#1613 Bolus 4 - Intro and Doritos

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Jenny and Scott talk about bolusing for Doritos

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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.

In every episode of Bolus four, Jenny Smith and I are going to take a few minutes to talk through how to Bolus for a single item of food. Jenny and I are going to follow a little bit of a road map called meal bolt. Measure the meal, evaluate yourself. Add the base units, layer a correction. Build the Bolus shape, offset the timing. Look at the CGM tweak for next time. Having said that these episodes are going to be very conversational and not incredibly technical. We want you to hear how we think about it, but we also would like you to know that this is kind of the pathway we're considering while we're talking about it. So while you might not hear us say every letter of meal bolt in every episode, we will be thinking about it while we're talking. If you want to learn more, go to Juicebox podcast.com. Forward slash meal, dash, bolt. But for now, we'll find out how to Bolus for today's subject, please don't forget that nothing you hear on the Juicebox podcast should be considered advice medical or otherwise, always consult a physician before making any changes to your healthcare plan or becoming bold with insulin.

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 All right. Jennifer, I have an idea, okay, and I've been workshopping it in my mind now for a few weeks, and I want to work through the rest of it with you now. Awesome. I'm very worried that I'm going to say something to you and you're going to go, oh, Scott, I already have that. And I don't want to steal your thing if that's the case, or maybe you don't, but I want to make a series of short episodes that's just about each episode is about bolusing for one food item. So imagine, right? So imagine that I might already have a list of hundreds of food items from listeners, and they're like, please tell me how to Bolus for this. Or, you know, this specifically, not just pizza. I want to know how to Bolus for Domino's Pizza, very specific stuff, not just cereal. I want to understand how to Bolus for Lucky Charms. Okay, that kind of stuff. And actually, good foods on the list too, Jenny, don't worry. Great. But when I started thinking about you, and I doing that, the first way I imagined it was me just saying to you, okay, Jenny, let's figure out how to Bolus for and then say the food item, and then us just talk it through, which I think is valuable, but I also think that there's got to be steps, like, whether we know it or not, there are steps in Our head about what we think about when we're bolusing, even if we're not actually thinking about it.

Jennifer Smith, CDE 3:05
Yeah, they're unconscious. They're sort of in a file cabinet. I've done this. I know how to it's almost like a behind the scene. Absolutely, there's their steps.

Scott Benner 3:14
Yes, do you have these steps written down? Ah, you don't. Excellent. Do

Speaker 1 3:19
I have steps written down for how I Bolus through things. No, that's 37 years.

Scott Benner 3:25
But like, what I'm thinking is, is that if there was a framework, then while we talk about it in each episode, we can use the framework, and then it'll become just a thing that happens without you having to know the framework. Can I give you the

Jennifer Smith, CDE 3:39
frame you can and I think it's probably while I don't have it written down, this is probably exactly how I teach bolusing for food, despite not having it written down, as I think about it, I know that I teach bolusing for food the same way, person to person and variable to variable. And then the one other thing that I was thinking about to, you know, you always talk about these ideas a little bit ahead of, you know, whatever. But my consideration too was, how do we bring into this Bolus thing for, let's say, an apple, and considering, then, is there something to adjust because of the aid system you might be using? Yep, right? So which I, I consider kind of, and I think you probably coined it. I don't think I've heard it anywhere other community in diabetes, but like the ninja level is now, you know, bolusing, you know the steps, but what's the system you're using? How does your algorithm work? Because that's going to make a difference in how you choose to Bolus for this particular

Scott Benner 4:52
food. Okay, I think this is going to be exciting. I'm pretty excited. So

Jennifer Smith, CDE 4:56
that was on, that was the only thing on this topic that I was like, You. This changes things, because people aren't just MDI and conventional pumps anymore, and

Scott Benner 5:06
I want them to, because CGM exists too, like all right. So here's how I have it laid out. I almost had it in an acronym, so close. Oh, so it's meal bolt, M, E, A, l, B, O, L, T, all right, meal measure the meal. So that step is list your carbs, fat, protein, glycemic impact, yep. E, evaluate yourself. Check your CGM, your blood sugar, insulin on board planned activity and stress level, okay. A, add the base units, calculate the food Bolus, the carbs divided by insulin to carb ratio. What is A? A is what add the base units? So the base units tough here. Okay, I'm trying to get an acronym in here. I don't know that we're going to end up with meal bowl, but I think the steps are here. So like, think about it right. List the carbs, the fat, the protein. Get that information. Check your blood sugar and your insulin on board. Am I about to go sit down on the sofa? Am I about to go for a run? Yep, now like calculate our food boluses using our insulin to carb ratio, yep. L, layer a correction look at the current blood sugar and the target. Use your correction factor right. Check on your insulin on board again. B, build the Bolus shape. Decide upfront percentage versus extended and duration. Yep. Offset the timing. Choose Pre-Bolus lead time or maybe a split dose. Okay. L, look at your CGM right to see to look for your curve. Are you on the way down? Are you on the way up? Maybe you need a little more. Maybe you need a little less. And then tweak for next time, log the outcome, adjust ratios split, so be flexible at the end. Yeah. All right, so I put it online, and people are like, that's a lot to remember. And I thought that's exactly what I think about every time I think about bolusing for food, but I don't consciously think about it that way.

Jennifer Smith, CDE 7:01
Well, that's why I said when you asked if I had steps 100% I have steps. They're just I've done them so much that I don't would have never come up with an acronym for them.

Scott Benner 7:13
Do you have any idea how hard it was to, like, sit down and go through it? I'm doing things so automatically, I couldn't find them when I was looking for them right away. It took me a while. Actually, I've been working on this for

Jennifer Smith, CDE 7:24
a while. Can I tell you what my favorite one of this is being the more type A versus that I tend to be. I really like tea tweak for next time. This encourages as much as people hate doing. It encourages some records. It encourages paying attention to the data that is all systems, even if you're just using injections, there is some place that's gathering that data for you that you can look back and say, Okay, I really want to figure out my apple, or I really want to figure out this great mark it down. Do these steps what didn't work. Tweak it for next time. That's my favorite step.

Scott Benner 8:08
Yay. So I think that everything's that's in these kind of like eight ideas. If you went right now and listened to the Pro Tip series, you'd hear they're there some version of that in the conversation, but it's very conversational. And I want these episodes to be small. I actually think I'm just gonna make them part of the small sip series, right? Like little tiny, like pieces of information. So what I was afraid was gonna happen was that I'd bring up a food, like choice, and then you and I would talk for a half an hour about bolusing for the food, because I think we could get lost talking about it. So I thought, like, we need a structure. Yes, yes, right? That's all so now, but, but what we really have to figure out is, is this actually, can there be fewer steps? Is this the step? Like, you know, like, that's the thing I want to figure out with you. So I'm gonna, like, I'm gonna actually make a thing and send it over to you. Okay, hold on one second.

Jennifer Smith, CDE 9:02
And for clarification, we're also talking about some of these foods will be simple, one item, foods like Apple, for example, and some things will be mixed meals. In fact, many of these are likely to be mixed meals

Scott Benner 9:17
as we go, yes, but in the beginning, you

Jennifer Smith, CDE 9:21
have them in order, from easy to hard. I'm still working on that. Okay,

Scott Benner 9:25
yeah, in the beginning, what I want is an encyclopedia of there must be like, I know I'm gonna say something crazy, like 50, but there must be like, 50 food items that most people eat, right? And

Jennifer Smith, CDE 9:40
most people have 20 to 25 themselves that are consistent over and over. Yeah,

Scott Benner 9:45
okay, I just sent you a link in your text. Okay, all right. So, so we'll, we'll look at these items, and I think we should practice a little bit, and then we'll like you and I will practice together, and then that's how we'll you. Start get these steps in order so that they're ready for when the next time we get on and we just start, like, because you guys don't know how Jenny, I make these, but we'll basically sit down for an hour and just hammer out as many as we possibly can, and you'll hear them five six minutes at a time. Like, so looking at it, tell me when you have it in front of you. I've got it in front of me. Is there anything glaringly missing, right? Like, really think about it like you're looking at food. How many carbs are in it? That's obvious. Is there fat or protein in it? Am I gonna have to Bolus for that? Yes. Is this a high glycemic or a low glycemic? Like, is it gonna hit me hard and fast, or is it gonna hit me, you know? Like, is

Jennifer Smith, CDE 10:36
it along with this? I think in measuring the meal, I think that's an

Scott Benner 10:40
appropriate I guess it's complete. We don't need anything else in that thought. I

Jennifer Smith, CDE 10:44
don't think so. But it also, when you're measuring, what are your look you're looking at measuring includes portion, how much are you eating, right? So beyond glycemic impact, there's also glycemic load, okay? And I think that that's valuable, because if we don't address portion size in the measure and talk about the impact or the difference that that can make, I think it may we may miss something right. We don't

Scott Benner 11:13
want to tell somebody how to Bolus for a bagel, but not talk about what would happen if you were going to eat three of those bagels, correct? Yeah, yeah.

Jennifer Smith, CDE 11:24
And my favorite one in that is watermelon, right? Watermelons got a really high glycemic index, but a portion, a single serving of it, doesn't have the load impact of eating four cups of it at a time, same glycemic index, but the load is what makes the difference, and then Bolus timing and all that kind of stuff goes along with it.

Scott Benner 11:45
Quite a handful or a cup of of watermelon, that's one thing. If I'm at a picnic and someone takes out a giant knife and slices off a two inch slab of it, and I sit down and shove it into my head, that's going to be different. Okay, so I added load to that. So list, carbs, fat, protein, glycemic impact and load, all right? The next step, evaluate yourself, check your CGM, your BGM, insulin, on board planned activity and stress. Is there anything else that the people could quickly assess about themselves?

Jennifer Smith, CDE 12:15
No, I think evaluate is. I think you've got everything here that would make sense. Okay. I mean, all evaluate yourself is not only where are you sitting in terms of hard numbers, but also what do you have going on? And those are the outside things, like variables that stress, illness, activity level, etc,

Scott Benner 12:38
right? Okay, the next one. I don't even know if I love the way I have this, like, add the base units, but calculate food Bolus, carbs divided by insulin to carb ratio. So calculate your food Bolus, so it doesn't have to be meal bulk, by the way. Like, I don't care what the acronym is. By the time it's over, this episode is sponsored by tandem Diabetes Care, and today I'm going to tell you about tandems, newest pump and algorithm, the tandem mobi system with control iq plus technology features auto Bolus, which can cover missed meal boluses and help prevent hyperglycemia. It has a dedicated sleep activity setting and is controlled from your personal iPhone. Tandem will help you to check your benefits today through my link, tandem diabetes.com/juicebox, this is going to help you to get started with tandem, smallest pump yet that's powered by its best algorithm ever control iq plus technology helps to keep blood sugars in range by predicting glucose levels 30 minutes ahead, and it adjusts insulin accordingly. You can wear the tandem Moby in a number of ways. Wear it on body with a patch like adhesive sleeve that is sold separately. Clip it discreetly to your clothing or slip it into your pocket head. Now to my link, tandem diabetes.com/juicebox to check out your benefits and get started today.

Jennifer Smith, CDE 14:00
No, the way you have this is correct, though, because the beginning steps of first you've measured, you know exactly, not exactly as precise as possible, what you're doing, right, and what the content kind of looks like. And then you're saying, Okay, well, my blood sugar's starting here, it's going up here, it's dropping here, I'm already low, blah, blah, blah. And then you're getting a calculation of knowing BG and knowing carbs, you're calculating what the dose would be just for the food to begin with. And then the next step is adding kind of a coating to that if needed a correction, or even taking insulin away, it could be correction in one way or another, more or a little bit less, yeah. And then the deciding pieces come in with the second word, which you know, the B, O, L, T, right when you're building in how you're gonna Bolus,

Scott Benner 14:52
Yep, yeah. So now we have, like, what the situation is, what situation I'm in, what are the details? Cells of how this insulin is going to get measured. Am I correcting for a blood sugar that exists already one way or the other? Like, you know, I know people hear that and think, Oh, if I'm 150 I need the meal, plus the, you know, the correction for the 150 but also you might get hungry and be 65 so we can still Bolus for that too. If we then look at the rest of it right, like, the side upfront percentage versus, am I going to extend this and how long am I going to extend it for? So build the Bolus like, shape like, think about how I'm going to apply this insulin to the situation. The B and the O kind of go together honestly, right? Because, you know, am I going to put it all up front? Am I going to spread it out? Am I going to spread it out for three hours? And how much of it is needs to be pre bolused? Right? Is kind of another way of thinking about it, because I don't know that like putting pre bolusing and split dosing together is really much I mean, is a split dose really much different than an extended I think that's kind of the same

Jennifer Smith, CDE 15:59
thing it is. But again, the way that, as you said, the build and the offset and they kind of go together. Sure they do, but for somebody who is newer, maybe to considering how to approach a meal, let's say they've used kind of pro tips, right, and now they need something like this as a stepping piece of in their decision making, because this brings it together. It kind of condenses all the pro tips in a way, which is, is nice somebody like me, all of these, they just float together like it's a quick, quick, quick, quick, quick decision. And if I had to, I guess I would have listed them like I had to think about a plan, but my brain just goes through these automatically.

Scott Benner 16:45
Yeah, you know. And I think that it does for most people, but there are still so many people online that are just like, I don't know how to Bolus for this item. And what that makes me think is they don't really know how to use their insulin well yet. But instead of continuing to tell them, like, Don't worry, you'll get it. You'll figure it out, which I do think is true. You know what? If there was a, like, a short Encyclopedia of 2040, 50 items that you just heard somebody say, because we're going to take a label and actually walk through this like, that's how you and I are going to handle this, right? If I figured that out for my basic stuff, and I did it over and over again, wouldn't there, like, that magic part you're talking about, where you just kind of know when it all comes out of your head, right? Like, maybe that would get them to it more quickly, is, like, kind of my hope also, you know, Jenny, there's stuff that I've thought I wanted to put into the podcast, and there's stuff that people have told me I should put in the podcast. And oftentimes those things are not things that occur to me. This is one of them. People have been asking for this for years, and I'll tell you the other thing they want us to do. They want us to break graphs down. Oh, and I always talk about, like, by the way, this might be the next series, but like, I always say, well, like, how am I going to do that without visuals. Like, the people listening can't see the graphs. And somebody said to me the other day, I was like, spitballing with a few people, and they said, why don't you just name the shapes? Because we all know them, right, right? Like, there's, like, you call them excursions at meals, but, like, a meal spike, right? There's a slow drift, there's a drop, a drop. Like, there's probably not that many different shapes on the graph. Most of us already probably think about them a certain way. Name them and then talk about the graph. And I was like, All right, I'll talk to Jenny about that and see Sure, let's, let's focus on this first Yes, yes. Okay, so you know, how long is the pre e Bolus gonna be? Then this is a step that I think can get lost. Like, look at your CGM, right? You know, Spot check your CGM. Are you one hour, three hour, five hours. Take a look at the curve. Are you on your way up? Are you on your way down? The way I talk about that in the Pro Tip series is I always tell people like, go to the three hour CGM line, go to the last three dots and see which way they're curving and like that gives you an idea of what what direction your blood sugar is going into. But I like the idea of thinking that part through for a half a second, because that's the one thing I still think I don't really get Arden to pay attention to all the time, is the trend. It's nice that you're eating. It's nice that you're Bolus sing for it. It's great that you're pre bolusing for it. But if you are pre bolusing 10 minutes before you were about to go from 150 to 220 I mean, you were screwed already. Anyway, yeah, right, right. And then your favorite one.

Jennifer Smith, CDE 19:33
The other thing is, in the look at the CGM, it is a slippery slope, so I think that it's valuable to point out when we're encouraging look at the CGM, the idea of spot checking at specific points along the post meal time period. And in the case of what we're trying to do is bring up specific foods or. Types of meals. If this is your meal that you really want to figure out, looking at the CGM doesn't mean every single day for every minute you're looking at your CGM, yeah? This

Scott Benner 20:09
is why you're learning how to do it right, like, right? Yeah. This is a

Jennifer Smith, CDE 20:13
spot check the Domino's Pizza at an hour. How are we looking you had a strategy in mind. The other piece to looking at the CGM is not being reactive, because you're trying to learn

Scott Benner 20:28
Yes. So like, just don't, like, freak out every time you see some like, let it play out so that you can, yes, you can figure it out. Like, so it's funny because you you kind of key down on one side to look at the CGM, and I keyed in on the other side for me, like, which is like, pay attention to where you are before you make this Bolus, but after you make the Bolus, the spot checking, like, go back an hour, three hours, five hours. Like, what's happening now, did this work the way I expected it to? If not, what am I seeing before CGM? So can you imagine the first person who figured out, like a fat rise, like, you know what I mean, like, without that, like, how many times they must have checked their blood sugar to be like, I'm telling you, if I eat a french fry, my blood sugar goes up faster than if this happens. You know, you've made these good decisions. You've you know, you've taken these steps. You put the Bolus in. An hour later you're still stable. Awesome. You know what I mean? Like, three hours later you're getting low, that'll help you with the Tweak for next time. Right, right. Maybe I didn't Pre-Bolus correctly, or, you know, whatever. And the

Jennifer Smith, CDE 21:27
only way that you can get, and I think that's why it is my favorite, the only way that you can really, truly get to tweaking what was an initial attempt is to really only do those spot checks. It's not a minute by minute, watch and react and hyperventilate because something's going on. It's a I am testing something out in order to adjust it for next time I have to let the scenario play out. Yes, I made a decision. It looks like my decision was not correct, but I'm gonna let it work itself out, because next time now I can spot what to

Scott Benner 22:05
change. This is a granular breakdown of the Eminem story that I tell in the Pro Tip series of somebody who just one day was like, Oh, I have a CGM now I can figure this out, and I'll put the insulin and see what happens. You can't, like, Jenny said, you can't, like, 10 minutes into it, freak out, like if you asked me, you know, at what point after a meal, Bolus, do you think, Oh, we missed. I need more insulin. I have an answer, but that answer is also based on me really understanding all these other steps that we just talked about. So while you're learning you can't just because you're just guessing the wrong direction, you'll cause, you'll probably over Bolus, cause a low or you'll eat at 120 because it's starting to go down and freak yourself out. And sometimes you just gotta wait. Okay? And

Jennifer Smith, CDE 22:47
the reason for these steps again, well, put together the very first step is what measure. So at the end of all of these steps, where you are watching the CGM trend, you know that your beginning pieces were well considered. It wasn't the random, I don't know it looks like 98 grams of carb, and this is what I put in, and this is the meal I'm no, no, no. Like, if you really want to figure out again your pizza or whatever it is, then take the

Scott Benner 23:21
steps, yeah, and you'll get there more quickly, because, yeah, this should work if you're swagging too, yeah, like, right, but you just might have to eat more pizza to get to the answer.

Jennifer Smith, CDE 23:30
And eventually, when you when you swag There's historical perspective to swagging. Yeah, you know when I go someplace and I'm on vacation and I am eating out 100% that's a swag. I mean, majority of the places that you go when you're on a vacation are not national chains.

Scott Benner 23:51
Yeah, right, yeah. You have no idea what you're eating. But I

Jennifer Smith, CDE 23:54
also know that I'm not going to choose the octopus plate, because I don't eat octopus so I usually on a menu. People are still more creatures of habit, right? They're more I know what I like. I'm going to choose something within the realm of my preferences, and because of that, I have some history around a food like this, yeah, so swaging becomes easier,

Scott Benner 24:19
sure. And I think that this process gets you to a place where you you talk about the way Jenny did earlier, like, I don't know, I know I do these things, but I don't think about them, right? But in the in the beginning, I just, I think this will be interesting, and there's a entire section of people listening who genuinely want this. So yeah, and they'll be sure that's awesome. Yeah. So now, do you have time to pick one thing and or do we do it next time we have

Jennifer Smith, CDE 24:44
let's see what do I'm full of my schedule. Look at your schedule. It's very

Scott Benner 24:47
busy schedule. People, people clamoring to speak with Jenny.

Jennifer Smith, CDE 24:52
Line out the door. I have about 15 minutes. Okay, so

Scott Benner 24:57
let's do this, since we have so maligned to read. Do's in the nutrition episodes, all right, let's use Doritos. Yeah, let's use Doritos nutrition

Jennifer Smith, CDE 25:08
label. Hold on, fabulous. Oh, poor Dorito Doritos took it hard, actually, everybody, right? They took it hard. But I guarantee that every time we said Doritos, people are like, Oh, Doritos. I haven't had Doritos in a really long time. I don't

Scott Benner 25:23
care about being healthy. They are so good. Okay, I've got a picture of a of a nutrition label from a Doritos bag. This is going to be clunky the first time because we don't have this worked out. Give a pen. Can you jot down something?

Jennifer Smith, CDE 25:37
I have a pen and I have a piece of paper?

Scott Benner 25:41
Yes. So let's start with the just so you know the serving size of this Doritos thing is, it's, oh, wait,

Jennifer Smith, CDE 25:47
wait, can I, can I guess what the serving size? Does it give it per chip? It's

Scott Benner 25:51
a grab bag. Oh, let me get it. Maybe I should get it off of a large bag so that I have how many chips it is. Hold on a second,

Jennifer Smith, CDE 26:00
because I want to try to guess how many chips is a serving?

Scott Benner 26:03
I think it's gonna be one. That's fun, yeah, they're like, oh, there's only 1000 grams in this. How many is it? Oh, don't, don't worry about how many for the serving.

Jennifer Smith, CDE 26:12
Well, I think it also begs a description of the difference between serving and portion. Yeah, right. Oh. Serving is what the label tells you is a single side or a single, you know, portion, and that's what everything on that label, then, is associated with that particular serving. Your portion might be for servings according to what the bag lists as a serving. I think it's a very valuable difference to make. What you put on your plate may be your portion, but I guarantee it's probably not one serving per the bag.

Scott Benner 26:47
So a nine and 9.25 ounce bag of Doritos, nacho cheese flavor tortilla chips contains approximately nine servings. So we're calling what a serving? An ounce? Yes. Wait. Is that gonna be like? That's just a few chips.

Jennifer Smith, CDE 27:01
It is usually from tortilla chip. Historically, is somewhere between nine to 12

Scott Benner 27:11
chips. This has it as 12. Oh, it has it as well. I

Jennifer Smith, CDE 27:14
just want to hear you guess first. Yes, nine to 12 is typical for tortilla

Scott Benner 27:18
chips. Okay, so 12 Doritos is a serving, okay? That's 150 calories, okay, it's eight grams of fat, okay, a gram of saturated fat, okay, fair amount of sodium in here. But that's what do we care about, sodium? Well,

Jennifer Smith, CDE 27:34
we care about sodium, but not from a store from, not from a standpoint or a Bolus thing, all

Scott Benner 27:39
right? It's 210 milligrams, just for that. Carbs. You wanna guess carbs

Unknown Speaker 27:45
for 1219,

Scott Benner 27:46
18. See, that's pretty close. Dietary Fiber, one sugar, one protein, two, calcium, calcium. How they get calcium into it? I

Jennifer Smith, CDE 27:57
would guess calcium is probably pretty minor. It's probably like one or 2% but it's because

Scott Benner 28:03
their daily value.

Jennifer Smith, CDE 28:05
If there's milk, there's some type of and I would expect it's also an enriched or a fortified product. So I would expect some of these are also added back pieces.

Scott Benner 28:15
Okay, yeah, there's potassium in it too. It's interesting, not an amount that you need. Okay, so, but that's not the point. So now we are, let's be a person who's, I mean, we got to keep this easy, right? Like, my insulin to carb ratio is one unit for 10 carbs,

Jennifer Smith, CDE 28:30
and we're following our steps. Measure,

Scott Benner 28:33
yeah, and, and, let's, let's, let's set up this person. Let's do, one unit is 10 carbs. That's our insulin to carb ratio. One unit moves us 100 points that

Jennifer Smith, CDE 28:45
way. So we've got a correction factor of 100

Scott Benner 28:48
Yeah, just to keep everything simple, okay, and and then we have to give the person a blood sugar, all right, so let's start, because this is us just practicing. Let's start with like, a blood sugar. We're not looking to correct 100 Okay, let's just

Jennifer Smith, CDE 29:04
do that. That's the unicorn number, right? Everybody takes pictures of 100 right? Yeah, I

Scott Benner 29:08
take pictures of 70 sixes. But okay, so, okay, so person has the blood sugar of 100 their one unit moves them 10 carbs. One unit moves them 100 points. They're going to eat Doritos. Now, let's go back to our list. All right, we've evaluated the carbs. There is fat in it. Yes, is it fat that we're going to need to Bolus for it in an extended way?

Jennifer Smith, CDE 29:31
No, in one single serving. No 12 chips. No, what if I eat the whole bag? Jenny ate the whole how many servings? Do you say? Five servings in a bag? Oh, nine, yeah. Oh, my God. Well, what's Scott, what's your math? Nine times eight is what

Scott Benner 29:45
70? That would be 72 grams of fat.

Unknown Speaker 29:47
Wow, that's a lot of fat. Oh, my goodness, it's

Scott Benner 29:50
only nine ounces of Doritos. Jenny, this easily could happen during I'm watching mob land on Paramount plus, right? Now, easily, right, right? You don't know mob land. You. I don't know Rob land, I don't, yeah, it's neither here nor there. So, so, okay, that's a good point. Like, so is it one? Let's say they're eating one serving. The hell is eating 12 chips? All right, okay. He's like, I haven't had 12 chips in a year. That Dorito is insulin to carb ratio is one to 10. We're going to be having 18. So, you know, I'd go two units, just for fun, but it's one. What is it? 1.8 units,

Jennifer Smith, CDE 30:28
right? One to 10 at 18, yep,

Scott Benner 30:31
and it's going to be, I don't think the impact is going to be crazy, like, I think any kind of a reasonable I mean, if, if my blood sugar is nice and stable. There's no insulin on board, and I'm having 12 chips. I mean, I think a Pre-Bolus of five to 10 minutes probably get you there. Do you think more? Do you think more?

Jennifer Smith, CDE 30:52
What I know about the processed nature of chips and the fact that these have fat, but it's not a considerable amount of I mean, eight grams is eight grams, but it's not like 50 at once, right? The fact of the matter being that these chips are, they're processed. What are Doritos? Are they corn? I don't

Scott Benner 31:12
even know. I'm sure there's corn in them somewhere,

Jennifer Smith, CDE 31:15
whatever the ingredients are. I don't even know. I can find out. Feel like I should

Scott Benner 31:18
know that. How would you know that,

Jennifer Smith, CDE 31:22
I feel like I should know. I would guess corn. Corn is there wheat.

Scott Benner 31:26
I'm looking for an image I can blow up and see corn, vegetable oil from sunflower, canola and or corn oil, something called malted dextrin, made from corn less than 2% of the following salt, cheddar cheese, milk cheese, culture salt, enzymes, whey, mono sodium,

Jennifer Smith, CDE 31:48
glutamate, glutamate, butter, MSG, buttermilk,

Scott Benner 31:52
romano cheese, part skim, cow's milk cheese, cultures salt, enzymes, Romano cheese, cow's milk cheese, culture, salt enzymes, whey protein concentrate, onion powder, corn flour, natural and artificial flavor, dextrose, tomato powder, lactose spices, artificial colors, yellow, six, yellow, five, red, 40. Lactic acid, citric acid, sugar, garlic powder, skim milk, red and green bell pepper powder, the sodium inosit Nate, the sodium guilate, potassium chloride and sodium calcium. Eight contains milk ingredients,

Jennifer Smith, CDE 32:36
so mostly corn, right? I think so corn. And then what struck me there was kind of funny. It's not really anything here and there, what we're doing, but is the fact that they have naturally an artificially flavored dextrose. Like dextrose is just sugar, right? We have to artificially flavor it in Benner Rita,

Scott Benner 32:54
I might not have had a comma, natural and artificial flavor. Comma, dextrose.

Unknown Speaker 32:59
Sorry. Anyway, that

Scott Benner 33:02
was just sorry about that.

Jennifer Smith, CDE 33:04
No, no, it's all good. But corn, that was my purpose in, yeah, going back now in the Bolus strategy, right? Because we're on the step of building the Bolus shape, and that includes the timing the Pre-Bolus, right? So we're really looking at, you're at a stable looking blood sugar. No, iob, you haven't treated anything in the past. This brings in and builds in the variables you might be considering, right? And my expectation is that you'd need at least a 10 to 15 minute Pre-Bolus. Okay, for

Scott Benner 33:34
Doritos, 10 to 15 minute Pre-Bolus, by then, you're not even gonna want the Doritos anymore, so you might as well give up. Seriously, right. Do I have to split the dose? No, not for Doritos, okay. And when do you think I checked to see if I missed on this?

Jennifer Smith, CDE 33:49
Yeah, great, because these are more processed, again, like most packaged snacky kinds of foods like this, I would be checking at the one hour mark, because, again, these are more true carbies, and they're going to have an impact that tends to be a bit quicker. And also, because you're not eating in this environment, we're talking about single food digestion, kind of like glycemic index was sort of, you know, established. It's an in and out. Okay, so you're usually going to have potentially a quicker rise followed by a quicker plateau point, based on your timing of insulin and what you know about how your insulin works for you, with a finish out and aiming to be back at baseline again, if you've tested all of your other settings, etc, does

Scott Benner 34:39
any of this change for you if it's three servings,

Jennifer Smith, CDE 34:42
I would expect it would change

Scott Benner 34:43
if it were three servings, yes, how so do you think

Jennifer Smith, CDE 34:47
that first step measure the meal? Now we're looking at what, 36 grams of 1812, chips, 18. So that's a heck of a lot more carbohydrate. So we are not changing like. Glycemic index, but we're changing the glycemic load. We're changing how much of this is actually going in. I would expect that Pre-Bolus timing probably about the same, because the more of a food that you have, it's still going to take you longer to eat that many chips compared to just eating 12 chips. Now you're eating a lot more chip, 36

Scott Benner 35:22
chips. It's 54 carbs. Yeah, all of a sudden I just hit me, like, these conversations gonna be great for people, because I don't think anybody thinks about it that way. You know what? I mean, a handful potato chips, 15 carbs. I go, like, right? You're at the next handful. I don't even know if you're like, you've got it in your head the same way after that.

Jennifer Smith, CDE 35:40
And what a great time of the year. I mean, I don't know when these episodes will come out, but what a great time of the year to be discussing this. Because where are we? We're heading into most kids getting done with school, heading into summer, heading into a lot of vacation time, heading into a lot of family or gathering type of spaces, cookouts, et cetera. And what do we have at most of those things, it's not your usual, prepared, great stuff that you focus on eating at home. It's everybody brings something along, and most often, what's on the table, chips and potato salad. Exactly. We're

Scott Benner 36:17
gonna have burgers later. Kids, fruit salad is everyone's grandmother not put three baskets out with three paper towels in it and run around and dump three different kinds of potato chips in them and go, Hey everybody, like, you know, like, I just want everybody to be happy and dead. So okay, now, you know, this person's blood sugar is 150 before they start. And now my heart that changes the Pre-Bolus time, because I like to see a falling blood sugar before, like, you know what I mean? Like, if you, if you're 150 and you throw in a Pre-Bolus for, you know, 56 carbs of Doritos, and 10 minutes later, you're like, Oh, I'm eating now, but your blood sugar hasn't moved. I mean, I think you're 185 in 10 minutes,

Jennifer Smith, CDE 37:00
you're going to be rising and again, that also begs, you know, evaluate, which is your second step. Evaluate, where are you? Is that 150 stable, and you've been stable and just hovering there? The correction for adding into the food Bolus, maybe it takes hold a little bit faster and starts that drift down that you're looking for before you start to eat. And this then begs the consideration of evaluating your CGM along the way, even because don't get hard tied, I guess is my point to an actual I always Pre-Bolus 10 minutes. My Pre-Bolus is always 15 minutes? Well, maybe that has to be a floating a variable, depending on where are you and where are you headed. If the 150 is stable, flat, no insulin on board, great, right? You could probably turn that around pretty quick, and your Pre-Bolus maybe isn't very much longer. But are you 150 and still rising? You are that rise indicates a deficit of insulin. It means a longer Pre-Bolus. Okay?

Scott Benner 38:04
Kid comes downstairs, Mom, I'm gonna take a handful of Doritos that I'm going outside to kick a soccer ball. You do it differently? Yeah,

Jennifer Smith, CDE 38:10
absolutely. There's a variable in the picture, a handful of the Doritos again. What are we looking at? We're evaluating, is there insulin on board already? Blood Sugar might be 150 going to hit the soccer ball around, or throw a football with a friend, or whatever it is at that point, do even Bolus, right? And that begs the consideration. Then, as I said about what kind of system are they on? Yeah, has the system already kicked in some help that handful of Doritos might be totally fine,

Scott Benner 38:39
right? Right? Yeah, you're gonna have to look to see. It's not as easy as that evaluate part becomes a big deal like it does. Yeah, you're 150 and the algorithm just bolused for it, and you're about to go outside and run around, and maybe you can have a few Doritos and go, and we're not gonna see a difference here, right?

Jennifer Smith, CDE 38:56
You may not even need to Bolus at all for it, and it's totally fine,

Scott Benner 39:00
yep. Okay, all right, so this is how we're gonna do this. Is this gonna work for you? I love this is awesome. Having way too good of a time. I looked up and I thought, we're a couple of dorks.

Jennifer Smith, CDE 39:13
I'll be in the dorky nerve.

Scott Benner 39:15
I was like, we're gonna talk. I'm gonna love this. Okay, so hopefully people love it too. Thank you. Yeah, I really appreciate this. Thank you, of course, yeah.

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. There are links in the show notes and links at Juicebox podcast.com. You.

In each episode of The Bolus four series, Jenny Smith and I are going to pick one food and talk through the bolusing for that food. We hope you find it valuable. Generally speaking, we're going to follow a bit of a formula, the meal bolt formula, M, E, A, l, B, O, L, T. You can learn more about it at Juicebox podcast.com, forward, slash, meal, dash, bolt. But here's what it is. Step 1m, measure the meal. E, evaluate yourself. A, add the base units, l, layer, a, correction B, build the Bolus shape, O, offset the timing, l, look at the CGM and T, tweak for next time. In a nutshell, we measure our meal, total carbohydrates, protein, fat, consider the glycemic index and the glycemic load, and then we evaluate yourself. What's your current blood sugar? How much insulin is on board, and what kind of activity are you going to be involved in or not involved in? You have any stress hormones, illness, what's going on with you? Then a we add the base units your carbs divided by insulin to carb ratio, just a simple Bolus l layer a correction, right? Do you have to add or subtract insulin based on your current blood sugar? Build the Bolus shape? Are we going to give it all up front, 100% for a fast digesting meal, or is there going to be like a combo or a square wave Bolus? Does it have to be extended? I'll set the timing. This is about pre bolusing. Does it take a couple of minutes this meal, or maybe 20 minutes are we going to have to again, consider combo square wave boluses and meals, figure out the timing of that meal and then l look at the CGM an hour later, was there a fast spike? Three hours later? Was there a delayed rise five hours later? Is there any lingering effect from fat and protein? Tweak, tweak for next time. T What did you eat? How much insulin and when? What did your blood sugar curve look like? What would you do next time? This is what we're going to talk about in every episode of Bolus for measure the meal, evaluate yourself. Add the base units, layer, a correction, build the Bolus shape, offset, the timing, look at the CGM tweak for next time. But it's not going to be that confusing, and we're not going to ask you to remember all of that stuff, but that's the pathway that Jenny and I are going to use to speak about each Bolus. The episode you just heard was professionally edited by wrong way recording. Wrong wayrecording.com.

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#1612 Chemo Caused Type One

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Nicole shares her journey through breast cancer, thyroid failure, and type 1 diabetes, balancing resilience, humor, and family support while finding strength in community and technology.

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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. You are listening to the Juicebox podcast.

Nicole 0:14
Well, hi there. My name is Nicole. I live in a suburb of Chicago, and I'm pleased to be here on the Juicebox podcast. If

Scott Benner 0:24
this is your first time listening to the Juicebox podcast and you'd like to 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. Please don't forget that nothing you hear on the Juicebox podcast should be considered advice medical or otherwise, always consult a physician before making any changes to your healthcare plan or becoming bold with insulin. 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, today's episode is sponsored by the tandem mobi system with control iq plus technology. If you are looking for the only system with auto Bolus, multiple wear options and full control from your personal iPhone, you're looking for tandems, newest pump and algorithm, use my link to support the podcast, tandem diabetes.com/juicebox, check it out. The episode you're about to enjoy was brought to you by Dexcom, the Dexcom g7 the same CGM that my daughter wears. You can learn more and get started today at my link, dexcom.com/juicebox,

Nicole 2:13
Well, hi there. My name is Nicole. I live in a suburb of Chicago, and I'm pleased to be here on the Juicebox podcast. Nicole,

Scott Benner 2:24
I'm pleased for you to be here as well. Thank you. Yeah, you have a very a Michelle Obama quality about your voice. Does anybody ever told you that before? No, never. I think it's the Chicago thing. It's possible, yeah, but it's coming right through like so have you always been in Chicago or not always?

Nicole 2:42
Yes, born and raised, I had a short stint in college, where I moved to South Carolina for a summer for an internship, but always have been here. No

Scott Benner 2:53
kidding, awesome. You like the area. No reason to leave. I do.

Nicole 2:58
My family is here, so I plan to

Scott Benner 3:01
stay Ah, I see it's too cold for you, but your family's there. Is that? What you're telling

Nicole 3:05
me I'm saying that, yes, because I just went to Clearwater Florida a couple weeks ago, and it was amazing.

Scott Benner 3:11
Yeah, the warm is nice. Sometimes clear water. What were you there for?

Nicole 3:15
Nothing, relaxation, eat, sleep, repeat.

Scott Benner 3:19
Very nice. I've only been there once, twice, maybe. And I went down for spring training for the Phillies, actually. Oh, wow. And we spent it for yourself. My son and I and my brother went down and we went to we basically went to spring training games all week, and then hung out on the beach and did other stuff. That's nice. Yeah, it was very nice. So what brings you on the podcast

Nicole 3:38
today? So I remember that about a month or a couple months ago, you got on the Facebook, private Facebook group, and you threw out a post that said, hey, my one o'clock isn't working out, or whatever time it was. Is there anybody who could record for an hour click this link? And so there were a number of us that click that link, and there were three of us with you at the time, and then you took the post down, and we had a chat.

Scott Benner 4:08
Yes, that one's gonna come out soon, actually, that one's almost done. Oh yeah, that was great. You know, what ended up happening for people listening is that, first of all, I underestimated myself. I thought like, Oh, I'll be lucky, like someone will be able to do it. And a lot of people were able to do it, and I was like, Oh no, no. There's already three people in here. So I just put a stop to it, basically. And then I wanted it to just be like, and I thought the conversation was nice the way it went back and forth between a number of people. But yes, as you guys were going online, it just became obvious that each of you would have made a great episode. So here we are. That's awesome. I appreciate that. Yeah, no, absolutely it was. It was a good time, but we're gonna have a better time right now. Okay, so tell me a little bit about your health background.

Nicole 4:49
I've been pretty healthy. I work out a lot, cardio, weight, lifting. I had not had any issues with my health. Probably. Me Up until late 2022, July or August, I found a lump under my arm and then one in my breast, and so I scheduled an appointment for a mammogram, and then several tests later, appointment with an oncologist, and I was diagnosed with triple negative breast cancer in October of 2022 and then I started chemo in November

Scott Benner 5:31
of 2022 what's distinction triple negative? What does that mean? So

Nicole 5:36
it's negative for all of the hormone receptors, like estrogen, progesterone, whatever. The third one

Scott Benner 5:43
is, is that news we want to hear or don't want to hear? In that

Nicole 5:46
situation, you never want to hear any of it. I

Scott Benner 5:49
was gonna say, yeah, not that, not that you want it. But like, is there once you're there? Is there a you know, I don't know better. Is the right word. But like, more favorable for outcomes.

Nicole 6:00
I think that the hormone positive is better for outcomes, however, because once you're finished with chemo and radiation, if you go through it, then they put you on like five years of some type of aftercare pill to keep keep everything at bay. And with triple negative, there is no aftercare. You go through your chemo and radiation, if you choose it, like I said, and then they just kind of watch you. Every six months, I get a CT scan, okay, and then I follow up with my oncologist, and that's

Scott Benner 6:38
been going on for three years, almost. Yes, yeah. So I want to kind of go backwards so you get that news. I mean, I assume the lumps themselves are pretty worrisome, but, you know, I imagine you do your best to regulate yourself till you get back the diagnosis. But once the diagnosis comes, we know what mind frame does that put you into?

Nicole 6:59
I'm going to kill it. I I'm just gonna beat it. I'm gonna be successful. And that's that,

Scott Benner 7:04
yeah, you just felt right away like, Okay, I'll fight the fight. Absolutely Okay. So then what's the next step? What did you have done after you decided how you were going to handle it?

Nicole 7:13
They scheduled me to get a port, which is like a catheter in your chest, so that you so that they can get the drug infusion through that port instead of a different IV in your arm every time you come. Yeah. So they set up my treatment plan, which was 12 weeks weekly. And then once I finished with that, then it was four treatments, three weeks apart. So in total, that is eight rounds chemo.

Scott Benner 7:45
Okay, and are the lumps removed? Is the breast removed? Like? How do they handle all that?

Nicole 7:50
So then, once you finish, and I had a couple of hiccups here and there, my white blood count, I want to say, was too low. So they give you a I had to miss a week of chemo for that, and then they give you something to get it together, and then you can resume. So that pushed my treatment plan back a week or so, okay, and then we're at the end. My thyroid decided to give up the ghost. So the range for normal is like zero to four, okay, and mine was like 84

Scott Benner 8:26
your TSH, jump to 84 Yes, wow, it definitely

Nicole 8:29
stopped working, huh? Yeah, that was, like a first sign. So hadn't had, you know, many other fall off the cliff moments, but that one, so was

Scott Benner 8:40
the thyroid a thing they were tracking? Or did you just get so ill that you've they started looking for it?

Nicole 8:46
Yes, I had labs, I want to say weekly, because they wanted to make sure you're okay for the next treatment, right? So they were monitoring everything, and then the previous time, it was normal, but maybe trending a little higher, and then the next time it was way high. Is

Scott Benner 9:06
the common wisdom that the treatment causes the thyroid problem, or is it

Nicole 9:11
bad luck? The treatments are known to have several side effects. There is one particular drug. I hear the commercials for it now, and I, you know how they rattle off the side effects? And I was like, yeah, that happened to me.

Scott Benner 9:28
I got that one. Thank you. And so thyroid issues are. One of them is type one diabetes. One of them, or no, it is, is type two. Do you know, I don't know if they differentiate, oh, or if they just say, diabetes, okay, sorry. So you get the thyroid labs back. How do they manage that?

Nicole 9:46
I'm on levothyroxine. I don't remember what the doses was at the beginning, and it's gone up and down since that time. So that was probably in April of 2023, Three. Did that happen? Okay,

Scott Benner 10:02
that about a year after your treatments, or not quite

Nicole 10:05
six months. So we go from starting treatment in November of 22 to finishing in April of 23 okay,

Scott Benner 10:13
is that news? I don't know. Like, I guess a lot goes to your personality and your how you deal with things. But does that news of the thyroid feel like, oh gosh, another thing, or did it just feel like, okay, fine, I'll take the pill. Like, you know what I mean? Like, how did it strike you when you

Nicole 10:28
heard like, I didn't want to be on a medication for the rest of my life, so this isn't what I want. And they said, some people's resolve once they finish chemo, but mine has not yet.

Scott Benner 10:40
Okay, is it late enough now to think that it won't or is there hope there for that still,

Nicole 10:45
I always have hope.

Scott Benner 10:47
Nice, nice. That's awesome. Okay, so your levothyroxine, you must take a fair amount of it. If is, do you know what your dose is right now,

Nicole 10:58
100 microgram. Okay, all right, that makes sense. And I take that once a day, every day, except on Sundays. Now I take two pills.

Scott Benner 11:08
Oh, you got a good Endo. Well, oh yeah, you figured this out on your own. How did this go?

Nicole 11:15
I love my Endo, but I was really, really feeling fatigue recently, within the last three to four months, and I have been listening to the podcast, of course, and listening to you talk about your wife and your daughter, and how the range acceptable is, you know, from here to there, but sometimes you need to be north of the middle, etc. So I was like, I'm doing all the things I'm working out almost every day. I'm having a calorie deficit. Yes, by this time, I am using insulin full time. But something else is wrong. It can't be anything else but my thyroid. So we had a little exchange, and she wasn't willing, but then she upped my they had a cancelation in the office. She was able to bring me in. So I went and I met with her, and she said, Well, you know what? If you think it would help, I don't think it's going to you can take an extra half a pill. So that's how I got to having two pills on one day,

Scott Benner 12:17
once a week. Yeah, there's a lot of different ways to if you're a person, for example, who has trouble remembering your men. Remembering your medication. There are some doctors who will tell you to take seven days worth of it on one day, oh, and then just do it once a week. I mean, I definitely talk to your doctor about that first, but I've heard, I've heard people adjust or mess with how that medication goes in a number of different ways. So, but that's awesome, because, you know, I think my wife is on a schedule where she doesn't take it, like, literally, like one day a month or something. I've seen other schedules for Arden where she takes a second pill twice a month, like every two weeks. The doctors who know how to to dose that medication, the ones who really know her are impressive with it. So that's awesome. Yeah, so that helped, that little extra half a pill changed your the way you were feeling. It did awesome. Think how easy everybody it did, just timing an amount, right? Everything to some degree or not. Okay, so you have your thyroid. You're working that out. At what point do they tell you you have type two diabetes. In this process, I

Nicole 13:22
finished chemo in April. I went for my last scan. So about a month out from your last chemo, they wait for everything to settle. So in May, which is right after my last I went for my pet scan. I think I had a PET scan. They took my blood, they ran my labs, and my blood sugar was 424

Scott Benner 13:47
Ah, that's too high.

Nicole 13:51
And I'm like, what? Yeah, how's

Scott Benner 13:52
that happening? You said you're active, right? You're exercising. You stay in a calorie deficit at times, like you're doing all the things, yes, yeah, and did they just say type two right away? Or how does that process go? You can manage diabetes confidently with the powerfully simple Dexcom g7 dexcom.com/juicebox the Dexcom g7 is the CGM that my daughter is wearing. The g7 is a simple CGM system that delivers real time glucose numbers to your smartphone or smart watch. The g7 is made for all types of diabetes, type one and type two, but also people experiencing gestational diabetes. The Dexcom g7 can help you spend more time in range, which is proven to lower a 1c The more time you spend in range, the better and healthier you feel. And with the Dexcom clarity app, you can track your glucose trends, and the app will also provide you with a projected a 1c in as little as two weeks. If you're looking for clarity around your diabetes, you're looking for Dexcom, dexcom.com/ Juicebox. When you use my link, you're supporting the podcast dexcom.com/juicebox, head over there. Now let's talk about the tandem Moby insulin pump from today's sponsor tandem diabetes care, their newest algorithm control iq plus technology and the new tandem Moby pump offer you unique opportunities to have better control. It's the only system with auto Bolus that helps with missed meals and preventing hyperglycemia, the only system with a dedicated sleep setting, and the only system with off or on body wear options. Tandemobi gives you more discretion, freedom and options for how to manage your diabetes. This is their best algorithm ever, and they'd like you to check it out at tandem diabetes.com/juicebox when you get to my link, you're going to see integrations with Dexcom sensors and a ton of other information that's going to help you learn about tandems. Tiny pump that's big on control tandem diabetes.com/juicebox the tandem Moby system is available for people ages two and up who want an automated delivery system to help them sleep better wake up in range and address high blood sugars with auto Bolus.

Nicole 16:14
Unfortunately, yeah. Okay, so my primary care physician, yeah. Well, you know, looked at my history. I hadn't had any problem. My a 1c was in the normal range for the last few years. It's possibly, you know, type two. She gave me a prescription for Metformin. Off I went. Hopefully it'll resolve itself once you once the chemo gets out of your system, and by June, so like a month later, in that month, I was noticing my blood sugars really were not going down. I do believe I had a no I was doing finger stick at that time, I would check my blood sugars. I believe three times a day when I would get up, and then maybe before each meal. So I remember going to Aruba, and it just was not working. So I went in on the portal to the doctor's office, and I don't remember she might have been out of the office, but they connected me with a different position in the practice, and he put me, he gave me extra. So this must have been right before I went to Aruba. So he put me on glamempod. And I don't remember what the dosage was or if I was supposed to take it once or twice, but along the way, they were increasing the Metformin. It wasn't helping. So when I got back from Aruba, I went into the office. I don't remember a lot of anything coming out of that. But by July 16, I told my mother. I said, Mom, if my blood sugar does not come down, I'm going to the emergency

Scott Benner 17:51
room because you needed a different doctor, or because you thought you were medically in trouble.

Nicole 17:56
I just felt like something else needed to be done because the Metformin wasn't working and the other medication wasn't working, something was wrong, and it needed to be addressed. Nicole,

Scott Benner 18:08
our AI overlords say that a 400 blood sugar, even with chemotherapy, is likely diabetes, not a result of chemotherapy. Apparently, the the the level of your blood sugar. Should have told them that maybe it's not as easy as like this is going to go away, maybe when, when your chemo is done. Yeah, it's interesting. And And how long were you on the the oral Med and not seeing any relief from it? When? What were they telling you during it?

Nicole 18:37
Probably a month. Okay, at one point it increased, and I want to say I didn't like the increase because it was taking my appetite.

Scott Benner 18:47
Oh, okay, and that's, is that already an issue with chemo?

Nicole 18:51
I think that's an issue with metformin, because I was finished with chemo by then

Scott Benner 18:56
I got you Okay, did you experience it with chemo, the not being

Nicole 19:00
able to eat. Oh yes, yeah, yes.

Scott Benner 19:03
Is that because of nausea or just because of lack of hunger or a combination, a combination combination? Okay, so you're on this for a month. They up it. It takes away your desire to eat, which is terrible. But those blood sugars are not moving,

Nicole 19:18
not very much, they would, you know, go down to something, go up to three, something, you know, back and forth.

Scott Benner 19:26
I gotcha, okay, so you told your mom that. Then what ended up happening,

Nicole 19:30
I checked myself in, and they did like an EKG. They took my vitals after a while, they took me back, they put me on like a hydration. What does that cost? IV and an IV with the bag. So then they kept doing finger sticks, and think they took blood. So hourly, they would come in and check on me, and it was late. And then I believe I had the on call endocrinologist to come in and say, well. We check, then you have one of the well, basically that you have type one because you have one of the

Scott Benner 20:07
antibodies they said you had. We checked and you had an antibody and positive that looks like type

Nicole 20:12
one. Okay, yes, well, that means you're going to have to take insulin.

Scott Benner 20:17
Okay, so I'm going to keep asking this question along the way. How does that hit you? You didn't want to take a pill, and you're doing that under protest. So what happens when somebody tells you insulin? You've probably heard me talk about us Med and how simple it is to reorder with us med using their email system. But did you know that if you don't see the email and you're set up for this, you have to set it up. They don't just randomly call you, but I'm set up to be called if I don't respond to the email, because I don't trust myself 100% so one time I didn't respond to the email, and the phone rings the house. It's like, ring. You know how it works? And I picked it up. I was like, hello, and it was just the recording was like, US med doesn't actually sound like that, but you know what I'm saying. It said, Hey, you're I don't remember exactly what it says, but it's basically like, Hey, your orders ready? You want us to send it? Push this button if you want us to send it, or if you'd like to wait. I think it lets you put it off, like, a couple of weeks, or push this button for that. That's pretty much it. I push the button to send it, and a few days later, box right at my door. That's it. Us. Med, Comm, slash, Juicebox, or call 888-721-1514, get your free benefits. Check now and get started with us. Med, Dexcom, Omnipod, tandem freestyle, they've got all your favorites, even that new islet pump, check them out now at us, med.com/juicebox, or by calling 88872115, 888-721-1514, there are links in the show notes of your podcast player and links at Juicebox podcast.com to us, med and all the sponsors.

Nicole 21:50
I don't know what that meant to me in the time and space me being in the hospital. I'm not sure that it really registered, but I do remember him, you know, like, I can't remember if I was in my room by then, they fully got me a room, or if I was still down in the ER in the cubicles. But he explained about the insulin pens and the long acting and the short acting, and that I would have to get an appointment with an endocrinologist in a couple weeks, and I think he helped to get me in quicker with one of the endos. But, yeah, no, I was resistant.

Scott Benner 22:30
Did you have that feeling of like, no, it's, I could probably manage it with this Metformin. You just didn't give me enough of it yet. Were you resolved and understood it wasn't type two? Yes, okay, but resistant in the idea that, like that this is going to be your process. So then, like, explain to me, then what the next couple of days and weeks look like when that's your feeling you're leaving the I mean, you're a grown person, you know what? I mean, like you're You're not going home. I mean, maybe you'll call your mom to check in, but like, You're not going home to a to an adult who oversees you, who's going to help, right? It's on you. Are you married? I'm sorry. I don't even

Nicole 23:05
know. I am not. I have a 17 year old son, and my mom have, you know, small family, but a host of friends took really good care of me, all of them very nice while I was ill and going through so I was kept in the hospital for two nights because I was in, I'd say a mild DKA, but they hydrated me, test, test, test, something came back odd with my heart, and the cardiologist wanted put me on something I'm like, I'm not taking that. There's nothing wrong with my heart. They then did a stress test, and all that came back fine. This is

Scott Benner 23:47
all in the course of how much time, a year and a half, maybe, like from the beginning of the lump to this moment,

Nicole 23:53
almost a year, maybe nine months. A lot happening in your life. I did chemo, was six months, and then right after that, the thyroid, right after that, the

Scott Benner 24:05
diabetes, right? And you're raising a 17 year old at the same time.

Nicole 24:09
Yeah, he's 17. Now, he was 15. Then, oh, gosh,

Scott Benner 24:12
that's a that's an age, right? There, he's looking for you, right? So, yes, so you have that pressure as well. Your mom, yes, live with you. Helps you with that?

Nicole 24:21
No, she lives nearby, but she did move in for a few weeks.

Scott Benner 24:24
Yeah, I bet I would have moved How old are you now? I am 55 Yeah, I still would have moved in. I would have been like, guess what? I'm going to hobble my over there and sit that house for a while with you. Oh my gosh. Did you guys ever talk about it you and your mom quietly about which part, just that your health was, you know, going to be the main focus for a while, and that you were going to need assistance with raising your son and and probably, you know, taking care of the, you know, life in general. Did she like? Did you ask her to come or did she offer herself? I guess I

Nicole 24:59
would say she. She did both. At first, she was like, Well, how can I help? What do you want me to do? You know, I can get all my things. I can come over. We can stay, you know, and it just That's my best friend, you know?

Scott Benner 25:11
Yeah, that's awesome. That's really great. Any point during this first year, are you thinking about your own mortality, or you are locked pretty much in on I'm fighting. I'm winning.

Nicole 25:22
I think that I never, you know, you think about it, sure, but it wasn't like I'm going, I'm fighting this. I'm riding continuously and still to the wheels follow. So I do what I think I need to do. I'm prayerful. I'm, you know, I try still to be healthy. And what I fought Scott was the pump.

Scott Benner 25:45
Really, yes, okay. So somebody said, Hey, an insulin pump might be the way to go. And you were like, This is my line. I'm not going farther than this.

Nicole 25:55
It was kind of that. So, June 16, 17th or so, I was in a hospital. I probably got my indoor appointment at the beginning of August. They also set me up with a really great diabetes educator. They had a Diabetes Center at the hospital close to me, so I had support. But you probably know how it is I'm drinking from the fire hose, and all I want is information. So I get on the internet, I'm like, I'm on Facebook. You know, there's got to be some groups. I need some education. I'm googling everything. They're telling me these things, and I just information comforts me. So that's how I found the podcast, and it's been immensely helpful, but I did not want to pump. I got the CGM. I was on the g7 to begin with, and diabetes office, my endocrinologist office, she had a pharmacist who could work with people longer than she could, so she and I would talk periodically, like when I would have my appointments, they could be for 30 minutes. 45 minutes, they could be an hour. And she was just educating me and listening to how I eat, and, you know, how I was processing, and how I was doing with the MDI and all of that. And a couple of times she would say, I think you should get on a pump and you have to carry this little controller, and I'm like, I'm not carrying two phones, and I don't want to wear two devices. And I cried and cried, and I said, You know what? I got to do it because I'm not managing well on my own.

Scott Benner 27:32
What do you think the resistance is? Is it looking for control, or is it not wanting to be controlled by something? Or do you have any hindsight on the not wanting the pump, feeling,

Nicole 27:44
probably thinking I could do it myself, the pump made it so much easier. So you know how you're kind of kicking yourself for not doing it sooner. But the process, your process is yours. Yeah,

Scott Benner 27:57
no, for sure, it takes a little while to get through it. What got you through it was it time? Was it seeing other people the counsel of the person that was helping you, like, what got you over the hump?

Nicole 28:07
I think it was that I couldn't manage it myself and be within range. I was always high and, you know, I was documenting everything. All my meals go in an app, and I would look at the carb ratio, and I would give my lighting scale, whatever that was at the time, and it would do what it did, and then I would report back. So they just found me to be very meticulous with my health and my eating. And just thought I would be a good candidate for the the omnipot Five, because also I'm still active, so tubeless was the way for me. But I think the education and just realizing I need some additional help,

Scott Benner 28:49
yeah, I remember you popping up in the group in the beginning, and I think it's something to do with, like, you have, like a hyphenated or, like a three name, name. I don't know if something stick to my head differently. I don't know why. I don't know why. Anyway, I remember you were, you were just voracious for information, like always, like if I was there, like if I popped up, you were there absolutely and you had a question, and I saw you interacting with people and asking questions and talking back, and you used that space, I think exactly the way people should use it would. Is it fair to say that it propelled you through fast forwarded you through the process. I

Nicole 29:24
think it did. It was exactly what I needed in perfect time.

Scott Benner 29:28
Good, good. I'm glad, and I'm glad that you found a way to the pump so but talk for a minute about what struggling looked like. Were you honeymooning at that time when you were struggling an MDI, or was it just your lack of understanding? Like, what do you attribute that time of struggle to?

Nicole 29:44
I doubt that I was hunting Mooney, like I said. I think the pancreas just gave up the ghost, yeah, and then so they were running around. You're such a brittle diabetic. No, you don't understand, and I don't understand, but we're gonna get to

Scott Benner 29:58
it. The endo called you that. Yeah. Yeah, okay,

Nicole 30:01
yeah. You know, listening to a lot of what you were saying on your podcast and whatnot, it's not that you're brittle, it's just that you don't have the knowledge, you don't understand, perhaps the timing and the ratios, and we were getting all of that under control. So one time, I was like, Hey, I'm not brittle. She stopped saying that. You got her to stop, yes, yeah, on her own. Like, hey, stop saying that. Yeah.

Scott Benner 30:30
It's such a shame, because, I mean, obviously I think what you just said, but timing and amount is so much of insulin use, and just thoughtfully putting insulin in the right place is understanding the different impacts of different foods. And you know, if you have those levers pulled, you know, slightly wrong, you're not your knobs dialed a little incorrectly. Everything seems like it's happening for reasons you can't wrap your head around like so much so that it's a joke throughout the diabetes community, right? I can do the same thing today that I did yesterday, and I get a different outcome, except the same thing didn't happen. You're just not seeing what's different. And once you can step back far enough to see the differences, whether just be I injected my slow acting insulin in my thigh yesterday and today I put it in my stomach, or I'm on the third day of a insulin pump infusion set versus a fifth day, or a second day or the first day. Like something there is something different. Are my hormones different, right? Is my sleep different last night? Do I have more adrenaline happening? Like, there are a ton of variables. And yet, the way people will kind of colloquially talk about it. It's like, Oh, I did the same thing and, you know, blah blah, I ate the same foods and the same thing. I'm like, No, it's not the same. You just, you're not seeing it. But to leap over all of that, as a physician, to leap over all of that, and then just look at somebody go, you're brittle. I mean, it's a give up on their part. I think they're saying, like, I don't know how to help you. You're just, you're brittle. The word is incredibly insulting, just in general, I would think, takes away a lot of your confidence. I mean, imagine if someone called you brittle. Forget diabetes for any reason. You're at work, and you say something and someone goes, Oh, you're brittle. You know, like, how you supposed to rebound from that exactly? Yeah, but you knew not to take that seriously, because of the conversations and listening to the podcast, yes, that's awesome. That's really great. Makes me happy. Awesome. So okay, so she stopped saying brittle, and what happened next?

Nicole 32:32
So, you know, I have to be honest, it's been two years that I've been type one and had to use insulin. I'm still getting an understanding, but it comes in waves. I got the pump in October of 23 Yeah, it's wearing two devices. But, like, I'm so grateful that the technology is here and different than what it was 10 years ago, 20 years ago. Not that I have it so easy, but technology is my friend, and I'm I'm grateful for all the of the all of the advances that they have made to help us to live a normal and healthy and productive

Scott Benner 33:14
life. Yeah, no kidding. I mean it this industry. You know, you hear people complain sometimes like, oh, you know, they're making money off of my off of my illness, and I take your point, but at least they're making the stuff. I mean, the alternative. You don't want to think about the alternative if there, if there wasn't money in this, no, these companies wouldn't exist. And everybody be running around still, you know, with a meter and, you know, some needles and hoping for the best. And you do those interviews with those older folks that have lived through that and that didn't end well for people most of the time. So yeah, this is, this is an awesome time. Also, I want to ask you, maybe I'm, of course, I'm inferring from having spoken to you for a very short amount of time and just watching you online, but you strike me as a bright, thoughtful person who is never going to feel like enough information is enough. And at the same time, I imagine you as a person who is, I don't want to say hard on themselves about outcomes, but I think you have high expectation, I guess, for yourself. Is that fair?

Nicole 34:14
Okay, it's true. You are psychic. I do have high expectations for myself, because between the diabetes educator and my endo and the pharmacist, you're doing a really good job. Well, no, I'm not, and I could be doing better. And I want a better a, 1c and I want a better time and range now, my time and range now is pretty good. It's maybe 85% I'm trying to dial all of it in. And so, you know, with the variables with driving to work in Chicago, rush hour traffic like I just heard you say, or I just saw you say to someone in your post Pre-Bolus, for the adrenaline, what can. Thank you, Scott.

Scott Benner 35:02
Oh, that was today. Somebody asked about, yeah, hour ago, how do I handle my kid going off to school? I'm seeing, like, adrenaline spikes. And I was, I was like, I would first make sure, you know what's gonna happen, and then I'd Pre-Bolus for the adrenaline. And that's how I did it with Arden, when she, you know, was in high school, and she would get, I think, I don't know, nervous or whatever. On our way to school, we were bolusing. I used to drive hard in the morning. Like, the last thing I would say to her, probably, when we left the house, is like, okay, like, it's time to like Bolus for the day, and she'd have to give herself insulin for whatever that rise was coming. So

Nicole 35:35
sometimes I creep when I'm getting dressed. I'm like, What is this? Yes, you're

Scott Benner 35:39
not wanting to go to work. Probably Wow, or thinking about life or whatever in the back of your head. But I do want to go back just briefly. I don't do this enough anymore, where I get smug for a second, but I only know Nicole from like her posts on Facebook and maybe 20 minutes that I spoke to her in another recording that you guys probably have heard already by now. If I tell you online, You're crazy. You're crazy. If I tell you you're something. Just trust me, I'm good at this. I'm very good at seeing people. I don't know if I see myself well, but I see other people really well. You strike me as a go getter. You strike me as a person who wins usually at things they try to do, does not give up easily, and someone who's gonna take an 85% time and range and wonder how this could be a little better, but without and again, you stop me if I'm wrong, but I don't see you as a person who beats yourself up about it. I just see you as a information in, information out, person.

Nicole 36:33
I would agree. I would agree. And I think you're a good judge of character. I see it. You know, periodically, when I see something for your post. I'm like, Okay, so who went bananas in the group? It doesn't matter, but listen to what's guys saying here, and stop it.

Scott Benner 36:48
I'm not, nowhere near perfect, but I am a good parental figure. Like, I don't know, like, how that worked out for me Exactly. Like, again, I'm, I'm, I've 1000 things I could do differently or better, but when I'm assessing other people, I'm incredibly accurate. Usually, I don't know where that comes from. I don't even know if I want to call it a gift. It just it comes in very handy with the job I have. I guess it

Nicole 37:13
does. And I just want to say thank you for just saying that. I appreciate that.

Scott Benner 37:17
Oh, of course, Nicole, as well as the person could who has never met you and only sees you through internet writings, I feel like I see you. You give me a lot of hope when I'm doing what I'm doing, because you are a person who I see show up and say, I can figure this out like I know the answers are here. I will mine them out myself and put them into practice, because that's the last step of this that I can't do for people. Yes, you know this is true. I had a conversation, a business conversation, this morning. I don't know if it's gonna work out. I feel like it might. I don't wanna use any names yet, but there's this company that is, they're basically offering like direction for children, for a lot of different things, but diabetes is one of the things they're doing, and they've kind of gamified it a little bit, right? Like the information that they want people to have. You know, what would your endo want you to know? But they don't have time to tell you, like, that kind of stuff. But how do you actually get people interested in it? And how do you get the kids to listen to it? How do you get the parents to listen to it? So this company has set up this situation where you get a like, you should get a backpack and a Chromebook, and the Chromebook is locked down, and it has this, this gaming system on it, and the kids need tokens to play the game. And they get the tokens when their parents complete training stuff. So it's set up so the kids will bug the parents to go do the thing they're supposed to do, so they can get the tokens to play the game. And when you stop and really look at it, it's a it's somebody saying, we know that there's information people need, but it's hard to get them to go get it. And how do we get them interested in it. And, you know, parents are busy and they're tired and they don't have time, and that's probably how a lot of these balls get dropped. But what if the kid was coming to them constantly and saying, like, Look, you just have to watch this 15 minute thing, or listen to this 10 minute thing, and I'll get another 1000 tokens that I can keep playing with. And then the playing is also informative for the kid, and if it works, it'll, you know, I mean, they already, they've tested with it. They see it works. When I say works, it's, how do you get it into a lot of people's hands, right? Like, that's always the problem with everything. They wanted to know if they could start off by putting, like, the small sips, episodes of the podcast in there. And I was like, awesome, because this is my biggest problem too, right? Like, you know, how do you get people to do what's best for them? Yeah, that's really hard, and not just around diabetes, around everything. And anyway, you're a person who I feel like is out there trying to do that for yourself. And. In a world where I can only take everybody's I can only lead the horse so far towards the water, right? It can get frustrating for me at times, just like I imagine for the people who made that game. They must have been frustrated at some point and thought, how do we get these people to take these last two steps anyway? When I see people doing that, it makes my efforts feel valuable. You taking care of yourself helps me to continue to do this thing. I don't know if that's obvious or not, but, like, it's very valuable for me too, and I really

Nicole 40:28
appreciate it. That is awesome. Yeah. Well, good luck with that.

Scott Benner 40:32
Thank you. Well, just in general, too, a side of the game, like just making the content for the podcast, keeping up with the Facebook group, coming up with different ways to say things, trying to keep up with how people want their content, having to go out in the world and do trips and business things like I just got done, you know, doing like, three different trips in like six weeks. And, you know, I got home yesterday and I was just telling, like, we just put our bags away, you know. And I got a call yesterday, and the person says, Hey, I'd like to team up with you for ADA, friends for life. And what is it? Ad CES, the Diabetes Educators Conference all next year, and I found myself putting it on my calendar. I was like, oh, no, I just got my bag put away. Like, you know, you're making me think about this again. I think that's what needs to be done if you're going to reach people. And anyway, so that's what I do, and I need that energy from somewhere, because I am trapped in this room. You know, most of the time so well I don't sometimes get the feedback I need to motivates the wrong word, but like, power myself, I guess. And anyway, thank you. It means a lot to me.

Nicole 41:40
You're welcome. I know you can't hear me nodding my head, but hopefully you can hear me smiling, and I'm very encouraged by the things that you've got going on for you. Thank you.

Scott Benner 41:50
Thank you. I really welcome. I feel good about the thing I decided to do with my life, you know, as an adult, and I would like very much, I want to finish up with this. I don't want to look back and say, Oh, I used to do a podcast. I'd like to, like to do this for as long as is, it's valuable for people. So it is, yeah, it is. It's really awesome. Thank you. Well, okay, so where are you at? And we, I think we understand where you're at with your diabetes. Sounds like you're doing well and you're still learning, but how does the cancer thing go? I asked a question earlier. I don't know that you answered me like, did you have to have your breast removed? Or is it? How did that work?

Nicole 42:24
So yes, I finished chemo, and then I had some things happen, and I decided to do a double mastectomy. So after that PET scan that I had, I think they said it everything looked like it resolved, but then there was something in the other breast, and I was like, nope, not doing it. Take them both. Yeah, we're not doing this again. There's no more. Yeah, I don't have anything else to give. So you

Scott Benner 42:51
don't regret, you don't regret that decision. I imagine, not at all. Okay, how long ago was that?

Nicole 42:56
At least, that was August 16 of 2023 that is my anniversary of being cancer free, so I'm a few days away from that today. Oh,

Scott Benner 43:06
congratulations. That's lovely. Thank you. Yeah, I was worried a little when we started talking today, when I heard your Chicago accent, actually, more than anything, because I just had my experience with cancer is limited to my mom, my family and I were on vacation last week, and we're returning home on a late night flight. We were out on the West Coast, and this older woman, I'm gonna guess, in her late 70s, is with her adult daughter, and the daughter's taking the mom to the restroom on the plane. And the mom's like, you know, she's struggling down the aisle. The daughter's behind her, like, half apologizing to everybody, half hoping her mom doesn't fall and it just strikes me that when my mom got her okay to move after her chemo and she wanted to move out with my brother in Wisconsin, we couldn't figure out how to get her there. She couldn't do the car ride. It was too long. We were very afraid of a plane because of this situation. And my mom and I ended up taking a train, an overnight train, from New Jersey to Chicago, where my brother then picked her up and took her the last bit of the way. That's awesome, you know, we're on the train that night, and we and she got hungry, and we had to make it two train cars to the car where the food was. And that walk was so difficult and reminded me so much of the woman going down the aisle. And it took me to that place in my mind, but I did a good job with it. I was like, I was okay. And then I could hear the woman behind me talking through the door of the bathroom, Mom, are you okay? Yeah. And then I started getting really upset. Oh, my wife is across the aisle from me, and she and we're a very light hearted group of people. And my wife looks over and goes, Are you crying? Oh, and I was like, Yes. And I was like, just give me a minute. Cut me a break, but something had happened just before that, and she thought, she's like, is this dumb? Crying about that? Like, you know what I mean, and, and so I'm like, give me a second. I was like, trying to collect myself, and I told her, you know, I kind of told her, I said, that lady, she just reminded me of being on the train with my mom, walking to dinner, and she's like, and that made you cry? And I said, No. I said, What made me cry is I realized that sitting on that stupid train is the last time I ever sat and had a meal with my mom that and it just like it snowballed like that. And the amount of times that that my mom's cancer experience has made me remember something emotional. Made me want to ask you, how is it getting back to life, or does it pop into your head? A lot? That was actually my question. I told you all that to ask you that question, I

Nicole 45:51
don't think about it a whole lot, except for when it's time to be with my oncologist or have a scan, a CT scan, and the other thing that I want to say is I mentioned that I went into DKA in July of 2023 Yeah. And so I was finished with my treatments, and so surgery was scheduled for August of 2023 since I was diabetic, most people have their mastectomy, and then they go either direct to implants or they start the reconstructive process then. But because I was recently in DKA and they didn't know how I and my body would handle the diabetes and healing, I was not able to have immediate reconstruction. Oh, okay, I felt horrible, because the plastic surgeon is the one who had to tell me, and I just Boo hooed in the office. And I was like, Are you kidding me? So I had a six month delay, and there are a lot of people who choose to not have reconstruction, so they have their mastectomy, and they stay flat. They may or may not wear prosthetics. Have the form of having breasts, but

Scott Benner 47:15
I'm so old that the word falsies popped into my head. That was ridiculous,

Nicole 47:19
but Scott, I'm older than you.

Scott Benner 47:23
Were you fighting around that word too when you were looking No,

Nicole 47:29
but I did that too, so you never know how you're going to deal with something until it presents itself. Yeah, and then you have a choice to make. The choice is, are you gonna sink or are you going to swim? And how you swim depends on you?

Scott Benner 47:50
Yeah, no, I agree with you. I really do. I think some people have sometimes, you know, implications that that stop them from being positive. But for the rest of us, like I do think you go where you point yourself, usually, there's a lot of value in not giving up and waking up every day fresh, making a good decision, following through, doing it again. What did you end up doing? Did you get reconstruction or implants?

Nicole 48:16
I did six months later. So I was flat for six months, and then in February, I got started the reconstruction process. So they put these expanders, they're like flat implants, and then they put saline in to them every every week or every other week to expand the tissues again, because they take all the tissue and the breast tissue right, and the skin is what I'm trying to say. They take all of that

Scott Benner 48:47
that skin's right on your breast bone when that starts right, and then it has to just expand to make space Correct. Okay, my question here is, it might seem like a tiny bit of a pivot, but you have such unique knowledge from like, taking the health out of it aside, but just from a, like, a feminine perspective, sexuality, etc, like, what was your findings living one way, and then, you know, having lived naturally, having lived before, the reconstruction, having lived afterwards. Is there lessons in there that that are worth sharing.

Nicole 49:20
I'm not certain. In some regards, I'm very matter of fact, kind of it is what it is. Did I like being flat? No, but it was a means to an end, and I got through it. So I felt like I wanted to have the prosthetics so that I could have that femininity. And I'm not, you know, if people ask, I tell them my story, because it can help someone else. There are people around me, family members of friends, who are going through it, have been through it, so we all try to share and encourage one another. Yeah, and I think that's important, because if you're scared, you're looking for resources to be re. Structured, and if I can provide that to someone I want to. But

Scott Benner 50:04
you were aware? You keep saying flat it strikes me oddly, but it's your word, so I'm gonna go with it. So with that flat time, were you aware, dressed, going out in the morning, like, did it strike you like, I wish this isn't how I looked? Or did it make you feel any sort of a way? Did you feel like people noticed or that somebody wouldn't be I don't even know if this matters, but somebody wouldn't feel the same way about you when they saw you. I'm really interested in how that, how that made you feel.

Nicole 50:31
I didn't want to go out without anything. I didn't go outside flat. Okay? My insurance, I have some pretty decent insurance, and they had a contract with Nordstrom. And so you go to Nordstrom and you get it fitted for your prosthetic, okay? And so they get you bras and try on a couple of sizes, and you like what you like, and then they send that home, and then they make a pocket with the bras, for the prosthesis to go in there. So, you know, it's a few weeks deal. I took the time to do that. Some people are okay without. I think that's part of who I am as a woman. So, yeah, I was, it was important for me to have that in the gap. My

Scott Benner 51:17
last question is, did you do the tattoo for the nipple, or was that not necessary? Or did you opt out of it? I

Nicole 51:23
have not done anything yet. It's been a full year since I got my implants, and so I'm, I guess, waiting for the scars to fade a little bit more. But I want to do the tattoo. I don't want to do the reconstructed

Scott Benner 51:38
nipples. Okay? And will that be covered by insurance?

Nicole 51:41
Technically, no, yes, and no, it has to be a certain amount, and it by the time you pay for it, they're gonna pay so little, but everything else was covered,

Scott Benner 51:52
right? Well, that's something. How long do you think until you do that?

Nicole 51:56
I don't know. I'm not in a rush. It's not a big deal.

Scott Benner 51:59
Gotcha. Okay, that's actually next year though. I got you so you're not in a rush, but you're doing it. Yeah? I'm gonna do it absolutely. Yeah. Well, I appreciate you sharing that. That's just not information a lot of people have to share. So I appreciate that. Is there anything that we haven't talked about that we should have?

Nicole 52:15
I don't think so. I just it was a wacky way to get to where I am. There has been I asked you, early on, had you heard of anyone else who had a similar situation to mine, and you didn't remember someone else, one of the group experts might have been Nico or Sylvia, came in and said, Well, yeah, and I listened to an episode that you recorded with another woman with a similar story, and while it is not prevalent, we are out there. Yeah, you know, I'm fortunate. I guess the medications help so many things. So what's the what's the takeaway your life, or diabetes?

Scott Benner 52:58
In retrospect, now, if somebody would have said, You look, here's the medication, you're gonna have. Medication you're gonna have to take for the cancer. It's gonna give you type one diabetes, but you're gonna be alive, you would immediately say, Oh, okay. Like, yeah, let's do that. But as it's happening to you, slowly, it feels like it's happening to you right, like this went wrong, and then this went wrong, and this went wrong, and then this one, I mean, you had four things go wrong in pretty short order, as far as I can tell, like you got cancer, you you know, chemo that probably destroyed your thyroid function, then somebody tells you have type two diabetes? No, no, it's not type two diabetes. It's type one diabetes. That's four things, pretty, pretty rapid fire happening to you, absolutely. Yeah, yeah, aside of all the other stuff that we're not talking about, which is you have a job and a child and things you enjoy doing that probably got ignored for a long time while you were were making your way through this and just generally feeling terrible. You know, people don't talk about it very much, but like chemo did. Did you get the bone pain from the chemo?

Nicole 53:56
No, no, I did not. They give you a couple of things like this 24 hour patch or something. I think it's called New last. And there's things that they give you to take so that you won't perhaps be plagued by it. But I didn't have a whole lot of

Scott Benner 54:15
that. Did you get that, that follow up medication after chemo that comes in an Omnipod?

Nicole 54:19
Yes, I think that's what the new last Yeah, right. I remember my

Scott Benner 54:24
mom called me. She's like, I'm wearing a pod, just like, Arden. I was like,

Nicole 54:28
All right, I don't remember it being as big, but it might have been, yeah,

Scott Benner 54:32
it's made by insulin. I don't know that it's the exact Yeah, that's an insult. That's the other thing they make, actually, is, is for that medication, that's a delivery system. Did you get restless leg syndrome? No, no, that's great. It's great that it worked well for you. Like that. My mom probably had restless leg before, but it got significantly worse

Nicole 54:52
afterwards. And I didn't have much. I didn't really have any neuropathy. Sometimes I have in my right arm, like. My index finger and my thumb, I have a little tingling, but I haven't like determined what that is. I don't have any other after effects other than creaky joints, but I say some of that is age, and my chiropractor and my acupuncture doctor have helped tremendously, and I'm feeling a whole lot better lately.

Scott Benner 55:23
It's awesome. Hey, listen, we didn't I didn't ask you, we? I almost said we, like, there's a group of people over here that failed to ask this question, but the chameleons, I didn't ask you. Is there any autoimmune in your family? Or do you think this is all generated by the chemotherapy?

Nicole 55:37
I personally think it's generated by the chemo. My great grandmother, my mother, remembers a little something with her blood sugar dropping when she was older. They had moved her here to Chicago, so it was maybe, you know, maybe the end of her life. I'm not sure how old she was, but they remember that her shaking and having to have something sweet, but they don't recall, like, being a full on diabetic, and she was elderly, so hard to know. I don't know if it was really

Scott Benner 56:08
diabetes, other thyroid with people in your family, no. So just uh, some bad luck. Then, okay, yay, yay. Bad luck. Your story is makes me feel good, because the way you're talking about it, the attitude that you bring to it, the effort that you put into it, it makes me feel like other people could do that as well. And that's what I need here on my end, is I need the hope that people are out there fighting for themselves the way you are.

Nicole 56:35
I think that they are. I think fear is a is a motivator, good and bad. Some people let fear stop them from moving forward, and some people take it as motivation to move forward.

Scott Benner 56:48
Yeah, I think it's an interesting position to be in the one I'm in, where I don't know who I'm talking to when I'm speaking. I feel like it's very important to say I know that everybody doesn't respond the same way to something at the same time, I don't think that it helps anybody not to say what you just said, which is, you know, sometimes people are faced with something and they rise up, and sometimes they don't, but if there's a pathway to rising up, I think we should share it with everybody so that as many people as possible can take advantage of the idea that you don't have to give up and give in. You don't have to take the first thing it said to you, you're not brittle because somebody told you you were, and everything else in between. It's important to keep educating yourself and keep demanding help, not letting people just draw a line on a piece of paper and go, Okay, we will. We give up on this one because they're, I mean, brittle is the one that's sticking out from my, you know, from your conversation. I mean, you could have heard that and crumbled and just stayed there. Can you imagine you'd be living right now with your blood sugar bouncing all over the place like it was, like, still, yeah, that could have happened. It, because it does happen to people. It could have happened to you. So anyway, I want everybody to take, take Nicole's energy and go throw it at whatever is trying to get you today. Absolutely. Yeah. Where do you think you got that from? Is it? Do you think it's upbringing, just how you're wired? Do you have any idea? Did you go through something hard that taught you how to be hard back?

Nicole 58:12
No, my mom, my dad, and some religious upbringing, but yeah, it's been

Scott Benner 58:19
good. Just kind of how you react. So you react to other things the same way I do. You do. Okay,

Nicole 58:25
all right, this is awesome. I've heard that one thing that you said, it was something about you. You come out a winner most times,

Scott Benner 58:34
yes, yes, I have said that. But it's different when you hear somebody say it back to you, though

Nicole 58:41
you might say it in a slightly different way, but first time I heard somebody say that, I was like, that's not true. You don't know what you're talking about. You do too, and so it's not a bad thing, but I'm very grateful for it. Yeah,

Scott Benner 58:53
I really do believe that when I try, most times, things go pretty well. You can philosophize about it and go deeper and say, I think I'm making reasonably good decisions along the way, and that's why things are going well. But I also think that just doing things, you know, moving forward is success, and it can be easy to look at the things that went wrong along the way and say, everything's out to get me. I can't win like, you know, whatever would come with that. And I have plenty of those things, if I chose to focus on them right now, and listed a ton of my failures for you, you could easily make the case that, like, look, this guy just fails at everything, but, like, it's not the case. And I think it's as simple as that. When I was growing up, I know we don't think of people making money as successful anymore. Everybody's mad at everybody who has, you know, made a million dollars. But when I was growing up, like, that was the that's the line, that was the Mendoza line, like, if I'm gonna win in life, I have to make a million dollars. Like, that's I was poor, and that's how it occurred to me. And I heard somebody say one time that they, I think they started three businesses and bankrupted each. One of them before they made a success, and now they made a million dollars. This is back in the 80s. And I was like, oh, like, so the person tried something and failed, and didn't just go, Okay, I'm a failure. They tried it again. It went bad again and again. It went bad a third time, and they still kept fighting and and that struck me back then, even as, like an early person in my early 20s, like the failures, just data in right and even the trying is moving forward. Even if you try and fail and try and fail, you still learn something along the way. Absolutely, yeah, 20 years later, I watched one of my kids, you know, working out for all star baseball or softball. I forget which team it was. And every year the kids would get these practice shirts because they practiced every day. So they get, they give them all these T shirts to practice in, so that you can keep them laundered, and they get a saying on the back of them. And I think one year it was, we never lose, we either try and we win or we fail and we learn, or something like that. It was, like, this long saying on the everyone else's sayings were so nice and, like, short, but that they had the, like, a book on the back of their shirt one year. And I thought, that's what those that's what that rich guy was telling me on the, you know, 20 years ago. He was like, Hey, listen, it's you're alive anyway, you might as well try. You know, I mean, like you're gonna get up anyway, you're gonna live a whole day. You might as well put some effort into it and see where it gets you. That's kind of how I think about it.

Nicole 1:01:29
So, yep, yeah, Andy, I was taught nothing beats a failure, but a try,

Scott Benner 1:01:33
really, that's simple. Gotta try. That would have been nicer on the back of that shirt. I don't know where you were that day, but, uh, that shirt was wordy,

Nicole 1:01:48
but it had impact. So that's all that matters. I

Scott Benner 1:01:50
think the next year just said down and dirty. So somebody gave up. They were like, Oh, we wrote a book last year. Let's keep it simple this year. Oh my gosh. Also, while, while we're talking about this at the very end, I'm gonna throw out there that Erica's daughter made all star softball this year, and I hope it went well. So if anybody knows Erica from some of the mental health stuff, her daughter's out there playing softball this summer, and I haven't checked in with her, but I'm going to All right, I'm not going to ask you why you think deep dish pizza is pizza, because that's reductive. We all know it isn't.

Nicole 1:02:23
I don't eat deep dish pizza. I have diabetes. I don't have the hang of that

Scott Benner 1:02:29
yet. You haven't figured that one out. No, no, all right. Well, come to come to New York or Philly or something, you can have a nice, you know, thin slice of pizza. It's pretty easy to Bolus for all right, Nicole, thank you so much for doing this with me. Will you hold Will you hold on one second? Please? I will thank you.

Head now to tandem diabetes.com/juicebox and check out today's sponsor tandem diabetes care. I think you're going to find exactly what you're looking for at that link, including a way to sign up and get started with the tandem Moby system. A huge thanks to us, med for sponsoring this episode of The Juicebox podcast. Don't forget us, med.com/juicebox, this is where we get our diabetes supplies from. You can as well, use the link or call 888-721-1514, use the link or call the number get your free benefits check so that you can start getting your diabetes supplies the way we do from us. Med. Dexcom sponsored this episode of The Juicebox podcast. Learn more about the Dexcom g7 at my link, dexcom.com/juicebox, I can't thank you enough for listening. Please make sure you're subscribed or following in your audio app. I'll be back tomorrow with another episode of The Juicebox podcast. Hey kids, listen up. You've made it to the end of the podcast. You must have enjoyed it. You know what else you might enjoy? The private Facebook group for the Juicebox podcast. I know you're thinking, uh, Facebook, Scott, please, but no, beautiful group, wonderful people, a fantastic community. Juicebox podcast. Type one diabetes on Facebook, of course, if you have type two, are you touched by diabetes in any way? You're absolutely welcome. It's a private group, so you'll have to answer a couple of questions before you come in. We make sure you're not a bot or an evildoer. Then you're on your way. You'll be part of the family. If you're looking to meet other people living with type one diabetes, head over to Juicebox podcast.com/juice, cruise, because next June, that's right. 2026 June, 21 the second juice Cruise is happening on the celebrity beyond cruise ship. It's a seven night trip going to the Caribbean. We're going to be visiting Miami, Coco, K, st, Thomas and St Kitts, the Virgin Islands. You're gonna love the Virgin Islands. Sail with Scott the Juicebox community on a week long voyage. Building. For people and families living with type one diabetes, enjoy tropical luxury, practical education and judgment free atmosphere. Perfect day at Coco Bay St, Kitts st, Thomas five interactive workshops with me and surprise guests on type one hacks and tech, mental health, mindfulness, nutrition exercise, personal growth and professional development, support groups and wellness discussions tailored for life with type one and celebrities, world class amenities, dining and entertainment. This is open from every age you know, newborn to 99 I don't care how old you are. Come out. Check us out. You can view state rooms and prices at Juicebox podcast.com/juice cruise. The last juice cruise just happened a couple weeks ago. 100 of you came. It was awesome. We're looking to make it even bigger this year. I hope you can check it out. The episode you just heard was professionally edited by wrong way recording, wrong wayrecording.com.

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Tara, 54, misdiagnosed as type 2 before her type 1 diagnosis, shares her journey with Monjaro, parenting two daughters, and life as an older parent.

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

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

Tara 0:14
My name is Tara, and I am a type one diabetic,

Scott Benner 0:21
if you're looking to meet other people living with type one diabetes, head over to Juicebox podcast.com/juice, cruise, because next June, that's right, 2026 June, 21 the second juice Cruise is happening on the celebrity beyond cruise ship. It's a seven night trip going to the Caribbean. We're going to be visiting Miami, Coco K, st, Thomas and st, Kitts, yeah, the Virgin Islands. You're gonna love the Virgin Islands. Sail with Scott in the Juicebox community on a week long voyage built for people and families living with type one diabetes. Enjoy tropical luxury, practical education and judgment, free atmosphere. Perfect day at Coco Bay St, Kitts st, Thomas five interactive workshops with me and surprise guests on type one, hacks and tech, mental health, mindfulness, nutrition exercise, personal growth and professional development, support groups and wellness discussions tailored for life with type one and celebrities, world class amenities, dining and entertainment. This is open from every age you know, newborn to 99 I don't care how old you are. Come out. Check us out. You can view state rooms and prices at Juicebox podcast.com/juice cruise. The last juice cruise just happened a couple weeks ago. 100 of you came. It was awesome. We're looking to make it even bigger this year. I hope you can check it out. Please don't forget that nothing you hear on the Juicebox podcast should be considered advice medical or otherwise, always consult a physician before making any changes to your healthcare plan or becoming bold with insulin. Today's episode of The Juicebox podcast is sponsored by the ever since 365 the one year where CGM that's one insertion a year, that's it. And here's a little bonus for you. How about there's no limit on how many friends and family you can share your data with with the ever since now app, no limits. Ever since the episode you're listening to is sponsored by us med. Us med.com/juicebox, or call 888-721-1514, you can get your diabetes testing supplies the same way we do from us. Med, this episode is brought to you by Omnipod. Would you ever buy a car without test driving it first? That's a big risk to take on a pretty large investment, you wouldn't do that, right? So why would you do it? When it comes to choosing an insulin pump, most pumps come with a four year lock in period through the DME channel, and you don't even get to try it first. But not Omnipod five. Omnipod five is available exclusively through the pharmacy, which means it doesn't come with a typical four year DME lock in period, plus, you can get started with a free 30 day trial to be sure it's the right choice for you or your family. My daughter has been wearing an Omnipod every day for 17 years. Are you ready to give Omnipod five a try? Request your free Starter Kit today at my link, omnipod.com/juicebox Terms and Conditions apply. Eligibility may vary. Full terms and conditions can be found at omnipod.com/juicebox find my link in the show notes of this podcast player, or at Juicebox podcast.com

Tara 3:35
my name is Tara, and I am a type one diabetic. Tara. How old are you? I am 5353

Scott Benner 3:44
and you were diagnosed 54 Oh, I turned 54 on Saturday last week. Oh, happy birthday. Thank you. It doesn't feel good. I was happy to be alive, but that was about the extent of it, and I did it at friends for life. The extent of my birthday celebration was my wife took me to dinner Saturday night, but we had to fly the next morning, so it was like, we went to dinner, like, went back to the room, and, like, at eight o'clock we were like, Okay, well, good night. Super exciting. The girl that was helping us with our room, because we had a room key problem when we got there, and she brought me a balloon and a Mickey Mouse rice krispie treat. So for my 54th birthday, I got dinner early bed, a rice krispie treat and a balloon that was deflated in the morning when I woke up. What are you hoping to get? I'm not

Tara 4:33
really hoping for anything. There's really nothing that I want we but I know the feeling of spending your birthday in Disney because I've done that with my kids. Probably had like, their first 15 birthdays in Disney. Yep,

Scott Benner 4:46
really, oh, I this was just completely random that it happened to me. I'd never even been to friends for life before. I really want to go. I'm hoping next year. Oh, awesome. Yeah. I It was a fantastic experience. I don't think I've been to Disney. Since Arden was, I don't know, maybe five or six. I'm not even sure, like, but she turned 21 yesterday, so that it's been a while, is what I'm saying. But the heat, my goodness, and the humidity and, like, I don't know how you people are living in Florida like that, without a pool. If there's not a pool near you, you're in trouble, is what I learned. Yep, yeah. So you were diagnosed when? How

Speaker 1 5:23
old it was, just two years ago. No kidding, yes, any diabetes in the family? Yes. The

Tara 5:30
first one I remember is my grandmother, my mother's mother. It was never really talked about what type diabetic she was. I'm assuming she was type one. She was on insulin. And you know, back in those days, you lived with your grandparents, that we lived in the same house as my grandparents, so we saw her doing her injections. We always had to hear about she had her doctor appointment in a week, so she just stopped eating carbs completely before her doctor's

Scott Benner 5:57
appointment. That's how she got her a 1c that's how she got,

Tara 6:01
I don't even know if there was an A 1c back then, but that's how she passed her appointments. No kidding, I'll never forget his name because she talked about

Scott Benner 6:10
all the time. Dr dressed says this. Dr dressed like that. How was her health? Overall? Very poor health. Dr dressed not the end all, be all.

Tara 6:20
No, he wasn't such a great doctor. She had other health care. I mean, I'm sure they all came somehow, from diabetes. She had multiple heart attacks, multiple strokes. Ultimately, she died from a stroke where she was in a coma. And my grandfather, God bless him, he kept her on life support with private nurses for over eight months, wow, which was a really terrible thing looking back on it now, but he somehow thought that, you know, there was a chance to pop back up.

Speaker 1 6:51
Yeah. How old was she? Do you think she was 64 when she died? Wow, that's

Scott Benner 6:55
so young. Yeah. My grandmother died at 73 and I remember that feeling young, because she was and she, you know, it's funny as I this is apropos of nothing, because I'm adopted. I now realize my grandmother had type two diabetes, and just they, no one talked about it. It was just like, it was a thing, but she looked so healthy because she was so active, and then, yeah, then she had a stroke and she died. So it's interesting how, how, how things can sneak up on you. Yep. So how about the rest of the family? Is there type one in amongst, like extended family, or anything like that? Well, a

Tara 7:33
cousin, son on my father's side, who was diagnosed with type one. He was very young when he was diagnosed. There is some type two, there is rheumatoid arthritis, there is celiac there's a whole bunch of thyroid. My mother had type two, and she also was being treated

Scott Benner 7:51
for her thyroid. How about you anything else besides the type one?

Speaker 1 7:54
So far, nothing. Thank God. Yeah, I hope, I hope it stays that way. Yep,

Scott Benner 8:00
I realized that I joke around about stuff like that so much I thought I said to myself, I'm like, maybe you should start saying, I hope it stays that way, instead of like, not yet. Oh, well, I'm glad for you. That's the one thing. So you're diagnosed a couple years ago. How does it present? I mean, I'm hearing it's not a ton in your family. So it's not like you were running around thinking, I think it's coming for me. I also don't think people in their 50s think they're getting type one diabetes, usually

Tara 8:23
no. Well, I was diagnosed with gestational diabetes my second pregnancy, so I was put on medication for that. But now looking back on my first pregnancy, I definitely think that I had diabetes, gestational diabetes, type one or type two, any sort of diabetes during my first pregnancy.

Scott Benner 8:43
Okay, they knew about it in your second pregnancy, but your Hindsight is telling you you probably had it both times.

Tara 8:49
Yeah, they told me that I was borderline on that, you know, the sugar test that you do when you're pregnant. But I gained almost 80 pounds, and I was, like, always, always on the thin side. And I was almost 200 pounds when I had my daughter, who was over nine pounds, and we had a problem with, you know, during childbirth, and she wound up with shoulder dystocia and herbs palsy.

Scott Benner 9:16
No kidding, what's the what's the palsy? What is that?

Tara 9:20
Well, from what they told me, and I don't really know, because she finished all of her physical therapy and all that so long ago that while I was delivering, her shoulder was caught, and I guess there was like muscle damage or nerve damage, or it,

Scott Benner 9:34
is that a thing that's been taken care of? It? Does she suffer from it at this point? Or is it,

Tara 9:39
I could still notice it. I don't think that she notices it anymore, but I still notice, like, mostly in her hand, the way her hands move. I could see that she doesn't have full range of motion in her hand, but she doesn't know it. I guess she just deals with it at this point. Interesting. Also,

Scott Benner 9:55
you said her shoulder got caught on something, and my brain was like, caught on what? Oh, my god, yeah. I know how you ladies get through life. That's terrible. What you just said was just so scary, like her shoulder got caught on something. Oh, okay, so second baby, they give you insulin for that.

Tara 10:14
Second baby, no insulin. I went to a new OB GYN for my second pregnancy and told him the whole experience, and right away, he said, I'm just going to assume that you have gestational diabetes, and we're going to start you on medication right away. And he started me on it was oral medication. I think it might have been like gliburide,

Speaker 1 10:34
okay, yeah. So how long ago did you have those kids? Well,

Tara 10:38
the oldest one is 21 she'll be 22 next month, and the younger one will be 20 next month. Oh,

Scott Benner 10:45
nice girls, both two. Girls, yep. Girls, congratulations. That's lovely, cool. Okay, they don't have any autoimmune stuff or type one so far, no nothing. So then back to you being pretty surprised when you're diagnosed. So how did it get to you, what did you notice first that, I guess, made you feel like, Oh, I've I was going through this when I was pregnant. But what were the signs?

Tara 11:07
Well, after the second one, a couple of years after I went to the doctor, and he just, he threw in the A, 1c, and it was a little high. So he said, Oh, we're just gonna watch it anyway. Long story short, I was eventually diagnosed, they told me type two, but I was put on insulin. Okay.

Scott Benner 11:25
Oh, right away, right away. I like that. We're just gonna watch it. That's code for you're gonna get diabetes one day. We don't want to miss it. Did you know that at the time?

Tara 11:34
I kind of figured it, and I kind of, I don't know. I always knew. And I look back now and I think about when I was young, very young, like, you know, less than 10 years old, I had some health issues that I look at now, and I'm like, nobody ever thought to test me for anything like what I was really, really underweight. The whole time I was in grade school that I was on some medication. I have no idea what it was called, but I could still smell it when I think about it, just to help me gain weight as I got older, there were a few instances, especially in when I was in college, that I would just faint, like, for no reason at

Scott Benner 12:12
all. Like, do you think low blood sugar now, when you look back, I think

Tara 12:16
now that probably is what it was, but my mom took me to a doctor who was a little?

Speaker 1 12:22
I want to be nice. He was, I can't wait to hear what you're gonna say. He was a little. What he was a little?

Tara 12:29
I don't know if he really should have been a doctor, like he would sit behind his desk and smoke in

Speaker 1 12:33
his office. I thought you were gonna say stupid, but well, maybe a

Tara 12:38
little stupid to anything that you had was cured with, like, cough syrup with codeine in it. That was, like, his go to

Scott Benner 12:45
for everything. My back hurts here. Get high on this cough syrup. You'll be fine.

Tara 12:49
Yeah. So he told my mom, and I, like, the reason I was fainting was because I was having panic attacks, and I was having a lot of stress while I was in college, but I had not a care in the world. Did you

Scott Benner 13:01
speak up? Do you remember going, that's not the case. Yeah. And he

Tara 13:05
was just like, No, this is what's happening, you know? So I always kind of knew that something was not

Speaker 1 13:11
right. And then he gave you codeine. He's like, here, this will calm you down.

Scott Benner 13:18
This will help. First Doctor in history 20 years ago is like, if you tried weed, I think you're just

Tara 13:23
upset. No, no, he didn't. He didn't offer that just, just the code. No kidding,

Scott Benner 13:27
how much of that cough syrup Do you think? What do they call it? By the way, when they make drinks out of cough syrup? I can't think of it now. Oh, I don't know. I'll figure that part out. Don't worry. So that was another thing. Was there more than that? Or

Tara 13:39
no, then the gestational diabetes, and I don't know, and after I had my kids, I really just never felt right. And even with like, the being on insulin and that endocrinologist had made just like on a sliding scale and no corrections, no carb counting, nothing like that, just take the insulin three times a day, and this is, you know, test your blood sugar before. This is a sliding scale, and even now that, well, I have a pump now, but I think about it seemed like so much insulin that I can't believe I wasn't, you know, having low blood sugar all the time. But I guess I needed it because you

Scott Benner 14:15
were type one, yeah, was that like a very slow onset, or did you need the amount you needed right up front. It always stayed there. I have always disliked ordering diabetes supplies. I'm guessing you have as well. It hasn't been a problem for us for the last few years, though, because we began using us Med, you can too us med.com/juicebox, or call 888-721-1514, to get your free benefits. Check us med has served over 1 million people living with diabetes since 1996 they carry everything you need, from CGM to insulin pumps and diabetes testing supplies and more. I'm talking about all the good ones, all your favorites, libre, three. Dexcom, g7 and pumps like Omnipod five, Omnipod tandem, and most recently, the eyelet pump from beta bionics, the stuff you're looking for, they have it at us. Med, 888-721-1514, or go to usmed.com/juicebox, to get started now use my link to support the podcast that's usmed.com/juice box, or call 888-721-1514, this episode of The Juicebox podcast is sponsored by ever since 365 and just as the name says, it lasts for a full year, imagine for a second a CGM with just one sensor placement and one warm up period every year. Imagine a sensor that has exceptional accuracy over that year and is actually the most accurate CGM in the low range that you can get. What if I told you that this sensor had no risk of falling off or being knocked off? That may seem too good to be true, but I'm not even done telling you about it, yet. The Eversense 365 has essentially no compression lows. It features incredibly gentle adhesive for its transmitter. You can take the transmitter off when you don't want to wear your CGM and put it right back on without having to waste the sensor or go through another warm up period. The app works with iOS and Android, even Apple Watch you can manage your diabetes instead of your CGM with the ever since 365 learn more and get started today at ever since cgm.com/juicebox, one year, one CGM, it always stayed there. Okay, that's interesting. When did you get an actual type one diagnosis? Well, I went into DKA

Tara 16:45
and I was in the emergency room, and they said, you know, any diabetes? I said, Yes, I'm type two. And the nurse said she gave me a really funny look, and she said, I think you should be tested for type one. And so I was tested for type one. I'm

Scott Benner 17:01
glad you met somebody who could help you. Yes, seriously. Also, the word I was looking for earlier was scissor. I mean, listen, kids, if you're listening, it's dangerous, and please don't do it. But I think it's kids may use cough syrup that have opioids in them and antihistamines, and they put it with like a soft drink sometimes, or, like, hard candy or something like

Tara 17:23
that. It's not familiar.

Scott Benner 17:26
You were getting prescription scissor. Yes, yep. Where is that guy? Now, I think he passed away. Well, yeah, the Cody stopped his heart eventually, my gosh. So once you know you have type one, can I ask? How do you process that? Like, is it shocking, or did it not? Did you were you just, like, a type two, type one, whatever. I'm using insulin anyway. Like, how does that process hit you?

Tara 17:49
No, it was shocking, very shocking. I don't know. Maybe it shouldn't have been but, yeah, I was really thrown off. I think I still am a

Speaker 1 17:57
little bit, but it is what it is. So how do you think you're thrown off? Still,

Tara 18:02
I have a little bit of anxiety now around anything, any kind of medical issues. I have anxiety about, just like leaving my house without a meter or glucose tablet, so things I didn't, never really thought about before, and now you don't have the cough syrup anymore, I don't know, so I can't use that to calm me down. Great.

Scott Benner 18:21
You finally, my God, can you imagine the guy, if he was here, he'd be like, I know it. So you have some anxiety around it. Now, why are you afraid of getting low in public, or afraid of getting low,

Tara 18:30
complete at all. I think just in general, yeah, yeah, you just don't. Has it happened? Not like a severe low, but, you know, I have my alarm set at like 80 so I can just keep an eye and see if I need to treat it a little bit earlier.

Scott Benner 18:46
And you don't want to be in a dire situation where you can't get help. Like, are you afraid that it's going to get progress to a bigger problem? You'll have a seizure, you'll die, or you just don't want to be a burden on people, or you don't want to be seen that way. Do you have any idea what part of it makes you

Tara 19:03
That's all of it, and I also just, I never want to have to be so low or so high, or in any kind of a medical situation where I would have to have other people really worrying about me, because

Scott Benner 19:15
you don't want them to worry about you, because you think they won't be able to help

Tara 19:19
you. No, I don't. I know that they could help me. I just don't want them to worry.

Scott Benner 19:23
Okay, it's funny. I worry that they can't help. That's interesting. So are you doing anything for that? Like, you know, being serious? Are you, like, seeing a therapist or, like, have you done anything to try

Tara 19:34
to impact it? No, but I probably should. But no, is

Scott Benner 19:37
it hurting your lifestyle? No,

Tara 19:40
no, it doesn't. It doesn't keep me from doing anything. It's just always on my mind,

Scott Benner 19:44
always on your mind. So do you pack a ton of stuff when you go out?

Tara 19:47
I do? I have this giant bag, the diaper bag. It's as big as a diaper bag. And it's funny, because I'm always getting compliments on it, and I find myself explaining, like, oh, I only use this bag because I have this much stuff to get.

Scott Benner 20:00
Are you? I have a small pharmacy in here. Case you're wondering, do you need to change your CGM six times, because I have seven of them in here, and even on short trips. Do I take short trips? No, like, I mean, like, grocery store and back? Is that bad coming with you? Oh, yeah, yep. Everywhere. Were you anxious prior to this? A huge thanks to my longest sponsor, Omnipod. Check out the Omnipod five now with my link, omnipod.com/juicebox you may be eligible for a free starter kit, a free Omnipod five starter kit at my link, go check it out. Omnipod.com/juicebox Terms and Conditions apply. Full terms and conditions can be found at omnipod.com/juicebox,

Tara 20:47
I would not have considered myself anxious, and I don't think anybody that knows me would consider me an anxious person either. It's really only that small piece that I worry

Speaker 1 20:57
about. Are you married? I am. Yep. Has he noticed a difference?

Tara 21:01
Yeah, he probably does. I mean, just recently, we took a long vacation, about two weeks, and I switched my pump. I used the tea slim pump, but I used Omnipod while we were on the trip, because I didn't want to worry about the tube and disconnecting when, you know, for the pool and beach and all that. And when we got back, he said, You seem so much happier with the Omnipod. Oh, how come he said that I looked like I wasn't worried that much, and I maybe like, out of sight, out of mind, and the tube wasn't around, like to remind me to be checking.

Scott Benner 21:34
Okay, well, omnipod.com/juicebox. If you guys want to try it out, and if you think she's wrong and you want to use the Medtronic, that's Medtronic diabetes.com/juicebox. Links are in the show notes. Links at Juicebox podcast.com. How are you with your management like is, do you have things where you want them to be, or are you still on them in an adjustment period?

Tara 21:55
Things are pretty good. My, my, A, one, CS right now are in the sixes. So I guess that's pretty good. When I was still considered to be type two, they were always in the eights. Well, you

Scott Benner 22:08
weren't using basal, right? Or no, no. Well, listen that. That's good news for Medtronic and for Omnipod, you're keeping in the sixes, random or No, tandem, excuse me, so many sponsors, and I hear you out there. If you're like, I know Scott, it's good for tandem or for Omnipod, because right now you're like, look, I keep a six. Doesn't matter which pump I put on. Is that about, right? Yeah, yeah. That's awesome. So you so it is about like, for you, it's about your settings and the things you do. Yes. What do you think you do that keeps your a 1c in the sixes, I still

Tara 22:41
eat pretty much whatever I would whatever I want, which is very important, because I like food and I love to eat. So I try to as much as, as much as I can, try not to think too much about what I'm having or what I'm eating. Sometimes you have to, but most of the time I don't. I really think it's just the settings.

Scott Benner 23:01
Yeah, you just have good you have good settings. You Pre-Bolus. Your meals. I do, all right, you get a high blood sugar. You wait three hours to fix it, or you fix it sooner.

Tara 23:11
Nope. 160 I start correcting. You start correcting.

Scott Benner 23:15
So basically, just, like basic concept stuff, yes, yeah, what allows you to be focused on it. Meaning, like, you know, a lot of people say, like, oh, I don't want to pre balls takes forever, or, like, that kind of stuff. Like, how have you prior been able to prioritize it?

Tara 23:30
Now it just seems like second nature when I when I first heard about, which I think was the podcast where I first heard about pre bulls thing, I just decided I'm gonna do it, and I've always done it. So have you

Scott Benner 23:42
been like that about other things in your life? Yep. Okay, so this follows your personality. Then, yeah, yep. Very much. The room is clean right now. Yes, there's no shoes on the floor.

Tara 23:54
There might be a pair of shoes on the floor. They're my husband's

Scott Benner 23:58
not yours, though. My God, no, not this guy that you're generous enough to allow to live in your house. It's making a mess of everything. I see. Any people in your life, like, friends? Have you ever? Have you met people with diabetes? You mentioned, I think it was before, in the beginning about, like, wanting to go to friends for life. So like, are you looking for that kind of, like, in person community?

Tara 24:18
I think so, because I don't really know anyone, especially with type one diabetes. I don't know anyone with type one diabetes. I think it would be nice to have someone to talk to, or someone to, you know, bounce ideas off of not that I can't with my husband and my kids, because I do, and they're very open to it. But I think it's different having someone who knows exactly what you're thinking about and why you're thinking about it?

Speaker 1 24:45
Yeah, more practical, less academic. Yeah, I see okay. What made you want to come on the podcast?

Tara 24:51
I've been listening since I was diagnosed type one for the past two years, and it was actually my daughters who were like, You should go on the podcast. Cast. So

Scott Benner 25:02
did they tell you? Why did they say there's like, a reason in their head? Do you think or

Tara 25:07
I did X and Y? I was like, I have nothing to say that anybody would be interested in the area. And they were like, Yeah, you do. You're funny. You would have, you would tell a good story.

Scott Benner 25:16
All right. Well, let's work on thinking of what that good story is going to be. Yeah, I don't know. Well, you know it's gonna happen. Much to their chagrin, it's gonna be a story about them. They're gonna be like, I didn't want you to tell that one. You mentioned your weight earlier. So first pregnancy you gained. I mean, am I right to say you went from 120 to 200 pounds? Yep. How tall? How? What's your frame? I'm about five, six, okay, but still 120 was probably like a great weight for you. I'm imagining, yeah, yeah. Does that weight come back off after the baby

Tara 25:50
all of it did not. And my my mother, I used to be so sad about it. My mother would tell me, you know, it takes takes nine months to gain it takes nine months to lose it. But that nine months came and went and

Scott Benner 26:02
like this lady's full of, I wonder what else she's been lying to me about. I mean, are you comfortable telling me, like, how much of it still existed when your second pregnancy began?

Tara 26:16
I was probably up to still about 150 when I had my second when I went into my second pregnancy. And with that pregnancy, I only gained 23 pounds.

Scott Benner 26:27
Okay, so then it comes back off after that one, or

Tara 26:31
pretty easily, came back off after the second

Scott Benner 26:34
one. Interesting, back to 120 never back to 120

Tara 26:37
but I would say like in the 130s

Scott Benner 26:39
Oh, I mean, listen, that's pretty awesome, because I'm asking, because I'm trying to figure out, like, your little intake form here, like you're using Manjaro, but it was given to you for type one. Is that correct? Yes. So how does that happen? Like, if you're, I mean, you're only two years into this, I guess you're diagnosed into the GLP phase, or, I was gonna, I meant to say craze, craze or phase. I guess either works. But does the doctor suggest it to you? Do you suggest it? How does that come up, if your weights not

Tara 27:07
my? Well, my weight at that point was a little bit of an issue, because I had gained like, in the three times that year that I went to the endocrinologist, I had consistently gained like, I guess, over the course of a year, it was maybe almost 30 pounds that I had gained. Okay, and so she told me in her office, still, she still was believing that I was type two, that I would be a perfect candidate for minjaro. And she took it out. She's like, you want to try it. I had her obviously had heard about it, but I really didn't know what it did or how it worked. And I said, Well, do you know? Do you think it'll help? And she said, Yeah, it'll help. I'll give it to you right now. And she jabbed that pen right into my belly, right there in the office.

Speaker 1 27:54
My gosh, and how long you've been on it? I've

Tara 27:57
been on it since this so I guess about two and a half years now, yeah, and I'm still on the lowest dose, 2.5

Scott Benner 28:03
really, you never because you're not there. You're not using it for weight.

Speaker 1 28:07
No, not using it for weight. Did you lose weight? I did back to

Scott Benner 28:11
bring you back to the 130 back to the 120 Oh, no kidding. How about that? And do you find that it impacts your appetite.

Tara 28:21
In the beginning, it definitely did, without a doubt, there were times where I wouldn't even think about eating, but you know, you have to. There were times I would be making dinner, you know, for my family and like forcing myself to eat. But now it is no impact on my appetite at all, but it's still

Scott Benner 28:41
impacting your blood sugar. It is, yep. So I want to know more about that, but first I want to tell you that I was at an event this weekend, myself, my wife, 10 or 12 other adults, people we hadn't seen in a while, like, you know, a mix of folks, and we're sitting down, and someone just looks at me and goes, so I feel like, I have to say, You look like a completely different person. And I was like, yeah, like, you know, I've lost like, about 70, almost 70 pounds. Now. Said, How'd you do it? And I was like, Well, I did it through GLP medications. I've been using them for about two years, and that made somebody else comfortable. Like, it's I realized, because my wife's lost weight too. Like, I realized that, like, they thought it of both of us, but were comfortable asking me, but not asking my wife, which was interesting, right? And so then that, like, opened it up to like, and Kelly, you look great. And Kelly's like, Oh, I lost this much weight. I also did glps, blah, blah, we're talking about the person who asked, just goes, I'm using it too. And I was like, Oh, cool. And then her husband goes, me too. And I was like, Okay. And then I looked around the room. I was like, anyone else? Yes, someone goes, I use it for type two diabetes. I was like, so five of the 12 people here are using a GLP medication. I was like, that's crazy, you know, and everybody in a different way. Our insurance covers it. We're lucky, right? The other two people, one woman's like, using it for, you know, an air quotes problem was how she was able to get it through her insurance. One of the guys was, like, you know, my insurance covers for type two. One guy's like, I use it for weight. It was really interesting because then I sat back, because people tell me, I talk about too much. I don't know. Like, I think it's kind of amazing, I really do. But I thought, let me just hear what everybody else thinks. And then I listened for a half an hour while three other people told me how amazing it was for them. Yeah, they said everything I was going to say. And I was like, wow, it's their exact same experience. Like, they've had the exact same experience. So I want to know about yours. Like, take me to the beginning, like, she jams you with that, with the needle right there in the office. Yep. And when does it hit you? Like, do you know, in days? This is a difference maker. Does it take the next injection? How does it

Tara 31:05
it was hours. I'm not even kidding you, it was, it was hours. My endocrinologist at that point was in I used to live in this in New York City, so she was in one of the boroughs, but then I moved up to the Hudson Valley in New York, which is where I am now. Yeah, so I was still driving, like that hour and a half drive to go to the endocrinologist, because I hadn't really found anyone up here, and it would I was with her for a while, and I knew her, I trusted her, by the time I got home from that appointment. So I drove an hour and a half home. I was going to make myself some lunch, and I made a little like a piece of toast with some jelly on it, because I knew that I didn't have an appetite that quickly, that quickly, and I couldn't even eat it. I could not eat it.

Scott Benner 31:56
Have you heard me say that I lost like, over nine pounds in the first four days? Yeah,

Tara 31:59
I think that first couple of months was like, that's when I lost all the weight. I'm not really losing weight anymore from it,

Scott Benner 32:05
and you don't have weight to lose this point. No, no, right? What do you think it's doing to your insulin needs? I

Tara 32:13
can tell you from when I first started using basal insulin I was using, it was 38 units, 38 units every night for basal insulin, 38 units every night. Okay, now I am using, I guess my average insulin use on my pump now is like 22 units a day.

Scott Benner 32:37
Hmm, that's total, yep. Jeez, that's so you were using 38 basal, how much Bolus or meal insulin? Do you think you were using

Tara 32:45
Bolus? Well, they had me on a sliding scale, so it was a minimum of eight units,

Scott Benner 32:52
46 units a day, down to 22 and did you find that to be commiserate to your weight? Because there's going to be people who just say, like, well, sure, like, weighs less now she needs less insulin.

Tara 33:03
It started almost right away, before I before I really lost the majority of the weight. So I don't know. I mean, some of it probably has to do with weight, but,

Speaker 1 33:12
yeah, my

Scott Benner 33:13
goodness, isn't that something? Okay, so some of it's got to do with weight. I think just getting rid of the fat, you know, helps you with, like, hormonal stuff, which is probably weight issues too. And of course, you're eating less, so you're using less insulin. I think it's a mix of all that for most people. But

Tara 33:32
yeah, you all. I think now my appetite is back to normal. It has been for probably a year now, so I'm not really eating any less at

Scott Benner 33:41
this point. Gotcha. Gotcha. So if you're not eating any less and you're not gaining weight, then it is helping you in a couple of ways. Then, right? Because you're not, you're not holding the weight, and your insulin needs are almost in half, so it's helping you with insulin resistance, for sure. Yes, yeah, you feel that way. I'm not putting words in your mouth,

Tara 34:01
right? No, I definitely feel that way.

Scott Benner 34:02
That's interesting, isn't it? It really is. It's going to grow in popularity amongst doctors, which is going to get into people's hands. I think that. I think Lily and Novo are going to make, they say they're making a daily pill that's going to work as well as the injection. That'd be crazy if they accomplish that. This whole thing of replacing GLP is, oh, it's insane.

Tara 34:24
I tell everyone how amazing it is. And I actually was just with, I won't mention his name, but I was with one of my brothers. I have a big family, and he was telling me about some health issues that he had, and I said, please ask your doctor. I think you'd be a good candidate for Manjaro or ozempic, please ask your doctor. What was his reply? He said, I would love to do that, but I am afraid that I'm gonna have minjaro face. Yeah. I said, Would you rather lose the weight and have a healthier heart? Heart

Scott Benner 35:01
Yeah. Would you like to have grandmom strokes and heart attacks?

Tara 35:05
Yeah? Well, that's it too. Our mother passed away from a stroke too when she was 62 years old. Oh, hell. So yeah, I think. And there's six of us. I have three sisters and two brothers, and I think we all think about that all the time.

Scott Benner 35:17
Yeah, I bet you. So you're sitting there, he's talking, and you're thinking so alive and skinny face that looks a little like you lost weight or dead? Yes, yeah, I'm gonna go with alive, is what you're thinking. That's where I'm at, by the way, I actually, I have to tell you, I feel pretty lucky. I don't know how I got away with my double chin shrinking the way it did. I mean, it's the closest I've come to believing in God in quite some time. So, like, I'm very grateful that that happened. But the rest of it, I was already, like, built, like, classically, like a guy, like, my legs were already thinner, like the guy don't have a butt, you know what I mean? Like, I didn't have a lot of fat on. My arms were already lean. Or, you know, my chest, the top of my back, like love handles, like, you know, all around the midsection, like, you know, where it happens. And as soon as I started losing weight, I ran out and bought Spanx, like, shirts, the like, like, you know, just because I kept thinking, like, I'm gonna start like, the fats gonna come out, the skin's gonna be extra gravity is gonna grab it, and it's gonna get stretchy. And if I hold it up, maybe I'll get some collagen, like, a little elasticity, like, right? And it really is working. My wife always used to tell me, like, when she was young, she's like, I wear really tight bras because I don't want my boobs to drop as much. And I was like, Is that a thing you heard? And she goes, yeah. And I was like, All right, like, I don't know if that's true or not, but I was like, that's what popped into my head. I'm like, let me just wear, like, a tight shirt every day, like, whether I was going somewhere, I didn't care if somebody was going to see me. Like, I just wore the just wore this thing every day. And I think it really saved me a little bit. So have you seen me? Would you know me before and after

Tara 36:50
visually? No, I think I've just seen you recently.

Scott Benner 36:53
Just know what I look like now. Yeah, if I showed you what I look like like two years ago, you'd be like, Oh, that's insane. And again, I tell people all the time like I did not count myself as a person who ate like, incredibly poorly. And actually, as I look at my day now, I don't think I eat any differently now than I did two years ago. I do eat less most of the time. And you can get full credit to the GLP like, because if you're using Manjaro, I'm I'm using Z bound. It's the same drug I do not like think about being hungry like ever. When I started, one of the craziest things I had to tell people is like, there's an alarm on my phone to remind me to have breakfast. Yeah, yeah. So I don't have to do that anymore, and I actually did wake up hungry this morning.

Tara 37:37
So yeah. And it's weird, because when that feeling of hunger starts to come back, I like, I didn't know what it was. I didn't recognize it. When I first started feeling

Scott Benner 37:48
I know exactly what you're saying. The first time I had

Tara 37:52
it, I was like, Oh, wow, that's what it is. I'm hungry. I need to eat. Yes,

Scott Benner 37:56
you're almost like, worried about yourself for like that happened to me this morning. I swear to you, I opened my eyes and I was like, what's that pain in my stomach? And then I was like, Oh, I'm hungry. And then my first thought was like, Oh, I hope I'm okay. Like, why would I not be okay? You know, I don't know another way to explain it to people, other than it's just awesome. I know it hasn't worked for everybody. I will tell you the biggest thing to look out for, if you have type one, is I think people with insulin resistance are going to see a lot of value from it, and if you have type one, but if you're not a person with insulin resistance, you might take it and not notice anything. Like, I definitely think it's helping people with weight, with hunger, satiety, etc, but if you have insulin resistance, so I mean, like, on top of like, forget your type one. Like, would you have insulin resistance if you weren't type one? Like, I think that's where it helps people a lot. Yeah. But going back to your brother that you were talking to him, I was in a very similar situation again over the weekend. Like, somebody piped up, I don't want to do that cheating, they said. And I was like, Okay, I looked over and I thought, you really are in a situation here with your health, you know, like this, this person, and there's a mixed group of people. There were, like, classically lean people their whole lives there. There was, you know, smokers, there non smokers. People drank. People didn't drink. There was a regular mix of people. This person that spoke up has a fair amount of weight to lose, and his parent had a heart attack in their 50s, and the response was like, it's cheating. And I was like, Well, I mean, I don't know how much time you think we have here on the planet, but like, you're in your 50s, you know what I mean? Like, Ozzy died yesterday at 76 and he was pickled, and he could only make it to 76 76 we maybe have, like, 25 more years here. You know I'm saying, like, let's just, let's just say it is cheating for a second. Let's, I'll give you that. Let me give you your point. Okay, call it cheating. Cheating to stay alive. That doesn't hurt anyone else. Like. I don't have to drink a baby's blood or murder somebody or something, like in a ritual like, I just inject the thing, and the weight comes off, and my fatty liver goes I don't have fatty liver, but your fatty liver goes away. Your heart issues, you know, get better. If you have insulin resistance, it goes away. You're leaning towards type two diabetes. Goes away. Goes away. Go like, what I'm looking for somebody to explain to me why someone would say that you have any

Speaker 1 40:26
idea? I have no idea at all. Yeah, I really can't wrap my head around it.

Scott Benner 40:32
So it's cheating.

Tara 40:34
I mean, I just feel like I've had a good experience, and I, I'm not shy about it. I tell everyone, and I I I tell them that I have had a good experience. Some people are afraid of, not only majority the side effects, but I, I think once, in the very beginning, I had side effects from it, and that was it. I haven't had anything in the whole you know, mostly for the two years. You're

Scott Benner 40:57
not really on a very big dose either, like 2.5 that's the starter dose. What were your side effects when you had

Tara 41:03
them? I had a little bit of vomiting in the beginning. Okay, were you eating too much? Probably not, because I it affected my appetite right away. So probably, maybe I was just eating the wrong things.

Scott Benner 41:15
I met a person. This person was awesome to share this with me. As a type one lost a lot of weight. I see them, like, yearly. I guess last time I saw this person, I was like, Oh, my God, you look awesome. Like, amazing, yeah. GLP is really working. My insulin needs are lower. Look at all the weight I lost. Great. I was like, that's fantastic. I was like, how are you tolerating and he goes, I throw up every day.

Speaker 1 41:40
And I was like, every day,

Scott Benner 41:43
and he laughs, and he goes, Yeah, I'm eating way too much food. And I was like, oh my god, it hasn't stopped your hunger. He goes, not at all. It's like, that's interesting. So it's value. Was there for everything else, right? But it didn't touch their hunger. And I was like, Really, are you sure? Like, I actually said, Is it maybe time to see a therapist? Maybe you're covering for something else here with this, you know, you use the words, I use them on the podcast all the time that I eat through it, and I was like, why? And he goes, I don't love food. I was like, okay, so I'd stop. If I was you, I would tell you that I'm not good with, like, oily foods. Like, I cut a lot of oil out of my life number of years before glps. I'm not good with oil to begin with. But, like, I can't deep fried stuff. It's gonna send me to the restroom, you know, that kind of thing, but that's awesome for you. Your doctor is still this is, I'm trying to think of what people's questions are going to be like, you don't have weight to lose, you have type one diabetes. It's not indicated for that. How are you getting this is going to

Speaker 1 42:47
be their question. That's a good question.

Tara 42:50
I don't my insurance does cover it. That's it. They just cover it. Awesome. I don't know what kind of diagnosis. I mean, it's the same pharmacy is giving me all of my insulin, the pumps, the everything, all of the supplies, Dexcom and so I'm sure they're aware of everything that I'm getting and what my diagnosis

Scott Benner 43:13
is. What kind of industry does your healthcare come from?

Tara 43:16
My husband is, I don't know if I could say, No, I don't

Scott Benner 43:19
want you to tell me what he does. Like, is there an industry that you could say, without saying you, I mean, not real city of New York. Oh, he works for the state. Yeah,

Tara 43:30
he's retired from the city of New York.

Scott Benner 43:32
Oh, you got that good stuff?

Tara 43:34
Yes, it's excellent. It's awesome. Good

Scott Benner 43:37
for you. Yeah, I'm gonna knock on all my wood in front of you, for you, because that's really perfect. In your notes, it says, just healthcare, like, what do you want to talk about?

Tara 43:46
About healthcare? I did work in healthcare. This is actually a little bit about my type one diagnosis story, either, and how it threw me off a little bit mentally. I was working in a doctor's office. I was the in front office, and I really enjoyed my job, very small office, one doctor and us three ladies who worked in there. When I was diagnosed, I took some time off, which the doctor especially was fine with, even though now I look back and I see he I had told him right before that was the first time I ever had an A 1c in the sixes, it was actually 6.0 I don't know how it happened or how I did it, but I had told him. He was like, I guess kind of like my primary care. But I said, Oh, wow, Doc, I just got my a 1c results back, and it was a 6.0 and he said, Oh no, it shouldn't be a 6.0 you should keep it at least mid sevens. Oh, yeah. And I just thought, well, I thought I was doing great, you know, but whatever that's that's just something that I think about now that annoys me.

Scott Benner 44:55
Did he give you a reason why you would say that for lows?

Tara 45:00
He said 6.0 would mean that I'm having too many lows. And I was like, No, I'm not. I'm not having lows. I mean, I wasn't wearing Dexcom at the time either, so I don't really know if

Scott Benner 45:09
I was, but you didn't think you were. And when you said that to him, his response was,

Tara 45:12
he said, talk to your endocrinologist about that. So, oh,

Scott Benner 45:16
so you knew enough not to listen. Is that right? You were like, I'm not doing even at that

Tara 45:21
point, before I started listening to the podcast or reading the books or anything, I knew not to listen you

Scott Benner 45:26
still knew you were just like, I'm not going to choose poorer health, right? Did he put it in your head, the fear of the lows? Do you think? Or did you have it prior to that?

Tara 45:36
I did not have it prior to, I guess, the type one diagnosis when I finally got a Dexcom and put it on and realized what was happening.

Scott Benner 45:46
Yeah. Okay, so talk about that. How long into type one did you get a CGM?

Tara 45:50
It was only a couple of days, okay? And what did it teach you? It taught me, well, first of all about the lows, because I never really even knew that I was having them. I mean, sometimes I knew, like, I would feel a little dizzy and but I didn't know why. I didn't know that it was low blood sugar, and I never treated it, and thank God, never had any consequences from it. But when I started seeing it and knowing what was happening, it scared me a little bit.

Scott Benner 46:16
Yeah, yeah. No kidding, yeah. That is definitely stuck with you. Have you had a bad low? Like, have you had a low, like, where you were unable to help yourself?

Tara 46:24
No, no, no. And now my time and range is excellent. I have like, a 98% time and range with only, like, a 1%

Speaker 1 46:33
low. How did you accomplish that? I don't know.

Tara 46:37
I'm really good about pre bolusing. Usually it's like breakfast and lunch. I try to eat the same meal, so at least most of the day i i know how my blood sugar is going to react. It's always the dinner that will mess me up.

Scott Benner 46:53
Dinner message, because it why? Because you think you sit down afterwards, you're sedentary. It's a different kind

Tara 46:59
of food. It's usually my biggest meal of the day. And there is like, like, I'm Italian. We like to have pasta. I love pizza, like, just, you know, those kind of carb heavy meals I usually tend to have at dinner time.

Speaker 1 47:13
Okay, okay, all right. And you're learning to Bolus for that still, or you think you

Tara 47:19
I am still learning to Bolus for that gotcha, but I'm getting much better.

Scott Benner 47:23
What do you see happen that you're that you're trying to get on top of still, I still have that rise.

Tara 47:26
And, you know, it's so delayed, so sometimes I don't even know when it's gonna, you know, I'll think I handled it, and then six hours later it'll start again. So it's just kind of having to figure, Figure out

Scott Benner 47:40
I hear the Yeah, the timing of that next wave, yes, impact, right there. Gotcha, I'm sorry. You back on the tandem now I am, and it allows, did you do the upgrade to this software so you can do the extended boluses while staying in automation? I

Tara 47:56
did, and I don't know what kind of magic it's working, but

Scott Benner 47:59
it's you have a better success now with that, Oh, yeah.

Tara 48:04
And I don't even really know what it does, but

Scott Benner 48:07
well, so you're not using the extended boluses right now.

Tara 48:10
I'm using the extended Bolus, and I also figured out that I could use the temp basal at the same time I'm using the extended Bolus. Oh, so that has kind of helped a little bit with more of those, like, you know, longer rises,

Scott Benner 48:24
you found a way, with the with the tandem pump, to use the algorithm, the extended Bolus feature that they've added. And the way I talk about insulin on the podcast, you kind of like, smush the three things together, and you're doing it. Look at you, but you're in your 50s, right? Like you get diagnosed. What makes you think podcast? Or did it not? I don't know.

Tara 48:44
I just started doing some research on the internet, and I saw the podcast mentioned in a few places, yeah. So I found the Facebook page first, and then I started listening to the podcast. Okay? And

Scott Benner 48:57
then you just found something valuable, and then you started applying it and just kind of move from there. That's awesome. That's very cool. I mean, we're from the same area, so I don't seem objectionable to you. I guess.

Speaker 1 49:12
No, that's nice. How long did you live in the city?

Tara 49:15
I lived in the city. Well, I've been up here for 10 years now, so the majority of my life, 40

Speaker 1 49:22
years. Do you miss it? I do miss it. What about it?

Tara 49:26
Let me start by saying it's definitely not the same now, and I was just over the weekend back in Brooklyn. It's not the same, and it's not somewhere I would probably want to live. Now, of the six of us, my siblings, my one brother, is the only one still left in Brooklyn. Okay, we all kind of moved out. All of my friends moved out from it's, sadly, just not the place that it was when we were growing up. But I think that's probably everywhere, everywhere, yeah,

Scott Benner 49:56
yeah, yeah. I know when we moved I should probably not say this. Out loud, I know when we moved from home, and then, you know, we were, got rooted in our new place, and had been there for a couple of years. We went home one time, and we were driving down the street, and I just said to my wife, I was like, hey, was this place when we lived here? Or no? And she goes, I don't know. I've been wondering the same thing. I can't tell if our perspective has changed or if the place has changed, and we never really did figure it out, honestly, like, if it's just, you know what? I mean, like, it's hard to decide if it's you or if it's the place, or if it's maybe a little bit of both, or I never know. I mean,

Tara 50:39
we, we probably would have stayed. But my two of my sisters, my twin sister and another sister, had moved up here, and we were all very close. And I think my husband knew that he needed to be near your sister, that I wanted to be near

Scott Benner 50:53
them, yeah, yeah. Oh, it's nice. It's a nice area. Yeah, very nice. They have a little property. Or do like something you can sit out back of?

Tara 51:02
Yes, we do. We have a we have, I don't really even know how big it is. It's a good size. Yeah. And I have a little creek in my yard, and which my husband likes to tell me, you know, I always said I wanted to live on the water, so he gave that to me. My

Scott Benner 51:18
wife said, can we be near a beach? And I was like, I don't know. You keep telling me you want to be near an airport, in case you have to get the have to get to the kids. And I was like, You got to pick one. So, my gosh, do you see your children often? Yeah,

Tara 51:28
well, my oldest daughter just graduated from college in May. Oh, nice. So she's back home now. Yeah, you know, doing the job search. And so I feel bad it's so hard for kids now, and my youngest is in college, but she's going to community college. She commutes from home, so they're both home now.

Scott Benner 51:46
Are they having that experience where the thing that they're studying someone has said out loud, AI, is going to replace while they're studying

Tara 51:53
for it? I mean, I think so. Yeah, what a feeling. My youngest one is going for psychology. She ultimately wants to be like a therapist, like adolescent therapist. So I think there's always going to be a need for that. Yeah, the oldest one, we're not really sure was she studied English literature. She did great in school. The grades were outstanding. She was just published in a literary magazine, and she's having a hard time finding, you know, a niche or a place where she should be,

Scott Benner 52:24
yeah? I think it's going to be like that for a lot of people. Yeah. Really sucks. Yeah. And I know some of you are listening going, Well, Scott, stop using AI for things. But I mean, I'm by myself, like, it's the only way I get stuff done sometimes is to let it help me with things. Okay, well, that'll be fun. I'll enjoy an entire generation of kids, you know, not just saying I can't pay back my student loans, but I can't pay back my student loans, and the thing I know how to do doesn't exist anymore. Yeah,

Tara 52:53
well, we keep telling them, You stay home for as long as you know we don't. We love having them home, so we're like, you stay home as long as you can, as long as you want to, you know you're always welcome here. Hopefully they find something that they want to eventually leave and do. And

Scott Benner 53:09
yeah, when you say that, because we say that too to our kids, like, you don't have to rush out, but like, there's the party that knows that they're not really going to get going till they're on their own. Yeah? And there's the part of you that's like, Well, yeah, but if they stay here forever, I'll be happy. And then you have to find the balance between, like, I don't want them to leave, but they should leave. And then then the financial aspect of it, which is that can't really afford to leave. And, you know, that's another problem. Like, we're lucky enough to be able to, like, we have enough space for our kids to stay, you know, where they have their own broom? Yeah. And my son's trying so hard to, like, save money. I but I don't even know if he knows what he's saving it for, right? That's the interesting thing, too. You know what I mean? If you want to buy a house one day, and he's like, I don't

Tara 53:55
know. And they see now like that. They see now how much the bills really are like, when you're looking to Yeah, she sees her friends are getting entry level jobs, and, you know, they're making, like, about 60,000 and she's like, but how do you afford to pay for your rent and a car if you're driving to work or internet? And I'm like, yeah, that's, you know, you got to figure all that stuff out.

Scott Benner 54:19
Listen, mommy, found a sucker. Okay, and you call that sucker daddy, but I call him sucker, and he splits his money with me. I don't know why I'm meaning, like, how do you do it without, like, two incomes? Like, first of all, and how crazy is it that $60,000 leaves a person going, would I still be able to get internet? Yeah,

Tara 54:38
I know. Well, I mean the rent. I can't even believe how much rent when, when I got out of college, my rent on a two bedroom apartment was $800 a month. And I can't even believe how much these kids have to come out of pocket for. Now,

Scott Benner 54:52
it's crazy how they're gonna live in the city, that's for sure. But yeah, I swear to you, Mike,

Tara 54:56
even up here, even even where we live, the rents are about the same. It. Not too much

Scott Benner 55:01
cheaper, right? So you get that feeling like, so that's where I was with my son. I was like, Maybe you should just stay for years and save up enough money so you can put a down payment on something so that you don't because it's gonna be the same money monthly. It's the down payments. The difference usually could be so actually, you're not buying a not buying a mansion or anything like that. So I'm like, at least you'd own it, you know? And he's like, I don't know, do I want to own it? I'm like, Oh, my God, there's so many questions. I'm like, if you just do what I did and knock mom up, then you have to get a place. There's no way around it. Like, right? Like, now you have, like, you have roots all of a sudden, and now with the jobs are also remote. Like, that's even the other thing. Like, my son's like, well, I don't know. Do I want to tie myself down to a place? Because I could do this from anywhere? Yeah, yep. God, that's a good question. I don't know. I really don't know what to do. I don't even know how to explain it like I understood in the world I lived in. And if things would have changed even 30% from how I grew up, I would I would be valuable still, but yeah, so different. Now,

Tara 56:03
I had before my daughter, right before she graduated, I had said to my husband, you know, she if she decides to move out, you know, we better put a little money aside to help her, because she's going to need some help getting started. And he says he was mostly joking, probably 80% joking. He was like, you know, Tara, when does the when does the help stop? When do I slow down on the help?

Scott Benner 56:31
When can I take off on a Friday? I was wondering, yeah, how come I'm like, eating on a Saturday morning, trying to get my wits about me, and wondering when I'm going to cut that lawn and this, and think that, and go to I feel my wife says the same thing. Like, I There are days when I think like, we're doing our best to put money away for the future, but I'm like, Am I just gonna work until I die, and then just, there's gonna be whatever money's there gets split between my kids because I'd like to do something once. Yep, I grew up. Really broke down. I didn't do, like, we're going on vacation this weekend, and I am just focused on not feeling bad about that. Like, that's my whole week. Is, like, try not to feel bad that you're spending money to go on vacation. Yeah,

Tara 57:13
you can't feel bad about it. Yeah, you can't. My husband, I don't know if the situation was similar, but he grew up, really, with not very much, and I had a very nice, I wouldn't say we were rich, but we were very comfortable, especially for a family that had six kids. We did take vacations. We had nice things. My parents drove nice cars, and my husband did not have that. And now he retired from his first job, and he is working full time on a second job, and he wants to spend what we have. And then he says, I want to stay in the nice hotel. I want to go here. I you know, this is what I want to do,

Scott Benner 57:55
yeah, this is the money my whole life. Yeah? Well, tell him, I don't. I don't know how much money I have, but I have the same feeling like, you know, I swear to you, I think I said this out loud already, but I bought a pack of underwear the other day, and I felt like I splurged, because I got to the point where I lost I'm, by the way, I'm so proud of this, I had to buy medium underwear, or just, I just want to say how proud I am of that. I was like, okay, my underwear is baggy. It's not supposed to be. It's getting older, but it could last longer, but I'm gonna buy a pack four pairs of medium underwear. And I mean, as I pushed the button, I was like, Oh, I don't know. I don't really need these. Like, that's ridiculous, you know, like, I'm in my 50s, and I'm like, should I really be splurging like this? And that made me feel ridiculous. It also made me feel extra ridiculous when it showed up and I was excited.

Tara 58:51
I'm just laughing because it's almost the same thing. My husband saw that the underwear that he uses was on sale on Prime Day, and he told me to order

Scott Benner 59:01
them. I'm like, Hey, finally I can spend some money and not feel terrible about this. But I still felt that, like, as I ordered, I was like, I mean, it was like, I don't know. It was like, $24 and I thought, like, I really don't need this. That was me splurging. I was like, I'm doing it anyway. I'm gonna get underwear that fits. And then you think it was over, but then the package shows up. Somebody goes, What's this? And I was like, Oh, it's my underwear. People looked at me like, what's wrong with you? I was like, well, you obviously never made $4.50 an hour, but I have all right. Tara, what have we not talked about that we should have? Is there anything we missed about diabetes, your use of glps? Anything at all that you want to make? Make? No, no, I don't think so. Okay, your husband wearing boxers or briefs or boxer briefs? Do you want to say?

Tara 59:43
I guess they're boxer briefs. I guess that's what you would consider them.

Scott Benner 59:47
They're like shorts, but they're tight. Yes, that's what I used to tell them. I said, Hey, that's a weird club. Let's start a Facebook group for men who wear boxer briefs. See how many people. Get in there, I'm gonna guess none. And my last diabetes question for you is, you worry for your daughters at all. Do you mention it to them? Like, how do you deal with the idea that maybe they could end up with diabetes one day?

Tara 1:00:12
I'm trying not to cry because yes, I do. I do worry about it for them all the time. And they know they see me. They hear the podcast in the background, they know that there are genetics to it. I've tried to subtly mention, you know, the antibody testing, but

Speaker 1 1:00:31
they're young,

Tara 1:00:31
older and, yeah, I mean, they're over 18, so it's not like I'm going to be forcing them to do anything. And I don't think they would anyway. I think they're they'd rather not know until they have to know so well

Scott Benner 1:00:45
tell people about the worst part about parenting is when your kids are old enough to tell you no, but not old enough to pay for anything.

Speaker 1 1:00:52
Yeah, that is the worst,

Scott Benner 1:00:56
because you stop yourself from going like do you enjoy living here?

Tara 1:01:02
I can turn off that. Wi Fi,

Scott Benner 1:01:04
you love the free nature of your life. Could you just do this one thing without making a face at me? And then you realize, like, it's already a little unnatural that they still live at home, I think, and you want to let them continue to like separate because it's, it's good for them, but yeah, still, there's moments where you're like, ah, like, I broke my ass for this today, and, like, and now you're giving me, like, I loved it when you were nine. You just were like, Yeah, cool. I'll do that. Yeah, it's not a good thing. Like, it's interesting how parenting is shifting because of, mean, job market and economy and and everything else. It's a it's a new I was thinking about the other day, like it's a new generation of like, how people handle this time?

Tara 1:01:45
Yeah, I think I don't know. There's no. Well, I have this conversation with my sisters all the time because our kids are pretty much roughly around the same age. When do you stop paying their cell phone bill?

Scott Benner 1:01:58
Yeah? Well, I would guess now is the answer, yeah, I

Tara 1:02:01
know. I'm like, I don't know. I feel bad telling them like, you know, oh, by the way, next month, you're going to be hearing from Verizon, you know. But I feel like, at some point, I mean, when, when I was that age, I was pretty much paying all of my

Scott Benner 1:02:15
please, my we were just talking about the other day, like my wife was 22 when we got married. She was 25 when she was pregnant, the first time she was 30, the second time she was pregnant. Like we live in an apartment by ourselves when we were, I don't know, 21 something like that. It was expensive as almost $1,000 a month back then, like it was still it was a lot of money. You know, we were both working and, you know, we were grocery shopping and cleaning and learning how to be married, and we weren't good at that, like, you know, I mean, like, it's not like we had, like, great role models on that one. So we were, like, doing all that ourselves. Yeah, I mean, my son, we've transferred some of his larger bills to him, like, he handles his car, which is nice, but, I mean, he's still on my insurance, so he's probably paying less because of that, you know, like, food, like nobody asks for anybody to kick for food, you know. But that'd be sweet. Yeah, food's expensive, you know, electricity, like all the other stuff. Listen, I'm hoping that he's able to save up enough money that when he leaves, I won't feel guilty about it. I'll be like, Look, I did you solid. You got all this money that you were able to, like, save, like, you know, go forth and conquer. I'm not the one holding you back, for sure, at this point. I don't know such a weird thing, but I but the hardest part is that I resonate so much with the like, I don't really want them to go,

Tara 1:03:37
yeah, not tomorrow. But, you know that could change, because it's only been a few months since she's,

Scott Benner 1:03:46
like, maybe me and these girls are gonna have enough of each other, and that might be that, yeah, yeah, I do this. I have this. Tell me if this happens to you, and I'll let you go, like, sometimes, like, I see, like, my son's older than Arden, obviously, Arden still in college. Like, that's still kind of happening, but Cole's not and, like, sometimes he'll come over and be like, Hey, can you crack my back, like, something like that. And he likes to have his back crack like, so you're face to face, like, you reach behind him and kind of pull, pull his back up. And, like, afterwards, like, sometimes I'll hug him, and we'll stand there for a minute, you know, and then you stop, and I think I should have hugged him longer. He's gonna move out. Yeah, that feeling, I hate, that feeling, whatever that is, somebody put a name to that. I don't like that. Because the other thing is, if you hold on to him too long, he looks shit and he goes, What Are we dancing like it's over. Now, you know, but I don't know. I hate that

Tara 1:04:37
part anyway. Well, we recently, just like two weeks ago, my older daughter and I were just sitting around talking, and we had both for some reason, Boston came up, and we were both like, we should go to Boston. I haven't been in a long time. She's never been and my husband happened to walk in the door coming home from work, and. He's like, Hey, what's going on? We're like, Oh, we're just talking about how we want to go to Boston. And he was like, let's do it, you know, book a hotel, let we'll go next week. And after she left and went upstairs, I was like, Are you sure you want to do this? And he said, We don't know. How many more times are we going to have to do things like this where, yeah, where they're both not working yet. And he's like, everything's gonna change once they're out of the house and they're working full time, and it's not gonna be the same. So, like, it made

Scott Benner 1:05:30
sense, that's where we're at. I mean, like, I said we're going away this weekend. Like, I've traveled a lot for I mean, it's in technically, for business. I went on the cruise. I went to friends for life. Like, I have a talk at touch by type one coming up in September. I have a private speaking engagement I have in October, like, like, a lot of like, flying around and everything. And it would be so easy to tell you, like, I I would love to just stay home next week, but same exact thing, it's like, I don't know how many more times, like, we're all going to be available to do something like this together. So like, let's just go find a place where we can just chill out again, nothing exciting, even just like, a place to go relax and not be in a rush and spend time with each other. So, you

Tara 1:06:15
know, we take like, one long vacation every year. This just happened. It was like three nights we spent in Boston, and since we've come back. So it's been almost two weeks. All four of us, like that was the best trip we had the best time on. On that trip should have just done yeah, I'm glad we did it.

Scott Benner 1:06:31
Yeah, that's great. That's it. Well, that's what we're shooting for this week. So hopefully that all goes well. Yes, all right. Well, having said that, there's a long list of things in the refrigerator that my wife said I have to do before we leave. So I'm gonna say goodbye, and I'm gonna work on the podcast some more, and then I'm gonna get on my list. I don't know what to call this episode, but boxer brief seems appropriate. I was gonna say my husband, yeah, when your husband, your husband said, like, no, let's go to Boston. I was like, so soon after buying the boxer briefs. That's crazy. Oh, don't we need to recoup those funds first.

Tara 1:07:05
Actually, I think the boxer briefs were delivered while we were in

Scott Benner 1:07:09
Boston. That's hilarious. My God, all right, hold on. One second for me. Tara, thank you so much for doing this. I really appreciate

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The Juicebox Podcast is a free show, but if you'd like to support the podcast directly, you can make a gift here. Recent donations were used to pay for podcast hosting fees. Thank you to all who have sent 5, 10 and 20 dollars!

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