just stood there waiting for somebody to help me. Somebody would have handed me paperwork and told me to leave. I think yeah,

"Valerie" 54:35
potentially or you would have been there like during shift change, and then someone new, a different attitude. But yeah, I mean, yeah, it sounds like you definitely my biggest lesson is you have to advocate for yourself. And I mean, that's in all aspects of health care, right? Like if you have a lump or you have a funny mole or whatever. Like, you can tell your primary care about it and then like Do you need to follow up with a dermatologist or you need to follow up with, you know, whatever specialist, you have to do that, like, no one's gonna call and make that appointment for you. But people I think don't realize that because you kind of think they're there to help me. It's like, they're there to do their job. And sometimes that's make a referral and whether you follow up on that referral or not, that's up to you. So it's kind of the same coming into the hospital. It's like, if you think, oh, everyone here is gonna now manage my diabetes. For me. It's like, well, they're gonna keep you alive. You know,

Scott Benner 55:33
they're gonna try not to make it worse. Yeah, hospital equals try not to let me die. Right? Yes. And, and even like, I had a surgery on my toe recently, it didn't even happen in a hospital. It happened in an office building. You know, like I was put under, in a place that could have been an insurance company. Seriously, you know, like you go into you go into an office building, and they have a surgical suite. And that's that. Yeah. Okay, I got it. But, and I think everybody listening gets it. I really appreciate you sharing your knowledge on this. Just for fun. Tell everybody where you're at right now doing this in the hospital? Are you at least on a break?

"Valerie" 56:10
Are you still in a conference room? Yes. I took my lunch break. Okay. And it's Friday, and it's a holiday. So you know, what happens in the hospital on days like today is that everyone's like getting discharged. Actually. They tried to discharge everyone yesterday. So that because it's a long weekend below for? Yeah.

Scott Benner 56:28
It's interesting. That's very interesting. Okay. I know we're calling you Valerie. So I'll say Valerie, thank you very much for doing this. I really do appreciate your time. Yes, I

"Valerie" 56:37
appreciate it. Thank you.

Scott Benner 56:44
This episode of The Juicebox Podcast is sponsored by ag one. Drink ag one.com/juice box. head there now to learn more about ag one. It's vegan friendly, gluten free, dairy free, non GMO, no sugar added no artificial sweeteners. And when you make your first order with my link, you're going to get a G one and a welcome kit that includes a shaker scoop and canister. You're also gonna get five free travel packs in a year supply of vitamin D with that first order at drink ag one.com/juice box. A huge thanks to us med for sponsoring this episode of The Juicebox Podcast. Don't forget us med.com/juice box this is where we get our diabetes supplies from you can as well use the link or call 888-721-1514 Use the link or call the number get your free benefits check so that you can start getting your diabetes supplies the way we do from us med if you're looking for community around type one diabetes, check out the Juicebox Podcast private Facebook group Juicebox Podcast type one diabetes, but everybody is welcome type one type two gestational loved ones. It doesn't matter to me. If you're impacted by diabetes, and you're looking for support, comfort or community. Check out Juicebox Podcast type one diabetes on Facebook. If you're not already subscribed or following in your favorite audio app, please take the time now to do that. It really helps the show and get those automatic downloads set up so you never miss an episode. Thank you so much for listening. I'll be back very soon with another episode of The Juicebox Podcast.

#1097 Grand Rounds: Hospitals, Urgent Care and Initial Contact

Scott Benner and Jennifer Smith RD, LD, CDCES share diabetes insights for clinicians who want to do better. Today, they talk about the importance and impact of the initial contact in hospitals and urgent care when first diagnosed.

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Scott Benner 0:00
Hello friends, and welcome to episode 1097 of the Juicebox Podcast.

Welcome back to the 10th season of the Juicebox Podcast we are starting strong in 2024. With a brand new series called Grand Rounds, these episodes will be myself and Jenny Smith. And Jenny and I are going to be talking to two distinct audiences in these episodes. On one hand, these conversations are directed to clinicians. But on the other hand, they're also directed to patients. People living with type one diabetes deserve good care, and they need to know what to expect and demand from their physicians and physicians. It feels like sometimes some of you don't know you're from a hole in the ground. So with good humor, and much love, this is the Grand Rounds series, where we're going to try to explain to doctors what they don't know about diabetes. Please don't forget that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, always consult a physician before making any changes to your health care plan, or becoming bold with insulin. If you're not already subscribed or following in your favorite audio app, please take the time now to do that. It really helps the show. This episode of The Juicebox Podcast is sponsored by the contour next gen blood glucose meter. Learn more and get started today at contour next one.com/juicebox. This episode of The Juicebox Podcast is sponsored by touched by type one touched by type one.org. And find them on Facebook and Instagram touched by type one is an organization dedicated to helping people living with type one diabetes. And they have so many different programs that are doing just that. Check them out at touched by type one.org. Hey, Jenny, welcome back. Hi, how are you? I'm good. Thank you. How are you? I'm fine. Look at us on a Monday again. We've been doing so many Fridays lately. And now today, beginning of the week energy you're getting from us? Yay. I don't know what that means.

Jennifer Smith, CDE 2:23
Like, I don't know, weekend into Monday. I don't know if there's energy there. Maybe Yeah,

Scott Benner 2:29
well, we're about to find out. It's funny. We did the first Grand Rounds episode, which is like an overview of what we're going to talk about. And I think I vacillated a little bit I said I like it's hospitals. First, it's diagnosis first. And then as I really thought about today, like most people are going to end up in some sort of an urgent care hospital care scenario first, right? It's it's very few and far between where people figure out they have diabetes, and, you know, go right into a hospital like, right into a diagnosis. I mean, like, you don't end up at your physician going, Hey, I'm here I have diabetes, like you manage me from here. Like I think a lot of people end up in some sort of an emergent situation initially, do you think that's fair?

Jennifer Smith, CDE 3:12
I think it's fair in the majority of like a diagnosis setting, I think for adults, who may be a little bit more in tune with what their body has been feeling like, and they've just paid enough attention recently to say, This isn't me, like I, I feel horrible, or I've noticed, you know, I clearly can eat like the whole entire refrigerator. And I'm still like losing weight, or I, you know what I mean? That might prompt them to make an appointment with a primary care doctor to actually just go in and go over. And that obviously isn't an emergent, especially unless they call and they get a really good sort of intake nurse who's like, I don't know these symptoms, maybe you should just go to the emergency department instead of coming in here most often they're going to be and sometimes they're also caught, like, you know, you go in for a new job, and they might have you do a physical and you get a fasting glucose or even just a random glucose that kind of sparks up. Hey, we should do more testing here because this glucose number is out of range. But in general, yes, it's more emergent.

Scott Benner 4:20
I'm thinking then that these these two topics are kind of one one a there, you know, I don't know if I can, for sure say but I'm just going to start with hospitals. Because I think hospitals, urgent care, those sorts of things. These are the people who are probably least prepared to give you information and most likely to say something, it's just gonna say, Look at me starting right off most likely to say something that puts you on a bad path.

Jennifer Smith, CDE 4:51
Correct? Not in not because they're meaning to but because again, as we said in the you know, initial sort of discussion, it's because they Really, that's not a specialty for them? Sure they have, they have broad knowledge of a lot of different conditions. And a lot of honestly, I mean, emergency departments are a lot of like test results, right? And what do you do? What specialty do we knew now call it and because of this test result, or this type of trauma or this type of thing that the person came in with, so they have a lot of information. But they're like snippets, right? It's just the tip of the iceberg of information.

Scott Benner 5:27
And I think through that their professional experiences, especially if you're in an emergency room, or, you know, urgent care, any emergency situation, when you see people who have diabetes, they're not coming there, because things are going great normally. So these are people whose blood sugars could be wildly swinging around, they might be having a ton of low blood sugars, they might be having so many highs that they're having other kinds of concerns. And so that when that's your experience with people with diabetes, I think it's then when you meet a new person, newly diagnosed person, whether you mean to or not, you're colored in that direction, right? Like, you lean into, oh, this is bad. Or you want to make sure about like this, because all when I see the people they can't feel their feet and like like, and then does, it may not become a self fulfilling prophecy, then when you bring a newly diagnosed person who is going to be in shock, once you tell them what's going on, their blood sugar's are probably very high. So they're altered to begin with. And now you're saying all these things to them that they did not expect in their life. And if you're coming from the, oh, this is really bad. Then you predispose somebody to believe they now have a thing that's really bad. And you know what I mean by that? Yeah, I

Jennifer Smith, CDE 6:43
do. And I think something that also goes along with it, I mean, my husband would be the first to say that I clearly should never be a poker player, I have no poker face, I just don't like I, if something's up with me, like it's, I have a different expression for a lot of things. And so I think that's another piece in this. That's not verbal. But you know, if you're walking in with lab information, or a urinalysis or something, as the first point of contact of this new information for the family, or for the adult, or whoever it is, you're going to say, hey, you have diabetes, you know, I know you shouldn't be like looking like a happy, happy person. But really, you should also look like this isn't like the Grim Reaper expression on your face, right?

Scott Benner 7:31
I don't mean to say that people should be disingenuous. As a matter of fact, one of my favorite restaurants, there's a teacher, a school teacher that works there as a as a weight as waitstaff. And she teaches very young children. And so she comes at you with that energy. And the entire time you're talking to her you're like, I don't feel like this is real. But I actually think it's who she is. But it's still like, it makes you feel like is she pretending? And so you don't want to come to somebody with this happy energy? Like, oh, don't you have diabetes? No big deal. Because Correct. That's also like a lot about what we're going to talk about here is the path you're sending someone on. So you don't want to send them down a doom and gloom path, because if they think there's no hope they might live, like there's no hope. And they might educate themselves as if it doesn't matter what I learned, because I'm gonna end up back in that hospital one day, right? You also don't want to let them think like, everything is just amazing. And this is super easy. And you know, or that, you know, we talked about earlier to, you don't start telling them about a cure that you heard about an even yet, right? Because Because I know where that comes from, it comes from a, I want to make you feel happier, we're better about this. Correct. But what you might not know if you're in an emergency room is when you tell somebody something's going to be cured. Soon, you predispose them to not learning about it and not taking care of it because they think it's a temporary issue. Right?

Jennifer Smith, CDE 8:56
Yeah, absolutely. And I think that's another piece that temporary, it's a good, it's a good word, because I think something also that gets laid down early on not every time but many times is just do these simple steps. And it will, it will work right. And or, here's your here's your dose, you know, let's say this is a new diagnosis of type one diabetes, obviously and here are your doses. The explanation beyond that, even though you may not know what that transition may look like, should never lead the person to believe that these start these starting doses or this starting is where it is going to be that there will be movement you will follow up with a care team the care team will direct this your doses may change they will change you know all these all these points to have them understand that this is a like a moving picture. All right,

Scott Benner 10:00
if you put me in this position, I would tell people, listen, this is scary, I understand, it's going to get easier over time. But that's only going to come if you learn a few things. And really, at its core, you're gonna have to learn how insulin works. Now we're setting you up best we can, with some settings, and some ideas, just like you said, These things are going to morph and change. As a matter of fact, it's possible. Don't say things to them, like you might be in a honeymoon period, say it's possible, you may still be getting some assistance from your pancreas that will over time, and I can't tell you how much time will dwindle to nothing. And that could be a week, it could be a month, it could be a year, I don't know. But I can tell you that that's going to keep changing as that changes the how you use manmade insulin, the amounts. And I think, you know, a lot of the strategies are going to change as you move forward, leaving them with the idea that it's not going to stay static is super important in a society where people think about pills fixing things, correct? Yeah, right, exactly.

Jennifer Smith, CDE 11:09
Because most of the medications, honestly outside of insulin, and maybe a couple of other things, other medications, oral or even injected Ra, I take it in the morning. And that's it, I don't have to think about what I'm doing the rest of the day, because the medication just does what it's supposed to do. The understanding that you're giving them of this medicine, I hate calling insulin medicine, because it is something that your body does naturally make, right, just in the case of diabetes, it doesn't. But this insulin that you're taking essentially, will need to be adjusted, we are just at a starting place. And to understand, again, we're not your specialty team, we're setting you up with a place to be able to get out of the hospital, essentially, and then move forward into a team that can provide you with that detailed information. We are just covering the basic,

Scott Benner 12:08
I think when you're doing triage work, which is what that is, right? It's triage and initial, and then you move people on to something else. For most things that happen in an emergency room, the thing that's happening now goes away, when you get to the next step, I broke my leg, you know, hey, broke your leg, it looks good, it looks bad, I just shouldn't be a problem, we're gonna get you to somebody, boom, you leave. Right? A day or two later, what was said to you in the emergency room is no longer impactful to you. It's over. Now, this is a situation where the least knowledgeable person in your care plan and I mean care plan from day one being diagnosed, the day you die. The least knowledgeable person is the first person you see. And they imprint ideas on you. And they don't know like, I'm talking to the doctors. Now I know you don't know you're doing it. It's because you don't have diabetes, like and I get it. But you start saying things like, Don't worry, it'll be fine makes people not pay attention. When you tell people to worry, you ruin their lives. Like they, some people will go home and be burdened in ways you can't imagine. You need to say, I don't know a lot about this. But what I know for sure is all of management, at its core is how insulin works. You need to get to an endocrinologist and learn about insulin. And if your endocrinologist doesn't teach you go out into the world, do your best to find that information. Otherwise, you get lost in a direction you either get lost in over management direction, which causes significant psychological issues for people. Right, I was just talking to a girl the other day on the pocket. She's 21 diabetes, and she was five years old. And still, when she got to her adult endocrinologist who would just tell her you're a one sees too high. Just say that to her a couple times. Then one day, he said, Eat Fewer carbs. Well, then it got in her head. And that's all she could think about. Right? I'm not gonna eat more than 20 carbs today. And then she started having a disordered eating pattern. And if somebody else in her life hadn't come around to her and said, Hey, you're not eating well at all. This is what she would have done out of that fear. Because she said once she started using such a small amount of insulin, even though she wasn't nourishing herself. After she started using such a small amount of insulin, she saw more stability. And that's the building made her ignore that she wasn't eating anymore. Of course, yeah. And then when somebody finally came along and said, I don't think you're even nourishing yourself, and it was time to inject more insulin for her her meals. She was frightened and she couldn't do it. Right. I tell you that like quick story that people were listening, because that all came from a someone who just didn't know how to help her with her insulin and said once you just need fewer carbs, that throwaway idea caused that landslide of problems for that lasted two years. contour next.com/juicebox. That's the link you'll use. To find out more about the contour next gen blood glucose meter, when you get there, there's a little bit at the top, you can click right on blood glucose monitoring, I'll do it with you go to meters, click on any of the meters, I'll click on the Next Gen, and you're gonna get more information, it's easy to use, and highly accurate. smartlight provides a simple understanding of your blood glucose levels. And of course, with Second Chance sampling technology, you can save money with fewer wasted test strips, as if all that wasn't enough, the contour, next gen also has a compatible app for an easy way to share and see your blood glucose results. Contour next one.com/juicebox. And if you scroll down at that link, you're gonna see things like a Buy Now button, you could register your meter after you purchase it, or what is this, download a coupon, oh, receive a free contour, next gen blood glucose meter, do tell contour next one.com/juicebox head over there now get the same accurate and reliable meter that we use.

Jennifer Smith, CDE 16:08
Right, and you're talking about somebody who had been speaking with what we would consider is a specialist within the diabetes, you know, community, right. And so back stepping to the baseline. And I don't say baseline in a very generic way or in a you know, a not not educated way. But it's a baseline of information that those who don't have a specialty outside of this specialty of navigating so many different types of things that come in to an emergent situation, I mean, that that takes a special type of clinical mind, right to be able to navigate between, you know, this type of wound versus this type of vomiting versus that type of headache, there's a lot of consideration there to figure out and know what tests to do. It's a very quick paced environment. So nobody would expect them to be specialists in just one thing. But I do believe that from a general place. diabetes in and of itself is a hate thing easy, but it is, if you understand the baseline of type one versus type two diabetes, then in an emergency situation, test results are something that should be easy to interpret, right? And then what you provide with the family or the person who is going to be newly diagnosed, it should come from at least that baseline of this is what type one diabetes is. This is what it means. And I think those those basics for the person who this is very new four, are really important. Because again, I mean, we've talked in other things about, you know, blame or feeling guilty, and from the person who now has this diagnosis. And I think that even keel of you know what, we found out why you're feeling the way that you do you have type one diabetes, this is what that means. And, you know, I think that's at least a way for someone to accept the information, as well as for you to give them none of these like gray areas of like the unknown what to do with it.

Scott Benner 18:20
You know, it's funny, you said that we don't, we wouldn't, and shouldn't expect a person in an emergency room, for example, to know the ins and outs of diabetes. That's great. And you and I sitting here philosophizing about it is exactly right. But the person who's just been diagnosed five seconds ago, you're the most learned person in the world to them. Correct. And so if you don't know, the best thing you can say, is I don't know a lot about this, you know, and I'd be afraid to tell you something that would lead you in the wrong direction. But I hear I listen to this podcast, I probably don't tell them that you but but but you know, here's what I do know, it's a lot about how insulin works. When you get to the next step. If you feel like you're not getting good information about how insulin works. Don't accept that as a baseline. Everything's about how insulin works. You know, it's not difficult. Once you understand it, it takes a while to understand it. Be patient, be kind to yourself, I mean, that's the thing. I always feel dopey saying stuff like that, but it's absolutely true. Like you gotta give yourself a break. It's gonna take some time. This is the kind of stuff you can lead them with. You know, you're gonna learn as you go, right? I know plenty of people who live well with this by the way, if you don't, it's okay still lie and say you do. Okay. Like you know, like you don't say Nick Jonas to them, apparently that's one of the feedback things from the people that are like, without telling me about Nick Jonas when I'm diagnosed. But But ironically enough, down the road, there are some people who are very comforted to know that people who they they see as they know, functioning well in the world and that they're aware of have Diabetes. But yeah, it's funny how many people said like, Please don't tell me about Nick Jonas? Well, my kids being tagged

Jennifer Smith, CDE 20:05
with that is what? And again, that's, it's almost a, like you said before, oh, there'll be a cure kind of comment. It's not that bad. Yeah, when really, you're the one living this new thing. It is it's, it's

Scott Benner 20:20
ever happened to you the worst

Jennifer Smith, CDE 20:22
thing that's ever happened to you, right? I mean, in general, to when someone comes in emergent lead with this diagnosis, nine times out of 10, especially for kiddos are going to be admitted, there is going to be at least a day or two, depending on the status, when you come in with this type of diagnosis, depending on the status of the child, the teen, the young adult or the adult, there's going to be an admission, which means that you're again, you're the first explanation of this new diagnosis as the clinician who's there. But expanding on that, being able to say you know what, we're going to admit you, if that's what's going to happen, and there will be there will be specialists who will come and explain this further. I don't know all the answers, I'm not going to pretend to know all of the answers, you will have specialists who come in and explain and sit down and talk with you and answer all of the many questions that I know are probably sort of circulating in your head right now. And I think that's important to explain, because like you said, You're the first know all like, you're like everything right now in terms of delivering this new diagnosis to somebody, but also explaining, I know, I know what you have, but I can't do much more. That's why we're going to get you to the people who do

Scott Benner 21:47
it's an awesome responsibility to have one of those jobs that people just blindly trust teachers, police officers, doctors, you know, you don't realize that what gets said is it's gospel. It just it right away is and you know, if you're listening right now, and you're a nurse that's in working in an ER or a doctor that works in some sort of intake, and you think I've I went through this in school, I know, you don't know anything about diabetes, if that's all you know, and I will offer as a personal anecdote about that, that this podcast is strewn with doctors and nurses whose children or selves have been diagnosed with diabetes. And when they were diagnosed, they thought, oh, this will be easy. I know about this. I learned about this in school. And then five minutes into it, they realize, oh, they only told us enough. So we don't kill somebody. Right. Right. And, and bringing up that kind of language. There's this phrase I used in the podcast a number of years ago. I swear to you, I wasn't trying to start a catchphrase. I said, I think some doctors not all by the way, by the way, there's plenty of doctors listening right now and nurses and doctors who are very good with diabetes and insulin management who are just saying Hallelujah, like preach to people, right, but, but for the ones that aren't, I used to say, I haven't said in a while. Often you get what I call don't die advice. Like it's enough management, that you'll you'll be alive today. And you're not going to have a seizure. But there's no no view of long term health or long term stability mentally, physically. It's just enough that you won't die today. Oh, yeah. Yeah, once the seven, that's pretty good. You know, like that kind of stuff. Your blood sugar went up to 300. But it came back down. Yeah, yeah.

Jennifer Smith, CDE 23:32
And in an emergent situation, I think that you're not going to die right now information. I don't think that that's, that's very important. It's really, really important. This is a baseline, this is what's going to get us through to the next point, right. And that next point, again, is specialty. It's someone who's going to teach you not just how not to die, but is going to teach you how to live honestly, with this and strive and do all the things that you want to do in life that comes from a good specialist that that's not don't and as the person with diabetes, you know, newly diagnosed, shouldn't expect to get that either. Yeah, but as the clinician addressing them for the first time there, you should explain that to them. I am I am your baseline of information. This is what I know from the test results that we have. This is what it means. This is the basic definition of what you have. And we are going to get you people who can really explain this at a much higher level for you and I think that's really important for to not try to be the No at all. In that situation. Right? to not try to explain beyond what you truly don't grab it points. Essentially stick

Scott Benner 24:55
to what you know, and check into what you think you know, before you start spreading it around As if it's true, because there was two pages in your book in college. And, you know, even when you think about managing diabetes in a long term setting in a hospital, I mean, honestly, Jenny, they, you know, if your blood sugar's under 300, while you're in the hospital, they're going to be thrilled. They're going to be focused on not making you low, and they're gonna have you eat, and then they'll shoot your insulin later, even when sometimes people who really understand their care will say, I, you know, I can't let my budget or up to 200 and sit here all day. Oh, no, we're okay with that. Whose way? Like, I'm not okay with that. But once you say it's okay, now a person goes out into their life, and it's okay. You know, 200 is fine. Like, because that's what happens in the beginning, you're giving good you're giving don't die advice, which is very, very important. But if you don't say the rest, like over time, we need to tighten these tolerances, right? They'll just live like that forever, right? Some feedback from people, even a small pamphlet with resources and basic information would have been amazing to get to the hospital. Please, somebody educate the hospitals, I want doctors to understand that a diagnosis also causes mental trauma. And not just a mental trauma. But it's, I went through it having my daughter diagnosed, I didn't know which way was up. Like I've said it a million times in this podcast, it feels like someone ran up to me, hit me in the head with a shovel and started yelling math at me. And if I didn't remember it, my daughter was gonna die. That's exactly how it felt. And it went on for days. If you think the third day I was better off than I was on the first day. I wasn't every conscious moment you sit there thinking, Oh, my God, Everything's ruined. Like it's over. Like everything I thought is gone. Like because you don't know. Right? You don't you don't know that. It's, it's incredibly doable. And that millions of people live with it well, and like all that stuff. So you're just sitting there in a panic. And you're like, Oh, it's my problem to take care of the kid. But if you're an adult, it's almost worse, because it's on you. And you're the one who's going to get a low blood sugar and not be able to think at the same time. And you're going to end up with an adult endocrinologist who has you point out all the time very likely, mostly helps people with type two diabetes, at least when you're a kid you get at Children's Hospital? It's a little more. Yeah, yeah. Right.

Jennifer Smith, CDE 27:23
You know, right. I, you know, I think too with that, because of the constraints of hospital stays, that are dictated by essentially diagnosis status within that diagnosis, and honestly, insurance that covers all of that, right. I think that many times from a clinician standpoint, they're trying to pack as much as they possibly can to send you out the door with more than just the This Is How Not to Die. Right? And what gets lost in that it's great that you bring in the mouth mental component to that because what gets lost is the consideration for how much in of traumatic type of setting the human brain can actually retain.

Scott Benner 28:10
Very little from my experience. Yeah, well, and you're,

Jennifer Smith, CDE 28:13
I mean, you're not a dumb person by any means. So you know, I know it just in the many discussions we've had you grab on to information very easily and very quickly and you get it and you can dig deeper and you can understand much more so I think it was it not your daughter I would have been alright probably would have been okay, you would have gotten it you know if it is a nephew, okay, you have to care for him over the weekend, I got this, I got this, like I can do it, you know, but for somebody that you like your, your arm, right? It's like a piece of your body is your child, honestly, as a parent, and so you, you have this mental piece of not only do I have to keep them alive, but oh my gosh, I have to keep them alive with this new stuff that

Scott Benner 28:57
I'm supposed to do. And they'll say to you look too much is gonna kill them too. And you're like, wait, what, and then it's not enough is gonna cause long term complications. And too much is gonna cause a lot of it's about how it's said. It's the delivery, it's your communication and your delivery and listen, and to Jenny's point. I'm pretty good at diabetes. But on day four. On day four, I was crying in a room because someone was trying to teach me how to add fractions a thing that by the way, I knew how to do. I was beside myself. And it wasn't because I was learning how to like figure out a dose based off of carbs. That was easy. It was because of the pressure that came with it. Like what do you mean? Like she's like, when her doses were i My daughter was two years old when her doses are a half a unit and you make a math mistake and now you're at a unit and a half. Well, geez, right? I might just we'll just toss her out the window right? Like let's get it over with because I'm like, I'm gonna screw this up and I'm gonna kill her and then that fear turns into while just let her blood sugar boil little high. And then all the sudden it's, the doctor will say to you like, well, you know what? Let's make your let's make it I don't know 70 to 200, but we're going to treat 90 is low, but two hundreds, okay? Well, once somebody tells you two hundreds, okay, 220 doesn't seem that far over 200 Correct. And then you start, like, getting farther and farther away from healthy. And no one tells you on day one that a high blood sugar makes someone altered. I don't know that my daughter's not the person she's supposed to be because their blood sugar's 250. No one says that the mean, if they said it to me would have freaked me out more. So you're in this like paradox where you need the information, but you need it correctly. And that means time, it means a thoughtful explanation. And again, if you can't give it, I think it's better not to say anything. Right?

Jennifer Smith, CDE 30:54
That's, that's where understanding that those beginning pieces of information need to come with the explanation that this is a start, we will adjust. And you will, again, have some specialists who are going to help navigate the adjustments. Right now, the safe target range may be this to this and it may be very broad. This, again, is a starting place. So everything as the as the first person that this person who's newly diagnosed, is going to encounter, the baseline you give them should be this is just the start, this is going to be an OK place. And we're going to move further beyond this. So that you can really, again, live the life or have your kid live the life that they want.

Scott Benner 31:45
The number of people pointed out that as a an adult diagnosis. They're like I needed an endo console in the hospital, and didn't get one because the hospital so don't worry, like leave here, call this number, we'll get you set up with an endocrinologist. And then the endocrinologist sometimes will tell you, they don't have an opening for three months. So now you're holding insulin, you know that. And somebody told you it's dangerous, be careful, or worse, they didn't tell you it was dangerous. And they make it off you like loosey goosey and fancy free. And then there's so much feedback from here from people like I gave myself way too much insulin almost killed myself. And you know, and because who knew it was? Because if you take two Advils or three Advils, you're kind of okay. And that's how and until you've had a tea, you've had a serious medical issue, like a day to day thing that's always with you, right? You don't ever think about your health that much. And people just don't think about it, it's a thing you take for granted, you know? Correct, right.

Jennifer Smith, CDE 32:45
And as the adult level, which is great to bring in, because as I mentioned initially, many, many adults are actually not diagnosed in an emergency room scenario, right? They're actually, as an adult, they're like, I just don't feel good, or I just have not felt great i or I'm doing this and I didn't used to do this or whatever it is, and then they it's a primary care. And then like you said, the primary care may say, hey, let's get you to see a specialist, especially if that primary care, did a great job and actually did enough testing to diagnose type one versus type two diabetes, hey, you know, I'm not your specialist, let's get you to the specialist. But again, there is there's a problem in that we don't have enough specialty, with enough time on their schedule, to be able to get that newly diagnosed person in within two days or even three weeks, it many times is much delayed, and what does that leave the person who now has to take medicine, they now have to take, you know, their blood sugar, they have to understand a little bit about food and about, you know, activity and maybe their job is a heavily active kind of lifestyle in all of these things that in no way can primary or general medicine really expand on to the degree that's needed. I think there's a very big deficiency in our healthcare system in terms of the ability to get what you need when you need it. There just is and that's not, that's not a knowledge component from the clinical staff. That's, that's just the way that healthcare is set up. And it's

Scott Benner 34:24
unfair to talk to people who are working in emergency and, and to put this on them. But I think it's incredibly true. You're whether you know it or not, you're in charge of what happens to those people 30 years from now. And and it's you might say, Well, how is that possible? But I mean, I've done my best to say it here over and over again. If you put someone on the wrong path, they might never get off of

Jennifer Smith, CDE 34:48
it. Especially if they never get to see somebody who can clear it up for them

Scott Benner 34:52
right or the next person they get to is inept, or whatever. And you know, and now you have a doctor telling you Oh, you're a onesie aid. I mean, ADA says seven. So that's not too bad. Right? Right. Right. Yeah. And it's gonna be a problem. And so I think some people also go to scare tactics. I can't believe how often I hear from people that they've been scare tactic than a hospital before, but telling them trying to relate to people by telling them your dog has diabetes, your cat has diabetes. That's not good. Don't do that. Now, right? Telling them Oh, my grandmother lost her foot. I know all about diabetes. Don't do that either. Don't do that either. Right? There are some things that feel confident. It's funny, isn't it? When you see a conversational thought, hit someone's head, and then they speak it out loud? And you think, why would you say that? And even I think a moment later, the person might even think like, oh, I shouldn't have brought that up. But it's too late, then. Like it's too late. So you're sitting with a person who thinks their life, they either think their life is doomed, or they have so little understanding of it, they don't know, to put the effort into it to stop their life from being doomed. Right? Right, they need, they need a good launch from you. And that launch might just hopefully be to across the street tomorrow for another appointment. But you don't want to put a thought in their head that they can't get rid of that that sticks with them. And, and especially in that scenario, like you have to treat them like they were just in a car accident, and that they aren't following what's happening. Right? Because the other thing here, I this is also, I think very important. If the people are healthcare professionals who are being diagnosed, the parents or the adult, do not assume they don't need your help, or they don't need someone's help. And they've got it because they're doctors, because the amount of conversations I've had with doctors who said I was not educated properly, because they looked at me and thought, Oh, well, you're a doctor, you know. And that was it. That's incredibly dangerous. Those people then have to go home, by the way, and fight with their own ego for a minute where they're like, I should know this, then they feel defeated. That's a big one. Don't do that to health care professionals. I don't know like there's I feel like I could just talk about this forever. But I don't want to muddle it.

Jennifer Smith, CDE 37:07
Yeah, well, I think, you know, from my previous hospital and clinic based sort of experience, I had the unique advantage to work with a really wonderful endocrine team, within a big hospital system. And within this hospital, the emergency department actually came to the endocrine team and said, you know, we actually know that we don't, we want to navigate managing those with diabetes, both type one and type two and newly diagnosed, especially who come in better. But we also are a big city emergency department, right. And so from a staffing standpoint, we don't have time to walk through somebody's medication, exactly other than take it once a day or take at this time of day, and some of the education and so they worked really, really intensively with our endocrine team to develop actually a protocol of education specific to diabetes. And in stackable hours, not that we were there at two o'clock in the morning. But within hours of normal daytime operation, when people with diabetes were diagnosed, we got a page to come to the emergency department and actually provide the education as well as the medication dictation about how to start something and how to dose it, et cetera. So I think, you know, system to system if they adapted or adopted something similar to this. And if you have any, say within your, you know, for kind of talking to emergency or urgent care kind of staff, if you have any ability to have some poll about what could be done, you may actually be able to make more of a difference for those who are diagnosed with diabetes in that emergent situation, by just pulling somebody in, even if they're not going to be admitted for additional information that especially for the adults, if there's somebody on staff that could come, that would be a huge advantage for

Scott Benner 39:12
that big deal. Right. Now, of course, I don't want to overwhelm the person who's in that position who probably doesn't have enough information. I don't want them to and I don't want them to. But But I think again, saying things you don't know, is maybe the worst thing you can do. Like really and assuming too, that the next person they get to is going to fix the whole thing is also like so there is some responsibility there for you to give them some basic information and education. Or tell them there are places online you could go to, like meet other people who have diabetes, because unlike if I come into the emergency room in heart failure, I'm going to go to a cardiologist who is now going to manage my heart. I will just do what that person says and this thing will go as well as it could if I come in there with cancer, I'm going to go to an oncologist and they're going to take care of everything a broken leg, someone's going to fix it, they're going to teach me and then they're going to send me to physical therapy afterwards, you get diabetes, you go talk to somebody, they go, here's insulin, good luck. And then you go home, and now you're in charge. And that is just what happens type two or type one. That's what happens to diabetes, it's not a thing that the doctor is helping you with, or putting you on a path. And then you don't really have to do anything except take this thing on an empty stomach or like that. It's so different than that. And I know it's a misunderstood thing within the population, and that part of the population are nurses, and doctors and everything else. And I know it's misunderstood by them as well. But it's why we're doing this. And also, the opposite side of this, which I'm going to at the end of every one of these episodes bring up. This episode is not just for somebody who's a physician, or in a position to help somebody, you should be listening to this and saying, This is what I should be expecting. You know what I mean? Because maybe you're listening now. And yes, you already have diabetes, but you're gonna end up back in the emergency room one day for something if your mount but odds are, and you get there, and those people are going to still not know anything about your diabetes, you know, and they're, but they're gonna say they do and, etc.

Jennifer Smith, CDE 41:15
No, that's a great point to bring up. Because I, I was gonna bring up similar that as the person with diabetes or the family with diabetes, you have to know how to be an advocate for yourself, honestly, you have to be the one to say, You know what, I don't expect you to know all the answers here. I know that you can help me with this emergent situation, or maybe not. So let's can we get the specialty? Right? Is it within hours that a specialist would be here? Let's get them in here. Because I don't know what to do. I've clearly not done something right. Or I've been sick enough to bring myself to the emergency department with diabetes. I want to make sure that this gets, you know, figured out the right way.

Scott Benner 41:57
There's also a way to not I mean, it's hard, but you got to not flip out a little bit. These people. It's not their fault. They don't know about this. Like it's no, no, not not a little bit. It's not negligence, it's not apathy. It's just It's the system and the way it works, right. So it's a number of years ago, but Arden and I take her to the emergency room once for stomach pain. And we're there for a couple of minutes, and the nurse comes in and she goes, we're gonna get that insulin pump off of her. And I went, No, we're not. No, we're definitely not doing that. She has no, we'll get her some Basal insulin. I'm like, Whoa, no, no, you want to inject. I'm like, I haven't done that in 10 years. I don't even know how to do that right now, like, because you see that that's what the pump is doing. The pumps already doing that. And then at one point, her blood sugar as they gave her an IV, I guess that dilutes your blood a little bit. And her blood sugar started to go lower and lower. And she says, I'm gonna give her dextrose through the IV, maybe? I don't know, exactly, she was gonna get extra hit or something, you know? So I said, Listen, she's on an algorithm. As soon as her blood sugar jumps up, it's gonna, like start giving her instantly and we don't want that either. So tell me what you're doing. And I'll adjust the algorithms so that that doesn't happen. And then she's like, Oh, what's that? And then I explained it to her a little bit, then she became interested. And then she was a lovely person, and a thoughtful person. And in 10 minutes, she knew what we were doing. And then we were partners, you know, and now I had taught her a little something. And now she wasn't saying things like, let's take the pump off of her. Correct, trust me an hour into it. No one was more thrilled in that room than that nurse. sure that we had come to an understanding and educate each other.

Jennifer Smith, CDE 43:40
Because you had stepped up and been an advocate for your daughter, right? And or the person who has diabetes, as long as you come in. I mean, this is a piece in the education that I typically do with like, either preparing for a hospital stay or a surgery or planning for an emergency, right? Is the idea that if you come in and urgently know that they're one not going to have any extra supplies to help you, right? Right. And so you do everything you can, as long as you are verbally, okay, you can address and talk to them and you're not out of it. Then great 100% You're keeping your pump on you or 100% You're talking to them about these are the doses that I take this is this has nothing to do with the sore on my toe right now. Don't worry about

Scott Benner 44:31
it at all you want. I'm not taking the CGM off if I have one ether, like it's alright. We don't trust that thing. I'm like, Okay, I've been living my whole life trust in that thing, and it's working out pretty well for me, right? It really is. I don't know it's to dance. It's a little bit of a dance and you have to be a good community to cater to you can't just start ranting and because the minute you rant, it's over. You know, like they're gonna be like that lady's yelling at me and I don't want to be involved in this and then you're never getting anywhere. Correct. It's just a very it's incumbent on both sides to, to want to, you need to want to work together, I think. And it's it's hard because they're in and out of the room. They're tired, they probably overworked, they're probably underpaid. They've probably been eaten in six hours. And you're trying to explain your, you know, your, I don't know, your algorithm to and they're probably like, well, I don't even know what you're talking about. Right. Right. I was lucky once as Arden went into medical procedure, that one of the nurses in the room was like, my friend has diabetes. And all that happened was I used a word that she recognized. And that was enough to make her look, amigo tell me more about that. Yeah, that was it. And I said, Okay, here's how this is working. And she goes, Oh, that's great. We would probably love to use that. Let me get the doctor and find out doctor comes in and re explain it. He goes, Yeah, let's keep that on her. And I was like, great, but five minutes before that people were pulling at it. Because they don't know why it's just what they do. You know, and, and to feel, then that puts you in a position where you feel attacked. And and then you lash out. And it's tough to because you know, I have this note for myself in this in this document that we're working from for this series. It struck me a couple of weeks ago, while I was thinking about this, we always tell people, you have to advocate for yourself. But it has two different meanings. If you don't know what you're talking about advocate means please teach me you have to I need to know more. I don't have enough information, blah, blah. But if you know what you're talking about, what advocate really kind of means is you have to make them do a thing, right? They don't want to do

Jennifer Smith, CDE 46:34
advocating for yourself as explaining what you know, it's almost like proving yourself essentially proving that, like you did, hey, we've got this thing it does this, it will really help beyond what you think your protocol says. Yeah, this is above that. And this way, and again, from advocating sometimes you have to simplify it right? You don't want to tell them all the bells and whistles because quite honestly, they don't need that. And it's going to be confusing. Do

Scott Benner 47:04
what I did when I was dating my wife tell her the good stuff. Okay, no, yeah, she can find out the rest after it's too late. Way too late. Arden had a surgery once. But it was a quick one was like a 30 minute like laparoscopic thing where they were just kind of going in and looking around for something. I said, Look, she's wearing an algorithm. It's run from her cell phone, you have to keep the phone with her. And they said, Okay, that's fine. But I want you to turn off the auto Bolus thing. And I was like, Okay. And then I just didn't do that. I just picked the phone up. I was like, oh, yeah, I got it. There you go. And then I just go ahead, because she was gonna go in there, and very likely not eat insulin. Like she's sedated. Like I thought her and by the way, I thought that's what was going to happen too. But the minute she woke up, and she was like, you know, at her adrenaline kicked in everything, and her blood sugar started to go up, that thing started to Bolus in the recovery room, and I couldn't get into that recovery room for like, 30 minutes, right. And we stopped a blood sugar that was easily gonna go to 300 by just letting her algorithm run. And I never told anybody about that. And if they know me, this is when they're finding out right now. So and I don't believe they'll ever hear if you know, best then say, is really is what I'm thinking. And I think listen to this conversation, recognize that these poor people, they're not trying to screw you. And they just don't know. And it's not their fault, you know? Correct.

Jennifer Smith, CDE 48:36
They've got a protocol, they're not picking weird stuff from the air, right? They have a protocol. And the protocol is a safety based protocol. And it's based on a line of here is okay for the majority of people, or here is okay for the majority of peds. Right. And that's what they're going to use. Is it going to keep you from having a low blood sugar? It is absolutely, but it will not, you know, prevent you from having a high

Scott Benner 49:10
blood sugar. It's not a way to live long term. No, it's perfect for that set and setting in the moment. That's all the problem is again, and to end is you do not want to leave thinking this is how it works. Because you when you get into your regular life that is it's not going to fly. Right anyway. Okay, great. This is a good start. Awesome. Thank you very much. Excellent, thank you. I'm excited.

Having an easy to use and accurate blood glucose meter is just one click away. Contour next one.com/juice box. That's right. Today's episode is sponsored by the contour next gen blood glucose meter. A huge thanks to a longtime sponsor touch by type one, please check them out on Facebook, Instagram, and at touched by type one.org. If you're looking to support an organization that supporting people with type one diabetes, check out touched by type one. If you're looking for community around type one diabetes, check out the Juicebox Podcast private Facebook group Juicebox Podcast type one diabetes, but everybody is welcome type one type two gestational loved ones, it doesn't matter to me. If you're impacted by diabetes, and you're looking for support, comfort or community, check out Juicebox Podcast type one diabetes on Facebook. If you're not already subscribed or following in your favorite audio app, please take the time now to do that. It really helps the show and get those automatic downloads set up so you never miss an episode. Thank you so much for listening. I'll be back very soon with another episode of The Juicebox Podcast. The episode you just heard was professionally edited by wrong way recording. Wrongwayrecording.com

#1095 Over, Under or Around

Marsha is a social worker whose son has type 1 diabetes.

+ Click for EPISODE TRANSCRIPT

Scott Benner 0:00
Hello friends, and welcome to the last episode of 2023. This is episode 1095 of the Juicebox Podcast.

On today's show I'm going to be speaking with Marsha. She's a social worker at a community mental health agency who has a son with type one diabetes. Please don't forget that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, always consult a physician before making any changes to your health care plan or becoming bold with insulin. If you're looking for community around type one diabetes, check out the Juicebox Podcast private Facebook group Juicebox Podcast type one diabetes, but everybody is welcomed type one type two gestational loved ones. It doesn't matter to me. If you're impacted by diabetes, and you're looking for support, comfort or community check out Juicebox Podcast type one diabetes on Facebook. Thanks to everyone who listens supports shares downloads follows me online Facebook Tik Tok Instagram, you make this possible. I hope you have a very happy new year. At the end of this episode, I'll give you a few highlights from what's coming in January. US med is sponsoring this episode of The Juicebox Podcast and we've been getting our diabetes supplies from us med for years. You can as well. Us med.com/juice box or call it 888-721-1514. Use the link or the number get your free benefits. Check it get started today with us med Marcia.

Marsha 2:01
Oh, thank you.

Scott Benner 2:02
Hey, how are you? Can you hear me? Yes, you were I don't know if you get the same messages I get but it was like Marsh is connecting to audio and that was going on for a while. So I was like I wonder if it's ever gonna happen. But there it is.

Marsha 2:15
I had to click a button. I think I just missed clicking it. That's

Scott Benner 2:20
interesting. I have to keep that in mind. Do you have any questions?

Marsha 2:23
I don't think so. I'm trying not to be nervous. I'm trying not to freak out.

Scott Benner 2:30
How does? We're recording already to see you know, okay. How does trying not to be nervous work?

Marsha 2:36
I've just been sitting here scrolling through Facebook trying to find my Zen space.

Scott Benner 2:42
So did you find it? Ah,

Marsha 2:45
I think I'm pretty okay. Right now.

Scott Benner 2:47
What? Okay, what on Facebook made? You said?

Marsha 2:50
I'm just scrolling. Something's not to think about this.

Scott Benner 2:56
Gotcha. Yeah, just the mindless.

Marsha 3:01
The no meanness of just scrolling

Scott Benner 3:02
by and going by and going by. It is really interesting. How scrolling through an app or playing a game of chance. Or like, you know, a game on your phone even that there is no like you can play and then lose and then play again and lose again and win again. It doesn't matter. It's all about like the beeps and bloops and the right colors and stuff like that. Yeah,

Marsha 3:29
yeah. Yeah. Like you did it or, you know, try again. Yeah, doesn't

Scott Benner 3:33
it feels like the three app developers could put us all into, like awake, awakened coma if they wanted to. Like they're just, they're just being kind enough not to turn us into like living zombies. Unless we already are.

Marsha 3:47
Every now and then I have to go through and just delete stuff, because I'll just get so focused or so like, I've got to play this game. I've got to play this game, and it's ridiculous. And so every now and then I'll just go through and delete all my apps on my phone. And I'm like, can't do it. But then one sneaks back on there, and then another sneaks back on there. So it's crazy. My son's

Scott Benner 4:06
only 23. And he was gone for maybe a month at his first job and sent him a link. I was like, check this out. It's hilarious. And he texted back and he goes, I don't have tick tock anymore. I took that off my phone. I was like, yeah, he goes, I was just wasting my time with it. I was like, All right, good for you. No, no, if he's put it back on or not. He's been there five months now. But, but, but he knew he was like, I gotta get rid of this. Anyway,

Marsha 4:30
my niece and nephew are probably about that age. They don't have any of that stuff. They're like, they just aren't into it. They're like, I'd rather just connect with people and I'm like, oh, good person. Maybe I need to be like that. Well, that

Scott Benner 4:45
would be amazing. I also don't know me my son's like maintaining a distance relationship with his college girlfriend too, because they both got job opportunities that were just nowhere near each other. But I was like cheese Well,

Marsha 5:01
those kids that age can do it. I don't know how I'm like, yeah,

Scott Benner 5:04
I gotta tell you right now, if Kelly wasn't here for a couple of months, I totally forget who she was.

Marsha 5:13
I've always laughed that I've been so low maintenance and relationships that people forgot they were in a relationship with me. Oh, we broke up, I guess maybe. Oh, no,

Scott Benner 5:24
you just don't demand anything of people. Yeah,

Marsha 5:27
yeah. Whatever. I'm totally fine by myself. Okay.

Scott Benner 5:33
All right. My last question before we get going is being How old are you?

Marsha 5:37
I am 58. Almost 59. I

Scott Benner 5:40
was gonna say I thought you were a little older than me. And I was gonna say being your age with them. I thought, let me just ask first. How much of your life was met with people referring to Marcia Brady? From the Brady Bunch.

Marsha 5:53
Oh, my God. If I have to hear Marsha Marsha Marsha, one more time, like I just want to throw something at people. And you know when this so I grew up in the Brady Bunch era. And then when the Brady movie came out, started over, and I'm like, Oh, my God, please.

Scott Benner 6:13
I can imagine that the trailer coming on television. You being like, no.

Marsha 6:21
Do not do it again. Don't punish me again.

Scott Benner 6:24
Yeah, a lot of young people have no idea what you're talking about. But no, I don't even think it's worth checking into to be perfectly honest. Anyway, yeah. Okay. So good morning. Let's get going. Where are you at in the country?

Marsha 6:39
I am in Kansas. Oh, well, it's

Scott Benner 6:42
early there.

Marsha 6:43
It's 830. Why

Scott Benner 6:45
do people not think that's early?

Marsha 6:48
Because I get up and go to the gym at five in the morning. Do you really already? Yeah, I've already had a workout in and everything. Oh, my, I'm good to go.

Scott Benner 6:55
I don't understand what's the rest of your day look like? I usually get to work

Marsha 6:59
by eight o'clock and work until five and then come home and take care of this little wild child that I have.

Scott Benner 7:05
What do you do for a living? Can you tell me?

Marsha 7:08
I'm a social worker. And I work at a community mental health agency. That's

Scott Benner 7:12
lovely to work. Okay, why are we on the podcast? What's your connection to diabetes?

Marsha 7:17
So my son is type one, he has been diagnosed for about two years and three months, five months, two years, four months, four months, I will say no, these 10 He'll be 11. In about 15 days,

Scott Benner 7:37
I've been diagnosed around nine. And you just reminded me of my favorite story about my uncle. We were used to work for my uncle. When I got out of high school, I had what you would call no prospects grew up in a very kind of like blue collar household, the idea was go to school, well, you don't really have to pay attention to it because you're just gonna get a job afterwards. And then I graduated, I was like, I don't know what to do. And my grandmother basically forced my uncle into giving me a job in his sheetmetal shop. I think she could cajoled him. And so there I was, and worked there for quite some time, I did not make very much money. But every morning, there was a coffee break 10am 15 minutes, like the whole place shut down for 15 minutes, you could just sit there and just collect yourself and get through this 15 minute break. And then you all you had to do is make it till noon. You'd have lunch and then all you had to do was live till five, you know, but one day, we're all sitting around. And once in a while the boss would come out and he's passed now. So I don't feel bad saying this. He came out. And we're all just trying to you know what I mean? Like just this, I guess, scroll Facebook in our heads for a couple of minutes because it's a hard, difficult job in a hot environment or a freezing cold environment depending on the time of year. And he starts telling a story. Now God bless him, the man was not a gifted storyteller. And he's five minutes into a story that you still don't understand where it's going, you don't care about and he mentions a pickup truck. And he goes, You know, it was a 63 No. 64 Yeah, so it was the 1960s Might it be? Was it a 65? No, no. It was read. It was a 6060 I think the truck was uh, said I'm sitting there going like you guys listen to this podcast for a while. I'm like, everyone shut it off already, man. Let's go. Everybody goes, and he just he fumbled around for what felt like forever trying to decide on the year of this pickup truck and the story eventually landed on the idea that he was not going to recall the year of the pickup Truck Moving on. And when the story ended, I had to stop myself from saying out loud. That truck and what year it was born had no bearing on this story whatsoever.

Marsha 10:16
But I bet if my husband were in the room, he could probably tell you exactly what year if he told them what color it was, I

Scott Benner 10:23
don't know, just when you were deciding how long your child had diabetes, you were like, I don't know, is like 14 and a half, or 15 or 16 months. And I was like, Oh, my God, Uncle Bob.

Marsha 10:35
Anyway, I was trying to do the math in my head and social work and math don't go together. That's why people become social workers. So they don't have to do math.

Scott Benner 10:42
I honestly wish that man was still alive. I'd call him right now and ask him what the hell was going through his head when that happened? Okay, so we'll get back to your I'm sorry, son right now. Yeah, yes. Get back to your son in a moment, I want to know a little bit about what you do. So what's, what's a day like in your job.

Marsha 10:59
So I don't know if you're familiar, but most of the community mental health agencies of all across the nation are becoming certified community behavioral health centers. And it's known as nationally as CCBHC. And my job is to bring that model into our agency and create changes. So community mental health agencies aren't just focused on mental health. They're focused on behavioral health, substance use, and the integration of physical health. So it's kind of integrating all that stuff into a mental health agency. And then I supervise managers of like our mobile response team, and we have a jail team and behavioral health court team and our children's services. I supervise a lot of people.

Scott Benner 11:53
So what's the desire of making the shift? Is it so that you can offer more services in the location.

Marsha 12:00
So it's really helping people to focus on all person well being and not just mental health? For a long time, you think, here's mental health in one spot, here's substance abuse, and another spot, here's my physical health, and they're not interrelated. But we all know that they are interrelated. And so it's just really kind of forcing community mental health centers to move out of that thinking that we're just providing mental health services, but we're really providing whole person care, to, you know, the people that we serve. And I think about this a lot when I think about my son with diabetes, right? Because when he is that when his blood sugars are high, that kid is cranky and nasty, and just, you know, he's just not fun to deal with, right? And so when you think about how we have some of our clients who have long standing physical ailments that aren't treated, and then are depressed, it's like, Why? Why aren't we paying attention to what's going on with their physical health, because that will impact their mental health, right? And so if we can make their physical health better, maybe their mental health will be better.

Scott Benner 13:11
Martin and I were having a conversation yesterday while we were in the car. And I was on a mad dash around New Jersey trying to get my next dose of wheat ov I'd be honest, while we were together, and we were trying to avoid the the fires right now. There's fires in Canada, I guess, the timestamp this, and somehow the smoke is blowing into America. I'm pretty sure they're attacking us. And the skies are really orange here. And, and the, the air quality is like in the four hundreds. It's terrible, right? So we're zipping around, and we're talking about all kinds of different things. And I want to preface what I'm gonna say, by being very clear that I'm not doubting anybody's problems, issues, ideas, nothing like that. But I began to wonder and we were talking back and forth about social contagions. And how sort of, there's a, it feels like, somebody says something out loud. And then later, I'm gonna sound like a right wing lunatic for a second, but I don't feel like that just so everybody understands. But, like, how much goes into? My friend says she's anxious. I'm anxious, or like, that kind of thing. Like, like, how much is it just almost learned behavior? Like, you know, like we, we say, oh, there's people online and they're sharing their blank with us, and that's great. But are they also indoctrinating or talking other people into believing that a very normal feeling that they're having is actually not normal? And like, do you see that like, in waves, I guess? Yeah, yes.

Marsha 14:57
Yes. I think there is. Truly some of that. And I think there's a lot of that that happens, probably more so like in the teens and 20s. Well, now I'm gonna say it happens all across the board. But like, we work with kids who are like, Oh, I have dissociative identity disorder, or like, really? How about that's really about you feeling sad and lonely here and then feeling really happy and chipper here. And that's just the normal range of emotions. And so, you know, it's, it's kind of like, you know, I'm going to diagnose myself on the computer, and then I have all these ailments, and I'm really anxious. And I'm like, You know what, that's probably just this. You're probably just having some normal emotions. And it's really, okay. Stop reading that. Yeah, what even diagnosing yourself by Google,

Scott Benner 15:50
I had somebody telling me about, like, I'm feeling a lot of anxiety, but they were in a really pressure filled situation. I was like, I believe this situation dictates anxiety. But, but why? I don't know why anxiety is bad in this scenario, like, Are you anxious? Constantly? You know what I mean? Like? Or are you? Are you in a situation that needed you to be at a heightened state? And you are, and then you a friend looks at you and goes, Oh, you're you're anxious? I know, because I'm anxious to, but I take medication for it. And then you're like, well, maybe I should take medication for it or like, give me like, not to say that there aren't some, I hope I'm being clear. Not to say there aren't some people who are ridden with anxiety and need medication. I'm just saying, I wonder how much the internet and the ability for everyone to just say something out loud. And for you to hear it over and over. And then the algorithm will tell you, Hey, you like listening to people talk about their XYZ? And then the next five videos are the same person? Oh, my God, every one has this, I must have it too. Like, you

Marsha 16:53
know, I could probably go on a tangent about social media, because you think about even what happens in social media. Everybody posts what looks good, right? Or bad? Yeah, or bad, one or the other? But like, do they ever? Do you ever see the range that happens? And you're so just so very, right? There are situations that are intense, and, you know, are anxiety provoking? And when you're out of that situation, you're able to come back to normal and center and all that kind of stuff. Just because you were anxious for you know, an hour or two hours doesn't mean that you have anxiety? And it doesn't mean that it's going to impact your life over the long term. May it impact your life, maybe in that day? Sure. In that week, maybe. But does that mean it goes on and on and on to the point where you need to be medicated, and you have all these symptoms, and you can't cope, you know, now. And again, not to discount those people that it really does happen to because it is very, very true. Otherwise, I wouldn't be in business. We all have bad things that happen to us and we get sad, and we get depressed about them. And we have coping skills that we learn how to manage them, and we're able to move forward. But that doesn't mean that we're depressed it means to be on 15 antidepressants, and

Scott Benner 18:13
yeah, yeah, that's when things get fashionable too. Yes. And Oh, gotcha. Right. And then they have been flow. What's the one is just the thought just popped in my head? Oh, there was a time. And I I say online, I guess, where everyone was calling everyone a narcissist. Yes. And I don't remember when it was and it went on for a couple of years. But it became very fashionable that if somebody showed any signs of narcissism that people were like, That girl's narcissistic, or I'm always dating narcissists, or bla bla, bla, and then all of a sudden, you don't hear about it anymore. What did everybody did everybody fix it and stop dating narcissists. Or, like, did you move on to a another? social contagion? Another there? You know,

Marsha 19:02
I 100% agree tons of trends about who is what and what we move on to and you get buzzwords that are out there and half the time people don't even know what the buzzwords really are. You know, I'm just gonna throw it out there.

Scott Benner 19:17
Listen, I've met a lot of people. I'm not sure they should be in charge of which foot goes and chart in front of the next one, but then suddenly, I'm letting them tell me what a narcissist is. I was like, last week, I wouldn't have taken lunch advice from you say that I'm brilliant. But and you know not to say that if you think you've worked with a narcissist once you're not but it just we don't we let people say very impactful things. Not that they can't say they can say whatever they want, but they say very impactful things. We don't know who they are. Right, right. Like I have no idea who you are, what your qualifications are to call your boyfriend a narcissist. Like how do you know like, what did you hear? I mean, I used diabetes, isn't it sample. I can't find every doctor who understands diabetes. But the lady up the street definitely understands mental health disorders. And she's for sure knows what's up with the other lady across the street from her like, I don't know, like, it just it's a weird. It's a weird thing, and then we all get sucked into it. And then you're on your way. Yes. So yeah, it's

Marsha 20:25
interesting too, because people will come to me, you know, like, I could diagnose you. I mean, I could, like, I have the license, I have the credentials. I could give someone a diagnosis. They're like, what do you think about this, and I'm like, I'm not going to do it, and I can play your little game. If you really need help, you'll know that you really need help. Don't like, again, don't google it.

Scott Benner 20:46
And when p&l really need help, they make it to you. Right, right. Like you're, I'm assuming this, the place you work is not full of a bunch of people having small existential crisis is like, you know, they're really in trouble. Yes. How much in Kansas is, is drug related. I used to hate ordering my daughter's diabetes supplies. I never had a good experience. And it was frustrating. But it hasn't been that way for a while, actually for about three years now. Because that's how long we've been using us med us med.com/juice box or call 888721151 for us med is the number one distributor for FreeStyle Libre systems nationwide. They are the number one specialty distributor for Omni pod dash, the number one fastest growing tandem distributor nationwide, the number one rated distributor index com customer satisfaction surveys. They have served over 1 million people with diabetes since 1996. And they always provide 90 days worth of supplies and fast and free shipping. US med carries everything from insulin pumps, and diabetes testing supplies to the latest CGM like the libre three and Dexcom G seven. They accept Medicare nationwide, and over 800 private insurers find out why us med has an A plus rating with the Better Business Bureau at us med.com/juicebox, or just call them at 888721151 for get started right now. And you'll be getting your supplies the same way we do.

Marsha 22:32
You know, it's interesting because I actually live in Lawrence, Kansas. And what happens is a lot of the drugs come from like Kansas City, then cross the state of Missouri, me from St. Louis, across the state of Missouri to Kansas City, and then keep going this way. So right now we're seeing a lot of meth related stuff. And then we actually had three fentanyl overdoses just in the past week, which is a little unique to Lawrence. But I had spent the last 25 years in Kansas City working in substance use services I ran for residential and outpatient programs and to methadone clinics. And so we saw a lot more of it there. And now it's like coming this way. And so we do I mean, I think that's part of why there's this big push to really integrate mental health to look at substance use because you know, that they're so intertwined. And meth is really big here in Kansas. So put that

Scott Benner 23:41
sign on the highway. Yeah, hey, what are some off the top of your head reasons that people find themselves amenable to drug use on that level?

Marsha 23:56
You know, I think it really starts after working for so many years. And I think what it really starts is, is a lot of people start to experiment with something. And they do it because they have some kind of lack of skills in their life. I want to say that in very broad terms, so like, I am really socially awkward. So I start smoking pot, and when I smoke pot, you know, I'm a little more able to engage with other people and I'm able to have better conversations, right? And then that pot becomes not enough. And I have my friend who says, Hey, have you ever tried this crack? Let me try this crack, or I moved to PCP or move to something else. And so I think really, when it kind of boils down to it, people have some kind of pain or not skills to cope with something that's kind of challenging in their life. So they turn to something that just really helps them feel better, and helps them be able to cope with that situation. And then that just keeps happening more and More and more, that's typically the pathway that people get to like the heavier drugs. The other way is, if I'm in an accident, and I have something and my doctors prescribe me some pills, and after a while I use more and more of those to, you know, take care of whatever's going on, which by that point is probably not the pain, it's probably I become addicted to it. And then my doctor says, No, I'm not going to do that, then I start searching for that out in my community, because my doctor is not going to give it to me, so I can get it on the street. And then so you see people becoming addicted, like one of those two ways, like the pain pathway, or, you know, some kind of lack of emotional skills that people have,

Scott Benner 25:45
how much is boredom involved? I

Marsha 25:47
think that's, that's huge. That's also a reason why people don't stop using because they're afraid they're going to be really bored in their life

Scott Benner 25:55
gives you something to do, right. Yeah. Yeah. And because it would be someone's inclination, I believe, to say, how about poverty, but it happens to people on all, all levels of, you know, their social,

Marsha 26:08
yeah, just people who are richer, able to hide it better, right? Because like, if I am having a really challenging year at work, say, and I'm burnout, and I'm crispy, I have the means that I can go on a little vacation and rejuvenate. But if I, and that helps me hide maybe what I'm doing, right? I have the means to kind of hide it better if I have money. But if I'm working in that cheap iron factory, right, and I'm making minimum wage, where do I get away from that? Where do I get away from? You know, what's going on with me, I just turned to drugs. So

Scott Benner 26:49
almost crazy that you just said that because in our drive around yesterday looking for this a pharmacy that had this dose that I needed, we ended up in a diner in a town that was pretty far from our house. And what do I want to say the town was rundown. And we go into the diner Arden and I to have lunch. And there's a family behind us daughter, high school age mother in her 50s 40s, late 40s 50s. And their grandmother. And they argued and yelled at each other, and just generally speaking, acted in a way, I would be mortified to act out in public at the very least. But when they weren't yelling at each other, they would switch back to fantasy full conversations about where they'd like to go on vacation. And they were big places like I think we should go to Bora Bora, and blah, blah, and I'm like Bora Bora. Like who's paying for that? You know, and then it went to well, if we're gonna go over a sea, then we're gonna go to Paris. And all I could think was, oh, they they're never gonna do that. And it actually struck me is, I mean, it was sad, right? Like, I mean, I don't want to like, I don't want to paint a different picture. I can't afford to go to Bora Bora either, right? They definitely can't. And they are not in a position that is one day going to magically say, This is it right. And what I came to understand, was that sitting in that diner and talking about going to Bora Bora, I think that was their vacation. Yeah, you don't I mean, yeah, like they just kind of, and I don't know, like it was just I can't believe that's the example you use, because I was sitting there yesterday thinking the same thing. Like if you make X amount of money a day or a week, and a plane ticket to Paris is whatever it is like you can't even you'll never be able to afford to fly there, let alone stay in a hotel or keep yourself going or and then you don't get that respite,

Marsha 28:55
right. Yeah. You don't get a break. And

Scott Benner 28:59
so also, I think close quarters, like smaller homes, or have or your home not being a hospitable place, like a place that you actually want to spend time, right, like because now you're outside with other people who are in a similar situation. And I guess then that snowball starts rolling downhill pretty quickly. Yeah, yeah. So how do you help people in that situation?

Marsha 29:23
If you look at like national average, not very many people, the first time that they tried to get clean and sober, get clean and sober. It's like 10%, right? Because you have to think about this. You're just like, you're asking somebody to change absolutely everything in their life, who they hang out with how they do things, so on and so forth. So part of it is it's really kind of twofold. You give them a lot of education about what the drugs do to their body and their brain and all of that kind of stuff. And then you start teaching them skills, like how do you manage stress? What is the skill does it take for you to manage stress? What's the skill that you need to learn to To set some good boundaries with your family that maybe every time that they have a holiday, they're drinking and smoking, and you can't be around them, you know. So it's, it's really doing a lot of education. And then the other part of that is a person has to be really, really motivated to change. You know, like, they have to say, it's enough. And you can think about that with everything like with a person who wants to lose weight, like why do people lose weight, you finally get motivated enough to make a change in what you're doing. And some people have that motivation, put upon them, they lose their kids, they lose some freedom, you know, they have a heart attack, or some kind of health scare, that really is a motivating factor for them. And some people just, you know, they kind of try and then they don't, and they try, and they don't, and eventually, it just kind of sticks. And for most people, they just get sick and tired of being sick and tired and want to do something different.

Scott Benner 30:58
I'm looking online here, it seems that around 20 million adult Americans aged 12 or older, battle sub sort of a substance abuse disorder.

Marsha 31:12
Yeah. Seven, the younger you start the The quicker you get to that addiction part where you're truly addicted. 74%

Scott Benner 31:21
of adults suffering from substance abuse disorders in 2017. Struggled with alcohol. 30% of adults in 2017 battled an illicit drug. Wow. It's really something it makes you feel it makes me feel on how it makes other people feel. But it makes me feel just lucky. That like, that didn't happen to me. Yeah, yeah. And because I grew up in I mean, poverty. And my home was in a hospital environment, hospitable environment. And there were plenty of reasons why I should have I never, Whenever anyone asks me, why, why don't you drink? Or why don't you do that? I honestly don't have an answer. I don't know. Like, it would make sense that I would have. And so I don't, I don't know, I wonder if I'm just so cheap.

Marsha 32:16
I don't want to spend my money that way. I can't give you money for that. It's kind of funny, because I grew up in a very rule. My dad was a hog farmer. My parents went to dance club once a month, and they took their bottle of cherry vodka and old charter whiskey with them. And they would have that bottle for like, five years, it would go every time with them to dance club once a month. So I didn't grow up in a household that drank or any of that kind of stuff. Now, when I went to college, I drank a lot. I was our pledge class chug champion, you know, I just, I drank a lot. And I think about that, and like, why didn't I continue to drink because there's, there's also addiction in my family. Right. And so that means that, you know, there's some genetics that play into that, too. But I think it's at the same time, it's like, I had different skills to cope with what was going on. So that alcohol wasn't my only coping skill, right? So I had friends and, and, you know, I had motivation to work and learn and play and hobbies, and all that kind of stuff. But, you know, for folks who don't have that you grew up in home, where you don't have anything else and your family drinks and uses. And you learn that that's the way to make it through life. You know? Yeah, it's, it's, it's tough.

Scott Benner 33:35
Questions. What is that? What if that is the way to make it through? What if you don't have another escape, and you're going to lose your mind? Or, I mean, if you went to a doctor, I mean, right? Like, I must live in a town with a lot of what I want to say, middle aged white ladies who are being medicated by their doctors. You know, like, they go in and they get a Xanax or they get something like that, or they it's a glass of wine at one o'clock in the afternoon, or they're doing something to manage themselves. My bigger question is, it just feels like, this is how people in our are wired. Like, like, after a while, don't you just get that feeling that you're fighting, a losing battle?

Marsha 34:21
I, so I did that work for 25 years, right. And I was able to see a lot of people make a lot of significant changes in their life, I mean, to really become very different people. And I think that was the part that kind of kept me going is that people really want to live their best life, right? No one wants to be a drug addict. No one wants to be an alcoholic. They really want to live their best life. And so for those who make it out of it, and are able to do that the changes they make in their life are just remarkable. Oh, yeah, I'll tell you this little story. So I went one time to an AAA meeting, one of our clients was celebrating a year. And a friend of mine who had worked with her from a different agency said, Hey, come with me. So I go to this AAA meeting, and they're celebrating her year, and I'm just sitting there, you know, just just to be there. It was an open meeting. So you know, they're in a, another person from that group gets up to start to talk, right? And she looks out of the audience, and she sees me and she's like, Yeah, and I'm like, Oh, my God, oh, my god, please. No, no, no. And I'm, like, go on. She's like, Oh, yeah, I have stories about Marsha. And she went on to say her things, and then came up to me afterwards and said, I remember being in treatment with you. And I remember how much of a, like, a I was to, because she was just, Oh, my God, oh, my God. And so, but here she was. Now, at this point in time, she had 14 years of sobriety, there was a woman that sat behind me that as soon as we get up to leave, she's like, I just want to thank you. She goes, I wasn't successful when I came through treatment with you. But I've been clean and sober for two years now. And it was just by some of the things that you said, that really made me think about that. And here I am. And it had been like nine years, and she had been out of treatment. But I've only been clean and sober for like two years. So I you think about this, as in the kind of work that I did is that you think about this as like, I'm not going to save everybody. But I'm going to plant enough seeds that when people really want to make that change, they know what they do, they can do to make that change. And so seeing that kind of success over the years, is what really motivated me to stay in that work. But it also is what motivates people to make changes, like once I start to know more about what I'm doing, and know that there are opportunities out there for me to do different and be different. You know, it takes hold at some point in time, we just don't know when you

Scott Benner 37:08
just perfectly described how I feel making this podcast? Exactly.

Marsha 37:12
Yes, yes, I get it. But yeah. And I'd never related the two but you know, I get it. Yeah.

Scott Benner 37:19
And I don't I don't ask the question. Because I think things are hopeless. I asked the question to get the answer. And so people can hear why it's not hopeless. But but to go backwards? Why does it keep happening? Like why don't we produce a generation of people who think math? No, thank you. Like, why doesn't that happen? And it doesn't, right? Like it's, through some decades talking about how things ebb and flow right? Through some decades, it's cocaine, and then through another decade, it's heroin. And then some people hold on to it. And then then like fashion, it comes back into style, again, like cocaine is huge right now, again, around here. And you know, and so it just feels like what we're saying is that a portion of the population needs to escape. And some of them need to escape with alcohol. And some of them need to escape with hard drugs. And some of them need to escape with a risky behavior and like, and they're on and online web gambling online, and, you know, pornography, etc. And over and over, like, there's so many different things. How crazy is it? That this, that this soup we all come into is somehow not hospitable for such a large portion of us?

Marsha 38:37
Well, I think that goes to even greater than that. drugs or alcohol. It's, it's also about, you know, how do we build and grow a generation of people who can tolerate not having instant gratification? Right? How do you raise your kids so that they don't get everything that they want? Or everything that they demand? And how do they work for that? And how do they delay some of that gratification? I think about it now, you know, like, even just raising my son, you know, he wants something like, how do you build the tolerance that I can say no, without you throwing a fit and having a meltdown? Yeah. Right. Because that's part of what drugs too, are their instant gratification. I want to feel good, I do this, I feel better, right? And so it's that whole generation of how, what are we doing with our kids? And what are we doing to raise them in a way that they have a good strong work ethic and that they, you know, learn that they have to, like, earn money to then buy things and get what they want, and that doesn't happen today. That doesn't happen in the next instant. But, you know, for many of our generation, I just get on Amazon and order what I want, right? or I say that I want this, and I'm in front of social media, and I'm in front of this, and I'm getting instant gratification continually. And I grew up on a hog farm. Like, think about that, out in the middle of the country, we were poor, dirt poor, right. And so to buy a pair of jeans meant probably that I had to work, you know, for three months to be able to save my $20 to go buy my pair of jeans, now I'm old. So that's how much they were in that in that time. But, you know, it's like, we had to work to get what we want. And so, you know, needing that instant gratification wasn't a part of what I grew up with, I had the tolerance to be able to say, you know, I'm gonna, if I want this, I have to work for it. Right?

Scott Benner 40:49
Well, and it's interesting and easy to say, oh, parenting, if the parents did a better job, which, I mean, obviously, everybody could do a better job, not just in parenting. But if that was the case, then, you know, the hard working hog farmers of the 50s wouldn't have raised the generation of kids who were drinking all the time, and etc. So it isn't just that either. I just think, like, I don't want to sound like I'm like, headed down some, like Hocus Pocus, like Boulevard here or something like that. But it just feels to me that a large swath of people are not wired correctly, not even correctly, but wired in a way that gives over to this existence, the way it's set up right now. Like they're fighting against it all the time. You know, you mean like, there's sometimes I see somebody who's living in a van, and doesn't have a real job. And I think you know, what, good for them. That's probably where they're comfortable. You know, and, and feeling like, and I don't know if this is the same in all parts of the country, using America as an example. But around here, like, there's a pressure, like, I don't know if you know what it costs to live here. But you got to make money if you want to stay here. And it's, and it's the second you're standing up, and you're in your 20s. And it doesn't stop until you drop dead. Like, right, like, so I can see people being like, I don't want this. And there are also people who thrive in it. You know, like, I didn't be honest with you, like, I told the story recently. So I don't want to go deep into it. But I, we went away for like nine days to see our kids. I worked like a dog for like two and a half, three weeks to prep myself. So I could leave so that you guys listening to the podcast would not notice that I was gone. Right? Right. And I'm talking about like, 12 hour days for like a solid week of editing and like, you know, stuff you just don't see behind the scenes. And somebody said to me, why don't you just like, not have the podcast for one week. And I was like, what I was like, I don't understand. And it was like, someone else might like, you know, I might lose, like, I might lose ground, I can't lose ground. I don't work at this for nine years, I'm gonna stop, right. Like, and I know, there's plenty of other people would be like, I don't care. You know, like, as a matter of fact, I, I've seen people say I'm going to start a podcast, and after talking to them for 15 minutes, I'm like, Oh, that's not going to work for you. Right? Like, you're you just don't have the personality to like, do the backend work that that needs to be done. I'm sure you could sit down and talk, but you're not going to do the other things that like you don't fit in that. And, and I'm sure there are people who grew up in parts of the country that had very slow, and they're not okay with that either. And they have that, like, I'm so bored. I gotta get out of here feeling they want to be up here fighting with the rats with me. You know, it just I don't know, like, it's a bigger thought. And of course, it's not your job to know the answer to it. But it just feels like people are sometimes incompatible with their life or their surrounding. And then on top of that, they get bad direction from parents who are probably in the same situation. And we try to boil it down to something simple, like, oh, they weren't parented Well, or she's anxious, or you don't I mean, like, I'm like, I don't think any of it's that easy. Or simple. I

Marsha 44:16
always used to say that if I had the answer to why people got addicted, or you know, were became or became an alcoholic, I would just bottle it up, sell it for $1,000 stamp, your forehead is cured and be the richest person in the world because there is no direct answer to why it's fast. It's just all Yeah, yeah. It's about what are you going to do with it? Right, like, now that you're there? What are you going to do with it? It's kind of like I was just actually I was listening to your podcast this morning. I'm talking about the myth of why people became diabetic. And it's like, does that really matter? Like does it matter? Like you're there now? What are you going to do? How are you going? have lived your life. Now, what's the choice that you're going to make about that? I

Scott Benner 45:04
honestly, like, again, does sound strange, but I don't obviously know the answer. But it seems to me that caring about other people having a goal. And feeling like the thing you're doing is helping the greater good is what keeps me straight and narrow, like, like, like, I just, I'll tell you that Jenny and I spent 20 minutes texting yesterday. And she sent me this letter that a listener of the podcast sent to her. And it's just a thank you. It's an eloquent thank you from a younger person. And she said, Scott, you know, I got permission to send this to you. I thought you should say it. And it's hard. It's hard enough to just come out and say, like, the letter says, Jenny, and Scott, like you saved my life. And it goes over how, and I texted Jenny knows, like I said, it's, today was the day I was looking at my online messages. So I'll spend, like, I get tagged and so much stuff online. And I'm trying to find as much of it as I can. It's very, if you guys have ever tagged me, and I haven't seen it, it's hard for me to see it all. But so I'm jumping through. And it's message after message with pictures of adults and children and like, look how healthy I am. And I'm doing great and look at my graph, and blah, blah, blah, and I get through it. And it's very emotional, I almost have to wall myself off from it a little bit to do it. Because if not, I just sit at my desk and cry the whole time, like just out of like happiness. And then Jenny sends this email. And now I'm sitting here, and I'm just wiping these tears running out of my eyes away. And I texted her, and I said, I said, Oh, you pushed me over the edge. I'm crying now. And I spent, you know, I spent this morning and already looking at these messages. And she said, I cried for a while after I read that. And then we just sort of commiserated about what it feels like to help a stranger, like a person whose face I literally don't don't know what it looks like. And I just wonder, I mean, how valuable that is. And if everybody couldn't find a way to I mean, you could start small, right? In your family, or, like on your street or something. And I know this sounds like, I don't know, it just sounds like it's the 70s and I live in Malibu, but I mean, it just, it's, it's so true. Like, I don't have any, I mean, there are problems in my life too. And, you know, concerns and worries, I have all those other things that people have, I am not in a house that is unpleasant to be in. But other than that, like I don't, my life's not that much different from anybody else's, I get up every morning, and I'm like, I'm gonna make that podcast, and somebody's going to be better off because of it. And I might leave a seat behind like you were talking about where maybe 10 years from now, people will still use this exact Yeah.

Marsha 47:58
So it's about finding that life worth living, you know, like that, that you found that value and meaning to what you have going on and, and that's a life worth living for you. And for folks that don't have that, you know, that's the challenge. But it's, I think we all want to find that right? I think everybody wants to find this life that they find meaning to and all of that. And I will say that I do attribute a lot of how I manage my son's diabetes to listening to your podcast. Like, I don't know that we would be where we were with our diabetes management. If I hadn't started listening, you you know, and I hadn't started like kind of taking, taking control of what was happening with my son. So I appreciate you and Jenny tremendously.

Scott Benner 48:50
I'm going to shift to that in one second, right after I let everybody in on the big secret of this episode, as we're 50 minutes into this, and people are like, great. And other times God has brought on the person and they haven't talked about diabetes. But let me just pull back the curtain on what I'm doing here. In case you're not following along. This is exactly about you taking care of your diabetes. That's what this conversation is about. Because the there's no difference. I have not been able to see a difference. Except for access, right? Like, you know, there are people who can't afford certain devices, but you can live well without those devices too. And so, after doing this for so long, I don't see a difference in people's health success with diabetes generally speaking, like I'm sure some of you have like extenuating circumstances, but it just comes down to a little bit of education. Some desire, getting up every morning, doing the thing, not feeling burdened by it. Right. Like you didn't hear me say I worked like a dog for 10 days to go to go away, and I hated it, it was great. That's what my life was for 10 days, I worked really hard on this podcast for 12 days, 12 hours a day, I never once walked out of this room complaining, oh my god, I was in there all day or bye bye. So you have to accept what your life is. And, and like you said, like, attack it like, this is the thing now like, alright, this is it. And I don't know, like, that's just how I see life. Like, I expect speed bumps, I drive overtop of them. You know what he means? Like, if if one of them stops me and it's a wall, then we stop and we find a way over, under around it. And then we just keep going. It's that it pops into my head constantly that old like country music song is like, I just No one promised you a rose garden. Right? Like, like, but everyone thinks life is gonna be this perfect thing. And then, you know, you don't see it. When people are throwing tacks in front of you little things like I don't seem to be able to find a girlfriend, you know, like, I don't jive with anybody. That's a small problem, like, and it could be a big problem if you're alone. But those little things, we don't step back ever and go, I can't win, like, like, you know, but then this diabetes thing comes. And listen, I'm right there with you. It happened to my daughter. And I was like, you have to be kidding me. Like, like, you know, you spend months and sometimes years in your head, like negotiating with nothingness about like, how do I get out of this? Like, how do I get her out of this. And then you just realize, like anything else. I mean, like, like, somebody was put in prison for 40 years for something they didn't do. Like you can either be a prisoner, or you can, you can find a way to live in your in your surroundings. And I kind of see diabetes like that. And I see a lot of people who just fight against it constantly, they won't stop fighting it. And you know, I understand how that can happen. But I'm telling you, the only path that I've seen is just to not give up. But you just have to accept like, this is the world I live in. How do I live in this world? The best way possible?

Marsha 52:03
You know, so true. I think that's one of the things that that I think about a lot. And I read a lot of the posts on Facebook and that kind of stuff. And, you know, there was one post that struck me just like to the core of this mama, the newly diagnosed that said, Okay, we're getting out of the house for the first time, like in three months, since his like my son's or daughter's diagnosis. And I'm like, Oh, my God. Like, you just have to live your life. Like you just live your life, like you just go. Because if your son gets low at home, or your son gets low at the grocery store, you're gonna treat it the same way. Right? You're not even

Scott Benner 52:45
talking about somebody who wanted to leave the child behind. They were just leaving that, hey, listen, walking out of the house together. I can't I can't tell you that. That didn't happen to me. I mean, Arden was too and she was small. But I would think, well, what if she gets low while I'm driving? And she's in the backseat in that car seat? And I don't notice it? Or like, you know, and then you just think, okay, like you set up ways to take care of that. You know, what if what if we don't have something, it's impossible. Now, there's always juice in my car. It's in every door pocket of every vehicle that any of us traveling, right? Like that just doesn't happen that way. And yes, and two days ago, Arden left to get her hair cut. And she's home from college right now. And she's almost 19 next month. She took care of herself. I mean, all year at college on her own. One of the Spanish she was gone for five solid months. Right? She's doing terrific. And as she walked past here yesterday, while I was sitting here editing, and I heard her like she was go down the hallway. I was like, Hey, you're leaving for your hair? And she's like, Yeah, and I couldn't stop myself. I was like, Do you have a juice? And she goes, Yes. And I was like, Okay. And then that was it. Like I just, I still pictured her sitting at that place, getting your hair cut, getting low and not having access to something. So I get why people feel that way. But you're not wrong. You just have to go do it. Like you'll come to that wall. And then you'll find a way over around it or under it and you'll keep going you just can't sit in your house. And just think, Oh, I'm stopping something bad from happening by not doing anything.

Marsha 54:23
Right, because the diabetes is not gonna go away. Yeah, it's not right. That's

Scott Benner 54:26
the point and your kids not going to live his life or life, whatever, in your house like that. That I'll tell you. I'm gonna. I'll give you a little secret here. Okay. One of the most asked questions of me for years, Marsha. Oh, yeah, you're good at it, and you're helping her but what happens when she leaves like that fear. And people talk about it. Like, it's not going to happen. It's two ways either people talk about like, it's never gonna happen. So I'll just keep you here and keep us save almost that, like, hey, when you grow up buy a house across the street from mommy thing that you hear, like literally every person, every woman who's ever pushed a baby through her loins or come out in any way, or adopted one or anything says like, Oh, they're not going to move to live across the street, you think that's a new thought I've heard everyone says that, right? That's not gonna happen either. And by the way, when that does happen, it's stifling for your kids, they should, right, spread their wings, right. And then you'll hear people say that, like, nobody's ever gonna go into it, where someone will say, Look, you got to figure this out, because they're going to leave. And I know, that's hard to wrap your head around. But that's my experience, like, it's coming, it's going to happen, you can be prepared for it, or you can pretend it's not going to happen, and then send them out into the world completely. Just ill aligned with their needs. And that's where problems come from. And I got, yeah,

Marsha 55:49
I've kind of taken the attitude that, like, I'm going to help my son as much as I can right now. And I, but I'm also going to afford him the opportunity to step in where he feels ready. For the longest time, you know, well, not for the longest time really for a pretty short amount of time when we were MDI. He would, we would give him his shots. And he goes to school one day, and I said something to the school nurse. Now I've had a fantastic school nurse. But I said something to the school nurse, like he's kind of interested in his shots. He came home that day. And he said, Miss Diane taught me how to do my shots. And I'm going to do him from here on so he did, I've never given him a shot since. And when we change his palm, he's like, I'm gonna put it on. And I'm like, on. Okay, and so, like, he doesn't do anything else to get it ready. He just puts it on that whatever he's ready for is what we're gonna do. I know, by the time he's 18, he'll be ready. I won't be but he will be. And so that's just how it's gonna go. But yeah, you just have to figure it out. Just live your life.

Scott Benner 56:55
It's going to happen. You can either be prepared to approach the law, or act like it's not going to come. And when you get there stand next to it for 50 years going, I can't believe this happened to me. I thought I was gonna get through this without running into a roadblock. And now I'm it's the roadblocks fault. You know, but it's not by the way, I've decided to call this episode over under or around. That's a good one. Thank you. I wrote that. Yeah. So write down where you said 3625. But now that I did that, I have to write down 5818 Where I said, and then again at 5822. Okay. Sorry about that. Oh, it was fun.

Marsha 57:37
I'm surprised I haven't said anything worse.

Scott Benner 57:39
I mean, if you grew up on a hog farm, I'm pretty surprised you're on just like MFM this whole thing?

Marsha 57:45
Yeah, my dad had a plethora of words for pigs. So

Scott Benner 57:53
I'm sorry, I don't want to hear any of them. So I also want to say that there's somebody's listening to this. And they're like, you know, call Scott like, it's, you know, I'm addicted to something or I can't get through a week without doing I'm not discounting that. I'm not saying that I'm, I'm making a like I'm asking the bigger question, honestly. Like, it just it's baffling to me that so many people find themselves in this situation. But if you want to talk about hope, there's an after dark episode called after dark sex worker, because that's how the person like classified themselves to me, but in the in the pylons of my time. She's a stripper, okay? Yep. Yep. In the course of that conversation, Mila said I asked about her diet, because she hadn't had diabetes that long. And she said, without any sense of irony, she wasn't joking. She said, mostly tequila and coke. And she didn't mean like to kill on soda. Right? And she said it so matter of factly. And that episode has been out for over a year now. And I can't tell you, I think about her a lot. Like I literally think about her saying that like a lot. And I wonder if she's okay. And later in the episode, she talked about her father passing from a fentanyl overdose, if I'm not mistaken. And she just said it in a way that it was. It was like she was telling me that there's a sofa in her living room. It was just so normal, right? And I worry about her constantly. I don't even know her. And a couple of days ago, she sent me a note and she said, I want you to know, I've been sober for two months. Oh, wow. That's awesome. And I don't know why she was telling me. But it was almost like it felt like oh, God, she knows him. You know, and I said, um, and I you know, we talked back and forth on I'm gonna tell you what we said to each other. She did tell me she's what I think the gentleman on California silver referred to as California silver, I think she's smoking pot still, which I have to be honest with you. I don't really see the issue with. But I was like, Well, congratulations. I said, Do this for a year. And I'd love to come back on the podcasts and tell me about the process. And then I shared with her, I worry about I know, it's weird that we don't know each other, but I worry about you a lot. And she said I was a real mess then. And but but why I'm telling you that is because when I was talking to her when we were recording that she did not think she had an issue of any kind whatsoever. And that's baffling to me not not about her specifically, but about people in general, like, not baffling. It's fascinating. It is fascinating that you're asked to be on fire, and you're just like, everything's fine. And you believe you really believe in? You know, I don't know.

Marsha 1:00:59
That's that whole education piece about addiction is like, people need to be able to see that there's a life beyond like that it that something can be different. But if I can't imagine my life being any different than why would I think what I'm doing is that bad? Yeah. Yeah.

Scott Benner 1:01:17
I don't want to get too deep, but you're born and you die. That's your shot. If you want to believe in an afterlife, you can but I'm not putting money on anything I can't see hold or touch right now. So this is it right here. You're a you're a baby and a toddler and a young person and a preteen where you're all messed up with hormones. And then you're a teen where you're messed up with hormones. And then maybe if you're lucky things start to gel for you in your mid 20s. If you're lucky, right? And then I don't know how to tell you, but it's only 20 years till your knees start hurting.

Marsha 1:01:50
So are you getting a new one like me? Yeah. So

Scott Benner 1:01:53
you've got like, listen, I told my son on the way out the door, I said, you're gonna start figuring things out, that's going to take you five or six years to get a solid idea about what you're doing. And at that point, you're either going to have a baby, think about having a baby or not have a baby, but one way or the other. By the time you're 50. Your back's gonna hurt. A I said you played baseball, your whole life, your knees are gonna hurt, your arms are gonna hurt, like, your shoulders are gonna hurt. And you're gonna be, you're gonna come to that conclusion that everybody runs into at some point. The only thing that matters is my health. Yeah, it's the first thing. I don't have my health. Everything else is going to be a, you know, an uphill battle. And I said it rewires you, you think God, I wish I almost wished my knee hurt when I was 20. You know? And then and then it takes you back to like, why do people with diabetes so often have such clear? Like a clear understanding and perspective? Like, right, like, Don't you find the people that come on the show? The more problems they have, they either find themselves spinning out of control, or the most thoughtful people you've ever met in your life? Yeah, like how many, how many people on here have talked about like, serious health, like life altering, or possibly ending health issues. And they're the most Zen people in the world.

Marsha 1:03:19
Like, they just Yeah, they've like, it's almost like they've embraced what's going on with them, and have just figured out like, this is this is it and here we go, you know,

Scott Benner 1:03:31
again, it's it's like being in prison, and you didn't do anything wrong. But you can either let it ruin your life, or you can find the best way to live in your circumstance, right. And I just heard an interview with a with a person who had that twice stuck in my head and they were in prison for over 30 years, something they clearly did not do. And they're literally together person now they still have trauma from being imprisoned. And that's not to be discounted. And actually, in your note to me, you said that a diagnosis is traumatic. And you want to talk about that a little bit from a personal perspective and professional perspective.

Marsha 1:04:08
Sure. So, you know, my son was diagnosed, we just did what we had to do, right? Just to kind of make it through. And it wasn't till. Like I told you, I go to the gym every morning at five in the morning, and I was sitting on I found your podcast, and I was sitting there I was listening in is actually listening to Mark, what is it? He's the tight end for the Ravens his mom was on? Yes, his mom was on Mark answers. Right? Yeah. Mark Andrews, and she was talking about it. And the next thing I know, I'm just bawling. I'm just sitting there as she's telling her story, which she I think cried during the episode, but I'm just bawling because I'm reliving our son's diagnosis. My son was really really sick. He was in DKA A he had qu small breathing, you know, we go into urgent care because we thought he had the flu 10 minutes after walking into that door, they're like going your son's type one diabetic, he's going to the hospital, he's going to be an ICU, he's going to be on insulin the rest of his life, here, take him and go, you know, and we're like, we're gonna go get a diagnosis. But no, you know, and then we walk into the emergency room and four nurses and three doctors swarm him. And one doctor came over and said, Your son is really, really, really sick. You know. And so, you know, just hearing her talk about that just kind of brought that all up. And I'm like, You know what, that was very traumatic for us. And I think, you know, one of the ways through traumas, just being able to talk about it and share it and say, yes, that, that had some feelings associated it pretty strong feelings that I don't think I really recognized until I was listening to her tell about her son's diagnosis on the podcast, and I'm like, Yeah, I just, I see why some parents get really immobilized. And that's what I just want to say is like, here's what it is acknowledge it, talk about it, and move through it, like you've got to live your life, you can't change it. And so, you know, just acknowledge what's going on about it. So one of my things that I that happened after, which, you know, I'm a social worker, my life's not a secret, I tell everybody, anything, I'll tell everybody, anything. I guess that's what I say. So, you know, I just start talking about it, I started talking about it to the people that I work with, I started talking about it with my family, I started talking with about how scary it was, you know, what it felt like all of that. So I just think it's important that people understand that it is traumatic, it is difficult, it is a challenge, but it's, again, what you do with it, that's important. That really, you know, helps you kind of move forward and live with this, or just kind of get you stuck in that spot. And you're kind of immobilized, I

Scott Benner 1:07:11
always have the same thing pop into my head, I think about The Walking Dead, the TV show, for too ridiculous, but something shocking happens in the world that you can't possibly be prepared for. And the people who make it out, are the ones who don't stand around and wonder why are there zombies out there grabbing guns, and they're grabbing food, and they're grabbing water, and they're grabbing trucks, and they're the ones who are like, I, I'm gonna make it through all this, like, I used to say on the podcast a lot, just because it was it ended up being my life. Like if, like, if it gets sideways find me, like, I'm living through this, you know, and, and you could to, like, I know, you like, you might hear that and think, Oh, well, he's a special kind of person, or he has a special I don't have a special trait. I just, I don't give up. Like, I'm not, I'm not going down like that, like, whatever it is, like, if it's diabetes, or, you know, whatever. Like, I am not a person who's gonna give up. And I don't know why that is, I can't tell you exactly. Like maybe it's a set of circumstances and wiring and how I was raised or how I wasn't raised. Like, I know, it's all like, random and you can't You're not, you're not at fault if you don't have certain attributes, right? But, but you can what no matter what your attributes are, make a decision. I'm not going out like this, like, right, like, and then whatever that ends up being, you know, like, whatever that ends up being ends up being and if it's your story, if you do go out, okay, but at least like go down swinging. Like I mean, you know what I mean? Like, it's nothing more frustrating than watching somebody take strike three. Right?

Marsha 1:08:50
Yeah. You know, we were diagnosed right in the middle of a pandemic, right. And so I literally, I got my son on a CGM, and on a pump before we had our first in person, endocrinologist appointment. Like, we had one on telehealth and I'm like, Nope, I'm doing this. Like, this is what I hear. This is what he needs. This is what we're going with. And he was on a pump and on his Dexcom before we even went in and saw the endocrinologist in person, I'm like we're doing this is how we

Scott Benner 1:09:27
go. The first time somebody said to me, Oh, she can't have that. I was like, well, listen, let's get past that idea. Because that's not going to even yesterday, I will give you like a real world example of don't give up in a low stress situation. You guys by now if you're listening to the podcast, you recognize like I'm using weego V to lose weight, right? My wife is using it as well. I'm we're both down 20 pounds in about 10 weeks. It's really just terrific. I can't tell you how, how great it's been for us. But there's a bit of a show shortage of it right now. Right? Like they're just and it's with the lower doses more than the higher doses once you get up to like, I think, I think 1.7 or something that seems to be pretty readily available. People are having trouble starting on those those low doses, but to prescriptions go to our, our pharmacy, and I get a phone call that minds ready. And I call them up and I said, Hey, kind of weird. Like you said, my wife minds ready, but my wife isn't. And the girl on the phone says, oh, yeah, we don't have hers. I was like, Okay, why not? And she goes, Well, it's out of stock. And I said, Oh, okay, what will we do about that? And she said, we'll wait for it to come back in stock. And I said, Well, how will I know when it's back in stock? And she goes, you can call back and I was like, Well, what if somebody else calls back before me? Like, what if my prescription came today and their prescription comes in three days, but they call back before me? They get my weak ov? And she's like, Yeah. And I'm like, Well, I'm like, that's not going to be okay. And I said, so. Let's try to think this through for a second. And she's like, Okay, I said, What could we do to find me, we go v. And she was without an answer. Right? She stood there. And she's like, I don't know. And I'm like, Okay, well, can you take some suggestions for me? And she said, Sure. And I go, could there be some at another Walgreens? And she goes, Oh, yeah, there could be. And I was like, okay, then she stared at me. And I went, can you call them for me? And she goes, I can look in the computer. And I went great. And then she, she pulled it up, and she said, there's one box, like two miles from here, and I went, can you move my prescription to there? She goes, No. And I said, What would I do? And she goes, Well, you would have to call them. And I went, Okay. And then she starts looking over my shoulder, and I went, can I have the phone number, please? And she's and I'm being nicer than this right now. I'm just painting a picture of this girl was like, inept. And but at any point during this conversation, I know a lot of you would have just heard no, and gone. Oh, I guess I don't get it and then left. But I kept asking reasonable questions. So I was like, okay, so she gave me the phone number. I typed it right into my phone, now asked me, Did I wait to get home to call the phone number? No, I was calling walking out of the Walgreens. And then I got the pharmacist on the phone. And I said, I hear this, that you have this, I have a script at this pharmacy, can you please pull it over and fill it? And she goes, Yes, no problem. And I said, that's terrific. When will it be ready. And she goes in about a half an hour. And I said, I will be there in 30 minutes. And she's like, great. I did everyone's thinking for them. Because I needed this thing. I've done this with insulin. I've done it with pumps. I've done it with CGM I've been on Listen, I've been on the phone with Dexcom customer service, walking them through it because I recognize it's hard to get customer service people I don't care if your Dexcom or your tandem or who the hell you are. That's a hard job. Like, because they doesn't pay a lot. They don't get a lot of training. You know, mostly, generally speaking, sometimes you have to keep in mind. And I don't want to say be your own advocate because that's trite. Like, but I don't give up. That girl tried to shut me down six different times. And it turns out there was an answer. And even though I didn't know it in the moment, I found it. And I don't think that life is any different than that. You don't I mean? Yeah,

Marsha 1:13:46
I 100% agree. I 100% agree. I mean, that's like what I found when I was, you know, new to all of this and trying to figure out, you know, how do we get on a Dexcom? How do we get on we are on a tandem. So how do we get on that like, and then I'm on the phone to my insurance, which was a city funded, like city plan. So I'm like telling me what I need to do. And they're like, Well, if you can't do this, call us back. I don't. I was personal friends with that person. By the time I got on a pump. I'm like gone. Yeah, we're just gonna, we're just gonna keep doing it. And like, do I call the tandem? Rep? Do I call this person do I call this person? I called everybody because my son was going to have what he wanted, you know, and what I wanted him to. I wasn't going to let it stop. And I think that's, I think, I think that's probably like the key to life, right? Like, how do you get what you want? How do you advocate enough for yourself to do it, you can let it happen to or you can just go do it.

Scott Benner 1:14:45
I also want to point out that the girl at the first Walgreens is probably 20 years old. And she was just doing what she was told like nobody told her to, to, like problem solve. They she said what she knew. She was now out of decisions. All right, but I wasn't other questions yet. And it turned out she knew more, by the way, never yelled at her wasn't upset. I didn't like none of that. Like I was just like, oh, you had a lovely conversation. As a matter of fact, a month later, if I'm being honest, I just told you a story from a month ago, and acted like it happened yesterday. Sorry, that happens a podcast sometimes. But a month later, when I went back to pick up my next one, at the drive up, she like saw me and lit up and she waved, she's like, Hey, how are you? Because after we found it before I walked away and made the phone call. She said, What is this drug for? And I looked at it and I went, it's for weight loss. And she goes, does it work? And back then I was like, I've lost 15 pounds already. And she's like, Wow, good for you. And I was like, thank you. And we have like a little connection. And then a month later, of all the people that she sees face to face to face, she looked at me and she's like, Hey, how are you? How's it going? I said 20 pounds now. And she's like, that's incredible. And she digged it up and and gave me the next one, the one that they had. So anyway, I'm not saying people are idiots, I'm not saying that I'm saying that there are going to be speed bumps, and there are gonna be walls you run into. And you can't just bump your nose into them and turn around and go home. Like it just, it's not how things work. And especially with diabetes in a situation where you are going to have this traumatic thing. And then, at some point come to the realization of like, oh, hell, I'm not getting out of this. And then come to the realization of like, oh, it's going to try to kill me. I'm gonna have to stop it from doing that. And then you go, who will help me? Here you white coat. And then white coat goes, you know, or says I interviewed a guy yesterday, 35 years old. He's like your podcast, was given to me by my doctor, and included so much more information than the doctor was ever going to give me. And so now you're in that that doctor's office thinking? Well, they don't have the answer, either. That's where a lot of people give up right there. Or they accept? Well, this must be what it is. And I don't know how they would know differently. You know? Sorry. That's saturated.

Marsha 1:17:13
Think about that. Like about, oh, a month ago, I was just really frustrated with my son's numbers. He's had some growing going on. And he's a little sneaker, he sneaks food and candy. And I'm trying to figure out what's going on because he walks out the door for school and his blood sugar rises instantly, no matter what he has for breakfast, he just gets excited about that. And then he was going to bed and his blood sugar was rising after he went to bed. Right. And I kind of let it go on probably I kind of blamed myself for this, I'd let it go on a little longer than I wanted to. And I just finally said, Okay, stop it enough. I stepped back, I started looking at the graphs, I made all of these changes across all of his profiles. And he's had beautiful, like, two weeks after that we go into the doctor and she's like, um, I see you've made some changes. And I said, Yes, yes, I have just took ownership and said, Yep, I did it. Here's what I did. And she goes, You know what, I couldn't have made any better changes. And I'm like, yes, yes. Is that? Yeah, it's it's that just deciding that, like you, you can take control and charge or not. You know,

Scott Benner 1:18:29
I have to ask you a question. Like, that's an interesting, like, in my mind, I'd rather ask for forgiveness than permission. Right? And but at the end, I don't even think I would actually ask for forgiveness, if I'm being 100% honest. But like, what is it in people's minds? Do you think, where they go to a doctor, and the doctor is about to disagree with them, and they they turtle up? And they're like, oh, here it comes? I'm gonna get in trouble. I've never felt like that about anything in my entire life. And I wonder what that is?

Marsha 1:18:59
You know, I think it's because doctors have had this place in our like, in the hierarchy of our world, that they know everything and they know best. Right? I can even relate this back to addiction, you know, people getting addicted by the pills that the doctor actually gave him. Well, the doctor gave it to me, well, but if you really think about it, the doctors are just really doing the best that they can and they may not have all the information. And so like I started thinking about, you know, just partnering with our endocrinologist versus her being the lead that I'm just going to partner with her right? And she can teach me some things and she can tell me if I'm like off track or if I should make some tweaks but I wasn't going to wait for her to make some descent some decisions when I can see by looking at his graphs what was going on. Yeah, I've met other parents are like, Oh, I never make changes on that. I make them all with us.

Scott Benner 1:19:59
I think it would benefit everyone if they could meet people in professions that they think of is like, I don't know, like super important or anything because I know doctors personally. And you know, what's interesting about them is they're people who, who had enough fortitude to make it through eight years of college doesn't even necessarily make them any smarter than you. I've had Jenny say to me, I think of you as a colleague. And I barely got through high school. Right? i There's no pretense about me at all. As a matter of fact, lately I've been lately, Marsha, people have been recognizing me in public more and more. I gotta step up my game yesterday. My daughter's like, your shirt doesn't even match your shorts. And that lady knows who you are. And I was like, oh, yeah, I was like, damn. So like, no kidding. We were in and hi to the person that I met, I guess. But I took our into Ulta to get some makeup. And as we were going up the pay, I noticed the woman come through the front door, and the flashlight was on her phone. And she just stuck it in her pocket. And we intersected each other. So I said, Excuse me, I noticed when you were walking in the flashlight was on on your phone. And she goes, Oh, thank you. And I said, no trouble. And I walked away. And we got in line and paid for makeup. And by the way, whoever makes makeup, you're criminals and should not cost that much money. And we're walking out the door Arden's a little ahead of me. And this, this person is now back in like, in front of me again. And she goes, Do I know you? And I went, and I stopped and kind of backed up through the door. I'm like, I don't know, like, Do we know each other? And I, my first thought, I'm being honest, I was pretty close to home was is this like a person who's like, got a kid a year younger than me or older than me and I we kind of know each other. And I'm like, I'm not sure where from and she goes, Facebook. And my first thought was, I'm not on Facebook. Like, I have like a private I have a personal Facebook, I don't use it, you know? And I'm like, No, and she goes diabetes, and I went, Oh, well, that could be and, and then we started chatting, and she works at a local hospital and blah, blah and in diabetes. And we get outside and Arden's like, Yo, you're like internet famous now. And I was like, yeah, and she goes, dude, your shirt doesn't even match your shorts right now.

Marsha 1:22:22
Come on dad. Like she goes said,

Scott Benner 1:22:25
I look homeless. And I was like, she's like, this isn't okay. And I'm like, right. But that's on the heels of in the last seven days, I've met two other people in public who have recognized me. Wow. And so I was like, Alright, I guess I gotta do something about this. First of all, I'm not gonna stop using the week over, you know, I'm, I'm suddenly know why like, like, I'm making quotes around famous. But now I know why famous people are so worried about how they look, because you do have like, suddenly you're I wonder are people looking at me? Like, that be happening? And I'm like, oh, so I'm gonna not think about that. Anyway, I'm sorry. I don't know where I was headed with that. But you

Marsha 1:23:06
know, back to your point about if, if people could just see like doctors as as people, right? Yes. My next door neighbor's a doctor. Right? I see him picking up his dog poop. Like he's a real person. Yeah, yeah. He didn't know everything.

Scott Benner 1:23:20
Right. Nobody knows everything. But you get enamored, like, I mean, like, I met somebody the week before, and they were enamored with me. And I really wanted to say to them, like, this excitement you have is misplaced. Like, I'm a guy who has a kid with type one, I understand it maybe better than some people and I'm a good communicator. That's it. Like, like, I'm there's nothing beyond that. Like, it just this is it. I like doing this. It helps people. And it pays my bills. And so I do it every day. I can't tell you if I couldn't pay for my kids to, you know, eat, I wouldn't be able to do this. You know, they mean like, so like, there's an the doctors a doctor because he wanted to make money. And he maybe was like, Oh, I'm good at science. He might not even be like, I want to help people. You don't mean like, listen, I know a couple of different I know more than a few doctors and some nurses and they're all lovely people, and they go out and do a hard job and everything but they're not smarter than you. Right? Generally speaking, you know what I mean? So

Marsha 1:24:27
I think that's so true. Like, especially with like, I'm, like, clearly I'm around my son all the time, because I'm his mom, but like, I see what happens to his body. Right? My endocrinologist doesn't, she doesn't see what's happening to his body to what happens with what food he puts in his body and how that impacts him and all that kind of stuff. So I see that. So how is she going to be better at understanding the ins and outs of how diabetes affects him than I am who sees what he eats, how much he doses when he sneaks, and what it does to his blood sugar like, yeah, yeah, you

Scott Benner 1:25:09
know, anybody who's ever had their car make a noise, then they take it to a garage and it won't make the noise anymore. It's basically the same situation, you know, you're standing there going, No, you don't understand when I make a right turn, the wheels wobbling. And I know it's not happening right now. But it happens every day. Just because they can't make the wheel wobble doesn't mean that it's not happening to you, and you go into a doctor's office, you're like, here, these are my concerns. And they'll look at your graph, or do or they're your MLB. Like, they start turning dials and moving things. And I'm like, That is not a good way to do this. And, and, by the way, I'm not trying to give people the idea not to listen to their doctors, or that they're not valuable. I'm just saying they're not infallible. And right, and you shouldn't be cowering when you're explaining what you did. Right? You know,

Marsha 1:25:56
yeah, that's, that's the, that's the whole idea of me partnering with my doctor, instead of her bleeding. You know, I just need to be the partner in this. Yeah. And my opinion counts, and what I think counts, and what I see matters. And I should be able to say that. So, you know, I felt very proud when she said, You made the exact changes that you need to do and like, Yay, go me. And if she told me that I hadn't, I wouldn't have changed him back. Because what I saw was they were working. Yeah, right,

Scott Benner 1:26:30
Kelly, and a deal working. And by the way, a decent doctor will get to you with that. And a lot of you are not great communicators. And so like, it's that feeling right away of wanting to be adversarial, as soon as you're like, you know, like, oh, well, like you had one experience. But what if the doctor would have been like, Hey, you can't be making these changes. And then you have an opportunity to either say, Well, you know, we made them because of this. And this is the result. So we really do feel like this was was valuable. Or you could just be like, go to hell, and then get angry. And now you're in a fight. Like, I know, like, again, people think like, oh, they're professionals, or they shouldn't, like, you know, have an opinion about if they like me or not, or, but they're just people. And, you know, maybe, yeah, maybe you're crappy to them. And they're like, I hate Patti. Like, you know, I'm gonna help her because, you know, that oath I took and everything, but I don't like her. And then suddenly, you could be those, those people grew up poorly, too, just because they ended up being doctors doesn't mean they're great communicators, either. Right? It's just a lot going on. So I like to keep it simple. And I like to stand up and say what I did, right? This is what I did. This is why I did it. If you have input about it, give it to me. Because I'd love to know if there's more improvement to have here. Yeah, cuz

Marsha 1:27:52
there there have been times that I've made a change to like, Well, I think this is a little too strong. And this is why you're seeing that. And she, we talk about it, and she explains it to me. So that's why I you know, because we what ended in this two and a half years, right. And so that's why I felt like I was really happy that she agreed with what I was doing. However, the first couple of times, we were in there, it was a lot of me learning from her. And a lot of me saying I made this change, and I see why that wasn't good, too. So it's that whole just been really open to that communication. And really, like this idea of a partnership versus adversary or, you know, they're gonna tell me what to do there. You know, yeah,

Scott Benner 1:28:40
listen, Arden's been home from school for not even a week yet. And over the last couple of days, on my garden, you're getting low at like, 3am, like, over and over again. And not real low, but like, just at that, like 7069 ish, like, isn't gonna hold like that low. And I'm like, Okay, no more school food. So there was obviously something about her settings that was necessary at school. It's not necessary here. So I made her insulin sensitivity weaker overnight, I made her basil weaker overnight. And last night, I almost had it. And I was like, ah, and I went in, and I turned a couple more dials. And I think I'm good. I think tonight, it's not gonna happen, right? Yeah, yeah. But I don't know how long you'd have to talk to a doctor or how well they'd have to understand your situation for a PERT forget a doctor for a third party person to come in. And help me with that decision. I just don't know how I don't I don't know how it would be possible for them to know. Even if I had the mindset where I regurgitated all the information that would have led them to the answer. It's too much at once. You don't even know it, because where would that story start? Well, you know, she's a college and the food at college is bogus. You know, like the doctors gonna be like, I don't know. And then a lot of the problems like right now You're seeing a low at 3am. I had to make changes at midnight. Right, right. And often, doctors will see lows and take away far too much basil. Or they'll take it away at the wrong spots where they won't talk to you about what happened before, which in the end is the real answer to Ardens issue is that Arden is now not eating difficult to digest, processed crappy food at 11 o'clock, she still had a snack at 11 o'clock. But it was decent food. And therefore, the foods the is the culprit for the 3am low. Right? In a sense, like because it's not as difficult anymore. So you make adjustments to blah, blah, blah. I don't know, like it's, they never, I not never, never is unfair. But a lot of people I talked to they'll go in and they'll say, you know, we're having a low here. And they took away all the basil. And I'd be like, but yeah, but there was a big spike four hours before that, is that a meal? That's a meal. So you're not managing the meal? Well, we can't even tell what's going on four hours later, like you shouldn't be looking for hours later, we should fix the meal first. And once you fix the meal Bolus, if you're still getting low afterwards, okay, but but it's very possible you won't be. And so basically what I did was I fixed the meal Bolus and made a small adjustment to the overnight basil and insulin sensitivity. You know,

Marsha 1:31:29
it's good to hear you say that, because I just experienced that when my son it's like, when I was looking at some stuff on like, on Wait a minute, like, as I'm looking at, it dawned on me that what was happening around mealtimes was then impacting him later. And I'm like, he doesn't have his carb ratio was off, it was like way off. And so I changed that meal times went better. And then everything fell into line after that. I mean, it's good to hear you say that, that just gives me a little validation that my thinking is, see how you teach is working. We

Scott Benner 1:32:03
tend to look at something done is over. Instead of like, this is probably why I mean, you know, not for nothing. When you find yourself snorting heroin. It's not because you're bored. It's because of something that happened prior to this that gets you to this spot. And so you know, we are always looking at the wrong moment trying to decipher what's happening. And I the best way I've found to say it so far is that insulin for now, is for later. But more importantly, insulin from before is what's happening now. Like if the mind shift and how you think about it. You can't Yeah, you can't be looking. So micro in the moment, and trying to figure out why am I low at midnight? Because it's not about what's happening at midnight.

Marsha 1:32:54
It's about it's about what happened before that. Yeah.

Scott Benner 1:32:58
Listen, the two of us are geniuses like I figured that out. Actually. I shouldn't joke, Marcia, you're a fantastic surprise this morning. You're well thank you very, very good at this. Thank you. Please don't start your own podcast.

Marsha 1:33:11
No, no, no, no, I It's funny. I'll tell you how I found you. I went to the pumpkin patch. And my son went low. And I gave him some Skittles. He went low. And I gave him something else. He went he was still going low. I was totally freaked out. Right. He finally started going up well, because I just given him a ton of uh, sorry, a ton of sugar. He shot right up, and we're waiting in the line for this little trainer, this pumpkin patch. And he goes off. And this lady whips her head around and she goes Dexcom. And I said, yeah, here, and she goes, there's mine. And she goes, You need to listen to the juicebox because I'm not afraid of lows anymore. It's the highs that scare me. And that was a shift in thinking for me. But it was the best pumpkin patch experience I ever had. Thank you to her for her leading me to you because how we have continued to manage what's going on with him has really changed by your podcast. So I really truly appreciate the work that you do.

Scott Benner 1:34:16
It was my pleasure. And you were Linus and she was the Great Pumpkin.

Marsha 1:34:19
She was yes yes, it was great. Doesn't

Scott Benner 1:34:24
line this this sister yell at him throughout that episode? I think so. Yeah, think of her name.

Marsha 1:34:30
Was it Lucy is Lucy Linus a sister?

Scott Benner 1:34:33
No Lucy's got the dark Carolina sister is the blonde she's she's not Peppermint Patty. Oh, come on. Hold on.

Marsha 1:34:39
Oh, the blonde. I can see you're

Scott Benner 1:34:46
not Oh no, wait, I'm gonna figure it out. It's

Marsha 1:34:48
not Marsha Marsha Marsha.

Scott Benner 1:34:51
All right, listen, Peanuts characters. Oh, Lucy Van Pelt that you said Lucy. And I said no. Who

Marsha 1:34:59
was I thinking? of who is the dark haired one?

Scott Benner 1:35:03
She's the one who's mean to Charlie Brown.

Marsha 1:35:04
Yeah, what?

Scott Benner 1:35:06
Not pepper patty. Oh my god.

Marsha 1:35:10
I don't know. That's yeah,

Scott Benner 1:35:13
Marcy. This is ridiculous. How come I can't? It's very upsetting. Is there? It's not Paddy, Paddy. Where's the

Marsha 1:35:23
Peppermint Patties? The kind of but there's a

Scott Benner 1:35:25
patty and there's a peppermint patty. By the way, were there no extra names? It's not violet. Violet was like the goth girl showed her played the piano. Oh, wait, no. Lucy Van Pelt? Is is Linus a sister, but not who I'm thinking of? I'm thinking of Sally. Oh, yes, Sally's like the girl that like thinks she's Linus, his girlfriend, but by the way, they're like all five. So it's weird, but, but she's not really and he doesn't really care about her that much. Sally yells at him unmercifully while he's in the pumpkin patch.

Marsha 1:36:01
Oh, that's funny. I'm gonna have to watch that again. You

Scott Benner 1:36:04
think Charles Schultz had a bad relationship with women?

Marsha 1:36:08
Ah, but you know, the women are just kind of rude. Ruthless to those little boys, aren't they? Yeah. Is

Scott Benner 1:36:13
she is she is he was he? Hey, you want to hear something crazy? He was in an old folks home that my mom worked in in her 20s Oh, really? Yeah. Anyway, that's neither here nor there. But I wonder if he was trying to write them as strong.

Marsha 1:36:29
And they came across as really aggressive for if

Scott Benner 1:36:32
he didn't like women, and was writing them as nasty. Because they're worth research. They're all nasty, right? Except for patty. She just seems like she's on mushrooms. But she does, right. Yeah, I'm not making that up.

Marsha 1:36:52
It's all full circle.

Scott Benner 1:36:53
Yeah, you gotta go. You got to actually, I mean, he clearly he's writing Marcy as a lesbian. Yeah, right. And Sally's nasty to Linus. But she likes him and wants him to like her. Pigpen I never understood. I mean, it's very dirty. would have been easy to hose them off. Schroeder was kind of a dork. Right? Like a, like a piano player. All right. That's all I got two people not like I used to love the peanuts. But again, your omega point? It was because you had no access to it. You said that you said this earlier about instant gratification. Right? Let me make this point. As a child, and even as a young adult, once a year, the Great Pumpkin would come on television. And if you were not seated when it came on, you would not see it again till the following October. That is true. One day, they put it on VHS tapes. And my mom went right out. And it's like here, we can now watch the Great Pumpkin whenever we want. And I never watched it again. Right? It was too easy. Right? And yeah, and it turns out, it's not that great.

Marsha 1:38:11
Well, you know, the other show that you probably watch once a year was the Wizard of Oz.

Scott Benner 1:38:16
Oh, yeah. Right. CBS once a year, right? We have a putt along, or Rudolph the Red Nosed Reindeer that the claymation thing, which it was the scarcity of it that made it so attractive. Right, right. It wasn't that it was the greatest thing that ever happened. It was that I couldn't get to it. And then there was also a school, I have to watch it because it's here. Then they made it readily available and easy to get to. And I was like, Yeah, I don't want this anymore. It's not my thing too easy. And it's not as good as I thought. Yeah, although whatever. I might be looking too far into this. Marcia, you were terrific.

Marsha 1:38:53
Thank you, Scott. I enjoyed being on. Oh, you're

Scott Benner 1:38:57
very good at this. You can tell you talk to people all the time. Yeah, yeah. Anything we didn't cover that we should have?

Marsha 1:39:04
No, I think we did. covered it all.

Scott Benner 1:39:09
Yeah, what's the rest of the day, like, you're gonna get your tractor and go.

Marsha 1:39:15
I actually have to go to work. And I have a couple of meetings left today. So

Scott Benner 1:39:20
alright, my last question is, do you have chickens? Do you own chickens? No,

Marsha 1:39:24
but I am because I live in town here. And I don't know. I don't know that people have Lawrence with like chickens in the backyard. But I have a space for them. And I keep telling my husband we need to put some back there.

Scott Benner 1:39:36
Chickens are the thing I'm never going to do that I think about doing all the time. Like I'm gonna get a couple of chickens and I'm going to eat their eggs every day. Yeah. And then I'm like, my wife's like, who's gonna take care of them? I was like, guys a fair question.

Marsha 1:39:50
I have a co worker who has chickens and so I'm going to con her into bringing me her eggs. Well,

Scott Benner 1:39:58
that's even better. has probably tried to figure that out. That sounds a lot better. Thank you so much. Hold on one second for me

that was it. That was Marsha. She was the last episode of 2023. Thanks very much, Marsha. A huge thanks to us med for sponsoring this episode of The Juicebox Podcast. Don't forget us med.com/juice box, this is where we get our diabetes supplies from you can as well use the link or call 888-721-1514 Use the link or call the number, get your free benefits check so that you can start getting your diabetes supplies the way we do from us med. But just say something that's gonna sound trite, but I feel really privileged to make this podcast for you. And every day that I see you all downloading it and sharing it fills my heart in a way that I don't know that I can quite describe. So thanks to Marsha, and thanks to all of you. And thanks so much for listening. I'll be back very soon with another episode, who I'll be back very soon with another year of the Juicebox Podcast. If you want to hang on a second, I'll tell you about what's to come. In the beginning of January 2024, we're going to launch two new series one grand rounds. The other cold wind, cold wind is whistleblowers, people coming on the show taking on an anonymous name, having their voices changed, so they can tell us about what happens in their jobs as emergency room nurses, physicians, human resource professionals, and more. On Grand Rounds, Jenny Smith and I are going to lay out what doctors should know about helping people with diabetes. And we're not going to be how do I want to say this, we're going to be nice, but we're not going to be polite. Grand Rounds is there for doctors to learn from and for you. So that you can understand what you should expect. What doctors should do what you should expect Grand Rounds coming in 2024 to the Juicebox Podcast, you really have to check out the private Facebook group. It's not 44,000 members and it's called Juicebox Podcast type one diabetes. And if you'll give me just one second I'm gonna turn my microphone away. I don't usually sit so that I can see my whiteboard. If you're enjoying the podcast, please understand that my time is supported by ads Omni pod, who've been advertisers since the very beginning in 2015. Dexcom came on second, I think in 2016. And since then, we have built a wonderful group of advertisers us med the contour next gen blood glucose meter, G voc hypo pen ag one cozy Earth BetterHelp touched by type one and coming in 2024 We're going to add somebody else Medtronic diabetes. These advertisers support the production of this podcast. If you ever have a need or a desire to learn about them, or to get started with them, using my links, lets them know that you came from me using Juicebox Podcast links keeps the show plentiful and free for listeners. So if you have the need or the desire, click the links. There are links in the show notes and links at juicebox podcast.com to all the sponsors that I've mentioned here. Once again, thank you so much for listening. Have a Happy New Year. I'll see you very soon with another episode of The Juicebox Podcast.