#1520 Phantom Hemorrhoid

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Padma was misdiagnosed with type 2 despite clear signs of type 1. Originally from India with a family history of diabetes, she fought dismissive doctors to get the right diagnosis—and her story, while sadly common, is still wild to hear.

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

Scott Benner 0:00
Hello friends, and welcome back to another episode of The Juicebox Podcast.

Padma 0:14
Hi, I'm Padma. I'm a 37 year old female. I was diagnosed about a year and a half ago, and I was 35

Scott Benner 0:22
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Padma 3:07
Hi, I'm Padma. I'm a 37 year old female from Western New York. I was diagnosed about a year and a half ago, and I was 35 first, just type two, like most adults, and after some lots of fighting, got a type one diagnosis.

Scott Benner 3:22
How did you know to fight?

Padma 3:23
Because I was super healthy before. I had no symptoms at all before, my blood work came back. A strong believer in preventative medicine, and I have had regular physicals for a long time. It's never been blood glucose fasting sugars have never been beyond 90 to 100 I hadn't seen my primary during COVID, so I just figured, hey, it's been a while, I should go do my regular checkup. And I did that, and I was feeling great. I had no symptoms at all, but my fasting blood sugar came back at 275

Scott Benner 3:54
okay, so you're thinking that not necessarily because, like, Hey, listen, I always take care of myself, and I'm in shape. I couldn't have type two. It's that you think you would have seen it creep up and come on, because you were, yeah, watching so closely

Padma 4:05
familiar with diabetes. I'm from India. We are sort of the diabetes capital of the world. Congratulations. I've had a lot of family members with diabetes. My family generally acts like this. It's been very different, not trace it back to my great grandfather. And all of us have different symptoms that never matched what I had read about type two diabetes. Okay, it was hard to explain before, because my grandfather got diabetes at the age of 78 and he was a very fit person. It was surprising to everybody. He was biking till he was 78 did very long hikes and all of that. And he ate very healthy. He believed in a ate a plant based diet, and none of it made sense, and his blood glucose would always be very high. I was in charge of his finger pricks when I was in high school. And. And fasting would be like 181 90, even, even though he was doing all of the things he was supposed to, it never made sense, yeah? And when I got it, it was a different perspective. I was like, Oh, I feel it now. It's not normal,

Scott Benner 5:15
yeah, I have in your notes here, so not just a familial history, but like four generations of people, is that right? Yeah, okay,

Speaker 1 5:23
that's as far as we know. That's as far, yeah, right. Could be farther, right? Yeah. Can

Scott Benner 5:27
I ask you a question that that I'm just gonna kill myself if I don't ask? When I see Indian families walking, why do they hold their hands behind their back? Why is that so, like, classic, I don't know. You don't know. Padma, I finally get somebody I can ask, and you're like, I don't know.

Padma 5:41
I didn't know that was a thing at all, until you're just friends. Oh my god. I

Scott Benner 5:45
live somewhere where there's a fairly big Indian population, and a lot of older couples walk like in the late evenings, but the gentlemen always hold their hands behind their back when they

Padma 5:55
walk. I know a lot of Indians in my family. None of us. I haven't noticed that. It's like a, it's like a school headmaster kind of thing, I guess, very

Scott Benner 6:03
much like that. Yeah, and I don't ever have the nerve to ask my daughter's friends, because I'm like, I don't want to be the guy who's like, Hey, how come that's happening? But I thought, Oh, she'll be able to tell me. All right, my second thing, oh, God, I thought you're gonna be able to help me with these things. The second thing I wanted you to help me with is, Should I take my wife away for the weekend up in Western New York and like, rent, like a little cabin or something. Is that a good idea? It's

Padma 6:23
like, super cold this weekend, don't we didn't get any of the snow that the other people keep harping about. But, you know, we're just pissed because our grocery supplies didn't come so the shelves are empty. But it's been, like, super cold,

Scott Benner 6:38
too cold. Okay, all right, I'll wait till it's a little warmer. I just thought, like, you know, a place where we could light a fire and hang out for like, a night or something like that. But, all right, so there is a line where I don't want to be there. What do you mean for temperature? There's a temperature line where I just don't want to be there.

Speaker 1 6:54
Yeah, yeah. Okay. Like, I don't want to be here right now. Okay, all

Scott Benner 6:58
right, fair enough. Then I won't visit a place where the where the locals are trying to get out of anyway? What made you want to come on the

Padma 7:05
show? My diagnosis was mostly from podcasts. I discovered your podcast much later, and it was great place of information for me. Don't have much else and interesting going on. Nobody else is inviting me to podcast. So

Scott Benner 7:19
this is your chance. Finally, I've got a reason to get on a podcast. On the podcast. All right, so let's sort of go through it. So you do the whole thing, go to the doctor. You're like, hey, maybe it's time to go back. Next thing, you know, they say you have type two diabetes. And do you know immediately? Oh, no, no, no. Or do you start down that road with them? Oh,

Padma 7:37
here's the funny thing, they didn't say anything to me. So I'm a very active person. I'm a field engineer. So my work involves some field work. And this was all in 2023 I train for a bike ride every I do a bike ride every year, from New York City to Niagara Falls. It's a seven day bike ride. And that in 2023 I was like, Okay, I'm gonna do this well this year. So I started training. I was feeling great. I had no symptoms of anything other than that. I was biking much better than I was before, and I was slowly starting to lose weight. I thought, Oh, finally, my biking and all my healthy eating is finally working. The day I went for my physical was the day after a 60 mile, the weekend after it was a Monday, and the Saturday, I had rode 60 miles. I felt great, and I had lost about 15 to 20 pounds since the summer. And the appointment went great. The doctor was happy with everything. I had developed some my butt was really bad because I thought it was because of the biking. Okay, thought it was hemorrhoids. I was doing all the home treatments for it, and I talked to him about it, and he just said, oh yeah. He no exam or anything. He just said, Yeah, whatever you're doing from the internet is fine.

Scott Benner 8:53
So you're like, I called up and said, Hey, my butt is bad. I think it's hemorrhoids. And you're and I went on the internet. He's like, Yeah, that's good. Keep doing that. Today's episode is sponsored by Medtronic diabetes, who is making life with diabetes easier with the mini med 780 G system. The mini med 780 G automated insulin delivery system, anticipates, adjusts and corrects every five minutes. Real world results show people achieving up to 80% time and range with recommended settings without increasing lows. But of course, Individual results may vary. The 780 G works around the clock, so you can focus on what matters. Have you heard about Medtronic extended infusion set? It's the first and only infusion set labeled for up to a seven day wear. This feature is repeatedly asked for, and Medtronic has delivered. 97% of people using the 780 G reported that they could manage their diabetes without major disruptions of sleep. They felt more free to eat what they wanted, and they felt less stress with fewer alarms and alerts you can't beat that. Learn more about how. You can spend less time and effort managing your diabetes by visiting Medtronic diabetes.com/juicebox Spring is here. It is a time of renewal. You want to wake up every morning and go get it, you know what I mean. But how you going to do that when your sheets suck and you know they do, you know they're thin in some places, or they're too slippery and silky, or you're too hot in them, or whatever, and that wouldn't happen to you if you were sleeping on the same sheets that I am, sheets that I got from cozy earth.com I know this sounds like a sales pitch, and in fairness, it is, but these sheets are the best that I've ever slept on. They make every day better, every sleep better the lady next to me, she gets hot. This sheets help her stay cool. I am freezing cold because of the giant fan the lady puts on me, but under my cozy Earth sheets, I'm neither too hot nor too cold. Now you're out of bed and you say, Ooh, what's gonna happen next? Scott? Well, you're gonna get a shower and dry off with some beautiful towels. Then you're gonna put on my cozy Earth joggers or a sweatshirt, or any of the awesome clothing that they sell. It's even possible that you took off your cozy Earth pajamas. When you got off of your cozy Earth sheets, you're on the floor ready for the day. You go to the bathroom a wash, wash, wash, and then you tap yourself down, you get all your bits and your bingos and everything nice and dry, and you slip on some comfortable clothing, and you go about your day feeling good and looking good. Save 40% at cozy earth.com and use the offer code Juicebox at checkout. When you think of a CGM and all the good that it brings in your life, is the first thing you think about. I love that I have to change it all the time. I love the warm up period every time I have to change it. I love that when I bump into a doorframe, sometimes it gets ripped off. I love that the adhesive kind of gets mushy. Sometimes when I sweat and falls off. No, these are not the things that you love about a CGM. Today's episode of The Juicebox Podcast is sponsored by the ever since 365 the only CGM that you only have to put on once a year, and the only CGM that won't give you any of those problems. The Eversense 365 is the only one year CGM designed to minimize device frustration. It has exceptional accuracy for one year with almost no false alarms from compression lows while you're sleeping, you can manage your diabetes instead of your CGM with the Eversense 365 learn more and get started today. At ever since cgm.com/juicebox, one year one CGM,

Padma 12:29
yeah, like this that not even, like, a prescription, temp medication or anything. And I said, like, Well, I've been biking for a long time. I've been doing all of these. Haven't changed much. Why is this happening? Like, Oh, you've never been 35 years old before either, as always happens, this all happens. And like, Okay. And then he just said, Don't bike for two weeks and you'll be fine. I was like, Well, I have a big ride next month. I'm training for it. I kind of need to be training. It's like, if you want to do that, right, don't bike. I was like, Okay, that makes sense. And I went away. He ordered my blood work. I did my blood work. I wasn't expecting anything the day off the blood work, I did feel after giving blood and having breakfast, I went off to work. I felt a little bit dizzy. I thought it was because they took too much blood for me, and I ate a little bit, and then I was fine. I worked outside the whole day. We were having air quality issues at the time too, so I just chalk things up to that. And this was all just before the Fourth of July weekend, and because we were not because I was told not to bike, my husband and I decided to go on a hiking trip in the Adirondacks, right? So the fourth was on a Tuesday at that time, so Monday the lab results came in. And that was the day I was doing a big hike. We were going to scale Algonquin, which is, like, the second highest peak. Wow. In the morning, while I was getting ready, the email came, I got my questions alert saying my result was available. I looked at it was 275 I've like, I've seen high blood sugars before. I've never seen that high even my grandfather, yeah, like that didn't make sense at all. And then I went off on the hike. I did not tell my husband. Why not? I was too spooked. I was too shocked. I think it was in shock. We had a good breakfast, eggs and everything. I was like reeling. And then we went off into the mountains, no internet or anything, just, you know, me and my happy thoughts, just freaking out on my own, and I climbed up. The first hour or so was a little hard, but after that it got very easy. I was climbing up and like, heading way faster than my husband, and he was trying to catch up. As I am super fit, there's no way I have diabetes. I don't feel like any of the things that I'm supposed to and then the next day was a holiday, didn't expect them to call back. So I expected a call back on Wednesday, when the doctor's office is back, right? I got nothing. I got nothing the whole week, really. So I said, Okay, maybe the internet is just wrong. Maybe I'm fine, and maybe they see this all the time. They finally called me back the following Monday, and the. Nurse called, and I saw the number, answered it, and she goes like, Hey, you have diabetes. She

Scott Benner 15:05
didn't say, good news, it's not hemorrhoids, because that's how I would have done it. But

Unknown Speaker 15:11
I'm like, no kidding.

Scott Benner 15:13
How long have you been married? At least 20 years, 10 years old. How old are How long have you been married? Because I loved you were like, listen, we had a good breakfast. I didn't want to bring

Padma 15:26
it up. We were married three years. Oh, no.

Scott Benner 15:28
Oh, a newer wedding. I say. I say, you're like, listen, we had a nice breakfast.

Padma 15:32
I don't know, since 2017 or so. We had, like, a COVID wedding. Oh, okay. I

Scott Benner 15:36
felt like you were married forever, because you're like, I knew this news was going to ruin the day. So I just thought I felt, I found myself feeling bad for you, Pat. I'm thinking about you out climbing, but really just thinking about, like, your health the whole time, because that's what was happening, right?

Padma 15:50
Oh yeah, totally. And it was, it was a super hard climb, and like I said, there were air quality issues. So my husband was struggling too, and he was carrying up like a 10 pound camera with him. So on the way back down, I had already fallen a couple of times in the summer doing all my activities, and my knees were bad, so it was like, super hard coming down, and my husband wasn't raining long enough for me, so I was yelling at him. He had no idea that I had all these other things going on in my head. I was like, I was sure he was gonna leave me just

Scott Benner 16:21
keep climbing and leave you on the hill. Like, that's enough for her, yeah, oh, yeah. And I just made me feel it made me feel for you, like, thinking about all the stuff going through your head while you were out there. Oh, this all

Padma 16:32
went on for the next three months. So Whoa, no, but,

Scott Benner 16:38
but the doctor's office calls and says, you have diabetes. But then, oh, I

Padma 16:41
they were like, Oh, that you have diabetes, as though I was hiding it from them and left it for them to find out or something. Well, you've known me for like, eight years. You've been my primary care physician. And she says the doctor wants to see you right away. They go care. He has an opening in three weeks. Did you

Scott Benner 16:57
say I don't think the doctor understands what right away means. But okay, exactly. I was

Padma 17:01
like, No. I talked to the doctor about my bike ride. That's next week now, and I need that's in two weeks now. I want to be seen before that. So he says, Oh, you still have to do your blood work again. You need you to do that. Get that book. We'll see you next Thursday. So that's the day I went and told my husband, the day of the blood work, no, the day the doctor's office called, because I was it was like a week since I found out, so I thought maybe it was just a false positive, or these things just happen and it's not that big a deal, and when they called it, it finally felt real, right? So I made the appointment for blood work later in the week, and went home and told my husband we were both freaking out separately, doing a lot of research. In case I didn't mention I'm an engineer, super nerd. My husband is a computer scientist, nerdier than me. Both of us went all into research mode, and we're freaking out separately, on our own, all over the place, and I was in a very busy part of my work. We were working towards a Grant deadline, or multiple grand deadlines. So I was just pouring myself into work, and anytime I had a free moment, like in the bathroom, I was just researching diabetes and reading all about it. None of it brought anything much about type one diabetes. I've known diabetes for a long time, but nobody I knew had diabetes were ever classified as type one or type two. It was just diabetes. Okay.

Scott Benner 18:22
Did you find the research helpful in that early going?

Padma 18:27
Sort of most of the information online was only about type two diabetes, unless you search for it, most of it just mentions lots of things about diabetes, type two and, oh, there's type one too. There's mostly nothing you can do about it when you do a general search like that, right? So first, I didn't want type one because it definitely sounded horrible, but type two didn't. I couldn't believe that I was having it. Because I, like I said, there are lots of family members with diabetes, some of them were diagnosed at my age, but my grandfather, from whom we all got it, got it only at 78 so we thought it was just because he was very fit and stayed on a healthy diet. So if we did those things, we could also stave it off longer. Was my idea. That's why I was very active and focused on my food and focused on getting regular checkups and things like that. Yeah.

Scott Benner 19:18
So you thought there was this. It happens in our family all the time, but this one person, the active one, the fit one, he made it into his late 70s. We all just kind of mimic that.

Padma 19:29
Yeah, yeah. So like, even if I stay fit, I felt like I was going to get it, because, you know, our genes are stronger than all the workouts. He was fit, but he even he got it at 78 so we, we're all just going to get it, but if we stayed fit, I could still lead a normal life. Is my idea growing up. But when it actually happened, it was like a whole nother thing. I felt like I was prepared for it, but I was not at

Scott Benner 19:52
all. Yeah, so talk about how it hit you, like psychologically. Then

Padma 19:56
it was a very odd feeling, because I've seen other. People, I've heard, judgment just creeps in immediately. When you say you're diabetic, oh, he's not eating right, or they're not following any they're not being healthy and all of that, it makes you feel like it's your fault for getting it.

Scott Benner 20:12
Yeah. And then does that keep you closed off from other people you don't talk about it? Does that start the kind of like that cycle where it's not a thing you talk about with other people, so you hold it inside, and then that kind of doubles on itself. Yeah,

Padma 20:25
I didn't agree with the doctors right away, so speaking to others was the hardest thing for me, because they'd ask questions, and I didn't have answers to that. And I'm, I'm not used to that. I've usually known what happens to me, or I'm, I'm big on solving problems. I'm very good at those things. I didn't believe in the answers that I was getting from my doctor, so I couldn't have a conversation, and people were starting to get concerned because I kept losing weight. So I've never cared that much about my weight. I'm five four, and I was about 170 pounds in May 165 to 170 so I didn't pay a lot of attention to it, because I was still active. Weight was not a big issue to me. But, you know, I would, I would have always liked to be very thin, but didn't care that much about it. Yeah.

Scott Benner 21:09
So it wasn't a thing you had to think about or thought about much. But then as you started losing weight, it became obvious to recite,

Padma 21:14
I did track it. So one of the things was, in May, we went on a hiking trip to the Smoky Mountains. I was incredibly thirsty during that trip. I was also eating a lot of, you know, Southern food, heavy breakfasts and things like that. I just thought, you know, I'm from Western New York. I'm going south, and it's making me thirsty. I completely ignored that. My husband was also from here, and he was not as thirsty as me. That

Scott Benner 21:37
wouldn't help the overall conversation you were having in your head,

Padma 21:41
yeah. So at that time, there was no conversation, so I was eating a lot. I, you know, it was a vacation, so, and I did fall on the third day of the hike, I would go up, I would climb to the top of the hill. I would be fine, but then I would be just so exhausted I take a nap at the top, really, coming down on the third day I fell. And I fall a lot. I'm clumsy person, but that fall felt weird because there was nothing to trip me. We were coming down. It was flat, it was not a slope or anything, and I just fell hard and skinned my knee, my tore my pants and everything. It was a hard fall.

Scott Benner 22:14
I think we could call this episode clumsy hiker, if you want to, by the way, find another hobby. If you're falling down hills all the time.

Padma 22:22
I have a lot of hobbies. Okay, sometimes

Scott Benner 22:26
people say I'm very active, but then they go on to describe, like, a, you know, a moderately active lifestyle. You're very active. Yeah, there's no doubt. Yeah, absolutely. Hey, was there any judgment from people because of your cultural background. Like, did people look at you and go, Oh, it's the food. This happens to those people all the time. Like, were you getting that from people? I

Padma 22:47
think it was mostly from my doctors. Okay, so after my blood work came, I scheduled the blood work again. My ANC came back at 12.30 gosh. So that felt really bad. So the day I went into the blood work, did the blood work again, I did the blood work and went to CVS or Walgreens and picked up one of the finger prick kits. It all brought back a lot of memories, because I was in charge of my grandfather's finger prick. So I knew the Old finger prick things with where you know, you put a giant glob of blood, and then it has too much blood or too little blood after like a 22nd thing. So all of those things were flashing in my head. I picked it up, came home and realized that they don't come with the test strips. I had fight by those separately, and the day I got the results is when I finally had time to get this test strips. Also it was 12.3 and my fasting blood sugar and that day was like 280 even higher than the first one I come home and, like, try to test it, like I'm putting, like a giant glob of blood all over it. It was like my husband walked in and was a blood bath in the dining table. He still calls that thing my vampire. I'm

Scott Benner 23:55
laughing still, because I'm imagining you at the store really having terrible memories about your grandfather, probably feeling like, I can't believe this has happened to me, that you get home and open that box and you're probably like, god damn it, there's no test strips in this

Padma 24:10
box. Yeah. So when my grandfather had it finger prick, things were a whole new thing in India, nobody knew about it. My aunt, my grandfather's daughter, got it at the same age as me. Okay? So when her father got it, she brought us all the technology. She had finger prick kits and all of that. Our doctors did not know that our kit was from the US, and we had to wait for strips. We couldn't buy those locally in India.

Speaker 1 24:35
When did you come here? How old were you? I was 21 I came here in 2009 do you get home every year? Yeah, I'm actually going next week.

Scott Benner 24:44
I friends who go back every year, so I know it to be like a thing that they do very kind of religiously. How long do you go

Unknown Speaker 24:51
back for? I'm just going for two weeks. Is

Scott Benner 24:54
it culture shock for you? Have you been here long enough now that when you get back you're shocked by it? Or. You're not, Not particularly, no, I think it's because the people I know are through my daughter. So there's, they're kind of second generation here, yeah, and the kids, it's interesting, because they grew up here, and they go, they go back to India, and they're like, it's sometimes they come back and they look a little stunned for a while. So you go back visit with family a couple of weeks. Are you now the person who brings back diabetes supplies?

Padma 25:21
Well, sort of, yeah, I'm trying to get some of them to use continuous glucose monitors, and it's not worked out. Well, the apps don't are not compatible in India

Scott Benner 25:30
and things, yeah, you can't bring them from America to there and just expect them to work kids and

Padma 25:35
everything is better there. Now it's easier to get strips if you buy a machine there than from here. But back then, it was just not there. Like we would have blood camps where they test for diabetes, and we'll go in there and they just have these fingerprint kits.

Scott Benner 25:48
Does that break your heart a little bit because you want them to use the CGM, right?

Padma 25:52
Yeah, yeah, oh, yeah, oh, I'm not done with my whole diagnosis. Sorry, sorry, but I won't pivot. You go ahead. I go to the doctor's office with my husband again, and they're like, oh yeah, this is normal, just genetic. It's not your fault. That first meeting was actually very comforting, at least for my husband and I kept asking about all the different things. Like, you know, had a lot of questions like, Why is this happening? And I thought, you know, type two was insulin resistance, and all my I'm also a kickboxer, all of my training I thought was supposed to help with insulin resistance, why it's happening. And my doctor didn't have any good answers. But he was very comforting. I asked him if the meter was actually right. When we had the meter, after my husband called it the vampire, when we finally figured it out and tested it, I was at 460

Scott Benner 26:37
oh gosh, yeah, it was. It was really progressing quickly. Oh yeah, I

Padma 26:41
was at 460 and I hadn't eaten. It was like, three or four hours after lunch, so I knew that was very high. I thought the machine was broken. Tested, made my husband test, and he was at 90. Immediately mad at him. I tested again, and I was still at 460 but I was still starving because I hadn't eaten in four hours. So I went ahead and ate, and we discussed if we should go to the ER, I was like, Oh, what are they going to do? Just give me insulin. There's also all this fear about insulin. There's so many myths that sort of makes, makes you, at least in my culture, or in India, it was like, if you're on insulin, you're a bad diabetic

Scott Benner 27:20
kind of thing, yeah? So insulin is failure in your mind?

Padma 27:24
Yeah, it's sort of, it's sort of fear they I've heard things like, Oh no, if the diabetic is mad, like my aunt or my we are generally short tempered people with very little patience, but they would just blame it on the diabetes, right? Oh, maybe his, their sugar is high today, or maybe it's the insulin that's making them like this.

Scott Benner 27:44
How many generations has your family been covering for being dicks with their diabetes? Generally

Padma 27:49
not the nicest you know, my grandfather was feared way before he had diabetes,

Scott Benner 27:57
and later they just covered it up. They're like, that's that's his diabetes. Don't worry. I don't

Padma 28:00
think they cared. They were like, Okay, fine. Blame it on the diabetes. If not, I'd be an angel. I guess that's

Scott Benner 28:07
funny. Oh my gosh. So what did you do? Did you go to the hospital? No,

Padma 28:11
we didn't. So like, well, if my ANC is 12.3 it seems like I've been like this for a long time, maybe it's fine because the doctor's office didn't seem to care that much. Do

Scott Benner 28:20
you not know enough about the numbers at that point to know that that's crazy? Or were you talking yourself out of it at that point, like I

Padma 28:27
said, our numbers for my grandfather was always high. Even when he was on insulin, he dropped a lot. We didn't understand type one or any of that we just went by, you know, whatever the doctor told us to give him for insulin shots like, you know, once a month. They didn't do a one CS back in 2000 in India. They just did fasting and postprandial, okay? And based on that, the doctor would give us a number for the insulin, and that's what he would take if he dropped. He dropped low a lot. It was harder to manage. So when he was in the two hundreds, he was fine. So we just let him be I see. So we thought that was fine. So it's my dad. My father has type two, and it's very hard to get him to be compliant, because fizzy is a number of 200 regularly. It's

Scott Benner 29:12
like, that seems fine because that's what he saw with his father. Yeah. So it's

Padma 29:15
hard for us to wrap around that type regular, type two is different, yeah.

Scott Benner 29:20
And you're in the same boat then, because you've now seen it for a couple

Padma 29:23
I mean, the doctor's office didn't seem to care. Any other story I read was like, Oh, they rushed people right to the bus right to the emergency room or things like that.

Scott Benner 29:33
Okay, so you just figured you were on the family plan at that point. And yeah. So,

Padma 29:37
I mean, we were spooked. We just didn't know what to do. Okay? And we went to bed very scared, because I was I still tested about an hour and a half after dinner, and I was at 560

Scott Benner 29:49
jeez, were you have to be in dk by then, right? I don't

Padma 29:54
think I ever went to DK. So here's the thing. The next day, I went to the hot doctor and told him all this, and you. Like, Oh, that's fine. Say, Hey, I'm this high. Could I be type one? Because, you know, I didn't want to be type one, but I wanted to cross that off. And he was like, No way.

Scott Benner 30:09
Wow, that's a general practitioner still. Is that right? Yeah, okay, right.

Padma 30:14
Now I don't even trust that he went to med school. He's not my doctor anymore, like I'm an engineer. I know way more about medicine now than he ever helped me. I mean,

Scott Benner 30:25
I'm am fascinated that you told a doctor your blood sugar was 560 Yeah.

Padma 30:30
I was like, hey, is this meter right? I went to 560 Am I okay? Like, I've never seen that higher number before. I didn't know the meters could read beyond 500 and he was like, Oh no, that's accurate. But don't you know this is normal a diagnosis. Lots of people lose weight, so I had only seen him three weeks before, and I had lost eight pounds in that three weeks. Wow. They didn't even bring that up. And the nurse was like, oh yeah, we see this all the time. So it just made me feel like it's my fault. It's like, you know, I got diabetes, and, yeah, I'm

Scott Benner 31:02
fascinated though that 560 losing that much weight, and you said the words type one diabetes to him,

Padma 31:10
yeah, so when I asked about it, he just joked, like, you know, you'd be much higher if you were type one, and you're too old for that.

Scott Benner 31:18
Oh, God. So every misunderstanding was there,

Padma 31:21
huh? Like I said, internet's given me way more than this doctor, so I don't think he's a doctor. And then he's like, I'm gonna start you on Metformin and statins and lisno, prel and all of that, along with my high blood sugars. For the first time ever, my cholesterol was off too. The good cholesterol was, uh, was everything was borderline, not very high. The whole metabolic panel was kind of weird. And my hemoglobin was high. I think my sugars were just that high, or I was close to DKA that it threw all of my numbers off. So he started me on the regular things, and when I pestered about type one, he said, Okay, we'll test again in three months, and I'll add the C peptide test that'll tell you if you're making insulin or not three

Scott Benner 32:05
months. Wouldn't you be dead in three months?

Padma 32:08
Oh, it gets worse. Oh, go ahead. So he did refer to me an endocrinologist, and I said, Well, I'm going on this bike ride next week. Is that okay? And he said, Oh, no, you'll be fine. It's like, How often should I test with this? He said, Just test every morning. Don't go crazy about it. I'm going to refer you to an endocrinologist, because that's good practice, but I'm pretty confident he's going to send you back over to me and agree with my decisions. Oh, and I'll just see you every three months. We're going to manage this together. It's all going to be fine. Ask me, send me questions on the portal anytime, and all of that, right? I said, okay, and I left on the bike ride. It's a seven day ride. Every day we ride like 6200 miles. There's

Scott Benner 32:48
no way you got that done. I can't wait to hear what happened. What day did you die on the bike ride? I did not die the first

Padma 32:55
day I did 61st. Day is the shortest ride I did 66 miles. And this is all for a cancer benefit. There are some survivors who ride it, and we are very well supported. Yeah, I got to, like, 50 miles, and this is in the summer, so it was like a 90 degree day. I was sweating. I need I knew I needed electrolytes. I knew I needed food, but I couldn't bring myself to eat anything, or like everything has carbs, and I just froze every time I got to a rest stop. I was drinking a lot of water, but I knew I needed electrolytes, and everything has carbs in it. I just couldn't bring yourself to myself to eat anything, and I knew I couldn't go on for long without fuel. So I got to, like, 50 miles, and I wanted to test but I forgot to grab my finger kit the vampire, I asked the medics, and they didn't have it too so, but we came up with a plan, and looked at all the car ratings, and they helped me get some electrolytes, very low carb ones. And I decided I'll just stop at 50 miles. If we can't ride, we can get a boost right to the camp. So I did that. I went over to camp, grab my kit and test it right away. I was at 270

Scott Benner 34:03
Oh, yeah, but you were still feeling that badly. No, it

Padma 34:07
was also 90 degree weather. I was it was just regular hot. Oh, okay, okay, biking in the heat and all of that. But I was at 270 after a 50 mile bike ride. Yeah, right. And almost no food.

Scott Benner 34:20
Exactly when was the last time you ate? Do you think I had breakfast, which

Padma 34:24
was mostly eggs and maybe some potatoes? I ate some fruit and things on the rest stops, but 50 miles should have burned it. I was at 270 and I was like starving so, but when the food came out, I lost all appetite. I couldn't eat anything at all.

Scott Benner 34:40
When's the next time you tested in this on that day, I tested when

Padma 34:44
I got to camp, and then I didn't test again. I think it was the Metformin that was causing my appetite loss, and I didn't know at that time. They didn't tell me that all that will happen. Okay, so the next morning, I was still at 360 I barely ate anything. Everybody around me was eating, like three plate fulls, and I just. There staring at one plate, and barely got half of it down. I had to force myself to eat. And the next morning, I was, like, close to 300 at fasting. So I ate some eggs, didn't have any carbs, and got on the bike again. I rode like, 30 miles. I was concerned. I tested and I was down to 190 did you start

Scott Benner 35:18
thinking like this is going to be okay? Or did you start thinking I can't possibly go on like this?

Padma 35:23
I knew I couldn't possibly go on without eating properly, but I felt great while biking, you know? Oh, really, I wasn't tired much at all.

Scott Benner 35:30
Like, for a person who's in so much trouble, I'm doing terrific, I know,

Padma 35:35
so so torn and I had lost all this weight, so biking was really good.

Scott Benner 35:42
There's enough mixed message in what's happening to you that it's still easy to ignore the other stuff, I think I'm following. I appreciate you telling it like this too, because you're basically just drilling down on this one aspect of the diagnosis that I find really interesting, like the psychological game that goes on between you and yourself. You know what I mean, while you're trying to come to grips with everything,

Padma 36:05
yeah, and I'm reading everything I can find about type two diabetes, because at that time, they decidedly told me I was type two and I wasn't seeing any of it. Metformin is supposed to help right away. It's so great. It has so little effect for other people. So it didn't even cross my mind that it could be the Metformin was having issues, like bowel issues and things like that. That was all caused by the Metformin. But I didn't realize it. I thought it was still the hemorrhoids or something like that. It wasn't difficult to bite with hemorrhoids. Would be hard to

Scott Benner 36:36
sit on a bike, by the way. Did you actually have hemorrhoids? Or was that just the thing you made up? I thought

Padma 36:40
it was hemorrhoids. I don't know anymore, I decided I'll just stop testing anymore, because none of it was making sense to me. But and I also had a lot of work. I was working remotely my office also, because we had all these deadlines so and cut my right shot every day. Instead of fighting like 80 to 100 miles, I was only riding like 50 miles, okay, and working from camp, because I didn't want to be, like, just obsessed with diabetes the whole time, because it wasn't helping. None of the things that I was reading and my readings were matching at all. So I just went about what I was doing before, like eating normally or trying to eat normally. But I wasn't eating much. I was also taking stool softeners because I thought it was still the hemorrhoids, and I didn't want it to come back. At the end of the seven days, the whole week, I probably rode like 300 miles instead of the 500 miles I was supposed to ride. I got back and I had a deadline, like in two days, I decided I won't test until then, I just kept on working in the week. My husband was freaking out on his own because I wasn't a great communicator, and he had researched and loaded up on, like, healthy foods and salad recipes and things like that. He was taking care of feeding me, and every time he made the food, I was just upset and made me cry that I had to eat like that. Now this is my life, and I just focused on work completely. I worked for like three days after the ride. And when I was finally done with the deadline, I slept for like 14 hours straight. And the next morning, I started testing again because my endo appointment was in 10 days, and I wanted data for that. I was at like 300 after the ride. I was not able to do any workouts. I was just starting to feel sicker and sicker. I didn't realize that the Metformin was doing that to me, and every day, my numbers were over 300 fasting numbers, and I was barely eating. We tried the plate method. My husband would look at the plate, he would try to eat as much as me, and it's like, this is like pigeon food. It's not enough for me, and I wouldn't be able to complete that plate. It would take me, like, an hour to like stuff, the food in my face, and I was still losing like two to four pounds a week. Sure,

Scott Benner 38:45
you're not eating at all, and you have higher and

Padma 38:47
higher my fasting numbers were like, 400 right? You have, you have type

Scott Benner 38:51
one diabetes without insulin, and you're not eating. On top of that, like you were on your way, you were heading out,

Padma 38:59
people were starting to notice. First it was like, Oh, you look great. And they're like, are you okay?

Scott Benner 39:03
Right now, they probably thought they were riding that bike ride for you,

Padma 39:07
seriously? And there everybody was concerned. I had cancer, because, you know, that's a bigger fear. And when I said diabetes, like, Oh, we don't know anything about that, but are you sure? Because you seem great, you seem to be biking really well this year. It's interesting.

Scott Benner 39:21
Yeah, it's all the mixed messaging. It just and you this is a three month path right from the from the beginning,

Padma 39:28
give it. Give or take. Okay, it was very weird. So after that, the endo appointment finally came around, and I had all of this data. I was had notes of everything that I had eaten on my phone. I made a table so it's easier to show the doctor. I went and it was a 40 minute appointment, which was useless, that endo should not be an endo. He looked at my numbers. I showed him the phone app for notes app, saying, Hey, these are my readings. And this is what I've eaten. This is the workout I was I was just able to do some yoga every morning because I didn't have energy. Or anything else. There's all this news about, you know, exercise can make it worse. If you work out too much, your numbers could go higher. It was just blaming everything I was doing and every, every life choice up to that point, I saw it all to the Endo, and he gave me the a log book, a paper thing, and he just threw it at me and said, Hey, you can use this to log. He didn't like

Scott Benner 40:17
your notes app. Where

Padma 40:18
I log with is not the point. I have this log now. Can you take a look at it? And he was like, Oh, you need insulin. And I described this bike ride to him, and I like, well, I don't want insulin. I'm scared it can cause a lot of lows, and I'm not comfortable with it. And he was like, well, but your numbers are high. You're not doing the right things. And I said, Well, if it's type two, if you're sure it's type two, I should be able to handle it with diet and exercise, right? And he looked at me and like, Yeah, but these meds should help with type two. And he was like, Yeah, well, they want help on their own, though, but you need to focus on your diet and exercise too. This has been my diet and exercise for the last week and for most of my life. Yeah, if I have to do more diet and exercise to stay alive, it's not happening. How is

Scott Benner 41:03
that possible? Right? I mean, you are the most active person I think I've ever heard from. So, like, that's, oh, that must have been incredibly frustrating

Padma 41:12
in all of this. None of them mentioned continuous glucose monitors at that point. I did not know those existed. Okay? My fear around insulin was, I didn't know how to dose, like I didn't understand the math that we were told from my grandfather, take this much once a month, or once in three months, the doctor would tell us what dose to give him, and we just gave him that I see, and I still thought that was the way things were done, because, you know, I just didn't know at that time, and my doctors were not giving me that. So you were

Scott Benner 41:40
scared of insulin for all the reasons that we've covered but over and above, because the last time you were involved with insulin was back in India, with a with a type two grandfather who they would just do a fasting fasting and then give you a number, and then he'd get low all the time, yeah, yeah. No, it's got to be frightening. I

Padma 41:57
said, I don't want insulin. And he said, Well, we can put you on trulicity or xampp, those should help with type two. And I said, I don't want injections or insulin. I thought those were all the same. And he said, No, but Trulicity is not the same as insulin, but this will help. So he added trulicity, and I explained to him my bowel issues and digestive issues, and I said, he asked me about it, and I said, Well, I'm also on stool softener, so I think that's what's causing my bowel issues. And he looked at me weird and said, Oh, you don't need to do that. Metformin will give you Bolus issues on its own.

Scott Benner 42:28
He thought, Oh, that's lovely. No one told me that. Oh, nobody told me about

Padma 42:32
it. And then he went on to double my Metformin dose.

Scott Benner 42:35
I'll get you going. Don't worry.

Padma 42:39
He said, Star trulicity, and showed me how to do it and all that, and sent me home. I explained the bike ride and stuff, and he said, you probably shouldn't do those things with your condition, is what he said,

Scott Benner 42:50
Oh, now you don't get to do all the things you love. It's

Speaker 1 42:53
like, yeah. It's like, well, what's the point of living Yeah, I understand. I

Padma 42:59
went back home, I called one of my cousins, who was diagnosed around the same time as I was, and he was also very active. So I thought he would have figured out the answers, but it did depress me more because he told me the same thing. Say, I'm sorry you have it, but this is I haven't figured out a natural way to cure any of this. This is how we are, and everything you do will spike your numbers. And he was not in control at all, and it depressed me even more, and I refused to accept that. But I went home all this time. I was trying so many things, not eating the salads, and things were not working, so I wanted to go back to my regular food, and my husband thought I was being non compliant. I was just being,

Scott Benner 43:38
oh gosh, it starts impacting everything. Yeah, like I said, I'm not great at communicating now, you seem like you have a little bit of your grandfather maybe

Padma 43:48
going on. So I also asked as the endo about type one, and he said, Well, we can add a gad 65 test when you come back in three months. I asked him what it was, and he said, it's not an antibody test that'll tell whether you have type one or not, but I don't think you're type one. So I went back and I started reading more and more about type one. I read some misdiagnosis stories. I just went back to taking all of these meds, and I was just feeling worse and worse. I kept dropping more and more weight, and it was a very confusing period, and the more I read about type one, eventually, once I found the right prompt words and got type one information, I felt stronger that I did have type one, and I read about continuous glucose monitors and everything else. And it didn't seem as daunting, but I could not convince my doctors for anything. First, they prescribed real estate, and it made me even worse. The Metformin was making me worse, so after a month, I decided to go ahead and do the test that I was prescribed that was supposed to do in three months. I did that, and my gad 65 came back positive, but my C peptide was 1.8 it wasn't low enough, but the GAD 65 meant that I had out on. Antibodies. By then, I had read about T yield and everything else, and I wanted the other antibody tests. Contacted the endo on the portal, and he came back and said, like, well, you could still be type two. And then I had asked, like a child. I asked, like, what does my Gat 65 test mean? What does my C peptide test me said, Get 65 means you might have antibodies, but because you have high enough C peptide, you're not insulin, you're still making some insulin. Okay. I was like, Can I get the other tests? Yeah, right, other insulin antibody tests. And he said, Oh, we can add that in when you come back in three months, if you're interested in something like T Z. I was already passed that for tz, like, this is definitely stage three. If it's type one, I don't qualify for it. I knew that, and the doctor didn't. I was giving up on that Endo, and then I found out that that endo was not in my network, so we had to pay for him.

Speaker 1 45:53
Oh, awesome, bonus. Oh yeah, I

Padma 45:57
did the test early because I was still hoping that it was not type one, yeah, in the off chance that it was not type one, I was supposed to go to a higher dose of trilicity in four weeks. I didn't want to delay that or cancel that. It was like a whole pile of things. And I and then I told him I stopped Metformin because it's making me sicker. And he just said, Oh, just go back to your old dosage if it's making you sicker. And I like Gil supplied or guilty guilty sight or whatever. I tried even that for a few days, and it all just made me worse. So I went back to my primary care and said, Hey, can you just give me a different Endo? And he responded and said, Oh, you find anybody you want, and he'll give you a referral. Looked up a research facility near my house and looked into the research for all the doctors. And there was one university group had a lot of researchers that were that had both type one and type two, and I asked for one of those doctors, and he gave me a referral to them, but they didn't have an appointment for the next six weeks.

Scott Benner 46:53
People are really trying to kill you. Oh, yeah. First of all, as you're now, like, you know, you're stepping through this time period once you're in that office with the with the endocrinologist, and talking about gad 65 you are clearly educating yourself quickly. Oh yeah, right, because you're now talking more like a physician than the doctor is. Oh yeah. Or, you know, I guess the way you would

Padma 47:13
expect, the endo told me about gad 65 and then I researched more, and by the time I did that test, I knew there were other antibodies. And I had read about, you know, the hangry woman's podcast was one of the first I heard she was on TCO yd. And then I started hearing more and more about, pretty much finished all the TCO yd episodes. And then I became this crazy person who's on the internet, posts my symptoms on everything. My primary care had given me a couple of books to read, which was just garbage, which pretty much said the only cure to type two diabetes is bariatric surgery, and nothing else will work, and things like that. It was a whole roller coaster for a few months. And at some point I did start sharing properly with my husband. He saw that I was doing, I was experimenting very fast, and I had to tell him that, you know, I've been where you are, seeing nothing working for my grandfather or my aunt or uncle. I know how you feel, but I don't have time to explain things to you, because I'm just learning so much, and it's an overload. And he started following what I was doing. He was he would see I would making better choices for lunch or dinner, and the next morning, he'd come down ask for perceived blood sugar, and I'd be like, 400

Scott Benner 48:21
fasting so well, I mean, it was smart of you to get him involved, because it's interesting, isn't it? Like, were you able to see He must feel the way I felt when I was helping my grandfather. And, yeah, it took

Padma 48:35
me a while. We had, we had, like, a big fight before I saw that, because I was, it was information overload for me, and he was overwhelmed too, but I was just not even seeing his point for a while. And then we had, like, a big breakdown. And I said, Well, I see what you where you are right now, and I've been there for several years, but I just feel very strongly that the doctors are wrong and I don't have type two. I knew all of the stories of all of my family that really helped. And then we found out his insurance had a service called included health, or his employer provided that service. It's like a medical concierge service, so I could get a second opinion from them. So I uploaded all of my it's an app they assign independent primary care who will talk to you and then get all your test results and present it to a specialist. In my case, to an endocrinologist who never sees me, so it gives an unbiased opinion. I uploaded all of my details to him that should usually take two weeks, because they have to contact the doctors and everything, but I downloaded all of my results of my chats on the portal with the doctors and sent it to them, and in two days, they came back and said, You have type one diabetes. One of my questions was, if it was Lada? They said, No, it's not Lada. You're in full blown type one you need to be on insulin your insurance with insure, and you need continuous glucose monitors. You could go for libre or Dexcom, and it will cover it'll cost you this much with your insurance. All. Of those details in a 19 page report, and they send it to my primary care also so they can prescribe whatever I need. The remote Doctor contacted me right away and said, Well, we've sent it to your doctor, but go ahead and you send it to contact them so you can get unmet right away. I did that. I forwarded all that to my primary care, and they came back on the portal and said, Oh, the doctor doesn't think your insurance will cover continuous glucose monitors because you're not on three or more insulin shots a day. Well,

Scott Benner 50:26
it's because my doctor doesn't know what you're doing. He's trying to kill me. These people are trying to help me. Yeah, I took

Padma 50:32
a screenshot of that and uploaded it on my the second opinion portal, and that doctor called me back, like, five minutes later. It's like, Oh no, I don't think your doctor read the report. You need a new primary care, and he was freaking out.

Scott Benner 50:47
Well, I mean, you know, I've been having this thought the whole time you were speaking. I've had this thought a number of times making the podcast. But if I just bullet pointed what you said and put it into chat GPT and said, What's wrong with Padme, it would come back and say, she has type one diabetes,

Padma 51:01
yeah, yeah. I think I posted on TCO IDs. They had a page. I posted my story on that in the comments, and Dr Edelman responded on that and said, Oh, you need insulin. I was like, How do I get my doctors to test and how do I get an antibody test? I asked my primary care to prescribe the other antibody test, and he wrote back on the portal saying, Oh, I don't order that type of test.

Scott Benner 51:25
I think what they mean is, I don't know how to read the test. I wouldn't know what value it was later.

Padma 51:30
You know, they haven't in it. Anyhow, I already knew another Endo, another primary care that I knew through the Indian temple in Buffalo, and I contacted him, and I said, Hey, I need a new primary care. I told him my story, and he thought, like, Well, I'm not sure that your type one either, but with your numbers, you do need that, and I can know i'll see you in the next few days. And I had a trip, work travel, trip coming up anyway. So I said, I'll do that, and then come see you, because any other primary care was like months out in appointments. So went away on a trip, on a work trip. I had stopped all my medications by then, found a new window. I made the appointment, but that was out like six weeks, and went away on a trip with just, you know, I ended up walking like five miles a day and hoping. I considered becoming an alcoholic for a while, because that seemed to help my fasting blood sugars. But then I'm a lightweight. I couldn't handle more than a drink. The

Scott Benner 52:29
drinking was helping your blood sugars. And like, maybe this is the answer, yeah.

Padma 52:34
You know, if I can't get the test I want or anything, in the meantime, I also, when I posted on the TCO Y day website. They came back with a link to get a home test type, one tested.com I went on that and requested home test kit, and I got a call back from them, and they were really great. They were like, Oh, you're sort of beyond the thing for us, for you to be enrolled in the study, so we cannot send you the kit. I was like, well, you accidentally already sent me the kit. I have it on my desk here. They're like, Oh, okay, then go ahead and send it. We'll test it for you. You

Scott Benner 53:07
just live in New York, right? You don't live in like, yeah, yeah, yeah.

Padma 53:12
And this is not to the 1970s or anything. No, it

Scott Benner 53:16
makes it feel like you're just, I don't know what it makes it feel like, it feels like you're under a bridge asking random people like, what can I do? Yeah, oh my gosh, it's incredibly frustrating. Yep.

Padma 53:28
And the person who called from type one tested or a trial net was like, really great. Like all of you, all that you're saying, makes me believe it's type one. We'll test it for you, but it's very I'm glad you found a new doctor, because it's very common. I'm Indian. You know, there's also the medical bias that Indians are type two, right? Those doctors were just not willing to see that. So I I test sent like, one drop of blood, because I'm horrible at collecting blood myself, so it's my husband. So together, we managed to send them two drops of blood, and they sent me the report back, I was overwhelmingly positive for four out of five antibodies. The fifth one they couldn't test because there was not enough blood, gosh, and my gad numbers. It was like they sent me an email saying, you know, when it's borderline, we may question it, but you're so overwhelmingly positive that there's no other diagnosis. Here you are type one. Gosh.

Scott Benner 54:21
Well, I am so incredibly sorry that this is the pathway that you had to follow through. But I have to say, like, on some level or another, I think this happens to people every day, all day long. Yeah, actually,

Padma 54:34
I know that this all happened between end of June by September. I knew I had type one. I've read stories where people gone eight or nine years, and I've heard people come on your podcast. There was an episode that you released like two days ago, the day I made this appointment, that person was still struggling for an appointment for a diagnosis. Honestly,

Scott Benner 54:54
there are times that people tell stories that take so long to figure out. About that. It makes you think, like, they really have type one, like, how did they stay alive that long with those problems? But, I mean, what I've been able to figure out, the best I can figure out is that it's like a one and a half, like a lot of situation, and, you know, they do all these other things that kind of help it limp along and keeps it going for a while, and then the all the stuff that you talked about is what they're running into in their doctor's office, as well as just people who don't understand. They jump to conclusions, they have medical biases, and that all leads to this. And then a reason I appreciate your story so much is because you spent so much time discussing how it made you feel and how it caused issues between you and your husband and like, you know, it's not just the medical stuff, which is bad enough, right? It touches so much else in your life.

Padma 55:45
Yeah, and it's also the stark difference. When I was telling people I had type two diabetes and not believing it, I felt guilty like I had done it myself, or I could feel the judgment in people. No,

Scott Benner 55:57
that's what I'm talking about. Like it's touching your life in so many different, yeah, negative ways. I

Padma 56:03
also realized that there were so many of my family members who were exactly like this. There are some like the cousin I mentioned that I talked to had this bias on insulin. He's not on insulin. He's probably type one too similar to me. And

Scott Benner 56:17
because of the bias and the and the shame and everything, it's not even something they look at. All the

Padma 56:21
members of my family work very hard at their health, but to others, it look like they're just, oh, they're just failing as a diabetic, yeah, because they're going low or anything. So my great grandfather died in 1948 he was on insulin. It was in pre independence India that he was on insulin. We don't even, I don't. We're not like a very wealthy family or anything. We were very lower middle class back then, and they still made the effort to get him insulin.

Scott Benner 56:47
Yeah, he was gonna die without it, most likely. Yeah.

Padma 56:51
So he survived, but eventually he died because nobody knew about all that. And my grandfather was diagnosed at 78 and he was already old. I'm a very active person. He was as active as I am now at 78 and when he was tired or complained that things were not working, people just said, Well, you're old. You're supposed to feel like that. But for the closest of us, it was really hard to watch and deteriorate so fast. He died like seven years later of complications with his kidney and heart and things like that. But you know, he had had a full life.

Scott Benner 57:23
I just it makes me sad when it happens to older people too, because when it happens to you, when you're 78 they just think, Oh, this is the end of your life. Yeah, don't worry about he's

Padma 57:30
complaining that he can't walk four miles. Is like, well, you're an 80 year old. That seems normal to most people,

Scott Benner 57:38
yeah, right. And also, you don't get any kind of care at the end of your in those last years of your life, either, because people just think, Oh, well, this is the thing that's supposed to kill this guy. Do you know what I mean? Yeah, they get that vibe like, oh, that's the thing that's going to get you, I guess. So then we'll just ride it out and and you don't get any real assistance. And, my gosh, and then listen, even then, like you only talk this story right up until somebody actually told you what was going on. There's a whole other world that lives after that. Oh yeah, yeah. You might not understand what they told you, or they might not have done a good job of explaining it, and how are you gonna manage every day like this is, it's a bigger story. Even

Padma 58:15
after that, the care has been like the endo that I finally met. I've never met him in person. He's, I think, very old, but he has been researching with ozempic for type ones or newly diagnosed type ones. There was an article in the paper about him the day after I made the main appointment with him about how he was able to eliminate insulin needs for newly diagnosed so I met all of those requirements, and I knew all of that going in for the appointment, and I had my antibody results by then, all of that helped the new primary care that I had gotten. He didn't believe I was type one either. But then when I got all the results and showed it to him, he agreed. I asked him for more clinical tests for the antibodies. He had me write it down. He was writing it down, and then just handed me the paper, like, write whatever you want, and I'll go make a copy so I can learn about these tests. Also,

Scott Benner 59:07
I think the internet has done away with people's ability to just believe that doctors are magical, that's for sure, because now everybody can hear stories like this, like, I mean, it's awesome that he helped you like that, but at the same time, think about that from another perspective. Just tell me what you want me to say, like,

Padma 59:23
oh, and even he wasn't talking about continuous glucose monitors. To me, he explained, insulin. The way I got insulin is even funnier. He ordered Lantus, and as part for me or some or no log or something, I didn't get it this, the pharmacy didn't release it because they needed more information. This doctor is really nice. He called me at like, six o'clock in the evening because the pharmacy had not filled it. They said they needed more information from the doctor's office. He called me to make sure I got my insulin right, and I said, Well, they didn't release it because your office did something wrong. So he called the pharmacy, discussed it with them, and called me back and said, Go now you should have. Insulin.

Scott Benner 1:00:00
My gosh, did anything work out for you? Did anything work well for you? Hold on, okay, got

Padma 1:00:06
the insulin beds, but they don't come with needles. And it was like 755 at night before the first pharmacy closed at eight o'clock. So I sent him a text at night. I had his personal number. It's like, hey, the needles don't come. I did

Scott Benner 1:00:22
a cold wind episode yesterday. I've recorded one with a CD CES, who works in a GPS office, and she just spent the hour telling me like crazy stories that you wouldn't expect, and the number of people who are given insulin pens right for type one diabetes, type one, type two, diabetes insulin pens. And then they track them for months and months, and it seems like the insulin is not working. And so they say, well, use more. Use more. Use more. And then eventually she was in a meeting one day, you know, an appointment with a person, and you know, she said, Well, I don't understand, like, what's going on. And it finally struck her. She's like, go through this step by step with me, and the person went through it step by step, to come to realize that at the very last step, which is take the little cap off the needle, the protective cap off the needle, they weren't doing that. Oh, they were poking themselves with the needle and then injecting the insulin into the plastic cap, and it was squirting out on them. And she figured that out, because he said, I kept my fingers keep getting wet when I'm giving myself insulin, and she couldn't figure it out. Now, you would think, what a crazy one off

Padma 1:01:25
story. I thought you were gonna say they were squirting it into their mouth. Oh, she said

Scott Benner 1:01:30
other people injected into their food. Oh, but that's not that's neither here nor there on the first story. Now she steps back and looks at everyone in the practice and says to herself, I wonder how many other people are doing this, and then finds out that it's fairly common that people don't take the cap off the needle and aren't actually putting the needle in them when they're pushing the button. Well, okay, yeah. And she says, when you talk to the people, it's not because they're they're not dumb, they're not, like, not trying. She's like, they just got bad direction. And somewhere along the way, they don't see that little cap on the needle. Actually,

Padma 1:02:01
no direction. Adults don't get through get any of the instruction that, yeah, they do for kids. I was fascinated

Scott Benner 1:02:07
by that story because I think it says a lot more about the teaching than it does about the people. Yeah, yeah.

Padma 1:02:13
So then the next I sent him the text, and the next morning, he called me at eight, and he was very grumbly. He goes like, well, the needles are ordered now. It's like, oh, I didn't know they didn't come without needles. And he goes like, I didn't either.

Scott Benner 1:02:27
We're all learning together. Sadly, you'd think he might have learned. This is great, yeah, you think he might have learned before he started being your doctor. But okay, all right. Well, so

Padma 1:02:36
then I got my Lantus and no log, and then he had told me, like, you know, start with 20 units of Lantus day, and then see how it goes and moderate it. Like, how am I doing this? It's like, test, like, an hour after you eat or something. Say, can I get a continuous glucose monitor? He's like, Yeah, sure.

Scott Benner 1:02:54
Well, at this point, you're making the decisions anyway.

Padma 1:02:57
Oh, yeah, yeah, concert med school early on. I should have done

Scott Benner 1:03:01
that. Listen, it's possible. Well, not you, because you seem like you really research. But, you know, reasonable people like you who become doctors sometimes turn into doctors like that too, yeah, because then it goes back to teaching again, like the teaching in med school doesn't really help them. I mean, I understand they're trying to jam a ton of information into them, but it's a high level, quick overview about a lot of things. Then you go out into the world, you're supposed to learn on the job, except, apparently, then the system's so busy that nobody has time to learn. So they're just constantly, like, they're doctoring with, like, the first four sentences of the medical book. Basically, it's a bad system. It's reliant on people. People do not have the capacity to do what a doctor is asked to do. I'm not saying good doctors or bad doctors. I'm just saying in general, like the human mind, it can't hold all this information about all these different possibilities. It's, yeah, it's tough. You know,

Padma 1:03:53
they charge us a horrendous amount of money to do their job.

Scott Benner 1:03:57
They went to all that school and it was expensive. They got to take that money back somehow to do your job. Yeah, they charge you all that money, then you end up doing it exactly. And

Padma 1:04:06
I go every three months to educate them about things and pay them for it.

Scott Benner 1:04:11
Should ask them for a co pay every time you listen. I've told this story before, but I was once asked to go into another Um, another room at an endocrinologist office and explain something to another patient. I was asked by the the organization, like, Could you go over here and explain what you just said to me to them? I'm like, wait, what? I'm sure that's not right, but okay. And then the next thing I know, I wasn't I was introduced, Hi, this is this person. He's this girl's daughter. I'm going to ask him to explain something to you. Just explain to me. And then I had to explain, like, how I think about pre bolusing to them, yeah,

Padma 1:04:43
oh, pre bolusing. I had discovered that before I listened to your podcast, because good as part, was taking me, like 45 minutes to hit. I was supposed to eat, take it and eat within 15 minutes. I could see in my CGM that it wasn't hitting right away. Okay, so I had to take it earlier in. Earlier, and the doctors, even my new diabetes educator and everybody said, You shouldn't, you should eat right away. It shouldn't take that long. But they didn't consider giving me a different insulin until I asked them for it. I was on Lantis for the longest time, and it was just not enough. My a, 1c went from 12.3 to down to 6.6 within like, three or four months of starting on insulin. Yeah, but it took a lot of effort. Lantus doesn't last a full 24 hours. Yeah, my new endocrinologist didn't change that either, because they were focused more on ozempic helping newly diagnosed really,

Scott Benner 1:05:36
like, I mean, isn't it funny, though, that you didn't get, like, dress or a more modern insulin. I

Padma 1:05:41
asked for it multiple times, and they kept saying, No, I really wish my doctors had wear type ones too, but they kept saying, Oh, it's supposed to act the same way after like, six or seven months. I said, No, I want traceba, yeah. Atlantis is not working, and I'm not leaving until you change it. And they changed it, and immediately my lows and things went away. It's way more stable. Yeah, only the last appointment, appointment, I switched to FIAs good. I asked for tocibo. You guys changed it, and it's I'm doing much better now. So I want you to change this also. And they did. Yeah, they're

Scott Benner 1:06:14
not gonna argue with you ever again. Probably, you're probably in charge now, so don't let it go to your head. Hey, and I think I'm gonna call this episode phantom hemorrhoid. I've decided,

Unknown Speaker 1:06:26
Sure, thank you.

Scott Benner 1:06:27
I appreciate the vote of confidence on that one. I really think it's gonna draw people in. They're gonna be like what

Padma 1:06:34
I did think that too, because one of the other episodes that I had listened to, that person had strange but issues too.

Scott Benner 1:06:42
Hi, are you trying to get me to call it strange butt issues?

Padma 1:06:52
And I didn't understand. I didn't realize that it could have all been just part of my diabetes back until I heard that episode.

Scott Benner 1:06:59
Yeah, yeah. It's, I mean, listen, oh, she had the fistula. The girl that had the fistula, yeah, that blew up, like her, yeah, her ass exploded. Oh yeah, yeah, no, no, I remember. Didn't she have a, like, a fairly new boyfriend that had to help her with it? Yeah, yeah. That's just horrifying. Anyway, I

Padma 1:07:16
sort of felt like I identified that I've known my husband for a long time. He's not going anywhere. But still, I was sure when all this happened that, you know, it was only a matter of time, yeah,

Scott Benner 1:07:27
oh, you're reminding me. Now, by the way, that's my favorite title of an episode, I think because I called that one butt hole adjacent. She was trying to describe that this hole just, you know, appeared, and she was trying to tell me where it was, and that's how it ended up coming out. The story, oh my gosh, you and your husband are good now on all this. Like, yeah, so

Padma 1:07:46
at one point I was like, wondering why this was just happening to me. Like, you know, all the Indian bias and all of that. And I turned to him and looked at him and like, Hey, you're Indian too. Does your family not have this? And he just went, Oh, we my grandfather had to, we had to amputate his leg because it was not so uncontrolled. And that was another thing that reiterated, my my family was working very hard at this. No,

Scott Benner 1:08:10
I mean, the whole thing's just sad. I mean, Padme is just sad. Like the whole thing is, I mean, are you okay now, like modern, present day, are you in a good place? Yeah, I'm

Padma 1:08:19
still not on a pump. I was taking very little insulin. I was put on ozempic, and that caused me to lose even more weight, but it did help with my insulin needs. Yeah, at one point I didn't need any Bolus at all. I was just on basal, even with Lantis, and I was down to like, three or four units a day.

Scott Benner 1:08:39
Yeah, Arden's taking Manjaro. I'm sure she'll be thrilled when she hears this one day, but on the seventh day, when she needed to take it again, recently, she had her period, she really didn't feel well, and she's like, I just, I kind of want to skip this today, and in that one day, the difference about her meal spikes is incredible. Yeah. Just like, because, yeah, because the, you know, the GLP is gone. It's not doing what it's doing so, and it's not because she ate more or anything like that. It's just, yeah,

Padma 1:09:05
I could notice that too. But my bigger issue was, I'm not a very big eater. Even before all this, I eat just what I need, and I like eating good food. I went from like 166 pounds down to 112 pounds, wow. But I finally started on insulin and everything, I was down to 122, and with ozempic, I was very critically underweight. The treatment with ozempic for newly diagnosed is you start at point two, five and increase it every now and then I went up to one unit at one point, but then I was losing weight way too much. It was just not healthy. So I requested that I scale back, and I was brought down back, 2.25 and I didn't tell my doctors yet, but I stopped taking it, like three weeks

Scott Benner 1:09:51
ago. Okay, yeah. I mean, if it's keeping your weight down that far, it's tough. I guess I should say that Arden is not taking the full dose. We're not. Micro dosing it like she's not taking a little bit. Every day, we inject the self injector into a clean vial and then draw it out with an insulin needle and give her less than the 2.50

Unknown Speaker 1:10:13
you can do that by the clicks. Oh,

Scott Benner 1:10:15
no. This one's a self injector at all. It just goes in, if you're using ozempic then you did Manjaro is just boom, like, it gives you pen, yeah. It took us a while, but we figured out how many, how much of that dose helps her blood sugar, but doesn't slow down her hunger, okay? Because that became a problem for Arden too. Like, we were like, Oh, this is great. It's helping with her blood sugar so much, but she's losing too much weight.

Padma 1:10:38
It's not so much my hunger didn't affect my hunger that much. Okay, I just wasn't putting on weight at all. Generally, not a big eater. No, hungry to begin with. Yeah, of this, and I was still eating the same thing, but I was just not gaining any weight at all. I scaled it back slowly, and now I don't take it at all. It's not affected. Maybe if I took it, I wouldn't. I'm on like, 10 units of traceba at night, and maybe four units only for lunch and dinner. I work out so that covers my breakfast. Yeah, yeah.

Scott Benner 1:11:11
No, you you have more of, like, Jenny's vibe about, like, if you're super active, like, definitely is helping with your insulin needs.

Padma 1:11:19
Like, this year I did this. I didn't do the seven day ride. I didn't have time for it. I did only two days, and those two days I needed no insulin, and I was still dropping. Okay, even no basal. No. Yeah, no basal. I The day before the ride, I was already, like, I had started my period, so it was I need lesser once I started my period, so I reduced it to like two units the first day, and I kept dropping all through the ride, even though I had taken no Bolus. I ate a lot of

Unknown Speaker 1:11:48
donuts, but

Scott Benner 1:11:50
a bonus finally getting some donuts. Yeah,

Padma 1:11:52
and the second day, I skipped my basal too, and I was still fine for like hours after the ride.

Scott Benner 1:11:59
Yeah, that's interesting. I mean, Arden's needs drop when her period begins, her needs drop too. It's

Padma 1:12:06
also that adults, when we are diagnosed, we still make have more our C peptide doesn't go down to zero right away, maybe because our immune system is more mature when it hits it doesn't fully decimate the beta cells. Yeah, I'm

Scott Benner 1:12:21
not sure how to guess about that after all these years of hearing people's stories. But I mean, when people are Lada or are experiencing a slow onset, it can really go on for a very long time, and not for everybody. Some people's are shorter, but I mean, you're also eating well and doing a ton of activity, which I'm sure is helpful. And you know the osempic too well.

Padma 1:12:41
I can't do a whole lot, like, if I can do like, an hour before I need a snack, yeah? All right, drop. So I have to adjust. I have to eat a snack. I swam this morning for an hour before that. I have to make sure that I'm I go in at like, 160 Okay, really, yeah. And I've also found that the libre three is actually better than Dexcom. You enjoy that better, at least for me, how? So it was just widely inaccurate for me, I was on libre three, and I thought that maybe it was inaccurate before I discovered that Lantus was the problem. So my endos office Let me try a Dexcom. So I had both on at the same time. And the Dexcom was like over 30 off all the time, and it took, like, three days of calibration to bring it back in, to bring it closer to my actual finger prick

Unknown Speaker 1:13:30
value. No, we

Scott Benner 1:13:32
don't want that. That's too long. And the libre three with the

Padma 1:13:35
Lantus, it was struggling. Sometimes it would, there'd be white spikes. So I thought the sensor was reading it wrong, but it samples every minute, and it moderates it so it's actually very close to my actual my finger prick. That's

Scott Benner 1:13:48
great. I'm glad you found something you like. Do you think you'll go to a pump if your needs go up or no?

Padma 1:13:53
Yeah, yeah. Really don't have an idea of what, what is like a minimum value for a pump.

Scott Benner 1:13:59
I mean, you could use a pump now, but it seems like you it's not necessary. I mean, meaning like you seem like you're managing well the way you're going. Yeah. Do you feel like you want one? Though I'm

Padma 1:14:10
torn. Maybe it'll be easier, but I'm very clumsy, like I said, so I don't think it'll keep it on for very long, even the libre i keep losing every I hardly ever make it the full 15 days, I rip

Scott Benner 1:14:21
it off somehow. Why are you clumsy? Do you think it's just innate? Oh, that's that's

Padma 1:14:26
another side of the family. Okay, that's so funny. But I also do a lot of activity. So when I'm swimming, I could, like, rip it up or the sensor just fails. Sometimes. I found out that wearing it on my on my arm causes the sensor to fail more often. So I went with a longer swim bathing suit that covers that covers my thighs, and I wear my libre on my thigh. Okay,

Scott Benner 1:14:47
oh, you're fine. You're figuring it all out. You really, are. You really dove into all this? Yeah, yeah. It's awesome. I'm glad for you. I'm glad that you figured it out now, yeah, no, I'm just gonna say you just turned your nerd onto the diabetes. It sounds like that's. Kind of how I live my life in anything seems like it's working Pat. My really appreciate you doing this. Thank you for taking the time. And people don't know, but we talked about this before it started. You actually, and I'm glad this worked out this way. I had a cancelation. Usually my schedule is completely packed, and you had to cancel because of a work trip, so you jumped on to cancel, and saw this opening, and that's why we got to talk today. So I love the Kismet there. It's awesome. Sorry I ruined your you did ruin my sleep in today, but that's okay. I'm gonna get a lot done today, because I was

Padma 1:15:30
wake up at five. So I don't feel very bad about 20 years. I don't understand

Scott Benner 1:15:33
people who get up at five o'clock, but hold on one second for me. Thank you so much. You you. Thank you so much for listening today, and don't forget to go to cozy earth.com and use the offer code Juicebox to save 40% off of your entire order. Everything you throw in that cart is 40% off when you remember to type Juicebox at checkout. If you don't type Juicebox, you got to pay the whole bill. You don't want that 40% off. Get in there. Get yourself some clothes. Come on. What are you gonna walk around and that stuff you're wearing right now? I see you. It ain't good. Are you tired of getting a rash from your CGM adhesive? Give the ever since 365 a try. Ever since cgm.com/juicebox beautiful silicon that they use. It changes every day, keeps it fresh. Not only that, you only have to change the sensor once a year. So I mean, that's better. Thanks for tuning in today, and thanks to Medtronic diabetes for sponsoring this episode. We've been talking about Medtronic mini med 780 G system today, an automated insulin delivery system that helps make diabetes management easier day and night, whether it's their meal detection technology or the Medtronic extended infusion set, it all comes together to simplify life with diabetes. Go find out more at my link, Medtronic diabetes.com/juicebox if you're looking for community around type one diabetes, check out the Juicebox Podcast. Private Facebook group. Juicebox Podcast, type one diabetes, but everybody is welcome. Type one type two gestational loved ones. It doesn't matter to me, if you're impacted by diabetes and you're looking for support, comfort or community, check out Juicebox Podcast. Type one diabetes on Facebook. Okay, well, here we are at the end of the episode. You're still with me. Thank you. I really do appreciate that. What else could you do for me? Why don't you tell a friend about the show or leave a five star review? Maybe you could make sure you're following or subscribed in your podcast app, go to YouTube and follow me, or Instagram. Tiktok. Oh gosh, here's one. Make sure you're following the podcast in the private Facebook group as well as the public Facebook page you don't want to miss. Please. Do you not know about the private group? You have to join the private group as of this recording, it has 51,000 members in it. They're active, talking about diabetes, whatever you need to know. There's a conversation happening in there right now, and I'm there all the time. Tag me. I'll say hi. The episode you just heard was professionally edited by wrong way recording, wrong way recording.com, you.

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#1519 Best of Juicebox: Defining Tug of War

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Scott and Jenny Smith define diabetes terms In this Defining Diabetes episode we define tug of war.

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COMING SOON

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#1518 Habit Lab: SMART Goals & Identity‑Based Habits

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Use SMART goals, identity‑based habits, and quick daily “votes” to turn planning into real progress.

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Scott Benner 0:00
Friends, we're all back together for the next episode of The Juicebox Podcast. Welcome.

Welcome back to part two of our habit building, habit breaking, goal setting extravaganza with Erica Forsythe. If you haven't heard the first episode, go find it right now. And if you want to learn more about Erica, Erica forsythe.com 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. AG, one is offering my listeners a free $76 gift. When you sign up, you'll get a welcome kit, a bottle of d3, k2, and five free travel packs in your first box. So make sure you check out drink. AG, one.com/juice box. To get this offer, 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 Juicebox at checkout. That's Juicebox at checkout to save 40% at cozy earth.com the podcast contains so many different series and collections of information that it can be difficult to find them in your traditional podcast app. Sometimes, that's why they're also collected at Juicebox. Podcast.com, go up to the top, there's a menu right there. Click on series, defining diabetes, bold beginnings, the pro tip. Series, small sips. Omnipod, five ask Scott and Jenny. Mental wellness, fat and protein, defining thyroid, after dark, diabetes, variables, Grand Rounds, cold, wind, pregnancy, type two diabetes, GLP, meds, the math behind diabetes, diabetes myths and so much more, you have to go check it out. It's all there and waiting for you, and it's absolutely free. Juicebox podcast.com This episode is sponsored by the tandem Moby system, which is powered by tandems, newest algorithm control iq plus technology. Tandem mobi has a predictive algorithm that helps prevent highs and lows, and is now available for ages two and up. Learn more and get started today at tandem diabetes.com/juicebox the episode you're about to enjoy was brought to you by Dexcom, the Dexcom g7 the same CGM that my daughter wears. You can learn more and get started today at my link, dexcom.com/juicebox, Erica. We are back to talk about goal setting and building habits. Today we're going to start with, what is this? The SMART framework. What is that? Yes,

Erika Forsyth, MFT, LMFT 2:39
so this is probably one of the most commonly used or identified ways to articulate a goal. The SMART framework basically means, let's say you meet with a therapist, whether it's a physical therapist, or you're going to the gym, you're meeting with a trainer, they might say, Okay, well, let's let's put you. Let's say you you want to lose 50 pounds or you want to get stronger, they'll say, You know what, let's make this really specific. So SMART stands for Specific, Measurable, Achievable, Relevant and time bound. So in this other example, instead of just saying, you know, I want to save money or I want to grow my savings account. The SMART goal would be, I'm gonna save $500 in three months, okay, by cutting dining out to once a week. So it's specific. It's measurable. You have the actual action item that you're gonna be doing and measuring that. It's achievable. You know, you're not saying in one week, you're not saying in five years, it's three months. It's relevant. It's actually something that you can understand and actually do and time bound. Now this is really good in the mental health world. You might use this goal, particularly in evidence based practices. But what you'll find while you're trying to work on achieving these smart goals. And this is what we're going to get into. There are going to be barriers of, why is it so hard to not go out to dinner once a week? What is interfering with that? So this is one framework that I think is important to mention that might be relevant. As you said, I think in the in the first in our first episode, that you are going to achieve your own habits and your own goals in your own way. So we're going to talk about different ways to achieve that. This is just one way that can be helpful for many. Yeah,

Scott Benner 4:30
while you're listening to this conversation, in your mind, replace specific focus on pre bolusing, maybe, and CGM checks measurable track your pre bolusing success rate and a 1c reduction, you know, make an achievable goal of reducing, I don't know, a half a percentage point in three months, and then use three months as a time frame and and keep moving forward like that. Instead of looking at a 10, a 1c and saying to yourself, how am I supposed to get this to a six? That idea? Yes. Yeah. Okay, yeah. Yes. Okay, go ahead, please.

Erika Forsyth, MFT, LMFT 5:01
Yeah. Love that. Yes, I'm going to Pre Bolus. And even, you know, narrowing it down to I'm going to Pre Bolus every meal, I'm going to Pre Bolus just for one meal. Or sometimes that even feels too vague, sometimes we'll say because of various maybe concerns or fears around highs or lows, just start pre bullishing One minute before your meal, then in two minutes, because

Scott Benner 5:25
you'll see an improvement, and then you'll get the correlation between what you did and the improvement. And that might make you try it for two minutes and three minutes and four until you get to the space that works best for you.

Erika Forsyth, MFT, LMFT 5:36
Yes, the achievable part is really important, because if you set a goal that feels scary from the get go, you were not going to do it. I'm not going to do it right. Like it's we need to know, you know what? I think I can try this one minute before I sit down to eat and experiencing that. Like, yes, I did it.

Scott Benner 5:55
Let me ask you professionally, why is that? Why would people say I can't do that. Just not do it. You just said, like, if you, if you, if you set too large of a goal, what it seems insurmountable, and so you quit, or you just don't even try. Does it work in someone's mind?

Erika Forsyth, MFT, LMFT 6:13
It's various factors. It would most likely be from either trauma from the past, right? Oh, I Pre Bolus that time, and I had a terrible low, and I had a seizure or lack or kind of mass experience of doing it one way. And you become comfortable with that way of bolusing when you sit down to eat or bolusing right, as soon as you start to see the arrow go up, even though maybe in your heart and gut and everything you want to change, that you want to feel better, feel healthier, the comfort and attachment to the way you've done it really interferes with the change, and When you resist that, I was reading Carl Young, who says the famous quote, What you resist persists, okay? And so there can be this, like, internal battle within you of like, oh, I this is feels too scary. I just don't know. I don't have, I don't feel comfortable with this. And then that might lead to more shame. Why can't I do this? I can't I then you get stuck, but you resist, persists and leaning into that, like, Okay, wow, this is feeling really scary for me, right? Like, just even pause. And this might feel really silly, but this is part of the work we would do. It's like, gosh, let's lean let's just validate. Like, this feels really scary, and we are going to lean into some compassion and acceptance around that before we start waging war with ourselves in this goal that might seem very simple to some, just say we'll just rebol us five minutes before your meal start there, right? So this lands differently for everyone based on their experiences. So

Scott Benner 7:56
the resistance creates some sort of a an inner conflict with yourself now that's the fight instead of the thing that you were trying to get to. Yes. Really, yes.

Erika Forsyth, MFT, LMFT 8:06
So you can get stuck in your mind just battling it out, like, why can't I do it? Oh, I can't do it. I'm terrible. I'm never gonna be able to do it. I'm a failure. And with that kind of language and mindset, it's really hard to move out of that. Yeah, so that's part of the self awareness. What's

Scott Benner 8:26
that saying? Oh, darn. I laughed a second ago because I'm so interested and amused, and it's a wonderment how, like our brains work. It's so it actually made me think, when you said yes, I thought, I wonder how we'll be 500 years from now. That's what I thought. I'm like, I wonder if we'll get past this. Do you know what I mean, like, are we, like, the amoeba version of humans right now, and like, this will get better? Is this just where we're going to be stuck? And there's that saying energy goes where the where the attention goes, like Energy flows where the attention goes. That's the thing, right? So can you trick yourself into creating. I mean, how would you go about that? Right? Like you need to, you need the the actual thing you want to do be the thing you put your attention towards. Yes,

Erika Forsyth, MFT, LMFT 9:09
let's transition to that good. Good.

Scott Benner 9:13
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Erika Forsyth, MFT, LMFT 11:24
we've all just starting off with the very basics. We've all maybe heard, or maybe you haven't. That's okay, the visualization, you know, the vision boards. And we might think that's really silly or not worthwhile step in this process, and in no way do you have to do that, but I think it's an important part of the process of getting to like we just did in the I think the first episode of You know, why is it Who do you want to become? What is that identity that you are longing to create? And so James clear says, you know, start with the person that you want to become, and who's the type of person who can do this kind of thing I want to do, so that, you know, it's always easy to talk about these things in weight loss. We could also talk about it with, you know, diabetes, of like, I want, okay, I want to lose 40 pounds. That's the goal. That's the outcome, yeah. And the assumption is that when I achieve this goal, then I will be happy, like I'm not happy now, but when I do this, then I'll be happy. And he really encourages us to inverse that process and say, Okay, who's the type of person who can lose 40 pounds? Okay, I'm going to be, I want to be a healthier person. Yeah. So I'm not going to put the goal. I'm not going to put the number or the time frame. I'm not going to focus on that, which might be confusing, because this is a little bit different from what we just talked about with the SMART framework. For some people, that might really work the SMART framework, but for others, putting kind of that 40 pounds or six months, or, you know, when I go on this trip, on the shelf and say, okay, would that person with that with a healthy person miss a workout? Like, what would a healthy person do? So in the diabetes way, you know, you could say, Okay, let's say your goal is, yeah, yeah.

Scott Benner 13:15
I always just use Jenny in my head because, because she's a smart eater, she's an exerciser, a person who follows the schedule. You know what I mean? Like, she doesn't get dissuaded from her goals. I've tried before, like I've said to her before. I'm like, Jenny, what do you do on a car trip? Like you don't pull over to get gas and grab a candy bar. And she goes, No, they'll go, what do you eat? And she goes, I pack something and bring it with me. And I'm like, Oh, you're one of them. You know, she's one of people with low, stable blood sugars. Great time in range. Super freaking healthy. So is it fake it till you make it feels really good. She looks awesome. She's doing great. Is it fake it till you make it? Is that what it is? Or No?

Erika Forsyth, MFT, LMFT 13:55
Okay, no, so no and yes. Okay. James says, Okay, I love this quote. This is one of his most famous quotes. Every action we take is like a vote for the type of person we wish to become. So hat and he says, habits are how you embody the type of person you like to become. So if you're wanting to become a clean, organized person, and you want that to be reflected in your bedroom, make your bed, maybe. And that might feel like a huge task. There's even a book called, I was just looking at this, you know, make your bed, little things that can change your life and maybe the world like so starting off with that, you know, what? What would a clean and organized person do today? Oh, they're gonna make their bed. And then that action is a vote towards becoming that person, identity, becoming that person. And he talks about, you ask, like, is this? Just fake it till you make it? And he, even, he addresses this. You know, it's this mindset of identity based. Is a little bit different from that, because, well, first of all, it's important. It's that can be a good step, because you're telling yourself, like, you can do it right, like maybe you're fearful of speaking in public, you're really nervous, but you're going to tell yourself, I'm a really good public speaker. I can do this. I'm looking out in the audience, and I'm, you know, connecting with this person and making eye contact and feeling comfortable. I'm a great speaker, so you're kind of quote faking it till you make it. That works for only so long, because then you're asking your mind and your body to believe something positive, but you don't have the evidence in the long term. Okay, does that make sense? So it does. He kind of even jokes to say that, like, what you know, when we believe something without facts and without evidence, that that's actually delusions. I think there's an element that that is important and can be a good first step for some but if that's all we're hanging on to, is the fake it till I make it mindset, then that that will prove to not be effective eventually,

Scott Benner 16:02
all right. Well, I just put that book in my Amazon cart. Make your bed, yes. Oh, it's great. I also put my I needed soap, so I did that at the same time. I'm glad this is such, yeah, oh my gosh. Like, Oh my God, I need soap plum here. Ah. Uh,

Erika Forsyth, MFT, LMFT 16:23
well, that's a vote towards being a healthy person, you know, a clean a clean person.

Scott Benner 16:27
That book and that soap will arrive tomorrow, between 4am and 8am

Erika Forsyth, MFT, LMFT 16:32
it's a short book. It's, I have it right here. Oh, you do look at that. It's good, yeah, it's a good book, as you

Scott Benner 16:37
were describing. I was like, that's something I'd like to read myself. I'd like to pass around to my kids. So, yeah, so I can't give it to my wife, because, you know, she's perfect, but I would definitely, I would definitely give it to my children. Yes, just in case people are wondering, I like to use Tom soap in the shower, and it's hard to get.

Erika Forsyth, MFT, LMFT 16:55
I was gonna ask, but I'm like, I don't know if that needs to be. It's the

Scott Benner 16:58
lavender for it. It's lavender, and Shea and I prefer to bathe with it so my skin's sensitive. Otherwise, even with like, dove or something like that, I can get like, anyway, this is neither here nor there.

Erika Forsyth, MFT, LMFT 17:09
Okay, we all know now you have sensitive skin a little bit. I'm

Scott Benner 17:14
a little sensitive. Yeah, I'm sorry. Keep going. I apologize.

Erika Forsyth, MFT, LMFT 17:17
This kind of gets into a little bit of that we've talked in the past of the CBT triangle, which is the cognitive behavioral therapy and that the triangle is that our thoughts affect how we feel, and our feelings affect how we act or behave. And as you're envisioning that triangle again, the arrows go back and forth, right? So our behaviors can affect how we feel our thoughts can affect our behaviors, right? So they're always impacting and affecting one another. So his James hole, one of his main points also is that it's really important to lead with actions. Because if we start, if we say, well, I'll get to it when I feel like it, or if we're really kind of letting our thoughts lead us. You know, I'm a good public speaker, right? The Fake it till you make it mindset. What we really need to do and to create the habit over time is leading with the actions, okay? And that creates the identity formation. So it's going back to, what would this blank person do today? So whatever that long term goal is, right? Like, what would a healthy person do or choose or decide today? So you're

Scott Benner 18:35
not faking it, you're really doing it. You're just looking and you're saying, This is not what I would do today, but this is what a person who has the outcomes I'm hoping to have would do. So I'll do those things, and then through that, you are doing it. I once said on the podcast when I was trying to figure out how to eat better, I just started following healthy people through the grocery store because I thought they might know what to buy, that I don't know what to buy. That's it. That's yeah, yeah. And I actually found that this is gonna sound terrible, but the people who I didn't want to appear like, they ended up in the aisles with the food that I was like, Oh, I shop in this aisle too often, apparently. Like, so I'll leave this aisle go to another one. You know, it's funny, because it is how I have the podcast set up. Is aspirational, and that's what we're talking about, right? Like, just find somebody who's knows how to do the thing you don't know how to do, and copy them until it works out for you. Oh, okay, awesome. Well,

Erika Forsyth, MFT, LMFT 19:32
yes, and I know that, yes, yes. Okay, yes. Well, the grocery the grocery store example is so great because you were actually you had the tangible example in front of you, right? You were, instead of asking yourself, How would a healthy person grocery shop? You actually followed a person and then you and then actively, you are becoming that, yeah, it

Scott Benner 19:50
was like, How do I get that ass? I'll follow that person. Does anyone ever turn around? No, I mean, I'm not following them that closely. No, I just, I just, honestly, I just, I. Followed Healthy People like I was like, what see? What aisles they go into? What do they pick up? What do they look at? Right? Because, you know, I'm always telling people about diabetes like, you know, just because you don't have the tools doesn't mean you don't know how to do it first. You just need the tools. So the tools for me in that scenario were the food. Like, I was like, I don't know what food to grab, like, so I'll watch them. What do they grab. Okay, I'll grab some of that that looks not objectionable to me. Now I have tools in my hand. I'll go home and cook it, and then, you know, there was even part of me that's like, I probably am preparing this incorrectly, because I grew up like a trash person eating, so I don't know how to make this. So I looked online for how to healthy ways to prepare the food, made the food, and it helped me with diabetes. The same thing, like, maybe somebody didn't teach you how to set your basal up, or Pre Bolus, or something that, oh my gosh, that's what's going on. For most of you, you don't have the tools. You still have to be alive. You do the best you can. It doesn't go well. It gets frustrating. You can't even set a goal, because you know what the goal should be, but you have no idea the steps to get there. Okay, I got it. I'm sorry. I'm figuring this out as we go, keeping in mind that we're

Erika Forsyth, MFT, LMFT 21:08
the goals. The goal setting is actually really easy, right? We can all say, Yeah, we want a whatever number, a, 1c, we can all say, I want to be able to lift X amount like, that's really the easy part. It's breaking it down, creating the habits and getting into the systems that we'll get it we'll talk about right on this notion of of identity formation, of who do I want to be, and how is that person going to make a choice today? Just a little thought around Brene Brown, you know, one of my favorites, and that, and when we are pursuing certain habits. If we're choosing those habits that involve how other people perceive us, then that can lead to shame, internal shame much quicker and easier. Okay, right? So, if you're forming a habit to reach a goal, what's about other people and how they think of you or view you. That's like that external like, Oh, that. I'm gonna do this because this is however I want someone to see me in this way, then we are much more easily gonna go down that path of shame.

Scott Benner 22:14
Yeah. Okay, so I don't care what other people think of me, I just know where I wanna get and that's what's important. But

Erika Forsyth, MFT, LMFT 22:20
that's not always the case for everybody, right, right? Yeah. So

Scott Benner 22:23
what happens if that's how I feel? If I go, Oh, I don't if I, if I choose this person's path, and I think this is a path I'd like to follow, but I don't want somebody to mock me for doing it, like, how do you get around that, that

Erika Forsyth, MFT, LMFT 22:37
or I want to reach this goal, because I think other people are going to perceive me differently when I reach this goal. Every time we make a choice or don't complete that habit to get to that goal, we are going to feel shamed. We are going to shame ourselves, right? If, because, like, if the end goal is because I want my doctor to think this of me. I want my community to think this way of me, attaching the goal to how we think other people are going to perceive you when you reach that goal leads to shame, because when you don't take the step towards the habit building to get to the goal, you feel crummy. Okay,

Scott Benner 23:13
see the step, so setting the small goals, taking the steps, that's what's important, yes,

Erika Forsyth, MFT, LMFT 23:19
and being aware of the end result and why you're wanting that result, and is it for the you know,

Scott Benner 23:26
for them, or for me? Yes, yeah. So doing it for yourself is very important, yes, yes, yes, yes, because it doesn't if you're doing it for someone else, and you trip, then the shame fault flows in. If you're doing it for yourself and you trip up. Why does that help you?

Erika Forsyth, MFT, LMFT 23:45
Well, you, I mean, you, we still can go down the path of shame very easily. I think what, what James says that we can become these victim we can become a victim of the expectations that we think other people have about us. So if you're trying to reach a goal because we think other people expect us to or we think they're going to think differently of us and we don't reach that goal, then we're feeling kind of like a victim of their expectations. But conversely, if you're just doing it for yourself, we can you can also feel badly about yourself, but it's different. So

Scott Benner 24:27
is it about how you hold yourself or how you actually feel like you know, it's so strange you're bringing this up. So I'm gonna say something I'm a slightly embarrassed. Bucha, we ran out last night for dinner at the last minute, me and Kelly and Arden, and we were been working all day, so everybody was sort of, like, in sweat pants or, you know, like sweat shirts. I was had like, a baseball hat on. We're staying in this restaurant. And Arden looks over now, Arden's dress very well. You're not catching Arden outside if she doesn't look great, right? So she looks at Kelly, and she goes, Mom, I'm gonna need you to just try harder. And she and she, and she's like, and Kelly's like. I worked all day. This is just what's in. She goes, I know, but still, she looks at me and she says, for no reason, because he doesn't deserve to feel this way. Dad carries himself like he's the governor of a state. And I was like, what? She goes, You act like you own a state. And I was like, right? And she was, You're not acting like you really you're projecting how you feel about yourself. And I said, I guess, like, I don't know, like, it's not a thing I'm doing on purpose, but I thought about it a lot after she said it, she's not wrong. Like, I have a fair amount of self confidence. And I guess it comes out in that it also comes out in things we do. Like, for example, before we started recording today, you're like, Hey, how are you? Oh, my God, I'm like, knee deep in this thing. I'm launching a brand new community for people with diabetes. Do you know who I'm doing it with me, and it's gonna be a huge undertaking. And I said, like, it was nothing. I said, I think if I just put a good year into it, it's gonna be like, I'll get it. I just set it off handedly. You were like, I was like, Okay, well, a year is that all you're gonna do? Like, to me, that's all of this. It's goal setting. And this podcast taught me about goal setting. It taught me that set a goal, make sure it's reasonable, and then can do it. Like, don't, like, sit around and, like, plan it out for 10 years now, I will be honest with you, this community thing's been in my head for four years. I've been mulling it over a long time and setting up pieces in the background and assets for it, and building another community in Facebook that I think can help feed it. Like I didn't just like, run outside and y'all, I'm gonna do it. But when the moment came and I had all the pieces in place, I was like, okay, oh, I had the tools. When I had all the tools in place, it was like, All right, it's time to start building the ship now. And I don't care if it fails, and I don't care what anybody thinks about me while I'm doing it. And if it fails and people like, point at me I won't even notice. Like, even in a social media world where people could literally, like, make it known to me, like, I think you screwed this up, I'd be like, I don't care what you think I was trying to do something good, and I'll just do it again. So, but why? Like, you know, like, where does that come from? Is it experiences? Because I don't know that I was always like this, you

Erika Forsyth, MFT, LMFT 27:10
know what? I mean? Yeah, so I'm thinking, there's, well, there's two. I'm like, What is your identity formation? So you're at, you're already acting, instead of being like, what would a healthy person do? You're, you're already like, acting as if you could not. I don't know successful like, what would a successful person do? Secret

Scott Benner 27:27
time, Erica, that's how I built the whole podcast. I was like, what would a person who's actually in this position? Oh, my God, I was doing this. I didn't even know it. What would a person who's in the position I want to be in act like in this situation? I did that in business meetings. Like, I did it. When I set things up, when I put things into the world, I'm like, like, I don't act like, Oh, I'm making a podcast. I act like I'm making a radio show, and it's 1990 and it's the height of radio. Like, you know what I mean? Like, that's how I do it. Like, I act like that's what's happening. I am do. I'm not acting I'm actually doing it. Ah, so in context of the podcast, you can make a thing perfectly if people don't respond to it, it doesn't exist. It's a tree falling in the woods. Right the minute you get response back to it, that's probably when I was like, oh, people like this, I'm right. This will grow. And so as soon as I knew I was correct, then i was running. Does that make sense? So I did the thing. I didn't care if anybody liked it or didn't like it. That, by the way, if you're looking for my origin story, it's when I wrote the book, and I got a bad review one time, and I read it, and it was devastating. But I didn't care, because other people liked the book, and I was like, Well, some people liked it, everyone's not gonna like it. And then I was able to wash my hands of that idea that everybody had to like me. That's gone. And then I wanted to make this podcast, and I said, and I Oh, I had the freedom of not caring if everybody liked me at that point, yeah, yeah. So I started the podcast. I watched it help people, and then once I saw that, it was doing what I thought like once I saw I had cause and effect. I said, Oh, I did a thing. This happened. That's what I thought was gonna happen that was valuable and positive for somebody else. I'll do it again. Let me multiply it by a million, if I can. Then I was off and running. Oh, okay, so I had to get knocked down before I got up again. Is this a Chumbawamba song my life?

Erika Forsyth, MFT, LMFT 29:19
I know I was like, Oh my gosh, that's the song.

Scott Benner 29:24
Where'd I come up with? Chumba. Lumba, by

Erika Forsyth, MFT, LMFT 29:25
the way, that was impressive. Yes, I get knocked down

Scott Benner 29:29
exactly. We don't want a copyright problem. But yes, that's it.

Erika Forsyth, MFT, LMFT 29:32
Okay. Sorry, sorry, I was off tune. So it's all good. Going back to the you were acting as if you were a podcast creator in the beginning, right? Like you, and then, like, what? What would a podcast creator do? And you would do those steps. And then eventually you became one, right? So then, and then you had the evidence built in, but your actions in the beginning and you were acting as if you already had a podcast before you. Had a podcast. Yeah,

Scott Benner 30:01
that's all. I should be on YouTube telling people how to do things, but I'm busy, and I'm not trying to snooker you out of your money or your time or your views. And the truth is, where did I get that from? I got it from people I listened to, and when you look back at them, they didn't know what they were doing, either. And the one kindness they did in the world was when they told their story, they said, I didn't know what I was doing. And I started this thing where I was bad at this, when I started and I got better at it, you know, people told me no, and I didn't care. I did it anyway. I was driven to do it, so I did it. So you just take all of this here. Listen, if you're listening, just take all of this and apply it to your diabetes, and, boom, you'll be fine.

Unknown Speaker 30:43
Well, yeah, with

Scott Benner 30:45
a lot of work and help,

Erika Forsyth, MFT, LMFT 30:46
a lot of work and self awareness and compassion. What is the purpose of the goal? Who are you trying to impress? Are you feeling like you're a victim of how other people perceive you? Oftentimes, when you get stuck in that, and I'm just trying to think about, you know, in your experience, if you're feeling like, Oh no, is everyone not gonna like this, when you're kind of thinking about this, like, collective experience, when we get stuck in that narrative of like, Oh no, if I reach this goal, or will this habit make me reach this goal, and will that goal, will other people perceive me in this way to break it down and ask, like, put individual names and people in that and usually you don't really care. Like, do they care if I don't do this thing or if I do? And usually the answer is no. So just being aware of, are you feeling? Are you so concerned about how the people and we're human, we are all concerned about how the other people of the US?

Scott Benner 31:40
Yeah, I'm not unaware that it's important to me. Like, if people care about me and love me, but I just people outside of my sphere, I don't care. I don't care. Like, if a stranger gives me a bad review, I was like, Oh, they didn't like it because I had to go through that process, because the first time it felt like they didn't like me, you know what I mean? And then I was like, Oh, I don't why would that matter? There are people who like me, like, I that's I'm just not for everybody. Like, I would tell you that one of my secrets is, is being able to give things away, like, is to not like, hang on things and be burdened by them forever. Like, this thing, you know, was hurtful. It was impactful. I processed it, and I moved past it, and I don't think about it anymore. And I, trust me, there are plenty of people who don't like me, and some of them say it online. I've seen it like, but it's I don't know, like, what am I going to do? You know? Awesome. Yes, you know what? I want to give you a pat on the back. This is the wrong phrasing, but I'm going to give you a lot of credit here. It may not surprise people who are listening for a long time that Erica has sent me very thoughtful notes about what we're going to talk about, and it may not surprise you that I don't read them. I follow them while we're talking, but I don't read them ahead of time. And I'm always impressed that when I look up at the notes you got me to the spot, I'm like, Oh, I'm there. I'm there. This is where I would have been if I would have read ahead and like and I find that really impressive, and I think it's probably something that people enjoy about these recordings between the two of us, because you're doing such a good job of walking me through this process that I'm having a realization as I'm going and I'm imagining that's happening for other people as well. So really cool. Thank you. You're awesome. Thank

Unknown Speaker 33:19
you. Yeah, are we at the end of

Unknown Speaker 33:20
Part Four,

Erika Forsyth, MFT, LMFT 33:23
yes, the second episode, yeah, this vision, yes, identity based habits,

Scott Benner 33:27
and we're out of time now, so we'll stop. Is that right? Yes, okay, all right. Thank you so much. I really do appreciate

it. Thanks so much for listening to part two. There's more, so go find it. There's part three and four out there somewhere, and if they're not available yet, check out another episode or go to Erica. Forsyth.com to learn more about Erica, the podcast you just enjoyed was sponsored by tandem diabetes care. Learn more about tandems, newest automated insulin delivery system, tandem Moby with control iq plus technology at tandem diabetes.com/juice box. There are links in the show notes and links at Juicebox podcast.com. Today's episode of The Juicebox 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. I can't thank you enough for listening. Please make sure you're subscribed, you're following in your audio app. I'll be back tomorrow with another episode of The Juicebox Podcast. My diabetes Pro Tip series is about cutting through the clutter of diabetes management to give you the straightforward, practical insights that truly make a difference, this series is all about mastering the fundamentals, whether it's the basics of insulin dosing adjustments or everyday management strategies that will empower you to take control. I'm joined by Jenny Smith, who is a diabetes educator with over 35 years of personal experience. Comments, and we break down complex concepts into simple, actionable tips. The Diabetes Pro Tip series runs between Episode 1001 1025, in your podcast player, where you can listen to it at Juicebox podcast.com by going up into the menu, the episode you just heard was professionally edited by wrong way recording, wrong way recording.com,

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