Scott Benner 3/11/24 Scott Benner 3/11/24

#1149 Cold Wind: Healthcare Whistleblower Dr. Feelgood

'Veronica’ was diagnosed with T1D when she was 12. We talked about doctors inibriated at work while dispensing questionable drugs out of the endocrinologist office. Her voice and name have been changed to protect her identity.

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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, welcome to episode 1149 of the Juicebox Podcast.

Today, the person we're calling Veronica is a 47 year old type one. She was diagnosed at 12 years old and she works in a doctor's office. Today's cold wind is particularly chilling, as Veronica will talk about how the doctors in her office were drunk and high and dispensing drugs that were outside of what you might expect from an endocrinologist. 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. The T one D exchange is looking for US residents who have type one diabetes are are the caregiver of someone with type one. All they want you to do is go to T one D exchange.org/juicebox. and complete the survey. That's it. It'll take you about 10 minutes it'll help people with type one diabetes. It will help you and it will support the Juicebox Podcast T one D exchange.org/juice box. If you're looking for community around type one diabetes, check out the Juicebox Podcast private Facebook group Juicebox Podcast type one diabetes

this episode of The Juicebox Podcast is sponsored by the only implantable sensor rated for long term wear up to six months. The ever since CGM ever since cgm.com/juicebox. This episode of The Juicebox Podcast is sponsored by us med U S med.com/juice box or call 888721151 for us med is where my daughter gets her diabetes supplies from and you could to use the link or number two get your free benefit check and get started today with us MIT. This episode of The Juicebox Podcast is sponsored by the Omni pod five, Omni pod.com/juice box. My daughter Arden has been wearing an omni pod every day since 2006. And it has been a constant friend in her life with diabetes, consistent tubeless and worryfree Omni pod.com/juice box. So let's find out a little bit about you. Do you have type one or do you care for somebody? Who does?

'Veronica' 2:44
I have type one?

Scott Benner 2:45
How old were you when you were diagnosed?

'Veronica' 2:47
12

Scott Benner 2:50
Okay, about how old are you now?

'Veronica' 2:53
47.

Scott Benner 2:55
Seven. Okay. 20 230-240-2035 years ago? Yeah, that's a long time.

'Veronica' 3:04
It's been a hot minute time flies when you're having fun.

Scott Benner 3:07
Are you having fun?

'Veronica' 3:08
The first couple decades were rough.

Scott Benner 3:12
last 15 years, it's really coming together.

'Veronica' 3:15
I mean, honestly, yes. The technology has made things much, much easier. My highest agency was 19. Oh, wow. And that was 10 years after diagnosis. So I mean, I knew better.

Scott Benner 3:30
Yeah. And 20. That's just 25 years ago, which makes it like 1999 2000 ish around there. Yep. Yeah. Wow. You know, I just saw I get when people leave comments on things like I get notes about it and stuff like that. I just saw somebody leave a comment on like a YouTube video. And the person's like, you know, I've had diabetes for a really long time. And I was very accustomed to blood sugars and the 300 words and a one sees like, as high as 12. And then I got an Omnipod five, and the person's like, you amazed at what's happening. I'm waking up my blood sugar is like 115 in the morning, like that kind of stuff. And then I read that 20 minutes ago, and then you literally came on and said everything was a hot mess till technology got better.

'Veronica' 4:13
Well, I got a pump in 2001. And but I hate finger sticking like that is the worst. And so and I didn't like those early CGM that forced me to prick my finger. So

Scott Benner 4:27
I kind of avoided it.

'Veronica' 4:30
Did you try it? At least or no? So I got a pump in in 2000 2001. And I've worn a pump since then. And my agency was probably 1011 until the Dexcom G six came along.

Scott Benner 4:44
So walk me through how that happens. Is it partially because you don't want to test your blood sugar? Is it apathy, like where do you

'Veronica' 4:51
it's apathy but like so when I was diagnosed, I was told there would be a cure in five or 10 years and I think at that point, I just kind of decided I don't want to live five or 10 years with this disease. And I didn't make many plans for the future. And I got to the 10 year mark, and I was like, What do I do now? I mean, there's just a lot of stuff but so on with G six, and pumping, we were probably at eight, nine. And then with the control IQ, then it's like six, seven.

Scott Benner 5:21
So if you have access to the data, with a G six, for example, and you have a pumps, you're not shooting insulin all the time. So it's, it's as easy as pushing a button. And eight or nine a once the C still says to me, I'm not really counting my carbs. I'm not Pre-Bolus and meals, I'm not correcting highs Is that about right?

'Veronica' 5:39
Yeah, I still I'm not great at Pre-Bolus meals, I just, I struggle with that. And so, and there's a lot of other things that have happened, I struggled with depression for a very, very long time. diabetes, most of us know comes with a very generous side serving of depression. So and but I was able to mask it very well. And about five years ago, I had my first TMS treatment, transcranial magnetic stimulation. And that was pretty life changing, but it unmasked the ADHD that has always been there. But the depression always hit it. And so now I'm learning to like, I can finally identify the ADHD and know why. I'm not good about Pre-Bolus thing I just forget, like, I'll just skip a meal altogether and not even notice. So skipping. Bolus is like child's play. Like that's just how I roll

Scott Benner 6:37
when you said you could mask the depression. How did that work? How did you like nobody

'Veronica' 6:41
really knew the extent of the depression like I, if you meet me face to face, I'm happy I'm like, but there was still just this bone deep. And there were times that it would get a lot worse where I just couldn't get out of bed and couldn't function. But all of my energy would go into my work. So there was not any energy for anything else.

Scott Benner 7:08
Do you have a thyroid issue at all?

'Veronica' 7:10
Absolutely. That's the other side surfing.

Scott Benner 7:14
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'Veronica' 9:55
I don't remember much prior to diagnosis. I don't believe I was depressed I also believe that my elementary education was unique and could easily mask ADHD. Then I went on to middle school and sixth grade I get diagnosed. That's a whole nother story. That sounds crazy. How

Scott Benner 10:16
is it unique,

'Veronica' 10:17
your that education piece that would mask ADHD. So I went to a public school. And it was a special program that I got to choose my teachers and my classes. And there were no letter grades. I just wrote a letter home to your mom and dad, this is what I've been working on. So the mornings were split up between language arts and math. And it was a very tiny school that were for teachers when I started there. And I was there for five years. And then the afternoons the teachers would do two to three week units, teaching something that they were interested in which let me tell you, it makes a huge difference in education when the teacher is passionate about it. I didn't. This is crazy to say, I did not know the difference between science and social studies until I was in middle school. Because get this it's all connected. The

Scott Benner 11:10
what hippie part of California you from exactly. It was in the Northeast? Oh, it wasn't California. It was not California. All right. I got it. I see what's happening here. Yeah, so not hippies, high minded intellectuals.

'Veronica' 11:23
It was a nice combination of the two. Gotcha. But so for example, if we were studying monarch butterflies, we were looking at their migration patterns and how the weather affects it and the geography of where they go and calendars of when they when they migrate and their lifecycle. And so everything is connected. And that's why when I talked to people I talked about, well, we can look at the science of history, and we can look at the history of science. And so that's why those two things have have always been they're all interconnected. There's not any difference in my brain.

Scott Benner 12:00
All right. So is there any chance that well, let me ask first, when did the thyroid diagnosis come?

'Veronica' 12:08
I was 17. Do you can manage that? Well, it's okay. It goes up and down. And I, you know, I'm not great about being super consistent with my doses. Right now I have it set to where the doses set. Well, I just changed insurance. So I have to switch to unit three. So that's going to be a cluster of confusion. Yeah, I the dose is set so that I can miss every once in a while and not see a big impact.

Scott Benner 12:38
Or do you have as much trouble with that as you do with the insulin?

'Veronica' 12:42
Not as much? I don't think okay. I mean,

Scott Benner 12:45
so high blood sugars, and an unmanaged thyroid could easily give you depression? Yeah, yeah. But there's a doctor ever tie that together for you. Like, hey, Veronica, if we take our insulin and keep our blood sugar from being high, you'll avoid this cloudy feeling you maybe you'll feel better, your head will be clearer, you'll be able to, like live easier, like that kind of stuff.

'Veronica' 13:08
Not in relation to the depression, you know, lack of energy in my late 20s and early 30s. They're always like, it's your blood sugar. It's your blood sugar. It's your blood sugar. And I'm like, I'm doing the best I can with what I've got. Like, I don't know why I can't do the things I need to do. And so it was always get your blood sugar under control. And I never really believed them. I was always like, that's just a line. Like, there's gotta be something else.

Scott Benner 13:33
But the man is just trying to get you to do what they want to do. Yeah, they're

'Veronica' 13:37
trying to manipulate. But now that that my agency is better, and like, I'm feeling more energetic, and my husband and I joke, and we're like, we're in the prime of our lives right now. Like, who needs your 20s or 30s? Like, this is this we're loving life.

Scott Benner 13:55
I see your knees don't hurt too bad. No, no, no, here you go. Wait a lot of sores. Okay, so you just said I'm doing the best that I can like referring back to the past. In hindsight, were you doing the best that you could? I'm starting to take it for granted. I am I'm starting to take for granted that Ardens diabetes supplies just show up. But they do because of us med us med.com/juice box, we get an email that says you know do you want to refill your order? And you click and say yes, and then it just comes to the door. There's not a lot to say when things are done well yeah, I could stand here and tell you us med carries Omnipod five Omnipod dash Dexcom G seven G six tandem x two libre three libre two. I mean, they've got there's so much. I'm not even listening at all. I should be. I will at the end. I promise. My point is this. It just works and we Don't talk about things enough when they just work us med.com/juice box or call 888-721-1514 Get your free benefits check and get started today with the white glove treatment offered by us med us med here's what they got. FreeStyle Libre three and two. They got it. Omni pod dash. Yes. Omni pod five, aha, tandem? Yep. What about have they served a million people with diabetes since 1996. They have better service and better care is what you're gonna get from us med but you're also going to get 90 days worth of supplies, and fast and free shipping. They carry everything from insulin pumps to diabetes testing supplies, the latest CGM, and they accept Medicare nationwide. Find out why us med has an A plus rating with the Better Business Bureau at us med.com/juice box or call 888721151 for not the best that there is the best that you that you had available to you did. Does that make sense? The difference? Yeah,

'Veronica' 16:03
yeah. Like I'm gonna be really generous with most diabetics out there. I honestly believe that most people with diabetes are doing the best they can with the information they've been given, and they are sorely under educated. And you are as well. I don't know that I am. Like, I am able to pick things up and piece things together. And so in my role, currently, I talk a lot to people. And I'm a big advocate for experimenting with yourself. You know, I'm like, especially with the type twos and putting them on CGM. I'm like, experiment, see which foods drive it up. And then and I'm not about saying don't ever have that food again and like, minimize it, reduce it, don't don't use that as much. If you notice that rice makes you go up every day, then, you know, you got to change that has to change or find a good substitute. But I think most I mean, honestly, when I was, I don't know, 13 I had a week of inpatient education at Joslin diabetes Center in Boston. That was when insurance would pay for such wonderful things.

Scott Benner 17:18
But it didn't I mean, you still struggled right out of the gate though, right? With giving yourself insulin you didn't like the the fingerprint looks like I didn't like

'Veronica' 17:26
the fingerprints. So alright, let's go to the diagnosis story. I had an afternoon paper route. And the day before I was diagnosed, my one of my teachers said, NAME you're not looking very well. Are you okay? And I said, Well, my mom thinks I have something called diabetes, but I don't know. I'm going to the doctor tomorrow. I do remember drinking a ton of water. In fact, I felt like it. I would drink water. It would just still come out cold. right through me. It's

Scott Benner 17:56
a funny way of saying it went right through.

'Veronica' 17:57
Yeah, it was it was ridiculous. I finished up my paper out that afternoon, grabbed a snack at home before my dad took me to the doctor. And my mom ran a home daycare. And so the snack of the day was fluffernutter on graham crackers. And so that's peanut butter and fluff. Marshmallow Fluff. And I took an entire sleeve of graham crackers with and made them into the peanut butter and fluff sandwiches and ate the whole thing before going to the doctor. Oh my gosh. So yeah, my blood sugar was 800 or something.

Scott Benner 18:33
How did your mom know you had diabetes? She knew

'Veronica' 18:36
somebody that had it. And so she had grown kind of concerned I was losing weight. When I was diagnosed I was 95th percentile for height and fifth percentile for weight. And I think her cousin's kids had it as well. diabetes, I had never met them. I still don't think I have kids.

Scott Benner 18:58
I got it. So she had seen it before a little bit and then recognize some of the symptoms from other conversations she's

'Veronica' 19:05
probably had in the past. Yeah. And she didn't take me to the doctor my father did. Because she was at home with the kids watch. at the daycare. Yeah. And so they he took me to the doctor and the doctor said, okay, she's got type one diabetes. This is not a death sentence. Life still goes on. So continue with your normal activities. My dad took me over to the hospital and they started an IV. And he left to go home to get mom because they only had one car. Because this was the 80s Yeah, that candy striper came around and asked if I wanted a candy bar. I was like, oh, yeah, and and then she looked at my chart and she's like, you can't have candy ever again. I was devastated. So what are you talking about? So my mom came that night. This is where it gets tricky. The the doctor had said don't change you know your Plants life isn't ending life goes on. So keep your plans. The next day, my mom flew halfway across the country, to her parents on a trip that she had planned. And so I was in the hospital, she was still away. My dad learned to give me the injections and brought me home from the hospital on a Friday and gets

Scott Benner 20:22
tricky because you felt abandoned or why? Yeah, I

'Veronica' 20:25
mean, like, What parent does that?

Scott Benner 20:30
I mean, is this a thing we have come to expect from her over time? Or was it a one off like, weirdo thing, whereas the doctor said, Don't change your life? And she's like, well, I have a trip planned. So I guess I'll take it.

'Veronica' 20:40
She's never been real involved with the diabetes care, and partly probably from the beginning. And and you know, we joke about the abandonment issues now. But I still got a lot of work to work through with that. But that's just my work

Scott Benner 20:53
to parents still together. Yeah, yeah. And she didn't leave you leave you she just went away on this trip and came back. You went away on

'Veronica' 21:00
the trip. She didn't tell her parents before she left. And then she got there. And they could see something was wrong on her face. And they were mad at her for going. But they were auctioning off the family farm that had been in the family for 150 years. So I mean, I don't know, like, what would I do as a parent? I don't know. Like, you don't know. Do

Scott Benner 21:20
you have kids? Yeah, I

'Veronica' 21:21
have one. I would probably stay with her. Make sense. Which is funny, though. Because I, in our family on the hands off mother, my husband works at the school that she goes to and so they commute to and from school together. And, you know, he's was a teacher and so he's more hands on with the homework. And then I am is that

Scott Benner 21:44
because of how you were raised? Do you think you are you mimicking what your mom did?

'Veronica' 21:48
I don't know if I'm mimicking I just I know that the way that it's set up that they spend more time together. I also know that the elementary school experience that I had doesn't lend itself towards understanding her elementary school experience. Now that she's in high school, you know, we we compare, you know, we we talk Latin, we talk, biology, whatever she's taking, and, you know, work through the whole the homework, so,

Scott Benner 22:17
but you're not you're not emotionally disconnected from her though. No, no, just some of the day to day stuff falls more toward your husband. Yeah, I gotcha. All right. What do you do for a living now?

'Veronica' 22:29
So currently, I am. My title is point of care specialist. I work in an endocrinology office for a small distributor slash pharmacy have diabetes technology. And there have been some changes in the office since I've been there. But when I started, I was paid mostly by the company I worked for and a little bit by the doctor's office so that I could fall under the pump training contracts. And so I'm a certified Omnipod, and tandem trainer. And so I start people on CGM EMS, I get their orders going into the Alright, was doing prior authorizations. The doctor has since been acquired by the hospital and now I have no access to records at all. So it's changed but it's really it's been good. Okay. So

Scott Benner 23:19
you work for a company that we does distribution? Yes. Okay. So they're

'Veronica' 23:24
both DME and pharmacy, mostly Medicare, but soon to have some changes to that. So that's going to be good.

Scott Benner 23:31
And what's your educational background?

'Veronica' 23:32
Oh, gosh, um, I found a five colleges five, I don't know four or five. And I have an associate's degree in general studies. And I have that's an AE in General Studies. And then as in nuclear medicine, technology.

Scott Benner 23:48
Okay, what did you do before this?

'Veronica' 23:50
I worked with a homeless for a year and before that I was at another Endocrinol office as front desk, but ended up being their pump trainer and doing pretty much what I do now. So that job prepared me for what I'm doing now. But it was a Worcester house. So. So that was during COVID. So that was right when COVID started. And they work from home for a year and a half. Everything from home. And so I went into the office every day through COVID, collecting co pays, and doing punk trainings and all of that, but they also Hindsight is 2020. I didn't always see it while I was there, but pretty sure there was some pretty heavy drug use and a lot of drinking and

Scott Benner 24:36
for I'm sorry for you or for them for them. Okay, so are you talking about the people running the office?

The providers? Oh, okay. So

the doctors were involved in a lot of heavy drug use and drinking. Yes. I think he's your endocrinologist. Yes. Ah, geez. How did that impact the practice? They were were

'Veronica' 25:00
able to hide under the cover of COVID. And so a week before I was fired, one of them was like, Oh, we love you so much. We want you to stay with us forever. You're going to be such a wonderful diabetes educator level, blah. And I just smiled and nodded. I was seeking an exit plan at the time. But I also had a home refinance in the works. The day that I got fired, the phones went out and I was in and out of the office, trying to fix that. And I came back in and I could tell she was not happy with me. And she just started screaming in front of a room, waiting room full of patients get the eff out of my office. You have no I top of and then her husband had, it was a married couple that were the two providers in the office. And he had she charged at me at one point, and he had to hold her back. And I was like, I'm gathering my stuff. And I'm out. And I still to this day don't know why that happened. Were they both using? I am not sure. I suspect okay.

Scott Benner 26:02
Did they do it in the office? Like were they hired drunk? Like during the day,

'Veronica' 26:06
once they came back from COVID, there were a number of days that we had to send her home, quote unquote, sick. And he would he would cancel his day too, and take her home and care for her. And Hindsight is 2020. And I'm like, Oh, my. So yeah.

Scott Benner 26:26
Do you think that impacted the care they were giving to people?

'Veronica' 26:29
Oh, absolutely. People, the patients absolutely adore them. Absolutely adore them. In fact, she was my provider before I got fired from working at the office. And I enjoyed her. But I knew there were some things that were off. But like, it's a very codependent relationship, they will tell patients with patients want to hear and do whatever the patient wants. And, but, and if the patient has any problems with the front desk, they'll say, Oh, I'm so sorry. The front desk let you down. And I can't go and say to the patient, I have messaged her 15 times every day for the last 15 days and she has not responded. She is not doing her job.

Scott Benner 27:15
And then puts it back on the people working out front rack

'Veronica' 27:18
she'll she'll put it back on the people working up front and then play savior. So she's, she's making this problem and then saving the patients from it so that they never abandon her.

Scott Benner 27:30
Oh, you think that's on purpose? Like, do you think she created the problem to save the problem?

'Veronica' 27:36
I don't think she knows any other way of operating. Okay. Okay,

Scott Benner 27:41
I see what you're saying. Maybe somebody was pretty bad to her raise and her is what you're thinking of? It's quite possible. Yeah. Gotcha. Well, gosh, I wonder how many people ever wondered if their doctor was drunk? What kind of drugs do you know?

'Veronica' 27:58
Everything except ketamine.

Scott Benner 28:01
So heroin?

'Veronica' 28:04
I don't know if that was happening while I was working there. Okay. Coke. I don't know what was happening while I was working there. I know that hindsight, and from the wine I've seen in the office and the the pictures of of the alcohol consumption for COVID. I know there was alcohol and highly suspicious there were other drugs. She is flat out admitted to, to me that she's used everything except ketamine. I see another girl in the office that constantly had to heroin not like another employee. Yes. Like it like out front or a nurse in the back or something like that. The medical assistant? Yeah,

Scott Benner 28:45
I guess it's easy. But

'Veronica' 28:47
I grew up fairly sheltered. I didn't. I didn't even know what we'd smelled like until the job after that. Which is hysterical to me. After that. I went and worked with the homeless for a year and I absolutely adored that. So that's where I learned about weed.

Scott Benner 29:06
That's the homeless tell you about weed? Yeah, doctors more high end liquor and things like that. Yeah. It's nice. Holy crap.

'Veronica' 29:17
Oh, that's just the tip of the iceberg. Keep going. Like, that's that office. That pretty much sums. Oh, well. I mean, the other part of the story is, I can't make a report to the state or anybody about that, because I was fired. And then because it would be retaliation. But my dentist is in the same building. And every time I go to the dentist, he says, Oh, I started stumbling to work again today. And I say, okay, I get that. I can't report her, but you can make somebody has got to report her. But he says, oh, no, that's her husband's job. Okay, whatever. How long

Scott Benner 30:00
as that I mean, that practice been up for over a decade, probably

'Veronica' 30:03
a decade or less. Okay. They've, you know, they've made the rounds in our area in different hospitals and groups, and then they made their own practice together.

Scott Benner 30:15
Do you think you have to work there to know that about them? Or do you think that's common knowledge and people just ignore it?

'Veronica' 30:20
I think you have to work there to really understand it. But if you look on the court records, you can see the DUIs. Oh, I see. Gotcha. Oh, and felonies, I'm sorry, felonies for assaulting a police officer.

Scott Benner 30:36
Oh, you can't do that anymore. What's the World Cup? Oh, my gosh, I wonder how people can go about looking into their physicians. You don't I mean,

'Veronica' 30:48
I mean, other than knowing, like, if I look up the NPI, there's nothing. It's not until I look on the court records that I can see. I say,

Scott Benner 31:02
did you notice any like, was there a decline in care that they were offering people? Like I know, you said they basically just did whatever people wanted. You call it a code to pay? Yeah, between her and the.

'Veronica' 31:14
I mean, like, I will say that was the first endo practice I worked in. There were a lot of testosterone patients that were having to go to the one blood, because they will probably say keenetic. Which means if I'm not mistaken, that just means you're given way too much testosterone. The other thing was like, they were like, Oh, we don't need to palpate a thyroid, because the changes are so minuscule that we're just gonna send them out for for ultrasound anyway.

Scott Benner 31:53
So they may be overmedicating testosterone patients. Yeah. Yeah. And then not doing the physical checks on thyroid that that are called for. Yeah. And then if that if patients pushed for something, whether it was medically necessary or right or didn't matter, they would just kind of went with the flow to keep everybody happy. Keep everybody coming back.

'Veronica' 32:16
Yeah, well, I mean, he's, he's practicing as an endocrinologist. I don't think he's a board certified endocrinologist. But he's prescribing a whole lot of controlled substances for an endocrinologist like I don't in the other practice I'm in they're not prescribing. Other than testosterone. There's no controlled substances prescribed. What

Scott Benner 32:41
are some examples of stuff you saw prescribed out of their

'Veronica' 32:45
oxy code on from

Scott Benner 32:47
your Endo? Yeah.

'Veronica' 32:51
In fact, one patient, she wasn't real old, she passed away. And apparently, he joked to one of the other people in the office that it could have been his fault.

Scott Benner 33:02
That's something her third third hand, third hand, okay. Like, hey, I might have given her too much of the Oxy

'Veronica' 33:11
might have over medicated or, I mean, like she was, she was drug seeking. Like, like, Yeah, but when you're using yourself

Scott Benner 33:20
in the game, yeah. game knows game. I see what you're saying. Yeah. Oh, well, that's that's something. Yeah. This is usually the time in the interview when I tell everybody give up. Oh, my gosh, I never know what people are gonna say. So this has been something that's an adult endocrinologists office. Yes. So I'm assuming plenty of type two patients. Yes. Now these people, if they're going there for good help, they're not going to be finding it.

'Veronica' 33:53
They care. It's just such a weird thing. I don't know how to describe it because like I was her patient, and I, you know, she did what I needed her to do and was helpful and some patients are getting okay care and other patients are iffy. And it really depends on

Scott Benner 34:12
if your oxy buddies or not.

'Veronica' 34:14
I don't know. I have no idea. Like, holy

Scott Benner 34:18
hell. Now you're at a different doctor's office now. I am okay. And do you see any wrongdoing there? Is that a good experience?

'Veronica' 34:29
I enjoy this office that I'm working at now. I like it a lot. I'm not sure I could find another endocrinologist to work with that would understand my perspective the way this doctor does, okay. Because he has type one. And so there's a doctor in the office and there was a nurse practitioner. And at one point after Easter last year, I had my desk drawer are full of stale Easter candy. And the nurse practitioner came in and was like, Do you have any snacks? And I was like, Yeah, and I opened up my drawer and sheets. Her eyes got wide and she's like, Oh my gosh, you're so bad. And I'm like, normally when people tell me I'm a bad diabetic and like, you're not my doctor, leave it between the doctor and I. But I like, I was flummoxed. Like, are you kidding me? And so

Scott Benner 35:27
you took that you took that as a bad diabetic, not just like, oh, my gosh, you have so much candy in a drawer. Yeah, yeah,

'Veronica' 35:33
you're bad diabetic. I mean, I've heard it called patients that diabetics frequently so to their faces. Oh, no, behind their back. My mantra is, there are no bad diabetics, we're all just trying to keep ourselves alive. There may be some that are actively trying to kill themselves, but they're on the installment plan, if you will, but she went and got the doctor and was like, You're not gonna believe this. Come look at this. And he picked his head and looked in my desk drawer and looked at me and goes, No wonder you're so happy. And I was like that right there is what makes a good provider that understands that life is not over. I still have my favorite candy as long as I'm eating it in moderation and not going hog wild. Which I'm not always great about between the ADHD and just having a dysfunctional pancreas. But, so yeah, I

Scott Benner 36:30
like he overtreated a lower two.

'Veronica' 36:34
I've retreated some lows and maybe even some highs.

Scott Benner 36:40
overtreated highs with candy?

'Veronica' 36:42
Well, you know, you crave sweets when you're hot. Yeah, that's interesting, until you get too high. But he gets it. However, he's been in practice 30 or 40 years. He's not done anything for himself in the practice. What does that mean? I'm sorry. Like, he doesn't do the prescriptions. He doesn't like the the MA's, write the prescriptions, okay, and send the prescriptions and everything. So he just signs off on everything. He doesn't understand how the pump technology works. And so even the other day, I gave him a pump start order form. And it was completely blank. And I just got it back with a signature on it. No, you're supposed to fill it out. He's like, Oh, I trust you to do that. You got this, you know what you're doing? And like, that's all well and good. And I certainly would not trust him to do it. But that's not in my scope of practice.

Scott Benner 37:38
Is that lazy? Or is it just inadequate understanding? He understands

'Veronica' 37:42
because he wears some that he kind of wears the technology he wears, he wears a five but in manual, so he understands early pumping,

Scott Benner 37:52
there's an endo, who has type one diabetes, doesn't really understand how to use the technology. Exactly. And is basically like what, like, I don't know, like just the person who like comes in and waves and says the nice stuff to you and then sends the nurses chips, and then tells the nurses take care of the rest of it. Yep. Have you ever heard him give people advice as he helpful to people with

'Veronica' 38:17
their diabetes? Um, it depends on the day. He can be. And he has some things that he says that I think are helpful, like, I can't take your diabetes away. But I'm gonna have you talked to NAME, and she'll help you with some of the technology that can ease the burden a little bit. Yeah, diabetes sucks. Like, I've heard him say that a number of times. So he, he gets it from, like, having lived with it. He's also trying to change the practice a little bit now that it's been acquired, doing less with diabetes, and more in some other endocrine areas,

Scott Benner 38:54
because they're more they make more money on it, or,

'Veronica' 38:57
Oh, I still can't figure that out. It's weird. Because people I mean, endos for diabetes are hard to find very hard to find they're horrifically under compensated because, and this is the thing that we're finding since the acquisition is that the managing diabetes from a provider standpoint is very labor intensive. It takes a lot of time, if you're going to pour over the data the way you should and that type of thing. But not just pour over the data, forget the data. If you're talking about DME orders, ongoing prescriptions all the time, it is way more labor intensive than any other. There's there's nothing else like it. Yeah, even CPAP supplies aren't that labor intensive. I

Scott Benner 39:48
understand what you're saying. I didn't think of it that way honestly prior but there's more to understand there's more to explain. There's more paperwork to do more getting people for on the devices. Send, make sure they have their insulin and all this other stuff that and you're not being paid for that. Right?

'Veronica' 40:05
Yeah. So that's why the company that I work for puts these point of care specialists in the office to free up the time, so the doctor doesn't have to explain the CGM. I go in and do that for him. And we'll even put it on if I've got a sample to put on. But he relies on me for all the education. And I'm not trained

Scott Benner 40:29
for that. What do we really need the doctor for? I mean, maybe except for oxy. But like, what are we? What are we? What are we really, if they're just glad handing you coming through and then somebody else in the office is doing all the work on the paperwork side and training you on the stuff? Is the doctor just there because they need to be because we need that degree? Yeah. That's all very uplifting. I cursed the moment I thought to make this series by the way.

'Veronica' 40:55
I'm sorry. Like, there's there are glimmers though. Go ahead. So there's there's glimmers of positivity and hope. Of course, my story hasn't given many of those glimmers. But like I there's some other things I'd like to see change. For example, diabetes educators, from what I understand of the certification process that they have to go through. They're only tested on some very antiquated medications. And most of it is about type two. They're still talking Pio glitter zone, they're still talking NPH and regular

Scott Benner 41:37
wait in the States. Ca

'Veronica' 41:41
for the series, CDC is exempt from what I have heard, I haven't taken the exam yet. I'm also in school for nursing degrees, so I can become a CDE. But that's a whole nother story. I mean, because I'm pretty much doing it. Now. I add live as I go, which is really wonderful. But that's part of the reason I'm all about experimentation. And I say find what works for you. Because each and every person is unique. Each and every body is unique. And so we know what works in general. And the doctor says this all the time. We know what works in general, we just got to find out what works for you. And that's why he's pretty laissez faire, when it comes to Oh, it doesn't matter what you put on the pump start, you know, it's close enough, we'll fine tune it as we go. But when we're talking diet, I'm talking to people and I'm like, figure out what food does to you. And then I say, okay, so figure out if eating your food in a different order helps your blood sugar. And I then I got the glucose goddess and say, Okay, try this and see if this works. And they look at me like, Where

Scott Benner 42:48
have you been all my life? Yeah, just changing my digestion might help this like my god. Thank you. Yeah, yeah. Are you in nursing school right now? Like, where are you at in that, in that time?

'Veronica' 42:57
Finishing up my prerequisites for a nursing program. Okay, so I haven't gotten in yet. But I've been feeling pretty positive about it. Good for

Scott Benner 43:06
you. And then how long will you be in? In the nursing program? Oh,

'Veronica' 43:10
I'm just, I'm all about collecting the associate's degrees. So it'll be an Associate's in nursing. I should I mean, I'd had enough hours in this endocrine clinic that

Scott Benner 43:20
should be eligible for the CDC ces test, right? Well,

'Veronica' 43:24
I think you have to work in nursing for like, two years. So I'll have to, you know, put around and do something until I can sit for it. I can't. I like I feel like we could have a lot of other people encouraging people with diabetes. Not maybe not necessarily CDC es, but people with diabetes have a lot of knowledge. There are no dumb diabetics.

Scott Benner 43:46
You do pick up a lot as you go. That's for sure.

'Veronica' 43:48
You pick up a lot as you go. But there are no dumb diabetics. Unfortunately, it is a game of survival of the fittest. And if if you're not able to, to make the right choices for your blood sugar, you don't really last as long. The

Scott Benner 44:05
fittest you mean as much as being able to, like do the things over and over again, every day that you need to do. Well,

'Veronica' 44:11
I mean, like, what I mean is the fittest from a, a smarts standpoint, if you're not smart, you're not surviving. Oh,

Scott Benner 44:21
I think I get what you're saying. So, if people are challenged by the process of managing diabetes, like intellectually challenged by it, yeah, and they can't rise to the task, then they're gonna have more outcomes that are or are bad, and that really could shorten their existence. That's what you're saying. Absolutely.

'Veronica' 44:39
I mean, I knew guy. I don't. I don't know how much of the story I really know. But he got it from when I was growing up. He was having a low blood sugar and thought it would be a good idea to unfreeze his pipes with a blowtorch

Scott Benner 44:56
during his low blood sugar. Yeah, let's

'Veronica' 44:58
just say that didn't end well.

Scott Benner 44:59
I don't understand what's alright. Well, what the hell? I mean, I'm really stuck back on the drunk Doctor handing out the oxys. Like, it's really crazy.

'Veronica' 45:12
It's wild. It's, it's been a wild ride. But what I would like to see back to the CDC, yes, I would like to see some more specific certifications. So when I became a nuclear medicine technologist, you got your certification, and you were a nuclear medicine technologist. A few years later, they came out with some specific certifications. So you could specialize in cardiology, or PET CT, you had these areas of specialty. And I would love to see that with the CDC. Yes. So that you have people who are a diet specialist, or an exercise specialist, or a technology specialist, or type two specialists where you still have to qualify for the entire thing. But it's an extra step to prove that, you know, more than the average bear about these different topics.

Scott Benner 46:03
Yeah, that would be a big shift in how it works. Because then you have to find a way to build for those things, too. Right? Because that's what I mean, they don't, not the doctor, I'm saying that the industry itself, like, they'll come up with new subsets of, I don't know, job titles, if they can bill for it, you do see that moving that way, a little bit with like, nurses, right, like they're more training some nurses for in very specific things. Yeah, you know, so that they can say, oh, you know, this person needs this attention from a will have that person go through and do the training or whatever with them, then that's the thing we can build for. If that is really kind of how they think about it. They think about services as as billable time. Right. Yeah. I don't even know. Like, that's, you're pretty far away from getting that accomplished. But I know, I know. And I've

'Veronica' 46:53
been told that you reminded me of something that the first provider that I worked for, she had prescribed me Jardiance. And so as we came out of COVID, I had an incident where I was just, we were coming out of COVID. And I went outside and was outside all day. And but it was one of those cases where you can't take your mask off your face. And so I was way under hydrated, and I ended up in New glycemic DKA I had no idea I thought it was having a heart attack. And because she had put me on this, and she had told me but I completely forgot. I do think that when Doctor, or any provider prescribes something that's off label that they need to reiterate at every appointment. Don't forget, you need to stay hydrated, or you need to Don't forget you're using new 500 and a pump, you know, because those reminders, save lives. So

Scott Benner 47:52
you were on Jardiance which made being dehydrated, more dangerous. CHARNY

'Veronica' 47:57
it's is contraindicated in type one, especially when you get dehydrated it It lends itself to you, glycemic DKA. Why did she give it to you? blood sugar control and weight loss. And it was great for both of those. But I forgot to stay hydrated. And I honestly thought I was having a heart attack. But then when I got to the ER and the doctor was like, Oh, you're in DKA. And I'm like my blood sugar's to 12. Like what gives? And it wasn't until a month or two later that I put two and two together and was like, oh, it's the Jardiance that's what it was. But I bought myself a heart cath because my when when you're in DKA, or you leaked your opponent's, which is a thing that's released when you have heart damage, and so I leaked your opponent's and because I went in with heart symptoms, they were like, You got troponin, so we got to do a heart cath. But I've been worried about my heart for years and so I got the plane Bell health on that. So I was I was thankful for that whole experience in the end. Did

Scott Benner 49:00
a doctor you know it's so funny. I find myself saying that a doctor tell you but the more of these that I i do I'm like ah, it's a difference. But But did the doctor tell you that the Jardiance had was the reason behind what happened to you is just something you suppose I

'Veronica' 49:16
don't remember if I've had a discussion with her or anybody else about it since but the hindsight is 2020 and I go oh no, I know that that's exactly why that happened. Because I was warned about it went both way before it happened that if if you're not hydrated enough, you can go into DKA and you won't even know because your blood sugar will be fine. Yeah

Scott Benner 49:38
10 Side effects of Jardiance medication commonly used to treat type two diabetes and some heart problems common giardia and side effects include UTIs fungal yeast infection on your genitals that's fun, more serious giardia and side effects include dehydration, low blood sugar and serious infection. ketoacidosis too much acid in the blood is also possible but rare. When

'Veronica' 49:59
I had that 19 A one C, I had a low while in the ER with the dka. And they didn't believe that it was low. And my doctor, my endo at the time was nearing retirement and how only seen that, like two or three times in his career, and he's like your body is just majorly stressed out. And so my body does seem to want to boot me into DKA quicker than most. But that was my first time since being on a pump that I went into DKA. So it's not bad for 24 years of something. Oh, how do

Scott Benner 50:36
you knowing what you know, and having seen what you've seen in doctors offices? How do you moving forward take doctors seriously. I realize that everybody's not like that. And probably like, a using Doctor giving up is probably not the norm. I'm not saying that. But like, every day, you know what I mean? Like, how do you make the leap then?

'Veronica' 50:56
So I have a theory about that, or a sneaking suspicion? I've been trained since since age 12 that I'm responsible for keeping myself alive. And the doctor I currently work for will tell. Well, he told me that caring for type one diabetes is 90%. Patient led and 10% Doctor Yeah. And I would say it's, it's even less doctor and more educator or education. We don't relate to MDS are DEOs like other patients do. And so I've learned that I have to tread very carefully when I'm dealing with doctors and other specialties or PCPs. Because I've been taught that I am responsible for keeping myself alive. I am very attuned to what's going on in my body. Each of my shoulders has been frozen at different points in my life. And both times I went to a doctor early on and said, Hey, I think my shoulder is starting to become frozen. What are we going to do about what are we doing about this? And they're like, no, no, it's not frozen. And then six months later, I go back and see them. Oh, yeah, now it's frozen. Let's get you into physical therapy. I think cardiologists and are used to playing savior, you give the patient this pill, they take it, everything's better. diabetes doesn't work like that. And, and people living with type one have a very different relationship to all doctors than other patients. Does that make sense? It does.

Scott Benner 52:34
And it's something I've noticed, you know, by having these conversations, too, that I just interviewed a doctor the other day, we really like straight, straight guy like good stuff, like straight laced guy like thoughtful has type one is a peds, Endo. And, you know, still, like some of the messaging from him was like, you know, don't expect too much from your doctors. And, you know, it's interesting that the way you put it I agree with it's, you know, most things that you go to a doctor for are sort of finite. It's like, you go for this thing, and I'll give you a pill and it'll, you know, take it for eight days, and they'll go away. Or, you know, you have hypothyroidism take it forever. We'll test your blood sugar every test your blood every six months, make sure we have your dosing, right, like very, like kind of finite stuff like that. Yeah, there's no world where you're like, Okay, well, every day, every time you open your mouth, we're going to change the dose. And you're gonna have to figure that out on your own. So doctors aren't prepared to handle that. Right? So the ones that you get lucky when you get lucky, and you get one that is that's maybe more random than that not? Yes, yeah. Yeah, I hear. And for reasons that you brought up earlier, because there's not a ton of money in it, you need a lot of time to put into something to help them with their diabetes. Maybe they're not going to put that effort in to begin with. Right? Yeah. And some of them are high as a kite.

'Veronica' 53:57
Hopefully not many,

Scott Benner 53:59
what a great story. Franca. Thanks for coming on the show. This is terrific. I really do appreciate you doing this seriously, because my pleasure. First of all, no one listening should be like, Oh my god, I gotta go find out if my doctors you know, smacked out of their mind or not. I'm assuming most of them aren't. But you know, what? Day drinking, you know, alcoholism, functional alcoholics. Definitely a thing. You know, people using drugs to get through their days is a is definitely a thing. And why would it not also include doctors, I guess? Yeah. Doctors aren't immune from. Right. So just another one of those things you'd like to imagine. isn't happening. Yeah, like I get it. When I'm going to get new tires and the kid at the tire place is stoned. I'm like, Okay, I understand it like it's okay. He'll be able to get the lug nuts off. I'm alright with this. You just don't think about it. And you don't I mean, like I know the kid getting the carts at the grocery store is just a little high. I'm okay. Yeah. Yeah. Like I understand that I get oh well. I'll help. I appreciate you doing this very much. Is there anything we left out that we should have talked about that we didn't?

'Veronica' 55:04
I think the other thing I'm I want the whole world to know is that it's not a test. It's just a check. We're not testing blood sugar, it is not pass or fail. It is just information. And it is information about what's happened in the past. The only thing you can do is react and change going forward. You cannot change the past. So keep looking forward. You know, now we've got the arrows with the CGM. And that's great. Can we please stop calling it a test is the verbiage bother you that much to gauge? It really? Does

Scott Benner 55:40
he tell me why?

'Veronica' 55:43
Because it's not pass fail. And I feel like probably I've been called a bad diabetic too many times. And you heard me say it earlier. There's no bad diabetics, we're all trying to do the best we can. And for the most part, the ones that are not doing real well haven't been properly educated by their doctors, and there are a few out there that don't care, don't give a rip. And that's on them. That is their choice. There's no need to shame them for that choice. Like that is on them. Yeah. That is not your responsibility. It's like, if they want to live that way, they're gonna live that way.

Scott Benner 56:23
Is that something you take on yourself, though? Because like, I don't know, I don't own a pool. But if he I know somebody who does, and you have to test your pool water. Now nobody's thinking like, Oh, I'm gonna test my pool water to see if I've passed or I've failed. Like, is that? Are we just not commingling thoughts? Like, I get the idea. I know, you don't want to be judged every five seconds. And that a number is just data. And I completely agree with you. But I mean, if someone were to call it test your blood sugar, like, why would that set you off? Is that because of past experiences you've had you think? Probably.

'Veronica' 56:56
And I just I think that words matter and how we talk about it matters that I don't want to feel like I have to do 10 tests a day if I'm not wearing a CGM. And I feel bad for people that have test anxiety. What's funny is, as I'm in school, I love the tests. I want to know where I'm at. I don't want to know if my blood sugar but hey, when I'm at school, yeah, I want to know how I'm doing. But

Scott Benner 57:23
also Veronica, you know, there are other people who aren't bothered by the word, right? No,

'Veronica' 57:27
I know, there aren't. But I do. I feel bad for anybody who hasn't really thought through it and processed it and start seeing that, oh, it's a test. Oh, I got another I got a test again.

Scott Benner 57:40
Can I ask a question? If I say to you, hey, Veronica, you gotta check your blood sugar. And then you check it? And then it's 250. That doesn't feel like a failure to you? Because I said check in not test, you know, saying, like, what's the difference? I don't understand that. It feels like just a word to me. But I don't know. Because I also I'm not in your position,

'Veronica' 57:57
I think because it's not pass fail. Like it's not, there's no grade, it's you're just checking to see the status.

Scott Benner 58:06
It's not, you can't just be testing to see the status. So yeah, I don't know. I feel like I'm coming off as difficult. I don't mean to be because I completely agree with you. So yeah,

'Veronica' 58:16
I'm a verbal processor. And I haven't gotten there yet. And you're asking the right questions to get me there. I'm

Scott Benner 58:21
just I don't know, I it just bothers me. It feels like to me that something happened to you at some point. And now you have an unkind relationship with the word in this context. But I mean, there are plenty people who don't. And so that's where we get into this weird thing with like, you see people online, like don't call it diet, like don't say, I'm diabetic. That was the thing for awhile, people like, don't call me diabetic. I'm not diabetic, I have diabetes. I gotta be honest with you. I don't see the difference. So like, you don't I mean, well,

'Veronica' 58:50
I will say that my husband worked with children with autism for a while, and he's like, they are not autistic, that does not define them. I am not defined by my diabetes. So I occasionally I will say, I'm diabetic. But typically, no, I've lived with diabetes for a hell a long time, and I'm over it.

Scott Benner 59:11
I think a lot of those words come down to like intent when the person speaking it to me like, I mean, I can, I can imagine a way where I could call somebody a diabetic in a pejorative way. But to just say that person is a diabetic. I don't know. I mean, I don't know. Like, I am not sure just because I don't know how to like feel like I've been overweight in my life. If you would have said to me, Scott's fat, I would have been like, yeah, I am. You know what I mean? Like, if you were to call me a fat person, I would have said, Oh, that's accurate. I mean, I wouldn't have liked it. You don't I mean,

'Veronica' 59:47
I think there's some stigmas with diabetes that don't need to be there. And and some of those stigmas are more about type two but they get placed on type one. Okay. I'm so sick to death of people telling me what I can and can't eat. And that

Scott Benner 1:00:03
happens in your life the hell up. Yeah. People tell you, you shouldn't be eating something. Yeah, you can't eat that.

'Veronica' 1:00:09
You're diabetic? No, first of all, I

Scott Benner 1:00:12
am a diet badass. And secondly, you're not my doctor. So shut up, do not take them as verbalizing their thoughts. Like you can't eat that. I always expect is them in their brain going, Oh, I didn't think she could eat that she has diabetes, and then it comes out of their mouth that way.

'Veronica' 1:00:32
So I use it as an opportunity to educate and say, No, really, I can I just take a little more insulin for it. And so I do use it as an opportunity to educate but sometimes I do get snarky because, well, it's a pain

Scott Benner 1:00:49
in the ass to hear over and over again. That's Oh, yeah, obvious. Yeah. It's not your job to educate every person who notices you. Right? You know, eating. I mean, I take all your points. I am just playing devil's I hope people know I'm playing devil's advocate. But uh, yeah, get up. Get a note here from somebody's like, it's, you know,

'Veronica' 1:01:04
I love playing devil's. So I appreciate that. Yeah. You know, one of the ways I've described my diabetes is that the first 10 years I fought against it the second 10 years, I was like, Oh, I guess I was kind of resigned to it. Now. I'm leaning into it. And I'm making diabetes, my bitch. And I'm using it to encourage other people for you. That's excellent. So I'm trying, I'm trying. Yeah, no, I'm

Scott Benner 1:01:24
glad you got to that part. Seriously. What do you think stopped you from getting to it quicker.

'Veronica' 1:01:29
So I've blamed the diabetes on a lot. But I honestly now and thinking that the ADHD was, was like a legitimate thing. And I, I had no plans for my future. After high school. I didn't go to college right away. So I had a teacher in high school that said, she was the music teacher, and she was like, I will play at your wedding. If you accomplish a number of things before you get married. You need to travel the world, and you need to have a college degree. And you something else, I don't know what you need to know the person at least a year or two or something. And so I've like, I took that seriously. And I I traveled the world. Before I was 15. I didn't get my college degree ever. She still played in my wedding. So diabetes has not been a it's a weird dichotomy here. It's not been a limitation to me. But it has been such a limitation to me. I've limited myself because of it. But early on, I didn't when I was 14, I said, Hey, Mom and Dad, I saw this thing in this magazine about a mission trip. Can I do that? And they were like, sure if they accept you. And if you can raise the money, and I think they thought I wouldn't get accepted into this mission organization. Well, when I was 14, I went to the Amazon rainforest for eight weeks with a bunch of people my parents didn't know us. When I was 15. I went around the world, most of it on the Trans Siberian Express, flew from the US to Ireland to Moscow, took the train all the way across Siberia, even went in a Siberian prison at one point. And then on the other side from Qatar. It was Khabarovsk flew to Anchorage, to San Francisco and back to the east coast. But while you're doing all that you're not managing your type one really soon. Okay, high school, early years were were okay. It wasn't until I mean, later in high school, that was early high school later in high school, it started to fall apart. First college I went to I ended up in DKA. And, and the doctor in that other state was like, We need to get you on an insulin pump. And I went back to my home state and my regular endo was like, No, you don't have good enough control. And so I went through that for a couple of years until I moved away from my hometown, you know, 10 states away or something, and ended up in DKA, twice in six months. Got myself an endo. Who was like, let's get you on a pump yesterday. And then, and then I got married. And now I'm stuck happily stuck, but stuck nonetheless, in this state, and with a bunch, you know, I've had great endos and not so great. And I was here in my current state, and it's been a

Scott Benner 1:04:23
dream. Well, it's quite a journey. I appreciate your sharing it with us very much. My pleasure, sincerely. Thank you. Hold on for me for one second. Okay, absolutely.

I want to thank the ever since CGM for sponsoring this episode of The Juicebox Podcast. Learn more about its implantable sensor, smart transmitter and terrific mobile application at ever since cgm.com/juicebox. Get the only implantable sensor for long term wear. Get ever since. A huge thanks to Omni pod, not just my longest sponsor, but my first one Omni pod.com/juice box if you love the podcast and you love tubeless insulin pumps, this link is for you. Omni pod.com/juice Box A huge thanks to us med for sponsoring this episode of The Juicebox Podcast. Don't forget us med.com/juice box this is where we get our diabetes supplies from you can as well use the link or call 888-721-1514 Use the link or call the number get your free benefits check so that you can start getting your diabetes supplies the way we do from us med the Juicebox Podcast is full of so many series that you want and need afterdark s gotten Jenny algorithm pumping bold beginnings defining diabetes the finding thyroid, the diabetes Pro Tip series for type one, the diabetes variable series mental wellness type two diabetes pro tip, how we eat. Oh my goodness, there's so much at juicebox podcast.com. Head up into that menu and pick around. And if you're in the private Facebook group, just go to the feature tab for lists upon lists of all of the series. always free. Always helpful. Thank you so much for listening. I'll be back soon with another episode of The Juicebox Podcast. The episode you just heard was professionally edited by wrong way recording. Wrong way recording.com

#1148 Grand Rounds: Diabetes Management

Scott and Jenny discuss proper type 1 diabetes management concepts.

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Scott Benner 0:00
Hello friends, and welcome to episode 1148 of the Juicebox Podcast.

Jenny's back for another grand rounds episode and today she and I are going to talk about how doctors should be thinking about diabetes management, how to talk to you about using insulin, and so much more. While you're listening, please remember that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, always consult a physician before making any changes to your healthcare plan, or becoming bold with insulin. If you'd like to help with type one diabetes research right from the comfort of your home, it's easy to do go to T one D exchange.org/juicebox. and complete the survey. That's it, it takes like 10 minutes. We're looking for US residents who have type one diabetes, or are the caregivers of someone with type one of specific and special note. men and men of color were boys or boys of color. Difficult to get that data. The T one D exchange thinks they could really help people if they had it. If you fit any of these categories, I'm talking about men, boys, girls, ladies have type one, you're the parent of somebody filling out that survey is a great way to help. And it's a great way to help the podcast, it also might end up helping you t one D exchange.org/juicebox. Today's episode of The Juicebox Podcast is sponsored by the contour next gen blood glucose meter. This is the meter that my daughter has on her person right now. It is incredibly accurate and waiting for you at contour next one.com/juice box. This show is sponsored today by the glucagon that my daughter carries G voc hypo pen, find out more at G voc glucagon.com. Forward slash juice box. So today for the Grand Rounds series, we're going to talk about management. That's our that's our our header. And Rod topic. Well, and there's a lot here. So indeed, it is a lot of feedback from people, a lot of feedback from people a lot of notes that you and I made on this document back home, we're talking about doing this. A couple of things. Why don't we just start with a little bit of feedback, and we'll work our way into it. Well, I wish my doctor would have told me that staying high for long periods is just as dangerous as a low. Yeah. So that's education. Right? Like, that's, that's understanding big picture. And whether doctors know it or not, this don't. I was about to say don't have a seizure idea, which is something I really don't want anybody to do. Right? I didn't want to sound like I was minimizing it. But this this better high than low idea. I understand why they might say it initially. But you have to tell people, the rest of that story. And why high and low is bad, why stability is what they're looking for how to get through stability, because just telling them better high than low, I think leads them down the wrong path that that that's difficult to get back from mainly

Jennifer Smith, CDE 3:27
because there's not enough there's not follow up to it is what that really leads to, they are given a directive of better high than low initially. And you know what? Maybe Okay, right now, but define that, give them a week from now once we're seeing how your insulin is working, once we see where numbers really are, once we see how you're reacting to the current doses and we make some other adjustments. We will talk further about this, right? Because initially, you may actually, I mean it is there's a math equation to figuring out initial starting doses for any age and person. But it's still just a starting place. And it's still not as precise as it eventually will get. So sure, a little higher right now, let's see how things go. We're going to touch base in a week or in a couple of days. We're going to look at this and we're going to say okay, now we can nudge that high. We don't want to stay high, long term down the road. Right now. We're just going to keep things from here to here. Maybe the target range is wide right now. Narrow it when you have follow up and also put that into you know your your notes about what was discussed. We defined blood sugar target range here to here so that whoever is the follow up physician or clinician knows what you've talked about. They can easily see it in the medical record and then that doctor or caregiver can clean that up. Yeah, can help to define that further for you. But when you give a blanket statement that sticks

Scott Benner 5:09
Yeah, it also makes the next physician, not just the patient, but the next physician leery about changing what's happening right now. Right? Right. Right. They think this is this was for a reason somebody told you to keep your blood sugar at 180 all the time. And you can explain to them no, that's not the case. Because somebody didn't tell you. No, that's not the case. So, right. A lot of this series, I think is about, it's about not just saying the first thing that you that you think to say, but giving it real context and an explanation. This is what we're going to do. This is about the timeframe we're going to do it in, this is why it's important. You just can't forget about it and say, Oh, he said better high than low. And then you go on, you know, from their emergency situation, to you know, a GP, then the GP finally gets you to an endo. And then the endo gets there. And this, oh, everybody's got this person's target set at 180. They might think that's on purpose, because you can't handle it. Or maybe you had lows before they'll make assumptions. And you know, these assumptions are what killed everybody. Right? Yeah. But this is how it comes out. I wish my doctor would have told me that saying hi, for long periods is just as dangerous as a low

Jennifer Smith, CDE 6:23
end for this person, it might have been that there wasn't enough follow up then. Or maybe they didn't follow up with somebody who could have helped them put the targets a little tighter together, right? Maybe they also didn't know enough to ask, Hey, I was told initially, the higher targets are okay that I shouldn't necessarily live there. But if I touch to 50, after every meal, and four hours later, it comes back down. That must be okay. Right, because that's what I was told it. It takes I think, you know, diabetes, especially is it's an evolving sort of trend of discussion, where this is where I am, this is the scenario, this is the really important stuff to focus on now. Okay, a month from now, a week from now, whatever, you're very likely going to be in a different place, you're ready to get more information, you're ready to ask more questions. And the doctor should also sort of move down that path with you, if you're not bringing up that they should be bringing it up and saying, Well, you're here. And everything looks safe, right? It looks good. But you could be here, right? Let's try this. This is why and that explanation to the why is really important. It's

Scott Benner 7:37
the nuance of the conversation. Like you can tell somebody, it's not wrong to say to somebody, Hey, if your blood sugar shot to 250 and came back down and leveled out again, that's fine. Not every time, you know, but not every meal. Because if you want now you tell me that's okay. And what you're probably trying to do is, is give a little bit of comfort. You don't I mean, like, Hey, don't don't kill yourself if stress about Yeah, if it jumps up one time it jumps back down, let you you know, that's okay, let it go. But not, once you tell them it's okay. Then breakfast jumps up lunch jumps up, dinner jumps up, a snack jumps up, they get high overnight, but it comes back down three hours later. And before you know it, that's an eight a one C? Yeah, you know, and they in their head, they're like, Well, the doctor said, It's okay, if it goes up and it comes back down again, they don't understand the big picture. Listen, right. Most people don't understand the big picture of health. I was just talking to a nurse on another recording recently. It's not out yet. And she said one of the most shocking things about becoming a nurse was learning how little people knew about their own body. Like she called it. Jenny's making the face. Yeah, like shocking how bad it is. And it led me to say, I saw somebody eating nachos with a bowl full of queso the other day and I saw the bowl, like the size of a softball full of liquid cheese. And I thought you're not supposed to consume that in a year. Right? Yes, yeah, you know, like, and here you are, you know, in one sitting, and then metabolic issues come up, which you don't see right away and are hard to diagnose. And they end up looking like I get headaches all the time, or my knees always hurt or why does my stomach hurt? Or how come I don't poop? Right? Like it's because it's and then you're off to the races. And before you know it your blood sugars are hard to deal with, you have all kinds of other underlying issues. And they don't come to the surface until they come to the surface in a very aggressive way with like some specific problem. And when we're talking about people with diabetes, we're talking about renal and cardiac and your eyes and absolutely big stuff, you know, not just go on a diet for six months and this will all work itself out. You know, what

Jennifer Smith, CDE 9:44
you said initially is 100% the case unless you have any type of biology avenue of education, you really are left in the dark about what your body is supposed to be able to do. How does it function when I do this, this is what my body does with this, right? And I, one of like my best examples of that was years ago working just as a dietitian in education specifically in diet in gestational diabetes. A woman had come in to me, and we're talking about kind of her eating and how that impacted blood sugar. And I said, Well, you know what, I don't see like, a lot of fresh stuff. And I said, I don't see any fruit at all. And she's like, No, no, I eat fruit every day for breakfast. And I was like, Oh, we didn't mention that. You know, she's like, Yeah, I did ice. It's right here. I eat Froot Loops. i She was not kidding. She was not joking, which means that as an adult age where she was long term, she never knew that Froot Loops don't count as a fruit. Like

Scott Benner 10:50
me, I out myself for a second. I once said to my wife, I was half joking but contour next one.com/juice box, that's the link you'll use. To find out more about the contour next gen blood glucose meter. When you get there, there's a little bit at the top, you can click right on blood glucose monitoring, I'll do it with you go to meters, click on any of the meters. I'll click on the Next Gen and you're gonna get more information. It's easy to use and highly accurate smartlight provides a simple understanding of your blood glucose levels. And of course with Second Chance sampling technology, you can save money with fewer wasted test strips, as if all that wasn't enough the contour next gen also has a compatible app for an easy way to share and see your blood glucose results contour next one.com/juicebox And if you scroll down at that link, you're gonna see things like a Buy Now button. You could register your meter after you purchase it or what is this download a coupon? Oh, receive a free Contour Next One blood glucose meter. Do tell contour next one.com/juicebox head over there now get the same accurate and reliable meter that we use. If you take insulin or sulfonylureas you are at risk for your blood sugar going too low. You need a safety net when it matters most. Be ready with G voc hypo pen. My daughter carries G voc hypo pen everywhere she goes because it's a ready to use rescue pen for treating very low blood sugar and people with diabetes ages two and above that I trust. Low blood sugar emergencies can happen unexpectedly and they demand quick action. Luckily, G voc hypo pen can be administered in two simple steps even by yourself in certain situations. Show those around you where you storage evoke hypo pen and how to use it. They need to know how to use Tchibo Capo pen before an emergency situation happens. Learn more about why G voc hypo pen is in Ardens diabetes toolkit at G voc glucagon.com/juicebox. G voc shouldn't be used if you have a tumor in the gland on the top of your kidneys called a pheochromocytoma. Or if you have a tumor in your pancreas called an insulinoma. Visit G voc glucagon.com/risk For safety information. But I don't think I was completely joking. She's like you don't get enough vegetables. I ate veggie sticks the other day and she goes Scott, those are potato chips. There's carrots in them.

Jennifer Smith, CDE 13:28
Yeah. I mean, and there are a little bit of like a humorous component to that. But I was just like I came home and I said to my husband, he's like, No, he's like she was joke. I was like, no, no,

Scott Benner 13:39
I told you before when my mom looked pre diabetic, a handful years ago, and a doctor told her to change her diet. She put together a diet that was worse than the one she was eating. Yeah. And she was trying trying to eat something that would follow along with what he was saying. Didn't people just don't know. So it's not your fault. But the doctor needs to know that that's the situation. Yeah, you know. So this next person says there are ways to have a lower more healthy a one see there being kind here about the podcast, such as being bold with insulin, let us know that this is possible and help us to achieve better agencies. Please don't shame us for falling short, but do encourage us to do better. I see this a lot, right. Like nobody wants to tell somebody they're not doing right. Well, right. became a social thing for a while. You know what I mean? Like nobody wants nobody wants to tell you the truth. Sometimes

Jennifer Smith, CDE 14:34
I feel people are worried. On the end of professional people are worried about creating like a shame type of explanation. When really that's, that's your job is to tell somebody when they're not healthy. That's that's your job, right? You didn't go into health care, to tell people to keep eating what they're eating or to keep, you know, not doing what they're not doing. You're

Scott Benner 14:57
not there to make friends and know that Yeah, you're and I get that I would listen, I would bet the argument back would be, if I push these people, they're not going to come back again. And to that, I might say, least you told them the truth. Right? You know, like, now it's on them, at least, you know, but keeping it from them or pretending they're going to do the right thing. That's not helping anybody. That's just mean, that's, that's you're lying, and they're lying. And we all know each other's lying. And none of us are saying anything about it. It's weird, right? You know, I

Jennifer Smith, CDE 15:26
see, I see questions often still, in this sort of day that we're in with technology, I still see questions about why people are. And it goes right along with this management and even like, target range for blood sugar and whatever. Why are we explaining blood sugar targets that are outside of the realm of what somebody without diabetes? Right? Why? Why are we saying that? A 200, blood sugar, a 250, that's safe. That's okay. You can come up here, you can kind of settle back down, etcetera. You know, the human body does not do that without diabetes. So why are we constantly telling people that it's okay for you to be in this really wide range, and then down the road, their expectation comes to be? Well, I stuck within these targets. And now I have problems with my eyes, or now I can't feel my feet. And I did what I was told. I was told this is okay.

Scott Benner 16:27
Yeah, no, I think it's got something to do with the physicians either not understanding it themselves, the mechanics of getting to those other blood sugars, or they've seen so many people fail at it that they think it's not possible. So why am I going to give them a target, they can't reach at least I'll give them one that they can, they can get but, but that's where this this person here says learn how to communicate diabetes, those things, suggestions. So often, we're told to do something, but not given a reason why? And then you and I made a note after that, that said, that says don't just give us a fish. Teach us how to fish. And right. Yeah, right. Yeah,

Jennifer Smith, CDE 17:03
absolutely. I think you had a thought. Let me bring it back into my brain. Like right there on the tip of my tongue. It'll come back to me.

Scott Benner 17:12
It's okay. Well, I think we got thrown off when your cat's whiskers came into the camera first.

Jennifer Smith, CDE 17:16
Yes, I sorry. I was gonna comment. And I was like, No, it's okay. I know she was

Scott Benner 17:21
you were like you I say something about that or let it go? Yes. Sorry. On the fault, though, I stepped over you. You had a look on your face. Like you were gonna say something. And I said that it's okay. Don't worry about it. I wish it diagnosis. They told us that what we learned at the beginning is foundational. And there are many things to learn. Moving forward for best management like Pre-Bolus and glycemic impact load bolusing for fat and protein, being aggressive when aggressive isn't necessary. Also, I wish they would have emphasized emphasize that ratios and basil will change and what numbers we get aren't set in stone. Okay, so this becomes another big problem. You know, you you set somebody's this happened to me. I remember the doctor was saying what's Arden's insulin to carb ratio. And when I pulled it up, it was like one unit that like, I don't know, like some insanely large number 300 carbs or something like that, because she was diagnosed when she was so little. But we were like, years later, and no one had ever changed it. Oh, and I didn't know anything about it back then. So I'm like, Oh, she's having all these high blood sugars all the time. And I'm like, I'm having a lot of trouble with meals, and I can't figure it out, back then I wasn't the guy who was like, Oh, just do this. I went back to the doctor, and I was like, I don't know what to do. And they pulled that setting out. They're like, Oh, and it was like it was off by like, I think she was one to 100. And it was set at one to three, she was using two thirds, too little insulin at every for every carb. So, you know,

Jennifer Smith, CDE 18:46
that actually, it kind of made me think of what I was going to. What I was gonna say is that, I think that in, at least initially, and maybe even for somebody who has had diabetes a long time, and now is really coming in with a set of questions. What it boils down to is explaining that this initial information is just that it's a baseline to start with, and navigating diabetes. I wish people would just be honest, and say it's not easy. It can get along the way of learning, you experience a hoz Oh, well, that totally makes sense, right? Or, gosh, this definitely can be built in now. So they're, they're stepping stones, if you will, to management. But as you just said, There's not just a start here, dose this there is again, kind of evolving changes. And that growth has to happen in your understanding, but how you understand it needs to be what comes from the clinical team that's helping you so they should explain to you that this isn't simply just put the insulin in and eat the food, right? That's not how simple this is.

Scott Benner 19:57
Yeah, I remember a doctor once saying when our was younger Wait, oh, she gets hormones like, oh wait, do you see the female hormones? Oh, and I was like, what she was like, wait a minute, UAH context? Is there any context? You know, oh, hormones make it harder. And I'm like, and, and you don't you mean like, though I figured it out between that and, and when it actually happened for myself, but nobody ever likes in that time no one ever stepped up and said, Are you bolusing? differently? Do you notice any strategies that help or hurt? Or, you know, are there times of the month that are different than others? That conversation never happened? Just oh my gosh, you should see Wait, do you see what happens? And I spent years going like, oh, like,

Jennifer Smith, CDE 20:41
like, I'm worried I wonder what's gonna happen? Yeah. And as if she didn't have hormones. age that she was,

Scott Benner 20:48
she was growing, I'm sure she had growth hormones. So at the very end others, this person says, this is kind of funny. bolusing for fat and protein impacts is a type one diabetic should not be considered an advanced topic. And I thought, but that's really true. It's very, very true. You cannot, you can gather up 100 People with type one diabetes and ask them, you know, what is your endocrinologist taught you about dosing for the impacts of fat or protein? They're not gonna, I mean, two people are gonna say somebody had mentioned that to them, you know? Correct. And yet it throws off every meal, almost every meal of every day and someone's management for 24 hours, that turns into a week that turns into a month. And it's it can be at the core of the whole thing the other day, Arden. She's weighed school. And she said, I did get a text from her. Hey, I had to stop at a drive thru on the way back. I'm, you know, I had to grab some DT amount of time. I said, What do you get? She said, I got Chick fil A. And I said, Okay, 45 minutes from now your blood sugar is gonna go up. And I was like, Don't forget. So you know. And by the way, you know what she did? She forgot. And but I was, she was probably driving. Well, she was now at another place doing this homework. And then she had to get into a class and stuff like that. And I said to her, I'm like, I'm like, okay, look, just look at your algorithm. Is it suggesting any insulin? And she said, Yes, I was like, I think you should put it in. You know, because the algorithm was trying to fight. It was trying to fight the fight, but it wasn't going to because it wasn't compensating for the she didn't put fat into the she didn't it didn't know what it was trying to fight. Didn't know what I was doing. Just like this morning, by the way. She thought she lost her ID. Oh, so like, I get this call. I'm like, why did that happen? This is gonna happen a couple of times, I'm pretty sure. Yeah. But while she's searching for the ID and doing the math in her head that she doesn't leave five minutes from now she's gonna be late. And if she's late, and she misses a class, and she only gets the missed so many. And she says I'm watching her blood sugar, it is just going up. It just went from 100 to 120 to 130 to 140 that he got an arrow straight up from trying to find her ideal stress. Yeah, from the stress of it. Oh, Doctor, I gotta tell you that. They're gonna say something like, oh, the mornings, huh? Yeah. Oh, no mornings. They're hard. Thanks a lot. Right. And

Jennifer Smith, CDE 23:13
that will be as we talked about before, that'll be one of the fingerpointing on the records. We'll see what happened here. Yeah. No, it was probably in school one

Scott Benner 23:25
month from now if you ask garden, what happened there, she's not going to say I lost my ID thought I was going to be late and got upset. Like she's gonna I don't know what this is, you know, so. But all this goes back to Tools. Like give me this person says, give me the correct tools give me parameters and instructions. Let me know I could probably do this, if I had these these things in place, right. And to what your point is, I always say, it's experiences. Like you have to have them over and over and over again before they just start becoming not just like second nature, but they make sense to you. Like out of nowhere, something happens you I know what to do? Yes. As soon as she drove away, like, you know, she had her ID this morning, and she left. I thought she needs a temporary Basal increase. Like I don't care if she's on an algorithm or not like right now she needs a Temp Basal increase this algorithm is not it doesn't know there's an impact here. It's it's changed rising as if she ate food. And it has not been told there's any food there. So we did that. And it came back down pretty quickly. Yeah.

Jennifer Smith, CDE 24:25
Good example I have of like those lived experiences. You can provide all the information possible. And then when you get into like, from my angle of providing education, and give you scenarios, things that might happen, but until they really happen, you have nothing to apply that to and you may need to dig deep and think about it right? A good example is somebody I work with, who had emailed me about a scenario and emailed me just to say, You know what, everything that I've learned, I knew how to work around I found it. And I think I did the right thing. Yeah. And 100%, this person had done the right thing, right? blood sugars that were doing something that shouldn't have been happening based on everything else that had led up to that point. And what did the person do? They change their site, they changed their, their insulin, and it all navigated back down. But without some lived experience and some information pointing to Hey, If this, then this, right, right, they're gonna throw their hands up and be like, I don't know what it was not

Scott Benner 25:31
make that change. I also, you know, that's true. Because oftentimes, you'll see people changing out sites, when it's not the problem, right? When their settings are bad, and they're constantly the pump doesn't work, the pump doesn't work. They over and over, and I, sometimes I online, I'm like, stop there, like, I've changed the pump three times, like, Stop changing the pump. Just stop. It's not your site, right? Like, your settings are bad. Like, we're your settings are great, but something's happening right now. And your settings aren't up for the challenge of what's happening today. You know, like, it's, again, lived experiences. That's how you'll figure this all out. I like this, this feedback here, give me all of the options, not just the ones that you think are best or better or efficient. I would like to make my own decisions, and then craft my own ecosystem of how I deal with this. I think that's a great point. You know, there's more than one way to do this. And everybody's brain doesn't click with the way you say it one time, right? That just you have to give people the autonomy to autonomy is such a big part of this. Because if they don't have that, they don't have all the ideas, and they can pick and choose from it make their own tool belt. That's a problem. But if they don't feel like they can make changes on their own, that's also a problem. Like, that's a big, big problem for people with type one diabetes, the ones that don't feel comfortable, or don't feel like it's their job to make changes to settings. They're the ones I see struggle, the most long term is adults. Do you agree?

Jennifer Smith, CDE 27:05
Yes, absolutely. Because they from an early on diagnosis, whether it was childhood, and that's how their parents navigated, because that's what they were taught how to do. And then they move into adulthood, managing that way, really only following up with the doctor every six months. And that's when something gets shifted and changed and not not really knowing that they're in the driver's seat. 24/7, between that 1520 minute visit with the endo every six months, right, you are the Navigator. But unfortunately, if you don't tell somebody, it's almost like giving the Okay, many people with this type of a, you know, a use of something that supplies like insulin, right? You really have to be directive and say, You know what, I'm going to give you these starting places. And here are some pointers for adjusting. I'm happy if you adjust. In fact, give me feedback when you try and adjustments so I can help you behind the scenes if there's you know, communication with an electronic record or something like that. But you do you have to almost give the okay to people. Otherwise, they may also come back to the office and not provide feedback that they've been tweaking things on their own, because they may feel like they're gonna get their hand slapped. Yeah.

Scott Benner 28:20
Oh, that's definitely happening. Right? Yeah, people are definitely lying. They're always like, I can't I can't let my doctor catch me doing this. And when people say that, to me, I'm like, What are you talking about? Like, oh, I want to make an adjustment to the basil, but I'm afraid I'm gonna get in trouble in trouble, like, so. Ironically, you're not in trouble, quote, unquote, for the seven and a half a one C, but you wouldn't be in trouble for putting the Basal up point three an hour and making it a sentence? fascinate, right. Yeah,

Jennifer Smith, CDE 28:45
absolutely. And insulin, interestingly, is, I think it's, I can't think of any other medications on the market, that people self adjust, right? Like you don't go to your cardiologist and they give you blood pressure medication, you're like, today, I think I'm going to take two of these tablets with you. It's gonna happen, right? Like insulin is one of those. It's I think it's the only thing that really, it does require you to look at your own information and make adjustments based on what you're seeing and where you want to end up. What is the target you're aiming for? What are you trying to get to, things aren't working?

Scott Benner 29:23
It's also interesting where the line gets drawn, and I had a, I had a root canal go bad. It was like 11 years old. So I was pretty happy. It lasted that long. So I'd have changed out right. And when he got in there, he's like, Hey, there's like a little bit of an infection there. You know, this is really going to hurt tomorrow. Let me give you a prescription for a pain medication. He said, The one I'm going to write for you is highly addictive. He said, so you have to be careful. And I was like, I'm gonna go with Advil if you don't mind, right? And he goes, No, no, you should probably take this script because this is gonna be a problem, blah, blah. And I was like, I'm good. I don't I don't need your script. All right. By the way, I didn't even take an Advil when it was over the guy said, great dentist and did a great job. But he was so willing to be like here, would you like a week's worth of narcotics? Because I dug around in your gum for an hour. And I was like, and I'm like, Wow, look how easily he would have given that to me. Yeah, but then you go ask an endocrinologist. Hey, you know, wouldn't it be cool if that lady could change your basil and they can't handle that? Right? Again, and all that, but you can give them oxy. I was like, right. All right. Can we make sense once in a while? No. All right. This person says, Can you give me your medical opinion, please don't parrot what you're reading, ah, in this example, as their kid was doing a six for a lot of years. And then it rose up. And the doctor went, That's okay. It's still within target. And they're basically just telling them like what the ADA said, like ADA says sevens fine. This is fine. And like, so then that takes the onus away to do better again, it's again, it's just like, oh, whatever, you're fine. It's like, what's your blood pressure supposed to be? I don't know these things. 120 over something. It's

Jennifer Smith, CDE 31:06
well under 140. And it's like, what let's call it like, 130? Over 80. Okay, right. But in anything kind of, you know, within that sort of the range, but just your blood

Scott Benner 31:20
pressure was 150 over 90 all the time. What a doctor guts. Alright, it's cool. Not bad. No, no,

Jennifer Smith, CDE 31:25
they shouldn't.

Scott Benner 31:29
But you I saw you getting upset earlier talking about those column? 250s. Okay. You know what I mean? Like, that's the same thing. But you don't but that doesn't get seen that way. A cardiologist would never say that to you. an endocrinologist would say that to you all day long. Oh, just 250 it comes back down. You're fine. What? How am I gonna be in 20 years? Right? Yeah, yeah. What do you do you own a LASIK center or something like that. And you're thinking of getting into diabetes surgery to like, what are you trying to have happened to me here? And what and oh, sorry, I got upset. Now you can talk? No,

Jennifer Smith, CDE 32:04
I was gonna say and for the person who is a little bit more concerned about the lower blood sugars because of whatever fear that was instilled eons ago or whatever. Those numbers that are higher that they've been told are okay, even for lingering or you know, non lingering time periods, like a blip up and then it kind of comes back down. Eventually, they may get to feeling that they're safer. They're okay at those numbers, because in their mind 250 becomes okay, then all the time. Yes, not just the up and it comes back into what you define as the as the healthy brain to be re

Scott Benner 32:47
in range. Yeah, yeah. Especially with the thing that you don't feel. Listen, if your blood sugar's if you're a one sees rise slowly enough, you won't feel the impacts the physical impacts, your body is going to do a pretty good job of trying not to die and like what it was it this opens up blood vessels that like does all kinds of stuff, right? Like to try to like Yeah, yeah, yeah. To, to do that kind of stuff. So. So when you say it's okay, this person is slowly not becoming themselves anymore, they're altered mentally even, you don't even realize how foggy they are, they get used to that their body gets used to trying to exist like this no different than, you know, how you end up with an enlarged heart from smoking. Right? Right. Same idea. And, and yet, it's like, it's okay. It's okay. It's not okay. Like, it wouldn't be okay for you. If if you were that if the doctor, his blood sugar was 250 all the time. They'd be going like, we gotta fix this, you know, so I don't, I don't know why that that tired. It's just tired. It's lazy. Well,

Jennifer Smith, CDE 33:50
and again, with today's technology, and everything that we have, that it's got such tight ability to have alerts and alarms to keep people safe. And yes, technology can be a little weird and whatever. Yeah. But the majority of the time, what we have today with the alarms and the alerts, there's no reason to say that you can skirt up to this value as long as you're not under here. And as long as you're not hanging out in the low zone. And again, that's not even often very well defined. Yeah, what's too low? Where do you want to hit? What how long? Can I sit at what you're not telling me about a low number? What do I do it? Again, it's very like Flim

Scott Benner 34:32
Flam. It's nebulous. It really is. And by the way, even now with a within a non aggressive algorithm, like the eyelet, for example, that thing's still targeting probably under like 180 or 170. And you and I would be like, I mean, listen, it's a great tool, and I think it's going to help a lot of people but I wouldn't rely on my daughter and like, and that's 70 points better than telling somebody to 50s Okay, so I just need to understand speaking Understanding even though we had management under control and a consistent a onesie in the fives, my Endo, my son's endo said that we need to do less work, we need to do less work and let his numbers get higher. So as a one sees more like in the mid sixes or sevens, that whole you're trying too hard thing. I don't get that, like I really don't, because I know they don't want people to go crazy taking care of themselves. Right. But at some point, it does become second nature. Like you don't you mean you? It's a lot of hard work upfront for a lot of benefit long, long term. And

Jennifer Smith, CDE 35:39
I think in a visit where you the clinician, you're looking at that, let's call it a one C, which again, is not

Scott Benner 35:46
that shallow, I'm enraged and everything just

Jennifer Smith, CDE 35:48
not right. Are you asking more in depth about how much work it is taking? Because again, once you've been there for a while, as you said, it becomes more most of it becomes more second nature and you you're able to just navigate and keep that yeah, because you're doing what is pretty typical. And until or unless something changes with a growing child or a teen or something in adult life. For the most part, you're doing a good enough job. And that's when you have to define or ask the person. Gosh, how much are you checking? Yeah, right. If you can see that, you know, even in a visit somebody's like every two seconds, they're like looking at their numbers. There might be something more like on the mental angle to logical

Scott Benner 36:34
issue. Yeah, they might be under a lot of stress and pressure. But yeah, just assuming, you know, it really does it piggybacks on to this point that you added to here, you told me please bring it up, that seeing a good low a one C and assuming it's from like low blood sugars is a dangerous way to think as a doctor. This is Oh Jenny, this happens constantly the amount of people who listen to this podcast, then head off back to the doctor super excited, oh my god, I got my one seat down. It's nice. It's not that hard. Even I figured it out. Like turns out my settings were wrong. And the doctor yells at them, because they as soon as they see a number that's lower on that agency, they assume you've had multiple, you know, elongated lows to create that agency because they don't even know how to do it. It's such a unknown quantity to them, that they just assume that you've cheated the a one C test by having a lot of lows. Right? Yeah. And some of them won't listen, when people try to explain it to them, or the people are put their head down and you know, don't stick up for themselves. Right? It's a dangerous assumption to make. That's just because somebody has an A one C and the sixes are the five that must mean they're low all the time. My kids never low. Like, like, once in a great while. And even that means a drifting to 55 not like, you know, oh my god, what you know, Bob a lot most of the time her blood sugar's I don't know, it's not it's never usually under 70. Right, you know, honestly. So we have some bullet points that go through here at the end. So we'd like 10 minutes left. Yes, some of them are repetitive, so we might have to pick through them. And I'll skip over the ones I wished my doctor knew that tightly managing my son's blood sugar is far less stressful than living on the roller coaster. That's the thing you wouldn't know unless you lived with it. Correct? Like actually trying and working towards it is not as hard on you as the unknown aspect of it. You know, I think it's the difference between being told you're about to walk through a haunted house and not being told, you know, when stuffs just jumping out from around the corner all the time. You're always like, I don't know what's gonna happen next. Right. But yeah, working hard. I find this to be true for me. I don't know that everybody would find this to be true. I assume you do. Right? Like the work you do is, is worth what you get out of it? Absolutely.

Jennifer Smith, CDE 38:49
Yeah. 100%. Because I have, I have things that are known. And it makes the majority of my management, more like brushing my teeth. I don't think about the like, brush my teeth, whatever, right? It's not a thought. I have the time it's like out of my brain that you're putting the toothbrush on the brush and brushing and whatever. That's how I think about the majority of my management, unless something is really shifting stress or whatever, or I'm ill. But even that I've got enough enough years of experience to have a go to. Yeah, right. It's a starting point of oh, I can try to do this. And definitely it helps, right?

Scott Benner 39:32
So I always describe it as walking through a door. I don't like consciously think reach out, grab the knob, turn it pull. I just I just end up outside the door. And that's how diabetes works for you after a while and it is it becomes a muscle like I bet you Mike Tyson hasn't fought in a while but I bet you if you walked up to him and tried to slap him, I bet you his head would move pretty quick and he'd pop you right in the mouth. And so like and that's kind of how diabetes ends up working out. You don't know what to do. happening. But now you have all this experience and you know, blah, blah. This person says, Please tell people that they could actually go into decay with a normal blood sugar number. Yeah.

Jennifer Smith, CDE 40:11
That's so important. And where do you usually go? If you have ketones, and you're not feeling well, and you can't keep something down? Where are you going back to

Scott Benner 40:25
the hospital? That doesn't seem to know anything about helping me with my diabetes. And

Jennifer Smith, CDE 40:28
in that scenario, we actually, unfortunately had a really sort of a bad situation with one of our clinicians who her fiance had to advocate for her. And she's actually kind of corresponding with the hospital system, because of how they navigated it for she knew she was there for five hours, trying to get them to just give her fluids, her blood sugar was normal. They kept telling her she wasn't in detrimental need,

Scott Benner 40:59
right? Yeah, yeah. But she, I

Jennifer Smith, CDE 41:01
mean, and that's it. She knew she knew what she needed. I mean, sure, if you can stick your own IV. Oh,

Scott Benner 41:08
great. Imagine knowing so much about it that you know, you're in this trouble. This is the next need you have you need, you need IV fluids, then you take yourself to the right place, tell the people who are supposed to know and they're the ones who are going to be the impediment between you and not maybe dying. And that's by that happens quick. By the way. I forgot how nursing, how do they put it like it's not compatible with life, the acidity, right? That happens, right? The

Jennifer Smith, CDE 41:36
changes in all of your electrolytes and all of the things that should be being measured in the body. And ketones are one marker. And obviously, with diabetes, blood sugar would be technically another thing that they look at. But you know, when we talk about you, glycemic DKA, that's unfortunately, a level well above what most emergency departments even understand how to navigate Yeah. So

Scott Benner 42:01
I'll run through the rest of these here. Somebody said, Please, you should talk about the benefits of like mini glucagon injections for some people, especially with little kids who have trouble with lows. Please tell people about Pre-Bolus thing this woman says how we said this already today, protein and fat and how it impacts blood sugars and spikes. An explanation of insulin resistance would have been nice, when it happens, why it happens and how to manage it. So that's a person saying even if your settings work, when something else happens, I should know, like what to do next. Right? I wish my doctor knew that a one C wasn't everything. As soon as my doctor hears that my a one C is 6.8. I hear from them. You're doing great, don't worry. Meanwhile, I'm on a roller coaster all day long. I've at 50 blood sugars and 400 blood sugars on most days. And I have no idea where to begin. But they saw the 6.8 and said hey, you're doing great, right? Yeah, that's it. I wish they knew that there was no good reason to delay a person from getting a continuous glucose monitor. Within the hospital or as soon as after diagnosis as possible. I still want people to learn how to prick their fingers. But uh, CGM is such a, it's a next level, I think people deserve it. Who have type one diabetes. I think anybody using insulin deserves one. I agree. Same thing with pumps, please tell us about pumps sooner. This person says you should tell people about the podcast that's very nice. Whoever put that in here.

Jennifer Smith, CDE 43:31
I would say along with the pumps that I think it's gotten better crack. Most practices now have more knowledge about the multiple options that are on the market. But I still see practices that are more prone to offering or suggesting heavily one particular pump versus another. And what that often comes from his just their knowledge about that one particular system and they feel so strongly that it is the right one. Again, this is where individualization needs to come into the picture. So you need to know about everything to help the person pick the right one at the right time.

Scott Benner 44:10
I think in a world where you know, especially while we're making this episode, these episodes in a world where people are so under educated in the things that you're talking to other people about. I understand where this comes from, like, you know, I figured out how to use this one pump at least I can talk to them over the phone about where the settings at and stuff like that, but you are eliminating choice from people and not just their personal choice but choice that might allow them to find something that actually fits in their lifestyle better. Right. You know, I use I saw a little girl the other day online. So happy holding her tandem. Her ex too. Yeah, she's so thrilled, you know, and someone said, How come you didn't get her an omni pod? There wouldn't have been any tubes. And she said this just works better for her. And like, like for her personality. She said, good. Like, that's great. Yeah, but You shouldn't get like, because the, you know, I mean, because think of how that happens. Why are you? Why do you know one pump better than the other one? Right? I don't know, because the salesperson got there first. You know what I mean? Like, what the heck? Because back in the day before all the laws, they sent the doctors on better vacations. Yeah. Why we're doing this one. Jenny's laughing because that is what they used to do. That's not legal anymore. I'm sure that doesn't happen. Good lunches. That's it. They used to have like meetings, but they'd have them in Hawaii.

Jennifer Smith, CDE 45:31
Yeah. Or take you out for you know, good, like dinners where it was like a lunch and learn type of experience. Right?

Scott Benner 45:37
So yes, yeah, a bottle of bourbon and a steak. And all of a sudden, we're getting a pump.

Jennifer Smith, CDE 45:41
I remember when that all changed. Yeah.

Scott Benner 45:43
Yeah. Was that was actually a good law. I don't I don't have anything else for this one. So I'm just want to ask you, you know, for your kind of closing thoughts on how doctors should be talking about actual management to people? Yeah,

Jennifer Smith, CDE 45:55
I think we, I think we discussed the majority of what was I really do, especially along with all of the comments that people offered just in consideration. I think, you know, all of this communication and management and everything that we've talked about so far, it just it It boils down to individualizing. And really knowing starting place and where to move from there with somebody, because that starting place again, is just that you're going to have to move that person along and or help them move along because of the questions that they're bringing you. Maybe they're further along in understanding than you think they would be right so you have to meet them where their need is. Yeah,

Scott Benner 46:40
I know it sounds I always felt I always feel stupid saying cliche things but meet people where they are big deal. You know, you understanding what you're talking about. Big deal. You being able to communicate what you're talking about big deal and giving people a complete story. And not just snippets is is very, very important. Anyway, thank you for doing this with me. Thank you of course.

A huge thanks to the contour next gen blood glucose meter for sponsoring this episode of The Juicebox Podcast. Learn more and get started today at contour next one.com/juice box. A huge thank you to one of today's sponsors, G voc glucagon, find out more about Chivo Capo pen at G Vogue glucagon.com Ford slash juicebox you spell that GVOKEGLUC AG o n.com. Forward slash juice box

if you are a loved one has been diagnosed with type one diabetes. The bold beginnings series from the Juicebox Podcast is a terrific place to begin listening. In this series, Jenny Smith and I will go over the questions most often asked at the beginning of type one. Jenny is a certified diabetes care and education specialist who is also a registered and licensed dietitian and Jenny has had type one diabetes for 35 years. My name is Scott Benner and I am the father of a child who has type one diabetes. Our daughter Arden was diagnosed in 2006 at the age of two. I believe that at the core of diabetes management, understanding how insulin works, and how food and other variables impact your system is of the utmost importance. The bold beginning series will lead you down the path of understanding. The series is made up of 24 episodes, and it begins at episode 698. In your podcast, or audio player. I'll list those episodes at the end of this to listen, you can go to juicebox podcast.com. Go up to the menu at the top and choose bold beginnings. Or go into any audio app like Apple podcasts, or Spotify. And then find the episodes that correspond with the series. Those lists again are at Juicebox Podcast up in the menu or if you're in the private Facebook group. In the featured tab. The private Facebook group has over 40,000 members. There are conversations happening right now and 24 hours a day that you'd be incredibly interested in. So don't wait. So don't wait. Check out the bold beginning series today and get started on your journey. Episode 698 defines the bowl beginning series 702, honeymooning 706 adult diagnosis 711 and 712 go over diabetes terminologies hit Episode Seven pick team we talked about fear of insulin in 719 the 1515 rule, Episode 723 long acting insulin 727 target range 731 food choices 735 Pre-Bolus 739 carbs 743 stacking 747 flexibility. In episode 751 We discussed school in Episode 755 Exercise 759 guilt, fears, hope and expectations. In episode 763 of the bowl beginning series, we talk about community 772 journaling, 776 technology and medical supplies. Episode Seven at treating low blood glucose, Episode 784. Dealing with insurance 788 talking to your family and episode 805 illness and ketone management. Check it out it will change your life when you support the Juicebox Podcast by clicking on the advertisers links you are helping to keep the show free and plentiful. I am certainly not asking you to buy something that you don't want. But if you're going to buy something, or use the device from one of the advertisers, getting your purchases set up through my links is incredibly helpful. So if you have the desire or the need, please consider using Juicebox Podcast links to make your purchases. Thank you so much for listening. I'll be back soon with another episode of The Juicebox Podcast. The episode you just heard was professionally edited by wrong way recording. Wrong way recording.com

#1147 Rest My Case

Mellisa was diagnosed with type 1 two years ago at 44 years old.

+ Click for EPISODE TRANSCRIPT

Scott Benner 0:00
Hello friends, welcome to episode 1147 of the Juicebox Podcast.

On today's show, I'll be speaking with Melissa she's 46 years old and she's had type one diabetes for two years. Today we're going to talk about all kinds of stuff on the pod five learning how to take care of yourself having to pay for your own C peptide test, and some personal tragedies. While you're listening, please remember that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, always consult a physician before making any changes to your health care plan, or becoming bold with insulin. If you have type one diabetes, or are the caregiver of someone with type one, please go to T one D exchange.org/juicebox. and complete the survey when you do this. You'll be helping with diabetes research, you'll be helping the podcast and you may be helping yourself T one D exchange.org/juicebox. The T one D exchange is looking for anyone who has type one diabetes, or is the caregiver of someone with type one, as long as they are a US resident. It is particularly hard to get data from males and males of color. So if you fall into that category, please do go to T one D exchange.org. Forward slash juicebox. If you're looking for community around type one diabetes, check out the Juicebox Podcast private Facebook group Juicebox Podcast type one diabetes. This episode of The Juicebox Podcast is sponsored by the 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.

Melissa 2:19
Hi, Scott. My name is Melissa. I am a type one diabetic. I just turned 46 I think we would refer to ourselves as ladder. So I was diagnosed when I was 44.

Scott Benner 2:30
So did your was your onset very slow.

Melissa 2:35
No, it was not.

Scott Benner 2:36
I don't know that you're a lot of like to me Lata is about the onset. The very like slow, methodical way that the pancreas just stops working very gently, but yours just kind of shut off.

Melissa 2:48
It seems to have given us two weeks notice pretty quick.

Scott Benner 2:52
I think you just have type one diabetes, then.

Melissa 2:54
That's what my endocrinologist, he just calls me type one.

Scott Benner 2:59
Yeah, I mean, honestly. So a lot of it is latent autoimmune diabetes in adults, right? That's correct. But the latent is the is the part that we want to hold on a second. I just don't want to talk wrong about it. And the last time Jenny made me say it out loud. I was pulling it so far out of my butt that I was like, I think I'm saying this right. Yeah, I that really is just about the very slow onset. I'm going to just say you have type one, and we're going to be done with it.

Melissa 3:28
Well go with type one.

Scott Benner 3:29
Why not? Any other type one in your family?

Melissa 3:32
I have no family history on mom or dad side. The only person that has diabetes is type two was my grandmother. She was diagnosed in her 60s and managed it with diet and exercise for 15 odd years.

Scott Benner 3:47
About that. How about other autoimmune stuff in your family? Not that I know of. Do you have anything else? Thyroid celiac stuff like that? Nope.

Melissa 3:56
No. Okay. Well, just the lucky type one, just

Scott Benner 4:00
just this little thing. Are you married? Do you have children?

Melissa 4:02
I am widowed. I have five children.

Scott Benner 4:05
Holy hell five.

Melissa 4:07
Yes, I do. I have five children. I haven't locked them in the basement right now. That's why it's so quiet.

Scott Benner 4:12
Melissa, I'm gonna say something we're gonna get off to a start where either you're gonna love me or not love me. But is that what killed your husband? Or?

Melissa 4:20
Well, it was me or it was the children or actually he did pass with cancer.

Scott Benner 4:24
Oh, I'm so sorry. That's terrible. Yeah, so then it wasn't you or the kids? Luckily, no, not an unreasonable question though. For 5g Even just the the effort to make the five children and keep them alive. Good. Well,

Melissa 4:36
I'm pretty sure he had a good time. Me. It was a little rough.

Scott Benner 4:41
Why was it rough for you?

Melissa 4:44
Five pregnancies doesn't number on your body. Maybe that's what caused day one.

Scott Benner 4:47
You think so?

Melissa 4:48
He just No, actually, I don't know. I wish we had a cause. Yeah.

Scott Benner 4:53
Wow. How long has he been gone?

Melissa 4:55
Five years.

Scott Benner 4:56
Oh, I'm so sorry. That's crazy. Well, you guys similarly aged Yes,

Melissa 5:00
he was one year older than me. Wow. How

Scott Benner 5:02
old are your kids?

Melissa 5:03
My oldest is 19. I have 1918 1614. And my little guy is 11. Wow. How

Scott Benner 5:10
about that? Do you ever consider sending their bloodwork in for trial that or anything like that to see if they have any markers for Taiwan?

Melissa 5:18
I have. I have not yet acted upon it. I am much more concerned about the cancer through their father's side,

Scott Benner 5:25
which tell me what kind of cancer it was. It was colon

Melissa 5:29
cancer. And so his colonoscopy at the time was it's not it wasn't indicated until 50. He was diagnosed at 37. They've now moved it to 45. So I just had my colonoscopy came back nice and clear. But he was diagnosed at 37 with stage four. Wow. Oh, geez. All at once. All at once. Was that our anniversary as well? I should add.

Scott Benner 5:50
Oh my god, what are you trying to make me crazy? She's Melissa. I'm gonna cry in a second. My mom just died of cancer like a month and a half ago.

Melissa 6:00
So sorry, that it's difficult. I'll give you a virtual tissue.

Scott Benner 6:04
Thank you. I appreciate it. Wow, he was so young. And he and he lived with it for a couple of

Melissa 6:11
years. Not hard. Yes, he passed. He actually lasted five years. He fought very hard, very valiantly.

Scott Benner 6:18
That's crazy. Do you get the feeling looking back? Was he doing it? Because he thought it was gonna work out or was he just trying to hang around for you guys? I think it was a little bit of both. Yeah. I mean, your youngest would have been like

Melissa 6:33
he was 12 months old. At diagnosis.

Scott Benner 6:36
Jesus. Yeah. You're gonna make me cry. Melissa. Okay. Wow, it does that kind of cancer run in your husband's side of the family?

Melissa 6:43
No, there was no family history on his mom or dad side. Oh, geez. Does He have brothers and sisters? He has one sister and one brother.

Scott Benner 6:51
Are they very careful now? Yes.

Melissa 6:55
I think we all are after that. Yeah, I

Scott Benner 6:57
would think so too. All right. I'm gonna try to shift this a second. Do my best here. What's the you're in a very unique situation. So do you think about dating ever?

Melissa 7:09
I'm currently in a relationship with my running shoes. And I have been for about 10 years. Well,

Scott Benner 7:15
let's say you sound like you set your voice you have such a lovely voice. The I don't know if you know that or not. And when you think you and you said that or like seriously, are you doing voiceover work on the side? What are you doing?

Melissa 7:25
I wish I'm just one of those pesky attorneys. You're

Scott Benner 7:29
an attorney. I am. No kidding. What kind of law do you practice?

Melissa 7:33
I do corporate law. And I also work for veterans. Disabled Veterans. Nice.

Scott Benner 7:39
Let's see. Five kids. No diabetes, yours is late. You didn't expect it? I guess my big question is is that after what happens to your family? It's only a few years later that you get type one. Is your first thought this isn't fair.

Melissa 7:58
Absolutely. Oh, 110%. Yeah, I

Scott Benner 8:01
feel like that's what I would think to. How long did it take you to process all of that Dexcom G seven offers an easier way to manage diabetes without finger sticks. It is a simple CGM system that delivers real time glucose numbers to your smartphone, your smartwatch. And it effortlessly allows you to see your glucose levels and where they're headed. My daughter is wearing a Dexcom g7 Right now, and I can't recommend it enough. Whether you have commercial insurance, Medicare coverage, or no CGM coverage at all Dexcom can help you go to my link dexcom.com/juice box and look for that button that says Get a free benefits check. That'll get you going with Dexcom. When you're there, check out the Dexcom clarity app where the follow Did you know that people can follow your Dexcom up to 10 people can follow you. Right now I'm following my daughter, but my wife is also following her. Her roommates at school are following her. So I guess Arden is being followed right now by five people who are concerned for her health and welfare. And you can do the same thing. School Nurses, your neighbor, people in your family. Everyone can have access to that information if you want them to have it. Or if you're an adult, and you don't want anyone to know, you don't have to share with anybody. It's completely up to you. dexcom.com/juice box links in the show notes links at juicebox podcast.com. And when you use my link to learn about Dexcom you're supporting the podcast.

Melissa 9:32
Well, I was originally diagnosed as type two. So when I was 44, they had diagnosed me as type two kind of an interesting story. The insulin Gods nudged me a little bit. So I went on to Amazon Believe it or not, and I got a glucose meter. So I didn't have any symptoms that sort of classic symptoms going to the bathroom. You know very frequently I had actually gained a couple of pounds. So I just felt like something might have been off So I bought a meter, my blood sugar was 531. So I make a visit to the doctor. He asked me the list of questions, I say no to everyone and he said your meter is incorrect. Here is a prescription for a meter. And so I get that meter. And sure enough, was roughly the same.

Scott Benner 10:20
That I figured it out. It's the meter you bought

Melissa 10:24
an interest? I wish it were the meter. Unfortunately, it was not Was

Scott Benner 10:27
there some time after he, the doctor said that you thought, oh, I don't have diabetes. I just bought a junky meter.

Melissa 10:33
Absolutely. And I so wished that was the case. Oh,

Scott Benner 10:37
and then you find out that it's not the case? Do they start treating you like a type two? Initially, they

Melissa 10:42
did. My my agency was 11. I was put on Metformin and Jardiance, a combination pill called sin Gerety. So I took that daily, and he said, You can take it what a once weekly injection, and I thought, Oh, no way. I will never inject myself. That is the scariest thing on the planet. And, of course, here we are.

Scott Benner 11:02
Yeah, now you're doing it. Like it's like it's nothing like

Melissa 11:06
it's going out of style. Exactly.

Scott Benner 11:09
Okay. I just had a thought. I don't usually do this at night. By the way, I'm a little thrown off by this. Getting myself gathered, okay, so that the doctor sees you like any type to a mum. Okay. Did you have any big illnesses or viruses prior to your diagnosis?

Melissa 11:31
I didn't.

Scott Benner 11:33
So they say sometimes, that stressors can also be like kind of things. Like the my assumption would be that you've been living with markers for type one diabetes, most of your if not all of your life. And I'm wondering if the passing of your husband wasn't so stressful that it didn't put your body in a in a unique situation?

Melissa 11:56
It may have it very well may have i That's something that I have thought of.

Scott Benner 12:01
Me, there's no way to know. It's just right. Yeah. Interesting to wonder about. So okay, so you. So you have the quick onset? How long did they treat you like a type two, it was

Melissa 12:15
about four or so months, I bought every single book that I could get my hands on thinking if I work hard enough, I could put this into remission. So I read a bunch. I actually ordered my own C peptide and antibodies tests. And that revealed that I my C peptide was terribly low. And I tested positive for the GAD antibodies.

Scott Benner 12:37
You did that on your own?

Melissa 12:38
I did.

Scott Benner 12:39
Is that something that Dr. Fight you want it? Or was it pretty harmonious when you asked?

Melissa 12:45
It was a self test that you I purchased on my own? How much of it was a pretty penny? It was several $100 out of pocket. But I wanted to know, from all of the literature that I had read if I was indeed type one.

Scott Benner 13:00
Did you not think mom trying to figure out why did you not go to the doctor and ask for the that testing, like through your insurance?

Melissa 13:07
I had switched physicians at that point.

Scott Benner 13:12
You didn't like the last one did not like the last one. Does the cancer battle teach you not to put up with bad doctors?

Melissa 13:19
I think it teaches you to be a strong self advocate.

Scott Benner 13:24
Yeah, I agree. I often think that my mom stole a couple of years. And it's because I this is gonna sound strange. But it's because I have all this experience raising a child with diabetes, right? Because there was a moment where doctors told my mom like this is it like, you know, just get your affairs in order a couple of months. And, and it's gonna be over. And I was the one who was like, No, I we could figure this out. Like if we try hard enough. And we got a doctor to perform her surgery, which led to two more years. And but doc, but the doctor we were at and even the institution she was at was not interested in helping her. Right. And so, you know, I really believe in that strongly. Well, it'll serve you well moving forward, I think. I think so. I hope so. Yeah, absolutely. How are your kids?

Melissa 14:20
Oh, they're doing just fine. I've got two in college two in high school for this upcoming school year and one in middle school. Wow.

Scott Benner 14:26
Is it exhausting raising five children by yourself?

Melissa 14:29
Oh, being mom and dad has me very tired. Yes. And then I worked full time as well.

Scott Benner 14:34
What did you find? What did you find the slack that needed to be picked up? Like what did you look at and say this is an important thing my husband would have done? It needs to get done. I'm gonna have to jump into unfamiliar territory here and do this thing.

Melissa 14:53
Really showing up for myself? Because kind of like the airplane analogy you have to put on Your own mask first and then save the littles that is so incredibly important. And then ditch the mom guilt that is so strong and so important. So if I don't take proper care of myself, especially now as the only living parent, my kids will have no one. And that's not acceptable.

Scott Benner 15:17
How did you do that? How did you get rid of the guilt?

Melissa 15:20
I don't know that I've gotten rid of it entirely. But finding moments of gratitude daily is really important. And something that I cherish.

Scott Benner 15:28
It really is a situation where you're owed your feelings as well. As certainly, yeah, and I'm assuming you've, you know, made five children with a person you really cared for. So, and it's such a, I mean, you probably really started. I'm so sorry. I feel like I'm bumming you out. But like, worries. I mean, that really is just, I mean, it's still the beginning of your life. You know, 37 years old, honestly. Right. Yeah. Right. Wow. That's a lot of kids that 37 You've been like, do you guys start early or go fast?

Melissa 16:01
Started in law school.

Scott Benner 16:04
Really? Law school? Not hard enough for you?

Melissa 16:09
Yes, like she's my Christmas break, baby.

Scott Benner 16:13
We've got to do something to get rid of all this tension. Why don't we make more tension?

Melissa 16:20
Simply get out there. They're cute and squishy. So you know what's for more? How

Scott Benner 16:24
do you make it through law school with a baby? Like that's interesting.

Melissa 16:29
Just a day at a time, kind of like, like today?

Scott Benner 16:33
So you've kind of always operated this way. Yes, yes. Yeah. Did you have like family help with the baby and everything? Do you guys get mad? I have so many questions. Do you guys get married right away once you got pregnant and what did you do?

Melissa 16:45
We met in college. And so we got married a year and a half later. And then he went to law school, then I went to law school. Wow.

Scott Benner 16:55
That's really something hey, most Mormon.

Melissa 16:59
We're not Mormon and we're not Catholic. I do get those quite often. Yeah, no

Scott Benner 17:03
kidding. Well, they're obvious. Like you know, generalizations to make. I like how you answer everything like an attorney. Do you know that about yourself? Now I do your questions or like your answers or like you pause, you think your direct you don't say more than I asked, which is interesting.

Melissa 17:25
Like, we don't want to know how many listeners you have. So

Scott Benner 17:28
I just always think of attorneys as people were like, I don't say anything extra because extra stuff gets us in trouble. So we just keep it to what we're doing. Anyway. That's lovely. I on point, I'm also enamored by your voice, by the way, definitely think you could be a mom in a sitcom or something like that. Oh, thank you. Now you, um, you're like, thank you. I'm an attorney. I don't need to be in a sitcom.

Melissa 17:51
Might be a little more fun, a little less stressful. Actually, I love what I do. I've only wanted to be an attorney. So I'm, I'm grateful that I get to do that.

Scott Benner 17:58
Okay, good for you. That's excellent. You talked about having to be there for your kids. So I'm going to try to piece together a little timeline here. Your husband passes. Your your health is how at that point, I mean, your mental health is probably shaky. But how was your physical health?

Melissa 18:14
I was running a lot. So it was I was in pretty good shape. I still am, hopefully in decent shape. I saw Ron, I did a lot of rock climbing. I have yet to do outdoor rock climbing since being diagnosed. So mainly indoor rock climbing. So I've always been pretty athletic. And type line is definitely not slowing me down. If anything, it's helping me to get out there and sort of show the world that you can run a 50k or climb a mountain with type one.

Scott Benner 18:43
I don't know the metric system but 50k Sounds far.

Melissa 18:46
It's a little farther than a marathon. So it's it's not too terrible.

Scott Benner 18:50
So to you. I jogged up the stairs to do this with you. And I was like great. Now I'm out of breath. Wow, that's something so how do you? How are you managing right now? Are you on a pump? Do you use injections? What do you do?

Melissa 19:04
I am now on? Luckily I love it the Omnipod five and the Dexcom G six.

Scott Benner 19:10
Nice. What did you start with?

Melissa 19:12
I started on MDI with Joseba and human log.

Scott Benner 19:17
And what were your needs? Huh? What is the question I want to ask? I'm looking at your age. You're still so sorry. You're getting your period still is what I want to say. Right? So do you see fluctuations? Did you see fluctuations right away with hormones? Well,

Melissa 19:33
it's interesting. I I'm actually on an IUD. Once my husband was diagnosed with cancer, we put a stop to the baby making for obvious reasons. So I had an IUD. So the IUD that I have is the marina and the Marina means I don't get a period so I don't actually get the monthly cyclical changes. So I believe that I'm actually Peri menopausal at this point, just from some other types of symptoms, but I have not no Just my insulin needs varying within the weeks of a given month.

Scott Benner 20:04
Can you spell the name of the IUD? It's

Melissa 20:07
Marina and I Rena.

Scott Benner 20:11
Oh, okay, so you don't see the fluctuations? But what are the things you're seeing that make you think you might be perimenopausal is the

Melissa 20:18
temperature stuff? Temperature? Oh, the temperature? My wife

Scott Benner 20:22
takes something. Are you do you get the sweat ease? The sweats? Yes,

Melissa 20:26
I do. Wait, hold

Scott Benner 20:27
on. I'm gonna text somebody in another part of my house and get you the name of something that stopped it for my wife. Yes, please. What? This is, by the way. Sorry, Kelly. All right. I'll get the name back of that for you. Wow, look at us. Old. Oh, my gosh. All right. So your, how long on MDI before you move to Omnipod five.

Melissa 20:57
I was on MDI for about six months. It was grueling work, I maintained an A one C of 5.4. I counted my injections, because I really wanted to figure out what I ate, how it affected my body, my running my climbing, how that affected. So I kept meticulous records for about the first six months. So I was doing in order to keep that line from shooting up or going too low. I was doing on average, about 10 to 13 injections a day, I had the human log Jr. So I was able to Bolus in half unit increments. I have now a wonderful endocrinologist who writes me the best prescriptions ever. And after six months, I said I'm I think I'm ready to start pumping. And it was the best decision ever.

Scott Benner 21:43
Did you take to it all very quickly. It sounds like you figured diabetes out.

Melissa 21:49
I had done a lot of research. And in fact, when I was diagnosed as type one, I did a search. And it led me to one of your podcasts with a physician herself who was diagnosed as type one. She was loud as well. And that was such an encouraging, encouraging episode to know that I wasn't alone, because I didn't know anybody that was type line. I do have one friend in person to actually that are that I can receive support from that are here in real life. But that was I just recall, and I don't remember her name. But that was just the best episode ever. It gave me so much hope. Wow,

Scott Benner 22:27
that's really something I I have to tell you that. Even though I understand that that happens when somebody says it to me, it still takes me by surprise a little bit. It feels lovely that that, that that all worked out like that. But absolutely,

Melissa 22:41
it was just a godsend. I wish I could remember her name, or had some way to contact her just to say thank you.

Scott Benner 22:48
Yeah. Oh, well, let's just assume that I invited her on. So thank you. Me. It's enough. Do you want to figure out so this stuff is over the counter? It's called estrogen. e s t r o v e n? O yes.

Melissa 23:04
I've heard of that. I have yet to try it complete

Scott Benner 23:06
MultiSymptom menopause relief? My wife says that made her stop

Melissa 23:11
sweating. So I will try that out. No, tell her thank you. Oh,

Scott Benner 23:14
please, I will absolutely pass it on. She'd be thrilled if it helps somebody else. And by the way, if you so if you don't have you don't have any thyroid stuff. So you probably wouldn't have listened to the thyroid episodes. But the doctor that was on to discuss thyroid stuff. Dr. BENITO is the one who told my wife about estrogen. So okay, yeah. Good luck with that. I think it's just like, I think you're probably grabbing it at Amazon to be perfectly honest. Oh, beautiful. Perfect. Good luck. Let me know by the way, seriously, if you stopped sweating, send me an email. I definitely

Melissa 23:42
will stop sweating. I just hope you remember me and

Scott Benner 23:47
please don't give it any context. I just want to get an email like in three months it says I stopped sweating and see how long it takes me to go. What the hell is this about? Right? I really have the worst memory for things like this. I got a note today. Hold on. I wish I could get it up for you. So I'm now I'm using an editor for the podcast now. So like you and I will talk we'll do our whole thing. At the end of this episode after you and I are done. I'll leave myself like a voice note like listen I talked about this and that and blah blah blah and maybe think about naming the episode this like that's pretty much it right? And then I'll upload the file and someone else will go clean it up. Although I gotta be honest, your microphone sounds so good that if we don't curse I probably can save the money on this one. Anyway goes up to an editor and that person like takes like leave some notes for me at the end. And the note I got today was something about like reconstructive surgery on somebody's i don't know I'm sorry most I'm not a doctor, but you know,

Melissa 24:51
they're telling you just play one on TV Exactly.

Scott Benner 24:54
The part between their button their vagina, and then and all this stuff and so Um, and he sent me a note, he goes, Hey, you're gonna want to listen to this and hear and make sure you're okay and comfortable with this and this and this. And I was like, Okay, I don't remember this at all. I said, I can't wait to put it on and remember what the hell you're talking about.

Melissa 25:17
It's like opening a Christmas gift twice. You forget the first time, you know, I'd double gifts

Scott Benner 25:21
or by gosh, I swear to you. I mean, honestly, though, with that set up, don't you think your brain would go? Oh, yeah, well, that's this not I can't, I've just recorded too much. But you you joked a minute ago about I said, I'm not a doctor. I'm certainly not. But I just got surgery on my foot. During the initial consultation with the doctor, we were having a conversation. And I started saying some things. And there's a pause. And he goes, Hey, I'm sorry. Are you a medical professional? And I said, I got embarrassed. And I said, I have a podcast

Melissa 25:56
that is under the medical category. Does that count for something?

Scott Benner 26:00
What is the budget so that I started telling me about it? And he said, Oh, you're you're incredibly knowledgeable. And I said, Oh, thanks. And like, let go of it. Like not a thing that we kept talking about. But then weeks go by and then you get the surgery and then you know, little time goes by and you visit with the doctor and I and I had to come see him because the dressing was just not holding up. And I called them and I was like, I can just rewrap this and they were like, no, no, come in, we'll rewrap it. And I was like, All right, whatever. So I rewrapped it. But I kept the appointment. I think I just wanted to get out of the house for an hour. I was like, Oh, I can still go somewhere. And so I kept the appointment. I walked in, he goes, That looks fine. I said, I rewrapped it and he goes, Oh, that makes sense. You're a doctor. And

Melissa 26:45
I was like, Well, it matters into your own hands. Quite literally.

Scott Benner 26:48
He said that podcast is really coming through. So he looks at my foot and he goes did a really nice job. And I said I all I did was wrap it with gauze and tape. I'm like, I don't know that there's a like a high ceiling here for this. Anyway, it's ridiculous. Okay, so you move from MDI to Omni pod five, after not a long time, but not a short time using MDI, either. You were very diligent about your MDI. I mean, it's a lot of shooting to maintain a number, I guess. So during the MDI time, what was your a one see, like,

Melissa 27:20
it was 5.4. I kept a 5.4 a one C, I'll choose Milissa. So it was a tremendous amount of work. Yeah,

Scott Benner 27:29
no kidding. So you're making small bumps with injections? When you see blood sugar's rising, that kind of stuff. Right, exactly. After CGM. At that point. Are you MDI with the CGM ever?

Melissa 27:40
Yes, yes, I went to my endocrinologist, he gave me the libre, I prefer the Dexcom, it was just a little bit more accurate for my body. So I just actually got insurance coverage, I was paying out of pocket. Okay, but it was well worth it. For

Scott Benner 27:55
you. I liked the way you, you attack this, for the lack of a better word, I enjoy your perspective and how you like you're like, I couldn't get a I couldn't get an antibody test. So I bought one. I didn't like that. So I paid cash. Like it's pretty cool. Okay, so now you what makes you well hold on a second, let me go back a little bit. When you're managing that tightly with MDI. Is that a thing you figured out on your own? Did you hear it through the podcast? Or read it in a book? Like, how did you decide to go after it like that? It

Melissa 28:27
was a lot of being part of the Facebook group, the juicebox Facebook group, there's a huge amount of support there. So that also being just a solid advocate. And then being of course, my kids only living parent, I felt like I didn't really have a choice but to maintain nondiabetic numbers or at least really try put in a solid effort. Wow,

Scott Benner 28:50
I was going to ask you about that earlier, but I just decided to wait to see if it came up. The idea of I gotta stay alive. Right? Right. Absolutely. Yeah. Me. Yeah. I don't know. I don't know another way to think about I think of it like that. And I didn't have anything happen, like you had happened. So it's

Melissa 29:09
really something to be faced with your own mortality or to watch the my husband pass. It's it brings a lot of things to the forefront. So it's important to be strong to be healthy, you know, mentally, physically, emotionally. Just the whole gamut. Yeah,

Scott Benner 29:24
I mean, and the five children, right. So add them to Yeah, well throw them in. Well, here's the question. If, let's say you just disappear, you float away like a balloon. We don't want to kill you. In my scenario, we'll just let you float away. Did they all go to the same person? Although under 18, like who?

Melissa 29:42
Oh, as an attorney, I have that under lock and key and it is well thought out. Yes. Yeah. But my husband was an attorney as well. So we had plans upon plans upon plans.

Scott Benner 29:52
When you told me you had five kids I knew you were both attorneys. Yes. You were guys are like I can afford this. Don't worry. As everyone else gets to and goes, we're in trouble. We got to stop. But do they go to? Like, was that a thought? Like, they have to keep them together? Where was the thought I need to put them where they fit best? Or how do you

Melissa 30:19
stay together? Yeah, they're all provided for. And luckily, I was able to get life insurance pre type one. So there said, I worry about them killing me in my sleep more than I worried about me dying from type one.

Scott Benner 30:33
Son, my son started an IRA the other day, I was very proud of him. He's just out of college. And he's talking to me about like, he started talking to me about like, you know, what am I gonna do when I'm 50? I'm like, wow, okay. We'll talk about this. So we sat down, and we talked, and I said, I think you could probably start, like opening up a simple IRA somewhere and putting an amount of money in every month and having a goal for maybe buying a home or something like that, and then a more long term goal. And so he was he was like handling all that. And I said, I want to give you the first bit of money to put in it to get you started. And he was like, Oh, great. And I told him the number which, by the way, it's not a lot of money. And I'm, you know, it's just a reasonable amount of money to get them going. And we get on the phone that day. And he said, I got the whole thing set up. I gotta sign the paperwork and everything. That guy is gonna get it to me. And I was like, great, that's all great. And he goes, How much money did you say? You were gonna give me again? And I could see that he had a number in his head. But he didn't want to say it out loud in case he was low balling it. And I watched him go, did you say, Uh huh, what did you say? is amazing. He's like, he's afraid he's gonna say five. And I said six. One and two, whatever. He doesn't want to screw himself out of it.

Melissa 31:54
You got to read the room. You got to read dad.

Scott Benner 31:57
Just for fun. Anyway, okay, so you I mean, you're doing a five four MDI. Lot of work by a lot of work. You're injecting a lot. You're watching closely. What kind of Jenny told me to say fuelling plan. Well, but it doesn't sound right to me. How do you eat? I guess, like, what's the style of food?

Melissa 32:18
I love food. I will eat anything and everything. There's two things on this planet I won't eat. That's about it. I will eat anything and everything. I love eating. In fact, my endurance running allows me to really enjoy food. So I'm certainly glad that that hasn't the type one hasn't stopped me from just eating. Yeah,

Scott Benner 32:37
you know, people aren't going to be okay with it. If I don't ask the two things you only

Melissa 32:41
oysters on the half shell And Rob Bell peppers. I just can't. Oh,

Scott Benner 32:45
interesting. The oysters I'm with you. I can't I can do mussels in a pinch. Like if I had to. If

Melissa 32:54
you were on a desert island, talking to you know, Wilson that's

Scott Benner 32:57
been in the bar and had a couple of mussels and gone. That's enough. I don't know what everyone else is going crazy on. I had three um, good. Oysters. I can't do though. That's interesting. But to just things that do not like the way they feel in your mouth or the way they taste.

Melissa 33:14
It's disgusting. It looks like a big pile. It's not I'm sorry. That's just so gross to me.

Scott Benner 33:20
What about the peppers, though?

Melissa 33:21
I don't know, they have such a strong flavor roasted I can do. But I just can't do RAW. Okay.

Scott Benner 33:26
Okay. So you're eating an eclectic mix of food. It sounds like and you're still managing that five, four. So when you decide to go to a pump, is that a difficult decision to make? Because you're doing so well? Or did you just feel feel like you needed the brake.

Melissa 33:42
I felt like I needed the brake. I knew in my gut that it was the right thing. And in fact, it had my insurance had denied it. And my doctor appealed it. And when I got the letter, I just broke down. I was picking up my son from the bus stop. And I started to cry. I showed him the letter, I knew that life was going to be so much easier, which it absolutely has. I wear a Garmin watch. And so I'm able to get my blood sugar on my watch. I'm able to Bolus through my phone, I have an Android, it could not be easier. This is a great time to be a type one if you happen to have the unfortunate fortune to be a type one. Oh, I

Scott Benner 34:18
agree. Jenny and I were talking about the other day. Well, I thought we were recording something. I don't know when you'll hear it. I can't keep track of everything. I were just talking about that. Like just you know, you just go back 100 And some years 100 And some years and Melissa you'd be gone. You don't I mean, like you would have got diabetes and you just would cease to exist. And then somebody comes up with insulin and then you know that's a miracle. And and you think well how can you get better and then it does and then the insulin gets better and then pumping and then the continuous glucose monitors are just they really are the rest of it. As far as I can tell right now. It just it's a it's a hell of a leap and I will tell you if you even go back to when Arden was diagnosed like when Arden was diagnosed it was a meter and syringes. And that was it. That's what you got. So it was just 20 years ago, right? Not even. Let me do the math. She's 19 She was diagnosed when she was two sounds like it was 17 years ago. Yeah. So Yeah. And, you know, it's funny, I really don't even know 2006 She was diagnosed. I really don't. It's not a thing I track. As a matter of fact, I think she was diagnosed in August, but I'm not even 100% sure of that. I really don't like, I don't know, I'm not that person on that stuff. But yeah, it's just it's come so far, so fast. And, and I mean, because the leaps that have happened in the last 10 years are, are really astonishing. Like, you know, really wonderful. The podcast, the Facebook group, gave you all that stuff. Did you use that to transfer your knowledge to pumping? Did you lean on this again? Or did you have it pretty solid by them? I

Melissa 35:54
did. In fact, I listened to the pro tip for the Omni pod. And that helps so much to make sure that I had my settings appropriate that I was able to Bolus in at the appropriate time Pre-Bolus seeing all of that everything is encapsulated in those I think it's four or five episodes. It is it's it's gold. Well, let's

Scott Benner 36:16
go. The diabetes Pro Tip series for Omni pod five is three episodes long. And it is available at juicebox podcast.com, forward slash Omni pod five, or it's in your player, etc, and so on. That was I'm going to take a little bit of credit here. People listening for a long time are laughing It's fine, you gotta laugh at me, I'm just gonna take credit here a number of years ago, when the idea of on the pod five G's back then they were going to call it horizon, it was going to be called Omni pod horizon. And it was in the very early stages, even nowhere near being, you know, even sent to the FDA years away from that happening. But the conversations are happening behind the scenes, we're working on this thing, here's what it's going to be. And I started advocating back then between me and the person that I do business with it on the pod, I was like, we have to make like a pro tip series to help people transition to an algorithm because it's not a thing people understand generally. And when it goes wrong, when they have their settings wrong, or when they fight with the algorithm or something like that, it's gonna go wrong, and they're gonna blame the pump. And not only is that going to be bad for you, as the company, but it's going to be bad for them. Because a number of them are going to, they're going to give up, they're going to think, oh, I tried the thing, the thing doesn't work. And that's not what we want. And I don't mean from a sales perspective. I mean, from like, a health perspective, and, you know, an ease of use and all the other good things that come out. I mean, how much do you love sleeping? Now? You know,

Melissa 37:43
it's beautiful. I love sleeping. I did my do with all of my kids waking up in the middle of the night.

Scott Benner 37:49
You didn't want a six go around with diabetes? No, thank

Melissa 37:53
you. No, thank you.

Scott Benner 37:55
I agree. But it's a different way of it's a slightly different way of thinking not just Omnipod five, by the way, but if you were going to use the tandem control IQ, or probably even the new Medtronic 780 You know, if you're going to loop if we're going to do do it yourself loop, it's all just it's a slightly different way of thinking about it. You want, you don't want to be fighting it, you want to be working with it. You know, right. That's very cool. Beautiful thing. I love it. How do you make out? I mean, it sounds like you're incredibly active. So how do you manage your activity with only about five

Melissa 38:27
if it depends on the time that I exercise during the day. So as is common, I tend to be a little bit more insulin resistant in the morning. So when I run fasted, I don't put it on activity mode, but any other time like after 10 Like today, I I hit the gym during my lunch, and I ran a couple of miles on the treadmill, I made sure to put an activity mode about an hour before to suspend the insulin. And I still actually ended up needing a little bit of sugar. So it's I always carry sugar with me always, always always, especially when I run back country. Yeah. And I of course have a little meter that I take and I do take my boxing as well. That's

Scott Benner 39:07
excellent good for you. Like just being prepared. I just got done making a couple of short episodes with people telling their experiences of using glucagon. And you know the amount of people who are not prepared or don't even didn't prior to it happening even understand why they needed to be prepared was interesting and there's that episode from not long ago. What is it the wife is telling the story of the husband going on a hike with their child he the husband gets low and starts to explain to his I think is pretty young daughter how to get back down the mountain they're on to find their grant her grandfather and have him come back and while the husband was explaining this to the child, he believed he was explaining to his kid how to go find somebody to come back and find his body like he thought he was like he He thought he was really in trouble. And then and then he found berries that he took to help bring his blood sugar back up. That is so scary, isn't it? Yeah, so scary. So if you're gonna carry your glucagon, then you know, you won't have to. You want to think give your children a map to bring back the the people who are going to drag your carcass back. You know what I mean? Right?

Melissa 40:18
Yeah, well, my kids would drive up in a Ferrari. But I have, I have definitely briefed the kids on where everything is located in the house, in my purse in my bathroom, I have the locations listed on my fridge, just in case step by step instructions. I've actually alerted my local police department and fire department. So I have a key so they don't have to do force entry in case I need to call 911. I've really thought about this. Because at some point, I will be living alone. The kids will fly the coop. So I want to make sure that I give myself I sort of stacked the deck in my favor. That's so

Scott Benner 40:58
smart. What it was that like when you contacted like your local municipality, I

Melissa 41:02
am lucky to know a couple of first responders. And so I asked them, what would be the situation if I called I knew I was going low. I just needed emergency services, but I couldn't make it to the door. And they said two options, forced entry. And I thought, well, I like my door. And they said second option is to have a lockbox with a key and then have kind of what realtors have when you do your open house and then have a code and so you can let them know the code. So no problem. They're

Scott Benner 41:34
smart. Hey, the joke earlier about the Ferrari that was that your kids were going to spend the money from the life insurance. Oh, the little stinkers Of course they did this they heard of your past and then come get you. Exactly. It was wonderful. I think this is what she said. I mean, sad.

Melissa 41:58
If you can't laugh at it, you can't laugh at it. You got to be able to take life with a grain of salt sometimes.

Scott Benner 42:03
No kidding. It does. I mean, listen, you've been offered, in my opinion, you've been offered two of the most significant perspectives that a person can have. I mean, the loss of a spouse at a younger age. And then your diagnosis, I think are two things that if you weren't already a person rich with perspective, I would imagine you you leveled up about 1000 times.

Melissa 42:32
I would hope so I think so. I really think as I mentioned earlier that taking moments for yourself doing if you're the meditative type to do some deep breathing or meditation or just revel in those moments of gratitude. The other day, I had my little guy and he brought me a flower. He goes on a walk with my oldest after dinner sometimes, and especially during summer break. And so he brought me back a flower and he said, I love you, Mommy. And so I put that flower in that's on my nightstand. And it's just those little moments. It's the last thing I see before bed. It's the first thing I see in the morning, that keep me I think in a good headspace.

Scott Benner 43:07
Is it possible that without that effort, you could have gone the wrong way?

Melissa 43:12
Oh, 100% 100% Is

Scott Benner 43:16
it? Is it something that you did you feel the draw of it and resist it? Or did you get ahead of the draw? Does that make sense? It's something

Melissa 43:26
that you're faced with, I think when anybody is faced with any difficulty or any hardship in life, it's your choice. There's a everybody faces this, whether it's type one, it's a passing of a family member, it's a loss of a job, but whatever it is, you are faced with a choice, how am I going to handle this, and I was faced with that choice. And instead of picking up something that was going to be detrimental to my health, I laced up my running shoes, I put on my climbing harness, and I just went for it. And so I ran long and I run hard I climb. And I then that's kind of really what keeps me sane. It also helps with blood sugar, a great deal as well.

Scott Benner 44:02
You're getting the double bonus there. You've beaten up absolutely up the road and getting the exercise. Oh,

Melissa 44:08
the best thing today is I didn't have to Bolus for my lunch after my run. So I got to be sort of a non diabetic for one meal. Oh, wow,

Scott Benner 44:16
that's cool. You said something earlier that I want to loop back to oh, that you can run in the morning fasted. I think that's something that you really learn with an algorithm. Because you know, you're not going to be in that situation where your Basal was too heavy overnight, and you wake up and you get low or something like that. If you don't need like, I really don't have a ton of time with this. But you know, when Arden was injecting or even when we were just using pumping, you know without an algorithm of any kind. There are times where you'd be like, well I managed this overnight. I have a nice blood sugar overnight, but you wake up in the morning and then you don't want to eat right away and hours go by If you end up getting low, then with an algorithm taking away basil and with it guessing that in the future you're gonna get low and taking taking away. You really can go. I mean, I don't know how to tell people like Arden didn't eat today. Today's an example she did not eat today until five in the afternoon. That's it. She went to bed really late at night, three, four o'clock in the morning, she got up at noon. And then she wanted to go to lunch with her friend, but her friend wasn't available. So they just she just waited, and then they went to dinner instead. And her blood sugar was super stable the entire day. Oh, I bet yeah, yeah. So no act of insulin on board and runnings not the same as active insulin and running, even if that active insulin is only just like your normal Basal, for example. Absolutely,

Melissa 45:44
the ability to suspend insulin is, is one of the hallmarks of what makes a pump I think, in my opinion, it or at least for me a little bit better than MDI, so that I can make those gameday decisions to go bang out those few miles on my lunch break, because that's the only time I have because I have to get up take the kids here their school work whatnot. So that's the only time and that's my, my sort of me time. And I'm able to fit that in, of course, always have the sugar, but the ability to suspend is something that I think is unique to pumping. Yeah,

Scott Benner 46:18
no, it's one of my favorite. I mean, honestly, I, if people may have heard me say it in, like the Pro Tip series, but being able to start and stop your basil, this is one of the first things that I thought of when we were at a pump class all those years ago for the first time. And because that that feeling of like I put the I put the Bazelon it's in there now. If it's too much or too little, it's too late. Like I already injected, you know, back then it was love Amir for Arden. But that idea, like I remember standing at that pump class and saying to my wife, look, we could like tempt the Basal, like, make it stronger, weaker, we could shut it off. I was like, I think this is like, like, it was like, mind numbing at the moment was like, what that sounds like so much control that we don't have right now. Absolutely.

Melissa 47:07
And it also means that you're not having to ingest extra fuel extra calories if you're on a weight management plan, which is important for a lot of people as well, to stay in that healthy range. I know with running extra weight is extra pressure on your joints. So it's it's definitely something that I'm aware of. And that matters. Yeah,

Scott Benner 47:31
no, it's um, it's astonishing. It's just one of the most important things I can't even say. So what I'm sorry, we're 47 minutes into this, but are we getting to the things you wanted to come on for? Or is there other stuff you want to talk about?

Melissa 47:44
I just am, I just passed my year, my first year. So I'm in year two, I think if there's one thing that I wanted to say is that there's hope this is not a death sentence, you can continue to exercise, you can eat the cupcake that you wanted to eat it, it is not an end of life type of a situation where you have to do this, that and the other, of course, you have to check your blood sugar, you have to maintain good health, but you can live and you can live quite successfully. So it's something that given the current technology today is something that is absolutely doable. You can thrive with this. I've seen it I'm living it and and the listeners can as well. Good for you.

Scott Benner 48:29
I appreciate that message. Honestly, if I can loop back around a little bit, there's this. So there's this thing that happens blesses that people say nice stuff to me. And then if you listen, you know, I get embarrassed, and then I act like an idiot because I'm not good with it. And I say stupid stuff all the time. But there's this one thing, I'm always afraid I'm not giving the right weight to. And it is that Facebook group. It's it's got so much value, but I can't like I can't bring myself to be the one to say it too much. Because I feel like it'll just sound like I'm trying to get people to join my Facebook group. That makes sense. But I wondered if you wouldn't talk a little bit about as it like an adult like a person who's just diagnosed that how was that valuable to you? Yeah, it

Melissa 49:13
was actually a lot more valuable than I was thinking because I was thinking this is probably comprised of a lot of parents, their children, their cute little babies. They're the ones with type one. So maybe this is more parent focused. But when I started becoming more active, there is a ton of adults in there that are just like me that were not diagnosed when they were two. They're diagnosed in their 40s or their 30s or 20s 18. up so there's a there's a lot of support for adults. And then when I ran the LA Marathon this last year, I think I had something like 500 comments saying a great job and almost 2000 thumbs up I mean it was it made me feel so warm and fuzzy and like I had just done something amazing. It the sub chord is there, it's there.

Scott Benner 50:01
I'm glad that I just you know what I mean? Like, it's hard for me to just say, you know, for those of you who wouldn't consider joining a Facebook group, there's

Melissa 50:10
no one to join. Yes, there's, it's

Scott Benner 50:13
there's just a ton of value in it in ways that I mean, you said you didn't expect, I didn't expect. I tried saying it over and over again, I only made the Facebook group because people, people bothered me for it. And, you know, and it was, we needed a group where we can talk about the podcast, and I was like, my first thought was, oh, no, no, no, like, I don't I very much don't want to be involved in that. But then that kind of kept coming, you know, that that pressure kept coming? And I thought, oh, will it hurt? I'll open it up. And I don't know if anybody like, like, now knows this. But I started that Facebook group, I had one rule. And the rule was, it said, Don't be an oral closed this whole thing. I don't need this problem. It was something,

Melissa 50:53
something that's funny. That's what I tell my kids. That's our family motto.

Scott Benner 50:58
You know, my wife and I, when we had kids, we, we really did settle on that as our goal. Like, we just don't want to raise kids who like when they're out and about when they leave a social setting, that they're the ones that people go. Like, exactly, yeah, that was really, that was really the only like, marching orders we gave ourselves and that we were pretty young in the beginning, although you were in college still. So I'm pretty young. So

Melissa 51:23
that's like the one thing that you learned in kindergarten that that should stick with you forever. Yeah,

Scott Benner 51:28
no kidding. Like, just anyway, that's that. If you've if you've ever thought Scott's kids sound like they came out, okay, that was really our marching orders. You're like, we just don't want that to be like, we'd make the joke about like, keeping Arden off the pole, I think because Chris rocks stand up was very popular around that time. And I think that was the joke that really, like right rang out of his standup at the time. But I mean, we really like between the two of us. That's what we said, like, just want them to be nice people. And we'll see good humans. Yeah, yeah. And the rest should work. And so I started the Facebook group, not wanting to be the person running a Facebook group. And now the joke's on me, of course, because there's, there's over 40,000 people in there, and it's like, part of my job, you know, like, a reasonable amount of my day goes to making sure that that place is somewhere you can go and have a reasonable conversation, you know, get other people's opinions without being treated poorly, and, and hopefully come out of it enrich somehow, you know, and that's

Melissa 52:25
exactly what it was. for me. That's exactly what it was. for me. I can't say enough good things about the podcast or the group, the amount of support that is needed, especially in that first year can be astronomical, especially if you don't know anyone, or you are just you're blindsided by this and all of a sudden, you're on Bolus and Basal insulin overnight, like I was, you have so many questions, and you don't know where to turn. You don't know what is credible information, what is not. You need real time feedback from people. And because we're all located in different areas of really the globe, you're going to have a question answered in minutes. It's

Scott Benner 53:04
fascinating, isn't it, like, in the middle of the night, it just like Europe just takes over for the Facebook, or Australia or New Zealand, you know, people just pop in and I that never forget the first time that happened to me that somebody was messaging me from like a South Pacific Island. And, like, it was like three in the morning. And I picked my phone up. And I'm like, You know how some people message in long messages. And some people I say, I can't Oh, if I say this, it's gonna make somebody upset that I correspond with everyday. But some people text like 14 year old girls, like one thought at a time they send sense. And that makes sense or not. But this person was doing that. And so it was ding, ding. And I just I got on, I was like, Hey, this is so nice. But it's like 330 in the morning, I need you to like, just send your whole thought, please. And I'll answer you tomorrow. My wife's like, put your phone on Do Not Disturb. I'm like I can't because Arden has diabetes at all. So you know, anyway, that's a big sales pitch for it. It's probably what it sounds like to some people. But I swear it's the value. I've gotten value out of it. Like, like even some of the things that you've heard on the podcast like ideas about a series or like sometimes I see people talking and I think that we haven't covered that yet. Or that obviously needs to be drilled down on more because look how many people bring this up, and it's just been really valuable. So anyway,

Melissa 54:32
absolutely. Especially just for plain old garden variety, encouragement when you're having a terrible day, or you've been on that roller coaster. You know that you're not alone. And I think that's the main thing that helped me is I I wasn't alone when I felt so alone.

Scott Benner 54:47
Okay, hey, so unfairly. I know what you look like because of all this. And earlier you said having babies was hard on your body, but let's be honest, you have the stomach of an 18 year old girl at this So what did you mean by that? Exactly?

Melissa 55:03
I had. My third was I have big babies. They my third was 10 and a half pounds. So my smallest one, I think was eight, three, and he was a month early. So it just, it was rough. And then, of course, they never sleep. And I nursed them for the first year. So of course, you're up every two hours. So I don't remember it. There's a gap of about 10 years that I it's just, it's all dark. I really don't remember the 10 years of my life.

Scott Benner 55:34
Just making babies and getting them bigger. Yeah, that's right. Yeah, it is. It is really true, isn't it that that time is so like, I don't know, fraught with things to do and decisions to make? And I don't know, the only thing that even compares to it is when they get older, and they have to start going places. And you're you've just basically turned into an Uber driver for children.

Melissa 55:58
Right? Yeah, that's me right now. Yeah, I

Scott Benner 56:01
was gonna say you, you've probably hold on to your kids play sports.

Melissa 56:04
I have a couple that do basketball. My son did play basketball. My other son, I have two girls and three boys played baseball. So they've sort of kind of round robin all the different sports tennis. Wow,

Scott Benner 56:18
geez, it's a lot. It's just a lot of running and being places and how do you make decisions about where you park yourself and stay and where you're like, drop and go and come back?

Melissa 56:28
Well, it has become so much easier now that I have other drivers in the house. And I still have all five living with me. So I offer them free college tuition, if they stay home, and they can live here for free, I will pay for their college. And so it's really the only way that I'm going to be able to pay for five kids and college. So they do that they live at home. So we really do a cost reduction that way. And they help out and my girls help out a whole lot with driving and picking up groceries so on and so forth. So it does get easier. In some ways. You just worry a little bit more because they're out doing God knows what sometimes

Scott Benner 57:06
to try not to figure out what they're doing. I do my only like proviso is I'm I'm always like, if you want a cell phone and you want me to pay for it, I get to know where the phone is. Right? That's one of my things. I just like I get it, I get to know where your phone is. I'm not tracking you. I'm not sitting here watching you constantly or anything like that. But if I get worried, I want to know where your money comes in handy. A little bit I've talked about before, like, like I've seen art and below while she's a college. But But before I've stepped in to say hey, are you okay? I'll look at where she's at. And if she's in the dining hall, for example, I go, okay, she's taking care of this. And then that saves her from one of me pinging her about it, which I think is a big deal. But I liked that also. Yeah, I may or may not have once watched my son on a map drive to work one day. I really missed him one morning. And I picked up my phone and I realized oh Cole must be on his way to work. I have like a widget on my phone like a find my widget. And it seems to randomly show you one person that the other in on the widget screen and it was him and I touched it and it opened up. And his like the picture I use for him in my contacts is him like he's like four years old at a baseball game like running like running to first base. So I watched little four year old him run through Atlanta for like four or five minutes. And I thought I'll never ever tell him I did this.

Melissa 58:39
Well, Your secret's safe with me and 12 million other listeners.

Scott Benner 58:43
Everybody knows what I did that one morning. And meanwhile, there's no way these kids are ever listening. i My assumption is the only way my kids ever listen to this podcast is if I if I die and they get sad. They're like, oh, I want to hear my dad's voice. Because Oh, Melissa, Let's bomb each other out again. Did you keep voicemails?

Melissa 59:01
Yes. Oh, yes. And videos and all of that. Oh, yeah. You have to have that for the for the kids. So

Scott Benner 59:07
once my mom was diagnosed, I stopped deleting her voicemails. And I would even is more but I think but sometimes she'd leave me a voicemail, but I knew I was going to call her right back. So I wouldn't listen to the voicemail. So I still have some I've never heard before. And I do go listen to them once in a while. Yeah,

Melissa 59:32
I don't think there's any wrong way to grieve. Yeah, there's no timeline. There's no way there's no map. It's just you go with sort of your your heart and your heart will always lead you toward healing. Yeah,

Scott Benner 59:48
I get blindsided once in a while. But I feel a little grateful to be the age I am that my mom lived as long as she did too. Because it does feel I mean the thing that I mean, obviously, it's not a spouse but I at least had the feeling that she lived a long life, which is something you don't get to think. But anyway, I anyway, once in a while I opened up a voicemail I've never heard before, and I listened to it. And it's I don't know, it's comforting for some reason. Oh, for sure. Absolutely. Christ now I'm gonna make myself cry. And then I earlier I said, If I don't curse, there won't be any problems. So now I cursed the basically cost me money to curse today, because now I have to send this out for editing. And the guy who's editing it is hearing this right now and go and chit Ching. Right, Rob? Sorry. If

Melissa 1:00:44
he wants to talk about my pole dancing class, it needs to be edited out either.

Scott Benner 1:00:48
Well, wait a minute. We're at the end, Melissa.

Melissa 1:00:53
What's the word on that? Don't

Scott Benner 1:00:54
stop now. Okay, I'm gonna circle back around to one of my earlier questions. Do you think you'll like bait again, to

Melissa 1:01:03
be determined right now it is just really being here for my kids. And it's managing my diabetes and making sure that I can hit that LA with a better mileage time than I did last year. So that's an obviously I want to just do great work too, especially for the disabled vets that I that I represent.

Scott Benner 1:01:24
The disabled vets thing. Is that something you do through you're like, do I don't know how to ask this question. Do you work for a company? Or do you?

Melissa 1:01:30
Are you a nonprofit? nonprofit law firm? Wow.

Scott Benner 1:01:34
Oh, that's you've been doing nonprofit your whole life.

Melissa 1:01:37
I have here in there on a volunteer basis. Okay.

Scott Benner 1:01:41
That's excellent. So you work for a private company where you do something for yourself, and then you do the work for the nonprofit as well. Yes. That's nice. That's a lovely use of your time.

Melissa 1:01:51
It feels fantastic. It's there's just when they look at you, and they say thank you, it means the world. Yeah.

Scott Benner 1:01:58
I never thought. I guess I didn't wonder about it when I was younger. But helping people is really a large part of my life. Which I mean, I guess if people are listening, they think yeah, obviously. But it wasn't that obvious to me. So I didn't know. Like, I started the blog. To try to chase I started my blog because I tried to raise money for the JDRF. And it didn't go well. And the internet was just becoming a thing. Like, I know that sounds weird. And I thought I could use this blogging thing, maybe to tell more people about diabetes. And again, I know that sounds ridiculous. But in 90, munchies, when was it? 2006. Blogs weren't even a thing people exactly knew what they were like, it was all kind of new. And then that worked. And then then there's that drive for like, Oh, what do I put on here? Like, if I'm going to keep doing it, I have to keep doing things. And I went the route of like sharing very, like raw, like feelings. And after doing that for a while, I thought, Well, that's nice. But I mean, I've got people's attention now. Like I should help them. And that's where that all started. Because I was not a person running around helping people prior to that. But it's been one of the most valuable parts of my adult life. And certainly,

Melissa 1:03:17
and it kind of gets you out of your own life. It allows you to connect with other people in a different way that you wouldn't ordinarily connect that connection so important just to being a human were meant for connection. Oh,

Scott Benner 1:03:32
million percent. I'm sorry, I cut you off. I didn't mean to. Oh,

Melissa 1:03:37
yeah. And so that's it. It allows the feelings of the good feelings, the good vibes to come coursing through. So you just it just everybody wins. And

Scott Benner 1:03:47
if you're like me, and you're like a resolution oriented mind, like, like me, you can hear it earlier, like such a ridiculous thing. My mom got cancer, and I was like, there's a way around this. I can't fix enough problems to properly make whatever's wrong with me feel better. So being able to help more people, actually is more helpful for me.

Melissa 1:04:13
Like certainly, yeah, yeah, I've tried great way to help yourself is to help others. Yeah, yeah, I get that. I

Scott Benner 1:04:19
used to say that the podcast helps me more than it helps you. You just don't realize it. So right. Yeah, I love watching. Like, I can't tell you it seems. I don't know. I'm not boasting, but I probably hear from a dozen people a day. You know, in different different ways. Instagram, Facebook, email. Some people who I've made the mistake in the past of texting. If any of you heard that, it's fine. We're all good. Don't worry about it. But a lot of people will text me. I used to be for the podcast. I used to have conversations like like, the podcast is probably just the recording of conversations I used to have with people probably Lily about diabetes. And so I hear from people a lot of different ways over and over again every day. And every time I see them have like a resolution or like an aha moment or something happens for them where their life gets better or easier or healthier or something like that. There's like a small part of me. That just feels like oh, I helped with that. Oh, absolutely. So it helps me a lot. I didn't know this. Absolutely. Gonna go like this when we got on tonight, but thank you. Anyway, is there anything we haven't talked about that we should have?

Melissa 1:05:38
I don't think so. I think we covered quite a bit.

Scott Benner 1:05:41
We did. Okay.

Melissa 1:05:42
I think we did fantastic. Why

Scott Benner 1:05:44
did we move this so many times? Was it for work? I can't even remember for you. It was my work. Yeah. I'm gonna put a couple of nighttimes on the calendar next year. This is I found this nice after I relaxed

Melissa 1:05:56
I certainly hope there's no storms next time. No, no,

Scott Benner 1:06:00
it actually it was crazy. It was supposed to storm the entire time you and I were on but it just it came a little earlier was really violent. And it stopped just as you and I were getting started so

Melissa 1:06:09
I was pretty excited when God's are favoring tonight. Finally,

Scott Benner 1:06:13
finally. Thank you. Alright, well, let's I appreciate you taking the time and doing this. Oh, thank you. Of course. Yeah. What can you hold for me for a minute? Yep, great.

A huge thanks to touched by type one for sponsoring this episode of The Juicebox Podcast. Check them out on their website touched by type one.org or on Facebook and Instagram. You can use the same continuous glucose monitor that Arden uses. All you have to do is go to dexcom.com/juicebox and get started today. That's right, the Dexcom g7 is sponsoring this episode of The Juicebox Podcast. The episode you just heard was professionally edited by wrong way recording. Wrong way recording.com.

If you are a loved one has been diagnosed with type one diabetes. The bold beginnings series from the Juicebox Podcast is a terrific place to begin listening. In this series, Jenny Smith and I will go over the questions most often asked at the beginning of type one. Jenny is a certified diabetes care and education specialist who is also a registered and licensed dietitian and Jenny has had type one diabetes for 35 years. My name is Scott Benner and I am the father of a child who has type one diabetes. Our daughter Arden was diagnosed in 2006 at the age of two. I believe that at the core of diabetes management, understanding how insulin works, and how food and other variables impact your system is of the utmost importance. The bowl beginning series will lead you down the path of understanding. This series is made up of 24 episodes. And it begins that episode 698 In your podcast, or audio player. I'll list those episodes at the end of this to listen, you can go to juicebox podcast.com. Go up to the menu at the top and choose bold beginnings. Or go into any audio app like Apple podcasts, or Spotify. And then find the episodes that correspond with the series. Those lists again are at Juicebox Podcast up in the menu or if you're in the private Facebook group. In the featured tab. The private Facebook group has over 40,000 members. There are conversations happening right now and 24 hours a day that you'd be incredibly interested in. So don't wait. So don't wait. Check out the bold beginning series today and get started on your journey. Episode 698 defines the bold beginning series 702, honeymooning 706 adult diagnosis 711 and 712 go over diabetes terminologies in Episode 715 We talked about fear of insulin in 719 the 1515 rule episode 723 long acting insulin 727 target range 731 food choices 735 Pre-Bolus 739 carbs 743 stacking 747 flexibility in Episode 751 We discussed school in Episode 755 Exercise 759 guilt, fears hope and expectations. In episode 763 of the bold beginning series. We talk about community 772 journaling 776 technology and medical supplies. Episode Seven at treating low blood blue ghosts, Episode 784 dealing with insurance 788 talking to your family and episode 805 illness and ketone management. Check it out, it will change your life. 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.