Scott Benner 2/26/24 Scott Benner 2/26/24

#1139 Grand Rounds: Communication

Scott and Jenny discuss the need for clear communication between doctors and the people that they care for.

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Scott Benner 0:00
Hello friends and welcome to episode 1139 of the Juicebox Podcast

Welcome back to the Grand Rounds series today Jenny Smith and I are going to be discussing the communication needed between doctors and patients. 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 cosy 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. 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/juicebox T one D exchange is looking for you. They're looking for US residents who have type one diabetes or are the caregivers of someone with type one to fill out a short survey, T one D exchange.org. Forward slash juice box. When you completely fill out the survey, you're helping people with type one diabetes, and you're helping to support the podcast. It only takes about 15 minutes T one D exchange.org forward slash 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 met. This episode of The Juicebox Podcast is sponsored by the contour next gen blood glucose meter. Learn more and get started today at contour next one.com/juicebox. Jennifer, welcome back to the Grand Rounds series. Today we're going to talk about communication.

Jennifer Smith, CDE 2:17
Yay, yeah, let's say munication. That's a broad topic.

Scott Benner 2:22
Well, we're gonna we're gonna lean on listeners a little bit for this one actually, maybe a little more so than we have in the past, we have a lot of feedback from listeners about what they wish their doctors would do regarding communication. So I'd like to step through it. Yeah, it's kind of a long one. So we'll jump right in. The first one here says I want my doctor to know that I am an entire person who has diabetes, not a diabetic. And that this is not my entire life. It ebbs and it flows, my controls are normal, and they're okay. And in the end, I need to be treated like a person. And I think that's a good way to start. Because, you know, you and I were just speaking before we recorded and we probably should have just said this while we were recording, so I'm gonna bring it back up. Doctors need to talk to you, like they're real, and understanding how to communicate with people and be human and reflect while people are talking, not just talk at them, but see what they're going through. And respond to that, you know, instead of just yelling orders be more collaborative, I guess is the way I would think about it.

Jennifer Smith, CDE 3:28
Right. And in that collaboration, what you're going to take away, whether you're a doctor, or an educator or a nurse, or you know, whoever is the clinician, that the person with diabetes trying to interact with, they, they need to take that all into consideration for the data that the clinician is looking at, because that data is only truly numbers. And those numbers translate into somebody's life, and why they look the way that they do like you said it might be I've had a really great couple of weeks, everything's been lovely. I had a week off, you know, from my job, I got to relax, I didn't have any crazy, I have to go to school because my kid got in trouble. You know, all the variables that could sneak in, everything was calm, whereas two weeks prior to that, maybe everything was hitting the fan, right? And so, as a clinician, if you're not asking or learning how to communicate on a personal level, you're gonna miss why the information looks the way that it does. If you're really just looking at it black and white people aren't numbers.

Scott Benner 4:40
I don't imagine that anybody listening has never been in the situation where you kind of look up one day and you think I haven't cooked a meal for myself and days. Like I've been eating leftovers or I stopped on the way home or I did something like that. It builds on you. You don't recognize that you're out of your rhythm. Yes, right. And then if you to go look at that weak of blood sugars and say, I see a lot of spikes here, there's some lows. And you know what happened? Right? That what happened? First of all is mind numbing. Like, I don't know what happened, it was two months ago. That's that's the first problem with it. But the second problem is, even if I could remember, you've probably looked at the chart when Oh, that's the week that I wouldn't put two and two together, I wouldn't say oh, that's the week I stopped cooking for myself that week, because right work was hard, or to feel that humanity is important. Because otherwise, what you're saying is, Hey, what did you do? That's how it feels. And you a don't know what you did? And B, you were trying the entire time, like that, I think is the that's where the damage point comes in, is that these people are working really hard. And trying to do well, it's not going their way. Okay. But instead of saying, What did you do, do better? Find out what happened, if they don't know, then just say, look, let's just look at the graph and see what we can do here. You know, like, Let's offer a suggestion, if you don't have a suggestion than asking what happened is almost cruel. You know what I mean? Correct? Yeah, absolutely.

Jennifer Smith, CDE 6:08
Because oftentimes, whether the person with diabetes voices that or not, they are coming in, because there is something that is often not going 100% The way that they want it, they may not know themselves, how to communicate that back to you as the clinician. And so for you to, it's almost finger pointing, and it's a blame scenario, when you're saying, Well, what happened here, pointing your finger at, you know, one, high blood sugar, one really extreme low blood sugar. And again, the person may have no idea three weeks ago, what happened. But if there's a recurring theme, then your job as a clinician is to help figure that out, and give them suggestions. And be able to say, Well, I see that, you know, every three weeks, you've got this big project that you're trying to do with your business. And I can see that this translates into meals that aren't, you know, as timely or a lot of stress that keeps things high. Why don't we try this, I can see that this variable is hard for you to make it better and maybe make you feel a little bit better, better, you know, looking blood sugar's would help in this scenario, let's try this, try this setting change, try, try to, you know, have meals ordered at regular time. So they come to your office or give them a solution that they can start with, I guess,

Scott Benner 7:30
something that is clear, concise, and you know, is going to reasonably speaking work to because I think the other problem can be is when you just start like spitballing and they go home, like you knew, you know, hey, the guy said, you want to go home and you you put it into action, it doesn't work, you're like, well, he doesn't know what he's doing. And I'm still lost, and he's gonna yell at me when I go back again. And even if you're not yelling at them, they feel like they're being yelled at. Right? So it mean, I have a pretty big personality. And I still have been in that doctor's office, and I'm like, Oh, my God, like what's going on? Like, you're coming at me? Like, I don't think she was coming at me. And I think I was somewhere deep down. I knew I'm not doing well at this, you know, like, Arden was little I didn't know what I was doing yet. And any kind of feedback felt attacking because I was I was vulnerable. You know, like, I was in a bad spot. I didn't know what I was doing. I was pretty sure I was hurting my daughter. I was starting to think about long term stuff. Short term, you know, was a mess. And then that's where I don't know. Like, that's where that part of the doctors thing is so important. Like, it's how they approach you. It's like coming at a I don't know, it's like to care approaching a stray cat like kind of very slow. Yeah, exactly. I'm here to help.

Jennifer Smith, CDE 8:48
Right. And when you when you first come into that, that office space with the person who has come in, they've made their appointment time, and they made the time to bring in some records and reports and whatever your question to them is, I'm always asked, I mean, this is my no one. But well, how are you? Do you have time to hear how I am? Like I could I can tell you how I am right. But what is important right here. And now for you to know about how I am what are the biggest things and this goes to the person with diabetes. It's what are the checklist things that are really, really important so that when they say, how are you you can say, well, I'm okay, or I'm doing really great, I've changed this, I've changed that, you know, this is looking much better. So there has to be enough communication to really, to really, I guess, give to that question of how are you? And you have to be receptive of it too.

Scott Benner 9:40
Yeah. In my mind, you need to hear people and really see what's going on with them. And at the same time, you need to be a leader, right and not a leader in the way of like, Oh, God, this guy again, but like, you know, like, right, you know, prior to the podcast, and even in the early days of the podcast, I would do like I'd have a lot have phone calls with people where I would just talk to them about their diabetes. And what I learned pretty quickly, is that often, they don't know what they're talking about. They think like, they think they know what's happening. And they're not right now, you still need to listen to them and hear what they're saying. And then I hear what you're saying, you know, and what I think might be. And I never know what to think. Like, how do you know when you're just meeting somebody very quickly, right? You go back to basics. Yes. You just say, look, let's look at your basil first. And let's say that the easiest question I've ever found is away from food or active insulin. Does your blood sugar sit stable? Right? If If yes, where? You know, if that number is 90 I go, Oh, Basil is probably okay. If you tell me Oh, it's very stable at 121 3151 80 I go, Oh, Basil seems weak to me. Let's fix your basil first. And then maybe this will you know, help your meal Bolus is to work better. And I always say like, you know, adjust your basil. Get it right. Be careful while you're boasting and correcting because now you're adding extra basil on these boluses and corrections are gonna eventually need you know, less insulin. Let's get this right first. Give them a path. You know, once you get your Basal right, go back and reevaluate your meal insulin, your carb ratio and your and your insulin sensitivity. And honestly, just telling people that it mostly works for them, you know, like it's but when you start going, I don't know, let's try this at nine o'clock, like, I don't know what you're doing then be entertaining right now make a different problem. So this next person says, you know, it's a long, it's a long story. But basically, they said, I was basically told I'm probably going blind and probably losing my foot, I got very jaded, which really quickly actually did turn into me being non compliant. I stopped going to an endo just went to a GP to get my scripts. And, and I think that the takeaway here was, that hope is just is very important, and that these initial messages over and over again, I want to say initial messaging sets people on path. Contour next one.com/juicebox. That's the link you'll use. To find out more about the contour next gen blood glucose meter. When you get there, there's a little bit at the top, you can click right on blood glucose monitoring, I'll do it with you go to meters, click on any of the meters, I'll click on the Next Gen. And you're going to get more information. It's easy to use and highly accurate. Smart light provides a simple understanding of your blood glucose levels. And of course, with Second Chance sampling technology, you can save money with fewer wasted test strips. As if all that wasn't enough, the contour next gen also has a compatible app for an easy way to share and see your blood glucose results. Contour next one.com/juicebox And if you scroll down at that link, you're gonna see things like a Buy Now button. You could register your meter after you purchase it or what is this download a coupon? Oh, receive a free Contour. Next One blood glucose meter. Do tell contour next one.com/juicebox head over there now get the same accurate and reliable meter that we use. 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 says hi Arden. This is your friendly reorder email from us med. You open up the email to big button it 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 are called 888-721-1514. I never have to wonder if Arden has enough supplies. I click on one link. I open up a box. I put the stuff in the drawer. And we're done. US med carries everything from insulin pumps, and diabetes testing supplies to the latest CGM like the libre three and the Dexcom g7. They accept Medicare nationwide, over 800 private insurers. And all you have to do to get started is called 888-721-1514 or go to my link us med.com/juice box using that number or my link helps to support the production of the Juicebox Podcast. So this person thought I'm gonna die anyway. Why try? Why

Jennifer Smith, CDE 14:43
try right? Why continue to go to somebody who hasn't and in this case, not everybody but in this case they weren't being given anything. Positive, valuable. Yeah, to try positive and valuable and applicable probably to their life. They were Being maybe given some advice about well adjust this here, or change this there? Or maybe it was the don't well don't do this. Why are you eating at McDonald's every day? Or why are you doing right? I mean, don't don't badger somebody into a change that isn't really going to make much different? Yes, for that,

Scott Benner 15:20
I get the idea. So I think what probably happens is that jaded doctors who have seen more than their fair share, you know, in their defense more than their fair share of people who are just not doing well, and it probably seems hopeless. And they probably think let's just jump to the end and try to scare them. And, you know, because I've seen that work with a few people. And by the way, I've actually heard from adults who the scare thing worked on them. Well, yeah. And but more people than not say, scaring me just scared me, or scaring me froze me, or it made me think I can't win, right? It's why everything goes back to understanding how insulin works, because in every situation you find yourself in whether it's somebody who's struggling forever, or just starting out, if you give them these these basic tools to begin with, they have successes that they can build on. Right, you know, and it relieves stress. And I think that, you know, this next statement here from somebody said, I wish somebody just would have told me I could have with insulin moved my anyone say, it's funny, they just didn't have that idea, like I was told, seven, two, good a one say.

Jennifer Smith, CDE 16:26
And also almost that the numbers that they were getting, were as good as it was going to possibly get that it was all about almost a stable point of where their body wanted to sit in terms of blood sugar, and that it was going to sit there. And other variables didn't have any impact on that one of them, obviously being insulin, and that an adjustment that's more precise, could actually move the needle in the direction that you wanted to go. Even without adjusting activity or food or anything else. A lot of times it's the right place to adjust the insulin.

Scott Benner 17:03
And how hard would it be to say, look, the ADA recommends this number, but I'm your doctor, I'm standing in front of you, I don't have diabetes, my one sees probably 4.9, you're not going to probably be able to get that but I bet you we could get you into the sixes. And then work on the fives maybe make some modifications to how you eat. Who knows like, right, if you want to go low carb, maybe we could get you in the forest. Right? But when you say sevens, okay? And the only thing is a quarterly report card, and they hit the seven or even I know it doesn't sound crazy, but 7.9 in somebody's head is still seven. It's still sad. Yeah, like I did it. I'm in the sevens in the sevens. But what's your one thing? Will you tell me?

Jennifer Smith, CDE 17:44
Will I tell you Sure. My a onesie is 5.5. Okay. That's what we want. That was my last one. The one before that was 5.6. So really, I'm I it's there.

Scott Benner 17:54
Yeah, right, right. It's there. Right? It's five you have type one diabetes, it's five, five, it's five, six. You know, you manage that by understanding insulin exercise and diet, boom. Like, you know, if I didn't want to exercise if I was Jenny, but I didn't exercise you probably have a six two.

Jennifer Smith, CDE 18:11
Right? Sure. Yeah, and be using more insulin than I use respond to food differently than I respond. Absolutely. They're those big variables that you do have to understand. But mean insulin is, it's the mover of blood sugar. I mean, right. And if you have it squared away, and you have somebody to guide you, I think, thanks to the podcast, obviously, I think people have a lot better understanding of insulin, and the fear component gets removed and they're willing to do their own trials of changes. But then there are still a good majority of people who are not confident enough about making adjustments and are still going back to their clinical team to make those and because they're not made maybe at most every three months you're left with this idea of again, I'm seven I'm seven one I'm you know, whatever and the doctor says that that's that's in a really great place or it's come down so I'm I'm clearly moving in the right direction and you are but it could be improved even further you could be getting closer to what we would hope for getting in the range of people without diabetes safely. Of course, you

Scott Benner 19:21
know, and people I think generally speaking humans like reaching right they like seeing something out ahead trying for it and succeeding. It feels good it works it I mean, we spend so much time talking about oh, I'm scrolling it's you know your dopamine your D you can give people a dopamine hit with a with a good blood sugar. Like if somebody came in to this conversation right now. And they said Look, you guys are talking about a seven a one c minus 10. I you know, I'd kill somebody for a seven you don't have to kill somebody for something first of all, you just you know, need some changes insulin, yeah, just make some changes in your settings and how you're, you know, timing your insulin. That's it. I mean, honestly, good settings Pre-Bolus your insulin a once he's somewhere in the 60s, you know, it just, it really well be if you're in the 10s, you don't know what you're doing. That's all for a doctor to look at that and say, Oh, I give up on this one. If you knew what I knew, or what Jenny knew you would go, I could fix this tomorrow. I can, you know, like, what are we doing here? So,

Jennifer Smith, CDE 20:23
and the unfortunate thing about those a one C, there is sort of a range, right? A onesies over I think it's over about a nine or a 10 really is a deficit of lots of basil and Bolus, if there's a deficit, definitely. And the person with diabetes may not know what to change the clinician, the one with the degree and all of the, you know, panels on their walls and whatever. They're the ones that should be able to say, Hey, your agency is here. Clearly, there's not enough insulin and you might then start to add insulin to hopefully get those those numbers down. Anytime that a one C is kind of like above where you'd want, let's say it's above seven, but kind of under that 10, then we start looking a lot more at mealtimes. And we start looking at, okay, as you said earlier, if you can float around at a at a stable blood sugar, even if it's 120, right, and you're safe there, then your Basal isn't really the wrong thing. What we end up seeing is these major excursions around meal times, which could be relative, that the dose is not necessarily wrong, that it's the timing, people haven't been taught the right timing of their of their dose, it could be both it could be timing, and that the dose has never been appropriately adjusted. And so those those a one sees as a, you know, just average, could be brought down by attention in a different place.

Scott Benner 21:53
And a little trick to figure out if that's the case is if that stability is higher than you want it to be. But like Jenny's saying, it's very stable. If you missed on a meal prior, like she's saying, you might end up at 120 with a perfect basil. And you know, Basil is doing its job perfectly, it's holding you steady. It's not its job to shoot you down. But I tell people all the time, if you see that stability higher, and you're not sure is this my basil, or did I miss on a meal corrected. And when it starts to go down, if it goes down and stays down, you missed on the meal. If it goes down and it comes back up, that could be your Basal being two weeks. Yep, it's a simple way to just check to see what's happening. That's the thing, you should be able to empower people with this, this person says I want my doctor to not be so by the book, I'd love for her to constantly be educating me, let's talk about off label use for medications if we need to, I'd like her not to be afraid to help me change my settings, to empower me to change my settings. And just because I do have a one C that's lower, it doesn't mean that I don't need help ever. Right. And I made a note next to that, when I said you gotta be a guru a little bit. Like it's, I mean, the by the book thing, it's not going to work for this, like you need their variables, you need your information, need the tools, you need the understanding of how to use insulin, they all have to work together, you can't just say, you know, 15 minutes 15 carbs, like that kind of stuff. It's right, it's too bare bones. It doesn't it doesn't do the right things for you know,

Jennifer Smith, CDE 23:17
and it I think a lot of the beginning tidbits of information that are given, they're just a starting place, kind of like the 1515 rule, which is really, really old school, obviously at this point. But it's still being taught because it's a, it's a quick and easy teach. But then you have to end up going beyond that as the clinician when you can say, Okay, I've taught them this, they're using it. But now my job is to say this isn't working, maybe you need less, or maybe we need to consider a change to this. Or maybe we need to, to do this and in the visits with people, then you have to bring that in so that they can see why you're making suggestions, or changes. Don't just give them a directive and expect them to move forward. They need to understand why What are you seeing? What are you seeing that suggesting I should change this or to change that or to think about this differently? Because otherwise you're just sending them out with a map that doesn't apply to their life.

Scott Benner 24:19
I wonder if doctors don't feel almost embarrassed to talk out loud to think out loud. Which would be a shame because it's a large part of how I taught my daughter to take care of herself was just everything that we were doing was spoken. Hey, it's time for you to change your pod. You know, we don't want to leave it on too long. Because you're only supposed to leave your cannula in for you know, about three days. So let's not wait. Let's get that off now. Right. Oh, you know, when we put it on, we'll watch your blood sugar. If it goes up, maybe we'll have to put some insulin in with a new site next time. My daughter doesn't know it. She could not sit down and explain diabetes to you. But she can do it. Right Is it To

Jennifer Smith, CDE 25:00
become habit, because she just knows what to do,

Scott Benner 25:02
because I'm narrating her life around diabetes out loud and not all the time. Like, I don't want people to think, oh my god, this guy up this kid, you know what I mean? Like, they just don't just, you know, like, at times when something was happening, we do it, you know, a plate would come out, I'd go, hey, you know what I'm thinking here, we're going to Bolus you think about how much you think it's going to be. And then we'll compare, you know, and she'd say, I think it's 45 carbs. And I go, Alright, where do you see the carbs? You know, don't don't just guess the number. Tell me where you see it. And then I'd say I see what you're seeing too. But I think you're forgetting the breading of the chicken. So let's throw in like seven more for the reading. And that over there is fried. And so I think you're gonna get a little bump later from from the slowdown and your digestion. So why don't we put a little more in for that, too. And then years later, she just knows how to do it. Like it's not. I think that there's that the doctor brain learns differently. I imagine. I don't know, I don't have it, I have more of what you might call like, an artist's brain. Like, I just, you know what I mean? Like,

Jennifer Smith, CDE 26:05
yeah, I'm a, I'm a talker, when I, when I work with people. And I'm also when I respond to email requests or inquiries about data and whatever. I have very lengthy, like emails and a very lengthy discussion, because I talk a lot. And I want you to go forward with why I'm suggesting a change. Or even if I'm questioning, hey, let's work together. What do you think you know, your life better than I know, I see that we could do it this way. But I also think that we could do it this way. What do you think you'd like to try first, so it gives some options, and it gives them the ability to move forward out of our visit together? To try something without checking back in? Yeah, right away, or without going three months, and then saying, well, it didn't work. I didn't know what else to do. So I just kept doing it.

Scott Benner 26:57
Look, I don't know how many doctors are allowing emails. Now. I guess there's a lot of portals where you can message people. But people need to feel autonomous, like they just really do they need to like and if even if it's a new person, and you're like God, I can't let them make too many changes. They don't know what they're doing. I mean, they can move their Basil 10%, like you don't I mean, like you could, you could give them a little bit of freedom so that they could like trial and error out a little bit. And I'm assuming that the word error doesn't sound right to a doctor. But that freedom that you give them, it's how you get to where you're trying to take them, like you can't shackle them the whole time and then go, I don't know why they don't run, you know what I mean? Like, like giving

Jennifer Smith, CDE 27:36
somebody this dose adjustment, maybe you explain it, but then saying, You know what, try this for two or three days. And if this isn't quite enough, or it's just too much, then we're gonna give you this next option, giving them handing it to them and saying, here, here, here's an option. It's not just you're stuck at this. And you know what, for further collaboration, it's checked back in, send me an electronic message, and let me know, did it work? Did it not work, I am happy to check back in with you to make sure that I give you another suggestion, or to see that it actually is safe to continue changing things. Right.

Scott Benner 28:11
I think also, if you don't believe that conversating with people can lead them to understanding things that you should, I'll tell you this little story. So Jenny, and I have made all these different series together. And the feedback overwhelming, I'm talking about overwhelmingly like hundreds of 1000s of millions of downloads, right? And people come back, I listen to this my one season the sixes, blah, blah. And I even to the point where I sometimes think, what the hell did we say in there? You know, you mean, so like,

Jennifer Smith, CDE 28:40
what really hit for that person, like God, like,

Scott Benner 28:44
I don't think I know that much about it. So I did this thing recently. And it's gonna come out on my social media at some point. But I chat GTP like AI has gotten to the point now where it's fascinatingly good at breaking down conversations. So behind the scenes, I'm feeding the transcripts of everything you and I have done together into AI, and I'm telling it just one simple thing. What are the key takeaways for people living with type one diabetes? And it writes in bullet points, my brain doesn't write in bullet points, but it does. Wow, that's cool. It's so good, Jenny, that when I put it in front of you, you're gonna think you wrote that list yourself. Or you're gonna think I wrote it, or you're gonna think we wrote it together. It's really technically

Jennifer Smith, CDE 29:28
we kind of did. All we're doing is feeding information and something is putting it together and very concise.

Scott Benner 29:35
It literally can read through it and filter out all the bowls. And just come back with this is what was spoken about. I'll tell you this, we you and I did an episode called setting Basal insulin, the math behind Basal insulin or something like that. You can ask the transcript, what your Basal insurance should be based on your weight and a couple of other things. And it just from our conversation knows the answer. It figures it out for you. That's insane, right? But here's the plan. Here's my bigger point. I know I'm helping people with this conversational style. But I also know there are some people who don't enjoy this conversational style, right? So I'm finding a way to give that information to them the way they want it, doctors have to do that, too. You can't talk to people the way you learn, right? I'm sure all your engineer patients are probably thrilled with you. You don't I mean, like, seriously, but if I came in and you started bullet pointing me to death, I don't know what to do. If you told me right now to take three thoughts that I understand and write bullet points about them, I guarantee you, I'd write them out in a paragraph instead, right, and then I'd have to stop and break the paragraph apart, and then reward them. So they look like bullet points, because my brain doesn't work that way. It's really something I

Jennifer Smith, CDE 30:41
mean, what you're kind of boiling it down to is what I feel about. Educating the way that I do is getting to know a person, I understand that I have a little bit of a different way to do that. And you know how we work with people. But in an office space, time is really the constraint, I get that. But because I have the time, the nice thing is that I could tell you what impacted someone's blood sugar in one way compared to another's, because I know them, I don't know them just their name. I know them, I likely know the siblings in the house. And I know that this child goes to a grandparents house, you know, four times a week, and they're served these things versus at home, it's different. And so those are some of the things that also go into management, that may not be a setting change. And that you have to be able to learn in order to educate, or to be able to teach a strategy that's applicable to that one person. I know that I teach differently, a little bit differently for each person I have the opportunity to work with, because I meet them where their need is.

Scott Benner 31:55
I think if a doctor hears you say that and thinks I can't do that, I think yes, you could. You can you just need more practice talking to people. I swear to you just call me like get on the podcast, and we'll chat. And just after an hour, you'll be like, Oh, I can just conversationally talk about diabetes, and people understand it. That's crazy. I'll do that. You know, it's it's so doable. Jenny, this person here says, If you don't know something, just tell me you don't know. Yeah, honestly, would be the bedrock of our of our relationship. And I actually just interviewed someone recently who had that story, she asked a question about her pump, to her doctor. And instead of Bushcare, were sending her to go and go watch a YouTube video. Which, by the way, there are a lot of comments in here from people like do not go tell me to watch a YouTube video, like Teach me how to do the thing. Okay, so if you were the doctor don't know how to do it. I mean, hey, why don't you take a weekend? You know what I mean? Cuz kind of your job. Be honest. And so anyway, this doctor says, I don't know, I'm gonna find out and come back to you. And then they actually followed through and did it? Yes. And it was a big deal for this lady. You know, that would be a

Jennifer Smith, CDE 33:10
that's a big deal for me. I mean, I have fired essentially, or just not gone back to clinicians through the history of my adult life as choosing my own clinical team. Because I got the sense very much that they couldn't answer my question, they kind of be asked around not knowing how to tell me that they didn't know. And so I was just like, Okay, I'll find somebody else.

Scott Benner 33:35
I wished my doctor not only knew how to tweak, you know, my diabetes, about my lifestyle, like, have like a, she actually says here, I wish you had a primo list of referrals, mental health, you know, nutrition, stuff like that a CD, they actually knew what was there was willing to work with you. And listen, I'll say this, I know a number of doctors privately. Don't just say like, oh, there's a guy over here. I know the girl in this practice, and you know, they're crap. And you send people to them anyway, because they're part of the system or something like that. You just create another problem. Again, say, you know, I don't know anybody that's going to fit that bill should ask around a little bit, or call some offices, ask some leading questions. How do you guys deal with this? You know, like, pick on your own? But yeah, this person's like, you know, please just help me find other practitioners at times. If you can't do it, just say, I don't know, let's get you to this person.

Jennifer Smith, CDE 34:28
And sometimes that takes from the clinical or you know, the physician angle that that means that even if you can only refer to people within your organization, then know the people that you do need to refer to, right know the mental health specialists in your organization, get to know a couple of them. Who would you really click with who really would be great and who was kind of iffy and totally wouldn't be somebody for diabetes to talk to right. Get to know kidney specialists get to know good cardiologists get to know your system. I'm because I guarantee that there's not just, there's often not just one practitioner to refer to. And if you get to know those different teams, you'd have a better list that you can easily pull out or look up on your notes on your phone and say, you want to see this person, you could see this person, but they're not my first choice. Why? Who cares? It's important for the person that you're telling.

Scott Benner 35:25
And if you don't think that's important, this person says, Look, I'm a researcher and a reader. So I ended up clashing with my doctor who just wanted to take complete control and not empower us at all. If you're a doctor is like, that's how I want it, like, I'm gonna crack the whip, and everybody's just gonna do what I'm gonna say, this person said, I switch practices because of that. On top of that, she was told that her and her daughter would difficult patients. Yeah, for wanting to understand how to take care of themselves, they'll think about the psychological ramifications of that. If you're like, not everybody can speak out, here's a person who spoke up, right. And but most people aren't head down. A lot of people are head down, right? If you dominate them, they'll take that, and they'll never stick up for themselves ever. And you will be directly responsible for the poor health outcomes that they have. And you won't think so you get around at a party and tell your tell your friends, what a great job you're doing for everybody. But this is how these people could feel.

Jennifer Smith, CDE 36:20
Yeah, I think it kind of goes along with a lot of I wouldn't say a lot, but maybe half of the time I hear from parents, especially where their pediatric practice really wants to do the load of the adjustments. They really don't want the parents stepping in and adjusting and doing things in between the visits, which may not be close enough together, as their child is growing. And all those changes are happening. It's not soon enough. Now there are really awesome practices that have a lot of close, you know, I guess communication, but then the other ones do a lot of hand slapping, I did you change this? I would you adjust that. I told you not to do this, or you know, that doesn't help and long term. If the child is in the room, hearing those comments, they're also now learning that they don't have any voice in their own health.

Scott Benner 37:16
I don't know what I'm doing. And maybe worse, my mom doesn't know what she's doing. Right. I think that's a thing I see all the time, especially when we speak in public Jenny, and, you know, I, you know, I'll go to the parents and all, you know, a license stuff out for them. And then you go to the kids, and you're like, hey, you know, I told your parents and stuff today, and maybe they'll and the kids are like, my mom does not know what she's the devil coming out and say it like, she's tried three things. My one seesaw seven, maybe that's the most just the most terrible thing is taking the a child's you know, confidence in their parent away, you know, like, what's gonna happen at the end of this series, Jenny, and I gave it away a little bit here. But there's going to be an episode where I'm just gonna read the takeaways for everybody. And I'm gonna go over them with other people in like, kind of bonus episodes or supporting episodes for this series. In the end, as a doctor, empathetic kind. If you don't know something, figure it out. Teach people how to use insulin know how to talk about that very fluidly. It's all you have to do. Like, like it just, there's not much more to it than that, then let it be a conversation and give them give them power. Now look, do you have some people who, you know, you're like, Listen, if I give them power, they're gonna kill themselves in five seconds. Like, I'm, I'm not saying sure those people, you know what I mean? But those people can also be helped with basic tools, and a little bit of like, carrot and stick. Like, there's nothing wrong with saying, Hey, you're a 10. No problem. I think in six months, we could be in the eights. Like I'm going to help you get your settings right, then you do a couple things for me, we'll come back do another blood draw, we get you down to the AIDS. Now we're off to the races. I don't see why a year from now you couldn't have a six a one say, like, give people something to work towards? Like, we're basically just ants, Jenny. Humans are not good without a task. No, they're not. No, you gotta give him something to do. You know,

Jennifer Smith, CDE 39:15
right. You know, and from, from the doctor standpoint, too. I think when we're talking about diabetes, you're talking about a specialty. Right? You're talking about beyond just general practice. You've chosen to go into something that requires you to keep up with the changes that are happening. And this is very specific. And you might be you might end up being an endocrinologist who has nothing to do with diabetes and then that's great. That's your practice is not specific to that but if it is, you should be able to answer a question about a device. You should be able to keep up with what medications what is changing how to use it, who to use it for, you should be a able to answer questions, because you've chosen to specialize, it would

Scott Benner 40:04
be like if I climbed into a Nissan ultimate, it said driving school on the side of it, got behind the wheel looked over at the person in the other seat and said, which one of these makes it go? And you said, I don't know. I don't know. Well, then what am I paying you for?

Jennifer Smith, CDE 40:18
Right? Absolutely, I just I don't understand. If you've chosen, as I said, if you've chosen to specialized, you need to know your specialty.

Scott Benner 40:29
Jennifer, there is no doubt in my mind, that if I wanted to make a living a different way, I could offer private courses to doctors. And I think in three hours teach you how to take care of your patients. I know you could do it, too. There's a lot of people that could do it. But my point is, if that could be done for you, you could probably do that for yourself. You know, like you don't like go like find out that one of the things I'm always fascinated by, if someone comes in the office, they figured it out, they get their agency where they want it, they've got these great stable graphs. And the first thing that happens is Doctor yells at them out of fear. You're too low, you're gonna have a seizure. What about saying, hey, what didn't you do? Right? Could you tell me what you just did? Because I got to be honest with you. I didn't see this coming. Right? It happens all the time. And if they say something like, I listened to a podcast, don't yell at them and say the internet's not a good place for you to learn. Because your doctor's office hasn't been a good place for them to learn. They're trying to figure something out. So in the end, Jenny, meet people where they are, give them agency, and for God's sakes, think before you speak. Yes, leading a sentence in the wrong direction leads 15 minutes into the wrong direction. Start Strong.

Jennifer Smith, CDE 41:38
I wish to my point, don't point fingers do not

Scott Benner 41:41
point fingers at people like it's we're in this together and give people I can't believe I'm going to say this. You have to give people their flowers to when they do well. You got to like and it can't feel phony. You got to really mean it. You know, this is amazing. I know how much hard work this took good for you. I think there's more keep going. Right? And

Jennifer Smith, CDE 42:02
it doesn't have to be with what you what you see as where you would want them to be. If you've got somebody you've been working with who is so fearful of Lowe's that they run blood sugar's at 250 or 300. And now, your work together whatever education they've provided themself, now they're averaging a blood sugar around 190 or 200. That's a give them flowers. That's not a well, we really want to be lower than this. Oh, no, no, no, they've achieved something like, let's keep the ball rolling, right, you have to give them good positive reinforcement, regardless of what your down the road, like goal is for them. My

Scott Benner 42:44
daughter's first endocrinologist was brilliant. I could tell by talking to her. She never helped me once with diabetes. Just stood in the room smart, and said smart things and

Jennifer Smith, CDE 42:56
didn't help it that didn't translate into helping you. Oh, no,

Scott Benner 42:58
no, no, I was in a panic. You know, it might have been easy to say things like, hey, if your blood sugar is too high, you might not have enough insulin, I would have gone. Oh, that makes sense. Thank you, you know, Jenny, there's a note here from you that says Please don't look at a static number and then say everything is great.

Jennifer Smith, CDE 43:19
Right. And I wonder if I don't know if I gave context to it. But I think that I think that I was possibly talking about a one C two there. Because it is it's we understand that a one C is just an average, you really do have to get into the whereas the agency coming from what are the kind of the data points that are pointing to this because then you have more room as the clinician to say, Gosh, you came in your agency is now you know, 5.8, and it used to be 6.8. And in my mind, that's lower than I want it to be. But gosh, that a Wednesday is really stable. Look, you have like less than 1% of the time low, you have a standard deviation that's like those, those little pieces that go up to make that one standard value. That's really important to

Scott Benner 44:10
look at. I'm gonna run through a couple of things here at the end for people, I wished my doctor was a resource for other resources. Tell me, why did I have to this person says directly? Why do I have to find this podcast on my own? Listen, there are plenty of doctors and I want to say thank you to all of them that recommend this podcast every hour of every day. The Facebook group, which gets 150 new members every four days is overwhelmingly they have to answer a couple of questions. It's a private group, right? One of those Where did you hear from this from my physician from my doctor from my hospital? Like it's a fair amount of people. So thank you to all of you doing that. Obviously, I don't think we're talking to you. But you know, for everyone else, if you don't know, send me somewhere that might know and don't do that thing of like, well, I don't know what you're going to hear when you get there. Because the thing that's happened thing now is bad. So, no, I don't know like what could go wrong now maybe he wants he's nine and a half. I'm on the fast track here. You know what I mean? Like, good, go try something like whatever happened to like, I don't know get out there and do something like sometimes just doing anything and seeing a little bit of a positive return is enough to supercharge and get you going again, even local support networks, people are asking here like, please know where I can go meet other people. My teenage daughter just hears you're doing Oh, this is I think we've covered this in another one. But there are people who are looking for more, okay, so don't just look at their six five, a one C and go You're doing great. Because they might want to do better. And they'd like to hear from you. I mean, they know they're doing six fives. Great. They know they're doing great. So there's a double edged sword there. You could lull somebody into complacency. But what this person says specifically is when my daughter hears that, then I go home and try to say to her, Hey, listen, we should try Pre-Bolus. In five minutes longer. She goes, Hey, doctor said we're doing great. So yeah, you took away her desire to try to help herself. There's a way to say you're doing well. But there's always room for improvement. So here's some ideas like that kind of stuff. Right? Real quick. They don't make us feel bad about my agency Don't say things like, well, it's okay, this time, please don't use guilt as a communication tool. And then here says this is some feedback from somebody else. It just kind of gave me like a stream of consciousness that I want to kind of end here with she said, relationships, person to person person, the diabetes, clear relationship expectations, level setting, meet people need to feel safe. freedom to express things is very important. psychological safety is a big part of how you can get these visits and your relationship to work in everybody's favor. That's kind of where I'm at today with communication. If you have a minute, I'm going to share something with you, Jenny. Okay, go ahead. Anything you want to say or finish with before I jumped to the end? No,

Jennifer Smith, CDE 47:07
I was actually going to add one thing to that list is the be supportive of the caregiver. Be supportive of a caregiver, I talk a lot about like parents as the caregiver for kiddos, and be supportive in the way that you would be willing again, this goes along just communication, hear what they need, and also hear what they've tried. And if the child or the teen is in the room, be supportive of the efforts of what the parent is really trying to do. So again, you you may have some things to share with them. But really try to prop them up with all the effort they've been putting in. And if they come to you with questions, being able to again, communicate back in a way that they can understand how could this work? Could this be something that would be better, just really support them?

Scott Benner 48:05
That's a perfect way to end, I was going to share one of the takeaways with you. So from Episode The second episode of the Grand Rounds series is called diabetes diagnosis. And I asked an artificial intelligence to give me the key takeaways from that episode. And it said doctors and regular primary care settings may diagnose diabetes due to the rarity of the condition and the similarity of symptoms to other illnesses. misdiagnosed excuse me, it is important for patients to clearly communicate their symptoms and concerns when contacting their doctor's office. misdiagnosis or delayed diagnosis can lead to complications such as diabetic ketoacidosis. Doctors should be proactive in ordering appropriate tests such as blood work in your analysis. When patients present with symptoms that could be indicative of diabetes. Patients should not be dismissed or ignored when they expressed concerns or symptoms that could be related to diabetes. education and guidance on diabetes management should be provided to patients at the time of diagnosis, including information on insulin use, blood sugar management, and the impact of diet and exercise on their blood glucose levels. Doctors should be aware of the impact of their words and actions on patients mental health and well being. Collaboration between primary care and diabetes specialist can ensure comprehensive and effective diabetes management. Patients should be directed to reliable sources of information and support such as diabetes education programs and online communities. And doctors should continuously update their knowledge and skills and diabetes management to provide the best care for their patients. That's what AI picked out of your mi conversation. Isn't that fascinating?

Jennifer Smith, CDE 49:36
Well, and what it actually it's what's interesting about it is that it it sounds like the summary that you'd get in like a research project. We looked at all these things in 3000 participants in this study and these are the key takeaway points in order to be able to provide somebody with diabetes, the right care. That's what it sounds like.

Scott Benner 50:03
I'm also almost I'm being boastful a little bit here if I'm being honest, because you and I, you're a lovely person who comes on my podcast. I mean, like, We're not sitting in the same office talking to each other for a month about what we're going to do, you and I pop on when you have free time and free time is in quotes, right? Like when you you jump on here and I go, Hey, Jenny, we're going to do that Grand Rounds thing. Let's do what happens when you're diagnosed in your doctor's office today, and you go, okay, and then we chitchat for five minutes about our lives, then we have a conversation that when you asked a I provide key takeaways. That's all it said. That's what he came up with. My point is conversationally, is a good way to get out good information, right? Absolutely. That's how people's brains hear storytelling, not you reading a bullet point list of them. So Right. Also, by the way, in this is pretty far off. But that's not all i Sai. What I said was provide key takeaways in English, Spanish and Hindi. Wow. And it did that. So I finally found a way I think people are always asking for this template in Spanish is a big one. And the podcast has become very big in India, there's a ton of dialects so I don't I just picked the one that I think is the most kind of central, sure to imagine these key takeaways in other languages for diabetes, Pro Tip series for bold beginnings for that kind of stuff. Gonna be nice. So Scott, he's on it in 2024 door.

Arden has been getting her diabetes supplies from us med for three years, you can as well, US med.com/juice box or call 888-721-1514. 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. A huge thanks to the contour next gen blood glucose meter for sponsoring this episode of The Juicebox Podcast, learn more and get started today at contour next one.com/juice box. I have one thing to tell you. But I'll do it after the music close.

So I waited until 50. People found this on their own to say it out loud. But I've added a thing if you're listening in Apple podcasts, you can actually subscribe to the podcast pay a fee. Now the whole podcast is free. So don't now you're like, Well, why would I do that? Scott, if it's free. If you pay the fee, which I think is like 599 A month or $59 a year I think that's about it. If you do that you will get currently you will get the bowl beginning series without ads and you will get the diabetes Pro Tip series without ads in it. And so far one episode that has all the curses at it. Now, why did I wait until 50 people signed up on their own to bring this up. I wanted to make sure it would kind of pay for itself. This is not like a money. I'm not gonna make any money on this. Because the editing on like pulling ads out of old episodes and you know making episodes with curses in it. It's gonna cost money in editing. But anyway, now there's 50 People, I'm going to tell you about it because if I can get if I can get 50 more people to do it. I can add a another series without ads. And we can start offering episodes once in a while that have all the curses in them. So if I go crazy in some episode, we're cursing all the time, and we can afford the editing. I know that sounds weird that it would cost money to not edit out a curse but I have to edit the episode for the regular show. And then that basically means it has to be edited twice to leave the it's not important. This is just it's what it is. It's an added expense. Anyway, if I see this pop up, another 50 People 100 People something like that, then I'll be able to turn to the editor and say listen every time you get one with a bunch of curses in it, give me two edits give me the Kersey and the non Kersey in that way the people who are paying for the subscription can hear the cursing. And as that builds up a listenership that will also afford me the ability to take ads out of some of the more popular series and offer them to the subscribers as well. Anyway, there's no pressure to do this. But you can if you want. Besides what I mentioned, you get I think you get each episode like 18 hours earlier than normal. And ad free bull beginnings ad free Pro Tip series and some random cursing here and there. Anyway, do it. Don't do it. Please, it's entirely up to you. But it's a great way to help me pay for more content. So if you're up for it, you'll see it right there in your apple podcasts that if you're looking for community around type one diabetes, check out the Juicebox Podcast pro COVID 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. Thank you so much for listening. I'll be back soon with another episode of The Juicebox Podcast. The episode you just heard was professionally edited by wrong way recording. Wrong way recording.com

#1138 Reheated Happy Meal

Kerrie has Hashimoto's, her son, sister and aunt have type 1 diabetes.

+ Click for EPISODE TRANSCRIPT

Scott Benner 0:00
Hello friends and welcome to episode 1138 of the Juicebox Podcast.

Carrie is a nurse she has Hashimotos her son Liam is three and has type one diabetes diagnosed at 14 months old. Carrie sister and Aunt both have type one diabetes. Carrie wanted to come on the podcast because she said that without the show she wouldn't be able to do what she's doing for her son and that she wasn't getting answers from her doctors. We spend a lot of time talking about little kids in type one and I have some remembrances about raising Arden with type one diabetes. 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. 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. 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 cosy earth.com

I'd like to take this opportunity to welcome a brand new sponsor to the show ever since CGM. I don't have an ad for you yet, but I want to welcome ever since and let you know that there are links in the show notes right now if you're looking for them. But you'll be hearing more about that implantable CGM very soon here on the Juicebox Podcast welcome ever since ever since cgm.com/juice box, this show is sponsored today by the glucagon that my daughter carries. G voc hypo pen. Find out more at G voc glucagon.com. Forward slash juicebox.

Carrie 2:07
My name is Carrie and I am a mom of a three year old type one.

Scott Benner 2:12
Is that child your only child?

Carrie 2:15
I have a nine month old. Oh, congratulations. Thanks.

Scott Benner 2:19
It's very nice. Three and a nine. You're married for how long?

Carrie 2:25
11 years.

Scott Benner 2:26
Did you not know Were you counting?

Carrie 2:29
So funny. My anniversary is next week. And I'm like I don't even know how long I've been married for. Did you? Like happens? A

Scott Benner 2:35
gift or something?

Carrie 2:38
Um, we're gonna go on vacation actually.

Scott Benner 2:39
Oh, that sounds like a gift. That's nice. Yeah, I my anniversary was just seven days ago. Oh, hi, anniversary. Oh, you're very nice. Thank you. You're now the first woman to wish me happy anniversary. So because that was the day before. And my daughter and myself and my wife, we were standing in the kitchen, like making plans about something. And I said, I said about like, well, tomorrow. What if we would like to go out like for lunch in the middle of the day? Do you have a little time we could go out for anniversary and she go like my wife paused. And Arden goes she didn't know, tomorrow's your anniversary. And I said, I said yeah, I'm seeing that right now. And she's like, Oh, no, I can't like I have a meeting and I'm like, oh, okay, no problem. So we've been married a long time. So I'm 27 years. Wow. Yeah.

Carrie 3:30
That's amazing. Is it? Yeah, totally. With two kids. Totally.

Scott Benner 3:34
I know, right. But anyway, the next day came and we did not go out to lunch. I gave my wife flowers, an arrangement I made myself. And she said thank you. She gave me nothing. And that was that's how it goes usually right. That's my expectation. I was like, I don't even know what I would want to be perfectly. Yeah. You know, like, if that's true, like if something happened, what would I want it to be? I have no idea. It's a long time. 27 years. It's insane.

Carrie 4:01
It's really insane. Yeah, but it's awesome. Yeah,

Scott Benner 4:05
no, I'm very excited about it. I think she was too. I can tell. Yeah, totally.

Carrie 4:08
Did you meet like, Did you meet like in college or

Scott Benner 4:13
Kelly worked at a movie theater that that a number of my friends worked at. And she was college aged. And I had known her for years before just like as a like as a person who worked at this theater, but I didn't know her like know her. I was aware of her I guess. Yeah. And she went on an island vacation with friends and came back very tan with her hair braided. And I became very focused on trying to have sex with her. Oh my god, that's so funny. So I purse Yeah, so I pursued her for a while. And that is where I met her at actually. That's awesome. Yeah, I think if she didn't get her hair braided, even I don't even know what would have happened.

Carrie 5:00
Yeah, it was it was it the braids? I mean, it could have

Scott Benner 5:02
ruined her life that braiding that hair. She wouldn't have done that she couldn't have she could have stayed away from me and all these problems, you know?

Carrie 5:08
Oh my god, you're so funny.

Scott Benner 5:12
I guess if we look back at it getting her hair braided was her was her major life mistake. Oh, I

Carrie 5:17
don't think it's a mistake. Not No, of

Scott Benner 5:20
course not. I'm being facetious. Okay, so wait a minute. So you have a nine month old? And a three a three year old, right? Yes. Okay. Your three year old has typed was a girl or boy. He's a boy. We're going to use his name or no. Oh, yeah, we

Carrie 5:35
can use it. His name is Liam. Okay. All right, William.

Scott Benner 5:38
How old was Liam? When he was diagnosed?

Carrie 5:40
He was 14 months old. Wow. Yeah, pretty

Scott Benner 5:44
young. Okay, do you have any type one in your family?

Carrie 5:48
I do. My sister's type one. And my aunt is type one. We have like, my family's full of autoimmune diseases. So yeah, I mean, it was definitely a shock him being so young, but I wasn't anticipating it. But yeah,

Scott Benner 6:02
we do. How old? Are you? Okay, I ask.

Carrie 6:04
I'm gonna be 41 on Saturday. Okay.

Scott Benner 6:07
So happy birthday. Thanks. There's a lot of celebration going on. Yeah, there's tons. So you're 41 you had a baby three years ago when you were like 38 diabetes. So did you recognize the diabetes symptoms and the baby.

Carrie 6:23
So I am also a nurse. So I had just noticed for like a week prior that he was like drinking a lot more fluids. He was like soaking through diapers. And it was the end of April when he was diagnosed. And I was just kind of like, I was kind of I was kind of hot we lived in well, we live in New Jersey, we lived kind of near the beach. So we were outside a lot of the park and kind of brushed it off. But then like four days before he was diagnosed, I like went to put him to sleep. And he was breathing on me and I could smell like ketones. And I turned to my husband, I was like, I think I smell ketones on the EMS breath. And he's like, whoa, what has been first of all was like, I don't even know what that is. I was like, something's not right with him, you know. And so I had reached out to our pediatrician a couple of times with concerns about the fluid, like the extra fluids and all that stuff. And she kind of brushed it off. And then there was just one day that I just remember watching him in my living room chug, like a huge bottle of water. And I was like something isn't right. So I called my pee and I was like, I want to take him in. I think there's something going on. I think it might be like suspicious of diabetes. And she's like, he's way to go. And I was like, okay, so I made my husband go to Walgreens and I was like, let's just dip his urine for ketones because I was like, something isn't right. So, took his diaper off and waited till he peed. My husband like caught his pee in his hand. And we dipped it and he had large ketones. So I called my doctor back and I was like, Okay, so now he's has large ketones. Like I'm suspicious. She's like, Oh, that's normal. And I was like, oh, no, that's not normal. Like I knew enough. So I went set my husband back out to get a glucometer. And then I ended up just doing like a heel stick on him. And he registered like over 500 Wow,

Scott Benner 7:58
look at you. Did your doctor not know you're a nurse.

Carrie 8:02
She knew I was a nurse and like I pretty much like reamed her out when I got to the hospital. I mean, she I think she was taken aback. But I think my my heart like, thinks now and I still think about it now. Like what would have happened if I didn't have that knowledge. You know, when I didn't keep pushing my doctor to be like, there isn't some there's something not right with my son, you know, and she just kept brushing it off. Like, I don't know, I think it's really sad. And I think there's so many young kids that get diagnosed, and it's so traumatic because their symptoms are so easily misdiagnosed as like, oh, labored breathing. Oh, that that's RSV or you're vomiting. Oh, you have a stomach bug, but like, these kids are in DKA. And I just, I'm just so grateful that he wasn't DK when he was diagnosed. No, of course, but

Scott Benner 8:45
you're I mean, you're specifically saying, hey, my kid has ketones. I think they have diabetes. He's drinking a lot of water. I think he has diabetes. Like it's almost like you're describing the sun. And you're saying to her, Hey, I'm going to describe the sun do you go it's around and she goes That's not it? And you're like well it's yellow and she goes no, that's not it either. It's very hot. Now it doesn't sound like the sun to me. That's just very strange. If you take insulin or sulfonylureas you are at risk for your blood sugar going too low. You need a safety net when it matters most. Be ready with G voc hypo pen. My daughter carries G voc hypo pen everywhere she goes because it's a ready to use rescue pen for treating very low blood sugar and people with diabetes ages two and above that I trust. Low blood sugar emergencies can happen unexpectedly and they demand quick action. Luckily G vo Capo pen can be administered in two simple steps even by yourself in certain situations. Show those around you where you storage evoke hypo pen and how to use it. They need to know how to use Tchibo Capo pen before an emergency situation happens. Learn more about why G vo Capo pen is in Ardens diabetes toolkit At g voc glucagon.com/juicebox G voc shouldn't be used if you have a tumor in the gland on the top of your kidneys called a pheochromocytoma. Or if you have a tumor in your pancreas called an insulinoma visit G voc glucagon.com/risk. For safety information. Yeah,

Carrie 10:20
it was really disappointing. And she was also like a really like, well known pediatrician, like, everybody, like loves her. And so I like I just the frustration around his diagnosis was like, I'm just happy that he was okay. And he was an NDK. And I was able to catch everything, but I just, yeah.

Scott Benner 10:37
Did you go with thoughtful anger? Or did you just randomly yell at her when you saw it?

Carrie 10:44
Was not thoughtful at all. You know, like, what are you going to do? Like, I literally was like, I'm pretty sure my kid has diabetes. And she's like, No, like, I mean, when I dipped his urine, he was like dark purple, like, like large ketones. And I was like, he has large ketone. She's like, if that's normal, I know. It's like Lady, Emily, a nurse, but like that is not normal for kids. Did

Scott Benner 11:06
she know that you have relatives with type one?

Carrie 11:10
I told her my sisters are very well versed. I said, I smell ketones on his breath. I can smell like the acetone on his breath. completely dismiss me. Yeah.

Scott Benner 11:19
You were in so he found a new peed? Yeah, I was gonna say that's the obvious end of that story. But you were in some sort of a power struggle with her ego.

Carrie 11:27
Yeah, for like, it was like four days that I was going back and forth with her before. I was like, You know what, like, this is ridiculous. I am doing this myself. And I just dipped his urine saw the ketones. I called her back and then I was like, she was like, that's normal. Come in. It was like a Thursday. She's like our Friday. She's like, come in on Monday for bloodwork. If you're still concerned over the weekend, and I was like, I I was like, I can't sleep until I know what his blood sugar is now, like, we need to just go to heal sick. And then it was like, I think he was 638 when he got to the ER and I was just

Scott Benner 11:54
really Yeah, 14 months old. He couldn't wait much. Right?

Carrie 11:58
No, he was like, 20 something pounds. Yeah. Good.

Scott Benner 12:01
Do you think you caught it really early? Or do you think it was going on for a bit?

Carrie 12:05
It's a once he was nine. So I don't think I caught it early. But he wasn't a DKA. So I don't I don't really know. I know that a couple more days he would have been there just by like looking at like from my like looking at his labs now. I can kind of like figure out like, he wasn't indicate but he was close.

Scott Benner 12:20
What other autoimmune stuffs in your family.

Carrie 12:23
So my sister was actually on the show. Like I want to say like eight months ago. Really? She Yeah, Michaela. She will she has. My sister has epilepsy. And she has type one. She has lupus. My mom has sarcoidosis. I have Hashimotos my other sister has Hashimotos My aunt has Addison and type one. So we have a lot.

Scott Benner 12:44
Wow. By the way, I thought sarcoidosis was just the thing they'd used on house to get you to the real answer is that actually,

Carrie 12:50
yeah, it's an actual thing. It's like, it's like a lot. It's like long. It's like a sarcoids that like get on your lungs and stuff like that. I actually don't know a lot about it. I probably should. But

Scott Benner 12:59
yeah, a rare condition that causes small patches of swollen tissue called granulomas to develop in the organs of the body. It often affects the lungs and lymph nodes and can affect your skin also. Yeah. Did you ever watch House anybody who watched the show house, and it was about this diagnostic Doctor Who would figure out tough cases. At some point in almost every episode, someone would float. sarcoidosis. Really? Yes. It was like it was almost they became a joke. Actually, at some point. They always would be like, this could be sarcoidosis. And then it never was. Like I was just kept thinking like will it ever be that actually? Anyway, I've never really got into house well, power. Watch it. You'll hear the word a lot. Yeah. I'm gonna have to listen to it. Okay, so So there's is this consistent with just the females on your side? Are there men too, with issues

Carrie 13:51
as men? So I'm one of seven kids. I'm the oldest, but there's five girls. My mom has more sisters and brothers. I maybe it is more consistent with the females. That's actually really good point. I never really thought about that. There's just more girls. I think that's probably why

Scott Benner 14:04
Okay, yeah, I see that with my wife's family though. Yeah, seems to be more specific with the females for some reason. Anyway, okay. So diagnosed in the hospital. And I'm always interested, did your nursing help or get in the way

Carrie 14:20
it got in the way? Nurses are the worst patients and probably even worse as a mother. It was we did not have a good hospital experience either. We had like a nurse lose his blood. When she did a blood draw on him. She like lost the blood vial. Like we had another nurse give him his first insulin injection with the cap on and then she came back and she's like, oh, sorry, actually didn't give him the shot. Now I'm really gonna give it to him. It was really a nightmare. And I was like, what

Unknown Speaker 14:45
they don't understand how could you I

Carrie 14:49
I don't even know it was a it was it's a well known Hospital in New Jersey, very good pediatric er. And she came in she gave him his first shot of insulin and she walked away and I I looked at my husband, I was like, That is not what an insulin injection is supposed to look like. You could see like the whole cap that was an indented on his leg. And then she comes back in five minutes later, and she's like, Oh, I'm really sorry, I accidentally gave it with a cap on now. I'm really gonna give it to him. I was like, Oh, my gosh, just give it to me. I'll give it to you.

Scott Benner 15:16
I gotta be honest, that one would have i That might have been enough for me right there. Especially after the doctor experience. I don't know that I could have like, I might have been like, we're leaving. Can we go somewhere else?

Carrie 15:26
I have to say I was really traumatized by ever. I think every parent is when you have a child that's diagnosed. And you know, like the, your it's hard to process everything. But then like when like people are start screwing up with your kid. It's like next level, like,

Scott Benner 15:40
listen, see? You're being polite that her like screwing up as one thing. She took the needle with a cap on it, and somehow believe that she gave it an injection.

Carrie 15:48
Yeah, I mean, thank God, she was honest, and came back and actually gave it to him. What's

Scott Benner 15:51
she gonna know? Yeah, you know, she should have come back in and said like, Hey, I was just kidding. That's what it looks like when you don't. I'm just trying to teach you what's happening. Well, that's faster than that. Yeah. Okay. How long did it take them to get his blood sugar down and get you out of the hospital? So

Carrie 16:11
that's actually I think what I'd never understood about his hospitals day is that like, they never got his blood sugar down. Like he was like, well, also, we were bolusing after he, when we were in the hospital, but they just cleared they were just concerned about his ketones being cleared. And then they were like, ready to send us home. And I was like, I'm not ready to go home because his blood sugar is still like, 400. Like, this is kind of ridiculous, but they like, thought that was fine. And sent us home. And so we were in the hospital for like, two nights, three days. Was this during COVID? Yeah, it was during that like, the first COVID way, but like COVID was going on. It wasn't like bad. I mean, we were wearing we were obviously wearing masks in the hospital. We were in like single room. But like it was I was kind of disappointed. I actually went to the doctor and I was like, I'm not comfortable bringing my son home yet because his blood sugar's is still 400 Like, we haven't gotten a grip on it yet, you know, but they were like, you know, it's just gonna be like, trial and error. And I was like, okay, that's whatever.

Scott Benner 17:04
I was just wondering. Yeah, I was just wondering if they were trying to move people out quickly because of COVID. But that also doesn't sound like that. Now, maybe just because he was never in DKA. They

Carrie 17:15
weren't as concerned. They just wanted to make sure his ketones were cleared, which they were by like, the next morning after a couple like, after he was hydrated, and he had a couple boluses in him. He's ketones were cleared. And then they were like, okay, like, we're gonna do a training and you guys are gonna go home in the morning, my husband and I were like, what?

Scott Benner 17:28
You might have got the medical professional bum rush. The she knows.

Carrie 17:33
I think it was Yeah, that happens. Yeah, actually, it's a shame because I was like, so overwhelmed, because they don't anybody that is like a nurse. Like they don't teach you any of this stuff in nursing school. Like I knew, like nothing. I learned nothing about diabetes in nursery school. So yeah, interesting.

Scott Benner 17:47
Okay, so he leaves on injections. Do you have anything different than what you left with? Now? What do you do now?

Carrie 17:57
So my son, my son is still MDI, we are pursuing we're in the process of pursuing a pump. Now, up until now, he was still like, pulling off his Dexcom and stuff sometimes. And it just wasn't the right timing for me to throw another device on him and deal with him pulling off two things. Yeah. So yeah, so we're in the process of getting a pump now. So we are just trying to figure out which pump is gonna be more appropriate for him. Okay.

Scott Benner 18:21
But you've been doing MDI for years. Yeah, yeah. How long have you had a Dexcom? For?

Carrie 18:27
I demanded Dexcom. In the hospital. Okay.

Scott Benner 18:31
Yeah. When the next day, how did you know about that? My sister, right. Okay. She

Carrie 18:35
was like, don't leave the hospital to Dexcom. And I was like, You got it. And I was like, I need a Dexcom. Or I'm not leaving. And they're like, Here, get out.

Scott Benner 18:41
Did it scare you about having another baby?

Carrie 18:44
I very much so. Okay,

Scott Benner 18:46
but you did it. So yeah. What was the what was the conversation like, between you and your husband?

Carrie 18:51
I just I didn't want my son. I think what Liam growing up without having a sibling and I didn't want the fear of another child with diabetes to get in the way of having a family. You know, I guess we just both kind of looked at it like, well, if we're going to have another diabetic, baby, it's going to be the best parents for him or her or whatever. So yeah, I mean, I worry about my second getting diabetes all the time, but I mean, I can't change it. So

Scott Benner 19:21
yeah, are you having that unreasonable thought that it's just five months away from happening?

Carrie 19:25
Yeah, you know, it's funny, I smell his breath, like all the time, because I get so worried you know, where I'm like, oh my god, he soaked through two diapers last night or like he you know, he has diaper was so full this morning, that those are always my first thoughts or oh, he really likes water. You know, like, all those things always go into my mind. But yeah, I don't want I don't want the fear of diabetes to get in the way of me having a family so

Scott Benner 19:45
that's excellent. Okay, so you came home with a CGM. And I mean, was he was still around 20 pounds. He didn't lose a lot of weight off of the off of his weight.

Carrie 19:57
During those he lost a pound. Okay, that was the only yeah so nothing really.

Scott Benner 20:00
And so I'm just really interested in hearing about what your experience was like absorbing diabetes and, and figuring it out with such a small person.

Carrie 20:12
Yeah, it was hard. I was also breastfeeding and I ever all my, the endo that we were seeing in the hospital was like you need to stop breastfeeding, like very much like you need to stop. And I was like if I will not take away the one thing right now. And that is going to keep him like content and happy and I'm not. I just refused to stop breastfeeding. So that was very difficult to manage the breastfeeding with a bowl thing with overnight. It was just, it was really hard. That was the hardest time of my life is when he was diagnosed and I just had a really hard time we had a hard time with the Dexcom changes and he was getting reactions to the decks comps. And yeah, it was it's really hard when they're that little ya know, it's really hard. No,

Scott Benner 20:50
it's It's, you know, so much about the dosing the insulin is is incredibly difficult. Yeah, just really, it's hard to put into words, when in a half a unit. It's like a massive amount of insulin. Oh, totally. Yeah. And you're and you can't even reason with them 14 months old, like what do you do you look at him like a Liam, listen, I need to do this man. There's going to be problems. You're like, you can't have those and breastfeeding. You don't even know what's what they're taking in. Really?

Carrie 21:17
Yeah, yes, feeding was really difficult. Yeah. So it was, it was hard. I think I went through like my own, like, emotional, like, space in my life where I just was like, I don't want to say angry, but I was kind of angry. Like, why does this happen to my kid? And why am I you know, like, having to go through this. And my son is having to go through this so young. And it was

Scott Benner 21:36
hard. Yeah. No, I imagine. Yeah. Did you go to a therapist financial with, I

Carrie 21:41
did see a therapist right after he was diagnosed for a while. But then it just kind of became like, I don't want to say like my life, but I just have on better terms with it. Now. You know, I think my biggest thing for me it was like I always hated when people would be like, well, things can be so much worse. You can have cancer. And I'm like, you're like totally dismissing what I go through on a daily basis. You know,

Scott Benner 22:01
I don't understand the idea of like, comparison. Yeah, it's actually interesting. I just put it on my list to talk to Erica about because I'm trying to figure out what the the human need is to compare everything.

Carrie 22:15
Yeah, what is that? I don't get it. I don't know. You know, he just have diabetes. And like, he does get shots. But like, think of it like he could be getting chemo right now. And I was like, what you're doing right now is like totally missing, what my like, what my son goes through and what we go through on a daily basis in my house. So like, just stop. You know, I just, that's one of my biggest pet peeves is people comparing like, it could be worse. And I'm like, but it could be better.

Scott Benner 22:37
So what if it didn't exist? When that'd be No, yeah. Like,

Carrie 22:40
what if there was a cure, it would be a lot better. So yeah, I'm always confused

Scott Benner 22:44
by I mean, I guess to me, the worst thing that's ever happened to you is the worst thing that's ever happened to you. So if the you know, a person over here has cancer, and your kid has type one diabetes, and you know, another person lives in a house, and another person is homeless, and they they all have bad things happening to them. Like, yeah, they're, you know, the guy in the house isn't maybe as bad off as the homeless person. It doesn't make the guy in the houses situation. Different to him. And yeah, and that's, that's the thing. I hate the I hate the you're a good parent for this. Yeah, that one. I'm not I'm not a fan of that at all. It could be worse is terrible. But those that one that was said to me that God gave Arden diabetes, because he knew I could handle it. Yeah, I've heard that one too. I did not find that comforting in case anyone's Yeah,

Carrie 23:34
like why like? Yeah, thanks. Yeah,

Scott Benner 23:38
I actually I responded, I said, so if I was a big screw up, then Arden wouldn't have diabetes. This let me say, Well, we started making sense. And the conversation went away pretty quickly. But But you But I mean, also, in fairness, I know what they meant. And it was it was meant to be comforting. And yeah, even if I can understand the context that they meant it in like, you can handle this, but just say I, Scott, I've known you for a while and I think you can handle this and you'll be okay. That would Yeah, that would be great. Yeah. Don't tell me that my kid got diabetes, because God was like, Oh, that guy can take care of diabetes. Also, by the way, I've met a lot of people whose kids have diabetes who can't take care of it. So yeah, same. Yeah, they gotta get bored that day, and just give it to that person. Like, try to make more so it's good. Let's just give it to her. It's fine. Yeah, I

Carrie 24:28
totally agree with you on that. But okay, so

Scott Benner 24:31
your How long did you breastfeed? I guess after the diagnosis.

Carrie 24:37
Oh, like a year. Oh, wow. Yeah. Yeah, I, um, he wasn't ready to wean and I was just like, and then I wanted to get pregnant again, have another baby because I was getting really old. So I was like, We gotta, we gotta cut it. But yeah, I think it was I think I probably did it longer for him because I just, I felt like I just didn't want to take anything away from him, you know? So we're

Scott Benner 24:59
You were you I was gonna say at least but were you pumping and then and then putting in a bottle so you can see how much it was or were you actually breastfeeding both

Carrie 25:08
in the beginning I was trying to pump to see how much but it became really difficult in the overnights because I just never knew how much he was taking in. And then I tried to get my breast milk analyzed, someone mentioned like trying to get your breast milk analyze, and it was like all carbs, and I was like, okay, but I mean, breast milk is mostly carbs anyway. Yeah, depends on the time of day. But yeah, and then it just, we ended up just bringing up our Basal dose much higher to kind of cover the overnight feeds and it just got messy. And then it was it was time. It's

Scott Benner 25:35
a balancing act. I mean, it will, it will get as he puts on body weight. I'm sure you're seeing this right. It's getting easier. We

Carrie 25:43
our growth spurts in my house are like, brutal okay with him. There are so hard this is that's been the hardest part for us. This past like six months is like dealing with growth with him and being MDI

Scott Benner 25:55
is I was gonna say is this part of the reason you're thinking about a pump now? Yeah, or overnights are

Carrie 25:59
really rough with just like growth hormones and stuff. And I think it's time that we just get on a pump just so are nicer, better?

Scott Benner 26:05
Do you think you'll try an algorithm? Or do you think you'll just go for like a manual pump?

Carrie 26:09
I'm pretty sure I'm really leaning towards the T slim, my sister has a T slim, I'm very familiar with it. It's just really, it's really comes down to is he going to keep it on. But he's going to school in September, he started in pre K. So like, I'm hoping that we can fit it in over winter break, like do like the whole pump and get used to it before he goes back to school. So that's my hope.

Scott Benner 26:31
You think he'll be okay with the Tethered part.

Carrie 26:33
We talked to him a lot about it, we're going to try and get like do like a trial where we keep like the Tethered part on him and see how he does. The problem is that he's a really smart kid. And like, I just worry about him. Like, I know, there's like tons of safety features to the pumps, but I just worry about him like doing something and I

Scott Benner 26:49
don't know. I don't know, this is a difficult decision. Honestly. Yeah. huge for us. Yeah, no. Yeah. Well, you said that you're talking to him about a lot. What you think is like grasp of his diabetes is.

Carrie 27:04
It's interesting. So I was at the park with him the other day. And he had well we use iport. So he has an iPad on one arm right now. And he has his Dexcom on the other. And this little girl i i Sometimes I'm a helicopter mom with him because I don't want kids to, you know, make him feel different about his devices or anything. And I was at the park and I was holding my other son and I was watching a little girl staring at his Dexcom and I was like, this girl is gonna come up and say something to him that I was like, have to just watch, you know, before I like happen to this. And she like walks up to Liam and she's like, what's on your arm? And he goes, Oh, that's my Dexcom checks my blood sugar. And she's like, Okay, do you like McDonald's? And he's like, yeah, she's like, me, too. And then they just walked away. And it was like, I could just breathe for a minute. Sounds like you because you know, like, yeah, he understands. But it was just that and that was it. Last

Scott Benner 27:50
year at the Jersey Shore, you didn't know what kind of attitude she was gonna have. Exactly.

Carrie 27:54
She could have been the hammer and you never know what you're gonna get there.

Scott Benner 27:57
What do you use wearing on your arm there? Yeah, exactly. Um,

Carrie 28:02
but it was it was fine. So I think he I think he did say he's like, you know, his blood sugar and like all that. He's a smart kid. Yeah.

Scott Benner 28:09
So he knows I eat I need insulin. This is why. Yep. I actually had a conversation with Arden the other day about her thyroid medication. And I was like, Oh, I don't think she completely understands what's this? Oh, really?

I made a little note for myself. Like, let's have a 15 minute conversation about thyroid review. Because she, she,

I mean, she's 19 Right. So she she was out with her friends like all night, the other night that she's home from school on a break. And she literally came home in the morning. And I just said to her Hey, before you go to sleep, take your, your, your terrassen and your T three. And she goes

Carrie 28:44
why take tiersen you'd never hear about anybody taking tiersen

Scott Benner 28:47
it's cleaner. That's why we like cleaner. Yeah, so don't be Don't worry. So she takes tears and she takes sleight of mouth. Is it Saito? I think so. Okay, do you okay, we'll talk about that. Hold on. So she I said take that before you go to sleep. And she goes, I'm gonna take it when I wake up. And I was like, no. And she goes, yeah, it's for energy. And I went, Oh, God, what did you just say? And I went, hey, it's not yet. We'll talk about this later. I was like, just take that. And she goes, okay. She went into a room. I was like, oh my god,

Carrie 29:22
it does kind of give you energy.

Scott Benner 29:25
I know where she's coming from. Like, she's like, I you know, that's the stuff that peps me up. I don't want to do that before I sleep. I'm like, that's not how that works. Exactly. We'll talk about this tomorrow. I'm like, You need to keep it 24 hours apart like you're trying to and I looked at it and I was like, we'll just talk about this later. But how long have you been taking tiersen? Oh,

Carrie 29:43
God, like six, seven years. I was starting to add Synthroid, I hated it. And then I saw an endo who was like, I think you'd do much better on tiersen and I was like, sold and I like read the ingredients and just made more sense to me to take it and it's kept my thyroid like, perfect ever since I've been taking it Never had any issues with my thyroid since I started taking it through it. I was like all over the place. And then even like, what through my pregnancies? It was it. I just think that tiersen is the best thyroid men out there.

Scott Benner 30:10
So what were your symptoms? What led you to it? To Hashimotos?

Carrie 30:13
Yeah, I was just really tired and like, I had no idea that I was I like, went to the doctor and I was like, I'm just feeling like really tired all the time. Like, I didn't have kids at the time. So she was like, Okay, we'll just do like a blood draw. And my TSH was like, 10 Oh, okay. Like really high. And then they checked for the antibodies, and I was positive for those. So yeah,

Scott Benner 30:32
yeah. How long did you do that? Before they added T three.

Carrie 30:35
They actually just added tea free for me this year. What was what led to that? Well, I don't even know I don't like it's so funny. My focus is so much on my kids and like my, their endo that like she's like, do you want to try a T three? And I'm like, Yeah, sure, throw it in. And I try it. And I was like, I feel great. I don't sleep anyway. So

Scott Benner 30:52
should we put carrots in this too? I don't see why not just do it. Well, so for Arden, her T the tiersen is the T for replacement. Right? And her numbers can be terrific. But she's still tired. Oh, really? Yeah. If you don't give her the T three. She's exhausted. Interesting. Yeah. It's and I don't just mean like tired. I mean, like dripping in a puddle tired. Like I've told I've told the story before, but I'll tell you in Arden's yearbook for her her senior year in high school that you know when they people like take out like ads, you're basically paying Yeah, yeah. Right. So we did one of those. So there's this beautiful picture of art in the middle and then around it. If you can imagine nine small photographs around one in the middle they are all like cell phone pictures of Arden asleep on different hard surfaces in our house. Like passed out. So she needs it. Yeah, like passed out, like come home from school sit down at an island and just face down on a piece of stone asleep. Oh, that's crazy curled up on the floor, like any like in just like random places like she'd get on the floor to play with the dog and you'd look over to be asleep. And wow, yeah, it was it was insane. And you add she needs it. Oh my god. It's she does not function without it. It's really interesting. As a matter of fact that the end of her last school year, I think that's what it was. She ran out of it a few days before the end of the year. And it took about seven days for her to get home and to get new. And it like it decimated or she was back to like not being able to function. Wow,

Carrie 32:19
that was really that's crazy. Yeah, holy. She has it. She

Scott Benner 32:22
knows oh my god, it's so much better. If it was 50 years ago, we would have like, put her to sleep like a dog or something. Like seriously, I don't know what to do with her like she barely could like, even now that she's on all these things. She still says sleeping for me is not refreshing. Really? Yeah. She's like, I never

Carrie 32:39
reaching her. Like a deep sleep. Is she getting to that? Like, Carrie?

Scott Benner 32:43
She sleeps forever. If you if you don't wake her up, she'll she'll stay asleep forever.

Carrie 32:49
Yeah, sounds to us.

Scott Benner 32:52
Like a nice 12 hours. Like when she got home when she got home from the overnight thing. She's like, I'll be up in five hours. So I was like, Don't imagine that's gonna be true. But okay. But But anyway, so are so are you watching that with your kids to do you add that? Yeah. bloodwork good.

Carrie 33:07
Yeah, we do like the annual bloodwork for the for his thyroid. It's been fine so far. Knock on wood. So yeah, good

Scott Benner 33:12
for you. Did your husband after all this started happening? Did he say hey, this should have been disclosed before I married you. Yeah,

Carrie 33:19
I mean, he was just kind of like Go figure. Like, like our kid gets like the worst. You know, jeans like, I don't know, my husband is like the specimen of health. His whole family lives to like 100 Right. And like, great teeth like everything is like perfect. It's so annoying. And then like my family has got like all these autoimmune diseases and like they people are dying younger and like,

Scott Benner 33:38
whatever crate teeth is hilarious.

Carrie 33:41
Yeah, he has great. My husband has great teeth. Like he has great teeth. I don't know, for some reason people might be like, we just don't have great teeth. So

Scott Benner 33:48
people in your family die younger. Yeah,

Carrie 33:52
I mean, I think the grandparents died when they were like in their 60s. That's about

Scott Benner 33:55
right. Still, though you're almost my age like this. Were you I guess you're right. You and I are like the first go round of people who did not grow up like in a salt mine, basically. So I think this is where you're gonna see a leap. Those of us who grew up a little easier, although half of us are gonna probably just go the wrong way with nutrition and it'll be a different thing that kills people but totally Yeah, but I think Yeah, for now. Yeah. If you're if you have a less impactful job, and you're actually taking reasonable care of yourself, like I'm interested to see how long people can can go even the thing being diagnostically seen Yeah, like my I've like low iron but because the diagnostics and decent like health care, like I'm ahead of that otherwise, I'd live my whole life making cells over and over again with not enough iron in my system and I probably would die sooner.

Carrie 34:47
Didn't you get an iron transfusion? I thought I saw a picture of you on I've had a

Scott Benner 34:51
couple packs. Yeah, a couple so I haven't had them in a while and I have my fingers crossed that that they won't happen again with supplementing, but I Don't know like it could. Yeah, totally. But still, it's within reason I get a little sleepy I call a doctor. They draw some blood. They go, hey, it's low. I wait a couple days, I go to the thing, a Jackie backup, and you're on your way again. So yeah, I've

Carrie 35:14
had a couple two, I always feel amazing afterwards. Yeah, this is great. It actually, like I feel better. I don't know.

Scott Benner 35:19
I can't say enough. When if your iron, I did a whole series of conversations about it, because I wanted people to know, but even what the what the testing parameters are. It's, it might not be enough. Like, you know, I had an endo on that said, if you're a woman of menstruating age, for example, that she sees 70 as the absolute bottom of where your ferritin should be. I agree with that, though. Yeah. Yeah. And that's not like

Carrie 35:47
d3 to the vitamin D, they always say like, you always want to put on the high, high, high upper end.

Scott Benner 35:52
Yeah, I take 5000 I use the vitamin D every day. That's see

Carrie 35:57
that's so crazy. But that's so good for you know, Liam's was like, critical low when he was diagnosed. Yeah, no,

Scott Benner 36:05
no, I mean, I think that's there's space for good supplementation and definitely agree with you. definitely helpful. And I actually drink Athletic Greens on top of all that, to which I don't think I'm supposed to call Athletic Greens anymore. Ag one. I don't know. Oh, did it change my link when from athletic greens.com juice box to drink? Ag one.com/juice box. So I'm assuming

Carrie 36:24
that stuff. I think I'm going to get it for my husband. So be it.

Scott Benner 36:28
This is not an ad, but they are advertisers. It's the only green drink I ever tried that I could that I could drink that, Nick. Yeah, and it's not. And it's not just that I can stomach it. I drink it. And I go, that was great. And it's over. And like, really? Oh my god, the other stuff. I couldn't get through my mouth. I was like, some of it's really gross. And it would get in your stomach and be like, sit there real weird, you know? It's not good. But yeah, he won. I'm very happy with so it's a matter of fact, I gotta keep selling it because I get it for free. As long as you guys keep buying it.

Carrie 36:59
Oh, that's good to know.

Scott Benner 37:03
No, no, if that stops, and then I'm on the hook. Because I think I gotta keep trying. I need you guys to pay. Anyway. It's worth it. I do think it's worth a try. Yeah, let's get oh, let me just say drink@one.com forward slash juice box. You get a free year supply of vitamin D and five free travel packs. Gary. You're smiling like Sorry. I feel like an idiot anyway. Algorithm. You think? Yes. You'd like to go pee slim? Control? Like you? Yeah, yeah. Okay. How much insulin does he getting in a day? He,

Carrie 37:39
I mean, he needs what he needs. So he gets like eight of the eight. His Basil is right now is eight. He's about 5050 To be honest with you. Yeah, he gets usually like, usually about eight to eight. If you log in about it's he's he's on eight of Joseba right now. Okay.

Scott Benner 37:54
Yeah, that's how much do you weigh now at three?

Carrie 37:57
He's, he's three and a half. He's 40 pounds. He's like 95th percentile for weight. 95th for height. He's the solid kid.

Scott Benner 38:05
He's your husband big.

Carrie 38:06
No, you know, it's so funny. Went to the pediatrician the other day. And he's like, you know, he's like, 90 is for weight and 95th for height. He's like, at least he's proportion that was like, You're right. He least he is. He's like at least is that overweight? And I was like, Dude, he's three. Okay. Don't even go there with a week with me.

Scott Benner 38:22
I heard you apologizing for him. And you went, Hey, listen, he is three and a half. So

Carrie 38:26
he's three and a half. Like he's still before this winter. Yeah, he's just he's a solid kid.

Scott Benner 38:30
Your husband not a big tall guy. Are you tall?

Carrie 38:32
I'm like, five, six. My husband's six foot. We're not like crazy. So I don't know. Yeah.

Scott Benner 38:37
It doesn't always work out. I mean, for instance, my children are attractive and athletic. So I don't know where the hell that came from. I used to tell people all the time that my my mailman must be a very good looking athletic guy. Oh, you're so funny. My assumption because, I mean, there's been times I've watched my kids do think things athletically, and I'm just like, I'm probably not there. But anyway, as actually as Cole gets older, he's starting to look more like me. Oh, really? Which is interesting. He's,

Carrie 39:09
I can't remember I released a new one episode recently. He's he's in college or high school here.

Scott Benner 39:14
Now. He graduated from college. He's got his first season done with college. Yeah, he's at his first job now.

Carrie 39:19
I don't know why I thought he was he was younger. Wow. Yeah. It's crazy. Because the podcast can

Scott Benner 39:23
jump around. So yeah, but he's been living on his own for eight months now. Very far from home. And he is he likes the job and he's getting good experience from it. But he's like, I need to leave here. Because I'm so by myself is like he's like, yeah, there's just nobody here and his girlfriend's somewhere else. And, you know, they're trying to figure all that out. So got it. Yeah. Okay. But he had the experience and it was it was a very good job with a great company. And he's like, I'm, you know, this is how I'm going to move up. I gotta get this so I can go to the next thing. Yeah, totally. So he's still got that I'm proud of him. He really is on his own. So yeah, you should be that's really cool. Good for him. Yeah, I would be like mental. Like, oh, same here. Yeah. So the saddest thing to me the other day he goes on. What do people do after work? And I'm like, Oh, he's got a TV to watch. He's like, I play basketball in the park. And, like, I go shopping. And he's like, talking about the things he asked to do. And he's like, can I keep gonna keep my place clean and stuff he's like, but what else do people do? And I was like, Oh, buddy, I was like, This is life. I'm sorry.

Carrie 40:32
Really nothing, no other secrets. It

Scott Benner 40:34
was like I said, when I was your age, I had a kid. So like, are getting ready to have one. I was like, I was moving towards that. I'm like, I don't know, man. I'm like, you gotta find a hobby or, you know, something. He's like, I might start going to a Boxing gym to work out. I was like, That's a great idea. Like, try that. But this is very strange moment where at 23. He was like, Oh, this, this isn't all like just Ferris wheels. And this this

Carrie 40:58
thing. What else do I do? That's funny. What else

Scott Benner 41:01
is there? That was like? Nothing. Yeah, there's nothing else.

Carrie 41:05
Welcome to adulthood. There's nothing else. There's no secrets for somebody so you can die. Sleep when you can. So funny.

Scott Benner 41:17
Can you explain how blood sugars reacted? So you're you're in a unique situation. You're watching an infant who's breastfeeding and going on to solid foods on a CGM, like what kind of shifts did you see in blood sugars,

Carrie 41:30
crazy shifts, I mean, I had to rehaul everything. I was feeding him at that point, because he just I don't know what it was about him. When he was diagnosed, no honeymoon, right off the bat, he needed a lot of insulin, he needed a lot of, you know, he needed a lot of diesel like he just had high needs for insulin. And I was really scared about that, because I was like, This just seems not right for, you know, a 14 month old be taking this much insulin, he just was resistant for a while. And then we just kind of gotten to a groove when I started listening to the juice box. And they started kind of like riding the wave of the Dexcom all day long, and kind of watching how he reacts to certain foods and kind of, you know, finding alternatives to some of the foods that he likes. Because I didn't want to him on a roller coaster all day long. Yeah. So that was that took that took all a really long time for me to figure all that out, like a really long time. Actually, I think you actually talked to my husband, right after Liam was diagnosed, I posted on the juicebox. Like, I'm losing my mind. I'm not sleeping. I don't know why my son is running so high. And I was like pleading for someone to help me and you responded, like, let's talk. And so I hadn't you like talked to my husband and and you've read off of that. Were like, he needs more basil. And you were right, because we ended up like going up a lot in his basil shortly after that. So yeah, he

Scott Benner 42:48
and I talked by phone. Yeah, yeah, I remember that. Okay, I

Carrie 42:52
think because you saw that we were like in New Jersey. And you're like, you know, like, let's talk about this. Because I think I'd post I posted a lot and the juicebox like, right when he was first diagnosed, because I was really overwhelmed. And I was just feeling so defeated by seeing these numbers all the time. Not trying to like figure out what I was missing, you know? And so yeah, you talk to my husband right after Liam was diagnosed. It's

Scott Benner 43:14
such a good guy. No, can you are? I just look to your sister's episode was nine 911. Yeah, it's called T one D lupus and epilepsy. Yep. Okay. She turned you on to the podcast, or vice versa?

Carrie 43:28
No, I turned her on to it. When we were in the hospital, we actually started listening to like the beginnings. And then shortly after, like, I contacted Jenny to start making appointments with her. Okay, I was like, I

Scott Benner 43:38
need help. Yeah, no kidding. Oh, so Jenny helped you with the baby.

Carrie 43:41
Oh, Jenny. I've been working with Jenny since he was diagnosed or so we're still working with her. Oh, that's

Scott Benner 43:45
lovely. Good, good. But still, you're still like on the group going? I don't know what's wrong. That

Carrie 43:52
yeah, in the beginning, I will. Also we did, we had some issues with our Endo. We like I had to leave the endo that we had seen at the hospital because I hated them. I thought they were not helpful at all. And then I was like, my husband, I lived in Boston for several years prior to having kids and I was like, well, then I'm moving to Boston. I'm sending I'm bringing them to Jocelyn like so it was a no brainer. And my husband's like Carrie, you're losing it and I was like, okay, maybe I am. So we did like virtual with Jocelyn because I like knew somebody that worked there from working there and whatever. So we worked with Jocelyn for like a while until we got we switched to our endocrinologist that we have now. But our endos prior to our endo Now, none of them were helpful. I just like everybody was just like, correct, correct. And I was felt like I was choosing highs and you know, treating lows. I just never gotten to a groove with him for a really long time. Yeah. So

Scott Benner 44:43
they said is his settings up? And then even as his settings were too weak, they would just tell you just the correct the high blood sugar. Yeah,

Carrie 44:53
we had I just they were questioning me a lot. They were like, Why are you doing it? It's just Yeah, it was just it was hard. We just never gotten to a groove with an endo for a while, why were you doing what? Like, you know, like your carb count was wrong. Like I had to do the logs afterwards. And you know, it was just hard. Like, I don't know how many carbs or my breast milk I was estimating, and they would get on my case that I was estimating wrong, or I was imposing enough. And it was kind of it was kind of a nightmare. And then I was like, I can't do this anymore. It's affecting my mental health. I need a new end of the socket to question me, it's gonna support me. Yeah. And then we went to chop. And it's been like, an amazing experience. So yeah,

Scott Benner 45:27
by the way, if anyone needs an indication of how upset you were, you were like, we'll relocate to where there's a better hospital.

Carrie 45:33
Yeah, that was like, we're just going to move to Boston. My husband was like, Terry, you think you're losing it? And I was like, Okay, well, then I'm going to leave. And I'm going to bring them to Boston, and we'll go see a new endo there. And he's like, we have chop here. We just need someone around here. And I was like, okay, like,

Scott Benner 45:49
you're gonna live here. We're gonna live in Boston. So yeah, it is a lot. It's just a lot of stress. And it's nonstop. I mean, honestly, it's 24 hours a day, nonstop. And the baby small, and it's got to always be in your head. Like, if he gets too low, and I can't talk him into eating something or whatever. Like, we're gonna have a real problem. Oh,

Carrie 46:09
I still have those thoughts now with him. Sure. Oh, please.

Scott Benner 46:12
I think you're gonna have them for a while. Yeah, don't worry. I

Carrie 46:15
think toddler toddler stage is even harder, because he's like, he takes swim lessons. And like, we went to swim and after swim lessons, he gets to go to McDonald's. And it's like my thing, and I have no mom guilt about it, because he enjoys it. And it's that's it. So I have mastered a happy meal for him. And we went to McDonald's, and we sit down, I Pre-Bolus him are sitting there waiting for the food and the burger comes and he looks at me. He goes, I don't want this. And I was like, why? He's like, I just don't want it. Let's leave. And I was like, oh, like, it's just you know, it's hard with toddlers.

Scott Benner 46:45
No, we're gonna I was like,

Carrie 46:47
why you want to? You told me you want to have a meal. He's like, I don't want to now and I was like, Okay,

Scott Benner 46:51
what do you do?

Carrie 46:52
I have cookies in my purse. I just gave him the cookies. And I was like, let's get out of here. Of course you wanted an hour later, but whatever. Did

Scott Benner 46:59
you go back? No, I

Carrie 47:01
had it still brought it

Scott Benner 47:02
home. Oh, yeah. He ended up his happy meal. Yeah, yeah. Can we call this episode reheated Happy Meal, maybe? Perfect. Excellent. Yeah. I mean, it's just, it's not a thing that a lot of people are going to understand. I mean, you can, you can imagine it, but I live through it. And it's frightening. And I was on edge for years. Like you really have to imagine that Arden was diagnosed in 2000 762 1006 weight of sex. And she was two years old. And she weighed like, 18 pounds when she was diagnosed. And there was no CGM. They like syringes and Novolog and, and a Basal insulin that was so ineffectual. Nobody uses it anymore. Basically, a you know, and you were just on your way. And it was up and down, and up and down. And you couldn't even tell you were just testing trying to like, get ahead of the problem and always worried. Like, I haven't talked about it in a while. But I mean, for like a full year, I'd live a whole day with Arden, like, at home with her. My wife would come home from work, and I'd be like, I have to get a shower because I didn't get a chance to get a shower. Today. I went in the shower to cry. Yes,

Carrie 48:13
really, I totally feel you on that. It's really hard. It's also really hard finding other parents or friends that you can like relate to, like, for me, at least, you know, like you like, sometimes I would find like I would talk to other moms and they will be like, Oh, my night was so hard. Like, my baby woke me up twice. And I'm like, Are you serious? Like, I treated the high for like, four hours last night I finally slept two hours. You know? Like, It's hard finding, you know, people that you can, I don't know relate to sometimes, right? Yeah.

Scott Benner 48:40
commiserating is helpful. And, and that's actually what that person is trying to do with you, except they don't understand the, the level you're at versus the and, and again, not to compare it I'm sure it's terrible for her to, like, you know, but it's not helpful for you as far as like finding, I don't know, an actual sounding board who understands your situation? Yeah,

Carrie 49:01
it's really I think it's just, it's just harder when they're younger. I know you can relate to that. You just I always just felt like for a really long time, or still do like I just wait for the next ball to drop. You know, like, what's going to happen, just kind of live your life always like on edge. Yeah.

Scott Benner 49:13
I mean, in the end, I think the best you can do is get good settings, understand how insulin works. And, you know, give yourself a chance to be in the fight. Really, you know, instead of being blind, I was blind the whole time. For those first number of years. I didn't know what I had literally didn't know what I was doing. It was a mess. And you know, how did you like figure it all out? I think writing the blog was partly helpful. Yeah, I get that because you could kind of like, relive what was going on later, when you weren't as upset about it. And then I started asking people questions. So one of the things that got me there was, I asked Arden's nurse practitioner one time I said if I gave you a magic wand, and I said you could make people with diabetes, no one thing What would you make them? No. And she said, I tell them how insulin works was that and I said, Okay, so I don't know how insulin works. That's a problem. So I'll figure out what that means. And then I just started quantifying it. Like I put it in here, I see a spike, you know, the spike crashes, like, you know, like, I just started trying to make sense of it. And then I mean, CGM is came. Yeah, it was a huge part of it. The first Dexcom kind of wasn't so much about the number it was almost about the graph and the arrows. Totally. Right. So you can kind of see like, okay, like, it's going up now. Like, I got that, like, you know, why is there not enough resistance here? I put the insulin in at a good number, like, why is the number going up? And why is it staying up? And how come I mean, I put in the right amount of insulin, but her blood sugar's really high, it's not moving. And they would tell you then like, Well, don't put more insulin and you'll be stacking. But after you watch it happen a number of times you think, well, that's, that wouldn't be stacking, because her blood sugar is never going to come back down again. And then you kind of reverse engineer, you go, Well, if I would have put more insulin up front, what did he even gone up? Right. And then that started making sense. And I started making leaps. The next leap I made was, I was afraid of insulin. Yeah, I know, I was afraid of it. And so one year, I used to write for Omni pods blog, which I don't know that it exists now or not. But I would write six pieces for them a year. They came to me at the end of the year, and like, what do you want to write about next year, and I said, I'm gonna write about not being afraid of insulin, it's going to be a six part series about not being afraid of insulin. And they were like, okay, and I told them why and, and that was it. Like, I just I talked myself into not being afraid of insulin. Like it's not like I knew something. I wrote about it in a way that talked myself out of it. Yeah, it was it really. So. I did misspeak earlier, the magic wand story, she said, I would tell people not to be afraid of insulin. So they knew how it worked. There was a little more to it than that. So yeah, so I just was like, Okay, well, I am afraid of it. There's nothing that's gonna make me not afraid of it, except maybe understanding how it works. So I'll start paying attention to how it works. And then then that leap of trusting that I knew what was going to happen was going to happen. Interesting. That was a big deal for me. Yeah, I'm sure. How many times can you not Pre-Bolus a meal, watch it go to 300 have to put into more units to bring it back down? Before you say to yourself, let me see what happens when I Pre-Bolus. Yeah. And then you Pre-Bolus And it goes to 200. But it doesn't come back down. How many times you have to do that before you think okay, well, I Pre-Bolus that help. But obviously, there's not enough insulin here. So I don't care what the carb count says. This meal needed two more units of insulin. Yeah, so I'm gonna use it. Like, why would I just do it again, tomorrow, when I know it's gonna happen again. So then I was like, alright, you know, the carb count says three, but I'm gonna use five. And then it worked. And I was like, All right, well, I'm going to trust that that's going to work. And it's almost the same kind of leap you have to make the first time you realize that, you know, if you had three blood sugar meters, and you took the same blood drop on all three, you'd get three different numbers. Yeah. And then you have to say to yourself, I have to just go with what I have. And I think those little leaps got me there. And then I started seeing it like that it slowed down. Like it's such an old reference. Now, I don't even know if it works for people. But diabetes, like it started feeling like the matrix. And I felt like I was standing in the middle of the bullets, and they weren't moving very fast. I was like, Oh, I see it all happening now. And once I saw, it's really cool. Yeah, that's how it felt it felt like before, everything was happening way too fast. And I couldn't make sense of it. And I had found a way to slow everything down. So I could kind of almost look up and like reach and grab a bullet and go, I'm just gonna move this one over here. So it doesn't hit me. Yeah. And then I don't know from there. I wrote about it more. And, you know, kind of clarified my thoughts, and then kept experimenting, and then kept getting good feedback. It was working. And then one day, I just told my wife, I was like, I have a system that works. Like, I don't I don't have a name for it. I don't quantify it. Like, I'm not going to write a book about it. But I know if I do these things that will work and then I made a podcast about it. So, so cool. Pretty much it. Yeah. Really cool. I had a lot of free time. I was a stay at home parent. Yeah. So you know, so cool. Just do the laundry. mop the floor. go grocery shopping. Yes. That's pretty much it. You know, do it again the next day. Yeah. And I honestly, I just, I'm a really emotional person. And like, her health being poor was like killing me. See? Yeah, so I couldn't let her be like that. And I couldn't Yeah, I couldn't be the one that did it. You know, like, so that this I was fighting against all of that.

Carrie 54:47
Yeah, yeah, totally. Yeah, I feel that so much.

Scott Benner 54:51
And it just feels easy now because now I'm like, the guy gets in the phone. I'm like, turn your basil up. You're like he knows everything. I'm like, not really. But I have like, I haven't have knowledge that I can look at it and with reasonable certainty know that this is what I'm seeing. Yeah, you know, so and then the doctors, they don't I don't know, if they don't have it, I tend to think of doctors biggest issue is really the same issue that all businesses have, which is that people come and go. Right, like so. Yeah. You know what I mean? Like, you bring somebody in about the time they know what they're doing, they go somewhere else, because they can sell themselves for more, because now they have more responsibility. The next person that comes in doesn't know crap, because they're just starting. And, you know, so everybody's always either dealing with somebody who really knows what they're doing, or has no idea what they're doing. And it just you can't build consistency. It's, it's, it's how free agency killed football. Yeah. You know, totally not that players shouldn't be free to move around. I support that. Like you. It's hard to build a core and keep it together now. Because people people jump around. And I think that happens in business. And I think that doctors offices are businesses. And yeah, they are usually. So you know, when you get the girl with the needle calf was probably like, she's probably in her first six months of this. Totally. Yes. So. And those people are always cycling in and out. I think that yeah, the bigger problem, actually, every problem we have in the world is a failing of people. On some level, like, it's just yeah, you're right. Yeah. It's your job. It's not your life. And so if I have a bad day, or I don't get a lot of sleep last night, or God knows, like, the, I don't know, maybe the receptionist schedule, got a little coke problem. Like, who knows? Like, you know, like, everybody's got their own lives, and they go to this thing during the day, and they put as much effort into it as they think they need to to keep their job. And then, you know, it's not really, I mean, how many people do you know who have a job they really care about? Not many. So, and then you show up with your kid, or I show up with my kid or whatever. And I'm expecting these people to be perfect. And you know, beyond reproach, and the truth is, is that they live up the street from me, and they really are just dreaming of getting home and having three beers and watching American Idol. And yeah, that's it. So true. Yeah. It's one of those. It's not a big deal. Just is what it is. If you know it, then you can work around it.

Carrie 57:23
Totally. That's all. Yeah, I

Scott Benner 57:24
agree with you. Yeah, I just don't have any big high expectations for people. Yeah, same. I think teachers are people who want to have off during the summer. It's true, not that teaching is not a big thing. But I bet you that it attracts, a lot of people are like, wow, three months off cool.

Carrie 57:40
Like, I want to be my kids school nurse eventually, because I'm like, I get the summers off of them.

Scott Benner 57:46
That's exactly my point. And by the way, I'm sure there are plenty of people who really want to shape young minds, and blah, blah, blah. I'm sure that's all true. But if if 50% of the people are just like, I just got to make it to August, and the other 50% are working really hard. Well, then you get a mixed bag. And yeah, totally. It's just yeah, what it is, I don't know, I was sitting here yesterday looking out the window. But for people who work for my Township, were picking up three branches with a machine big enough to knock a house over. And I was like, just walk over and pick it up. Oh, they could have driven over with a pickup truck and grabbed it in eight seconds. But instead, it's like, we just use 72 gallons of diesel fuel using a machine that I could be part of a war if it needed to be it was so big, and I was like, What are we doing? And you know, I don't know how I got to that. But that's my point is that I guess my point is that you need to, on your own, figure out what this is. And then advocate for yourself and see your doctors as people who if you're lucky, you get a great one. And that's great. You take their information. And if you get a bad one, then you you know, then they're the nice people with the prescription pad and you go do what you got to do and and get what you need. And then you go home and make your own decisions. I'm watching someone online. Now. This is such a common thing with people with diabetes. She's looking at a chart or graph, she puts it up online. She says what's going on here? I said this graph screams not enough basil to me. And she said, I said that to the doctor. But they told me no. And I'm like, Okay, well, what now? Because you still have the problem. They said that's not it. You say that's it. I say that's it. 30 Other people are looking at it and tell you the other thing. What are you gonna do? Like, you know, yeah, so it's up to you at some point. That's all. Forget diabetes. If you're waiting for somebody else to tell you the right thing to do. You're making a mistake. Yeah, totally. You gotta get in there. That's all. What are we not talking about? Sorry, that we should have. I

Carrie 59:48
think that's it. I don't know. I just, I was just really excited to be able to get the chance to talk to you. I mean, this this podcast has like changed my life. Oh, in so many ways.

Scott Benner 59:56
Would you take a minute to tell me how

Carrie 59:59
Yeah, I mean, first of all, it's been an amazing support system for me just having other people to like bounce things off of. But I mean, I learned so much from this podcast, like his chi completely changed by way of managing Liam. I mean, because of obviously, when he was diagnosed, I was listening to the doctors, and it just got me nowhere. And, you know, when I found this podcast, I was like, I'm doing everything on my own. I mean, not like on my own, but I mean, I'm making the decisions. And I, I mean, it's just been a lifesaver for me and my husband. We both I mean,

Scott Benner 1:00:33
I'm glad. Yeah, it's very nice. And you got your helped Mikayla hope to? Yeah, totally. Yeah. Do we get the Angelus and by any chance? Because I can use more listeners? Yeah,

Carrie 1:00:43
I should ask her. You don't really talk. But I see. out there.

Scott Benner 1:00:47
For me. Really? He should talk to her. Yeah, totally. Yeah. Feels like, feels like you owe me a little bit. And this is what I'm asking for. Yeah, sure. You got it. Liam's names, not Scott. That's too late. Yeah, you didn't name the next boy, Scott.

Carrie 1:01:00
Yeah, this is, I guess, doing everything for this podcast.

Scott Benner 1:01:05
You're very well, listen. I'll be very honest with you. I wrote the blog because I was trying to raise awareness. And at some point during writing the blog, I realized that it was, what do they call it shot in Freud? What is that? It just, it was just people complaining? Yeah. So I was I was saying what was going wrong? And other people were coming in and going, Yeah, that happens to me, too. You know, it sat and then people would like commiserate. And I thought, oh, there's value in this, like, there's value in knowing that somebody else is going through it. But it wasn't doing enough. And so I thought, like, Well, I'm gonna really try to help people. Like, like, Why buy I know this thing now? Like, I should tell them? Yeah. And then I did that. And it was, it was nice and everything. And the blog did well, but it didn't do nearly as well as the podcast, like when when I moved to podcasting, like, that's when, like, a note a week turned into like, 10 notes a day? For sure. Yeah, it was, it was really interesting. But it's just not something. The space just doesn't do what we're doing here on the podcast. Like, you know, if you stop and think about, I don't know, Instagram content that you see that kind of stuff around diabetes, it's all just very still like, hey, like, I have a recipe for this, or Don't you hate it when this happens? Like, yeah, okay. Like, yeah, great. I hate it. When that happens. Like, is there a way to stop it from happening? Could you tell me that? Yeah. And the only people who will tell you, like how they manage, I mean, often are just trying to drive you to a coaching service. So they tell you a little bit and then they want you to pay them. And I I'm not good with that either. Like, I just think that they carry between you and I, if I charge $9 a month for you to listen to this podcast, I'd be sitting in a gold chair. Okay. But well, you're very nice. But I'm trying very hard not to charge people for that. Like so like, I to me, it's like I take ads, and then the ads support the production that I it takes me 6070 hours a week to make the podcast. So like, I make the podcast and everybody gets to have these conversations, they get community, they get, you know, maybe tips and tricks and stuff like that, or learn things they didn't know before. And there's nowhere to go. You don't have to go pay somebody you don't have to like take a class, you don't have to have a frequent meeting with some jackass who just wants to have that meeting with you so they can charge you for it. Like that kind of stuff. You know, I think that's important. And yeah, you know, it to me, that seems like the right thing to do. Now, don't get me wrong. If I ever lose all the advertisers. I'm 100% gonna charge you for the podcast. You definitely should. But without at that point would be to keep it going. Yeah, I'm sure we'd all pay it too. So I just want I just want everybody. It feels really good to me to know that. You found it. First of all, you said you found at the hospital? Yeah. Was that just googling?

Carrie 1:04:01
Yeah, Google that. And I started listening to one of the series, I think it was like, I want to say it was bold beginnings. I can't remember. And I had it on playing and my husband was like, Carrie, we have so much going on right now. Can we like listen to this when we get home cuz I was like, No, this is, this is like, this is gonna be really important to us, you know, but we had, like, everybody coming in and trying to educate us so they can get us out. And so I just remember being like, Hey, I'm gonna come back to this because I just was overwhelmed. But yeah, I did find it in the hospital.

Scott Benner 1:04:28
The nurses. This guy on the internet is telling me about diabetes. Hold on. Yeah, they're like, yeah, he doesn't have diabetes. But don't worry, we're not gonna let that stop us from listening. But But anyway, like, you found it that early. So in my mind, you avoided some of the heartache that I had. Yeah, totally. I'm sure I did. That makes me feel good. Like there's things that didn't happen to you that trust me, you would not have found pleasant. Yeah. And like that, I think is terrific. And there's no reason that can't happen for anybody. I mean, you spent Yeah, a reasonable Hold on to this hour talking about, like, you just weren't getting good direction from people. Yeah, you know. So I don't think that's not the norm. I think that's what happens more often than not. I totally agree with you. Yeah. So I don't want that. I don't want that. I don't want you to I don't want that to happen to you. And I don't want you to pay for it. Yeah, that's pretty much what I'm what I'm trying to do here. So anyway, cool. Thank you very much. I appreciate you coming on.

Carrie 1:05:24
Thanks so much for having me. I was so excited for this. Oh, good. Great to talk to you. Oh, thank

Scott Benner 1:05:29
you. You were terrific. I appreciate it. Thanks. Yep, hold on one second.

Huge thank you to one of today's sponsors, G voc glucagon. Find out more about Chivo Capo pen at G Vogue glucagon.com forward slash juicebox. you spell that GVOKEGLUC AG o n.com. Forward slash juicebox. If you're looking for community around type one diabetes, check out the Juicebox Podcast private Facebook group Juicebox Podcast type one diabetes, but everybody is welcome. Type one type two gestational loved ones. It doesn't matter to me. If you're impacted by diabetes, and you're looking for support, comfort or community. Check out Juicebox Podcast type one diabetes on Facebook. Once there was a time when I just told people if you want a low and stable a one C, just listen to the Juicebox Podcast. But as the years went on, and the podcast episodes grew, it became more and more difficult for people to listen to everyone. So I made the diabetes Pro Tip series. This series is with me and Jenny Smith. Jenny is a certified diabetes care and education specialist. She is also a registered and licensed dietitian and a type one herself for over 30 years and I of course, am the father of a child who was diagnosed at age two in 2006. The Pro Tip series begins at episode 210 with an episode called newly diagnosed are starting over and from they're all about MDI Pre-Bolus Singh insulin pumping, pumping and nudging variables exercise illness, injury surgeries glucagon long term health bumping and nudging how to explain type one to your family. Postpartum honeymoon transitioning all about insulin Temp Basal. These are all different episodes, setting your Basal insulin, fat and protein pregnancy, the glycemic index and load and so much more like female hormones and weight loss. Head now to juicebox podcast.com. Go up in the menu at the top and click on diabetes pro tip. Or if you're in the private Facebook group, there's a list of these episodes right in the feature tab. Find out how I helped keep my daughter's a one C between five two and six two for the last 10 years without diet restrictions. juicebox podcast.com Start listening today. It's absolutely free. Thank you so much for listening. I'll be back soon with another episode of The Juicebox Podcast. The episode you just heard was professionally edited by wrong way recording. Wrong way recording.com

#1137 Teach a Man to Fish

Natalie has type 1 diabetes and uses Omnipod 5.

+ Click for EPISODE TRANSCRIPT

Scott Benner 0:00
Hello friends, and welcome to episode 1137 of the Juicebox Podcast.

Natalie is 50 years old she's using the Omni pod five, but she was originally diagnosed as a type two in 2012. After having gestational diabetes, she just got her type one diagnosis three years ago. Today Natalie and I are gonna talk a lot about Omni pod five and how it's helped her. She has hypothyroidism she says just a little bit, and Natalie is actually a returning guest. She was originally in an episode called cattle drive, which aired on September 14 2022. It's episode 754. 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 cosy earth.com. When you place your first order for ag one with my link, you'll get five free travel packs and a free year's supply of vitamin D. Drink ag one.com/juice box. This episode of The Juicebox Podcast is sponsored by the continuous glucose monitor that my daughter wears the Dexcom G seven Dex comm.com/juice box Get started today using this link. And you'll not only be doing something great for yourself, you'll be supporting the Juicebox Podcast.

Natalie 1:51
Hi, I'm Natalie, and I've been using the Omnipod. Five for about a year now.

Scott Benner 1:56
Natalie, how old are you?

Natalie 1:58
I am 50 years old soon to be 51.

Scott Benner 2:02
That's the M means I'm really 51? Basically, no,

Natalie 2:07
well, almost I mean, it's this month my birthday. So I might as well say that I'm 51. And my husband likes to remind me that I'm an entire four months older than he is. So there's that. Well,

Scott Benner 2:17
happy birthday. It's very nice. How old were you when you're diagnosed? Well,

Natalie 2:21
it's kind of tricky. I had gestational when I was pregnant, which was now 20. Some years ago, I was diagnosed as a type two, back in 2012 or so. And then recently, they don't know if I'm type one or what they call a typical diabetes. Somebody that's type one without antibodies. And that came to light a couple of years ago, so I don't know. 15 years, something like that.

Scott Benner 2:51
So you've been treating yourself as a type one for about 15 years? No,

Natalie 2:55
I've been treating myself as a type one for only about three years.

Scott Benner 2:59
Okay. 15 years total three years as a type one. Got it? Yeah. All right. I'm going to ask you a question here that maybe I'll just edit out, depending on how you answer it. Are we telling people you've been on the podcast before? No. Okay, well, if you don't want to, we'll just chop this part out. And I'll keep going. Well, we can tell them I'm fine with that. Okay. All right. So your episode was what seven? My

Natalie 3:23
episode was the cattle drive episode. And you'll have to forgive me, I don't remember what number it was. And in that episode, I was still pretty early in my journey to try to figure out what type of diabetes I have. And I talked a little bit about the study I was in to try to help figure that out, which ultimately, after a boatload of tests and a day spent in a clinical trial wing of a hospital. They still don't know exactly what I am. My my pancreas acts like it's a type one. But I don't show insulin resistance or some of the other typical hallmarks of type two. Right?

Scott Benner 3:58
I have a question. And if you have an answer for it, I'm interested. Is there any, like you've heard your episode? So why did I call it what I called it?

Natalie 4:09
Um, that's a good question. We talked a little bit about how with type two diabetes, it's a lot of driving people to an end. And sometimes there are outliers along the way that doctors don't know really what to do with

Scott Benner 4:26
and I called your episode cattle drive. Okay. I wasn't sure. Like, if you were gonna say, I work on a steer farm, or if it's gonna be something.

Natalie 4:34
You've been watching a lot of Yellowstone at that time, Scott, it's um, I think cattle drive was pretty high up there in your mental.

Scott Benner 4:43
You're probably onto something right there. Yeah. Okay. So, so you're back on the show more specifically to talk about being on Omnipod five. So,

Natalie 4:51
a while back, you had asked for people especially like different people across the whole spectrum of folks that might be using the Omnipod to speak to their experience. I'm pretty sure I was my endos first patient on the Omnipod. Five. And so I've been having a decent amount of success with it and just wanted to try to add my perspective. So

Scott Benner 5:13
a tiny bit of context. And so for three years as a type one, how were you managing prior to Omnipod? Five,

Natalie 5:20
I was managing with injections for about six months to a year once I finally relented and agreed to go on what I call mealtime insulin or full time and insulin. I've been using a long acting for a little while prior to that, so about six months with injections, but I knew once I started injections that I wanted to go to a pump as soon as possible. So I started the dash fairly quickly after starting insulin. And then I was on that for about a year before I could get my hands on Omnipod five, oh, I've had it for about a year now a little over.

Scott Benner 5:53
Alright, great. So let's talk about when you transition from MDI, to dash originally, that's probably like a weird time because you're just starting to use insulin more like, traditionally, I guess, how long did it take you to find a rhythm pumping with Dash,

Natalie 6:10
I'd have been pretty quick. But I also have to give you credit for that, because I found the podcast about a month or so before I actually started my Omni pod. I think that just starting to listen to the podcasts and some of the concepts about insulin and how it how it works. And hey, it's okay for me to want to take charge of my own health with it and not necessarily rely on the endo to tell me every little thing I need to do that made a huge difference in in my mindset, which I think then affected the way that it worked for me. So I went into insulin at about a nine a one C. Once I started insulin, I was down in the sevens. But after I started the dash and started listening to your podcast, I was down in the low sixes. And I haven't been above six in about 18 months. Good for

Scott Benner 7:03
you. Congratulations. That's wonderful. Yeah, no, of course. Okay, so what made you go from dash to Omnipod five, honestly,

Natalie 7:11
I wanted an algorithm. The idea I was doing a lot of interventions with the dash all the time, all day long, I had my nighttime Basal fairly well tweaked down, but I was still waking up in the middle of the night, multiple times a week, sometimes multiple times a day to either correct a hi or fix Hello. And during the day, I was doing a lot of extended basals a lot of temp basals just to try to keep my my numbers in the tight range that I was liking to keep them in. And so the idea that I could go to an algorithm that would kind of take a little bit of that burden off of me was definitely appealing. I didn't really consider tube pumps very well. And probably just because being diagnosed as an adult, it's hard enough to conceptualize having a another device stuck to you. And especially at that time, I don't know that I'd be that worried about it now. But the idea of having tubing connected when I'm a klutz I run into things all the time, I can just imagine the number of times I'd pull the tubing out or the dogs would grab it or whatever. I really looked at the Omnipod five and I thought about looping but I haven't been brave enough to to go down that road yet.

Scott Benner 8:25
The Dexcom g7 is sponsoring this episode of The Juicebox Podcast and it features a lightning fast 30 minute warmup time, that's right from the time you put on the Dexcom g7 Till the time you're getting readings, 30 minutes, that's pretty great. It also has a 12 hour grace period, so you can swap your sensor when it's convenient for you. All that on top of it being small, accurate, incredibly wearable and light. These things in my opinion, make the Dexcom g7. a no brainer. The Dexcom g7 comes with way more than just this. Up to 10. People can follow you, you can use it with type one, type two, or gestational diabetes, it's covered by all sorts of insurances. And this might be the best part, it might be the best part alerts and alarms that are customizable, so that you can be alerted at the levels that makes sense to you. dexcom.com/juicebox links in the show notes links at juicebox podcast.com to Dexcom. And all the sponsors, when you use my links, you're supporting the production of the podcast and helping to keep it free and plentiful. So you are having success without an algorithm but it's causing you to be involved more than you want to be involved. Yeah,

Natalie 9:42
I constantly had the controller in my hand. I did a lot of numbers watching too, right? Because with what you can only set your alarms so many times, right. You can't set a Hey, pay attention here alarm versus a hey, the world is ending alarm. And so you know I I do a lot of watching to try to keep it from getting to the point where the alarms would go off. It was a lot mentally, and that definitely is one of the biggest things. That's benefited me going to the five I sleep at night now, regularly. Yeah, I still have a nights where something didn't go quite as planned.

Scott Benner 10:19
But if you're making, like, if you're bumping and nudging, basically, before the algorithm is that mostly with, like corrections with food, like, where we use your intervention needed? Both,

Natalie 10:32
um, it would be like, Okay, I've been a little more active than I expected. And so I'm drifting lower than I want. And maybe I'm getting ready to get in the car, and I don't want to have to deal with it, dropping the low 70s. So I would if I was watching my numbers, and maybe I was a slow drift. And maybe I was getting ready to get in the car and drive. And I didn't want to have to worry about what would happen if I dropped below 70. While I was trying to drive, a lot of that kind of thing. Honestly, I think it was a lot more using temp basals up to catch a rise, and then maybe not cutting it off quickly enough. And then I would drift low later and have to correct it. You

Scott Benner 11:13
had a Basal rate set up that worked ish, but maybe wasn't strong enough. And so then you would come by push back on it cause a low later eat food drift up like were you kind of caught in that loop a little bit?

Natalie 11:27
A little bit. Yeah. And I think I was also using a higher Basal to offset meals without realizing that that's what I was doing. Because now that I've been on the five, my Basal rate is

Scott Benner 11:38
a lot lower is a lot lower. So then my question is, how did that work? When you started on the pod five, like where you're setting so messed up? Because you were intervening that it didn't allow the algorithm to work? Well, when started? Or how did the transition go into the algorithm? It actually

Natalie 11:53
went pretty smooth, because I had listened to all the things I could listen to your podcasts about. The five came out after I started, but I tried to do as much research as I could. And I knew that it was starting with a 5050 assumption. Yeah. And so I did a lot of research into gluco to see. Okay, what am I what kind of insulin Am I really using at this stage? How much insulin Am I using here? What's my usual Bolus to Basal ratio. And I calculated up my total daily and created a program for my basil, that was pretty close to what my dash would use, but it was more in line with what half of my total daily would be. And then once I got on the five, if I started drifting up, I would go ahead and correct pretty quickly. And that I think, helped the algorithm learn how much total insulin I was truly using a day rather than just what I told it I was using.

Scott Benner 12:55
Okay. So, you know, it's funny, Arden used AMI pod fire for a while, those episodes came out before she started. And I thought the same thing. Like I was like, Oh, I wish I would have made these episodes before she started trying to use this. Because there's so much information in them that leads to a good transition. But okay, so now you're using it. And it's good, like so I just want to say for people like contextually, you kind of said like the 5050 assumption, when you're setting up Omni pod hives, specifically, they want the algorithm to have some autonomy, I guess like like, you know, like, and they wanted to have like the autonomy is the wrong word. Like they wanted to have the flexibility to make decisions. If you were in a situation where let's say your basil should have been a unit an hour. But you were for some reason how to add half a unit an hour, but we're constantly making adjustments and adding insulin somewhere else. And then you go back and tell the algorithm my basil definitely point five an hour, well, then it's going to be way off of what you need. And so the assumption is that a lot of people probably just don't really know why their settings work, but that their total daily insulin is probably pretty accurate. So start with total daily insulin, give half of it to the to the basil give half of it to the Bolus during the setup process. And that gives the algorithm a chance at making good decisions. So it's so based on total daily insulin, really, those episodes are terrific. I should put the names of them in here somewhere. Maybe I'll put them at the end. Yeah, you know, so for when people are starting, it really does help. I also found a lot of people who did the same thing started before they had the information and went back and reset the algorithm and started over again. I got a lot of luck out of it that way the second time because the settings are really the whole thing. I've

Natalie 14:42
recently received a new controller from them because of the whole situation and I haven't set it up yet because I'm a chicken. But I think I mean knowing now what I know that I didn't know then I expect it to go pretty smooth. It's just been a little hack. Jake and I haven't done it yet. Yeah.

Scott Benner 15:01
Okay. All right. So I want to know about actual day to day use of it. I want to know how you handle meals, how you handle high blood sugars, like the whole thing. So can you tell me, like maybe take me through a day you get up in the morning is your blood sugar where you expected to be when you wake up, for example,

Natalie 15:20
I would say probably 75% of the time, my blood sugar is in a range that I'm comfortable with which I try to keep my numbers between 70 and 150. I don't freak out, usually it is 65. But if it gets much lower than that, especially if it's a trend down, I'll I'll take care of it. I do intermittent fasting. And so I usually don't eat breakfast, and I rely on my basil to hold me steady throughout the morning. And it does a really good job. I'm usually around 100 to 110. The exception is sometimes i I seem to have a fairly strong Dawn phenomenon. And I think lately, the algorithms been struggling a little bit to manage that the way I would like. So I might be waking up at like 130 instead of 100. So I've just been correcting in the morning to try to address that. And it usually drifts back down then about where I want it. But I will find that regardless of then the activity that I do in the morning, which might be going into the office, it might be chasing dogs, it might be what you know, going for a walk whatever, it does a pretty good job of keeping me pretty steady between 90 and 110. Good. That's

Scott Benner 16:37
amazing. What about overnight, like so is it? Like you go to bed at a stability and it stays there? Do you like what's your, what do you see when you look back over the next? It

Natalie 16:49
probably doesn't drift more than 10 or 15 points during the night. Unless I've done something crazy, like have pizza late at night before we go to bed or some sort of food that's going to have a really long impact, like sushi or something like that. It seems that sometimes the algorithm doesn't handle the rises for that as aggressively as I would like. But it still handles it. It's just I don't like looking at a number above you know, 150. And so yeah, I a little impatient to get it to come back down.

Scott Benner 17:25
So do you do intervene when you see that? Yes, usually.

Natalie 17:29
But what I have learned is that for me, I will tell the pod that, hey, I want a correction. And I'll use the CGM button to see what it's recommending I have. I've learned not to override that and give myself more, even though my head will tell me. Oh, no, you need way more than that. Because what I found is that that those will be the times that I end up going low later. And the one thing for me, I don't know if this is true for everybody else. But for me, I found that my loads are much less frequent. But sometimes it seemed like they take a lot more carbs to bring back up than what they did before when

Scott Benner 18:08
they do happen. Yeah, not necessarily when you overcorrect though,

Natalie 18:13
correct. If I don't overcorrect, then I don't end up having that low later.

Scott Benner 18:20
But if a low comes without correction, they're harder to bring back up.

Natalie 18:24
Correct?

Scott Benner 18:26
Is there any correlation between that way you've eaten before do you think

Natalie 18:29
could be, could be, it could also be that perhaps I was a little more aggressive with my meal rise then then what I had or maybe I overestimated my carbs. And so then later, if I dropped low then instead of needing one glucose tabs, clot, one glucose tab, maybe I need three.

Scott Benner 18:50
Okay, nothing. That's still not crazy. Like, no, no, of course,

Natalie 18:55
no, I'm not eating the kitchen. I'm not going nuts with juice boxes. Usually 15 grams will more than take care of it.

Scott Benner 19:06
Okay, I gotcha. What What's your eating style, like?

Natalie 19:10
I try to stick to a diet heavy in fruits and vegetables, lean protein. But I like carbs. And I firmly believe that. If you're out, celebrating with family for something that you should feel free to have a bite of a celebratory food if that's what you want to have. That being said, I find myself choosing lower carb options A lot of times just simply because I don't feel like fighting with blood sugars later. I know how to dose for just about everything, but sometimes I know that it's going to be a lot of work. And sometimes I just don't feel like putting in that work. The food itself isn't worth it. I often have a big salad for lunch with probably chickpeas for protein for dinner. err, I do a lot of, you know, some sort of protein and then a veggie and aside, I do have kids that are still at home, I do have a full time job. So some days are crazy. And if we all end up having to eat out, I want to be able to eat out without worrying myself sick about what my choices are. Okay.

Scott Benner 20:20
Yeah, I mean, I think that makes sense to me. So what do you think your total carbs a day are?

Natalie 20:24
It's usually under 150. Usually somewhere between 101 25. Some days might be more than that. Some days are less than that. But, but

Scott Benner 20:35
that's not a low carb lifestyle. It's just it sounds like a me honestly, just sounds like you're making very targeted choices about your food.

Natalie 20:43
Yeah, I tried to avoid processed carbs, you know, the white bread and the flowers and stuff like that. But like, if my stomach's upset rice is my comfort foods. So that was one of the things that I forced myself to learn to dose for. Because if I don't feel good, I want to have something like that. And it's easier for my tummy to digest. And so it works for me.

Scott Benner 21:11
Nice. That's excellent. I'm just trying to figure out like, where the lows come from when you have them. Do you think their activity?

Natalie 21:17
Yeah, sometimes, I think what I've noticed is that sometimes my sensitivity seems like it changes and so things that I would do, and dose accordingly and not have any trouble with maybe another day, I do the exact same thing the exact same way. But my result is a little different. And I know that it's probably due to different time of day or changing sensitivity or something like that,

Scott Benner 21:42
or hormones still an issue for you. Yes.

Natalie 21:45
So that could be part of it, too.

Scott Benner 21:48
Mostly I had foot or excuse me, I'm looking at one thing and saying another literally sorry, Natalie, I had a I had a foot surgery recently. I need to put my foot up. So hold on a second. Oh, go right ahead. I'm gonna make some noise. Just now happen on two episodes. I am all full of myself. Like it'll happen. I'll be fine. And then like, about a half an hour into it. I'm like, I gotta get my foot up.

Natalie 22:13
Yeah, it starts to throb or really hurt.

Scott Benner 22:15
What happened was what, what had happened was they told me the doctor, he's like, I'm just gonna make like this, like pinhole incision, I was like, okay, then he gets in there and decides, he's got to cut it open. Oh, and, you know, for the first number of days, like, I don't really know what that meant, because it's all covered. And you're like, Don't uncover it. Like, I like how they say, don't take this dress. For two weeks, don't take the dressing. I'm like, This dress is gonna last 48 hours, and I'm gonna have to cover it back up myself. So when I finally opened it up the incisions like four inches long. I was like, Oh, my goodness, like, oh, that's where all the pains coming from, like, really hurts. But I kept thinking like, it's whatever he had done inside of the foot, right. But that's not where the discomfort is coming from. It's the healing from the, like Frankenstein incision you put on my foot. So this the take your bone chip out? Well, it turned out to be more than that. So yeah, like so they the guy tells me, you know, gives me my inspection. I guess they call that an appointment. And he, he's like, Oh, that's gonna be a bone spur and arthritis, we'll clean out the arthritis. I'll take off the bone spur. I'm like, great. And then later, he's like, yeah, it was cartilage. It was torn, where we wasn't that much arthritis. And I'm like, Okay. He's like, I didn't take off the growth with the growth. Like, he called it a bone spur before, which made me feel old. Then he called it a growth and I was like, geez, we just stick with the same words, please. And, and he's like, yeah, it's gonna, he's like, I had to do microfracture surgery on your towel. And I'm like, What do you see, I made a bunch of little holes in the bone to try to get cartilage to regrow. And I go, Wait a minute, like, cartilage can regrow. And he goes, Well, no. And I'm like, Well, what? Then? He goes, it's more like fibrous cartilage. And I'm like, right? He goes, so it's not really cartilage, but like, hopefully, it'll support the toe. And any kind of like, whines up and I'm like, hopefully. Yeah. And I was like, I'm like, What, are you not telling me? Yes, I Well, you know, this is still a problem. And a couple of months, we might have to talk about fusing the bone in your toe. And I was like, No, I don't want to do that. I don't think that's a good idea. That was like, no, please. So now I find myself like hoping that fiber is Cartlidge grows in my toe. Anyway, that's where I'm at. But I got my foot up. So now I'm okay. Now I'm in a incredibly awkward position with a microphone on my face. But at least my foots not throbbing. Okay, so. So, I mean, what you hear people most say about algorithms in general, you've already said which is, man, it gives you your sleep back like that. It really is something. So can you talk about that for a little bit like what the impact that's been on your life of just sleeping through the night? To

Natalie 25:07
be honest, I think sleep and the lack of sleep is something that you don't notice how much it's affecting you until you actually sleep at night. I know when I worked night shift, and I had broken sleep all the time. I felt like garbage all the time. And I didn't realize until after I started sleeping at night that oh my gosh, this is what sleep slumps feels like this is what it feels like to wake up refreshed. And I kind of feel that way with the with the Omnipod five two is that I didn't realize how much I was getting up in the middle of the night on a regular basis until I wasn't anymore. And it just for me it it affects every part of me, I'm not so impatient, I'm in a better mood, I'm able to get more done in the mornings. Just because I've actually slept during the night instead of being woken up every, you know, two to four hours.

Scott Benner 26:04
It's such a slow drain on you when it happens. The diminishment happens so slowly, that once you're there, you don't know you're there. And definitely Yeah, and it's it really does suck like because you are having a significantly less desirable life honestly, and interactions with people. And it's, you know, just really, it screws you up. Now, like you said, you get it back, like oh my god, I remember feeling like this. I didn't know I didn't feel like this anymore. You know? Yeah, no, it's amazing. How often you said once in a while at night, but how often do you think you have to wake up

Natalie 26:41
and give yourself something? Probably less than once every two weeks?

Scott Benner 26:45
I was gonna say like, twice a month, maybe yeah, maybe once a month, maybe once

Natalie 26:49
or twice a month, depending on what's going on. And like I said, if if it's been a really active day, or if I've had a lot of activity during the day and didn't really realize it then sometimes that night, because again, I'm a little more sensitive than than what I planned, I might drift a little low. But I go back in the morning and I look at my, my numbers, and you'll see where the where it was taking insulin away from me during the night. So that I didn't get too low.

Scott Benner 27:19
Yeah, isn't that fascinating? When you look to see, like, wow, if this thing wasn't working, and didn't take my basil away for an hour here in an hour there, I would have had an hour whatever, like what's your Basal rate? Right

Natalie 27:34
now it's about a between a half unit an hour and about point eight minutes an hour, the idea

Scott Benner 27:41
that like to like one to two extra units would have been in you through basil. And then you definitely would have had a low and you would have been feeding that insulin, those two units of insulin, you wouldn't have known why. But the algorithm is just like no, no, just take it away. And then you don't get that extra. And even when you're drifting low. When you're drifting low, and the algorithm has been trying to stop you unless you've made some horrible mistake in the past. Even the low is not as like frightening because it happens slower. It's not falling. It's really it's, it's just change, I would

Natalie 28:15
definitely agree with that. There's very few times where I see an straight arrow down, or double arrows are even more rare. And it so usually catches the drift. And then I just need a little bit to bump it back up. It's in those cases where I've usually me screwing something up where I've been too aggressive or Bolus and then forgot to eat or you know, something like that that. Do you

Scott Benner 28:44
have a couple of questions around food? Do you have to Pre-Bolus still?

Natalie 28:47
I do? Well, half two is. The other day I didn't I was eating McDonald's and I didn't Pre-Bolus that. And I don't think I ended up going over 150. So Wow, that's great. There was that. But generally I find that a 15 minute Pre-Bolus to 30 minute, which is actually shorter than what I used to do MDI, really, it that seems to work pretty well with MDI. I saw that it would usually have to be 30 minutes

Scott Benner 29:15
to Brilli Well, you were also under you were under Basal too, right. Yeah. So you know, that makes sense as well, because now that that Bolus has to go in and has to overwhelm a lot just to get you moving. And then you've got us. Yeah, then you have to start falling so that when the food goes in, you don't see a crazy spike in the other direction. Yeah, yeah. Yeah, I try. I tried so many different ways to explain that a podcast over the years. But the best way I think I found is just imagine if your Basal should be a unit an hour, and instead it's point eight, like in that seems like well, it's not that big of a difference, but over 24 hours, it's point to an hour you're deficient. Right. So point 2.2 point 2.2 All this hadn't four hours have gone by, and four or five hours have gone by you're down a unit. So 510 1520, you're almost five units deficient a day of basil. If you're up, if you're a point eight basil when you should be a one. And that's, that's a significant amount, then you come along and have a meal. And you think the meals, only two units or three units, but you're also deficient the Basal all day as well, you started throwing in insulin, it starts making up for the Basal but doesn't impact the food, you spike up and you're like, I don't know what happened. I count the carbs, I did the thing. And it's everything settings, like, like, the algorithms are making it more obvious now two people, but I've been screaming about it forever. Like if your settings are wrong, like just nothing's gonna work, right. And basil has to be right. And people never pay attention to basil. So that's, I think that's the simplicity of why some people have issues. You know, you're right. Yeah,

Natalie 30:52
I was gonna say on that point, I firmly agree with you there. To that point, I will occasionally run in Manual for 24 hours, just so that I can be sure that my Basal settings are still spot on. Because I always worry, you know, what, what, if something were to happen, I need to know how much I really need, you know, that kind of thing. So I'll do that. Occasionally, you

Scott Benner 31:16
will, especially if something's changed, right? Like you come in with a one Basal into the algorithm. And over time, a month, a month go by and your needs changed. Like, let's say you gained weight, or you what if you had hypothyroidism and your medication was off. And you're, you know, you were a little more hypo than you usually are, that can even impact your insulin needs, like little stuff like these, right? So anytime I

Natalie 31:41
explain that, so because I also am a little hypothyroid. So.

Scott Benner 31:46
So I think that what you'll hear most people say is that when their TSH is high, they might end up using more insulin. And so the lower and more normal that you can get your TSH, you might end up using less insulin or, or your sensitivity might be a little better.

Natalie 32:04
Well, that's something I also have to thank you in the podcast for I doubt that I would have been as aggressive with my thyroid. With my Endo, had I not had all of the thyroid episodes to listen to mine was one of those that considered in range. But the symptoms I was having, were definitely not fun stuff to work with. My hair was falling out, my skin was dry, it's cold all the time. So I convinced my Endo, probably about six months ago now, to start me on some medication. And it's helped a lot. My numbers have come down. And I just had my visit yesterday, actually. And we're going to up the dose just a little bit. Because again, my numbers are still in range, but I'm starting to see some of those symptoms come back. And so just try it out.

Scott Benner 32:53
Since you just went yesterday, tell people what was your TSH?

Natalie 32:56
When I started treatment, my TSH was 2.8. Okay. And then after starting the medication, it got down to 1.02, I think. And then it had come back up to 1.8. So 1.8 is still below two, it's still well below four. But when I explained the types of symptoms that I was starting to see, she's like, No, let's try it. Good.

Scott Benner 33:21
That's great. Good for you. Yeah, I mean, you, I can say I should probably just print it on my forehead, but you don't treat the number you treat your symptoms. Yeah, and that's that's how you handle that.

Natalie 33:32
And I was just so glad to find an endo that was willing to work with some of them are very much insistent on the number so

Scott Benner 33:40
Oh, please, there are people walking around right now with three and a half TSH is and there and they have every hypothyroid symptom in the world, the doctors like you're fine. And that's it. It must be something else go for a walk, get some air, like you know, like stupid, and they should just use the medication to bring the number down to where the symptoms disappear. It just it's so simple. Natalie, it's such a struggle being the smart to understand.

Natalie 34:06
Here I am adding to your struggles. Right. Thank you. So

Scott Benner 34:09
there we go. Yes, yeah, it's just making me feel terrible for being so smart. I guess I'm joking, of course, because it's such common sense. And yet you watch people just ignore it constantly. And the idea of it was in range. So freezes some people, like I've had private conversations. I spoke with a woman who's was in the hospital once and I'm like you're describing a high TSH and hypothyroidism. And she's like, Well, the doctor said it's in range. I'm like, but you just listed all your symptoms. They're all hypothyroid symptoms. Like what would it hurt to try the medication and she was resistant? She's like, No, no, it's in range, like in range was like a speed bump for that was like 10 miles high. She couldn't get over. And then finally, you know, it goes six months goes by, and an email comes Oh, I finally did that thing. I feel So much better. I mean, I could

Natalie 35:02
have told you that, not

Scott Benner 35:03
only could I have told you that, I was telling you that, and it just, and you ignored it, it's just and then it'll happen to their kid. And they'll go, and they'll start the whole process over again, instead of just assuming, like what I learned the first time, you know, maybe I should put the practice here, it starts over again, well, they're having symptoms, but their bubble is high. And I'm like, Oh, my God, we're gonna do it again, I'm gonna go, okay. But anyway, I'm gonna do so anyway, with all these variables that are possible, see, if I can find my original thought. Imagine you go on the algorithm, and you're, you're rolling along. But then something's changed, you've gained weight, you've become less active, maybe you had a job where you used to walk a lot, now you don't walk anywhere, that is not a thing you would think about, right. And so if you weren't on an algorithm, and you stopped all the walking, you might start seeing higher blood sugars. And you might start giving yourself more in sample, the algorithm just sees the higher blood sugars and starts to give you more insulin. But to your point, you don't even know that's happening, really. Because you just, you don't even you just you're not going to know, right. And so then if you have to go back to manual for some reason, or, you know, I don't know what happens, your shipment doesn't come or you're suddenly MDI, and you're over here with your one unit of basil, because I know, this was what it was like before, and everything's still working, and you forget to factor in those other variables, then all of a sudden, you're not gonna have enough insulin. And by the way, the other way too, what if you got a more active job, and now the algorithms giving you less insulin, and you flip over to manual, and all of a sudden, you're getting low and you go, I don't understand, like, like, it's, it's that kind of stuff that I liked. What I'm saying is, I like that you go into manual once a while and test your settings, basically. Yeah.

Natalie 36:45
And like, when I was having trouble with the dawn phenomenon, and rising every morning, the first thing I did was, I went manual, so that I could adjust it and see how much I really need to come in to the number that I like, I like to float around at at night, if I can. And so once I did that, then I let the algorithm try, it still wasn't catching it. So I went back and adjusted my insulin seven sensitivity during the early morning hours, so that it would give me more insulin during those early morning hours. And that seemed to really help. And so I might be at the point where I might need to make a little tweak there. If I still continue to see that morning rise that's a little higher than I want, but

Scott Benner 37:31
I love it. Well, you've just said something that made me think of something. And then I looked at myself and thought, I can't believe my foots in front of me while I'm talking. And then I lost my train of thought.

Natalie 37:40
I can't see your foot. Nobody needs to know you're not

Scott Benner 37:43
distracted by but I'm staring at it. It's out in front of me. Oh my god, what were you just saying? Hello, I'll get back to it. Oh, I'll go to my other question till I get back to it. What do you do for fat or protein rises?

Natalie 37:57
I really don't. And I think that's the two factors. Number one, it's probably a factor the algorithm, I think it it catches it. Number two, I don't usually have low carb meals that are high in fat and protein. And I know that sometimes people see the protein rise a lot more if they're lower carb. But if if I've got a rise happening, that's outside of what I would expect, or it seems like it's lasting longer than the food should be sticking around. I'll go ahead and just do a correction then. But typically, I will stick with what the algorithm is recommending. Unless I feel like I know something that the algorithm does it like, Okay, I've been snacking on something and the algorithm doesn't know that. And so I'll do a more aggressive correction.

Scott Benner 38:48
Yeah, okay. Do you ever have like a french fries situation where you have like a burger and fries and you get like that 90 minute later rise.

Natalie 38:57
Um, sometimes what I'll do with those is I will Bolus for the carbs that I'm pretty sure I'm having an O I also usually don't Bolus more than five units at a time. So whatever my carb ratio is, that gets me to five units. If it's going to take me over five minutes, I'll break it up. So I'll do a partial Bolus. And then 30 minutes later, I'll do another Bolus because for me my body tends to reject big Bolus. Excellent. Yeah, it doesn't like big Bolus has no matter where I put the pod. And so I'll just break it up like that. And so if I'm having something like french fries, or something like sushi that I know is going to stick around. I'll set a timer on my phone for either 30 minutes or an hour depending on the kind of food and then I will just do another Bolus of a part like usually like, I don't know 50% or 20% of whatever it was that I ate. So that that controls that later rise that's going to happen. Okay,

Scott Benner 39:55
okay, good. I like that. What do you think you were seeing tunneling you know, It is when I say that. Yeah,

Natalie 40:00
yeah, that's exactly what was happening. It just seemed like there's too much insulin going on that my body could absorb at one time. And so then it would just like sneak up back out the hole and leak around the the edge of the cannula there. Yeah, once I stopped trying to do bigger boluses. And then also I, if, if I put it on my thighs, it seems like the pod gets bumped more there. And so I will usually go ahead and put an over patch that has a strap on it over the pod to keep it from rocking back and forth.

Scott Benner 40:35
Yeah, kind of bringing their cattle out a little bit. I think that's just for do you think it's getting bumped? Do you think it's just from walking?

Natalie 40:42
For me, it's probably a bit of both. I tend to bump into things, my dogs will hit it. I don't seem to gauge the wideness of doors very well. And so I when I first got my Dexcom I was constantly ripping them off on doorframes. You know,

Scott Benner 40:59
I find us talking about this sometimes hold on a second. About I think it's an actual thing. Hold on. Awareness. Yeah. I walk into doorframes homeless people seem to think that's an ADHD thing.

Natalie 41:15
You might not be wrong. My son was recently diagnosed with ADHD. And we've actually had to fight for a long time to get him diagnosed for a variety of reasons. But as I learned more about it and researched more about it, I'm, I'm pretty sure I'm an undiagnosed adult with ADHD. But I've been able to find coping mechanisms to deal with it. I'm, you know, I work in a professional job I get by, I'm getting by,

Scott Benner 41:43
like, I'm 51. But I'm almost finished.

Natalie 41:49
I just I don't know the point of being diagnosed at this point. Right? If I've made it this far, but I'm pretty sure. Yeah,

Scott Benner 41:57
the only other thing, there could be like a visual problem. But I mean, I think it's called vertical. Oh, God, hold on a second. I'll find it. Vertical header theory? Oh, I don't know. I'm just saying that the bumping into a doorframe is actually could be a sign of other things. I also used to be what I called a close Walker. And, and I stopped myself from doing it, which I've said on the podcast before, like, I used to turn corners and like catch the edges of walls and things like that. And then one day, I said to myself, I'm not going to do that anymore. I'm going to like purposefully not do that. And I stopped doing it. So it's not ADHD, because I was able to like, make yourself stop and make myself stop doing it. Right.

Natalie 42:42
Yeah, I think for me, once I got used to wearing either the Dexcom or the pod, that part of it's gotten a lot better. But I'm still a klutz. I still bump into stuff.

Scott Benner 42:56
That's why I just wanted to bring it up because it comes up. It's like that. That rapid eye movement, Rapid Eye Movement Desensitization like thing that people do with therapists, the amount of times that comes up on the podcast is fascinating. So just yeah, it's just an the bumping into things thing. So I like to like, shut out for a second, just to this, because like, right now someone's like, Oh, God, I probably do have ADHD. And I walk into things all the time. Like, I just I don't know, he didn't use this me to think someone's in their car right now thinking that. That this is where they figured that out at. But anyway, yeah, cuz

Natalie 43:33
you know, it makes so much sense to get so much medical advice from a dude you listen to on a podcast. Yeah.

Scott Benner 43:39
Badly. None of this is medical advice. I just want to say that right now. But

Natalie 43:43
yeah, that used to really floored me that I was learning so much from the podcast, but tell

Scott Benner 43:50
me about it. What like when you were first because I it makes sense to me. But tell me about the feeling?

Natalie 43:55
Well, you know, you always hear, you always know not always here. But the whole thing about, you know, you can't trust everything you see on the internet, or you can't trust all that you read on the internet. And oh, you're gonna let Dr. Google diagnose you and this kind of thing. And so then I start listening to a podcast that's put on by a gentleman that doesn't have diabetes, and isn't a doctor. But yet through his life experience and through the things that he's he's learned, the things he's saying makes sense. And then, you know, you brought Jenny on to and she was agreeing with the things you were saying. And it was just such a different way of thinking about things than what had been presented to me through the medical community. Yeah. I like devoured your podcast when I first started listening to it to the point where my kids are teasing me. Mom, are you listening to your doctor podcast again? Yes.

Scott Benner 44:52
Well, I guess he's to say, you know, like when, when one of you says that you like the podcast, you listen to it, I get it. For my wife, or my kids or stuff like that all the time, and I agree, listen, as as crazy as it might sound for me to be saying it, I agree with you, I don't think you should be listening to me either.

Natalie 45:13
Know how we ended up here,

Scott Benner 45:14
it just is, um, you know, when I speak in public, I'll stand up in front of a crowd of people, and sometimes their big crowds, you know, hundreds of people. And I'm like, Look, I'm going to talk about diabetes in a way that's probably going to sound almost foreign to you. And it's going to some of it's going to be shocking. And, you know, if you really, if you already know about it, or you've listened to the podcast, it's not shocking at all. But to hear somebody say, I want you to consider Pre-Bolus In your meals, or don't stare and look at a high blood sugar for three hours, because it's not stalking if you needed. Like those things. When you're told that by doctors, when you hear them somewhere else, you think, oh, that's crazy. Like, I can't do that. And then I mean, I do take your point. Like, it's a It's the strangest thing. It's like you're taking like, it's like somebody's telling you how to change a tire and they've never driven a car. I don't have diabetes, like so I don't really like I don't know what it's like to live with it. I know what it's like to manage it. And I know what it's like to care about somebody who has it. But still, like you said something earlier in the episode that really like struck me. You said, when my stomach's upset, I like to have rice. So rice is something I had to force myself to learn how to Bolus for. And when you said that, that makes me feel like, like, oh my god, there are things people won't put in their mouths, because they're scared of the Bolus. Oh, absolutely. Yeah. And that's prevalent for people. And that's the thing I don't know firsthand, I know that from listening to you guys and talking to

Natalie 46:50
you know, and sometimes it's because it's not worth it. And sometimes it's because oh my gosh, I would have to have X amount of insulin to to have this food. And that's so much more than what I normally take. And I'm afraid of taking that much. For me it was more, figuring out the strategy of making sure that it doesn't continue to hit me for, you know, four or five hours after I eat it. But I'm, I don't know, I'm pretty flexible in my eating style. I don't think I've weighed a food my entire life, even after having diabetes. Yeah, I definitely estimate carbs a lot more than I scientifically calculate them. I know, I would not have the control that I have. If I hadn't been learning from the podcast and the people on your podcast.

Scott Benner 47:39
That's excellent. I'm very happy to hear that. And it's kind of you to say, so I appreciate it very much.

Natalie 47:46
What I went to the endo yesterday, when you hear it, she said, I mean, I

Scott Benner 47:49
thought we were gonna do a monkey impression. Is that what that was? I was like, I don't have a monkey impression. But okay, yeah, you're really excited. I'm so excited to be here with you.

Natalie 48:00
My, my AMC is 5.4. And that might be the lowest I've ever had. And then she also, after going through all my data and looking at the things and asking me about the lows. She's like, Natalie, I wouldn't change a thing. You're doing great. You look like you're really on top of it. And you know, like, it looks like you know what you're doing? And I wanted to laugh at that part. But

Scott Benner 48:25
I said, Thank you. Why did you want to laugh at that part? Because you never feel like

Natalie 48:29
you really know what you're doing. Right? Right. Especially if, like this week, I went to the state fair, and my Dexcom decided to do take a break. When I got to the state fair. Luckily, I had a meter with me. And so I just had to do finger sticks throughout the day. But Oh, am I going to know what to do in this situation? What about this situation? That kind of thing?

Scott Benner 48:53
You went to the state fair without an extra Dexcom? I did. Yeah. That's because you're an adult art and just went out? Like Brian is ready to you and I were getting on art and left to go out with someone. And I was like, Hey, you're going kind of far from home? Are you taking stuff with you? And she goes, now I checked my pod, it has plenty of insulin. I was like, What about just extra stuff? In case she was now I'm like, okay, by the way, nine times out of 10 It's gonna be fine. And, but but the one time you're at the State Fair, like, I should probably keep one of those sensors with me. Like, you know,

Natalie 49:25
and it's so well, and I thought about going home to get one right. But I was like, you know, it's a two hour warmup anyway. And I'm an hour from home, and I would have to drive back up here to pick up my kid later. So I've got my meter. I've got my strips. We're just gonna go in manual. Pump. Yeah. And then I'll just fingerstick and I ate food that I wanted to eat. I had an era corn and I had I shared some videos with my daughter. Nice and it was a great day,

Scott Benner 50:00
I would have done it. Listen, in that scenario, I would have done exactly the same thing. In my mind. I think like I'm thinking ahead all the time. So to me, I think, Okay, well, the CGM takes a crap at a bad time, I'd swap it now do exactly what you did. But at least two hours from now, I'd be back again. Like, that's how I think about it. Like, then we're back. And but also, you didn't do anything wrong. I'm just saying, if you were if you were a kid, if your kid had diabetes, and you were me, I bet you would have had stuff with you when you went to the fair.

Natalie 50:31
Probably would have had a spare Dexcom. Yeah, yeah. And typically, like if I'm going somewhere around home, I don't carry extra decks comes usually I will carry extra pods, extra insulin and a pen, and usually a meter. But I usually don't necessarily carry extra decks comms. Now, if I'm traveling, or going far away from home, then I packed like, I'm going to be gone for three months, even if it's only a week. Yeah. And there's been times that I've needed the extra supplies. And then there's a lot of times that I bring everything home, but to your point, it's the one time that you don't have it that you really need it that you prepare for. I'll

Scott Benner 51:12
tell you to In fairness, CGM are one of those things like they either go on time, or they were they go, and you can usually see them going. It's not usually a thing that just happens. It's almost like you know what I mean, you get choppy data from it or something like that happens, you start having connection issues or something like that. You can kind of see it coming. Usually,

Natalie 51:33
I should post the picture of when it happened on the website, I think. Okay, so I know that spray sunscreen affects the pods. Does it also affect the Dexcom? Because it was within five minutes of me putting sunscreen on that the Dexcom decided to take a break. The

Scott Benner 51:49
only thing I know about spray sunscreen is that if you get it on an AMI PATA could crack the shell of the Omni pod, right? Yeah, I don't I mean,

Natalie 51:58
I've never heard of anybody having trouble with the Dexcom. But it was just so coincidental that within just a couple of minutes, it decided it was not happy. Yeah, I

Scott Benner 52:07
think that's just Murphy's Law. I think that's really what that is. Because it

Natalie 52:11
normally I last 10 days, usually. And this one was only on day like four.

Scott Benner 52:16
Oh, yeah, something was definitely off. I you know, that's actually difficult for me when people try to talk about Dexcom not lasting for them. It last so consistently for Arden, like I did, it's just like, it's just good luck, you know, but 10 days, and now the g7 has a grace period, she goes into the grace period, no problem. Like it's she's always had really good success with XCOM. So

Natalie 52:40
I'm sure most people loved it. Yeah, it's, it's been so informative. And it's really changed how I manage. And I started using it when they thought I was still a type two. And so that was very helpful. Especially once I started insulin. It's just been great.

Scott Benner 52:57
Cool. So I'm gonna ask you, do you have anything else about Omnipod? Five, you want to say before I ask you my next question. No,

Natalie 53:03
I mean, I think even though it's got a target of 110. I mean, I'm able to as an adult, have a, a one see that's, I think spot on an average of 110 or 106, something like that. And so don't let the target dissuade you from trying it. Yeah. Well, no,

Scott Benner 53:21
it's terrific. It's terrific. And this is this is it like the in my mind like these, this is the year of like algorithms, I can't wait to see what happens to them as we move forward. Like it's very, very exciting. So my last question is before we started talking, wow, that's not fair. Also, it's not accurate. Before we started recording, you were talking about the other episode that you did, and that you wish it would have gone differently. And like all this other stuff, so I wanted to like chat through that with you if you're comfortable chatting about that. Okay, do that. So, go ahead, tell me what you said first.

Natalie 53:56
So I just said that I, I reminded you that I'd been on the show before. And that I really wasn't very happy with my episode, I felt like I didn't sound like myself, that I really wasn't very engaging. And it could have gone a lot better if maybe I'd let you do more of the leading on the episode rather than having like a specific list of things that I really wanted to get across than it. It stemmed from the fact that I was so passionate and still am very passionate about helping all people with diabetes, but especially those that have been misdiagnosed as type two, or maybe they even do have type two and they're getting a lot of, of shame or grief or not support from the medical community that it can get better. And there's there's things that can help.

Scott Benner 54:51
So your goal was to help people so you came on and you had a list with you? Yes, and then I probably drag you around. Not letting you get to your list. Is that fair?

Natalie 55:01
I mean, yes, a little bit, but I think you did. Let me get to the list. But I think that if I had just let the conversation flow flow a little bit more rather than having prepared, not poorly prepared, but you might be surprised at how much I practiced because I really just really wanted it to go really well. In the end, I wasn't super satisfied with how it went just because I didn't feel like very many people would. Wait,

Scott Benner 55:29
wait, wait, how do you practice? How do you practice to be on a podcast? You

Natalie 55:33
practice your your list of topics and like, what questions do you think the host might ask you? And how would you answer that then?

Scott Benner 55:42
Oh, that's nice. Thank you. Well, let me tell you something. Your episode has been up for less than a year. And it has well over 20,000 downloads. Oh, wow. So it's doing good. And yeah, and if you're worried that it's not helping people still, it is downloaded on an average of 30 times a day. Oh, my gosh, that's a long time after it initially. Yeah.

Natalie 56:10
So in the in the Facebook group, I occasionally will see one of the one of your helpers, reference. My episode. Isabel is really great about Isabel and Nico. Both are really great about helping somebody that's, especially if they're type two, or they don't know what they are. Or if they've got something weird like I do, where they don't have antibodies. Yeah, they'll refer them to my episode, which I really appreciate. Because ultimately, if it can lead to more people being in that study that I was in, we might get more answers for folks like me.

Scott Benner 56:42
So you had an expectation of how it was going to sound or how it was going to go or what you were going to say, and then you didn't hear that back? Is that right?

Natalie 56:49
I heard the words, I didn't hear the excitement, or the tone or the flavor. So

Scott Benner 56:56
you have a very specific way of speaking. You know that you speak in a very specific way, like so you're somebody from the Midwest, you're not monotone. But you don't vacillate very high or very low while you're talking. Right? And so you're not, you're not purposely engaging people with the sound of your voice, you're speaking you have a lovely speaking voice, it's fine. You speak a little slowly. And that throws me off a little bit. So because but not me, personally, and not you specifically, when people speak slowly, there's a clock in my head. And I want there to be talking. And I want there to be shifts in conversation. And that's me, like producing the show while I'm making it. So I have to go back and listen to yours to find out if, like you talking more slowly made me be more like made me try to like make up for that. Because that happens. Sometimes

Natalie 58:00
you're probably on to something there because I, I often have to speak in my job. And by nature, I speak very quickly, especially when I'm excited. And so I've had to have years of practice of slowing myself down, especially in situations where I might be nervous, and I was definitely nervous. So I very likely could have been speaking much more slowly.

Scott Benner 58:25
Well, and by the way, if Isabel is suggesting your episode to people, then it's good. Because I don't know that you see, you're saying thank you, but I'm giving you an insight Isabel that other people don't. So like if she didn't like the episode, she wouldn't share it with people. Oh, that's funny. Yeah, you're good. Trust me. I'm always just amused like i. So this is what I told you before we started recording. And this stays completely true. If I let people be involved in the process after they recorded the episode, I don't think any of the episodes we get on the air. Because everybody has either an idea of what they're supposed to sound like or what they were supposed to say or what this was supposed to accomplish, instead of just trusting that I know how to build the podcast, so it helps people and and they all have like the site. A lot of people have an idea of what how it should go. And if I gave them any editing power, then people wouldn't get the shot. Like if I gave you your episode, it wouldn't exist because you'd be like, no, no, it's bad. I didn't do what I meant, or blah, blah, blah. And But meanwhile, it's being given out by group experts in the Facebook group as something to listen to. So who's right? I mean, I'm right to go ahead and say, Man,

Natalie 59:34
you're Isabel's. Right. Let's put it that way. Right.

Scott Benner 59:35
Like, exactly. And so you're you're wrong about it. And so you are the worst judge of an episode about yourself. So here's the question. I usually ask people when they get into your situation. Do you like the podcast? I love the podcast. Does it help you? Absolutely. Then you should trust me that I thought your episode would do the same for other people.

Natalie 59:59
And I will do You bet. Yeah.

Scott Benner 1:00:00
Let's see that long pause you made after I said that. I was thinking about it, you're while you're thinking about it, my brain is yelling, oh my god, Natalie faster. Let's go

Natalie 1:00:12
on with it. You don't think that has anything to do with you'd be an east coast you.

Scott Benner 1:00:16
So I don't know, because I've lived here my whole life, I couldn't judge that. What I can tell you is that from a listening standpoint, I am a fan of audio entertainment. And I know what I don't like. So I don't like pausing. I don't like I don't mind if people think. And every once in a while, like a long pause, I'll cry during some people's pauses, because you can feel the emotion hitting them in the silence. But when people just have a slower way of speaking, I think it's it doesn't engage the listener. And I want people to stay engaged because you said something, 45 minutes into this that was really impactful. But I don't want people to get 10 minutes into it and be like, Oh, she talks slow, and then not make it to the 45. And by the way, people don't have that conscious feeling. Like, oh, she's speaking slowly, I'm not going to listen, it just it hits you wrong. And so you need something to kind of pull you in, I don't know, like a total world and just keep spinning you like so you're you're stuck to the outside wall and can't get away. You're like I have to stay here and ride this ride. And that's that's it. And it also it's it's an unfair thing to expect the people. So making the podcast has taught me to be more patient, because there's nothing wrong with it. It's just not 100% right for me. So, I will tell you, I will never tell you what it is. But there is an episode of the podcast that went up this year. It was the first time it ever happened to me. I put up an episode and I didn't like it. I was like This sucks. And oh, I can't believe I'm doing this. It's so bad. I hated the way the person spoke. I hated that. I hated what they talked about. It just ate it. I hated it. And oh my god, do people like that episode. I was like, son of a bitch. And like I got emails about it like, Oh, I love this episode with this person. I was like that one. Are you kidding me? I was like, oh my god, her voice is so annoying. No, like, but it just turned out what I learned from it is it wasn't for me. It didn't make it not for other people. And I have gotten good enough at this now that I was actually able to moderate the conversation. Even though I wasn't enjoying it, it was still a good conversation for somebody. And that was a big learning moment. For me. Real it really was honestly, like even talking to you today. If you if I would have spoken to you. Two years ago, I would have talked over you a lot. Like because I know what you're going to say in those pauses. And there's a part of me that's like, just say yes, like, let's go. And I've learned to like, like, just wait, I'm getting better. The podcast is making me a better person. Honestly, if I'm being honest. So well,

Natalie 1:03:06
I will say when I first started listening to you, I was like, Well, this guy just shut up and let the guest talk please.

Scott Benner 1:03:12
Now, I know what I know what needs to be said now, like, I don't need them. But even that, like back then I needed the thing to do a thing. Like I don't know if that makes sense or not like I know you think of it as your personal story. But the way I think of it is it's a slice of life a look at something from a certain perspective, and people want to hear it so they can draw from it what they need and move on. Like nobody is. I'm sure there are a couple of episodes like this. But for the most part, people who listen to the show religiously, don't know everything that happened in every episode, but they know what they took from it. And you know what I mean? And so that's the, to me the important part. And I'm like, you know, I've slowed down over the years, right?

Natalie 1:03:57
Yeah, I would say that for sure. Because

Scott Benner 1:04:01
I'm like, I don't know. But also keep in mind, there was like long stretches of time where my iron was really low, and I was still making the podcast. So I don't even take responsibility for any of that. What do you think?

Natalie 1:04:13
It's all done under different circumstances. Yeah, I

Scott Benner 1:04:16
was a completely different person. Listen, I gotta I gotta review the other day where someone just didn't like that. I talked, I spoke to somebody personally about like, their personal life. And the person's like, this is supposed to be about diabetes. I'm like, well, first of all, it's supposed to be about whatever I think it's supposed to be about. That's why it's my podcast. You know, like, so if you want it to be about what you want to be about, go make your own diabetes podcast. Good luck. You know, like, that's fine. That's where the conversation took me. Like, am I always right? I'm not, like, am I always exactly like, do I speak exactly the way I should? I don't, but if I start measuring my words and practicing for the podcast, you guys aren't going to you're going to hate it. It's gonna suck. And that's part of the reason why I don't let people do it who Come on. Because it seems it seems like practice, like, imagine if you would have last time been like, Oh, I remember practicing this part in the mirror, and then you did it again, it would sound, it would sound rehearsed, you know. So anyway, that's one

Natalie 1:05:17
of the things that I love about the podcast is that you've got so many different elements, right, you've got the management episodes, management from all kinds of different perspectives, you've got, the how we eat, you've got the defining diabetes, the bold beginnings, all of that, you've also branched into the type two stuff now to help folks on that part of their journey. But then you also have the personal stories, and I, I love listening to the personal stories. In the beginning, the management side of it is what really brought me in because I needed it. But the personal stories, I think, help on a different level. And they they help you appreciate both where you are, and they give you ideas of where you could go. Yeah, some of them have been really, really inspirational. And you know, we I find myself crying along with them.

Scott Benner 1:06:10
Yeah, trust me, I am. So that's the key to this whole thing, right? Like, you could get on here and read a list and say, Here do these things. You're a one seal by this, but no one's gonna listen to it. They just aren't like, so you have to like I've told people privately, I've probably said it on here, I'm not scared to say it on here. I partly see my job is I'm tricking you into paying attention to something that's boring, so that you can take better care of your health. And I'm doing that by giving you like conversations with people that are like the ones you just described, you know, and, you know, again, there's no shortage of entities, Ada, for example, who has all this information written down. And I defy you to know where it is or what it says. Because just because you make good information available to people, doesn't mean they're going to find it, it doesn't mean that if they find it, they're going to absorb it, it doesn't mean that they're going to take the time to listen to it you still see online? I mean, how often does someone come to me and say, I don't know what to do. And you'll hear me and I'll respond back or I'll you know, the people who helped me in the group will respond back and say, Here, listen to the bold beginning series. I don't have time for that. Can you just tell me what to do? I'm like, why? Like, I know, because that's not a valuable use. I can't tell each person individually what to do. Like, that's why I made this thing. Even if

Natalie 1:07:33
you could tell them what to do. There's a difference between somebody telling you what to do and you working through it on your own. There's part of the learning process in there to Scott that, that people have to take responsibility for their own learning in their own care through it

Scott Benner 1:07:49
only are you trying to name the episode on your own? Are you trying to name the episode Teach a man to fish? Is that what you're trying to do? Because that's, that's what you're saying? And you're 100%? Right? 1,000,000%, right. I can't if I come and do it for you, you won't be able to do it again the next time. Like just listen to the stupid I did it. I gave you all the Listen, you mentioned Isabel earlier, she texted me this morning because she's doing something that's going to put a variable into her life. And she goes, Hey, I'm doing this and this, should I do this? And this like as an example with my insulin? And I answered her back. And she goes, yes, yes, I know that from the podcast, and I would do well. Everything I know is in the podcast. Like, I'm not gonna, I don't have like a magic extra thing. I didn't I didn't say out loud at this point.

Natalie 1:08:32
magic bag of secret. Yeah, no.

Scott Benner 1:08:35
Here's what I don't tell anybody. Right, like so. But that feeling that people are like, just tell it to me. Like I understand it. I genuinely understand it. They're probably overwhelmed and scared and they just want it to be right. But the truth is, you have to live through this. You have to go through it. You have to learn. And the podcasts will make it easier for you. But you still have to I don't want to say do the work, but you have to experience the experiences. You have to react, watch it happen, watch it work or not work, learn from it, do it again. And that's just, it's just that's the truth of all this. Absolutely. There's no shortcut to it. But there is the podcast is the shortcut. But it's still not. It's still not five minutes

Natalie 1:09:22
doesn't prevent you from having to do it yourself. You still have to do it. It's 1,000,000%.

Scott Benner 1:09:26
Right? Like yeah, and I don't know, like, I do my best. Like I do my best to get it to people. I do my best to make it interesting. I avoid like the plague all the people who do who do the rounds, the diabetes rounds. Like you don't I mean, they're saying the same crap over and over again in 16 different places. They've been on every blog, you know, you see them like talking 16 Instagram accounts are all saying the same crap. And you know, they're there. I don't know what they're looking for clicks maybe like I have no idea But the content to me is not. It's not accessible. And I don't usually like talking like that. Like, I'm like saying out of the box and accessible and meet people where they are and like that. Oh, that's

Natalie 1:10:09
all the jargon. Yeah. Let's see. Oh, now see, they're all fallen out of my head. But yeah, sorry. No,

Scott Benner 1:10:18
no, no, please. All that anything you've heard on a meeting at work? I'm not going to say, we're

Natalie 1:10:24
not going to boil the ocean here today. Is that what you're telling me?

Scott Benner 1:10:28
It's a way that people talk to say nothing. Yep. And so there's these I just had someone explain this to me yesterday, he hears this, he's gonna be like, I can't believe my thoughts are on the podcast. But we were we were talking about somebody I do business with. And I said, I don't understand why more companies don't have me speak at events. And by the way, I don't even know if I would say yes, but I don't understand why they would. And he said, well, because everyone sticks with safe and what they know. And so it's this narrowcast information that is neither incredibly helpful, or incredibly, not helpful. It's banal, okay, like, and they will feed you that banal information until the end of time. Companies, Instagram accounts, influencers, are all going to say the same crap. Because it doesn't take any thought. It's not going to offend anybody. It's not really going to help anybody, but it's not going to hurt you either. And then it's just down the middle. It doesn't, you don't have to infer from it. You don't have to learn. You don't have to do anything. You can be a passive passenger on their content Express. And they get clicks. And then they sell those numbers, those clicks for ads. Right? And you might think, Well, yeah, Scott, you're doing the same thing. But I'm not. I consciously decided to say what people need to hear. So that that will help them so that they will share it was someone else, and then that creates the clicks. And then full disclosure, I sell those clicks, for ads,

Natalie 1:12:13
which is what why we continue to keep getting the podcast. That's

Scott Benner 1:12:17
why on a Friday afternoon, at three o'clock, I can sit here chatting with you recording it, and then putting it up for people to hear. Because there's going to be two ads on this episode, those people will pay me money for those ads. And that provides me an income so I can make the episode the podcast, which by the way, is not I don't think like that's surprising to anybody. But the difference is, is that the content is valuable. And, and it's not just valuable, but it's entertaining or engaging. And that's the other thing, because I'm not the only person. Listen, between you and me, Natalie, a couple of people try to rip me off every year. Like there's content out there. That just sounds like they listened to Jenny and I on the on the Pro Tip series. And they repurposed it, but they don't have whatever it is that makes this work. And I don't even know how to quantify that, to be perfectly honest with you. I don't know why it's working. I can't take credit for it. I couldn't probably reproduce it. If you asked me to, like whatever happened here. Like whatever made you say the kind things you said earlier about the podcast. I didn't do them on purpose. I just made the podcast and that was your experience. They're out there. I don't know. Bad voice bad timing. Maybe they're just not likable. Like who knows? I'm not likable to some people are damn sure. You know what I mean. But I also don't like I don't vanilla myself up so that I don't offend anybody. Like I just like, like I said, I got an I got a review the other day and I'm like, That person doesn't like me, but it's not terrible. And I'm like, perfect. I'm right on that line. And that's kind of where I want to be. You know. So anyway, I have a lot of big thoughts about this, that I'm sure are boring to people. But there's a way to get this information to people and to not waste their time. And I mean, honestly, if you don't agree with me, please say but aside to diabetes. This is a good podcast, right? Yeah.

Natalie 1:14:23
I mean, there's definitely episodes that I've listened to just for the pure entertainment value of the episode. I still listen multiple times a week to the podcast because I find that that I enjoy the information and I know that it has helped me so much that I like hearing how it's helped other people as well.

Scott Benner 1:14:46
Do you think I could do it if it wasn't about diabetes? Do you think if I left the niche, like people would listen to me interview people about other stuff. You

Natalie 1:14:53
you have a way of pulling things out of people that's really entertaining. Now, you know So in my case when I first started listening to you, and I would get irritated with you for one reason or another, but I kept listening because the info was good. If it wasn't something that that the info was good, then I don't know that I would have listened to it as long as what I did.

Scott Benner 1:15:15
So I grew on you like a fungus you're saying? Absolutely.

Natalie 1:15:19
Right. Yeah, your mushroom. Oh,

Scott Benner 1:15:21
I love that. I think that's terrific. Like the way content is delivered. Nowadays, right? Like the face the forward face of content. I'm not the mold for that. Like, I didn't say mold like fungus. Although that would have been amazing. If I did. That would have been really Yeah. But I'm not the most like, I'm not young. I'm not pretty. I don't just like say things that are, you know, it just vanilla so nobody can disagree with it. And, you know, I'm I'm kind of like somebody told me recently that I'm like, my, I have aggressive opinions. And I was like, Oh, I don't know that about myself. It's like, really? And they're like, yeah, like, she's like, you're like unapologetically you. And she's like, I like it. She goes, but I could see why we're might scare somebody. And I was like, Oh, I was like, I don't know that about myself. Like this is just how I am like, I'm not out here acting like a thing. You know what I mean? Yeah, you're just being you, man. But anyway, like, so that is part of my plan, by the way was to put out information that was so good that even people who didn't like me would kind of be forced, you've heard me say on the podcast, who are my favorite review, basically says, I hate that guy. But my a one C is so good that I listen to this podcast. Like, that's my I swear to you, that's my favorite review.

Natalie 1:16:39
Well, and every time I hear you talk about that review, I giggle to myself, because I will tell you the first couple episodes that I listened to, I was like, Who is this guy think he is? Why is he talking over these people? And and then you went through the phase where you actually started looking at how much you talked versus how much they talked. And so I think you made some adjustments there. But you know, you said it earlier, you've grown you've evolved. And I think the interviews now are really entertaining to listen to. I'm so glad. Like we said the info was so good that, that I kept listening.

Scott Benner 1:17:11
I hooked you. I kept you here, I guess basically against your will. And then yeah, yeah. You've basically been human traffic is what you're saying.

Natalie 1:17:23
Your traffic. I've had to listen to

Scott Benner 1:17:25
you. By the way, there's a great example of something most people wouldn't say. And, and even as I'm here, I'm like, Yeah, I like, I don't think I shouldn't have said it. I just think it's not something I don't even know what I meant by it, to be perfectly honest with like, You got hijacked basically, like, and I just don't have. I want to say that I don't care. But that's not true. I just think that the ends. I don't think that's right, either. I was gonna say the ends justify the means. But I don't think that's right, either. I guess what I believe is, is that this has to be enticing some way or another. Because it's information about diabetes, and who in the hell wants to listen to that? Like, that's just what I think of it. ever see the movie private parts? You know what that movie is? Okay. Private Parts is like a. It's like a movie about the Howard Stern's career. And there's this

Natalie 1:18:21
okay. I probably did watch it. But it's been a long time. Okay. And

Scott Benner 1:18:25
so there's this, there's this scene. I don't know if it's real, or it's not. But he goes into a different market. They're having these reactions to him. And they're doing the, you know, the people who he works for are looking at the data. And they're looking at the feedback from people. And they're talking about how long people who like Howard Stern listen to him. They say oh, like the average listener who says that they like the I don't know, the whole quote, but like, who says they like him? Listen for this long. When asked why they listen, answer most oftenly given is I want to hear what they'll say next. And then they say the people who don't like him, they actually listen longer than the people who do like him. And when they're asked why they said, I want to hear what he's going to say next. Next thing. And part of that is what I'm doing here, whether you know it or not, so

Natalie 1:19:19
but so we want to hear what you say next. That's

Scott Benner 1:19:22
all like he just like, is he gonna say something stupid? Let me let me find out like is this going to be like valuable? Is it going to be like a tear jerker? I mean, honestly, like, some of the episodes are me people say that. There are times that while people are talking, I'm thinking, Are you sure you want to say this? You know, like, and we'll get to the end and we're not being recorded anymore. And I'll go like, Hey, you said some fairly personal stuff back there. You okay with that? For sure. Like we're not being recorded anymore. Like now's the time. Just go. I shouldn't have said that. And they're like, no, no, I want it to help other people. And everyone always comes from that person. back there. And I think that's part of why it works is because now the people who are coming on the show are saying, this show helped me. I've got some odd stuff in my life that I didn't think would have happened to anybody else. But it turns out, I might be wrong about that this crazy stuff happens to everybody. And let me go tell my story. So somebody else can feel like how I felt. So I can't thank those people. I know, you're so

Natalie 1:20:23
authentic Scott. And then you bring your guests on, and you allow them to be authentic to and I would have never guessed in a million years that I would reach out to you and say, Hey, I think I need to be on your podcast. But it was in that that interest of helping people and telling what's happened to me so that maybe other people can identify with it as well. And it hopefully will help them.

Scott Benner 1:20:46
Yeah, that's a great place to stop. Okay, thank you, Natalie. I really appreciate you taking the time. Thanks, Scott. Yeah, hold on a second.

You can use the same continuous glucose monitor that Arden uses. All you have to do is go to dexcom.com/juice box and get started today. That's right, the Dexcom g7 is sponsoring this episode of The Juicebox Podcast. 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. Thank you so much for listening. I'll be back very soon with another episode of The Juicebox Podcast. The episode you just heard was professionally edited by wrong way recording. Wrong way recording.com