Scott Benner 1/30/24 Scott Benner 1/30/24

#1119 Cold Wind: Origin Story

This interview gave me the idea for the Cold Wind series. My anonymous guest has type 1 diabetes and is a nurse practitioner in an endo office.

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

Scott Benner 0:00
Hello friends, and welcome to episode 1119 of the Juicebox Podcast.

Well, the new cold wind series is four weeks old now and I thought it would be interesting for those of you who are enjoying it, to know where I got the idea. The goldwind series came from my experience recording the episode you're about to hear. This episode features an anonymous female. She's a nurse practitioner who works in an endocrinologist office, and she has type one diabetes. I think this episode may be two years old. While the recording is you've never heard it before. At the end of the episode, you'll hear me say, I don't think we should put this out. I'm afraid you would lose your job. And it was in that moment that I thought I wish I had a way to mask her voice. But back then I didn't. I held on to the recording because I really did wish I could put it out and I thought maybe one day we'll be able to change people's voices. And of course now we can. And we're using that technology in the cold wind series. So you want to hear this anonymous guest talk about where she works, and tell her story buckle in, because we're gonna get going in just a moment. Please don't forget that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, always consult a physician before making any changes to your health care plan or becoming bold with insulin. This episode of The Juicebox Podcast is sponsored by the Dexcom G seven made for all types of diabetes Dexcom G seven can be used to manage type one, type two, and gestational diabetes, you're going to see the speed, direction and number of your blood sugar right on your receiver or smartphone device. dexcom.com/juicebox This episode of The Juicebox Podcast is sponsored by touched by type one touched by type one.org. And find them on Facebook and Instagram touched by type one is an organization dedicated to helping people living with type one diabetes. And they have so many different programs that are doing just that check them out at touched by type one.org. Hello, and welcome to the cold wind series from the Juicebox Podcast. These episodes will feature physicians, nurses and other professionals who agreed to come on the show anonymously to share what they see in the healthcare profession. I've altered the voices of each guest so that they can remain anonymous, and feel comfortable telling us what really goes on at their job. Just listen to how well the voice altering works.

Speaker 1 2:48
My name is Beth and my oldest child has type one diabetes diagnosed in October 2020. My name is Beth and my oldest child has type one diabetes diagnosed in October 2020.

Scott Benner 3:01
If you work in health care and have a chilling story to tell about your experiences in the healthcare field, contact me today. I'll get you right on the show. Your story does not need to be specific to diabetes. I'm going to find out a little bit about you. How old were you when you were diagnosed?

Anonymous Female Speaker 3:20
I was 17.

Scott Benner 3:22
That's only four short years ago. Yeah,

Anonymous Female Speaker 3:25
no, it feels like an eternity. But it's really been like nothing.

Scott Benner 3:29
So really, it does feel like a long time.

Anonymous Female Speaker 3:32
It kind of does is the past few years is like when you're like actually becoming a human like the rest of it is like growing up. And I mean, that's obviously part of your life. But like the part where you're like you're autonomous and like making decisions like my adult formative years, I've had type one so it kind of just feels like it's what I do.

Scott Benner 3:48
Yeah. So you kind of don't think of yourself prior to that. adulty starting makes sense. You were you graduated from high school when you got it or not quite.

Anonymous Female Speaker 3:59
Um, so that's a whole weird story in itself. I graduated from high school in a different country when I was 15.

Scott Benner 4:05
Okay, slow down. Hold on. She's Jesus. Okay, hold on. How why were

Anonymous Female Speaker 4:12
so I, I got a scholarship to study abroad. And it was my mom was like, you can never study about it. I was like, What if I get a scholarship and she's like, that'll never happen. It ended up happening. I went abroad and the school systems kind of different. So I was able to like use the credits I had and I graduated high school there. And then I after that year, I came back to the US re enrolled in American High School and kind of did like my last two years again, so it was like weird, but it worked out

Scott Benner 4:42
what made you want to study abroad like when you're 14 or 15 years old. What makes you think I want to go to another country to finish high school.

Anonymous Female Speaker 4:49
I kind of just wanted to see something else because like, things get like monotonous. It feels like the same thing every day. Like I love it. But it's very much the same all the time. And I was like I kind of want to see what's out. They're so seriously. No, it wasn't. It was a really neat opportunity.

Scott Benner 5:03
How long did it take you to get acclimated?

Anonymous Female Speaker 5:06
I kind of felt okay, after about three, four months. Wow.

Scott Benner 5:10
And how long were you there in total? I was there a year. Wow. And the credits piled up differently. So. So you were graduated. When you were 16,

Anonymous Female Speaker 5:20
though? Yeah. So I graduated. And then I moved back to the US.

Scott Benner 5:24
Were you planning on going to college early, or were you going to like mess around, so I

Anonymous Female Speaker 5:30
didn't want to go to college, really. So I went to EMT school. And then I finished the NP school. And I was like, this is cool. But I want to do more. So I went to paramedic school. And then once I finished that, I went to college. Wow.

Scott Benner 5:41
So all those different experiences led you to believe you wanted to go to college? Or were you just finally willing to separate?

Anonymous Female Speaker 5:47
Yeah, so I got back. And it was like, it was being away was like that, like exhilarating thrill of like, this is something It's all new. And then I knew that college was going to be like, more mundane than that, per se. Which sounds bad.

Scott Benner 6:00
I don't know that. When you're away by yourself. Do you end up having more adult experiences than you would have at that age? Or is it not like that? Completely?

Anonymous Female Speaker 6:09
Like, I never imagined that as a 15 year old, I'd be like, lost in a train station in the middle of nowhere and like, have to find my way back. Like, absolutely horrifying in the moment, but it kind of gives you that like, feeling like I can do this. I'm

Scott Benner 6:23
okay. You feel like that because nobody jumped you. Exactly.

Anonymous Female Speaker 6:26
Probably like I would have been accosted from behind that would be

Scott Benner 6:30
great. If you're like No, somebody beat me senseless and took my wallet from me, then you'd be like, you know, I've learned I really don't want to be by myself at the train station. It's interesting how your experience shapes the rest of it. 100% All right, cool. So you went you got your high school diploma, you came home. You're like, Hey, this is great. And then you got diabetes? Yeah. Yeah.

Anonymous Female Speaker 6:52
100% Total

Scott Benner 6:53
party. Anybody else in the family have type one or other autoimmune issues?

Anonymous Female Speaker 6:59
No, but no type one, but autoimmune. Like my mom has a host of autoimmune things. My grandma, my great grandma. My dad like it's there, for sure.

Scott Benner 7:08
Really? Can you give me a quick fire cell list? Yeah,

Anonymous Female Speaker 7:11
so my mom has hypothyroid she's rheumatoid arthritis, and she has lupus. Wow. And then my dad has rheumatoid arthritis

Scott Benner 7:18
is a trifecta for your mom. So yeah. Yep. Do you have any of those?

Anonymous Female Speaker 7:23
I do not knock on wood. Let's keep it that way.

Scott Benner 7:27
I can we can beat on someone actually, if i i might hit my desk. My desk is what I gotcha. Do you feel worried that there might be coming?

Anonymous Female Speaker 7:35
I mean, I've never really kind of like, put it in the forefront of my brain. So I hope it doesn't happen. But I don't like sit and like, sit in my bedroom at night and like lose sleep over it.

Scott Benner 7:46
Yeah. Okay, so tell me a little bit about the experience of I mean, were you like a paramedic and EMT while you had type one. So

Anonymous Female Speaker 7:54
it's actually kind of funny, because you just put out an episode with I believe her name was Sarah. And she was talking about how she was like diagnosed in EMT school. Yeah. So in the paramedic program I was in it was like an expectation that the paramedic students would help teach the EMT class. And EMTs couldn't check what glucose values until like 2017, which is wild to think that like, you think someone's showing up to your house to save you and they can't even check your blood sugar. Well, so we were teaching the EMT students how to check blood sugars. And we were using like the paramedic students like dummies, and I was like, Oh, you guys can check my blood sugar and the meter just read Hi. And I was like, Haha, that's funny. It's broken.

Scott Benner 8:34
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Anonymous Female Speaker 10:27
And then another group did on a different meter. And I was like, oh, all these meters, let's just be broken. But in my brain, I was like, This is not good.

Scott Benner 10:34
I have to ask the question. It's nothing to do with us. Yeah, go ahead. When you heard Sarah, tell that story. Were you like son of a? That's my story.

Anonymous Female Speaker 10:42
I'm not lying. I was on the highway. And I pulled over. I was like, I'm not hearing this right now. I was like, This is insane. Like, I didn't think that this could ever happen to anybody.

Scott Benner 10:52
And not only that, but she stole it from you telling it on the podcast, too. Yeah,

Anonymous Female Speaker 10:56
I know. I was like, I think I have this like Sorry. It's kind of wild. And then it was like, actually not that wild happened to

Scott Benner 11:03
a girl named Sarah as well. That's amazing. I have to tell you, I I had to google Arden's name today. And because we were talking about, I just recorded with her and I was talking with her. And we were talking about how, at one point, I was aware of another person with her first and last name, who also had type one diabetes. That's why and that just seems crazy, because I don't have a completely common last name. And Arden's first name is, is fairly uncommon.

Anonymous Female Speaker 11:31
And I know it's not like a Joe Schmo like John Smith or something like that. It's pretty unique. Yeah.

Scott Benner 11:36
So I googled it. And then I found there are two other people with that name living within like, like one of them's in Harrisburg, and one of them with the school in Philadelphia. And I was like, but we're not related. A while. Yeah, I thought that's odd. Anyway, um, I'm thinking the same thing about your story, but it is interesting. Like you were like, I have an incredibly unique diagnosis story. And then it's just not. And then a podcast, you're listening to some girl comes on and tells your diagnosis.

Anonymous Female Speaker 12:04
Yeah, I was like, Am I hearing this or not? Is like, is this real? Yeah, it's really, that's,

Scott Benner 12:09
that's really amazing. Okay, so you find out and do you get a free ride an ambulance when that happens, or what do you do?

Anonymous Female Speaker 12:17
No. So I went to my pediatrician. And the whole thing kind of manifested weirdly. My, like my blood sugars. It was just strange. It wasn't like a classic diagnosis situation, because I had like, really wild pies, where I'd be like five hundreds, and then I'd have days where it was like, okay, so it was actually started on like Metformin, which is strange, because I'm a very small person, then on Metformin, then on the nuvia. That didn't really work. And then we kind of just and then it was like, Okay, this is type one. And I started on insulin.

Scott Benner 12:51
So how long was that process of going through the medication?

Anonymous Female Speaker 12:54
Aisle? Like a long while? Yeah, a year? It was probably, yeah, it was actually honestly, like a year. Oh, okay.

Scott Benner 13:02
Yeah. So now you're 18 You've done everything, right. You've lived away you have your diploma, you've decided no college, but at some point, when does the experience of being a paramedic and EMT and make you feel like I'm gonna do something else?

Anonymous Female Speaker 13:19
So that summer, I did end up going to college, and I like worked as a paramedic through college, which was, I didn't love school. I mean, for me, it was just weird. Like, I my interest. I'm like, the world's most boring person. I don't drink I don't go out. I'm just like, boring. I know that sounds bad. But like, I don't really do anything. So for that, he's I didn't love college. But I loved like working as a paramedic through college and like, showing sounds sounds so bad, like showing up for the drunk people. I'm so bad, but I don't know. It was just weird.

Scott Benner 13:53
Wait a minute. First of all, I don't think it's boring. If you don't like doing stuff like that. I think that's fine.

Anonymous Female Speaker 14:00
Yeah, it was it was an interesting experience. Yeah. Also

Scott Benner 14:03
the school you went to and not drinking. That's fairly uncommon. Oh,

Anonymous Female Speaker 14:08
trust me. I know. I know. I don't think there's anything wrong with drinking. I just think like smells really bad. So I sound like an idiot saying this. I

Scott Benner 14:17
don't mind how you feel about it. I'm just saying that to get through that particular college without drinking is a bit of its own accomplishment. Honestly,

Anonymous Female Speaker 14:26
I like I didn't live on campus. I lived in the firehouse so I was like slightly removed from it all but wait,

Scott Benner 14:32
yeah. Wait, you live. Were you a paid a paid person? So

Anonymous Female Speaker 14:36
I was paid for a local hospital. I was a paid medic for our local hospital and then I was a volunteer in the firehouse and

Scott Benner 14:43
you got to live there.

Anonymous Female Speaker 14:44
Yeah, for for the deal. Really? Yeah, I did college in three years. So I mean, I didn't like freeload from them for four but still so

Scott Benner 14:54
that's pretty cool. And you also got, you got to save on your on your Room and Board to

Anonymous Female Speaker 15:01
Yeah, 100%, which I mean, and it was a great group of people, they were hilarious. So I enjoy that.

Scott Benner 15:07
That's really excellent for you. That is that's interesting and different stories. See, finally see, Sarah, you didn't do that, did you? Hi.

Anonymous Female Speaker 15:13
There'll be someone after me who will have the same thing.

Scott Benner 15:15
I'm now thinking Sarah is gonna write me an email. I mean, like, I live in a firehouse and college.

Anonymous Female Speaker 15:21
We should just share stories. If

Scott Benner 15:23
that happens, you guys should totally meet each other. Okay, so All right, very cool. I want to understand now. So you have type one. So why did you reach out to me originally? Were you having trouble?

Anonymous Female Speaker 15:37
No. So I honestly just reached out completely in gratitude, because I don't know how I would have been able to do like, working as a paramedic, running. Because I mean, I run distance. So I was like, running long distances, like, just kind of like, because of the things I learned on the podcast. I didn't have to lose who I was, if that makes sense. Like, I feel like, if I didn't have what I learned on the podcast, I wouldn't have gotten to be myself. And that meant a lot to me.

Scott Benner 16:06
I'm glad. That's really that's lovely to hear. Are you still in college?

Anonymous Female Speaker 16:10
No, I graduated three years. She

Scott Benner 16:13
said, Yeah, I just wanted to make sure it wasn't okay. But you would be if you didn't graduate in three years. All right. Yeah, I would. What, what was your major? And

Anonymous Female Speaker 16:23
so I majored in biology. I thought I wanted to go to med school. And then I decided, I mean, I did the whole the whole stupid nine yards, I took the MCAT I did all that jazz. I got into med school. And then I was like, You know what, I want to be a nurse practitioner instead. So I'm in school for that. Now. You

Scott Benner 16:42
got in you got accepted to a school? Yeah, we say which one? I mean, could you tell me and I'll bleep it out if you don't want it in here. Sure. Okay, good.

Anonymous Female Speaker 16:55
So I got accepted into

Scott Benner 16:57
he got accepted into four different medical schools.

Anonymous Female Speaker 17:01
Yeah, please leave that out. I don't want people to know why.

Scott Benner 17:05
Cuz you're calling your your sister a badass. And you're one is that why?

Anonymous Female Speaker 17:09
I don't know. I just I don't know.

Scott Benner 17:13
I don't know. You feel like you're bragging? Kind of how many did you apply to?

Anonymous Female Speaker 17:18
I applied to 10. That's

Scott Benner 17:21
an astonishing ratio. Thank you, for you super smart.

Anonymous Female Speaker 17:27
I like school. But at the end of the day, like, I don't know, it makes I just want to be a good person. That's my only objective. And I just feel like, silly. I don't know.

Scott Benner 17:34
I listen, my wife got out of college and wanted to go to medical school, but we couldn't even afford the applications. It's wicked expensive. Yeah. And so we were on our own and really young. And so we just picked one and set one off. It was a complete, like, there was no way it was gonna happen like that. But her M cats were good. Her grades were good. She went to a university that's respected for its sciences. And she's Kelly's super, like smart and studious. She loves to go to school and learn everything. And it was it was, you know, we never got back to it. Because we just, we have a process.

Anonymous Female Speaker 18:10
It's just ridiculous isn't the word and I don't mean to sound like condescending but it's just like, it just feels so. So like, inhuman? I don't know,

Scott Benner 18:21
if they are definitely making it as difficult as humanly possible. Like they're trying to weed people out. And even maybe I understand that a little bit. But back then, like Kelly, could I use the little grace like she was in a in a bad spot and would have been nice. If we could have applied to a couple of places. I always wonder how she would have made out I think, Well, I actually think Kelly would be a good doctor. But, you know, you make babies and start making money and you're

Anonymous Female Speaker 18:43
like, Well, life happens. And then it's like, priorities are different. And yeah,

Scott Benner 18:47
you gotta keep doing this. Right. Okay, so you don't feel like you just like let's go backwards for a second. You just want to be a good person. Yeah, that's kind of my big goal. Have you not accomplished that goal yet?

Anonymous Female Speaker 19:02
I mean, I hope I have but I don't know if I'm the person to be the judge of that. So are

Scott Benner 19:06
you like, shy?

Anonymous Female Speaker 19:10
I'm not shy. I'm kind of like an introverted I'm like an extroverted introvert. If that makes sense.

Scott Benner 19:18
It doesn't pay you for tell me more about it. I will understand it better here an extroverted introvert. So the process of dealing with people is tiring. But you enjoy the idea of

Anonymous Female Speaker 19:29
love talking to people, I love making connections with people. I find it so neat to like hear people's story and like find ways to help people and stuff like that. But at the end of the day, like I do kind of just like, come home, I go for my run. I decompress. I train and like that's

Scott Benner 19:43
that. Yeah. Wow. That's lovely. You living with your parents? Are you on your own?

Anonymous Female Speaker 19:48
I am. It makes me feel kind of like I'm not a real adult. But I moved back home a little bit ago. So

Scott Benner 19:56
are you still volunteering or working at the fire department? So

Anonymous Female Speaker 20:00
I since I moved out of that area, I'm not running right now with them and I miss it a ton. I go up every once in a while just to run a run a few calls, because I do miss it. Yeah, but I'm, I'm working now at like an indoor office and I love that. So, okay,

Scott Benner 20:16
I want to hear about that in a second. I volunteered for three years. And as a fireman, and I was there one day visiting, there was a fire and somebody else your gear still here. And I was like, I was like really? Like, yeah, I was like, alright, so I put it on and I went and it's like riding over trying to remember all the things that I need to do. You know? I'm praying nothing was really on fire. I was like, let this just be like something simple. Like 95%

Anonymous Female Speaker 20:45
of the time. There's like no real fire. But yeah, anyway, yep. That's fun, though. So

Scott Benner 20:51
you you just went out in the world. I mean, I'm assuming we're like, got the first job you applied for right?

Anonymous Female Speaker 20:58
Yeah. So like, I had no idea what it was doing my first job interview, I biked down a highway in the pouring down rain, and then like dried my clothes on a hand dryer in the basement of the hospital. Somehow got the job. I'm convinced this because they were desperate. But it worked out. You

Scott Benner 21:16
believe she showed up on a bike? I didn't have a car

Anonymous Female Speaker 21:19
and I had to get it was.

Scott Benner 21:23
It was something did you tell them that? Did you say? I biked here? No,

Anonymous Female Speaker 21:28
no. Like, I got there. And I was like, I don't know where to do. I'm soaking wet. I look like I just walked out of the shower. So I'm like stumbling around in this hospital. I find this bathroom. I like because I show up ridiculously early. The thing is, it's just how I am. And I didn't have time to like make myself look presentable. I like walk into this room with a bunch of like men who were like 20 years older than me. And it worked out. But like I was terrified.

Scott Benner 21:52
I'm sure they saw something in you. I don't know. But it worked out so good for you. And it's not it's a hospital merit. It's part of a hospital. Yeah, the hospital. Okay. So you sent me a note, one day, not so long ago, I feel like and I was really touched by it. So, but you are now I'm seeing now that I'm speaking with you. The note makes more sense. Why did you reach out to me? Like what was the give me the whole genesis of that of that thought in your head? Because I don't think it started where it ended. Is that correct?

Anonymous Female Speaker 22:26
Yeah, no. So I got this job. So my end goal is to be a diabetes nurse practitioner. Like that's kind of what I want to do. It's not kind of that is what I want to do. And so I'm working in this editor's office, and I love it. I love my job. And I love patients, and I love every bit of it. What I really hate is the advice like I can't, it drives me insane. Like, I pull up a I was working on something yesterday and I pulled up a chart note yesterday that said patient is incorrectly treating hyperglycemia with one glucose tab. And I wanted to like read my computer screen off of the monitor. Like it just it's these little things that like people want to do well, and they're trying to do well. And they get this advice. Like you know this, everyone who's listening to this podcast knows this, like, you get this advice that sets you up for failure. And it drives me insane.

Scott Benner 23:20
And you're very passionate about it, too.

Anonymous Female Speaker 23:23
Yeah, no like it, it really blows me because like, I go home at night, and I think about these people who want to do the right thing. But they they're given advice that like it's it's like this is supposed to be the person who's supposed to lead you down the right path. And I mean, like, everyone, like I said, everyone who listens to podcasts knows that that's not what happens. And I I think that's something I didn't even realize until I was working here is like the group of people that hear things like this and the group of people who have access to things like this, it's it's so much of a smaller group than we know. And we think like, I have not come across a single type two diabetic on insulin in our office who is not on a sliding scale. Like no one has a carb ratio of our type ones. I'd say that probably more than 50% are on a sliding scale. And like you think like standard of care is gonna be that carb ratio. And people are not on that. And it drives me a thing.

Scott Benner 24:22
You're saying half the people you meet are on a sliding scale if they have type one. Yeah, yeah, that's crazy. And that makes you nuts. It drives me absolutely bonkers. Yeah, no, I love that about you. That's one of the things I love about you. So yeah, no 100% I We need like motivated people like you to do things for masses of people who don't know they need it done for them. And I agree with you, wholeheartedly. I mean, I'm very proud of how many people the podcast reaches. As a matter of fact, yesterday was Sunday, and Sunday is usually my lowest day of the week. That makes sense. And yesterday Today was the most popular Sunday by Triple Bottom knees, the best one ever. And I was even like, what's happening? I started asking quite I went on Facebook and I put a poll up and Mike did a bunch. You just start listening to the show recently, or like, I was trying to figure out what

Anonymous Female Speaker 25:15
I saw that I was like, and it made me super excited because I've been listening since I mean, I've been listening since I was diagnosed, I felt like super excited clicking like, more than a year ago, I was like, I'm gonna be Oh, geez, you

Scott Benner 25:25
are? Yeah, some people were like, I felt like it. One woman said, I started listening in episode four. And I was like, wow, I have to be honest with you back then. There were maybe maybe 1500 people listening? And yeah, you know, and I'd be surprised if there's not 1500 downloads while I'm talking to you. So that's,

Anonymous Female Speaker 25:45
that's just like, that makes me so excited. Because if people would just hear this advice, like they would be able to fly it. And I know that sounds cheesy, but like, this is what people need. And this is what people don't get? Well,

Scott Benner 25:58
I'll tell you why I don't think it sounds cheesy, because I got an email from Jenny the other day, let me see if I can find it. So sometimes when Jenny meets people who I don't get to meet, and they talk about the podcast, she'll send me a note and say, Hey, I talked to you, she keeps it pretty generalized. You know, like, like, you know, you sometimes talk about Yeah, good. All right, you just talk around that a little bit. And it's, you know, somebody who had had diabetes for I want to think it was a, if I'm remembering, right, a woman who had had diabetes for a number of years, and she found the podcast, and God, like out of the sevens, like she was just stuck in the sevens forever. And got out, got her agency down into the lower sixes. And very crazy, and she said it was from the Pro Tip series.

Anonymous Female Speaker 26:47
And like, it's so true, like the bat, that is the core of it all. Like, it's all right there.

Scott Benner 26:53
Yeah. And it's just it's, I mean, look, I hate saying it like this, because I know, diabetes is really difficult. But there really are these kind of core tenants. And if you get them even close, he wants he drops pretty quickly. You know,

Anonymous Female Speaker 27:08
it's so true. And, like, I know, it's, it's hard, because like, there's the medical advice piece of it. And then there's the like, real life piece of it. And like so we know, it's possible for providers to give that advice. So as an example, we have like a satellite. So we have our main office, and then our one nurse practitioner, who is like, the most amazing human being ever, she, she has type one and she runs our like diabetes clinic at like the maternal fetal medicine, part of our like, hospital. And I kid you not all of those patients are in the fives, like all of them are in the fives or the low sixes. So it's possible it's possible for a provider to get those results by giving the right advice and they see it and I'm like, she like I just I want to tell her like, can you just see every patient? Because it's so possible,

Scott Benner 27:58
you get to see the results from different providers. Yeah, and so you, you really, that's interesting. So you know, when you look at a person, you can look them in the face and think if you were just seeing a different doctor, your agency would be lower.

Anonymous Female Speaker 28:12
It's the worst feeling ever. So I love data. And I ran the numbers for our practice and I have all I ran all the numbers and I have a one C average a one c by provider average day when c by diabetes type everage. AMC by if they're on a CGM or not if they're on a pump or not. And the numbers it's so clearly the biggest one is CGM makes a huge difference. Pump makes a huge difference and provider, which is unfortunate. But it does. Yeah, yeah, it's it's it's a stark difference.

Scott Benner 28:43
Next time you mess with the numbers. Do CGM users by their high alarm?

Anonymous Female Speaker 28:49
I would love to do that. It's just the only thing is with 1000 patients, I'd have to pull each one of their reports.

Scott Benner 28:55
That's a shame because I guarantee you that the lower their high alarm is the more stable and lower their agency. Yeah, no, I 100% agree with that. Yeah, that's really cool. So when we're going back and forth one day, then you sort of just asked me like a big question. Right. So what were you wondering?

Anonymous Female Speaker 29:12
I guess the question was, if we could get this to providers, this info, right.

Scott Benner 29:18
And I said, Yes. And then you apologize. That would be me. But so we we got off on you know, we went back and forth a couple times. And I could feel your excitement like I can. It felt like we were like standing in a doorway together. I was on one side, you were on the other. And you were like, I'm gonna go find out right now and just ran away. And you know, and then I didn't hear from you for a little while, which is reasonable. And my wife's like, what are you doing? And I said, I said, there's a girl and she goes, Okay, and I said she works in a practice. And I think she would like me to come speak to the practitioners. And I said, I don't know if that so a lot of people say that not many Have them get it worked out. Yeah, it becomes there's a lot of hoops to jump through and you start getting down to like, you've probably heard the episode with Kathleen. Right? The Endo. Yeah. So you get down to like, you really start getting down to brass tacks and you're like, Will Will 30 People sit in a room and listen to some guy who shows up and says, If I was you, I would talk about it like this, you know, instead of the way you're doing it? Yeah. So I just thought like, I'll never hear from you again. Maybe other than for you to go. I'm so sorry, this didn't work out. But you sent me another note. And you're like, hey, this might be working out for real? Like, are you sure you want to do this? So can you tell me a little bit about what you did in the office to try to get it going?

Anonymous Female Speaker 30:38
So I kind of forcefully convinced a few of our providers to listen to a like, it was like probably, it was the beginning of this year touched by type one did that thing where you did like a really quick presentation for like an hour? Yeah, I recorded that. And I showed that to them. And because it kind of like it kind of puts all of the pro tips into like one hour, if that makes sense. Because yeah. And then I do that to our medicine physician, and they gave it to our CDE. And I talked to our practice manager. And he was like, this guy, we need him, please. Wow.

Scott Benner 31:17
And they watched it. And so first of all, that our talk, which I've never given the same way twice, but in my mind, it's a primer to the podcast. Yeah, it should make you want to go listen to the Pro Tip series. That's the that's the best I've been able to figure out given a short amount of time. And keep in mind, usually I give that to people who are fairly newly diagnosed. And my goal is really just to make them believe that there's better that better is obtainable. And that they could take the steps that would be necessary. That really is that's my whole goal with that. And then hopefully, they go listen to the Pro Tip series. That makes sense. And then I think of it as like, then they can slowly implement it on their own time, if it's something they're interested in. So you gave it to three people did, did you get any bad? Feedback?

Anonymous Female Speaker 32:07
No, not at all. Excellent. Not at all, like, and I think the thing that really, so the biggest thing that really cued me into the fact that this could be super helpful is like everything that has been effective for me and is effective for this entire, like Juicebox Podcast community is oftentimes the opposite of what's done in like an endo office. So if a patient calls in and says, like, this happens all the time, a patient will call in and be like I had a low blood sugar, a low blood sugar might do like not like a pattern of lows, a singular low blood sugar. And there's certain providers that will hear that, and I'm not trying to, I'm not trying to point fingers, but like, there's certain providers that will hear that and will completely change everything. For one low blood sugar. And mind you they're considering a low blood sugar like

Scott Benner 32:51
an 86. Right, and they take away their Basal, right,

Anonymous Female Speaker 32:55
exactly. And that's, that's what I was gonna say they don't adjust the carb ratio, they cut off the Basal, and then they're on a roller coaster. And it's like, I was like, hey, just like listen to this. And it's like, we're basil like focus on the basil get the basil, right? Because that like like you say, that's the foundation and whenever someone has a low the first thing that I feel people cut out is Basil. And then people were on this horrible roller coaster of they can't get anything. Right,

Scott Benner 33:19
right? Yeah, you so for me, I look at the graph. And if if the balanced times like away from food and away from away from mealtime, insulin or correction insulin if those times are fairly steady, but higher, I think, okay, the basil might not be high enough. There are people who look and then see the lows and right away think oh no, the basil is too high. It's dragging you down. And so you're just overcorrecting for the lack of basil. And it's probably that you're overclocking that don't get me wrong. Sometimes people's Basil is way too high. And they do a homeless curse. I don't know, why have you made me want to curse. They do a terrible job of Bolus thing their meals or they don't Pre-Bolus at all. And so the hi basil tries to fight with the meal and just can't and they can't win. So you get higher but then eventually the meal is gone. And the bait the two high, basil's left hand drops you back down again. But on a on a chart on a graph, they almost look the same. Yeah. And I really don't know how to put into context that they aren't like when they look differently to me, but I can look at them and most of the time think I know which one this is. And I do that by asking a very simple question of the person whose graph it is, which is, do you find yourself more frequently feeding the insulin or do you find yourself more frequently trying to impact a high with a correction?

Anonymous Female Speaker 34:44
Yeah,

Scott Benner 34:45
if it's, you know, and that's your answer, usually. Exactly.

Anonymous Female Speaker 34:47
And like I think the coolest thing for me like working in there's offices I get to look at like, I nerd out over this stuff I like I get to look at like all sorts of cracks graphs all day every day and it's like Do you see these things? And like the hardest part for me now is like, I'm in school. I've not done with school one day, but I sit there. And I'm like I just wanted, I just want to say this. I just want to suggest this, but I have to shut my lips and

Scott Benner 35:12
let the provider say anything. Yeah, yeah.

Anonymous Female Speaker 35:15
And that, like, I had a situation last week where a provider was honestly going to cut away, like, a ridiculous amount of a patient's Basal rate for compression well, and I said to them, I was like, this is a compression low, and they had no idea what that was. And it's like, it's just things like that. So I'll get off my rant now.

Scott Benner 35:34
Oh, I love your rant. You're right, it makes me excited. So you're one of the people who like, and there's a lot of people who do this that are probably all gonna hear this the same time and laugh, but you're one of those people who like, purposefully by mistake bumps into people in hallways, gets up to them, because Juicebox Podcast, and then walks away from them, kind

Anonymous Female Speaker 35:51
of like so I get to do this kind of cool. The role I'm in right now is like an interesting mix of random things. But the my favorite thing to do, and you can ask any of my co workers as they come to me when they have one of these, but starting a patient on a CGM, like that is my favorite thing in the world. Because I get like my, like 20 minutes where it's just mean a room and I can impart on them like anything I want. And it's always like, this is not just a way to, like not stick your finger, like use this to not get high rather than to know when you're wildly high. And listen to the Juicebox Podcast.

Scott Benner 36:25
Oh, thank you. So I have to say I get a lot more. The Where do you when people come into the private Facebook group? There's a couple of questions to answer. And one of them is like, where did you hear about the podcast? These two answers are becoming more and more frequent, which I'm super excited by one of them is from my health care provider. And I'm always like, yes, that's cool. And the other one that I really love is everywhere. That's the one I love. Like where did you hear about the Juicebox Podcast are like everywhere. It's everywhere I hear about all the time. I'm like, ooh, like that

Anonymous Female Speaker 36:58
just made me smile. And I know that sounds so stupid, because it's your it's your project. But like, I just like, This is how you succeeded have died. Like Pete my coworkers obviously asked me they're like, how is diabetes? Not like your entire life, because you work here and you have diabetes. And I was like, You don't understand. Like, I don't think about diabetes. When I go home. I don't think about it. Because I know that I'm going to know if I'm under 65 and over 120 Like, I'm going to know this next I'm going to tell me and I'm going to fix it and I'm gonna go on with my life. But it's like this is how diabetes doesn't run your life.

Scott Benner 37:32
Well, that's what the episode I put up today with Arden. You know, she she came on? And um, there's no way you heard it yet. It's literally just went up a few hours ago.

Anonymous Female Speaker 37:40
But I saw it was up. I was like, I need to watch this. But I was like running from from work. So no,

Scott Benner 37:44
I'm just saying that. I assume you haven't seen it. So are her, excuse me. But she just says the same thing. She's like, I don't think about diabetes very often at all. Now, she doesn't think about it at all, because I live here. You don't I mean, not because she knows all the nuances of it. But she's also 17. And she's had it for a really long time. So she's in a different scenario. But I like that feeling the feeling of she's like, it'll be fine. Like, I'm like, Well, what if you get low at college? She's like, I'll be alright. Like, it's yeah, that vibe. I'm sure it's gonna happen to her. I'm sure I'm gonna get a note one day where it's like, hey, wow, oh, last night did not go well, you know, but like, she's on an algorithm. I expect her to continue on with an algorithm I expect her to go to on the pod five at some point. So, you know, I don't think she's ever going to get like, I mean, not that it couldn't happen. But I think generally speaking, she shouldn't have too many incredibly dangerous lows. She doesn't have them now. She does know what she's doing. My wife reminded me. My wife listen to the episode that Arden did which by the way, she's so sarcastic and it's interesting to listen to. My wife reminded me that we started to tell a story in that episode that we didn't finish the the finish to it was that my wife had gotten sick, she had gotten a kidney stone. And for the two days after she got back from the hospital, I wasn't around and only Arden was an ardent exclusively took care of herself for 48 hours plus, and she was I didn't know I was somewhere else and remotely. I could not tell on her CGM that, that I wasn't there.

Anonymous Female Speaker 39:19
Yeah, that's awesome. And like she knows what she's doing.

Scott Benner 39:22
But if you ask her to explain it, she has no idea. What's

Anonymous Female Speaker 39:26
kind of like speaking English, like you know what you're doing, but you don't know how to explain it. You know what I mean? Like, it's just any so I guess that's like, that's a very good sign of just being intuitive.

Scott Benner 39:34
I felt so too. And at the same time when I said to her, what's the name of your insulin? And she's like, I don't really know. She told me she thought for a long time that it was AMI pod. One day she heard me say it like Omni pod and she thought I was mispronouncing the word. Or I asked her what version of the G CIG were version of the Dexcom Ashiana. I had no idea. And when I asked her how to use her glucagon, she said, I don't remember. And, and, and I was like, I used it. I use the brand name of it. And she's like, What? What is it? And I was like, the G voc hypo pen, and she goes, what is is that the thing in my purse? And I'm like, Yeah, I'm like, you know, you have glucagon, right? And she goes, Oh, yeah, she goes, I take it everywhere. And I was like, okay, there you go. And I have a trainer. Like it's been on my desk forever. It's just a plastic trainer pen. I pulled it out. And I was like, it's like this. Yeah. Pop off the cap. On the skin, it clicks Once it clicks twice. And you're all done. You remember me showing you this? Right? And she goes vaguely, or something like that. And I'm just like, so yeah, so I think it would have been easy for some people to hear it and go, Oh, my God. See that? That girl? She doesn't know what she's doing. Like her dad does the whole thing, but it's not true. left on her own. She does really well.

Anonymous Female Speaker 40:53
Yeah, and she knows what she's doing. And she's going to be just fine. Ya

Scott Benner 40:58
know? So we're going to do some more episodes where we're going to talk through, like some of the, you know, the bare bones stuff that I think she'll need to know like things like if I was dying tomorrow, things I would sit down and tell her about her diabetes. Although I gotta be honest, we're only a day left. I'd be like, Listen, if you just go listen to some of those episodes, I have very limited time.

Anonymous Female Speaker 41:17
You've got like, all she's like you said this in the recent episode. But like, this is like, kind of like the vote of like, your connection with her. But like, Honestly, though, it's like, anyone can find this and be chill, and like, if we've all succeeded, like clearly Arden's gonna be just fine. Like she should.

Scott Benner 41:31
I mean, she listens to me say it to her all the time. Yeah, just, I would think that Arden would benefit from this podcast more than anybody, because she's already primed for it. You know what I mean? Yeah, my wife actually said something to me the other day. And we were talking, like, when you get older, you start talking about weird stuff. And, you know, she's like, if you died, I was like, Oh, sounds like I'm gonna get murdered in my sleep. But okay, go ahead. She's like, if you died, I would go listen to the protests right away. And I was like, good. That's what you should do. Yeah, I was like, that would be fine. You'll do that. So if I die, if I die, I make an error. She's gonna pillow No, it's not a sweet idea. She's gonna kill me in my sleep. Pretend I like had sleep apnea or something like that. And then stage it perfectly hide all the evidence. I'm worried about saying it out loud. Now, in case this gives you the idea, honestly. Good. Yeah. But anyway, so do you think it's gonna happen? Do you think I'm going to come to your hospitals or your practice and speak to the practitioners?

Anonymous Female Speaker 42:31
Like, honestly, 100%. The only hard part is like, when you are like, This, to me is like the most exciting thing that's ever happened. But unfortunately, management, like the higher ups who like give us schedules and dates and calendars, like to them. It's just like another event, they have to find dates for it. That makes sense, which is unfortunate. So it just takes time. But I have no doubt that it's like, you really think it's 100%? Cool, like not no doubt in my mind. It's just the semantics of like right now just like waiting for dates and availability. And wow.

Scott Benner 43:01
That's great. What did I ask how much time? Did I ask for? Two hours? Two hours? I think that's right. Yeah. I think we talked for a good hour, I do a high level overview, like you would have seen in the video, and then just answer a lot of questions. Look at a lot of graphs, and let people bring up scenarios and answer questions. I don't see the practitioners as being any different than speaking to a person with type one or speaking to a mother of a kid who's had it for six months or something like that.

Anonymous Female Speaker 43:30
Yeah, it's honestly the exact same thing. And I think that if anything, it's like, more valuable because for the most part, they don't live it. Like our super awesome nurse practitioner. She has type one, which is, I mean, I shouldn't say that. That's why she says super awesome, but like, they don't live it. And it's hard to expect someone to be able to, like, finesse something when they don't see it all the time. Oh, yeah. But at the same time, like, honestly, I there's this one provider, and I really shouldn't say this, but she considers anything under 100 hypoglycemia, and in the office, she gave a patient 64 grams of carbs to treat a blood sugar of 98. I was like, I literally wanted to like, leave work. I was like I can't right now. I was like, I can't believe I'm watching this right

Scott Benner 44:17
now. Depending on the scenario, I may have made a small Bolus for an IDA.

Anonymous Female Speaker 44:22
Oh my god. 100%. And then the the icing on top is that she in her after visit summary for this patient? She puts your diabetes is not meeting your goal of XYZ percent. And it's like okay, if they're not at like an agency, that's our goal, it's because you just treated their low to 250 they're low in quotation marks to 250. And now that they're 250 You're gonna tell them that their agency is not at goal. I

Scott Benner 44:46
was gonna say 64 carbs for a 98 blood sugar makes you like 222 50 Probably yeah,

Anonymous Female Speaker 44:53
yeah, this patient ended up like, it was like 250 something and I'm like cringing the entire time. I'm like, Please don't leave it. is all just a bad injury? Do the

Scott Benner 45:02
patients notice that's wrong? Or just some of them go? Okay. So

Anonymous Female Speaker 45:08
I have an unfortunate amount. I don't know any better. I did have one. I think I told you about this guy. He was like he was, I think he was like 85. Newly diagnosed, I got into like, they do a CGM kind of teaching with him. I gave him my two cents of wisdom, listen to the Juicebox Podcast. And then in his next office visit he was in and his blood sugar was like 85. And as he's walking out the door, this provider asked me to help them treat a while and he looks at me, he goes, I'm not doing that, because I'm not well, and he credited it to the Juicebox Podcast. So that was like, That is awesome. Like, there's people who do know better and who, who succeed. Granted, this cable is next office, because they got told that his average of 120 was fake because of his lows,

Scott Benner 45:52
because it was the 85 lows. Yes, because which

Anonymous Female Speaker 45:55
I wanted to scream, but I just had to sit beside that's myself on my little desk and pretend they don't hear anything. Well, doesn't

Scott Benner 46:00
that make you wonder how many other people in your situation are sitting in other offices around the world, doing the same thing?

Anonymous Female Speaker 46:08
I'm willing to bet that there's like a there's a someone who feels exactly the way I do in every single endo office. It's just sometimes the I don't want to say the power dynamics, because that's not it. But sometimes you're forced into oblivion, and you can try to respectfully impart what you want to say. And some people are open to hearing it, and some people aren't. Which is tough.

Scott Benner 46:31
Yeah. So is there a lot of confirmation bias? Like do some sometimes you see a provider say something that's so out of bounds? Does it do you see it make the patient comfortable? Like, oh, I could just leave my blood sugar at 150? Great, like, Does that happen?

Anonymous Female Speaker 46:45
I think I think that there's certain times where it definitely does. If a patient's in the office and like, is sitting in and they'll do like a random finger stick. And it's like in the one hundreds, maybe it's like 190. They're like, Oh, that's not too bad. But then when their agency correlates to an average of 190, they get scolded for it. So it's like, I feel like there's this discordance between reality, and like, like, yeah, a 190 You're not 500 But that's also not healthy, like. So I think it's yeah,

Scott Benner 47:20
thanks for the dual message to 190 is correctly Yeah.

Anonymous Female Speaker 47:25
Want you to succeed, but hey, let's make this more hard, more more hard. Oh, my God, I can't talk more difficult supposed to me.

Scott Benner 47:32
So tell me if I if I gave you the power, and you were able to change one thing? Like, what do you think would help people? Being the providers? I mean, what would help the providers? This

Anonymous Female Speaker 47:44
is gonna sound cliche, because this is exactly what you said that your nurse practitioner has told you guys, but the fear of lows because it's the lows that drive people to this insanity. Like, because providers are so afraid of people having lows, like terrified of lows, like if we get if we have someone call in and they're say they're having a low blood sugar, it goes high priority in our like, in basket, which is our like messaging system. And it's like, yes, lows are important, but like lows or like, lows are part of like diabetes, like, just like, you don't always get an A plus on every test. Like, that's just part of how it goes. And it doesn't mean that like, everything's wrong, your Basal rates are totally screwed up, like a pattern of lows might one isolated well, it doesn't. And there's this just, there's this fear of lows that providers put into patients. And it makes everything so much harder for everyone.

Scott Benner 48:37
Yeah. So apparently last night, I was working late at night. I know. You said you're boring. I was like 11 o'clock working on the podcast on Sunday night. And that

Anonymous Female Speaker 48:48
sounds like something I would do just like homework on Yeah. Oh, we got it. Yep, I believe Arden

Scott Benner 48:52
and Kelly, we're watching Big Brother. Nice. And Arden decided potato chips would be the way to go for a snack while she was watching Big Brother. And I don't think she got the timing of it. Right. So she went up 150 or 160. And then I went to bed and everyone went to bed and a couple of hours later, she was like, you know, 50 because she just she didn't Pre-Bolus Well for the chips, right? And eventually the chips cleared her system and there was insulin leftover and it brought her lower. And so I you know, she tried to treat it herself with the juice. And it didn't work. And so it just she just stayed like she she was stopped what was happening, but it didn't. There was still enough insulin in there and it burned through the juice and she was just now she's stable in like the mid 50s. So I got up and I'm like, Hey, did you do anything? And she's like, Yeah, she's like, I drank juice. I was like, Alright, I said, she's like, I'm hungry. Which once she's low for a little while she's gonna ask for food. Yeah, so I was like, Well, I can get you a banana. I don't want a banana. I was like, hey, Arden it's 330 in the morning. Oh, who cares? Which one? Yes, yeah, this isn't like we're not at a restaurant right now a banana is soft, it's easy. And you can swish a little water in your mouth afterwards and be done with it. I was like, we're getting a banana. So I brought a banana up and I restocked her room with juice boxes, which we don't use much anymore. So I was like, you know, I brought some with me to be sure we had them and shaved the banana. I waited for like two revolutions of the CGM. And I saw a little dip before it went back to 55 again, and I was like, this banana is not going to do the trick. So I said, I need you to have one more juice, and then you're gonna be fine. And she was like, I don't want another juice. I was like, again,

Anonymous Female Speaker 50:40
it's 3am just drinking dangerous, I

Scott Benner 50:42
don't really care. I was like, so she drank the juice, I gave her half of it. I was like, I'll give you half and I'll wait five minutes, I gave her half I wait. And I was like, just drink the rest of it go to sleep, you're gonna be okay. She drank it. She went to sleep. I sat in my bed for 20 minutes made sure that we got the right outcome, which we did. And it was over. And now she's fine again. And yeah, I do not expect that to happen again tonight. Like it was just because of the Miss on the potato chips. Yeah, it's like that's simple. And a provider would see that take away all of her basil overnight. And then her blood sugar's would start bouncing all over the place, and it would ruin weeks, if not months of her life. And no one, no one would think to put the basil back up, because the doctor said the basil was the problem. Remember, we had a problem. And the doctor said the basil was too high. So that gets wiped from your memory now.

Anonymous Female Speaker 51:35
And that exact phrase The doctor said is it's in. Its it's like impregnated in so many people's brains that like, this is how it's supposed to be. And you've talked about this a million times, but it's that like, it's that there's so much of and I think part of it's because like your your endo is not following your, your Dexcom like part of that, but there's so much I feel like 95% of the advice you get within your undos office is that static diabetes management and to succeed, you have to be dynamic with it, right?

Scott Benner 52:04
It wouldn't, it wouldn't even be terrible. If they gave you that information and said, Listen, this is kind of the basis of it. And you're gonna need to, you know, it's more like a dance, you're gonna have to stay light on your feet here and bob and weave a little bit, you might have to duck a couple of punches and take your shots where you can like, there's more of that going on, then it's not math, it's left with like, it's mathematical. And it's so not, it's

Anonymous Female Speaker 52:28
so true. And honestly, like, there's a ridiculous amount of our patients on pumps who don't even know how to change their settings, they don't know how to manually flick whenever there's like an adjustment. Like, I spent like two and a half hours on the phone to this woman last week, like walking her through how to like change her settings. Because like, the people just don't know how to change your settings. They don't know how to like, press the buttons, they don't know which which process it is because they just don't click, I mess with my settings all the time. And like I like the provider I see is like in our office, but like, she's like, right on, how about it. But like, people, it's a scary amount of people that just don't know how to do that. I

Scott Benner 53:09
was helping someone this week. And I don't think they would mind me saying this much about it. But you know, their kid having it's classic, exactly what we've been talking about. And I, I let her message me for a little while, like to get it out of her system. And I was like, Okay, well, do you want to like, are you looking for my help? Like, you know, I can try to help you. I don't know if I'll be good at it or not, like keep in mind. I'm not a doctor and all that stuff. And she's like, No, I'm just what do you think? And I said, Well, your Basal profile doesn't make any sense to me. It set up like, at least four times a doctor looked at it and said, Oh, are you having a low here? Take away the Basal.

Anonymous Female Speaker 53:48
So 1001 Different Basal rates by our

Scott Benner 53:51
Well, how about one of them is two units an hour and one of them's point three an hour? Yeah,

Anonymous Female Speaker 53:56
that's just that's called like, so that's and that was probably around a meal to compensate for a carb ratio is my assumption.

Scott Benner 54:03
And I'm just like, listen, ya know, if there's no way that two is right, and point three

Anonymous Female Speaker 54:09
is right, absolutely not 100 Some, Something's fishy here.

Scott Benner 54:13
But what would you do? I said, I just shoot for the middle and start over again. And then I did my little thing where I asked how much the kid weighed, which has no real basis in medical theory, I just completely anecdotal from all the conversations I've had. And I was like, Alright, I said, if I'm you, let's set it at this at 24 hours. I said you're probably gonna get a little low overnight. So if that happens, take something away. But the person had trouble making the decision like, like to like take it away and they did it finally, you know, okay, we go back and forth for I just said, like, 24 hours. Now send me another graph. You know, I think we did like three days in a row. And on the third day, I was like, Well, what do you want to do? Thinking Like, you know, she started to get the vibe and she had ideas to do it. And then I was like, Okay, well, I said, if you were seeing a lower sugar overnight at like one starting at one, I'm like, what if you cut the basil back at like 11? And we'll see what happens. And she's like, Well, no, I think he needs it here. So we settled on these, these three numbers, which I was pretty cool with, like, there's a daytime, and overnight and a leading into overnight Basal ring. I was like, Okay, well, she goes to set, set it up in the pump. And she really struggled to set the Basal profile up. Yeah,

Anonymous Female Speaker 55:33
it's like astonishingly difficult for a lot of people because they just never, like, it's a lot of times it's here handed over to the doctor doctor will do it, or the phrase that I hate that I get told a lot is call the manufacturer to find out how to do it like no, no one's gonna do that. They're just gonna sit there with the beds,

Scott Benner 55:53
you've heard a doctor tell a person to call a manufacturer to learn how to change their Basal rates.

Anonymous Female Speaker 55:57
That's what that's what, like us, as assistants in the office are supposed to do, we're supposed to tell the patient to call the manufacturer so I'm like, no. So I'm like anyone who needs to change anything. Bring it to me, and I will walk them through it because I'm not leaving someone high and dry. Because if you told me so I used to slip. If you told me to call Tim to find out how to change my Basal rates, I'm not going to do it. So I'm gonna talk someone through it because I want to make sure that they do it. Not

Scott Benner 56:19
only that is like has the internet, it's pretty popular. Now. It's no one heard. Ya know? It's

Anonymous Female Speaker 56:24
just like, No,

Scott Benner 56:25
there's a whole system of computers, Eva, and they're, I know, fancy. They're connected to each other people's ideas are available. It's really crazy. Check it out. 100% call the manufacturer meanwhile, the manufacturer does not want to be involved in that. And 100% Now isn't allowed to be involved

Anonymous Female Speaker 56:42
in it. Exactly. Because if they make some if they make a mistake, then it's their fault. They're not allowed

Scott Benner 56:47
to give medical advice. No one's allowed to give medical advice. We live in a in a situation where everyone who knows should be saying what they know. And instead, no one will say anything. And like

Anonymous Female Speaker 57:01
I think that's honestly what drives diabetes care to be so poor, is because if Imagine if providers weren't afraid of the liability of a patient having a well, like, just imagine, like, I think that would make so much difference, like and so I'm in school to nursing right now. And so I'm spending a lot of time in the hospital and like, I had like a 350 pound patient on 10 units of Lantis and a sliding scale with no base dose. And I was and I'm like this is absurd. And it's because they're like, Oh, well, we'd rather have him be high than low. And it's like he's trying to recover from osteomyelitis like he's got a wicked infection. And despite these high blood sugars aren't helping. And it's like, imagine what things would look like if we weren't afraid of the liabilities of the world we live in. You're

Scott Benner 57:46
telling me a 350 pound person using 10 units of Basal insulin. Yeah,

Anonymous Female Speaker 57:50
it was like That's enough Basal insulin for his toe? Like no, there's

Scott Benner 57:54
a strong possibility that they need. I mean, 5060 like something like that. Yeah,

Anonymous Female Speaker 58:03
it's no a sliding scale with obese those. So like, if their blood sugar's in range at meals, they're not going to get any insulin at all, and what's in range. So a lot of the sliding scales in the hospital are like if they're under 150. They don't get a base dose. But then you're curious why it bedtime. They're like 300 and you have to correct the 300. And it's like, well, it's that exact idea. The insulin for now is insulin that was for leaders like do you just fix the later now? You're curious? Not? Yeah, you can't not give someone with type one. Insulin at me like I'm sorry, like use your brain. Oh,

Scott Benner 58:36
yeah. You're curious is the is the most delightful thing you've said so far today? Like you're curious as to why which meant that was like your like, that was your sarcasm right there. Yeah. Is there anything that we have not spoken about that we should? I honestly can't think of anything? Is there any chance you don't want me to put this up because you think you're going to get fired? I

Anonymous Female Speaker 58:59
was honestly just thinking that I was just sitting here like I've said a lot of things that I probably shouldn't have said yeah,

Scott Benner 59:06
I'd like you to think about this before I released this. Yeah,

Anonymous Female Speaker 59:10
I know. I was I was honestly just like staring out the window

Scott Benner 59:13
and thinking like the very least maybe we should take your name out of this. Yeah,

Anonymous Female Speaker 59:17
it's just honestly though, it just I need if I go down like this, I go down like this, but

Scott Benner 59:23
we're not we're not doing that. You're gonna you're gonna help far more people where you are than at home go and you believe I got fired over that because but yeah, think really think about and if you want to hear it first or something like I'll send it to you so you can hear it. I can take you up on that. I can totally take all your identifying markers out but you are going to be able to hear and we did talk about me coming to your place so it won't be hard for someone to figure out if they're listening. Listen, I enjoyed our conversation. If you and I are only the only ones to ever hear it. It's okay with me. Okay.

Anonymous Female Speaker 59:58
I might take you up on here. Get through first, I definitely don't wanna lose my job. But at the same time, like it just, it's the things that like, just don't. The things that go into the rug, and it's like the deep dark and dirty of what goes on at the end is office and that sounds horrible to say, but it's like, yeah, it's like that like back closet that no one ever opens. But it's so true when you have to, at one point face it. I don't know. Could

Scott Benner 1:00:21
this be the time I put a voice changer on somebody? That'd be great. If you're like a robot,

Anonymous Female Speaker 1:00:26
there's like, it sounds like a squirrely mouse like, I

Scott Benner 1:00:29
don't know. I don't even know how to do it. If I'm being 100% honest with you, I'm not certain I would be able to do it. Okay, all right. Well, let's stop recording and I'll say goodbye, and give me one second.

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 supporting people with type one diabetes, check out touched by type one. A huge thanks to Dexcom for being longtime sponsors of the Juicebox Podcast dexcom.com/juice box head over there now get started today. I'd like to thank cozy Earth for sponsoring this episode of The Juicebox Podcast and remind you that using my offer code juice box at checkout will save you 40% off of your entire order at cozy earth.com That's the sheets, the towels, the clothing, anything available on the website. If you have a story to tell, or you know somebody whose story would be interesting, please contact me through the website juicebox podcast.com. I would love to tell your cold wind story. 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. And I'd like to take another second to thank Rob at wrong way recording for this awesome edit. I swear I know what the original voice sounds like from this and I don't even think the person is going to recognize themselves. It's really amazing. The episode you just heard was professionally edited by wrong way recording. Wrong way. recording.com Thank you so much for listening. I'll be back soon with another episode of The Juicebox Podcast.

#1118 Grand Rounds: Pregnancy

The fifth Grand Rounds discussion focuses on pregnancy.

+ Click for EPISODE TRANSCRIPT

Scott Benner 0:00
Hello friends, and welcome to episode 1118 of the Juicebox Podcast

Welcome back to the fifth episode of the Grand Rounds series. Of course Grand Rounds is Jenny Smith and myself talking directly to doctors about what you need. And today's episode is about pregnancy. 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. 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. 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/juicebox If you're not already subscribed or following in your favorite audio app, please take the time now to do that. It really helps the show

this episode of The Juicebox Podcast is sponsored by cozy Earth. use the offer code juice box at checkout at cozy earth.com. And you will save 40% off of your entire order. US Matt is sponsoring this episode of The Juicebox Podcast and we've been getting our diabetes supplies from us med for years. You can as well. Us med.com/juice box or call 888-721-1514 Use the link or the number get your free benefits. Check it get started today with us med Jenny Welcome back. How are you?

Unknown Speaker 2:11
I'm great. How are you?

Scott Benner 2:13
So good. Christmas is over. I hope your holiday was good.

Jennifer Smith, CDE 2:16
It was really really nice. It was quiet. It didn't do a lot. We didn't go a lot of places. So there. It was just nice to be quiet and enjoy time. Yes,

Scott Benner 2:27
I'm a fan of that as well. We sat around I think one of the best things we did this Christmas is we bought this big Lego thing that everybody could work on. And we like Oh, which fat? Oh, it's a 3d portrait that you hang on the wall. Oh, I see no. Spider Man. Okay, yeah. So we just saw like, it started off all four of us. Then I think Kelly and I got tired. And then Arden kept going for a while. And then the next day I saw Cole come back into it. Arden Arden was the one that was really focused on it, though. She sat down and she really hammered through it. And it's all done now. And now I'm like, Oh, we have to hang it up somewhere. So yeah,

Jennifer Smith, CDE 2:59
they started bringing those out quite a while ago, I remember, my husband's my father in law really, really, really likes Marilyn Monroe, like, really likes her. And they had one of her quite a number of years ago. And we had looked at getting it and at the time, we were like, oh, we'll just wait until it's like a little bit last, like a holiday sale or something that'll get it for him. And then it was gone. anywhere anymore. So we missed it.

Scott Benner 3:26
This was not inexpensive. But I did catch a sale. And I thought it's about the cost to take us all to a movie. And we'll kind of sit together and it was nice. So I'm glad you had a good holiday. Yeah, we

Jennifer Smith, CDE 3:38
did. Thank you, of course. And it's almost the end of the year. This

Scott Benner 3:41
is it. It's December 29. Yeah, we're making a grand rounds episode today instead of doing whatever it is we usually do at the end of the year. Usually we just sit around and chitchat. But this year, we're gonna we're gonna put some effort into these series, which I'm very excited about. Actually, as you and I are recording like the eighth or ninth episode of it today. The very first episode of it actually goes up in a couple days on December or January 2. So yay. I'm excited for people to hear it. Today. I thought we could talk about pregnancy. Well, now this is a topic that when we asked the audience about it, to be honest, not much came back from them. Oh, but of course you were very passionate about it when we were putting the list together. For people who don't know Jenny co wrote a book about pregnancy with type one diabetes called Yes,

Jennifer Smith, CDE 4:28
it's called pregnancy with type one diabetes your month to month management. Your monitor my blood glucose management? Yes.

Scott Benner 4:37
Can you put our sales voice on there? She's like, Well, hello. It's important because not only does it present a number of issues along the way trimester to trimester and after giving birth and through the postpartum time, but I think that from a human perspective, a lot of young women who are dying Most young women that I've spoken to who are diagnosed prior to the years where they want to have children spend a lot of time thinking that they can't have kids or that it's not going to work out well for them, or it won't be a healthy experience. It's a lot of fear leading up to that, right. And I'm wondering if doctors couldn't do a good job of being able to talk to them in those years. So they don't spend that time scared of what's coming. So maybe like, let's start there. Let's talk about what doctors should be saying to young type ones, or you know, anybody at all really, who might be thinking about having a baby one day, that can give them some comfort and guidance, and maybe start getting themselves together in their mind to think that this is doable? Because it is

Jennifer Smith, CDE 5:43
it is absolutely. And I think you're considering it from the right starting point. You know, any young woman who has started monthly menstruation, right or monthly period, should be told what could potentially come from now having a monthly cycle, right? I Pregnancy is a potential. And if women don't understand from an early age on what that may mean, even though in the teen years, I would, I would expect that most women are not considering pregnancy, right? That's just not what their plan is at this time. In fact, it's much more about prevention. Yeah, at that point,

Scott Benner 6:27
the way I hear my daughter talk about it, she just thinks about that if she believes it's going to hurt and she wants to avoid it. That's

Jennifer Smith, CDE 6:35
great. But hopefully somebody teaches her that that's not really the truth. But But yeah, the teen years are when to start that discussion of even if it is in a preventative way it's know that if a pregnancy happens, whether it's unwanted or you know, unplanned, I should say not necessarily unwanted, unplanned or it's later on planned and something you definitely desire, your glucose management is going to shift, it's going to need to change your targets are going to change. Understanding how to navigate insulin management and everything else within that time period becomes tighter and kind of just much more controlled overall. And so from a non scary standpoint, starting out by saying you can absolutely have children, if that's your desire, someday, even though you don't want it now, Someday you may want kids and if that's the case, you can have them. I

Scott Benner 7:34
used to hate ordering my daughter's diabetes supplies, and never had a good experience. And it was frustrating. But it hasn't been that way for a while actually for about three years now. Because that's how long we've been using us med us med.com/juice box or call 888721151 for us med is the number one distributor for FreeStyle Libre systems nationwide. They are the number one specialty distributor for Omni pod dash. The number one fastest growing tandem distributor nationwide, the number one rated distributor index com customer satisfaction surveys. They have served over 1 million people with diabetes since 1996. They always provide 90 days worth of supplies and fast and free shipping. US med carries everything from insulin pumps and diabetes testing supplies to the latest CGM like the libre three and Dexcom G seven. They accept Medicare nationwide and over 800 private insurers find out why us med has an A plus rating with the Better Business Bureau at us med.com/juice box or just call them at 888-721-1514 get started right now and you'll be getting your supplies the same way we do. This episode of The Juicebox Podcast is sponsored by cozy Earth and right now I'm looking at cozy earth.com to see what's going on. I got oh look at this bamboo pajama set for ladies. The jogger pants for ladies looks like plush lounge socks. That's one of Oprah's Favorite Things. There's the bath collection. We love the waffle towels but there's also premium plush bath towels. Everything that you see here can be had for 40% off with the offer code juice box at checkout. Even the sheets now we use the bamboo sheets, you may choose different linens I don't know what you're going to love when you get to cozy earth.com But we sleep on bamboo sheets from cozy Earth. They are incredibly comfortable. And I bought them myself with my own money using my own offer code. juice box at checkout. 40% off is what I saved. You can as well at cozy earth.com 100%

Jennifer Smith, CDE 9:57
Nobody in this day and age He should be being told, Well, you have diabetes, and you should consider never having children. Or you should really think that you don't need children down the road, right? They shouldn't be told

Scott Benner 10:10
that it's going to be so difficult that it that it makes them think, Oh, I can't do it or, you know, you put it off. Also, you know, this also impacts people's personal relationships. If you're, you know, getting serious with somebody, and that person one day mentioned, oh, I can't wait to have kids one day. And you know, you're secretly harboring inside of you, I can't have children, my a one C seven, I can't, the doctor said it needed to be six. And I don't I can't figure out how to do that. It just has a lot more impact on people than I think it meets the eye perhaps. Right. And from my perspective, I spend a lot of time like you have talking to people about their diabetes and how to help themselves. From my perspective, it all comes back to the basics, right? Because right now, what I hear from women who are just experiencing a cycle, just a monthly cycle, is I don't know what happens, you know, there's a week where everything goes nuts, I just accepted my blood sugar is going to be higher. And instead of teaching them how to handle that cycle, we tend to teach them that that's, that's the cost of doing business, you know, right. And that's just not right. But now, yes, that impact, which is significant, any woman with a period who has type one knows how significant it is the need for insulin, how it changes and fluctuates. But that's going to happen times a lot more during pregnancy. So if you know how to handle your cycle, prior, I think it gives you a better chance to handle your pregnancy, then it does, yeah,

Jennifer Smith, CDE 11:34
absolutely. It also sets you up with the idea, you know, anybody who's going to a gynecologist for just, you know, the yearly checkups, and all those kinds of things. That's honestly, outside of endocrine, bringing up this topic, especially from a female perspective, your gynecologist should also be bringing this up seeing on your medical history that you have diabetes, it should be a piece of the discussion, you know, what are you doing for prevention? Or are you planning a pregnancy, if you are, this is the protocol, I'll stay with you for this portion, you may need to be handed off to a high risk doctor for this portion of it, or you're going to go right to a high risk doctor for this. And the idea of then how to navigate and what to expect should be part of that discussion. So that again, there's a fear factor that's removed, you can see that it's doable. But you can also see that having kind of your ducks in a line, if you will, is really, really important. Pre pregnancy, that preconception time is so valuable. Once you are pregnant. You know, I usually when I get to start with somebody, I hope that I get the preconception time so that we have, you know, one, two, even three months to work on, as you said, getting things all in order, getting Bolus timing, getting meals that are working really well understanding exercise, insulin dosing, and timing and all of that. Once you know that, yes, it will change in pregnancy. Yes, it'll change a lot in the early weeks of pregnancy, because hormones shift considerably, to keep that pregnancy viable. And if you know that ahead of time, you're not gonna be so surprised. Yeah, if you're planning a pregnancy, you also won't be surprised with what's happening. Because you know, to watch for it, right?

Scott Benner 13:29
I think the diabetes tools are universal. Yes. And it's funny that Jenny and I were talking before we started recording, and it's about something different, but this came up managing insulin is, is a lot about Pre-Bolus, eating meals, having your settings right, knowing how to react if something goes wrong, not staring at a high blood sugar. Like these are just kind of basics that if you go through the Pro Tip series, you'll understand. And then after that, you apply them in different situations. And I really do think that one of the variables that exists for diabetes is pregnancy. Yes, not this, like separate thing off to the side. Like oh, you know, if you have type one diabetes, this is your life. But if you get pregnant, it's a new thing. It's the same thing with Swift are moving harder impacting variables. Like I think that's it, right. But if you have the tools to react, and the knowledge to say, oh my gosh, all of a sudden, my food seems to need more insulin or my I don't know, my, my, you know, my standing blood sugar. My my basil doesn't seem to be working anymore to hold me somewhere away from, you know, away from food, right? I need to react and do something correct. And it's going to, like Jenny said, with these hormonal impacts, it comes hard and sometimes it by the way, it takes it away as quickly as it gives it to you. Right? So this isn't all about more insulin. This can be at times where you have to back your insulin down. You can't be waiting three days or until the doctor calls back or whatnot. Like when you start having these impacts you need to react and Right, I mean, Jenny, to put an emphasis on the point, what's the increase, you can see in the amount of insulin that some women need during certain points of pregnancy, I'm trying to I'm trying to paint a picture of what the how much it can go up.

Jennifer Smith, CDE 15:15
Yeah, it and an overall again, we kind of think about pregnancy, insulin management or insulin dose changes. It's kind of like a long duration variable. So that's a great kind of way to describe it. It's like a marathon, right? It's not this little sprint that you get through and you take care of it. And the next day is all better, right? Things shift and change, we look at variables, and then we say, okay, over the course of a whole pregnancy, women's need for insulin can double or even triple, depending on what their preconception dose looks like, and what variables that are healthy lifestyle variables that they keep in the place. If you remain active. If you know your insulin dose timing, if you pay attention to the changes that you're seeing, and we usually say in pregnancy, a trend over about two no more than three days suggests a shift that's needed in a setting. It's not a variable. It's a setting that needs to be changed. So we change much more swiftly than many, you know, many other times of life, maybe leave it a couple more days outside of pregnancy. But yeah, doubling tripling insulin needs, especially, you know, by third trimester, by about 30 plus weeks, up until about 36 weeks or so that's the heaviest amount of insulin that you're going to see changes in insulin dosing on about a weekly basis. You know, 10% more Basal adjustments to Bolus timing. I mean, by about 30 weeks, your Pre-Bolus time could be upwards of about 45 minutes, right. So we're thinking, you know, we're thinking, well, ahead of the meal, you're thinking, I have to Bolus and we're looking, of course, nowadays, we thankfully have technology that shows where things are and how they're drifting up, down stable. So we can use that to our advantage. But it's really, really intense third trimester

Scott Benner 17:16
of pregnancy is a job in itself. But pregnancy with type one, it's a real job, like you have extra things to do now. And in a world where doctors don't often give autonomy to the patients, right? They will tell them things like well, next time you come in, we'll adjust that or call me first. That scares people, then people can't make adjustments. So in a world where they're not even able to turn a dial for 10%, more or 10% less, because they feel like they don't have the ability to seriously the wording that comes from people all the time is I'm afraid I'm going to get yelled at. I can't move my insulin because my doctor will be mad at me. Can you imagine? My doctor told me if I change my settings, they'll drop me. Right? Right. So you're taking away people's ability to like, read and react and see what's going on. A lot of them don't have that to begin with. Now you're putting them in a position that Jenny just described where their insulin needs are gonna go up maybe weekly. And then once it really hits in that third trimester, I've heard women tell me meals that took three units took nine units. Yeah, right. If you can't make the leap to go up 10% In your Basal without asking somebody? Where are you going to get the nerve to Bolus nine units for something you think, you know, historically? Three, three, you can't make that decision on your own. Right. So I think that it's more about I don't think we can't help people who have become pregnant, right? Like I know you can. I've heard plenty of stories of people like, Hey, I got pregnant, I didn't want I didn't mean to like it when she was eight. And I boom, I snap myself together. And I got it down. I did what I needed to do. But often those stories are followed by then the baby came, Mia once he went back up again. Right? Yes, she got through the pregnancy and good for the baby. But the baby's counting on the mom for a whole lifetime. So Correct. Why don't we do some things that help her throughout her life, not just for nine months. That's why I think that doctors need to hear this, so that they can be pre planning and laying this groundwork. And by the way, here's the big secret. We're not saying anything here. You shouldn't be saying to a man either, because all we're telling you is they need to understand their diabetes and how to react to it and how to make good decisions and how to see things and, and you know, and go, Oh, I know what that means. I need more. I need less, right. That's what they need. They need autonomy. And

Jennifer Smith, CDE 19:36
on a broad scale, what they also need, kind of talking about here is really a care team. Again, when I work when I get the chance to work with somebody prior to conception. A big emphasis is who is your care team? Who do you know is in your corner? Is your endo on board? Or are they going to shuffle you off to mainly be managed by a maternal fetal man? venison, a high risk doctor is your OB GYN to manage along with a high risk is your team six people deep? You know, and everybody, it's like too many cooks in the kitchen and you don't know who to believe about what? Right. So I think planning again, goes a long way when we're talking about pregnancy, which is almost the course of a year, right? And a care team that doesn't slap hands, that you say, I've made these adjustments, you let them know, because that's also very important for you to tell them what you've done. So that they could acknowledge and say, Okay, I would have suggested that it looks like they did that already. Great. We'll go from here, right? So you have to be you have to be on a team. And you all have to have even jobs on the team. And you have to have that discussion to know who is going to do what part of this? Do you want my records every week? Do you want my CGM information? Do you have an online database that I can download and send information so you can send me weekly, you know, feedback that we can connect in between our visits that we're going to have more and more frequently, right? I mean, that's a piece that unfortunately, some women who have not planned the pregnancy did want it, but they weren't quite sure that it was going to happen so quickly. And now all of a sudden, oh, here we are. I don't know who I'm supposed to go and see, it makes that early, tiny, even a little bit more, I guess, worrisome or concerning, because they're not quite sure who they're supposed to be checking in with. And

Scott Benner 21:28
you may see an increase in women with diabetes getting pregnant soon. This is a little extrapolation, but and very anecdotal, but I'm seeing on some GLP groups online, women who are just like, I don't even practice birth control. It's not necessarily I can't get pregnant, I've been trying for 20 years, they're magically getting pregnant on GLP medications. So sure, you know if maybe this is impacting PCOS, to some degree, which is allowing pregnancies and by the way, PCOS and type one can go hand in hand a little bit. So this could be the time, you know, like, you could see an inflation of people who are like, Hey, I'm pregnant. I never thought this was going to happen. I've never been planning for this. Right? You know, I'm not ready for this at all. I just think that it is so incumbent upon doctors to do more than just say, Oh, you had the baby. Now, your needs are going to change? Well, thanks. Yeah.

Jennifer Smith, CDE 22:23
Like, what does that be? Yeah.

Scott Benner 22:24
What am I supposed to do? I've lived my whole life, not knowing what I'm doing. And now I've have these crazy variables, these impacts are swaying back and forth. And the extent of your help is, look out. It's coming. You know, and if you don't know, it's so disheartening to look into a physician's eyes and say, Well, what do I do? And they got, I don't know. Yeah, just great, right.

Jennifer Smith, CDE 22:45
And even if you did have some fairly good care during pregnancy are really phenomenal team during pregnancy. As you said, that postpartum time period is a very significant shift. And it after nine months of navigating and managing and understanding insulin resistance, and I have this Bolus timing, that's like 50 minutes long, and I, you know, I've, I've stayed away from these kinds of things, because I just can't navigate and I'm trying to control in these target ranges, and now postpartum, well, goodness, all those pregnancy hormones, they like, go and get washed out, they're gone, right? But now what do you have, most women are trying hard to nurse at least to some degree, that can have a major shift in terms of sensitivity to insulin. And if you're not ready for that, if you haven't been taught ahead of time, what to expect, and how to set up, let's say you're using an insulin pump or using injections with a certain amount of insulin. If you haven't been taught to set up a postpartum strategy, or a management plan with your insulin doses, you are going to be on a roller coaster, and it's going to be a roller coaster of a lot of scary lows, quite honestly. So again, those are all things to think about. And as a physician, or you know, a clinician who's taking care of women in the ages where they may be able to get pregnant or may want to get pregnant. These are discussion points that are really, really, really important. They should almost be check offs on that list of everything else you're checking off. They should be checkups have talked about and discussed pre pregnancy planning targets, et cetera, or, you know, prevention techniques, so that they don't have something that's unplanned happen. Yeah, it's just Well,

Scott Benner 24:33
I guess a couple thoughts here. The first thing I'm thinking is, I get worried that doctors will hear Yeah, you're gonna give them information. They're not going to know what to do with it, and they're gonna make a decision that's going to hurt themselves. But I would tell them that it's like learning to drive when you put a 16 or 17 year old into a car, right? And you you say, Alright, here's the basics. You're not teaching them how to drive completely they haven't been through all the experiences and they're not going to react as well as a 25 year old or a 30 year old would in an emergency situation, right. But they're never going to get to that if you don't teach them that the brakes, you know, on the left three guests on the right. And this is how you turn and you don't over, you know, overcompensate when something happens, keep your eyes up, get to teach them all the basics, then send them out there in the world, and let them have experiences. And then one day something unexpected is gonna happen. And you'll see how those experiences aid them in that moment. Because I just I hear it too much like, well, they don't know how to do it. And I tell them to Bolus more they're going to make themselves well, if you don't, the other things can happen. Right. And the other thing is, is worse, in my opinion, right? So when we're talking about lifelong problems, life shortening issues, not I got a little low, I figured it out next time. I didn't use this much. You know, you have to give people the opportunity to to fend for themselves. Yes. You can't just act scared and tell them, they'll we can't tell them because they won't know what to do with it. That's not fair. No. Like you need a shot at taking care of yourself. And the other thing I wanted to bring up is, you were talking about the nursing and how it could lead to lows. Right? Hmm, I think that what you really need to understand as a physician is that if you don't prep somebody for that, and it happens, here's gonna be the decision tree. I'm holding a newborn baby, trying to nurse it, I got low, I'm never gonna let that happen again, right? You just put that person say once the up one or two points, because they're going to be fearful with their insulin from now on. In another situation where they didn't need to be if they knew how to use it correctly. Either that

Jennifer Smith, CDE 26:40
or they're going to stop nursing. Oh, I didn't even think because yeah, if the nursing is what's causing the sensitivity to insulin, and every time they nurse, they put two and two together, and then why gosh, if I just stopped nursing, I clearly wouldn't be low all the time, or I wouldn't have all these issues. I guess I'll just switch to formula when quite honestly, it's better to breastfeed, it's better to provide breast milk, whether it's pumped or it's nursing or whatever it is, it's just better for many reasons. And if those if that's what you put together, then unfortunately, somebody has missed their job and teaching you how to avoid that as a problem not only being too high, and also not feeling great, it great. But on the opposite of that being able to continue doing what you wanted to do to begin with, for your infant, you're

Scott Benner 27:29
just not putting people in the best possible scenario, like that point right there about them, maybe stopping breastfeeding, right. And the health implications of it aside, forget, like, put those aside for a second, you have no idea. Unless you've been a woman or been married to one for 25 years, like I have been their entire life. They'll never let go of it. I wanted to breastfeed that baby and I didn't. And it's gonna feel like a like, it's gonna be a mom guilt thing that will never leave them. And that is another opportunity to alleviate another problem from people. And with what are we talking about some pre planning some light knowledge of how insulin works, and some you know more? I don't know, laser focused knowledge about what's going to happen during your pregnancy and how to react to it. It's not undoable People do it all the time. Jenny shepherds people through it, I get notes all the time. What do you hear me jump out of the pockets all the time, one day, someone's gonna name a baby after me. It has not happened yet. But I did get a dog in something else. Not the point. The point is, is

Jennifer Smith, CDE 28:30
that I do get a lot of great name for a dog. You

Scott Benner 28:34
know, it's not, by the way, my name is terrible. Don't name your baby Scott. It's just very short and Curt, and it's not really very melodic. And I don't think you should do it. But my point is, is that I get a lot of notes from people who say that I just had a healthy baby because of this podcast. And it's just a podcast, you're a doctor, like you could you could do this for people all day long. Right? You know, right?

Jennifer Smith, CDE 28:55
I mean, on the same note of what nursing can do, if someone is also not navigating, and they have a roller coaster, or they're just ending up writing higher blood sugars, from a safety standpoint, that's also going to have an impact on their breast milk production. Okay, right. So you know, hydration is really important. Hydration is a very under discussed, unless you're talking to the nurses in the hospital, postpartum, who are really awesome at bringing you water and making sure you're drinking, drinking when you go home. There's nobody who's going to bring you your water. There's nobody who's going to emphasize how important that is. There's nobody really who's going to re emphasize for you. How important not running consistently high blood sugars is for actually providing enough you know, quality breast milk, honestly. So

Scott Benner 29:50
you're already asking a lot of your body before you're trying to make breast milk. And you see it with people living with diabetes all the time, just being the height graded slows down their insulin use the efficacy of the insulin that they have in them. Now they're pushing more insulin to get the same response. They don't know, all of a sudden they get hydrated or they, you know, they they find a better way and boom, they're dropped low they're eating, you turn the whole life into this, right, this chase that that's just you're always chasing diabetes instead of I don't know, like impacting it and bending it to their will to some degree, you know, right. Especially with CGM, you know, right. All of this is just so eminently possible. And if you're cheese, if you're kind of you're helping a person who's pregnant, you don't have them on a CGM. I mean, you've made a mistake, you know, so correct. Absolutely. We'll talk about the other side of it for a second, Jenny, because we're not horrible people who just think that doctors don't do a good job.

Jennifer Smith, CDE 30:47
First of all, not at all, there are many amazing teams out there immensely.

Scott Benner 30:50
Great, you know, just I've seen it over and over again. But it's not what everybody gets, right. And, you know, if you're in a position to help somebody, and you don't understand these things, I mean, this is gonna sound like I'm saying, just listen to my podcasts, but just trust me enough people listen to it already, that if you as a doctor, don't listen, I'll be okay. So I don't I'm not just asking you to listen. But you could take, I don't know, a couple of hours and listen through some of the Pro Tip series, or you could listen to we have like 16 episodes about pregnancy, from like pro tip episodes about pregnancy down to I think I did an interview with one woman after each of her trimesters, and then after she gave birth, right, like, yep, somebody said, it felt like my insulin needs changed as soon as I delivered the placenta. And I thought, Oh, that's so interesting. Who would think about that, you know, like, she's like that placenta came out, and I was turning down my Basal. And heading back home, I've heard other people say, it took days for my insulin needs to change, like, anywhere in between the least, you know, to look for it.

Jennifer Smith, CDE 31:53
I mean, this whole honestly, this whole, like discussion here is really the reason that, you know, we're emphasizing to the clinicians benefit, to provide education provide information to provide a start, so that somebody doesn't feel so lost through what is a fairly long amount of time, you know, in terms of a developing baby, right? I mean, it's the reason that I put together the book that I did with, with my co author was quite honestly, there, there wasn't anything. I mean, I went through my two pregnancies, my first one, especially looking up researching, doing a lot of ahead of time work to know what I was getting into, and to know how I could expect, but where was that information coming from? Like, research articles? It wasn't like a pamphlet online that was like, This is what you should expect. Oh,

Scott Benner 32:49
you're pregnant. Right? Right. Well, that's where I mean, that's how the podcast became what it is, right? I'm just one day thinking like, how do I help my daughter, and then you just pull information together, you put it into practice, it works, you keep what works, you get rid of what doesn't? And then from there, it's about how to communicate it, which is what this is about, like, I don't know something about diabetes, that you can't go read somewhere. I'm not a magic person who understands something that does the rest of you don't get to know. Right, I do understand this stuff. I do know how to implement it. But the thing I think I'm good at is describing it to other people. Right. And I think that is a thing that doctors could become good at, right? But you have to first become proficient at it as if you're trying to save your daughter, you know, like, we're as if you're Jenny, and you're pregnant, you're like, I don't know what to do, I need to figure this out. Right? Like, you have to put yourself in their position while you're collecting the data and feeling the importance of it. Right. And then you learn how to talk to people about it. And the only way you're going to learn is the same way those people are gonna learn how to use insulin, you got to start and you might maybe you'll screw it up at first, maybe you will, right? Like maybe the first time you try it, you may go, oh, I shouldn't have said it that way. And it might take you a couple of people before you really get good at it. But it doesn't take that long. And don't be scared, you know, like, just get out there and try to help somebody. Right? You'd be surprised what happens, you

Jennifer Smith, CDE 34:11
know, and I think because the grand majority of general medicine practitioners are going to see women who potentially don't have pre existing diabetes, you know, before pregnancy. I think there's an unfortunate group of women who have gestational diabetes, right? With testing in that like late second trimester, a glucose tolerance test reveals that their body is not navigating glucose. It's not navigating food the way that it should, and that there is something that needs to be done in order to have a healthy baby. They're on out right. But what I've really seen is the aftermath delivery for women who have had gestational during pregnancy, while there is postpartum, further testing To evaluate that, yes, your glucose levels have gone back to normal your body is responding like it should. I think it's an underserved under educated in terms of lifestyle changes they made in pregnancy, and how important those changes are to keep, because there's a high risk of type two diabetes, if you have had gestational diabetes, right. And so it's an under followed.

Scott Benner 35:26
Oh, yeah, it's treated like we got you. We got the baby. Right. It's over now. Right? Yeah, it's Yeah. Am I gonna get diabetes one day? Maybe? Good luck. Yeah. Yeah. Right. Like, right. Never think about it again. Oh, my gosh, the people with type two Oh, my God, like, you know, if you think people pregnant with type one aren't getting good, good information, people with type two are being just dropped left and right. Like we have somehow, as a society decided that there are some things that happened to you. And when they happen, you get pushed off onto another line, you know, like, oh, oh, they lose. Yeah.

Jennifer Smith, CDE 35:58
And, and or it's not until something really significant is happening. You know, let's say pre pregnancy, a tight woman with type two is managing quite well, right? And is again, undereducated in what to expect to happen. And so they don't know how to keep up enough. And they end up coming in and now blood sugars are all over the place and their medications they were using, they're not working anymore, or medications maybe weren't discussed well enough to say here, you're likely going to need to change to using insulin. Are you ready for that? You know, this is what it would look like. And we're going to have you follow up with a high risk doctor, to ensure that you're being managed really, really well, again, it's a missing part of education. For that group,

Scott Benner 36:43
it's become popular to say that, you know, it's not health care, you know, you're not really getting health care, right? It's not nothing's preventative. We just try to fix you after you're broken. Right, that that's how the system works. And it is how the system works. I'm not saying that. No, no, you're right. Maybe it's not that simple. Maybe it's more that we're not good at preventative. Not that we're not trying. But maybe people just don't know how to do it, or how to communicate it. Because you know what I mean? Like, I know, there's the business and the money side of it. And the money side is directed at what it's directed at. I understand all that I'm not being I'm not being Pollyanna about it. But I do think that part of the reason I wanted to make this podcast series is because I don't think that this doesn't happen just out of apathy. I think it doesn't happen because people don't think to do it like that. Everyone is like they see themselves as either working or broken. Do you don't I mean, and when you're working, you don't have to do anything about it. Like nobody does sit ups when they're thin. I mean, listen, after New Year's go outside, and everyone jogging, you're going to look at and think, oh, they should have started jogging like three years ago. Right? Like, right. But it's not till it hits you where you're like, I have to do something. It's not a very human thing to work on things that aren't obvious. But in this specific situation, if you know how to do it, you're saving a ton of problems. Right on the back end, just like you would with anything else. But here. It just seems more imminently important to me. Yeah,

Jennifer Smith, CDE 38:15
no, absolutely. I think. I mean, you set it in a very nice way you said it, that there is that there is no preventative medicine. And you know, the reason like for that, right? I mean, no money in it. Yeah, there is no, I mean, I did not I there's no way to delicately say there's no money in preventative medicine. If you've got somebody coming in who is really healthy, because you've told them this, this and this in terms of lifestyle. And yes, these vitamins, no, you don't need this, eat carrots, you whatever it is, that's a one visit. And you know what, maybe they're gonna go off on healthy life for the next five years. Because we're come back, you're taught them to be healthy. That's awesome. That's an heart hook. Your system should work. But it doesn't make money. Yeah,

Scott Benner 39:01
it's a shame. I mean, honestly, I understand how it happens and what the cycle is that brings us to that. And then once you get into that cycle, it holds us in that cycle, like that, I'll get ya get all that. So maybe this is the part of the conversation for the patients where I'm telling you, if you just go listen to the Pro Tip series, then when you get pregnant, you should probably be able to do this no trouble. Right? You know, and I do honestly believe that. I don't think that the podcast is magical. I don't think that the information is magical. I just think that it's being communicated in a way that is digestible for you understandable and will put you in a position to make good decisions, right. And I think that really is the key to this because as much as I'm hoping that doctors figure it out and that people listen to this and go I'm going to do that. I'm more certain that you're probably going to run into a doctor that helps you yes or no, it's going to be a coin flip. And you're not going to know the difference when it happens. That way really is the biggest trouble is that you're not going to know if you've got a good one OR, or NOT a good one until it's a little too late. By the way, marriage is like that too.

Jennifer Smith, CDE 40:10
Well, it all starts with three.

Scott Benner 40:12
Yeah, I could explain to you how not to do that too. But it just would take too much time. But listen, if you want a good life, you do the work first. Right? That's it, you do the work first. And then the rest is easy. And whether it's pregnancy or marriage or being a doctor, I mean, we're not really saying anything that difficult here.

Jennifer Smith, CDE 40:33
It's not rocket science. And we've said, I don't know how many times we've said that is not rocket science,

Scott Benner 40:37
effort upfront, everything else gets easier. That's all. So I know, not everybody is going to make a baby on purpose. Or, you know, and that doesn't make your pregnancy invalid, obviously, or that the love, you're going to have invalid. But if you're running around with an ad, one C, and you're a woman who could at any point be pregnant, I'm going to tell you that this podcast is full of stories from women who are in that situation. And when you hear them tell that story, what you're going to hear them say at some point is, I wish I would have learned how to do this sooner? Yes, I just don't want you all to be in the position where you're always saying, I wish I would have. Instead you could say you know what I did? You know, I learned about this thing that really impacts my life, and it made my whole life better. Right? That's what I'm hoping

Jennifer Smith, CDE 41:26
for. And if you learn it the way that it's presented, and again, digestible, right bits and pieces that you can take, you can apply based on what you see happening long term in that post partum time period, you're going to stick with what you know, because of the fact that you have been applying it already. So it's not going to get all thrown out the window because Oh, it's all over now. And I can just go back to completely forgetting everything that I've learned, you're more likely to continue it, especially if you've planned to have another child someday, right? You don't want to start out from ground zero all over again. You might as well continue with what you know, and keep things in a range, that long term is going to keep you healthy, whether you have kids or not.

Scott Benner 42:13
Yeah, that happens for some people. And then for other people, they fall into that trap where everything gets slotted above, it's the baby first, and then things that affect the baby. And then the next thing you know, you're not even thinking about yourself 20 steps down on your list, right? And when you have diabetes, that can't happen. No. So you if that's mom guilt, I don't know what does that right? What makes you although I was a stay at home dad for 20 years, I was the one like I'd make food and then like eat what was left

Jennifer Smith, CDE 42:41
your family first and then you took the scraps, right?

Scott Benner 42:44
And you think nothing of it while you're doing as a matter of fact, you feel kind of, I don't know what the word is, but you feel good about it, almost like I put people before me, it can't be like that with your diabetes, I tell my daughter all the time, all of the time. You are first. I don't care in what scenario in life. If you're out driving with your friends, if you're off to college, if you've met a boy, if you're just living your life sitting around the house, it's diabetes than anything else you want to put after that we cannot ignore the diabetes first, because it will ruin everything else if we ignore, right? Absolutely. It's diabetes first. And when you do that, it makes diabetes. This is gonna sound strange. But if you make it first, and you understand what to do, and you have the tools, which are very accessible here in the podcast, then everything else like I just said gets easy, like and then all of a sudden you don't think about I think people must believe that I'm constantly think or Jenny's constantly thinking about her diabetes. I mean, honestly, Jenny, you really think about it that often?

Jennifer Smith, CDE 43:48
No, in fact, I don't. I mean, I know a lot of people who sit with like, you know, their apps open and whatever their tools and they look at it, unless my thing makes noises yet me

Scott Benner 44:00
for some reason. It's three o'clock in the afternoon. I haven't looked at his blood sugar. Right,

Jennifer Smith, CDE 44:05
unless it's making noises at me or, you know, my pod is like, decided to give the death toll. The you know, the, for some strange reason that I addressed something but yeah, yeah, I mean, I try really hard to because I know what I am doing. And most of the time, you know, 90% of the time I'm doing similar things over and over. I can let it take a backseat, but not in a way that I'm forgetting about it. It's just because things work because I know how to make them work.

Scott Benner 44:37
It's the driving analogy again. Yes, you can get in a car and drive 100 miles. I just drove 700 miles one way and turn back around and drove 700 miles back again. I didn't hit anything. I didn't come close to dying. Like right like I just been driving a long time I have these tools that I don't even know I'm using that I'm using it doesn't weigh me down. I didn't get home ago. Oh my gosh, my life is ruined. I had to think about driving. Man I think diabetes the same way I just said, I haven't seen Arden's blood sugar today. So I opened up my phone, or blood sugar's 107. It hasn't been below 70 or over 110 in the last 12 hours, yay. But all that is, is Settings and Tools and insulin timing that I've already taught myself that happen almost automatically when we need them to happen, right. That's my point about all this. That's my point about the whole damn Podcast. I'm sick of telling people dammit, Jenny, I made myself upset. Go make a baby weight or throws up on you. It's gonna be a big ball of fun. Congratulations.

Jennifer Smith, CDE 45:42
It is fun. Sure it is.

Scott Benner 45:43
It's absolutely fantastic. Everyone should have a whole bunch of babies there. A lot of the big party. Good luck paying for college. Thank you for doing this with me. I

Jennifer Smith, CDE 45:52
appreciate it. No, that's great. Thanks.

Scott Benner 45:59
I'd like to thank cozy Earth for sponsoring this episode of The Juicebox Podcast and remind you that using my offer code juicebox at checkout will save you 40% off of your entire order at cozy earth.com. That's the sheets the towels, the clothing, anything available on the website. 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 of the sponsors. The episode you just heard was professionally edited by wrong way recording. Wrong way. recording.com. Jenny Smith holds a bachelor's degree in Human Nutrition and biology from the University of Wisconsin. She is a registered and licensed dietitian, a certified diabetes educator and a certified trainer and most makes and models of insulin pumps and continuous glucose monitoring systems. She's also had type one diabetes for over 35 years, and she works at integrated diabetes.com. If you're interested in hiring Jenny, you can learn more about her at that link. BetterHelp is the world's largest therapy service and is 100% online. With better help, you can tap into a network of over 25,000 licensed and experienced therapist who can help you with a wide range of issues. Better help.com forward slash juicebox. To get started, you just answer a few questions about your needs and preferences in therapy. That way BetterHelp can match you with the right therapist from their network. And when you use my link, you'll save 10% On your first month of therapy. You can message your therapist at any time and schedule live sessions when it's convenient for you. Talk to them however you feel comfortable text chat phone or video call. If your therapist isn't the right fit. For any reason at all, you can switch to a new therapist at no additional charge. And the best part for me is that with better help you get the same professionalism and quality you expect from in office therapy. But with a therapist who is custom picked for you, and you're gonna get more scheduling flexibility, and a more affordable price betterhelp.com forward slash juicebox that's better help h e l p.com. Forward slash juicebox. Save 10% On your first month of therapy. 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. Hey, if you kept listening through all that, I really appreciate it. I just wanted you to know that. It's Saturday night at like nine o'clock and I'll make it a podcast and you never know who's gonna listen to it. But the fact that you listened this long, it really means a lot to me. Thank you so much.