Scott Benner 1/11/24 Scott Benner 1/11/24

#1104 Fifty Five and Fab

Denise was diagnosed during the covid crisis at fifty-five years old.

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Scott Benner 0:00
Hello friends and welcome to episode 1104 of the Juicebox Podcast.

At age 55 In the middle of the COVID shutdown, a 55 year old audiologist named Denise was diagnosed with type one diabetes. She also has a 17 year old daughter with an immune deficiency. Of course, her doctor thought she had type two, but you know the story and if you don't know it, here it comes. Please remember that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, always consult a physician before making any changes to your health care plan or becoming bold with insulin. 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. Don't forget to save 40% off of your entire order at cozy earth.com All you have to do is use the offer code juice box at checkout that's juice box at checkout to save 40% at cozy earth.com If you're looking for community around type one diabetes, check out the Juicebox Podcast private Facebook group Juicebox Podcast type one diabetes this episode of The Juicebox Podcast is sponsored by the insulin pump that my daughter wears Omni pod learn more and get started today with the Omni pod dash or the Omni pod five at my link Omni pod.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 benefit check and get started today with us met.

Denise 2:16
My name is Denise and I am 57 years old and I was diagnosed with type one diabetes when I was 55.

Scott Benner 2:25
Oh wow, this just happened? Yes, it did a couple of years. Well, then the obvious questions are is there autoimmune in your family, other people with type one or any reason you would have expected this to happen?

Denise 2:37
Yeah, no reason that I expected it to happen. No type one in the family. No other major auto immune that I know of except some of my own. So I've had minor episodes of psoriasis. I've had I know you've talked about it in some of the other podcasts. I have a history of endometriosis. In I know they're looking at that as potentially autoimmune inflammatory. I have lots of inflammatory responses, did not expect it to happen. And so yeah, kind of came out of left field, have a medically complex and chronically not functionally, chronically, chronically ill child until he was diagnosed with an immune deficiency in the middle of COVID. And so I was chalking up some of the symptoms to stress. I mean, we've all talked about and heard on the podcast of, you know, well, I attributed this symptom to this thing and that symptom to something else and never put the whole picture together. Yeah,

Scott Benner 3:43
you were doing the same thing. Lots of fatigue and

Denise 3:45
yeah, yeah.

Scott Benner 3:47
How old is your child?

Denise 3:49
She will she just graduated high school. She's 17. Okay. All right.

Scott Benner 3:54
Okay, so during. So, this is all happening. Are you having any of the real big classic signs you're losing weight or

Denise 4:02
I was losing weight, but you know, I'm a 55 year old at that point, perimenopausal woman so I wasn't concerned that I was losing weight. I was kind of trying to lose some pounds, right. And it was coming off. I mean, I didn't drastically over the course of about six, seven months, I probably lost I think 12 or 15 pounds, but you know, a couple of pounds a month and I'm working it getting healthier and exercising more and watching what I eat. So I wasn't overly concerned about the weight loss. I was drinking more in an interesting one. And I think you've talked about this one too. I have always been averse to having ice in my drinks, but I couldn't get enough ice. I mean, I wanted I wanted ice water. I wanted ice cold water. I was getting up in the middle of the night and filling a glass with ice. which was unusual for me but I wasn't going to the bathroom and people like Aren't you going to the bathroom? More didn't weren't you and I'm like no I wasn't but you know, I'm a busy mom who works so I ago breakfast, lunch, dinner Bed Breakfast. I mean, so I didn't have time to stay take the time to go the bathroom. But yeah, so fatigue, a lot of thirst. In hindsight, I hadn't attributed this either. I've had lots of orthopedic issues, I was having muscle cramps in my legs, okay. And as soon as I got the diagnosis, I hadn't even told the doctor about that one, too, did the lab work and came back with the diagnosis. And then when I went for the one week follow up, I'm like, oh, yeah, by the way, I've got all these cramps. She's like, Of course you do because you're dehydrated. I thought I wasn't eating enough bananas. And I was working out trying to lose weight. So I thought it was all related to that. Honestly, that's really intense cramping in my legs. Like, it's

Scott Benner 5:42
really interesting to hear an adult tell that story. After hearing so many, like parents talk about all the things that in hindsight, they see and that they wish they would have understood better. But I mean, how are you going to do that? Like you've been alive a long time, you've obviously you're helping a child that has issues you're not you're not, not alien to looking into things. And and still, that's what happened to you? Well, okay, yeah. So what pushes it over and helps you figure it out. So I

Denise 6:08
was having lots of fatigue. This is through the winter holidays. So Christmas time. diagnosis came in the first week of January, if we back up in time, and that summer into July, early August, I was ill, and was in at the doctor, she did lab work. So at that time, she didn't do an A onesie, but she did a cmp and my glucose levels were fine. I think I was like 110 After eating breakfast, like mid morning labs or something. So nobody flagged, oh, wow, that's a problem, which is the general glucose level. So it was all fine. In July, I was ill had a virus had all of the stress around my daughter's diagnosis and her management and her health. And I just was still really, really fatigued coming off a Thanksgiving into Christmas. And I'm like, Okay, I just got to make time for me. I just gotta go the doctor and see what's going on here. Yeah, so she did some lab work, a fair amount of lab work. Did a physician like yeah, I don't, you know, maybe it's a sister, you know, your cortisol levels are probably through the roof with all the things that are going on in your life. You know, and so talk to me about stress relief and trying to balance that. And then she did lab work. And it was on a Friday, very clear. She called me as I was driving to work instead. And so this was during COVID. So I wasn't seeing a whole lot of patient. It's just, well, I'm just gonna say it. You are I was driving to my workplace to get some things I don't typically work. I didn't usually typically work at that time. She's like, you are a diabetic. Now. I'm going to tell you, Denise, I don't think you're a typical diabetic, but I need to start you on some oral meds. I mean, so I think she meant, quote, the stereotypical type two. Okay. So even though I was wanting to lose a few pounds, I was not extremely built as she would expect a type two, I exercise. I have lots and lots of food sensitivities. So I eat a fairly low carb whole 30 type diet I had been for years just because it helps with inflammatory other things in my in my body. And so I felt better when I ate that way. So I ate that way anyway. And she's like, so I know what you eat. I know, you exercise. I know you do this. So I don't think you're typical. But we need to start you on Metformin, we need to start you're on this, we need to do that. I'm like, Yeah, hold the phone. Can we retest? Because this just seems like really strange. Because I agree. I don't know that. I've seen any markers for that. Can we retest tomorrow? She said, Absolutely. Let's hold off. But I do need you to get some insulin. Because my blood blood glucose at that point, I think was it was not high. It was like 300, maybe 300 400 something. My a one C was 13.5. Wow. And she's like, so how do you feel? I'm like, I'm feeling different than I did yesterday, or three days ago, when I was in your office, I'm fine. Like because maybe you need to go to the hospital. I'm like, why I've got this at home. I've got that at home. I don't feel any different. I'm just tired all the time. Why would I want to go to the hospital because they're gonna keep me and she goes, Okay, then I'll send you home. But I need you to get the insulin and probably will shut down Metformin tomorrow, but we need the insulin to get it down right away. And, and we'll retest tomorrow.

Scott Benner 9:23
I love how easy it is to push your doctor around on any thought whatsoever.

Denise 9:30
If you like that, just wait until the next step. So then I go home, I go into work. And I'm like, I don't know that I can do this right now. I was picking up some paperwork and we were trying to schedule some things. I'm like, they just told me I have diabetes. We're not sure what's going on. She thinks I'm pretty sick. I think I need to go home and processes. So I did and I called my phone a friend neighbor who is my walking partner in the neighborhood and she has a daughter who is in her mid 20s now but was diagnosed it 11 with type one diabetic diabetes, and they went to our small school parochial school 200 students, so I mean, so knew her very well. And I'm like, and they just told me I have diabetes. And she's like, I'm coming over. She's like, Look, I know you. And I know this sounds judgmental, but I'm telling you, you're type one, you need to call that Dr. Back. She had called me from her personal cell phone on a Friday afternoon. She's like, I don't care. Call her back, call that number, leave a message. Tell her you want to GID 65 Run, because I'm telling you right now, this was autoimmune. I know you I know your life. I know your lifestyle. Make sure that they run that because we're not getting this wrong from the beginning. Wow. And she was right. They ran it and God 65 The next day, they ran an insulin assay. Okay, so looking at the total insulin in my body. I just pulled that back up to look for the podcasts. The normal range was three to 20 something plus I don't remember the high end because I remember I was 3.2. Right. I thought I didn't have enough insulin in my body. Wow. And the GA D 65. Came back flagged. She's like, how did you know you are right. You are type one, my doctor. She's like, so now I need to get you to endocrinology. And we're not going to start metformin and take that insulin. And

Scott Benner 11:15
did you tell her I asked my neighbor instead of a doctor. I know,

Denise 11:18
right. But it just goes to support what you're doing here too. I mean, again, I talked to someone who lived the life walked the walk. And she's like, Yeah, no, you know, I've been in this space. I'm telling you, I think this is it. And she knew about my other inflammatory issues. I mean, we chat like members who aren't on our walks and stuff. So she knew about some of my health history and food stuff. So the transition wasn't terribly hard, because of the way I ate already. Right? Yeah. I mean, so I didn't have to quote I modify my food, even in the beginning to get hold of it. To get hold of how the insulin

Scott Benner 11:54
worked. Was there any kind of a honeymoon? Or did you have a pretty significant knee?

Denise 11:58
And actually, yeah, fast forward to it. i She's putting an urgent call to an urgent referral to the endocrine office. And they come back and said, We can see you in three and a half months. And then like, I come back, I'm like, yeah, no, that's not gonna work for me. All right. Mind you. I have a medically complex daughter. So yes, I do push the switches around. And they're like, No, but that's when we can get you in. I'm said, Excuse me. I was not just diagnosed as type two. I'm not taking some oral meds. I need to know what the heck I'm doing with this insulin. And you need to see me now. Yeah. And then I got it in three weeks. Do you

Scott Benner 12:33
think that because of your age, they just assumed you were trying to change practices at first, or did they know you were a new diagnosis?

Denise 12:41
No, they knew I was a new diagnosis. Because I didn't call my physician referred me over and said, I have this new diagnosis. All right. You put it in the referral and the endo office called me I didn't even call them I was

Scott Benner 12:52
trying to give them the benefit of the doubt. Yeah, I heard a stat yesterday I don't. I heard a stat and I'm going to tell you, I don't remember any of the numbers. But there are not endocrinologist in like a significant amount of counties in the country. In 2015, I needed support to start making this podcast and Omni pod was there. They bought my first ad in a year when the entire podcast got as many downloads as it probably got today. Um, the pod was there to support the show. And they have been every year for nine seasons. I want to thank them very much. And I want to ask you to check them out at Omni pod.com/juicebox. Arden has been getting her diabetes supplies from us med for three years, you can as well, US med.com/juice box or call 888-721-1514 My thanks to us med for sponsoring this episode. And for being longtime sponsors of the Juicebox Podcast. There are links in the show notes and links at juicebox podcast.com to us Med and all the sponsors.

Denise 14:04
So it doesn't surprise me yes to again. I had a support network, my neighbor across the street to other families in that small school another. I had children with type one in another family in our neighborhood that also went to our church. The husband had been type one since he was like eight or nine and he was in my age range. So I had lots of resources right away. By the time I got to the endo office three weeks later, this goes back to your honeymoon. I'm like, okay, so I said, here's, here's my insulin. We figured out in the first week, my insulin to carb ratio, My correction factor all with no Basal insulin, no long acting insulin. And so I went in to meet virtually during COVID. I met with the CDE nutritionist first and then I met with a physician but the CDE said Yeah, I Okay, so we'll skip all what we usually tell you because you just told me your insulin to carb ratio. You just told me your correction factor you just told me. She's like, and then maybe in the next appointment, we can talk about technology. I'm like, no, no, no, I want a CGM. And she's like, Okay, well, there are two kinds. I'm like, Yeah, I know. And I know which one I want. And she goes, Okay, well, which one do you want? And I told her and she goes, Oh, good, because that's the one I would have recommended. I mean, so it all went different. But she told me she's like, you know, you will probably honeymoon. And actually, you may honeymoon forever. I mean, the, the way you've described your lifestyle and your food and stuff, you may. Yeah.

Scott Benner 15:38
adult onset sometimes can take forever. She might have thought maybe you but maybe she's a lot, a lot or something. Right.

Denise 15:44
And so, but I go back to I had labs six months before that were normal.

Scott Benner 15:49
Yeah. So the onset was really fast. I think the onset was really fast. Yeah. Also you the way you describe it. I don't think it was not just fast. But I don't think it had been very long either. Like when you when you look back, right? It wasn't something that lingered for you're here, correct? Yeah,

Denise 16:08
I'd say six to seven months that it was kind of building up. So interesting, though, then as we go back. So she's like, I think you might honeymoon forever. I think we may have you in this special box over here by yourself. You know that. But I think I'm coming out of it now. Because in the last few months, I noticed a difference with fat and protein. I mean, because before that fat and protein, I'm like, yeah, they could talk about this fat protein rise and Warsaw method and all this and I'm like, I don't see that. I don't see that in my lines. I don't see issues with that. But now, but now I'm starting to

Scott Benner 16:43
they're letting me out of that special box. So

Denise 16:47
I'm trying to claw my way back in to the mainstream here.

Scott Benner 16:50
So in your mind, what shape is the box?

Denise 16:53
In my mind? I think it's a very special diamond shaped box.

Scott Benner 16:57
Oh, that's lovely. I was thinking that Nirvana song heart but wait is that isn't Ivana song heart shaped box? Or is that a remake that nirvana? I

Denise 17:06
don't know. My husband's the music person in the family? I

Scott Benner 17:08
don't do I don't think it matters. Also, I think a lot of people listening are like, what's nirvana? Yeah, yeah. But I knew that I knew you're old like me. So I figured, yeah. So okay, so you're, you're married, you have kids? There's a lot going on in your life, this happens, not something you're expecting. How would you say you accepted the news?

Denise 17:30
So I mean, it's like, okay, fine, especially with my phone a friend, if this is what my life is, let me get this figured out. I am, as I described myself a type a firstborn, OCD control freak. So I'm like, Okay, I don't have mental space for this, because I got all this stuff going on with the other family members. So tell me what I need to do. Let me get this figured out. My walking buddy is an engineer math person, who's so we're like, okay, so she's like, I'll step you through. I mean, and so we got it figured out right? For me. I'm like, I don't have time to deal with it. So I just need to get it figured out, too. I found juicebox Facebook page. So diagnosed in January, how to CGM by mid February after fighting with the insurance for a couple three weeks. And then I started dash in May. Well, the CDE said I could start them both at the same time. And I said, Thank you. I've got a lot going on. I think I want to learn learn one thing and get it and get it figured out. And then I'll add something else in and I was fine. My doses were low enough with MDI that it wasn't like I was trying to push in tons 1015 units at a time. I mean, my Basal dose was four units. And if I was taking three to four units at a meal, because I also ate and still eat so low carb that I wasn't taking much in. So I'm like, the injections really aren't bothering me. Let me get the CGM. And I mean to tell you, I had it two days, and I had a sensor failure. And I put on a new sensor and then transmitter failed. And then I called my friends with these other families. And I'm like, I can't I don't have it. They're like, No, we told you you as soon as you got it, you were gonna love it. And you were gonna have a love hate relationship with it. Because as soon as it goes out, you're gonna go What do you mean? Where's my data? And finger breaking? You know, to get the trendline? I mean, within two or three days, my engineer brain is following that. trendline. Can I missed it?

Scott Benner 19:24
I have a question in the beginning when you had a failure of the device, right? Have you had a lot since then?

Denise 19:30
No, no, it was just a fluke thing at the transmit. I mean, so the sensors. I think maybe in the two and a half years, I've had two or three sensor failures total. So that first one, so not really, but I don't know why that transmitter failed sensor failure, user error. Listen,

Scott Benner 19:47
I wasn't there. Right. And this is anecdotal at best. Yeah. But a lot of the failures, I'm not that stuff doesn't fail. I'm not saying that. But a lot of the failures that I see online are very frequently with people who are newer to the equipment to

Denise 20:01
well, it was interesting because it didn't fit. It feels like on day three. Yeah. I mean, so it wasn't after an insertion. So then the sensor failed in, in. So I don't know if I damaged the transmitter trying to get it out. I don't, because then I put in a new sensor, and it started giving me a transmitter error. And I'm like, What the hell? Like no, no, no, the center was bad, not the transmitter, and I called support. And they're like, well, we can get you something in a week. I'm like, You don't understand. I just got this. And I don't have a backup yet. I've built a backup.

Scott Benner 20:33
Again, not to say that that's what happened to you just anecdotally, i That doesn't surprise me. Also, a favorite of mine is there is this person a couple of weeks ago in the Facebook group. And she's an adult, she hasn't had diabetes for very long. And she's like, there's something wrong with my pump, I'm going to change it changes that change. And by the time I'm watching this thread, she says, Well, I've changed my pump three times. And I'm like, I got it. And I was like, hey, stop doing that. I was like, every new site doesn't work great. You're just staying in this, like, just leave it on, push them insulin through it. And that's the thing you learn one day, and then that doesn't happen to you anymore. And it's just, I mean, it's very common. And again, not that this is what happened, because it doesn't sound like it is but when it's always interesting, when people then jump online, they go, this stuff doesn't work. And I'm like you've been using it for eight seconds. Why do you think you're the arbiter of what works or what doesn't? It's just interesting. That's all I

Denise 21:27
deal with that professionally, too. I'm an audiologist. And so then I'm prescribed hearing aids. And for the last 10 years, I've worked with the VA. And so then trying to explain technology and Bluetooth connections and medical devices. So so when I when I got the news that Oh, well. Yeah, don't update your your iOS yet, because we got to work out the bugs first. I'm like, Oh, well, yeah, of course. Because that happens in the hearing aid world, too. They're like, that makes sense. Used to answer my phone. And now it doesn't it rings different and why does it keep alarming every time I get a text message? And I'm like, okay, here, let me help you with your settings. So I mean, so I get that. And

Scott Benner 22:04
so I'm incredibly amused and managing. You're sitting in a room with an older person like yelling. It's Bluetooth. It's Bluetooth. It's how the phone connects. Can you hear me Bluetooth? Yeah.

Denise 22:16
So different hearing aids connect differently. So along that same line? So then I'm like, do you have an apple or an Android phone? Or do you use a flip phone? And they're like, I don't know. It's a Verizon phone? I'm like, yeah, yeah. And so I mean, I'm very much Okay, so now we do you have a computer? Yes. Okay. So you know, like Windows is part of it. And then you can have a, you know, a Dell computer and you get your cable service in your. So I don't want your service provider. I want the brand of your phone. You're already Verizon.

Scott Benner 22:48
Yeah, you're on my phone. This seven, the eight and the nine are in a line. Do you know which one that is?

Denise 22:55
I know. Right. So yeah. So so I get the work through the troubleshooting and stuff. So yeah, I don't know if that's what happened. But it was for sure knew, but it was for sure I was depending on that. And then. And then like, yeah, you won't care as much if a pump goes out as you will if that CGM goes out once you get rolling with this technology, and I totally agree with that.

Scott Benner 23:14
So where why did we have you on the podcast?

Denise 23:18
You reached out and I said I'm an adult? Who started on Omnipod five. Oh,

Scott Benner 23:23
so wait, but you're using dash now? No, no, no.

Denise 23:27
So I had the dash within a few months. So then I Okay, diagnosed in January of 21. CGM. I got a Dexcom in February of 21. Dash in May of 21. In Omnipod, five in June of 22.

Scott Benner 23:40
That is definitely why I wanted to have you on because to ask this question, but when you kept saying dash, I was like, oh, maybe she just went back? No,

Denise 23:48
no, no. So I switched that. No, that was just what I started with. Okay, so I started with, it was interesting, because the adult that I talked to in the neighbor, I mean, the my go to resource, I told I asked all of them, okay, so how long? Do I need to wait till I get a pump? And they're like, it's going to be six months, the insurance will make you and the doctor's office will make you and I'm like, Yeah, well, I don't know about that. I'll get it when I'm ready. Okay, but, okay. And so, in, I said, Tell me about the different kinds of pumps because I knew the families that had children, even high school aged children used Omnipod, which tubeless was very appealing to me. And then the adult use, I think he's Medtronic, he had a tube to pump. He had just switched to a TCM I think when I talked to him, okay. And so, he said, I said to what can tell me, I'm an information gatherer decision maker type. So I'm like, so tell me about tell me about tell me about and I said, So what time, what time, how long and what kind and he's like, you'll probably want a tube to pump because they'll hold more insulin. So you'll get 300 units into the cartridge versus a tube pump. You can only put 200 units and so that was probably cycled through faster. So you probably will end up getting a tube to pump like, Okay, file that away. And I'm like, Yeah, I want one of those. And then I'm looking at my charts and my data log and my paper and pencil notebook. Because I'm old, I did paper and pencil for about three months. And then I went to an app, one app for a few months. And then I switched over to sugar main app and tracked all of my exercise all of my carbs, all of my food and everything in there until I remember hearing you say, and I'm like, I don't know that I'll ever get them to type a and I'm like, yeah, no, I'm over it, tracking all of it. Like, yeah, no, that's about No, I'm in a way that learns a potato or because I eat carbs. So infrequently. Those I need a little more specificity and but he's like, you're gonna want the more insulin. I'm looking at my charts going, you know, right, even out of honeymoon in Bolus seen for fat and protein bumps to correct. I use about I can get the 80 hours and I use about 80 to 100 unit. Yeah, was that at our Ardens

Scott Benner 26:06
insulin to carb ratio is like one to 4.7 right now or something like that. And she doesn't have any trouble using it on the pod. It does. It does the 200 units doesn't run out and Shinto

Denise 26:16
minus one one to six right now.

Scott Benner 26:19
No, no, I

Denise 26:21
mean, I eat but I eat so look few carbs that it's like, I don't even I learned the hack on how to underfill them to begin with. So I wasn't throwing out

Scott Benner 26:32
your Facebook group, you think you only need ad units to initialize Nami pod? Is that right?

Denise 26:38
That's what they tell you. Okay.

Scott Benner 26:42
I don't know if I'm allowed to say what that what's

Denise 26:45
actually my my, my mom trainer, I had told her I'd heard about a hack. So maybe use a little bit she's like, we and again, I've worked in medical device. As an audiologist, I actually worked for a medical device company for about four years. So worked with the FDA FDA approval, so totally understand that process, too. I'm like, I understand you cannot support this. I also very quickly started putting my Dexcom other places when I saw that in European markets and other places it was approved. I'm like, Well, this is an FDA thing. So I'm going with that. But she said what I can tell you is when you hear the two beeps, you can stop. Right? Okay, so there is a way to get the two beeps to happen with less than 80 unit going

Scott Benner 27:29
slower. Interesting. going slower. Yeah, I'm never gonna,

Denise 27:33
she's like, I'm not gonna tell you how many units I'm just gonna tell you. You may stop when you hear the two beeps. I'm like, Thank you.

Scott Benner 27:37
Good enough. You just made me laugh. Arden had she's on g7 Now Dexcom g7. And she had one failure of it. And we were trying to figure out what happened. And so we were actually on the phone. She was a college I was home, we were like three way calling with Dexcom trying to work it out, like figure out what was going on. And the guy on the phone says, Where are you wearing it and Arden's like, like Oh my God. And he goes, it's not approved for their art and goes, You think my guess is the problem? And I'm like, This is hilarious. It's so we're on the phone. And. And he's like, he's like, Well, no, you're trying it on your arm. And she goes, I'm gonna put this on my arm to make him happy. She's texting me like outside of the things she does. But there's no way she's like, I have bigger problems If my guess is the problem. And I was like, okay, and it turns out it was not us. And but I mean, I think I think Ardens wanted Dexcom on our arms. I have four times in her life maybe, you know, like and she's been wearing it for years and years and years and years. So it's not FDA approved for where she wears it and it works terrific there. Right so what are you gonna do so on the pod five algorithm, but on a lower carb like lifestyle? So can you tell me how many carbs you eat in a day approximately? 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 888721151 for a huge thanks to Omni pod. Not just my longest sponsor, but my first one Omni pod.com/juice box if you love the podcast, and you love to boost insulin pumps, this link is for you. omnipod.com/juice box, usually

Denise 29:37
probably on, quote heavy day where we're out at some kind of activity or celebration. Maybe 100 to 120 but on an average day, it's usually like 60 to 80 Okay, and how to fruits and vegetables and proteins is where most of that comes from

Scott Benner 29:55
and how active are you the course of a week.

Denise 29:58
I used to be more active because at my new position with the VA, I'm 100% remote seeing patients via telehealth so I now sit at my desk 40 hours a week before that I worked part time. And so I was up and about in the part time was in person patient care as an audiologist. So I was up and moving a whole lot more so not as active. So I have noticed a change in actually talked to my new supervisor and said, I think I need to make some changes here. And I may need to plan because I don't get up even to quote, go get the patient from the waiting room anymore. So I show finishing chart notes. So I'm sitting, we're in this 40 hours a week,

Scott Benner 30:40
I have an idea. Most people would say, get a standing desk, but that's an investment. What about one of those carts? Like it's a standing rolling thing, you're like, your laptop would go on it, there'd be a little bit of desk space in front of you. And you could like move around with it while you were walking. I don't

Denise 30:56
know, because I've got three monitors because I'm doing diagnostic testing. So I've got one that's a video audio feed. I've got one that's the remote computer where I'm running the audio metric equipment. I've got one where the charging is going.

Scott Benner 31:09
Oh, I didn't know you were very special. I didn't know you work at SpaceX. Okay.

Denise 31:13
Yeah, yeah, exactly. Right. So no, I worked for the federal government. That's who I worked for. Gotcha. I worked for the VA.

Scott Benner 31:21
Oh, nice. So I mean, it's a it's a great job. But yeah, you're gonna have to like, Hold

Denise 31:25
on, I need to build in breaks and stuff. I said, I'm noticing a difference.

Scott Benner 31:29
Have you seen? Have you seen the little pedals that you can put under your desk? No, but that

Denise 31:33
might work. Because that I mean, yeah. So I have noticed a difference. I was more active. So I do workouts and stuff. And I'm still doing those, but the day to day activity has gone down. Now

Scott Benner 31:43
I understand. Okay, well, but But So how was the device working for you? Because that's one of the things you hear people go like, well, I don't know, like, what if I'm very low, lower carb, like how's it going pristinely?

Denise 31:52
It works really well. And I'm, I'm after this trip contemplating a reset, but I was one who very quickly ascribed to your here, set your ranges and set your target. And so I again, I was pretty obsessive about my numbers and my math. And so when I was on the dash, I, you know, had those nighttime targets at 85. And I rode at 8587. All night. Yeah, I was very concerned, my a onesie was gonna go up. Because that's just a thing that we all worry about. It actually stayed the same. So I got the dash in June, my next a onesie was that following August, and it was exactly the same as the one six months before. Great for you. And then the next one went down. So even though it still says that it's targeting 110 I'm still holding my own in the mid to low fives.

Scott Benner 32:46
Well, good for you. And so Wow, how far did it drop? When when you saw the drop?

Denise 32:51
But not I mean, within those tolerances? I went from a five, four to a five one. Okay, so

Scott Benner 32:57
I mean, jeez, that's amazing, though. So that's a lot to do with your your diet. You think? I think so? Yeah. What do you eat mostly?

Denise 33:05
Fruits, vegetables and proteins and things. So I mean, I'll, I will eat and we will bake, but I'll bake with almond flour. So I am grain free. So no corn, soy, no corn chips, no flour. No wheat flour. No oats. No rice.

Scott Benner 33:21
Is that because of your inflammatory stuff? Yes. Okay. So

Denise 33:25
I was eating that way before the diagnosis. Yeah. So my number ratios, I'm still look to be most days. 3070. So 30%, basil. 70%? Well, I mean, so they are off. But yeah, I'm about sugar mate says I'm 90% in range with a range of 65 to 140. Oh, that's

Scott Benner 33:46
terrific. Good for you. Well, congratulations. That's really wonderful. You know, I so

Denise 33:52
it's been a learning curve. That was the thing I wanted families to know, I think coming at this as an adult, there was a huge shift, once I went MDI, to dash. And in a whole relearning, and it took almost a month to stabilize, again, mentally numbers ratios to kind of relearn the whole system and how my body is going to react with the variables. And then a year later, when I did it with Omnipod, five, it took, I think, three to four weeks before I settled in, and that's why I thought the agency that was just going to be a couple months later was going to be off, because there was absolutely a learning curve. Significantly more lows, significantly more highs, trying to kind of get it balanced.

Scott Benner 34:34
And it took you a few weeks to get it straight. Yeah.

Denise 34:37
Each shift. There was absolutely a learning curve

Scott Benner 34:40
on your own too. Right. Do you have anybody helping you? I mean, besides your walking buddy, my walking

Denise 34:45
buddy helped me and it was very interesting because once I started listening to the juice back so her daughter has married and grown and lives in another state. So and then we've got the other couple of families but it was once I started and I've been telling them all about juice box Once we started listening to juicebox, so I was in the Facebook group mid spring, somebody had recommended it in, I think, a Dexcom group. And so I was watching the Facebook group and I'm like, I don't do I don't have time to do podcasts. I got all this health appointments. I got these doctor's appointments. I don't have time to do podcasts. Yeah. And then I got a COVID vaccine. Right? And then I was laying in bed. And then I'm like, I got this. So like, I binged over those couple of days. And then I'm like, oh, no, I'm sold. I gotta find a way to make time to listen to these. Until then my support network, then we kind of transition she's like, and I'd say think she's like, wow, she's like, No, no, no, I think the student is being I think, you know, more now than I helped you with. I'm like, I couldn't really got started without you. So in some of those other families, I'm like, these things that I hear you saying that are problematic, or that you're concerned about or whatever? Maybe they weren't? Yeah, maybe maybe you can listen to and there might be some solutions. Check this out. I learned this here. Try this.

Scott Benner 36:01
That's so nice. I'm glad to hear that.

Denise 36:03
There are no I talked about you at the airport to like clear in security. And they saw my things. I'm like, oh, yeah, you know, I'm like, I'm like, get my CGM. And they're like, what about this? And what about that? I'm like, Yeah, but if you really want to learn, you need to check out this podcast. I write it on a sticky and handed out.

Scott Benner 36:17
You're very nice. Thank you so much. And probably part of what's happened been happening to me the past week, I have been recognized in public three times in six days in three different states. Really? Yeah. It flipped me out. Honestly. Yeah. happened in Georgia. at a gas station, it happened in South Carolina while driving on the highway. And they're

Denise 36:44
like that just box bumper sticker that that guy has, wait a minute, that's Scott driving,

Scott Benner 36:48
I swear to you a car like kind of drove by me a little and then it dropped back again. And then I looked over thinking like, Oh, I'm going to be shot. Because it was really, it was very strange, you know, and I just looked, and there's this gentleman there. And he's like, like, I think he was like pointing like I like pointing it himself. They pointed his ears and then pointed at me. I listen to you. And I was like, okay, and I thought, Well, that won't happen again for a while. And then we got back home, and art and needed makeup. So we were at the altar. And this, this lady is coming through the door. And she's got like, she's putting her phone in her pocket. But I noticed I just have we're walking to the register. And she's coming in the door. And I noticed that her flashlight was on when she stuffed her phone in her pocket. And we happen to intersect each other. And so I said, Excuse me, I noticed when you put your phone away through the flashlight was on. And I think she just thanked me and we got in line art and I paid and we're getting ready to walk out. And then she's sort of there again. And I was like, and she goes Excuse me? Do I know you? And like, but I'm close to home now. So I think like, I'm looking at her. She's like, Seriously, she's my ages. Yay. And I'm like trying to figure my way through that. I'm like, I don't I don't know, like where we're from. And she goes Facebook. And my first thought is I'm never on Facebook. But I'm never on Facebook is me. Like I'm on Facebook constantly managing the group, right? But my stupid brain just goes like, No, I don't I don't I don't really use Facebook. And then she just goes diabetes. And I went, Oh, yeah, you might know me from that. And then we chatted for a couple of minutes. And then we walked outside. And Arden goes, Yo man, if people are going to be recognizing you, you really have to like step up your game. He she's like your shirt doesn't even match your shorts, right? And I was like, Well, I was making the party all day. And then I took you to the altar so I could pay for your makeup. So like I'm like, like, just like just give me the money next time. Yeah, she's like, you want to dress better. She's like, you're dragging me down. If people are going to recognize you, they're going to then they're gonna see me and I was like, okay, she was an Ilocos. So like, I was like, alright, but anyway, thank you for for sharing the podcast with people so much. Honestly, when you're talking about it. It's so heartwarming to think of how well it works. But I have to tell you my brain almost immediately after it feels good switches to like, I'm like, Why can't you reach more people dummy? Like, like me, like, like, like, how do you get to I guess I can see the numbers in my head. Ya know how many devices everyday download the show how many episodes they grab, I hear your experience. And I think, Oh, I'm not reaching enough people, you know, but that's

Denise 39:34
the way of the world and that's the way of medical we do the same thing to do you know how many people who have hearing loss actually have hearing aids?

Scott Benner 39:40
Yeah. Or once they have them can use them and can use

Denise 39:44
them or how long it takes that that statistic last I read it it's like seven years from onset of when people know they have a hearing loss before they'll actually even try one and then if you can get it to get them out of the drawer, right. So I think it's the way of the world and

Scott Benner 39:58
I know it's not my fault and I also know the podcast overwhelmingly reaches more people than probably any other thing in this space, to be perfectly honest, but it still feels like it just still feels like you're not doing quite enough like because there's someone like you, not just someone like, Look, you had this circle of people around you who all were like telling you what to do, and saved

Denise 40:19
my life, literally and figuratively got me off on the right foot. I mean, I hear these horror stories of being misdiagnosed as an adult and in that could have been it could have gone that way very easily.

Scott Benner 40:31
But in a short enough amount of time. It's two years they're looking at you going wow, you know a lot about this. Yeah. Yeah. And then I think, why didn't reach any of them? Yeah, like, that's how it feels yet so, but we had, I mean, I don't know we're working on I'm getting old. Like, I gotta get to it now. Yeah. I

Denise 40:46
did have a couple other things that make my story interesting. The, the, oh, now I'm gonna have a total blank out. The survey, type one survey.

Scott Benner 41:00
The one I did? No. Exchange.

Denise 41:03
That's the one. Okay, so I did that before I found the podcast. But one of the things that they asked about that I'm like, Oh, see, I knew it. I knew I had to frozen shoulders. In 2018 2018. I ended up having surgery on one we couldn't get it going and the orthopedic I went back to the I said, as I'm still in PT, about four months, four weeks post op, I said, I think the other one's going he's like, No, I'm like, No, I think the other one's going No, I know my body I got he's like, that'd be very unusual. I'm like I get it I think and he looked at his like the other ones going saved myself a second surgery but so I had two frozen children's who's like you know, do you have any autoimmune things going on? I'm like, like, just the psoriasis as a kid I mean, on and off minor minor that kind of self treated with cortisone. After we learned what it was not major flares, but that in a little rosacea, and the endometriosis, I'm like, so no, not not major stuff. He's like, I think you need to talk to your GP, I think they need to look for some type of something because I wonder if there's something autoimmune because we don't see the two frozen shoulders. It's unusual. Like okay, so she did kind of a workup with just a basic sed rate and a Basic panel at that point to didn't find anything. Did we check for the five t one D antibodies? No. But then so I'm wondering even if that was predisposing again, if something was happening in that, I don't remember what they call it. Now. They don't call it pre diabetic. But if something had tripped in that I had the antibodies and there was damage being done but my pancreas was still cranking out enough insulin that I didn't

Scott Benner 42:48
where maybe the auto immune implications even from the major frozen shoulders led to the type one to what can you breathe still

Denise 42:58
the type one d the T Wendy exchange asked if as an adult if if I had had a history of frozen shoulder that they put that in the Okay, the red flags?

Scott Benner 43:08
Can you briefly describe what it was like the frozen shoulder? Yeah,

Denise 43:12
it so it literally is what it says so that it's something with the nerves and the capsule in the shoulder tightening up so that I couldn't move so I would get shooting tingling pain downs, my arms in gradually to avoid that I stopped moving is where the directions where that goes, right? Because that hurts. And so then I would get less and less range of motion. So I mean, I couldn't hardly move my arm at all on the first side. And so then basically what they do in the frozen shoulder surgery is they anesthetize you, so you don't feel it. And then yeah, busted around. Yeah, yep. I've heard and then so the other side started doing the tingling and stuff and he's like, no, no, it's the other side just fatigue because you're compensating and I'm like, I get that but I've also had six orthopedic surgeries on the ankles. I've got a fused ankle got a complex medical history with or the peds and I'm like, I know what my body feels like. And there's a difference between sore and pain and fatigue from overuse. I'm telling you, I'm getting a tingling in my fingertips again, and it's the same thing going on and he Chinese like you do have, like,

Scott Benner 44:17
what were the surgeries on your ankles for?

Denise 44:20
I had a congenital bone defect that there was an extra piece of bone that connected my heel to a part of my ankle. They started bothering me when I was 10 on one side. And then five or the peds later, I got a correct diagnosis when I was 16 went away to college. At that point, they told me it was probably in both ankles, but they didn't check the other side because it didn't hurt. They told me they could do surgery, they would have to fuse my ankle and it would be six months in a cast and my leg would forever be atrophied compared to the other and we're like yeah, we'll just grin and bear it a little bit longer. He's like, you know, I get the pain but if the pain is manageable with pain meds, let's wait The time I got to college and went to a big 10 campus, I was walking everywhere and activated in the other foot. It was not manageable when it's an orthopedic there who sent me to a specialist in Chicago who said, wow, you're kind of old for this. Usually we see this when people are 1011 12. I'm like, let me tell you my history. So I'm one surgery on the side that it only had been going for two or three years, and it took five surgeries, a fuse ankle, that didn't totally work. So they went in and broke some bones and realigned things and redid tendons. So

Scott Benner 45:31
wow, that's so crazy. How long have you laid off from that.

Denise 45:34
And by that point, I wasn't laid up six months, I was laid up six weeks. So I mean, I had a walking cast, I was able to bear weight. And three, four of the surgeries, I was able to bear weight coming straight out of the hospital. And on the other two, I was weight bearing within four weeks, and then a cast eight weeks, so crazy. So in those five years, medical technology had advanced enough that the grim prognosis that they gave me when I was 16. By the time I was 21, was not so grim. That's pretty

Scott Benner 46:04
great. Do you have any? Like, what are your better, like best tips for on the pod five? What have you learned along the way?

Denise 46:14
Um, I've learned exactly what you've said to trust what you know. And it's amount about a mountain timing. So that even though oh, this was one that I heard on one of your recent podcasts, so changing the numbers in automated mode, does it change anything, and I've decided that when I changed my insulin to carb ratio, it doesn't change the automated per se, and how much it micro Bolus is, but it does change what it predicts I need for a meal. Okay. So it changed, it changes what's in the calculator. So it changes how much I'm going to give myself yeah, so but I have not been afraid to override what it says, again, trust what you need to know. And so I know it's going to take some away, right away after I Bolus, it will stop there micro doses. So then I gotta calculate some of that into what I'm doing. So I have the autocorrection off. But if you use the calculator and use the CGM amount, you can only turn it off so far. So it still wants to take some away. And so I've learned to trust what I know is going to happen in either except depending on the activity level, except that reduction or say, no, no, I want the full amount.

Scott Benner 47:29
So you've just basically taken good practices and applied it to how the algorithm works.

Denise 47:34
Correct? Yes. Okay. I just recently listened. And I'm sorry, I don't remember anything. But the team player when I totally agree with that, the episode where the title was even a patent five as a team player, that, that I take what I know, and use that to make my life simpler. Again, just to give me more bandwidth to deal with the rest of the stuff that's in my life. Yeah,

Scott Benner 47:56
I think it's valuable if people can get out of their head that the any pump like me modifies what we're talking about, but any of them yeah, that are automated, that they're just gonna be perfect. And you're not gonna have to do anything. Like, if you can just get rid of that idea. At first, I think you're going to be much better off and then you know, do what you know is what works. And then when it's when it's smooth sailing, just enjoy it like overnight. I imagine your overnights are probably great with only about five, right? Yeah. And, you know, times away from like, heavy carbs are probably terrific stuff like that. Yep. Yeah, it's just what's

Denise 48:30
hard for me with the pump is that I don't eat heavy carbs. So when I want a gluten free piece of birthday cake, or my daughter has graduated from high school, if I wanted to have things because I don't have celiac, I know that these things that I avoid what they'll do to my body, but they're not life threatening or dangerous in the long term. I fully believe from all of my physicians and understanding of how my body works, that I have these food sensitivities and inflammations. Because of the decades that I took NSAIDs as anti inflammatories to manage the pain in my orthopedic issues. Oh, interesting. So my gut is not what we would prefer it to be working on healing that. And so I know what the food sent. And so corn will give me rashes on my elbows, arms and feet. I mean, so that I know what so if I choose to do it, just to enjoy what the group is doing, then I don't know what to do. I mean, because then I'm doing my best guess, but I don't have enough experience to know. How much do I give up front? How much do I give an hour later? And so that's where my spikes come from? Is just still I feel like I'm even though I'm several years in early days in the learning curve, because I don't eat that way often enough to know how to manage.

Scott Benner 49:51
Yeah, that's very interesting. And, you know, I just did, I mean, I just put up an episode today with the founder. of beta bionics. So they have that new islet bionic pancreas. Yeah. And we spoke for two hours. And it was clear what they did was they they made a device that can get your a one C to about a seven. But it's with almost no effort. And I realized as he was talking like at first I thought, oh, people are going to be like, Well, why don't why can't I do it for this? And then I just thought like, why are we talking about what it isn't? Like, like, look at what it is, is yeah, there are so many people living with double digit a one sees who are going to have terrible ends so much sooner than necessary. They can't, can't won't excetera of what doesn't matter the reasons, right? They're not getting diabetes, right? The way you're getting it. And you're telling me I put this thing on them? And yeah, their blood sugar's he said like, you might see spikes to 200, they might stay for a while, but they're gonna come down. And when it's all said and done, you might have an A one C around seven. And you know, and I thought, well, that's great. Like he's targeted a section of the population who's suffering greatly, who was never going to get relief. And you know, and I'm my thought was, is I don't want the online community are people who are doing, you know, like, who understand that the way you and I do to be like, well, that's not good enough like, for you. It's not good enough. It's an insane improvement for them. You know, and so, I don't know, like, I just think that it's important to talk about it that way. And I don't know if we have always so anyway,

Denise 51:32
support network. The other piece, I just had that note down here, too. Yeah, there were two other pieces as we're kind of looking at the end here. The other piece that made my case, I think, interesting, and a little bit of more of a stressor. When you asked how I accepted it, we had to get over one hurdle, which is my dad died of pancreatic cancer. So with this fairly sudden onset of mine, the endo did immediately once I got in and three weeks order a full CT and panel to make sure that that wasn't why my pancreas suddenly stopped

Scott Benner 52:04
working. Oh, good. Yeah, that was worth looking at. And I'm glad that wasn't. And then

Denise 52:08
once we got past that and went, Oh, no, that's not it, then then it was easier to accept. And then I do have a husband at home who is very helpful and does 95% of the cooking and so forth. But that has been a training piece to all my anti inflammatory. And then I'm like, No, but this matters. We finally had discussion when I'm like, no, no, no, you are balancing all this. And I so appreciate all of the cooking you do and all of the help in the grocery shopping and all of that, but, but you don't get to tell me that you just adjusted this a little bit, and it won't matter and it won't hurt because you don't know how much exercise I got that day, or what time the sun came out or what time my shower was, or if I just had a pot change or not. So I do most 90% of the management. But it's hard. Because I do 90% of the management in that 10% of the time I need help. He doesn't kind of like me with the carbs. He doesn't have the experience to help. Yeah, well, let's one to help. But he doesn't have

Scott Benner 53:06
a boy, you'll be training him his whole life.

Denise 53:07
Right. Now, so those were the last couple of things. I mean, the CT scan, and then the fact that Yeah, so I mean, I remember one time, he went to go get takeout for us. And I'm like, No, I need to eat. And this was early days within probably the first couple of months. And I think the first month I don't know, I think I was on MDI and he went to go get takeout. So I didn't dose before he went, but my numbers are all over. I'm like, I need to eat, I need to eat because my numbers are dropping. And I haven't dosed and I'm just in that honeymoon. And there was a problem at the store and his phone died because he's a boy and he didn't hadn't charged it. And so he's sitting in the Mexican restaurant getting ready to bring home food and have a margarita and I'm like, where is my food? And I can't call him and he came back and I'm like, You didn't you are gone an hour and 20 minutes and why were you gone? And he's like, why didn't you order takeout? And unlike, because I couldn't remember how my numbers had I mean, the brain fog that comes. That was the hardest part for me as an adult, especially a type a firstborn control freak, that I didn't seem that I noticed I have that mental fog, up bleeding on the uptick to diagnosis. But when we started bringing my numbers down, I remember very much trying to balance some of my daughter's medical records and my mom helping me and I'm going no, my brain hurts. No, I don't have a headache. I just I can't think

Scott Benner 54:28
Yeah, and that's something I am like, look what happens. Just one Margarita and look where you ended up.

Denise 54:33
I know, right? Yeah. I mean, I can't I can't think I mean, and so the loss of that, and I had no vision problems until they tried to break my sugars down. Yeah, that happens too. Right. So they said aren't wasn't your vision blurry before? I'm like, No, it didn't seem to change. It didn't. So as my sugars were rising pre diagnosis, I didn't notice a difference. But as soon as we tried to drop on my dead Yeah,

Scott Benner 54:57
I have a thing for you at the end here. So I want to ask you Before I get to that, if we've missed anything, or or No,

Denise 55:03
I knew you're gonna ask. So I threw those couple of things in about the CT scan and about my husband. So I'm good. That was my list.

Scott Benner 55:09
I'm gonna thank you for a second. Okay. You very much by mistake or the perfect person to be on this podcast today, and this is going to seem sad, but it is sad. But about two or three hours ago, I was woken up from a phone call that my mom was having a stroke. Oh, no, she's no your mom's had health. Yeah, she's in surgery right now they're removing a clot and talking to you really helped to pass this hour for me. I really, I really appreciate and because of your type a nature. I think when you started talking in the beginning, I thought, Oh, good. I'm not gonna have to talk too much. But at the same time, just having this conversation, I got lost in it a number of times, I forgot about what was going on. It was really helpful for me. And as I was, as I'm watching, I got people don't know like, I there's a timer running in front of me while we're talking. Right. So it counts up. Yep. And I know you're on a schedule here because you're you're you're on vacation, which is lovely of you to do this during vacation. I also like new, like that number is going to get to the end and I'm gonna, I'm gonna get back on the phone and get back on the phone and find out about my mom. So I am actually going to get off with you in a moment. I am going to I'm going to look oddly, I'm not choked up my my throat just I am going to look for flights and I am going to come and we're going to my brother and I are going to fly out to where my other brother is and see my mom. We have no idea what's going on. I spoke to the surgeon to make the last decision about what to do. We got this talk. We talked to my mom before she went into surgery. But anyway, this was really he did a really nice thing for me today. You don't know it. So thanks. Thank you. Thank you. Yeah, I appreciate it very much. If you hold on for one second, I'll check button this up for you. Yep.

Oh, a huge thanks to Denise for coming on the show and sharing her story with us. And I also want to thank Omni pod for being a longtime sponsor remind you that you go to Omni pod.com/juice box to learn more and get started. Don't forget about us med us med.com forward slash juicebox 888721151 For call or use the link. Get started today with 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. The episode you just heard was professionally edited by wrong way recording. Wrong way recording.com

#1103 Cold Wind: Healthcare Whistleblower, H.R. and Insurance Professional

"Anonymous female" is a former Human Resources professional and current Insurance company employee. Her voice and name have been changed to protect her identity.

+ Click for EPISODE TRANSCRIPT

Scott Benner 0:00
Hello friends, welcome to episode 1103 of the Juicebox Podcast.

I'm back today with my second installment of the cold wind series. On today's show, we'll be calling our guests, Laura. She is on the show today because she has worked in human resources and in private insurance 23 plus years in human resources, and she has seen some. Now Laura works in insurance where she's also seen some if this one doesn't kill you right down to your you know what's nothing's going to. 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 are becoming bold with insulin. 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. Don't forget to save 40% off of your entire order at cozy earth.com All you have to do is use the offer code juice box at checkout that's juice box at checkout to save 40% at cozy earth.com.

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 benefit check and get started today with us met 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/juice box.

"Laura" 2:11
My name is Laura. I have two type one children for the past like 23 for 23 years, I worked on the benefit side of it from HR standpoint, like for your company. And then the last like year and a half or so I made the change to work at the actual insurance company.

Scott Benner 2:33
You work for those people. Yeah. You have two sons. Yep. They both have type one. So this is all within the last four years for you. Yes. Okay. Do you have type one?

"Laura" 2:45
I do not have any other autoimmune issues? Yes, I do. And all four of my children also have some sort of autoimmune. So

Scott Benner 2:55
hypothyroidism for you know, mine

"Laura" 2:57
is more of a Lupus issue. My daughter has Hashimotos and my son has grave. The older one of the younger one. His twin brother has graves. Four kids, my 21 year old has Hashimotos you have lupus diagnose diagnose lupus. No, not yet. We're still in that process. I have to go again Tuesday. On fun, husband anything? Nope. Down the line and your families know if we're being completely honest. I think my dad had undiagnosed type one and not contributed to his death 56 Which is why I had all my older three children tested and they all came back negative. So the one twin went into DKA. I never suspected type one because I was told he didn't have any antibodies. Everything was clear. So it came on here last a long time. Yeah, to like, wrap my head around that.

Scott Benner 3:59
And this isn't why we're here. But your father was sick and died pretty quickly.

"Laura" 4:04
I know he was from what we knew healthy. Great. I hadn't been out of you know, I hadn't lived at home in many years, but he just fell over at Easter dinner actually. In 2012 he was 56 he didn't get back up three days later. Nope. I'm so sorry. I don't know how we weren't gonna say no. Okay, I apologize. No, we've made that joke a million times worse. Yeah.

Scott Benner 4:35
Don't touch him. He'll be up in like 72 hours. Oh my gosh. So your dad had a real fast onset of what you think was type one diabetes DKA died? Yep. He's he

"Laura" 4:45
lived in a small farm town and they did CPR for like an hour and couldn't revive them. And I was like, Okay, so once I got the autopsy and I started putting it all together and thinking back of like, the symptoms that I noticed now Now that I know what they are, I was like, okay, yep. They did an autopsy because they thought it was Pontius Pilate. Yeah. They thought he had a heart attack.

Scott Benner 5:08
I say, Okay, you're not gonna keep going with this joke about the religious. So anyway, don't want to cry. Oh, I'm sorry, how long ago was this?

"Laura" 5:17
2012 So it's been an 11 and a half years. It still hurts. Some days, just because, uh, you know, I, I feel like not that I could have prevented it. But if I had been able to educate him to be like, listen, dad, like, Oh, I understand, you know, but also, he was my biggest champion and trying to figure out what's going on with me. And so I have a lot of guilt of, I didn't help him, but he helped me. You

Scott Benner 5:46
know? No, yeah, I helped my mom a lot with her cancer. And I think I think I made decisions that directly elongated her life. And I still feel bad about whatever it is, I didn't think to do. Yeah. Which is, you know, not really fair. But I understand how you feel. And I'll stop joking about I apologize. Mike, I need to laugh. Yeah, well, I think in a minute, you're gonna get to let your aggression out in other ways. So. So you're on the show today, anonymously. Because obviously, you have some backroom knowledge about human resources, insurance. And now about type one diabetes? Yes. So let's start with your career as an HR person. What is it? You saw that now in hindsight, you think, Oh, that wasn't? Right, we shouldn't have done that.

"Laura" 6:35
Um, it's always about the cost, right? Like, it's always, what can I do to save the most money so I can make the most money. And 110% of the time, it's, we're not paying for technology. In my previous experience, obviously, you know, 20 years ago, technology wasn't then what it is today. But I had no understanding of type one, what type one was, or why the technology was important. And I look back and I'm like, Oh, my God, even today, like I'm like, Oh, my God, why are insurance companies forcing people to live barbarically? Like, we have technology use it. But it's always about, I didn't fight hard enough, you know, to help this person. Why can't we add this to the formulary? Why? You know, just, it's always why like, Yeah,

Scott Benner 7:27
let's, let's break that down for people so that they can understand because I think that the phrase that your company feeds, you is Oh, the insurance doesn't cover that. But they're the ones who chose what the insurance covers. Right? Yeah. So when the insurance cut when your employer is saying, insurance doesn't cover that, what they mean to say is, for reasons of cost cutting, we decided not to pay for you to be covered by that. Right? Yes. Okay, especially

"Laura" 7:53
on a self funded plan, when they're fully insured, then the insurance company does have a little more control over that. But I am from the Midwest, it's a hotbed of self funding. I have never worked for a company that wasn't self funded. And they 100% control what's covered and what's not. And what that cost is,

Scott Benner 8:15
can we define those two things? So what is tell people that self funded means? So

"Laura" 8:20
self funded means the company itself is paying medical bills, fully insured means that the insurance company is paying the medical bill?

Scott Benner 8:29
Why would a company choose one over the other cost? It's

"Laura" 8:33
a gamble, obviously. But if you're self funded, and you have a relatively healthy population, then you're going to charge you know, $1,000 a month and an insurance premium, but you're only going to spend $400 a month. So you have, for example, so you have the ability to make a whole lot of money, right? And just sock that money away. When you're fully insured, you're paying $1,000 a month and insurance, but someone else controls okay, what portion of the bill gets paid.

Scott Benner 9:07
So fully insured is the company is paying a premium. And then that premium is set up based on the tier of insurance that they've purchased. And then if you get sick, the insurance company is the one taking the risk there. They're collecting money every you know, however, how, however frequently from your employer, and they're risking if you guys don't get sick, then we get to keep this. But that costs more because it shifts the it shifts the risk onto the insurance company so they charge more for it. Right self funded is yes, a company is a silly like you might have a card out and it might just say Aetna on it like great. And you think oh at this my insurance company. But really Aetna is just handling the billing and everything. And they literally send a bill to the company probably quarterly and say look this quarter are this is what it costs to give healthcare to your employees? write us a check for? Great.

"Laura" 10:05
Yep. Yeah, you're simply borrowing that network. So network United Healthcare network does not work, etc.

Scott Benner 10:12
So when you're in human resources, do you ever see someone come in, say they interview four people for a job? And they get it down to two people and they're equally qualified, and one of them's 50 pounds overweight? They go through this, then one, because maybe that'll be better for us.

"Laura" 10:29
The reality is, yeah, there is a little bit of that that happens. I

Scott Benner 10:34
mean, I'm just thinking of it. From my own perspective, I own the company, I'd be like, let's get the one who wasn't winded walking up the stairs? Like, I just, I think I would do that. So yeah,

"Laura" 10:42
I have one employee that I worked with, who had a blood disorder and needed lots of blood transfusions, lots of different things. And I was like, This guy is amazing. And so I took him with me to my next company. And they were like, what, why? Why do you know how much money we're losing on him? And I'm like, because he's making a lot of money to like, you can't just look at it from one perspective, but also, we're not discriminating. So don't talk to me about that.

Scott Benner 11:12
But if, if we can all do it with a wink and a nod, then why not? And so when, when people say the conversation I usually see online is like, well, when you go to a job interview, you don't have to disclose your health. And some people are like, Well, I have type one diabetes, I want people to know, and I'm not hiding it. I'm like out about it. But the truth is, is that if you got into that situation, they might go, oh, that lady looks like she's wearing an expensive gadget on her arm. Like, let's not go with her. Yep. Okay. So

"Laura" 11:43
my children will always be covered up, I don't care if it's 100 degrees, and you're interviewing for a job outside, you're going to wear long sleeves, and I just or you're gonna not wear your device ID or whatever. Just because I know that the discrimination from an HR side is legit

Scott Benner 12:00
gonna happen. And you can't prove it, right? No, how would you because nobody says it out loud. Nobody writes it down. So that's that?

"Laura" 12:09
No, that's why you have closed door meetings and you get yelled at.

Scott Benner 12:13
And you're all covered by NDAs. When you go in that meeting, you can't you go back out. And so therefore you kind of have to do this, which is be anonymous about it. Yep. Absolutely. Yeah. Well, I'm glad we're doing this. Actually, I have to be honest, I asked for health care professionals. And you reached out and said, Hey, I was in HR and I work in insurance now. And I was like, Oh, why didn't I ask for that? That's great. I was like, Thank thank God, Laura is thinking for me, you're producing the show. Now, some other examples. So your company might set up, you alluded to this earlier, but like to be clear. They they'll look at tiers and say, Okay, well in this tier, if you had type one diabetes, you'd get a CGM. But in this tier, you don't. And we pay less for this tier. So we're going to take this one, right,

"Laura" 12:58
or they're just going to exclude it completely. And so you're not, we don't cover CGM at all.

Scott Benner 13:03
So when you're making the contract, you just go through and you go, we like this tear, but like, scratch out these things.

"Laura" 13:10
So the company kind of tailors, the insurance coverage, ala carte, but honestly, it's about money, not about choice. Oh, absolutely. So like compound prescriptions. For example, one company that I managed benefits for just wiped those out completely, like, I don't care what it is, it's not being covered just because compound drugs are expensive. Up until last year, insulin prices weren't regulated, they would be like, Oh, we're gonna charge $200 a month for insulin, or we're gonna do you know, XY and Z things. Or we're going to, I don't know what the the post Obamacare term is, but before it was, we're gonna laser this out like this person has, you know, this is lasered out, so to speak. Now, with ACA laws, it's the verbiage is a little different, but the practices are still happening.

Scott Benner 14:00
Interesting. Yeah. So the world is the way I expect it. That's what you're telling me?

"Laura" 14:08
Unfortunately,

Scott Benner 14:11
I thought it was by the way, I'm actually generally speaking, I'm usually surprised when people act Pollyanna about things. And they go, Oh, that couldn't happen. There's laws against that. And I'm like, What? What are you talking about? Of course, that's happening. You know, like, it's not the way I see it is, generally speaking, you either work for somebody who has so much money that it doesn't matter, which some people do, like, you know, like you work for such a large corporation, that they can be fully funded. And it's still not be super expensive because the insurance companies still making a boatload off of them because they've got 20 3040 50,000 employees so they can get the price down because they've got overhead the insurance they've got they've got enough people and the insurance companies still making The money they want to make on the policy. But smaller companies are going to go self pay, because they're going to bet on their population not getting sick. diabetes comes with a lot of things to remember. So it's nice when someone takes something off your plate. US med has done that for us. When it's time for art and supplies to be refreshed, we get an email rolls up in your inbox says hi Arden. This is your friendly reorder email from us med. You open up the email, it's a big button that says click here to reorder. And you're done. Finally, somebody taking away a responsibility instead of adding one. US med has done that for us. An email arrives, we click on a link and the next thing you know your products are at the front door. That simple. Us med.com/juice box or call 888-721-1514 I never have to wonder if Arden has enough supplies. I click on one link. I open up a box. I put the stuff in the drawer. And we're done. US med carries everything from insulin pumps, and diabetes testing supplies to the latest CGM like the libre three, and the ducks comm G seven, they accept Medicare nationwide, over 800 private insurers. And all you have to do to get started is called 888-721-1514. Or go to my link us med.com/juicebox. Using that number or my link helps to support the production of the Juicebox Podcast.

"Laura" 16:36
Yep. So statistic in full transparency, I worked for five different companies, all of them self funded. And all of them had around 500 employees. The biggest difference that I noticed was the CEO. If the CEO is not, obviously he's always worried about the bottom line. Like that's his job. But also if he has a little bit of integrity, he's going to you're going to have these conversations like there were times it happened all the time, he would walk in my office shut the door, and we would talk about something, you know, at 7am before anyone else got there. In another instance, it was I don't care how you do it. But you do this, and I want them out. I don't I'm not paying for this. Like, we just got a $250,000 bill from UMR. Why? Like no, I'm not paying, figure it out and get rid of the problem. A person

Scott Benner 17:29
has looked you in the face and said, Get rid of that person. They're killing us on health care costs.

"Laura" 17:35
Oh, absolutely. happened more than once. Gotcha.

Scott Benner 17:39
Oh, all right. Well, this is uplifting. That's what I expected. By the way. You know, like when you said you'd come on? I thought this isn't to tell me how great everything is. That's Do you think people right now mostly I miss I'm imagining to two distinct different reactions for listeners, either someone's like I know it mother, or more. They're thinking, Oh, my God, I don't understand. But I'm on the I knew it side for sure. Did you know before you got into it?

"Laura" 18:09
No. I mean, I was 19. I was still in college. Like I had no idea that it was this discriminatory. I had no idea that I also had no idea that there were so many health issues out there. Like I was a young, healthy, 19 year old, I had no idea that you know, so and so John over there has whatever going on. And even though he's like an employee, he's costing the company a lot of money from health insurance wise. So then you're like scratching your head, you're like, what this is happening. And you want me to fire him kind of illegally, like, so those are the unemployment claims, you just don't fight. If I'm being honest.

Scott Benner 18:48
So you owe so it's a calculated maneuver, then we're gonna ask this person, we don't have a real reason. But we got to get rid of him before another $250,000 bill comes up, they'll sue us in unemployment, for unemployment reasons, we'll pay but it won't be nearly as much as we'll lose in the health care cost, right? Yep. Absolutely. Does the company get dinged for that somehow? Is there like a thing that keeps track of it or anything like that? Yeah.

"Laura" 19:15
So there is an unemployment amount that you have to pay every month. And obviously, the more claims you have, the more you have to pay in not just because you're paying that unemployment, but also because you're being quote unquote, penalized by the government for having that many claims is that thing people can check on when they're looking for work?

Scott Benner 19:35
That can I see. I mean, the companies who seem like maybe they're getting rid of people. Yeah,

"Laura" 19:40
I'm not sure about that. But there is a way to check and see if a company's getting ready to do a mass layoff like major companies are getting ready to do a layoff. I'm looking up as we speak the exact parameters. But I have one of my my best friends works for a major company and they're doing Doing layoffs and I was like, Hey, why don't you check and make sure like, she was like, I don't know if it's my department. And I'm like, well, they don't specify departments or names, but they do have to give the government 30 days notice why they're doing it. They can be really discreet about that. Okay.

Scott Benner 20:18
I know from when, when my wife's companies say they're going to do a reorganization, that's usually means everybody. And it's funny, I always think of it is every few years. They hire, they hire they hire, and eventually the bad employees shake out, you figure out which ones aren't as valuable as you hoped they would be or or didn't end up being necessary. And they move them along which business wise makes sense to me. It never occurred to me that we'd sprinkle in a couple of people with a heart condition or something like that. And to that list, too.

"Laura" 20:50
Yeah. And they're always going to say it's for budget reasons. And of course, it's for budget reasons. But the reality is, it's also because you have a health condition, and you're costing too much money. That's the budget issue.

Scott Benner 21:03
The budget is you coughed too much, I gotcha. Right? Would it be out of line to say, so I know a person who lost their job. This person was, by all accounts, fantastic, their job, a great employee, they were a little higher on the pay scale than anyone else. And then one day, out of nowhere, one of these little like, rules in the handbook on like, the last page, like literally, you can't chew gum while you're at work. That kind of thing. Someone walked up to this person said, is that gum in your mouth? And they went, Yeah, I'm sorry, I forgot. And went to throw it away. And they said, No, nevermind, come to the office. And they fired him.

"Laura" 21:46
Those are the stupid reasons that HR has to come up with to fire a good employee. Gotcha. Or whatever other reason, I can't wait to tell that person that. Yeah, but definitely, when you're looking at jobs, like you want to check the war notices for your state, W AR n that tells that gives a decent indication of layoff,

Scott Benner 22:07
if they're coming or how many you've seen in the past? Both,

"Laura" 22:10
it'll tell you, it's me, I hold on, I look up what it stands for Worker Adjustment and retaining Notification Act.

Scott Benner 22:20
So if you see a company that is consistently laying people off, they might be one of those companies who bring you in make a big, like, oh, it's gonna be great here, you're gonna love it. And then when they're done with you, or the work dies down, or whatever else, they just sweep everybody out with the trash on Friday afternoon when nobody's looking.

"Laura" 22:36
Great. Gotcha. Huh. Not always. I mean, sometimes they're for legitimate reasons, you know? Yeah. Yeah. But I mean, many times, it's just because

Scott Benner 22:47
so if I told you that that story I just told you about that person happened right after a new company took over the business that would even be less shocking to you, right? Honestly, not shocking at all. Right? They come in, they evaluate where do we it's always money. Where do we cut money?

"Laura" 23:04
Yeah, always. You're never a person. It's always about a number.

Scott Benner 23:08
You've never been in a room where they were like, Hey, how can we make everybody happier today?

"Laura" 23:13
It's happened a couple of times. And I convinced the CEO to serve everyone breakfast, just you know, to be like, Hey, I'm normal. And not a total asshole. But normally, yeah, I mean, it's all about money. Like it's always, where do we cut? How do we put the most overhead? And so I've been through a couple of sales, right? And you always make a spreadsheet of salaries versus expenses. And whoever is in the top obviously goes.

Scott Benner 23:46
That's why they say don't get too high. Like, don't make too much. I used to hear people say that, like, I don't want to make I don't want to I don't want another promotion, or they're going to take my head off in four years if I do, right. Yeah. Gotcha. Can I ask, since your kids diagnosis is did you have any, like quiet moments where you look back and thought, Oh, I wonder how many people's jobs I helped get rid of that had this stuff going on?

"Laura" 24:13
Absolutely. Because there are a few I know of. So I wonder how many I didn't know love. And I it kills me.

Scott Benner 24:21
But in the moment. I mean, imagine especially when you're younger in the moment, you're like doing your job which by the way, I also I'm not coming down on you like some this is how business works. I don't I mean, some people might have been surprised by it. I wasn't. And so people are going to do these jobs. Not everybody's job is pleasant, that I'm not coming down on you at all. I'm wondering about like, personally, like you have this moment where you think oh god, I was in a meeting and i i I came up with a reason to get rid of that person. That contour next gen blood glucose meter is the meter that we use here. Arden has one with her at all times. I have one downstairs in the kitchen. Just In case I want to check my blood sugar, and Arden has been at school, they're everywhere that she is contour next one.com/juicebox test strips. And the meters themselves may be less expensive for you in cash out of your pocket than you're paying currently through your insurance for another meter, you can find out about that and much more at my link contour next one.com/juice box contour makes a number of fantastic and accurate meters. And their second chance test strips are absolutely my favorite part. What does that mean? If you go to get some blood, and maybe you touch it, and I don't know, stumble with your hand and like slip off and go back, it doesn't impact the quality or accuracy of the test. So you can hit the blood not good enough, come back, get the rest without impacting the accuracy of the test. That's right, you can touch the blood, come back and get the rest. And you're gonna get an absolutely accurate test. I think that's important because we all stumble and fumble at times, that's not a good reason to have to waste a test trip. And with a contour next gen. You won't have to contour next.com forward slash juicebox you're gonna get a great reading without having to be perfect. Yep, yeah. Is that hard happened?

"Laura" 26:20
It's very hard. Especially when I think about, like, you know, because there are times like, I'll find out after the fact like, oh, so and so had this health condition or so and so was pregnant and you didn't know yet or whatever. And you're like, I mean, I can't tell you Scott, how many times I've put my hands on my head. And I've just been like, Oh my fucking god, what did I just do? Now,

Scott Benner 26:43
to give you the flip side of this, how many employees have you dealt with who are habitually taking advantage of like short or long term? Like coverage? Like somebody's like, oh, I, my doctor says I need to take a month off. I have a cough. Like there are people who like do that, right? Like they work a little, quote, get sick, take off three months on like long term disability, then come back, want their job back work six more months, get like that this happens? No,

"Laura" 27:13
it absolutely happens. And that's why FMLA laws are what they are. That's why it's 100 or one year, and, you know, the all the hours like, because to stop that. And it sucks. You know, when you're in a position where now I'm on the flip side of it, and I'm like, I needed FMLA, like two years ago, but I didn't qualify for it until one year ago. You know, yeah. And then, but then you see that all the time of like people that are requesting STP or Ltd short term disability or long term disability and you're like,

Scott Benner 27:48
No, over and over. So they they limited to a year for to stop people from taking advantage of it. But the flip side of that is there are actually some people who need it for more than a year and they just get aged out of it. unscrew them. And that's part of doing business. This is what this is what the speed trap catches, it catches people who need it and people who don't need it as well. Yep, absolutely. That's upsetting. Is that hard to watch somebody because that's stealing, in my opinion, you know, Oh, yeah. So did they ever prosecute people? Do they ever go after them? Or is it just too difficult?

"Laura" 28:20
I don't know that. I've seen any one prosecuted for it. But I have definitely seen short term disability and long term disability claims denied because they were frivolous. Yeah, they just tell him Look, come

Scott Benner 28:35
back to work or you're done. That's it, right? Yeah. Gotcha. Am I missing anything so far? Like, is there something you should be telling me that I'm not going to ask about?

"Laura" 28:45
I just want to reiterate that, especially if you work for a self funded company, your HR has total control over the formulary and what's covered.

Scott Benner 28:55
Have you ever heard my story about artists dental work? No, I don't think so. When Arden was really little, obviously, we didn't know what we were doing. She was drinking a lot of juice at night, like, you know, saving her from lows over and over again. And a lot of her baby teeth got cavities. And it was too soon. She couldn't just take them out. Because she needed them and she wasn't going to get teeth for a little while. They had to be fixed. So we went to a dentist who looked at her and said Look, I am not comfortable putting her under has her blood sugar get low. We need to do it in a hospital. I am not comfortable doing the office. I want to do it in a hospital where I can have somebody monitor her blood sugar or have her on a sale, a drip of glucose if she needs it, that kind of stuff. And I was like okay, so then our insurance denied it. Okay, yeah. And they kept denying it and kept an eye even though it's now a medical procedure because it was happening in hospital wasn't dental anymore. They denied the data and it just went on forever. And it was like 15 grand, I think and we were young still and I don't want to say that $15,000 Not a lot of money to me. It is but on They're like penalty of death, I can probably pull it together for one of my kids if I needed to. But back then I could not have, right. And so I called my wife's company. I literally called Human Resources. My wife's like, they're not going to help. And I was like, I got nothing else to do. So I called the company, I spoke to somebody. And they said, let me see what I can do. And they got back to us a couple days later. And they said, Yeah, it's fine. Go ahead and book it, we'll pay for it. But it was a self funded company and a big company. So all I had to do was actually get to the person in charge. And they were like, what's 15 grand to help this kid will do that. And that was it. It was just over.

"Laura" 30:39
Yeah, and that's the thing I think a lot of people don't realize is, I can't tell you how many spouses I've talked to, I've spoken to over the years, let alone the employee themselves. And you know, it's true, the squeaky wheel is going to get the grease, however, don't call in and be a jerk about it, like, you know, have like a decent conversation because we're people too, we're just trying to do what we're supposed to do

Scott Benner 31:03
yelled at a lot.

"Laura" 31:06
But like, at the end of the day, you know, I'm, I, we've I've been able to make dozens of changes to plans mid year, like you have to give appropriate notice legally, obviously, but like, you know, each quarter, you can change your plan from a company's perspective. So I've been able to pull that off many times helps people.

Scott Benner 31:28
Yeah, I just called and I honestly, I didn't understand self pay and full pay back then. This is actually how I learned about it. But I just called and said, Is there anything you can do to help us like, I thought I was asking them to call the insurance company. And like, you don't mean like, I thought I was asking the company to call the Wizard of Oz and talk him into letting us into the city. Like Like, that's what I thought I was doing. And they were like, oh, no, that's on us. We'll just pay for it. I was like, Oh, okay. So we just got lucky when I told my wife. She's like, what I was like, See, I told you I work it out. But the truth is, I just got lucky. So good. I don't know what the hell I was talking about. Even at the time.

"Laura" 32:03
No, you asked, the only thing they could do was say no. Yeah.

Scott Benner 32:07
I mean, that's actually it's how I got a girl to party for me to marry me even I was like, I mean, you know, she's tall. She's pretty people don't see, they seem to be like afraid of her. It's like, I'll just try.

"Laura" 32:18
I mean, if I'm being honest, my husband, his CIO, my husband's a computer nerd.

Scott Benner 32:27
And, by the way, not what you say, but

"Laura" 32:32
um, his CIO, it has a wife, that's also a T one. He obviously has paved the way but they cover things. I mean, he has amazing insurance because his CIOs wife was like, No, you you're going to do? Yeah.

Scott Benner 32:48
Well, and so yeah, I understand what that means, too, is that once you get, you know, people here, oh, this place covers this, that cover CGM covers all that. Like every person they hire in with that. That's money going out the door. Again, that's them paying for your pods or your pumps or your insulin or whatever. That's really and so that's a real kindness when you find people doing that.

"Laura" 33:10
Absolutely. It's because you have executives with integrity.

Scott Benner 33:14
That's it. You don't see another reason for it at all.

"Laura" 33:17
I mean, I'm sure. You know, listen, I'm sure that he brings great value to his company. And I'm sure as does everyone, right? Or he wouldn't have a job. But at the end of the day, it's because you have executives with integrity, right? Because

Scott Benner 33:34
they could hire somebody as good as you who doesn't need an insulin pump. Right, right. Hmm. I have other questions that might not be connected to this, can I just ask real quickly? Go for it.

"Laura" 33:45
I'm a wealth of information.

Scott Benner 33:47
I think you might be back actually one day, but we like when the company's like, Hey, you can get life insurance through us, for example. And it's like up to one to nine times your pay or whatever. There's always value in doing at least what they're what the company is paying for. Is that right? Absolutely. Yeah. Always, always take that. What about health care spending accounts? Is that a good thing to do? Depends

"Laura" 34:10
on the plan. So previous to diabetes, we always had an HSA. But since diagnosis, we have gone to back to a traditional PPO plan, with a low deductible because HSAs are hit and miss because they only find as you get paid and you fund them. So if you have a $3,000 bill in January, you may not hit $3,000 in your HSA until June, right? So they're tricky, and it's always something to look at.

Scott Benner 34:46
That is what happens to us. We so we we take the mat I actually we put the maximum we're allowed into our HSA and because you're really it's just the tax shelter for the money, right? Right. Yeah. So but like you said, In January, when like, it's pomp time or this time, you're like, ooh, the first time like your your CGM is cost $2,000. And you're like the other 20 bucks in June, what the hell, you know, like that, that kind of stuff is shocking. And if you don't have cash aside for it, it's obviously problematic. Yeah. Or it's like that initial hospital though, when your child first goes in and is diagnosing, you have to pay it literally on the spot. And you're like, Okay, I'll

"Laura" 35:27
give you whatever you need. Just keep my child alive, right? And you're like, Holy shit, that was a lot of money. Like, how did I just come up with five grand to give them like literally on the spot, and then you're re evaluating, okay, we maybe need to change our insurance, because I don't know that I can do that all the time. That's not necessarily practical. Yeah, it is a thing too. I

Scott Benner 35:50
never forget when I moved into my house, my neighbor was older than me by almost 20 years. And he was already sending his kids to college. And I was like, how do you pay for all that? And he goes out, you'll figure it out. I was like, that's your advice. And he goes, that's how it works manually to figure it out, or you won't, I was like, Okay, thanks

"Laura" 36:09
for being college right now. And I'm like, Oh, my God,

Scott Benner 36:12
how are we doing this? Nicholas, I mean, they call me I am working art in art in just left school, like five hours ago, striving home, like the semesters or the quarters over. And she's like, there's, I need money in my account for the drive home. And I was like, okay. So I'll transfer some money in your account.

"Laura" 36:31
I mean, I literally had to send my daughter $900, a couple days ago for a new computer. And I'm like, okay, cool. I don't have anything else going on. Sure.

Scott Benner 36:41
I'll just keep wearing these sneakers, another six months, it'll be fine. Forget the hole in the side, I'm wrapping it with duck. It really does. It is the way it goes. So it was like you're living. You're living like you're in college. And they're there. Okay, that was going on. Anyway. Okay, so that's the HR side and what you might expect from your company, but now you work for an insurance company. So how are we getting stuck that way? Because

"Laura" 37:09
they're gonna deny everything you said to them, at least once. And then thankfully, we have a really good endocrinologist who literally, you know, when I'm like, listen, they're not gonna, like, they're not going to approve it, you know, blah, blah, blah, like I work, not for the insurance company that we have, but like, I work for an insurance company, and they're gonna deny it, like, I know how this works. And she's like, No, no, let me take care of it. We know how to write these things to make sure that it gets approved. And I'm like, Okay, I don't know this, the science or the specific behind it. But I have come to realize how insanely important it is, to find an endocrinologist who will write the prior authorization requests the way that they need to be written to get approved. It's fascinating.

Scott Benner 37:58
I, I needed. So I don't know how much of the podcasts you listen to, or you don't listen to. But I've been using weego V for weight loss for like nine months now. And I really need I've lost 40 pounds. It's made a significant change. You look amazing. Oh, thank you very nice. Anyway, when I went to the doctor, the doctors like, look, obviously you need this, your BMI supports it. But I said, Do you think it'll get covered? She goes, I know what to do. I was like, okay, and boom, right through like it was nothing.

"Laura" 38:25
Yeah, like my son, he's now 19. So I can't do it for him anymore. I just send them insulin. So he doesn't die, because he doesn't get it himself. But the difference is, and the endocrinologist are like, night and day, like there's not enough words to describe it. And I'm like this, like, how do you not even have enough insulin to get through a month? Like, why is it not being approved? And he's like, I don't know. That's just what they'll give me. And I'm like, okay, clearly, I need to have a conversation with them and be like, you, you know, here's how you write this. This is where my 10 year old, I have a ton of extra insulin. And thank God because that's how I'm keeping my 19 year old alive. Like literally, I'm shipping it to him every month.

Scott Benner 39:10
Your younger kid is that a pediatric Endo, they know how to say, Yeah, let's just we'll say the need is this and that way, you'll get an extra vial and you'll be okay. And like that kind of stuff. And the adult endo is just like, they don't give a crap and they don't try very hard and your son is 19. So he's not pushing back. And that leaves him without insulin. Right? Yep. He gets about half of what he needs uninsured person. Yeah, yeah. Gotcha. And that's just because the doctor doesn't know how to deal with the insurance company.

"Laura" 39:41
Yes. And also I have a child but I got like, Yeah, whatever.

Scott Benner 39:46
He's a little dopey or whatever we got going. I don't want to say to your kid don't say, so. He might hear this one day, like I'm not dopey

"Laura" 39:55
all the time. I'm like, you're pretty mouthy for a kid who relies on his mother at all. If

Scott Benner 40:01
you're like, I'll shut the insolence pick it off, and then we'll see who's listening. But what this points out bigger picture, my opinion is that there are rules set up on the insurance side that are meant to block you from getting your services. And then doctors and other people on the outside have to figure out how to navigate the system, which is a polite way of saying write down what doesn't get caught by the computer or the checker. So it somehow slides through the machine and ends up at the end with a check mark on it. You get your thing, right. Yep, that's exactly how it works. Everyone's just trying to screw you. Yep. And if you go with it, they're not going to say this is a contention I've had the entire time. Like back when I was younger, Arden was diagnosed. Again, I told you, I didn't know what I was doing as much. But that's the first thing I said to Kelly was like, they deny everything the first time. Yep, that just happens. And it doesn't matter if it's covered even they just go No. And then because if you call if you're not willing to call back, they just saved the money. Right? It's that simple. And then if it's covered, you call back they go Oh, yeah, you know, we just needed this from the doctor. And then they tell you what to get. And then it's covered. So you push back a little bit, you get your covered things paid for. But then the what happens when things. So there's, I don't know if you're, how much you're in the private Facebook group. But there's a lot to do you know, Sam, who helps people, Sam writes letters that get people their stuff. She's magical at it. But that's really what it is, is she's able willing her brain works the right way to sit down, look at the look at the rules. And she knows how to write something that circumvents the rules that the insurance company put in place to stop them from having to pay you for the things you deserve. Yes,

"Laura" 41:55
yes. Okay. Like my I work for a small boutique insurance company, right? And they decided, when they announced the 2024 plans, it specified that CGM weren't going to be covered anymore, like in any capacity. And I, internally and to my husband through the biggest fit, I was like, Oh, my God, no, we are not doing this. And then a couple other people that like, No, my passion for this spoke out and and it quickly changed to oh, well, Medicare covered will cover Medicare covered CGM 's. And I'm like, Yeah, you will. And so why did

Scott Benner 42:36
why do you think that happened? Did it happen because they were seeing more people with diabetes? Or do you think they saw the news about people wanting to use CGM for overall health and stuff and they thought, let's get ahead of this and make sure we don't cover these things?

"Laura" 42:47
I to be honest with you, I think it was purely cost. purely a budget like we weren't, you know, it was, hey, we're gonna save X number of dollars by not allowing it CGM. So we're gonna just exclude it from coverage next year.

Scott Benner 42:59
Can you do me a favor? Can you put $1 amount that was saved? And tell me the like the operating budget for the year for the company?

"Laura" 43:07
I don't have that info.

Scott Benner 43:09
Can you guess about it? Like, how much are they saving? How much do you think they saved?

"Laura" 43:13
Oh, goodness. Well, we have I mean, I talked to probably five people a day that are on a libre, a few that are on a duck's calm that I talked to. So that's not just me. And there's 100 of us, right, that take those phone calls. So I mean, it's definitely in the millions. They're saving

Scott Benner 43:34
millions of dollars by saying so. So basically, they look at that spreadsheet you talked about, they see a line, the numbers read, they go over to the left, it says CGM and they go okay. They don't even know what the hell that is. They don't even care, right?

"Laura" 43:46
No, no, I, I would venture to guess 85 to 90% of them have no idea what a CGM is.

Scott Benner 43:55
It's just a red. It's a red line. And they need to get rid of it. Yep. It was something they wanted to laser out. Is there no, like, what if it was like cancer medication? Is there any thing where like, societal pressure stops them? Well, I

"Laura" 44:10
think that was why they ended up a week later, changing their tune was because of the societal pressure. Because there was not only employees, but there was a lot of members that they insure that we're like, Hell, no, you're not doing that.

Scott Benner 44:24
Oh, so even the companies that are buying the insurance from them are like, Hey, I have diabetes, like hold up, like that kind of thing. Do you think if they would have known that before they struck it, they wouldn't have or do you think they would just strike it just see what would happen next?

"Laura" 44:39
Oh, the way that this company operates, they were gonna do it anyway and then just take the gamble. They're always going to take the gamble,

Scott Benner 44:46
right? And then if somebody benches, then we'll backpedals. We have to.

"Laura" 44:49
Yep. Always.

Scott Benner 44:52
You know, again, I have to say purely from a business perspective. It makes sense to me. I'm not shocked I'm not even appalled, actually. I'm just like, Okay, I get it. Like I see. Now, if you told me that this is a, you told me this is a $25 billion a year company. And they, they did this and they were gonna save 3 million bucks. Then I go, come on, like, you know what I mean? Like, what are we doing here? Do you think that that's charged by operating budget? Like we want to have more in the bank? Or is it can it literally be the more of these things we cut away? The more money the CEO and the board and that those types of people end up taking home at the end of the year? No,

"Laura" 45:34
it wasn't the people. They're working on building new hospitals and they want they want the money. I know that they took a decent loss. I think every company took a decent loss during COVID. And they're trying to make up for that shortfall. By doing anything they can and have art, they're wanting to expand. They're trying to expand. It's just not able to happen as fast as originally planned. Yeah,

Scott Benner 45:58
they wanted it as capital, they needed it for operating. Yeah. You know, anybody who's got kids in college through COVID. And after COVID, will see that the incoming freshman classes after COVID don't fit in the buildings, right. And the colleges don't care if they're like, We need more like there are a pile of children in colleges they probably couldn't otherwise get into because they had money. And those colleges needed to sell those spots to get the money back. They lost during COVID. Absolutely, yeah. And then it hurts everything going forward. Everything except the bottom line, the bottom line is service. And you get poor poor experience in college you get you know less, more students to teachers, you get crappier teachers, like you get all kinds of like bad all kinds of bad comes from it. But in the end, the school will have more money in the bank when it's all over.

"Laura" 46:48
And your personal reward is hundreds of 1000s of dollars of student debt.

Scott Benner 46:51
That yes, and you'll go get a job that won't cover your insurance rates for you. And then you can just work your life away trying to pay it off. And hopefully you won't get sick but if you do, don't worry, we'll find a reason to fire you. Right. Perfect. This has been really uplifting thank

"Laura" 47:09
god, oh my god. But I have discovered like so a whole nother subject but like an LPN at my son's school two years ago when he was diagnosed like literally almost killed him not once but twice. And so I you know, we wrote the OCR, we did the whole thing. And I realized like that this is my job in life is like to be a whistleblower to like, these practices. I'm gonna hold schools accountable. You companies, you do dumb shit. I'm coming after you. I'm gonna hold you accountable

Scott Benner 47:43
for you. Well, we gotta get you a job doing that. Like, I know, we need like a small nonprofit to hire you. Yes, absolutely. People.

"Laura" 47:54
I'm literally a wealth of knowledge. I have so much legal background, like not from the employment law side anymore from like, you know, EDA, 504. I have, I'm telling you, I'm a wealth of knowledge. I

Scott Benner 48:07
know, an HR professional, pretty high up in a midsize company. And you can tell it everything about their job pulls on their heart, like, constantly, like they're always downtrodden when they're talking about work. And it's a little bit like, I can't believe I'm the one that has to do this stuff. Yeah, that kind of feeling.

"Laura" 48:26
Well, I officially retired from the HR side, when I had an employee fatality. I was like, Nope, I will never be the person to do that again. So by Can

Scott Benner 48:36
you give me color on that? They

"Laura" 48:38
had somebody die. Oh, yeah. So they were 18 came to work. Hi. And I was driving a forklift and trying to do fun, fancy tricks on it. And

Scott Benner 48:57
yeah, but it was like

"Laura" 48:58
10 o'clock, the day before Thanksgiving. And I was like, I will never, ever and of course, me being you know, the only female on the executive team got a guy nominated to make that phone call. You had to call his parents. So I had to be the one to call up parents. I had to be the one to do the press release to you know, talk to the media because it was everywhere, right? And I was like, never again, not doing it. So I, you know, had to bring in the grief counselors and do the whole thing. And I mean, you know, of course, I got a very nice bonus out of it. And literally, three months later, I was like, nope, not doing this guy's like, bye. I'm out. And I went that's why the company

Scott Benner 49:42
didn't do anything wrong. Like the kids showed up high. Nobody knew it and this is what happened. Right?

"Laura" 49:47
Yeah, the company didn't do anything wrong. And we I you know, but just with OSHA, we reinforce safety roles, all of it, but like I still personally don't want to ever do that again. This

Scott Benner 49:59
the poster on The wall now say no heroin while you're working, or I mean, what is the like? How do you reinforce that safety role? Well, ultimately,

"Laura" 50:07
the facility ended up getting shut down, not by OSHA, but just because there were a slew of other problems. And I just was like, Okay, I am putting together a lot of us, were you but like, I'm out. So I gave, I gave him like, three months. And then I was like, okay, it

Scott Benner 50:26
just made you. It made your heart heavy, and you want to move on and do something else.

"Laura" 50:29
Yeah, so I came to the benefits I thinking like, or to the insurance companies, I thinking like, that would be easier for me personally, to deal with, like mentally. And now I'm like, maybe not, Oh, hell no.

Scott Benner 50:42
I, when I was very young, like in my early 20s, I used to collect credit card debts. And I had to stop doing it. I was I was really good at it. And it just made me feel bad all the time. Like, there's no doubt these people spent this money they owed the money, like all that. And I'm not even talking about the the interest rates, like I know, they're, you know, I know that I know the game, might they get you to buy a couple things. I mean, right now people's credit cards are like it like 24%. Like, I don't even like if you're buying something on a credit card, and you don't have to please stop. But But anyway, this would happen. People get under, then, you know, they're just trying to get your monthlies out of you. Like really, I don't know that people understand that credit card companies, insurance companies, some businesses, they're all really just, they're in business to make money. So they can their investment companies, basically, the most insurance companies are investment companies, right? Yeah. So they need the money so they can invest it and make more money. So they get into something where they make a bunch of money, your health is probably 20th on their list of what's important to them. And, you know, they're just they're collecting fees, and then using the fees to, you know, buy stocks, do trading, like that kind of stuff and try to make money that way. Anyway, I couldn't do it anymore. I was just I was too good at it. And some of those people were lying, and they just didn't want to pay. But some of them were really in trouble. And I was good at cajoling them into paying. And then I just left one day and I told my wife, I'm like, I have to stop doing this. Like, it's hard. It's just it's heavy. I don't want to be the one that makes these people give somebody this money.

"Laura" 52:20
So yeah, I mean, I've experienced that with the company I work for Right? Like, the most heartbreaking stories like, is it me, it was me four years ago of, hey, my teenager just got diagnosed with type one. What do I do? And I'm like, Okay, this is what like, I give them like, line by line, like exactly what you need to write what you need to do. And at the end of the day, I know I'm costing my company money, but like, do I care? Now? Because I'm going to do what? Like, I know what that mom's feeling like, I know that the mental anguish, the emotional, the physical, like, I know exactly how she's feeling because that was me a few years ago,

Scott Benner 53:00
we will at some point your company, do an auditing of the people who have your job and say, Laura is costing us more money than other people. I think she's being too kind to them. No, they

"Laura" 53:12
actually have offered me a promotion. I declined it because I don't want to be in management anymore. Because

Scott Benner 53:17
of your knowledge, because you know what you're doing? Yeah, I see because you know, your way around even their rules. Yeah. So they'll put you into management to put a stop to other people understanding how to get around the rules. Yeah,

"Laura" 53:30
I'm 100%. And outside the box thinker always happen. Like you give me a roll off, figure out how to break it not like in a mean spirited way. But like in a you tell me that x y&z has to happen it fit inside this box, I'm gonna figure out how to get a outside. Like, that's how I've always been.

Scott Benner 53:48
This is all very disappointing. Even though I was even though I was ready for it. Like I knew, I mean, nothing about again, nothing about this surprise me, I'm still incredibly disappointed. But, you know, you know where, where you have to look for, like a bright light is you have to you gotta have to hope somebody like Laura is just like, I'm not going to do this anymore. Or a person like me is like, you know what, I'm too good at collecting data from people and I feel bad about I'm not getting my son coming out of college. I had a job opportunity. And he I don't want to say what it was. But he he said to me, I don't want to police people. And it wasn't he wasn't going to be a police officer was a job where you would have overseen people he's like, I hope people are using or understanding the term policing correctly, but he's like, he's like, I don't want to be in charge of telling people what to do. I'm not I'm not doing that. And it was really good paying. And he said, I am I'm not going to be a party to to overseeing people like that.

"Laura" 54:47
Yeah. And I totally I totally get that sentiment because that's kind of how I I was I felt, especially towards the end of my HR career. I was like, nothing more than a referee. You're

Scott Benner 55:01
in general, your job is. I mean, it's nice to you to come on and take this conversation from another perspective. But your job is like, how do I screw people to save money? That's your whole job. And it happens to be around health. But the truth is, is that in almost every walk of business, that's what's going on? Oh, absolutely. That's what's going on down to the littlest things like, I take ads on this podcast, right? The podcast does incredibly well for the people who advertise on it. And at the end of every year, someone gets in a room and half heartedly goes to me, we can afford it to go up. And I'm like, Yes, you can. You know, you can, I know, you can, you know, you can't afford to stop buying ads on this podcast, like the whole thing. But we still go through the motion, every time, the same thing happens. And it's not, they're not bad people, not a bad company. As a matter of fact, they're fantastic that the podcast exists there, somebody's going to get this information for free. Because of the advertisers. I love them. They're fantastic. But we still dance the dance, every time, we all know where the dance ends up. And yet we put on our shoes and play the music. And here we go. Let's see if I can squeeze 3% out of this, like, you know, so I can go back and tell somebody I squeezed 3% out of this. It's just, it's it's miserable. Miserable is a good word. I don't know another way to put it, I actually, I'm okay with it, like big and not just okay with it, I'm happy about it. Because that means the information gets to people, and it's free. And that's important. It's important for the podcast to be free for a couple of reasons. The top reason is not everybody would pay for it. So now, for the cost of like, whatever I would have to charge $6 a month or something for you to listen to the podcast, 99 cents a download or whatever, like to save a you know, $100 a year for you as a listener. Some people won't spend that. And now Now for the love of $100. For example, there's some kid walking around out there doesn't know how to Pre-Bolus and 30 years from now we'll be getting needles in his eyes or something like that, because they didn't have access to good information. So I'm not I won't restrict the information. Well,

"Laura" 57:11
listen, given what we just talked about. People can't afford it. You know what I

Scott Benner 57:15
say? Yeah, no kidding. Like, yeah, now I'm asking, like, anyway, at my fundamental core, I am not up for asking people to pay for better health. That's not something I'm okay with. Like I just, I'm just flatly not okay with it. And so it has to be advertiser driven. Because this is a I know, some people might be like, it's a podcast, you're just talking to the microphone, you'd deck but it's a it's a 70 hour a week job at minimum 24/7. I don't take a day off. I'm managing something at midnight, while you're all sleeping. I was up till like 11 Last night making edits and ads. And then I got in bed and somebody's like, hey, somebody reported a post in the group, you gotta go look at that. I was doing that at like two o'clock in the morning. I'm recording with you and getting taxed right now. Hey, somebody put a post up. We think it has to come down. And can you take a look at it? Like it's a nonstop thing? Right. So I don't think I should be wealthy over it. I'm not saying that. But I am like, it needs to be covered financially, because I have bills and children in the home and stuff like that. Absolutely. And

"Laura" 58:17
I have to tell you, thank you, to you. We went to pediatric endocrinologist Monday, and our 10 year old agency was 5.4. And we could not have even come close to doing that without your help. Oh, that's lovely. And all the knowledge you provide us.

Scott Benner 58:33
So nice to have you. I appreciate you saying that. And congratulations. And oh my

"Laura" 58:36
god, that's the funny story in my house is my younger ones always like I just don't want to be like him because he knows that the older ones fairly non compliant. And he's like, I don't want to end up like him. Why? Why is he being so stupid? Why does he do that slide. And he's like, Mommy, I'm not moving out until I'm 25. And I'm only going to move out when I have a responsible wife and like the other because he sees what the other one's going through and how his girlfriend is like, you're on insulin. Oh, well, maybe you should call your mom. Not like Hey, buddy, you're gonna be out of insulin in three days. Call your mom.

Scott Benner 59:12
Why don't we do something? Your your I like your young sons, like I need a lady to tell me what to do, or I'm gonna be in trouble. That's some clear thinking. I'm in trouble with that a lady telling me what to do. I'm being perfectly honest. So

"Laura" 59:26
I'm being very honest about that. He's always like, we were joking about boarding school. Cuz, you know, it was a joke. And he was like, Mommy, I can't go I don't have you to manage my diabetes. And I'm like, buddy, I'm trying to teach you because like, I know you are but like, I can't do it without you. Yeah,

Scott Benner 59:43
well, and the point is, is like your point is when people are living like that. Can you imagine that? Even if I were to say like, Hey, look, I have the answer for you, but it's gonna cost you $250 a year. And you know, and I people would go no, thank you. And so from me being focused on helping people Oh, I can't put a paywall between the information. Like it just won't work. Right?

"Laura" 1:00:06
I consciously couldn't do it. Like,

Scott Benner 1:00:08
I mean, I my conscience, but I mean, you heard me with the debt. Yeah, I'm not good. I couldn't do it. Like if I if I was reaching in my pocket to buy a sandwich, and I thought I was pulling $10 out that someone gave me to learn how to Pre-Bolus I would probably vomit. So yeah, I'm not the right person for that job. But it's interesting that you made it into this kind of work, but you're the person you are. So did you, like you said, you started out really young? I'm assuming in the beginning, you didn't know what you're getting into. And then once you're into it, you're like, Well, this is how I make my living. I'm good at it, whatever. Like, I can't just leave here. And and then that's kind of how that how can I ask this? If you have a group of employees that are all doing the same thing as you, do you think if we got them all together, most of them would say, I do the thing, and I feel bad about it.

"Laura" 1:00:59
I think you probably have 5050, I've, I've run across so many HR professionals in my career, and some of them are like, I hate my job, but I'm really good at it. And it been funny, so I do it. And then you have the other half that are like, Oh, I don't care.

Scott Benner 1:01:18
You know, whatever little dangus cons, they would have been like, five, 6000 years ago, they would have been like, Whatever, let's just Yeah, that's fine. Listen, I also don't, I don't That doesn't surprise me either. That people's you know, sensibilities are different. I was just wondering how many people are like downtrodden in these jobs? And, you know, so here's my I'm gonna let you go. Right, unless there's something we haven't said. But I have a last question for you. Of course,

"Laura" 1:01:43
is there a fix in this that serves the company and the employee? Or Is there really no winning? The fix, honestly, is honest conversations, finding out what your employee base needs. But people are too scared to talk about it from both sides, not just from the employee side, but management is also scared to talk about it. So I think that that's the biggest thing is going to be lots of honest conversations, aside from the fact like, the whole system just needs an overhaul like, why am I filling out a PA, diabetes didn't go away? Like, you know, I still have it. I've had it, you know, for three years now, like, Stop making me fill out the same paperwork, but they're gonna keep doing like, that's just stupid. Yeah, like, they're gonna keep doing it until someone says something like,

Scott Benner 1:02:31
at the beginning of the year, when like, your district, your distributor goes like, well, we have to get, you know, a letter from your doctor that says you have diabetes, and like, my daughter's had diabetes for 15 years that didn't go it didn't like, What are you talking about? How it's done? Like, oh, okay, and they don't know, either you have them on? And they go? Yeah, I don't know. It's what it is, we have an entire world, that if, if you every stop for five minutes, looked at each other, and we're honest, everyone would go, I don't know why it's like this. It shouldn't be like this. But yet it is. And it perpetuates itself, and keeps everybody going. And they're, you know, there's an argument that it's just that society gives people things to do, because people need things to do, or they'll become either lazy or aggressive. So you just you build these, like, bullshit tasks into people's lives to keep them focused.

"Laura" 1:03:19
Yeah. And I mean, I have to say, like, I pride myself on I am, obviously my best interest are with the company, right? But like, I am a very empathetic person. So I always and I did a lot of project work, consulting. Once I got, like, good at my job. And I would always sit down employees, and be like, Okay, listen, let's have an honest conversation. And some of them were extremely honest with you, because they were like, Oh, my God, no one's ever talked to me about this before. And I'm like, What can we do to make it better for you know, blah, blah, blah, other employees that were like, it's fine, let's just keep it the way it is. I'm gonna go back now. And I'm like, okay, so you're you get that. But you also have to take that information up the chain, and you're looking in the white of a CEOs eyes and being like, look, the people think you're a complete douchebag fix it. Like, you know, you're you're just money hungry. You're you're not a lot like this is how they're seeing you. And so it's having lots of honest conversations, but people are scared. I've never been scared. I don't get scared about people. Hence why. I've done OCR, and I've talked, I've done all the things I've done, but it takes a lot to do that. And I I like to bridge that gap, but it also takes a mental toll on the person doing it. And that goes unnoticed, right 100% of the time.

Scott Benner 1:04:45
And this this why all this what we're talking about. This is why small companies can't even afford to offer people health insurance. Yeah, yeah. Because if they go full pay, it's probably crazy expensive because the insurance company is not making enough of a VIG off of it because there's not enough P People, and if they go self pay and one person gets sick, they're out of business. Right? Gotcha. Yep. Okay. Well, everyone jumped out a window.

"Laura" 1:05:12
I told my husband every day, I'm like, I don't care how much you don't like your job, you're never leaving it like you have anything. This is

Scott Benner 1:05:18
what's happening. I have to say my wife's benefits are terrific. And they are it is, it is the thing we passed on to our kids. As far as I've said to them, Look, you want to work for a large cash rich organization? That's your best bet at getting decent health care? I mean, am I wrong about that? No,

"Laura" 1:05:39
I don't think you're wrong about it. I would say I don't know that being cash rich as a company is like, it's a priority. But I don't think it's the biggest priority, just because

Scott Benner 1:05:48
they might just choose to keep more of that money for themselves and not spread it around. Or

"Laura" 1:05:52
they could be, you know, executives have integrity and be like, Look, we need to do this to get work a good working population, because the reality is, from what I've experienced in my career and talking to others, your highest performing employees always have some sort of health situation going on. So they're going to be expensive, but they're also going to save you your you know,

Scott Benner 1:06:18
they're going to cost you but they're also going to make you a lot more money. hardworking people are killing themselves faster. Yep. Yeah. That's, that's a joke about my wife's job that we have between us. And like, they pay you a little more because they know they're killing you. And they're trying to keep you here doing it. And the only way they can figure out to do it is to incentivize you like that. Yeah.

"Laura" 1:06:38
So I think that, you know, the reality is, there are some companies that realize that, but like, realize, hey, we've got to take care of these employees if we want them. If not, we're gonna settle for mediocrity, and we're gonna get what we get. So you either pay for health insurance, or you don't. And that's a gamble, too. Yeah,

Scott Benner 1:06:57
about that. Isn't that interesting? It's all very, it's all incredibly interesting.

"Laura" 1:07:01
I can tell you by name, every single one of my high performing employees I ever worked with, and I can tell you also by name exactly. Every one of the medications they took for every single one of their diagnosis.

Scott Benner 1:07:13
Wow. Well, that's, again, not surprising, but interesting to hear you say it out loud. I really appreciate you coming on and doing this. And let me call you, Laura. Of course.

"Laura" 1:07:24
I'm happy to be here.

Scott Benner 1:07:25
I'm gonna ask a question. Now, you told a story earlier about an accident. You think that that story has too many details? And do you think people would be able to tell who you are from that?

"Laura" 1:07:36
Now? Well, that. I mean, at the end of the day, that company doesn't exist anymore. They were bought out. That was the final thing I did. Okay. All right. Well, we can pretty much notice and I was like Carol put the package together. And then I'm out. I'm doing this

Scott Benner 1:07:49
last thing and then I'll go and by the way, you did take the bonus, which I would have as well. I just it's interesting. Oh, of course, but it's a thing we don't even talk about, like you had to do a distasteful difficult thing. And the way they did it was their like your take some extra money, like Sorry about this. Like that was really it. Like, thanks for going in there and cleaning out that sewer. Here's an extra couple dollars. Yep. Everything's money. Yep. Okay. All right. I'm gonna go, I'm just gonna go sit, and I'm gonna weep in a corner, and then I'll put my keyboard. Oh, my God, do you think everyone's scared now listening? They're like, Oh, my God, I know, it's not enough to just get a job with insurance. I have to pretend I'm not sick, or they'll boot me out eventually.

"Laura" 1:08:33
I mean, well, that's why there are laws that say you don't disclose this. You don't have to. I mean, you know, of course, everyone has a personal choice to make. But there are laws for your protection for a reason. And I highly encourage everyone to do their research before they go interview.

Scott Benner 1:08:54
And if you get if you get fired for some tic tac, little bolts reason, tell them right away, you're getting an attorney, right?

"Laura" 1:09:01
Yeah, don't do anything else don't. Like, in my positions, I always had to sign an NDA when I was coming and going, or, you know, signing different documents. And I have learned, yeah, don't do that. Because then I gave up my right to, you know, sue for sexual harassment, or I gave up my right for whatever, my sign of the NDA,

Scott Benner 1:09:23
you give up your rights.

"Laura" 1:09:26
Yeah. But again, that was also almost always in exchange for money. He was here, we'll give you $10,000 But we need you to sign this. And it's like, and of course, when I was younger, I did it. But now I'm like, oh, no, no, because your $10,000 is pocket change compared to what I'm gonna get from you. If

Scott Benner 1:09:47
you guys break these when they turn you in. Yeah. Wow. I can't believe the whole world like works like this. I'm gonna get a small cabin near a running Creek and give up. If you're all lucky, I'll get a good dinner. connection and keep making the podcast but I'm getting out of this. Like that's it. You know, I'll leave you with this. My neighbor's, like I told you like 1520 years older than me. And I was talking to him recently. And he just looked at me super seriously. And he said, Scott, I don't know how much money you think you need to get through the rest of your life, but get it together as fast as you can and stop working. It's my best advice. And I was like, Okay, thanks. Goes to Christmas future. Like, like, sad Ghost of Christmas Future. He's just like, I have medical problems now. And all the things I thought I was going to do I can't even do when I did save the money, but it took me longer than I thought I was going to. And he starts laughing. He goes, your generation is going to need way more money to live than my generation. Did he laughing and I'm like, Oh my god. Okay, I'll quit now. He's like, Oh, you can't quit now. You're gonna save up money first. And it was like, but you don't think I'll be able to save it up? And he goes, Yeah, probably not. And I was like, so I just worked till the end. And then he goes down and your feet hurt and you die. And I went, okay. Alright, thanks. I was like, again, everybody with the good news? You know, Damien was like, All right, Laura, thank you very much. Hold on for me for a

"Laura" 1:11:07
second. Sure.

Scott Benner 1:11:14
Like to thank Laura for coming on the show today and sharing her knowledge about the human resources and insurance processes and the back room things that we don't see. 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/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 enjoying the cold wind podcast, please share it with someone who you think might also enjoy it. And if you know a health care professional, who would be a great guest on the podcast, please share it with them as well. 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.

#1102 Grand Rounds: Diagnosing Diabetes

The second Grand Rounds discussion focuses on what happens when you're diagnosed with diabetes by your regular doctor. We explore the common symptoms that could be misinterpreted, the misinformation surrounding diabetes, and how doctors' egos can sometimes play a role in the diagnostic process.

+ Click for EPISODE TRANSCRIPT

Scott Benner 0:00
Hello friends, welcome to episode 1102 of the Juicebox Podcast

Welcome back everybody today Jenny and I are going to do another grand rounds episode we're going to talk about being diagnosed with your regular old doctor. We'll talk about symptoms that could easily be misdiagnosed. misinformation about diabetes, and a little bit about doctors egos. 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. Don't forget to save 40% off of your entire order at cozy earth.com. All you have to do is use the offer code juice box at checkout that's juice box at checkout to save 40% at cosy earth.com. 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. If you're a physician listening to this and you'd like to make a rebuttal or add to the conversation, you can find me at juicebox podcast.com and send me an email I'd love to have you on the show

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. This episode of The Juicebox Podcast is sponsored by the continuous glucose monitor that my daughter wears the Dexcom G seven dexcom.com/juice box Get started today using this link. And you'll not only be doing something great for yourself, you'll be supporting the Juicebox Podcast. This show is sponsored today by the glucagon that my daughter carries. G voc hypo Penn. Find out more at G voc glucagon.com. Forward slash juicebox. Jenny, welcome back to the Grand Rounds series. Yeah, are you?

Jennifer Smith, CDE 2:31
I'm fine. Oh, so

Scott Benner 2:34
far, so good. Today, we did our opening intro episode, we've done emergent care. So if you're diagnosed and in such trouble that you're in urgent care and emergency rooms, something like that. But today we're going to talk about, you know, what might happen if you have symptoms that come on and you end up in your regular doctor's office, nothing that makes you go to the hospital, but still lands you in medical attention. So yes, yeah, well,

Jennifer Smith, CDE 3:04
that's an interesting place to kind of start to because most people who have some symptoms that are concerning, are typically going to call their primary care. Yeah. Right. And or talk to the intake nurse or whoever. And depending on what you say, when you call, you may or may not get in today, tomorrow or a week, right from now. So I think it's important to think about how you present the symptoms and the fact that, you know, these are very irregular, this isn't what normally happens to you or your child or you know, the person that you're caring for. And to be really specific in what you say in that call. Because again, it may be a more emergent type of setting. And in those cases, I think what I've mostly seen is that parents especially they don't wait, they just off to the emergency room, you go call

Scott Benner 4:08
this go kid seems sick. I don't want to make another one. Let's do this. Now. I think this is an interesting conversation, because if you have it specifically from the perspective of people who have diabetes, or have been through this, they'll tell you things like I don't understand why doctors offices just don't do a finger stick when you present with the symptoms. And and that's because you know, that's why you think that right? Like I'm not saying if we couldn't snap our fingers and have everybody who had flu like symptoms, get a finger stick, that wouldn't be a great thing. It would I'm sure it would catch a lot of issues. But doctors offices until they see it happen, aren't going to think that way. You know, the problem could be you call your doctor and say I feel rundown. Right? I'm losing weight. Like you're describing how Bringing the flu, and then they'd be right and but who you're talking to, you're talking to the person at the desk at the doctor's office who maybe as a medical assistant, probably, maybe not, maybe you're lucky to get to a nurse, and you start describing flu like symptoms during flu season. And they're gonna say, you've got the flu, because in medicine, and you're trained, so this is just something I know colloquially. But if it walks like a duck, and it quacks like a duck, it's not a lot of reason to think it's a tiger. And so, you know, I think that's how that works. Also, if you know, physicians, especially like general practitioner, people, you'll know that they see themselves more as sometimes just reflecting what's going on in the community, if you come in with symptoms that people have been coming in with for two weeks. That's where the assumption gets made. So it's not it's not even anyone's fault. Honestly, that it gets missed,

Jennifer Smith, CDE 5:55
especially seasonally, and or, you know, we've just had now a month ish, or maybe a little bit more, depending on where you live, of school starting. And so the influx of kids coming in or being called about, you know, my child was sent home from school with such and such, or, I've noticed this, you know, in Frankie, because, you know, this wasn't normal, but school just started. So there's a lot of consideration that's like gray area, when you present with symptoms that they do need a good evaluation, but how it gets evaluated? Is the question.

Scott Benner 6:32
I think that it's important if you're the doctor to hear this. I know. I mean, what what is the number Jenny? How many Americans have type one diabetes? Is it like getting close to 2 million now or something like 1.8 or something? Look up

Jennifer Smith, CDE 6:47
this, I think it was about a year ago that I looked, I usually look in January, when more statistical kinds of things

Scott Benner 6:53
might point out. There's a lot more people than that. And so you're already being diagnosed with something that I think would be considered rare, right? I mean, type one diabetes is considered rare, isn't it?

Jennifer Smith, CDE 7:03
I think when you consider the or compare to type two diabetes, type one is the lesser right. Yeah.

Scott Benner 7:12
Well, I mean, I kind of mean, compared to everything else. They're seeing, like more than that, like quacks like a duck situation again, sure, like colds,

Jennifer Smith, CDE 7:20
you're going to have many more colds coming in than a child who comes in or an adult or anybody who comes in with symptoms, then oh, gosh, this must be type one. So yes, it's, it's more you're looking for something that's more frequently seen. Yeah, then looking for something that I guess rare would be the right word in this context to use

Scott Benner 7:41
Mayo Clinic. This year, it's estimated that about 1.2 5 million Americans live with type one diabetes. So you know, I'm just gonna do a real quick how many Americans are there? Yeah, there's 340 million. So that's not a lot. Can if that makes that makes it rare. And so I guess my point is, is that if this is the first time for you, as a doctor seeing this, I can see it getting right past you. What I don't understand is after you've seen it once, or twice, why we don't adjust why you could miss it. Yeah, yeah. Like, let's start like remembering what what happened learn from learn from the past. Because here's something is from a listener, right? I wish our regular pediatrician would have known that it was okay to just do some blood work. So the pediatrician was so scared to just draw blood because they thought it was going to scare the kid sure that they just kept throwing different medications and different things that the kid try this do that. And meanwhile, further and further into DKA. Sure. I think that what to me, what that points out, is that you can't allow yourself to be dismissed. And on the physician side, dismissing people, I think is, is dangerous, like, you know, like it, you have to assume that people know what's going on with them better than you do, even if they're not,

Jennifer Smith, CDE 9:06
even if they can't give you a diagnosis that you can't they can't name a diet diagnosis, right? They know what they've been seeing or feeling or they know that, you know, little Johnny has looked and acted this way for the past eight years, and is no longer doing that, right. Things have changed, doesn't want to play is now wetting the bed again, and wasn't before all of these things. Are there red lights in our world of knowledgeable like diabetes, because we've been living with it. But for the newbie, again, and or the new Doctor Who, like you said, maybe it's somebody who's fresh into their first job, you know, in a pediatric office or in a general practice or whatever. And then it might look rare. Yeah.

Scott Benner 9:53
So yeah, it happens to adults just the same way it happens to kids, by the way, and so there's this balance if you're the physician, and I can See where it would be difficult? I need to listen to what they're saying. But what if what they're saying doesn't make any sense at all? If I said I've been urinating a lot, right? That would be me indicating that I think I'm urinating more than I normally do. Correct. But But if the doctor says, Hey, how much do you urinate? And they tell you a number that seems high to you, but it's not high to them. You have to push back and say, That doesn't seem right. We should look into that. Like there's a balancing act within every question. Dexcom g7 offers an easier way to manage diabetes without finger sticks. It is a simple CGM system that delivers real time glucose numbers to your smartphone, your smartwatch. And it effortlessly allows you to see your glucose levels and where they're headed. My daughter is wearing a Dexcom g7 Right now, and I can't recommend it enough. Whether you have commercial insurance, Medicare coverage, or no CGM coverage at all Dexcom can help you go to my link dexcom.com/juicebox. And look for that button that says Get a free benefits check. That'll get you going with Dexcom. When you're there, check out the Dexcom clarity app, where the follow Did you know that people can follow your Dexcom up to 10 people can follow you. Right now I'm following my daughter, but my wife is also following her. Her roommates at school are following her. So I guess Arden is being followed right now by five people who are concerned for her health and welfare. And you can do the same thing. School Nurses, your neighbor, people in your family, everyone can have access to that information, if you want them to have it. Or if you're an adult, and you don't want anyone to know, you don't have to share with anybody, it's completely up to you. dexcom.com/juice box links in the show notes links at juicebox podcast.com. And when you use my link to learn about Dexcom you're supporting the podcast. Because there's, there's what's going on, there's what the person believes is going on, it's what they don't understand is going on, uh, you know, it's there's a lot happening, and it's your job to dig through it. But the real concern here is emergent, really, if you don't figure it out quickly enough. Now we're DKA. Correct. And that puts you down a different path. Right? You know, like, again, I've spoken to so many people, people who catch something early, where they're just like, I don't know, if something didn't seem right, I went to the doctor, and he was a great doctor, and he figured it out. And I went home and I didn't have to go to the hospital. That whole path changes their life. And I know that's hard to imagine, but it really does.

Jennifer Smith, CDE 12:37
And it makes it I mean, what you're kind of alluding to is a very emergent scary scenario of diagnosis, versus a scenario of, hey, I had these symptoms, it seems kind of weird, I'm feeling kind of off but not like terrible at this point. Again, at that point, your ability to provide a little bit more in depth, searching for them. And in depth asking of what what they feel like has changed. Again, this is where addressing the person as a person, not just as a case to evaluate becomes really important. Because as you said, if you're going to the bathroom a lot, you have to say, this is really a lot for me. Like I don't I don't get up overnight. I don't you know, have to get up in between meetings at work. I you know, all these things are very different from the clinical side, then they have to, they have to remember to take that the step further and say, Well, you know what, I don't know. But we could easily do this test this test in this test. And I think that's where when people say things who are already in the group of people who have diabetes, they say, Well, why didn't they just do? Why didn't they just do this? And you the new person is like, I don't know what to ask for? Clearly, I'm coming to the doctor, they should know what to do for me. Why didn't they do it? Yeah. And, again, that's where from the clinical standpoint, I think, in general, there maybe need to be some guidelines that are changed a bit. That's, you know,

Scott Benner 14:11
I don't know what that's supposed to be. But I think that from practice, to practice and doctor to doctor, you should be able to figure it out on your own. You know, like, have a meeting, sit down and say, hey, the last couple of times we've diagnosed a person with type one, it's not gone well, and here's why and right, you know, what could we have done? So many people get sent home with insulin, and told to go find an endocrinologist. But now they have this insulin, they don't know how to use it. And it's, they're scared of it. And then the doctor will say something like, you know, listen, high blood sugars are the leading cause of blah, blah, blah. So now you're you've just been diagnosed with something, someone who says something very scary to you. Then they've given you insulin. If you're lucky. They've told you the insulin is dangerous. Some of them don't do that. I don't know if it's because they don't know or they don't want to scare You, but now you've given them these competing problems. Insulin makes your blood sugar low, and could kill you right now. And high blood sugar is gonna kill you later. And then you get sent home with that paradox. And what are you supposed to do with that with no knowledge? It's, you know, it's, if you're doing that to somebody, that's terrible. And it happens, every single I think it happens every hour of every day, from the people I talked to. And this woman asks me, how did my general practitioner not see how upsetting it was to tell me for 15 minutes? How bad high blood sugars are for me, and then they handed me insulin and said, keep your blood sugar high until you can see an endo. Right? Yeah, right. I mean, what, what is she supposed to do with that? Exactly, except go home and be out of her mind word.

Jennifer Smith, CDE 15:49
Right? Yeah. And Or try to. And hopefully, the goal is with a diagnosis that you do get a new, essentially, kind of introduction, kind of a nice handoff, if you will, to the knowledgeable clinician, who will be your next go to in the dive into the education. But, again, a very good baseline of each and every practitioner, who is just a general medicine practitioner, should have the same guideline of if these symptoms, you know, are presented to you. And I mean, the symptoms aren't weird symptoms, no peeing a lot, you're losing weight, you can't get enough to drink. I mean, those I mean, as classic symptoms, the grand majority of people who come in complaining of something, those are going to be the top three, I think, classic symptoms. So you would think that in learning about all the different types of disorders or you know, diseases in the body in general school, you would think that he would remember some of that and be like, Oh, well, an easy thing that we could do is, we could do you know, a urinalysis, you can look for glucose, we could look for all these things, we can look for ketones, we could also do a finger stick. Those are some pretty simple things that should be I think, on a broader scale of this, they should be something that is done when you present with symptoms that could possibly be diabetes. And if you

Scott Benner 17:28
don't, if I think is a regular practitioner, if you if you're not aware of this, could you not reach out to a local organization, hospital endocrinologist and say, Look, we'd like to have, you know, a checklist for ourselves. Yes, could you help us put that together, and we'd like to have something to send people home with because we know it can be difficult to get an end dose appointment, like just some learning materials that they could go home with or a link that we could actually, it makes more sense than handing them a learning material, you should hand them a link, you know, whatever your practice name is slash type one, and that you could actually keep updated and you know, turn it into a resource for them and explain the questions that they're obviously going to have in the beginning. Because all this all this does, by the way, is you send people to the internet, and then it's luck of the draw if they find good or bad information, correct. And then you yell at them later for getting their information from the internet so you don't help them they go to the internet, then you tell them you know you're not a doctor. You shouldn't be on that line. Well who was going to help me if you take insulin or sulfonylureas you are at risk for your blood sugar going too low. You need a safety net when it matters most. Be ready with G voc hypo pen. My daughter carries G voc hypo pen everywhere she goes because it's a ready to use rescue pen for treating very low blood sugar and people with diabetes ages two and above that I trust. Low blood sugar emergencies can happen unexpectedly and they demand quick action. Luckily, G vo Capo pen can be administered in two simple steps even by yourself in certain situations. Show those around you where you store G vo Capo pen and how to use it. They need to know how to use G vo Capo pen before an emergency situation happens. Learn more about why G vo Capo pen is in Ardens diabetes toolkit at G voc glucagon.com/juicebox. G voc shouldn't be used if you have a tumor in the gland on the top of your kidneys caught a pheochromocytoma. Or if you have a tumor in your pancreas called an insulinoma visit G voc glucagon.com/risk For safety information.

Jennifer Smith, CDE 19:42
You sent me home with this information about and or maybe they even as especially as an adult maybe got sent home without any insulin right because the doctor wasn't sure. And while the test results were more conclusive towards this being diabetic. Eat is the idea that they could get in the next day with someone who could educate them. And give them a little bit more. I mean, I've seen so many different diagnosis stories go so many different ways. Yeah,

Scott Benner 20:14
no, but isn't there, there has to be a fairly centralized way to keep most people from being in a bad situation, we're not going to stop everybody from having a problem, right? But it can't be that crazy of a problem. I feel like if I put you in I and a couple of other people in a room for four hours, we could come up with that list, and a way to implement it, it just it. But I can't do that for you. And if we sat here and did it, by the way, you wouldn't listen to it, you'd be like I heard on a podcast ridiculous. But you know, you have to go do that yourself. Because, again, the problem you're not seeing as the practitioner is the thing that only people like Jenny and I and people have lived through it can see that there are these multitude of paths that you can lead people down. And I'm not kidding, you can destroy their lives, like psychologically, medically, with their relationships with their, like their mental health, it's not an overblown thing to say that what happens to them in the beginning, goes a long way into how they live their life after that, and you're, you're the ground zero for this, you know,

Jennifer Smith, CDE 21:21
depending on who they get connected with, after their visit with you, after their diagnosis with you. It could completely turn around if they find somebody who is really good in is a great educator or has a great, you know, diabetes practice, and they get in sooner than later to clear up. I don't want to say it's misinformation, I think it's misguided information about what to do. And I think, as you said before, the initial diagnosis in a general practice is going to be to some degree, it seems often to be fear based. Right? It's, well, this is your diagnosis, this is what we've figured out. These are why you're having these symptoms, and you're going to have to start injecting insulin, and insulin is going to do this. And if you don't take it, your blood sugars are going to be high, like you said, or if you do take it, you have to be concerned that you don't take too much, or you're going to end up with low blood sugars. And they may or may not tell you about symptoms, honestly, yeah. Right. They may or may not tell you what you might feel like when that happens. There's a cascade effect from that initial diagnosis. And you can send somebody home in just a whirl of,

Scott Benner 22:42
there's a difference between throwing me in a giant, never ending warehouse with no lights on and telling me the answers in here somewhere. And giving me a flashlight. Like, I'm not telling you, you have to show me exactly where it is. I'm saying, you know, say the rest of the sentence, which is a phrase, I think about all the time, like don't just say, hey, low blood sugars are dangerous, like keep talking, complete it, why are they dangerous? In what scenarios might I find myself in this situation. And if you as the practitioner, don't know the answers to the rest of the sentence, you need to educate yourself. Because that's just you don't know enough to give this information to somebody, you know, you were just talking about, like a low blood sugar. And I think about all the time, how many people are probably told, for instance, chickens free, like there's no carbs in it chickens free, right? But protein gets broken down it gets, it gets stored as glucose that can make your blood sugar rise, sometimes 90 minutes after your meal. In the beginning, these people are probably honeymooning, it's probably not that much of an impact. It's possible that you don't have their insulin right. And so you're not noticing it because their Basal is too strong or something like that. Or by the way, you don't have their insulin too strong. You have a two week and they're seeing these weird spikes all over the place. And then you start turning knobs, you don't know what the hell you're doing. And that right there. That's it. That's the beginning of the end. Like once you start chasing blood sugars around it, you don't know why the variables do what they do. When that happens, you are on an hour, day, week, month, year, lifetime long struggle. And that's it

Jennifer Smith, CDE 24:22
from the practitioner standpoint. If that's the road of navigation that you're leading people with, they will be the ones who are always tied to coming in and asking you to make the adjustments. Right. And if you don't know as you said, if you don't know the knobs to turn or which one to turn to impact what you see happening, nor do you likely know how to interpret the data. That should teach you how to turn the knobs one way or another. Then they are there seeing your adjustments. One way or or another, and those adjustments are likely not teaching them the right things to do when they go home. Because while their visits with you might be every three months, four months, every six months or whatnot, in between that person at home has diabetes every second of every single day. And they need to know how to turn the knobs. So if you're turning them one way, and adjusting in a way, that's not good for them to learn, then it's gonna get more fuddled up in between, as they think that they will, I can adjust it that that I saw the doctor do this, yeah, I should try to adjust it this way. Or I saw the doctor do this or told me to that it looks like this is what we need to do. So in between those visits, where they may not be connecting with you via you know, electronic record or even via phone, they may try, I will tell you firsthand that people with diabetes, want to try to navigate? Well, they want to try to do the best. And if the best is the knowledge that you've given them, and it may not be 100%. Correct, then you can expect their management to be I

Scott Benner 26:18
mean, in honesty, kind of your whole like career is getting people after they've been funneled up, which I've never heard, but let's just keep going. I like that. I love it. I'm going with I'm using it again. And so you see this every day? And and be honest, how busy are you? I am very busy. If there were 10 of you, would you still be this busy?

Jennifer Smith, CDE 26:40
If there were 10 of me, I would still be this busy. I mean, our office has a number of clinicians who all have the knowledge base that I do. And we are all very busy. So

Scott Benner 26:51
yeah, my point is, is that too many people get put on the wrong path. Correct. And the people who are reaching you or are, you know, more upwardly mobile people that can that can afford this, like, can even afford the time to sit down and think I don't know what I'm doing. I gotta go find somebody who knows what I'm doing. You know, I gotta not worry if it's an insurance thing. Now I'm I know I'm in I'm in real trouble. Everyone's in that situation. The minute they're diagnosed with diabetes? Yes, they just are. I don't know how often I say it. I was so bad at taking care of my daughter. In the beginning. I didn't know what I was doing. All I had and we went to a and I hate saying this. But we went to a prominent Children's Hospital in the East Coast, that I think most people would say this is amazing. And again, it was it was 18. I don't know how long it was, like 15 years ago, I guess. But it was before all this technology and everything. But it doesn't seem to matter now, because the technology is here. And still nobody tells anybody how to use anything. Right? And I can't tell if it's because you don't know, where you don't want to be involved. Like, like, I can't figure out what it is like, is it liability? Or is it you just don't understand.

Jennifer Smith, CDE 28:01
So what was it from your, from your perspective of diagnosis again, being years ago? And yes, things are very, they're very different technology wise right now. But when Arden was diagnosed, what was the difference between that initial diagnostic information that you are given? And how soon after, were you handed off to a team that up to the level of understanding so that you felt like you could take her home and at least have an idea?

Scott Benner 28:32
I mean, keeping in mind that Arden was two and right? We were young girls. I mean we were given syringes and insulin vials and a freestyle meter and test strips. And they taught us how to do the math for insulin to carb ratio for MDI. And that was it.

Jennifer Smith, CDE 28:54
And that was with though a specialist right, that was with a peds Endo? Yeah, we

Scott Benner 28:59
were on vacation. And we were lucky enough to find a children's hospital on vacation that had a dedicated peds, endo diabetes wing, like a real another great place that as far as you know, people would say, I didn't know what I was doing at all. Like, like not at all. I mean, I think Arden had a seizure in the first six months, because we counted the carbs and gave her the insulin. And it was a slower, it was a slower digesting, like like food. So the blood sugar the the insulin meter really low. There was an initial spike, but the initial spike went away. It was like simple sugar and then I'll hit later with a with a different glycemic impact. And she, you know, we got her out of it with glucose gel, but looking back on the person I was then I did not know what happened. Right? I had no idea what happened. I thought, Oh, my daughter's gonna have seizures all her whole life. Like this is the way that it goes. This is what this is right? and you go to the doctor doesn't say anything. No, listen, I'm just going to be honest with you. I have figured this out myself, right? That's why the podcast is so colloquial a blue collar or like simplistic, because I don't have any big words for the things I learned. Like no one told me about, like, no one ever said glycemic index to me. And if they did, I was like, that seems like too much. And I didn't listen. Right? Like, it's like, that's a lot of words. What I need you to tell me is that some foods hit harder than other foods and some foods that quicker than other foods like that, I would have been able to wrap my head around, right? Yeah, honestly, it was depressing, and scary, and overwhelming. And I started to write a blog about it. And I got to the point where I thought, Oh, I'm just writing what everyone else is writing. And so because there were a lot of diabetes blogs back in the day, like 1000s of them, and I thought, I'm wasting my time saying what everybody else is saying. And then I thought, I'm just going to, like, dig deeper into this. And I started off by asking, Arden CDE, I know I've said this before, but here I asked her, I said, if I give you a magic wand, what would you make people with diabetes do if you can make them do one thing. And she said, I'd make them not be afraid of insulin. And at the time, I didn't think what I'm thinking now, which is, oh, well, you probably should have explained it to them then. And maybe they wouldn't be so afraid of it. But I took her thought that she sees a lot of people afraid of insulin. And I just started doing the work on that. And I dug through that made myself not afraid of insulin, it took me a year of like writing about it and talking to people about it and having conversations with people. And then I think the next thing that happened was Dexcom became available. And that opened up my understanding of what was happening. And then I was able to sort of apply my feelings, that information. And then we started having good experiences. And I'm like, Oh, this worked. And then I just started chasing things that worked. Yeah. And then you'd go back to the doctor, and her agency would be coming down. And they'd say, What are you doing? Is she having a lot of lows? And I'm like, wait, what, that's when I realized they expected her a one C to be eight. And that it was now seven, going into the sixes. They thought I was crashing her blood sugar all over the place, because they can't even imagine that someone could manage a blood sugar in the sexes. Sure. That was 15 years ago, right? You know, like so. And I understand how old thoughts impact now. But now it's not then anymore,

Jennifer Smith, CDE 32:37
right? Because we have the amount of technology that we have, right? We should aim for better. And we should teach, we should be able to teach people that better is possible in a safe way, right? And we're not aiming for blood sugars to sit at 60 all the time, just to enable a blood sugar and an average that looks you know, like you're in the range of those without diabetes. I think you're right about the old school thought still really being a piece of it. I mean, if you being who you are now, and looking back on who you were without the knowledge level that you had,

Scott Benner 33:17
what did I need? Right? What

Jennifer Smith, CDE 33:20
did you need? What did the doctors like? If I Was Your clinician? At that point? What would you have been like, Hey, I don't get this, or what should I have told you that would have made you I mean, and also what if you hadn't been on vacation? Great that you had access to a facility that actually had good people who were trying to give you more information? But what if not, I mean, what if you would have just been sent home with? Right? Yeah.

Scott Benner 33:47
Oh, please, I don't know that I would have been that much different. Also, the internet wasn't really a thing, then. No, the way it is now. We have the ability to communicate better now. True, and to get information to people quickly, digest doubly. I mean, listen, if they handed it was that pink panther book? Is that what that was? I

Jennifer Smith, CDE 34:05
have one, I still have mine. Sure. I

Scott Benner 34:07
think we just think we just are hours away. So I get if I'm a doctor, I hand somebody this big book. My first thought is they're not going to read this. And you know, like so then you can easily write them off. Well, they don't want to take responsibility for their care. I mean, come on, no one wants to read that stupid book. Like it. Just it. I get that that's what there was back then. But it's not like that now, and we still treat people like it is like that's the thing I never understand.

Jennifer Smith, CDE 34:36
And I think there's something important in there to remember, if you are the clinician, what, what you say? And even just the base diagnosis, you have type one diabetes, right? The good majority of people as I hear so many times when I talk to somebody who's new, is right away upon diagnosis. The caregiver or they themselves are online right away. What is this? What's type one diabetes, and you're brought into this gigantic room of information with so many different files that you could pull to get the information from. So as as the clinical person diagnosing, I think it's really important to provide some good guidelines of the right places for education, because people will search online. Dr. Google is

Scott Benner 35:33
Yeah, so really how it works. Now, also, I will tell you this. I've given a lot of thought to this. You can't dumb things down. No, you can communicate them in a way that a lot of people can understand. But you can't dumb things down. Everyone deserves the knowledge. Right? Correct. You shouldn't assess someone because if you would have assessed me on the first day, I was crying in Arden's room, while they were trying to teach me how to do the math for her insulin to carb ratio. Like I was like, it hit me all at once. Oh, I'm a stay at home dad. My wife is gonna go back to work this two year old kid. Oh, my God, this is me. I'm in charge. Overwhelming, right? Yeah. So I cried. The nurse left because Kelly said, I think maybe he needs a minute. They never came back and tried to teach it to me again. I guarantee you, they wrote me off. They're like, alright, that one doesn't get it. It was probably that simple. You can't write people off, you have to give them the information enough that at least it sparks their mind later when they aren't crying. And they can think a little bit that this person here says I wish they didn't dumb things down. I need support, you should show me where there's community around this. I'd like a brief explanation of type one diabetes, it was very overwhelming. It sent me home to watch video after video and I got drugged down a rabbit hole. Right? I needed Quickstart information. That I think is the big deal. Right? I wish they would have told us. So there's this phrase that gets used in the podcast? I don't know if I say it as much anymore. But I refer to what a lot of doctors do is they give you don't die advice. It's enough. You know what I mean? Yeah, it's enough that you won't die, but you're not necessarily going to live healthy with it. Right.

Jennifer Smith, CDE 37:09
And that's more general to it is it's more, I'm going to send you home with this. It is it's it's don't die advice. It's take this do this at this time, and then connect with this person, because they're going to they're going to dig into this for you. But again, when that ends up happening, or between that happening, and seeing somebody who can really help you understand. And at a time when you're not crying anymore about this, yeah. In between that time, you're not. You're not sitting at home not looking up information. So what happens between diagnosis and formal education, if we call it that, that educator now has a load of stuff to clean up from wherever that person went home and looked up information? Which may not be correct, right?

Scott Benner 38:00
I can tell you Look, I know at this point, everybody's pretty like internet savvy at this point. So I think doctors can understand this next point. My Facebook group adds 150 new people. Do you know how long it takes to put 150 new people in the group? A couple of days, four days? Yeah. Every day. It's a three. But you heard in 50 new people show up. I have my 10,000 hours that watching them. Okay, I know the storm that they're living in, right. And they are so confused. And by now they've been online, they have absolutely found somebody who's telling them don't eat a carbohydrate ever. There's absolutely they found somebody that tells them that insulin is bad for them. They've absolutely found somebody that told them that they can reverse this whole thing. This is the myriad of different information they're getting over and over and over again. I see this happening. Please listen to me. Not once in a while. All the constantly. So you're sending people out into the world. Like, look, not even everyone's going to agree this podcast is valuable. Right now I see how it helps people and at the at the scope and scale that it does. So I know. But you can't even get everyone to agree about that. So they're out in the world looking for what ever has a good like, return like when they Google something. And now they've got 16 different perspectives. They are twisting in the wind at this point. They're scared they think they're going to kill themselves. They think they're going to kill their kid. And I want to read with this woman said she I wish they told us more than don't die advice. That advice that we got a diagnosis from them. We haven't gotten any new information since that quick class we had at the hospital discharge. I've never had any advice about improving time and range. Nothing about Pre-Bolus Sing no one has ever mentioned Pre-Bolus seem to me nothing about how fat and protein affect blood sugar, no guidance on how to exercise or play sports. No guidance on how to adjust insulin to carb ratios, how to adjust long acting insulin. Honestly, I am fairly sure that this don't die plan is the standard of care. And this is forever how they want it to be. And

Jennifer Smith, CDE 40:10
the unfortunate thing about that is what this person is getting to is the in depth what should be being covered in education, This by no means should be coming from a primary care, right? It should not because they don't, there's not a bandwidth there for it at all, unless you found a general practitioner, you know, who is a specialty in diabetes? And then many times it's even just a specialty in type two management, likely not type one. But

Scott Benner 40:39
yeah, but my point is, this is what happened to her. Correct, right. So she went to the hospital even and didn't get anything. This is your responsibility, if you're the doctor like this lady situation, is because of the lack of guidance that she got at the beginning. That's it. So you can say, Oh, this is her endos problem, or the hospital failed her. You can say whatever you want. This is still who she is now. So you know, and she's raising a child with diabetes, that kid is going to his? Well, by the way, nothing bad's gonna happen to this kid, because he found a podcast, like his Mommy found a podcast. So now she understands all these things. But you could. I don't want to out myself here, Jenny. The podcast isn't really that in depth. Like it's it's understanding how to use insulin, understanding the impacts of foods. That's it. Right? You could explain that to somebody, listen, I can explain it to them. Use, you must be smarter than me, you're a doctor, you absolutely could do it. I trust me, I couldn't even barely graduate from high school. So like, I know, you can do this, I figured it out. I figured that out. Because I had to. You need to put yourself in a situation where you feel like you have to, like I have to learn how to talk to these people about these things. Because if I don't, here's what happens next.

Jennifer Smith, CDE 42:01
And especially because you've decided to specialize, you've decided to specialize in something that does encompass diabetes, unless you really are only a thyroid endocrinologist, you're really only a hormone based right then great, you're probably not even taking patients who have diabetes, right? But if you have gone that route, then you're 100% Correct. These are the pieces that should be being discussed. And there should be there should be, I guess, some things that are asked of each person with diabetes in terms of their understanding that then you can dig in with them and say, Okay, well, we need to start here, you want to get here. Let's start here, so that I can get you to playing three hours of soccer on a Saturday, right? The way that you want. I

Scott Benner 42:51
mean, I'll take it further. If you're a GP, type two diabetes is everywhere. You don't when an adult is diagnosed, please, this person asks, please check them for anybody's before telling them they have type two diabetes, you have any idea how many type ones you're sending home on Metformin. And they're not dying through good luck, because they're still in their honeymoon yet, and we're getting very sick because you're like, oh, diabetes, that can't be that's type two, cuz you're fat, or cuz you're old, or whatever the health thing you think that isn't accurate? And, you know, type ones, have this happens to them constantly. Go pick through the podcast, find people living with that with type one diabetes, for years, on the brink of death. And it's because somebody told him they had type two never checked, or who have

Jennifer Smith, CDE 43:39
literally done every single one of the lifestyle changes that you've told them to do. Type Two often gets, you know, I'm gonna give you this medication and oral medication. Let's say you mentioned Metformin. Sure, it might be Metformin, then you're, let's try to get some exercise every day. And let's try to watch what you're eating. Some people will especially again, with the information now online, they will take that to the level of they're now eating lettuce and their blood sugar on you know, they're doing their finger sticks. And it might still be 200 or 300. In the thinking, I can't eat less. I can't walk anymore. My dog doesn't want to walk with me because I walk him eight times a day, right? I mean, and then they go back and they say, I'm doing what you asked me to do. And it's not, it's not better. So at that point, you look and you say, Well, gosh, maybe we should do some testing.

Scott Benner 44:37
And if you think Jenny's just making that up as an example out of her head, I've been told that story 50 times. It's incredibly common. This person here says please do not let patients leave your office with insulin and zero education regarding lows Because managing lows without causing fear is really important and it requires a playbook like you don't Just get to do it on like, oh, 15 carbs, 15 minutes. Like, if you're still saying that shame on you, first of all, here's what I think there are, however many people being diagnosed today with type one or type two diabetes, even I mean, we can lump them together to be perfectly honest with you. Each one of those people, if you don't help them has to learn it all by themselves, millions of people having to learn this thing that if you just learned, you could explain to them, right.

Jennifer Smith, CDE 45:26
And if you come back at them, and you say they bring you some results, they bring you some information. And they say, Well, I went online, and I looked up this information, and now look what I've achieved. And then the turnaround ends up being where did you get that information? You got it online? Or what kind of, you know, they're not looking at even what the person actually achieved? They're just looking at the fact that well, this person got it out of like, you know, the back end of somebody's blog about something, something diabetes related. And this person has no information about where that information came from. So they blame you, instead of just saying, Well, gosh, where did you get this? And this looks like you're really what what has made the difference? Because you know what, you as a clinician, you might actually learn something.

Scott Benner 46:13
This by the way, you don't know because you all don't know Jenny as well, as I do in public. This is as angry as Jenny gets, but she's mad. I'll just be mad for her. Yeah, I'll be mad for her. They just made me laugh. They're so mad.

Jennifer Smith, CDE 46:30
Because my my angry doesn't. I don't know that you've ever seen. I tell my kids when I'm angry about something. I'm like, you don't want the dragon lady. And then they're like, Okay, Mom, you're right, we don't

Scott Benner 46:41
make your point one more time very succinctly in one sentence. My

Jennifer Smith, CDE 46:45
point is to take the success of somebody that has come to you and look at where and what they've done. Don't just blame them for getting their information from someplace else. You didn't supply it, they went looking, yep, they have found some success. Help them keep that going.

Scott Benner 47:08
Right. And the reason why that creates anger in genuine in me as well as because I get those people's emails. And those people come to me to tell me, I listened to the podcast, I got my time and range down, my agency started to fall, I was so excited. And then I went to the doctor, they yelled at me for 15 minutes and changed all my settings so that my blood sugars would be higher. And these are not people who walked in there with like 70 blood sugars all day long. And they were walking all precipice between life and death. Like it wasn't it's not that it's just they learned how to Bolus for their food. Right? And then they they understood, I don't know, like simple things that you could understand, too. I mean, you're a freaking doctor, like, learn it or, or leave them alone. Like, you know what I mean? Like, if they're doing well, don't get in their way, for God's sakes, you've gotten in their way twice already now. Like, like, you can do it again, you know, or

Jennifer Smith, CDE 48:00
with their success, say, Well, what are we working on next? And your your job as the person that they're coming to, to share this really awesome, exciting success with is great. How can we move on? Or hey, ask, what did you get this information from? Yeah, maybe I should take a listen. Maybe I should, you know, check into the clinician that you talked with outside of my practice, or whatever, so that you now have more to work with other people who are going to come in, you could get them started in a really good place to begin with.

Scott Benner 48:36
It occurs to me that you have to put your ego aside in that moment. Yeah. And just want to you need to want better for them. Because what's gonna happen next, when someone tells you, I don't know, I listen to this guy. He's got a podcast. Sometimes there's this lady that comes on, she seems like she's from Canada, I can't tell whether accent and like, you know, like, and now they were talking about this thing. Because Jenny, you and I think that people hear every word and remember it like the Torah, which is not how it works, right? Like we have these conversations, and they pick things out of them. Correct. You might have to go listen to that conversation to and trust me, if you feel like well, I'm a doctor, I don't need to do that, then you're never going to help those people. Then I'm telling you that I've spoken to them over and over and over again. So as Jenny, and they are all they're struggling significantly in their lives, and you're not helping them. So

Jennifer Smith, CDE 49:28
and I think that from a clinical perspective, too, you have to you have to find a comfort level and working as a team. I mean, there's a saying that's been there forever, right? It takes a village to raise a child, right? It takes a really significant good care team to navigate managing life with diabetes. A lot of the people that come in to our practice, you know that work with me or one of the other clinicians in the practice. We are very happy in fact When there are other clinical participants in that, you know, some people come to us and they're like, We have a phenomenal endocrine team. We love them. But this is the piece that I'm missing. And they haven't gotten as in depth about it, as I think that you can, can you help me with this? Can you help me understand, but I'm getting this, this and this from my tear team. So I don't need that from you. Fantastic. From a clinical perspective, you have to be able to say, You know what, I don't know everything, because I'm very happy myself to say, you know, what, I don't know anything, everything. If there's somebody that comes to us and is like, hey, I want to work with Jenny. And I'm like, that's not my wheelhouse, though, you would be much better working with this person. That's the same approach that I have with other clinicians. I'm like, You know what, you take care of this, and I've got this.

Scott Benner 50:50
So I had to make this leap. I'm just gonna be completely honest. I know. I've always known that community around diabetes was important. I never knew exactly how important it was. I heard other people say that it was important. One day, I got so much pressure from listeners to the podcast about making a Facebook group that I just did it. And I want you to know, it was not a thing I was excited about at the time. I thought, Oh, God, I'm gonna have to moderate a Facebook group. I pull Jesus, that sounds terrible. But here I am. They asked for it. I did it right. Now, that's, I think three years ago, now, maybe a little less. There are now over 42,000 people in the Facebook group. In the beginning, I it was me going, that sounds like this. Show me your graph, I think. I think that like, you know, because doctors frequently mess things up. Even graph reading. Here's the thing you guys do all the time, people come in with a low, and you take away their Basal. Like that somehow is the fix for a low blood sugar instead of looking and saying, Hey, you had a meal here, right? And then you spiked up and crashed down? When did you give yourself the insulin. And if you by the way, if I'm now talking, and you don't understand what I'm saying, You have no chance of helping people with diabetes, okay? Because where you time that meal, insulin stops that spike from happening. And more importantly, it uses up the meal insulin to combat the carbohydrates. So the meal insulins not leftover to cause a low later, if you don't know that you are doing people a disservice. So anyway, I used to have to go through over and over and over again, like I said, I learned once like so I could tell other people. At some point, I thought I can't do this. Like I cannot keep up with us. And then I realized I didn't have to. Because so many other people heard me say it. They were helping other people. And before I knew it, I was watching people respond thinking, holy, they're using my words, like they're talking to that person the way I spoke to them. It's a beautiful moment, a beautiful moment, when you see that you you put something out into the world. And it's it's being redistributed by other people. So I understand if you're the doctor, you can't say these things a million times a day, there's not even enough time. But you can't just make that be the the end of it. Like you have to find a place to send them off to I'm not saying your doctor's office should start a Facebook group because the truth is mine only accomplished this level of proficiency for people because it's so big and far reaching. Because when someone asks a question, there's at least three or four or five people in there to answer,

Jennifer Smith, CDE 53:37
you know, and what do you have backing it up? There are episodes backing it up, to be able to point people to for a broader understanding or like you said, maybe some people take one snippet out of one whole episode. And that's what really made the difference for them. And in that same episode, there might be one or two other snippets that really hit or resonate with another person. They're both improving, but because they heard the information that they needed, right about the same topic.

Scott Benner 54:08
Yeah. So what Jenny's kind of alluding to in the first part there is that if someone asks a specific question, at some point, I have moderators or I will jump in and say, here's a link to an episode you should listen to to get more information about this. Now you think, Oh, I'm only helping one person. You're helping everybody who read that thread. And it's way more people than likes and hearts would indicate to you. So that's another thing you don't know is that you think oh, only one person asked this question and only five people got attracted to answering it. This is a six person situation. Now what you can see is that this thing's been through 1000s and 1000s of people's like feeds and they're taking time to look at it, which means a lot of people have those questions. They're too scared to even ask them out loud, right? So if they won't ask them online, what do you think they're going to do when they get in the doctor's office

Jennifer Smith, CDE 54:54
or they don't know how to ask ask them. They don't exactly quite know what the issue is. They have have maybe like a subconscious level of considering, but they don't know how to voice it. They don't know how to bring it up and they need somebody to sit down. And as you said before that one example of, oh, now you're low, I think what I've seen so many times over and over is that you go into a visit, all prepared as the person with diabetes, you brought in all of your documentation, you brought in all of your logs, and, you know, the printouts from let's say, you're using a continuous monitor, whatever it is. And clinically, you may sit down as, as, you know, the doctor, and you might say, Oh, what happened here? You can you pinpoint one, most often it's lows, or it's the extreme highs, what happened here, and the person with diabetes is honestly thinking, Well, I don't know. I was like, four weeks ago, and I've got three kids, and I truck them all over the sick. I don't know what happened at that point in time as a clinician, it's the bigger picture of a trend. You're not looking to pick apart the data, and picking it apart also makes the person with diabetes feel judged.

Scott Benner 56:09
don't frustrate them and judge them. Like that's correct. What what happened here means What did you do wrong? Right. And by the way, if I knew I would stop doing it, because so like, now you're asking me the question, like you said, bring all these logs in, I did it. It's a pain in the ass. I brought you all this stuff. I handed it to you. And you sit. And instead of telling me, here's an answer, you said, what happened here? Are you kidding me? Like that's your plan. And by the way, if people come in the office and don't ask any questions, do not sit there smugly thinking, Oh, I'm so good at this. They don't have any questions. They don't know how to ask their question. They're embarrassed. They don't want to be judged again, you're an asshole. And you don't realize it, which happens. Sometimes some of you are assholes, and you yell at people and talk down to them, and then they don't come back. And then you think, Oh, they're non compliant. They're not non compliant. They don't want to be near you. Right. You know, like, that happens. I'm not saying everybody. But if you're wondering, does, it happens, you know? Yeah, it's, I

Jennifer Smith, CDE 57:10
mean, from the that standpoint, too, you know, remembering that the person coming into your office is, they're a human, they're a person, they are just like you when you go home, you've got a life right outside of your office, when they come in. The first things should really be more personal questions, you know, how are you doing? How are things going? You know, what are your concerns today? What? What is on your list of what's working really well, please tell me or what's not? What What can I help you with today? Yeah, right, because it opens a door of personal connection. That isn't white coat.

Scott Benner 57:53
This is just very important. And, you know, I watched my mom live with cancer for a couple of years. And the truth is, every day of her life was about that cancer, like a lot of other things get swept under the rug, right? diabetes isn't like that. Like those, these people are not at home, like 24/7, like mired down, like they're trying to continue living, they think they either believe there's a way out of this. And they're looking for it in the time they have available to them, or the situation and the lack of information has beaten them into believing that they get a lesser life than everybody else. And they're just going to push on. Right? And I'm just going to live my lesser life now. That's not true. Right? Like, I just, I mean, take it from me. You can. Jenny, I know you could do this too. And I know you're probably getting low on time. But if you put me in a room for one hour with a person who is newly diagnosed, I can put them on a good path. And then I could speak to them again a couple of times over the next six months, and they'd be okay. Right? If I could do that, and you can do that, then doctors can do that. Yeah. Don't tell me the system's wrong or you don't understand how many people I have to see or the insurance figure out something. Don't just say don't wash your hands up and go Oh, this isn't my fault that this is happening right? You might not be your fault but you're the last year what we have so

Jennifer Smith, CDE 59:18
right trying to get a connection and yeah, yeah,

Scott Benner 59:22
try harder. It would be nice anyway, I didn't expect to get upset but here we go. Thank you for doing this with me here welcome. Any doctor still listening to this episode right now that like those people yelled at me for a while.

Jennifer Smith, CDE 59:34
So well, they you know, I think in in a really big way. It's It's hard because you don't want to call out like as a listener if I was a doctor and I was hearing it I'd feel very like singled out but you have to have a wider view. It's not have to have a wide view and say, you know, but I'm not doing that you have to remember and say but you know what, I learned something. I could do this better. I could pass this on better, I could hand them off like a gentle handoff to another, another practitioner that can get them to help. The other thing I think I wish could be heard here is behind the scenes. What it really calls for is a very specific medical protocol of when you come in, this is the checkoff of what you do flu symptoms. You do a urinalysis, you do a finger stick, that's the protocol, you will do it whether the person is two minutes old, or you're they're 98 years old. This is the protocol that you will do. I think it begs a broader change to our medical system, for sure. It really does. Yeah,

Scott Benner 1:00:42
I mean, hearts and minds is only going to take you so far like the system has to, here's a good example, when the system gets in the way, not overblowing this a half a dozen times a year, I get contacted to come to a facility and explain how I talk to people about diabetes, to hospitals, to doctors offices to big practices, you know how many times I've actually done it? None? Never. Because by the time it goes up the chain, somebody squashes it.

Jennifer Smith, CDE 1:01:08
Somebody says no, yeah. And do you know, do you know why? I know, you know, I'm not a doctor. So they don't want me to have you have no initials behind your name. Right. So my

Scott Benner 1:01:17
point is, is that even? Yeah, and sometimes people get good ideas, and they are motivated, and they want to help people. And then the system squashes that, I understand that, I guess I don't know what to do with that. And that's why I'm hoping that just this conversation leaks into people's minds. So that at least what they have control over. Right, they can maybe make more purposeful decisions with

Jennifer Smith, CDE 1:01:41
Well, I think even if they wanted truly just the educational pieces that you've put together, I think, again, from a protocol standpoint, I mean, my like end all would be that they all just get a little handout pamphlet in every single medical practice that's like, hey, you know what, this is your new diagnosis. If you want the right place to look for information to begin with, because I know you're gonna go on whatever internet doctor visit, you know, a site you're looking at, this is the right place to find this, this and this bit of information. So

Scott Benner 1:02:15
when people come into that Facebook group, they answer a few questions. One of them is Where did you hear about this 40% of them from my doctor. So it is good. I mean, it is getting better, but it's just the ones that slipped through the cracks. I can't I can't state firmly enough, that the ones that slipped through the initial cracks very frequently don't get back out. Like that's, that's the part that I'm upset by. Like, if somebody's got to struggle for six months to figure out the truth. That's, I mean, not preferable, but okay. But like, there are so many people who just never leave or never look again, or they're disoriented or they're, they're overmatched or whatever. They don't have the time all the things we've mentioned, they never get out their whole life like this. So it doesn't need to be that way is my only point. No, I completely agree. Okay, thank you. I appreciate it. Absolutely. Talk to you next time. We'll try to have a more upbeat one next time. Thanks, bye

if you're enjoying the Grand Rounds series, good news, there's much more to come. Don't forget to share it with somebody who you think might also enjoy it. Even a doctor. A huge thank you to one of today's sponsors, G Vogue glucagon, find out more about Chivo Capo pen at G Vogue glucagon.com Ford slash juicebox. You spell that? G VOKEGLUC. Ag o n.com. Forward slash juice box. A huge thanks to Dexcom for supporting the podcast and for sponsoring this episode dexcom.com/juice box go get yourself a Dexcom g7 right now using my link. A huge thanks to a longtime sponsor touched 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's 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. The episode you just heard was professionally edited by wrong way recording. Wrong way record korting.com Thank you so much for listening I'll be back soon with another episode of The Juicebox Podcast.