#1536 The Pitt

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ER PA turned T1D shares raw insights from both sides of the bed—especially what it's like inside The Pitt.

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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
Here we are back together again, friends for another episode of The Juicebox Podcast.

Jane 0:15
Hi, I'm Jane. I live in DC, and I've been a type one diabetic for about three years. I am 36 now, but I suppose I was 32 when I was diagnosed, but just so right around maybe three and a half years. But there was actually a window where I was considered not diabetics.

Scott Benner 0:34
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, nothing you hear on the Juicebox Podcast should be considered advice medical or otherwise, always consult a physician before making any changes to your health care plan. This episode of The Juicebox Podcast is brought to you by my favorite diabetes organization, touched by type one. Please take a moment to learn more about them at touched by type one.org on Facebook and Instagram. Touched by type one.org check out their many programs, their annual conference awareness campaign, their D box program, dancing for diabetes. They have a dance program for local kids, a golf night and so much more touched by type one.org. You're looking to help or you want to see people helping people with type one. You want touched by type one.org. I'm having an on body vibe alert. This episode of The Juicebox Podcast is sponsored by ever since 365 the only one year where CGM, that's one insertion and one CGM a year, one CGM one year, not every 10 or 14 days ever since cgm.com/juicebox, this episode is sponsored by the tandem mobi system, which is powered by tandems, newest algorithm control iq plus technology. Tandem Moby 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

Jane 2:55
Hi, I'm Jane. I live in DC, and I've been a type one diabetic for about three years. No kidding. How old are you? I am 36 now, but I suppose I was 32 when I was diagnosed, but just so right around maybe three and a half years. But there was actually a window where I was considered not diabetic, so we can get into wait. So there you're

Scott Benner 3:16
going to try to tell me that something happened. People are like, you don't have diabetes, but you did,

Jane 3:20
oh, exactly. And I complicated out, I'm a physician assistant, and I've been in ER medicine for eight years. And so I, you know, have been treating type one diabetes and DKA mostly for the better part of my career. And so, yeah, it was, it was a whole ride to become type one after them being my patients, I

Scott Benner 3:39
realized I giggled in a weird spot for people, but like, my mind always races ahead to, like, where you're gonna just be like, Yeah, I don't know, Scott, like, I've seen it 800,000 times, but when I had it, I didn't notice it at all, or something like that. But let's we'll get that exactly. Yeah. So how about in your family, any other autoimmune stuff? No, not

Jane 3:56
a single thing. Not in any one of my family is very large, or my extended family is large, nobody. And do you have kids? I do. I have two kids, and I actually was pregnant when I found out I was a type one diabetic, really, yes, so that I actually have never yet been diabetic without breastfeeding or being pregnant. So the entire three and a half years I have been a type one diabetic, I have either been pregnant or breastfeeding, so it makes it really hard to know my baseline, essentially, which is really important when you're

Scott Benner 4:26
diabetic. So you see, you're like, see, that makes it really hard. And what I'm thinking is, well, when the breastfeeding is over, it's gonna be, you're gonna be like, Wow. Why is this so

Jane 4:32
easy? Yeah, I mean, I hope so. I hope so. I'm just like, man, what it would be like to be a male being diabetic, because you don't have to worry about the hormones, you know, the up and down. So, yeah, I know who knows how long that'll take, but I would have

Scott Benner 4:43
to say, You made me pick. I'd say boy type one probably a little easier, although in that growing time, like for the parents who are listening right now, I'm like, Oh, you, you never saw my son come home from soccer practice and, you know, eat everything totally that would be hard. Listen. Here's what I'll tell you. Yeah, I think you'd just prefer not to have type one diabetes. Yeah, exactly. Yeah. I don't think we need to start going, which ones got it harder, totally. But the hormonal thing is, is crazy. Breastfeeding, I know from people tough on you, right? Like, your body's constantly making stuff. You're burning calories, like, I've seen, seen, sorry, I've heard conversations from people where women are like, I'm eating like, Kind bars while the breastfeeding is happening, trying to keep my blood sugar. Yeah, that's crazy. Okay, so what was your first sign of, like, any kind of illness? Yeah, I

Jane 5:30
was about 28 weeks pregnant with my first child, a girl, and I went in for my glucose tolerance test, as you do, between the window of like, 24 and 28 weeks, and I just had and I just happened to hit it on the later side, and I failed spectacular. I was working in the ER when I got a call from the OBGYN office. And I actually was with the midwives at my program. I went to GW or PA school, George Washington University. I live in DC, and they have a really good midwife program. And I was, you know, low risk. I, you know, wasn't yet a geriatric pregnancy, and I had no health conditions. And so I was like, I loved the midwives from learning, you know, working there, and at one point they were like, you know, we're gonna have to kick you off of our program because your glucose came back at 267 I think I was like, in the ER, and I was just kind of stunned. And I went over to my co workers, and I was like, my glucose is 267 like, I've never checked my glucose in my life. Like, I think I had blood work maybe, like, once or twice before. Then I was not somebody, maybe, like most healthcare providers who ever, like, actually went to the doctor, but I, like, you know, didn't really have a reason to. And everyone was like, Okay, this is gestational diabetes. You have it really hard. Because I think at first I was like, Well, should I take it again and, like, make sure it's right? And they're like, well, with how badly that number looks, we don't think you need to take it again. And then, like, sunk in. I was like, Yeah, you're right. Isn't it

Scott Benner 6:51
funny how quickly you become a patient? Like, because if you gave me a glucose tolerance test and it came back 267, I said, We should do it again. That's probably not right. You go Shut up. Even

Jane 7:00
though, yeah, exactly as a provider viewers who tells people frequently they have diabetes. Like, I know a spot check, you know, over 200 for probably my non diabetic friends who might listen to this, like, just automatically means you have diabetes.

Scott Benner 7:13
Shane, stay in this space for a second with me, right? Like, what do you think cognitively happened to you when someone gave you that number. I think

Jane 7:21
I was thinking, wow, pregnancy is nuts. Like, man is my placenta just hate me, you know. Or, like, what's happening? Like, I've never heard of gestational diabetes being this severe unless you're already, like, close to being pre diabetic, and this just flips you more so into it, like,

Scott Benner 7:41
so ergo, I must have type one, right?

Jane 7:45
I was actually, no, I thought I had gestational because I couldn't wrap my mind around it. You'll, I'll get to, you know, like, how I eventually was, like, had to prove it to everyone that I had type one, which was a fight. I was just like, Okay, I just have one of the more crazy gestational diabetic presentations than I've heard of. And so what I was told then by the midwife program was like, we'll need to get you in with the maternal fetal medicine specialists, because now you're high risk being a gestational diabetes diabetic. And here's your instructions, add protein, exercise and don't eat sugar. Thank

Scott Benner 8:19
you everyone. Thank you. I appreciate all your help. Feel free to Bill my insurance for that.

Jane 8:24
Yes, exactly. And I, you know, and they're like, we'll set you up with a nutritionist, you know, which is, you know, interesting, because I am, generally, you know, a pretty healthy person. I love to run. I have been extremely athletic, generally, and eat very well at baseline. So when they're telling me this, you know, they don't know me over the phone. I think they're just like, yeah, I even had somebody who I was trying to talk to say, well, I bet you were, like, pretty diabetic beforehand, and this just like you probably would have gotten type two diabetes pretty soon. You know, anyway, with these numbers, who said that to you? It was actually a nurse practitioner at a a clinic that I went to who I really do respect the clinic at one medical clinic, and I've considered writing a note to them after this all, when I want

Scott Benner 9:07
you to ponder this thought for later. Okay, because I'm not going to ask it to you now. I just want you to ponder it as you're talking. Yes, do you see not just the community of medical people differently today, but do you see actual people that you work with differently 100% Yeah, but I want to know how it literally is for at the end of the conversation, it's gonna be the last thing I ask you, okay, okay, yes, so I'm sorry. No, it's

Jane 9:31
okay. We like. So I was like, okay, my instructions were, meet with a nutritionist, and this was and I was like, Okay, well, I don't know how much I could be doing it better. Like, that's cocky of me, you know. And I realize now I didn't know what now, what I knew about, what I thought I knew about nutrition then, so I've come a long way as well with, like, protein and my like, you know, protein, first carbs, second. Like, I didn't know that stuff. I didn't, nor did I need to, you know, ahead of time. But I was like, I'm generally pretty good on my diet. Like, I don't know how much I can diet more. There, you know. But I was like, I'll meet with this nutritionist. I got my a 1c back. Because then they were like, go ahead and go do some tests. And it was actually, don't think it was that bad initially, because it was like, once again, it was like, right after I got tested, I think it was like 7.6 which, you know, it's just definitely like, okay, that's diabetic. But I was like, had no clue what my base I had never gotten my a 1c tested before, had you felt off in

Scott Benner 10:21
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Jane 12:31
well, like, Yes, I look back. But the whole story for me being so like, a little bit like, gaslighting myself in some ways, like I had never been pregnant before, and I had no idea what pregnancy was, like, you know, so I felt weird. But like, like, for instance, going through pregnancy, I kind of expected getting pregnant. Like, like, I said, I'm I'm an active person. I'm pretty lean. But I thought, like, when I got pregnant, I was like, Yeah, I'm gonna be probably so pregnant. Like, my ears will be pregnant, my toes will be pregnant, my lips will be pregnant. Like, I will look pregnant, you know. And I remember, like, weighing in and being like, I'm not getting enough weight. Like, this is weird. Like, this is just not what I expected.

Scott Benner 13:07
Not even, like, a happily, like, look at me lean and pregnant, but like, maybe something's wrong. Yeah, I

Jane 13:12
don't think I was just like, wow, my body is doing the opposite kind of what I thought. Like, huh? Like, how often do you see people, like, look a little gaunt while they're I could probably have 20 babies, yeah, or just yeah, just like, Huh? You know, up until that point, probably the first six months, pretty normal. And then I started going down the scale, and my weighing was, like, I'd only gained 10 pounds at 28 weeks pregnant from when I was pre pregnant.

Scott Benner 13:35
No one waves a flag for that. Yeah,

Jane 13:36
exactly. My doctor said, Now, by now, I was in the Maternal Fetal Medicine at GW. It is a great program, but I don't think they know what to do with me, because I, like, went from being super healthy to being like, Okay, this is just weird. But he had been like, you need to eat more, but then also eat less. Like, you need to eat more, but I would bring my husband is very into Excel. I started finger pricking, being like, you know, gestational and after, I'll eventually get back to what the nutritionist told me and why I kind of thought I flipped into type one, but he tracked everything I ate and all of my blood glucose readings. And I was like, I know what this means for the baby. Like, I know with my medical backgrounds, like, which is, I think very it was helpful in so many ways. Like, I don't know if I would be alive, or at least would have gone to the ICU if I didn't have my background from how it went for me. Everyone assuming this was gestational, you know, yeah, he had a whole like, everything in Excel, and I brought it to my doctor, and I was just like, I'm eating eggs only, and my glucose is over 200 like, eggs only, like, I don't have like, anything else. And I'll spot check, and it'll be like, 203206 and like, you can look and I think only because I had it all tracked down. And that was, I think, my second visit. Because at first, you know, I was being told, okay, you're not getting enough weight. You should eat more. But then I would, you know, message in being like, Well, my blood sugar is, like, super high. And he's like, Okay, you need to eat less meals. Like. Less, little bit less. And I was like, You don't understand, I could not possibly be eating less.

Scott Benner 15:04
Also, could you stop saying competing things to me that's really, yeah, upset, yeah.

Jane 15:08
And I was like, I am eating like a rabbit at this point because I'm so worried about my blood sugar. And I think he was just like, okay, that maybe explains the weight loss in some way, you know. Like, somehow your glucose is really, really high. You're trying to eat a lot less

Scott Benner 15:21
somehow. Let's think, how could that be? Let's think about it. Yeah, and it's

Jane 15:26
just so weird. I don't know a single other person that has ever gotten type one while they're pregnant. Oh,

Scott Benner 15:30
please, let me just tell you I know like 20 people from making this podcast, but go ahead, yeah, yes,

Jane 15:34
yeah. And I've listened to some of them, but I just mean, like, in my personal life, I hadn't, like, at the time, and then, so actually, when I was meeting with my nutritionist, who was very, very sweet, who just kept going, Oh dear, oh dear. Like every time I'd say something, she's like, oh dear. And I'd be like, Could this be related to COVID? And this was in 2021 I was in healthcare, so I had gotten the vaccine December of 2020 like, right when it came out, and I hadn't gotten, managed to not have gotten COVID until August 2021 when delta was kind of on rampage, my symptoms and like the glucose tolerance test, happened to be four weeks later. Technically, you know, when you would think maybe a virus flipped you into type one with the time frame kind of it's plausible, you know? Yeah, I just had COVID for the first time a month ago. It was so mild I basically had the sniffles, and I just was wondering about the time frame, because I was like, something, and it was the first time, and I started looking up data on if COVID caused any links with gestational diabetes, because I knew it was making diabetes a lot harder to treat and doing things to my diabetic patients. And I was like, could it potentially make somebody who might not have been like, and I didn't really, gestational diabetes, you know, is its own thing for, you know, anyone who doesn't know it's like, the placenta is what is theoretically causing insulin resistance, you know. And ideally, once you like, birth the placenta, your body goes back to normal. You don't have diabetes anymore. So that was the assumption. She was like, I have no idea, but I'm gonna try to figure that out for you. And so we looked up some things, and it was just very new. Nobody had

Scott Benner 16:59
really, I was gonna say you're in the middle of it. It's not exactly full of answers. And I just can't wait from

Jane 17:04
10 to for 10 years from now, for, like, more things to come out on this. Because, like, since then, I have learned about the association, and I'm curious to know if you have with COVID and type one diabetes, specifically when pregnant. Because I have like, you know, through Reddit and other Facebook groups, and even like some friends of friends have, and I don't know if this matches like a regular percent of like people, but like them having, you know, no family history or anything, and getting COVID, and within a month, becoming type one while pregnant, and thinking that was gestational so I think, and I already know, like, from, you know, medical background, like when you're in your second semester a trimester, sorry, when you're in your tri second trimester and pregnant, you're immunosuppressed, and you are more likely to have viruses impact your immune system. Specifically in the second trimester, there's some weird links to

Scott Benner 17:55
when viruses have more impact. Yes, during pregnancy, I

Jane 17:59
remember learning that in school. And I don't know from my research yet, and I haven't really, you know, personally talked to people, but I've, I remember going on Reddit and seeing all these people who were like, Yes, I'm a type one after getting COVID while I was pregnant. And like, all of the people that were like, Yes, me too. Me too. Like, this is definitely a thing. And even, like my cousin knows, like two other girls in their 30s who were pregnant and then got type one. It's just like a weird like, after COVID, like, within a month of COVID. Love for more people to send me information on that, because I'm but I'm fascinated with, like, if there's going to be more to come with that. But I already had thought that there was something weird with the timing and the possibility of that. And, yeah, that's my best guess. Anyway, of so

Scott Benner 18:41
I've spent zero days in medical school, and I want everyone to keep in mind that my real focus of studying High School was baking. I have been making this podcast for a decade now and talking to a lot of people. And I have the experience of my daughter being diagnosed right after Coxsackie. I have the experience of researchers coming on here who are working on new drugs, who have brought up like the Coxsackie virus. There was a gentleman on here that said, I'd love to make a vaccine for Coxsackie, because I think if we could stop kids from getting Coxsackie, we might put off them getting type one diabetes. A virus can often precede a diagnosis. But the idea here is, I don't know, obviously, because I make a podcast, yeah, and I don't believe, based on anything I've heard so far, that a virus just walks into your body and goes, here, let me pull some wires off this pancreas, and it doesn't work anymore. Like, I think it's more like, you know, your body has an immune reaction. That reaction gets misguided, hits your beta cells in your pancreas, you have type one, but that you were very likely predisposed to that to begin with, and probably had auto antibodies pointing to type one diabetes before the virus got there. Yeah, now I don't know if being pregnant makes you more or less, by the way, I did try to look while you were talking, and yeah, I so inarticulately typed it. Our friend here chat, Chief. Game. Said, it sounds like you're trying to ask which I was like, Well, God, how horribly did I type that out. But like, is there a trimester that's more, you know, impacted by viruses? First trimester is a critical period when the embryos organs are forming exposure to certain viruses, Zika, rubella, during this window carry the highest risk of major structural birth defects or miscarriages about the baby, fetal growth and maturation problems are predominant in the third trimester, viral illnesses late in pregnancy or more likely to cause pre term labor, low birth weight, neonatal infections, rather than congenital malformations, the flu they use as an example, influenza infection now in the second trimester, it says organ systems are maturing. Viral infections can still cause problems, growth restrictions, neuro development issues, absolute risk of the major structural anomalies like Zika. But what about for the mother I

Jane 20:53
know curious, and I honestly so bad at using chatgpt, I could probably ask them a lot more

Scott Benner 20:58
if I could go back to college right now, I'd go back to college to learn how to talk to chat GPT. I think it's actually, I think it's going to be a job, yeah,

Jane 21:06
yeah. So I, you know, agree with what you're saying. I'm just curious, like, in terms of like, it flips you into like, yeah, the virus itself doesn't cause it, yeah. I want to be careful of what I'm

Scott Benner 21:15
all saying. Here we go. Hold, on hold. Second trimester maternal risk still relatively moderate. Many women tolerate common viral illnesses fairly well. However, some viruses, notably influenza and SARS, cov two, can begin to show higher rates of pneumonia or hospitalization compared to non pregnant women. What about type one diabetes? This thing's like, oh, yeah, I forgot you make that podcast. Yeah, I should know you by now, although it does, sometimes I ask it a question, and I don't like say what I'm asking it. It's like, Oh, you mean for this, although the overall maternal risk for most viruses remain moderate in early pregnancy, women with type one diabetes, nah, see, yeah, it's not leading me there. Can it? I'm just gonna use the word cause, even though that's not, that's not what I mean. But I'm trying to get it to think that way. And I don't know, yeah, I don't

Jane 22:02
know if anyone's really looking into it yet, you know, like, I just all of my things is anecdotal, based on word of mouth and Reddit, which could be correlation and not, you know. Like, listen,

Scott Benner 22:11
this is chat GPT. This is Oh, three. The the deep research version, some viral proteins share structural similarities with B cell antigens. When the immune system mounts an antiviral response, cross reactive T cells or antibodies may also target B cell proteins. I think that's what I said earlier. They call that molecular mimicry, bystander activation, viral infection of the pancreas or nearby lymph node system tissue can induce local inflammation. Cytokines and chemokins released in the process may non specifically activate, auto reactive T cells that were previously dormant. Certain viruses can infect and directly destroy B cells, beta cells. The resulting release of beta cell antigens can further fuel an autoimmune response that's called direct cytolysis. Isolus, chronic low grade infection, persistent viral infections in the gut or the pancreat islets can maintain a smoldering, inflammatory milieu, gradually eroding BSL mass over months and years. It says here, virus is implicated in type one onset enter a virus. So a key example would be Coxsackie. The second one is rubella. Third, mumps, fourth, CMV, what is that? Cytomegalovirus, yep, rotovirus and SARS, COVID. Two, that's the ones that it listed, and I didn't ask it to implicate viruses that came back with that on its own. So, I mean, listen again, not a doctor, but people get viruses. Their body goes wonky. If they're pre disposed to type one they end up with type one diabetes sometimes. So would you have gotten type one diabetes if not being pregnant you weren't pregnant, if you didn't get COVID, maybe later. I think

Jane 23:53
this is my theory. And like I said, this is just my own and, well, I guess I can't say it's a theory, just my own. Things is I just feel like I was in a state of immunosuppression by being pregnant, and I don't know I, like I said, I don't know enough. I'm not like an immunologist, for some reason I've internalized whether that's true or not, and like I said, I'd love to learn more about it, that if I wasn't pregnant while I had COVID, it would not the double effect would not have. I

Scott Benner 24:19
mean, I understand your thought process. I'll just tell you this. Like, you're probably getting type one at some point. Yeah, I'm curious. Batman's parents get killed in every universe where you hear the Batman story, do you see what I'm saying? I love Yes, totally. At some point, like, I try to think about this for Arden, by the way, this again, is not what we would call technical, but this makes me feel better about Arden, yeah, so it sucks that she got it when she was two, right? Totally. But if she didn't get Coxsackie when she was two, she got the flu when she was four, would she have gotten diabetes then, like, would it have happened when she got, like, another thing when she was 10? Like, like, I don't know, the kids got autoimmune issues. Mm. Get this isn't her only one, you know? So, yeah, I mean, at some point it feels like it makes sense that she was going to get type one. Now, would I have preferred she got it when she was 15 or 30 or two or nine or 35 or 63 like, I don't know, you know what I mean? Like, I just don't think it matters once it's happened, like, it's fun to fun funds, the wrong word, it's interesting to talk about. But like, it's all academic, because getting diabetes type one or type two sucks, no matter what age you are, yeah.

Jane 25:30
And, I mean, well, COVID, you know? Yeah, I'm curious if COVID is what did it for me, which is what I, you know, based on the list of it can you know whether or not I was pregnant or not. It was such a weird virus in the world. You know that I'm curious to know if another virus would have done it. And I guess I'm not convinced of that, but because I already was 32 you know, like, you know. But

Scott Benner 25:50
listen, I interview people every day that are 3330 430-740-4562, they get type one diabetes.

Jane 25:57
And I it could have, I think COVID was what did it for me based on the timing. It could have been something else.

Scott Benner 26:02
You might have a little bit of my magical thinking. I used to think like, if I can make it to this age, then this won't happen. If you get to that age, then that wasn't happening. If you're married for this long, you don't get divorced, if you like the only mean, yeah, do you think like that?

Jane 26:15
It's impossible to really know, but it is fascinating to think through.

Scott Benner 26:19
Can I ask a big question? Totally, why does it matter? It

Jane 26:22
doesn't I just think, like, it's more for educate, like, purposes of educating who I'd love to know the studies, like, I would just love to know, like to understand COVID more, because I think we have so far to go with that, you know. And we were seeing things in COVID that just weren't true for other viruses in a lot of ways. And it just such a weird virus and, you know? And so I'm just like, Man, I have not seen too many people talk about COVID and type one diabetes, but that was I was like, I think even early on, I was like, I think there's a link. Now, could have gotten it later or from something else, very possibly, but at least what I thought did it at that point was the combination of being COVID and I have no other autoimmune issues. Who knows? I'm going to get one? You know, I hope not.

Scott Benner 27:04
But I'll ask a couple of weird, difficult questions here. So when you're having these thoughts for three years, but the world's not letting us talk about COVID, is that hard? Like, because you want No, no, it's you end up on Reddit talking about it, then I don't know,

Jane 27:17
it was a weird number. Like, I said, I have no, like, a weird number of women in my same position. I'm

Scott Benner 27:21
saying, like, if you were at work and you saw a doctor and you were like, Hey, man, we've known each other a long time. Let me ask you a question. You think this COVID gave me type one diabetes? Are you worried that he's looking back at you going, Uh oh, this one I didn't realize she had a tin foil hat. Or no, I

Jane 27:33
was No, no, no, no, and I was No. Well, I had a lot of questions. Like, are you sure it's not the vaccine? And like, you think the vaccine gave you COVID? And I was like, well, it didn't really line up with the just the timing didn't make didn't make sense for it to be the vaccine, if, like, you know, and I'm not anti Vax at all, but just was like, I had the vaccine in December. It wouldn't based on the limited stuff I know. Like, I was like, I don't know. I don't have any clue. But it seems to be that it makes more sense timing wise, with all of a sudden my body shutting down. But who knows how long that was brewing. I'm gonna

Scott Benner 28:00
go out on a limb here and say, I don't think we should be saying anti Vax anymore. Oh yeah, I think there's, like, a way to, like, I don't know totally,

Jane 28:07
and there's dangerous too. There's dangerous to vaccines. I always want patients like, every every medication has side effects, every

Scott Benner 28:13
conversation deserves us to be able to talk about all of the variables without, like, labeling something like, if that was my point. Like, were you worried that, like, somebody would pre judge you? No, I

Jane 28:24
actually never expected to feel judged. Because I feel like I'm very pro, you know, just

Scott Benner 28:30
open mind, trying to figure out what's going on. Say,

Jane 28:32
yeah, exactly, yeah. I was just like, yeah, yeah, no. I actually never thought judgment would come into the picture, you know, because I am a healthcare provider, I, like you generally follow CDC recommendations, and I'm just like, we were seeing all these things. We were, you know, we were like, Okay, we're seeing diabetes get worse and hospitalizations increase, and a lot of other things. And like, I'm not an expert at all with COVID, but I was just like, it just seems to be such a weird timing. And then hearing and seeing some other people in my same position, I was like, weird. Yeah.

Scott Benner 29:03
I mean, I take your point, like, if you fell out of bed today and tomorrow, your legs started hurting and you didn't think, I wonder if this is because I fell out of bed. That would be an odd thing to skip over, yeah. And so it's not. And by the way, maybe that's not what happened, but it would be weird to just ignore it and pretend that it didn't

Jane 29:22
think maybe it's, like the red Jeep theory, like, unless you're looking for it, you're never gonna see it, sure, and so, you know, there's, that's why I just throw it out there.

Scott Benner 29:28
That's why I'm continuing the conversation. Because, like, in the end, you're never gonna know.

Jane 29:32
No, well, yeah, maybe not. I'm very curious. And, like I said, in like, retrospective data in the future, if they're going to, you know, because up until you said that I, like, in like, I do know, in the past, the list of viruses that had caused, not caused, like, careful with the wording, but were more likely to influence a type one response. But I COVID, you know, when I was in the middle of it, they hadn't put that on the list. You know, no.

Scott Benner 29:57
I mean, obviously the stuff about. COVID is still like, Listen, my wife has long COVID. It's horrible. I mean, who knows? Yeah, yeah. Like, it really, genuinely horrible. Like, it's got, you reading? It gets got, I'm reading research. It's like, hey, try now. I actually went to my wife the other day. I said you should try nicotine gum or a patch or something. And she's like, what now? And I'm like, I don't know. Like, I saw a thing, yeah. You know, once you're two years into a problem and nobody's helping you, you're down to, I saw a thing like, why don't we see if we throw this at the wall? Fit sticks? Yeah? And that's a place to be with your Yeah. I mean, at

Jane 30:31
this point I'm just fully type one, and I just am curious as to, like, the No, could I do anything differently? Probably not, you know. And it doesn't keep me up at night. It's just more like a huh? Because everyone asked why, you know, like, why? And I'm like, I had, you know, like, this is all I can point to, of a weird grouping of things I know to be, you know, true, and kind of coming up against me and causing me, anyway, to have this, what they thought was gestational diabetes, right? Interestingly enough, I also wondered if this factored in. I don't think it did, but I had this most severe, like, around that same time I was diagnosed with gestational I had this crazy rib pain, which I think was something called, like, intercostal neuralgia. I'm not sure, but it was like my nerves were trapped in, like this one dermatome, which is like a couple ribs that, like, went from my mid back around to my right, like, side, and my ribs would pop in and out even so, like, it would feel awful, and I was in so much pain, and so I was like, Is there, like, I don't know. Do I have a pancreatic mass or something like that, you know, like that could be causing my, you know, like, because my pain is right there. Can I ask you a question, though?

Scott Benner 31:37
Like, I just realized a little while ago that this was during your first pregnancy, because when you said, I've only ever been pregnant or breastfeeding with type one diabetes, I thought, God, is she breastfeeding a four year old and but I didn't, I didn't say that. And then, because I don't want to be judged, oh yeah. But then I realized you you meant like you were pregnant and then breastfeeding,

Jane 31:55
and then I got pregnant with my second while I was breastfeeding. Yes,

Scott Benner 31:59
yes, that's Yeah. How did that happen? So you had, you were newly type one and breastfeeding. Your husband was like, let's do it again. Yeah? Well, yeah, funny. Well, actually, so like, you didn't run, like, you weren't, like, get away.

Jane 32:10
Well, after I determined, okay, the rib pain was awful. It wasn't because of, you know, like, I had a pancreatic mass. It is some ultrasound and, like, or anything like that. Never really figured out what it was. But it was a little ironic that everyone was telling me to, like, go exercise when I, like, couldn't walk. I'd actually leave my job early. I was in so much pain when I was a brand new diabetic, you know, things like that, my doctor finally believed me. Was like, we're gonna put you on shots. We're gonna put you on injections, because this does seem severe. And then my my instructions, you know, for my injections were, if it's under 15 carbs, don't have to Bolus for it, which I'm sure is might be true for gestational diabetes, but you know, definitely not true for wasn't working out for you that way. Yeah, type one diabetes, exactly. And do a night snack. Don't Bolus for that. But like, before you eat, like, eat something protein heavy, like, mix with protein. But the instructions I was, like, given on, like, in my guidelines, and that I found on like, Instagram was like, mix raisins with nuts. Like, that's a great bedtime snack. You know what I mean? I'm like, now, if I knew now, I knew that was like, I was just like, eating a bag of raisins with nuts. But like, right before I went to bed, and didn't like, Bolus for that at all. Did

Scott Benner 33:13
you love the raisins and nuts? Or were you like, I can't believe I have to eat these. No, I just was, like, doing

Jane 33:16
it because I thought they're like, I'm supposed to control my blood sugar. And then, because I was now on injections, you know, and I was finger pricking, you know, now, knowing now what I'm, you know, like, I'm just like, Oh, thank God, I survived that, because, and my baby survived that, the

Scott Benner 33:33
doctor was trying to keep down big spikes at meals, and did and didn't want you getting low overnight, because that's how he thought About gestational women who he gave insulin to, exactly,

Jane 33:41
yeah, and that makes sense, but it's just like, yeah. You mean, under 15 carbs, your body should be able to handle it, you know. So I would like, I think just my finger sticks were just wildly inaccurate, you know, like, depending on when I checked, like I was following the one to two hour like, postprandial glucose check, like, after you eat, you do your checks, and in the morning and stuff like that. And I feel like I never could figure it out likely, because, like, what I know about my body now is I'm way more likely to spike, like, five to six hours later. I wasn't checking then, you know, he he was really well intentioned, called me even on the weekends, to see how I was doing, which was very nice. I don't think that was like, I think it was just all like, this lady, because I was in so much pain too. Like, I cannot understand, like, that's the most pain I've ever been in my life. So I was, like, in so much pain, couldn't bear barely, like walk, and then I was trying to figure out injections for the very first time. Now that I understand what, like a high blood sugar or a low blood sugar feels like was just wildly different and so much more empathy. Like, I remember being at IKEA and having my first low, because I was just newly on injections, maybe first week, and I took them seriously, but I was just like, well, I can just eat. What I didn't understand with a low is how much your brain slows down to the point where, like, even trying to remind yourself to eat is like swimming through like mud or something like that when you're low. Yeah. Yeah, and I nobody was with me, and I was just, like, very pregnant, and I was just trying to buy some stuff, you know, probably for the nursery at IKEA. And I remember being like, Oh, I feel really shaky. First time ever feeling that way. Let me check my blood sugar. I remember it being like, in the 30s, oh, juice. And being like, I think that's low. That sounds low. I know that's low. Let me see if I can keep checking out of my kitchen, like, I'm in line to check out. And I was like, Okay, I think this is bad enough. I need to go to the cafeteria, because I wasn't bringing snacks by myself. Like, I wasn't really, like, with gestational I guess you are on insulin, but like, I wasn't prepared for really being low quickly. Yeah, I wasn't bringing it.

Scott Benner 35:36
Or how far the goofer Nook is from the cashier at IKEA, I bet that was probably a problem, exactly.

Jane 35:41
So I got a chocolate bar in the line, and I remember sitting down. I don't know, I think I was at the same table for hours, but I remember like, because I just couldn't, couldn't get up. And I do remember being like, put the unwrap the chocolate bar. Like my brain was like, stringing one thought to the next thought, like, unwrap it, put it in your mouth chew it. And I was like, after I bounced back, I was like, Oh my gosh, I understand now how dangerous sometimes it is for you to be alone with low blood sugar, because you are thinking so slowly, like if it gets low enough. Now I you know, can usually nip it in the bud before that happens, but that was just my first ever instance of that happening.

Scott Benner 36:17
Was that fear after you got through that and look back on it. Did you live fearfully after that? No, I

Jane 36:23
didn't know enough to be fearful. What kind of a nurse Are you? Jane, APA, physician assistant.

Scott Benner 36:27
Sorry, you're a physician's assistant, right, right? You're working in you work in emergency medicine,

Jane 36:33
yeah. So I have all my own patients, like they're mine completely. Like, I don't know laws elsewhere, but like, you know, I manage their care, and I treat diabetic patients all the time, you know. And to that point, I just mean, like, it is different, being the person going through it, then being like, yes, I would have seen that number. Another, another point to your earlier question of how it changes. My practice is I would have probably shot that person with D 50, like, you know, dextrose, 50% solution, and spiked up their blood sugar because I was more comfortable with being high, because when we're, you know, in the ER, we're just, we don't want to

Scott Benner 37:03
be a low, yeah, but for people listening who were thinking, how can she not understand this, if that's her job? Like, tell them why that is. It's not because you're like, dopey, or you didn't pay attention in school, or you don't care, or anything like that. Like, explain, like, what the lead into your job is that lets you be so good at so many things. I watch the pit. I know what's going on. Oh yeah, I'm watching that right now. Of course, you are that leads you to be so valuable in people's emergency care. But then you get to something like this that every person listening to this is like, Oh my God, I know that. How does she How did she not know that? But

Jane 37:37
I guess, think back to the very first time, and maybe a lot of people are diabetic when they're kids. But like, nobody else knew more than I. Like, it was the very first time I'd ever used injections on myself, so I just didn't know my own body pattern. Like, I guess in the ER, we're notified of a low blood sugar, and we just treat it with either, like, now I'm much more likely to treat it with just orange juice, or, like, I don't want to make them spike high, so I'm not trying to load them with the sugary stuff.

Scott Benner 38:01
So is it that, professionally, it's a thing you're trying to stop, not a thing you're trying to understand. I don't manage it

Jane 38:07
on a day to day basis either. So that's a difference, you know? Like, I'm not that was a huge difference of being like, No, I'm trying to understand it. I'm trying to say, I guess I don't really understand, maybe I don't understand your question, because

Scott Benner 38:18
I think you've been in this profession for so long, you're not following my question. Like, so like, imagine if you went to get new tires, yeah, and when you were done, your tires were on the ground, not on the car, and your car was sitting on the ground, on its wheels, and the guy goes, you can leave now. Like, wouldn't you think, how could you not understand so completely this simple task of putting tires on my car. I think that's how people with diabetes feel when they're at a hospital and nobody seems to understand what's going on. You mean from the healthcare perspective, like, Why? Why? Like, yes, not. You personally, you professionally. How come you don't understand professionally as

Jane 38:54
a patient when you like, Why hadn't I understood that point that I was type one? Is that what you

Scott Benner 38:59
were? No, no, no, no. Like, I didn't realize I should have snacks to do that I'm walking around. I didn't know, like, all like, all that stuff. Like, I guess I'm putting myself in the perspective of people listening, yeah, I'm thinking that. They're thinking, I don't get how a person in the medical field wouldn't know this. Like, I I know that. Oh, okay,

Jane 39:14
okay. Because I'm like, Well, remember when it was your first week, but yet I am in the medical field. Well, I guess, because I'm never I'm only treating the emergency side, so I'm pretty good at like, I'm not going through people's first weeks of diabetes, I guess, even though I know the base stuff. But with insulin, I didn't take insulin as seriously as I do now, like, I know it can lead to lows, I know it can lead to highs. The lack of it can lead to highs. Too much of it can lead to lows. But, you know, didn't have the ins and outs of all of the insulin knowledge I know now, yeah, and I don't think I and now I know how dangerous of a drug it is. Yeah,

Scott Benner 39:48
I think people who are not involved in health care professionally, yeah, they make a generalized assumption that anything health care related, the health care person is going to understand. Oh, and

Jane 39:58
I that is one of my big takeaways. Is how. Little, little. I mean, at least from the ER perspective, we do not know, Matt, how to manage diabetes or type one diabetes, right? When you come in like we do not.

Scott Benner 40:07
I did a cold wind episode last year where an ER nurse with type one said to me that she'd be safer having a seizure at my house than in the ER she works in an

Jane 40:18
interesting seizure. How come? Oh, like, a diabetic seizure, yeah,

Scott Benner 40:22
yeah. She's like, you would, you would know what to do, handle it better than the people I work with this,

Jane 40:27
yeah? Because in, er, we know, you know, an inch deep and a mile wide, you know, and you know, we don't know the mile deep about diabetes that you get to know when you're diabetic yourself. That's

Scott Benner 40:37
why we're having this conversation, Shane, because you just put it so perfectly. No one's ever said that before, but that exactly highlights my point. We understand things an inch deep and a mile wide. Like, yeah, that really is. Is that a thing people say in the ER,

Jane 40:52
I don't know. Actually, I have thought it. I'm sure somebody has said it to me at

Scott Benner 40:56
one point. Well, guess what? I think that was incredibly valuable for people to hear, like, seriously.

Jane 41:01
And I'm constantly trying to now, like, diabetic patients are my favorite now. And I'm constantly trying to, like, talk to my like, I have my co workers pas or MDs, like, sit in with me going through some and you don't have a time for this, always in the ER, but like, going through what I'm talking to patients about so that they can learn I could get somebody stabilized, fine, but like to actually educate them. I think the problem is, you know, in the ER in which I work in and a lot of years in America, that is their primary care, we are seeing people repetitively, and if we don't do better, and like I said, there's a lot of constrictions with that. Like, it's definitely not all the ers fault, but just like, they're just not getting the tools they need from resources, or, like, knowledge wise, or who knows what to to manage this. And we are their primary care office, so I need to do a better job of trying to, like, you know, give them more tools, you know.

Scott Benner 41:51
I mean, it's awesome that I hate to say this, but, like, people say this all the time, like, oh, like, I wish somebody famous would get sick so they'd fix it. Or, like, hey, it's nice that a person in healthcare got this so now, like, your understanding will continue to grow. You'll work around people, you'll help them understand more. Like, there'll be a lot of good stuff that comes out. Oh yeah, Scott,

Jane 42:07
you'd be shocked at what my coworker said to me, no, go ahead. Even though we treat Type one all the time, they're like, couldn't get it. Like, when I became type one, which I'm sorry I keep like, getting haven't even gotten there. But like, they have been like, Well, does it go away really? A nurse asked you that. Pas, doctors, yeah, oh, yeah. Well, will it go away? You know, let's

Scott Benner 42:27
fast forward, because I'm on a bit of a time crunch today. So let's fast forward to, yeah, by actual, like, just what happened? Because you said at the beginning, like, I had to, like, force people to believe that I had it well.

Jane 42:38
And it's, I guess, just interior, like, how did you not know? Often is like, you know, how did you not know? As a healthcare provider, too, it was a traumatic birth, I guess, and I, like, lost a lot of blood, but anyway, like, my body was doing a lot of stuff in my birth, and so I they did one finger stick, or I did, really, I don't know if, you know, if they checked, but I did my finger stick, and it was 85 and I reported it to them. They're like, great, congratulations. You no longer have diabetes. And I ate like, a burger and fries. And I was like, excellent. This is, like, great life. You know, did you let out all the blood that

Scott Benner 43:05
had the glucose in it? You said you lost so much blood? I figured you lost so much blood. They replaced it with blood that didn't have glucose in it. Then tested your blood sugar. I'm like, Hey, you're 85 I

Jane 43:14
wonder about that too. I can't remember the timing. I was so out of it. I had, like, yeah, I lost so much blood. I hemorrhaged. And it was really true. Yeah, it was really traumatic. I like, could only tell how bad it was going when they called in, like, the ICU team, and then they, like, kept, like, saying, and we're gonna give her TX A which is the blood stopping medication that's really toxic, and then and we're gonna give her some antibiotics, which I know they were only gonna do if, like, I ripped through my rectum, which I did, you know. And I was like, Okay, this is going bad, you know, at least con, at least my daughter seems to be fine. That was the entirety of my diabetes care. I don't even remember if the glucose was before or after the blood, okay, like, I don't remember at what point I'd like, that's like a fever dream, a little bit to me. But I just remember thinking everyone has told me I had one of the hardest gestational cases I've heard of, and when I gave birth, I looked at that placenta and I was like, I'm so glad you're out of my body. This is, I'm done with this. And then why did I not know, like, in the next three months? And I just, you know, my daughter really, yeah, like things I don't know that. I'm curious, you know, maybe I'll chat GPT about it sometime. It's just my daughter had really bad colic. I was up all night, as many newborn moms are, but I just all of the things that you would think I still have diabetes. How can I not figure it out, especially having just had diabetes, it was I was extremely thirsty while I was breastfeeding. I was extremely hungry while I was breastfeeding. I was losing weight while I was postpartum, you know, I am breastfeeding, you know. And I was like, exhausted and tired and irritable. I also had a really hard time breastfeeding at first. I do not know to this day how my body did it like I was on this insane pump. One of my friends is a lactation consultant, yeah, and she had me on this power pumping like 20 minutes for every two hours. For two weeks, I was pumping to try to get my breast supply because I was extremely dehydrated. Now that I know that I was diabetic, like the diabetes never went away, I was still trying to breastfeed. I don't

Scott Benner 44:56
think people give women nearly enough credit, and I think women. Get a lot of credit for, especially around making a baby, but, like, my rectum rips. Everything's over. I don't care. Somebody's like, take care of the baby. I go the baby. My exactly, tore open. Oh yeah.

Jane 45:09
And I bled for three months, and I was wondering why I wasn't healing. And they're like, how do you go to a special they're like, Wow, you're really not healing. I

Scott Benner 45:15
would have been like, you still tried to breastfeed. I would have been like, give that kid a piece of lettuce, see if I can eat that couldn't

Jane 45:20
even, like, sit for a long time because I was, like, trying to heal down there, you know, like, three months of bleeding, and it was like, no wonder I wasn't healing one you know, because my sugar was so high I can't believe my body produced breast milk. I must have put it through the worst states, because when three months, three months took me three months, I finally was like, this is weird. I brought out my old glucometer from under the sink. Three months postpartum, I checked my blood sugar and my fasting was 440 what made you check it? It was the night before I went out to a really nice dinner, and I remember everyone being like, Man, I'm full. And I was just like, I could eat this entire everyone's plates, plus more. And I also was like, we had had a party, and I was like, eating frosting out of a tube. I was like, so hungry, and so craving sugar. Gotcha, you know? And I thought, but my thought was, man, breastfeeding is wild, you know, like, Huh? I'm apparently burning a lot of calories once again, and I am, like, really hungry. I

Scott Benner 46:15
would have stopped eating completely, trying not to go to the bathroom. I just want to say,

Jane 46:21
and yeah. So I just was like, exactly like, all of these things that I'm like, I could just explain that mentally by postpartum, but I was just like, breastfeeding. I still, yeah, my poor, my poor body, and then my, my fasting was 440 and then it was amazing to try to prove to people, even though I wasn't pregnant, that I was type one, because, like, the nurse practitioner at one medical and like I said, I have many friends that work there really like them as a company generally, I just think, wow, you've got ketones in your urine. You're fasting. Your sugar right now is in the three hundreds. It was like, the next day I got in with them. I had an old insulin pen I hadn't actually thrown away, weirdly, so I just injected myself with alantis. Because I was like, Nope, I think I'm type one. And I went in there, and she's like, I think you probably were predisposed to diabetes, and you just it never went away. And here's some Metformin, and come back in three months. And I was like, but this is my blood sugar. I know you could there's no body type, but I was like, I like that. Can, you know, completely be type two or type one or anything. But when she was just once again trying to be like, do a good job with dieting and exercise. I am, like, very small at this point, yeah, you know. And, like, I lost too much weight postpartum. Then you really should, you know? And so, man, I had to. Oh, and that's, man, getting an endocrinologist. I love my endocrinologist right now, but it was at least in DC during COVID. Six of the eight endocrinologists at the GW practice had left. I think they just were exhausted, and like, I was asking people, and they were like, the nurse literally told me they had enough. And so they were like, we're done. So they were rebuilding their entire technology practice. I couldn't get an endocrinologist appointment to save my life, and I even was looking for private endocrinologist. They were like, we've filled our diabetic quota. I was like, I will prescribe this medication on my own if I need to. But I am, would really love some help, because I do not know what I'm doing, you know. And I finally got a friend of a friend, whose co worker used to have an endocrinologist, who now lived in New Jersey, but she's the endocrinologist was still in DC, texted her because she still had her number, and was like, will you meet with my co worker's sister's friend? Because she is like a PA and she can't get an appointment, and like, Would you please meet with her? And she has been the best endocrinologist ever, and I skipped her nine month waiting list. I finally got my auto antibody tests. Was clearly type one, I kind of wanted to be like, Oh man, what a journey me. Just like, listen,

Scott Benner 48:38
I wish that, like, misdiagnosis of all kinds are such a common story on here, I don't even, like bat an eye at them anymore. Yeah, and even just like regular times, not regular times, like, you know, like COVID, not COVID, eight years ago, somebody I texted me personally, three months, three weeks ago, like, it's just it happens constantly. So I guess it's really hard to figure out. Now

Jane 49:01
I tell my patients, I'm like, you know, home, like, Man, this doesn't seem right. Like, this doesn't seem like a type two presentation. Or the problem is, like, they don't, like, we don't order those auto antibody tests from the ER, you know, and I like, they can't. They, just for a bunch of reasons, it's really hard to get an endocrinology appointment. Or their primary doctors don't know how to manage it. And at least in the ER, I like, I'm always like, you need to try to figure out, like, Has anyone told you you could be type one? Because please go and ask to get the testing, because this is fishy, you know, like, there's too many fishy things, and I do that more now than ever. I'm just like, please try to figure out if you're Lata or type one or whatever. Because, like, I'm seeing so many people to manage like a type two, that I just wonder, and their diabetes is like most of the patients I see in the ER, they're, they're, they're not in control, like with their injection regimen or their Metformin regimen. Often they're in the three hundreds, four hundreds, and who knows, for whatever reason, but I'm like, I think you need insulin. I'm not the one to start. You want, necessarily, from the ER, but, or, you know, but I also think you should be looking into these other things, and Does

Scott Benner 50:05
that scare you, sending them off, thinking they might not get that help? Oh, yeah.

Jane 50:09
Like, I have a type one who in DKA last week who, like, doesn't have a Dexcom because of insurance problems. So I'm like, you know, trying to reach out to social work to try to get some help. But just like, Yeah, from the ER. It's like, I can't make follow up appointments, and so anyway, I want to in the future, like, this is really inspiring me. Like, I want to do a, like, I don't know, diabetic management pa job maybe. Like, I know they're they're out there a little bit. My technologist actually would, like, told me she was like, hey, there's a PA job opening at this hospital. I think you should apply. But it was full time. And I still really love the ER, and I'd love to stay in the ER, but then do this, like, maybe part time in the ER, and then part time do diabetic management, because I'm like, what I want to do is not what

Scott Benner 50:48
I can do. What makes the ER attractive to you? So you see a little bit of everything,

Jane 50:51
and that's what I kind of love. And you never know if you're going to get something that's like, really serious, or just like a sore throat, you know, or even a sore something that looks like a sore throat ends up being like emergent, you know, do you have ADHD? No, I

Scott Benner 51:03
just like, wondering if, like, if that feeds that thing for people, I know, because it moves all the time, like,

Jane 51:08
juggling a lot, so I think, yeah, I don't know it actually, when I went into high school, I thought er was awful. I don't really love true emergencies. I was so scared. It's like, I don't know how I wound up here. Honestly, it doesn't fit in my personality completely. Like I don't really love people dying. And honestly, like, I'm in a level two trauma. So unlike the pit, which is like, level one, I don't, I do see gunshot wounds and things like that, but I'm not, like, constantly, people are not falling apart on me every day. You know, it's a lot of like, pancreatitis and, you know, appendicitis and people you can talk

Scott Benner 51:35
to a friend of mine's kid did a year at Hopkins in Baltimore, oh yeah. And then it's like, I gotta leave. Oh yeah, yeah. I asked her why, and she said, I no longer am upset when I see somebody shot, and I'm worried about myself for that reason. Honestly, I understand

Jane 51:50
that. Like, we have a guy I'm training right now, and he's so like, but she's in pain. And I'm like, Oh my gosh. Like, that's so sweet, but, yeah, I'm like, everyone's in pain here. You know, all of the like, veterans look at each other and we're like, man, we're callous a little bit.

Scott Benner 52:02
That's the cow. The cow she, she didn't want to feel callous, so she Yeah, also then she became a travel nurse, and her life is, like, awesome now, as far as I can tell. So yes,

Jane 52:11
that is really nice. Yeah, I made pump setting adjustments like a patient who had never I had a patient who was vomiting even, I think, last week to type one, and I was like, well, let's just, what pump Are you saying? Let's just, like, do you think you should, like, you know, lower your basal right now because you're vomiting, not able to tolerate a lot. Like, you know, let's lower your basal. And she's like, I've never done that on my own. Yeah, she didn't know how to do it. I was like, you've been a dad type one time. She was in her 50s or 60s, and I know, like, that generation of diabetes, you know, have just been through them, probably like, you know, the most change. Yeah,

Scott Benner 52:46
it's not as generational as you would hope, by the way, like I found myself saying the other day in a recording, if you just understood how insulin works, the timing and amount, that's most of it. But if you really want to succeed long term, you have to become comfortable making changes to your settings,

Jane 53:04
yes, and honestly, that's what I feel comfortable doing, that generally, because I think about it through a practitioner's mindset. But I I've learned a lot from your podcast as well. And and, oh, I tell my I told my endocrinologist about your podcast. I tell my patients to listen to it. I'm like, You listening to listen to like, you know that? Like, if you really want to get good, listen to these episodes, you know, things like that. And I'm still trying to get good, you know, at it, but I get frustrated wanting it to be perfect. Still, you know, where's your a 1c at will you share my most recent one was 5.9 I don't know if this is true for you, but I tend to trust my clarity app a little bit more than I feel like I do my blood, which is not probably accurate, you know, but I am like, Oh, I'm, you know. So my clarity is usually like, 6.1 so I go between like, 5.8 6.1

Scott Benner 53:50
Okay, yeah, that's awesome. I mean, and how's your variability? You low all the time, high all the time.

Jane 53:55
And, like, I like, and once again, like, I, I was pregnant for like, over a year and a half of the last three years I'm diabetic, so it's also, like, just trying to figure that out. Like, yeah. Like, so I was more strict when I was, you know, pregnant, than my a 1c now, which is just breastfeeding my let me look up my clarity right now. See what it is, yeah, this is, I'm curious to know what it is recently. I don't think it's been good recently, because I just go, I'm making me log in. I don't remember. Do you feel

Scott Benner 54:20
like you're just learning now, like, or you're through the fog of the pregnancies and the and the breastfeeding and everything, like you starting to feel like a person again? That makes sense. Yeah. I've

Jane 54:31
luckily felt like that for a while. I think I learn more things though every day. Like my endocrinologist, I think is like, wow. You know, people I will see in your podcast are very generally motivated. Like, I'm sure you talk to people who are, like, trying their best, but at least the most of the diabetes I come in touch with, I come in contact with, and my endocrinologist does just from what, what she usually says, she's like, you are doing far better than any of my other patients. I think you need to, like, back off, you know, like, you need to, like, calm down a little bit. I'm like, I want. To do like 13 different pump settings in my you know, which pump

Scott Benner 55:03
are using? Islam, are you using control IQ,

Jane 55:06
yes, I do control IQ, but I like to and I went on, I went on to slim actually, based on, we know what my endocrinologist had recommended. She said the algorithm at the time, three years ago, who knows? She said it was far better. And also the Dexcom at the time didn't have bolusing from your phone, which was important to

Scott Benner 55:23
me, not that, what do you mean?

Jane 55:24
I could Bolus to the T slim from my phone, but you couldn't from what other pump with at the time. If this is true with the Omnipod,

Scott Benner 55:33
Omnipod, yeah, okay, yeah. And I

Jane 55:35
don't think they had, like, the control IQ function yet for Omnipod, right? Like, that's more recent Omnipod

Scott Benner 55:40
five. Is Omnipod five three, you might have gotten there right before it came out.

Jane 55:45
Yeah. Like the Omnipod five came out after I had gotten this pump, so I'm interested in it. But so far, I've liked the T slim. I'm in control. IQ a lot. For a while I was in sleep mode all the time, which I know they've said to do in pregnancy. And just like another one of your podcasters, I listened to who, like, I was like, well, this seems to be smart. Like, why don't just keep in sleep mode all the time? And I realized that control that control is not as good,

Scott Benner 56:03
right? Have you listened to control? IQ, Ninja, yeah, I'm in the middle of

Jane 56:07
doing I'm halfway through those awesome, yeah, yeah. And so, yeah, I'm interested in those. And so I'm in control IQ, but like yesterday, I switched into manual because I was like, oh, what I can't do on the T slim, what you can do on the Omnipod is, I don't love that. I can't increase my Temp Basal when I'm on control IQ. I want both. And now you can, as of, like, just a couple months ago, but I haven't updated it yet, but you can do that. From what I believe on the Omnipod is you can increase your Temp Basal to, like, you know, 120 5% while you're on the control function. Yeah, is that correct? Because you couldn't do that up until very recently on the T slim, they just updated the software. Okay, yeah, they just did it for T slim too, which I'm excited about. But because I would go back and forth all the time between being like, Oh, I'm gonna lower my basal, or I'm gonna increase my basal and do an extended Bolus, or, you know, things like that that you can't do being on control IQ. But like last night, I did that and then forgot overnight to put myself back in sleep mode. So then, you know, I, luckily I didn't spike high, but I was like, woke up being like, why am I 160

Scott Benner 57:07
so you're using the algorithm, but you're you got your fingers in it a lot I do. And my

Jane 57:11
intercultural is like, let's make this so that there's a little bit less work for you. But I'm like, Yeah, but I want to just get better.

Scott Benner 57:18
Do you think you couldn't do that? You don't think you could do a five nine with less work?

Jane 57:21
I think I can. I just think I'm learning. And like, honestly, she like your podcast and hearing from people that have figured it out is more information than I've been able to get anywhere else. Okay,

Scott Benner 57:32
oh, well, I'm glad. Oh, thank you very much. That's awesome. Yeah, listen, you got to keep going through those algorithm episodes, because you'll get better at it. Yeah.

Jane 57:39
And I already have, like, and it's giving me like, I'm already pretty bold, and what I feel like I can do, but I feel like I'm like, oh yeah. Like, this isn't I? Once again, my endocrinologist is amazing. I've she just is so great. But she also, like, you know, is managing everything out there, and she doesn't know the nitty gritty of the things you talk about on your podcast, you know. So that's something she wants me to back off a little more, because often my lows will lead to highs, because I'll they'll suspend my, you know, my and I'm always trying to balance doing too much

Scott Benner 58:07
you're not letting it where you're not letting the algorithm letting

Jane 58:10
it work for me, right? Yeah, and where sometimes I'm like, I should just be on manual, because I almost have an inability to let it go, you know. But those two kids aren't keeping you busy enough. Yeah? I know. I know. Well, honestly, I'm like, man, what was I? Yeah, my brain cells, what it gets devoted to? Like, I'm like, when people would ask me how having kids was, I was like, honestly, diabetes, and trying to manage that is harder than having a newborn. Jane.

Scott Benner 58:30
I have to go backwards for a second. So you have this birth, you find out you have diabetes after the birth, your butthole rips, yeah, you've hemorrhaged, yes. And then how long is it before you're like, you know what we should do? Let's have a second baby, kid.

Jane 58:44
I know. I know what happened. My daughter had turned two when we started trying again. Two, no one. Oh my gosh. One. She turned one. We started trying because I wanted about two years apart. Is this

Scott Benner 58:56
a little bit about you wanting to space them away? But is it also about your age a little bit. Yeah, yeah,

Jane 59:01
totally. That factors in. I was 32 when I got pregnant, and just to turn 33 When I gave birth to my first and then I was like 34 and I just turned 35 just about exactly two years apart, yeah. So yeah, that factors in. I'm trying to think through whether I want a third now, I just don't know. Yes, I know. And honestly, it's like, I'm not even someone who, like, I like, I was like, Maybe I won't have kids. You know, I wasn't like, for sure, I want to be a mom. What happened?

Scott Benner 59:27
Oh, I don't know. How did the butthole thing not stop you? Seriously, I know,

Jane 59:33
right? Luckily, my second so this is what happened. My second child was an angel baby, and he is like, so, I mean, he's a hard, little, hard sleeper now, but, like, my first was like, and once again, I just like, I would love for chat, GPT or somebody to be like, from with a little bit I have researched, I don't believe the high, like, my glucose, I was, or, sorry, my my hyperglycemia was amazingly, like, really impacting my breast. I was like, looking back, I'm like, was my daughter just drinking? Like. Complete sugar in my breast milk

Scott Benner 1:00:02
or something. I was wondering, like, Is this, like, crappy milk she was getting? Like, why

Jane 1:00:05
she is starving in colicky or something like that, you know? Like, does this have any correlation? And I looked at one thing, and I think I was just too stressed to really figure it out at that point time, but I'd love to look into it again, being like, from the one thing I looked into was like, No, somehow your body and the amazingness that it is like, will be able to keep hyperglycemia from really going into like, it's able to separate from breast milk or something. Well, you're

Scott Benner 1:00:32
gonna feel better here, because our overlord says that it doesn't matter. I said, Can? I was really, like, blunt. I said, Can an uncontrolled type one breastfeeding makes subpar milk. I want to say, No, having poorly controlled type one diabetes does not make your breast milk subpar. In fact, even when blood sugars are higher fluctuating, human milk remains remarkably resilient, resilient in its basic nutritional composition. Yeah, that's what,

Jane 1:00:54
that's the little bit I had heard too, and it made me feel so much better. Didn't understand, you know, still understand the colic, but it made me feel so much better that I wasn't like, starving her or giving her something unknowingly for months. Yeah, but like, Isn't it amazing, though, that the body can be that sick, I agree, and also produce Yeah? It says if

Scott Benner 1:01:09
your diabetes isn't perfectly controlled, your breast milk will still provide protein, fat, carbohydrates and immune factors your baby needs. That's just insane. Go, ladies. I knew those boobs were awesome for more than one reason, and he was just

Jane 1:01:22
easier pregnancy. I did not have the pain I would, did not have to go, like, the birth was easier, like, it was all like, if I would have had her second, I'm pretty sure I'd be done. Yeah,

Scott Benner 1:01:30
I see, I see, and your husband's, like, helpful and all. Or do you know

Jane 1:01:35
he's the best, and he also is, like, after one though, he was like, I'm good. Oh, this is you now, if you want a second, great, like, I think two sounds probably good, but especially now, he's like, I'll leave that decision to you. He was like, you can figure that

Scott Benner 1:01:48
out. We got to wrap this up, because I have a meeting soon, and I apologize for that, but that was great. I am 53 I have two kids, and two seems good to me, yeah,

Jane 1:01:57
and I grew up with two, boy and a girl I'm super grateful for. And, yeah, I don't know. I guess a lot of my friends have three kids. Maybe it's just like, feeling like, oh, that's like, what? I don't know. People keep telling me, if I'm on the fence, how

Scott Benner 1:02:09
much did it cost you to go to college? Think about that for a second. Too much. Yes. Now, times that by two, yeah. And then probably times it by 10. For 20 years from now, aren't you hoping,

Jane 1:02:18
though, that it changes? I'm like, I'm like, I know it could just get more sense of part of me. It's like, expensive. Part of me is like, I just can't imagine it can get more sense. As a part of me just hopes

Scott Benner 1:02:27
it just changes. You're still young. I didn't realize how young you were. In your heart, that's lovely. No, it's gonna get worse. Everything gets worse. Yeah. Have you lived through this week with the rest of us? Do you have a 401? K, oh

Jane 1:02:37
yeah. Do I join by luckily? Yeah, I do the medicine. My husband does the finance. So guess

Scott Benner 1:02:43
what? He he's paying attention to it, and you're not. He's quietly banging his head against the floor right now. And to

Jane 1:02:49
top it off, he quit his job a couple weeks ago and is going to start something on his own. So you

Scott Benner 1:02:54
go over to him right now and say, I was thinking we should have a third kid and see if he doesn't throw you out a window. I know. Yeah, exactly. Well,

Jane 1:03:00
part of me did say, you know, I'd really love for you to have a, you know, a stable idea of what you're going to do in the future if we do decide to do this, because I also don't want to kids.

Scott Benner 1:03:09
Mommy left, yeah, yeah. She's at the bottom of a lake at the park now, yeah, yeah. I don't know. Listen, this wouldn't be the time to ask. Is all I'm saying. Like, for anybody, anybody who's watched their money for the last week. It has any kind of an investment. Is not busy going we should do some stuff now without definitely

Jane 1:03:26
wanting to. Yeah, I'm older and I want to space it out more. But I I feel like, who knows? I

Scott Benner 1:03:32
think three kids brings the two doesn't

Jane 1:03:35
good question. I I don't think anything.

Scott Benner 1:03:39
Are you hoarding babies? What's going on? So I think

Jane 1:03:42
three kids might it's my maybe. No, I think I love watching them play together. That's great. No, it brings a lot of heartache. I think you're right. I think it brings a lot of heart. It brings a hard couple years. I mostly this is what, this is what I always said about kids. I don't necessarily want them right now. I want them when they're 20 year on my Thanksgiving table, you know. And I feel like the future projection of being like, seeing that, and being like, Oh, I could just see what another person like does. Sounds appealing to me, but now, now just sounds incredibly hard, because it already is hard. Like, I'm not even, I'm not doing it really well right now, you know, like, it's hard, it's

Scott Benner 1:04:15
interesting. It really is. I mean, listen, I have hindsight. I've got years, and my kids are 25 and 20 and stuff like that. And I like, I can look back and tell you, I don't think another kid would have changed anything. For me, that's good to know. Yeah,

Jane 1:04:27
interesting. Because I think everyone else is like, Oh, if you're thinking of three, just do it. But that's all people have three kids, so who

Scott Benner 1:04:32
knows? Yeah, I'm just saying it's possible that you're using the same collecting mentality as people with fish tanks. And I'm worried for you. They're like, I built this tank, and it's running now, and it's awesome. And I do like looking at it, but it was so much fun building

Jane 1:04:44
the tank. Also, I have a two bedroom apartment in DC, you know, so you

Scott Benner 1:04:48
don't need, you'd need one less kid, yeah, exactly. We

Jane 1:04:51
I'm like, Yeah, my kid, actually, my Yeah, my son, who is a year and a half, is been in my closet for like, the entire time. So that was my gosh. So, like, yeah. Yeah, like, do we have the space? No, we don't have the space. We don't have the space or the money. The

Scott Benner 1:05:04
third one's gonna be like Harry Potter. He's gonna live under the stairs Exactly. At least they're gonna be used to little. Listen, things are expensive. Have two twos, enough. Trust me, you're fine. And

Jane 1:05:14
sure. I mean, man, the takeaway from my type one diabetic, this type one is expensive and insurance is impossible. So, yeah, I don't need more. Also, have

Scott Benner 1:05:21
you, and I hate to say this, but have you given any thought to the idea that could your kids get type one eventually?

Jane 1:05:26
I have. I I've listened to your podcast about one of one, somebody on your podcast who got their kid tested with the new testing that's out there. And I think I would think about that at least. I'll be hyper, and like to see if I can prolong if that, like, you know, if they are type one risk to prolong that, I'm, I'm losing my words of what that is, but the infusion, you know, to try to prolong that. So that sounds in like, I will, I will be interested in, like, trying to do what I can to you

Scott Benner 1:05:58
would consider, like, a tz old situation, if that,

Jane 1:06:01
yeah, that's it. That was the TZ. That was the word I was wanting, Yes, uh huh, a Tuesday situation, or in, like, you know, being aware of their symptoms and stuff like that. Yeah, yeah, no, yeah. Type one. Nobody else in my family has it, so I last I had checked correct me if I'm wrong, like, the risk is, like, you know, like, one to 3% or something like that, if your kid's getting it, and if you're the mom, I

Scott Benner 1:06:19
mean, listen, you your kids might never get type one, like, yeah. I mean, like, in they might, does your husband have any autoimmune on his side of the family? No, nobody like celiac or

Jane 1:06:29
no autoimmune on either side of the family? Yeah. And I have no other health conditions either. So in

Scott Benner 1:06:33
my opinion, just from making this podcast, that should help a little, hopefully. I mean,

Jane 1:06:36
that's what the data says. So I just got to go by so just Yeah. So I my hope is, you know, hope is that not, but also, I mean, I used to think before your podcast, in some ways, I used to think like, that would be my worst nightmare. Is not just having, about having my having, like, my baby habit. And now I just feel like, okay, so many parents can do it like you are more equipped to handle it like, especially now, like, with all the technology and everything, like, they just, it's not as bad as when I first got type one of thinking through my kids getting it, that really

Scott Benner 1:07:08
makes me feel good. Thank you. Yeah, it's true. I'm glad you feel that way. It's awesome. I do.

Jane 1:07:13
I'm like, okay, these moms, like, can do it, you know. So it's not the end of the world.

Scott Benner 1:07:17
Shane, I appreciate that. Thank you for doing this with me. Oh, thank you for having me on it. Did you have a good time? Yes, yeah, awesome. How did you find the podcast? Great

Jane 1:07:26
question. Oh, you read it. Read it. Oh, yeah. And Instagram, Instagram too. And I'm not even, I was not a redditor until this. So it's like, I until just me looking up diabetic things. And I also, like, am not, I'm never on the computer, because I work in the ER and I, you know, never, I'm never like looking on things. So I also never use chat GPT. I never, you know, do things like that. I started just looking at Reddit to see what type one day, how type one diabetes are managing things and and then they were all, like, a lot of people pointed me to this

Scott Benner 1:07:55
awesome well, thank you, Reddit. I appreciate that. Yeah, awesome. All right. Hold on one second for me. Yeah,

I'd like to thank the ever since 365 for sponsoring this episode of The Juicebox Podcast, and remind you that if you want the only sensor that gets inserted once a year and not every 14 days, you want the ever since CGM, ever since cgm.com/juicebox, one year one CGM, 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/juicebox diabetes.com/juicebox there are links in the show notes and links at Juicebox podcast.com. Touched by type one, sponsored this episode of The Juicebox Podcast. Check them out at touched by type one.org on Instagram and Facebook. Give them a follow. Go check out what they're doing. They are helping people with type one diabetes in ways you just can't imagine.

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Real-talk nutrition with Jenny Smith—simple, practical, no-nonsense.

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

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

Welcome to my nutrition series with Jenny Smith. Jenny and I are going to in very clear and easy to understand ways walk you from basic through intermediate and into advanced. Nutritional ideas, we're going to tie it all together with type one diabetes, talk about processed foods and how you can share these simple concepts with the people in your life, whether it's your children, other adults or even seniors, besides being the person you've heard on the bold beginnings and Pro Tip series and so much more. Jennifer Smith is a person living with type one diabetes for over 35 years. She actually holds a bachelor's degree in Human Nutrition and biology from the University of Wisconsin. She's a registered and licensed dietitian, a certified diabetes educator. She's a trainer on all kinds of pumps and CGM. She's my friend, and I think you're going to enjoy her thoughts on better eating. 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, and we break down complex concepts into simple, actionable tips. The Diabetes Pro Tip series runs between Episode 1001 1025 in your podcast player, or you can listen to it at Juicebox podcast.com by going up into the menu. 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. This episode of The Juicebox Podcast is sponsored by Omnipod five. Omnipod five is a tube, free, automated insulin delivery system that's been shown to significantly improve a 1c and time and range for people with type one diabetes when they've switched from daily injections, learn more and get started today at omnipod.com/juicebox, of my link, you can get a free starter kit right now. Terms and Conditions apply. Eligibility may vary. Full terms and conditions could be found at omnipod.com/juicebox today's podcast is sponsored by us med. US med.com/juicebox you can get your diabetes supplies from the same place that we do, and I'm talking about Dexcom, libre, Omnipod, tandem, and so much more us, med.com/juicebox, or call, 888-721-1514, All right, everybody. I am going to do something with Jenny that I've been threatening to do with Jenny for, feels like five years now, and we finally got time to do it. So we're going to unleash a different part of Jenny's background today. So yay. Give people like a real quick overview of your schooling. Like, you know, got outta high school, what'd you go do? How did your career move along?

Jennifer Smith, CDE 3:13
Yeah, great. So I went to school one of the few college students who often knows what they're planning to go into, right? That's not surprising, yeah, went in specifically with a path to become a diabetes educator. I knew that was like the end thing, but in order to get there, you have to have a couple of different types of credentials, right? So I was very interested in nutrition, mainly because of type one diagnosis. I had a really great dietitian educator that I worked with when I was diagnosed, but also my mom was like, she cooked. She home cooked all the time. So I grew up with cooking a really great garden in the summertime, and just a lot about food that I really started to love. So I went into college looking for a degree within the nutrition realm. And I did a human biology with an emphasis in human nutrition, came out with a bachelor's degree, and then went on further with a kind of a, it's a, it's like a master's program that you move into in order to become a registered dietitian. It's essentially an internship program to be able to study all the physiology of the body relative to all the nutrients that you're putting into it, and how to navigate health management and all the different types of health problems we can have, and how nutrition works with that. So

Scott Benner 4:41
awesome. And then you go, like, to practice afterwards. Do you start off as, like, a nutritionist? Like, how does like, what's your work life like? Then?

Jennifer Smith, CDE 4:51
Yeah, so it's a great one too. So all registered dietitians are nutritionists, not all nut. Nutritionists are registered dietitian. Gotcha, not negating nutritionists, you know, but in general, yes, registered dietitians are all nutritionists. We

Scott Benner 5:10
are just laying out your bona fide days. We're not We're not cashless versions than anyone else, right?

Jennifer Smith, CDE 5:15
Yeah, I wasn't a diabetes educator yet, so I took a position with a hospital system as a registered dietitian, and in that role, initially, I was a general dietitian, so I saw people on all wards of the hospital, in all states of medical distress, all different types of disorders in all areas of the body, which I think, as I've mentored a number of other people who've gone into the nutrition field prior to their internship or within it, my recommendation is always do something that allows you to use everything that you got from that internship that you can actually begin to explore. Hey, maybe I really wanna work with those who have cancer, or maybe I really want to work with cardiovascular conditions, or, you know what, or pediatrics, whatever it is, but it's a it was a nice way for me to apply everything that I had gotten to know and retain that information. Eventually, I specialized, and I went into cancer, both inpatient cancer, as well as some of the outpatient kind of infusion centers and different outpatient cancer. Obviously, nutrition impacts healing a lot there. I also my favorite as a dietitian in the hospital was not educating people in the hospital, because it's a really, it's a hard environment for education because they're being taken for tests, and there's so many things happening, right? My favorite was actually being an ICU dietitian, really. So I and, yeah, I had ICU and imcu, so an intermediate, and it was great, because I never, I never really had to talk to people. What I had to do is work with the pharmacy side and making sure to check lab values. What were the people in for? What were their conditions that they had come in with, outside of now being on tube feedings, or what we call IV nutrition, and so it was my job to kind of do the calculations. Oh,

Scott Benner 7:13
my God, I just realized. So you did the same thing for their nutrition that you do with people's diabetes. You turn their dials and get their

Jennifer Smith, CDE 7:18
settings right. Yes, exactly. Interesting. But there, and there's a lot, I mean, they're very similar, yes, in turning dials in a formula that goes in through a tube, that feeds in through the gut, versus, if their gut can't be used, you have to do IV nutrition, and then the parameters are slightly different as well. What can go through a vein, and, you know, in what way, and the right macronutrients as well as micronutrients for healing. So it was like, I'm an algebra person. I love algebra. I don't really love geometry, but I really liked the figurings that you had to do. So that's kind of how my brain works,

Scott Benner 7:54
right? I mean, also, you have a personal background in eating, Well, honestly, like, the way you were raised, you know, like, so it all kind of melts together. So that's awesome. Then you move into becoming a CDE at that time, right? Diabetes comes with a lot of things to remember, so it's nice when someone takes something off of your plate. US, med has done that for us when it's time for Arden supplies to be refreshed, we get an email rolls up and in your inbox says, Hi, Arden, this is your friendly reorder email from us. Med, you open up the email. It's a big button that says, Click here to reorder, and you're done. Finally, somebody taking away a responsibility instead of adding one us. Med has done that for us. An email arrives, we click on a link, and the next thing you know, your products are at the front door. That simple, us, med.com/juicebox, or call, 888-721-1514, I never have to wonder if Arden has enough supplies. I click on one link, I open up a box, I put the stuff in the drawer, and we're done. Us. Med carries everything from insulin pumps and diabetes testing supplies to the latest CGM like the libre three and the Dexcom g7 they accept Medicare nationwide over 800 private insurers, and all you have to do to get started is call 888-721-1514, or go to my link, usmed.com/juicebox, using that number or my link helps to support the production of the Juicebox Podcast. Today's episode is brought to you by Omnipod. We talk a lot about ways to lower your A, 1c on this podcast. Did you know that the Omnipod five was shown to lower a 1c that's right. Omnipod five is a tube, free automated insulin delivery system, and it was shown to significantly improve a 1c and time and range for people with type one diabetes when they switched from daily injections. My daughter is about to turn 20. One years old, and she has been wearing an Omnipod every day since she was four. It has been a friend to our family, and I think it could be a friend to yours. If you're ready to try Omnipod five for yourself or your family, use my link now to get started omnipod.com/juicebox get that free. Omnipod five Starter Kit today, Terms and Conditions apply. Eligibility may vary. Full terms and conditions can be found at omnipod.com/juicebox,

Jennifer Smith, CDE 10:28
yes. So within all of the work I did hospital and clinical outpatient stuff along the way, I'm starting to gather my hours, if you will, to be able to apply for and then sit the exam to be what is now a CD CES, but CDE at the time, yes, okay. And eventually, I started working with an RN mentor who was a diabetes educator. She had control of the education program for type two diabetes at the hospital that I was working at, and really got a chance to accrue a lot more hours. And then in my outpatient I had a chance to really start to connect a lot more with type ones who were coming in, not many of them in hospital. Those were it was mostly type two diabetes in hospital. But in our education classes, I got a chance to teach all of the important nutrient pieces, as well as the physical activity parts. And I got a really lovely understanding from the nurse about all of the medications and the monitoring and how they really they all work together. If you understand what you're doing, the biggest piece that I took away from it, what we're working on, I'm super excited about, because it's been like long term. The idea that I got from working with so many people is how many people aren't educated in nutrition, like, it doesn't sound like it should be that difficult, but it's not taught unless you truly choose a path of education beyond high school, for that, most people don't understand what to put in their body and why,

Scott Benner 12:10
right? They're not eating for nutrient value or anything, right? It's all like, I like that, or that tastes good, or this is what we have. And yeah, so I can tell everybody that I think Jenny is just going to be perfect for this, obviously, because growing up, she had parents who helped her eat well, it's important to her. You can hear her when she talks about her diabetes and how she handled food that and how that helps her with her type one, plus she's awesome at type one, then she's got all this background in, you know? Thanks, you know, no, obviously, like, you have all this background coming out of college and your work life. Then you become a CDE now, you have all this knowledge as it applies to people with type one. You have it personally, you have it professionally. And anytime food comes up, you're like a horse. I have to put a bit in their mouth to keep them from running. And Jenny wants to talk about this. And we finally have time to put a series together that'll help everybody understand their nutrition and the decisions that they have in front of them that they can make. And we're going to try to do it in shorter blocks. Like, we don't want to have like, hour long conversations where you're just like, Oh God, I think somebody said micronutrient again. What does that mean? But I want people to be able to hear like little chunks and say, okay, like, maybe there's something actionable in there, something I hadn't thought of before. But for today, like we do in all of our series, we're gonna take your awesome notes and we're gonna put them in order so that we can record in that order. So this will give you guys a feeling of what's coming and in what order it'll be in, so that think of this as, like a little overview for you, and that's it. So Jenny and I are basically going to work now and record while we're doing it. Yay. Yeah. So if we look at are you in the document, I am all right. So if we look at how it sent you now, I believe that the way you sent it to me is at the top, and then the way that it got reorganized is underneath of that, correct, right? So, yes. So if we take what it's calling module one, basic nutrition introduction for all ages, I'm going to bring that to the top, okay, and then I want you to tell me from your initial notes all of what belongs underneath of it.

Jennifer Smith, CDE 14:27
So okay, and the summary of kind of reordering what I had put together is, I think it's really well structured, okay, because from what I can see, the notes that I had sent to you or the document I had sent to you with teaching notes I had used previously. Are it? It pretty much did almost a copy of

Scott Benner 14:52
it. It did change it. It just reordered it. Right? It reordered it and it simplified it. Okay, the first one is going to be. Basic nutrition for all ages. An Introduction. We're going to go micronutrients, macronutrients, basic food groups, simple, healthy eating principles. That's going to be it. So now I'm going to Okay, so if it likes that for you, then we can move that out and then call that the first conversation. Okay, second one is

Jennifer Smith, CDE 15:21
Module two is next, right?

Scott Benner 15:23
Intermediate nutrition, eight and up, understanding energy, okay, so it just kept it in.

Jennifer Smith, CDE 15:28
It looks like it kept essentially the same, again, the same concepts or ideas, okay, in the same order. The idea with Module Two was to expand on the beginning of education, right? The beginning of what makes up food. And this kind of expands on, well, once you know what makes up food, like, how do you balance it, and what does your body do with it, and that kind of thing, right?

Scott Benner 15:54
So then, what do you think, while I'm moving up module three, what do you find that people are most like, not shocked, I guess, but like, when they walk away and they think, wow, I learned something here today. Like, what is the thing that they hear that they just didn't know before? When you talk to people about about how they eat, Oh, what have you seen over the years that you're just like, wow, I can't believe, I can't believe nobody knew that. But okay, good.

Jennifer Smith, CDE 16:19
I think that what I found in talking to people who don't have diabetes in general, right? Because majority of what I do is diabetes and just talking to nor not normal. But you know what I meant, like people without diabetes, right? I'd actually like being not normal because I have diabetes, I'm special. So anyway, I'm astounded consistently at conversations that I have with people. At some point we get to food and talking about it, especially being a parent of kids, you know, you end up talking with other parents and about how much your kids eat, and like what they eat, and where people go to eat, and where they buy their food, and, you know, whatever. And I'm always astounded, especially by what I expect should be easy to understand information, what makes up food, what food groups are comprised of, which macronutrients and why are they important, and things that I consider really baseline, like the basics of understanding, right? I find that really, really smart people just don't know. They just don't know these concepts. And, you know, my kids get, they just get what I know to give them, right? And then I look at other kiddos again, not diabetes specific. I think people with diabetes do have, at some point, a little bit better understanding.

Scott Benner 17:47
They see the cause and effect of food correct exactly, and

Jennifer Smith, CDE 17:51
so they reach further to learn more about why right, and then they can make sense of that. People without any tools like continuous glucose monitors don't really know why their kid that they, you know, they ate like, six apples, why they're like, bouncing off the rails and then two hours later complaining that they're hungry again, right? Well, I fed them only apples. Well, sure, but you know what I mean. So it's like this misunderstanding of making balance, and why you need to make the balance. And it's just not, it's just not out in the general public. So

Scott Benner 18:27
like in the apples example, it's sort of like fruit good. I don't know why this went wrong, right, right? Exactly. Yeah. I know Apples are good because fruit right? Yeah, right. Or, you know, the box says it's part of a balanced breakfast, that kind of thing. I don't understand why these golden grams are not doing what they're supposed to be doing. Or

Jennifer Smith, CDE 18:45
a graded one too, which, for years, you know, we've now had things about this is a low cholesterol or a no cholesterol food? Well, your foods that didn't come from an animal are not going to have cholesterol in them, yes. So putting no cholesterol on the package is, it's not a lie, but it's kind

Scott Benner 19:04
of a trick, right, right? It's like, it's like, feeding you paper and going, Hey, there's no cholesterol on this. Right? Awesome. Thanks. Great. I can eat more of it. I've said a million times to you. My favorite one is that the and now I'm gonna get in trouble with people over my accent, but the water ice place around here, they have a giant sign on the front that says fat free. And I'm just like, well, it's fat free now, but after you ingest all the sugar, your body's gonna go I wonder what we should do with this show. Let's store it as fat Exactly. Yeah, that's marketing. There's no lie. There's no fat in that. Water ice, no,

Jennifer Smith, CDE 19:35
right? Yeah, there's no fat at all. And actually, what you just said, sort of just in conversation is where I hope that this nutrition kind of educational piece expands into the understanding of sure it says no fat. It could never have fat in it, but eventually getting to the physiology in the body. Which is down the list, and understanding that we might think we're putting in something that shouldn't be harmful, but in a way it is also it ends up being, well, what does your body do with it? Yeah, right. Listen,

Scott Benner 20:14
we're not going to be preachy in this at all. I'm especially not going to be you have a leg to stand on if you wanted to be preachy, but at the same time, like, this is just stuff we should know. We should know this stuff, and it's worth two hours of your time spread out over two months in a podcast to understand it. You know what I mean? Like, it just, it really is so module four here, processed foods and their impact on health, I think this is the first time that it's kind of repackaged things for you a little bit here, nutrition deficiency, weight gain, blood sugar and insulin resistance, increased inflammation, heart health, gut health, mental health, risk of chronic disease, addiction, like eating habits. So what part of your if you scroll down there, like, what part of your notes, do I put up with that? So, just so people know, I took Jenny's notes. And I mean, I don't think this should come into any like great surprise people are listening. I fed it to a pretty advanced AI, and I said, Look, we don't want to change anything about these notes, but we want to order them in a way that allows for, you know, a process of learning slowly, so that you know you're not overwhelmed at the beginning, and that what you heard before builds on or what you hear now is building on what you heard before. So it's kind of, we're just putting it in order right now. So now. So my goal,

Jennifer Smith, CDE 21:23
too within it, specifically for your podcast, which is primarily those who have diabetes, right, is to understand that the baseline of this knowledge goes further in managing a chronic condition like diabetes. That in this module four actually truly does start to delve into with diabetes. Could there be nutrient deficiency? Could we have issues with weight gain or obesity, or dysregulation of how your body uses insulin or insulin resistance? Right? So understanding the basics can help you understand, well, goodness, if I'm not putting in the right stuff in the right amount, the way my body needs it, gosh, diabetes, with high blood sugars already creates inflammation in the body, what else am I not doing very well that's actually just pouring more, you know, fuel on to that fire, Right? So you're

Scott Benner 22:21
already a person with an autoimmune issue, so correct? Let's not help, right? Yeah, if we can. So tell me of your notes that are under this what should I be abutting to module four? Like? Did it just take all of your numbered things here, one to nine, and just package them in module four, right? It

Jennifer Smith, CDE 22:41
looks like that's what it did, and I think in a really good way, because then it's all one specific area of looking at, yeah, I mean, we're talking about module forward. It's processed foods and their impact on health, but processed foods, again, we'll talk about it, but they can impact all of these different areas. And then when we bring diabetes into the picture, these are areas that are already being impacted based on our glucose management. And we want to do the best that we can almost get

Scott Benner 23:14
a double hit on some of these things. Yeah. And by the way, just to call this Jenny's notes, is it's reductive. This is an exhaustive and really well thought out document here. So if I take out the nutrition deficiency the numbering all the way down, that's already in what we have here in module four, so I can just remove that. We don't need to duplicate it. And then I'm going to go down and grab five and bring five up. You guys are done. You're gonna you're gonna listen to this and know what you're talking about, which I think will be whether a person listens to this and says, I'm gonna make changes in my life or not. I think at least just knowing is incredibly valuable. Like, you know what I mean? Like, if you decide to do something with it, like, right on. But even if you don't, I at least like you putting something in your mouth, and it not being a surprise. You know, when whatever happens happens or doesn't happen. You know, the

Jennifer Smith, CDE 24:08
other hope that I have from this too is so often we are really just trying to navigate diabetes within the realm of being, as I said the word before, like normal, like someone without diabetes, right? And with that, food is a huge hitter. And so so often people just say, Well, why can't I just eat it like anybody else eats it? Why can't, you know, why can't I? Why shouldn't I be able to give my child everything that everybody else is having at the birthday party or this type of treat at the business, you know, convention or whatever it is. And my hope is that with loaded with more information, you can make healthier decisions to say, okay, like I haven't done this in two months. Great. Eat. We're going to eat the chocolate cake and the ice cream, or we're going to go out and have, you know, the Mexican part, Mexican food party with you know what I mean, but rice,

Scott Benner 25:09
Jenny, I hear what you're saying,

Jennifer Smith, CDE 25:13
but at least you have the idea of, despite everybody else doing this who doesn't have diabetes, that doesn't mean that everybody else is doing it the right way?

Scott Benner 25:21
Yeah, it's something hasn't been taken from you as much as it's been shown to you. Correct. It's unpleasant to have a light shine on it. You know? It's funny. You just said, like, Mexican food. And I was like, oh, a tortilla with rice. And you know what flood into my head after that, the countless people from that cultural background who come on this podcast and are, like, my dad is so sick and it's and when I ask what it is, they just say it's cultural, like, Do you know what I mean, like, and I understand the idea of, like, you were raised, and this was around all the time, and it's comforting. But, like, listen to a second generation person with diabetes talk about their father, and now the father has type two. Swear to god, I've had this conversation. A half a dozen times. The father's type two, their type one. They're, of course, forced to pay closer, quicker attention because of, you know, the immediacy of type one diabetes. Whereas type two can kind of allow you to drift a little bit. They're looking up. They can't get through their parents. They pull their mom aside, Mom, you can't cook like this for Dad, like, blah, blah, blah, they can't stop themselves. And now this person still has that, like, oh, it's been stolen from me feeling, but they have enough context to all of a sudden not care. And I think this could be context for people, right? If you've been diagnosed with type one diabetes and there's a food you just can't figure out how to manage, and it's gone out of your life. Now you can miss it, and I wouldn't begrudge you that, of course, but there's got to be another aspect of your mind that says, like, I do miss that, but this is better for me. Like, yeah, like, I'm going to live better, be healthier. And I think your conversation is going to explain to them the little ways where they'll How do I want to say this? I think of like, if you're eating not optimally, and you move slowly towards eating more optimally, it's sort of like taking a vitamin that's actually going to help you. Like, let's say you have really low vitamin D, and you're going to take vitamins, and eventually your vitamin D is going to come up, and it's going to help you. The truth is, is today, while your vitamin D is low, there are things going wrong inside of you, and you don't feel well, but you don't know it anymore, because you're accustomed to it. And you're slowly going to build up the vitamin D in your system, and then one day, those things are kind of going to dissipate, but because of how our brains work, you're not going to know it went away, correct, right? So you're going to feel better, but it's your new reality, and everything's your constant, consistent now reality, and when you change it slowly, you know, let's say it takes, I'm making up a number, but let's say it takes two months for your vitamin D to come up. You're in a better position every day taking that vitamin D. You don't know it, it's a little better, a little better, a little better. And then you get up to that vitamin D level that you're supposed to be at, things are better. But oddly enough, and I know this sucks, you don't feel any better than you did 60 days ago when you started. But you are, but you are, yes, yeah. And I think that's what's going to happen here for people, is that you're going to it sucks, because you can't just sit down one day and be like, All right, fine, I'll have broccoli, and then everything's

Speaker 1 28:19
and magically, the next day you're exactly how you thought you should be. Yeah,

Scott Benner 28:23
and I'll tell you, like, I know this sounds probably would sound counterintuitive to some people, but because of the fact that I've now been using this GLP medicine for two years, like, I finally had something managing for me in a way that allowed the time that needed to pass to pass right like, so I now know the value of the patience that it takes to get to it. And before, to me, patience was like, Hey, I dieted for 10 days, and I'm not better. So you know what I mean? You give up a little bit.

Jennifer Smith, CDE 28:54
That's a great point, too. Because I think if you understand all the concepts I hope that we'll discuss, you won't choose a particular and I hate the word diet, you will choose a fueling plan that really does optimize your overall health, as well as hopefully shed some light on your blood sugar management and your medication amounts and uses and your strategies that we've talked about many times in the pro tips episodes, right? It'll shed a little bit of light to be able to say, oh, I can make the connection. Now I see how these things definitely, you know, work together. And

Scott Benner 29:34
I think you're gonna see the value of having an indulgence, and it actually just being an indulgence, the way I imagine, what am I watching on TV right now? I'm watching 1923 right now. So the way I imagine, like, if a person in 1923 like, oh, a sweet treat. You know what I mean? Like, like, it was like, like, it was like, wow, this is awesome. Like, I don't I never get this. Like, we have these three times a year, right? We've somehow turned ours. It's so much about access. Right? Not that I'm unhappy that people have access to food, but I'm saying that 100 years ago, to have a piece of cake would have been a thing that happened, like, once, you know, or maybe seasonally, or something like that, or pie with a fruit in it would have been like a thing you did periodically. And now we have, we have the ability to, like, eat a bag of something and then just magically make another bag of it come back again? Right, right. Yeah, absolutely.

Jennifer Smith, CDE 30:22
That reminds me of, like, every year growing up, my dad's my grandpa, my dad's dad, he for his birthday, always requested my mom make a cake for him, and my mom was phenomenal at making homemade cakes, and his cake of choice was a German chocolate cake with dark chocolate frosting, and in the middle she made this, like, date and becan filling that went on the top of the cake. Yeah, that reminded me of it only because that was, like, that was an indulgence. It was exciting to go to grandpa's birthday party because, again, we didn't, we didn't typically get that kind of like we had homemade food, but we didn't have homemade treats. Even before I was diagnosed with diabetes, it wasn't something regular. My

Scott Benner 31:09
grandmother, once a summer, would drive back to where she was from and get a shoe fly pie, which I think was just molasses in a shell. I'm not exactly sugar, yeah? But then she'd bring it back, and it was like, it was like Christmas, and then she had a slice of it, and then maybe had another piece of it two days later, and then it was gone. And then next summer, she drove off and got it again. I'm just saying that, like at this point now, everybody with a car is five minutes away from from food, from $20 worth of like, calories that are meaningless to your body, that taste awesome. And, you know, it's funny, you you mentioned the birthday because Arden just made, she made a treat to bring to my mother in laws for her birthday. And it was like a strawberry shortcake, but it wasn't. It was just strawberries in a bowl. It was this cream that she whipped up and, like, kind of a thick tart, almost. And you kind of just put them together. They weren't judged up with anything that wasn't just the, like, it was a very basic to make it with, yeah, like, and so the cream doesn't taste like whipped cream. Like, ready whip it taste, you know, it's just kind of light fluffiness. And the strawberries were just strawberries. They didn't, they didn't have, like, a handful of sugar thrown over to tear up on it. And it was really good. But as I ate it and looked around the table, people put in their mouth and they're waiting for that, like, the hit, yeah, the hit from the sugar, and it's not there. And at first everybody was sort of like, is this good? I don't think this is good, but what I was watching, I was like, Oh, this is just what strawberries taste like. You're waiting for the strawberry filling from a pop tart to hit your tongue, like that's not going to happen now, right, right. Anyway, let's get back to what we're doing. I'm so sorry. So that's No, that's a good little aside. Yeah, so module four here we love. We brought module five up key areas to address in nutrition education for type one. So this combines blood glucose management, basics, carbohydrate counting, understanding the role of fats and proteins, meal planning, frequency, perfect module six. Good kind

Jennifer Smith, CDE 33:12
of might just be an overview where I brought in the idea of this ahead of time nutrition information. I wanted to tie specifically into how this could be beneficial in terms of your type one management. Yeah, so this is probably more of a an overview. I expect we've talked a lot about this in a lot of the episodes that we've done, but we want

Scott Benner 33:32
to keep it together in the series for sure. Yeah, no, it'll be great. Plus the first three will build and allow the fourth one to really make sense for people or the fourth and fifth one. So module six teaching approaches for different age groups. So this is where you'll talk about, like, more specifically, teens, adults, seniors, how to think about things. Oh, there's, there's a ton here. And I

Jennifer Smith, CDE 33:53
think in this the different age groups was also meant to be helpful for those who really are caregivers to understand how to be able to teach your children and your teens and maybe young adults and whatever a little bit more and or for the adult kind of population to understand I don't understand this as well. What should I delve into? What should I be able to focus on what are some practical tips that I can apply, because I'm my own navigator, right?

Scott Benner 34:26
So then here's the summary for everybody. It's going to be a six part series, basic nutrition in module one, intermediate nutrition, two, advanced nutrition three, processed foods and their impact on health will be four key areas to address in nutritional education will be five with, like, a bunch of like, like, Jenny just said overview for diabetes stuff. And then module six will be teaching approaches for different age groups. So this is going to be like, once you understand what being said, like, how do I broach this to, you know, to other people in my life, depending on their on. Their age group, and there'll be conversation in between. Like, I'm sure you guys, Jenny has a lot of, like, just a lot of opinions about this stuff, and they're nice and solid opinions. So we want to really, like, just let her run. And you said that very nicely. No, you do. You're very you're how some people eat makes Jenny upset. So we'll, we'll let her, let her really just run with it. I

Jennifer Smith, CDE 35:22
think actually more than it's not really how people eat. I think it's the misinformation, the lack of information and what's available to eat, that makes it really hard for people to choose well, more of the time. I think that is, it's a huge piece. As I said the word food before, and then I was like, you were saying, like, five minutes from here I could go and get something. And I said, yeah, there's food all available, but it's we defined food a while ago. And I said, food is not equal to food. Food has its own definition of quality, which, again, I we're going to expand on. And then there's stuff that contains calories. Yeah, we really shouldn't think of as nourishing our body, right?

Scott Benner 36:03
Yeah, sometimes it's fun to eat, or you're just accustomed to it, or it's, you know, I mean, I think some people, I mean, listen, I'm not preachy about anything. You know, generally speaking, I don't, but we're using food and I'm making quotes as drugs. Honestly, 100% Yeah, these are extensions of alcohol, weed, coke, whatever it is you're doing at home. Some people are doing a bump during the day and some people are eating a ho, ho. So I don't think it's much different, to be perfectly

Jennifer Smith, CDE 36:32
honest. No. And the pre I mean, the the nature of the companies that make what we all call food randomly across the board is it's a combination of specific, different nutrients that make it taste the way that your taste buds are. Say, Go back for that. You can't just have one bite, right? You have to have more, and you have to have more, and then you're addicted to it in in a way, right? So I'm

Scott Benner 36:56
going to share something personal.

Unknown Speaker 36:58
Oh, geez, your middle name?

Scott Benner 37:01
Oh, you saw that online again. You people gotta shut up. I'm not telling you my middle name. I said. Every once in a while a post comes up and like, what's Scott small? I'm like, I'm like, if one of you guesses it, I am not telling you if you're right or not. So the last Easter that my mom was alive, the company that made the jelly beans that she loved had some sort of a problem, and they weren't available. Oh, and I don't know why. This is very sad. She just wanted, just born jelly beans, not the spicy ones, the regular ones. I've never heard of that brand. They're so good, and they weren't available, like they just weren't my brothers looked where they lived. I was looking everywhere. We were going to ship them to her. We couldn't, like, we just couldn't find them anywhere. I contacted the company, like, just to see if they had stock of it. Like, nothing, right? Oh, so the other day, she's, she's gone now, and I'm in the grocery store the other day, and there is this, like, I don't even know how to describe, like a giant basket. It's got to be four feet square and four feet tall, and it has five pound bags of them. And I stopped, and I thought I was like, Mother, you know, like, I was just like, I was like, come on, and did you buy a bag? I bought a five pound bag of jelly beans. But I'm on a GLP medication. I don't get any of the woo out of them anymore. Like, right?

Unknown Speaker 38:28
Jelly Bean, from memory, you don't

Scott Benner 38:30
understand, if you're not using a GLP, you don't get it like, like, all that, like, judge you get from food. I don't feel that anymore. I can't even taste the sugary, as sugary as sugary as it is, I know that's maybe hard to, like, understand, right? The other day, I said to somebody, I was like, We got to throw these goddamn jelly beans away, because I'm walking past them, and I feel like I'm five, and then I feel bad that my mom didn't get them, and I take, like, a half of a handful of jelly beans, yeah? And I don't like and listen, I'm gonna be honest with you, I'm lucky. I'm on a GOP. I haven't gained any weight, yeah? But there's gotta be two pounds of jelly beans going at this point. You know what I mean? And I don't enjoy it. It doesn't bring anything to me. I'm not getting the zip out of it. It's purely psychological. It's memory, yeah, and it's making me happy when I'm eating them, because I remember the flavor and it being around my house and etc. But it's such a, just such a lesson, honestly, yeah, you know. And there's nothing valuable about them, as far as like me eating them like it's not doing anything for me. You know what? I mean,

Speaker 1 39:39
you can't even fix a low blood sugar with them for a real cause. It's not like I'm not

Scott Benner 39:43
It's not like I'm even saving my life. And by the way, Arden doesn't like jelly beans, so I am going to end up pushing them into the trash, but it's going to be heartbreaking to throw them away. I should not have bought them. And ironically enough, now that I have the GLP medication, I just don't buy stuff like that anymore. Like I was grocery shopping the other day. I don't know how many of you trick yourself into going out the food aisle to the register so you can just grab something on the way and go, Oh, I can't believe I'm in this aisle, Swedish Fish. I definitely used to do that, like I'd finish my shopping and then I would pick the candy aisle to walk out of and grab something for my car. So I reflexively did it yesterday, and not for, like, to buy something. I just, that's how I think that's just now, how I exit the grocery store, and I'm walking down, I'm looking it up at all these things that I bought in the past. And I was really stunned by the fact that, like, I don't want any of this. Yeah, I couldn't be bothered with this at all. And I'm hoping that, like, I mean, listen, if it takes a GLP to get you there, whatever. But like, I'm hoping that for some of you, if you can just kind of follow along with what we're doing here, maybe your body will just lose the flavor for it at some point. For some of it, at least really make a big difference for you, I think. I

Jennifer Smith, CDE 40:53
mean, and what you're really also getting in and is that that mental piece of it we've been kind of coaxed into either remembering something that was really, really good, and we associate a really good memory with it, and so we keep it in our life, despite knowing that it's really not providing anything similar to the loveliness of when we had it, that making the Memory right? Yeah. I mean, there are things from childhood, definitely that I my grandparents, my mom's parents always kept a dish. It was a beautiful, like, greenish color dish that had a lid on it, and it was their candy dish. And my grandpa always had, do you know the the anise candies, yeah, like liquor, like licorice flavor. They were hard candies, and they came in like a reddish kind of wrapper, and then he had butterscotch buttons. Those were his favorites, and they were always in that dish. And I still, I see them at the grocery store. I have no desire for them anymore, but it still brings that memory back. But I don't buy them just to have them in the house, because grandpa had them right kind of that association that you you can have memories about food and retain the great thing about them without actually continuing to put something in that doesn't really work for your body. I

Scott Benner 42:18
just think I was angry like that. There were now five pound bags available, and there were so many of them there. Like, I just stood there, and I was like, this couldn't happen before my mom died. Like, I just wanted 10, yeah, yeah, yeah, right. And then that was the other thing too. Like, I was just like, Oh, I just like, if I would have taken a couple and walked away, I would have been like, that's awesome. But like, anyway, also five pound bags. Why are they making five pound bags of jelly beans? Well, you know? Well, I guess I do know. Like, I guess that's what this is, you know? Yeah, I will say too that I have also seen people who grew up poor, who are not poor anymore, buy food, almost like a power move, like, I can afford this. Like, do you know what I mean? Like, and so they grab a bunch of stuff they don't even want, because it's almost like, it almost feels like, wow, I won. I could buy three of these if I wanted to. You know, like, I think there's a lot of different psychological reasons, but let's understand the, let's understand the nutrient part of it first, and then you guys can go talk to a therapist about the rest of it. Awesome. Okay, all right, hold on one second.

You this episode of The Juicebox Podcast is sponsored by Omnipod five. Omnipod five is a tube free, automated insulin delivery system that's been shown to significantly improve a 1c and time and range for people with type one diabetes when they've switched from daily injections. Learn more and get started today at omnipod.com/juicebox of my link, you can get a free starter kit right now. Terms and Conditions apply. Eligibility may vary. Full terms and conditions can be found at omnipod.com/juicebox the conversation you just enjoyed was brought to you by us, med, us, med.com/juice, box, or call 888-721-1514, get started today and get your supplies from us. Med, 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. If this is your first time listening to the Juicebox Podcast and you'd like. Hear more. Download Apple podcasts or Spotify, really, any audio app at all. Look for the Juicebox Podcast and follow or subscribe. We put out new content every day that you'll enjoy. Want to learn more about your diabetes management. Go to Juicebox podcast.com up in the menu and look for bold beginnings, the diabetes Pro Tip series and much more. This podcast is full of collections and series of information that will help you to live better with insulin. Hey, what's up, everybody? If you've noticed that the podcast sounds better and you're thinking like, how does that happen? What you're hearing is Rob at wrong way recording doing his magic to these files. So if you want him to do his magic to you wrong wayrecording.com you got a podcast? You want somebody to edit it? You want rob you?

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#1534 Modern Fairytale

You can always listen to the Juicebox Podcast here but the cool kids use: Apple Podcasts/iOS - Spotify - Amazon Music - Google Play/Android - iHeart Radio -  Radio Public, Amazon Alexa or wherever they get audio.

Three generations, one brilliant mom: Ellishia nails timing-and-amount, buys a home, raising her fairytale family.

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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
Welcome back friends to another episode of The Juicebox Podcast.

Elle 0:15
I'm Elle or Alicia for my long name, and I'm a diabetic. It's actually spelled phonetically. But you'd be surprised the amount of people that get it wrong.

Scott Benner 0:27
If this is your first time listening to the Juicebox Podcast and you'd like to hear more, download Apple podcast or Spotify, really, any audio app at all, look for the Juicebox Podcast and follow or subscribe. We put out new content every day that you'll enjoy. Want to learn more about your diabetes management. Go to Juicebox podcast.com up in the menu and look for bold Beginnings The Diabetes Pro Tip series and much more. This podcast is full of collections and series of information that will help you to live better with insulin. 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. This episode of The Juicebox Podcast is sponsored by the twist AI D system, powered by tidepool that features the twist loop algorithm, which you can target to a glucose level as low as 87 Learn more at twist.com/juicebox, that's twist with two eyes.com/juicebox. Get precision insulin delivery with a target range that you choose at twist.com/juicebox. That's t, w, i, i, s, t.com/juicebox. This episode of The Juicebox Podcast is sponsored by the contour next gen blood glucose meter. Learn more and get started today at contour. Next.com/juicebox this episode of The Juicebox Podcast is sponsored by us Med, us, med.com/juicebox, or call 888-721-1514, get your supplies the same way we do from us. Med,

Elle 2:15
I'm Elle, or Alicia for my long name, and I'm a diabetic. Alicia,

Scott Benner 2:20
I was so excited when I saw your name this morning pop up in front of me because I pronounced it correctly in my head. Oh, I love that. For you, I was super excited.

Elle 2:29
It's actually spelled phonetically, but you'd be surprised the amount of people that get it wrong.

Scott Benner 2:35
I believe. Do you want me to call you? El though, whichever. Okay, so not first. Okay. Also, listen, my brain's obviously not right, because every morning I wake up to someone's name in front of me, and the first thing I have to do is type it somewhere else. So I look at it, and then I transfer my eyes six inches to the left and go to type it, and can't spell it. I don't retain what the name is. I just I look at it, and then I go, Okay, I'm gonna type it now. And then it's gone, and then I have to look back again. And for some reason I looked at yours today, and I was like, Alicia, huh? And then I was like, I think I said that correctly. You did.

Elle 3:11
I'll give you that you said it correctly. Thank you. And then

Scott Benner 3:14
when I went over to type it, I could type it. Whoa. So I saw anyway, here come the emails. Scott, you have ADHD, it's fine anyway. Tell me a little bit about yourself. How old are you now?

Elle 3:26
So I'm 24 I have a very ordinary life, other than obviously the insulin. I live at home with my partner and my four year old. Yeah, I'm quite a boring person. I'll be really honest with you, there's not a lot to me. I'm very one dimensional. I work. I'm a mum. Obviously, the reason I'm here is because of my diabetes.

Scott Benner 3:46
Yeah, I take this as a challenge, because I don't believe that you're a boring person. We're going to find out more. How old were you when you were diagnosed?

Elle 3:53
As I was 15 when I was diagnosed. Originally, I was diagnosed with type one diabetes, so yeah, it's like, it's crazy story, even just my diagnosis, my dad was a type one diabetic. Is all of his adult life, and because of that, he had this irrational, way, kind of rational, in hindsight, fear that one of his children would get diabetes, so he'd regularly finger prick us. And, you know, probably once a month my whole childhood. And one time he did my finger, and it came back at like 11, which, for all you Americans out there, that's like 200 so just on that cut off immediately took me to the GP, and after a barrage of tests and an oral glucose tolerance, and they said, Yeah, we think you've got, like, the very beginnings of type one diabetes. So they popped me on insulin. And fast forward a couple of years after being on a pump and all of that good stuff, I just kept hypering Like my sugars just couldn't come up one day, and ended up weaning off of insulin, and I was insulin free for about. Year after that,

Scott Benner 5:01
wow. Hey, I know you were just like 15, right when that happened, yeah, but do you think your dad was relieved because he caught it, or do you think he was like, decimated because it happened? No,

Elle 5:15
I think in his head he all. He just really had this feeling that one of his children would get diabetes. So his dad was also diabetic. So it really like runs quite heavily within his family. A couple of his siblings are diabetic. For him, it was just a no brainer that at least one of his children would get it. So I think it was more of a gotcha kind of moment for him, like he's caught it and he'd done something brilliant,

Scott Benner 5:41
yeah, got out ahead, didn't he didn't want you to say, How many siblings do you have? So

Elle 5:46
I've got two full siblings. And my dad had an older sibling. Well, he had an older child, who's my older half sibling.

Scott Benner 5:53
Okay, so there's he has four children in total. Yeah, he's got

Elle 5:57
four children, but I'm the only diabetic, so I must have got the good genes from him. Does

Scott Benner 6:03
your mother have any autoimmune stuff? She

Elle 6:07
does. She's got a condition that's very similar to lupus. No kidding, what's it called? It's called relapsing polychondritis. It's lupus, lesser known cousin. Wow.

Scott Benner 6:19
Congratulations on saying something on the podcast no one's ever said before. Oh, look at me. Tell your mom, thank you relapsing. What

Elle 6:27
relapsing? Polychondritis. It's basically, it's a mixture between lupus and arthritis, and in it, all of your cartilage gets attacked by your body, so all the cartilage in your ears, in your nose, in your heart, all in your veins, any passage in your body is slowly attacked and destroyed. Geez. In

Scott Benner 6:47
a world where you could be hot and rich, what a mixture to get, you know what I mean? Like,

Elle 6:54
yeah, very much.

Scott Benner 6:57
Hey, how would you like a little lupus mixed with a little bit of arthritis. Awesome. Two best things in the world. It's going to be great. Can I be tall and handsome instead? Is that possible? What's the impact on your mom?

Elle 7:11
Yeah, she handles it incredibly well. I think for her, she'd had health problems for years and years, but because she was looking after my dad. It wasn't until he passed away five and a bit years ago that she then had that sort of chance, like get in touch with her own health and start seeking out a diagnosis and talking to people. So now that she's got that she's obviously on medication, she is back at work. You know, she's just, she's just at a much better place. Medication

Scott Benner 7:39
helps her. Is it an

Elle 7:41
injectable? So she's on steroids every day, and she, I don't know if she still gets it, but she used to get these infusions done at the hospital, and I know that they were really, really good for her, because they helped with, like, keeping her bones, like, intact or something.

Scott Benner 7:55
Geez. How about your siblings? Any other issues there with them.

Elle 8:01
Sure, they're very, very healthy. My little brother's got his own problems. He's got autism, so he lives in supported accommodation. But health wise, they are both bright as rain, thankfully. How old was your father when he passed? He was 50. He was about to be 51 Oh, my God. Was it sudden? I'm sort of but not really. It was a weird mix. So because of his diabetes, he ended up getting kidney failure when he was in his 30s, but he wasn't diagnosed until he went to stage four kidney failure. So he went on dialysis, and he ended up getting a kidney transplant when I was 14 or 15, but then what people don't tell you about kidney transplants is the medication that you're put on is very, very harsh, and I don't want to put anyone off of it, because they're absolutely amazing things that save people's lives. But my dad got a rare complication where all of the immunosuppressants and everything he was on caused him to get cancer, or, well, become more susceptible to cancer. So then he got cancer, and he didn't go very well with that. And because of you, he was also an alcoholic, which didn't help anything. He got liver failure, and he got something called corsicoffs, which is an alcohol related dementia, and all of those things sort of came together and created this perfect storm where he ended up in hospital in DKA with liver failure. His kidneys had gone, and there was nothing they could do. I'm sorry. That's terrible. That was awful.

Scott Benner 9:39
Yeah, the other people in his family line with type one. Do they have similar like poor outcomes, or is it different for them?

Elle 9:46
No, no. My granddad, Bunny. He lived until he was 9697 he was very, very old when he passed away, and he'd had type one since World War Two. So they're all doing pretty good for themselves.

Scott Benner 9:59
Hey, wait, his name is bunny. Yes, that's like his like, that's his name, name, or it's what you called him. No,

Elle 10:07
no, his real name was something weird, like Edgeworth. Edgeworth, yeah, but he had a lot of kids, so people called him bunny.

Scott Benner 10:15
Oh, I got you. I see it now. Did he have all those kids with the same lady?

Elle 10:20
Oh, he had eight with my nanny, and then he had an unknown number with one of her friends.

Scott Benner 10:29
Did they call your nanny tired uterus and him bunny? Or what did they? Did they have a name for her? She was just nanny. Yeah. Do you remember nine minutes ago when you said you had a boring life?

Elle 10:40
I have a very boring yet slightly interesting life. You

Scott Benner 10:45
just said my granddad, Bunny, who lived to be 96 with type one diabetes since World War Two, had eight children with my nanny and a bunch of children with her friends. My Dad, hold on. Your mom has the thing I've never heard of before. Your father died of three different things that were trying to kill him all at the same time and everyone in your family has type one diabetes? Well, not everywhere. Well, I mean, a lot of them,

Elle 11:07
yeah, very prevalent in my family. Yeah, no,

Scott Benner 11:11
I'm saying you're not boring. You had to remember when you came on, you're on a type one diabetes podcast. This isn't a podcast about going clubbing. Yeah? On that podcast, you suck. Also tell people where you're from, because it sounds like maybe Nebraska or no.

Elle 11:29
So I'm from a little place in England called Northampton. Share for those who don't know England, it is just north of London.

Scott Benner 11:38
Very nice that your accents. Lovely. You making my day. Thank you. Absolutely I want to dig a little more in, though. So you said in your intake that you want to talk about your dad, so, like, this is good, right? You're okay with all this? Yeah? No, I'm absolutely fine with it. Okay? I actually said that so that the people listening would realize that this is what you wanted to talk about. And then I wasn't just digging through your father's death, like, just heartlessly. You understand what

Elle 11:59
I'm saying. Oh, you know, because you just love digging through people's trauma Exactly. It's

Scott Benner 12:03
my favorite thing to do, actually, on the list of other things I have to do today, this would be probably going to be the best thing I have to do today. So I see a lot of paperwork in front of me, and I think it's tax time, and a lot's going on here. So yeah, it's horrible. Nevertheless, if your grandfather, your father's father, had such an amazing outcome. Did his style of management not transfer to your dad? Like, how do you think it went wrong for your father? And do you think you're going to pick up a different style, or do you are you worried you'll follow in your father's footsteps? Contour next.com/juicebox that's the link you'll use to find out more about the contour next gen blood glucose meter. When you get there, there's a little bit at the top. You can click right on blood glucose monitoring. I'll do it with you. Go to meters, click on any of the meters. I'll click on the Next Gen, and you're going to get more information. It's easy to use and highly accurate. Smart light provides a simple understanding of your blood glucose levels. And of course, with Second Chance sampling technology, you can save money with fewer wasted test strips. As if all that wasn't enough, the contour next gen also has a compatible app for an easy way to share and see your blood glucose results. Contour next.com/juicebox and if you scroll down at that link, you're going to see going to see things like a Buy Now button. You could register your meter after you purchase it. Or what is this? Download a coupon, oh, receive a free contour, next gen blood glucose meter. Do tell contour, next.com/juicebox head over there now get the same accurate and reliable meter that we use the brand new twist. Insulin pump offers peace of mind with unmatched personalization and allows you to target a glucose level as low as 87 there are more reasons why you might be interested in checking out twist, but just in case, that one got you twist.com/juicebox that's twist with two eyes.com/juicebox. You can target glucose levels between 87 and 180 it's completely up to you. In addition to precision insulin delivery that's made possible by twist design, twist also offers you the ability to edit your carb entries even after you've bolused. This gives the twist loop algorithm the best information to make its decisions with, and the twist loop algorithm lives on the pump, so you don't have to stay next to your phone for it to do its job. Twist is coming very soon, so if you'd like to learn more or get on the wait list, go to twist.com/juicebox. That's twist with two eyes.com/juicebox. Links in the show notes. Links at Juicebox podcast.com.

Elle 14:49
So I think so looking at my granddad bunny, because he was diagnosed in the 40s, and things were very, very different back then. So from what he said, they didn't even know that. Carbs affected your blood sugar, or at least, he didn't know if the wider community knew. Maybe you know, they didn't test blood sugar. They did insulin almost at random. There was no sort of titrating your doses or anything. Not saying it was luck, but I think for bunny, a lot of it was pure luck. He thought that he had an allergy to a lot of food, so he avoided them, and those foods were very high carb foods, so I think that helped a lot in keeping his blood sugar under control. And then when he had my dad, because he managed things in such a haphazard, Lucky kind of way, there was no good management for him to pick up on, if that makes sense, it does. Yeah, from my dad's point of view, Bunny just lived his life and, you know, diabetes was never a problem, and he somehow, you know, came out with no complications. Like, hey, the biggest complication Bunny got was his eyes were a bit messed up. That's to be expected when you're that old. Anyway, I thought

Scott Benner 16:01
you were gonna say a sperm work too well, but, I mean, it

Elle 16:05
did, which is quite rare in diabetes, yeah. So I think with my dad, he didn't have, like, a good role model to follow, and I think he just didn't want to accept it, you know, he was like, 20 or early 20s, when it first became a problem for him, you know, and at that age, especially as a young man like you, don't want someone telling you what to do, do you this is the last thing you want to suddenly be told that you're diabetic and you've got to test your blood sugar. And I don't know if carb counting was a thing when my dad was diagnosed, but let's say it was. Yeah, that's a lot to take on at that age, and he just decided not to take it on, basically.

Scott Benner 16:45
So when you're diagnosed, does he have a message for you around diabetes? No,

Elle 16:50
no. He was very laid back about it. Probably too laid back. He

Scott Benner 16:55
didn't know enough to impress upon you. Hey, my stuff's not going well, but here's what I've done wrong. He's like, I did what my dad did. It's not working out the same way. And then do you think he felt like it was luck of the draw? Yeah,

Elle 17:08
I think very much so. And I think there was so. For example, when I was diagnosed, my dad was still on mixed insulin, which is a very old fashioned type. He'd never moved to carb counting or anything nine

Scott Benner 17:20
years ago. Yeah, wow. Okay, sorry, I didn't mean to cut you off. Go

Elle 17:24
ahead. No, he just refused. He'd never change. You know, the idea to him of car counting was so alien. So when I was diagnosed, and I was obviously put on a basal Bolus, like the rest of the modern world, you know, to him, that was brand new. That was nothing like he'd ever known before, yeah, and he didn't really take much interest in it, you know, I tried to encourage him several times to ask them about going on to it, you know, but it didn't match with his lifestyle.

Scott Benner 17:51
Does that weigh on you at all, that you had that knowledge and couldn't transfer it to

Elle 17:55
him? I used to, I think I used to hold a lot of anger to him, because I used to think, well, it's not that difficult to manage, you know, and it's not that difficult sort of ask for advice and ask for help if you're struggling with it. But I think the older I get, the more I realized that actually he had a lot of other stuff going on in his life, and the idea of managing blood sugars on top of it was probably just an extra thing that he didn't really need or want to do something

Scott Benner 18:23
that he wasn't brought up with he didn't understand. Yeah, it probably didn't seem necessary, because his dad's, I mean, I think

Elle 18:30
it didn't seem important. He always, as long as I can remember, he had this view that he was dying anyway, so there was, like, no point doing a lot of stuff. Like, there was no point. Oh, sorry. Tell people what it is. Okay, that's just my delivery. I thought you're gonna

Scott Benner 18:46
say parcel again. She said, go get it. I'll be I'll be here when you come back. Don't worry. She said parcel earlier, and I was so excited for her to say it again. Then she said delivery, which is very boring. All right, guys, while she's gone, I'm going to tell you that this chameleon is staring at me. He's just looking and looking. He won't look away. Look away. You're making me uncomfortable. I'm trying to talk to hell about her family. It's not my fault. You didn't want to eat yesterday. I gave this one a perfectly, perfectly good silkworm yesterday, stared at it. Now he's staring at me like, why won't you bring the silkworms?

Elle 19:19
Sorry about that.

Scott Benner 19:22
I was talking to the people. Am I allowed to know what's in the box? Oh

Elle 19:25
no, it's just moving stuff. We're getting ready to move house, so we've been ordering boxes and tape and bubble wrap and giant cling to film and all of that good stuff.

Scott Benner 19:36
Are you moving because you want to move and you're upgrading, or are you being booted out? What's going on? We're buying our first

Elle 19:41
house, so it's really exciting. Congratulations. Yeah, it just feels very nerve wracking because we've given our notice on the place we're in now, because that's rented, but we don't actually have a date

Scott Benner 19:53
to move into our new place. Can I give you some advice from an older person?

Elle 19:57
Oh, go for it. I'd love advice. It'll be. Fine. I'm sure it will keep

Scott Benner 20:02
doing it, keep making the best decisions you can day by day, and everything will work out.

Elle 20:06
Yeah, and then we'll be in our nice house, and we'll all be good. It

Scott Benner 20:10
will it be a cottage in the woods that has moss on the roof, like in all the stories about England?

Elle 20:15
No, do you know what? It's nothing like that. I didn't think it was. It's a new build pre bed detached in a brand new estate.

Scott Benner 20:25
Good for you. Hey. Why are you so successful at a young age? What's going on? I don't know. It just drew me and it's working out. It seems to be everything always works out. That's the funny thing about life. Then why are you worried about the bubble wrap thing I told you, if you see, you know it'll be okay. It'll

Elle 20:43
be okay. But it doesn't mean I can't stress. I'm gonna ask a

Scott Benner 20:47
question. It's my first question where I'm risking upsetting you. Okay, do you make that baby on purpose when you were 20?

Elle 20:53
Well, I got pregnant at 19 during the COVID lockdown, and we were very, very excited to find out that we were pregnant. It was a bit of a surprise, but very exciting surprise. Good.

Scott Benner 21:08
How long did you know that boy before you got locked up with him? Oh, yeah, a

Elle 21:12
good little while. We started going out the November, moved in. In March, when the country went into lockdown, we had no choice, found out we were pregnant July. It's

Scott Benner 21:23
not an uncommon story. I just interviewed somebody last week that said the same thing, yeah,

Elle 21:27
and we're engaged now. Buying a house got a lovely little four year old, good for you. So the lesson is, meet random people off Tinder and invite them to your house and let them move in, because it's all good.

Scott Benner 21:39
If they don't kill you, you'll get married to them exactly

Elle 21:42
5050, chance

Scott Benner 21:44
there. Flip it. That's what you're well, I was gonna say that's what your dad did, but that didn't work out well. So like, let's just, let's keep moving. Okay, so you have type one. Gosh, when you move in with him, No, I don't,

Elle 21:55
actually, I don't have type one. Wait, what I I have type None. What are you talking about,

Scott Benner 22:02
I used to hate ordering my daughter's diabetes supplies. I never had a good experience, and it was frustrating. But it hasn't been that way for a while, actually, for about three years now, because that's how long we've been using us Med, US med.com/juicebox, or call 888-721-1514, us. Med is the number one distributor for FreeStyle Libre systems nationwide. They are the number one specialty distributor for Omnipod dash, the number one fastest growing tandem distributor nationwide, the number one rated distributor in Dexcom customer satisfaction surveys. They have served over 1 million people with diabetes since 1996 and they always provide 90 days worth of supplies and fast and free shipping us med carries everything from insulin pumps and diabetes testing supplies to the latest CGM like the libre three and Dexcom g7 they accept Medicare nationwide, and over 800 private insurers. Find out why us med has an A plus rating with a better business bureau at us med.com/juicebox, or just call them at 888-721-1514, get started right now, and you'll be getting your supplies the same way we do.

Elle 23:25
So I don't have any antibodies. No one in my family has ever had a single antibody to diabetes. Yeah, and then I don't have Modi, because they text for that, because my doctor was like, well, obviously, this is a case of Modi. You've got a strong family history. You've got diabetes at an early age. I don't have Modi, but then I don't have type two either.

Scott Benner 23:49
Well, wait a minute, how come no one's ever said this on the podcast either? I

Elle 23:54
don't know. There's loads of people like me walking around England. I

Scott Benner 23:58
like that. You don't think you're spec Why do you not think you're special at all? I

Elle 24:02
don't know. I just, I don't think I am. I think I'm just a very ordinary person. You're just a 24

Scott Benner 24:07
year old person who met a guy on Tinder, fell in love, had a baby, is buying a house, has got a little fairy tale? Yeah? I mean, a lot of people are out there, like, swinging for that fence. They can't find it.

Elle 24:19
I think the key is you just have to be, like, obnoxiously optimistic with life.

Scott Benner 24:25
I agree with that. How did you find this podcast, and are you in my Facebook group?

Elle 24:30
I am in your Facebook group. I'm always asking stupid questions on there. You'll probably see me at some point. You'll probably

Scott Benner 24:36
see me giving a stupid answer. So that'll be perfect. Wait, what did I ask you before that?

Elle 24:41
Oh, so finding the podcast. So after I gave birth to my little one in 2021 my sugar started going up again, because I've been off insulin for a year or so at that point. And then I went on Metformin. I went on, I can never say the name of it, but like glycoside, or however you say it. And. It didn't work, so I ended up back on basal Bolus routines, and I I hated it. You know, I absolutely hated it. I was very, like, upset with my life. I felt like what the doctors wanted me to do was just gonna kill me. That sounds very traumatic. I know. Why? How did that? Why did it feel that way? Do you think I think because of my dad's kidney failure, I've always had this fear that I'm turning into him. It's like this huge fear in like, the back of my mind that I'm turning into him, that my kidneys are going to fail, that I'll be dead by 50, that I'll get a bad back, and I'll become an alcoholic, and just all of these like thoughts. Then when the doctors were saying to me, like, oh, like, don't correct your blood sugar until, like, it gets to, like, 15 and stuff like that, and you should only do four injections a day, I was just getting very, like, frustrated. So I started, like, reading, like, books about diabetes. And so recommended your podcast, and I started listening to it. Like, when I go to work, I just have it on constantly. And I was like, Yes, this is what I need in my life. Like, I don't need to be scared of my diabetes. You know, it's about sort of working with my diabetes as part of me, yeah. So not that I stopped listening to medical advice, not saying that I did that, but I started to think, well, it's not their life. If they're not me, they're not the ones living with it. You and I can make sort of these decisions for myself. If I want to do a correction, I'll do a correction. You know. Who are they to stop me? You know? So I started doing that, and I feel a lot better about my management. Now I don't have so many worries about complications, and I feel like I can actually live my life like it doesn't. It's not sort of this overriding thing, like diabetes is just a small thing now, whereas at the beginning it was like this massive, all consuming thing. I was constantly checking my sugar. I was on finger pricks back then as well. So you can imagine my fingers were fucked and and

Scott Benner 27:03
all this came from just giving yourself more control, or,

Elle 27:07
I think it was a mixture of, like more control and like more understanding. It's very different from what I understand in America, like in the NHS, you know, we don't give our pumps that much. It's starting to change. We've just started to get artificial pancreas is like the closed loop systems for kids and some adults. We get given the bare bones. So it used to be you got given finger pricks, you got given carb counting, and you got given a physical book your carbs and cows, book that had all your carbs and then your calories, and then you're on your way, yeah, and you're on your way. And, you know, some people get more regular appointments, but I get once a year checkups with my consultant. And yeah, he's a lovely guy, but the issue is they don't always move as fast as the time moves. So like with CGM and everything, you can have a lot better time in range. But the NHS doesn't necessarily move with that. They're much more like risk averse and scared of hypos and things. Yeah,

Scott Benner 28:08
it's interesting how long it takes for institutions to come along with ideas. I don't think it's specific to diabetes or specific to a certain country or anything like that, but I was struck yesterday when a major diabetes organization sent out an email celebrating this idea. And I thought I've been saying that for 10 years. They said it as if it was an idea that just happened yesterday, and they can't believe how lucky they are to be coming and telling you about it. They said, after much research, I was like, research. You need a research to tell you this. I figured this out in my living room, like, 15 years ago. I've been saying on the podcast for a decade, and here you are today, the bastion of good information, and you're finally speaking up about it. Like, awesome, you know? Like, yeah, way to let a decade of people down.

Elle 28:58
And it's really sad. And I think, you know, diabetes, especially, like, yes, hypos and things are very, very bad. And, you know, we should all have, like, a healthy fear of going too low. But with technology nowadays, it's, you know, it's a tiny complication compared to what it used to be.

Scott Benner 29:17
Anybody can hear your dad's story and then say, people don't need CGM, and you don't have to worry about time and range, like, That's ridiculous, you know, yeah.

Elle 29:26
And I think if he'd have had access to things like CGM, so if he could, actually, if he was almost forced to confront these numbers and see what was going on, you know, was his outcome have been different. Possibly

Scott Benner 29:39
more information may have changed his his outlook on things, and it might have adjusted how he thought over time, maybe. And he could have done better, you know, yeah,

Elle 29:48
or if he'd had access to something, I know it wasn't a thing when he was first diagnosed, but even towards his later years, if he'd have had access to a pump, you know, so he didn't have to do injections, you know? That. In itself would have made a huge difference, in my opinion, right?

Scott Benner 30:04
This is going to seem like a left turn for a second, but I've been wondering for half an hour now, was your grandfather a handsome

Elle 30:09
man? He was a five foot six Jamaican guy, not the most handsome, but also not very ugly. Okay,

Scott Benner 30:17
this explains your hair, because I know what you look like, and I couldn't figure your hair out. But now I got, yeah, now I have it. Okay, awesome. Well, he got around, for sure. He knew what he was doing. The ladies loved him. Yeah,

Elle 30:30
they did. You know a Jamaican man in England in the 40s and 50s. He

Scott Benner 30:35
was just different, right? And he had, everybody was probably interested.

Elle 30:38
He had a very, very lovely accent as well, yeah, the type of, it's like a really low and slow way of talking, and just very, very nice, very relaxing

Scott Benner 30:49
about that. Well, listen, and you knew him your whole life, right? Yeah, yeah, yeah. Well, obviously he was my granddad, no. Well, sometimes people split up and you don't see people and stuff like that, but, man, your grandmother must have been tired. I just

Elle 31:03
tired for a lot of reasons. I think having eight kids in itself is very tired. That's what

Scott Benner 31:07
I was talking about. Like, just like, that's so many kids.

Elle 31:12
I do feel for

Scott Benner 31:14
no kidding. How long did she live? She

Elle 31:16
passed away when I was nine. I think she was 82

Scott Benner 31:21
the only way to live to 8220 years ago, or whatever, and it not seem like a long time, is if your husband lives till 96 and then, yeah, it's really something.

Elle 31:30
And now he just kept on going, though, no one expected it. Like,

Scott Benner 31:34
was he Spry to the end? Like, could he talk get around stuff like that? Yeah,

Elle 31:40
yeah. He was such a great guy. You know, there was something about him. He used a walking stick, but not until, like, the very, very end. You know, he could hold full on conversations with you. He lived alone, just like a perfectly, like, fully functioning, like all of his marbles were intact. He was a bit weird. But what old person

Scott Benner 32:01
isn't it's a bit weird. I'm a bit weird. Yeah, are you planning on having more children?

Elle 32:06
I think we'll just have the one. My little girl was born quite premature, and there was, like, some complications. And, you know, realistically, I don't want to go through that again when I've already got one child. I don't think it's worth that risk. Is she okay? Now she's perfectly healthy. She is so happy, like when she was born, she had a heart defect as a result of her prematurity, so she had something called junctional tachycardia, which is like where your heart beats wrong, and then she had these two little holes in her heart just from being premature. But they've all sorted themselves out now, and like she's doing really well, but I think that trauma for me is her mum is still there. I was

Scott Benner 32:47
gonna say the process of that really impacted

Elle 32:51
you, yeah, and I think it really messed with my head. Do you think that could ever change? No, no. I think we're very stuck on that decision, because we know if we have another one, that they'll also be born very early. And

Scott Benner 33:04
how was your pregnancy with type one? Was it difficult? Were you able to keep your a 1c? Where you wanted? Yeah,

Elle 33:09
so my pregnancy was actually perfect. So when I was pregnant, I was in that weird gap where I was, like, some doctors say it's like an extended honeymoon or whatever, where I wasn't on insulin, and my whole pregnancy, it was brilliant. And then, like, a month or two after I gave birth, my blood sugar started creeping up,

Scott Benner 33:28
okay? And then that's where it kind of all took off, yeah.

Elle 33:32
So then that's when they started me on Metformin, on, like, the glycoside, and eventually went back onto the insulin, which

Scott Benner 33:40
was what, I'm sorry,

Elle 33:42
which was not very fun,

Scott Benner 33:43
because you had newly given birth, and there was a lot else going on.

Elle 33:47
Yeah, I think when you've got a new baby as well, and you find yourself a routine, don't you, when you've got a new baby, and you're sort of in the throes of it, and then all of a sudden, you spend months and months just feeling awful, because the issue is, despite the medications, my blood sugars were just climbing and climbing, you know, like they weren't controlled at all on them, so I wasn't feeling any better, and then I was getting side effects from the drugs that they were giving me. I ended up breaking down to the consultant and to say, I could just can't do this, like I just physically can't do this, you know? And he said, Well, we'll do a C peptide. And she's like, attach your insulin levels and see what's going on. And then they found I've got quite a low C peptide, but it's a bit higher than a type one diabetic

Scott Benner 34:35
low C peptide, but higher. What was it? It's like, 0.4 Okay, How involved is your soon to be husband in your diabetes? Oh, I would say, like a zero. Is that your doing or his? I

Elle 34:49
think it's just how we've both fallen into it. If I have, like, a hypo or something, he knows about it. He follows my Dexcom so he can see all my readings. But it. General, there's not really a reason for him to be more involved. Have

Scott Benner 35:04
you been taking care of it by yourself your entire life? I mean, your father didn't have knowledge about it. Was your mom helpful?

Elle 35:10
No, I don't. My mum wasn't very helpful with I don't think she ever saw a need to

Scott Benner 35:15
be. Did you see a need for her to be?

Elle 35:18
No, because I, I think when you're 15 as well, it's a very awkward age to be diagnosed. You know, I know like looking back at how I was, how I thought I was this really small adult who could do everything. And I think it would have been nice if my parents supported and helped a bit more. But at the same time, I do get it that if your child saying that they like they've got this, and they know what they're doing. You do? You just sort of leave them to it, don't you?

Scott Benner 35:46
Not me. I'm a bit of a hard head. What happens if, 10 years from now, God forbid, I hope this doesn't happen, right? Your daughter gets type one diabetes. Says, Mom, don't worry. I don't need help. I've got this. What do you say?

Elle 35:57
Oh, I don't think she's got it.

Scott Benner 36:01
Did you have it when you were 15? No, I

Elle 36:04
don't think I did. Put it in perspective, one of the first things I did came out of hospital at 15, and I just announced to everyone I was like, but that's it. I'm not eating carbs anymore, and I put myself on a low carb diet. And no one, like battered an eyelid, no one thought to have, like, a conversation with me about it, or, you know, challenge those ideas in my head and I stayed on this low carb diet for three years.

Scott Benner 36:32
Wow. How low? How many carbs a day? Probably

Elle 36:36
not as low as I thought I was eating. Being a teenager,

Scott Benner 36:40
I'm eating a low carb. Give me a biscuit, and we're gonna put that with this little gravy on that. Yeah, but I would say, like,

Elle 36:46
still, probably under 50 carbs per day.

Scott Benner 36:48
Still, I mean, that's, that's, it's not pretty low. You're holding yourself up against people online who are, like, I had four carbs today, but like that, yeah, 50 is a small number. It

Elle 36:58
was nowhere near as much as some people who are really good at it and take it very, very seriously, like, I still eat, like fruits and things like that, but I didn't eat any sort of like bread or pasta or rice, you know, those sort of typical starchy carbs. What

Scott Benner 37:12
happened three years into it? Did you see a piece of bread again? Or what happened?

Elle 37:16
No, no. So three years into it, I just gave up one day. No, as teenagers, do you just sort of wake up one day and you think, what the am I doing?

Scott Benner 37:28
I haven't had a pastry in three years. I haven't had a Starbuck.

Elle 37:32
Like, why am I doing this to myself?

Scott Benner 37:35
And why were you like, once you ate more carbs? Did it change anything? No,

Elle 37:39
not really. I don't think my life, like dramatically, got better or worse. What

Scott Benner 37:44
about your management? Did it get easier or harder? Neither,

Elle 37:47
I don't I think it just changed. Because even when I was doing low carb, I was still doing, like, my Nova rapids for things. Yeah, I was still very, very cautious. I was still having to correct seemingly all of the time. And I can't remember, I might have been on the pump when I stopped low carb

Scott Benner 38:06
already. Oh yeah, we haven't even talked about that. How do you manage today? So

Elle 38:10
today I'm on just a simple NDI so venal injections I take levemir and something called FIAs. Do you guys get FIAs in America?

Scott Benner 38:18
We do. How come you're using lever mirror, though, I would love it. If you're using something more modern for your basal insulin,

Elle 38:24
that's actually that's a personal choice to do. Levemir, why tell me? So I tried procedure in the past, which is like that ultra long act thing, and it works quite well at like, keeping things very steady, but I wasn't a huge fan of it. And then I tried something called sembly, which is the same as Lantus. It's just an off brand version, because the NHS loves its off brand stuff. And I just, I really hated Lantus, like, I absolutely despised it.

Scott Benner 38:53
Levemir, you like, do you split it? Do you shoot it every 12 hours? I do a

Elle 38:58
split dose of levemere. What I love about it is I feel like it just gives me so much more flexibility. I found that a lot of people, they have, like a basal dose, and then they just keep it as that. So every day, they'll take however many units, and they'll do that forever and ever, until they have to change it, whereas I constantly change my 11 minute dose. So if I know the for example, Christmas is my biggest one, I upped it by loads. I'm not recommending that to anyone, but for me, I know that I eat an awful lot over Christmas. You know, I'm constantly snacking. I'm cooking and eating as I cook. So when I up my morning leather Moon, I have that sort of flexibility to be able to do that without worrying so much. And then if I know that I'm going to be doing a lot of exercise, or if I've got things, I'll drop my left mirror. If I've been ill, I can up it, you know. And it just gives me a lot more flexibility, whereas, like tracebo, I couldn't do that at all. That's

Scott Benner 39:56
so thoughtful and and I'm. Really pleased that you shared that and at the same time, what strikes me more probably because you're half my age and you're like, my son's age, I'm like, proud of you. I know that's not my place to be proud of you. But like, you know, being brought up by someone who wasn't paying attention to his diabetes, who was brought up by somebody who wasn't paying attention to his diabetes, that's an incredibly thoughtful way to manage.

Elle 40:21
I think it's because of that, you know, if my dad hadn't died and he hadn't had his issues with his kidneys, you know, I would have fallen into that same trap as him as of it doesn't really matter that much. You think

Scott Benner 40:35
your dad's passing broke the cycle of how your family takes care of type one? Yeah,

Elle 40:40
I think it massively has, you know, I see things very different. I'm not compliant with it. You know, if I notice that my sugars are higher than they should be, or if they're lower than they should be, you know, I'm taking action to correct that. I don't just accept it as well. This is diabetes. What do you expect? You know, I'm not striving for 70% in range. I'm striving for 100% in range in a straight line. You know, that is my goal. And you

Scott Benner 41:07
don't feel burned out or overwhelmed. This seems very natural to you.

Elle 41:11
No, it doesn't. It overwhelm me at all. Where'd

Scott Benner 41:15
you learn to split the lever mirror? So

Elle 41:16
in England, we usually do split. Levemir, good. You know, that's how, like, the sort of standard, but yeah. And then I just sort of work out how much I want to take based on me. Your dosing is up to you with the NHS. Like, you've got nurses and doctors that can support you with it, but once you've learned the basics, you know, it is up to you how you dose and when and how.

Scott Benner 41:38
It's clear to you that you're allowed to adjust doses. Oh,

Elle 41:41
yeah. Like, no one really cares, because here

Scott Benner 41:45
the idea from, from a lot of people, is like, you don't touch it. We'll tell you when to touch it.

Elle 41:49
Oh no, you would be dead if you left the NHS there. I mean, I only see someone once a year. Yeah, my doses change way more than yearly. Arden

Scott Benner 41:58
used levemir when she was first diagnosed, we used to split

Elle 42:01
it. I love it. I think it's the best insulin. Wow. That's awesome

Scott Benner 42:05
that you found something that you can use like that takes more effort and some paying attention, but

Elle 42:11
it takes getting used to. But I think when you're on daily injections rather than a pump, it gives you sort of the closest to that flexibility of a pump. Obviously, with a pump, you can adjust your background, you know, freely whenever you need to. Yeah,

Scott Benner 42:27
I was thinking earlier, you're acting like your own algorithm with your basal, like, I'm going to eat more this week or today, or I'm going to go running or whatever, like, and you're making adjustments to your basal that

Elle 42:37
way, yeah, and it's one of the reasons I wanted levemir, I think, yeah, I've listened to your podcast so much, and obviously most of what you talk about revolves around insulin pumps. And at first I thought, Oh, well, this is so frustrating, because I don't have a pump and I can't get a pump because we only get pumps in England if your diabetes is like, what they say is like, uncontrolled. So if your HBO and C is quite high, and mine wasn't, and I used to get very frustrated, and then I thought, Well, why am I getting so frustrated? The principles are no different. It doesn't matter if I'm on a pump or if I give myself insulin. You know, the key is making it so I can have that flexibility. All a pump does is give you flexibility. Yes, you can't have it as much when you take injections. You know, I can't do really tiny doses, but I can still do point five unit corrections. Now this is the closest

Scott Benner 43:31
anyone's coming to making me cry so far this week. So thank you, because I've been saying this forever, like, I know that if, if you're listening, and it's like, oh, everybody's talking about pumping. I don't think we are like, I think we're talking about insulin timing. Yeah, yeah. I think we're talking about the amount of insulin you use and when you use it. And I genuinely believe that you can do that with MDI. You just have to be willing to shoot a little more frequently. Exactly,

Elle 44:01
you know, I take probably seven to 10 injections every single day. You know, it is way more than you know, when the NHS says you should do four, if you do four injections, you're not going to have good control. It's impossible. Yeah, we smack. We're humans. I don't know anyone that doesn't smack. For example, if you don't inject for your snacks, you're going to go high. I

Scott Benner 44:24
swear to you, this is the happiest I've been in a while, making the podcast. Bless you. I'm seriously like to hear you say that at your age too, which I know you've been a fully formed adult who knows everything that they need to know since you were 15. You mentioned that earlier, to hear you at 24 from where you came from, from diabetes, to say that I just, I found that very fulfilling, honestly, like, I think I'm gonna have a really great day. So I appreciate it. Thank you. I know it's the end of your day, but it's, it's just the beginning

Elle 44:51
the end. It's only it's coming up to 2pm over

Scott Benner 44:55
here. Oh, is that

Elle 44:56
it? Yeah, I'm on my lunch

Scott Benner 44:57
break. Oh, wait a minute, you're only four. Four hours ahead of me. Why do I not know that? Hmm, all right. Well, now I know I'll try to remember seriously, like, that was awesome. Like, people who listen to the podcast a lot will listen back now and realize I didn't say a word while you were talking about that. Because I was just like, yeah, say it. Say when you started. I was like, oh god, she's gonna say it. And then you said it. I was like, oh my. And then you, as you elaborated on I was like, she really understands this. How long do you think you've really, really deeply understood your diabetes? I'll

Elle 45:27
tell you exactly. When it was. It was August 2022 you know. And I was listening to one of your podcasts, and I was walking around Asda at the time, which is like your wall marked. And I was listening to one of your podcasts, and I was getting frustrated someone was talking about a pump, and then it suddenly clicked in my head, you know, where I thought it doesn't matter that they're talking about a pump, like, that's not the important thing. Like, I can still do Sally. I can still do everything. It doesn't change it. I can't have that level of flexibility, but I can still have flexibility. That's

Scott Benner 46:01
awesome. I'm literally speechless, but I'm only talking because it's a podcast. I'm just I'm so happy. I'm just so happy for you, and that that message got to you is, is just awesome. You know, I spend too much of my life having to answer people who are like, well, I try to listen to your podcast, but it's for people who pump. But I'm like, I think it's for people with diabetes. Like, listen closer, yeah,

Elle 46:24
yeah. And I think that does need to be more representation in the world for people on injection. Yeah,

Scott Benner 46:29
of course. But the problem is, is the people like you don't step up very often to be on you know, yeah, even at that, it took us 40 minutes for you to say that you were MDI, right now,

Elle 46:38
yeah. And I guess it's because when you're MDI, it's just it's normal for you, like, it's not a big part of my diabetes management. And I forget that for other people, it can feel very scary. Yeah.

Scott Benner 46:50
Now I imagine you are wearing a CGM, obviously. Which one? So I

Elle 46:54
wear something called the Dexcom one, plus, oh, really, the NHS, the beautiful, lovely thing that keeps me alive, looking for a deal. Are they what's going on? So they look for a deal. And a couple of years ago, the NHS said that all type ones, or people like myself that aren't quite type one, but the closest that we fit in, need to have a CGM on the NHS. And the NHS said all that that's very, very expensive. So they went to Dexcom and they said, Do you mind making us some some cheap CGM? So they came up with the Dexcom one, which was basically the g6 but didn't have some of the special features, like you couldn't share it, you couldn't calibrate it, just a very paired down version. And now we have the one plus, which is the g7 but it's paired down, but we can still share that one. We can calibrate it if we want, but you don't need to, and it looks the same as a g7 you have

Scott Benner 47:51
a Dexcom, but it doesn't have leather seats or interior lighting or anything like that. Yeah,

Elle 47:56
it's just the basic one. And the benefit of it is, you know, it's completely free of charge. To me, I don't pay for my prescriptions. Yeah, all my Dexcom are free. My insulin is free. And you know for that, I will take a budget version. Yeah, I

Scott Benner 48:11
want to be clear, I would too. If somebody would like to offer free ones,

Elle 48:16
I would take a budget version. I do not need the Dexcom g7 and I cannot afford to pay for that privately anyway.

Scott Benner 48:23
Yeah, no, okay. Well, listen, how could you you're 24 and you're buying it. Do you ever step back and say, We're 24 and I'm buying a house? I

Elle 48:30
do. I say it's my partner. Sometimes. I'm like, Oh my God. Like, how did we get to this point? Yeah,

Scott Benner 48:36
is it easier to own a home there than it is here? Like, what is it? I'm not understanding. Why

Elle 48:41
don't I don't know how much houses cost in America, but it is. It's very expensive over here.

Scott Benner 48:47
No, I mean, it's expensive here too. I don't know what the median house cost is here, but like, you have to put 20% of your purchase price down in cash when you buy.

Elle 48:56
Oh, no. See, in England, we only have to put a minimum of 5% that would be easier. So that's probably a big difference there. So we do 5% deposits or 10% deposits as, like the standard, and then you just pay, like, your mortgage and everything. How long does the mortgage go for? So we've got a very long mortgage. We've got a 36 year mortgage.

Scott Benner 49:18
Oh, wow, yeah. Here. 30 is typical? Yeah, I think

Elle 49:22
30 is quite typical over there as well, but we've gone for a longer one just because of

Scott Benner 49:27
finances. How much does your daughter know about your diabetes? Do you know

Elle 49:32
what? She's actually extremely adorable with it. So when she was very little, she used to pretend to give herself injections, but had, like no sort of concept of it. And then she got to a point where she thought that all mummies had diabetes, like when you became a mummy,

Scott Benner 49:47
oh, you got diabetes with the baby,

Elle 49:49
yeah, basically, which I thought was very, very cute, but now that she's just turned four now, so she understands that sometimes mummy's poorly, and that means that mummy needs sugar. Her, and she's very, very good with that. If she notices me lying on the sofa, even if I'm just relaxing, she'll go into our snack cupboard, and she'll appear with like, a cookie or something, and she'll be like, for your diabetes. And I'm like, Oh, I'm not gonna say no.

Scott Benner 50:14
I'm not gonna say no, I am actually not feeling poorly, but will take this cookie. Thank you very much.

Elle 50:19
Yeah. And in the morning, she started a new thing where she asked to see what my sugars are. Oh, really. So, like, she'll wake up and I, obviously, I check my sugars. I do a finger prick every single morning, even with my Dexcom, just to make sure, like, force a habit. And then she started asking. She's like, Oh, money, what's your sugar? She's like, are they white? Are they yellow? Oh yeah. And then I'll show her. And then she's always so, like, proud of me and pleased. She doesn't know what it means, right? Do you guys have glucagon? There we do, but I don't actually have one because, because the NHS doesn't provide them anymore. They used to. So when I was 15, I had one, and I'd have one on me at all times, one at home and, like, one at school or something like, however it was. So then when I went on insulin again, I was like, Oh, can I get a glue gun? And they were like, No, you can't. We don't

Scott Benner 51:12
care anymore. Sorry, yeah, they only

Elle 51:15
give them to children and people that have either, I think, had a really bad hypo, or at risk of a bad hypo, interesting. I don't know why. I don't know if they're expensive or maybe some idiots did something stupid with them. I don't

Scott Benner 51:30
know if it's cost or dummies, but it's one of them. I guarantee it.

Elle 51:33
Yeah, it'll be one of them.

Scott Benner 51:36
So I learned with Google that the average, like the median home price in the US is $420,000 yours is about 290 pounds sterling, which equivalent is about a $376,000 equivalent. So your average price is like $50,000 less than ours. That

Elle 51:56
is crazy. And our houses are built correctly. They're not made out of wood or anything. It's

Scott Benner 52:01
nice that they're cheaper, but they're not, like crazy cheaper. I mean, you're talking about $400,000 50,000 is not really, you know, a ton. I think

Elle 52:10
the thing I also I've never been to America, so I am purely just guessing of television that I've watched. I think American houses are quite a lot bigger as well.

Scott Benner 52:19
How do you measure your house? Uh, square feet? How many? How many is yours? So

Elle 52:23
the one that we're buying is 1100

Scott Benner 52:28
Okay, so that would be around here, sort of like what they call a, um, gosh, I can't think of it. Is it like one simple footprint, one level? No, no.

Elle 52:36
So it's a two story house. It's a, like a three double bedroom, detached house. It's quite a nice house for

Scott Benner 52:43
England. That's awesome for England. No, it sounds lovely we're in at the moment, which

Elle 52:48
is a two bed and like terrace tiles, it's like 600 square feet. It's a big upgrade for you then, yeah, so I think in America, your guys houses are quite a lot bigger. You've got way more space, haven't you? Let

Scott Benner 53:01
me see average home size in us, 2300 square feet is an average home size here. Gosh,

Elle 53:09
so like, double, yeah, that is crazy. That's huge. Yeah,

Scott Benner 53:13
Tinder boy, what does he do for a living? Is he out? Is he selling crack? Or how's he making this money? What's he doing? No,

Elle 53:19
no, he can't sell crack. I work in the drug and alcohol service. Don't say that. Wait, what do you do for a living? I support family members who are affected by people living with addiction. Oh,

Scott Benner 53:30
my god, yeah, that definitely wouldn't be a good job for him. Then you imagine the conversations you'd have at dinner be terrible. But

Elle 53:36
yeah, he's an engineer.

Scott Benner 53:38
Oh, smart kid.

Elle 53:39
He's very, very nerdy, socially awkward, that kind of smart. Is that what you liked about him? Yeah, he's such a lovely guy. Because when I met him, he was working as an engineering officer on cruise ships, so it was pretty cool job. And I think that, like, drawed me in, and now he works in like, a food factory, working with, like, dried nuts and dried fruit and stuff. This sounds interesting.

Scott Benner 54:06
Did you go through any boys with different attitudes? Or have you always been attracted to guys like that? I've

Elle 54:12
dated some very interesting people in the past, but he's definitely the nicest. I think that's why I'm stuck with him. I was gonna

Scott Benner 54:21
say that's pretty important. I would tell my daughter the same thing, like, but try look at the person not like what they would look like in your Instagram photo

Elle 54:28
Exactly. And it's about someone as well. That, for example, I had a conversation with Harry the other and it's quite a depressing conversation I had where it suddenly hit me one morning that one day, I'm going to be 80, and I'm going to be living with diabetes, and you know what if I can't manage it? You know what if I go into hospital and you know, for whatever reason, I can't manage my diabetes, and I don't like the way that hospitals manage it. And me and him had this conversation, and he was so like reassuring and so lovely that. Something like that was to ever to happen, you know, he would make sure that people knew my wishes and my views, you know. And it's things like that that I think you know, when you're looking for a partner and when you're with someone like, that's what matters. Like, yes, all the good stuff matters, and all of that's brilliant, but it's someone that I know, and I implicitly trust him that if something was happened to me, you know, he would not only look after me, but he would advocate for me, and like, that's the important thing.

Scott Benner 55:28
That's lovely. But do we not want him to know more about your diabetes so that he can do that better?

Elle 55:33
I think he has an idea of it. He just doesn't get involved.

Scott Benner 55:36
Oh, I see. So you think he understands it, but you guys have a, like, a healthy separation there. He knows

Elle 55:43
what my blood sugar should be. He knows when it's not bad. He has a good understanding of what to do in, like a medical emergency. He knows about ketones and things good, good. That's all we want. Does he know my doses? He wouldn't have a clue, gotcha.

Scott Benner 55:59
And you're not just comfortable with that. You like it this way, yeah, and

Elle 56:03
I think as well, like, sometimes we all have bad days, yeah, we have days where our sugars are way too high and we can't get them down. And, you know, I like the fact that he doesn't always understand that. I like the fact that sometimes, you know, like, let's say we go for a meal, I can eat what I want, and sometimes I won't do insulin, or I'll do it after my meal. And there's no raised eyebrows, there's no judgment, because he doesn't know if I'm meant to do that or not.

Scott Benner 56:30
Tell me more about that. I'm super interested in that. Like you, like that he doesn't know in that situation, because dig into that more.

Elle 56:36
It's hard to put into words to explain it, but like, let's say we go out for a meal, like, to a Chinese buffet. Yeah, it's one of my favorite places. Now that is a diabetics last night, minefield. Yeah, the way I deal with a buffet is chaotic, to say the least. So what I'll do to start off with is I Pre Bolus with just a bunch of incidents, just a random amount. Yeah, there is no like, rhyme or reason to how much I give, you know. And then I just eat whatever I want, and I turn the alarms off of my Dexcom so it won't tell me if I'm going high. And then when I get home afterwards, I'll just correct and I'll correct myself down, you know. And I like that with Harry, because he doesn't, he doesn't know what the numbers mean. He doesn't know he knows when something's high, but he doesn't know if it's like a normal high, like, if that's to be expected with diabetes, if that makes sense. So he doesn't think about it too much, and he doesn't become a conversation like, he'd never pull me up and say, Oh, shouldn't you be doing some more insulin for that cake. Have you done that? Have you checked your levels? Like, are you sure that you're not too high to be eating that? And I like that. I can just go out with him and enjoy a meal when you know there's no comments, and I can just do whatever I want, like, with my control.

Scott Benner 57:55
Has there ever been a time where you wished he would like, Have you ever gotten stuck and wish somebody would push you.

Elle 58:01
No, no, not really. I think it's very much my own responsibility to deal with it. This is really interesting. Yeah. I think if we rely on other people as well, like, we need to have that motivation within ourselves. Like, if we're not motivated, it doesn't matter how much other people push us, we're not going to want to deal with it, yeah. And then that's when you get into that territory of, like, secret eating and things where you're not dosing, or, you know, dosing too much, but not caring, yeah, that's

Scott Benner 58:32
really interesting. I think that's going to help me. Your insight will help me with Arden, I think. And

Elle 58:36
it being a like a teenager and a young adult with diabetes is awful. There is no getting away from it, but you find a way, you know, and there's always a chance to fix it. Yeah,

Scott Benner 58:51
no. I mean, you have to remain hopeful. That's for sure. You have that, like wake up every day, like renewed right? That? Yeah, yeah, it's a new job. Have you been listening to the small sips series as they come out? No,

Elle 59:03
I haven't. I've been so busy with everything that I've not listened to the couple of months. It's really bad. No,

Scott Benner 59:08
no, no, no, I I just asked, because I took all of the Well, what I did was I went back to the audience, and I went back to the content that I know really helps people, and I asked people for, like, foundational ideas, like, tell me, okay, a thing you heard in the podcast, right? That really, really helps you. I think it's 20 or 21 they're like, little short, like, 10 minute episodes, right? But the last one of the first set was wake up hopeful. Like that was one of the things that people came back and said from the podcast. What I learned was that I need to get up every day and just have a renewed sense of like it's a fresh start. Yeah,

Elle 59:46
and that's the beauty of diabetes. You know, every day is a fresh start. It doesn't matter what was going on yesterday or last week, you can always make changes. And sometimes it is simply, as simple as if your sugar. High you need more insulin?

Scott Benner 1:00:02
Yeah, no. I mean, obviously, like, yeah. I think one of the episodes is called more insulin. It's one of the things that somebody said, you said one time. And I was like, oh, that's brilliant. I'll do that. It's interesting to reach out to a group of people and say, Tell me the sentences, just the simple sentences that you heard that were so valuable for you. And then, you know, have people vote on them, and you collect them up, and it's not just somebody said, Oh, this. It's 100 people said, I heard this, and it was great. You're like, Okay. And then when you collect them and look at them, I look and I just think, oh, it's not, it doesn't feel that special to me, because it doesn't seem any great secret when I look at it. Does that make sense? I think

Elle 1:00:39
the beauty of your podcast is it puts things in such a basic way where it all seems so simple, just like simple things that you come out with, you know, like with the more insulin, is such a simple concept, an idea, that obviously, if your sugar is high, you need to take more insulin. But I think there's such a anxiety when it comes to diabetes and diabetes management, that you don't want to correct too much, you don't want to change your ratios too much, you don't want to over treat a hypo, and you don't want to do this and that and the other that, when someone sits there and really just brings it back to basics and goes well, if your sugar is too high, you Need more insulin. You know, if you're peaking too much after a meal, then take your insulin a bit earlier. You know, just having someone else say that and almost confirm what you think or what your views might have been, it creates, like a light bulb moment where you go, I can, I can just do more. It's not the end of the world if I do more, or if I've already done my correction, and three hours later it's not coming down, I can just take more. There's physically nothing stopping me. And if I hypo, I'll just eat some carbs. Yeah, I'm

Scott Benner 1:01:53
going to go through these with you, because I'm really interested in your opinion. And then I want to ask my last question, which is wrapped around why I'm asking you the first question. So I'm looking at the I brought the list up in front of me. I'm sure there'll be more small sip episodes, because they've they've become very popular, and people like shorter content sometimes. But these are the topics, right? It's diabetes. Is hard. Insulin used now is for later. The difference is your fear you get what you expect. Tug of War. Are you stacking insulin? All carbs aren't created equal timing an amount, using a CGM. Well, stop the arrows, swag, meet the need. Blanket of insulin. More insulin, low before high steal a 1c overnight, that's just diabetes. Avoid hot takes. Trust will happen. Just smile and wave and wake up hopeful. Did I just encapsulate the entire podcast to you? Yeah, pretty much. Yeah. Isn't that something? Because, yeah, but when I look at the list, it's almost underwhelming to me. But I don't feel that way anymore because of the explanation you just gave me. Oh, in the end, like, I broke it down. I'm like, That's it. Like, that's the genius in the podcast. You know what I mean. But like, I think it's because it's broken down so simply that it seems so simple when it's delivered. This is going to sound crazy, but when I put the list together, I was underwhelmed by it. I was like, Oh, I thought. Like, the cumulative knowledge of the diabetes podcast that everybody finds so helpful would have been more,

Elle 1:03:35
I don't know what groundbreaking and Earth shaft, yeah.

Scott Benner 1:03:39
Like, it would have felt like, yeah, it would have felt like, Oh my God. Like, I can't believe this is awesome. Like,

Elle 1:03:45
I'm a genius. I need to write a medical research study right now. Lightning

Scott Benner 1:03:49
strike, and God's talking and like, this is what the people found to be. But in the end, like, the reason it doesn't feel that way to me, and the reason it also works is because of what you said a moment ago. And it leads me to my last question for you. And if you have more to say afterwards, that's fine. But my last question for you is, why in the hell are you so like mature?

Elle 1:04:10
I think that's a very complicated question, and there's not a simple answer to that. Yeah, growing up with a dad that he is very ill, makes you grow up early. Yeah. To put it in perspective, I was seven when my dad got kidney failure, yeah. So I, I never really knew him as a well person. He was pretty much bed bound for several years. And, you know, I had to become, I wouldn't say, care at him. I think that takes things too far. But, you know, I took on a lot of responsibilities at a very young age, and I think just having that experience, it makes you grow up in all areas of your life. You know, you grow up with this kind of fragility around you, where you're very aware at how easily life can change, and how important it is to hold on to that optimism. And, you know, to the good things going on around you, yeah. And then I could go on for ages about other random stuff that's happened that makes me very grown up and but I think that's the main thing. I think just growing up in that environment. Give

Scott Benner 1:05:14
me one example of a random thing that happened,

Elle 1:05:17
oh, well, you know, obviously having a child at 19. And well, getting pregnant 19, having her at 20. And, you know, my little girl, she was born very premature, as I mentioned. And the birth and everything was such a shock. I labored for less than an hour. So it's very much like, boom, all of a sudden you have a premature baby. You know that in itself. You know, that makes you grow up. You know, dealing with my dad's death, I I just turned 19 when he passed away. And, yeah, he was out in France at the time because he was on holiday. So with that came a bunch of complicating things.

Scott Benner 1:05:58
He didn't see your daughter ever. No, no,

Elle 1:06:01
no, yeah, you never met Harry either. So my dad passed away in the October. So I turned 19 in the September. Was moving into a my first ever flat, got the keys to that September 30, went to call my dad to tell him. My mum answered the phone to say, well, he's not breathing. I can't wake him up. I've tested his sugars, and they're just saying, H i, what do I do? And I said, call an ambulance, crazy lady. And then he was in a coma for nearly a month. Then the end of October, he he pulled out his breathing tube and died. And then November, I, I got with Harry. Hell,

Scott Benner 1:06:40
you have an insane amount of perspective that a person your age usually doesn't have. That's what this is.

Elle 1:06:46
I think you have to, I think when you've grown up in that environment, you have to have a level of perspective, because otherwise you get very depressed with your life, and that doesn't help anything. So that

Scott Benner 1:06:57
was my question. Like, is this a decision you made, or is it just how you're wired?

Elle 1:07:01
Well, after my dad passed away, I got very depressed for several months. Yo, I really, really struggled. My dad wasn't just my dad. He was my best friend in the entire world. Yeah, we had an extremely close relationship, and I wasn't very close to my mum for various reasons. We have a much better relationship now, but at the time, we weren't very close, and we didn't talk. So it was like I lost not only my dad, but my best friend and, you know, my biggest support and cheerleader in my life. So I got very, very down, and then I found out I was pregnant with my little girl, and I thought, well, this can't be our life. You know, this can't be my life, and this can't be her life, because she doesn't deserve this. And what is the point in spending all of my life just moping around and going to work and laying in bed and crying all the time, it's not going to bring him back, is the truth. Nothing will bring him back, and all I'm doing is wasting my happiness. And it took me a good while because I used to feel very guilty about being happy and enjoying life. I felt like his life had been robbed from him, like he's not got to enjoy that. And how could I be moving on with my life and enjoying things? And it sounds very cliche, because, you know, everyone always says it, but I think I started thinking, Well, you know, he would want me to enjoy my life. He probably wouldn't want me to be sat here moping, you know? And it is cliche, but it's true.

Scott Benner 1:08:36
I don't know to call it cliche. Maybe it is, but you were able to break free of it and follow that like, that's the impressive part, and you weren't always that person. Is that? Right? No,

Elle 1:08:48
no, not at all. Wow. I was a very, I was a very pessimistic person once upon a time, not anymore. No, it's one of those people that walked around with sort of a chip on their shoulders, really.

Scott Benner 1:09:00
Yeah, 100% I know what you look like. You're like an adorable little person. It's hard to think of you that way. Oh, stop it. No, you are. It's hard to think of you that way, like you just you just seem like a pleasant person. It's awesome, but I'm so proud of you and happy for you and thank you. No, no, it's a pleasure to say that to you. I mean, because the alternative would have been terrible, yeah, yeah, yeah. Bluntly, bird would be Yeah, and you just didn't do it. Boy, that's interesting. You didn't go to drugs or alcohol.

Elle 1:09:31
No, no. I'm very, very straight laced, and always have

Scott Benner 1:09:35
been something. And the boy doesn't do any of that stuff now. He's

Elle 1:09:40
never been in Harry is a very straight laced person. He grew up with a silver spoon in his mouth, and he's very prim and proper and

Scott Benner 1:09:48
lovely when he ever acts up. You ever call him Prince Harry to make fun of him? No, he never acts up. So, oh, look at you. He's got this boy. Got this boy walking the right line. This is awesome. Do

Elle 1:09:59
you know. He's, he's an absolute gem of the person. Look at

Scott Benner 1:10:03
that Tinder, huh? Yeah, look at that. Good for you. I know you're just a modern success story, modern fairy tale. Seriously, you want to call your episode that? Because I was going to call it Elle's best friend. But do you want to call it a modern fairy tale that is

Elle 1:10:18
so cute, I love it. Which one modern fairy tale? Okay, that's

Scott Benner 1:10:22
what we're calling this episode. You're done. That's it. I have to tell you something. I hope you feel the same way, or otherwise, it's gonna feel ridiculous. I feel like I could make a podcast with you every day. Ah, that is so sweet. Seriously, this, did you have as good a time as I did?

Elle 1:10:37
Yeah, I quite enjoyed it. It wasn't as scary as I thought it would be. You thought this was going

Scott Benner 1:10:41
to be scary. You just told that whole story about your boring life, and you thought this was going to be scary.

Elle 1:10:46
Yeah, I thought it'd be very, very scary. And, no, yeah, it wasn't

Scott Benner 1:10:51
you. More than anybody I've spoken to recently. Know how you feel and know what you think in such a comforting and steady way. The truth is, is that, because of your accent and how you speak, if you told me you were 45 I would have believed you. It's not an old soul. You have a thought process that I wish I had

Elle 1:11:13
seriously. I think my work helps with the way. I sort of think, because I'm talking to different people all day, every day, about very complicated situations in their life, you know, I think I have to be very sure of what I'm saying and sort of the message that I'm conveying to people. And because of that, I've changed the way that I sort of think, because otherwise I end up rambling to them, and people don't want that. They don't want to come talk to me to hear my weird rambles.

Scott Benner 1:11:43
Like five minutes into their problem, you start telling them about your

Elle 1:11:48
they're like daydreaming. I'm in another world.

Scott Benner 1:11:51
Awesome. No, I don't want to talk about would be awesome. What helps me? For God's sake, I don't know how to exactly put it, but there have been a handful of people who've come on this podcast over a decade where I thought I wish that person was my child or my friend, or I wish I would open this microphone up every day and be talking to this person. You're one of those people, and we just met an hour and 12 minutes ago. It's really crazy.

Elle 1:12:14
So sweet. And guess what? I actually have an opening for a dad, and

Scott Benner 1:12:20
you have a great sense of humor, because that's very dark. What you just said, Are you not looking for me to pay for stuff, right? Just like,

Elle 1:12:28
Well, I mean, if you have the money to pay, why would I say no? I just thought maybe you'd want advice once in a while, or something like that. Yeah, that would be nice as well. Like, general life advice would be a huge bonus. That my dad wasn't very good at giving life advice anyway, so I'm

Scott Benner 1:12:43
awesome at it, and yet my kids don't care. It doesn't matter. Like, no matter what you are, people want something different. You know that, but

Elle 1:12:50
one day, your children will be very, very grateful for life advice. It'll be the point when they stop needing it, and then they realize how good of advice it was. I

Scott Benner 1:12:58
swear I'm so good at it, they don't even know. They just make fun of me. They made fun of me last night. The boy did at least and my wife, by the way, I was trying, was trying to never mind, I don't want to sound like a I we were talking about, like social things. And I have a perspective on one of these things, because I oversee, I mean, a Facebook group with 60,000 people in it, right? So my life is sort of like a probably not much different than yours. Like you see a lot of people, they come and they tell you about their things, and you get a different perspective on the world, how people think and everything. It's

Elle 1:13:38
really interesting, isn't it? Like the little insights into people's brains and their lives. Yeah, it's like taking

Scott Benner 1:13:44
a Master's class on how people think, but all in one second, like, just watching people respond. Like, there's nothing you could write online that I won't know how, like, how many groups are going to come back and respond, and what they're going to say, what their perspectives are going to be, and how they're going to fight with each other, like, I know instantly from that. So I start to say that, and somebody, like one of the two of them pauses and goes, Oh, where is that? How do you know about that? What's that from that? You know about that from is that from your is that, Oh, you must have a Facebook group. And then, like, and it went like that. And I was like, stop making fun of me. I just have a very specific experience. And then they just made fun of me until we stopped talking

Elle 1:14:22
about it. Oh, that is so funny. Yeah, this is gonna really make you laugh. So obviously my partner knows about Juicebox and like your podcast and your Facebook group and everything, and he refers to it as my diabetes

Scott Benner 1:14:34
cult. Hey, that's fine. I'm good with that.

Elle 1:14:37
Oh, he finds it absolutely hilarious.

Scott Benner 1:14:39
I don't know that it's inaccurate, just so you know,

Elle 1:14:43
no, he reckons it is very, very cult,

Scott Benner 1:14:45
like, how? So what does he say? Well, he

Elle 1:14:48
basically just makes fun of it being a cult. Oh,

Scott Benner 1:14:54
I'll take I just feel like that means a lot of really passionate people, passionate advice. Followers of an idea that's all and all. And what's the idea? Take care of yourself. Like, you know what I mean? Like, don't let somebody else tell you your health is okay where it is, like, check and make sure that's right. First, you know, if somebody says you're a one c7, and a half, that's great. You don't have to do anything else. Maybe you say to yourself, maybe I'll check and make sure that's right. Yeah, maybe

Elle 1:15:18
I'll see if I can improve it. Like with diabetes, there is always room for improvement. I don't know a single person that's insulin dependent who can put their hand on their heart and say there is nothing that I could do better.

Scott Benner 1:15:31
Yeah, exactly. Tell them I take that as a badge of honor. I will.

Elle 1:15:36
I let them know that the cult leader is proud to be a cult leader.

Scott Benner 1:15:42
I Oh, my God. Well, this diabetes thing ever blows up, maybe I'll try starting an actual cult and see if I can

Elle 1:15:47
do that. Oh, you probably don't want to say that. Oh, yeah,

Scott Benner 1:15:51
yeah, it's joke. I was kidding. Are they illegal? They're illegal, right?

Elle 1:15:56
They have to be illegal. Yeah, I

Scott Benner 1:15:58
don't think I'd be comfortable with a lot of like, the rules of

Elle 1:16:02
you know, you'd set them up, you'd make the rules. I

Scott Benner 1:16:05
know, but don't you think eventually they all just evolve into having 20 wives? Like, isn't that how it eventually and then everyone's dead at the end? Like, isn't that how it eventually

Elle 1:16:14
goes? Is some reason it's very odd they start off so normal, just like a little diabetes podcast.

Scott Benner 1:16:22
Oh, we'll just, we'll plant, we'll plant some vegetables, and we'll live out here in our yurts. And then at the end, everyone's running and screaming and there's 33 wives and the guy's naked in a tree. And never, never ends well, yeah, so that's my goal in life. I'm gonna endeavor not to end up naked in a tree at the end. That's

Elle 1:16:40
a good goal. I like that goal. I think I'm aiming for a little bit higher

Scott Benner 1:16:44
than that. It's simple. Oh, you're really awesome. Hold on one second for me.

US med sponsored this episode of The Juicebox Podcast. Check them out at us. Med, Comm, slash Juicebox, or by calling 888-721-1514, get your free benefits check and get started today with us. Med, I'd like to thank the blood glucose meter that my daughter carries, the contour next gen blood glucose meter. Learn more and get started today at contour next.com/juicebox and don't forget, you may be paying more through your insurance right now for the meter you have, then you would pay for the contour next gen in cash. There are links in the show notes of the audio app you're listening in right now, and links@juiceboxpodcast.com to contour and all of the sponsors. The episode you just enjoyed was sponsored by the twist a ID system powered by tide pool if you want, a commercially available insulin pump with twist lube that offers unmatched personalization and precision for peace of mind. You want, twist, twist.com/juicebox, thank you so much for listening. I'll be back very soon with another episode of The Juicebox Podcast. If you're not already subscribed or following the podcast in your favorite audio app, like Spotify or Apple podcasts, please do that now. Seriously, just to hit follow or subscribe will really help the show. If you go a little further in Apple podcasts and set it up so that it downloads all new episodes, I'll be your best friend, and if you leave a five star review, ooh, I'll probably send you a Christmas card. Would you like a Christmas card if you or a loved one is newly diagnosed with type one diabetes and you're seeking a clear, practical perspective, check out the bold beginning series on the Juicebox Podcast. It's hosted by myself and Jenny Smith, an experienced diabetes educator with over 35 years of personal insight into type one our series cuts through the medical jargon and delivers straightforward answers to your most pressing questions, you'll gain insight from real patients and caregivers and find practical advice to help you confidently navigate life with type one. You can start your journey informed and empowered with the Juicebox Podcast, the bold beginning series and all of the collections in the Juicebox Podcast are available in your audio app and at Juicebox podcast.com in the menu, the episode you just heard was professionally edited by wrong way recording, wrong wayrecording.com you.

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