#1412 Life Coach: Anonymous Female

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A woman in her 50s (anonymous T1D mom) seeks advice from Scott on leaving a psychologically abusive relationship.

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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
Friends, we're all back together for the next episode of The Juicebox Podcast. Welcome.

I'm hoping that this episode becomes a series. I have a couple recorded already, but this is my first one. I asked people to reach out if they wanted a life coach. And to be perfectly honest with you, I was being sort of light hearted about it, but then I got a real request. Today's episode is with a woman in her 50s who wishes to remain anonymous. She knows about me because she has a child with type one diabetes, but this episode is not about that at all. This is about being in a psychologically abusive relationship that she liked to get out of, and she was looking for advice. The reasons that she came to me are revealed within if you're looking for a pretend life coach who has a podcast, reach out to me through my website. It doesn't have to be about a serious matter. It could be about anything. 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. When you place your first order for ag one with my link, you'll get five free travel packs and a free year supply of vitamin D drink. Ag one.com/juice, box. You

this episode of The Juicebox Podcast is sponsored by the contour next gen blood glucose meter. Learn more and get started today at contour next.com/juice box. Make better sleep your New Year's resolution with cozy Earth best selling bedding, because quality sleep is essential for managing your health. Learn more at cozy earth.com and don't forget to use the offer code juice box at checkout to save 40% off of your entire order. Today's guest is going to remain anonymous, so we're not going to use any kind of names, and we're going to be pretty vague about other things that could be identifying. But why don't you tell me a little bit about yourself as much as you're comfortable, and then we'll get into your

Anonymous Female Speaker 2:14
story. Okay, I am a longtime podcast listener, Juicebox Podcast. I'm the mother of a type one, and that's how I found the podcast. And when Scott proposed this new series where he was going to coach us, I thought this would be a great opportunity for me to get some wisdom from someone I respect, and to bring some attention to the kind of situation I'm in, which is, to be more specific, I am In a long term relationship that has become emotionally and psychologically abusive, and I I need to get out of this situation and heal.

Scott Benner 3:12
Okay, let's see what we can figure out. So we're going to keep you just so people know your your voice is going to be changed, like when you listen back to this, you won't recognize it too. So if anybody is listening right now and they think, Oh, I know who this is, you don't you just know what your voice sounds like when it's changed to sound like something else. Let's figure out a little bit about yourself so you're married, yeah, okay, for a long time, like more than a decade, more than two decades,

Anonymous Female Speaker 3:41
more than two decades we've been together more than three decades, like 35 years.

Scott Benner 3:47
Wow. Okay, and you have one child with diabetes? Do you have other children? You don't have to tell me how many, but do you have other children as well? No, no one child. Okay, give me a little like, like flavor. I guess, of these 30 years, you're having problems now, did they start immediately, or are they more recent? How would you describe your relationship up until now?

Anonymous Female Speaker 4:11
I would say that the situation has escalated in the last three to four years, and we can get into what's happened since that has led to this. But as I'm going through the process of reflecting back and wondering to myself, why didn't I see these things, I can recall what should have been red flags, but at the time, I was young and naive.

Scott Benner 4:44
What do you think some of them are like? Looking back, I would

Anonymous Female Speaker 4:48
categorize them as little points of exerting control. Particular incident that comes to mind when we first started dating, we were. Were at the supermarket, grocery shopping. We we didn't live together. At that time. I was an independent person. We met in college. I was independent. He was independent. We happened to go grocery shopping together. So I was gonna buy my own groceries, and he would buy his own groceries. That was the way I'd always done it, the way I assumed. But for some reason, he insisted on buying my groceries, I guess too, at the time it, it seemed like an act of kindness, but I remember he started taking the groceries out of my basket and putting it into his and I took them back. And I kind of laughed about it, like it was a light moment. And I just remember him taking them back. Then I take them back. I thought it was kind of funny, but then he said, God, you're annoying. And for some reason, that particular moment has stuck with me all these years. And I know that there were issues from the beginning, but I was just too I love to see. How did

Scott Benner 6:18
that strike you then like the god, you're annoying. Did you think it was playful, like, I'm trying to help you and you won't let me help you? Or did you see it as more like attacking of yourself at that point? And if so, then I guess, start there. Like, how did you see it in the moment? Do you recall it

Unknown Speaker 6:40
was more the latter. The tone of voice, the facial expression, which stick in my mind, were not playful.

Scott Benner 6:50
Did you see him treat other people that way? No,

Anonymous Female Speaker 6:52
you know, as we got closer to the present, that's one of the things I came to understand, is that behind closed doors was a different person than when we're out and about or when

Scott Benner 7:07
other people are around. How was he in front of his family?

Anonymous Female Speaker 7:13
Oh, caring, yeah, caring, protective, everything you would hope for and boyfriend, eventually, husband, definitely and

Scott Benner 7:25
towards his parents and his siblings, if he had any same No, oh, how

Anonymous Female Speaker 7:31
does he treat them? Yeah, I would say that there are times when he sort of lashes out at them or criticizes some of them, not all of them. Oh, ones whose life choices he disapproves of.

Scott Benner 7:49
Okay, so he's judgmental about the people he disagrees with in his family. Very gotcha, and that has been very consistent the entire time,

Anonymous Female Speaker 7:59
yes, from when we were dating till now. Yeah,

Scott Benner 8:03
and had that bothered you when you were younger? Or did you not kind of rub up against it back then,

Anonymous Female Speaker 8:10
I took his word for it, because I didn't know them. I hadn't met them or been around them much. I mean, when I finally met them, it was just sort of limited in big family gatherings. So it's not like I had time to have intimate conversations and really get to know them and and at the time we we lived kind of far away, so family gathering gatherings were few and far between, so I really didn't get to know them on my own. I depended on what he was telling me, and I trusted his judgment at that time. Okay,

Scott Benner 8:51
did you find yourself like, getting on his team, like, if he was harsh on people? Did you find yourself being like, yeah, they do suck. Or, how did you handle that if you didn't like get on board?

Anonymous Female Speaker 9:03
I'm embarrassed to say that. Yes, I went along with what he was saying, Not ever when we were around those people, but when we were in our apartment or wherever. And he made some kind of comment, I feel like, oh, gosh, that's that's not right, that's not good.

Scott Benner 9:27
So it starts off like that. That's kind of the entry. And how long are you together before you get married? A while, a while, like five years, more, less, more, more than five years. Okay? And what's the impetus behind that? I guess, like, did you want to get married? And he didn't. Vice versa. Did nobody ever bring it up, I

Anonymous Female Speaker 9:49
wanted to get married. He never said, No, I don't want to get married. But it was, I don't even remember the exact excuses, but. I was just like being strung along. I mean, I made very clear that I wanted to get married, but I don't know I stayed. I thought I was in love with a great person. I assume that the hiccups and ups and downs were natural part of any relationship. And the thing to do when you love someone is you love all of them, The Rose and the thorns and All

Scott Benner 10:32
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Anonymous Female Speaker 12:24
No, no. And I would say to parents out there who are thinking that that's a protective mechanism to not let your kids date when they're under your roof, it's not wise give them an opportunity to learn about themselves in a relationship, so that they can recognize when someone else is valuing them for who they are and not just what they bring to the table

Scott Benner 12:54
when he stretches out the courtship process while you've said, like, I'd like to get married, and you're getting older, and I mean If you met in college, and you mean you were, were you in your 20s, so when you got married, or were you into your 30s and to my 30s? Okay, so he strung this out for a long time. And is there a moment during that where you think, Oh, God, I did the wrong thing, but like, now I'm like, pot committed this is it like? What am I going to do?

Anonymous Female Speaker 13:22
I did feel stuck. I felt like I didn't know how to start over. And at that time, we were living somewhere where I had no family, so I didn't know where to go. It comes back to having no experience on my own, and even though I had a pretty important job and I felt confident at work, maybe importance the wrong word, but I had a job with a lot of responsibility, and I felt confident, and I knew my bosses believed in me and I was being promoted somehow at home, my mindset was just frozen and different, like

Scott Benner 14:10
you were a teenager. Still, yes, yeah. Do you think in that period of time he was aware of the the control aspects that he had like, do you think he was not marrying you on purpose to keep you in flux? Do you think did he move you away from family, or did that just happen?

Anonymous Female Speaker 14:29
He didn't say, you know, we're going to move now. It's never that explicit. It's it's more subtle, and that's one of the things that's one of the reasons I'm doing this interview, is it's not so easily recognizable as more over types of control, where it's like, you're gonna do this or else, it's more subtle, like, oh yeah. Want to pursue my career over here, and you can come along, you know that kind of thing,

Scott Benner 15:07
yeah. Can I ask, like, I'm gonna play devil's advocate here for a minute, like, do you think that if you were in a different part of your life or a different person, that you would have resisted it because you've had a long time to think about this, right? Like, you've been thinking about this forever? Am I right? Like, the last five Yeah, for a long time. Yeah, right. So like you've been going over this in your mind and trying to figure out where you went wrong, and yeah, it has there been a point in time where you've ever thought to yourself, like, I have to take responsibility here, like I could have done something and I didn't. Or do you see, I'm not saying that you should have I'm asking you, like, what your assessment of it is, Do

Anonymous Female Speaker 15:44
I have any blame or culpability? Of course, you know I, I was an adult, but I was a very inexperienced adult in matters of the heart, and I didn't feel like I could speak to anybody about this or learn about what I was going through. Nowadays, there's so much information out there, and that is, that's how I got to this point. Is social media, somehow those algorithms are so smart. Started putting little things in my feed about these kinds of relationships, and I watch one, and then all of a sudden, 50% my feed is like this. So I start watching more, learning more, and like this haze or cloud, just like lifts, because I finally have the vocabulary and the understanding to step out of the situation emotion, step out emotionally and look at it objectively, and see What has been happening when you're in deep, emotionally deep, I don't know, like, it's like the other part of your brain, the thinking part, the logic part, gets impaired. Yeah.

Scott Benner 17:09
Have you heard people say my algorithm figured out I was gay before I knew? Yeah, yeah, that kind of stuff, right? Yeah, yeah. So your algorithm figured out that you weren't happy or that you were being controlled by a partner or something like that, and started feeding you more stuff. You started seeing people speak openly the way you're speaking about it now, and you you're like, oh god, that's me. Like, I recognize myself in these people's stories. Absolutely, yeah. Were you ever afraid that that wasn't you, but it offered an explanation, so you would just go with it. How do you fact check that to make sure you're you know, I'm saying, Does that make sense?

Anonymous Female Speaker 17:53
It just makes sense. This the information I was seeing on social media. Part of it, yes, part of it was individuals like me speaking about their personal experiences, but the greater majority of it was PhD psychologists who have clients in this kind of situation, who have a lot of experience, who've written books about it, who've researched it. They have YouTube channels and books and practices where they specialize. This is the niche. And when those people are talking about certain things and defining certain things, describing experiences, and it's all clicking in my head, like, wow, yeah, this person could I have no idea who this is. They have no idea who I am, but they could be describing my life right now,

Scott Benner 18:45
right? Do you think your husband? Does he know this stuff about himself? Like, no, consciously, he's not aware of it. Like, if you turn to him today and said, Hey, I'm leaving. Here's the reasons why he'd be blindsided by that. Yes, and so have you brought this up to him in the past, and he's ignored it, or have you never said anything?

Anonymous Female Speaker 19:07
We have had discussions, arguments, whatever you want to call it, about other things, like more specific thing, whereas, like this, I call, like a higher level meta kind of thing. And it's clear to me, and by the way, our our t1 also has similar experiences,

Scott Benner 19:31
experiences that they've brought to you, or experiences that you've witnessed, and you've said, Oh, that happens to me with their father too.

Anonymous Female Speaker 19:38
Both, both, so we've all been in the house when something happens between them, and I'm hearing it with my own ears, or the kid is out with my husband, and the kid calls me like this, and this is happening, and I don't know. How to Deal with it. And this is really frustrating. He never listens. They used to say that all the time. He never listens. And that is also my experience from in your previous question, Have I talked about this before with him? I've tried having adult, mature, calm discussions. I don't think there's a lot of capacity to receive criticism and to self reflect. Why do you think? Why do I think? Yeah,

Scott Benner 20:30
I mean, you've, you've had to have diagnosed them and and dissected him over the years, like, Why do you think he can't?

Anonymous Female Speaker 20:37
I actually think he might be on the spectrum, and how they say that, I think that's part of the reason I have kind of stuck around, because I would make excuses for just the general behavior, the general lack of I think it's a lack of empathy and understanding, ability to self reflect. I'm obviously, I'm nowhere, anywhere, trained in anything like that.

Scott Benner 21:08
Well, we have that in common, because I am completely untrained in this. I want to make this is probably a good time to point this out. I have no certificate, I have no training, I have no education. I had this idea the other day, somebody was talking to me and said, you know, you could be a life coach. And I laughed about it, because, I mean, and no offense to life coaches, but it doesn't seem like a real thing to me. I know it is, like, don't get me wrong, like, I understand that there are people who need help, like, you know, formulating direction, and I understand that, like, I'm not, I'm not teasing anybody. It just seems like one of those things, like, I'm a little older, you know what I mean? It feels a little, a little hocus pocus E, but I thought they'd be fun conversations if people wanted to come on and, you know, people who were connected with diabetes and talk about other ideas. And I could whip out some of my, you know, 1970s ideas that I think are sometimes valuable. And you reached out. A number of people actually reached out. It's awesome, but, yeah, I just want to point out I have no training. I should not be doing this. This is not, uh, this is not legally binding. Can I take a right turn for just one second before we get back to it? Yeah, what has happened between you and I through this, this medium, that this actually seemed like a good idea to you. Well, I

Anonymous Female Speaker 22:23
think that a coach, whatever training they have, they have, but it comes down to being a good listener, a thoughtful person who has seen a lot of life and who can communicate to the person they're coaching ideas in a very digestible manner. And the Juicebox Podcast is, is that to perfection?

Scott Benner 22:52
Thank you. I'm gonna say I'm a life coach. I'm gonna have a T shirt made. Never mind you've talked me into it. You're sweet. I really appreciate you saying that I wanted to understand like so that happened to you or for you from me, through diabetes conversations,

Anonymous Female Speaker 23:10
absolutely, you know, a diagnosis. I didn't know where to turn for information at the very start, we were in the ICU, but I knew that I loved listening to podcasts, that I was the longtime podcast listener, and I knew there was a podcast about every subject on Earth. So I just opened my app and there's like, there's got to be a diabetes podcast. Found the Juicebox Podcast, and I probably tried listening to one or two before, but upon listening, it's it's just immediately apparent that you have a gift for talking with people and using their stories to educate this is gonna come off like crazy when I say this, but please, I'm a person of faith, and it's the same technique that Jesus used with parables. Certain things are just more digestible and more memorable when you hear them through the art of storytelling, whether your storytelling in a format like This American Life podcast where you storytelling in a Q A interview format, by knowing how to bring out what questions to ask to bring out the person's story. And I knew that I could listen to the Juicebox Podcast over and over and not get tired of it and learn learn so much from it that was immediately apparent because I listened to other podcasts when they're very pedantic, just like instructional, it's so boring and nothing sticks.

Scott Benner 24:53
Yeah, I agree with that part. I can't I mean, I don't understand when people put content out like that. It's just like. Uh, check boxes. Go forward. No personality. I mean, listen, you said a lot of words there. What I just heard, basically, was Jesus like, so I'm gonna go with that. Um, I'm gonna change my life. Coach, first of all that you're, you're lovely. I appreciate that and, and I am kidding for anybody who would imagine that I'm not, I think you're right. I think that I don't know why it occurs to me this way, right? I have no idea. I don't I don't know how I became who I am, or why I respond the way I do, or think the things I think or say the things I say. But to listen to you thoughtfully break it apart. It's so funny, because earlier you said my social media fed me, you know, psychologist talking about my situation, and I thought, Oh, they're describing me. And when you described what makes good storytelling, I thought, oh, that person is describing me, but I never would describe myself that way. It's interesting, isn't it? Like, if you asked me, like, you've, you've listened for a while, so, you know, like, if you ask me what the podcast is, I'm the least articulate about what it is, because I don't, I'm just doing the thing that occurs to me to do. But then when you described it, I was like, Oh, I do that, but not on purpose. Maybe that's why it works. I don't know. Anyway, that's that is really nice of you. I didn't I didn't expect all that, but I'm definitely going to take it and say thank you. I asked you if you thought he was cognizant of who he was, because you do not want to be in a situation where you spring this on him, because it's going to turn into anger, because you're going to be this person with very reasonable, measured, time, honored, you know, experiences, and you're going to say, I don't want to do this anymore. I'm going to stop doing this now, and what you're going to get back is anger. Then the way you're being treated unfairly is just going to shift, like you're going to trade the controlling part for the anger part. I don't want that for you, but I don't know if there's a way to avoid that or not. And it sounds like you've tried to explain a number of times what your problems are, and he doesn't seem receptive. Doesn't matter, by the way, if he's on the spectrum or not, like, whatever it is, he's he's unreceptive to your Hey, listen, this is happening. Explanations. I don't want this to happen. We can't do this. You can't treat the kid this way, you know, etc. You're in a bad spot, like, for sure. Can I ask you, do you have love left?

Anonymous Female Speaker 27:38
Love, not the way you're probably thinking of it. When you ask that question, I try to, and this is one of my problems, is I try to find the good in people. I even, even in this situation, for example, he, he's always been a good provider. We don't live in any or fiance or anything, but I always have had a roof over my head. Food on the table. Kids always been taken care of, so have no complaints.

Scott Benner 28:12
Are you going to be okay trading one sadness for a different one? I think you can expect that by giving away your problem, you're going to be happy, but I think that what I see most people do is they give away their problem and they trade it for a different problem. And I'm not saying you should stay because the next thing is not going to be fun either, but I do think it's worth being aware that in the interim, at least, this is not going to be fun like and it might be a number of years of not fun, you know, lawyers and arguments and splitting the kid and one person having control the diabetes on the kid one time, and the other one the next time. And, you know, the first time you see a blood sugar that's crazy, and you think, Oh, I can't call or text because the lawyer says I'm not allowed to, or whatever it's going to end up being. It's tough because this isn't fixable. You don't think this is fixable, right?

Anonymous Female Speaker 29:09
No, right. No, I don't, but I do want to make you aware of two other important things. So one is the kid is a legal adult, now off at college. Okay, so thank you Juicebox. Thank you loop community. Kid is doing great at college. Awesome. What led to at the beginning of this conversation, I had mentioned that things had escalated in the last few years, so the situation which has also kept me here is that few years ago, I was diagnosed with cancer.

Scott Benner 29:50
Oh, my God, I didn't know

Anonymous Female Speaker 29:52
okay, and the treatment kept me alive. Thank God. But. The side effects were somewhat debilitating. I am officially disabled, and for me, what that looks like is constant fatigue. I need I need helpers to help me with the activities of daily living. So showering, changing my clothes, I can feed myself, but like preparing meals, things like that, are a little harder. And I'm not only dependent financially, I'm very dependent, and that has kept me here, and

Scott Benner 30:34
he's helping you with those things, or he's paying for services

Anonymous Female Speaker 30:38
he's paying, and I am grateful for that. He's made clear that this is all too much, which I absolutely acknowledge being having your spouse severely ill, and then going from an active person who used to take care of the household, the groceries, the laundry, driving the kid around, if someone who went from that to being bedridden for quite some time. I can walk now, but not far I don't drive. So I need people to help me. He's made very clear that that's not his role, actually helping me with day to day things I'm not not for him. So

Scott Benner 31:32
you're not having a lot of contact. Then none. Sorry. When did you stop having sex? How long ago? I

Anonymous Female Speaker 31:40
can't remember a decade. Probably

Scott Benner 31:45
Gotcha. So you're not even like good roommates, like you're not even he's not even like, Hey, let me get that dish for your roommates so you sleep in the same room. Still, no, no, functionally. Did that happen when you got sick and you came back? Or had it happened before that, even before before that. Do you think he cheats? I don't know if you call it cheating in this situation, but do you think he's got like a relationship outside of your marriage,

Anonymous Female Speaker 32:10
not that I'm aware of, and you know, I would say it's not likely i He, to me, is like a rule follower who wants very much to be perceived as the good guy. No people can always surprise you. So if that's what's happening, that's what's happening. I don't have any evidence, and I don't I don't think it's in nature, but I would never say never to anybody if

Scott Benner 32:42
that happened, would you care? I'm so interested if you'd be hurt by it, or if you if it would just seem like it's Tuesday and the newspaper game. I

Anonymous Female Speaker 32:53
don't miss intimacy with Him, actually. Let's not call it intimacy. Let's just call it sex. Don't miss it. It was okay. I'm trying to be kind here. Would

Scott Benner 33:06
you be hurt by it, though, like but would it feel like a betrayal or No, no,

Anonymous Female Speaker 33:11
you know what feels like the greater betrayal is, is to get sick and then feel abandoned.

Scott Benner 33:19
So you guys had split your lives up pretty much before this, but then your illness comes, and it turns things more stark, like things are getting said out loud now that we were just agreeing were happening prior to that. Yes, things

Anonymous Female Speaker 33:34
are definitely getting said out loud there. Let's see, do I describe this without details. Certain things are such the details are so particular, they would be identifying. I like my bedroom a certain way. It's, it's, it's very within normal people. Nothing crazy. It's just a bedroom. The accusation was that this thing that I'm doing to my room is harming the property. Okay, you just have to trust me when I say it's like, totally normal. Okay, everybody does it. I am actually friends with the people who used to live here, so I call them up like, I haven't talked in a while, like, this crazy question for you, I'm in the bedroom that they were in. Did you guys ever do this in in the room? Like, do this to the room, and they're like, Yeah, of course, everybody does that. And I said, Well, did it ever hurt anything in the house to do like, what if they thought it was crazy? Because it is totally crazy. So that night, there was just this big I'll call it an argument. But. It was really one sided, because at that point I stopped being reactive. I realized that when I tried to reason, it just escalated. So I learned that not reacting would at least de escalate, but the things that were being said to me were like, You need to leave. You're damaging the house. I make the rules in this house. This is him saying that kind of stuff. You're

Scott Benner 35:31
making reasonable requests about stuff, and you're being told that it's not your decision. You can't do it, and moreover, it's not okay, because you're ruining the resale value of the home. Yeah, which doesn't appear to be true, as far as you can tell.

Anonymous Female Speaker 35:47
No, yeah. And then other other things are okay. So I mentioned that I'm kind of limited in mobility, so I really don't go anywhere. I can't unless somebody takes me and he doesn't take me anywhere. So I rely on my helpers, my paid helpers, and friends. So I'm pretty isolated, and I know that's not healthy, so I I actively accept when people text me and they're like, Hey, can we come over to see you, please? I'm not talking about having a party and play like one friend. Come over we chat for half an hour, something like that. There have been complaints that this has become like a hotel, like people, complaints about people coming in and out of that house and Google and there's no privacy, and like the day after Thanksgiving, two of my friends dropped off food, like home cooked food, which is nice, because mostly I eat processed food, because I Order from, I ordered whatever frozen food from grocery store gets delivered, and because that's what I can handle, right? I can't I can't cook anymore. So my friends, two friends, separately, they stop by and drop off the food. So they didn't stay if they've got stuff going on with their family. It's the holidays. One was here. I went back and looked at the ring camera. One was here for three minutes because she had brought a bunch of stuff, and she helped me unpack, put in the fridge. The other one was here for, I think it was like 30 seconds. She came in, gave me a hug, handed me a little bag of food, said, Happy Thanksgiving had left. I

Scott Benner 37:40
got a role, yeah. How did he characterize those visits? Where are

Anonymous Female Speaker 37:44
all these people coming over? I can't get any peace and quiet that

Scott Benner 37:51
kind of stuff. Does your friend group know that he's like this, like, Is it obvious at this point, or is he doing a good job of hiding it? He was

Anonymous Female Speaker 38:00
doing a good job of hiding, and so was I, and I recently, so I recently told all my very close, trusted friends, because I did see on one of my social media educational videos that after the first step of acknowledging that you are in this kind of situation, the Next step is to stop hiding and let people know. So I started telling my dear, dear friends and everybody shocked, because I kept up such the pre temps that, yeah, they were, I gotcha, and that's why I want people to hear this, because as a society, we speak a lot about sexual abuse. Did he, whatever? Send the news a lot. There's a physical abuse you can prove, let's say you've got bruises or whatever, emotional, psychological abuse you can't see it, and when the abuser acts so differently in public, you really believe. You come to believe no one would ever believe you if you told them the things that were said and done behind closed doors. So you keep silent to that, and that's what I did. What's

Scott Benner 39:19
your plan moving forward?

Anonymous Female Speaker 39:23
Well, the kids gone. Kid is aware, actually, as I said, they experienced a different kind of, different

Scott Benner 39:33
form of it, yes, yeah. And

Anonymous Female Speaker 39:35
they're like, I'm so happy for your mom that you have finally opened your eyes. I have always wanted you to be treated better, and I think you need to go live your life without all of this, because coming back to my health diagnosis, the stress could literally kill me. I. Good. You probably heard of that, but the Body Keeps the Score. Yeah, yeah. I'll never be able to prove it, but I think the stress of all those years probably, I think there's a good chance it led to my initial diagnosis, and then people had been telling me, but I finally accepted and understood that if I stay in this situation, this toxic situation, my recovery is going to be an uphill battle, because I'm not only battling the physical health situation, the mental stress, it

Scott Benner 40:34
doesn't stop. I was going to say like, you know, I said earlier, you're going to trade one sad thing for another sad thing. But then you you kind of opened up a little more and and told me more of the story. And I don't think I feel that way at this point, like you are alone, but with a force in your home that's making you uncomfortable constantly in a number of different ways. Obviously, it would be much better to be alone without that force. Your child being older, right? Like, and not being like, you're not gonna be passing the child back and forth. There's no like, kind of custody issues there. That's not gonna be a an impactor for you. Are you able to like, what is your goal? Is your goal for him to leave the place you live? Or is it for you to leave that place? Have you thought of how you want that to go. Because

Anonymous Female Speaker 41:22
of my limited mobility, it would be easier if he were to move on, but that doesn't seem to be what

Scott Benner 41:33
will happen. You think he'll defend he'll want the place for himself

Anonymous Female Speaker 41:39
or control of it? Yeah, well,

Scott Benner 41:42
I don't think it's gonna, I mean, I don't think it'll end up working out that way. I think you might be forced, you might be forced to sell it, to split proceeds, if that's a situation, if you own some of it, or all of it, do you have a place to go? Have you worked all this like, how far are you? I'm trying to remember if this is something you brought up to me before we began recording or not, but your plan is to leave, right? So, like, Yeah, is this a short term plan? Like, do you think this is going to happen within three months? It

Anonymous Female Speaker 42:11
depends. It's not easy for me to go apartment hunting.

Scott Benner 42:16
Yeah, no, I hear that. However,

Anonymous Female Speaker 42:20
gosh, I just love my friends. They're like, we'll do it for you. We will, on the weekends, go look at things, and then we'll narrow it down and then dance like two things, two places. And then you can look at those two and

Scott Benner 42:36
figure which one you like, choice. Yeah. Do you have any physical concerns? Do you think he'll like when you tell him? Do you think he'll become violent or extra angry, or anything like that?

Anonymous Female Speaker 42:45
I don't think so. There's never been physical violence or a threat of physical violence. Now, that's too specific. I'll tell you after, but something happened. And I have another friend who's a social worker, I told her, and she's like, that gets very close to and maybe even crosses over to a form of physical abuse you could I don't even know how it works, like you file some sort of complaint with whatever court handles such things, and is

Scott Benner 43:26
that a thing you want to do? Or do you just, what's your pie in the sky? Vibe here, like, what is it you're hoping happens? You're gonna let him know? Hey, listen, I think we both know, you know, we're not really married, so I, you know, it's time to split up. I'd love it if you'd leave if you don't want to, you know, if that's not something you're open to, you know, we're gonna have to make some, some plans to get me a place to live. Obviously, I'm gonna need you to keep covering my medical like, that kind of stuff. Like, I mean, you're like, look, I've got a lawyer. Like, you should get a lawyer. Like, how do you imagine that opening conversation to be

Anonymous Female Speaker 44:05
that sounds about right? I, I have had a free consultation on, you know, a friend of a friend of a friend is handles these kinds of things, and she offered to do phone consultation to help me understand the laws where I am, because my number, I have two major concerns. One is health insurance, because, yeah, the UN the United States system is so screwed up. You

Scott Benner 44:41
definitely can't lose what you have, that's for certain.

Anonymous Female Speaker 44:45
And the second would be housing, because I don't know, it's very expensive, yeah, so

Scott Benner 44:55
do you have that? I mean, does the household have that kind of money? Like you said you had a. A job before, but have you worked since you've been sick? No,

Anonymous Female Speaker 45:04
but I'm on disability. Okay, like, I qualify for disability, but it's not anywhere near enough to cover rent where I live and my helpers, yeah.

Scott Benner 45:19
Is that covered by insurance or the people that help, or is that a is that a cash prospect? You pay people out of pocket for that? That's

Anonymous Female Speaker 45:27
totally out of pocket? My limited understanding is that long term care insurance could have paid for it. But I think very few Americans have that. They have that,

Scott Benner 45:38
do you have any fear that you're going to be an out of sight, out of mind for him, like he's paying for people to help you, because he doesn't want to be involved. But if he's not there, then, like, is that a concern?

Anonymous Female Speaker 45:49
Do you mean if we were to be formally divorced, yeah,

Scott Benner 45:54
Mike, I mean, obviously that would get taken care of in some sort of a an agreement, but like, prior to the agreement like that, that gray area my parents were divorced, there's a gray area in between where there's nobody's being compelled to do anything. And you know that can sometimes take time. So my thought is, is that right now, he's probably happily paying for people to help you because he doesn't want to be involved with you to begin with. But if you are off in an apartment, and there's no court order in in place that says that, you know he needs to keep paying for your care. I'm gonna guess that's gonna be difficult money to shake out of him. You see what I'm saying? Yeah, cuz you're gonna be out of sight, out of mind. Then, like, if you're in the house and you need something, if he doesn't pay for somebody to get it for you, he's gonna end up having to do it, so he's probably happy to spend the money to avoid the contact, but the contact gets avoided when you leave. That's my concern for you, is that in the middle time, like, how are you gonna get the services you need so that you can actually make the separation leave and get the process underway? So there's an actual court order in place that that handles this like that in between time. I'm concerned for for you.

Anonymous Female Speaker 47:08
Yes, thank you for bringing that up. That's something that I hadn't thought of yet.

Scott Benner 47:13
Make sure you understand what that's going to be, because you could very well end up, I mean, you guys are so separated to begin with, that you might be one of those people who gets divorced while you're in the same house, and that you never leave during the divorce process. That happens and then eventually someone moves out. I can't see that. It's not going to end up being him. You know what I mean? Like, it seems unreasonable for someone to try to compel you to leave it does

Anonymous Female Speaker 47:43
seem unreasonable. I'll tell you why after I

Scott Benner 47:49
bet you a lot of your life seems unreasonable. Jesus. I mean, do you see what I'm saying? Like, if you've got a mediator, or if you get lawyers talking right away, like I don't know that if I was you, that I would leave right away. I

Anonymous Female Speaker 48:06
don't plan on it. Yeah, for two reasons. One, one is this just hard for me, right? And I have thought that okay. Once, once I leave, I have no way back.

Scott Benner 48:21
You lose a lot of power by leaving the house. I think, yeah, yes.

Anonymous Female Speaker 48:24
I mean, as a resident here, I just think there have got to be laws. We've been here for 1617, years. Yeah,

Scott Benner 48:36
it's your house too. I wouldn't go anywhere. That was my point. That's what I was getting to I wouldn't just move out. I'd stay unless you were you felt like you were in danger, and if you feel like you're in danger, then I'd get him removed. But I wouldn't secede that house if I was you. Okay, you know what I'm saying? Because, like, you said, like, once you're out, you're out. I mean, that's your house as much as it is his. You have a medical reason that leaving is difficult. And I can't see a world where a court or a judge or a mediator says, Hey, one of his got to go, and it's you. It just doesn't. It doesn't make sense. And I'm going to guess that once you put the proceedings into motion. He's not going to be comfortable there. You might be surprised that he might. He might happily move to another place at some point.

Anonymous Female Speaker 49:30
It's possible. I wish he would. He actually, he knows people where he could stay there easily. You

Scott Benner 49:41
know what I mean? It's going to become uncomfortable. Also, like, right now, you get to keep pretending that you're like, you're more that your relationship is morphing like even though you're not sleeping in the same room, or he doesn't seem interested in helping you with your health concerns. But he's still getting to pretend that, you know, for. The outside. People don't know for the most part, oh

Anonymous Female Speaker 50:03
Exactly yeah. How is it gonna look if he says, Oh yeah, my wife has cancer. I'm divorcing her. The optics of that,

Scott Benner 50:14
I do think at some point the optics will get the better of him, and probably deservingly. So by the way, I don't want to sound bitter, but like, I mean, I'm not hearing his side of the story. But like, you know, if your side of the story is anywhere near accurate, then I would think he'd get embarrassed and leave honestly. So you've had a consultation, a phone consultation, your child's over 18, away at school, you're looking at, were you trying to get through the holidays? Were you trying to get through like, a thing with your health? Like, are you ready to go? Is it just a matter of, like, getting the nerve where you at?

Anonymous Female Speaker 50:49
I'm trying to gather the information that the attorney recommended that I have before taking a more formal step, okay,

Scott Benner 51:04
bank records, writing down, writing down, your your experiences, things like that.

Anonymous Female Speaker 51:10
I suspect that there are things I don't know of. I suspect there may be hidden assets.

Scott Benner 51:18
Oh, got money in the walls, maybe awesome.

Anonymous Female Speaker 51:25
I saw some mail that was clearly financial. That was nothing I had ever heard about before, interesting,

Scott Benner 51:40
so you're looking into that as well?

Anonymous Female Speaker 51:42
Well, yes, or at least my attorney, or when that person becomes my attorney, you haven't hired them yet formally said that their firm has ways to find anything that's hidden, if that is the case, is the case, and to have some screenshots of said mail to help. Jeez.

Scott Benner 52:14
It's ugly. It sucks, doesn't it like I mean, are you so far past it sucks that it doesn't bother you anymore, like you just said, I'm saying like, there doesn't sound like a lot of again, you're not longing for a thing to be the way it was, like that that's out of your mind. You don't have that expectation. You're old enough that I don't imagine you're thinking about like, you know, I get away from this person and restart another relationship or something like that. Like you're just trying to just get yourself some distance to see if your health will respond to to a better environment. Is that correct?

Anonymous Female Speaker 52:53
Yes, that is my number one priority. Who's the hottie? Now I don't even know my date was Brad Pitt. Well, he turned out to be kind of mature. A hot guy could walk through the door and it wouldn't matter to me.

Scott Benner 53:09
Yeah, that's not your situation. That's somebody. Do you think this is going to be a crazy question, perhaps, but do you think that if it wasn't for the cancer, you ever would have decided to leave

Anonymous Female Speaker 53:18
no and that is, you know, coming back to my faith. You know, I had heard people say things like, when, when bad things happen. Oh, this is a blessing. And I thought they were dulu, or whatever the kids say now, but I understand, I fully understand now I would have kept justifying and justifying and trying to understand and trying to be empathetic and sympathetic and be the one to bend and flex to keep things going. And I realize now none of that effort amounted to anything, because this is not someone who is open to change. And I, I joined a support group. I mean, it was originally for health, the kind of health issues I have, and I I got to know these people pretty well. And one day, I was just like, I know I've been telling you I'm struggling with this physical health thing, and that is true, but I need to, need to give you a little more color on why it's been so hard

Scott Benner 54:32
for me. Yeah. Talk about the rest of it. Yeah.

Anonymous Female Speaker 54:35
So I talked about the rest of it. And what did you know? Like half the group had similar experiences. And apparently I haven't fact checked this, but I it did come up on my feed, just like a meme. And actually, you've talked about it a little bit, something similar with regard to Team One dike. System. Anyway, something came up on VIP that said the divorce rate for marriages where there's a chronic illness is 75%

Scott Benner 55:12
it goes up to like two. It goes from like one in two to two in three. The last time I had heard about it, yeah,

Anonymous Female Speaker 55:21
significant, yeah, this is where one of the partners is the one who's chronically ill. And it says something like, if, like, if it's a heterosexual couple, that's the male is the one who is sick. That's like 3% of the divorce. Anyway, if it's a female, it's a much higher number.

Scott Benner 55:44
You saying boys bail quicker than girls, by a significant margin.

Anonymous Female Speaker 55:49
I'm saying this is a meme that came up for, I don't know. It's not, not a meme, but a post that came up in my social media feed. I have not had the time to fact check it. Well, some I read

Scott Benner 56:03
the comments. Doesn't sound unreasonable. Is that what you're

Anonymous Female Speaker 56:06
saying? I've read the comments, and just anecdotally, so many people commented that, yeah, exactly, totally believe it. That was my life. That was my situation. So, I mean, I'm not here to bad mouth men. There are amazing men. I just not with one of them.

Scott Benner 56:25
Just didn't get one. It's funny too, right? Like you, you coupled up so early in college, and you were, it sounds like you were head over heels. So, like, you overlooked a lot of different things. You didn't even know what you were overlooking, probably at the time. I don't think any of us do. But then, you know, like, some people get lucky, right? Because I don't think anyone's perfect. Like, there's a world where a different you and a different him get together and, you know, you Zig when you should have zagged, or something changes a little bit, or something does happen or doesn't happen, and you grow in it, and it's a different situation. But this is just how this one went. So, I mean, for whatever reason, eventually pushed you to do something, you're gonna have a net positive for making this decision. I don't want to tell you that. I think it's going to be 100% better. Like, it could be crazy. You could wake up three years from now and be like, Oh God, I wish I was still married like I have no idea you know what I mean, but I don't know what to tell you is going to happen. I just know that if you believe right now that you're being treated that poorly, if you're being isolated already, if this is the life you're leading, but there's stress is in your house, and you're worried that this stress is compounding your health issues, then I think the only reasonable thing to do is the thing you're doing. It makes sense to Yeah, it makes sense

Anonymous Female Speaker 57:46
to me. That makes sense. Yeah. I'm really thankful for this opportunity to talk things out with you. Oh,

Scott Benner 57:55
my God, did this help by any chance? Yeah? Yeah. I have no idea what I'm doing. I'm just like, this might be a good idea for the podcast. Do you have, like, the the feeling like you want to ask a question of me before we go, or do you just feel like the conversation was valuable?

Anonymous Female Speaker 58:11
I think the conversation was definitely valuable, and especially since, like, that point you made about the in between period being prepared for that, because, unfortunately, I do not live close to any family. I have a lot of what we call, call it family by choice. I guess people friends became friends over the long period, and I trust them very much. One has even offered like a spare bedroom. But I think I need to mentally prepare for staying here while things get worked out, because that would just overall be better for me and my health needs, and I have to put those first. Yeah, no,

Scott Benner 59:07
for sure. I mean, you obviously you couldn't share too much, because the details would let people know who you are. But I mean, you've had a significant health issue. It's ongoing, and to give yourself the best chance possible, I agree with you. I don't see how you could live around all the stress. So, yeah, I mean, listen, you're in a bad situation, you know, like, this is not like. This isn't like. If you just made one different decision, this would all be like, you know, rainbows and sunshine. This is a this is a mess, like your illness, your relationship. You know, the years that you guys have put into pretending this wasn't happening until it was like, You know what I mean, like, it's not going to be easily untangled. I don't know if you'll ever untangle it, but you could certainly put yourself in a better spot. I think yes,

Anonymous Female Speaker 59:53
and then I wanted to figure out how to heal and move on. So I don't know if it. If you want to how much time we have left, or if you want to go there, but I met him so young, like I didn't really give myself time in between leaving home for college and getting into a serious relationship to just be on my own, not attached to anyone or anything, and just learn who I am. And, hey, you want to do that? My kids said you can do that now. You know, once you're out of here, um, I in my 50s, I just don't even know where to start. And I think that thought is another reason people in situations similar to mine stay Yeah, like the thought of and forget about, like, even if you don't want to do dating, set that aside. I I've been a stay at home mom. I don't know if I can work, and even if I can, like, how do people go about getting jobs now? Like, so much has changed, so you

Scott Benner 1:01:08
feel like the world changed while you were doing this and and it's hard to imagine starting over again, even

Anonymous Female Speaker 1:01:16
just that I'm from the day of paper resumes. And now it's like, everything is online. You have to have certain keywords or whatever in your resume or their the algorithms, those algorithms don't pick you. Yeah. And then I take your point, blame my absence for the workforce, like, like, AI is taking over everything. Who's gonna hire me? Like, that's going through my mind

Scott Benner 1:01:48
a lot or and even if that person exists, like, how do you find them? Yeah, and how do they find you? Yeah, I hear you. That's the bummer. And I'm aware my son just found a job this year, and so I watched him go through that process that you must have to keyword your resume so that the algorithm likes it enough to show it to somebody. Yeah, it's interesting, and that's not a thing you know about anymore, not currently. You could learn.

Anonymous Female Speaker 1:02:16
I'm willing to learn. But where does a person? Where does this person go to learn these things? Like, I'm from the day and age where you take a class or whatever? I guess so much is on social media. Now. I mean, hey, I learned about narcissistic abuse over social media, so maybe there's a way for me to learn how to reinvent myself over social media.

Scott Benner 1:02:40
You learned how to take care of your kid. It's diabetes. With social media, you learned about your life situation. I'm sure you could figure this out as well. And you have a good, astonishingly, a good attitude about I mean, unless you're unless you have, like, a ton of seething rage inside of you that you just didn't tell me about you seem like you're in a at least mentally in a reasonable place to do this. I

Anonymous Female Speaker 1:03:07
spent a lot of time being angry over the years.

Scott Benner 1:03:12
Are you just done with it now?

Anonymous Female Speaker 1:03:14
Yes. I mean, I came to understand that it didn't help me at all. Yeah. You know, I'm just redirecting, like I don't want to waste any more energy or just head space on someone who doesn't deserve my time?

Scott Benner 1:03:32
Yeah, no, I hear you. I think that's an incredibly healthy decision to make. Really, you should give yourself a lot of credit because you are like you said, you're in your 50s. You've been at this for a long time. It would be easy just to, like, dip your head in the sand and go, like, I just got to make it. Like, 10 more years, you know, we'll all get real old, none of this will matter anymore. And blah, blah, blah, no, I think, take advantage of the time you have left, no matter what that time is, or the you know, how much you can get around or not, get around like you're still living your life every day. You might as well live it, at least in the way that you see fit, and in a way where people are not, you know, asserting their on you and making you feel a certain way or feeling burdened by you. Because, I mean, maybe the most insulting thing of the conversation, I mean, of your explanation of your life. I feel like the most insulting thing is just being told, like, well, you're sick now and you need help, and I don't want to be involved in that. That's, yeah, I think that's terrible actually, but I don't think it's uncommon, but I do think it's terrible.

Anonymous Female Speaker 1:04:36
Yeah, I completely agree that that's the thing that psychologically kept me confused for the longest time, because I kept trying to figure out ways to make him care, and then it just I got educated, and I let go of that expectation, and. The freedom came with that. So coming back to what I the reason I put myself out here in this podcast now I know you have such a huge audience for anyone who's listening, who is in a similar situation and feels so stuck, I just want you to hear this and realize you are not stuck, man or woman, you are not stuck, and you can educate yourself, look up narcissistic abuse and use that education to empower yourself. It's one step at a time. We did not get here overnight, and extricating ourselves from the situation won't be quick either. Yeah, that's for sure. Or painless, it'll be quite painful. But think of it if, if I who am dealing with cancer and the side effects, the rare side effects of the treatment. Can make this shift in mindset and start taking baby steps, one step at a time, to get out. You can too. Don't stay I think

Scott Benner 1:06:14
it's a reasonable way to sum it up, right? It's not going to be easy and it's not going to be fun, and it's a decision. You don't have to let life keep happening to you. You could at least make a decision and try to move it into a different direction. I don't say that any of us could sit here and know for sure what's going to happen to you through this process, but you know what's happening to you now, and it's not something you're interested in, so change something and see what happens. Maybe it'll get better. I think it will, like you said, for time, feel like it got worse, but you're gonna have to go through the you know, like you said, it took a long time to get here. It's gonna take a long time to get out of it again. So it's all very good advice from you. It sounds like you've really had a lot of time to think about this, and it feels to me like you're, you're well thought out and probably ready to make the next step. It sounds to me like you're gonna, you're gonna be okay.

Anonymous Female Speaker 1:07:08
I do a lot of praying for that, and I do believe I'm going to be okay. I've got great friends, and I'm taking my power back. It's awesome. Whatever the young kids see

Scott Benner 1:07:23
you're still young. I know somebody who would tell you you're still young. They tell me all the time, and I tell them, No, I don't think we are I think we're old. But they keep saying we're young. So I choose to listen. You have plenty of, you know, plenty of good years to do something great with it, you just got to go figure it out. Do you think I the one thing I didn't ask you about your condition is, is there a prognosis where you're you're doing better than you're gonna than you are now? Or do they expect this to be your baseline?

Anonymous Female Speaker 1:07:55
It could very well be my baseline. If this had happened to me, a few years ago, I would probably not be here, but some new drugs have been developed in the recent years, who have been released or approved or whatever, and they've made a significant difference

Scott Benner 1:08:17
okay

Anonymous Female Speaker 1:08:18
to keep people like me alive, and maybe the next step is in the next 10 years, whatever 15 years is to then improve quality of life. So I'm hopeful, and I have to just stay positive and be hopeful. But if I'm where I am, my objective is to find a way to to be happy, to be of service to other people, to give back. Because I have, I mean, the amount of doctors and nurses and pas and MPs who have just helped me so much over the years. I want to find a way to give back, and that keeps me going too. Yeah,

Scott Benner 1:09:06
well, that's a great purpose that you won't need to keyword a resume to do. That's for sure. Maybe you'll be one of those people on social media that helps other people get out of their stuff by sharing their thing. Have you thought of that? You come full circle maybe one day. Who knows? Like you said, the world's different now, like it's it's incredibly digital. People are able to find ideas and voices that they never would have met in the past. You know, you do a good job of telling your story, and you go out there and tell people like, look, this is my situation. And you know, it's not any Imagine, imagine a couple years from now, like this isn't my situation any longer. You know about getting through problematic relationships, you know about getting through incredibly difficult health issues. There's a lot of people out there that could use that at uh. I don't even want to say advice. I would just more say an example. I think part of what the podcast is for people with diabetes is just like I had a daughter diagnosed very young. We had to figure everything out on our own. And now we're just, I'm just re sharing the things that I figured out. That's all like, I'm just talking about the things that I figured out. And, you know, that stops other people from having to struggle the way we struggled. I'm really just doing what you said you wanted to do. You could do it too. A lot of people do it. You know, a lot of people out there that need help. You never know. Well, you'll figure it out. That's for sure. Let me thank you for doing this. I really do appreciate this is obviously very difficult thing to talk about, like, just like this. I can't thank you enough for adding your voice to the podcast and for being the first person to reach out when I said, like, I think what I said was, like, Would you like to be coached by a completely, I forget how I put it, but untrained life coach, and you were like, yeah. So thank you. I really appreciate it.

Anonymous Female Speaker 1:10:58
Oh, you're welcome. I really hope this series becomes a huge success. I'll be shocked if it's not, because you're just a great person to talk to. Scott, it's very easy to talk to you. Thank you, lovely.

Scott Benner 1:11:11
You're very nice. I'm sure the people in my life are probably like, no, he's not. But you know, like for everybody else, awesome. Thank you. Hold on one second for me,

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.com/juice box. I'd like to thank cozy Earth for sponsoring this episode of The Juicebox Podcast and remind you that using my offer code juice box at checkout will save you 40% off of your entire order at cozy earth.com that's the sheets, the towels, the clothing, anything available on the website. If you'd like to be on the life coach series, give me an email. Guess I usually say give me a call. You can't call me, but you can email me through Juicebox podcast.com Make life coach your subject line and let me know what you want to talk about. Hey, kids, listen up. You've made it to the end of the podcast. You must have enjoyed it. You know what else you might enjoy, the private Facebook group for the Juicebox Podcast. I know you're thinking, Oh, Facebook. Scott, please. But no. Beautiful group, wonderful people, a fantastic community Juicebox Podcast. Type one diabetes on Facebook. Of course, if you have type two, are you touched by diabetes in any way? You're absolutely welcome. It's a private group, so you'll have to answer a couple of questions before you come in, but make sure you're not a bot or an evildoer. Then you're on your way. You'll be part of the family. Thank you so much for listening. I'll be back very soon with another episode of The Juicebox Podcast. If you're not already subscribed or following the podcast in your favorite audio app like Spotify or Apple podcasts, please do that now. Seriously, just to hit follow or subscribe, will really help the show. If you go a little further in Apple podcast and set it up so that it downloads all new episodes, I'll be your best friend, and if you leave a five star review, ooh, I'll probably send you a Christmas card. Would you like a Christmas card? My last thanks to rob at wrong way. Recording. Rob is the editor for the Juicebox Podcast, and he changed this person's voice so magically, I swear, if you heard this person's real voice, you'd just be stunned. Did such a wonderful job of protecting her anonymity. I want to thank him so much. Check him out at wrong wayrecording.com, you.

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#1411 GLP Essentials with Dr. Hamdy

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Dr. Hamdy, Medical Director of the Obesity Clinic Program and Inpatient Diabetes Program, discusses GLP medications and the important steps to take when using them.

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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
Friends, we're all back together for the next episode of The Juicebox Podcast. Welcome.

I'm very excited to share this episode with you. I'm talking today with Dr Hamdy. He is a senior staff physician at Joslin Diabetes Center, the Director of International Medical Affairs, the Medical Director of the obesity clinic program and inpatient Diabetes Program, and an associate professor at Harvard Medical School. And he's here today to share his very important message for those of us using GLP meds, please don't forget that nothing you hear on the Juicebox Podcast should be considered advice medical or otherwise, always consult a physician before making any changes to your healthcare plan or becoming bold with insulin when you place your first order for AG, one, with my link, you'll get five free travel packs and a Free year supply of vitamin D drink. AG, one.com/juice, box. Don't forget, if you're a US resident who has type one or is the caregiver of someone with type one, visit T 1d exchange.org/juice box right now and complete that survey. It will take you 10 minutes to complete the survey, and that effort alone will help to move type one diabetes research forward. It will cost you nothing to help.

The episode you're about to listen to is sponsored by Omnipod and the Omnipod five. Learn more at omnipod.com/juicebox use my links to support the show. We're also sponsored today by touched by type one, and they have something great coming up on March 8. Touched by type one is hosting their very first steps to a cure walk. And you can register right now to participate. Touched by type one.org Go to the Programs tab, click on Steps to a cure and sign up today. You can sponsor walk or volunteer. Check it out.

Osama Hamdy, MD, PhD 2:06
I'm Osama Hamd,. I'm the Medical Director of the obesity clinical program at Joslin Diabetes Center and associate professor of medicine at Harvard Medical

Scott Benner 2:16
School. How did we meet each other? Who put us in touch? Do you remember one of

Speaker 1 2:21
our nurse practitioner, Daniel rock,

Scott Benner 2:25
what did she tell you? I'm interested. What made you be willing to do this? Yeah,

Speaker 1 2:30
he told me it is a very popular broadcast, very efficient broadcast. He follow a lot, and he thought that it would be a good idea that we comment on muscle mass and some of the work that we frequently do in that space on obesity. I had been in obesity field for 40 years now, wow, and I created the obesity clinical program at Joslin Diabetes Center as one of the biggest programs. We had been doing several weight management. You know, we did research that cost us almost $16 million to come with the the best weight management, multi disciplinary weight management program for our patients. It's called, why weight, weight achievement, intensive treatment. And then we have another program called diabetes remission outcome program, drop program, which aimed for diabetes remission in early inpatient, was early diabetes.

Scott Benner 3:27
Can I go to the beginning and ask you about how we got to that? Yeah, yeah, we can. You can ask whatever you would like. You know, you've been in it for 40 years. Let me ask you what got you into it, and what was it like back then, versus what is it now, and how did it change throughout the time? Oh,

Speaker 1 3:44
there is major, major change. You know, the whole concept that link obesity to diabetes was not clear in the old days. You know why people with obesity develop diabetes? Who will develop diabetes? Why Some develop diabetes and others are not until we discover the whole idea of insulin resistance, that once you are obese, and especially if you have more fat in the abdominal area and visceral area, you'll become insulin resistant. And this could be the reason why people, when they gain weight, the start to develop diabetes. So my early research back almost 25 years ago, we found that 7% weight loss improves insulin sensitivity by 57% Wow. So I remember I was whispering to my colleagues at that time, telling them that means diabetes is not a chronic disease. Actually, in reality, we can reverse diabetes. But that concept was not there at that time. Concept that this is a chronic disease, whatever you will do, there is nothing that can reverse it. But people who repeated those studies found 7080, even 90% after. Bariatric surgery significant improvement in insulin sensitivity, which means that if you catch it early enough, especially within the first five to seven years, you can actually reverse diabetes. So

Scott Benner 5:12
for type two, how does the bariatric help? Does it help with the weight loss, or does it help with the with something else, too many?

Speaker 1 5:19
The best to answer is that patients with after bioethic surgery, they stop their diabetes medication in frequently. Why they are in the hospital even before weight loss?

Scott Benner 5:32
Why do you think that is the what's the cause and effect? It is a

Speaker 1 5:36
reduction, significant reduction, in the anti hepatic fat, so when they are in the hospital. After surgery, they are not on oral feeding that much. It is all IV fluids or IV glucose. There is significant deficiency in nutrients in the beginning. So the easiest for the body to do is to take the fat inside the liver and use it as as a source of energy. And immediately, with the reduction in the intra hepatic fat, you will, you will start to see improvement. And then later on, when they start to lose weight, that's when you get the maximum improvement.

Scott Benner 6:17
Wow, that's insane. So, so you saw that you saw, give these people bariatric surgery, they what can reverse type two or stop pre diabetes, either or,

Speaker 1 6:29
you know, it depends in at what stage you are doing. If you are in the pre diabetes phase, definitely okay, you will prevent the type two diabetes. But if you're already on type two diabetes, when it is shorter duration, less than five years, definitely remission can occur for how long that remission will maintain. It is not studied significantly right now.

Scott Benner 6:53
So is the biggest hurdle, then, is losing the weight, not

Speaker 1 6:58
losing the weight in precisely it is when you lose weight, when you say lose weight, you lose muscles, you lose fat, but when you are when we are talking here, we are talking about the critical fat in the body. This is the intra abdominal fat and intra hepatic fat, visceral fat, intramuscular and sufficient fat, all this ectopic fat is dangerous. Okay, this is a problem.

Scott Benner 7:25
I hear people talk about all the time how extra fat impacts hormones and causes hormonal issues. Is that, is that something that you're aware of, today's episode of The Juicebox Podcast is sponsored by Omnipod. Before I tell you about Omnipod, the device. I'd like to tell you about Omnipod, the company. I approached Omnipod in 2015 and asked them to buy an ad on a podcast that I hadn't even begun to make yet because the podcast didn't have any listeners. All I could promise them was that I was going to try to help people living with type one diabetes, and that was enough for Omnipod. They bought their first ad, and I used that money to support myself while I was growing the Juicebox Podcast. You might even say that Omnipod is the firm foundation of the Juicebox Podcast, and it's actually the firm foundation of how my daughter manages her type one diabetes every day, omnipod.com/juicebox whether you want the Omnipod five or the Omnipod dash, using my link, let's Omnipod know what a good decision they made in 2015 and continue to make to this day. Omnipod is easy to use, easy to fill, easy to wear, and I know that because my daughter has been wearing one every day since she was four years old, and she will be 20 this year, there is not enough time in an ad for me to tell you everything that I know about Omnipod, but please take a look omnipod.com/juicebox I think Omnipod could be a good friend to you, just like it has been to my daughter and my family. That's

Speaker 1 9:05
absolutely right, and I wrote about it before. You know adipose tissue is not an inner tissue. This is an endocrine gland. It secrets hormones like, for example, Leptin hormone, the satiety hormone, the major satellite hormone is coming from adipose tissue, from fat tissue. There is another hormone called the bone actin, which actually increase insulin sensitivity. Unfortunately, when people are obese, adiponing is low, and that's why they are insulin resistant. Interestingly, when you lose weight, adiponing start to go up. And to make it even more complicated, visceral fat is different than subcutaneous fat. Okay, those are two different organs in their genetic expression, in their hormonal secretion, in their even relationship to each other. And so the distribution of fat is. More important when it comes to the endocrine function of the devastation.

Scott Benner 10:03
How does it impact satiation? Yeah, there is a hormone

Speaker 1 10:07
comes from subcutaneous fat. Subcutaneous fat, okay, there's external fat, not the internal fat. It's called leptin. So Leptin is a hormone, one of the major hormone that induced satiety. Just to consider leptin as a defense lawyer for your fat. You know, anytime you start to lose fat, leptin goes up Shut your appetite. Try to preserve fat as much as you can. And interestingly, leptin has a circadian pattern, so it is mostly secreted between 8pm till 8am that's why we will are eating during the day, and they don't eat during during those hours, right? Exactly, right. So let me give an example. If we will get leptin abnormality or Lipton deficiency, they start to eat significant amount of food in the evening. We call them night eating syndrome. So night eating syndrome affect around 2% of the US population. And the eating average studies showed, in average is three big meals after their supper, three big meals. Each meal is 1250 calories. So you can imagine if that hormone is just deficient. Yeah, wow. Some people are, they are born, but this very rare born nose lipicsy And they are very obese from their

Scott Benner 11:34
younger childhood. For people who would say, just do a setup, go for a walk, like, can you tell them why that doesn't work all the time for people who are or in this situation,

Speaker 1 11:46
you know, your your body, need different types of exercise, and each exercise had its own benefit. It is, you know, walking is aerobic exercise. This is very valuable for your heart, for your cardiac effect. But other types of exercise has measured, measure different, different angle. For example, you you need, you need to stretch your body. And stretching your body, which people can do it just for 10 minutes in the morning, increase blood flow to to the body, reduce energy injury, improve movement across the joints. There is a lot of benefit from stretching, but the most important component of exercise is actually strength exercise. Okay, and you cannot do exercise without doing muscle strength exercise. And the reason, the reason is that as you age, you lose muscle mass over time. So normal people without diabetes lose around 5% of their muscle mass every 10 years from age 30 up, people lose diabetes lose around seven to 8% of their muscle mass every 10 years from age 40 up,

Scott Benner 13:02
do we know why people with diabetes lose more than people without?

Speaker 1 13:06
Oh, yeah, there are that is a very complex metabolic issue. But the bottom line is that from age 40 to age 70, you lose around 24% of your muscle mass. I see by ages 70 up, you lose 15% of your muscle mass during your lifetime. If you live till 40, from 40 till 80, you lose 40% of your muscle mass.

Scott Benner 13:32
Is that something that I can I can't stop it completely, but I can get in the way of it, right, try to to slow it down. Is that the idea?

Speaker 1 13:39
Yeah, yeah, no, you do all the effort to prevent it, right? Because loss of muscle mass is, in my personal opinion, is a crime. You know, if you lose your muscle, or anything that makes you lose muscle, you will be in terrible scenario. This is how frailty occurs. This is how we will get poor quality of life. You can even stand from your chair. It is a problem, but there are three major problems. Just to be clear, there are three major problems when you lose muscle mass. Number one, you will not regain muscle mass. You can't get it back, bye, bye, muscle mass. It is very difficult, because you build the muscle mass over years by three hormones, growth hormone, insulin, sex hormones, okay, when you get older, all those hormones are noose down, so you don't have them, so you cannot build muscle mass that much in your older age, or I will say, from even middle age, there's a first problem. Second problem is, once you lose muscle mass, your energy expenditure start to go significantly down, to a degree that if you return back to eat whatever you used to eat, you gain weight, and that weight is not my. Muscle and fat. It is mostly fat. So every time that you lose weight, you lose muscle, and then you gain fat. If you return the back and then recycling, go care. And this leads to what's called sarcopenic obesity. Sarcopenic Obesity means you lose muscle and then you have more fat, okay, but if you age normally, you lose muscle all the time, until you reach a sarcopenia. In this scenario, I say, Okay, the third drawback, just to complete the drawbacks of losing muscle mass, that quality of life start to go significantly down and by percentage loss in the muscle mass. So if you lose 10% your performance of the muscles start to go down. 20% you start to have reduction in your immunity, and you get infections and and problems. 30% you can get pneumonia with zords. 40% of muscle mass loss means mortality will be significantly higher. So

Scott Benner 16:00
how do we balance in I guess, starting with obese or type two community, people are getting GLP medications. They're having some of them significant benefits as far as weight loss goes, but so I don't imagine you would trade their weight loss. But how do you mitigate the muscle loss in the same situation, like, what else should they be doing that we're probably not telling them about Yeah,

Speaker 1 16:21
this is a very, very important issue, because we have to differentiate, Scott from the beginning, between quality weight loss and quantity weight loss. Okay, the weight loss was in keratin mimetic drugs. This is a group of GLP one and GIP and GIP and all this group is volume weight loss, quantity weight loss, not quality weight loss. Quality weight loss is entirely different. Quality weight loss means you lose adipose tissue. You maintain muscle mass, you maintain muscle performance. And quality of life is much better. But if you lose the adipose tissue and lose muscle mass in the same time and have poor performance, weakness in the muscles and so on, you will you will be in in trouble. And that's exactly what happens with those medication. You know, people are happy with the volume of weight loss, but it is not a quality weight loss. So is it

Scott Benner 17:23
possible? Do you think to use the GLP and be exercising and supplementing at the same time to keep a balance? Yeah,

Speaker 1 17:30
we need a lot of research in that area. But theoretically, that's absolutely right. If you take enough amount of quality protein, if you do a Strengths exercise. Very good quality of strength exercise, especially in the muscle, in the bearing muscle the body, bearing muscles around the size and back and and all this area, I think maybe you will mitigate some of the problem with loss and muscle mass. Yeah,

Scott Benner 17:59
so you don't know this, but I am 57 pounds lighter than I was two years ago, and from a GLP medication. Now I try to balance that with a significant amount of animal protein, and I do a protein drink every day to make sure my protein is high enough during that what I try to do is light to medium weight training in the beginning, arms, legs, poor, but it was harder in the beginning, because I was so I was so out of shape. Now, the irony here, I guess, is that as far as the amount of calories I take in, obviously I take in less now, because the GLP, it does, obviously, you know, kind of shut down your hunger. But at the same time, I'm not eating that much less, and so I noticed a difference immediately. I don't have diabetes, I didn't have diabetes, but I would have described to you that throughout my entire life, my body never responded to food in a way that made sense. My digestion didn't work well, and I had to, as an adult for years, get iron infusions, because my ferritin would drop through the floor, like every six months. But since the GLP, I don't need the iron infusions anymore. I now defecate like a normal person would, like, I eat, I don't get sick right away. And like, it has changed so many things for me, and I don't know how to put it all into words, like it feels like it's having impacts that weren't intended by the label, and I'm done now, like I don't really need to lose any more weight. I have some mid section fat that I'm still working through, but everything else I've been able to to get rid of. But I'm 53 I have very dark hair, so it might be hard for you to see that right now. I got to the point in my life where I thought everything I've tried supplementing, exercising, eating, right, all the things that people talk about, none of it was happening like, it just it wasn't doing anything for me. And I thought, I'm gonna die if I don't do something like I genuinely thought I'd have a heart attack in the next 10 years. So I thought, well, let me get rid of this weight the best I can. I'll try to mitigate. The the muscle loss, as best I can, and now that the weights gone, I'm upping my activity and being more strenuous and looking towards more building. Because the exact same thing that you're talking about, like, I I just watched my mother, you know, at the end of her life, in her early 80s, like, not be able to get up and sit down and get out of a chair and, like, I don't want that to be how I go out, so I'm trying, you know, but I don't know if I'm doing the right thing. Because, to your point, they came up with the meds, and they were like, here, and people got so excited that everybody started taking them, and nobody really knows what they're doing. So I'm, you know, lucky enough to have a nutritionist that I talked to on the podcast who warned me early on about the protein and the muscle building. Nobody told me about that, you know, so I don't know, like we're in a weird spot right now, I'm wondering what you feel about all that.

Speaker 1 20:50
What you did is, right? You know, you try to lose weight, because, you know, initially, you are talking about the complications of obesity. You know, Obesity is a disease. You know it is not symptom or a sign. Obesity is a disease. And you have obesity, you have many metabolic and you have many mechanical problem and you are at very high risk for cardiovascular disease and diabetes and many other problems. That's why people are basically awful in that scenario. But reality is that many obese people are malnourished. In reality, you know, study among the US population found the US population in general, obese or non obese, 40% of them have micronutrient deficiency. So when you are talking about iron or any other test elements or any of minerals, 40% have macronutrient deficiency. What do

Scott Benner 21:44
you think that is because I don't eat I'm gonna try to hold this up to the camera. I don't eat much differently now than I did then. I was eating protein, I was eating healthy, I was taking supplements. But look, can you

Speaker 1 21:56
see that? Oh yeah, yeah, I can see it different. It's a significant

Scott Benner 21:59
difference in who I am now, and so that person in that picture doesn't eat much differently than I do. I can tell you that if I inject on a Wednesday and eat normally, everything's fine, but if, even if I get to the end of the half life on the medication, I can see myself starting to gain weight having not changed one thing about what I'm doing in day six and seven. Do you think that there's an inflammation component to this for some people? Because we're also seeing people use it for PCOS. We're seeing people use it for a number of different things that it's not on label for, that all seems inflammation related, but I don't know anything. I only know what's happening to me. I don't really know what's happening.

Speaker 1 22:42
You know, the medication does two jobs, okay? And this is a reason for weight loss. The first is chat appetite. It works on appetite center in the brain, chat appetite. And you know, most of the obviously, problem is related to larger abortion, frequent eating, stress eating, night eating, binge eating, all kind of stuff. So when you shut up, per se, you lose weight the second that is slow gastric evacuation. So basically, what you eat is slowly digested over time, because it takes longer duration in the Git to to move,

Scott Benner 23:22
and that's how I'm getting my iron from it now, because it's staying in there long enough for it to be extracted. Is that right,

Speaker 1 23:28
you know, but, yeah, when, when the food is slowly processed, definitely more digestion, more absorption, more rather than it, if there's, you know, a quick evacuation for, for, for that. But you know, once you lose weight, your body adjusts itself in many aspects. But the most important is that once you start to lose weight, the critical and the bad fat is a thirsty fat to go down, okay, the intra abdominal fat, the intra muscular fat, the intra hepatic fat, the intramyocardial all those ectopic fat start to go down. Once that visceral fat and intramuscular fat goes down, inflammation in your body will go way, way down. Okay, because that fat in your ectopic area is a source of the inflammation in your in your body. This was called sub clinical Corona inflammation. Why this happens? You know, when the fat cell gets larger. Let me explain it in a much better way. When the fat cell gets larger and larger and larger, it can, you know, can be a very big volume, the fat cell rupture. Actually, it is, I will not say rupture. It will be what's called fat cell necrosis. You know, the cell membrane of the fat cell get necrotized and so on. This death of the fat cell attract cells in your blood called the macrophages. Macrophages is like janitors. They come and to clean the debris of the fat cell. But. When they come in, there is it inside adipose tissue. We call them adipose tissue resident macrophage. They live in the adipose tissue. And this macrophages start to produce significant amount of what's called cytokines, inflammatory Cyto This is the reason why people get cardiovascular disease, heart attack, stroke, insulin resistance on type two diabetes is basically inflammation originated from macrophages raised in the adipose tissue in the ectopic area in your body. That's

Scott Benner 25:32
crazy. I never would have understood the pathway to that. That's really something. Yeah.

Speaker 1 25:36
So people who studied all this area, myself and many others found that the core problem of all this cardio metabolic issue is poor nutrition, because when you eat poor nutrition, you start to accumulate more visceral fat. Visceral fat attract the macrophages. Macrophages secrete inflammatory cytokines. You get inflammation, and then the three branch, dyslipidemia, hypertension, Corona, kidney disease, cardiovascular disease, until we will end up in ICU, heart attack or stroke.

Scott Benner 26:11
Is it possible that the increase in autoimmune issues like hypothyroidism, Hashimotos, type one diabetes? Could this all just be nutrient fat over generations?

Speaker 1 26:24
No, no, no. This entirely different scenario, type one diabetes and autoimmune disease, Hashimotos and autoimmune disease, those are entirely different. We are talking about the process of people who are gaining weight, and especially if they are gaining weight in this wrong area and the wrong area, the divorce tissue, in the visceral area, it can be just one to two kilograms of fat, but is extremely dangerous fat, okay, so you can, you can be lean and happy and so on, but you, if you have that visceral fat, you are at that major risk, like, For example, go, go to people living in South Asia and in India, the average body mass index, 2223 but if you do acidity scan for them, you'll find significant amount of edible station, okay, in visceral area, in the visceral area, that's why they get Diabetes at younger age you get cardiovascular disease at younger age, by age 4050, the may have heart attack. Yes, it doesn't matter how your body mass index looks like it is where that fat is located.

Scott Benner 27:33
So for people in India as an example, is that genetic, or is it food related? Is it more cultural?

Speaker 1 27:40
You know, the accumulation of fat and fat distribution in your body is based on ethnic background and some genetic components, like, for example, in the US, African American women accumulate more visceral fat than white women. In the in the in the same time, white men accumulate more visceral fat than African American. Men in Latin America, men and women accumulate more visceral fat. In South Asia, men and women accumulate more visceral fat. Middle Eastern is the same. Just to give you a very simple example of how this can be a problem. If you look to the women Indians and the Bema Indians, Native American they have the highest tendency to accommodate visceral fat. Do you know among the Bema Indians, the prevalence of diabetes 60% 60% because they accumulate significant amount of disorder of fat. You

Scott Benner 28:36
said something, I make sure I didn't misunderstand it if, if I take that same person, like you said, black women in America. Does that mean that black women on other continents don't have the same issue? Is there something to do with them being here or no? Not necessarily.

Speaker 1 28:51
Distribution of fat is entirely different across the globe. Like for example, if you are in the Mediterranean area, South Italy, South France, Greece, North Africa, we will accumulate fat in their periphery, in the lower area of the body, in the side. This is what is called pear shaped right obesity. This is entirely different than Apple shaped obesity, where the fat is accumulated around central

Scott Benner 29:17
area. Is one better than the other. Of course, yes, pear actually,

Speaker 1 29:20
if you have a pear shaped that fat will be protective. Ah, not even, not even harm. It is protective for your body. I want

Scott Benner 29:30
to get my belly into my ass. Is that what you're telling me?

Speaker 1 29:35
But not by transplantation, yeah, let me. Let me tell you something which is so funny. Yeah, when we did our study of the 7% weight loss and we found that insulin sensitivity improved that much, ballistic surgeons said, Oh, that's easy. Let us go and suck 7% of the body fat. Did that work. I will tell you they actually sucked the. 10% of body fat, 10% and I don't know how they suck the 10% i My brother is a plastic surgeon, and I asked him, how you how we can suck 10% of the body? He said, Oh, we have new techniques and and procedures and so on. But do you know the results? 00, benefit, because the what they removed is a wrong fat. They remove the subcutaneous fat, not the visceral fat.

Scott Benner 30:23
I see, oh, that's so disappointing, because I was going to start saving my mommy. When you talk about, I've heard people talk about before their doctors tell them that they sometimes have fat between and under their organs. Is that visceral fat?

Speaker 1 30:37
Visceral fat is inside the intra proteinal cavity, around the organs, around your intestine, all the entire organ and, of course, in the in the liver and around the stomach and all this, all that fat in the visceral lady, when you open the protein, the muscles and protein, you'll find that visceral fat.

Scott Benner 30:59
So the fat I'm left working on now is more about vanity and not about health or no, what

Speaker 1 31:06
you need? You need to reduce a visceral fat. That's that's the aim. You know, if you need health benefit, there's aim. But if you need to maximize the health benefit, you increase muscle mass, okay,

Scott Benner 31:18
the the way to get rid of this fat now is to build more muscle and

Speaker 1 31:22
build more muscles, okay, okay. And by the way, building muscles is the most important thing they can do in your life, especially in elderly population. Okay, so let us go back to the GLP one medication. Yeah, okay. And, but this is around the numbers about, you know what we have been talking about. If you lose weight by just cutting caloric intake, 25% of the weight loss is muscle. So if you lose 10 pounds, 2.5 pounds will be muscles, right? If you do exercise during weight loss, around 15% of the total loss will be muscles. Okay. So if you do nutrition, hypocaloric diet and exercise, the percentage of in muscle mass from the total loss is only 15% okay. When you inject the GLP one hormones. 40% of the total loss is muscle. Why

Scott Benner 32:23
is it different with the GOP than without it? You know,

Speaker 1 32:26
for, yeah, for many, many reasons. You know, a version of food loss of appetite, protein in general, is nussiating. People don't eat that much protein, macro nutrients becomes, you know, lower there is a lot once you suppress appetite and you are not eating, basically imagine someone in the hospital, sick not eating. They lose significant amount of muscle mass during that period. So 40% this is equivalent to around 20 years of loss in one year, 20 years of age, related loss and muscle mass. So this is not a small amount of loss and muscle mass. Like for example, if you look to the studies that had been done on semaglutide, the step one study, they take group of the population, and they did Dexcom to study body composition, and they found that people lost 17 kilogram in average, 17.57 kilograms are lean mass. Okay, seven kilograms are lean mass. This is around 4140 41% okay, of the that that loss, in a year, you are losing all point 5% of the muscle mass. So if you are aging normally, I told you, you lose around 5% ever, every 10 years, right? So in one year you are, you lost nearly around 20, 20% but lean mass is you have also the defined in mass. Lean mass is soft tissue, organs and muscles. Fat, free mass is different. Fat free mass is bone and muscles and all other tissues. But lean mass and muscles is nearly 50% of the lean mass. So the absolute loss in muscle mass, if you calculate it from that whole equation is around 10% 10% of your muscle mass is lost.

Scott Benner 34:25
But you still said you want people to lose the weight, so, like, Dan, so we have to, you got to keep eating, right? Like, I mean, listen, I've been using it for almost two years, and there are days that you have to just walk into the kitchen and say to yourself, I'm going to eat. I'm going to eat something good for me, because I it can happen. I'm not going to lie to you yesterday, I think at five o'clock yesterday, I thought to myself, Oh, I don't think I've eaten yet today, and I did not know it. I wasn't hungry, like my brain wasn't hungry. My stomach wasn't hungry. I was not hungry that. Doesn't happen to me often, but a number of things happened yesterday. People in my house got sick. Things got tossed around. I find it to be incredibly valuable to tell people like you have to eat like chicken, beef. You know, these things like nutrients, get your nutrition, take your supplements, do everything you can do to keep that going while being active, lifting weights, weight training. That's how I've tried to talk about it so far.

Speaker 1 35:22
You know what? We need to educate our patients who are getting on this medication, yeah, that you need to eat high quality protein and do enough strength exercise to mitigate the loss in muscle mass. So usually we will our average we will eat or the recommendation are 0.8 gram per kilogram of body weight. We recommend at our institute 1.2 to 1.5 gram per kilogram of adjusted body weight. But in general, after barretic surgery, the usual patients eat 1.5 gram per kilogram of your ideal body weight of protein, and it has to be high quality protein, right? High quality protein is not plant protein. High quality protein is mostly animal protein. So we have to differentiate, because the Amino the essential amino acids are very important. This is a building block of your hormones in your body. Insulin is insulin growth hormone, other protein based hormones are all a need for that essential amino acid.

Scott Benner 36:20
So now that we understand this about weight loss type two, like, let's sort of pivot a little bit, because a lot of type ones are starting to use glps for insulin resistance. I know it's off label still, but it's happening, and I'm seeing it more and more, to be perfectly honest. So do you have thoughts about how type one should be managing this?

Speaker 1 36:41
Yeah, it is not of label for obesity. Indication, no, no, of course

Scott Benner 36:46
not. But there are type ones now that are getting it for insulin resistance. So what they're doing is they're going to their doctor, and they're the doctor saying, Look, if you didn't have type one diabetes, you'd have type two diabetes, because I see insulin resistance here, and they're getting it covered. You

Speaker 1 36:59
know, I am among the people who created that term in the old days, double diabetes. Double diabetes, really. So double Diabetes means you are type one by auto immune mechanism. You are taking insulin, and so is a growth hormone. And every time you optimize your insulin, you're basically putting in your body more growth hormone blast. They are exposed to the same environment like anyone else, the environment of this activity and high carbohydrate eating and so on. They gain weight. Then they start to be insulin resistant, and then their need for insulin becomes higher, and the insulin is a growth hormone, makes them gain even more weight. So reality, we did that. We published a very nice article about obesity type two, and we were shocked, 53% of type one. Sorry, obesity type 150. 3% of people whose type one diabetes are actually overweight or obese now. Wow. This is totally different from 2030, years ago. Yeah. Let

Scott Benner 37:58
me tell you this, Dr him, because you don't know my daughter. The reason I come by this podcast, my daughter was diagnosed with type one when she was two years old. Yeah, and today she's 20 years old, almost 21 yes. She also seems as near as we can tell to have PCOS. Yes. It shows its head through acne, through painful, longer periods and insulin resistance. Like at some points in the last two years, my daughter's insulin to carb ratio was one to four, and her insulin sensitivity was as low as, gosh, I think 42 one to 42 and so her doctor put her on a GLP and her insulin sensitivity is now more like one unit covers 8085, her carb ratio is up to, like, almost to 10. It's like eight, between eight and 10. She did lose some weight. She did not have a weight issue, but it did, like, just through hunger. It knocked 20 pounds off of her. And she's tall, she's five seven, but she was probably 571 40 when she started, and she's more like 571 30. Now she got to 120 it was too much like she had lost too much weight. So we were stuck because she was doing Manjaro, just 2.5 and it was working great on her insulin resistance, working great for her PCOS, but it was making her not hungry. So what we ended up doing was we now take clean vials and milk the pen into a vial, and then give her less than the 2.5 and we have found the balance where it controls her blood sugars, helps her with her PCOS, but leaves her hungry still, and that has been like the sweet spot we found for so she gained back 10 pounds. She's at a very healthy weight now, and she probably uses, I'd have to guess, 20 to 25% less insulin than she was using before. And she just looks

Speaker 1 39:53
at that's usually the case. You know, we're an hour why wait program around 30 40% and. Range are type one, and we have significant experience in managing obesity in type one. You know, actually, we published several papers about it, and we have to differentiate between two issue, good. This is a benefit of JP one, or the benefit of weight loss.

Scott Benner 40:15
Yes, okay, yes, I know, and I, I struggle with the same thing. Yeah, the

Speaker 1 40:19
benefit of weight loss is huge. You know, you said that she went from 140 to 130 you mentioned at one point she lost she lost the 20 pounds. If she lost that much, she is now more insulin sensitive, she will use less insulin. For sure, the answer is more efficient, because every time that you become more insulin sensitive, your body responded to insulin is much better way. Yeah, so even less insulin can improve. But the most important is that she should continue to do strengths exercise, especially younger. Younger people benefit a lot from exercise because they they can build the muscles more than what you can do now. You know, from age of 40 up, it's very difficult to build the muscle, but in her age, it is easy to build the muscle. Yeah. So my advice for her is to eat more protein, enough protein, and by the way, protein per se, will improve hair diabetes as well. You know, we know that for years, and it doesn't raise a blood sugar up like carbohydrates, right? I have to

Scott Benner 41:22
tell you, like talking about it technically like this. It makes sense. Everything makes sense. It's the the actual living with it and losing your appetite and then having to eat and like, it seems like a vicious circle, like it's not, it's clearly not a perfect fix. But I've done two interviews this past six, eight months that I found astonishing. One was just with the mother of a then 13 year old girl who had had diabetes, type one for four years. She was using almost 70 units of insulin a day. She has antibodies. She has she's type one, right? But her mom had PCOS, and had used the GLP to lose weight and changed her life. The girl was gaining weight, so the doctor put her on the GLP for weight. But today, I'm still in contact with her. Today, her daughter's not wearing an insulin pump anymore and injects like one unit of basal insulin a day. I'm not saying it cured her. I'm certainly not saying that, but she's having an amazing impact on it. And I also had on a gentleman in his 50s who was type one for like, six or seven years, admittedly, Lata, right? It was a slower onset. He got put on zepbound for weight, which I know is Manjaro. He lost so much weight, they took him off his insulin, and he hasn't been on insulin for a while now, but he's got antibodies, and he is type one. And I expect one day that Lot of will complete its path and he'll end up on insulin. But for the moment, it's astonishing.

Speaker 1 42:48
It's quoted all. What you mentioned is not a surprise for me, Wow, because you remove the type two component, yeah, when they lose weight, the type two component, an insulin resistance component, is gone. They remain was type one. So the need for insulin becomes less and less and less. So to be down to one unit per hour on insulin pump or or sorry, or less, or whatever, not surprising, your body become insulin sensitive after you lose weight. Whether you are type one or type two, if you are type two, you get remission. If you are type one, you remain on answer, but in a very small dose.

Scott Benner 43:24
So then this double diagnosis isn't just a way to trick your insurance company. It's important to know if you have both of those impacts,

Speaker 1 43:30
we don't have COVID for double diabetes, right? You know, you cannot tell insurance that that person has double diabetes. The insurance understand from ICD 10 that either type one or

Scott Benner 43:41
type two. Your opinion, should there be a double diagnosis code, double diabetes? Yes, we should

Speaker 1 43:45
diagnose double diabetes in in people. But my advocate for that term to be used scientifically, rather than just be used that way. I want to thank you

Scott Benner 43:54
for a second, because I didn't really know where our conversation was going to go today. You've indicated me because I took a fair amount of crap online for putting those two episodes up where type ones used the GLP and then came off their insulin. I got a lot of pushback from that. I mean, I understand why, like, type ones don't want you running around telling people, like, don't take your insulin, which is not what I was, you know, definitely not what I'm saying either. I think it does point out how much over the years, old ideas get folded into new ideas, and then along the way, like something gets lost in translation along the way. Do you know? Do you know what I mean by that? Because you said something earlier that made me feel the same way, and it was around the double diabetes, because I had heard people say that in the past, and then other people come along and they poo poo. It like you're either you're type one or your type two. It's then that becomes the argument. You know,

Speaker 1 44:43
let me Scott, let me make it more complicated. We are looking in the future in precision medicine of diabetes, and there will be no type one and type two. There are five different phenotype clusters. Okay, each cluster is treated in entirely different. Way. So type one will be under a cluster called auto immune, severe auto immune diabetes, or said sa ID, severe auto immune diabetes. This will include type one and ladder the antibodies are positive in them. There is another group that exactly similar in the phenotype, but without antibodies. It's called severe insulin deficiency, diabetes, and this is around 18% of people with diabetes, so they are not making insulin. They are lean people, but if you test antibodies, it's negative, and then you have mild obesity, diabetes. This is a common type that we think that, or most people think that this is type two diabetes. That's actually 22% only of all people with diabetes and the diabetes in mild obesity, diabetes is related to obesity. Take the obesity out of the door, diabetes will go out of the window. And this group significantly benefit from weight loss, whether multidisciplinary weight loss or by pharmacologic or by bariatric surgeon I see, and then you have another phenotype cluster called severe insulin resistant diabetes, or cert this group had the severest insulin resistance their body, all the body is resisting insulin, liver, muscles, a divorce tissue. This group, weight loss can be very beneficial. If you see one of those people, they need 100 units of insulin, even 200 units of insulin, sometimes. And then you have mild age related diabetes. This is the biggest one. When you get older, you get diabetes. This is around 39% of people whose diabetes, wow. Basically, understanding the phenotype clusters in the future can tell us who will benefit from what we call it now, type two diabetes is not all of them, but mild obesity diabetes, which is around 15% 22% and the severe insulin resistance around 15% so 27% 20 37% of people with diabetes will benefit significantly from weight loss.

Scott Benner 47:00
What's the roadblock in making this more well understood in for clinicians,

Speaker 1 47:06
you know, this is a classification that you expect to come in few years from now. Okay, there is a cooking for this classification now, and many countries did phenotype clustering, and it looks like the five phenotype clusters are reproducible in a good way. This will help precision medicine in the future. You know, similar to cancer breast, for example, not all cancer is the same. You know you have genetic based cancer. You have hormonal based you have what you know you can manage it in the very precise way. So

Scott Benner 47:42
we're in the not, maybe the infancy, but we're still in the beginning of understanding diabetes then and the way it gets treated more more over at

Speaker 1 47:50
any point in your history of diabetes, you are beginning to understand diabetes.

Scott Benner 47:55
Damn perfect. That's what I wanted to know. Awesome. And for all the people who give me crap online, ha. Dr hand, he just said that I was right. That's awesome. I'd finally write about something. This is great. Listen. I'll tell you something that maybe you'll find interesting, because you're a researcher. I have so many conversations with so many different people who have diabetes, so I record this podcast sometimes more than once a day, but at least once a day, I've had 1000s and 1000s of conversations with people. Have type one. Who are the parents of type ones with people, have type two. With people, have lot of like, all this stuff. After a while, I step back and I say to myself, like, it's not really the way that we're talking about it. Like, until somebody, until you just said what you said, I have to be honest. Like, I never, I'd never heard it, you know, put technically to me, but that all makes perfect sense to me. After having these conversations all these people, they're not all having the same experience, but we call it the same thing. And you know, it's confusing, and then the human component gets twisted into it, because often type ones don't want to be thought of as diabetic or type two, because type two is so closely related to a thing you did wrong instead of, you know what I mean, like, instead of like it happened to me. And I think that argument is where so much of the the resistance to seeing the differences comes into play. But you really think this will be lay the land in a few years the way, the way you spoke about it, yeah, yeah,

Speaker 1 49:23
absolutely, you know, change. The definition of diabetes has changed over time. Many, many times, sure, oh, at the beginning it was just one diabetes. Then they call it after that fatty diabetes and lean diabetes, and then juvenile diabetes and other tons of diabetes. And then insulin dependent diabetes and insulin non dependent diabetes, and then type one diabetes and type two diabetes. But the future will remove all type one and type two and become the five phenotype clusters. And then once we identify the cluster, and by the way, each cluster develop different complications. Okay. Okay, okay. So I told you there are three mild form, three severe form, and and one mile and two mild form. So for example, severe auto immune diabetes, develop micro vascular complications, diabetes, retinopathy, nephropathy, neuropathy, all those kind of complications, severe answer, resistant diabetes, although they are also severely insulin resistant, they only develop diabetes retinopathy and diabetes neuropathy, okay, mild obesity, diabetes, don't develop that much complications. They can develop maybe cardiovascular complication, if they have this liberty or hypertension, severe insulin resistant diabetes, develop hepatic steatosis and mesh and develop Corona kidney disease at younger age, mild age related diabetes, basically don't develop complication except cardiovascular if they have this liberdemia and hyper and hypertension. So if we know the clusters very well, I can tell you what is a prognosis will look like in each one very soon. I had been using the phenotype cluster for two years or three years now in my practice, and I hope in the future, we can educate primary care physician to identify those clusters and treat them in a proper way. Good luck. That's

Scott Benner 51:15
incredible. I'm so happy you came on. Do you see a world where who are type one who don't have weight issues are going to get in my mind, and this is probably a very simple way of thinking about it, the glps have to start coming in vials, so that doctors can help you with dosing, so that it can help you with the things you need without impacting the things you don't because the like, if you don't need the hunger to go away, But you're seeing a ton of help in other spots, just the PCOS help, right? Which is awesome for people. There are people who have PCOS who don't have weight to lose. So, like, what do they do? Like, how do you imagine that endos are going to mix glps into type one care, I guess is my question.

Speaker 1 51:59
PCOS, by the way, related to type two more than type one. Okay, you know, it's kind of care when anyone but it is mostly related because it's part of insulin resistance, and the best treatment is actually not only weight loss, but also some medication that improve insulin sensitivity, like Metformin. And you know, nearly Most cases of BCS are treated with metformin because it improve insulin sensitivity. There are several other hormone medication that also improve insulin sensitivity, but But mind that BCS, they secrete more testosterone hormone, and actually testosterone make their muscles much better. You know, this is a building a block for building hormone for muscles.

Scott Benner 52:42
If I told you my daughter has a bit of a deeper voice, that wouldn't surprise you, then, like, if she has PCOS,

Speaker 1 52:50
you have to measure the three testosterone level. That's the most important point, and then find the reasons. Maybe the testosterone is not just coming from the others. Maybe some other reasons for higher tests.

Scott Benner 53:03
Okay, okay, this is just the thing that happens. Like I said, I talk to a lot of people, and this comes up a lot with women with who have diabetes, or people who have it in their family, and they're talking about their kids or their, you know, sisters and brothers and things like that. Siblings like, I see the same stuff coming up in conversation. This probably is apropos of nothing in our conversation, but the frequency in which someone with type one diabetes tells me they also have a bipolar person in their family is pretty significant. And I don't know if that has anything to do with anything or if it's just

Speaker 1 53:38
random. Yeah, a lot, you know, if we go to the the whole issue of the causes for obesity and hormonal and neurotransmitter changes and so on, you know, we can spend, you know, 345, hours really, because, you know, I wrote many chapters about obesity in mid e medicine, Even textbook, Sister textbook of medicine, and we are explaining a lot of a lot of stuff, but there is a lot that need to be be done. But let me explain you one, one simple thing. Do you know how many hormone and neurotransmitter controlling your body weight in your brain? I have no idea. 34 hormone and neurotransmitter. 34 and it is a very delicate balance. It's like a web all interlaced with each other. So neurotransmitter that related to mood swings and reward system, there is very small, tiny area in the brain called the ventral tegmental area. You know very, tiny area. They know that very tiny area is called the reward center. Reward center is rewarding you for any behavior that you do, so if you are not addicted to anything to make that area happy. The best addiction and the easiest addiction is addiction to food. Okay, a lot of people start to work on blocking the hormonal aspect in the brain, like endocannabinoid receptors. People kill themselves during the study, really, they get severe depression, and they ended up with committing suicide. You know, the brain is very delicate in relation to all those mental issues and all the psychological issues and body weight in the same part. And that, for that reason, many of the major anti psychotic medications, the major one circle and the bricks and the cost significant to again, significant to again, even we will develop diabetes because, because they work on the appetite center, open your appetite to the maximum, okay, antigenic and the significant amount of food, and again, significant weight. So there is interaction all the time between six hormones. For example, you know, melanocortin pathway, which is responsible for skin. Do you know, if you block that bus way, or you stimulate that bus way, you can change the body weight significantly up and down. You know, there is a lot this is a web interaction in that web has to be very delicate, so we are lucky to have a hormone that's relatively safe and working on the appetite without damaging a lot, but still, psychological issue can occur in that scenario as well. How

Scott Benner 56:37
far do you think we are from glps Being a thing of the past, and what you're discussing being the way that you manipulate your body to do what it should be doing. It

Speaker 1 56:46
has to be on the periphery. It has to be with medication that makes you lose weight and preserve the muscles, okay? And there is actually medication in research now that does a job. It's called the myostatin inhibitor, or active in inhibitor. It actually makes the body fat goes down by 20, 30% and the muscle must go up by four or 5%

Scott Benner 57:08
How come that one didn't take off? It

Speaker 1 57:11
is about, it is about what is called the BMA group map, and it is infusion every month. And you know, one of the big companies now got that medication to combine it with GDP one, wow. What's it called? Again? Pima group app. Pima group app, thank you. And it is a monoclonal antibody. Sorry

Scott Benner 57:29
about that. I'll try it better. I'll just say I'm of the opinion Life is short. My body was not doing what I needed it to do to have a long life. And then I have to tell you, like, I really started doing this, like, these are not things I would have normally done till I saw the end of my mom's life, and I thought, I can't let that be how the end of my life goes. Like I'd have to try something. And this is what was available. My point is, if something better comes along, I would certainly be open minded about it. Can I ask you if you could give me some advice? I've been making this podcast for 11 years now. Can you tell me about a couple of things that are coming along that I should be paying attention to and having more conversations about? Besides what we've talked about now,

Speaker 1 58:14
it is definitely we need to understand exactly how the mechanism for weight loss, because this is not even touch it in our conversation, how we can do a multi disciplinary approach for weight management. And we have been doing it for, as I told you, for very, very long time since 2005 and do you know what b will up till now? Are maintaining weight loss? We publish data on five years, 10 years, and we resented that. And the American Diabetes Association for 15 years, and they are still maintaining 8% weight loss. So actually, multi disciplinary, which is proper nutrition, balanced exercise program and Cognitive Behavior modification and medication adjustment, by the way, for people whose diabetes during weight loss, there must be an algorithm for medication adjustment and then good education. When we do that, it is very expensive, but it works very, very well. And people can maintain weight loss for very long duration, but people just take it very, very simple, I will cut my caloric intake, and I will lose weight. This is a commercial way that commercial weight loss, that can end up with people recycling and recycling and recycle. And when you take GLP one, you are in catch catch 22 if you stop the medication, you will gain all the weight back, right? If you continue the medication, you continue to lose muscle mass. So you have to understand very, very well. And this is advice now that intake of protein is very important with those medication strength exercise is very important, and especially high muscles, quadriceps, same string, gluteal muscles, those are the muscles that get weaker and weaker. So I usually ask my brain. Chance take more protein, more animal protein, in a very efficient way. Or you can even take some shake that has protein, especially the I had a shake liberal diabetes, yeah, and do 2030 minutes of strength exercise every single day. And if you don't do it, don't take the medication you need to do 2030 minutes of strength exercise, especially with your soy muscles. Elliptical, against the resistance. Stationary bike against the resistance, squatting, stretch band under your feet. Rowing machine. Squat is quiet, yes, would a rowing machine help? Rowing

Scott Benner 1:00:35
for rubber? Oh, that's for more rubber and lower

Speaker 1 1:00:37
that's absolutely fine, okay. If it is against the resistance it will be. I'm not all looking for a speed. I'm looking for, yes, muscle action.

Scott Benner 1:00:46
You can't see this because I have a green screen, but I'm putting my hand on a bike. My office is making this podcast a bicycle to keep my legs strong. And if I'm being honest with you, a pet chameleon that's over there that you can't see Perfect, that's all to watch you need keep me relaxed. Yeah. Oh, this is, this is fantastic. I really appreciate this. Let me ask you, like, a question that I think people are wondering, we hear so much that it's the food. Like, are foods bad food? Like, you'll hear people say, like, oh, I went to Italy and I ate pasta and it didn't make me sick, but I eat pot. Like, is our food inherently causing this? Or is it just speeding it up? Like, what is it about Americans in general that that puts us in this situation?

Speaker 1 1:01:29
There are two problems in the in the US, you know, and we did tons of research and nutrition. Let me just to make it very clear, high carbohydrate intake, this one big problem, process the food is another big problem. Okay, if we eliminate as much as we can both, you know, process the food, any food you have in a refrigerator, processed or even minimally processed, you have to avoid whole food is a way to go if you need healthy eating. And then carbohies, and you have three major carbo problem, sugar, whatever, added sugar in dessert, in juice, in whatever, any sugar, wheat flour products, bread, basta, beets, bread, so bagels, P and peas, right? Starchy food like potato, rice and corn okay. If you cut those significantly down, you'll find significant with weight loss and soft drinks that has high sugar as well. So usually, when I tell people in my practice do that, say, Okay, what we eat. Vegetables is okay. Fruits are okay, legumes are okay. Bees, beans, whatever. And then dairy products are very, very beneficial all kind of dairies, eggs, chicken, fish, lean meat, Turkey, dark chocolate, even I have no problem, right? Tea, coffee, cinnamon, you know, there is a lot that people can eat, but not just a low nutrition. Sugar, for example, is just empty calories. There is no nutrient. Nutrient effect, right? It doesn't have any macronutrients or any any value. Would you

Scott Benner 1:03:10
think that I should take as low a dose of GLP as possible as long as I'm not gaining weight? Like, does the dose matter? Like, should I not stay on a higher dose if I'm not trying to lose weight? I'm not just talking about me. I'm talking about me. I'm talking about people in general. Like, should they titrate down to where it's working? But not as much as,

Speaker 1 1:03:27
yeah, you got it. You have to be, if you would like, maintenance, and you don't need to regain weight back be on the main the minimal dose that suppress your appetite, and more the state, is suppress appetite. You don't have to have what, you know, 100% suppression, because, you know there is tolerance to this medication. You need more doses and more. By the way, we don't know the ceiling of those medication you know, like, for example, semaglutide, oral revulsus. You know it is in the market, four, seven and 40 milligram, but the company is testing now, 2590 or 100 or 75 milligram. So they are testing, we don't know what is a ceiling for those medications.

Scott Benner 1:04:08
Rebels is an example. They're seeing what's happening with the injected and they're thinking they can maybe get that pill to a point where it's in pill form and helping people.

Speaker 1 1:04:18
It will not work with I don't think that will seem like, look like I guess. But there are other medication coming in the future in oral format, synthetic, non peptide, small molecule, that will cause significant weight loss and improvement in diabetes as well. And this will Bush away all the injectable, yeah, that's good. I don't think that injectable will be the future. They will be only for people with very, very high BMI, but oral will will come in the future. And the prism, how

Scott Benner 1:04:47
long do you think for that next year? No kidding, that's awesome. I actually told my daughter the same thing, as odd as it might sound to some people, my daughter has a fairly significant needle phobia. It's pretty traumatic. Or to have to do this every week like she does Okay, putting on her insulin pump and her CGM and everything, but she's been banned with needles since she was little, and she struggles through it because she sees how much it's helping her. And I kept telling her, I'm like, Look, I think very soon this oral medication, I think it's gonna do the same thing, and you can get off of this. So it's it's comforting to hear you say that too. Thank you. Is there anything I haven't asked you about that I should have? I actually think I could talk to you all day, but I assume you have a life to get back to. It's wonderful that we've met. I'd love to invite you back on if you ever have anything else you want to talk about. This was fantastic, but anything we didn't talk about,

Speaker 1 1:05:34
we need another podcast to talk about nutrition. Yeah, because we didn't, we didn't spend enough, enough time talking about nutrition. Those nutrition, you know, people start to understand the nutrition and the history of nutrition, and how this stuff changed over time, and why we're eating what we're eating right now. But you know, this is very important. Maybe, you know, it's a very, very big topic to discuss.

Scott Benner 1:06:00
I'd be happy to also, let me tell you that. I guess you'll be happy to hear that just this morning with the nutritionist, who's also a CDE and a 35 year type one that I do some podcast episodes with. We were just talking this morning about how the next series we're going to do is about nutrition. We're going to do a whole series about it. I'd love to do an interview with you and fold it into the series, that'd be awesome. Absolutely thank you so much. All right, I'm gonna say thank you for now, because this was absolutely terrific. Ask you to hold on for one second, and then I'll set something up with you for something else. Hold on one second. Thank you

Unknown Speaker 1:06:33
again. Okay, thank you. You

Scott Benner 1:06:44
if you'd like to wear the same insulin pump that Arden does, all you have to do is go to omnipod.com/juicebox, that's it. Head over now, and get started today, and you'll be wearing the same tubeless insulin pump that Arden has been wearing since she was four years old, touched by type one is hosting their very first steps to a cure walk. And you can register right now to participate. Touched by type one.org Go to the Programs tab, click on Steps to a cure and sign up today. You can sponsor walk or volunteer. Check it out.

Are you starting to see patterns, but you can't quite make sense of them. You're like, Oh, if I Bolus here, this happens, but I don't know what to do. Should I put in a little less, a little more? If you're starting to have those thoughts, you're starting to think this isn't going the way the doctor said it would. I think I see something here, but I can't be sure. Once you're having those thoughts, you're ready for the diabetes Pro Tip series from the Juicebox Podcast. It begins at Episode 1000 you can also find it at Juicebox podcast.com up in the menu, and you can find a list in the private Facebook group, just check right under the featured tab at the top, it'll show you lists of a ton of stuff, including the Pro Tip series, which runs from episode 1000 to 1025 I want to thank you so much for listening and remind you please subscribe and follow to the podcast wherever you're listening right now, if it's YouTube, Apple podcast, Spotify, or any other audio app, go hit follow or subscribe, whichever your app allows for, and set up those downloads so you never miss an episode, especially an apple podcast, go into your settings and choose, download all new episodes. The episode you just heard was professionally edited by wrong way recording, wrongway recording.com, you.

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#1410 iLet User Experience

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Dakota moved from Omnipod 5 to iLet to lessen his carb counting burden.

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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.

Dakota 0:00
Hi. My name is Dakota. I was on Episode 1198 and today I'm here to talk about my switch from Omnipod five to the islet bionic pancreas. You

Scott Benner 0:23
you, Hello friends and welcome back to another episode of The Juicebox Podcast. Nothing you hear on the Juicebox Podcast should be considered advice medical or otherwise, always consult a physician before making any changes to your health care plan. If you are the caregiver of someone with type one diabetes, or have type one yourself, please go to T 1d exchange.org/juice, box and complete the survey. This should take you about 10 minutes, and will really help type one diabetes research. You can help right from your house at T 1d exchange.org/juice, box. Don't forget to save 40% off of your entire order at cozy earth.com All you have to do is use the offer code juice box at checkout. That's Juicebox at checkout to save 40% at cozy earth.com when you place your first order for AG, one, with my link, you'll get five free travel packs and a free year supply of vitamin D drink. AG, one.com/juice box. Hey everybody. I know there's so many episodes you might be like, I don't know where anything is, but if you go to Juicebox Podcast com, or go to the private Facebook group and look in the feature tab, you'll see a complete list of all the series that exists within the podcast. Today's episode of the juice box podcast is sponsored by the Dexcom g7 and the Dexcom g7 warms up in just 30 minutes. Check it out now at dexcom.com/juice box. This episode of the juice box podcast is sponsored by us Med, us, med.com/juice box, or call 888-721-1514, 887211514, get your supplies the same way we do from us. Med, hi.

Dakota 2:07
My name is Dakota. I was on Episode 1198 and today I'm here to talk about my switch from Omnipod five to the islet bionic pancreas. Awesome.

Scott Benner 2:18
Welcome back. Thank you, of course. What'd you say? 1198, Yep, let's see what we call that one hitting cows, one of my favorite titles. Do you remember like when you look back on that? I mean, that went up. Would you say May 1620, 2322 I don't even know 24 excuse me, just this past year, I've now lost track of everything. When you think back on that episode, it's been year and a half since you since it's been up. So it's been two years since you recorded about Wow, is it 2025 Dakota, how about that? Yeah, you heard me get confused there, huh? Like I said two years ago, and put myself into 2022 when you think back on that conversation, like, what do you think the overall message is like, if I if you didn't know you and you listened to it, what would you say? Like, this is what the code is talking about.

Dakota 3:13
Probably along the lines of, this is a young guy who's just starting his journey throughout diabetes and just learning everything you can, yeah, and

Scott Benner 3:23
then what's changed for you since you recorded that two years ago? Like, what did you learn? What did you try? What did you decide?

Dakota 3:33
Uh, perfection is very hard to achieve,

Scott Benner 3:37
for sure. Were you trying at first?

Dakota 3:39
Yeah, I was trying my hardest. I got burnt out very quickly.

Scott Benner 3:44
So what was like, functionally? What did that look like? What did trying look like? Counting all my carbs, dosing as often I could, pre policing, corrections and it all just, it got to it got to be too much,

Dakota 4:00
yep, thinking about what I'm gonna eat constantly,

Scott Benner 4:03
when it felt like too much. Did it stop you from doing it, or did it just make the whole thing drudgery? A little bit of both? Okay, yeah, I dreaded diabetes, and

Dakota 4:17
at the same time I wanted to do my best, but to a point I just

Scott Benner 4:23
couldn't. Is what it felt like. So did it turn into like, no matter what I do, this is how this is gonna go. So why bother?

Dakota 4:31
Yeah, and I was seeing like, 40 to 400 in the same day, multiple days

Scott Benner 4:37
in a row. And did you think you didn't understand what you were doing? Or do you think that, how do you get to 400

Dakota 4:45
so I think I was honeymooning in the beginning, okay, and then my insulin needs just started increasing, and I didn't know the first place to kind of begin,

Scott Benner 4:57
I see. So you're now using incor. Settings, but making the same steps, and then you're not getting the outcomes you were accustomed to exactly, all right? And then can I ask why you didn't adjust the settings? I was

Dakota 5:11
adjusting the settings the best I could by myself. I think at the time, I was not seeing an endocrinologist, so I was between endos and waiting for a new one to come into the office. So I was just with my primary care, and she was doing the best she could, but didn't know the Omnipod five system.

Scott Benner 5:29
Yeah, remind people the reason your episode is called hitting cows is because you live in the middle of a field the middle of the country. Is that correct? Pretty much, yeah, you're pretty much seemed defeated. Would you like to come out here and see the city Dakota? Is that your

Dakota 5:46
as long as it's not snowing, the

Scott Benner 5:48
snow horrifying the weather is. So I don't want to talk about this, but the weather has become so strange over my lifetime. I don't know if it's just changing, and I'm locked into what I remember as a child. But I mean, it's January 2 here, and two days ago, I walked outside in a T shirt. It was like 56 degrees, and now the wind is blowing and it's freezing. I don't understand what's happening. I don't know what there used to I feel like there used to be a smooth transition in and out of seasons, but I don't think that's gonna happen anymore anyway. All right. Well, you know, you can always come out and visit come out and visit, can't stay with me, but you know what I'm saying? It's yeah, I just want space. So okay, so you get this feeling you're not getting reasonable help with making the adjustments you're trying. But what's happening are you just not making them quickly enough, and then days turn into weeks, and then you make another small adjustment, but it's not enough again, yeah? Or I'd adjust too much, and oh, it would Yeah, so then I'd dial it back a little bit. Oh, man, I just couldn't find the right place to be at, yeah, but I'm sorry. And so even on an automated system like Omnipod five, you didn't have your settings right, and it just wasn't

Dakota 7:01
working exactly. Yeah, the settings are very important on that system. They

Scott Benner 7:05
certainly are so in a normal world, a world before your new pump, you would have probably continued on, figured it out, reached out, helped people, or maybe just tumbled further into despair. Like, I don't know. I've seen it go both ways for people, but instead, what did you do? You can manage diabetes confidently with the powerfully simple Dexcom g7 dexcom.com/juicebox, the Dexcom g7 is the CGM that my daughter is wearing. The g7 is a simple CGM system that delivers real time glucose numbers to your smartphone or smart watch. The g7 is made for all types of diabetes, type one and type two, but also people experiencing gestational diabetes. The Dexcom g7 can help you spend more time in range, which is proven to lower a 1c The more time you spend in range, the better and healthier you feel and with the Dexcom clarity app, you can track your glucose trends, and the app will also provide you with a projected a 1c in as little as two weeks. If you're looking for clarity around your diabetes, you're looking for Dexcom, dexcom.com/juice box. When you use my link, you're supporting the podcast dexcom.com/juice box. Juicebox head over there. Now, eventually,

Dakota 8:24
I got in with my new endocrinologist, and he looked at my like my clarity report from Dexcom, my ANC kept rising over like six to nine months, and he had suggested that I should try the islet or the Medtronic 780, G, and I was apprehensive about Medtronic. And I had heard good things about the islet and what it can do and what the technology is and where it's headed.

Scott Benner 8:53
Tell me what made you apprehensive about Medtronic, just the things I hear or read about online. Okay, so some you heard something somewhere, and it was not a positive thing. And so you thought, okay, that's not a good option. But then you heard something positive about eyelet. Is that what happened? The more

Dakota 9:09
I looked into it, the more it seemed like this is what I wanted. This is what I needed. It was a lot for, like, mental health reasons,

Scott Benner 9:18
more of the promise of what eyelet is. That was what was attracted to you. Yep. Got you tell people how old you are? 2727 Well, used to go to we're all getting old. Are we gonna be 54 this summer? That's why, that's why it's hard to get the young people to listen. You know what? I mean, I don't have any hip things to say. I don't know any of the new phrasing for anything like,

Dakota 9:40
like you. I mean, I know of it, but I don't know what any of it means. You

Scott Benner 9:44
don't you don't use it. No. So funny, when an older person tries to throw in a word, you're like, Oh, Mom, stop. It's over. Mom, don't do it again. Okay, so the doctor is the one that says eyelet to you. I was hoping you heard about it from me or. From I had already known about it at that point. Well, that's important to say, just in case they want to be a sponsor, one day, they'd be like, Oh, Dakota. Heard about eyelet from Scott, and that's why, when his doctor suggested it, he was like, Okay, I'll try that. Is that about right? Yeah, pretty much. Excellent. Good job, Dakota. Now. Okay, so how long have you been using it nine months around there. That's how long it takes to make a baby. Yeah. Oh, wow. Your Isla could be giving birth right now. Let's take steps through it. The doctor suggested to you, do they hook you up with a company? Does they come to the house like, how do they do it? Isla

Dakota 10:37
gave me a cold or bionics? I guess it would be. They gave me a call, got me scheduled. Well, first they ran my insurance and seen if I was covered, found a place to send it to me from sent it to me, and then I had to wait, I think, two weeks before I could do a training session through zoom. Okay, because I didn't have anyone local.

Scott Benner 10:58
How was it training? Virtually? Did you have a problem with it, or was it pretty good?

Dakota 11:02
So when I was like, putting on my set, my insulin set, my infusion site, they couldn't see it in the camera, so they were like, I think you're doing it right.

Scott Benner 11:13
The sounds you're making sound right? Yeah. Okay. So not perfect, not being in person, but it worked out. Yep. Okay. Walk people through it. How do you set up an eyelet so you're

Dakota 11:22
gonna take it out of the box, and to turn it on, you have to set it on the charger, because there's no power button. And then when it turns on, it asks you how much you weigh, and that's the only setting that it needs. Did you tell

Scott Benner 11:35
it? Did you lie to it? Were you like, Well, I'm just kidding. I

Dakota 11:39
wanted to, no, I wanted to. Oh no, I'm,

Scott Benner 11:41
you know, I'm more, like, 20 pounds less than that, exactly. That's interesting. There's no power button, so you have to, you set it on the on the charger, that brings it to life, charges it up, and then on a screen, it asks you how much you weigh, or on an app on the screen, on the screen, and you like, I weigh this much? Islet go. And that's it,

Dakota 12:01
yep. And then there was something with, I think my Omnipod had ended earlier that day, so I was off insulin for a few hours, and my blood sugar was, I think, in the three hundreds when I started training, okay, but it quickly came down, and it was like 225 by the time we ended. How long was

Unknown Speaker 12:21
the training? About an hour.

Scott Benner 12:22
Okay, you pop that thing on, it makes a Bolus, and an hour later, you're falling already, yep. Now take me back to that moment right before you know if you're gonna like eyelet or not. And we don't even know if you like it yet, because we haven't gotten that far. But do you have that like, uh, there's a piece of tubing. Now I'm connected to a thing. Did you have that feeling? I did.

Dakota 12:44
Yeah, I wondered how I was gonna sleep with it, or I was gonna hook it up to if I was gonna snag it on doorknobs.

Scott Benner 12:53
Did it end up being an issue for you? A couple

Dakota 12:55
times it's fallen and ripped out, maybe twice. There was one time I was holding it in my mouth and I cracked the screen with my teeth and I had to get a replacement.

Scott Benner 13:09
Diabetes comes with a lot of things to remember, so it's nice when someone takes something off of your plate. Us, med has done that for us. When it's time for art and supplies to be refreshed. We get an email rolls up and in your inbox says, Hi, Arden, this is your friendly reorder email from us. Med. You open up the email, it's a big button that says, Click here to reorder, and you're done. Finally, somebody taking away a responsibility instead of adding one us. Med has done that for us. An email arrives. We click on a link, and the next thing you know, your products are at the front door. That simple us, med.com/juice, box, or call 888-721-1514, I never have to wonder if Arden has enough supplies. I click on one link, I open up a box. I put this stuff in the drawer, and we're done. Us. Med carries everything from insulin pumps and diabetes testing supplies to the latest CGM like the libre three and the Dexcom g7 they accept Medicare nationwide over 800 private insurers, and all you have to do to get started is call 888-721-1514. Or go to my link, us, med.com/juice, box. Using that number or my link helps to support the production of the juice box. Podcast. Did

Dakota 14:32
you tell them? That's what happened? I told them the screen was broken. Hello,

Scott Benner 14:35
beta, bionics, I was chewing on my pump. Would you please right now? They're listening. They're like a kid snooker at us. So you're saying couple things that can happen. This is not specific to eyelet, but like, you have the pump in your hand, you drop it, the tubing tenses up, it yanks out your infusion set. Yep, okay. And one time you ran out of hands, put it in your mouth, bit down too hard and broke the screen. Yeah. Yep. Do you have a unusually powerful bite

Dakota 15:03
I am known for clenching and grinding

Scott Benner 15:09
my teeth. Are you here to ask the people of beta Onyx to please make the screen a little thicker so you can chew on it some more, right? And I have to admit the sleeping part. You know, you guys know if you guys know, if you listen like, Arden has been wearing an omnipot Since she was wearing a pump, so since she's four, which means she's coming up on 17 years with it. Is that right? Jeez, yeah. My God, I am old. The sleeping thing hits me right away. I'm like, How do you like sleep with a thing attached to you by a cape, like you wake up and it's like, I almost said something ridiculous, Dakota, that would have been funny between you and I, but not while we're making a podcast. But does the tubing get wrapped around things?

Dakota 15:50
Not necessarily. It'll get wrapped around, like the clip on the pump, if it falls off my waistband, and then it'll get tangled up in itself. Yeah.

Scott Benner 15:59
Is it cumbersome when you're I don't want to dig into your life too far, but like with the ladies or anything like that, you just disconnect. You disconnect to people, yeah, to do that part. Okay? You find that all okay, yeah, all right. Nine months later, you look back on how you felt that day. Has it been a like would you characterize it as a problem or just an adjustment. Just an adjustment. Okay, all right. So day one, it's on. Blood sugar starts coming down. What do they explain to you? Is happening? Is it figure like, you know what I mean? Is it figuring things out? Is it, you know, what's the explanation you got? So

Dakota 16:37
the first week you're supposed to eat like you regularly would, which I mean that in itself, is a loaded statement, so it can learn you and learn like you're eating, styles and how much insulin you need for each meal. Because when you dose, you choose if it's breakfast, lunch or dinner, and then if it's a usual amount of carbs, less or more,

Scott Benner 17:00
when it asks breakfast, lunch or dinner, is it asking about time of day or type of meal?

Dakota 17:05
That is a good question, and I ran into that when I was eating dinner for breakfast within the first week of having it. So I had messaged my trainer, and she said to choose breakfast, because it's a breakfast meal, but it's a different type of day. I'm recording an

Scott Benner 17:22
episode, you know this. I'm now talking to the people who are listening. I'm recording an episode tomorrow with someone from beta bionics. I'm going to write that down as a question for me is, how did I just put that? Is it the time or type for meals? It's good question. Scott, thank you. Okay, so it must have felt like a week long. Pass about eating, right? Because your goal wasn't good blood sugars. Your goal was just eat, be normal and let the thing figure things out. Yep, yeah. What'd you do? Would you eat?

Dakota 17:53
That was the same week I was going on vacation. Oh, jeez. So it wasn't really a good week to start the eyelet,

Scott Benner 18:01
because your eating was not common for you,

Dakota 18:04
right? Yeah. But at the same time, I wasn't eating three meals a day, and I knew when I was on vacation, I would be eating more consistently because I was going to be with friends and family. Okay,

Scott Benner 18:16
all right, so you go through that process, it learns how you eat. I guess that's the phrasing, right? And then that's it. Like you get up in the morning, you go, This is breakfast. It's what are the three questions, again, is

Dakota 18:29
size of its uh, usual, less or more? Usual? Less

Scott Benner 18:33
or more than normal? Is that right? Is that the phrasing? Okay? So you get up in the morning, you're like, I'm having breakfast. This is usual. Do

Dakota 18:41
you Pre Bolus? I don't Okay. And I thought I read somewhere that it's not recommended that you do with the pump, because your blood sugar starts going down and then it backs

Scott Benner 18:53
off. Because it backs off. So do you get too high after you eat? But it brings it back. How does it end up working? Occasionally,

Dakota 19:00
that does happen. It's kind of a task in itself to think about. Is this my usual amount of carbs, or is it more Okay? Something that I struggle with still is deciding the amount of carbs

Scott Benner 19:13
to choose. When you're faced with that question, you think I don't know. Sometimes,

Dakota 19:18
sometimes I'll just press a button and go on, because I know it'll correct me back down, or do whatever it needs to do, I see. But if I am thinking about it, and I say actively trying, I usually don't go high after meals, it'll keep me within range. What's the range? 70 to 180

Scott Benner 19:38
Okay, so after a meal, if you don't go over 180 you feel like this has been successful. Yeah. Okay. How long does it take for it to bring it back to 80? Like, where, actually? Where does it hold you, generally speaking, away from food and insulin. So

Dakota 19:52
there's a higher target and a lower target. I believe there might be three targets. There might be a usual two. Yeah, I'm pretty sure the number is 120 is where it's supposed to target you back down to

Scott Benner 20:06
and do you stay at 120 or how do you where do you sit? Stable?

Dakota 20:09
My average is like, 141 50.

Scott Benner 20:14
Okay, where is it? What was it on Omnipod five, when you had your settings all messed up? Oh,

Dakota 20:19
I know I was in range for like 40% of the day,

Scott Benner 20:23
between 70 and 180 Yeah, and now, now,

Dakota 20:27
on a good day, I'll hit like 90% and I'd say I'm about 70 to 80% four days out of the week.

Scott Benner 20:38
How often do you get low where you have to save yourself throughout the day. Sometimes I'll get a couple lows. They're usually nothing like intense. Are they after meals? Like couple hours after a meal?

Dakota 20:52
Yeah, and usually I'm working at the same time, so there's some activity involved.

Scott Benner 20:57
I see when you were using Omnipod five your goal. What were your goals that you couldn't get to?

Dakota 21:04
I had it set for 70 to 150 and every time it would go over 150 I would like put in a small correction, if it would let me through the basal calculator. Yeah,

Scott Benner 21:16
that. That was the game, by the way. I think Bolus calculator, I tell you. I just told that to Arden yesterday, so, like, you know, she's getting older now, obviously. And I said, you know, we had your goal, like, your your alarm was lower. And I said, but I think as you get older, I think it makes more sense to bring it up a little bit. And I said, I think maybe we should start at 150 like, we don't want your blood sugar going sugar going like, like, what I told her was, I think if she assumes a miss at 150 after a meal and makes an adjustment as she's approaching that that'll be like, a good place to begin for her to, like, find her own rhythm with it. You know what I mean? Yep. So that's what you were doing. You were at 150 you're like, oh, it's, I'm getting too high. Give myself insulin. How often do you have to inter Well, it's not just intervene. You can't intervene, right? So, like, I was gonna say, like, how often does islet put you over 180 after a meal? And you're like, oh, I need more insulin, but you can't Bolus with it. Is that correct?

Dakota 22:16
That's correct. And if you try to, like, announce another meal afterwards, and that'll just confuse the algorithm. You

Scott Benner 22:23
can't lie to it about carbs. Yep, exactly. Okay, so how frequently do you find yourself thinking, I wish there was a button on here that gave me more insulin. Maybe once a day. You get stuck, too high, too long, ever?

Dakota 22:38
Yeah, every once in a while, if I, like, Miss real big. So like, this morning, well, while I was sleeping, I ran out of insulin in it, so it holds 160 units, and I think I ran out like, four hours before I woke up.

Scott Benner 22:57
Dakota, that Mm, hmm. Was very parental. I don't know if you heard it. Yeah, I could tell Yeah. Thank you. I don't I please, please change your pump before you go to bed. Is it a cartridge or do you fill the pump?

Dakota 23:08
It's a empty cartridge that you have to fill.

Scott Benner 23:10
It's a coda. How long does that even take? So and

Dakota 23:14
I got this little container where I can do multiple ones at a time and stick them in the fridge. So you're telling

Scott Benner 23:19
me that you neglected to walk to the refrigerator before you went to bed last night and risk DKA over that.

Unknown Speaker 23:24
Yeah, yeah.

Dakota 23:29
Dakota, listen, I didn't, I didn't know that I was even getting low on my insulin before I went to bed. That's not something I checked regularly. I

Scott Benner 23:37
would like you to check it regularly. I know. Okay, so, yeah, no, it was recently. We were, where are we going? I think we were going to see wicked. Have you seen wicked? No, no, I didn't imagine you had we were going. I was going with the girls to see wicked. And we're like, you know, like sitting in the kitchen. People are like, pulling on shoes and coats and stuff like that. And Arden goes, oh yeah, this pumps almost out of insulin. Good thing I looked like, yeah, good thing while we're sitting in the movie that cost $50 for three people to watch. And like, beep, beep, beep, beep. And like, Wait, we're not near our house. Like, so we changed pump, or she changed her pump, obviously, but then we brought insulin with us, which I think is a thing I would have I think I would have done that. I don't like going to places where, if something happens to a pod, it ruins the experience, if we don't have one with us. Does that make sense? Yeah, yep. Okay, so I have questions, I guess. What are they? Is it worth it?

Dakota 24:35
Like I think, I think so for me, a big part of it, again, was for my mental health. So when I was starting to feel defeated with the Omnipod five, I would like rage Bolus, and sometimes it would be before I'd go to bed, which is not a good idea to do. No,

Scott Benner 24:52
you're making a list of things I don't want you to do here. It's okay. I like your honesty. Dakota. I appreciate you. Yeah. Okay. So it's worth it, because you were having other challenges, and they don't exist anymore. I feel like they don't. That's awesome. Yeah, did you exchange one problem for another? Like, what, I think my wife, the only reason my wife doesn't leave me. She's like, you know, the devil you know. But have you exchanged one problem for another. Like, did you fix it one set of issues, but you have a different set now.

Dakota 25:24
It feels like when my when I need to work on my mental health, my diabetes, takes a back burner. So yeah, in a way, trading out one problem for another, and it kind of goes back and forth between those two,

Scott Benner 25:37
like a slow game of tennis, yeah, yeah. The ball's on that side of the court for a while, then it comes back over here. Yep, I don't remember from our last conversation, and I'm going to apologize for that, but do you have any anxiety or any stuff like that going on?

Dakota 25:52
I did anxiety, depression. I've recently been diagnosed with ADHD, so I'm starting to deal with that too. Sounds fun, yeah, but the medication for that has helped with my anxiety a lot. And I think just like the constant mind running

Scott Benner 26:11
ADHD medication helped you with your anxiety, yeah. What's the medication?

Dakota 26:16
I'm on the lowest dose of Adderall, okay, just

Scott Benner 26:19
a little. What is that? That's actually, you live in the Midwest, you must know, what is it? Yeah, what?

Dakota 26:27
It's a D, it's a D amphetamine, salt combo.

Scott Benner 26:29
Okay, all right. Have you had any, um, it's the word I'm looking for, like, adverse events from it. Or do you, do you like the impact

Dakota 26:36
of it? No, I like the impact of it. Yeah. Is that a daily pill? It is, yep, and it's an extended release. So I just take it once in the morning just

Scott Benner 26:44
to avoid other medication with it. Or can you take it with other stuff, like vitamins and things? You know, you're 27 you don't take vitamins, but I would take vitamins. Dakota, thank you. See now look at that. See now you get the now the parental like, Happiness comes back. Awesome. Thank you. Just the vitamin. I just want you all taking a vitamin. By the way, if you buy a vitamin, it says that the serving size is two a day. Don't just take one and tell me you're taking vitamins. That doesn't count. Awesome. Oh, that's excellent. So are you able to take them together?

Dakota 27:13
Yeah, I haven't had any issues, and they didn't tell me to avoid anything while taking it.

Scott Benner 27:18
Well, I think we all know that they Dakota don't always tell you the things you need to know, so we'll find out to be sure. Excellent. Okay, so you announce the meal, and you never think about it again, or you do you think like, also, what CGM are you wearing with

Dakota 27:35
it? I'm on the g7 now. Okay,

Scott Benner 27:38
so you announce a meal, but it's pancakes, and now it's Beep, beep, beep, beep, beep, beep, that like, are you not? Is there no like, anxiety of like, oh my god, there's something happening that needs attention, but I don't have any power. It

Dakota 27:53
was very difficult at first. So at first I did. I would announce, like, a smaller meal afterwards, and then later, like, the next time I'd announced that meal, it would think I would need less

Scott Benner 28:05
insulin, okay? And so that's what you're not

Dakota 28:10
supposed to trick it, and then it would just get worse.

Scott Benner 28:13
Okay, yeah, so you felt the pressure. You're like, I just had five carbs and or a small you can't do that. You'd be like, I just had a small lunch, and then it just messes things up worse. Yep, okay, so then that doesn't fix the problem. Then, right? Like, how do you manage that feeling of, I know I need more insulin

Dakota 28:33
first. It was really hard. Now I just wait for the pump to do its thing. I've been on it long enough I've gotten used to giving that,

Scott Benner 28:42
did you you've done with that? The girl in that Frozen movie said, you just let it go. Let it go. Yeah? I like how you started laughing. You're like, Oh, I know what he's talking about. So you just, you were able to let it go, yeah? What's your a 1c, today, I was supposed

Dakota 28:56
to have an appointment at the beginning of last month that I missed. I slept through it. Dakota.

Scott Benner 29:01
What's going on there? Uncle's got the visit what's going on? Okay, it's

Dakota 29:07
rescheduled for like, in a week or two, okay, but my GMI is right at seven, and before that, my a, 1c was 6.8 before I started islet, it was 7.6

Scott Benner 29:22
Well, all right. I mean, that's a win. Yeah, right. No way around it. I mean, I'm listening to other people online talk about it, and then some of the things they're concerned about is, like, could you make the target lower? Like, have you had that thought

Dakota 29:35
I have? And then at the same time, the algorithm can be pretty aggressive at times. Okay, there's times like you don't really see insulin on board, but if you go into the settings, you can see how much it's dosed you. And there's been times when I'll look and there'll be, like, 18 units, and I'm like, oh, geez, that's a lot of insulin. So. For me, I would never do something much myself, but it's usually when I have candy after a meal, okay? And I spike, and it catches it real quick.

Scott Benner 30:09
So do you if you had a meal, like a regular meal, you're like, This is a normal dinner, and then an hour later, you're like, candy canes, Christmas. I love Santa. And you started, do you like say there's no snack button? Is there?

Dakota 30:24
No there's not. You're supposed to select the last meal you had and choose less than

Scott Benner 30:30
so if you said dinner normal, but then you're like, I'm gonna have two candy canes. That's dinner less than, right?

Dakota 30:37
And then the way the algorithm works is it gives you 75% of what it wants to

Scott Benner 30:44
upfront. So do you end up not telling it about the candy cane every once in a while? Yeah. Does that seem I should say often? Yeah. I was gonna say that seems sketchy to me. Yeah. Is that even a word the young people use anymore? No, right? That's over now. It's sketchy over, I think so? Yeah. Do you find yourself thinking I have a lot of questions about this? Or do you find yourself thinking I'm in a rhythm This is working. I'm done thinking about how eyelet works, a

Dakota 31:13
little bit of being done and thinking about how eyelet works. But there's still, like questions I do have, yeah, yeah.

Scott Benner 31:21
I mean, I've seen people online, like, because I'm gathering up questions for them, and they do feel a little like, hey, it would be great if it did this. It would be great if it the target was lower. It would be great. Like, so I think people are having the same experience you're having, right? Like, if they were struggling, if they were burned out. If they were like, You know what, this is just gonna keep getting worse on my mental health. Not here for this. There's a ton of win in islet, right? And, yeah, also, you were a person who was, like, actively trying, even though you weren't having a ton of success. And, you know, your settings were wonky. You were actively trying. I think they're also thinking about this not, you know, I don't think it's just for people who are just like, I don't know, I shoot my basal so I don't die and I don't do anything else, right? But like, that's going to be, I imagine, a huge benefit for people that are in that boat, because look at you, 781 say, boom, you know, right? Also, you got to imagine, I don't know if this is true, but ADA says seven, right? That's what they're saying right now. So it sounds like they probably set the pump up to shoot for seven, and it's giving you a seven, yep, which I'm happy with. Yeah. So the expectation here for me is like, if they could shoot for seven and hit it, maybe they could shoot for six and a half and hit or whatever else, like, maybe they'll and that's one of the questions I'm gonna have for them. Like, is there gonna be a time in i Let's life where you can turn it on and say, I weigh this much and I want an A, 1c, that's 6.3 like, Do you know what I mean? Like, why? Why not? Right? Yeah. Okay. Who wouldn't you suggest uses it? Like, if I said to you, should Arden do this? What would you say?

Dakota 33:03
I don't think Arden should do it. You guys seem like you adjust your settings quite frequently, yeah, or just, you know, like little tweaks at a time, right, right? You can't do that on the islet at

Scott Benner 33:14
all, yeah. So you have to really give away all your control. And you hear people talk about how you had to give away a little bit of control with Omnipod five, because it really doesn't tell you what it's doing, right, right? So was this more so or different? Definitely more more. Okay, yeah, so control freaks are not going to love this. I don't think so. Okay, gotcha all you Type A's out there. Hmm, how you gonna do it? Oh, we're not mocking people for being type A and being all like involved. It seems like a leap to me, like, for a person like I interviewed a guy yesterday. He is, first of all, by his own admission, way too involved with his kids diabetes. But like, if I just said to that guy, Hey, we're gonna slap this thing on now, I don't know if he'd have a moment of Zen where he's just like, Thank God, I needed this, or if it would make him pull his hair out. I can't figure that part out. Be interesting to see with the the meal announcing. Is there a chance, or has it happened? Are you concerned? Could you get burned out on this? Like, could this new normal at some point become burdensome to you? Do?

Dakota 34:25
I think the most burdensome part is changing out the infusion set. There's a lot of parts and steps. So as it mean, it's, it seems quick, but it's just you got to think about it, and the rest of it, you don't really have to think about an

Scott Benner 34:41
omnipot is so automatic, like, it's so easy, yeah,

Dakota 34:43
yeah, yeah, omnipot is a lot more user friendly in that aspect. Somebody,

Scott Benner 34:47
the person who designed that, like, I've interviewed him already, I was gonna be but, like, she's genius. You know what I mean? Like, peel, stick, button, done. Get out of here. You know? I mean, like, awesome. And two, it's funny, too, 200 units, everybody, and not everybody, but a lot of people, like, they'll bitch up a store about omnipotent you know, only holds 200 units, but you went from 200 to 160 Are you changing your site with eyelet more frequently than you were changing Omnipod? No,

Dakota 35:16
I wasn't filling up my Omnipod. Oh, all the way completely. And I had my prescription to change out every two days if you needed to, so I was changing it every two days. And now with Isla, I make it to the third day, but I don't make it through the third

Scott Benner 35:32
day. Okay. Is that a problem for you? No, no, because you're accustomed to changing every two days to begin with. Yeah. Why'd you, like, every two days with Omnipod? Was it for, like, having a nice site that was working? Yeah, yeah, I see that Arden does really well riding pods till the end, like, as far as, like, absorption goes. But if she didn't, she would, I mean, I would definitely ask her to change more frequently. There's no way she would do that. Yeah, I could see that being a problem. Sorry, I'm drifting off in my own head. It's now a podcast between me and my brain. Sorry, what don't I know about it that I should be asking you, what don't I know? Because I'm not using it like what? What are the things that you love about it? What are the things that you hate about it that we haven't spoken about,

Dakota 36:22
right? So there's no activity feature or exercise it's recommended that you either disconnect or take in carbs before

Scott Benner 36:33
you exercise. So

Dakota 36:36
I don't like exercise regularly, but when I am being more active, yeah, I get low pretty quick.

Scott Benner 36:44
Okay? Because it doesn't know and there's no way to tell it, right? I'm gonna run around now. Yeah, that is one of the concerns I've heard, especially people with like, little running around kids get what I mean, those little, like, whirlwind kids, yeah, that they're like, Well, how do I like this thing's out there doing what it's doing. I mean, I've heard people say the same thing about Omnipod five. Actually, any of the, I guess, the algorithms that are kind of built on this idea of, you know, like, this is how we do it. Like, you're not going to get a ton of, like, user control, and then if your situation changes greatly, sedentary to active, active to sedentary, then there's problems and so, so you would like them to put some sort of an Activity button on there. Yeah, just pause.

Dakota 37:32
There's a pause button, but there's no Activity button.

Scott Benner 37:35
Does it feel unfinished? A little bit like it's still a work in progress. Yeah, they feel like you bought a beta sometimes.

Dakota 37:45
Yeah, from beta bionics. Oh, I didn't mean

Scott Benner 37:48
that, but awesome. Look at you making dad jokes. Good job. I'd like to see you put that effort into changing your pod before you go to bed or you're pumping. I mean, like, Listen, I'm not digging at them. Like, I think they're great. It's possible they might come on as an advertiser at some point, like, but I'm just saying, like, does it feel like, like, it's an early product where they're just like, hey, you know, it would also be cool. Like, and do you know, as a user, are they thinking about that stuff? Is there any communication from them or stuff online that makes you feel like they're moving in a direction

Dakota 38:21
I'm not sure. As a user, I don't, I haven't heard anything from them about it. Yeah, it's not but since I've got so the one I have has a black and white, a black and white screen, and they've since come out with a smaller one that has a colored screen,

Scott Benner 38:36
colored screen, saved tandem. Oh, did it? Oh, it absolutely did tandems, a rags, the richest kind of insulin pump story. They were on their way. Like, I've heard like, this is years and years and years ago, I want to be clear, but I heard that they were starting to make internal decisions about maybe not selling the pump in America anymore, and like it was getting dicey, like it didn't look like it was going to take a foothold. They came out with that color screen, and people were like, Whoa, color. And that was it. Now they're here. It's like, it's interesting. What changes the experience for people? Yeah, yeah. So do you prefer the color screen? So

Dakota 39:14
I don't, I don't have it. The replacement one that they sent me was another

Scott Benner 39:18
black and white one. You should have written a strongly worded email. He should

Dakota 39:21
have. I asked for the new style of clip, though, so it wouldn't, so I wouldn't have to hold it in my mouth,

Scott Benner 39:27
Dear Sir or Madam. I am tired of putting this pump in my mouth. I need a new clip, and don't make me bite this thing again. I want a color screen right size wise, not, not bothers them to carry you're happy with that.

Dakota 39:42
I'm happy with that. I don't like rolling over on it in the middle of the night. Sometimes that wakes me up a

Scott Benner 39:48
little clunky, like square, too square, too pointy. What is it? It just feels,

Dakota 39:53
yeah, it kind of feels like a brick on your hip. I mean, it's not that big at all, like this. It's a little bit, it's about the size of a deck with. Charge. Somebody

Scott Benner 40:00
from beta bionics is listening to this right now, and they're like, awesome. We'll put that in the brochure. Thanks. Did you feel Omnipod when you rolled over on it? No, it's that curvature. Maybe what was helping? Yeah, interesting. All very interesting. Well, listen, let's be fair, like we're talking about things very specifically, Omnipod five and eyelet right now, none of these pumps are perfect. They all have things, you know. And at the same time, I think it's incumbent upon you and everybody else to find the one that works best for them. Exactly. Yeah. I think that's important. Like, like, if people are listening to this and thinking like concrete things, like, he said this, so no, or he said that, so yes, I don't think it works that way. Like you're a specific person, you have diabetes, you have other issues going on, like you're trying to balance a lot of different things you're saying for this moment. You think this fits best with who you are, not that this is perfect, correct, all right? And exactly. And if Omnipod five would have worked the way you expected it to, if you would have got your settings together sooner. Do you think you'd still be on it? I think so. Yeah, okay. It's interesting, because, you know, we have those Omnipod five pro tip episodes, and I still know, like, not everyone's gonna intersect with it. Like, maybe you listen to them and you're like, I don't understand. Or maybe you just were like, I didn't even know about those. Or you were like, I know about them, but I don't feel like listening whatever. Like, I don't know how you did or didn't intersect with that information. You you specifically Dakota, but like, it's important that it's there, because these algorithms, if your settings aren't right, it's just as random as, you know, a needle in a meter, and you know, it being 20 years ago, yeah, you know it's everything is settings. Listen, I'm excited about eyelet. I'm going to tell you right now. I don't think Arden would ever leave a tubeless pump, but if she did, it would have to be for a reason, like the one you're explaining, like the promise of being less involved, yep, right. But that promise would have to come with a six, A, 1c, in my opinion. Like, that's that for me and and maybe the difference between a SEVEN and a SIX is manually making adjustments. And maybe the way islet works, I'm not I'm gonna ask, like, maybe the way I look works, like, if they let you get in there and start monkeying with things that algorithm can't respond. Like, maybe it can't rebound fast enough from you making a mistake. Like, I don't know, I don't know what the the engineering ideas were behind not giving you any autonomy beyond, this is the size and this is the type of meal, right, you know? But it's, I think it's an interesting idea, and I can't tell you that, you know, if they don't keep going the 10 years from now, I won't say like, wow, like, out of sight, out of mind, six, A, 1c, let's go, you know, yeah. And

Dakota 42:49
I'm especially excited if they get, like, the glucagon part working

Scott Benner 42:53
the dual chamber, the dual chamber, yeah, well, I mean, then listen, anybody who figures that out, if that really works for you, trying to imagine a scenario where the pump is like, Hey, you're 90. I think you're going to be 50. Here's, you know, drip, drip of glucagon, and it stops the 90, like, and holds it at 70 or whatever. Like, you know what I mean, like, something like that. You never get under 70. You never get dizzy. You never have to intervene with food. Man, I'd like to see that. Yeah, you know, that'd be pretty awesome. I know there's a, you know, a handful of days of my life. I think it would have been awesome if something like that existed. So I'm just here, Listen, man, I want everybody to keep pushing. That's what I want. Like, people are probably like, oh, Scott, Omnipod. You're said to think it's not about that, like it's, I love Omnipod. I think it's awesome. I think if you got an Omnipod you'd be thrilled with it. I think if you got an Omnipod five, and you've got yourself set up, well I think you'd be thrilled with it. You know, I also think it's possible that Dakota is thrilled with eyelet, and I think that's awesome too. And I know people who use that new Medtronic device, right? The 780 G, yep. They love it. Love it. You know what else they love? Hand them. They love control like you. Some people love the movie like, you know what I mean? Like, and that's only good for you. It's only good for you. It's only good for the people listening. It's good for me. It's good for my daughter. If we have a number of people in different companies, and they are all motivated by success and money to do better for you. That's what we want. You don't want just one company making a thing, right? Just doesn't work out. Go, get out there and kill each other. Go, try to make a good thing. You know what I mean? Like, try to make it better. Don't. Don't sit back all the time and go, Oh, this is good enough. You should be doing R D on this stuff. Listen. Let's be honest. Dakota, when there's loop and trio and Android APs and that kind of stuff that you know between you and me and anybody listening works really well, really. Really well, and they all know it works well, like, and I know they're fighting with the FDA, and, you know, the person making, you know, an adjustment, the loop is not but, I mean, those are goals. I think those should be everybody's goals. I'm not on the board of directors at these companies, and I don't make any decisions, but I don't see how you're not shooting for that. All of you, right? Yeah, Jesus, this is I yelled at you. I yelled at them. Who else am I gonna yell? What else is going on? Dakota, how's your life? Pretty good, yeah, yeah, good place right now. I don't really have any complaints. That's a good place to be. No complaints. You still doing the same kind of work,

Dakota 45:37
yeah, still doing the same kind of work. I think I should be getting a promotion here in a little bit. Good for you. Yeah,

Scott Benner 45:43
very nice. What about people in your life? You got any relationships brewing? How do you kids date nowadays? Hinge, what is it? How does it

Dakota 45:50
work? It's a lot of apps. Definitely.

Scott Benner 45:55
Do you respond when someone swipes? You go, okay, yeah. Or I, because I see, I see Arden and her friends, and they sit around, they go, Oh, I wish something like this would happen. Blah, blah. And then somebody swipes up and they look like that person. They're like, nah. I'm like, Wait, how do you expect to meet people ever?

Dakota 46:10
Yeah, I don't like the apps. I feel like everybody's just judging on there.

Scott Benner 46:16
Yeah, right. It's not like for dating. It's for like, fun. Yeah, you blaming girls for this, or guys too? Uh, both of us. Okay, all right. So where do you meet people?

Dakota 46:26
I don't go out much, but the people I do meet usually are customers at my store.

Scott Benner 46:33
That's how you generate

Dakota 46:35
friends of friends.

Scott Benner 46:36
You guys confuse the hell out of me. DECO, I'm gonna, I'm gonna share something with you from this is one of the places where, like, I'll get an email later, I'll be like, Oh, why does he have to be creepy? I'm just telling you how the world worked. Okay, I was born in the 70s. I was a teenager in the 80s. And from the time Dakota, and I don't want to make you uncomfortable, but from the time of my sexual awakening till a half an hour ago, 78% of my day is spent trying to make a lady like me, like, I don't get how you guys aren't like, I don't know, like, how are you guys not all driven by sex? Like, I don't understand what's happening. Do I sound like a, like, a, like, like a caveman to you when I say that? No, no, I don't think so. My whole life, Dakota, as a teenager and young men in his 20s, was trying to figure out how to make a girl think I was a reasonable person to be naked with. Like, I don't know. You guys are just like, I don't go out much.

Dakota 47:36
There's too much going on right now. Oh

Scott Benner 47:39
yeah, I don't know, man, like, go find a go find a pretty girl. Change your attitude. You know what I mean, she'll at least make you want to buy your she'll at least tell you you have to buy her a house, and we'll give you something to do. No? Yeah, yeah. Trust me, my wife has got a to do list for me that she started writing the day that she decided to date me. And I believe I saw her put three things on it. Actually, I don't have to guess. She told me this morning, my car needs an oil change, and I think there's something wrong with my driver's side rear tire, which meant to me, you got to get my tire replaced and get my car an oil change. Yep. I said to her, and I want to say, this is a very capable lady. Okay, I said to her, how about later, when I check on that tire, I bring you out to the car, and I'll show you how to do it like, you know, in case I die or something one day. You know what she said in response, she left not even that total silence. She acted like she didn't hear me. Oh, what? No, I'm okay. Thanks. Here's what you should do, buddy, go fix my tire and don't die so you can fix the next one. That's what I heard. Anyway. That stuff gives you, um, motivation. Is that what you're calling it? Dakota, I grew up in a very transactional world, but I know that you guys all want to say, like, if I do enough nice things, somebody shows me a boop. That's how my life has been run for like, 35 years, and you guys are like, I meet I met somebody on apps, but the apps really don't work, and I don't go out like, I don't get you guys, the ladies would love you. Dakota, you're full of personality. Why are you not answering me? What are you doing? I don't

Dakota 49:17
know. I was taking a drink of my coffee.

Scott Benner 49:21
COMM, I want you out. In the world. I want you changing your pump before you go to bed, if it's gonna run out. I do not want you sleep. Listen to me. This is for everybody. I do not want you sleeping in a situation where you could be running out of insulin. Please don't do that. Okay, and don't change your pump eight seconds before you go to bed, because if there's an occlusion or a problem or something like that, you're going to be asleep and not have any insulin. Yeah, Jesus Christ. And now, you know what just happened there, Dakota. Now all the people who like me, but wish I wouldn't say Jesus Christ are passed so, and that's your fault. I

Dakota 49:54
just want to you write down the time and have your editor take it up. No, because I'm not going

Scott Benner 49:59
to. End to their will, God damn it. And I added god damn it, because that's the other thing they don't like. And I know because they sent me a lot of notes about

Dakota 50:10
you're gonna get a one star review, dude, my

Scott Benner 50:12
emails just sound like this. Don't be creepy, which means we don't talk about sex anymore. But screw you guys. You should and my end, please stop saying Jesus Christ and God damn, those are pretty much my emails. Anyway, I apologize to everybody who I've offended. All right, what have we not talked about that we should have? Dakota? Where should this conversation end? A few more things about the Iowa. Go ahead, roll it out to me, from what I understand, the way the meals adapt, they'll only adapt if they're spaced four hours apart. What do you mean? Explain that to me. So

Dakota 50:50
say you dose for breakfast, and then three hours later you dose for lunch, and you choose those two separate options, breakfast and lunch, the pump isn't gonna know which one to adjust for the next time you choose the option, the

Scott Benner 51:08
second choice or the third time. Like you're saying, If I said, Hey, I had a normal meal, a normal breakfast, excuse me. And then three hours later, you're like, I'm having a normal lunch. It's not gonna know what, what? Won't understand.

Dakota 51:21
It won't know which, if it's breakfast or if it's lunch, that the insulin needs adapted for. Ah,

Scott Benner 51:27
because so it can't hold those two meals independently in its thinking, right? Ah, it's just, it's just attacking carbs and highs at that point. Yeah, is that problematic for you? Do you find yourself not eating inside of that four hour window on purpose?

Dakota 51:45
I find myself eating more in the four hour window. You're like,

Scott Benner 51:49
I'm like, No, you.

Dakota 51:53
And then, and then nothing in my settings change.

Scott Benner 51:55
What do you mean? So, like, it'll

Dakota 51:59
decide for a normal lunch. Say it wants to give me 14 units, and I think that's too much. My normal lunch should be a little bit less than that. Okay, I have to eat that lunch, choose the normal or the usual, and then I have to wait four hours before I can eat anything again to get that insulin dose to decrease. Okay, I feel

Scott Benner 52:24
like I'm talking about a fresn now, so like, a four and an eight to 12. And I'm like, Oh, yeah.

Dakota 52:28
So I think that's something that you should ask. Okay,

Scott Benner 52:32
well, hold on a second. Let me get my marker on my whiteboard and ask you to, like, put that into words for me. Like, simplify that question, how do the meal doses adapt? How do meal dosing doses adapt when they're less than four hours apart? Yeah, okay, I'm gonna go blank when they're explaining that to me, because that's how I feel when, when the guy was like, so I took a four, and then another four, and then I'm like, can you just please easily explain to me how to dose of friends? It's an eight, the 12. And I'm like, oh, in the end, the answer ends up being like, it's kind of an art and you figure it out. And I'm like, that I accept. I'm like, okay, I get it. Okay, so I'm gonna ask, How do meal doses adapt when they're less than four hours apart? Okay, that's good. Thank you. I'll add it to my list and what else. And then

Dakota 53:32
I have heard that. So you can change the cartridge and the tubing at the same time, or you can just click an option that says fill tubing, and that's when you just change out your your infusion site, and not the tubing or the cartridge. So so you get an occlusion or it rips off, and you just need to change the part that's in your skin. You put that on, and then you click a button on the eyelet that says, Fill tubing. From what I understand is it forgets the last six hours of data that it's learned.

Scott Benner 54:02
Wait, when you change, look at everybody here Dakota, he's got a he's got a direct line to bite of bionics right now, through me, somehow, when you change the tubing or the site, the site, the site, and what then Phil, Phil canula and fill canula. Does the system what forget the

Dakota 54:28
last six hours of data that it's learned? All right, I got it

Scott Benner 54:33
cool. We're gonna make a nice episode with them. We'll learn a bunch of stuff. How does it adapt when the meals are less than four hours. They're gonna get this email. They're gonna be like, Oh, he was talking to people. He knows stuff. That's good, though. That's what they want. They want good questions so we can get good answers out there for people also, I'm gonna hit them up about dual chamber. Yeah, they've been on talking about that already. They were very excited when they made the agreement with the gluteagon company. Was the G, VO was, I think so, yeah, was it right now, the people at, uh, at zeros who are like, Oh, good job, buddy. Way to, way to remember things we buy ads, you know? No, I have that there. So, so I'm actually going to find out, because this is a good episode if you've heard this one and you want to hear something that is potentially exciting about islet, I'm going to type in here islet, and then glucagon at Juicebox podcast.com and let you know that I have a couple of great eyelet episodes, actually, 1217, islet from beta bionics with Dr Stephen Russell. He was a great conversation. I've spoken with Ed Damiano. It's Damiano right in episode 934 when they first released. But how come I'm not seeing my episode with them and the look at me, I'm like pimping the Juicebox Podcast. Calm. Search button, and we're not getting what we want. Let's try this again.

Dakota 56:04
You didn't even talk about how the site was recently redesigned. Oh, I

Scott Benner 56:08
did redesign this. I do like it. Is it better? Yeah, I like it. Awesome. Good. Thank you. Five days of my life sitting here, not moving, terrible, staring at the screen. Oh, my God, my elbow hurt. I just, like, people are like, I dug a ditch today, but I make a podcast. And, like, I still had to make the podcast. And then in the like time, I was like, Oh, I'm gonna take off a little bit of time for the holidays. Instead, I sat here for a week like a lunatic redoing the website. Because I was like, I've been wanting to do this for like, two years, and I just, there's never time I'm just gonna do it. You know, I got it 1209,

Dakota 56:46
glucagon in an insulin pump. You

Scott Benner 56:48
found it. Paul and Sean are CEOs of their respective companies, beta bionics and zeros. Today we talk about their new relationship and their desire to create a BI hormonal insulin pump like that's an interesting conversation, too. Anything else?

Dakota 57:01
I am working with a dietitian through a company called nourish, okay? And I meet with her every two weeks and we review my report that my eyelet pump puts out. Kind

Scott Benner 57:14
of report does it put out? Like, how is that valuable with the nutritionist, is my question.

Dakota 57:18
So she'll look at like, how often I'm dosing like when I'm announcing meals, and I'll make a meal log in a separate app, and we'll go back and see like if I went high afterwards, what did I eat? And we will decide if I chose like the wrong

Scott Benner 57:40
meal announcement, like the size,

Dakota 57:44
yeah, that's so then the next time I have that meal, I can

Scott Benner 57:47
choose the correct option. Does your insurance cover that? Yep, my insurance covers it, and I have a $0 copay. That's wicked. Excellent. You finding it valuable? Definitely awesome. Yeah. Is that online as well? Yep, through zoom nice, do it on your phone or at a computer.

Dakota 58:05
I do it on my computer. Important stuff you got to do on my computer. My

Scott Benner 58:08
kids are like, Do you want a laptop? Like, I'm not a child. Like they don't they don't understand. And I generally, I don't understand either. I like sitting at a desk with a computer in front of me. I think it's just because it's how I interacted with the computer. Computers when I was younger. I hate laptops. I hate that how small the screen is. I'm the same way. Oh, good. That makes me feel good. Yeah. Like, I like my phone because it's interesting. It's like, the pumps the phone presents a ton of convenience, but like, there are certain things you go to do on a phone, and I'm like, I would rather this not happen than me have this experience on this tiny screen. So, all right, Dakota, this was awesome. Thank you. I appreciate you reaching

Unknown Speaker 58:50
back out about this. Yeah, no problem. Thanks for having me back on. No,

Scott Benner 58:53
is my pleasure. Listen, I'm not your dad, but you know what you're gonna do this weekend, right?

Dakota 58:59
Change my insulin cartridge before I go to bed.

Scott Benner 59:03
All right, how about if you change your insulin cartridge and then go out in the world and try to find a cute girl who seems like she might like you, and then be nice to her and really be nice to her. Don't pretend to be nice to her, really be nice to her. And see if you guys get along. And maybe you'll get along and talk and have things in common. And then one day a baby will come, oh, a baby, yeah, like a baby. Or, if you don't want a baby, a puppy, but there's a girl in your house while you have it. I think this would be good for all of you listening, and vice versa. Girls like, go. I know boys are icky. I'm one. I get it. Like, there's got to be one out there that you would like, you should go look for him and see if you can find him. Now also, let me speak to the gays. Same thing, girls that like girls, boys that like Boys, boys that used to be girls that like girls that like boys. I don't give a shit. Like go out there and find somebody. You don't want to be alone. It's not good. And then when you find them, and I can't. Stress this enough, Dakota, when they're in the room with you, don't look at your phone. Please. Just don't look at it. Just pretend it doesn't exist. And then look at them, and you'll be like, Oh, she's pretty. Maybe, if I'm nice, she'll touch my hand, like, this is the stuff you should be working on. Well,

Dakota 1:00:22
maybe someone listening can go find me on the Facebook group and, yeah,

Scott Benner 1:00:28
that's fine. That's what you want me to do. I gotta hook you up. I need you out in the world, my friend,

Dakota 1:00:34
you gotta go turning into a dating podcast. Yeah,

Scott Benner 1:00:37
oh my god. Can I do that? By the way, I've done two life coaching episodes so far, they've been awesome. I definitely need more people to do that. I coached a 12 year old kid about his Pre Bolus thing that was fun. A woman in her 50s about her desire to get divorced. I did see you post that I'm super excited because Dakota, I'm completely unqualified to have these conversations with people. But at the same time, who else you gonna talk to? You know what I mean?

Dakota 1:01:06
Yeah, yeah, no one better than Scott. Have

Scott Benner 1:01:09
either of your parents told you to go out there and try to make a person with boobies like you? Nope, no. Well, they should have. Your mom is like, how long she gonna stare at you? You know what I mean? Right? All right. Maybe you got to talk a little bit man, but like, yeah. Like, we got to get out there. Like, this should not make you uncomfortable. This should make you be like, Yeah, I do want to see a boob. That's how it should make you feel. And then, and I don't just mean see and for all you girls out there, like, I'm not being like, not just like, somebody like just has to show you one, but somebody like is like, super excited to show it to you. Like, like, you don't need to like this, Dakota, he could be. I love him. He's awesome. I'm gonna let him see my boobs. Yeah, now you're getting it. Get out there, Dakota. Listen to me. If you all don't start fcking you're gonna us all. Do you understand what I'm saying? I'm gonna get old. I need one of your kids to work in the nursing home I'm gonna live in. You gotta get moving to go. No, I'm not making this up. I'm serious. I am one day gonna need a 21 year old with not great job prospects to carry me to the bathroom, and one of you has got to get out there and make that baby we're gonna cease to exist. You understand what I'm saying? Yep, I need you out there. I don't understand. Sex is so wonderful. How is it you're not like, just like, all day long thinking about, like, how do I get to have sex? That is not in your head constantly. I'm working 14 hours a day. I don't care. I work in a sheet metal shop with a bunch of dirty guys. And in any spare moment I had, I thought to myself, I wonder how I could have sex I once had a brief relationship with the of age. I just want to be clear daughter of the guy that drove the lunch truck to the shop I worked at like I want you to imagine that a truck would roll up at the filthy pit that I worked at, okay, and it just had sandwiches in it and drinks, and we'd walk out and it's just owned by a guy, you know, or a girl, I forget who owned it. But one day that person started bringing their teen I was young still, I want to be very clear, but one day that person started bringing their teenage daughter with them, like I think the girl was being punished. Do you know what I mean? And she was my age, and I successfully at a sheet metal shop, hit on this girl, started a conversation with her, got her phone number, went out with her, and eventually, through the goodness in her heart, she gave herself to me, and I'm telling you right now, I also gave myself to her. I just want to say it was a very loving exchange. And I want to tell you right now that I don't think someone your age in 2024 could pull that shit off if their life depended on it. We're all too awkward in personal interactions that are online. I feel bad for you. The

Dakota 1:03:56
internet's ruined everything

Scott Benner 1:03:58
it has. It made boobies too available. They have to be a thing. I would just want to say that for people who are understanding this, like, we're probably bleeping out boobies or we're not, I haven't decided yet

Dakota 1:04:08
that could be the name of the episode.

Scott Benner 1:04:12
I don't understand. It motivates most of my existence, like, just a girl being kind to me, like, I don't mean like, I don't actually mean them exposing their price being intimate with a girl like, or having them want to do that with me, that like, motivates my life. Like, I think if that didn't exist, I wouldn't, like, I don't even know if I'd have a job. But what motivates you guys? Like, what do you get up in the morning and go to work for pay my bills? Yeah, but I had bills too. I didn't give a about the bills. What I cared about was girls. Like it's not girls. I'm so confused by this I

Dakota 1:04:50
don't know what does motivate me, not a whole lot. How to take a

Scott Benner 1:04:54
phrase that seems more reasonable to me than how you guys treat like dating and interaction. Options. So weird. I don't know how to fix this. I think we've gone in a direction at this point. We went from free love in the 60s to this. 60s, 70s, 80s, 90s, 2000 to 1061. Years. 6070 years. We went from like, get high have sex with anybody you bumped into to I don't know. I'm awkward, and I need to pay my bills. They

Dakota 1:05:27
looked at me weird. Yeah, they looked

Scott Benner 1:05:29
at me weird. I don't know what to say. I was very upsetting. All right, listen, good luck. God bless and we're all, we all need help. I don't know who's carrying you to the bathroom. You guys are really screwed. Like, I might still get you to carry me to the bathroom when I'm like, 80, but, like, I don't know who you're getting. You have a plan, Dakota, you've had sex, right? Yeah. And is it awesome?

Dakota 1:05:57
Yeah.

Scott Benner 1:05:58
Okay, go. Wash your hair, clip your fingernails, put a little file on them so they're not sharp, you know what I mean? And then, and then, like smile, stand up straight, make eye contact and engage with people. You'll it'll happen again, and then again and again. And then eventually, get married, and it'll stop.

Dakota 1:06:20
That's what I hear. What happens, 100%

Scott Benner 1:06:23
true, Dakota, I just want to say like they're not lying to you about that at all. I

Dakota 1:06:28
read your book over the summer. Did you really? Yeah? I mean, three of my friends, we had a little book club. Three

Scott Benner 1:06:34
of your friends read my book. Yeah, that's why you're not getting laid. I mean, was it any good? It was, yeah, I liked it. Oh, good. It was funny, I'm glad. But that was about making a family, right? I thought it was gonna be a little bit more about diabetes. No, it's got nothing to do with diabetes. Yeah, I realized. But when you read it, were you like, oh, I should make a family. I thought about it first was second, and then somebody looked at you weird, and you walked away. Yeah, a lunch truck. I'm not even attractive. Do you understand me? You have to try, because there are other people out there who are also uncomfortable, and they they don't know how to try. And if someone tries, they'll go, who me? Oh, yeah. Like, you know what he means, like, because if a girl came up to you and you're like, hey, Dakota, he'd be like, huh, Dakota? Me, okay, do you see how you would get immediately? Like, they're waiting for that too. But if you don't talk to each other, neither of you are gonna know you won't know that. Yeah, everyone's awkward. That's why you can turn the lights off in the lights off in the beginning. When you're figuring it out, you don't do it with the curtains open till you're like, you know, really good at it. We're super comfortable, I guess is the way to put all right. I don't know how this got down this this road, but for everybody listening, in your 20s, please, would you start having sex with each other? I really am worried about who's gonna fix the roads, but I'm older, I'm worried about who's going to be at the grocery store. I'm worried about who's going to make the food at the restaurants. I'm worried about who's going to work at IBM. I need you out there. Again. It's not going to happen like this. What about those Tesla bots? Jesus Christ, Dakota, that's what you're hoping for. So first of all, I want to be clear, I would buy a robot and have it in my house if it was safe and affordable. I do think that sounds awesome at the same time, like in my house with my children and my wife, not by myself, in my domicile. You understand? Yeah, life is for the living, my friend, it's a saying. Have you ever heard it? No, you know what it means. Um, don't it means get out there and live your life. Oh, okay, did you not know that? Yeah, no, that makes sense now. Yeah, you sure you understood the book?

Dakota 1:08:56
I read it in sections.

Scott Benner 1:08:57
I broke it down into bits. See, you have good sarcasm.

Dakota 1:09:01
I'm full of sarcasm. Yeah, I get in I get in trouble for it, yeah, but there's

Scott Benner 1:09:05
some girl will like that. And then eventually, when she decides that you're okay to marry, she'll make you stop. But like, you know, she'll like it in the beginning. It'll be fun watching her change you.

Dakota 1:09:18
Well, I'll get right on that, and then I can bring her on to talk about me on the next time.

Scott Benner 1:09:25
All right, the phrase life is for the living suggests that life is meant to be actively experienced, enjoyed and embraced. It emphasizes the idea of seizing opportunities, being present and making the most out of the time we have, rather than merely existing or being being consumed by fear, regrets or excessive caution, it's a call to action.

Arden has been getting her diabetes supplies from us med for three years. You can as well us med.com/juice, box or call eight, eight. 87211514, my thanks to us, med for sponsoring this episode and for being long time sponsors of the Juicebox Podcast. There are links in the show notes and links at Juicebox Podcast com to us, med and all of the sponsors. The conversation you just heard was sponsored by Dexcom and the Dexcom g7 learn more and get started today at dexcom.com/juicebox,

if you or a loved one was just diagnosed with type one diabetes, and you're looking for some fresh perspective. The bowl beginning series from the Juicebox Podcast is a terrific place to start. That series is with myself and Jenny Smith. Jenny is a CD CES, a registered dietitian and a type one for over 35 years, and in the bowl beginning series, Jenny and I are going to answer the questions that most people have after a type one diabetes diagnosis. The series begins at episode 698, in your podcast player, or you can go to Juicebox podcast.com and click on bold beginnings in the menu. I can't thank you enough for listening. Please make sure you're subscribed or following in your audio app. I'll be back tomorrow with another episode of The Juicebox Podcast. Hey, what's up, everybody? If you've noticed that the podcast sounds better and you're thinking like, how does that happen? What you're hearing is Rob at wrong way, recording, doing his magic to these files. So if you want him to do his magic to you, wrong way. Recording.com, you got a podcast. You want somebody to edit it you want rob you?

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