#589 Be the Change
Dr. Arwa Al Hamed is creating the change in Saudi Arabia that people need.
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Scott Benner 0:00
Hello friends, and welcome to episode 589 of the Juicebox Podcast.
I had a terrific conversation with r1. Let me tell you a little bit about her. She came to the United States from Saudi Arabia. When she got to the United States, she got herself a PhD, and then moved back home, where she is now a nurse scientist, and the first pediatric nurse practitioner in the country of Saudi Arabia. I think you're gonna find that our conversation is about more than diabetes. It's about how difficult change happens. And it shines a spotlight on one person's effort to make that change. Please remember, while you're listening that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, always consult a physician before making any changes to your health care plan, or becoming bold with insulin. If you're from the United States and have type one diabetes, or from the United States, and care for someone with type one, please take just a few moments to go to T one D exchange.org. Forward slash juicebox and fill out the survey. It'll only take you less than 10 minutes. It helps people living with type one it helps research and it supports the show
this show is sponsored today by the glucagon that my daughter carries. G voc hypo Penn Find out more at G voc glucagon.com. Forward slash juicebox. Today's episode is also sponsored by touched by type one, please head over to touched by type one.org. Or, and and or find them on Facebook. And Instagram touched by type one helps people living with type one diabetes. And you may be very interested in how they do that. There are links in the show notes of your podcast player and links at juicebox podcast.com. To these and all of the sponsors.
Dr. Arwa Al Hamed 2:10
My name is Arwa Al Hamed. I am from Saudi Arabia, identify myself as a pediatric nurse practitioner. Right now I'm not practicing per se but I'm an assistant professor at the University. In the School of Nursing, where I am teaching pediatric nursing to undergrad I'm also doing clinical instructing for the pediatric nursing care course. I'm also involved in research with pediatric were affected by chronic illnesses focusing on their cognitive functions, psychosocial health, as well as transitioning and quality of life.
Scott Benner 3:00
Wow. Okay, well, how does that all happen? Let's um, how old are you?
Dr. Arwa Al Hamed 3:05
3033 Are you reaching? 34?
Scott Benner 3:08
Have you been in college since you were seven?
Dr. Arwa Al Hamed 3:13
Yeah, I think I've been in school most of my life. I practiced nursing. I own the bedside for three years. But then I immediately joined the post grad where I just came back from the US actually, two years ago. So yeah, for more information I did my master and PhD in the US. Part of it in New York and and other parts in Ohio, Cleveland. This is where I met Julia Blanchette. That's right, three,
Scott Benner 3:45
Angela has been on the show a number of times. And she introduced us. Yeah, that was really sweet. So how do you when you decide I don't want to be a bedside nurse anymore? I'm going to get a PhD. What's the what's the search, like for where to go look for it.
Dr. Arwa Al Hamed 4:02
Right? So it's actually it was not a time where I didn't want to do bedside, I would never stop doing bedside. But at that moment, in the place where I was working, it sounded to me like a dead end. And I was I found myself into studying more specializing more in academic areas, because at that time, my only option was either to continue to be only to on the bedside or do admin work, though the career path for nurses at that time was not not promising from my perspective, in terms of higher education. And I was, yeah, I was always hoping that I finished my undergrad and then proceed to Masters and PhD immediately. I was worried that continuing to be on the bedside area will prevent me from doing my master's in PhD. At that time, there was no option to go to do my masters and PhD through through the hospital. So the only option was to me is moved to academia. And there was opening and they wanted people to come and work there as teaching assistants, and then they would sponsor them to go and do their masters and PhD. So they come back and teach at that time, and we still have a big shortage in faculty in the nursing, undergraduate studies,
Scott Benner 5:38
what's the length of time you spent in the US?
Dr. Arwa Al Hamed 5:41
About seven years?
Scott Benner 5:43
Wow, by yourself? Or did you go with family?
Dr. Arwa Al Hamed 5:46
No, by myself? Of course, family we'd visit every now and then.
Scott Benner 5:50
No, but still, you moved from where you are now to? Yes. The Midwest of the United States or Vegas? Not really, wherever you are not in Ohio.
Dr. Arwa Al Hamed 5:58
I started in New York, I started New York, actually, I was very shocked with the snow. So many times I wanted to go back just because of the snow. So I'm very glad that my brother was with me. Initially, he came with me for first three weeks to just help me settle, etc. If he wasn't there at that time, I would have been in Saudi because I couldn't stand the snow. Like you didn't make sense to me. People. Oh, it's that. Yeah.
Scott Benner 6:27
The people listening? Well, no, because we started recording after we talked about it. But you started in a room that was a little noisy. And I said you know it, but is that you said it's air conditioning? And I said can you turn it off? And you were like, No, I'll die. Yo, I just know must have been? I mean, how what's the temperature outside where you are now?
Dr. Arwa Al Hamed 6:45
About 100 to 200? Yeah. And that's only the beginning.
Scott Benner 6:50
Your summer runs concurrent with ours. So you're in spring right now moving into summer?
Dr. Arwa Al Hamed 6:56
Yes, yeah. But you know, our spring is basically your summer. And then it gets different summer that you will never have, hopefully, you'll never experience. Unless you happen to visit in the summertime, which I don't recommend.
Scott Benner 7:10
You think I'll just burn up like a piece of paper, probably.
Dr. Arwa Al Hamed 7:14
Especially in the central parts of Saudi. If you go south to be nicer, it's mountainy. heli. But in in the central area. It's really, really hot and dry, and dusty. We get lots of sand storms. So you know how you guys spend most of your winter indoors. We have the same thing. But in the summertime, most of the monthly spend in the summer are indoors just because we cannot do anything without Daisy. So it's you're either in a mall, in the restaurant or in the house. Yeah, mostly indoors
Scott Benner 7:50
and the trunk of your car has seven cases of water and it just in case you stopped.
Dr. Arwa Al Hamed 7:56
Actually, you wouldn't do this because it will be very hot. It's not drinking anymore.
Scott Benner 8:02
What about in the evenings? How? How much does it cool down?
Dr. Arwa Al Hamed 8:07
Um, it's still very hard. Sometimes some nights are nicer than the others. But generally, it's not really nice. Gotcha.
Scott Benner 8:18
Wow, that sounds terrible. But I understand being scared by the snow because I hate the snow. And I was born here. So you see it and and that wind, right? Especially in New York City, people who've never been there don't know that the wind whips one way through the city. So you can be walking down one block where you're where you're shielded from it, and you're just like, Oh, this isn't so bad. Then you get to the intersection and a wall of frozen air just hits you.
Dr. Arwa Al Hamed 8:46
Right, will make you be tearful. I didn't know that kind of a phenomena. You were crying in the wind just because of how strong is the wind?
Scott Benner 8:57
Yeah, I must have been hacking a shop. Okay, so you're in? You're in New York for a while, and then you went to Ohio after that? Correct. Okay. So you get a master's and what was your PhD in?
Dr. Arwa Al Hamed 9:11
Um, so I did my masters as a pediatric nurse practitioner, and I finished and immediately got accepted in Case Western, in the in their PhD of nursing program. And my focus was basically the cognitive functions, together with some specific cognitive measures and quality of life in children who are living with chronic renal disease, or early stages of renal failure.
Scott Benner 9:44
It's interesting. Let me ask you another question. Before I get to that, though, the US health system versus what you were coming from in Saudi Arabia were their vast differences or was it fairly similar? What did you find?
Dr. Arwa Al Hamed 10:00
Okay, so right now we kind of have both systems if if I would say, yes, the Saudi has the government funded health care system, meaning that every Saudi citizen is entitled for free health care, and we have certain amount of government hospital in addition, we also have private sector like health. Health services being offered through private sector, meaning we have hospitals, private hospitals, that if you want to go pay out of your pocket, you can, you can still do that. Now, it's increasing, it seems like the country is even now giving more support to private, private companies to open and establish more hospitals, clinics, etc. So both of them are flourishing at the same time. Generally, everyone is entitled for this special also those who go to the military, or work in the military, or in the National Guard, for example, in my case, they also can have their access to their military hospitals. What happens is, because of that, still, we you're not, you're not going to get quick access to health care, unless, of course, if it's emergency emergency rooms are open, but thinking about dental health, dermatology, or like those primary health care services, we will have to wait sometimes months to get appointments. And this is where you might choose to go to private. It's not completely for specific services, if you if you need there are also the
Scott Benner 11:47
I'm sorry, for the speed of being seen, where are their quality differences as well?
Dr. Arwa Al Hamed 11:53
No, for that, mostly for the speed of being seen. I'm pretty lucky living in the US because we're still a little bit centralized, where all the good services are located in Riyadh. So you would really or in this case, the government hospitals, as well as the private hospitals offer pretty good quality. I personally would choose to go into government, because most of the government, hospitals are educational, or university hospitals. So you're being treated with very, you know, long standing. medicine, medical colleges and nursing schools, etc. With that being said, I'll also need to make clear is a few work in companies, some, some big companies, they offer also your they can offer you what you call medical insurance. And it depends on of course, in the coverage level, etc. They have levels, depending on your position, etc. And now the country is moving toward pushing all those who work in private sector to to offer all their employees
Scott Benner 13:12
will be can insurance. That's interesting.
Dr. Arwa Al Hamed 13:14
So that's why it's now it's confusing. We have both systems. Right? Well,
Scott Benner 13:18
it's also interesting that here, people are complaining about health insurance and pushing for a private, you know, a lot of people want a private answer, or excuse me a government answer where everybody's sort of covered, you know, at the same rate, and there you have that, and you're moving towards medical insurance.
Dr. Arwa Al Hamed 13:40
I don't think we're moving but I think
Scott Benner 13:43
it's becoming more prevalent.
Dr. Arwa Al Hamed 13:46
Right, it's, it's, I think it's because of the high load that the government hospitals are facing, especially from those who are not covered under military hospitals, we have many military hospital, big hospitals. So the load will for the other like, citizens will will fall on to some big government hospitals, where you will have to wait, sometimes months, sometimes years to do procedures. And I think one strategy is that the government is trying to support more entrepreneurs to open private hospitals and then we will help you paying for for for insurance, just make sure that everyone has at least an option. So they don't have to wait months and months for the government. Right? You know what I mean? So you will still be entitled for the government service, but instead of waiting, you can still have other options.
Scott Benner 14:47
Okay. Now, what about the standards of care? Did they vary between there and here or were they pretty similar?
Dr. Arwa Al Hamed 14:54
Right, many hospitals in Riyadh and in Jeddah, the two Me in large cities in Saudi and the East in the East Coast, we have an another two big cities. Most of the hospitals there are JCI accredited, I think joint commission accredited most of them. So I'm assuming most of the hospitals follow the US standards, specifically the military hospitals. Surprisingly, a lot of them worked or collaborated with, develop what United State developers like, for example, in my case, in my hospital, they they collaborated with some companies from the US early on to establish those standards, even in terms of equipment, etc.
Scott Benner 15:53
What have been in diabetes, specifically, if you're if you're diagnosed there today, what happens do you get, you don't get regular and NPH insulin you get? You get modern insulins, right, like some version of Novolog, Humalog, that kind of stuff. Correct? Right? And do people start off with injections? Because I get a lot of letters from people living in your area? Asking me if I know how to get CGM and insulin pumps there, that actually happens frequently. Are they not readily available?
Dr. Arwa Al Hamed 16:28
Um, they are. But again, I would still consider, well, it's very important to mention that still services are mostly, like heavily provided in central areas or big cities. So maybe you will hear that from residents have rural areas or areas far away from the central areas or from the large cities in the kingdom. The other thing? I think, yes, it depends on where they are from, or that they're, depending on the supply, or if they got those new equipments. I also noticed some people are a little bit afraid of the pumps. In my family, a few of my cousins actually have type one diabetes. And two of them, actually, their parents are not very comfortable having the pumps, so they still prefer the injections. But they are still they're here. They're offered. And I think it's based on preference.
Scott Benner 17:39
Yeah, I actually know a few families that fly to America buy products and cash and flight back. And maybe, maybe things are changed since even I've heard those stories. That's a it's, I mean, it makes sense to that, as you get further away from population centers. Can't care. I don't know if it slips or if maybe just the ideas haven't gotten out. Because there's fewer people. And you know, they don't get a chance to see each other using them. I would also wonder how you keep insulin cool. They're like, yeah, they
Dr. Arwa Al Hamed 18:15
will it same, same thing. Same thing applies to the US in the summertime, they will always move with their small refrigerators with them. Okay. All right. But we don't do lots of summer activity in the summer time. So unlike in the US, for example, in the US, you would be worried right about kids going camping or going for the beach or going for sports. I'm very, very limited. Things we do out during the summertime, so they're always in the refrigerator.
Scott Benner 18:45
has these.
Dr. Arwa Al Hamed 18:47
Yeah, referring back to the to the pump, over the one I give wrong information. There might be other factors that I'm not only pretty aware of. So yeah, I'm just not one to be honest enough. I might not be very familiar with all the other factors.
Scott Benner 19:06
Okay. No, I appreciate that. I just, I'm just interested in your perspective. So when when you get your PhD, I guess that kind of drives your, your your focus moving forward. So you come home, was it always the plan to come home and practice? Yes, it was. So you come home with an eye on helping with the cognitive issues. And you're you're in this one focus right now. Is that right? Or do you move outside of it as well?
Dr. Arwa Al Hamed 19:33
I know a little bit outside like for example, lately. Actually, Julius specifically inspired me to look at that variable, where transition specifically that we don't have transition clinic that transition clinic by itself is a new idea. In some specialties they started applying them, for example in rheumatology They already have transition clinics to treat kids who are moving from childhood into adulthood. But for type one diabetes, despite the high the high prevalence here, they don't. And what's also concerning to me compared to the US is that we consider children as as to be treated in the pediatric clinic. If they are from one day old until 14 years old, only. Unlike in the US, where they can continue with the pediatrician until they are 21. I'm not wrong. We're 24
Scott Benner 20:44
You can stay with your knowledge here. I'm sorry. If you're in college, you can stay with your nutrition till you've graduated. I'm sorry, you broke up,
Dr. Arwa Al Hamed 20:55
right? No, I'm here. He only until 14 Once they get into it.
Scott Benner 21:07
Or why you just disappeared? We lost our Yes, I'm back to the dog get you? Yes. Yeah. I'm okay. No, no, it's fine. Yeah.
Dr. Arwa Al Hamed 21:22
So that was concerning to me. Because I was wondering what happened to those kids? Do we just send them to the adults? area? Starting from 50 years old? How about if they're, like, even if you're considering them physically at puberty? In terms of mental or cognitive? or you're not? You don't know yet, you know, even deciding who's mature and who's not takes a psychologist to review that it's right. So they just at 14 years old, they just discharged from the pediatric area, and they send it to adults, where everything is different, their approach is different providers different and the family should not be involved that much, and all that has an influence on their compliance.
Scott Benner 22:10
Can I? So is that cultural that age cut off? Or is that? Yeah, it is?
Dr. Arwa Al Hamed 22:17
It's, it's a Yeah, because I'm not sure if you're familiar we consider for a boy who was at puberty, or a girl who was at puberty, they're considered already mature. Oh, so you have to, for a female she has to cover up from other male who are not from her family? And for the for the male, he cannot be cannot be with other females who are not among his family, or they're not? They shouldn't they should cover up. I see. So in that case, we regularly admit, admit them in pediatric units. Of course, that was mostly before we had shared rooms, etc. So usually the sitters or the those who are admitted with the patient are usually mothers. So for this patient to be boy at puberty was very inconvenient. So usually they they put that cutoff limit. So they it's for segregation purpose is to help segregation.
Scott Benner 23:20
Make sure I understand continued, yeah, make sure I understand if my son was diagnosed, right as he hit puberty in that age, then my wife could not go with him to the hospital. Because there'd be a commingling of genders is
Dr. Arwa Al Hamed 23:39
no no, no. admission for admission, your jewelry for convenience, but no role to prevent anything. No, they can still go and do everything together. But I mean, for convenience purposes, they organize it that way.
Scott Benner 23:51
So this one cultural idea, leads leads to separating, like putting children into adult care was something that's really confusing that they're probably not ready for it. Because at that age, I mean, I have to be honest, at that age, I was like, stupid. I didn't you know, I didn't understand anything and I had no context for anything still. I guess I didn't grow up where where these kids did so maybe I would have been more mature at that age. I'm not sure. But that's incredibly interesting. So you said that the care differs between the segment of children in the segment of adults how does how does the idea of carrot change
Dr. Arwa Al Hamed 24:30
like for example consider how the care in in pediatric clinics for example is always family centered right? You're not gonna be able to access the child without his parents in and most of the cases are usually mothers. But now with with moving to adulthood, your family or or not really The focus you are the focus now your should be all of a sudden, the one who is taking care of all the details, including scheduling and compliance and not only prescribe administering your medication, but following up all these different appointments and supplies, etc. So the approach is different. Now you're not only communicating, you used to communicate with the whole family, but with adult you mostly communicate with the patient. How does that work? And the other thing
Scott Benner 25:35
I like? How does that end up working out? Like, is that a, like a? Okay, rock solid? Everybody's doing really well and super healthy? Or is it problematic? Somewhere in between?
Dr. Arwa Al Hamed 25:47
It's a it's actually a very good question. Because when I came back, and I noticed that I, I communicate with some of the endocrinologist, we work with the pediatric endocrine, and they, they told me that they they tweaked a little bit within this system just to keep their patients with them until the physician feels very comfortable. discharging the child from pediatric to adult. Which is to me it's nice, but at the same time, it takes a lot of effort from the physician side to our would it go assess the
Scott Benner 26:27
kids, right? Yeah.
Dr. Arwa Al Hamed 26:29
And yeah, they still have to what to call it compromise that it's a bit and talk with with sometimes admin people or you know, hospital admin people, because they they keep pushing for that, like, you have to move this child to adulthood he's he's already in the system, he's 14 You need to move into other then they will go and a little bit Jani advocate for their patient to just keep them under their care until they feel comfortable. Making sure that the child started to be independent, start administering his medication or following up his coming at least to the clinic, sometimes alone, etc. And once they feel ready, they, they they transferred them, but it's not always possible. Sometimes you will have to do that.
Scott Benner 27:21
What are a one seagulls there?
Dr. Arwa Al Hamed 27:25
Huh, I don't have an accurate number. But I'm assuming
Scott Benner 27:31
Well, what would you ask some what would you hope someone wish was aiming for? If you were if you were I would
Dr. Arwa Al Hamed 27:41
say six 6.5? I would say okay, that's fine. Five
Scott Benner 27:46
is diet there. There any cultural differences in foods that make type one management easier or more difficult?
Dr. Arwa Al Hamed 27:55
Um, I would say yes, it would make it more difficult just because the, the culture or the lifestyle here is is sedentary a little bit because especially that the weather people are very reluctant to go out with that. Weather, especially in the summertime. And summertime, or summer weather specifically coincides with summer vacation, which is quite long. And not every not all kids get to travel or do activities. Most of them are indoors. gyms and look or to to to participate in a gym or something indoor usually costs money. It's not possible for all families to offer that for all their kids. So I would assume the the diets with all the options, we have people like dessert here, people like variety of food, we have vary. Now the fast food thing is, is becoming an expert here. Like making all sorts of us fast food, but now we no longer have changed restaurant or we do but we're very becoming very, like good at making our own local restaurant or fast food and especially kids that they're like adolescents or, you know, they cannot resist all these options, especially in the summertime. So I'm assuming it would be a little bit difficult. I personally noticed that when I came back, people eat lots of snacks, unhealthy snacks here compared to in other countries where snacks are limited here. They have a lot of options. It's very tempting. We're very very good at making dessert here. Very, very good, like insanely good. You're welcome by the way.
Scott Benner 29:50
We We've exported all of our best goods to you to learn from McDonald's. Congratulations. That's terrible. Can I ask just from a personal like standpoint? What? Is there anything you miss about the US? Either professionally or personally a lot.
Dr. Arwa Al Hamed 30:15
Um, I miss a lot. I miss the weather, I miss the green life, I get very attached to the lifestyle where I do go out during the summer all the time to parks, mountains, lakes, rivers, I miss all this, to be honest with you. I missed the diversity very much. I kind of got addicted to it. So now every time I go out or socialize, I get bored very quickly, because people are mostly the same here. There's from the same culture from the same place. We you know, we don't have a lot of we don't have a strong immigration history. We do have expats coming to work here, but not immigration, per se. So people don't end up mixing and being just one. One country. No, we still have a lot of people coming to work, but not so much mixing. And unless you make active efforts to do that, which I ended up doing, I ended up joining meetup groups as if I'm still in a new country, just to just to fill that need of meeting new people or diverse people every time. That's interesting.
Scott Benner 31:26
Yeah, I guess you ask a question. And once it gets answered the same way, four or five times in a row? Not a lot of excitement about asking it again.
Dr. Arwa Al Hamed 31:33
Exactly. Yeah, exactly. It was always interesting here to conversate with people and you'll always hear different religion, different culture, different ethnic background, there are different interests to like people who usually do the same thing that a majority of people are kind of similar. And even there, and you know, we're very social oriented. Society here, we still like to fit in. And it's, it's now it's changing at least. But still like the overall picture is that everyone looks the same talks, the same, does the same thing. So on
Scott Benner 32:23
you made me think of earlier, I kind of had a light bulb go off in my head when you said people are either at home or in the mall. And it reminded me of a time I visited the Dominican Republic, and there was this mall. And it just felt like everyone was in it. It was it was the busiest place I've ever seen in my life. And it never occurred to me that it was about getting out of the hot weather. Until Ryan just said that. And the the idea of diversity, that's not going to change there anytime soon, I would imagine.
Dr. Arwa Al Hamed 32:56
It's actually changing in Riyadh, specifically in VR, but now is becoming like a very big hub for all new companies and new investments and with with most of them the vision of 2030. All this is they're attracting more businesses to open and beyond. So a lot of people coming to work in Riyadh every year, right? It's interesting. Yes, it's very interesting. Compared to before, now, I see more and more opening up. If you go out now you see a lot of people from different places, going out more before with with COVID. And all the travelers restriction, people would come work and then they travel, you would rarely see them coming out in the weekend or coming to entertain in Riyadh. But now with the COVID restriction, I came to realize how much diversity we have in Riyadh. Because now with all the travel restriction, people ended up spending their weekends you're spending their vacations and be out. So you start seeing people from different countries and places in Riyadh, some of them are and I think you and I think it's going to get even more diverse because the plan is to have like, more foreign companies opening their headquarters and beyond. So I'm expecting to see more and more that's
Scott Benner 34:29
like that. That's probably particularly exciting for someone like you who's lived somewhere that's more diverse.
Dr. Arwa Al Hamed 34:36
It is I'm enjoying it very much. i It's true. You don't see any changes at the level of the society like comparing it to people who would be living here for years and years changing even though like building block of the country itself, but you will still see six to see changes people opening up more now and and being more accepting of differences where now you don't have to do active effort to look like everyone else because you start being more than welcome then accepted the way you are. So I'm enjoying it for now.
Scott Benner 35:19
Yeah, I would be excited. Are you married? I didn't ask. No, I'm not. I have no idea what's happening right now. Siri just started talking for some reason that really messed with my head hasn't happened.
Dr. Arwa Al Hamed 35:35
Maybe she wasn't happy with the question.
Scott Benner 35:37
Yeah, I gotta try harder. I marriage question I couldn't hear with my headphones on. Do you think it was? Do you think my speaker just started going? Like, come on, buddy? Try harder? No, I just was. I was just interested. So your your are you? Is that something you're interested in? Marriage? Yeah. Is it uncommon for you to feel that way at your age living there it is.
Dr. Arwa Al Hamed 36:02
Mostly, most of people in my age are married and have kids, including, like me, whether despite of the gender, but I think especially living in Riyadh, again, I will keep pointing back to Riyadh is because even in the other, not only the becoming the hub for all the new jobs and for all career, nice career pathways, people would move to Riyadh, from different cities, even in in the kingdom. So you start meeting people at their 30s, who marriage is not in their priority, because career is their priority, mostly. So now it's becoming common that you see people in my age, or not married and they're okay. They're, they're not desperately looking forward, or they're not facing pressure from the family to get married. It's becoming normal, just another normal. I think it's mainly because of carrier. Most of the people I meet who are in my age and are not married, they're always very passionate about their carrier what they're doing.
Scott Benner 37:28
So it basically breaks down some lines, like you're gonna build a family or you're going to or build a career but it doesn't those two don't mesh well together. Like the idea of two really career motivated people living together doesn't happen quite as much. No, it is not for you.
Dr. Arwa Al Hamed 37:49
But I think it's very interesting. If we start talking about this, I will be talking for like, two more hours. I think, I think what happened is with this transition, that the the to the sudden and quick changes that happened in Saudi in terms of society, and economy, of course, economy has been okay all the time. But now is there a major society changes for example, now, we were driving before we didn't, and all the breaking of the segregation that's happening now in many places, et cetera. So there's major dramatic societal changes. What happened is up in Wilson, their 30s. There, they're still there in between. They're not from those who are before the generation who are older or they're not even the current generation who are already experiencing these changes, that they don't feel anything different for us or people in my age. We're facing lots of conflicting ideas. We continue to compare what we see now compared to what we've been taught to what venues to do or what they've been prevented from doing etc. Compared to now where everything is different. So I think what happens is those who cope very well and adjust quickly and and fit in they they might they need to find someone who's that similar to them. Who who's adjusting well and adopting all those new changes without feeling any conflict, any internal conflict. And and here comes a problem. I think girls are doing much much better in this compared to guys in our age. Where they still not sure if they like what they see now and if they're okay to completely adjust to what they see and they're still stuck to some old Ideas are old about, you know about gender about what to expect from a wife what to expect from marriage, all this? Right? Well, I think I'm in that space and that gap in that space. Yeah.
Scott Benner 40:13
Yeah. I mean, listen, it makes sense, right? Because when, when human rights and civil rights and things like that get more and more available for people, it really does end up benefiting women. exponentially, right? Where, right? Whereas men are like, Wait, so then yes, there's no lady that's gonna clean this stuff and make me food. But you don't like me? You don't get quite the same deal if you're on the other side of it. So that makes 100% sense. And so people are holding out, they're like, I wonder what life could be. I'm gonna wait and make something cool, right?
Dr. Arwa Al Hamed 40:50
Yes, yeah, some of them are actually waiting to be stuck
Scott Benner 40:53
inside the air conditioning. Because
Dr. Arwa Al Hamed 40:57
a lot of girls in Saudi know, they don't want to wait, they feel that they spent so many years in that old mentality. And they don't want that anymore. So they're very eager to live their life to their maximum capabilities and maximum potentials, either at work, or even in social life. So they always have plans when I meet girls in my age, it's, it's, it's very surprising. And interesting, because most of them are in the same page. Most of them, they just want to enjoy all those privileges that we have right now. can travel anytime, anywhere. We can do any hobby that you wanted before, and was not an option. For example, music, playing instruments, you can only do that at your home or practice it with your family, but never something that you can work on or be have a carrier or something that you can make a business out of it. Well, everything is just all of a sudden open. It's kind of distracting even from looking for marriage, believe it or not, you
Scott Benner 41:58
know what it sounds like? It sounds like Netflix for life. Like there's so many. You just scroll and scroll and scroll and never watch anything. You're just like, there's too much to do. I can't pick. But that makes sense, though. And it kind of sounds exciting. What what do you think, started that kind of boom? Was there one cultural shift that moved everything in a different direction?
Dr. Arwa Al Hamed 42:23
I think there are so many. But for example, I give you a very, very simple example. Some of the, I think king king, King Abdullah, previously he was Prince Abdullah Ahmed. And then I think probably I'm not sure if you're familiar with all the royal family members. But King Abdullah, for example, he started a move that was I think, about 15 years ago, where they started the studying abroad program. They have, they created a program where they sponsors students with high GPAs starting from like fifth when they finish high school. And they can sparse they sponsor them for studying abroad. Programs in different countries started with the US, Canada, UK, and many others. But the three main big countries that we used to go is the US, Canada and the UK. It started a long time ago about 15 or 20 years ago, I think the plan would from what you see is that they want to prepare a generation of people who are let's say, Western, educated, they're, they're, they're used to seeing different cultures because think about we've been a little bit Yani introvert for some time, in terms of like exposing to different cultures, different races of religion. So I think the plan was is to not only make them get Western education, but make them mix with other cultures or other religions and and then when they come back, they're more ready to absorb the new changes or that are already happening. So I think that worked for big part of what's happening because those students when they came back, most of them now are the leaders and most of them that say ministries, all the government services or the big, big companies in Saudi Arabia. So I'm assuming that in part worked. And then, of course, the new Prince Mohammed bin Salman, with that knew, of course, that's the first and the only time we ever had a young leader, that young leader and that kind of changed everything because he is I think he has chords to change things that others were very reluctant to change us. They were very afraid to change those social things that were fully yeah thought about it as religion when in fact it wasn't. I think he was just courageous enough to start pushing for those changes that has been already there. But it would, no one has the like, really the chords to apply them or implement them.
Scott Benner 45:35
Right? I have to admit, the first time that I saw in the news that it was a big deal that a woman was driving a car. I was I stopped me for a second I thought, Wait, women couldn't drive cars. Like I didn't. That was not something it even occurred to me. But this is it's kind of fascinating because you're, you're transitioning, but that transition still has to happen culturally and slowly to some degree like you can't I imagine you can't just like if you could just magically flip a switch and move everybody into a different space. It would probably short circuit most people's minds, right. Like it's it's that different from what they're accustomed to and what they were expecting growing up. Mm hmm. Wow, that's fascinating. Yeah,
Dr. Arwa Al Hamed 46:17
but because lots of people don't realize that just give me a minute.
Scott Benner 46:27
No, you're fine. Do we have to shoot somebody away?
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Dr. Arwa Al Hamed 47:32
Yeah, my brother is just looking for my car keys. So yeah, it's people don't realize that we didn't wait for driving to to start developing very quick. Well,
Scott Benner 47:55
are you broke? Are you back? You're not back. Tell me when you can hear me again. Hello, hello. Oops.
Dr. Arwa Al Hamed 48:11
Sorry, mixed environment.
Scott Benner 48:13
I'm so sorry. Hey, I gotta cut you off. You. You were gone for about 20 seconds. So I apologize. But you the last thing I heard you say was it didn't just happen with driving? Yes. Yeah. Okay. I'm sorry.
Dr. Arwa Al Hamed 48:27
Yeah. So I'm saying it didn't just happen when we started driving, but it would it started. Very long time ago. We had women working in, in businesses in medicine, and academia, their Dean's, they're working everywhere. From very long time ago, my mom was one of them. And then driving was a very, very minor compared to what we were empowered to do. Long time ago. What was going on is that for some reason, they associated driving with some religious restrictions, which wasn't a right. Connection. It was never a true connection that was made, right? It was very easy for it to like, stay there. Don't touch it. Okay, that's fine. Just keep it it's not really preventing us from doing anything. We can still study, we can still travel, we can still go to the US and do PhD, we can come back and be prime ministers, etc. So it was never a barrier. But
Scott Benner 49:47
if I had to go Yeah. All right. If I had to guess it sounds like one of those things that men who wanted you to wash their clothes and make them food thought, whoo. If we start letting women drive, they're going to get out in the world and figure out it's not as much fun to do my laundry as I told them it was, doesn't that have like sort of like that just like the idea of you restrict somebody travel or their ability to see other people or interact with other people who have different ideas, then you restrict their ability to dream those things. And then you can kind of it's easier to control them than I would imagine.
Dr. Arwa Al Hamed 50:19
Yeah, yeah, of course. Yeah. Although we we wasn't just about like watching the laundry. It's more like, it's more deeper than that. But yeah, it's 100%. True. I, I get I still meet people are compensated with people who would still feel threatened by by having their wife striving for the same exact reason, although they weren't admitted. He would tell you Oh, no, I'm afraid it's too crazy out there. People don't drive nicely, oh, I don't have money to buy another car. They will, they will use all these other excuses. But if you start pushing and pushing and pushing here come to the, to this true, true idea behind it is that it's such Right,
Scott Benner 51:05
yeah, you get you get frightened that people will see a world and think, Wow, this is better than the world I live in. And not come back. Yeah, I mean, and when you're, when you're so accustomed to that being the truth. I mean, giving it away, if you look at it from the male perspective, like just giving it away, must be it must be difficult. You know, I mean, I'm, I'm 50. And in America, you know, I was I was I became a stay at home father in my 20s. It was incredibly uncommon at that time, when I when I did it. And it was looked at unfavorably by most of the older people in my life, they mostly looked at me like, Oh, he's taking advantage of her. And he should be working. And they didn't understand that we thought that this was a the best balance for us, you know, and the way we can make things work. And I will tell you that there have been times when I'm growing up, where I think I love the way my life worked out. But you do wonder sometime like what was it like to, you know, 1950s America, come home and have a bunch of people just treating you like a king walking through the door? You know what I mean? Like, that's never happened to me in my entire life. I don't think I would want that. But might have been cool. Cool to see it one time just to see what it was like, you know, my example about the laundry is because I'm the one that does the laundry at the house. And I want to get away from it. Yeah, I hate doing the laundry. But that's that's not the point. The point is that you guys are making these amazing leaps. And are they? Are they transitioning? I would think not just in the medicine, but everywhere because you're getting new ideas. People have been exposed to more, I mean, you you might well see a real, a real Renaissance.
Dr. Arwa Al Hamed 52:55
Right, actually, with medicine, the medicine started to advance in the country, way, way, way, way back. It was actually one of the few specialties that the country didn't really, or the country sponsored all endeavors related to medicine, from the early ages of this country. So that's why if you compare hospitals in Saudi Arabia, specifically as compared to the other Middle Eastern countries, even other Gulf countries, we have some of the best physicians and hospitals I'm not saying this because I'm Saudi, but this because really, really it's it's it's true. They spend a lot of money in this in the country invested a lot in most of them are prepared either in Canada, Germany, UK, US, and most of them, they've spent their fellowship there. We still collaborating with big hospitals, and big. I'm not sure how you call those kind of companies, but those who develop hospitals. Yeah. So yeah, we a lot of ongoing businesses that started decades ago.
Scott Benner 54:16
Yeah, they're like private for profit hospitals. Hmm. Right. Exactly. Yeah. Well, I just had a question on the tip my tongue and just fell right out of my head. Damn. Shoot, shoot, shoot, shoot, shoot, where did it go?
Dr. Arwa Al Hamed 54:32
Say you're asking about the transition? Yeah,
Scott Benner 54:35
I'm sorry. I blanked out for a second. But yeah, um, the, the idea I'm wondering about is, will like, at what point do we see the information that was brought back to other places, refined by other places, and built on top of like, that's because I don't think that diabetes care. In the US is particularly finished, right? It's better than it was. But you can still go to plenty of places who are operating like it's 10 or 15 years ago. And so my expectation, well, I guess it's my hope is that the diabetes care will become more, two way, meaning people won't go into doctors offices and just be told, Do this, do this, do this. And then you come back, and we'll measure it again later. And we'll change some things. Like I want to see people in a position of power in a position to say, I'm going to make a change to my Basal insulin, or I'm going to, you know, I'm going to come to realize that this meal needs more insulin than this other meal, and not just use some carb ratio, and just, you know, let my blood sugar be high for four or five hours afterwards. And I'm wondering if this spreading of information won't in time lead to people understanding that better? But I mean, do you think people understand that they need to be more proactive with diabetes care? Or do you think that that understanding exists some places and not others?
Dr. Arwa Al Hamed 56:13
What what's good about type one diabetes, specifically, that it's affecting the, unfortunately, at least considering that the prevalence is increasing with recently compared to before, I think it's being affecting the gender, the new generation, who are very, let's say, first of all, they're tech savvy, most of them, they are, they are being raised differently than kids before. So most of them, they, they do things because they want to do what they need to be convinced the you cannot tell them what to do anymore. You need to convince them why they need to do things. So this type of mentality or mindset, is, will make me think that it's possible. Because you see them now I, I interact with a lot of like, let's say, school, school aged school age, kids to dollar since they they're very mature compared to we when we were at their age, and they're very independent, more getting there, they're given more opportunities to practice their independence compared to us back in the days, specifically girls, for example, I was not, I was never allowed to go to pointment alone or everything, my mom would be very worried. So she prepared to go with me. Now, they do everything alone. So I don't I think that this was tacitly tait the implementation of like self care of all the principles of self care or individualized care. However, what I think still might be a barrier is the approach from medicine itself. The like, I think health care providers are not confident enough that those kids are able to do that. And that's why they maybe insist on depending on the parents, so you know, that's this age generation difference where you as an as an adult don't think that they know enough, or they don't trust them enough. But unless if we start adopting this new mentality that no, this new generation is able to do it, just simply because they are raised differently. They've been allowed to experience everything they've been allowed to do do things alone, so they are stronger than when we were at their age. So I think the change needs to start from that provider itself.
Scott Benner 59:05
It's exciting, isn't it to see a generation of people who are less restricted than the one before them, and to see what they kind of do with it. And, you know, obviously, everyone doesn't take it in a great direction, but some people really do. And that idea of self care for medicine really translates to self care for a person in total, just their ideas and their goals and their focuses. Everything is within their control, I guess, and no one's telling you what to do with it. So they're able to explore directions and your people are going to find people are going to find lives that they just never would have been able to find in the past, because they felt so I mean, it's not even that you just felt so much but your parents were scared, like you said, and they would insist Still that fear on you whether that fear was safety, or religion or government or whatever it ends up being, you know, you can't do that. Or we don't do this. We can't say this. We can't go here. I mean, you can't play a flute outside of your house. And now that just, I'm super excited about where, where it's heading. I think this is the a very exciting generation of people to pay attention to. I've always thought that I was interested that you said it to. So yeah, they're
Dr. Arwa Al Hamed 1:00:25
very, very, very self determined for their age, honestly.
Scott Benner 1:00:29
Yeah. It's crazy. My daughter made 35 If you talk to her, and she's exactly she's 16.
Dr. Arwa Al Hamed 1:00:34
Yeah. Yeah, like, if you notice, especially now, these days, for example, I have three brothers. One of them is 40. Of course, they're all adults, but they all can spend time with the friends from all different age groups, like they all together that they have 10 years different from each other. But when they gather with their friends, they have friends from all age groups, and they enjoy their time they travel together, they do things and look, wow, before we didn't do that, we would stick to people at our age. Yeah, even for me, when I when I gather with with my family, we can spend hours and hours conversating with 16 years old, and you would never feel like she's only 16
Scott Benner 1:01:22
I interviewed three girls who were like 1315 and 17. I interviewed them together. They're these three friends who live on this island together. And they all have diabetes. So I was like, I'll just, you know, I never done an interview with that many people before. And it was a little it felt like hectic to me sometimes. But when I got to the end, I thought, huh, that's crazy. I'm, I could be their parents. And we just had a very normal conversation. It was, it was fascinating. Three girls taking care of their diabetes that you know, 15 I think 1617 Like, whatever they were there, they're young, you know, and they just didn't come off as young. Like, don't get me wrong, they're still, you know, they're a little giggly sometimes. And you know, they maybe don't follow sarcasm as well as an older person would or stuff like that. But they're just they have thoughtful, they know who they are. I guess that's really what it ends up being is you ask them a question. And they know the answer. Because they're connected to themselves. They're not just these robots that their parents are controlling through life. They're their autonomous people, and is absolutely lovely, you know, really great, right? I don't.
Dr. Arwa Al Hamed 1:02:34
So, again, good. Going back to the transition. Yeah, I think maybe they are better off compared to other generation. But I think still, right, that the purpose of transition clinics, sometimes it's really not only for the patient themselves, but really, it's for the provider to, to prepare for this transition. Because we we don't have some somewhere in the middle, we either have a pediatric who's very nice, and who will involve the whole family. And then all of a sudden, we will have an adult endocrinologist who is used to older people, and he was just asked specific questions, and he's not going to dig deeper with the patient and just tell them a list of things that they need to do. And then they just go home.
Scott Benner 1:03:25
Yeah, that's a shame.
Dr. Arwa Al Hamed 1:03:28
Hey, but for this specific generation that we just said, I think, physician physicians or, let's say, providers in general, whether professional nurse practitioners, they need to be prepared to trust them. Or at least to be able to assess those kids from different standards or standpoint, not just use our our own ideas that oh, they're they're young, by default. We shouldn't trust them. Or by default, they shouldn't be controlling their condition 100%, etc.
Scott Benner 1:04:07
Yeah, I mean, there are people who are able to do things that their age wouldn't indicate sometimes, and those people shouldn't be left behind. Because you're like, Oh, well, they're, they're 13 they don't understand that I've had kids come on the show, that are astonishingly good at taking care of their diabetes. And they're, they're young, I have one coming up soon, a girl living in Russia, and she's young and found the podcast on her own and figured everything out by herself. It's fascinating, you know, but it's really, really cool. And I think that that shouldn't be taken from people like everyone's not going to get it on a deeper level, but everybody should have the opportunity to try. You know, that's, um, it seems like the old way of thinking about it was most of you aren't gonna understand this. So I'm not going to bother explaining it to anybody. You know, answer my questions. The dials us a little more here. That's it. That's, um, and now there's glucose sensing technology, which just opens your eyes to what's really happening with your blood sugar. Fascinating, you know? Yeah. So what is your goal? Like, what do you, you got all this education, you came home, you're living a, you know, a different lifestyle in Saudi than probably, you know, two generations ago if your family did? What what are you going to do with everything you've amassed? What is your? What is your hope?
Dr. Arwa Al Hamed 1:05:31
Okay. Two big questions of carrier? Yeah, it's a big question. It's a very big question. And then it also keeps changing, I think, because sometimes what you come back, hoping that you want to do is really not feasible for probably not, not going to say not possible, but it will might take you years and years to even do 10% of it. But so you show you I think, what what parts of resilience mean is even your goals, we need to keep modifying them, not necessarily lowering your expectation of yourself. But know, maybe you now have a better perspective of how is it really going on here? Because I may, I may had ideas about what I want to do. But when you come here and experience, life, here are the flow of things and what exactly needed, you might start realizing that there are other other areas that needs to be worked on as compared to what you had in your mind. Or instead of this one, this is more important for the country at this time, specifically. So this is what's been happening with me is that I've been trying to find the right way to reach or not reach, because I don't think there should be one goal that you reach it, and then you're done. No, it's always changing random underneath. So the plan is, when I did my PhD, I focused on cognitive functioning, and how it affects their school performance. And then eventually, their chances of getting accepted in colleges and then getting good jobs for patients with renal failure. But now I'm trying to expand it more on other kids with chronic illnesses. Because what happened, especially with renal, or children with renal failure, although it's considerably a rare condition, especially in developed countries, it's still the focus in their care is mainly stabilizing them. Physiologically, at least, or maintaining Yoni is at least, to stay alive and decrease mortality, decrease morbidity, etc. But the advancement in career or schooling is not a priority at all. Which is I understand why it started like that. But I also don't understand why it continued. Of course, initially, we will just want to make sure they survive, right? But then eventually, what is it just make them survive, but how about their quality of life? How about their opportunities to pursue their life goals without affecting their economy, IQ, status, etc. So that was my plan is to go back and dig deep in the system, and find out those gaps where those kids sometimes just don't go to school because they get admitted quite often to the hospital. So the family feels a burden, and then they stop sending the kid to school. So those kids will, will will not be able to catch up with the schooling system. And some of them don't end up never going.
Scott Benner 1:09:16
They just stop advancing right you so you just end up being as mature and as your age of when you're diagnosed with something like it's almost like getting sick ends your life instead of exactly right instead of figuring out a way to incorporate it into your life.
Dr. Arwa Al Hamed 1:09:36
Exactly. Even sometimes when they get the kidney transplanted the new kidney transplant and they still because of fear from getting infection, it's some families don't send them to school. Of course, we don't have such a role where they can be where they need where they can be referred to protection services due to that, it's still not technically considered neglect. We do have child protection service but like not send them to school per se for a chronic condition is not really something clear cut, you know? So, so yeah, sometimes out of fear, they just don't send them to school and continues being a problem. So I, this is this is where I started developing the research ideas, why and what can we do to prevent that? I heard when I was in the city, I heard that their start, they have some tutoring programs where they can come to the child during his data session, and offer him some schooling, etc. We didn't have that. We don't have that yet. So my hope is was to create this program where it can be a collaboration between Ministry of Health Ministry of Education, where we can have a whole program established for children with chronic illnesses in which they have regular follow up regular cognitive assessments, psychosocial assessment, and it's, you know, embedded in the education system for these kids. So they can sign up on this program once they are diagnosed. So we track them early on, we identify any limitations if they have, if they have specific problems with math, per se, just due to for example, anemia, maybe with with renal patients, for example. Maybe they will have specific problems with memorizing due to anemia and poor memory, etc. Do you recognize that? Do we have that into consideration? If yes, how and what we're going to do about it? It's unfair that those kids are being treated as normal kids, or they should they have all the right to be treated as normal kid, but I'm, I'm afraid that sometimes we will miss some limitations that are specifically to their condition. But we don't know. Yeah, so that they don't do anything.
Scott Benner 1:12:12
So they don't become disposable. And you don't just see them as a they've got an issue. And now that means they shouldn't enjoy the same ideas that everybody else gets the hope for. It's just exactly. It's amazing. That's beautiful. So you keep bringing them, the idea is to keep bringing them services, that keep them up to speed while they're taking care of their health. Right. Yeah, that's it. I mean, it's so simple, right? Doesn't it just make sense? You know, yeah, people should not because,
Dr. Arwa Al Hamed 1:12:41
as I, as I mentioned to you, when I came back, carry alized, we have other gaps that should start before that, that needs to be fixed. Before we start implementing such programs, for example, we we had, we don't have school nurses yet. Okay. So when you first think about such a program, right, you would think immediately of the school nurse who will be doing the evaluation, or the follow up for this kid, at least in the school, right? Who will be going to do this, for example, cognitive assessment or these regular assessments, I was hoping that this can be implemented in the school system. But if we don't have a school nurse for a specific school or for this specific district, then who's going to do that? Right. So this is where I started realizing, okay, let me modify my goal and start looking for, like, other things related to that to see where the gap is where you can start fixing the the issue is,
Scott Benner 1:13:41
Is it crazy to think that school nursing could become a thing? Like the gift somebody got behind it? Would there be a way to get it funded? And and
Dr. Arwa Al Hamed 1:13:50
I think the funding is just what's what's what's preventing it's, it's, it's a as a law, it has been issued four years ago. But now each hospital needs to have school nurse implementation. Not yet. And I think mainly because of funding issues.
Scott Benner 1:14:11
So you have to you really do have to jumpstart things, they don't just either things start out of necessity, or they start because someone who has the the ability financially gets behind an idea and moves it forward quickly. There's no, there's no other way that things begin really.
Dr. Arwa Al Hamed 1:14:30
Exactly. And you know, what's the major major problem here is the lack of data, unlike in the US were already well established. The search data are there to be to support your ideas, let's say yeah, to support your ideas or to support your proposals for policy health policy changes cetera, we still don't have that. So that's why you come to realize that okay, I need data. In order for me to come and approach decision makers or leaders in the healthcare sector, where they have a lot of huge priorities to come and tell them, you know, what, stop and fund school nursing system? First question that will come to mind. Why, why why now? Why is it urgent, but if you have the data, and if you can show that this is exactly what's going on, those there might be facing additional difficulties making families additional additional difficulties finding jobs. They don't, they just can't, they are not allowed to make good GPAs, basically, just because of how their condition is. So yeah, this is my help starting from the basics and trying to establish some database.
Scott Benner 1:15:42
Well, I hope you are able to figure out a way to make it happen, because it's obvious while you're talking to me, like it makes me feel this way. It's it's, it's obvious why things take so long to come together. Right? Like, it's just it's clear, there's so many moving parts and so many people that you have to talk into it, there's money that has to be raised, and you have to actually do the physical thing, it's not enough to just have a great idea, you actually have to accomplish it afterwards. And then it takes time, then you imagine that you bring in the school nurses, and some of them you hire suck, and then you have to be replaced with other schools, you know, it takes time to get it working smoothly. And thanks. And we all don't have that much time. Like, we're all just like, hey, like my kids in school for this long, or my life is only this long. And then people get frustrated that things like that don't exist. And that frustration can sometimes end up killing your motivation. Yeah, it just takes away your drive. You just think, Oh, I'll never get this done. I might as well go do something different. And you need people to do those difficult things and have those fights. Right? Yeah. So you might as well be one of those people go get them? You know, it's got somebody's got to do it. Somebody has to decide. This isn't I mean, listen, it's a much different scale. But when I began this podcast, I thought, I'm going to talk to people about diabetes the way they need to be spoken to, and not the way that the establishment says, okay, like that, that just needs to start there. Like, we can't just keep telling people, Oh, it's okay, you're fine, you're doing great. Don't worry about it. You know, meanwhile, they're having all the problems that come with out of control blood sugars, and then they're being told by somebody don't worry about it, when they could have gotten actionable information that would have helped them, maybe pull things together a little better. And and instead, we were, you know, oh, we don't talk to people like that. That's dangerous. You can't tell them like you can't tell them how insulin works. Like, shouldn't we at least understand how insulin works? I mean, how many people don't understand how to Pre-Bolus a meal don't have never even been it's never been mentioned to them ever. And they have diabetes. It's, it's crazy. You know, so I just thought, well, I'm going to do it, and we'll see what happens. So sometimes you just got to leap. Because trust me, there were people telling me not to do it. established ideas were very much against it. And I had to fight through many times of people, you know, speaking poorly about me behind my back, or sometimes to my face and telling me that I'm doing it wrong, I'm doing it wrong. And I was like, well, you can do what you're gonna do. And I'm gonna, I'm gonna do what I'm gonna do. And it worked out very nicely. And I hope you have the same kind of success.
Dr. Arwa Al Hamed 1:18:20
What's your background? If I may? I have
Scott Benner 1:18:23
no background with the speaker.
Dr. Arwa Al Hamed 1:18:25
I know, I mean, education. No, I
Scott Benner 1:18:28
know. I know you do. And I don't have any background. I graduated from high school. I went to, I went to work in very blue collar jobs. Okay, I met a woman who was nice enough to recognize that I might be more than my station, if that makes sense. We made a family. And my second child, our daughter, Arden was diagnosed with type one, when she was two, I began using the skills I had writing to write about it online when she was three. And about seven years ago, after developing, I don't want to call it a system, but developing a way of managing blood sugars no matter what you're eating, and keeping a one sees my daughter's a once he's been in the fives for like seven years. And she has just no diet restrictions. And it's because I fundamentally understand how to use insulin. So about seven years ago, I started this podcast, and
Dr. Arwa Al Hamed 1:19:26
I beat this podcast is seven years old, seven years
Scott Benner 1:19:29
old. Yeah. And it's been heard, you know, it's been downloaded. I think we're up to about 4 million now. And it's all over the world. And if you go to just as an example, the Facebook page for the podcast, you will see people constantly all day long, either sharing their struggles and helping each other or sharing their successes and motivating other people. It's really, like astonishing, you know, and it just was, and I will honestly tell you that on day one This somebody established in this community told me you can't do this. Do not talk to people like this, that you can't tell people this stuff. And I was like, Well, I think I think I can. And I'm going it's not a secret. Yeah, well, it is a secret because people are scared to. They're scared to say anything that isn't concrete about diabetes. And I believe that people are smart enough to hear nuance, and apply it to their life. Crazy me. Right. Right.
Dr. Arwa Al Hamed 1:20:27
So yeah, what's the problem telling people that is, is not concrete? Now after COVID? Everybody knows that? Nothing is concrete. Yeah, right. I think people are, I think, again, you know, what, Scott, I really think it's the old mentality that the younger generation are fragile, don't tell them this, they don't need to know this. They don't need to know all the details behind this, and, and so on. So I think you, you came to realize from your experience with your daughter that they are not, they're actually sometimes stronger than us, because they are just born in a different generation. So even I think it came in the right time. Despite all the the recommendation not to it came at the right time, where were kids at this age, are prepared for this level of knowledge for this, that's for these specifications that they're able to do with it, especially that this came with technology, advancing technology, and having this smartphone in my hands with all those potentials that it has, it became very easy for this generation to absorb all those details and apply it in their daily life. Unlike us before, I mean, our generation, we only had TV, and we only watched whatever they tell us to watch whatever they have on the TV. But now they have this, they can choose every moment they have the ability to choose what to read what to listen to, and what to write. So all this gives him this capacity to deal with all the details. Maybe you we are more fragile than them now. Oh, no.
Scott Benner 1:22:15
Yeah, I mean, and you just keep getting to enrich yourself any way that you see fit. And I'll tell you to, here's an aspect of forward thinking that impacts the podcast success that you would never consider. But it's it's this is that 1015 years ago, if I would have done this, let's say the technology existed, and I could have done this. It's a full time job. So I can't I have to sell ads on this podcast, if I don't, I can't do this, right. So 10 or 15 years ago, if I had a podcast, this same podcast, and it had ads on it, people would have yelled at me for making money from diabetes, they'd say, Well, you can't make money off of someone else's illness. And ads are insulting to me. And trust me, I've seen it happen to people. But somewhere in the last handful of years, people became savvy enough about the internet, to understand that if you want somebody to give you something that is consistent, and quality, that they're going to need to put time and effort into it, and that they have lives as well, and bills and families. And so suddenly, no one. It's it's an idea that's gone in the world. Like no one watches a YouTube video. And when the ad comes up, yells and screams at the ad you go alright, I understand I'm not paying for this, the ads paying for this, I get it. And now that that's acceptable. That actually supports me because honestly, this is I record with you today, someone tomorrow, another person on Thursday, in the last 48 hours, I've edited together five episodes, and prepared them to be online, I've probably put, I've probably put 45 hours into the podcast in the last four or five days. And wow. And that's a that's a job, right? So now I'm suddenly able to do that because of people's acceptance and growth and understanding of how the world works. Everybody needs to understand reality so that they can have reactions and experiences that are real, and not just, you know, I'm going to be mad at you because you have a podcast and it makes money and I wish I had a podcast you don't I mean or something like that. It's just it's right. It's a growth of people that's allowing us to help people grow. It's really cyclical.
Dr. Arwa Al Hamed 1:24:28
Right? I bet you also have some of your fans are probably YouTubers too, right? Because now all kids are YouTubers. They all talk in the YouTube language. I have my nephews they they know all the details behind how to become a YouTuber. They know how much money they will give you. You they know what what is the guidelines, and how long is your YouTube should be and how many likes you get in order for you to sustain them. I'm talking about kids who are 11 years old. Old are nine years old, you know, the language I'm talking right now is something very advanced. I mean, so that's why I, the the, the it's easy for this generation to understand why you need to maintain ads in your right. Well, you need to have ads in your show, etc. It's very easy, unlike before. So I think it all happened just in the right time.
Scott Benner 1:25:23
It really did. And there also seems to be this idea now that people seem to want good for other people. Like it's not as competitive anymore, I guess, you know. So, you know, so they look at you and they go, Oh, you have an ad in your pocket. That's cool. I hope to have a blah, blah, blah, you know, and they're, they're excited by the, by the possibility. And I talk this way about diabetes as well. Because there used to be a fervor an idea that you did not share your success with insulin online, like don't show people flat graphs, don't show them that you could Bolus for pancakes, because you're showing off and you're making other people feel badly. Well, I didn't believe that what I thought was that if I could do it, then maybe you could believe that you could do it. Right. Like to have an example in front of me. That's like, wow, that's that's possible. Oh, okay. Well, I'll try that. And and I think that people feel the same way about the podcast, older people will look at me and say, Well, you make money from A what now. And they're almost mad about it. Because they because they work the last 30 years in a car, plant manufacturing cars, and I get it like in their mind, I'm sitting in a room and I'm just chatting. And but younger people are like, Oh, that's cool. Because they see it as a way to live. Whereas older people see it as a as a like, somehow, like you cheated. It's an otologist perspective. It's really terrific. I'm excited about what's to come. And I'm excited. There are people like you out there having thoughts like this.
Dr. Arwa Al Hamed 1:26:53
One more last. One more last idea before. Before, it's just a toy for me. I think what's what was although I, I was a bedside nurse, and specifically the unit I worked at was sub specialize in endocrine and natural. So I dealt with lots of newly diagnosed diabetes kids with a lot of decay after they're stabilized, of course, not in critical care, but in the unit. How, however, my experience with one of my cousins who had type one diabetes, since he was I think, 11. And then with Julia, specifically, being the first close friend of mine who, who had diabetes. So it What was nice about this experience is that it simply normalized. living with diabetes, even for me, for someone who was from the health care area, but I never lived with diabetes daily, I never had diabetes as part of my daily conversation or routine or where I have to, like, think about it all the time. Whenever we talk about oh, she will check her blood sugar, she will mention her blood sugar then often mentioned something about the diet or today I had my blood sugar, blah, blah, blah. That's why I'm feeling this now. And it was part of the daily conversation. So it was to me like something normal. I'm not saying normal in terms of like, of course, they're not normal in terms of their physiological needs are different, but at least the they're not isolated anymore. Or just they have to be isolated. Just because you have this condition. It helps having this normalization making even the conversation the terminology. Very, you know, very witty call it it's reacquainted. So everyone knows, and it's not something, oh, you have diabetes. And I don't I don't need to feel sorry about you anymore. I just feel that this is part of life. Someone has a B to someone doesn't and that's it. This is how life but before you don't know that, that there are a lot of people are experiencing this on a daily basis and you have to deal with it. So what I like about approach of Julia, where she used to share this with us all the time is was it was normalizing it to me I was not stressed out or I mean worried when I'm whenever this topic is mentioned in front of me. I'm more prepared to deal with it, even psychologically, that's just because it happens in front of me all the time. Yeah. So I think even podcasts like yours serves this purpose unintentionally, where you're meeting with people, different countries, and you're normalizing that the experience of type one diabetes and making it Very special. Honestly, it's
Scott Benner 1:30:01
an out and proud mentality. It really is. It's just like, I'm not gonna hide anything, you get to see it. And then like you said, after I see it a number of times, it becomes normal to me something that I hadn't seen before. And then it that's it, the issue is gone, it just disappears into the ether. You just, that's all you have to do is, you know, what is it? What do they say? Sunshines the best antiseptic? Is that the saying? I'm probably not, right, right. Now I've said it, and I don't wanna hold on a second, the sunshine I'm gonna find it is the Sunshine is the best disinfectant, which just means, you know, bring things out in the light of day and it it takes care of the rest, you know, and that's amazing, right? Yeah. It's very exciting. So would you say in general, then, based on your studies, and what you're saying is that is to take someone with an illness, who and understand hopefully, that that illness isn't such that it's going to, you know, end their life, if it's something you're going to live with, that you need to get up and get back to normal? As fast as you can. And that you might need to understand that you're gonna need some support in different places. Yes, but that the most important thing you can do is to not stop, keep going. And don't give away the idea that the life you thought you could have is still available to you.
Unknown Speaker 1:31:25
Right? Yeah, absolutely.
Scott Benner 1:31:26
I love it. All right, we did it. Thank you.
Dr. Arwa Al Hamed 1:31:30
Oh, thank you. Thank you for giving me that chance to share my perspective from 1000 miles away. I hope things went very well with the recording. And thank you very much for this opportunity.
Scott Benner 1:31:45
You're very welcome. No, everything's great. You sound terrific. I've got I've got your recording captured here. And I am I'm super excited to share with you. A huge thank you to one of today's sponsors, G voc glucagon, find out more about Chivo Kaipa pen at G voc glucagon.com Ford slash juicebox you spell that GVOKEGL You see ag o n.com. Forward slash Juicebox. Podcast like to thank touched by type one for their continued in long time support of the Juicebox Podcast check them out at touched by type one.org and find them on Facebook and Instagram. Don't forget the T one D exchange T one D exchange.org forward slash juicebox. Take a few minutes and fill out the survey.
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#588 Diabetes Variables: Final Episode (Sorta)
#588 Diabetes Variables: Final Episode (Sorta)
Scott and Jenny Smith, CDE share insights on type 1 diabetes care
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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 to episode 588 of the Juicebox Podcast. I thought this was going to be the last variables episode. I had a lot of examples sent in by listeners left, but some of them weren't feeling like, like they needed their own episode or were really variables. So Jenny and I were going through them. And then it occurred to me how to finish up the list. is gluten one or no?
Jennifer Smith, CDE 0:30
No, I would not consider that a variable because quite honestly, gluten if you did group it with anything, it would be grouped with inflammation and it would be then grouped with like digestive stuff in terms of inflammation, and once it's gone, it's not a variable anymore.
Scott Benner 0:46
Yeah. Now I'm looking like we did a really good job of getting through these headaches, wet weather and esteem. Some people are just like, it rains in my blood sugar gets funny. Oh, I get low. It says wet weather causes highs and sunny weather causes lows. Wet weather makes you sit around. Right? And sunny weather makes you get up and move around. Is that right? Gotta be yet right.
Jennifer Smith, CDE 1:15
I would expect that that's what it is. Honestly, yes, we'll
Scott Benner 1:19
drop that into something at some point. Ooh, constipation. That doesn't strike you that way.
Jennifer Smith, CDE 1:27
I you know, I mean, the question really becomes with constipation, how much is that leading into pain or stress because you haven't gone to the bathroom? Or is it really in terms of things aren't digesting as well? So we have slow digestion I mean, that's like a bunch of things that constipation could be causing that are then the impact on blood sugar a constant Yeah. It's in and of itself is not a very
Scott Benner 2:07
Arden was little before we knew she was on the she a thyroid medication. Her blood sugar's would be more and more difficult. And then she'd go to the bathroom all at once, and it was level right out again. But it was just, you know, I don't you can't I can see how people might see it and then think it but
Jennifer Smith, CDE 2:25
right. I mean, I can see it in terms of pregnancy. Women's digestion slows in pregnancy. And if they are having significant issues with constipation, again, the question is, is there enough backed up slow digestion that is continuing to impact things enough, from an absorption standpoint that you're missing? Covering stuff that should have been eliminated a while ago? You know, or is it that there's pain because of it or, you know,
Scott Benner 2:57
I have to tell you, we have a half an hour here and our little chatting just now made me realize how to handle the rest of this list, okay.
On today's episode, Jenny Smith and I will go over the rest of your diabetes variables list. We first talked about variables in Episode 231 In a protip called diabetes proto variables. And then wow, two years later, I started the variables series. It began with trampolines went to temperature travel, exercise, hydration, food quality, leaky sites, video games, stress masturbation school, bad sites, growth hormone, sleep pump, site placement, full moon diabetes, tack weight change Walmart today is and the rest I'm not sure what the call it yet. And then by the way, there's going to be two more after this, but you'll hear about that later. While I'm talking to Jenny Smith, who by the way, has had type one diabetes for over 30 years. My friend Jenny holds a bachelor's degree in Human Nutrition and biology from the University of Wisconsin. She's a registered and licensed dietitian and certified diabetes educator and a certified trainer and most make some models of insulin pumps and continuous glucose monitors. She is also simply the best, the bestest. You want to hire Jenny. She works at Integrated diabetes. This show is sponsored today by the glucagon that my daughter carries, G voc hypo pen. Find out more at G voc glucagon.com forward slash juicebox. And as season seven winds down and the end of the year approaches. I'd like to mention all of the sponsors this year we were sponsored by Dexcom they make the Dexcom G six continuous glucose monitor by Omni pod makers of the Omni pod dash tubeless insulin pump touched by type one my favorite diabetes organization, the Contour Next One blood glucose meter, G voc hypo pen that's glucagon. And towards the end of the year TrialNet did a little sample ad with us for about seven weeks. Hopefully they're happy and maybe they'll come back in 2022. I did just add another advertiser for 2022. I'm not allowed to say who it is yet, I don't think. But it's somebody who's been around before. And I'm glad they're back, we'll say that. On top of the advertisers, there's the T one D exchange, who, while they are not an advertiser, every time you hear me talk about them, they don't pay me to talk about them. But they do give me a couple of dollars. Every time you take their survey AT T one D exchange.org. Forward slash juicebox. I've thanked everybody this year, over and over again. Who has bought me a cup of coffee at buy me a coffee.com Ford slash Juicebox Podcast. What else? Have you heard me talking about these bumpers and ads? No, I tell you to go to the private Facebook group for the podcast right Juicebox Podcast type one diabetes that now has like 17,000 or more members in it. So bustling type one diabetes page full of really good people. It's very unlike Facebook, but happens to be on Facebook. I tell you about Juicebox Podcast calm, the diabetes pro tips, the defining diabetes series, the variable series how we eat algorithm pumping, after dark, you guys are just over and over again. Terrific. So much so that November, I'll tell you that today's the 29th when I'm recording this November just became the most popular month in the history of the podcast. As a matter of fact, every month since May of 2021, has been the most popular month of the podcast, this podcast will do over 2 million downloads just in 2021. And it's all because of you guys. It's how you share the show and talk about it. It's when you put great ratings for it wherever you listen,
it's word of mouth, there's nothing else to it, if you enjoy the show, tell somebody else it helps the show to grow. When the show grows, more people hear it. When more people hear it, we have a greater chance of somebody needing one of the advertisers. When that happens, and you click on one of my links, the advertisers come back. And I get to keep making the podcast. And then you get to keep listening to it. It's a circle of life kind of thing. So thank you very much to everybody listening to everybody who's ever shared or told their doctor or a friend or to the lady this year who told me she bumped into somebody at a Costco wearing a Juicebox Podcast t shirt. Like my favorite story of 2021. Two people who listened to this podcast met strangers, right out in public. That's pretty cool. Anyway, I appreciate you guys so much. And I appreciate the sponsors. It's a terrific lineup of quality products, organizations and services for people with diabetes. I'm super proud of it. I really am. I've never once ever thought, Oh, I can't say this ad. You know, I'm lucky to have advertisers like this. And I'm lucky to have you guys listening to the show. So that's it. Here's Jenny and my conversation about the end of the variables list where we basically just go over a bunch of variables. We've gotten to the point on the list of variables that were sent in by listeners where there are multiple ideas that sort of they fit together. You know, they're the, you know, somebody says emotions, but then somebody says getting angry and stewing and being angry, Jenny and I can't do a variable for each and every one of them. So what were tantrums? Yes, right. That's right. So instead, what we're gonna do is run through what's left on the list, and just hit each thing very quickly will tell you if we think it's a variable or not, but probably doesn't deserve its own episode or need need its own episode. And then that'll be it. We'll move on, we're gonna start adding more stuff back to the Pro Tip series after that. So, alright, Jamie, here's what we haven't done yet on the list. And to be clear, the list is 150 things long. We've already done the things that are clear variables that, you know, translate to a lot of people, right. We can't do the, you know, the one thing that somebody is like, you know, pointing to for themselves specifically, we're not going to start doing personal variables. But here's some stuff that we didn't get to, but probably mentioned in other episodes, so showers and baths we talked about in the temperature episode for sure. Right? Yeah. So if you want that head back to their illness we did talk about and obviously being sick blood sugars, was one week could have probably made its own episode, but then you would have seen how it leaned into other ones is somebody just said Life, they're trying to be funny, I get it, right. Life is all variables, high blood sugar moves around because things happen. But that's what the whole variables episodes are about is that there are these little things that happen in your life that you don't, you don't think of as being impactful. And I think what happens sometimes, and Jenny and I were just talking about it kind of privately a second ago, is that we don't see the forest for the trees, sometimes, you know, Walmart makes me low, not usually I sit around and my, my blood sugars are at one level, and I have an insulin use at one level, and then suddenly I get up and running around, I'm grabbing things in the store. And then my blood sugar goes down, Walmart doesn't make yellow activity. When you have a bunch of active insulin, make sure though, but that's the life thing. Right? Like, there are things that happen. I think, I think that the thing to remember here is that you have your settings put together in a way that works best, during the largest swath of your 24 hour period, as you have, you've been able to figure out during your
Jennifer Smith, CDE 11:13
typical, yeah, honestly, your typical day, you have, which is the reason that we do testing on more typical days are not going to tell you do testing of settings and stuff when you're sitting at Disney World. That wouldn't be purposeful, right? So the purpose of discussing variables is to understand that in a day, variables could become part of your day. And this is how to expect your blood sugar to maybe react with this variable in the picture. But it doesn't know it's not always going to be there, you know, maybe 80% of your days of the week, you cost along just fine. Until you know, Aunt Mary comes to visit on Friday, and you didn't expect
Scott Benner 11:58
you decide to cook a big meal and it gets hot in the house. And right like there, I get it. Like you don't want to be thinking about diabetes constantly. But those things are impactful. And if you're, you know, if you're a person, for example, who's fairly sedentary and you're using a heavier Basal profile to combat that, you might not even know that's what you're doing. Right? You know, and then all of a sudden, you're running around putting a lasagna together, it's 80 degrees, you're sweating, you know? Sorry, yeah, it's impactful. You know, it just going down the list. Somebody sent in insulin efficacy, like expired insulin or insulin, let's hit like, extreme temperatures. And yeah, I mean, okay, that's a variable. But I mean, how often is that going to happen? You don't I mean, like,
Jennifer Smith, CDE 12:47
right, on a day to day basis? No, right. But on a, again, a setting where you are out of your normal environment. Let's say you're carrying your insulin around, or you're hiking through the desert with insulin in your pump, or in your backpack and a pen, or whatever it is, that is a variable that now becomes something to consider. If, in fact, you start to see blood sugars that are not the typical for you,
Scott Benner 13:14
right? But if you opened up your vial of insulin seven days ago, it's been working great. And suddenly, it's not working anymore, but it's been in the refrigerator the whole time. That's a weird place for your brain to go. But it happens, correct? Because it does, why does it happen to them? Because they can't imagine bigger picture what could be going on? So they start going through the real obvious of oh, maybe this since it's not working? It's the same thing as when we just did a diabetes technology episode where people are like, this pump doesn't work. But sometimes it's you don't know how to use it. Right? Yeah, you know what I mean? And yes, you don't see the forest for the trees again. And I think that right, not that your insulin can't go bad, like Jenny's saying if it's out in the heat, or if it's if it's way past, you know, a date, but it didn't just magically stop working. So write fairly
Jennifer Smith, CDE 14:01
well, one I would definitely add to that, though, is consider the mode of transit that the insulin got to your house as well. Okay, especially in different temperatures or different areas of the world, right? Because if you like I go to my pharmacy to pick up my insulin, I pick it up, I bring it home, it goes right in the refrigerator, there's no delay, right. Many people get their insulin supplies shipped we do. Right. So depending on time of the year, I always recommend people check you know, was the ice pack or the dry ice or whatever it typically arrives with? Was that in there Was it cold when it arrived? Did you put it right in the refrigerator? All of those things would be considerations in terms of Yeah,
Scott Benner 14:46
perfect. We there's somebody put on here gluten, if sensitive or celiac or other food intolerances. And you said when we went over it privately, you didn't really think it was its own variable, but If it was, it might be bundled together more with another one that's on here, which is inflammation. So, yes, yeah. So people who are gluten sensitive who are not eating a gluten free diet do have inflammation in their stomach lining, and I'm not a doctor, but down there towards the middle of your Yes, yeah. And that inflammation can make you seem what insulin resistant,
Jennifer Smith, CDE 15:25
more resistant, typically, because inflammation is like a stress in the body again, you know, we're talking and I said, kind of goes along with a lot of the inflammatory not only the digestive, but also things like lupus, and rheumatoid arthritis, and fibromyalgia. And all of those types of things are an inflammatory type of condition. And so uncontrolled or mismanaged, they will usually create a sort of a system of stress in the body, which will usually keep your blood sugar's running higher until they are better managed, which kind of goes along with the the gluten component, right? If you're on a gluten free diet already, you shouldn't have that inflammatory nature in your digestive system, you it should be calm, you should be digesting food the right way. If in the case that you went to a restaurant, you've been following a gluten free diet, and you do get gluten containing bread, let's say even though you ordered the gluten free bond, for example, could you have potential change in blood sugar because your body is so sensitive that you notice a difference? Digestive Lee right away and you don't feel good? Right? All of those would come along with kind of some of the things around like a stomach bug, possibly in terms of adjustment and what to plan for and how to adjust.
Scott Benner 16:50
If I say if I say one of these that you think is its own episode, just stop me and go. That's actually okay. Okay, so the next one, I don't think so. Specifically, somebody said, and this is very timely vaccines. So does a vaccine impact your blood sugar? Or does the fact that the vaccine makes your body, you know, introduces something into your body that your body has to fight off and create a resistance to is that process?
Jennifer Smith, CDE 17:16
It's that process, it's really not, I mean, overall, it's not the I got a shot, my blood sugar went up, that the case at all, it's actually the content of it, that creates a system of your body reacting to it, and some people's bodies react fine. With no issues, no symptoms, they go along fine. Some people have the typical like sore arm kind of thing, you know, those kinds of injections like intramuscular, whatnot. And sometimes just that sore arm kind of feeling could be enough, again, inflammation in that site to create a little bit of a bump in blood sugar. I would say that the only thing that would coincide with actually getting a shot in terms of like a vaccination, but they're they're pretty big needles for the most part. So if you could have a quick rise in blood sugar in that like setting, because you're scared here.
Scott Benner 18:11
Yeah, that stuff. But But again, to use the Walmart reference, again, the vaccine, just the sheer, I touched the vaccine to my body, my blood sugar went up. There's a mechanism in there. It's not just that you got a vaccine, it's the rest that happens afterwards. Yes. Is alcohol its own Do you think?
Jennifer Smith, CDE 18:32
I would think so. Yeah, I think that's a good discussion.
Scott Benner 18:35
All right. So I'm gonna mark that as its own episode. Medications in general, people just put medications. So I mean, there are some sugar fillers in some medications, right. Like, there are
Jennifer Smith, CDE 18:53
kids, especially kids, like, you know, antibiotics are often a liquid of some kind that is flavored sweetened to some degree to get the child to take it. So those could certainly and usually do have some type of carbohydrate in them or sugar in them. Other people, though, in terms of medications, could have reaction. And that's where it's really important. Anytime you start on a new medication, ask your doctor if they've checked. So they can tell you whether or not you start paying attention to your blood sugar. Because some medications that you will take long term could definitely have an impact on blood sugar, either making you more sensitive or making you you know, more resistant or whatever it is, while the med is doing what it needs to do for what it was taken for. It may have an indirect you know, sort of impact on your blood sugar.
Scott Benner 19:46
Alright, I have a thought but I'm going to add it to something else. So pain we're in the same situation. We talked about that already adrenaline, like you know, reactions to, to pain. I don't. I don't think that needs its own. I mean I don't think so. For second episode was a pain Yeah, if you're on paying your budget or Miko up we'll see you later. Right? Is menopause its own
Jennifer Smith, CDE 20:12
I would say menopause could be its own definitely.
Scott Benner 20:15
I thought so too interesting. Waking up in the morning Okay, guys, we have great episodes on that. So we have what did we do? We did feet on the floor defining diabetes we did defining diabetes, Dawn phenomenon and now we're gonna we did. How do you say it Jenny's? Oh, this smoky? Yeah, we did that. So go find those defining diabetes. If you're are you thinking waking up in the morning is its own thing? It definitely is. But we've got that covered in space covered. Yeah, yes. Lots of involve our allergies, like illness.
Jennifer Smith, CDE 20:56
Allergies, or like illness or kind of like inflammation, quite honestly, I mean, allergies create right, a reaction in the body that inflames kind of somewhere in your lungs sometime most often like nose sinus cavities. And so that could create enough of a stress on the body to cause a rise in blood sugar until you get it controlled. Now, the other variable with allergies is what type of medication again goes along with meds? What kind of medication are you taking to control the allergies? Some meds for allergies have done definite impact on blood sugar and will cause them to go up? Okay? If especially if they're steroid
Scott Benner 21:38
based. Yeah. And steroids in general, just Yes. Are gonna make your blood sugar go up and yes, and be incredibly resistant. Meaning Yes, you might. I've seen people with like two or three times their Basal rate trying to fight steroids for days and days. Yes, yeah. I actually just interviewed a boy from gosh, where was he from Ecuador, who has an illness that requires them to be on steroids all the time, and the amount of insulin he uses is spec exorbitant,
Unknown Speaker 22:09
I'm sure. Alright.
Scott Benner 22:12
So then it right. dreams, dreams or adrenaline. Like you just get really scared because your blood sugar grew up in the middle like that ever happened to you?
Jennifer Smith, CDE 22:21
I would guess I mean, I, I guess I if I've ever had bad dream, and thankfully, gosh, I don't remember really that many, like nasty, bad dreams where I wake up. I'm like, Oh, my gosh, you know. And at that point, I was probably just happy that I woke up like in my bed and like not in the weird scenario of my dream. Right. So whether I checked my blood sugar or not, I mean, it's typically just a it's it's sort of a an unconscious sort of reflex for me to be like, what's my blood sugar when I get up? Even if it's just to go to the bathroom? overnight? I always check. I would expect though, it would have adrenaline type of impact on blood sugar, if it was a scary enough or a worrisome enough situation in the dream? Yes.
Scott Benner 23:07
Okay. They're out. Cortisol is I mean, hormone hormone. So we've done that already. Singing makes my blood sugar drop.
Jennifer Smith, CDE 23:21
Oh, well, if singing is something that brings you a lot of like happiness and pleasure, then it could very well be that relax, you're relaxing, and you're really you're got those like feel good hormones kind of kicking. It could be that or if you are singing, again, context to the setting of singing, right? Because if you're singing and you're singing on stage, and you're in a theatre production, and you're moving around and changing, that could be a bit of activity as well as just the happiness of singing.
Scott Benner 23:55
Interesting. And then ironically, on the list the next one's emotions. So
Jennifer Smith, CDE 24:00
Oh, yes, I mean, emotions, definitely. I mean, emotions could be adrenaline based emotions, they could be happy based emotions, they these definitely kind of all go together. I would say that happy is often associated with like a drop in blood sugar, or more stability or more sensitivity, right? But I've also seen kids who are super, super excited about their birthday party, and their blood sugar rises, despite them being so happy. That adrenaline rush that they get because it's like they just were dropped off at like Disneyworld. Right?
Scott Benner 24:40
So the adrenaline overwhelms the emotion. Right? Yeah. Is caffeine its own or no,
Jennifer Smith, CDE 24:47
no, I think caffeine is an easy one caffeine. In the majority of people that I work with, and myself included Haftar years ago doing enough testing around x I was like, What is this weird strange thing after I start Drinking coffee. Most people need to Bolus for caffeine. It's it's not an unless you're not already covering like creamers or sweetened creamers or something like that. Well obviously, consider that as a first step Bolus for something that you're adding. But if you're just drinking a black cup of coffee, and you have this rise in blood sugar, nine times out of 10, more than that even is going to be the caffeine and you have to figure out usually I say, figure out how much of a rise you're getting. And then cover it with what would correct that rise.
Scott Benner 25:33
Okay. The next two we've literally talked about in the last couple of moments in a different way infections and excitement so we're good there. I will say this. If this one's an episode, I don't know because I've never understood when people talk about this daylight savings. How the heck does that change things that much it's an hour right.
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How the heck does that change things that much? It's an hour right? It is.
Jennifer Smith, CDE 26:56
And I think it's a it's a pretty quick in what I would expect in terms of explanation. Depending on what you're doing with your insulin doses, it may have some impact. Like, let's say you are the person who has different settings overnight for your Basal, right. And you don't adjust your pump accordingly. So now you could be running settings that are not jiving with the actual timeframe that they're now needed it. Okay. So in a way, could it? Yes. If you're not adjusting, so that your system can give you your right doses. Right.
Scott Benner 27:47
So then that goes right along with this one here. schedule change, same thing. Yes.
Jennifer Smith, CDE 27:52
schedule change, same thing. And in fact schedule change, especially for someone who has a very drastic schedule change from what they had been doing a nurse who had been doing day shifts, who is now working the like 11 to seven shift, right. That's a big change and a definite difference. And most likely we'd have to do some new testing around that to figure it out.
Scott Benner 28:16
Let me see if you agree with me here teething. Oh, hold on. I was almost dead right there. Just almost went down. Oh, no. Can you imagine you'd be like,
Jennifer Smith, CDE 28:29
it'd be like, 911 Yeah, I'm calling for this location, not where I live.
Scott Benner 28:34
Making a podcast with a man in New Jersey just fell right out of his chair. Please help. Teething and getting a tooth is going to be pain, inflammation, and maybe
Jennifer Smith, CDE 28:47
an irritability, more temper tantrums, probably less sleep. I mean, all a collection of variables in one.
Scott Benner 28:55
And we be looking for higher blood sugars from that correct. Okay. Moving. I mean, is Walmart, right? Like you're moving? Yes. Either excited or nervous? And probably more active than you think. So emotions, adrenaline. Yeah, hopefully this is you know, I'm actually enjoying this.
Jennifer Smith, CDE 29:15
But yeah, it's kind of fun going through them because I think people think about it in terms of words, right? People have a lot of different explanatory words for the same thing,
Scott Benner 29:26
the same thing over and over again. Yeah. And they give you an insight into their lives, injuries, breaks and concussions. I feel bad for this person. Oh, that's not good. Yeah, but but that's, uh,
Jennifer Smith, CDE 29:37
maybe they're a hockey player.
Scott Benner 29:38
I hope so. Alright, but we definitely covered that. Okay, so here's one where people I mean, we've talked about illness over and over again, it's in an illness episode. I'm going to skip that. Hormones we've done I mean, carbs and protein. You know, guys, there's tons of episodes on that we you know, if you
Unknown Speaker 30:00
go back and listen.
Scott Benner 30:03
If carbs is like the OG variable, right in diabetes, I don't think that its own episode, but I appreciate you putting it on here. This person, you know, talks about work about how they need different Basal rates on different rotations of their job, which is really just spoke about cyclical hormones in a tween who hasn't had their first period yet. So, I mean, in the lead up to your first period, you can start seeing hormonal impacts. If I was you, I would take that as a nice thing. It's like, they're like training wheels. Yes, yeah. For for learning how to do that. Yep.
Jennifer Smith, CDE 30:43
And I think we talked a lot about that in hormone based episode. Yes.
Scott Benner 30:49
Definitely did absorption injection sites we did site. We talked about sites, scheduled transitions, shared custody of families. I'll tell you what, I don't I get that that's a variable. But I still haven't found a good way to talk about that. And when we do, it won't be in a variable episode, it will be in a longer one. Because agreed there is a huge there's a huge problem. If you're managing one way and someone else is managing a drastically different way. And you're passing this person back and forth. Correct? Yeah.
Jennifer Smith, CDE 31:21
And I've worked with plenty families where it can work really well, as long as everybody's on the same page in terms of the best interest of the child. And it can work really, really poorly.
Scott Benner 31:35
Yeah. If if they were just hey, do you have enough information in your head to do a pro tip about how to do it? Well, you think? Yeah, yeah. All right. I'm gonna mark out for that one. inactivity is, you know, I think obviously, if it's not your if it's not your normal situation, right? If it's not your typical, like you said, then inactivity could make your blood sugar rise, if you're usually more active and suddenly inactive, you would probably get a rise from that. Mm hmm. This one's really interesting. But we already talked about being around different people. This person says that their steps on their blood sugar goes down when they're around their daughter, which is probably just the happiness and comfort thing, I don't believe I would think, yeah, unless their daughter is magically giving off. Insulin in the air.
Jennifer Smith, CDE 32:26
Right? Or again, I mean, it kind of does go back to like us a separate household type of management, you know, maybe the child whose blood sugars now even out when they're with you. It could be because they feel more secure, they feel more supported. They feel like somebody is actually helping them to pay attention versus the other scenario.
Scott Benner 32:47
And here's another one. The next one, my daughter is blood sugar rises, the minute we walk into the my parents house, so either your daughter's really excited to be at your parents house or doesn't like being there would be my guess, right? Correct. Okay, yes. No. Isn't that interesting that you kind of have like a little meter on you, that tells you? Oh, yeah, it's interesting. Time Zones, I think, are the same thing, as you just talked about with daylight savings time, except it happens quicker, right? Instead of happening
Jennifer Smith, CDE 33:17
in time zones are it is it's kind of the same thing as just paying attention to remembering especially if you're on some type of technology that delivers your insulin, right, some type of pump, making sure that you change the time, once you arrive at your final like, stay their destination. So that you have all of your settings that are now coinciding with the time that you're in.
Scott Benner 33:43
What do you think about times of day eating? Do you think do you think that chicken parm with little pasta takes a different amount of insulin at 3pm that it takes at 8pm than it would take at 9am? Or do you think that people's just have such varied Basal rates? Maybe. I mean, can food really hit because I don't think of food that way. I Bolus for something the way Bolus for it. I've never considered the time of day but Arden's settings are really rock solid, so I don't know.
Jennifer Smith, CDE 34:13
Right? Which means that you've tested and if she and I don't know what her settings are like, but if you have more than one insulin to carb ratio through the course of the day, her dose may be different for something like she decides at nine o'clock in the morning she's going to eat chicken parm versus at eight o'clock at night. The doses may be different but your strategy for managing that meal should remain the same in terms of that she needed a Temp Basal increase does she need an override does she need some kind of you know assisted in in something like that. But most often, people's insulin to carb ratios are what are going to drive the control around the same meal despite it being a different I just got that question the other day from a family so well you know, he's getting two and a half units of insulin for dinner for this. He eats it for breakfast Shouldn't he also always get two and a half units? Depends on what the ratio of the time of the day
Scott Benner 35:11
yeah and it's important that I'm glad you pointed that out because the reason I don't notice it is because Arden's carb ratio is the same 24 hours today it's super aggressive and it's the same
Jennifer Smith, CDE 35:23
are her ISF is different based on the system that she's on or her ISF different through the day then that may make a difference?
Scott Benner 35:29
Yeah overnight but not when well d times the same yeah day times always the same. Yeah. Lobby insulin go Yes. We'll work it out later. Let's stay ahead of this blood sugar. Eating girl lots of insulin. She and she eats a fair amount it's um she's a definitely a she's got a good appetite when she has a good appetite. We talked about this one because we found it interesting. Off off off microphone but this person says during wet weather that causes high blood sugars and sunny weather causes low lows. And the best agenda and I can come up with is
Jennifer Smith, CDE 36:13
that you're less active if it's wet and rainy and whatever outside and you're more active when it's sunny, and you're probably outside more or you know just enjoying even being out in your yard and gardening versus sitting inside.
Scott Benner 36:26
It's got to be like barometric pressure doesn't move your blood sugar, right?
Jennifer Smith, CDE 36:32
I've never looked that one up. That'd be an interesting thing to look up. I've never, I've never checked.
Scott Benner 36:37
All right. Well, if it turns out that it does, we will come back and apologize. Yeah, Anastasia, does that make your blood sugar go up or down?
Jennifer Smith, CDE 36:46
I think it's probably what I would expect is that it's more relative to how your body reacts to anesthesia. Honestly, I mean, my personal and one is that I react horribly to anesthesia. In fact, I always tell the anesthesiologist I'm like You Give me whatever cocktail has the most to stop the nausea and whatever after because after everything that I've ever had anesthesia for. I am knocked for a loop and I feel horrible and that actually drives my blood sugar up because I feel horrible.
Scott Benner 37:21
Okay, so alcohol is does that need its own?
Jennifer Smith, CDE 37:26
I think we set Yeah, I think calls definitely. We're gonna make
Scott Benner 37:29
that its own episode. One that we talked about, about people said constipation and stomach motility and Jenny's like I'm not sure about that. But I have seen that a little bit with Arden. If she hasn't gone to the bathroom in a while her blood sugar can get sticky. And then the minute the event happens, it starts to come down. Come down. Yeah, but I mean, it's got to be a pretty drastic scenario. Constipation scenario, like I just haven't gone since yesterday. You know what I mean? Like?
Jennifer Smith, CDE 37:57
Everybody should go to the bathroom every day.
Scott Benner 37:59
I was gonna say that to everybody poops and everybody should poop every day. And if you're not, yes, fine Metamucil or eat a vegetable.
Jennifer Smith, CDE 38:07
My boys love that book. It's I think, actually, it's called everybody poops. They love that. They think it's hilarious.
Scott Benner 38:12
I'll tell you what, at a certain age. I thought it was hilarious too. And that age for me was 37
Jennifer Smith, CDE 38:19
is another fun you want to say? I need a new but oh my god. We laugh and laugh when we read it. It's so funny.
Scott Benner 38:27
Glycemic Index of food is definitely a variable and we have multiple episodes on them. Please go find Yes. Hot tubbing shopping Pre-Bolus thing versus non Pre-Bolus. And these things are all self explanatory playing hockey is act in track and field violin lessons, which is probably stress or anxiety I would imagine.
Jennifer Smith, CDE 38:46
Could be I don't know I was a violin player. But I also didn't have a CGM at the point at which I was playing violin so who knows what was happening?
Scott Benner 38:55
So I'm gonna draw a line here because you're out of time but let's just end with this. Were you any good at the violin?
Jennifer Smith, CDE 39:00
I was really good at the violin I haven't played in years I just I don't really have the time or you know keep up with it. But I yeah, I played from kindergarten all the way through college.
Scott Benner 39:11
Oh, wow. Do you think you could pick it up and like knock something out with it?
Jennifer Smith, CDE 39:15
I could I actually I really right now I need a new bowl for my violin because the strings on my on my bowl are done. So but other than that I could
Scott Benner 39:25
your violin is good. You just need a bow.
Jennifer Smith, CDE 39:27
I just need a bowl. And I've looked into getting it repaired and getting a new one and I just I look at it and I'm like, Ah, I could spend that money.
Scott Benner 39:38
Just don't do it. If I leave this in someone's gonna send you a bow so the other night somebody went on my buy me a coffee link and left me so much money. I was like, stunned Oh, and with this really wonderful note and I wish this was more and it made me I was very happy that they felt that way. And I took the money and I bought hard drives to backup episodes. This sounds awesome. Yeah, but I was also it's weird. It makes me uncomfortable. So that is I know if a bow like if somebody said to me, how do I send a bow to Jenny? Okay? No, you'd be like, Oh my god, don't do that, please.
Jennifer Smith, CDE 40:16
No. I mean, I've gotten really nice thank you is, which are, I think they're, they're the most appreciated. I just, I love hearing how much this helps people, honestly. And those are, those are the best, like feedbacks kind of thing. You know,
Scott Benner 40:33
sorry. I really do. Okay, so the next time we get together, we'll do a couple of them that we've that we've set on and then we might do another run through the rest. And I thought this was good. So awesome. Cool. All right. Yay, one second. Yeah, I like it when things work.
A huge thank you to one of today's sponsors, G voc glucagon, find out more about Chivo Kaipa pen at G folk glucagon.com Ford slash juicebox. you spell that GVOKEGL. You see ag o n.com. Forward slash juicebox. That's it for this one. Thanks so much for listening. And for sharing the show. I'll be back soon with another episode of The Juicebox Podcast. If you want to wait till after the music, I'll run through the links for every one of the advertisers just in case you need them.
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#587 Carb Counting Mess
Laura lives in Switzerland and she has type 1 diabetes.
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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
You're listening to Episode 587 of the Juicebox Podcast. Welcome Friends
Today we're gonna be speaking with Laura. She's from Switzerland, is in her 20s and has type one diabetes. You can find her on Instagram at carb counting mess. Today while you're listening, please remember that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, always consult a physician before making any changes to your health care plan, or becoming bold with insulin. I'd like to remind you that if you're from United States, and you have type one diabetes, or you're from the United States, and you're the caregiver of someone with type one, you can complete the T one D exchange survey in less than 10 minutes right from your sofa. right on your phone. T one D exchange.org. Forward slash juicebox. It's pretty much what I got here, but there's a lot of music left. Oh, you know what, check out the Facebook page Juicebox Podcast type one diabetes, actually, that's on the Instagram to even put something up on Tik Tok. But the contents not quite ready yet, but you could still follow me to get a head start Juicebox Podcast this episode of The Juicebox Podcast is sponsored by TrialNet. Find out if you or a loved one have the genetic markers for type one diabetes for free at trial net.org. Forward slash Juicebox Podcast is also sponsored by the Contour Next One blood glucose meter, my favorite blood glucose meter, the one that I found to be the easiest to hold, to use to love to hold to caress to sing to it night contour next one.com forward slash juicebox. For clarity and honesty, I've never sung to a blood glucose meter. It just sounded sweet in the moment. And I guess if I'm coming clean, I've never crossed or one or held it lovingly either. But it's still a great meter contour next.com forward slash juice box.
Laura 2:16
My name is Laura. I'm 25 years old. I've had type one diabetes since 2007. And I live in Switzerland.
Scott Benner 2:25
Right off the bat. I'm very I'm aware of you from Instagram. Right? So that's how I know you. And I've never heard your voice before. And even though I recognize that you don't live in America, when you started speaking I got all excited.
Laura 2:43
Why? I was like, oh, Laura
Scott Benner 2:45
has like a an accent that I vaguely think might be not French but close to France ish. And then that was the best I could do. I said this Yeah, it's fun for me.
Laura 2:57
People actually have a hard time locating my accent. Because I'm, I feel like I'm all all over the place. I I watch a lot of American TV shows, and movies. But yeah, in the end, you can tell that I'm not native.
Scott Benner 3:16
Well, and so are you born and raised there.
Laura 3:21
I was actually born in Italy. But I moved to Switzerland when I was nine months old. So I basically grew up in Switzerland. But my parents are Italian. So I speak Italian at home. I actually grew up bilingual, so I speak Italian, German. And then in school we learn English, obviously and French and Spanish.
Scott Benner 3:47
Wow. So the English that you possess now, which is great by the way you got from school and from television. Yeah. Wow. That's impressive. I think if I watched Italian television, night and day, you'd be surprised that I would not learn one word.
Laura 4:05
Well, English is is quite easy to learn, honestly.
Scott Benner 4:08
Is that a dig? Or is that a good thing? What are you saying?
Laura 4:11
No, it's a good thing. I mean,
Scott Benner 4:15
your trashy little language is so easy to pick up for a mind like mine. So you grew up in Switzerland with Italian speaking parents? Yes. And what's the language? Is there a is there a national language in Switzerland? Is it English or is it French?
Laura 4:32
So actually, Switzerland has four national languages. So German, obviously, French, there's an Italian speaking part. And there's one which I guess it's best described as a mix between Italian and like German. And then there's like Swiss German, which is only spoken language. It's not very And it doesn't have any grammar. But it's the spoken language. So, and every region has their own accent. And sometimes they're so different that you, you can really understand someone from another region, which is very funny.
Scott Benner 5:19
But that's fascinating. But may I offer a critique? You can't say we have four national languages. That's like saying, If I said you, what's your favorite ice cream flavor? You can't say, well, here are my four favorite ice cream flavors that doesn't work that way. Well, Laura, you're gonna need to make a big sign, but I'm gonna stick and get outside and start protesting right now. It's gonna say pick a language. We'll do that after you get out there and get to work. Like you have nothing better to do. How old were you and you're diagnosed? I was 11 1114 years ago. Ish. Yeah. Is everyone impressed with me? subtracting one from five.
Laura 6:02
I'm very impressed. I was waiting for your joke.
Scott Benner 6:05
It's not a joke. I wish it was when I said 14. And you said yes. There's like a little band inside of my head that goes You did it.
Laura 6:14
I mean, technically, it's 13 and a half. But you know,
Scott Benner 6:17
but I like you going along with it. You listen to the podcast, you know not to disagree. That's obviously, obviously obviously. Oh, this is great. Are you a very sarcastic person?
Laura 6:28
Um, yeah, yeah. I'm with people. I know. Well, I tend to be very open and funny and step sarcastic. But I'm mostly a very shy person. Not very outgoing. Typically, with people I don't really know that.
Scott Benner 6:46
Yeah. How do you get to know people then?
Laura 6:51
Through my boyfriend, he was much more outgoing. Now I just, I just like to smile and people people respond to me smiling. So I guess so
Scott Benner 7:06
your boys breaker your boyfriend? Is the the trap basically. Yeah, he's the I think what they call the honeypot in some circles, right? And then, so he brings them in. And then you retain the ones that react to your smile.
Laura 7:25
Well, I mostly I smile. This is gonna sound weird. I smile at strangers sometimes. Just because I'm a, I don't know, a kind person. And I don't like to look grumpy. Okay. So, yeah, those are two main ways to, you know,
Scott Benner 7:47
learn, I do the same thing, but for a completely different reason. So I smile at everyone. I'll say hello to anyone who comes within like six feet of me if we're walking face to face together. But I just do it to see how they react like it to me. It's just a social experiment. Like I like it too. I should be clear. I'm not just effing with people, like I really do. I really am interested. I'm, I'm, I think I'm a pleasant person. And I do like to say hello. And I don't think people making eye contact and smile and things like that hold doors, that kind of thing. So I am very active when I'm in public like that. But I guess the secondary interest is to see how many people are. I think they're mostly shocked. I don't think they're put off. And I think that sometimes even when they're shocked, they'll rebound and you'll be past each other and they'll turn and go Oh, hello. Like it just they're not expecting it. But that might be an American, or even colloquial to my, my, where I live geographically, perhaps I'm not sure. But it so are you introverted?
Laura 8:53
Um, yeah, I guess you could say that. This interactive spend time alone. It's just it's not that I don't like other people. I just need to recharge my social batteries. So I've actually been enjoying COVID
Scott Benner 9:11
Because you're one of the people that's like, Wait, stay inside and don't go out. Oh, thank God finally.
Laura 9:18
Yeah, totally. I've been. Yeah, I've been loving spending so much time at home and just doing my own stuff, organizing, you know, stuff like that.
Scott Benner 9:29
So when you smile at somebody, is there not a concern that they'll engage you and then you'll have to spend some of your social capital on that.
Laura 9:38
I'm not that much because Swiss people aren't as friendly as American people. So most of the time, it's just a smile. People don't really smell black back. So it's just, you know, just being kind and whatever. But, so these people are very reserved and Not that talkative. So it's not a big problem.
Scott Benner 10:04
You think they're all pissed off? Because they know the rest of the world confuses Switzerland and Sweden.
Laura 10:09
Oh, my God. Yes. Please, please, to everyone stop confusing Switzerland and three, it's enough to say,
Scott Benner 10:16
well, in fairness, they both begin SW, and they're both in that version of the world over there ish. So for people who don't understand geography, or you know, spelling, it's the same place. I know, it is for me.
Laura 10:33
I mean, you know, it's funny, though, because I feel like Europeans know, so much more about the US than Americans know about Europe. So like, we watched the presidential election on CNN, we're very engaged. We knew, like, all the counties, and, you know, the blue counties in red counties. I could, you know, I know the names. But then American people confuse Switzerland and Sweden. I'm like, those are two different countries, people.
Scott Benner 11:07
We don't care. You should try being American. It's kind of fast. It's fantastic. Sometimes, my wife works with people daily from France, and Switzerland, Germany. And so I hear it more frequently. So I stopped myself before I make the Switzerland, Sweden mistake, but I have to, like, I have to, like set it in my mind correctly. Like even when you said Switzerland at the beginning, I was like, No, don't mess this up and say she's from Sweden at some point. So I had to, like put the thought into my head. I'm sorry. I'm very fascinated by you. So. But But okay, so you were diagnosed? Oh, God, I'm 11 years old. Is that what you said?
Laura 11:48
Yes. On 911 actually get out of here.
Scott Benner 11:51
Seriously. While the whole world was going through a tragedy, you had your own personal tragedy?
Laura 11:56
Oh, 911. Like 2000 700. Okay.
Scott Benner 12:02
All right. I guess my math could have been better when I should have said to myself, that was 21 years ago. And she said 11. And you were almost weren't even born? 20 When you were like four, right? Yeah. So now now we can see that between the math and the Switzerland, Sweden thing. You've thrown me off kilter. You all now know why I didn't take the LSAT ever is like how am I going to keep all that in my head at one time? Okay, so you're diagnosed in Switzerland? What's the protocol? How does it work? What do you remember?
Laura 12:36
Um, so I remember going to school in the morning, and then over lunch, we actually go home and eat lunch at home. And then instead of going back to school, in the afternoon, my mom picked me up and she said, oh, we need to go to the doctor to check something out. And at that point, I had been drinking tons and tons of water. I had been losing weight. I was pale, you know, to classical science. And I actually, I was 11. But I was so I started panicking when I didn't have a water bottle or access to tap water. Because I was so thirsty the entire time. And I would actually cry if I had to go to go out without a bottle. So my mom was like, This is not normal. And she went to Google, if I remember correctly, and typed in the symptoms, and it actually said type one diabetes. And so we went to our period to my pediatrician, and I, I think I had a urine test. And they checked for glucose. And obviously, there was lots of glucose. So they were like, Oh, you need to go to the ER immediately. So we went, I think to the Children's Hospital. Yeah, I think Children's Hospital. And I don't remember too much. Actually. I just remember my mom crying at some point. And going outside and actually getting myself my first my very first insulin shot. And I was diagnosed with a blood sugar of 33 million more, which is 600.
Scott Benner 14:37
Yeah, I have a couple of questions. So my first one is pretty basic. You go home every day for school for lunch from school for lunch. How far is school from home?
Laura 14:50
Um, it's about the 10 minute bus ride.
Scott Benner 14:53
So every day they pick you up, take you to school, then put you back on a bus take you home then come back and get you take you to school, then put you back on a bus and take you home.
Laura 15:05
No, actually. So Swiss children are very independent. So by the time they're in first grade, they actually go to school. Like alone. The parents, like don't bring them they don't pick them up. They go on the bus and get home alone.
Scott Benner 15:25
Yeah, I'm saying but the bus takes you the bus picks you up in the morning takes you to school, then it brings you home for lunch. Then it has to pick you back up again and take you back to school after lunch. Am I right?
Laura 15:36
Or no? Yeah, but it's on a school bus. We don't have school buses. What is it's just, it's just a normal bus. Like a like public transport.
Scott Benner 15:45
Oh, the boss. Not a bus. Not not like a bus that belongs to the school. Just the bus that runs around town.
Laura 15:52
No, no, no, no, just a bus.
Scott Benner 15:55
Gotcha. Okay. So I'm sorry. I know where to going down the wrong track here, but I can't help it. So do people trickle back in after lunch? Are people back on time?
Laura 16:06
Oh, we're sweet. They are back on time. I guess that's
Scott Benner 16:09
how the watches work. Right. So well. Yeah. Okay. So everybody's back on time. And then what's the gap of time that you're gone from the time it's like, Okay, I'm gonna go home now till I'm back. How long is that?
Laura 16:22
Um, so we I'd say, one and a half hours, maybe?
Scott Benner 16:29
Wow, that's sweet. can I describe to you my lunch at school, just very quickly, a bell rings in your ear. It's atrocious. You grab your books, sprint through a hallway that if I'm looking back now was honestly just one of those cattle shoots. They used to lead steer to slaughter, right. And then they just move you through quickly. You're banging into people. People are going the other way. You're dumped out into this horrible room where they give you a piece of bread soaked in Ragu sauce with four pieces of fake cheese on the top and they call it pizza. You have 20 minutes to eat it. Put your tray back and run to your next class. How does that sound to you? Awful. Yeah. And in those 20 minutes, you talk a lot about other people. So you know like you point over to other tables, make fun of kids. I was probably being made fun of by the table across from me. Just like chatting. People get into fistfights. None of that happened for you, huh?
Laura 17:32
No, luckily, that didn't happen. But when I went to high school I had to eat at the school. So
Scott Benner 17:39
like a common person. What is this? What did you still get 90 minutes for your nosh or
Laura 17:45
No, no, I wish. It was just like one period. I thought
Scott Benner 17:49
you were gonna tell me they came in and they would hold warm towels to your neck and forehead and free fresh. Always. So I'm sorry. So you're diagnosed in the hospital? You learned to give yourself a shot. You leave with needles in a meter? What did they set you up with? Do you remember?
Laura 18:07
So I was at the hospital for nine days. And I left with pens and just the meter. Okay. And I actually stayed on pens and the meter until I was probably like 1819. And then I switched to the adult Endo. And he actually put me on Dexcom.
Scott Benner 18:31
Okay, what did you I'm sorry, I'm gonna ask one more question before I move forward. You talked about, like panicking without water before you were diagnosed? Was that a a physical understanding that you'd be in some sort of distress or pain and that you wanted to have it to stop that? Or was it a psychological almost kind of god rolled desire? Do you remember?
Laura 18:59
I actually don't remember at all. Like, I don't even remember. I don't I don't remember being aware of my thirst. I don't remember losing weight. I like I was just living my life. And just
Scott Benner 19:15
dying. You know, same time. I'm dying. I just, you know, I asked though, right? Because you're the first person to describe it that way. And I thought, oh, maybe she's got a remembrance of it. Meanwhile, I don't expect anybody's going to. I just, I mean, I assume this is just your body in survival mode telling you, you know, in not not in words, but telling you hey, if we get away from this water, we're in trouble. But it's just it was just kind of fascinating. So okay, so I'm sorry. So when you got to an adult endocrinologist, they gave you a Dexcom what were your outcomes like as a child and what were they like after you could see your data?
Laura 19:56
So that's so that's the interesting part. So while I was at the children's hospital there like that specific Children's Hospital is famous for being not up to date, and like, even now. So that's great.
Scott Benner 20:18
Yeah, it doesn't do a great job and everyone knows it.
Laura 20:23
Right? No, but so during puberty, I was I was actually doing quite well. My agencies were like in high sixes, low sevens, mostly high sixes. But obviously, my blood sugar was a whole other story. So I was, you know, giving insulin after I ate my blood sugar would would shoot up to 400 and then come back down. But still, I was one of the kids that was doing so well. And my, my endo at the Children's Hospital kept telling me oh, you're doing so well, you're doing so well. I wish everyone was like you. So they even gave me a one point when Tresiba came to Switzerland. I was one of the first kids to try out to see that. Because the end was like, your control is so good that we can, like we can see the effect of Joseba on your blood sugar's. So we want you to try it. And so I thought I was doing quite well, when, in fact, I wasn't. And my parents kind of knew what something was up. But they Yeah, it was a very difficult situation, because so to get back to get back to, like, Swiss children are very independent. That something that, you know, gets pushed very hard. Like, children need to be able to look out for themselves from a very young age. And so when I was diagnosed, and at the hospital, they were like, You need to take care of this. You as an 11 year old, you are in charge of our charge of everything, and your parents, you know, they don't have to do anything. Yeah. And, you know, the doctor told me this, and I was like, okay, that's, that's my job. Now, I need to get this under control. But obviously, as an 11 year old, I had no idea I had no tools, no education, to get even close to managing this disease. And so the end, though, was actually pushing away my parents, and my parents wanted to help me, but I was pushing them away. Because the end told me it was my job to manage this disease, so I didn't want their help. And it put us in this very strange triangle. And it caused so much stress and fighting with my parents. And just
Scott Benner 23:29
tell me, tell me why fighting because you needed their help. And you could feel they wanted to give it to you, but they were stopping themselves.
Laura 23:40
I knew, I kind of knew I needed their help. But I didn't want to accept it. Because I, I felt like a failure. If I had accepted their help. It meant that I had failed because I wasn't able to manage this disease by myself. And also, because the doctor kept telling me, you know that like, they told my parents, she needs to come. Like, also, every three months, you go to the Endo. And from the very start, I like I went on my own. My parents weren't even in the room. So
Scott Benner 24:21
you take a bus. What did they draft your parents drive you?
Laura 24:27
I don't remember. I think that drove me. And then they waited outside. But I'm not sure. Actually.
Scott Benner 24:35
That's fascinating. But no, but that really is interesting. I mean, going back to how you and this is from the beginning, from from the very beginning at your youngest a very start. Well, I guess you also described a society where first and second graders were expected to jump on buses and make it to school on their own. Right. Right. So that's the idea. What what is that? Is that the? Is that the German influence on Switzer. What do you think that is?
Laura 25:01
Yeah, definitely. Yeah. Because my parents are Italian. So they've got, you know, they've still got some Italian mentality left in them,
Scott Benner 25:13
you take off the afternoons, what do they do? No, no, no, no
Laura 25:17
budget, they're very protective. So for them, it was extra hard to see their child struggle and not being able to do anything. And they, they actually got quite angry at my Endo, because because he was pushing them away. And I was clearly, you know, I was doing okay, but I could have done so much better. And, and it just created a huge, you know, resent feeling of resentment. And, to this day, I, I actually can't really talk to them about diabetes. I, yeah, it's just, it's, it's strange, I
Scott Benner 26:03
am interested if this thing that your doctor was doing, if it had any benefit, or if it was all kind of negative. So obviously, first of all, he created a barrier between you and your parents and diabetes. But did it turn you into some like, amazing practitioner of diabetes? Where you just like, Oh, I've got my Dexcom now, am I a one sees 4.9? And I'm amazing at this, because I'm so accustomed to doing it by myself, or did that not happen either. Like, I'm trying to decide if this is just a bad idea, from the doctor's point of view?
Laura 26:36
It was just a bad idea, honestly, seems like it to me,
Scott Benner 26:39
I'm just wondering what you thought I could,
Laura 26:41
yeah, I I hear you talking about, you know, parents supporting their child, and when to you know, give the child more responsibilities and stuff around diabetes management, and and so many people say, Oh, if If only my parents had supported me, or, you know, helped me out. And I'm in the same boat. If I could go back out, I would, you know, I would choose. I would actually, you know, want my parents to support me and, and get to know the disease, because, honestly, I don't think they even know how to check my blood sugar with a meter. Because they've never had to do that. They have never given me an insulin shot. They never had to use glucagon. They know how to carb to count carbs. Because they, they did do that for me. But they never got up at night to check my blood sugar. It's just everything was on me. And it's a lot for a teenage girl to to carry this burden. And just course, yeah, I just felt like a failure the entire time. Sorry.
Scott Benner 28:04
Yeah, I don't. I mean, listen, the part of it that makes it so crazy, in my opinion, is, is that the story you're telling should fit more of a 20 year ago? Diagnosis, not an 11 year ago diagnosis. But maybe that's just the difference between the US and where you are? I don't know. But like, it's interesting, because I have to remind myself while you're talking, you're 25, you've only had diabetes for like, a decade. Because seriously, I know I'm repeating myself, your story sounds older than that, like delta have to do it themselves. And here it is. And by the way to praising you, for an A one, see, without any consideration for how you got to it. They didn't care. They didn't care that you were 400. I'm assuming if you were 400. That means you were also 50 Some of the times two.
Laura 28:54
Yeah. And the thing is, they didn't know that because I they didn't check my meter, they checked my diary. So like, the night before my end appointment, I would just write some random numbers in my diary. And that would be it. So I dried like 120 Maybe 200. You know, like the not perfect numbers, but okay, numbers and, and they just bought that they never checked a meter.
Scott Benner 29:31
You just feel you're like what gets me through this conversation. I'll put in numbers that aren't perfect, but don't look too bad that they won't dig any deeper. And you had to do that when you were a kid too. You were kind of manipulating your way through those appointments.
Laura 29:44
Yeah, yeah. Because I just I hadn't grasped what it meant. Like I view high blood sugars were bad. I knew I was supposed to give insulin before I ate. But I didn't and I knew you know, the The end of had scared me to, you know, compliance by telling me stories about, I don't know, 28 years old year olds who are blind because they never took care of themselves. We all know the stories. But I just hadn't. It just hadn't clicked, you know.
Scott Benner 30:19
So with your parents sitting out in the car, you're at that age being told by a doctor, you have to do this right? Or you're going to go blind, like the person in this example. Yeah, that that could not have. Were you introverted before diabetes?
Laura 30:39
I was. Yeah. Okay.
Scott Benner 30:40
I just wanted to make sure they didn't break you. Doctor, Doctor just wasn't like, I'm gonna really screw this kid up, watch this.
Laura 30:49
became really close, but they didn't.
Scott Benner 30:51
Well. So that's interesting, because your moniker on Instagram is carb counting mess. Do you feel like a mess?
I think you should care about the quality of your blood glucose meter. Right? That sounds like common sense. But nobody really thinks about it that hard. Mostly, we just get the meter that a doctor gives us and we go about our business. We never even wonder, are there others? Are they better? Should I look? Well, there are and you should. And I would start looking at contour next one.com forward slash juicebox. And specifically, I would train my eye on the Contour Next One blood glucose meter. It is easy to use, easy to handle easy to see has a bright light, Second Chance test strips. And I love it. Just I have my hand up in the air I'm swearing to something it is my favorite blood glucose meter that I've ever used. Contour next one.com forward slash juicebox. Here's some things about it, you might not know you may be eligible for a free meter. The meter may cost less in cash than you're paying for your current meter through your insurance. All of these things are possibilities that you can learn more about at Contour Next One comm forward slash juicebox. But let me just finish with this. Really focus on your needs. Bright nighttime light, easy to read screen. Second Chance test strips. That means if you should touch the blood drop with you with the strip. And it's not enough, you can go back and get more without ruining the integrity of the test. We're wasting the strip. These are the things that will impact your days and nights. And it's super easy to carry your pocket your bag wherever you put your type one gear. Now we're going to move on to a type one diabetes risk screener called trial net. And it's completely free. For those who are eligible who are who's eligible, you qualify if you are between the ages of two and a half and 45 and have a parent, brother, sister or child with type one, where you're between the ages of two and a half and 20 and have an aunt uncle, cousin, grandparent niece nephew, or half brother or sister with type one. Or if you've tested positive for auto antibodies outside of trial net. Okay, now you know what trial net does and you know who's eligible, the rest is easy. Go to trial net.org forward slash juice box, answer a couple of quick questions to make sure you fall into those categories. Then you can choose how you're going to test where you get an in home test kit, a lab test kit, or go to a trial on that site. It's completely up to you. After you get your kit and send back your sample in four to six weeks. You'll know do you have early stages of type one diabetes? If you do try on that we'll schedule a follow up visit to see if you're eligible for a prevention study. That's it, trial net.org forward slash juicebox when they ask you how you found out about trial net, say the Juicebox Podcast if you can't remember all of that there are links in the show notes of your podcast player links at Juicebox Podcast comm or you can just type in trial net.org forward slash juicebox. And since it was a couple of minutes ago, let me remind you of this. Get yourself a Contour Next One blood glucose meter at contour next one.com forward slash juicebox now let's get back to our
Laura 34:34
that's a good question. I do still feel like I feel like a mess. But definitely less than the time at the time when I started my Instagram account. So I have I have turned around my diabetes management completely and honestly it's It's all thanks to your podcast. I couldn't have done it without you But you know, I'm nobody's perfect. I still have my days where I mess up or I feel lazy. I don't count carbs correctly. I don't actually count them. I just wing it.
Scott Benner 35:15
Yeah, counting carbs. That's, that's lame. That's, that's for that's for beginners. If you're still counting carbs, just know, you won't have to forever, eventually you'll be able to just be like, boom, that's 53. Let's do this. And just roll up on it and be done. Oh, yeah, that's great. Okay, listen to the podcast, right? Because then that stuff kind of becomes more and more obvious how to do things like that. I have to tell you that, that a lot of cheese. I want to say something larger. But I don't want people to take Oh, I give up. I don't care if anybody thinks things the wrong way. A lot of people say what you just said to me, and it doesn't lose its impact on me. No matter how often I hear it that you know, something about the podcast was, like valuable for them. But somehow because of your accent, it meant more to me. Oh, I had a woman from Canada tell me the same thing yesterday, but she had kind of like a rough and tumble Canadian accent it didn't hit me as close to my heart as yours did. Which is ridiculous.
Laura 36:22
It's okay. Yeah. Your Podcast means a lot to me. So, no,
Scott Benner 36:27
I'm glad I very much am. I'm very happy to know that says I appreciate you telling me. What made you start on Instagram? Like you found me after you started your Instagram account? Is that right?
Laura 36:39
Yes. Okay. i Yeah. Because I started my Instagram account in. Hmm. And actually remember,
Scott Benner 36:48
doesn't matter. My point is, is when you jump on, what are you doing it for? Are you like, maybe I'll find somebody to commiserate with maybe I'll find somebody who knows about this better than I do. Like, what is it you're looking for when you make it public? Because you? I mean, I guess this shouldn't be a surprise to me. Because I know a lot of introverted people who, you know, personally, aren't looking for a ton of interaction with people can be very expressive online, and it doesn't seem to drain them the same way. Am I right about that? Okay, so maybe is that just part of it too? Are you looking to talk to people, but the idea of doing it in person just seemed not like a good idea?
Laura 37:28
Um, yeah, yeah, absolutely. I think I started it because, like, for the longest time, I really think I really thought I was the only one like, I know everyone, everyone says that. But, you know, I don't get why. Because I knew there were camps for children with type one. I never never wanted to attend one of those camps. And I was like, oh, no, I like if I I just wanted to ignore diabetes, honestly. For the longest time, and then my, when, like, towards, like the end of my teenage years, I was struggling really, really bad. And my boyfriend actually, he found the beyond type one app. And he showed me the app. And I was like, Oh my God, there's other people. There's other type ones. And so I joined the app. And I, I somehow discovered some type one blogs. And so I started reading the blogs and like, Oh, my God, they have the exact same experiences I do. I was just, I was mind blown. And then, somehow, probably someone on the beyond type one app mentioned, like the community on Instagram. And I already had a private Instagram account. So I started following some people, and then was like, Screw it, I need to do my own account. So I can interact with people because I didn't want to, like get one wanted to keep my private accounts separate from my diabetes account. And so I was just looking for relatable content. I was looking for people who could you know, who understood me and the experiences I had had. So that was my initial thought when I joined the Instagram, diabetes insert, sorry, diabetes online community. But then I discovered, you know, I saw other people's graphs and how other people were handling their pipeline. And actually, I remember seeing Like someone who someone's grass who was, you know, like in the mid to hundreds and like 300 Maybe like 150. You know, like, other people have these kinds of kinds of blood sugars. I'm fine. I was, you know, I was looking for some sort of some sort of guide. Yeah. And, and so I was like, that's fine, I'm doing fine. But then I started seeing people with 100 blood sugar, and like straight CGM like lines. And I was intrigued. And I was like, No, it's that's possible. Why Why am I not doing that? Why are my blood sugar is so much higher. And so I started working really hard, trying to improve my control. And it was still on pence at that time. And it just wasn't working for me. I feel like my, my Basal wasn't tried. I tried splitting doses. But that wasn't working. So I ended up going on the Omnipod. And, yeah, so I was I kept improving my agency. I had actually, I had a very acute hypo fear at that point. And because of that, my agency Shut up to 9.3 from like the high sixes. And so I got from 9.3 to 7.2. And at that point, I discovered your podcast. And, you know, over the past two years, maybe I've been able to go from a 7.2 to a 5.5.
Scott Benner 41:58
Wow, congratulations. That's wonderful. Thank you. Yeah. And you made a point a moment ago, very eloquently, that I've maintained for a very long time. And just simply put, there was a time where if you shared a good graph online, people would come at you and tell the they would tell you, you're making them feel badly. And I just always thought, that doesn't make sense to me. Because if I, if someone shares a graph, like you described 201 5300, all over the place, then someone else sees that and thinks, oh, well, this is normal. So I'm okay. But if you put out a graph that's more stable at a lower number, then people should be able to look at that and think, Well, that's possible, like that person's doing it, like, why would it be different for me, and without any excuses in the middle? And you're too young to remember this, but there used to be that idea of like, well, it's diabetes. So if you're not having success, and someone else is, it's because you have a different kind of diabetes, and their diabetes is easier, which is not the case. You know, you know, in a huge majority of people that are outliers who have other health issues that make make it possible that that could be the truth. But for the most part for most people, if you use enough insulin at the right places, you have better outcomes. And so I have just, I mean, I was ahead of that curve. It was it was my my thought that we're going to project success. So that people can believe success as possible. And that it that actually reached you all the way in Switzerland. And, and helped you is it's, it's wonderful and, and I want to thank you in return, because without knowing it, you and many other people, you know, when you're just living your normal day, and it's nothing special, I'm not working, I'm just out doing something and the day is getting long, or it's getting boring, or I'm not doing the things I need to get done. And I'm starting to feel the weight of being alive. I can you know, imagine you somewhere a person I've never met, never spoken to whose health is in a much better situation, through something that I've made, and it helps me feel better. Do you know what I mean? So it's, um, it's nice to hear your story. Because that means I'm not just making that up in my head to make myself like happier. I'm not just walking around going you help people. It's okay, if we are stuck in traffic. You know what I mean? Like there's there's this thing, and it's cool because the podcast is perpetual. And because it's worldwide, it means that I've done something that's helping somebody even when I'm sleeping. Like it feels it feels very, it feels good. i There's no other word that needs to be attached to lovely feeling. And I appreciate you telling me that and I appreciate you sharing with other people. That seeing success can breed your own success. It doesn't have to be something that you look at and go Why are you making me feel badly because I'm not good at this. You'd like to be cuz no one's failing at it because they're not good at it. Like Laura's explained what happened to her, she came up in a culture where they were like, you're two seconds old, take care of yourself. And then you know, and then and then she gets diabetes, they're like, Yeah, keep taking care of yourself. And the doctors, like, don't go blind. And she's, you know, in her teens, you know, which is a crazy time to be telling somebody, you're in charge of diabetes. And by the way, it's gonna kill you if you mess it up. And then you still came out the other side of this. That's just wonderful. It's a, it's a great simple story. And you're so young, that you really have an opportunity to live your whole life this way. It's heartwarming.
Laura 45:41
Yeah, I completely agree. I like being being in the diabetes online community can be so empowering. And also, it's just a great place to be. But there are a couple of things that I don't really like. And the one with the A onesie is one of them. Lots of people don't post their a onesies. They're like, Oh, it's just such a personal thing. I, I don't want anyone to feel bad. I just don't get it honestly. Like, I think it's important to post normal agencies, normal blood sugars, because you get what you what you expect. So, um, you know, sometimes I'm, I, whenever I see, you know, other people posting their graphs and and, you know, you follow people, and you kind of get to know, how do they handle diabetes? And like, what kind of blood sugars they have? Of course, social media is never the full picture. But yeah, you kind of get a grasp of it. Yeah. There's I just, I'm sorry. Sorry, go
Scott Benner 47:02
ahead. No, I cut you off, I apologize. I was just gonna say, look, there are some people who don't share their a onesies, because they have their reasons, who cares what the reasons are, but there are other people who are trying to be, quote, unquote, diabetes influencers, and they're trying to make money off of it. And if they showed you their a one, C, you'd think well, why am I following this person? You know, and so they'll say, oh, I don't want to, you know, make people feel bad. But I'm, listen, I know a couple of people's stories privately that they would know that I know, and they're out there taking money off of people to teach them simple things like Pre-Bolus thing, and they don't know what they're doing. either. They're getting their information from other places. So and that's not the diabetes community. That's the world. Real, you know, like, that's, you know, what you're really describing, you know, what I talked about earlier, like somebody said, don't make me feel badly. That's just a weird thing in society right now. Like, apparently people can't be successful. Because if you're not successful, it makes you feel bad. Like I don't I don't know when we got to that point in the world. But you know, like that, that is everywhere. It's not just, you know, nobody disagrees and has a conversation. They're just like, You're wrong. And that's it. And then we just burn everything down seems to be what happens online. But that's not how the real world works. And so I think part of the reason why the podcast is still it works that way, is because it drags people into a form of digital media that they had no idea existed and had no interest in, like, Do you have any idea how many people listen to this podcast, but not other podcasts? You know what I mean? Or how many people listen to this, who would never have an Instagram account or never think to go on Facebook and don't care about the world and what other people think of each other. They just want to be healthy, they don't care how the hell they figure it out. You those that's the common sense that I represent. You know what I mean?
Laura 49:01
Yeah. And I also think it's it's important to change the narrative around type one diabetes, because I feel like it's it's just common knowledge that oh, you know, managing type one is so hard and oh, it's normal if your blood sugar fluctuates, and yesterday to a degree it is normal like healthy people's blood sugar's do fluctuate a little bit. But it's it's just so sad to me that type one diabetics feel like it's it's totally okay to have like 250 300 blood sugars when in fact it's not and and no one has ever told them and doesn't expect that from them and and it's just it's a sad because everyone deserves better Everyone deserves deserves to be in charge of their diabetes. And that's what I learned from your podcast, which is so, so useful and just empowering. I used to be, you know, in the passenger seat, I used to react to my blood sugar. And now I can act to get in front of my blood sugar and, you know, and decide where the car is going. I'm in the driver's seat now. And that's, I yeah, it's just, I, I don't really like in German, we say someone suffers from diabetes. And I hate the term because I used to suffer. I suffered for a decade. But ever since turning around my management, I honestly feel empowered by diabetes. So much so that I, sometimes I bring it up in job interviews, because so I loop with Omnipod and Dexcom. And, and I was asked once in a job interview, I was like, tell me a personal success story of yours. And I was like, Sure, okay. So, you know, I've got type one diabetes, and you know, I've got the insulin pump, blah, blah, blah. And I told him about loop and how I had to build the app on my iPhone. And it's just, you know, I, I reframe it as a as a personal success, because honestly, it is. And I just wish everyone could have this feeling of empowerment and being able to live well and be happy with type one
Scott Benner 51:44
you are, you're not reframing it, you're just explaining it properly. It is a it is a it's a major accomplishment. It really is. Yeah, no, you're very welcome. I listen, as you're talking. I, for one of the very first times, I'm 500 episodes into this, I thought to myself, I hope my daughter hears this episode one day. That's the first time I thought that while someone was talking, I really did like this. Your your success makes me feel proud of myself, and proud of you at the same time. And I don't normally feel like that. Normally, someone says, Hey, the podcast helped me and I feel like a little, I get a little giggly inside. I'm happy that it's good for you. And like I have that kind of thing. But I've never while you were talking, I thought there's a 25 year old person in Switzerland whose life is better. And I had something to do with it. And I didn't I don't usually think of it that way. And I suddenly oddly want my daughter to know that I did that for you. I don't know why all of a sudden, it just made me feel that way. So I hope she hears Arden if you're listening, and I'm dead, you should be at my grave more visiting me.
Seriously, think about me more often than you are and stop having sex with boys there. That's a message for the future Lord.
Wow, this is really terrific. You're making me so happy because? Because this is it's possible for anyone. And and the sooner people learn about this, the better. And I just I hear from too many people in their 40s and 50s and 60s, who say I can't believe I found this podcast so late in my life. That's a sadness. I don't want people to have to have is there. Was there anything that made the show assessable to you like, like, why did it strike you? Because I mean, look, as we're talking, I'm twice your age from another country. I have a completely different sensibility about most things, and you would imagine you do. And you and I Jive really well together. Why is that? Do you know?
Laura 53:57
Um, I don't know. I honestly your podcast is just so what it's funny, first of all, and that's important. And you're just such a good resource and just your your approach to diabetes is very, like I distinctly remember when you said like in one of your first episodes, you're like, explaining maybe it was even bold with insulin. I don't remember. But the one where you said just Bolus for a juice box. If it'll go low, you you'll just have the juice box if it doesn't, you know, you need the insulin. And I I just I remember I even remember where I was standing. When I heard that phrase because it just I don't know it just it just blew my mind and was like, of course how did no one ever think of this? And I just kept having moments like this when I was listening to your podcast, and it just, it was just, like such a huge learning curve. And it's not it's not boring, it's not very sciency. It's not, you know, super medical. It's just, it's just an easy conversation with amazing management ideas. And that's like, That combination is just, it's just so powerful. And it's not easy. Like, I think you're doing an amazing job. And I, honestly, you're, you're putting so much work in it. And I, I wish everyone could listen to the podcast. And I even try, you know, convincing some people here in Switzerland to listen to the podcast. But unfortunately, not everyone speaks English. That well. And, you know, the terms are quite technical. And, and you speak really fast. So it's not that easy for, for people here in Switzerland. But yeah, it's, I think, every seriously everyone should just listen to a podcast. And I don't know if you if you remember. Okay, a couple of years ago, I actually told my endo about your podcast, and she told other patients and those patients then came back with better results. And I, I like, like I wrote to on Instagram, and like you even said something like, on a show? I don't remember what I remember. But, um, yes, so I really hope to spread the word
Scott Benner 56:55
you tried to make me cry here at the end, Lauren is out today. It's gonna work, keep going. Just so you know, a little misty over her. I don't know what to say other than something sarcastic. So let me just say, I completely agree with you. I'm amazing. How's that? I don't know, I don't know what to say about that. I, I'm, I'm happy that it that it works. That's it, I'm very happy that it works. There's some weird mix me, we could sit here and pick it apart. But there's some weird mix of who I am and how I talk and what I know, and how I approach diabetes and how I approach talking to people. And for whatever reason, like, let's just be happy it works and keep going. You know, like, I don't need to understand that, that that deeply. I know that, I enjoy it. And I know that I'm excited to do it. And I and you're not wrong, it is a lot of work. And yet I don't feel like I'm working on it. I'm very excited to do it. Like I booked the recording, like on a day that I don't normally record because I got somebody and I was so excited to get them on the show. I just was like, Look, if your schedule doesn't fit mine, like I don't care, you just tell me when to do it. And they don't mess up my day that day a little bit. And it'll cause a little problem for my family. But I know it's gonna build the tapestry of this podcast more. And I know it's gonna it's gonna help people, and then has a chance of helping people in a big way. So to me, that doesn't seem like an imposition at all, just seems like obvious. I think, good.
Laura 58:28
Sorry. As a listener, like we can, we can really feel your passion. And I think that makes a difference. Like, you're really passionate about this topic. You You know, you speak from your own experiences, of course. And, and we can feel that and I honestly, it it's very motivating. Because there was a time where when I, I just had, I was so busy, and I didn't have the time to listen to your podcast. And actually, my agency increased a little bit because I wasn't like it wasn't this regular check in with with you with the podcast, like a weekly reminder to you know, people with insulin to do well to stop the arrows. And, and when I started again, it was I just I remember thinking, Oh, wait, that's why I was listening to this podcast because it's so amazing. And it's just
Scott Benner 59:35
like a mental exercise. When you have Yeah, it's mental exercise. It really is. It keeps you engaged. And I mean, listen, I could I could put on a different hat and tell you why I think the podcast works but it keeps you engaged and it it keeps you honest, it keeps it keeps you you know he talks about always being you know to take if you're gonna you know, do a weight loss thing, do it with a friend like that kind of stuff. So you have somebody to You know, can kind of check you a little bit, it's, it's the same idea is when people post their before picture online and then say I'm gonna start running now and you're accountable all of a sudden, to something. And this is kind of great because you don't have to be publicly accountable. You can just be accountable to a voice that doesn't talk back to you and doesn't know if you're not doing the things you wish you were doing. So it's kind of the best of both worlds in that case. Yeah, no, 100% and I treat it like that. I don't treat it like a hobby. Or I don't set it up to make money. It you know, it does it. It has ads, obviously. But you know, you know what I mean? Like, you see things on YouTube that, you know, like the person making the video doesn't care anything about this, they just know that this, this word gets clicks. And so they do a thing about this, like, I don't do that I have people on that I know will bring down the listenership that day. I think children are important to talk to. And there are a lot of adults who won't listen to the kids on. But I still do it with with great glee. I never think oh, here I go. I'm giving away downloads this week. I just think this is important. And and I genuinely believe what I've said to a lot of people, I think if you start at number one, and listen through, I think you're a once he goes into the sixes easily probably into the high fives. That's it. And yours is what right now.
Laura 1:01:23
So my last one was
Scott Benner 1:01:25
five, do you see those 300 400 blood sugars anymore? Never. Of course not. And you said something earlier about even somebody without diabetes, blood sugar goes up, and they have a spike to your 100%. Right, I've worn a CGM, and I've seen it myself, I was able to get my blood sugar to the 130s and the 140s. I think one time I had to eat a lot of pizza. But I got up into like the 160s for a couple of hours. But the difference is that if your blood sugar gets into the 160s, and you don't have diabetes, your body is going to effortlessly at some point bring your blood sugar back down to where it belongs without getting low. If you have type one diabetes 140 is not a big deal. But if 140 turns to the 160 turns the 180 turns into 225 You have such a crazy imbalance of insulin going on that either your blood sugar is going to stay high forever like that without intervention, or you're going to intervene in a way that's going to cause a bad low later, that's going to throw you into a rollercoaster. And the reason that I believe that intervention will cause a low is because if you knew what you were doing, your blood sugar wouldn't be 250 to begin with. So the same brain that got you to 250 is now trying to fix 250. And so you're just going to keep making problems because you just don't know what you're doing, which is fine. But there's a way to understand what you're doing. And not for nothing, Laura, but those things are available at diabetes pro tip comm or they begin at episode 210 at the podcast, right? Right, right. And Jenny's amazing. And you'll find Jenny in the pro tips. That she's amazing. Even though she has that weird accent. You can say she's lovely. She is lovely. But I mean she She talks like she's somewhere between Canada and, and Wisconsin. And she's so sweet. I'm just teasing because you have a weird accent. So I thought if I could get you to make fun of her accent and your accent, it would be hilarious. But then you didn't. You didn't take the bait. You just called her lovely. Nevermind, let it go or we'll move on.
Laura 1:03:22
Yeah, no, I completely agree with you with you know, diabetes roller coaster. And on that point, I, I would like to really encourage everyone listening. Like don't underestimate the power of the Dexcom alarms. i So, you know, I know you're a big proponent of pushing down the alarms as far as they go. And, you know, you're right. Like it seriously does matter. And it does make a difference. And for the longest time I had my alarm at maybe like 150 my high alarm and my emergency stayed in the low sixes high fives and when I changed it to 120 it actually came down like I'm rarely over 180 Because whenever it whenever it goes off I will have I mean of course loop is looping on it. But even if the if loop doesn't give enough insulin I'm I'm on it because I know it's happening and it's just it doesn't honestly bother me. It's it's like I see the alarm as something positive because I get to have the time to react before it's too high.
Scott Benner 1:04:49
That's something someone said in the past that I thought was amazing. She said I used to see the alarms as me messing up. But now I see the alarms as an opportunity to do the right thing that stopped something from going wrong. The way I think of it, the sooner you know, the sooner you can react, the sooner you react, the less insulin you need to react with, which will stop the spike, and significantly decrease the chance that you're going to get low later. That's it. A little bit of effort now stops a big problem later, or you ignore everything, until it's a huge problem, and then spent hours and hours and hours trapped in that problem. It's an obvious decision. Just you know, just and it's so simple. It really listen, if it wasn't easy. I couldn't explain it or good. I mean, really, I'm still reminded myself, she doesn't live in Sweden. She doesn't live in Sweden, and we're an hour into this. I'm no a brain surgeon. You don't I mean, like, it's, it's just it's simple, obvious stuff. And I think, I think the podcast does a good job of explaining how easy it can be and why you might think it's so difficult. You know, and, and all kinds of stuff. I'm so thrilled that you wanted to do this. I really appreciate it. Did we not talk about anything that you wanted to talk about?
Laura 1:06:04
Um, maybe just one less thing. I like I mentioned my hypo fear. And it was, yeah, maybe if we could talk about that a little bit. Because it was, it was really, like I struggled a lot. And it was really hard for me to get out of that fear. And I to be honest, I still am still a little bit afraid of insulin and being bold with insulin is can sometimes be a bit hard for me difficult because my thoughts keep going to open What if you go low? What if the insulin kicks in before your food? But yeah, I just
Scott Benner 1:06:57
how'd you get over it? I mean, how did you get as far over it as you have so far? Because it's a very obviously real thing. And it's one of the things I feel weird talking about not having diabetes, because I can't I don't believe that I can completely imagine what it feels like to willfully take something shoot it into yourself and go hmm, if I did this wrong, it's probably going to kill me. Here we go. Like that's a that's got to be a pretty big leap to make. I do. I do practice what I preach as best as I can. I can tell you that last night, Arden Arden's friends are starting to get their driver's license. Arden's a couple months younger than some of her friends. So she's going to be the last one. And last night, her and a friend, Bella, they went out, and then they ended up at dinner, where Arden texted me and said, Hey, we're getting like chips as an appetizer with cheese. And then I'm gonna have a waffle on I was like, okay, so she was a little on the lower side going into the meal so that when we put the carbs in, she didn't get all the insulin she should have gotten. And I was cutting the lawn, and she was at a restaurant. And so between the two of us, neither of us really noticed that she didn't get the insulin. And then it struck me about 15 or 20 minutes later, I was like, Oh, I wonder, you know, I'll check. So I texted with her and I said, Oh, no, we got to get that insulin in now. And so we put a lot of insulin in she was in a restaurant eating a waffle that I imagine had real, like syrup on it not like sugar free, I think where she was doesn't have sugar free. So I tried to, I tried to get all that in my math. And I was like, here use this much. I think this will work. And then she ate dinner, and everything was great. But as she got to the car to leave her blood sugar was suddenly like dropping, you know, which, I think if we were together, there weren't so many circumstances, we probably could have avoided pretty easily. And but she was in a car driving at that point, you know, with a brand new driver with a girl who basically had driven like three times before that by yourself. And so I didn't want to be like, hey, race home as fast as you can, because I thought that'll just get them killed a different way. You know, so I said, Hey, you got a juice with you? And she said, I do. I said, Why don't you go ahead and drink it. So she drank the juice. We stopped the arrows, she leveled out around 78. And she was okay. But without the intervention of the juice. I think she gets the 50 That's my guess. Right. But still, I can tell you that in the face of potato chips dipped in cheese and waffle dipped in sugar. I would rather have what happened than what would have happened if we weren't as aggressive. So okay, so we missed a little bit, right because we got out of balance a little bit. And so we were way more aggressive because we messed up the timing, if that makes sense to people listening. But still, I'd rather stop a low or falling blood sugar, then fight with the high one. I think that's a great decision in the moment. I think that's a great decision for long term health. But at the same time, I did it with my daughter remotely while she was in a car with a new driver like I'm not foolish Laura like I we do What'd I say on the podcast? You know what I mean? So, but again, I'm not 25 A doctor didn't tell me I was gonna kill myself. My parents were never helping me. And I'm working on this by myself. So that fear was with you. The entire time you had diabetes, when did you start to try to conquer it?
Laura 1:10:21
So actually, I, I wasn't like, I didn't have a fear of hypose until my like my late teens. And I like I had one experience, which kind of triggered it. So I I wanted to eat breakfast, and I had like yogurt and cereal. And it was like a huge Bolus. And I was Pre-Bolus Singh at the, at the time. And I was already on the lower side, like maybe 80 ish. And I play Bolus I forgot to eat. So I waited a bit too long. And then as I started eating, I felt sick to my stomach. So I, I had also insulin on board and I just couldn't eat. And I was like, Oh, crap, what am I what am I gonna do? And so I, I felt like I couldn't hold down anything. So I started eating, like bread, and I think glucose steps, shoving them into my mouth. And I told my mom, like, I have all this insulin on board, I am not sure if if this is going to go well, like, prepared to glucose, just in case. And I was there was the first moment I actually felt afraid, like, some sort of existential fear. Yeah, so we got into the car and drove to the hospital. And I kept eating glucose tabs until we got to the hospital. And we just sat in front of the hospital in the car, and waited for my blood sugar to come up. So that was the first experience. I didn't end up in the hospital. I hadn't, I didn't have to use glucagon. But like the fears struck, very deep. And then, like a couple of weeks later, I was at university. And I was in this huge, huge class with like, 600 people and I was sitting like, on one side of the room, and I wanted to eat a yogurt, and I bought last and ate yogurt. And then I watched my blood sugar, my Dexcom and it went up to like 130 and then it stayed there. And I just panicked. I thought oh my god, the insulin is gonna kick in and I'm just gonna tank and I will have a seizure in this room full of 600 people. Oh my god, I can't do this. So I I left the room. A good friend of mine came with me. And like we're asked where I study, the university is literally right across the street from my endos office. So I just walked to my endless office, drinking juice on the way. I don't even know why I went to the office because honestly, what
Scott Benner 1:13:41
they would have just told you you were going to go blind probably. Yeah.
Laura 1:13:45
Well, that was a different end. But yeah, I just I was seeking some sort of security. I was like, maybe it like if I have seizures take I'm sure they can help
Scott Benner 1:13:59
these people know what to do. Yeah, right. I just stare but did you fix it on your own? Or was it ever a problem? Or was that just anxiety about being in a room with all those people?
Laura 1:14:11
Honestly, if I had just, if I had just stayed there, my blood sugar would have been perfect. But I was just panicking. And so I completely over treated my It wasn't even a low I just over treated periods. And I
Scott Benner 1:14:28
sorry, you didn't need that juice at all.
Laura 1:14:30
No, no, not at all. Like I ended up at a no 350 And when I got to my Endo, I was like, I'm just I'm just so afraid of like of the incident i i thought i was gonna pass out and he was really rude. She just didn't take me seriously. I was like, Oh, you'll be fine, just whatever. And and I was having this issue Potential fear and, and he would just, he just didn't get it. He didn't give me the comfort and he didn't make sure I felt safe. And that just stuck with me. And I was I wasn't able to shake this fear. So I started, I literally couldn't get much higher. Yeah, yeah, I was I was giving my Basal insulin, and but I couldn't Bolus for anything. So I started eating very, very low carb. And basically not following so. So that's when my agency Shut up to 9.3. Because I, my blood sugar was 250 the entire time. Sometimes I'd have 1015 Day stretches where I get my blood sugar wouldn't get into the one hundreds. Because I had so much fear around insulin.
Scott Benner 1:16:03
Can I tell you that part of my feeling around this comes from a very, very long time ago. So a really long time ago, the diabetes community lived in earnest on Twitter, it's not really there anymore, with the same kind of power. But there was this one girl, and I don't know her name, honestly, I'm not saying I don't know her name. Because I'm trying to keep it private. I don't know her name, I don't remember who she was. I remember her being in her mid to late 20s. And she would periodically reach out. And she was frozen. She couldn't give herself insulin at all. She had some sort of massive hysteria about it like it was it was beyond just fear it I don't know if I'm saying that correctly. But she was having some sort of a breakdown, it felt like to me from a distance. And I just remember thinking, she's got to pull this together, it's gonna kill her. And people would try to help her. And sometimes she'd say she was doing better. But it just looked like she was doing worse and worse. And then one day, she just disappeared. And I just always wondered, you know, I have no way of knowing what happened to her. I never really knew her, I don't think I ever even corresponded with her, I just was watching it happen. And I thought, look how real the fear is, like, everyone must feel some percentage of the she's obviously feeling all of it, you know, plus, she's getting for people's doses of fear. But I just thought I'm afraid to, you know, I have to not be afraid. And that's about the time that I started talking to people more and more writing about and trying to decide how to not be afraid. Because it just seems like step one to me. You know, you can't be afraid if you're afraid of the insulin, you can't use the insulin, if you can't use the insulin, you're not gonna have great outcomes, etc, etc, on and on. So the fear is real, it's understandable. And there's a way to mitigate it. So how did you end up mitigating it?
Laura 1:18:05
I don't actually know. It's it just happened over the years. I? Well, so my boyfriend was he was very supporting, and he, whenever I'd get anxious and just afraid, he'd say, oh, but it's okay. Just, let's just wait 10 minutes and see what your blood sugar does. And if it does drop, you can you can always drink something or eat something. And so I just, I just trusted the process, honestly. And,
Scott Benner 1:18:39
but yeah, a little support to there was somebody standing next to you like, like, alright, I'll stay we'll do it together. You weren't alone anymore.
Laura 1:18:46
Yeah, right. And also, I, I started carrying around glucagon. And so I had this kind of security blanket. Just in case something happened. I don't actually know if people would know how to use the glucagon, or even find it. But you know, it's just my I kept telling myself, you'll be fine.
Scott Benner 1:19:09
Here. Someone will take it. I have to be honest, I can post in my head but never typed out. Hey, why don't you explain how to use the Chivo Kibo pen to your friend while you're driving? Like, yesterday when I was talking to him, like I had the thought I'd like the juice is gonna work. But I knew after the juice hitter if I didn't see a change pretty quickly. She was in a car and she was out of options. She didn't have any more sugar with her. They weren't that far from home either. And so I thought like how will I like, like, what's the least? What's the least frightening way to say I think you might have to stick that hypo pen in your thigh in a second. You know what I mean? Like if this doesn't go our way, so I kind of thought it through the best I could. I never even typed it out. But I did I had a lot of comfort in it. And I have to admit, and I know they're a sponsor, so it sounds, but there's something about it just being in that premix pen that makes me feel more comfortable. Because I can't imagine saying to Arden, hey, now would be a good time to get the powder out and the liquid and get the liquid. Okay, just you know, while you're driving along in a car, it that all seems daunting. The other idea just seemed like, oh, wow, we really messed up like it's time to jam the pen. She's never done it, but it didn't seem scary to say, I guess.
Laura 1:20:31
Yeah, yeah. But that's how I feel about the vaccine. Yeah. Oxymoron.
Scott Benner 1:20:36
Is that the nasal one?
Laura 1:20:38
The nasal one. Yeah. Okay.
Scott Benner 1:20:39
Yeah. Just it seems easier. And that's great technology, making people's lives better again, because now you you don't have to wait until something goes wrong wrong. Because you're not getting involved in what feels like a super it's, it's physically you're launching something to the moon. But that'll, that'll, that'll glucagon. You know, like, I don't know if I can do this or not. It seems like a lot. So it's cool. But so you found it, you found some stability. And now you're right on it. Right? And and in all truth, when your settings are good. When you're not guessing at your Basal. And when you're not just throwing insulin wildly around, those kinds of fluctuations are far fewer, I would imagine.
Laura 1:21:22
Yeah, definitely. Yeah, I'm, like, I'm mostly well controlled. I do still struggle a bit with my blood sugar dropping because of activity. So for example, yesterday. We also we ate dinner, and I Bolus to cover my dinner. And then I just ran randomly decided to water all my plants. So I was walking around the apartment with with a heavy, whatever it's called, like the thing to water the plants. And my blood sugar went from, like, I don't know, 150 to 40. Just because I was watering the plants. And if I had stayed, you know, if I had just sat down and watch TV, I would have been completely fine. And so that's where I'm still struggling because I don't want to limit myself. I want to be able to be spontaneous, and randomly decide to do things without my blood sugar crashing like crazy. And
Scott Benner 1:22:41
what are you watering the plants with a fire hose? And how big is your apartment?
Laura 1:22:45
It's actually so small. But I've got lots of small plants all around. So I need to walk into every room.
Scott Benner 1:22:52
Do you get low every time you water the plants?
Laura 1:22:56
I'm mostly Yeah. Interesting. But it's not just watering the plants. It just, you know, it could be I don't know, ironing or, you know, like tidying up, whatever it takes to just, you know, just walking around the apartment and or moving or whenever I get ready to leave. There's just a huge ache I get so insulin sensitive whenever I start moving and walking. And that's a struggle because I like I need enough insulin to cover my leg by Basal when I'm sitting when I'm doing nothing. But then as soon as I start moving, I need so much less insulin and I just hate to eat or drink something because I feel like I'm putting on weight.
Scott Benner 1:23:49
Well, what about what about this? What about you said you're looping? What about making your Basal a little weaker and your meal ratio a little heavier? Do you think you could accomplish that? Like if you took a little bit out of your Basal but major meals more aggressive? Do you think that you could find a balance there? So when you were away from food you wouldn't have I probably wouldn't be by a lot like you're a tiny person right? Like your pictures not very big right? Okay, so what are your Basal is like, like point eight an hour or something like that?
Laura 1:24:20
Um, yeah, I have I've got some point eight 1.1
Scott Benner 1:24:29
Is anyone else impressed that from five Instagram pictures? I guess your Basal right.
Laura 1:24:36
I'm very impressed.
Scott Benner 1:24:37
I was too honestly because when I said I was going to be wrong about this. So you know, like maybe that's the case like maybe you could steal a little bit of Basal and switch it around a little bit for those activity times is the one point something daytime or nighttime. Daytime daytime and the point is overnight. Yep. You could try lowering impressive. Thank you. You could try lowering the daytime a little bit and maybe be more aggressive with Could you take away some Basal and then first look at the insulin sensitivity during the day, or maybe meal ratios, I'm not sure where I would start. But there's got to be a way to do that because you should be able to water your plants. At first I thought, I thought you were like using a euphemism for something else. I was like she's trying to talk about sexy time without saying it. And so, because I just couldn't, couldn't imagine walking around watering your plants. But maybe that's it, maybe you're being kind of real aggressive with your Basal, and it's making up for a little bit of where your meals are lacking could be thinking yeah, yeah, that could be think about meanwhile, you don't listen to me. But this, this begs the question then. And you are young. So I start feeling weird when I say it, but what do you do for private time?
Laura 1:26:03
Hmm. So there's actually enough time between like, a meal and like private time so that I don't have any insulin on board, so it's fine. Alright,
Scott Benner 1:26:14
so I'm gonna ask a really weird private question. Is most of your private time in the evenings after your Basal rates lower?
Laura 1:26:23
Well, now I like now I can tell my parents to listen to do you think they'd be disappointed?
Scott Benner 1:26:31
Do you think Laura, they'd be more horrified to know that you do it when you can see each other? Oh, God. Alright, well, oh, and they're, they're very tight. They're probably Catholic, too, right? Yeah. Oh, I'm sorry. Your daughter doesn't have sex. Don't worry about it. I just forget it. Nevermind. Anyway, you understand what I'm saying? I just wanted you to be able to put those ideas into your life. Not. Not not, you don't have to tell me the details. There's anyway, I'm sorry. You guys. You guys should stop listening. Now. It's over. Goodbye. Bye. Bye. Sorry, I actually have to roll I have. So I'm having a really great time talking to you. But I do have something else I have to get to. I apologize. But I really can't thank you enough for doing this. And in all honesty, if I keep this podcast going for years, you were one of the people I would like to have back on one day.
Laura 1:27:27
Oh, I'd love that.
Scott Benner 1:27:34
I want to thank Laura very much for coming on the show and sharing her story. I'd also like to thank TrialNet and the Contour Next One blood glucose meter for sponsoring this episode. Head over to trial net.org forward slash juicebox to get your free type one diabetes risk screening. And if you're looking for a great blood glucose meter, look no farther than the Contour Next One. Find out all about it at contour next one.com forward slash juicebox. Don't forget to check out the private Facebook group for the podcast. It's called Juicebox Podcast type one diabetes. Find those diabetes pro tips at diabetes pro tip.com.
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