#1108 Cold Wind: Healthcare Whistleblower E.R. Nurse

Anonymous female E.R. nurse shares stories that will blow your mind. Her voice and name have been changed to protect her identity. 

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

+ Click for EPISODE TRANSCRIPT

---

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 1108 of the Juicebox Podcast

Welcome back everyone the cold wind is gonna blow today. This time, an anonymous ER nurse is going to share her stories about working in a small local hospital. Each of these cold wind episodes has been eye opening and somewhat disappointing. This one's not going to be any different. Nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, always consult a physician before making any changes to your health care plan. If you're looking for community around type one diabetes, check out the Juicebox Podcast private Facebook group Juicebox Podcast type one diabetes, but everybody is welcome type one type two gestational loved ones. It doesn't matter to me. If you're impacted by diabetes, and you're looking for support, comfort or community check out Juicebox Podcast type one diabetes on Facebook. When you place your first order for ag one with my link, you'll get five free travel packs and a free year supply of vitamin D. Drink ag one.com/juice box

this episode of The Juicebox Podcast is sponsored by us med U S med.com/juice box or call 888721151 for us med is where my daughter gets her diabetes supplies from and you could to use the link or number to get your free benefit check and get started today with us MIT. Today's episode of The Juicebox Podcast is sponsored by Omni pod and the Omni pod five. Learn more and get started today at Omni pod.com/juicebox I

Anonymous Female Speaker 2:09
was diagnosed with type one diabetes in 1999. So I've been managing it for 24 years and I'm currently an emergency room nurse in a small local hospital.

Scott Benner 2:17
1999 How old were you then in 19? I was 1111 years old. Wow. And how old are you now? 35. Okay, type one. Do you have any other autoimmune issues?

Anonymous Female Speaker 2:31
Before I was diagnosed? I was actually being seen yearly by endocrinologist I have vitiligo and also hypothyroidism.

Scott Benner 2:40
Hypothyroidism you take Synthroid.

Anonymous Female Speaker 2:42
Yes, yep. I think I started taking that when I was like six. So started early.

Scott Benner 2:48
Does that run in your family? It does. Okay. Is there any other type one in your family? Um,

Anonymous Female Speaker 2:53
so my dad was actually diagnosed in his 50s. So just about 10 years ago, your

Scott Benner 2:57
dad, your dad after he? Was your dad diagnosed after you? Yeah, look at that. Is 50. Does he have any other autoimmune? He has vitiligo as well. But that's it. There's nothing to do for that. Am I right about that? Yeah. It's just

Anonymous Female Speaker 3:12
like your skin's discolored like it's, it's not really like an issue. You're just you sunburn a little more, you're more susceptible to skin cancer, but like, it just destroys your pigment cells, basically. So how much

Scott Benner 3:25
of your body would you say is vitiligo impacting?

Anonymous Female Speaker 3:29
Not much like my hands completely, and my legs from like my knees down? And that's about it?

Scott Benner 3:36
Is it something you even notice anymore? Not

Anonymous Female Speaker 3:39
really. I didn't know. So it's actually like progress as I've gotten older. And I've had a few doctors told me that that's not a thing. But like, if you look at pictures of me, as a child, like it is a thing because I had picnics, like right? When I was little, it was just my feet, and then part of my hands had no pigment and now none of my hands. And most of my legs, like the bottom part of my leg doesn't have pigment. So

Scott Benner 4:03
wow, that's interesting. Yeah, Synthroid, do you take T three as well, or just the T four? Just the T four. Okay. Alright, so, type one diabetes, since you were 11 years old, you're 35. Now that's a good long time to have it. You must know what you're doing with it. Yes. And have a good firm grasp of it. Now, tell me what it is you do for a living.

Anonymous Female Speaker 4:22
So I'm an emergency room nurse. I actually went into nursing eventually, I'd like to be a diabetes diabetes educator. I just started I'd like to also have like nursing skills. So right now I'm working in a hospital just so I can develop, like, all the nursing skills. And then eventually I'd like to transition to diabetes education.

Scott Benner 4:40
How long have you been a nurse? Three years. Were you doing something prior to that?

Anonymous Female Speaker 4:45
I Yeah. So I, I was trying to figure out what I wanted to be. So I worked in a lot of like treatment center settings with like juveniles. And then I worked while I was in nursing school. I worked at the oncology center. So

Scott Benner 4:57
yeah, I'm trying to figure out what I wouldn't be still. Yeah. I think I'm getting to it. I'm getting very close. Okay, so you you've been in nursing for just a handful of years. Yes. Okay. Now you're on the podcast, they obviously this is a whistleblower episode and your voice has been changed, which is something I'm trying to remember to bring up. Because the technology is so good at this point that somebody might listen to this and think I know who that is. But trust me, if you think you know, this voice, it's not the first thing you think it's just it's been so expertly changed that, that it just seems very natural and normal. But you're on today, because, you know, I'll be vague, but you know, you've listened to podcasts a little bit, but somebody you know, listens to it more, I kind of put the word out for this. And this person reached out to you and said, I think you'd be perfect for this. Why did they think you'd be perfect for this. So

Anonymous Female Speaker 5:48
her child has type one diabetes, we actually met through my hospitals Instagram page, they like featured me to November's ago for diabetes Awareness Month. So she's kind of befriended me. We've actually never met in person, but we talk a lot about diabetes. And one of the things I actually reached out to her for my project for my bachelor's in nursing, I did a presentation at my hospital about diabetes. And I really wanted to gear it towards it was for the nurses and for the management team. But I wanted to gear it towards like what type one diabetics want their healthcare providers to know, like, what kind of things that they find when their patients that like, is very concerning, and like hard for them to manage. And so I reached out to this friend, a lot through that project, I put a lot of time into the project more than I actually was required to for school, just because it is so important to me. And I reached out to her I had her because I so I, I am a diabetic, but I don't have a diabetic child. And so I wanted to know, like how parents feel. My mom, you know, as I, I was diagnosed in the early 2000s. Like, it's way different. Now we have Dexcom. So we have things that help, you know, parents be more hands on almost with their kids when they're not with them. Sure. So I wanted to know how these current moms have little kids with diabetes, feel when their kids are in the hospital, maybe they're not able to stay with them the whole time. And so I talked with her a lot through that. And then she would follow up with me about this presentation. So full disclosure, disclosure on this presentation. I presented it to our administration team and all the department like managers in the hospital, they were very involved asked a lot of questions, but they don't work hands on with these patients, their you know, management. When I presented it to our med surg nurses, no one paid attention. People were on their phones. The director and the assistant director, were in the back. They'd already heard it, but they were actually talking through my whole presentation. And I just felt like no one was really even paying attention. I actually just ended it early. Because I no one was listening. So and it was my personal time that I was doing this right. She reached out to me, we talked about that. And she I mean, we both were disappointed in the nurses reactions to this presentation. Yeah. And we just since then, I have like the things that I see at work following HIPAA, because I, you know, I don't tell her names and everything. But whenever I see some of these concerning things regarding mostly type one patients, I'll reach out to her because no one It feels to me like no one at my job cares. So I'll reach out to her and say, do you find this odd? And then she and I will discuss it and talk about how, how sad it is that these health care workers that we're trusting, with our family members with ourselves when we're not able to care for ourselves, don't seem to care to learn how to help us as type ones in the hospital setting. Do

Scott Benner 8:42
you think that they don't care? Or do you think that they just don't understand that it matters

Anonymous Female Speaker 8:47
both. So as well with this presentation, I was asked before it to talk with the ICU nurses about what they would like to know because they take care of these newly diagnosed type one patients. So they're, you know, the first real care team past the ER that's helping to educate these patients. So I went and chatted with a bunch of them, and they said, Oh, we already know everything. We don't need help. However, I did a little quiz during my presentation about general things that type ones do everyday carb counting, using the insulin pump adjusting insulin levels for high glucose, all those things. And they were also confused by the words I was using the it's obvious that they don't know everything. And I think like you said, I think they just don't understand like, how important it is that while because sometimes the patients aren't there for type one related hospital visits, they're there for other surgery or, you know, they have another problem that we're treating and type one is just one of their comorbidities. And they don't realize that like, we have to still manage it 24 hours a day whether, you know, we had our gallbladder removed or we had, you know, a knee operation. That's something that they should also be managing. And I just don't think that they understand that like, that's something if we're not alert and oriented and able to manage on our own that they need to be paying attention to it for us. Would

Scott Benner 10:10
you guess that they don't know what happens? Generally speaking, when a blood sugar gets too low, do you think do you think if I asked an ER nurse, you know, could you have a seizure from your blood sugar? Do you think they would know that,

Anonymous Female Speaker 10:20
um, some of them so I actually have two er stories about low blood sugar that I can share. But I think that they don't understand what it looks like and what it feels like. And honestly, the what could happen if it remains low, just because so in nursing school, at least at my school, we learn so many diseases and, you know, medical conditions that people have, we talked about diabetes for two hours, in my whole two years of nursing school. And it was everything that we learned about was about type two. And it wasn't differentiated that, hey, type two and type one are managed differently. Like, they're different treatments and everything. When

Scott Benner 11:01
someone says to you, I don't need this, I know what I'm doing. Do you think, what do they mean? They mean, I know how to take a blood sugar once while you're in the ER and write it down.

Anonymous Female Speaker 11:10
I think that's what they need. But I understand what diabetes is. And I know, like, it has to do with eating sugar and, you know, checking your blood sugar. And that's about like,

Scott Benner 11:20
if we gave them, like, even just the I don't know, the first 10 Questions from a CD test, you think it would just go right over their head? Probably yes. And so from your personal experience being there? Why do you think that is? Honestly,

Anonymous Female Speaker 11:36
there's so much as a nurse and as a health care professional that we are expected to know, I think, honestly, I might have too high of expectations for my co workers, because I am type one. And it is so important to me. Because if you ask me questions about a certain disease, like, I don't know, if you asked me about people that with celiac disease, all I know is they can't really we and you know, I don't know that much about it. So I guess it's, it's kind of me having too high of expectations, possibly for my coworkers, because I don't know everything about every disease that affects people's lives. However, at the same time, I do feel like I need to have high expectations. Because if you, you know, well, I actually don't know the answer. But I don't think you can die from celiacs. You know, like, as MC diamond hypoglycemia, like, yeah. So I think it also, you know, as we all know, diabetes affects every part of your body. It's not just your blood sugar and what you eat. Yeah. So if we allow these patients, you know, I've had patients handed off to me, I was a floor nurse and med surg before I went to the ER, I have patients handed off to me that their blood sugar's have been 300 for their full three days there. That's not okay. And that's damaging to their body. And, you know, their future they have us not managing their blood sugar's and I think we just don't understand the impact that those three days or 300, you know, are having on those patients. Yeah.

Scott Benner 13:02
And I'm not minimizing celiac, but thinking about it in an ER setting. First of all, you're not eating in an ER setting for them. Yeah, likely. And and secondly, if you were, if you were actually going to eat, you'd be conscious to be able to say, Hey, I can't eat this has got gluten in it. Exactly. That would sort of be the end of it. They'd be like, Oh, okay, you know, I mean, it's a dietary restriction as much as it is a medical issue. Yeah, I mean, what so what I see what you're saying. So you're trying to say, look, and I've made this point in the podcast number of times, I don't know everything about everything I've done. And, you know, if you came in here, and said, I have, you know, blank, blank, blank, I'd go I don't know anything about that. But I'm not in charge of your health either. So I want to give them credit for the idea that they didn't go to 1000 years of medical school and study each individual disease state for a year, right? Like, I get what the job is the job, it's a functional job with a medical, like side to it, you're doing tasks, right? doing tasks, you're doing noting, you're going back and forth between the doctor, you know, you're trained to give people injections or IVs are things like that, like, that's all part of the job. understanding deeply is not part of the job. But how many things are like, type one, you only mean like, how many things are emergent constantly, if you do it wrong. Is there I mean, do other things pop into your head when I say that, like what else falls into this category?

Anonymous Female Speaker 14:36
Nothing you think of that's why I had such a hard time finding a, you know, condition that I could compare to type one that I didn't know about because I'm like, There's nothing like this where like, life or death is, I mean, sounds dramatic, but life or death is every day like you said if you do it wrong, like I've had friends who have type one they have died from hypoglycemia in their sleep because, you know, who knows why they were asleep but they died. That's, that is literally life or death.

Scott Benner 15:02
So I asked the question sorted to make the point because you said like I can understand, but that they can't know everything. But I don't think we're asking them to know everything. I think we're asking them to understand insulin and diabetes. That's really it right? You're not asking for them to have a firm grasp. I mean, that would be ridiculous. We're not asking anybody to have a firm grasp or anything. This is an emergent situation, you made the point, you very well may not be able to help yourself. And already even speak up for yourself in that situation. And the public has this expectation that I get there. And these are the people like they can keep me safe when I can't help myself. Yep, yeah. My daughter was in the ER recently, two different stays. I've probably been asking this of a bunch of people, but it just makes the point. So well. Two different stays 30 by 36 hours apart. So 12 hours, 36 hours later back in the same ER for 12 hours. So in a 24 total hours day, can you guess how many times they checked her blood sugar?

Anonymous Female Speaker 16:00
I would guess when she got there. And then they also do labs that show like their glucose and probably that's it. Honestly,

Scott Benner 16:07
never is the is the answer. It showed it showed up on her. It showed up on her labs, but like no one in 12 hours walked into the room and said, Hey, let's check your blood sugar. Or what is your blood sugar? You're wearing a CGM? Can you tell me what your blood sugar it? Never once and she was on morphine while she was there. And 19 years old. No one ever checked on her.

Anonymous Female Speaker 16:27
Um, something I've seen with the CGM. So I mean, I obviously recognize what they are immediately. I've had multiple co workers that Oh, I don't trust those because the blood sugar's not accurate. And I'm like, Well, you're not even checking it. Like you said, you're not even checking your blood sugar. So you might as well glance at it, and it'll give you, you know, an idea of where it's at. It

Scott Benner 16:46
also, they think it's not accurate. Because they draw, they do a lab, they get that number, which is not the same thing that's being read read by the CGM. And yeah, it's

Anonymous Female Speaker 16:57
different. So it's reading your interstitial fluid, which is going to have a different sugar level than your blood. And also then a finger poke and a blood draw are different because it's different types of blood. That's something they should understand those nurses know that like, it's different area. So like, it's not even diabetes, just anatomy. But you should understand that the same blood like sugar concentration is not going to be in those three different types of fluids. Right,

Scott Benner 17:22
so you said you had a couple of stories about low blood sugars in the ER, can you tell me one of them? Today's episode of The Juicebox Podcast is sponsored by Omni pod. And before I tell you about Omni pod, the device, I'd like to tell you about Omni pod, that company I approached Omni pod in 2015 and ask them to buy an ad on a podcast that I hadn't even begun to make yet. Because the podcast didn't have any listeners, all I could promise them was that I was going to try to help people living with type one diabetes. And that was enough for Omni pod. They bought their first ad. And I use that money to support myself while I was growing the Juicebox Podcast. You might even say that Omni pod is the firm foundation of the Juicebox Podcast. And it's actually the firm foundation of how my daughter manages her type one diabetes every day. Omni pod.com/juicebox whether you want the Omni pod five, or the Omni pod dash using my link lets Omni pod know what a good decision they made in 2015 and continue to make to this day. Omni pod is easy to use, easy to fill, easy to wear. And I know that because my daughter has been wearing one every day since she was four years old, and she will be 20 this year. There is not enough time in an ad for me to tell you everything that I know about Omni pod. But please take a look. Omni pod.com/juice box. I think Omni pod could be a good friend to you. Just like it has been to my daughter and my family. diabetes comes with a lot of things to remember. So it's nice when someone takes something off of your plate. US med has done that for us. When it's time for art and supplies to be refreshed. We get an email rolls up in your inbox as high origin. This is your friendly reorder email from us med. You open up the email. It's a big button that says click here to reorder and you're done. Finally, somebody taking away a responsibility instead of adding one. US med has done that for us. An email arrives we click on a link and the next thing you know your products are at the front door. That simple. Us med.com/juice box or call 888-721-1514 I never have to wonder if Arden has enough supplies. I click on one link. I open up a box. I put the stuff in the drawer and we're done. US med carries everything from insulin pumps and diabetes testing supplies to the latest CGM like liberi three, and the ducks calm G seven. They accept Medicare nationwide, over 800 private insurers. And all you have to do to get started is called 888-721-1514. Or go to my link us med.com/juicebox. Using that number or my link helps to support the production of the Juicebox. Podcast.

Anonymous Female Speaker 20:22
Yes, I have two I'll tell you both. You can pick which one do you want? Or using?

Scott Benner 20:27
Oh, no, I'm gonna, you can tell them both. I just wanted to start with one. That's perfect.

Anonymous Female Speaker 20:30
So I was a new ER nurse. We had this patient come in through the door. He was older. He was with his kids. He actually had type two diabetes. The story they gave us was we were at Costco walking around. We noticed dad wasn't with us. An employee came and found us. He was out in the parking lot wandering around and he fell. And he's acting confused. He's not like this, all these things. So I was the primary nurse. But like I said, I was a new nurse. So I had older nurses that were also helping me. So I'm asking, you know, does he act like this normally, because we do get older patients that are confused, and that's their baseline. They're like, Nope, he like I've never seen them like this. This is different for him. He has type two diabetes. I said Did he you know, what does he take the message that he takes insulin in the mornings? Okay. Did he eat today? They said he ate breakfast around seven. It's now 4pm. We didn't have lunch yet. So immediately, I'm like, hey, well, that's concerning that, you know, he managed it with insulin. He had a light breakfast this morning. He hasn't eaten since they haven't checked his blood sugar. We hadn't checked his blood sugar because he just came through the doors. He's sweaty. He's just mumbling just all these things. And so I said, Can we check his blood sugar, and I should back up. Those symptoms also are symptoms of a stroke which hypoglycemia can mimic stroke symptoms. So immediately, you know we aren't er strokes are very important that we get them diagnosed and treated as quickly as we can. So everyone in the room is, you know, stroke, this is a stroke, we're going to do a stroke workup. But here I am this new ER nurse, but this 24 year diabetic that said, Can we check his blood sugar? Can we you know, and I'm helping started IV I'm in the you know, in the thick of it. So like, I can't run, go get our glucometer and get it but I'm like asking other people to grab it. Everyone else was like, No, we gotta get him ready to go to CT. Fortunately, our house supervisor who's like a nurse, it's over the whole hospital. She came in, I said, Can you go grab the glucometer I'd like to check his blood sugar, which afterwards, I talked with my manager about this. And that's actually one of the first things we should be doing with a stroke workup is checking blood sugar because it can mimic a stroke, like hypoglycemia can look like a stroke. So she goes and gets it, I grab a finger stick because they're like Willingham way to CT, it's 25. So I turned to the doctor and I'm like, his blood sugar is 25. And so he goes, Hey, go grab, you know, somebody 50 All these things. So I asked the CT tech to wait a second so I can treat his blood sugar. And they say, No, we gotta get him to CT. And here I am this new nurse like, well, I don't want to, you know, harm this patient, if he is having a stroke, I don't want to delay this. Now, having been there almost two years, I would have said I don't care, we're stopping because I'm the nurse. And you know, this is my patient. And we need to treat this low blood sugar before we do anything else, or he's gonna die from that a bit. As a new nurse. I didn't want to, you know, fight with these people that have been there longer than me. And I even asked her charge nurse I said, Aren't Shouldn't we give him something before we go? And she said, No, we can do it when he comes back. And again, luckily, this house supervisor was standing there and she was all grab it for you. And I'll meet you in CT. So she grabs it, we go to CT, I give it to him before he takes us through all these things, we get back to the room and he's you know, maintaining appropriately talking with his family, not sweaty anymore, not weak, you know, all these things, because he had lobe ledger, not a stroke. And then the thing that bothers me a lot with healthcare, healthcare, and this is a different topic entirely. But now he gets charged with this huge stroke workup, where if we had just waited two minutes in the ER, and, you know, given the glucose and assess that this could be hyperglycemia not a stroke, you know, we could have maybe made some critical thinking judgments and, you know, tested for the, you know, done the Google's first and brought that up and then seeing if the symptoms are long anyway. Did you say the blood sugar was 2525 and I was finger poke? So

Scott Benner 24:27
you know, Ben, you said that out loud? Yeah, I

Anonymous Female Speaker 24:29
did. And everyone's like, Okay, let's go get a CT. And I was like, okay, 25 is bad. So I don't know. That's That's what I'm saying. Like, I feel like my expectations for them are too high. But that's something they should understand that that is entirely too low, like and dangerous for this man.

Scott Benner 24:48
What percentage of the people you work with are somebody you would trust yourself with?

Anonymous Female Speaker 24:53
None of them will. No one in my era would I trust to manage my diabetes? If I had needed my opinions out Sure, I needed my gallbladder out. Sure. But if I was, I've actually told my husband if I ever am in the ER, and I'm confused, like, actually, I say, you need to call my mom, because she's been helping me with this, you know, since I was 11. And I need someone to be with me the entire time, that's helped me with my diabetes, because I don't trust these people to do it.

Scott Benner 25:19
And you're talking about in an emergency situation, not saying like, you wouldn't invite people to your house. Right, right. In an emergency situation. There's no one there you would Yeah, doctors,

Anonymous Female Speaker 25:29
there's a few. So there's one doctor that if he was my doctor, I would be fine. He is actually, I can tell a million shares of Apple nominally, but he actually had a two year old kiddo that just wasn't acting right, all these things. So we did all these tests, did a workout for four hours, he had had his vaccinations two days before, and the doctor goes, you know, I'm gonna ask you to do something that you're not gonna want to do, but I need you to check his blood sugar. And me as a type one diabetic, I said, I would love to check his blood sugar. Because if it's that if we want to know, and I, it was like 500. So his vaccines had, essentially possibly caused him to go and you know, to have type one. And so he diagnosed that the only thing that his kid was doing that was weird, I would say is the parents were like, every once in a while, he does a weird little cough. And that's what they were concerned about. And but he this kid got diagnosed with type one within two days. I mean, you don't know when it starts, you know, but like, yeah, of course, it most likely was the vaccines that triggered it. And then so that doctor, I would definitely let him be my doctor. But

Scott Benner 26:30
he saw the oddness is maybe we should check a blood sugar. Yeah, because the high kids got an incredibly high blood sugar. And two years old, you said, Yep, two years old. Yeah. So there's not a lot of like, am I wrong? There's not a ton of like, testing you can do talking to them at age, right to figure out where they're at.

Anonymous Female Speaker 26:47
Yeah, and we rarely do lab work on little kids like that. Well, so we're not a pediatric hospital, we can treat pediatric kids but like, if they're sick, they have to go to our pediatric hospital. It's a couple towns over, okay. You know, we don't we try not to do blood draws, partly because we rarely do them. So like, you know, sometimes we have to poke these kids three or four times, you know, because our little on there squirmy. And it's just not our, like, forte that we're used to. So we haven't done labs on those can also because like, the complaint of the parents was kind of weird. Like, he just coughs every once in a while. And it's not even like a cough. It was like, he keeps doing this.

Scott Benner 27:24
And I'm like, kids do that. They didn't notice that he was altered at all. He

Anonymous Female Speaker 27:28
wasn't he was like he? I don't know, wasn't I mean, I guess with 500 He could have been but like, he just like was coughing weird. That was really the only thing we saw. I mean, we're not the parents. We don't know how he normally Yeah. But he was talking to us. I mean, as a two year old can and doing all the things that two year olds do that I kind of was like, okay, these parents are overreacting. And then luckily, this doctor was like, well, let's just check his blood sugar because I can't find anything wrong with him, like in my assessments and everything, because we did a chest X ray, because like, possibly, you know, pneumonia is making him do a weird cough, but not

Scott Benner 28:02
the case. Yeah. So if that's the situation for type ones in your ER, then type twos, if they don't come in specifically for something diabetes related, no one's gonna pay a lick of attention to that. Right. Right. So diet, nobody's going to offer advice, they wouldn't have advice to offer one way or the other. If I was in there, and I was struggling with my type two diabetes, there's no one in the ER that could set me on a good path.

Anonymous Female Speaker 28:26
Scott, there's no one in our hospital that does diabetes education. That's another issue I have with. Since I've worked there for three years, we had a diabetes educator, when I started, she worked part time, I actually started shadowing her and like I was transitioned to be her like backup, if she wasn't able to come in that time, she quit, she got a better job somewhere. And they just shut the diabetes Education Program down at our hospital. I talked to her chief nursing officer who's like, she's the CFO about that, because I was like, I'm concerned that literally no one here is doing diabetes education, like this is a major type one, type two, whatever, you know, whatever kind you have, this is a major illness that is affecting a huge population, you know, in our country, as like, we don't have anyone that's doing diabetes education for these patients. And then we do so like, you know, to me, the workaround, whatever it is, we have a doctors group that works with us that are like family practice doctors, that their offices down the street. And so like they technically Apparently our education group, so what she says she's like, well, when they get discharged, we send them to this primary care doctor to do their diabetes education, which I actually personally and as a nurse have an issue with primary care doctors being the diabetes manager because as I've said, we don't know you can't know everything about everything and if your primary care doctor, you know a little bit about everything, but you don't know enough about diabetes to manage a patient's diabetes like

Scott Benner 29:56
you just don't. You said it was a small hospitals this small All town. So we

Anonymous Female Speaker 30:01
are like a suburb of the capital of our state. It's a community hospital.

Scott Benner 30:08
So is your ER overwhelmed all the time or not particularly?

Anonymous Female Speaker 30:12
Not really, because the word trauma free, which was like, we can't take, like critical patients and like, we'll take them if they come through the doors. But if they're coming ambulance, you know, they don't come to us because we'll just transport them somewhere else, just because we don't have the extensive, you know, like treatment teams for them. Right? Our er is pretty full, like we're pretty busy. But like, we see like, 50 patients a day. So like, Okay, I was talking to my cousin who works in Minnesota somewhere that he works in the ER, they have 500 patients a day.

Scott Benner 30:44
Have you ever spoken to him about this, about the diabetes piece? This is any different? Yeah. Is it any different word they are in a larger hospital? But that's a good question. I will chat with you about that. So here's another question. So you're newer, right? You got this job? Here. You're seeing what you're seeing there are bigger hospitals close to you. Is it in your head to get to one of those bigger hospitals?

Anonymous Female Speaker 31:05
That's funny question. So tomorrow, I start I transferred to a hospital. Okay. That's

Scott Benner 31:09
not a funny question. My point I guess was going to be, you can't be in that place and watch that level of care, and then try to affect it, and then watch that not help anything and then stay, you have to go somewhere else and try again. Right,

Anonymous Female Speaker 31:21
exactly. Yeah. So I've talked to like I said, the CNO, multiple times. Two months ago, we had a sit down meeting about maybe, I mean, I said I would like to be it. But if not me, someone needs to be a diabetes educator at this hospital. Like it's not fair to our patients to I mean, what we do is we'll die we diagnosis history teacher, so I mean, he's old enough to be a teacher, but type one, six months ago, he was in our ICU for a week, guess how much diabetes education he got? Probably not because I talked to a couple of his nurses. And we're like, well, we didn't really know what to teach him.

Scott Benner 31:51
Yeah, they don't know what to do. They wouldn't know what to tell him. Yeah. Newly diagnosed type

Anonymous Female Speaker 31:56
one, I mean, adult, so he's like, what's this mean for the rest of my life? And like, we hardly taught him anything. I had him in the ER, I was his nurse on there. And so I basically did the, like, reassurance like, you know, you can live with type one, like, it's okay. It's gonna be a lot to learn, but like, you know, your life is, you're gonna, you know, you're gonna be okay. Because it's a scary diagnosis. But like, you can live with it. I've lived with it for 24 years, like, and so I didn't do a lot of teaching also, because you know, that first, the first time you're told to diabetes, like you're not ready to learn, like, okay, teach me everything I need to know, like, and

Scott Benner 32:28
so personalities are different. Yeah, it's their scenario. And so he went

Anonymous Female Speaker 32:32
out to the ICU, and we, in my opinion, like, failed him a lot. And then they, when they discharged, I told him in the ER said, if they tell you to go, I just talked about this, but to a primary care doctor, to help you learn about diabetes, I said, you need to call your insurance. Find an endocrinologist that specializes in type one, and you need to go see them. Because your primary care doctor could not teach you how to manage your type of diabetes. Not

Scott Benner 32:57
likely. I mean, there may be some that no, but not Yeah, not likely. Wow, this is I've been doing a number of these recordings. And so far, let me just say it's not an uplifting experience. Yeah. It's not surprising to me. But the level of ambivalence that you that you explained earlier, that part does surprise me. Like once it's thrown in your face, and you go and you're a nurse in an ER, and someone says to you, Hey, there's this thing. It's really important. Here's why it's really important. And you start flaking and not listening. That confuses me. I bet it confused the hell out of you, too. You probably thought you were like, I'm like really going to help everybody, right? Yeah. Yeah. Did that. Did you feel naive when it was over? Or did you feel let down, I

Anonymous Female Speaker 33:42
felt let down well, and so these are my peers, like I've been working with them for two years. And like they couldn't even listen to this thing that like, obviously, is very important to me, as a type one as a human like, and they couldn't even like there was one nurse, I got to give credit to her. She paid attention. And she asked a question at the end. She's the only one that interacted with me through that whole presentation. And the other thing that's shocking to me, people come in with their pumps, and their CGM. And the first thing that most nurses do and the doctors is take those off, we're not going to use those, we're going to manage your diabetes. As we discussed, we don't do that. We actually our hospital does have a policy that allows patients to wear their pump into where their CGM and to manage their own, as long as they're not there for like DKA or like something, you know, directly type one related. They can manage their own diabetes, all they have to do is write down what they did. Super easy. We're already doing that. And none of those nurses even knew that policy existed, which is very frustrating to me, because we have type one patients that shouldn't be allowed to manage their own diabetes, and they're not allowing that because they just don't care to learn it. It's in our intranet, like you can google type one diabetes is the first thing that comes up as this policy that allows them to use their own pump and use their own CGM. But

Scott Benner 35:02
people just immediately say take it off. Because the thing is the thing they don't know about. They

Anonymous Female Speaker 35:07
don't understand it. It's like in that time you need to do some what we don't understand scares us. Like, they don't they don't want the patient to be doing something that they don't understand. So they're like, well, just don't do it, which is to me scary. Actually, I have another story. When I worked med surg first, which is just inpatient, like general medicine. I entered, I worked three days in a row, or my first seven days, I was hearing other nurses give report about this patient. And they're like, well, she keeps giving herself insulin, she keeps doing this, this thing happened. And so on my third day, I heard them giving report and I said, I'm actually going to take that patient because she had the I had heard on type one, all this thing, all these things about her, I said, I actually will take that patient from you. And I'll just have an extra patient, like, don't worry about it. I'll take her. So I go talk to this patient. She's in her 50s. She's been diabetic, you know, 40 years. And she explains to me what, what happened to her. So she came in with her insulin pump on, they didn't notice she had an insulin pump on which is concerning to me, because they're hard to miss. And they should like we should be doing head to toe assessments on her patients every shift like I don't know how you miss it insulin pump anyway. So her pumps giving her insulin, the doctor orders are standard, which again, they ordered the same exact insulin treatment for type one and type two, which is very concerning to me, because

Scott Benner 36:29
it's different. What do you mean? I'm sorry, what do you mean, but what Institute we do a sliding

Anonymous Female Speaker 36:33
scale. So you take their blood sugar, depending so we have three different scales, but the general one, so we'll do Skill A, you take their blood sugar, it you they have a little like table at our Pyxis which is where the medications are dispense. That's okay, if the blood sugar is like 100 to 150 Don't give any insulin, if it's 150 to two, so is that normal sliding scale that when I was diagnosed, that's what I did. You know, if it's one, this is like low blood sugar correction scale, but so they we do not dose for food for type one diabetics in my hospital. There's no, like scale, there's no orders for like carb counting or like, ask the patient you know what their what they do at home, there's nothing we just we just chase blood sugars. That's the orders we get for type one or type two, that you just use a sliding scale, you check their blood sugar, you give them the amount of insulin that they need for that blood sugar. And that's it like you don't dose for the food. You don't. You don't do anything else. You just do the sliding scale. And we don't do like posts. We all checks like nothing like that. You just did a sliding scale. And then the next time you check the blood sugar, yes, I mean this Not really. But they asked the patient. Well, what have you been doing that made your blood sugar high, which drives me crazy, because it's us doing it to them. But anyway,

Scott Benner 37:48
I let you take care of my blood sugar if that's what made it Yeah, you guys did it. And so it's not so much about the expectation that some people just are going to be in the hospital because they're sick lead to begin with, and they don't know what they're doing. So they probably don't know what they're doing with their blood sugar. This is just a, we take this down to a you won't die from your diabetes if we do this. And that's all we care about. Nobody's trying to make you better make you educated make you healthier in the moment or healthier long term. There's no consideration around any of that in the ER. Yeah,

Anonymous Female Speaker 38:21
well, this is on the floor. So even inpatient. This lady was being treated like she was sent there for diabetes. She was there for something else. So like, we don't care about your diabetes, it's kind of the vibe they were getting. Yeah. And then also Oh, go ahead.

Scott Benner 38:34
I'm sorry, the food on the floor is garbage. Right is awful. Okay,

Anonymous Female Speaker 38:37
so another side story. I had a patient in DKA like, you know, this was in the ER, if they're not really supposed to eat like all these things, but she was like, adamant that she eat and so the doctors like whatever just ordered her diabetic tray. I called the kitchen myself. I said I need the for sure. Like a diabetic tray. Like it has to be diabetic. You know, a diabetic meal. They sent spaghetti or bread sick, putting like just normal putting and milk. And I was like cool. None of this is like technically what you know

Scott Benner 39:09
dieting, I fall back down and say hey, diabetic tray and they go no, that is one or is that

Anonymous Female Speaker 39:14
that's what we have tonight for the diabetic train.

Scott Benner 39:17
Pool is to the diabetic tray is pasta, putting bread and

Anonymous Female Speaker 39:23
milk. I was like, oh, okay, well, I don't know what to do with it. I actually went we have like a fridge for EMS partners that we sock with food. I went and took a salad out of it because I was like she can eat this like she's literally in DKA like she care how Yeah, that can be

Scott Benner 39:39
like 90 carbs. Yeah, just me roughly going over it my head real quickly. Yeah, like I was like, This is insane. So I got her salad. Not just not diabetic friendly. Not really friendly for your health in any way. She's

Anonymous Female Speaker 39:49
Exactly. Absolutely fantastic.

Scott Benner 39:52
Oh my gosh, is this upsetting to you? Does it make you feel like you're in the wrong line of work? Like how does it Make You Feel specifically,

Anonymous Female Speaker 40:01
honestly just kind of like, defeated because like I said, for the last three years I've really been advocating for more. I mean, my very first so as a new nurse, they do this program where you like, it's kind of like extra school, but it makes you better nurse. And then you have to do a project. So this is different than that project I talked about earlier, that was for my Bachelor's independent of my job. But for this job, you have to do a project and I did my project on meals for diabetics, and not even knowing that you know about that spaghetti train just about how blood and I had to present again, in front of a group of nurses. So how food affects our blood sugar, how you know, just all the things we do carb counting all that kind of stuff. And suddenly, so from the beginning of my nursing career, not even I mean, like I said, I went into nursing to eventually be an educator. But from the beginning of this career in the hospital, I've been vocal about diabetes, I've been vocal about diabetes management, like everyone there knows I have diabetes, like, I actually do have some nurses that that's a nurse, I told you that paid attention to my presentation, she's actually called me like when I'm off shift, and been like, I know you're not working, but can you please help me with this patient, they have a pump, and I just need to do this. And like, I'm like, please call me anytime you want. Because I would love to help that patient and you to, you know, have a better experience in the hospital. So there's a few that like, have listened, and that will come to me and ask questions. But the vast majority, like I says, a small hospital I know, almost every single inpatient nurse, the vast majority, in my opinion, don't care. And it's been really disheartening. For me like, I've been so vocal. And so like, if you haven't quite I mean, not that I know everything. But I know 24 years worth of things like that's a long time. It's longer than some of these nurses have been alive. Yeah, for sure. It's disheartening that like, I've been so vocal, and even to admin, that I'm like, Hey, we're failing our patients, because we're not, we don't have these tools for them. And like, just no one cares. Oh, I mentioned. So I met with our CFO two months ago, to talk about the need for a diabetes educator. I've heard nothing. She was very positive in the meeting. And they're like, Yeah, I agree. All this stuff, her brother house type ones, like she gets it. And at the same time, I'm not blaming her because it's a bigger organization than just her. Like, there's a lot of moving parts to like, get this approved, and all that stuff. But I haven't heard one word about it. And so as I was considering transfers, I'm just transferring, it's a sister hospital, but it's bigger, traveling to the ER there too. But as I was considering, like, Should I do this? I was like, Well, I don't want to let our CNO down. Because, you know, I've told her like, I would like this job. Like, I want to be the one that does this for a hospital. And then I was like, Well, how long has it been since I talked to her? It was in September, not to blame her, like I said, but I was like, I haven't even heard back in two months. Like, I don't owe this, this hospital and like my, you know, sitting around hoping that eventually they'll see that, like, we're not caring for our patients that have diabetes. And like, I can't, I don't, I can't owe them that. Like, I can't just wait and hope for something to change when it's not changing.

Scott Benner 43:03
So let me ask you this, if I put you in charge of the hospital, what do you think would immediately help the people with diabetes that come through there?

Anonymous Female Speaker 43:12
Well, okay, every newly diagnosed type one should have like, so I never when I got diagnosed, I never had an inpatient stay. So I don't know what it's like for most people that get diagnosed. But I would think that, you know, every few hours, there should be some new piece of education. That's just the basics of how to manage your diabetes every day, that you know, there is a dedicated person or a group of people is what I would have done, because I started thinking about after I talk to her, like what I would do to change diabetes education or hospital, right, I would have created like a task force of like, nurses that care and that want to learn about diabetes, that they could then so that there's at least you know, someone there every shift that has this base knowledge of it, they could go in every few hours, this patient because we don't want to overwhelm them. And, you know, do a six hour lecture for you know, one day, six hours long, but every few hours gonna be like, hey, now we're gonna talk about carb counting, now we're going to talk about, you know what to do on sick days. Now, we're going to talk about this and just have like, we don't even have like an education packet, we can hand them, like, go home and read this, like we don't even have like, it's, I don't even know what we have. It's we have nothing, nothing. It's just stuff we print off of like our, like, general information about what diabetes is. It's not anything like extensive and so I mean, that would be the first thing you could change just having someone in the hospital that knows at least enough to like help this patient to understand their new diagnosis. And then for those patients that aren't you know, new diagnosis that were like we talked about for their blood sugar's should not be two and three hundreds, their whole say type one, type two, it doesn't matter. And we're doing that to them. Like we're the ones that are supposed to Imagine their blood sugar. And we're not half the time the CNA goes in and takes it and like, when I was on the floor, they would like, tell me, but I was in the middle of something and I'm like, okay, like, what do you want me to do about that right now? But, and I, and at least I understood, like, Okay, I gotta fix that, like, I gotta address that, get them to insulin before the, you know, all that stuff. But for the most part, I think it goes in one ear out there that like, cool, thanks for doing that task, checking off that box. Like, I'll get to their beds when I get to it. Like,

Scott Benner 45:29
I have a question. It might be difficult, because I'm not asking you to tell me what you think people think. But I am asking you if you've heard people say, you know, something specifically. Okay. My question is, of the people who have directly said in front of you why they've become a nurse? What are the some of the answers? It mean? Is it I want to help people? Usually? Well, how can they say that? And then when it's their turn to help people go? Doesn't matter if I understand this or not? Yeah, I

Anonymous Female Speaker 46:00
don't know. I don't know how I should ask them that. But

Scott Benner 46:04
yeah, I don't think you should. I think that'll be that'll be a quick way to not having any friends at the hospital. Yeah, it just makes me wonder like, if, you know, I guess what I was wondering is if you ever stood around with somebody, they were like, I didn't want to be a nurse. But I was good at this or you don't I mean, like that kind of stuff. Or people really do start off thinking like big kind of pie in the sky grandiose, I want to help people. And then it becomes more about getting the tasks done than it does about doing those things in a healthier way. Is that basically what it is and other people have been on and talk to me about this. It's an emergency room, they only care about the emergency or therefore.

Anonymous Female Speaker 46:42
Right? Well, and even I don't know if I'm, I will say this on your podcast, but some nurses in the ER call themselves trauma horse. They liked the trauma. They liked the heart attacks, they liked the car accidents, like we don't get a lot of like gunshot victims in our yard because it's small, but like, they like feel like life or death, like trauma situations. But like we talked about before these I have another story about a guy that our one of our maintenance man had a blood sugar of 20 They didn't care about that. And I'm like, This is literally life or death this like, you know, in a couple minutes. His blood sugar's 20.

Scott Benner 47:15
Also, that's bill, we know him. Yeah. Yeah. So

Anonymous Female Speaker 47:19
he was fixing our lights and our nurse's station, the doctor notice he was like, acting kind of weird. I was actually walking into a patient room and I heard the doctor go, Hey, I was chicken changing them. Hey, Jake, are you doing okay? And I was like, that's weird. But I know this guy who's been in the ER a couple times because he's a newly diagnosed diabetic that hasn't had the education he needs or has diabetes. So he's been in there a couple times with hypoglycemia. And I was like, that's, that's weird. I'll check on him. When I come back out. I come back out the doctor and the other two nurses on shift are like holding him on this ladder. And they're like yelling for the other doctor and they're like all this up anyway. They they're like he's seizing on this ladder. He's having a seizure all this stuff and so I go grab a gurney I hit our like code blue bar and he's not dying but like we can't get this to underpin man off a ladder by ourselves. So a couple like another dot coms our security that comes all this stuff. I live in, I hit the button. I grabbed the gurney, I go over, I said, Hey, he has type one diabetes, and he's has a history of having low blood sugars at work, like, just FYI. So you get them off the ladder, we get them on the bed. We rollin back in the room, and they're like, Hey, does he have a seizure disorder, all this stuff like going over or something like, Hey, he has a Dexcom I know he has a Dexcom like, can we get his phone and this guy's awake? And he's like fighting us like, No, I'm fine. I just need to go back to work. But like he's not fighting. He looks terrible. Sure. Yeah. And like, he just you know, was convulsing on this letter. And I like can't get his phone. Like he has a Dexcom. And like, no one's this was literally last week. No one's like, I'm trying to tell the guy this guy, like, will see the guy on the ladder. Like we don't know. I mean, we don't know why right now. Like, we're just trying to help them figure this stuff out. But then the security guard comes in. And they're friends. And he's like, hey, you know what's going on talking to him? Like you just calm down, buddy. Like we're helping. I was up. As I look at our security guard. During his interview, I'm like, Hey, Sean, get his phone. He has his blood sugar on it. I need to know what it is. Because I had tried. Like, I didn't wanna just like reach in this man's pocket, you know, and get his phone. But I could have I would have if I could have but he was like fighting us. I'm like, I don't want to get punched in the face. But so the security guard tells me he's like, Jake, I need your phone, like him to your phone. He's like, okay, it gets out. And I asked him a few times, and he just didn't do it. In Windows. Yeah. So he hands it to the security guard. And I'm, I'm like, hey, you know, turn the screen on his ledger is 20 red arrow down. And I was like, I show it to the doctor. I'm like, Hey, this is his blood sugar. Like, can we do something about it? Which I've been saying it like the whole time we're trying to figure out what's, what's wrong with him like, he's diabetic. And he you know, he goes hypoglycemic all the time. Like, let's see what it is. And I had grabbed our glucometer and was like, gonna do a finger poke, but another one. fallacy I guess you say about the hospitals, they have to have a wristband with their patient barcode on it before you can access the glucose monitor, like you have to scan it. So it goes to their chart. But oh my goodness, like I and I've said it a few times, and no one really gives me a good answer why we can't just have like a $20 glucometer from Walmart, you know, that we can do like, goes until that can check his blood sugar that way because he wasn't in the computer because he was on a ladder like he's not a patient anyway. And so I like true

Scott Benner 50:30
or false. The custodian at your emergency room, if you weren't working would be better off having a seizure at my house than in your emergency room.

Anonymous Female Speaker 50:38
Yeah, because they were like, We gotta get a scan, we got to do this. We got to get Keppra, which is a seizure medication. Like, that's not going to fix his 20 blood sugar. And it was his Dexcom, which isn't, you know, and the moment blood sugar like that was, you know, 10 to 15 minutes ago, like, I'm

Scott Benner 50:54
so disturbed that you're describing a bunch of people who don't seem to have critical thinking skills. Yeah. When Yeah, that they follow like flowcharts in their head. Right. They hear words, then they do a thing. If that thing comes back this way, we'll either do this or this, but nobody can just think like, you're standing there yelling out, I'm assuming. Yeah, common sense. He has diabetes. People have said he's gotten low before. I've

Anonymous Female Speaker 51:21
had him all three times. Well, for at least three times for severe hypoglycemia. So I know he goes low. But yeah, yeah,

Scott Benner 51:28
he's got a glucose monitor on him. We could look at it. No order cesium medication. Yeah. Yeah, yeah. Okay. Yeah, we're all screwed. Don't get hurt yourself and bubble wrap if you're going outside. Sure, sure. Have the have the wherewithal to run into the ER yelling? Does anyone have type one diabetes? who works here? I only want to speak with you. Ah, oh, it's upsetting. It is. You know, it's scary. You're telling a story that's rooted in your in your absolute experience and truth. And people listening are freaking the fuck out right now. Right? Like, yeah, they're like, Well, what do I do if I feel the hospital?

Anonymous Female Speaker 52:05
Don't go. I'm just kidding. That's really bad advice. But Take someone with you that knows who knows what to help how to help you. Because

Scott Benner 52:12
if you have a heart attack, and listen, I'm gonna go over with you. If you have type one diabetes, you have a heart attack first find a friend. Yeah, knows all about your diabetes, call them up. Say, Hey, I'm having a heart attack, come over to the house and go with me to the hospital. Because I'm afraid they're going to kill me. Yep. Yeah. Like, yeah, great. All right. What about this? If I had written instructions, laminated? And I walked in there grasping them in my hands? Would they be ignored?

Anonymous Female Speaker 52:37
Depends on who your nurse and doctor

Scott Benner 52:41
could be. So again, we're looking for somebody who'd be able to read it. Yeah. Who can read? Yeah. Okay. Tell your story. Yeah. My daughter once had exploratory surgery. They just had to go in and poke around in her belly. Right. And we're, you know, it's obviously a scheduled thing. But you come in, and I forget how it was, you kind of came into the ER, they kind of they, they got you go in there. Then they took you upstairs and you know, and at the first kind of like, pitstop on the first floor, they got her ready, they put her in a gown and stuff like that. And I looked at the nurse to say, Hey, listen, she has type one diabetes, we've gone over all of this with the doctor previous to being here. Do you have all that information? And the nurse said, No, I don't see anything about that here. So that was the first thing I said, Okay. Well, guess what? She has type one diabetes. She's wearing an insulin pump. This is it right here. This has to stay on her. This is where she gets her insulin from. And then the nurses, I don't know if we lasted up. I've already worked this out with the doctor. It's staying on her. Okay, now she's lost. I said, Now this thing over here is a continuous glucose monitor. And she said, Okay, and I said, this thing is testing her blood sugar. And it's telling her pump through her cell phone, how much insulin she needs or doesn't need. It's literally giving her and taking insulin away constantly in a constant flow back and forth. Look at her blood sugar. And I pulled up her chart, I said, Look how steady it is. This is how steady has been overnight. And like since last night, this device and this device are talking to each other and accomplishing this. I need the phone to stay in the ER close enough to her that by Bluetooth that can speak to these two devices. We can't do that. And I'm like no. And she starts arguing like telling me all the reasons why this can't happen. Well,

Anonymous Female Speaker 54:30
it's one of those reasons starting to trap but what were those reasons we don't

Scott Benner 54:33
know how to work this stuff. It's not hospital equipment. Like she just started reaching me. I be honest. She started reaching upper asked for anything she could think of that would shut me up. That's what she was doing. Okay. There was no rules. She wasn't falling over rules. She was saying stuff out loud so that I would stop talking. I said, I'm gonna wait till the doctor gets here. We're not gonna take the stuff off or let's wait to the doctor gets here. Then she's in a huff. Okay. Then another nurse walks in sort of as this is Finishing up, and she goes, What's this? She has diabetes. And I said yes. And I just, you don't know me but I pivot from the one nurse right to the next one. And I just start retelling the story. I'm like, maybe I'll find a brain in this head is actually what I was thinking, right? So I re explained it again, I'm not exasperated, I'm like, this is this this is that here's what they do. As I'm showing it to her, she recognizes my daughter CGM. Her friend has diabetes. And she goes, Oh, my God, my friend wears one of those. I know what that is. And her just saying that made the first nurse sign off on it. She goes, Oh, okay, then it's fine. Like, well, I'm like, what is happening? This is all meaningless. Like, none of this is going to help her. So then I said, Okay, I'm like, so all you guys really have to do. And I said, I don't imagine this is gonna happen, cuz she's fasting and the CGM and all this stuff is working to keep her blood sugar stable, look how super stable or blood sugar is, etc. But you do have to be ready with some fast acting glucose through an IV, if she should get low on you in the room, and you can keep her phone if you want. And check it out by now we're going to put her on, we'll check her blood sugar intermittently, while we're in there. I'm like, this thing is trying to tell you what her blood sugar is constantly. It's like its whole job. You know? Yeah. The first nurse leaves the second nurses like, it starts telling me about her friend, as if this is if any comfort to me at all hurt, my friend has diabetes, and I'm like, Oh, fantastic. Then the doctor shows up. And she goes, it's gonna be fine. I'll get the the anesthesiologist in here to talk to you about it, blah, blah. So then the anesthesiologist comes in. And by the way, the doctor was great. And we had talked about it ahead of time, but she didn't do any of the things that she said she was going to do, like making the hospital aware and all that stuff before. Like that never happened. Yeah. And so now that the anesthesiologist comes in, and I say, Look, this is how all this stuff works. And he goes, Okay, well, we're gonna want you to shut off the algorithm. And I was like, Dude, the algorithms, what's keeping you from getting low? And he goes, Yeah, but if her blood sugar starts to go up, it's going to like, it'll give her insulin. I was like, Yeah, but it won't give her too much. It'll give her the exact amount of needs for the rise in the budget, that we're gonna really need you to shut the algorithm off. And I said, Okay. And I said, but you'll keep the phone near her, right. And he goes, Yeah, and they actually put it, he's like, we're gonna put it in this bag. Like, it's like a, I guess it was a clean bag or something like that. So he says, go ahead and shut the algorithm off, and then put it in this bag. And I gotta be honest with you, I took the phone and I swipe my finger out about a couple of times, and pretended to shut the algorithm off, and then stuffed the phone in the bag and stuck it under the gurney.

Anonymous Female Speaker 57:39
And that's what you should do. Because if they have a patient that has a function of pancreas, guess what's gonna happen if their blood sugar, so their pancreas is gonna give them insulin. So

Scott Benner 57:49
I just I was like, it's fine. And then I just stuck it under there. And guess what, everything was fine. Everything was fine. Yeah. And they weren't checking her blood sugar there. Although I want to give credit to the anesthesiologist who apparently got in the room, was intrigued by the whole thing and pulled Arden's phone out and left her Dexcom open.

Anonymous Female Speaker 58:08
I had that same experience kind of surgery last summer, and I was terrified, especially now being in the medical field. I've had like my gallbladder, I had a couple surgeries prior, I didn't really know to be scared. Now I'm terrified. And so I had this, it was like a minor surgery, but I was still you know, put under, and I was terrified that my blood sugar was gonna go too low. It was 134. When I went in, I still remember, and my husband was there. But you know, he couldn't go in the room. He also like, it's a lot to learn. And we've, you know, he, he gets overwhelmed. But anyway, so I'm like telling the anesthesiologist though, I was like, bro, my, like, I'm diabetic, I need you to watch my blood sugar. I also need you not to take my pumps. I had an omni pod at the time. I'm like, I need you guys not to take my pump and my Dexcom off because I need them on when I wake up. And also they're expensive. Please do not touch them. And he was like, Oh, do you have your phone? I'll just watch you. But like, I was shocked. I should talk to you more. But he was if you have your phone, I'll just watch your glucose for you. And I was like, I'm sorry. Why? How did you like like you're saying, How did he know? It was all my phone though? Like, I mean, a medical professional knew. But you found like, you found one that no, that's all. Yeah, but and then I'd even have my phone. So it's like, well, my husband has, like, please just don't let me die. He's like, we got you baby. And it was fine. But it was terrifying.

Scott Benner 59:23
Well, listen, I appreciate you coming on and telling the stories. It's It's upsetting to think that, that you can't find administration that's even interested in the education like they listened to you. But then when they gave you the chance to talk to somebody else, and nobody was paying if people really knew you had diabetes and went on their phones while you were talking?

Anonymous Female Speaker 59:44
Yeah, yeah. Like, well, this is what like devastated me the most, the manager who was my manager when I started and then the her assistant who was a floor nurse with me, we're in the back of the room, talking and laughing the whole time and Like, I, that's when I just shut down and stop, because I'm like, Are you laughing at me? Like, are you laughing that I care about, and I'm sure they weren't sure they weren't even listening. But it was just like, devastating to me that like these people that, you know, were my supervisors and a nurse that trains me like, they can. I know, they heard it before in the other meeting, but like, you can't even say here, it was a 15 minute presentation, like you can't even see here. And it wasn't boring. Like, I felt like it was pretty good. Like, you know, presentation that like would interest people. I was like, you can't even watch for 15 minutes and set the example for your, the rest of your staff to like, listen to this. So like, obviously, it's not important to any of you, except the one nurse that listen and ask the question.

Scott Benner 1:00:40
But, I mean, it's disappointing. I just I mean, by the way, not surprising, just disappointing. I don't, I don't know why I can't. For the life of me, I can't figure it out, it's not a thing. That would take it wouldn't take a nurse that much time or effort to actually learn about diabetes, type one, type two, and the management of it, it's just it and you might really help people. You know, like, I make this point all the time. But whether you're type one or type two, if you go to a hospital setting, where your expectation is the people around you really understand this. And they don't seem that concerned. If you're having pasta and bread, and milk, then you go home thinking, well, this is okay, pasta, bread and milk, this is an art, this is the diabetic food that they gave me at the hospital. If you're a type two, I mean, that can be disastrous, if that's what you think is okay. And the same thing goes for type one, my doctor tells me I gotta check my blood sugar every couple of hours or after I eat or before this, but the nurse never checked it, I must not even have to do that. And you just you lead somebody on a bad path. And that, that that's that like it just you're you're, you're supposed to be a good example. I mean, the verb that might sound Pollyanna and like I'm five years old, but if I can't expect doctors and nurses to be good examples about managing diabetes, who am I looking for? Like, who do I look to for this, then? That's, that's all. It's horrible. No, Jesus Christ. This is the best and worst idea I've had since I've been making this podcast. By the way, I'm like, God, people come on, I'll change their voices, so they can say what they want to say about healthcare. And now it just bums me out. Every time I do one of these

Anonymous Female Speaker 1:02:19
terrible things. I have like 16 More stories that would bomb you out more and more and more, just for three. That's something like three years, I've been in nurse three years. And I have multiple stories. And every single story except for one is about a type one patient, which is like so concerning to me that like, we don't understand this. We don't know what we're doing. And every story usually is the patient that speaks up that like saves themselves basically, like, it's so scared. Well, sorry, real quick. Just one patient had surgery. The doctor put him on a like a fluid drip afterwards. And he was actually my neighbor. So I went into say, hey, and I wasn't his nurse biozone and asked him, he goes, Is there sugar in my IV bag? I asked my nurse and she said no, but my blood sugar was 400. And I was like, Well, let me see what fluids you're on. It was like potassium, saline and dextrose, which is sugar. And I was like, Are you kidding me? Like your nurse said no, it's literally written on the back and your blood sugar's 400. Like something's wrong. But anyway, it just like just stuff like that. Like, were they keeping his blood sugar high on purpose? No, it just was like, texted his surgeon which I shouldn't have because I wasn't the nurse. And that's the thing. The surgeons not in the hospital. They're like managing these patients. But they're like that they're in the on the floor, right? So I like texted him. I'm like, Hey, Doc, his pleasures were 100 he has type one diabetes, you're giving him the five? And he's like, yeah, just take it down. So they keep it like the doctor would have no, like, if he would have thought about it, you would be like, maybe I shouldn't get this type one diabetic dextrose and this fluids, but it's the it's the fluids he gives to all his patients. So I knew why he was giving it because he just orders out for every patient. Because post surgery, you know, you want them to have those, you know, supplements and stuff and the electrolytes and the fluids. But like he's type one. So you actually don't want him to have that because when he goes he's like, I've been trying everything. I can't get it down. I'm like, Well, that's because we're literally feeding you sugar through your IV

Scott Benner 1:04:11
a firehose of liquid sugar at you and you don't have a firehose of insulin to shoot back. Can I? Yeah, I want to ask a question is where do you stand on this? If you had a strong feeling, I'm trying to find out if nurses are a little demoralized. If you had a strong feeling is it difficult to go back to the doctor and advocate for the patient?

Anonymous Female Speaker 1:04:33
Not not for me. So another story real quick. So when I was in the ER we hold the floor patients because the floors full and they there's no room for them upstairs so I had one the other night. He actually was not diabetic but he had high potassium which you give all these meds but one of them that we give is insulin because insulin and potassium are together in the body. We don't make it into all of it. But we give insulin to them to help lower the potassium but we're also giving them the IV push glucose like to like counteract that be transferred from it. ER doc to the Florida doc. He reordered all this stuff like I just give him I give him all the stuff as I talked to the doctor and I'm like, Hey, I just gave like, all these meds an hour ago. Like are you really want them again? And I've actually asked our ER doc because they're a lot nicer to us because they know us. And I was like, should I do these again, he's like, You should ask Dr. Smith because, you know, he like I wouldn't, but he's the doctor now. So I texted him, like you really want me to give him I guess I ordered it and and I and I was like, Okay, well, like I just gave him the insulin and everything too. And he hasn't eaten since like noon. And it's like 10pm I'm like, do you like Do you want me to be monitoring these blood? Like his blood sugar? And when he came in as larger was 62, which is okay, I guess we're like, they don't have diabetes, you know? So like, he only you know, they like normal, I guess, as like, as much as 62 when he came in, should I be watching this? And he just right? We're texting because it's easier than trying to get them on the phone? And he goes, nope. Okay, well, like I'm a little concerned about it. And so again, I go to our ER doc, and I'm like, Hey, you told me you know, like that I shouldn't be watching as much you're like, I'm concerned about it. Like it was 62 I gave it so we give 10 units of insulin IV. Like I've given that to someone and DK and they've dropped like 300 You know, from like, 500 to 300 and a couple hours, like, kind of scary, like, you know, they're just like, anyway to nondiabetic like giving them that much insulin. Yeah, it felt like a lot concerning. And it's what we do. Like it's the protocol, but I'm like, I just want to watch his blood sugar's too. And my eat. I will let this doctor take care of me too. I said just the one but there's two that I would trust. He goes, if you feel like you need to watch his blood sugar's with like finger pokes. You watch his blood sugar's he goes, because if doctors right to ask for that, like, he has no ground, you know, like if that's something because he told you not cuz I was like, well, he told me no. So I'm going against doctor's orders. It goes, if something comes of it, which nothing came of it. Because if something comes of it, like any person is not going to fault you for like, watching out for your thing. Yeah, that's I went, I went to the finger poke it was 52. So I'm like, Cool. I'm not going to give you insulin right now you're going to eat dinner is like 10pm I just gotten some food. Yeah, anyway, and then we checked it. I waited an hour checked it again. It was like 172 because we'd given like the push glucose like anyway, but yeah, so I don't feel scared because I'm like, I'm not gonna kill this patient. Because you are such an ass this doctor. So like, your soul? Do you think you're so smart? That like, you know, I ordered it and and I like it. But I know what I'm doing. And I was like, well, obviously, you do know what you're doing. But also

Scott Benner 1:07:35
not interested in that conversation. You're not interested in like, Hey, why are you asking me that? Maybe there's a reason that you have this feeling? I'd like to hear it. No.

Anonymous Female Speaker 1:07:45
Okay, so All right, I'm not scared, especially with diabetes, really, because I'm like, I'm not going to be the reason this patient dies or like, you know how severe side effects because I felt I knew I should do it. And I knew it was something I need to watch. And I just didn't want to upset the doctor. Like, I'll quit my job before I do something that I know could hurt a patient. So

Scott Benner 1:08:02
I hope you get to the next hospital and find a different situation. I really do. I have to tell you, I don't think you're going to but I really I really do hope that you do just maybe for your own sadly and I appreciate very much for coming on and doing this for me. Thank you very much.

Anonymous Female Speaker 1:08:18
Yeah, no problem.

Scott Benner 1:08:19
Very cool view Hold on one second for a huge thanks to Omni pod. Not just my longest sponsor, but my first one Omni pod.com/juice box if you love the podcast, and you love to Bolus insulin pumps, this link is for you. Omni pod.com/juice box Arden has been getting her diabetes supplies from us med for three years, you can as well us med.com/juice box or call 888721151 for my thanks to us med for sponsoring this episode. And for being longtime sponsors of the Juicebox Podcast. There are links in the show notes and links at juicebox podcast.com to us Med and all the sponsors.

Also want to thank all of the brave unkind people who are coming on and sharing their anonymous stories for the cold wind series. If you are in healthcare, or in some way impacting people's healthy lives, and you want to tell your anonymous story, reach out to me through juicebox podcast.com. If you're looking for community around type one diabetes, check out the Juicebox Podcast private Facebook group Juicebox Podcast type one diabetes, but everybody is welcome type one type two gestational loved ones. It doesn't matter to me. If you're impacted by diabetes, and you're looking for support, comfort or community. Check out Juicebox Podcast type one diabetes on Facebook. The episode you just heard was professionally edited. Buy wrong way recording. Wrong way recording.com If you're not already subscribed or following in your favorite audio app, please take the time now to do that it really helps the show and get those automatic downloads set up so you never miss an episode. Thank you so much for listening. I'll be back very soon with another episode of The Juicebox Podcast.

---

Please support the sponsors

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

Donate

#1107 Grand Rounds: Insulin and Safety

The third Grand Rounds discussion focuses on insulin safety.

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

+ Click for EPISODE TRANSCRIPT

---

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 1107 of the Juicebox Podcast

Hello everyone, welcome back to the third installment of the Grand Rounds series. In the first episode, which was episode 1097. We did hospitals urgent care and initial contact the second episode, Episode 1102 Grand Rounds, diagnosing diabetes, and today we're going to do insulin and safety. My grand rounds series has two objectives, one to let doctors know what you need and deserve and to to let you know what to ask for. Nothing you hear on the Juicebox Podcast should be considered advice medical or otherwise, always consult a physician before making any changes to your health care plan. If you're looking for community around type one diabetes, check out the Juicebox Podcast private Facebook group Juicebox Podcast type one diabetes, but everybody is welcome type one type two gestational loved ones. It doesn't matter to me. If you're impacted by diabetes, and you're looking for support, comfort or community check out Juicebox Podcast type one diabetes on Facebook

if you're not already subscribed or following in your favorite audio app, please take the time now to do that. It really helps the show and get those automatic downloads set up so you never miss an episode. This episode of The Juicebox Podcast is sponsored by cozy Earth cozy earth.com use the offer code juicebox at checkout to save 40% off of the clothing, towels sheets off of everything they have at cozy earth.com. This episode of The Juicebox Podcast is sponsored by ag one drink ag one.com/juice box. head there now to learn more about ag one. It's vegan friendly, gluten free, dairy free, non GMO, no sugar added no artificial sweeteners. And when you make your first order with my link, you're going to get a G one and a welcome kit that includes a shaker scoop and canister. You're also going to get five free travel packs in a year supply of vitamin D with that first order at drink a G one.com/juice. Box. Jennifer, we are back for the Grand Rounds series. Yay. Yes. Today we're going to talk about insulin and safety. Kind of these two things are gonna kind of go hand in hand in this conversation. They do. Yeah. So if you present Yeah, so far, we've talked about hospitals and diagnosis today, insulin and safety. And we're just going to start with what people sent us and then let the conversation unfold. Fantastic. The first bit of information that came back from a listener just said, we were terrified of stacking insulin. I think this goes to show that immediately on day one, you get told counting carbs, but in your insulin, you know, at the next meal, let's keep it maybe three hours from now. Do it again, right. And then inevitably, what happens is you either didn't Bolus well for the meal miscounted your carbs, maybe that ratio wasn't right, you get a high blood sugar. And that first thought comes into your head. Do I want to put more insulin in here? Right? But I can't because the doctor told me not to not to because it would be stalking. Yeah. So what that really points out to me, like if this was a management conversation, we would talk about, you know, when to Bolus again, or different impacts of foods. But in the context of this series, what it points out is you've sent people home with a misunderstanding of how insulin works on day one.

Jennifer Smith, CDE 3:59
Correct? Yeah, in fact, I've, you know, nobody reads the little insert in the insulin box, like Out goes the box or out goes that little insert that falls out all the time and nobody looks at what the profile of and we're talking right now rapid acting insulin right, the stuff that goes in out within a couple of hours. And it's got to finish to its action time. And I think it's a piece that's missing in initial education is the profile of your rapid acting insulin looks like this. I mean, if you're already teaching somebody how to inject a medication that will impact their blood sugar significantly, if they don't get it. Couldn't you also talk about that action profile? Because it would take away a fear factor? Yeah, it would give them something to visually be able to consider and so that you can explain stacking or the concept of stacking a little further right. I mean, in no way would be at advocate for well Bolus and if your fingerstick or your CGM looks like it's doing this within 30 minutes. Probably not a great Gordonsville. And Right, right. But there is there is that window of explanation that I think should be done up front. Because you're sending somebody home with something that this is 100% brand new to them. And

Scott Benner 5:25
here, this next statement, you know, if you're a physician, and you're listening, this person leads by saying, I wish my doctor would have told me to not be absolutely afraid to eat. This is a person who says that I've already lost a ton of weight because of my diagnosis. So they're in decay, they're losing weight, right, they're wasting away, they get lucky, and somebody tells them, they have type one. So they prior to diagnosis, they've already lost weight. Now, she says, I couldn't get enough calories or carbs, because I was afraid to eat. I was afraid that my blood sugar would rock it and cause blindness, the need for an amputation, a heart attack, or my demise. Wow. So that's what they went home with. So they got afraid to eat. So they saw one blood sugar jump up after what they were told, they don't know how to use insulin. And so you see this a lot. This is what drives people to like, like Uber low carb diets at some point to a lot of the time, right. And

Jennifer Smith, CDE 6:21
I think there's something to be said about, you know, we're talking from the perspective of newly diagnosed, right, from a clinician standpoint of explanation to that person. We're not talking about somebody who has had diabetes, and been using insulin for an extended period of time, there's a difference in explanation. And so I think initially, there is going to be a little bit of caution to dosing strategy. In fact, that's something that it's kind of like a marathon, you learn, and you learn, and you experiment and you learn along the way. But again, along with that should be a caretaker or caregiver, that actually is also getting good information and feedback from a clinician. And so from a starting point, decreasing that fear piece, when you're talking about insulin, having them understand some of the very basic concepts so that they don't fear eating, or they don't fear taking insulin at all. And they don't also fear correcting a high blood sugar, right? You know, if your blood sugar is sitting elevated, and they've not given you any, any information as to how and what to do about that other than just a set dose. That's your job to give that to them to begin with.

Scott Benner 7:45
So this never ending cycle that happens. And I obviously I record other stuff. While you know, sure. I've already recorded another episode today. So I have a lot of different conversations happening in my head right now. And I'm also making a series that I think I'm going to call whistleblower, which Jenny doesn't know about but it's clinicians, like doctors, nurses, pharmacists, people in health care, we're going to come on and speak anonymously, I'm actually even gonna change their voice so that they can talk about Jenny's like, Yeah, let's do it. So I had a conversation this morning with a pharmacist who works in an urban hospital, like an 800 bed hospital, pretty big hospital. Right. Yeah. And, you know, through that conversation, I almost got to the point where I said to myself, Okay, well, doctor, see a lot of mismanaged people with diabetes, yes, this becomes their expectation for what it is. And so that when someone comes into the hospital for an emergent reason, and has diabetes, they slot them almost automatically automatically into that space, right? Oh, you have diabetes, you must be unwell. You must not understand your blood sugar's probably high all the time, like all that, yes. But you just said something. Now, that brought this whole thought full circle to me, okay, which is, and it goes along with the statement that this other person wrote. So let me walk through it a little bit. She says, I wish no one would have said anything about a three hour rule or stalking or anything like that. I wish they would have just what Jenny just said, taught me how to use insulin. Right. And the note I made under that was that scaring somebody from stalking, which I understand why you would want to do that I would understand why you wouldn't want them to use, you know, uncovered insulin, sure, but it leads to their mismanagement. And it just hit me as this all comes together, I get diagnosed, and a doctor out of an abundance of concern scares me into not using my insulin correctly. And 20 years later, I end up in a hospital with high blood sugar's high one see I don't know how to manage my stuff and the doctor says up that's how people with diabetes are. But no, not if on day one. You want to help them understand and so maybe they never become that person and maybe that's how the system fixes itself. Right. Like right from from step one, not from you know what I mean? Like what I

Jennifer Smith, CDE 10:00
do. Yeah, I also think it's really important to, if you are a clinician, I think it's important to see the person and where they are. And expect that this might be your first interaction. And if they're in with a history of diabetes, as you're alluding to somebody coming in mismanaged for many years are not given proper information. This is your opportunity to start educating them. Every interaction with somebody who has diabetes, whether newly diagnosed or meeting have that information is your first point of ability to say, Hey, how can I help you understand this better?

Scott Benner 10:43
Yeah. And I think that based on this other conversation I just had today, the expectation is going to be that that's not going to happen, and that the doctor is going to have a reason in their head, why it's not okay. Why it's not their job, or they don't have time, and they probably they're probably right. But that's where I think, sure, we need to have a thing that you hand to somebody, and you go, hey, you know what it seems to me, you might not know how to use your insulin. And that's the core of this whole thing, just two sentences. Go listen to this, go read this, go see your doctor and tell them I said, XYZ, right. I think we can get you on a better path and keep you from being in this situation in the future. But that's, I think the problem is, is that we all are just waiting for the system to fix itself. And it's not that easy. It's not just a doctor, not wanting to do a good job. I think they all want to do a good job.

Jennifer Smith, CDE 11:39
Correct. Or they wouldn't have gone. Yeah, absolutely. If you're going into healthcare, I think 99% of healthcare employees are there in it to help.

Scott Benner 11:49
Right. All right. Yeah. I do think that based on some things that have been said to me recently, that maybe a certain personality drifts towards emergency medicine. Yeah. And that maybe a certain personality drift towards specialty, and that you might be getting a little more comfort and compassionate specialty than you are, you know, in the ER, absolutely,

Jennifer Smith, CDE 12:09
there is a certain personality that works the best in the emergency room. It's somebody who can compartmentalize a situation and then move on. And there's another new situation completely different, and they have to attack it. And they have to look at many different pieces that brought that situation in, and then they have to move on yet again.

Scott Benner 12:29
Right, right. So so it might be unfair to say I hope an ER nurse sees that my one C is nine and fixes it for me, that's not going to happen, right? Like no, top down there. They're trying to stop the thing is trying to kill you. Most importantly, you know, they also don't tell you to take vitamin D if you don't take it like they're not they're not there for your generalized. No. But when you get into a into a hospital setting, the expectation is, oh, this person must know a lot about this. But in the end, I don't think that's mostly ever true. You know, and if you don't know anything about your diabetes, and they don't know anything about it, then nobody's gonna do anything about it.

Jennifer Smith, CDE 13:06
Yeah, right. Absolutely. And acute care to, you know, in, in a hospital setting, not necessarily emergent. But in hospital is also it can be a tip of starting some information to bring to somebody but that person, you know, if you are the prescribing doctor or you're the doctor who's following the case or whatnot, it's not an educational environment. I worked in patient education for a long enough to learn one that that's not where I wanted to be. And to that you can only really give a little bit. And those little tidbits should be enough to send somebody out safely with some new information. But you have to be the one to set up the follow up. Yeah, you have to be the one to be able to provide them with the next step. I gave you this I taught you the basics of safely using insulin. Your next step is this person has been set up for an outpatient Yeah.

Scott Benner 14:10
This episode of The Juicebox Podcast is sponsored by cozy Earth and right now I'm looking at cozy earth.com to see what's going on. I got oh look at this bamboo pajama set for ladies. That jogger pants for ladies looks like plush lounge socks. That's one of Oprah's Favorite Things. There's the bath collection. We love the waffle towels but there's also premium plush bath towels. Everything that you see here can be had for 40% off with the offer code juice box at checkout. Even the sheets now we use the bamboo sheets, you may choose different linens I don't know what you're going to love when you get to cozy earth.com But we sleep on bamboo sheets from cozy Earth. They are incredibly comfortable, and I bought them myself with my own money using my own offer code, juice box at checkout 40% off is what I saved, you can as well at cozy earth.com. I partnered with ag one because I needed a daily foundational nutritional supplement that supported my whole body health. I continue to drink as you want every day because it works for me. Ag one is my foundational nutritional supplement. It gives me comprehensive nutrition, and it supports my whole body health, drink, ag one.com/juice box, when you use my link to place your first order, here's what you're gonna get a free welcome kit that includes a shaker scoop and canister, five free travel packs, a free year supply of vitamin D, and of course, your ag one. So if you want to take ownership of your health, it starts with ag one, try ag one and get a free one year supply of vitamin D and five free ag one travel packs with your first purchase. Go to drink, ag one.com/juice box that's drink ag one.com/juice box, check it out. Right, I'm not a Pollyanna person, I don't think that everybody who's doing poorly is doing poorly because someone just didn't tell them what to do. I know there are plenty of people who correct or a myriad of reasons don't take good care of themselves in a lot of different ways, what they eat, how they exercise, what they take in their body other than food. Like I understand all that. But when you initially set like, let's just say, you know, you see, I don't know, 500 new patients a year with diabetes, which is probably an astonishing low number, I would imagine. Yeah. And you don't give any of them a good direction, well, then they're left on their own to maybe find it or maybe not. But if you give them good direction, and a third of them take it, that's a win, you know, like, that's better than not anybody Correct? You know, this person says, Look, if you would have just told me that fat protein and adrenaline, for example, would have changed my insulin needs, it would have saved about three years of me banging my head against the law. Like, that's a long part of your life, to every day, every meal be going like I don't understand what's happening here. You know, and then you get that fear. Explaining why you're suggesting these changes would be great. This person says, also listen, when I tell you that they don't work and why I think they won't work, you know, so it's not enough to just say something blanket to them. Because your blanket idea may not be the answer. I'm just gonna go out and say that I've been doing this a very, very long time, speaking to people about diabetes, and seeing what leads them to success, right? And the answer, I think the only answer is information that they can access at their leisure. I think that's very important. Because you can't force somebody to care about it, just because it's day one, or because it's been a year, because you're a once they hit a certain number, they have to be able to intersect this information, when it's comfortable for them when they're ready to take it in. And I think that's what gives them the best chance at success and moving forward. Right,

Jennifer Smith, CDE 18:14
I think what you're talking about is kind of stepping stones, right? You give them a baseline, again, from a safety standpoint, this is safe, this will lead you to blood sugars that are more optimized, but then we're going to move on from here. And you have to look at it again, like a long duration of little pieces of inflammation information that collectively at some point, they'll start to fit together like a puzzle, they'll start to make a lot more sense. And it's, it's also from the person with diabetes standpoint, it's a lived experience, you know, if somebody tells them their diabetes educator, or their endocrinology doctor or whatever, says, why don't we start here and do this, and then you come back as the person with diabetes as the next visit. And the doctor should say, Well, hey, we talked about this last time, did you try this, you know, and did it work. And I think that that's the piece that often kind of gets missed, it gets missed in the jumble of there's lab work to look at and what they think they need to check off in terms of discussion, but what it needs to be is almost like a review, it's like, go back to what was talked about, did it work, and that's the person with diabetes that needs to bring in when you told me to do this. I tried it for a couple of days. And it didn't really seem to work. Right. Okay, then let's take another look. And let's see what else we can make a change to Yeah,

Scott Benner 19:42
and reasons why most likely doesn't work when it doesn't work. It's just settings, right? You know, if you don't have their Basal, right if you don't have their insulin to carb ratio, right, their correction factor, right. Like it doesn't even if you tell them the correct thing to do. doing the correct thing with the wrong amount of insulin is not getting you anywhere, right. And it points to this feedback here. A person that says that if the doctor would have just admitted to me that they were just starting me off that this wasn't the end all be all conversation, that would have been great. But at some point it felt to them, like, ego. Oh, almost like the doctor didn't want to admit, like the thing I told you in the beginning wasn't all of it, or they didn't know one or the other. But I'm telling you, if you're listening, if Basal should be a unit, and it's point eight, you're already screwed, right? It's that easy. You know, if you know your insulin to carb ratio is one to eight, but you've got it set at one to 10, you're going to lose, right? And that stuff, snowballs on top of people, and leads to the statements and leads to long term health. And you can't just say, well, that's diabetes, they're gonna have to figure it out on their own, right? Because, Jenny, I don't know, maybe that is true, on some level, that you are going to have to figure it out on your own. But you don't need to start me 10 miles deep in a hole, and then tell me to figure it out on my own. You don't I mean,

Jennifer Smith, CDE 21:03
right. And on your own, it implies that you don't have follow up or someone to check in with, right, what you're kind of seeing in a roundabout way to is that at that initial diagnosis time, or an initial re education time, but especially at initial diagnosis, it's the understanding that when you're talking about insulin use, and the safety of it, I think a safe piece to tell people is that we're starting here at a new diagnosis, this will change. And these are some of the reasons that as your child grows, or as you change your lifestyle as an adult, or as we see how things are moving and changing. This will get adjusted this 110 20 unit of insulin that we're taking now, it's going to change. So don't expect it to be this way for the next 20. I think if you're just told that right now, you are less likely to feel irritated when it does change. And you know,

Scott Benner 22:05
to look for it. Right? So my daughter was diagnosed at two, I mean, 15 years ago, and we struggled for years. I'll never, ever forget the time that I realized her correction factor was like one to one unit moved to 350 points or something like that. But that's because she was diagnosed when she was two, right? Yeah. And so like, now she's four. And I'm like, I don't know, why is there anyone seeing the eights? Like I can't figure this out? I'm trying to move her blood sugar with not nearly enough insulin. Right. And she went to a good children's hospital. They never change that. Yeah, even they weren't thinking about it, like so. I mean, I don't want to say like, it's, it's not, it's not, it's not hopeless. Okay. But, but I think it is important to remember if you're the person listening who has diabetes, that it could go this way. And if you're a doctor, and you're hearing it, I hope what you're hearing is that with tiny little adjustments, that what I say to these people, and how I say it to them, we could avoid a lot of these issues, I get a ton of them. And Jenny brought up such a good example, that she just kind of cruised over I think, but at the end of your notes, it should say, this is what we talked about. So that the next time you open it up, yes. Next time, we're together, you start with Okay, the last time we were together, we discussed this. And let's move from that point, instead of like you said, Oh, we're going to check your agency today. Let me check your sites. Don't put it here anymore. Move it over here. Great, thanks. How are you feeling? How school how school, shut up. told me how to make my blood sugar to be lower and stable. It's not asking me how math is for God's sakes, like like, you assessing my psychological well being, I tell you what, it would be better for me once he wasn't nine. What do you think of that?

Jennifer Smith, CDE 23:54
I could actually think when I was doing my test,

Scott Benner 23:56
I'd be doing great in math. If my head wasn't foggy all the time. And I wasn't constantly low and jam and a bunch of food in my mouth I didn't want while my mom's crying on the phone. Like I bet you all that would make it better

Jennifer Smith, CDE 24:08
or being pulled out a class because I mean, for kids, especially kids are consistently being pulled out of class because their blood sugar is too high for something or it's too low for something and they don't have enough, you know, authorized ability to treat it in the classrooms. They have to get pulled out and they go three hallways down to the nurse and they sit there for 20 minutes. Well that's 20 minutes of math class or 20 minutes of learning where to put the commas in your sentence. And

Scott Benner 24:30
while you're sitting here listening is a physician thinking that's not my fault. Yes, it is. I've told this story on the podcast before my daughter leaving second grade going into third grade. We thought she was like, stupid, but I'm not even gonna like idea. Like we were like, that kid can't do math, you know? But luckily for her, her second grade teacher did that leap thing with her class to the whole. She had the same teacher next year. And the woman just had an epiphany. And she said, oh my god Arden's struggles with math. If Arden goes to the nurse every day while I'm explaining the math section, and that's why it took her a whole year to get back on course with it by the way Arden's very good at math now, yeah, but why was that happening? It was happening because in Arden's insulin to carb ratio was wrong. So she had to go to the nurse because we were afraid of how high your blood sugar was going to be. And we were setting up the certain times of day to try to check them, no lie. If art in settings were better, she wouldn't have struggled in math. And that is a direct correlation. And you should be aware of that if you're a doctor. Because

Jennifer Smith, CDE 25:34
that's, that's where as a physician, again, you know, I understand time constraints and everything I really, truly do. But as I said before, that's a, you have to also have an idea, especially when you're working with kids and teens. Their schedules are crazy, honestly, and you have to have an idea of what is their life, like, if you're going to try to navigate, helping them manage with their insulin doses, and strategizing, adjust this way, one day and adjust this day, because this is the recess B and it comes right after lunchtime. You have to know that type of thing about your patient,

Scott Benner 26:12
you have to have that conversation with them. Right and ask them what are the struggles you're having? Like, where are you having these problems? Not just like what happened here at two o'clock? By the way people hate that question. Because it was three months ago at two o'clock. I don't know what happened. I have a low blood sugar, right? I don't know. And by the way, in case you're wondering, I know that you have to ask about the lows for insurance reasons or whatever. Like I get it like I know what's happening. But the people don't understand that they think this is like your high level, like deducing like you're trying to figure things out. Not that you're just trying to get them to say something that looks good on the form. Because I see what's happening when I'm in there. This this one person says, if you just would have explained Pre-Bolus thing to me, that one concept, oh my gosh, what things would have changed. I tell people all the time, if you're not Pre-Bolus thing, you might knock a point off, you're a one c by Pre-Bolus. And and that's not even like purposeful direction. It's just something that I've noticed. So Right.

Jennifer Smith, CDE 27:10
Yeah, absolutely. And I think it it boils down to, there's an there's an also an age appropriate component to that Pre-Bolus. Right, especially with a new diagnosis where you're not quite sure where, where the doses are gonna go in the next week or two, as the body sort of responds to getting insulin and having more normalized blood sugars and insulin, you know, maybe honeymooning comes into the picture. And so all of this as an explanation of this time period, it's going to look a little bit up and down, we're going to have real close conversation. Here's our office number. And many pediatric practices actually do that they provide enough hand holding. But if you're not doing that, that's really important. And it's even important for what I think is like the Forgotten crowd of people with type one diagnosis, which is adults. Honestly, if there's an under education that

Speaker 1 28:01
no one's followed up with adults, nobody fought like they're given.

Jennifer Smith, CDE 28:05
If anything, this baseline of this is how to do an injection, take this amount of insulin, and make sure you take it with your food, no reference to Pre-Bolus. And if they're at their insulin needs, and the type of food that they're probably eating and the load that they're probably eating. Most adults even at early diagnosis, need some kind of a Pre-Bolus They're not three years old, where you're questioning whether they're going to eat the 10 grams on their plate or better for

Scott Benner 28:33
my brothers that type two. And his last day once he just came back five, five down from seven, eight. Awesome in that crazy? Do you know who led him to the information that got his a one c into the mid fives? It was me. Yeah. A guy with a podcast pointing out you know, nobody can see that is Doctor Who, by the way had been doctoring him for three years to a mid seven a one C and tell him you're doing great. So yeah, but

Jennifer Smith, CDE 29:01
without also and I don't know whether he was using a CGM, but a mid seven could have been with a very considerable variance. So it may not have you even if seven was, quote unquote, healthy and where they felt like it should be fine at if his variance was excessive. Yeah. Well, that's not

Scott Benner 29:20
healthy. He was sick a lot. He was tired a lot. Like he just couldn't like get anything done. And finally listened. This has happened to me. And it's interesting because the people in my life, it's harder for me to tell a person in my life, I think you should do this than it is for me to tell a stranger on the podcast, which is interesting. We had this situation last night in the Facebook group. It's not really a situation like I sort of got irritated about something and I made a post and somebody was talking crap about me on the internet somewhere and I just kind of It's okay, don't worry, it happens sometimes.

Jennifer Smith, CDE 29:50
It's never kind of do I don't care who you are very nice. It comes with.

Scott Benner 29:54
I don't feel right saying this, but it comes with popularity. The more popular the podcast is the more people kind of take shots and stuff like that, so it's fine. So I put this post up that I guess led everybody to think that I was in a bad way. And to help me what they did was they came in and they told their stories about what the podcast has done for them. And if I spent the next two hours on this recording, I could probably record everything that was said. But suffice it to say, the podcast helps people. They say that that's me helping them, which okay, it is, but all I did was told them how insulin works, right? That's all I did. I know that everybody like, it's nice. And I appreciate the credit and all the good wishes. But all I did was teach you how insulin works. If doctors would do the thing I was asking them to do, I put myself out of business. And, and by the way, I'm getting older. So let's go. You know what I mean? Like, like, let's get to it. Now, I can't do this forever. You know, I wish my doctor would have told me about the balancing act of insulin to carbs and how insulin actually works. Over and over. These are different responses from different people all telling you the same thing. Now that I've had it for a while, now that I found the podcast. Now that my agency is low and stable, and I understand diabetes, I wish you would have told me how insulin works. It's what everyone is saying in here. Just everybody.

Jennifer Smith, CDE 31:18
And there is you know, as this is insulin and safety. There's a safety component to explaining that from the get go. Yeah, I mean, it's like it's like thyroid, for example. Right? That's a medication that is for everybody I've ever worked with who takes meds, Synthroid, for example, or the other, you know, options. They're given that information from their doctor or from the pharmacist who they get the medication from, about timing it away from food away from certain supplements away from other things. And this is a simplified example, in comparison to insulin, but they're told why y with insulin can cause such extremes in blood sugar,

Scott Benner 32:03
don't take Synthroid with this vitamin, don't take it on a full stomach don't like here are a couple of things to do. We'd like you to take it in the morning be consistent every 24 hours, actual direction about how to take the pill. Now, if you don't do it that way, then it's your problem. Like but at least,

Jennifer Smith, CDE 32:18
you're also not going to end up with a blood sugar. That's 42. Yes, right.

Scott Benner 32:23
Right. And so they do the thing of, instead of telling you what to really do, we'll just err on the side of caution, which is a way of making it sound like you're doing them a favor, but you're not doing them a favor, you're turning them into a person that 20 years from now in an ER is going to be treated like a scumbag for not understanding their diabetes, but your initial meeting with them put them 20 years later in that position, and maybe not 20 years, maybe much sooner. 510.

Jennifer Smith, CDE 32:49
Right, almost a blame for maybe they are coming in with some complications or something in the picture already. And I think it's an an unfortunate thing that happens, because your expectation about what you know about somebody just based on now seeing their diagnosis. Yeah. You don't know what's gone into their life up to that point. Yeah, or

Scott Benner 33:15
what their initial meeting with health care is put, listen, here's a here's an example that I think is pretty dead on. If an 18 year old kids caught with three joints in 1970, and thrown in jail for 20 years, and then murders two people in jail 15 years later, you say, Oh, look, we were lucky. We got him off the street, he was a murderer, I say, maybe if you would have just taken the weed from them and been like, hey, go home, you wouldn't have sent them on this path. Right. And that's what this I swear that it's going to sound harsh to a doctor. But that's what this is, when you intersect people early with diabetes and don't do the right things for them. And I'm telling you the right things are explaining how insulin works. Like when you don't do that. every bad thing that happens to them afterwards is likely avoidable. Or you'll never know. Maybe Maybe the guy was gonna murder somebody in 15 years, but you're never going to know because you didn't give them the right chance. In the beginning. I

Jennifer Smith, CDE 34:13
meant that could have encouraged the behavior for what happened 15 years later. Yeah. Versus like you said, Oh, slap on the hand, send them home, hey, probably don't sell those or give those are yours.

Scott Benner 34:26
We're not going to for you to for 20 years, which by the way, 20 years later, society generally accepts that that was the wrong thing to do. I mean, this, like, if you live your whole life as a physician doing this, and you go retire somewhere, and then you're just sitting around enjoying your life. And you see that health care has jumped forward and proves out that the thing you were doing now wasn't the right way to go. It's going to eat at your gut. So just like listen now like because Jenny mentioned thyroid a little while ago, we're talking about diabetes, but all of these disease states that require the user, the patient to understand it and to help manage themselves. We always say it right. I guarantee every doctor listening has said this, you know more about your diabetes than I do. First of all, why? Like, it's not that hard to figure out. And secondly, okay, well, if they know more, why aren't you listening to them? And why does it happen? A generation again, like, Okay, well, we figured out doctors don't know, but the users know the patients now, let's go ask them what they know. And we'll make that the standard of care. It's all I'm saying right now. That's all I'm saying. No, yeah,

Jennifer Smith, CDE 35:38
I think I think I mean, thyroid was my example. But I can think of another one that I was, as a dietitian, gave education on was the Coumadin diet, people get more education about using Coumadin, which is a blood thinner, essentially, and a specific, right, Vitamin K kind of type of diet, and what do you have to they get more education, you think that medication using insulin? So there you go.

Scott Benner 36:08
So what is really happening is, I'm left to look back on this and say to myself, you either don't know what you're talking about, or you are willfully not explaining it to people, those are the only two options and neither option is okay. So either educate yourself about it, I have a, I have a series of episodes you could listen to while you were driving, and a week and a half from now, you'd go Oh, I understand how insulin works. Now, that would be that easy. Or just admit you don't know. Right? But stop being punitive to these people and sending them down a path that leads to things you can't even imagine poor health psychologically and physically. relationship problems, you know, like because they can't write their blood sugar's are bouncing around, they can't even communicate with people well, and we hold the

Jennifer Smith, CDE 36:57
job well enough for absolutely, yeah, chronic

Scott Benner 37:01
pain comes and then they start doing things where they're like, oh, all start managing this. But this next thing, you know, they're taking 16 different meds, and they're smoking weed and stuff to try to get through their day. And I know that all sounds like that's not our fault. But yes, it is. In this specific scenario, every person you let leave who doesn't understand. This is what your basil is for. This is what your insulin to carb ratio is. This is what your correction factor is. Here's how these foods impact versus these foods. Don't just say glycemic index and glycemic load to them. And if they don't listen, it's their fault. Like because that's like Chinese. Yeah, I don't understand. I've said on this podcast a million times. Somebody said to me one day, hey, glycemic index, glycemic load, it's really important. And my kid had just been diagnosed with diabetes. I was like, what? And then I never thought about it again. I started making this podcast and I said to Jenny, one day, I'm like, Oh, my God, the biggest problem is people don't understand the impacts of their foods.

Speaker 2 37:55
So did someone try to tell me years before? I don't know, not really. They pulled me into an office, they set a thing. They checked a box, and they kicked me out again. That's what they did. Seriously. That's what they did to me.

Jennifer Smith, CDE 38:09
I'm sorry, you got to boot. They were able to say, hey, we

Scott Benner 38:13
told him, Hey, that kid drops that it's not our fault. Like that. That can't be the way you do this. No, it just Yeah. You know,

Jennifer Smith, CDE 38:21
can't I think I think it also brings up from a component of this conversation being safety. There's an elephant in the room that honestly needs to be brought up. And it's, if you prescribe insulin, Scott, what else should you prescribe?

Scott Benner 38:39
Oh, glucagon, yes. Because you're right, it is dangerous. And they might pass out and freaking try to die. And it would be cool if they had a thing where they could just jam it in them and stop that from happening. So Correct. And how do you get in that position? You don't tell them how it works. And then they start sniffing around it, and they kind of figure it out. But they don't have a lot of directions, they start doing these like crazy. Like, I'm just gonna give myself a bunch of insulin and see what happens ideas. And sometimes that doesn't go well. So it's not just use more insulin, or it's understand how to thoughtfully use things. How does the insulin work? How do I thoughtfully apply what I know about the insulin to my specific situation, diet, etc. Yeah. And by the way, poor women who are already told so many times, like, that'll go away after you have a baby, or I hear that happens to a lot of you like like that, like that's your level of care you get sometimes. How about no one tells you that you might be three different kinds of people with diabetes every 30 days. Right? You might be the nice stable one. Maybe during your period, you might be the one that has troubled prior to your period after. Yes, I know. It seems like Oh, they'll figure it out. A lot of people never put two and two together. As

Jennifer Smith, CDE 39:57
far as the person with diabetes. You You may not put it together, because it's never been defined to you as a difference from female hormones impacting a certain way. And impacting a certain way, depending on where you are in your life cycle of those hormones, creating a different type of impact compared to male hormones, which absolutely are very different than female hormones. And we, I feel like, you know, I work with a lot of women and women's health has become much more important to me to provide the right type of information for the females I work with. Because they've been left in the dark, they may have been given information about insulin reaction, and what to do and what their Basal and their Bolus do, they may have been given that but you ask the majority of women about whether they were told what to watch for once they start having a monthly cycle, or early like the preteen not even having a cycle yet, but the potential that there's a pattern that's starting to emerge, and you feel like a crazy parent that brings something up, and they're like, Well, I don't know, it's just, you know, we'll just adjust this way. And then the next time they come in, it's a different time of the month and the poor kid is like, well, let's adjust down this way. Instead, give them the reason that this is happening, right? And how to fix it. Yeah.

Scott Benner 41:22
Listen, I sometimes I even get frustrated because people give they bring you these very specific situations. What's happening right here? And I always answer the same way, you're not using your insulin correctly, right? There are different variables, there are things that are happening to you. Maybe they're hormonal, maybe they're food related, maybe they're exercise related, hydration related, there are a couple of like big ones, right? That it could possibly be. And, you know, setting setting settings settings have to be right, you need to know when to use the insulin. And I say all the time, like if I had five seconds to make this podcast, I would tell you that it's using the right amount of insulin at the right time. It's timing and amount, dependent on variables. So when someone comes to you and says, I don't understand, you know, I'm good at this except when I'm swimming. Okay, well, then swimming is the variable, right? And we'll figure out like, where do we put the insulin? How much of it and where, you know, so when do we put this so that you can swim without a low blood sugar? It's infinitely doable, right? It really is. And yes, your doctor's probably not going to explain that to you, the day you're diagnosed, or even in the first couple of years of you going into that office. But if you knew its timing and amount, it settings, it's understanding the impacts of food, the impacts of hormones, the impacts of those sorts of things. Hydration, if you're not well hydrated, your insulin doesn't move around. Well, it doesn't work the same way. This person here says, hey, it might have been nice to tell me that my insulin sensitivity would act differently if my blood sugar was higher, because you gave me settings and directions that drove my blood sugar up. And now not only were those settings not okay, when I had a stable lower blood sugar, they're really not okay, now. And all that gets boiled down to a doctor by like, oh, yeah, when your blood sugar is high, you need more insulin. Okay. valuable, but not not nearly the whole story. That's all. I got upset during this one. I apologize.

Jennifer Smith, CDE 43:15
No, it's all 100%. Correct. And I think you know, the point being that in general, you have to give the right information in the right timeframe. But starting out somebody with information that is lacking enough definition, that is going to set them up for going down a path of I don't understand, I don't understand I don't understand. So I'm just going to do the basic that I was told to do, because I don't know what else to do. And nobody's helping me. And then they also don't know what questions to ask to make it better. Even if it's with a, you know, a health care practitioner that's trying to do something for them. That person might be so in the dark that they don't even know where to start to ask.

Scott Benner 44:04
Yeah, I just I'm stunned that with the prevalence of diabetes, such as that is that the simple ideas aren't better understood, and communicated. Like Jenny, I'm not going to like I hope this doesn't sound different than how I mean it. This podcast is insanely popular. I know. It's not a podcast made by like a big company or like a, you know, 20 people. It's like, I make it I have you on and a couple of people and I have guests on and like I you know, I pay an editor to like, make sure it sounds good. Like, it's not a big operation, right. The fact that so many people listen to it should be an indication to physicians. We are not doing a good job with this. Like that's that's, it should because if people understood it, it wouldn't be needed. It's not a comedy podcast. It isn't fun to watch Listen about talk people talking about diabetes, like their list. They're trying to save their lives, you know?

Jennifer Smith, CDE 45:06
No, you're right. And in a broader sense, I think if there was, like a lot of the way that many people might even often come to the podcast is actually just by doing a search for more in depth education about diabetes, or type one diabetes, or support for diabetes, or whatever it might be. And obviously, it probably comes up pretty much first on a Google search, along with maybe a couple of other options, right? But right, the baseline here is that without the right information, people are left wanting almost with a almost with a subconscious idea that they haven't been given everything they need. And then they go searching. Yeah, wouldn't you rather that they get the right information from you to begin with, so that you don't have to repair all the misinformation, they may have gone down a rabbit hole of information online, perhaps they didn't find the podcast, but they found somebody else's. This is how I manage my diabetes and the like eating lettuce leaves all day or? Right? You know, if they're coming back to you like that, you're like, oh, oh, okay. All right.

Scott Benner 46:13
That's not right. Yeah. I didn't mean for you to just eat cabbage. Sorry, right. You haven't led them in a good direction,

Jennifer Smith, CDE 46:21
right? They're doing a search because you haven't given them the information they need to begin. Isn't it

Scott Benner 46:25
funny, too, that a doctor will tell you don't go online to find out stuff? You know, like, Why do you think I was looking? I was looking, because I completely understood it. And I just wanted to see if there was more. Like, I don't know what I'm doing. I'm dying, physically and mentally. And I'm trying to save myself. And by the way, those are the people who are lucky enough to take that extra step. Correct. Most people just sit down and go, This is my lot in life, and they take it.

Jennifer Smith, CDE 46:51
And this must be the way that it is because the doctor and I don't mean that rudely. But the doctor told me to do it this way. I do it this way. And as you said, this must be the way that this just works. Yeah, they don't go down the road of search.

Scott Benner 47:06
I guess this is what living with diabetes means. I have an eight a one C and I feel cloudy all the time. And I guess if I get lucky, maybe I'll just get frozen shoulder and I'll get to keep my toes like that's literally what's going through their head. And none of that's necessary timing and amount. I don't know, Jenny, the Pro Tip series is 26 long. It's maybe 20. You know, 20 hours worth of listening. Everybody listens to it and comes back and says Am I even seasonal oh six is now. I just understand now, Jenny and I did a talk. Let's finish with this. Because I know you have to go. Jenny and I did a talk in front of some people in Austin, Texas recently. And we were invited to talk. And we said, we'll do that. But we're not going to put a slideshow behind us. We're not going to do this the way we normally do it. We did two solid hours of conversation. Just you and I to the audience. We went on a lunch break. And we came back and did three hours of q&a. No one left. Right. Everybody came back. Yeah. My my ego made sure No, I checked hard. Okay, like everyone was there. Okay. Well, my point is, is that if I said to a doctor, hey, we're going to offer this thing of five hours worth of education about diabetes. They'd go, nobody wants that. But they do. They want it desperately. You know. And so we go down there, and we just have conversation. We're not talking at them. It's not bullet points. We have this big conversation. Jenny said you saw someone online who said what after that about pizza?

Jennifer Smith, CDE 48:36
Yeah, it was a The question had been raised about how to navigate pizza with a specific algorithm driven insulin pumping system. And I gave some baseline direction with some things to pay attention to. And when to put insulin in again, timing of insulin is the baseline here. So when to put it in and what to watch for. And from what I remember, the comment online was just back, hey, I did do a GT sat and look at what we got. I was I was very excited about that. I was like, thank good. Yeah. And

Scott Benner 49:08
I heard back from a family whose daughter went out into the world afterwards, they were going all over the place eating a bunch of stuff that you know, generally speaking is not easy to Bolus for, right. And the person said, like look at this graph and showed showed a nice, like graph of stability over the next day. But their indication was not that we even said something so specific, like they didn't go like put, you know, Peg a and hole B, just having the conversation led to her making decisions that lead to better outcomes, just hearing people talking about it. And I'm not asking a doctor to do that. But I am asking, if you don't think you're providing that to somebody, then you have to lead them somewhere where they can get that it's very, very important for diabetes. So like, if you can't figure this out, or you don't have time, or your system doesn't allow for it or whatever your reasoning is, that's fine. But don't just shoo them away, like, give them somewhere else to go. It's really valuable for people. So

Jennifer Smith, CDE 50:07
and I, you know, something valuable, I think I don't think I know that I see when I work with those that I get the opportunity to privately is when there are questions that come up that are their questions to me, too. I'm more than happy to say, You know what, I don't know, I'll have to look or I'll have to ask my colleagues, you know, I may have great resources with the other educators that I work with. And we all have wide ranges that we have good information in. We don't, each of us doesn't know everything. Sure. And so we use these each other as resources. And as a clinician, you have to be willing to say, I don't know. Yeah, it's okay. But I'll find the answer for you. I'll help you.

Scott Benner 50:51
I don't remember that. I honestly don't remember the context. But while we were at that talk, I remember putting the microphone to myself pace and saying, Oh, wow, Jenny just said something. I don't remember what I said. I didn't know that. I just learned something here. And like, even that

Jennifer Smith, CDE 51:06
was about honeymoon, something early morning. Basil needs.

Scott Benner 51:09
Right, right. Oh, yeah, I don't remember the the exact I do remember that. I don't remember that. But it's not even important. What's important is that in front of in front of a few 100, people who kind of see me as a person who knows what I'm talking about, I was happy to go, Oh, I didn't know that. Right, like so that they can go, oh, well, he doesn't know it is stuff I don't know and feel comfortable about that. And then I turn to you. I say tell me more about that. Like, that's fine. You need to make people comfortable doing things like that because they're embarrassed to but that's the other part of it. I don't know if we'll get to talk about that in here. Yeah, we will. We're going to do like, kind of like mentality humanity stuff. I'll save it. Okay, I'm gonna let you go then. Awesome. Thank you so much, of course.

This episode of The Juicebox Podcast is sponsored by ag one drink, ag one.com/juice box. When you use my link and place your first order, you're gonna get a welcome kit, a year supply of vitamin D and five free travel packs. This episode of The Juicebox Podcast is sponsored by cozy Earth cozy earth.com use the offer code juice box at checkout to save 40% off of the clothing, towels sheets off of everything they have at cozy earth.com The episode you just heard was professionally edited by wrong way recording. Wrong way recording.com.

If you're not already subscribed or following in your favorite audio app, please take the time now to do that. It really helps the show and get those automatic downloads set up so you never miss an episode. Thank you so much for listening. I'll be back very soon with another episode of The Juicebox Podcast.

---

Please support the sponsors

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

Donate

#1106 Weight Loss Diary: Nine

Goodbye Wegovy... HELLO Zepbound!

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

+ Click for EPISODE TRANSCRIPT

---

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 1106 The Juicebox Podcast and episode I didn't expect to be putting out today

Well, if you've been listening to my week OB diaries Welcome back this is we go V diary number nine. And the last one that's going to be called we go V diary. I don't know, I don't want to spill the beans just yet. You might notice this one's a little shorter than most actually a lot shorter. You'll see why at the very end. And the next time this happens next time there's a diary out about my weight loss should be about a month from now, you're gonna want to look for a slightly different title keep your eyes open, might not say we go V diary next time. 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. Don't forget to save 40% off of your entire order at cozy earth.com All you have to do is use the offer code juice box at checkout. That's juice box at checkout to save 40% at cozy earth.com. A huge thank you to one of today's sponsors, ag one drink ag one.com/juice box, you can start your day the same way I do with a delicious drink of ag one.

If you're looking for community around type one diabetes, check out the Juicebox Podcast private Facebook group Juicebox Podcast type one diabetes, but everybody is welcome type one type two gestational loved ones. It doesn't matter to me. If you're impacted by diabetes, and you're looking for support, comfort or community check out Juicebox Podcast type one diabetes on Facebook. Everybody It is December 12 2023. Time for another week Ovi diary. I had an interesting week last week. went on a little trip was gone for a couple of days. banged around New York City with my wife and my daughter a lot of restaurants. No home cooked food. Nothing of the sort actually, let's see what happened. Also for those of you who heard me cry in the last episode, if that made you uncomfortable, I apologize. What do we have here? Looks like today is the 12th which makes seven days ago the fifth is alright. Anybody want to do the math? It was the fifth. So on December 5, I weighed 195.8 pounds. That was a Tuesday. The next day is that right? Wednesday. Guilt Wednesday was here. Thursday morning, we left. We spent Thursday, Friday in the city couple of hours in the morning on Saturday and came home. I'm gonna say one meal out 23455 Or six meals in restaurants in a row. Thursday, Friday, Saturday, fair amount of walking as you can imagine got my 10,000 steps in for sure. And I ate us some stuff that you know you think of as being in restaurants. We Gosh one night I had shrimp tempura I had a steak sandwich. I remember having a half of a grilled cheese like when I was grilled cheese is a restaurant grilled cheese. I had a few bites of it. I've had a handful of so a french fries this week stuff. I don't normally have ice cream once a bunch of different things right. Anyway 195.8 pounds on the fifth. Last time I spoke to you today 195.4 pounds. I am somehow lighter today than I was last week after spending this week doing what I did, eating what I did. And being in so many restaurants. I can tell you for certain that without weak Ovie I would have gained four or five pounds this week. Absolutely. There's no way around. It is very exciting. But I want to spend the rest of the time telling you about future plans and a little bit about how I felt during the trip. I speaking to my endocrinologist recently. She's the one who prescribed that we go V and she seems to feel strongly that when the Mon Jarno is that mon Jarno when the mighty Jarno version of their weight loss drug comes out that she'll be moving me to that so we'll see that should be in the next couple of weeks to months maybe to get rid of some side effects that I'm having with we go V that honestly the one side effect is just that my stomach is very stable. I go to the bathroom when I want to, but I wouldn't call my bowel movements sorry for this. I wouldn't call them like, you know, solid as rock. So she thinks maybe that will help. I haven't really looked at a lot of the numbers recently with you guys. But I will hear BMI 34.6 When I started today it is 20.9. Body fat is down to 26.5 from a starting point of 35. By body water is holding nice and steady, skeletal muscle mass holding nice and steady. BMR is nice and steady, fat free body weight, which is today 140 3.8 began at 150 1.8. And my subcutaneous fat which is today 23 began at 30. When we started doing all this visceral fat has been very stable at 12. My muscle mass is holding stable. Actually, I want to say that my muscle mass is holding stable but I actually you know visually am seeing my muscles What do I want to say they're tight. You don't I mean not loosen and flopping around like because I feel good about my muscles right now. Definitely should probably lift some weights I think am I bet will my metabolic age still at 56. But you know what started at 58. So rock on. Anyway, this app has been great. It attaches to my scale. That was very inexpensive catalog on Amazon. I think it's called run on people ask me every time I bring it up so try to be proactive here and tell you what it's called. Ren fo r e n p hl. Anyway, I'm going to shoot this week over you while I tell you about my experience this week, take my glasses off. I I wear a jacket like an overcoat because we were walking around the city was very cold. I caught a glance at myself a couple of times in a mirror or piece of glass. I looked dumb, smooth, my body lines were smooth. It's the best thing I can say that the best thing I can say it's the best way I can put it I look normal to my tummy. I didn't have I was able to wear a scarf without feeling weird about like double chin or like my face looking you know, like chubby from being pushed up from underneath. I had no trouble walking around. It's a lot more walking than I normally do. You know there's a little sore, my hips, my feet a little bit. But, you know, nothing you wouldn't expect from doing way more, you know, walking than you normally do. But as far as energy goes, as far as air, you know, breathing, got out of breath. No trouble doing what we did really fantastic time. Got to see the city around Christmas was very lovely. And that's pretty much it. So I'm going to shoot this 2.4 of week Ovie. And I mean, at this point now I'm my weight seems to be staying pretty stable. I am noticing like, this has happened a couple of times over the past months, but it feels like there's a reshaping of your body that happens over time. So while I don't believe that I've lost weight, obviously recently, I am maintaining staying very stable. And I look different than I did even a few weeks ago, my stomach is tightening up in the front, my thighs, which were very like kind of like, Man, when I first lost weight. I was like, Oh my God, my thighs look like bat wings. But that's tightening up too. So that's good, because that was upsetting. But everything else is going really well. I'm incredibly happy. And we'll see what's next. So let's stick this in here. Let it do its job. And then we'll get back to it. Appreciate you guys listening. Hope you're enjoying this

last thing is that over the weekend, while we were in the city, I felt completely comfortable jumping into photographs. Not a thing that normally would have happened. It just no problem. Somebody picked up a camera. I was like cool. I'll be a mat and that was a really great feeling might have been the best part of this weekend. Hey, everybody, it's Scott December 19. I gotta be honest with you, I have a lot to say. But I'm about to get into a car and drive all the way across the country to pick up my son. So I gotta shoot and go. I weighed exactly the same as I waited Last week, I think, yeah, I'm 195 Six today, I am pretty convinced that I need a little more medication. I am losing weight through the first four days of the week. And then on the fifth, sixth and seventh day, gradually putting it back. And the eating hasn't changed. It's, I think the medication is just not quite heavy enough at this point. I've mentioned it before, but my doctor wants to put me on Manjaro, or the weight loss version of Manjaro. Know, for a side effect I'm having which in clarity is not formed poopies. And hopefully, this might also give me a little boost. Otherwise, I'm not sure what's going to happen here. But I don't gain weight. And that's really important. Because you can see at the end of the week, that without this, even just eating as normal as I've been for the last number of months, I would start to put weight back on this medication is the only thing keeping this weight off of me. It is not it is not willpower. It's not food choices. It's I just My body doesn't work, right. It's the best thing I can say 2.4 milligrams of we govi Wish me luck. I'm driving 700 miles one way sleeping, getting back in a car and driving 700 miles back another way. I am far too old to be doing this. So who knows how this will go. RBR Don't worry 123

All right, everybody, the next time I talk to you. It will be the day after Christmas. And indeed it is the day after Christmas. Funny thing. I woke up today and didn't remember that it was Tuesday. So I didn't even weigh myself this morning. I am back from my Atlanta excursion. Everybody is fine. We've had Christmas people are well, we're very excited that everyone is home. I have nothing to tell you, except that I'm shooting my week over and I'll be back in seven days to tell you what I weigh. Sorry about that.

Anyway, I didn't do a very good job for you. Oops, I did not do a very good job for you this week. I apologize. I'll be back in a week or in your lifetime. A couple of seconds to let you know what happened next week, I guess this week coming up? Yeah. Hey, I'm back. It's January 2. I lost like a half a pound this week. But got some good news. The local pharmacy says that they have access to zap bound, which is the weight loss version of Manjaro Manjaro not trying to say it exactly yet. And my doctor is gonna send in a script and we're gonna see what happens so fingers crossed everybody for that. Because I do seem to have plateaued here on the week OB weighed myself. Two days before Christmas 190 5.6 on the 27th. Two days after Christmas that was 196 Six, went up to 197 the next day. Got through Christmas 29th 196. Again, back down. I got the 194 eight on the 30th but then back up on ID five, four. And today I am 195 Two. So you know it's a bit of a yo yo now I don't think this 2.4 If we go V is quite enough. Hopefully. Hopefully we will find out if the zip bound is any different for me. I was toying with the idea of going to Canada for so is for some ozempic and doing the weego V with like a little bump of ozempic to get the dose up. But you know that seems like a lot so hopefully there's that bound will be the answer. We'll find out soon i guess but for now. Let's get this injected and keep going. I hope you're all doing well. Happy New Year. Okay, so we've got Thanksgiving and Christmas and New Year in the box. Doing 2.4 We go V hopefully we can get moved to Magento sooner than later but for now, stuff is the lifesaver let's go outside of my belly should I use left or right is that stage left? If you were looking at maybe my right side? I'm gonna go there this time. Were aware about here? Nope. I didn't like the way they felt about hear better

Alright guys, let's keep going New Year New us. Oh, we have a gift. My friends that time has come as Lionel Richie would have said, well, my friend, the time has come you know the song, raise the roof and have some fun. Guess what I have in my hand. You think? Oh, Scott, it's 2.4 milligrams if we go nope, it's not. It's five milligrams of zip bound. That's right friends. I'm zip bound. I've been talking about it for a while now. I've been plateaued. Nothing's working, talk to my doctor for a little bit as you're supposed to do. And she said, Let's try. The Manjaro isn't Manjaro Manjaro mine. So anyway ozempic is currently classified. Your insurance will say it's okay for type two diabetes. They use the same exact formula. same molecule, same drug called it we go V insurances that's for weight loss, we go V's for weight loss ozempic is for type two diabetes while Manjaro no Manjaro Oh God am I gonna have to learn how to pronounce this hold on a second. That's, you know, currently classified for type two. And they have a weight loss version called Zip bound. And I am my friends today is that bound. I'm going to learn more about it as we go obviously, and talk to you about it. But from our friends at Eli Lilly. I'm making the switch to Zep bound. Because I've plateaued pretty seriously actually. I'm gonna read you some of my numbers. So this is a good place to keep all that information. I'm also moving my injection date to Saturday. So today is January 6. I've actually, as you know, injected we go V on Tuesday, which I think was the fourth. But we're moving this to Saturday. My doctor also says that's okay. And so here we go. Today, when I woke up, I weigh 194.8 pounds. That seems to be my new place. I bounced between 190 481 95 for the last seven or so days. I'm gonna go over all my numbers with you real quick before we sat down at BMI is 28.8. Body fat 26.4 my hydration 53.1. That's body water. Skeletal muscle mass 47 Five Excuse me. BMR 1777. Fat free body weight 143.6. subcutaneous fat 22.9. That's down from the day we started from 30. visceral fat is 12. Visceral down from 17 on the start date, my muscle mass 130 6.4. That's been pretty steady the whole time. bone mass 7.2 protein 16.8 metabolic age still 56 Of course, I'm using the URENCO scale, a lot of you asked, so I'm sure to say it. Now. I do not have any kind of an agreement with them. They are not buying ads. But ask yourself this Renville why not. So let's shoot this round. And then I'm going to come back next week with a whole new bunch of information for you. I guess that makes this a pretty short episode, because I'm going to put this one out. Yeah, this one's only like 16 minutes long, but we got a big shift here. I guess I'm going to tell you that the next episode will be called zap bound diary. Formerly weego V diary or something like that. I have no idea. Okay, it's zip bound. So this needle is a little different. The other one you pop the cap off and you've just pushed the whole thing into you. It clicks in you hold it and it clicks off when you let go. It actually works. The pen the weego V pen is seems very similar to me to the G voc hypo pen. So this one is different. You pop the cap off. And then you unlock this the turnstile to unlock it and then you push a button at the top. Whatever. Oh, I shouldn't have put my shirt on. I'm undressing those are my snaps was very sexy. It's not trust me. Okay, exposing my belly. There it is. Before I inject this, let me say this. I've lost. I don't know exactly what 38.5 I guess I could have look. I've lost 38.6 pounds since March 28 2023. Today is January 6 2024. For those of you who have seen photos of me I look like a completely different person. It would be very easy to say, I did it, I'm done. But truth is my BMI is still high. I'm still technically obese. And though my legs are nice and trim and my arms are crossed, my chest is looking good. I have all this extra weight is in my belly. I am not having a heart attack, Scotty ain't going out like that. Okay. And on top of that, I've learned something. So I think I told you the story already. But real quickly, I had a photo taken of me the other day in the same exact position in the same exact places. I had a photo taken of me a year ago. They were both taken by my daughter, who then said, I'm going to share these pictures with you, because I think you're going to be amazed. And I looked in the picture that's one year old. I was sloppy fat on, I appeared unkept. Even though I didn't feel that way, my face look tired and sunken. was a mess, like I look a mess. But if I think back to a year ago, I didn't feel that way. And if I looked in the mirror, I didn't look that way to me. Today, I can look back 38.6 pounds later and tell you, I was in trouble. I do not, I did not look good. And it would be easy to say I'm so much better now. I'm good, I'm done. But if I forget who I was a year ago, and just assess myself today for who I am today, the person I am today is still not in a healthy way. Not completely. I'm much better than I was. I look better and clothing, look better photos. All that kind of like surface stuff is 1,000% Better, obviously. But I'm not there yet. And I'm not stopping so southbound, which is a we go visit GLP one is that bound is actually a GLP one and a GLP 2am I right about that hold on sorry. I'm gonna read here for a second then I'm gonna learn more about it as we go. People taking zip pound lose up to 48 pounds through a 17 month clinical trial people who died at exercise and towards that balance, sustained weight loss, but it's all sounds like you don't I mean, it comes in 510 and 15 milligram doses I don't know that I'll ever go up from the five we'll find out of course. Yeah, so from what I hear from my doctor, is that bound might not just be helping with weight. But it could also help with acid reflux, which I have but don't have as bad as I used to have when I was 38 pounds heavier. And it could also take away any side effects. I don't mean that what do I mean? She told me that she's hearing from her patients it's up bound maybe has fewer side effects for her patients than we go we had and I do still have one side effect. While I'm on we go V which is a Scotty hasn't seen a nice solid bowel movement in a while. You know what I mean? They're not like I can't believe we talked about this stuff. They're not like fire hose horrible or anything like that. They're just not what I would call where I want them to be. If this changes that well then that's just another thing clicked off the list, which I would really appreciate. I'm just looking to be healthy, to feel good. And to actually be good. Alright, I'm looking at my belly here which is significantly smaller than it used to be. And I have decided on an area I've popped the cat pop sorry there I just bought the cat Yeah, well okay. I'm pulling it up to my skinny skin skin. Unlocking the pen I'll do a little pinch and then a button right oh God Is this gonna hurt here we go

hmm I was pretty quick did hurt no. little drop of blood. I'd never had a little drop of blood would we go mana that that needle shoots out of there is like hello Here I come. Alright people I guess I would have normally said Here we go V but instead let's say something. I'm what does that mean? I was gonna say zap bound. What the hell's zap like here we go V was easy. That made sense. What is this zap zap is not a thing right? Hold on. Zap, meaning, maybe it means something I don't know. cookery. A long sandwich consisting of across the role cut lengthwise filled with meat, cheese, onion, lettuce and condiments. Well, that doesn't seem like that's good. Zeppelin. Zeppelin Zeppelin one. Oh Zeppeli I'm getting it now. A certain step is a certain type of submarine sandwich. I will that's not as much fun. Let's say this. I'm health bound

Scotty got the ZAP down. Next time look for an episode called zap bound diary. Maybe I should just change it to GLP diary GLP weight loss diary weight loss diary. Anyway, if I make a change to Episode 10, which I'm going to have to, I might have to go back and change the rest of them. I don't know. You'll figure it out. I want to thank you for listening to the podcast wish you a happy and healthy New Year. I haven't done that yet. And what else? That's pretty much it check out the private Facebook group. If you're enjoying the podcast, leave a five star rating and a thoughtful review. It helps people find the show. And of course, turn on those automatic downloads in your app. And please please be subscribed in that like Apple podcasts or Spotify, Amazon Music something like that. Let me just say thank you so much for listening. I get to order purchase. In thank you so much for listening. I'll be back soon with another episode of The Juicebox Podcast. Listen to that depth in my voice tonight. Let's go i sound good. You know being serious for a second before I say goodbye. I wish you could see me here it's Saturday night. I'm buttoning up the show doing a bunch of little things. And I'm sitting here in like a nice shirt. pants that fit well. I got new shoes on that are nice. Like Arden got me for Christmas. These boots. They're really lovely. I am I feel good. And I think I look better because I feel good. Like it's an attitude. Not a size, if that makes sense. Anyway, I went out to dinner with my lovely wife this evening. I looked terrific. She looked fine. We went out we had a nice time we came back here we're both getting a little work done on Saturday night. And I know you're like Saturday night you're doing work well. You know what? Work for myself and my boss isn't

---

Please support the sponsors

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

Donate