Scott Benner 3/8/24 Scott Benner 3/8/24

#1148 Grand Rounds: Diabetes Management

Scott and Jenny discuss proper type 1 diabetes management concepts.

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

+ Click for EPISODE TRANSCRIPT

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

Scott Benner 0:00
Hello friends, and welcome to episode 1148 of the Juicebox Podcast.

Jenny's back for another grand rounds episode and today she and I are going to talk about how doctors should be thinking about diabetes management, how to talk to you about using insulin, and so much more. While you're listening, please remember that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, always consult a physician before making any changes to your healthcare plan, or becoming bold with insulin. If you'd like to help with type one diabetes research right from the comfort of your home, it's easy to do go to T one D exchange.org/juicebox. and complete the survey. That's it, it takes like 10 minutes. We're looking for US residents who have type one diabetes, or are the caregivers of someone with type one of specific and special note. men and men of color were boys or boys of color. Difficult to get that data. The T one D exchange thinks they could really help people if they had it. If you fit any of these categories, I'm talking about men, boys, girls, ladies have type one, you're the parent of somebody filling out that survey is a great way to help. And it's a great way to help the podcast, it also might end up helping you t one D exchange.org/juicebox. Today's episode of The Juicebox Podcast is sponsored by the contour next gen blood glucose meter. This is the meter that my daughter has on her person right now. It is incredibly accurate and waiting for you at contour next one.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 juice box. So today for the Grand Rounds series, we're going to talk about management. That's our that's our our header. And Rod topic. Well, and there's a lot here. So indeed, it is a lot of feedback from people, a lot of feedback from people a lot of notes that you and I made on this document back home, we're talking about doing this. A couple of things. Why don't we just start with a little bit of feedback, and we'll work our way into it. Well, I wish my doctor would have told me that staying high for long periods is just as dangerous as a low. Yeah. So that's education. Right? Like, that's, that's understanding big picture. And whether doctors know it or not, this don't. I was about to say don't have a seizure idea, which is something I really don't want anybody to do. Right? I didn't want to sound like I was minimizing it. But this this better high than low idea. I understand why they might say it initially. But you have to tell people, the rest of that story. And why high and low is bad, why stability is what they're looking for how to get through stability, because just telling them better high than low, I think leads them down the wrong path that that that's difficult to get back from mainly

Jennifer Smith, CDE 3:27
because there's not enough there's not follow up to it is what that really leads to, they are given a directive of better high than low initially. And you know what? Maybe Okay, right now, but define that, give them a week from now once we're seeing how your insulin is working, once we see where numbers really are, once we see how you're reacting to the current doses and we make some other adjustments. We will talk further about this, right? Because initially, you may actually, I mean it is there's a math equation to figuring out initial starting doses for any age and person. But it's still just a starting place. And it's still not as precise as it eventually will get. So sure, a little higher right now, let's see how things go. We're going to touch base in a week or in a couple of days. We're going to look at this and we're going to say okay, now we can nudge that high. We don't want to stay high, long term down the road. Right now. We're just going to keep things from here to here. Maybe the target range is wide right now. Narrow it when you have follow up and also put that into you know your your notes about what was discussed. We defined blood sugar target range here to here so that whoever is the follow up physician or clinician knows what you've talked about. They can easily see it in the medical record and then that doctor or caregiver can clean that up. Yeah, can help to define that further for you. But when you give a blanket statement that sticks

Scott Benner 5:09
Yeah, it also makes the next physician, not just the patient, but the next physician leery about changing what's happening right now. Right? Right. Right. They think this is this was for a reason somebody told you to keep your blood sugar at 180 all the time. And you can explain to them no, that's not the case. Because somebody didn't tell you. No, that's not the case. So, right. A lot of this series, I think is about, it's about not just saying the first thing that you that you think to say, but giving it real context and an explanation. This is what we're going to do. This is about the timeframe we're going to do it in, this is why it's important. You just can't forget about it and say, Oh, he said better high than low. And then you go on, you know, from their emergency situation, to you know, a GP, then the GP finally gets you to an endo. And then the endo gets there. And this, oh, everybody's got this person's target set at 180. They might think that's on purpose, because you can't handle it. Or maybe you had lows before they'll make assumptions. And you know, these assumptions are what killed everybody. Right? Yeah. But this is how it comes out. I wish my doctor would have told me that saying hi, for long periods is just as dangerous as a low

Jennifer Smith, CDE 6:23
end for this person, it might have been that there wasn't enough follow up then. Or maybe they didn't follow up with somebody who could have helped them put the targets a little tighter together, right? Maybe they also didn't know enough to ask, Hey, I was told initially, the higher targets are okay that I shouldn't necessarily live there. But if I touch to 50, after every meal, and four hours later, it comes back down. That must be okay. Right, because that's what I was told it. It takes I think, you know, diabetes, especially is it's an evolving sort of trend of discussion, where this is where I am, this is the scenario, this is the really important stuff to focus on now. Okay, a month from now, a week from now, whatever, you're very likely going to be in a different place, you're ready to get more information, you're ready to ask more questions. And the doctor should also sort of move down that path with you, if you're not bringing up that they should be bringing it up and saying, Well, you're here. And everything looks safe, right? It looks good. But you could be here, right? Let's try this. This is why and that explanation to the why is really important. It's

Scott Benner 7:37
the nuance of the conversation. Like you can tell somebody, it's not wrong to say to somebody, Hey, if your blood sugar shot to 250 and came back down and leveled out again, that's fine. Not every time, you know, but not every meal. Because if you want now you tell me that's okay. And what you're probably trying to do is, is give a little bit of comfort. You don't I mean, like, Hey, don't don't kill yourself if stress about Yeah, if it jumps up one time it jumps back down, let you you know, that's okay, let it go. But not, once you tell them it's okay. Then breakfast jumps up lunch jumps up, dinner jumps up, a snack jumps up, they get high overnight, but it comes back down three hours later. And before you know it, that's an eight a one C? Yeah, you know, and they in their head, they're like, Well, the doctor said, It's okay, if it goes up and it comes back down again, they don't understand the big picture. Listen, right. Most people don't understand the big picture of health. I was just talking to a nurse on another recording recently. It's not out yet. And she said one of the most shocking things about becoming a nurse was learning how little people knew about their own body. Like she called it. Jenny's making the face. Yeah, like shocking how bad it is. And it led me to say, I saw somebody eating nachos with a bowl full of queso the other day and I saw the bowl, like the size of a softball full of liquid cheese. And I thought you're not supposed to consume that in a year. Right? Yes, yeah, you know, like, and here you are, you know, in one sitting, and then metabolic issues come up, which you don't see right away and are hard to diagnose. And they end up looking like I get headaches all the time, or my knees always hurt or why does my stomach hurt? Or how come I don't poop? Right? Like it's because it's and then you're off to the races. And before you know it your blood sugars are hard to deal with, you have all kinds of other underlying issues. And they don't come to the surface until they come to the surface in a very aggressive way with like some specific problem. And when we're talking about people with diabetes, we're talking about renal and cardiac and your eyes and absolutely big stuff, you know, not just go on a diet for six months and this will all work itself out. You know, what

Jennifer Smith, CDE 9:44
you said initially is 100% the case unless you have any type of biology avenue of education, you really are left in the dark about what your body is supposed to be able to do. How does it function when I do this, this is what my body does with this, right? And I, one of like my best examples of that was years ago working just as a dietitian in education specifically in diet in gestational diabetes. A woman had come in to me, and we're talking about kind of her eating and how that impacted blood sugar. And I said, Well, you know what, I don't see like, a lot of fresh stuff. And I said, I don't see any fruit at all. And she's like, No, no, I eat fruit every day for breakfast. And I was like, Oh, we didn't mention that. You know, she's like, Yeah, I did ice. It's right here. I eat Froot Loops. i She was not kidding. She was not joking, which means that as an adult age where she was long term, she never knew that Froot Loops don't count as a fruit. Like

Scott Benner 10:50
me, I out myself for a second. I once said to my wife, I was half joking but contour next one.com/juice box, 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 gonna get more information. It's easy to use and highly accurate smartlight 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. 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 voc hypo 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 voc hypo 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. But I don't think I was completely joking. She's like you don't get enough vegetables. I ate veggie sticks the other day and she goes Scott, those are potato chips. There's carrots in them.

Jennifer Smith, CDE 13:28
Yeah. I mean, and there are a little bit of like a humorous component to that. But I was just like I came home and I said to my husband, he's like, No, he's like she was joke. I was like, no, no,

Scott Benner 13:39
I told you before when my mom looked pre diabetic, a handful years ago, and a doctor told her to change her diet. She put together a diet that was worse than the one she was eating. Yeah. And she was trying trying to eat something that would follow along with what he was saying. Didn't people just don't know. So it's not your fault. But the doctor needs to know that that's the situation. Yeah, you know. So this next person says there are ways to have a lower more healthy a one see there being kind here about the podcast, such as being bold with insulin, let us know that this is possible and help us to achieve better agencies. Please don't shame us for falling short, but do encourage us to do better. I see this a lot, right. Like nobody wants to tell somebody they're not doing right. Well, right. became a social thing for a while. You know what I mean? Like nobody wants nobody wants to tell you the truth. Sometimes

Jennifer Smith, CDE 14:34
I feel people are worried. On the end of professional people are worried about creating like a shame type of explanation. When really that's, that's your job is to tell somebody when they're not healthy. That's that's your job, right? You didn't go into health care, to tell people to keep eating what they're eating or to keep, you know, not doing what they're not doing. You're

Scott Benner 14:57
not there to make friends and know that Yeah, you're and I get that I would listen, I would bet the argument back would be, if I push these people, they're not going to come back again. And to that, I might say, least you told them the truth. Right? You know, like, now it's on them, at least, you know, but keeping it from them or pretending they're going to do the right thing. That's not helping anybody. That's just mean, that's, that's you're lying, and they're lying. And we all know each other's lying. And none of us are saying anything about it. It's weird, right? You know, I

Jennifer Smith, CDE 15:26
see, I see questions often still, in this sort of day that we're in with technology, I still see questions about why people are. And it goes right along with this management and even like, target range for blood sugar and whatever. Why are we explaining blood sugar targets that are outside of the realm of what somebody without diabetes? Right? Why? Why are we saying that? A 200, blood sugar, a 250, that's safe. That's okay. You can come up here, you can kind of settle back down, etcetera. You know, the human body does not do that without diabetes. So why are we constantly telling people that it's okay for you to be in this really wide range, and then down the road, their expectation comes to be? Well, I stuck within these targets. And now I have problems with my eyes, or now I can't feel my feet. And I did what I was told. I was told this is okay.

Scott Benner 16:27
Yeah, no, I think it's got something to do with the physicians either not understanding it themselves, the mechanics of getting to those other blood sugars, or they've seen so many people fail at it that they think it's not possible. So why am I going to give them a target, they can't reach at least I'll give them one that they can, they can get but, but that's where this this person here says learn how to communicate diabetes, those things, suggestions. So often, we're told to do something, but not given a reason why? And then you and I made a note after that, that said, that says don't just give us a fish. Teach us how to fish. And right. Yeah, right. Yeah,

Jennifer Smith, CDE 17:03
absolutely. I think you had a thought. Let me bring it back into my brain. Like right there on the tip of my tongue. It'll come back to me.

Scott Benner 17:12
It's okay. Well, I think we got thrown off when your cat's whiskers came into the camera first.

Jennifer Smith, CDE 17:16
Yes, I sorry. I was gonna comment. And I was like, No, it's okay. I know she was

Scott Benner 17:21
you were like you I say something about that or let it go? Yes. Sorry. On the fault, though, I stepped over you. You had a look on your face. Like you were gonna say something. And I said that it's okay. Don't worry about it. I wish it diagnosis. They told us that what we learned at the beginning is foundational. And there are many things to learn. Moving forward for best management like Pre-Bolus and glycemic impact load bolusing for fat and protein, being aggressive when aggressive isn't necessary. Also, I wish they would have emphasized emphasize that ratios and basil will change and what numbers we get aren't set in stone. Okay, so this becomes another big problem. You know, you you set somebody's this happened to me. I remember the doctor was saying what's Arden's insulin to carb ratio. And when I pulled it up, it was like one unit that like, I don't know, like some insanely large number 300 carbs or something like that, because she was diagnosed when she was so little. But we were like, years later, and no one had ever changed it. Oh, and I didn't know anything about it back then. So I'm like, Oh, she's having all these high blood sugars all the time. And I'm like, I'm having a lot of trouble with meals, and I can't figure it out, back then I wasn't the guy who was like, Oh, just do this. I went back to the doctor, and I was like, I don't know what to do. And they pulled that setting out. They're like, Oh, and it was like it was off by like, I think she was one to 100. And it was set at one to three, she was using two thirds, too little insulin at every for every carb. So, you know,

Jennifer Smith, CDE 18:46
that actually, it kind of made me think of what I was going to. What I was gonna say is that, I think that in, at least initially, and maybe even for somebody who has had diabetes a long time, and now is really coming in with a set of questions. What it boils down to is explaining that this initial information is just that it's a baseline to start with, and navigating diabetes. I wish people would just be honest, and say it's not easy. It can get along the way of learning, you experience a hoz Oh, well, that totally makes sense, right? Or, gosh, this definitely can be built in now. So they're, they're stepping stones, if you will, to management. But as you just said, There's not just a start here, dose this there is again, kind of evolving changes. And that growth has to happen in your understanding, but how you understand it needs to be what comes from the clinical team that's helping you so they should explain to you that this isn't simply just put the insulin in and eat the food, right? That's not how simple this is.

Scott Benner 19:57
Yeah, I remember a doctor once saying when our was younger Wait, oh, she gets hormones like, oh wait, do you see the female hormones? Oh, and I was like, what she was like, wait a minute, UAH context? Is there any context? You know, oh, hormones make it harder. And I'm like, and, and you don't you mean like, though I figured it out between that and, and when it actually happened for myself, but nobody ever likes in that time no one ever stepped up and said, Are you bolusing? differently? Do you notice any strategies that help or hurt? Or, you know, are there times of the month that are different than others? That conversation never happened? Just oh my gosh, you should see Wait, do you see what happens? And I spent years going like, oh, like,

Jennifer Smith, CDE 20:41
like, I'm worried I wonder what's gonna happen? Yeah. And as if she didn't have hormones. age that she was,

Scott Benner 20:48
she was growing, I'm sure she had growth hormones. So at the very end others, this person says, this is kind of funny. bolusing for fat and protein impacts is a type one diabetic should not be considered an advanced topic. And I thought, but that's really true. It's very, very true. You cannot, you can gather up 100 People with type one diabetes and ask them, you know, what is your endocrinologist taught you about dosing for the impacts of fat or protein? They're not gonna, I mean, two people are gonna say somebody had mentioned that to them, you know? Correct. And yet it throws off every meal, almost every meal of every day and someone's management for 24 hours, that turns into a week that turns into a month. And it's it can be at the core of the whole thing the other day, Arden. She's weighed school. And she said, I did get a text from her. Hey, I had to stop at a drive thru on the way back. I'm, you know, I had to grab some DT amount of time. I said, What do you get? She said, I got Chick fil A. And I said, Okay, 45 minutes from now your blood sugar is gonna go up. And I was like, Don't forget. So you know. And by the way, you know what she did? She forgot. And but I was, she was probably driving. Well, she was now at another place doing this homework. And then she had to get into a class and stuff like that. And I said to her, I'm like, I'm like, okay, look, just look at your algorithm. Is it suggesting any insulin? And she said, Yes, I was like, I think you should put it in. You know, because the algorithm was trying to fight. It was trying to fight the fight, but it wasn't going to because it wasn't compensating for the she didn't put fat into the she didn't it didn't know what it was trying to fight. Didn't know what I was doing. Just like this morning, by the way. She thought she lost her ID. Oh, so like, I get this call. I'm like, why did that happen? This is gonna happen a couple of times, I'm pretty sure. Yeah. But while she's searching for the ID and doing the math in her head that she doesn't leave five minutes from now she's gonna be late. And if she's late, and she misses a class, and she only gets the missed so many. And she says I'm watching her blood sugar, it is just going up. It just went from 100 to 120 to 130 to 140 that he got an arrow straight up from trying to find her ideal stress. Yeah, from the stress of it. Oh, Doctor, I gotta tell you that. They're gonna say something like, oh, the mornings, huh? Yeah. Oh, no mornings. They're hard. Thanks a lot. Right. And

Jennifer Smith, CDE 23:13
that will be as we talked about before, that'll be one of the fingerpointing on the records. We'll see what happened here. Yeah. No, it was probably in school one

Scott Benner 23:25
month from now if you ask garden, what happened there, she's not going to say I lost my ID thought I was going to be late and got upset. Like she's gonna I don't know what this is, you know, so. But all this goes back to Tools. Like give me this person says, give me the correct tools give me parameters and instructions. Let me know I could probably do this, if I had these these things in place, right. And to what your point is, I always say, it's experiences. Like you have to have them over and over and over again before they just start becoming not just like second nature, but they make sense to you. Like out of nowhere, something happens you I know what to do? Yes. As soon as she drove away, like, you know, she had her ID this morning, and she left. I thought she needs a temporary Basal increase. Like I don't care if she's on an algorithm or not like right now she needs a Temp Basal increase this algorithm is not it doesn't know there's an impact here. It's it's changed rising as if she ate food. And it has not been told there's any food there. So we did that. And it came back down pretty quickly. Yeah.

Jennifer Smith, CDE 24:25
Good example I have of like those lived experiences. You can provide all the information possible. And then when you get into like, from my angle of providing education, and give you scenarios, things that might happen, but until they really happen, you have nothing to apply that to and you may need to dig deep and think about it right? A good example is somebody I work with, who had emailed me about a scenario and emailed me just to say, You know what, everything that I've learned, I knew how to work around I found it. And I think I did the right thing. Yeah. And 100%, this person had done the right thing, right? blood sugars that were doing something that shouldn't have been happening based on everything else that had led up to that point. And what did the person do? They change their site, they changed their, their insulin, and it all navigated back down. But without some lived experience and some information pointing to Hey, If this, then this, right, right, they're gonna throw their hands up and be like, I don't know what it was not

Scott Benner 25:31
make that change. I also, you know, that's true. Because oftentimes, you'll see people changing out sites, when it's not the problem, right? When their settings are bad, and they're constantly the pump doesn't work, the pump doesn't work. They over and over, and I, sometimes I online, I'm like, stop there, like, I've changed the pump three times, like, Stop changing the pump. Just stop. It's not your site, right? Like, your settings are bad. Like, we're your settings are great, but something's happening right now. And your settings aren't up for the challenge of what's happening today. You know, like, it's, again, lived experiences. That's how you'll figure this all out. I like this, this feedback here, give me all of the options, not just the ones that you think are best or better or efficient. I would like to make my own decisions, and then craft my own ecosystem of how I deal with this. I think that's a great point. You know, there's more than one way to do this. And everybody's brain doesn't click with the way you say it one time, right? That just you have to give people the autonomy to autonomy is such a big part of this. Because if they don't have that, they don't have all the ideas, and they can pick and choose from it make their own tool belt. That's a problem. But if they don't feel like they can make changes on their own, that's also a problem. Like, that's a big, big problem for people with type one diabetes, the ones that don't feel comfortable, or don't feel like it's their job to make changes to settings. They're the ones I see struggle, the most long term is adults. Do you agree?

Jennifer Smith, CDE 27:05
Yes, absolutely. Because they from an early on diagnosis, whether it was childhood, and that's how their parents navigated, because that's what they were taught how to do. And then they move into adulthood, managing that way, really only following up with the doctor every six months. And that's when something gets shifted and changed and not not really knowing that they're in the driver's seat. 24/7, between that 1520 minute visit with the endo every six months, right, you are the Navigator. But unfortunately, if you don't tell somebody, it's almost like giving the Okay, many people with this type of a, you know, a use of something that supplies like insulin, right? You really have to be directive and say, You know what, I'm going to give you these starting places. And here are some pointers for adjusting. I'm happy if you adjust. In fact, give me feedback when you try and adjustments so I can help you behind the scenes if there's you know, communication with an electronic record or something like that. But you do you have to almost give the okay to people. Otherwise, they may also come back to the office and not provide feedback that they've been tweaking things on their own, because they may feel like they're gonna get their hand slapped. Yeah.

Scott Benner 28:20
Oh, that's definitely happening. Right? Yeah, people are definitely lying. They're always like, I can't I can't let my doctor catch me doing this. And when people say that, to me, I'm like, What are you talking about? Like, oh, I want to make an adjustment to the basil, but I'm afraid I'm gonna get in trouble in trouble, like, so. Ironically, you're not in trouble, quote, unquote, for the seven and a half a one C, but you wouldn't be in trouble for putting the Basal up point three an hour and making it a sentence? fascinate, right. Yeah,

Jennifer Smith, CDE 28:45
absolutely. And insulin, interestingly, is, I think it's, I can't think of any other medications on the market, that people self adjust, right? Like you don't go to your cardiologist and they give you blood pressure medication, you're like, today, I think I'm going to take two of these tablets with you. It's gonna happen, right? Like insulin is one of those. It's I think it's the only thing that really, it does require you to look at your own information and make adjustments based on what you're seeing and where you want to end up. What is the target you're aiming for? What are you trying to get to, things aren't working?

Scott Benner 29:23
It's also interesting where the line gets drawn, and I had a, I had a root canal go bad. It was like 11 years old. So I was pretty happy. It lasted that long. So I'd have changed out right. And when he got in there, he's like, Hey, there's like a little bit of an infection there. You know, this is really going to hurt tomorrow. Let me give you a prescription for a pain medication. He said, The one I'm going to write for you is highly addictive. He said, so you have to be careful. And I was like, I'm gonna go with Advil if you don't mind, right? And he goes, No, no, you should probably take this script because this is gonna be a problem, blah, blah. And I was like, I'm good. I don't I don't need your script. All right. By the way, I didn't even take an Advil when it was over the guy said, great dentist and did a great job. But he was so willing to be like here, would you like a week's worth of narcotics? Because I dug around in your gum for an hour. And I was like, and I'm like, Wow, look how easily he would have given that to me. Yeah, but then you go ask an endocrinologist. Hey, you know, wouldn't it be cool if that lady could change your basil and they can't handle that? Right? Again, and all that, but you can give them oxy. I was like, right. All right. Can we make sense once in a while? No. All right. This person says, Can you give me your medical opinion, please don't parrot what you're reading, ah, in this example, as their kid was doing a six for a lot of years. And then it rose up. And the doctor went, That's okay. It's still within target. And they're basically just telling them like what the ADA said, like ADA says sevens fine. This is fine. And like, so then that takes the onus away to do better again, it's again, it's just like, oh, whatever, you're fine. It's like, what's your blood pressure supposed to be? I don't know these things. 120 over something. It's

Jennifer Smith, CDE 31:06
well under 140. And it's like, what let's call it like, 130? Over 80. Okay, right. But in anything kind of, you know, within that sort of the range, but just your blood

Scott Benner 31:20
pressure was 150 over 90 all the time. What a doctor guts. Alright, it's cool. Not bad. No, no,

Jennifer Smith, CDE 31:25
they shouldn't.

Scott Benner 31:29
But you I saw you getting upset earlier talking about those column? 250s. Okay. You know what I mean? Like, that's the same thing. But you don't but that doesn't get seen that way. A cardiologist would never say that to you. an endocrinologist would say that to you all day long. Oh, just 250 it comes back down. You're fine. What? How am I gonna be in 20 years? Right? Yeah, yeah. What do you do you own a LASIK center or something like that. And you're thinking of getting into diabetes surgery to like, what are you trying to have happened to me here? And what and oh, sorry, I got upset. Now you can talk? No,

Jennifer Smith, CDE 32:04
I was gonna say and for the person who is a little bit more concerned about the lower blood sugars because of whatever fear that was instilled eons ago or whatever. Those numbers that are higher that they've been told are okay, even for lingering or you know, non lingering time periods, like a blip up and then it kind of comes back down. Eventually, they may get to feeling that they're safer. They're okay at those numbers, because in their mind 250 becomes okay, then all the time. Yes, not just the up and it comes back into what you define as the as the healthy brain to be re

Scott Benner 32:47
in range. Yeah, yeah. Especially with the thing that you don't feel. Listen, if your blood sugar's if you're a one sees rise slowly enough, you won't feel the impacts the physical impacts, your body is going to do a pretty good job of trying not to die and like what it was it this opens up blood vessels that like does all kinds of stuff, right? Like to try to like Yeah, yeah, yeah. To, to do that kind of stuff. So. So when you say it's okay, this person is slowly not becoming themselves anymore, they're altered mentally even, you don't even realize how foggy they are, they get used to that their body gets used to trying to exist like this no different than, you know, how you end up with an enlarged heart from smoking. Right? Right. Same idea. And, and yet, it's like, it's okay. It's okay. It's not okay. Like, it wouldn't be okay for you. If if you were that if the doctor, his blood sugar was 250 all the time. They'd be going like, we gotta fix this, you know, so I don't, I don't know why that that tired. It's just tired. It's lazy. Well,

Jennifer Smith, CDE 33:50
and again, with today's technology, and everything that we have, that it's got such tight ability to have alerts and alarms to keep people safe. And yes, technology can be a little weird and whatever. Yeah. But the majority of the time, what we have today with the alarms and the alerts, there's no reason to say that you can skirt up to this value as long as you're not under here. And as long as you're not hanging out in the low zone. And again, that's not even often very well defined. Yeah, what's too low? Where do you want to hit? What how long? Can I sit at what you're not telling me about a low number? What do I do it? Again, it's very like Flim

Scott Benner 34:32
Flam. It's nebulous. It really is. And by the way, even now with a within a non aggressive algorithm, like the eyelet, for example, that thing's still targeting probably under like 180 or 170. And you and I would be like, I mean, listen, it's a great tool, and I think it's going to help a lot of people but I wouldn't rely on my daughter and like, and that's 70 points better than telling somebody to 50s Okay, so I just need to understand speaking Understanding even though we had management under control and a consistent a onesie in the fives, my Endo, my son's endo said that we need to do less work, we need to do less work and let his numbers get higher. So as a one sees more like in the mid sixes or sevens, that whole you're trying too hard thing. I don't get that, like I really don't, because I know they don't want people to go crazy taking care of themselves. Right. But at some point, it does become second nature. Like you don't you mean you? It's a lot of hard work upfront for a lot of benefit long, long term. And

Jennifer Smith, CDE 35:39
I think in a visit where you the clinician, you're looking at that, let's call it a one C, which again, is not

Scott Benner 35:46
that shallow, I'm enraged and everything just

Jennifer Smith, CDE 35:48
not right. Are you asking more in depth about how much work it is taking? Because again, once you've been there for a while, as you said, it becomes more most of it becomes more second nature and you you're able to just navigate and keep that yeah, because you're doing what is pretty typical. And until or unless something changes with a growing child or a teen or something in adult life. For the most part, you're doing a good enough job. And that's when you have to define or ask the person. Gosh, how much are you checking? Yeah, right. If you can see that, you know, even in a visit somebody's like every two seconds, they're like looking at their numbers. There might be something more like on the mental angle to logical

Scott Benner 36:34
issue. Yeah, they might be under a lot of stress and pressure. But yeah, just assuming, you know, it really does it piggybacks on to this point that you added to here, you told me please bring it up, that seeing a good low a one C and assuming it's from like low blood sugars is a dangerous way to think as a doctor. This is Oh Jenny, this happens constantly the amount of people who listen to this podcast, then head off back to the doctor super excited, oh my god, I got my one seat down. It's nice. It's not that hard. Even I figured it out. Like turns out my settings were wrong. And the doctor yells at them, because they as soon as they see a number that's lower on that agency, they assume you've had multiple, you know, elongated lows to create that agency because they don't even know how to do it. It's such a unknown quantity to them, that they just assume that you've cheated the a one C test by having a lot of lows. Right? Yeah. And some of them won't listen, when people try to explain it to them, or the people are put their head down and you know, don't stick up for themselves. Right? It's a dangerous assumption to make. That's just because somebody has an A one C and the sixes are the five that must mean they're low all the time. My kids never low. Like, like, once in a great while. And even that means a drifting to 55 not like, you know, oh my god, what you know, Bob a lot most of the time her blood sugar's I don't know, it's not it's never usually under 70. Right, you know, honestly. So we have some bullet points that go through here at the end. So we'd like 10 minutes left. Yes, some of them are repetitive, so we might have to pick through them. And I'll skip over the ones I wished my doctor knew that tightly managing my son's blood sugar is far less stressful than living on the roller coaster. That's the thing you wouldn't know unless you lived with it. Correct? Like actually trying and working towards it is not as hard on you as the unknown aspect of it. You know, I think it's the difference between being told you're about to walk through a haunted house and not being told, you know, when stuffs just jumping out from around the corner all the time. You're always like, I don't know what's gonna happen next. Right. But yeah, working hard. I find this to be true for me. I don't know that everybody would find this to be true. I assume you do. Right? Like the work you do is, is worth what you get out of it? Absolutely.

Jennifer Smith, CDE 38:49
Yeah. 100%. Because I have, I have things that are known. And it makes the majority of my management, more like brushing my teeth. I don't think about the like, brush my teeth, whatever, right? It's not a thought. I have the time it's like out of my brain that you're putting the toothbrush on the brush and brushing and whatever. That's how I think about the majority of my management, unless something is really shifting stress or whatever, or I'm ill. But even that I've got enough enough years of experience to have a go to. Yeah, right. It's a starting point of oh, I can try to do this. And definitely it helps, right?

Scott Benner 39:32
So I always describe it as walking through a door. I don't like consciously think reach out, grab the knob, turn it pull. I just I just end up outside the door. And that's how diabetes works for you after a while and it is it becomes a muscle like I bet you Mike Tyson hasn't fought in a while but I bet you if you walked up to him and tried to slap him, I bet you his head would move pretty quick and he'd pop you right in the mouth. And so like and that's kind of how diabetes ends up working out. You don't know what to do. happening. But now you have all this experience and you know, blah, blah. This person says, Please tell people that they could actually go into decay with a normal blood sugar number. Yeah.

Jennifer Smith, CDE 40:11
That's so important. And where do you usually go? If you have ketones, and you're not feeling well, and you can't keep something down? Where are you going back to

Scott Benner 40:25
the hospital? That doesn't seem to know anything about helping me with my diabetes. And

Jennifer Smith, CDE 40:28
in that scenario, we actually, unfortunately had a really sort of a bad situation with one of our clinicians who her fiance had to advocate for her. And she's actually kind of corresponding with the hospital system, because of how they navigated it for she knew she was there for five hours, trying to get them to just give her fluids, her blood sugar was normal. They kept telling her she wasn't in detrimental need,

Scott Benner 40:59
right? Yeah, yeah. But she, I

Jennifer Smith, CDE 41:01
mean, and that's it. She knew she knew what she needed. I mean, sure, if you can stick your own IV. Oh,

Scott Benner 41:08
great. Imagine knowing so much about it that you know, you're in this trouble. This is the next need you have you need, you need IV fluids, then you take yourself to the right place, tell the people who are supposed to know and they're the ones who are going to be the impediment between you and not maybe dying. And that's by that happens quick. By the way. I forgot how nursing, how do they put it like it's not compatible with life, the acidity, right? That happens, right? The

Jennifer Smith, CDE 41:36
changes in all of your electrolytes and all of the things that should be being measured in the body. And ketones are one marker. And obviously, with diabetes, blood sugar would be technically another thing that they look at. But you know, when we talk about you, glycemic DKA, that's unfortunately, a level well above what most emergency departments even understand how to navigate Yeah. So

Scott Benner 42:01
I'll run through the rest of these here. Somebody said, Please, you should talk about the benefits of like mini glucagon injections for some people, especially with little kids who have trouble with lows. Please tell people about Pre-Bolus thing this woman says how we said this already today, protein and fat and how it impacts blood sugars and spikes. An explanation of insulin resistance would have been nice, when it happens, why it happens and how to manage it. So that's a person saying even if your settings work, when something else happens, I should know, like what to do next. Right? I wish my doctor knew that a one C wasn't everything. As soon as my doctor hears that my a one C is 6.8. I hear from them. You're doing great, don't worry. Meanwhile, I'm on a roller coaster all day long. I've at 50 blood sugars and 400 blood sugars on most days. And I have no idea where to begin. But they saw the 6.8 and said hey, you're doing great, right? Yeah, that's it. I wish they knew that there was no good reason to delay a person from getting a continuous glucose monitor. Within the hospital or as soon as after diagnosis as possible. I still want people to learn how to prick their fingers. But uh, CGM is such a, it's a next level, I think people deserve it. Who have type one diabetes. I think anybody using insulin deserves one. I agree. Same thing with pumps, please tell us about pumps sooner. This person says you should tell people about the podcast that's very nice. Whoever put that in here.

Jennifer Smith, CDE 43:31
I would say along with the pumps that I think it's gotten better crack. Most practices now have more knowledge about the multiple options that are on the market. But I still see practices that are more prone to offering or suggesting heavily one particular pump versus another. And what that often comes from his just their knowledge about that one particular system and they feel so strongly that it is the right one. Again, this is where individualization needs to come into the picture. So you need to know about everything to help the person pick the right one at the right time.

Scott Benner 44:10
I think in a world where you know, especially while we're making this episode, these episodes in a world where people are so under educated in the things that you're talking to other people about. I understand where this comes from, like, you know, I figured out how to use this one pump at least I can talk to them over the phone about where the settings at and stuff like that, but you are eliminating choice from people and not just their personal choice but choice that might allow them to find something that actually fits in their lifestyle better. Right. You know, I use I saw a little girl the other day online. So happy holding her tandem. Her ex too. Yeah, she's so thrilled, you know, and someone said, How come you didn't get her an omni pod? There wouldn't have been any tubes. And she said this just works better for her. And like, like for her personality. She said, good. Like, that's great. Yeah, but You shouldn't get like, because the, you know, I mean, because think of how that happens. Why are you? Why do you know one pump better than the other one? Right? I don't know, because the salesperson got there first. You know what I mean? Like, what the heck? Because back in the day before all the laws, they sent the doctors on better vacations. Yeah. Why we're doing this one. Jenny's laughing because that is what they used to do. That's not legal anymore. I'm sure that doesn't happen. Good lunches. That's it. They used to have like meetings, but they'd have them in Hawaii.

Jennifer Smith, CDE 45:31
Yeah. Or take you out for you know, good, like dinners where it was like a lunch and learn type of experience. Right?

Scott Benner 45:37
So yes, yeah, a bottle of bourbon and a steak. And all of a sudden, we're getting a pump.

Jennifer Smith, CDE 45:41
I remember when that all changed. Yeah.

Scott Benner 45:43
Yeah. Was that was actually a good law. I don't I don't have anything else for this one. So I'm just want to ask you, you know, for your kind of closing thoughts on how doctors should be talking about actual management to people? Yeah,

Jennifer Smith, CDE 45:55
I think we, I think we discussed the majority of what was I really do, especially along with all of the comments that people offered just in consideration. I think, you know, all of this communication and management and everything that we've talked about so far, it just it It boils down to individualizing. And really knowing starting place and where to move from there with somebody, because that starting place again, is just that you're going to have to move that person along and or help them move along because of the questions that they're bringing you. Maybe they're further along in understanding than you think they would be right so you have to meet them where their need is. Yeah,

Scott Benner 46:40
I know it sounds I always felt I always feel stupid saying cliche things but meet people where they are big deal. You know, you understanding what you're talking about. Big deal. You being able to communicate what you're talking about big deal and giving people a complete story. And not just snippets is is very, very important. Anyway, thank you for doing this with me. Thank you of course.

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. A huge thank you to one of today's sponsors, G voc glucagon, find out more about Chivo Capo pen at G Vogue glucagon.com Ford slash juicebox you spell that GVOKEGLUC AG o n.com. Forward slash juice box

if you are a loved one has been diagnosed with type one diabetes. The bold beginnings series from the Juicebox Podcast is a terrific place to begin listening. In this series, Jenny Smith and I will go over the questions most often asked at the beginning of type one. Jenny is a certified diabetes care and education specialist who is also a registered and licensed dietitian and Jenny has had type one diabetes for 35 years. My name is Scott Benner and I am the father of a child who has type one diabetes. Our daughter Arden was diagnosed in 2006 at the age of two. I believe that at the core of diabetes management, understanding how insulin works, and how food and other variables impact your system is of the utmost importance. The bold beginning series will lead you down the path of understanding. The series is made up of 24 episodes, and it begins at episode 698. In your podcast, or audio player. I'll list those episodes at the end of this to listen, you can go to juicebox podcast.com. Go up to the menu at the top and choose bold beginnings. Or go into any audio app like Apple podcasts, or Spotify. And then find the episodes that correspond with the series. Those lists again are at Juicebox Podcast up in the menu or if you're in the private Facebook group. In the featured tab. The private Facebook group has over 40,000 members. There are conversations happening right now and 24 hours a day that you'd be incredibly interested in. So don't wait. So don't wait. Check out the bold beginning series today and get started on your journey. Episode 698 defines the bowl beginning series 702, honeymooning 706 adult diagnosis 711 and 712 go over diabetes terminologies hit Episode Seven pick team we talked about fear of insulin in 719 the 1515 rule, Episode 723 long acting insulin 727 target range 731 food choices 735 Pre-Bolus 739 carbs 743 stacking 747 flexibility. In episode 751 We discussed school in Episode 755 Exercise 759 guilt, fears, hope and expectations. In episode 763 of the bowl beginning series, we talk about community 772 journaling, 776 technology and medical supplies. Episode Seven at treating low blood glucose, Episode 784. Dealing with insurance 788 talking to your family and episode 805 illness and ketone management. Check it out it will change your life when you support the Juicebox Podcast by clicking on the advertisers links you are helping to keep the show free and plentiful. I am certainly not asking you to buy something that you don't want. But if you're going to buy something, or use the device from one of the advertisers, getting your purchases set up through my links is incredibly helpful. So if you have the desire or the need, please consider using Juicebox Podcast links to make your purchases. 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

#1147 Rest My Case

Mellisa was diagnosed with type 1 two years ago at 44 years old.

+ Click for EPISODE TRANSCRIPT

Scott Benner 0:00
Hello friends, welcome to episode 1147 of the Juicebox Podcast.

On today's show, I'll be speaking with Melissa she's 46 years old and she's had type one diabetes for two years. Today we're going to talk about all kinds of stuff on the pod five learning how to take care of yourself having to pay for your own C peptide test, and some personal tragedies. While you're listening, please remember that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, always consult a physician before making any changes to your health care plan, or becoming bold with insulin. If you have type one diabetes, or are the caregiver of someone with type one, please go to T one D exchange.org/juicebox. and complete the survey when you do this. You'll be helping with diabetes research, you'll be helping the podcast and you may be helping yourself T one D exchange.org/juicebox. The T one D exchange is looking for anyone who has type one diabetes, or is the caregiver of someone with type one, as long as they are a US resident. It is particularly hard to get data from males and males of color. So if you fall into that category, please do go to T one D exchange.org. 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. This episode of The Juicebox Podcast is sponsored by the Dexcom G seven made for all types of diabetes Dexcom G seven can be used to manage type one, type two, and gestational diabetes, you're going to see the speed, direction and number of your blood sugar right on your receiver or smartphone device. dexcom.com/juicebox This episode of The Juicebox Podcast is sponsored by touched by type one touched by type one.org. And find them on Facebook and Instagram touched by type one is an organization dedicated to helping people living with type one diabetes. And they have so many different programs that are doing just that. Check them out at touched by type one.org.

Melissa 2:19
Hi, Scott. My name is Melissa. I am a type one diabetic. I just turned 46 I think we would refer to ourselves as ladder. So I was diagnosed when I was 44.

Scott Benner 2:30
So did your was your onset very slow.

Melissa 2:35
No, it was not.

Scott Benner 2:36
I don't know that you're a lot of like to me Lata is about the onset. The very like slow, methodical way that the pancreas just stops working very gently, but yours just kind of shut off.

Melissa 2:48
It seems to have given us two weeks notice pretty quick.

Scott Benner 2:52
I think you just have type one diabetes, then.

Melissa 2:54
That's what my endocrinologist, he just calls me type one.

Scott Benner 2:59
Yeah, I mean, honestly. So a lot of it is latent autoimmune diabetes in adults, right? That's correct. But the latent is the is the part that we want to hold on a second. I just don't want to talk wrong about it. And the last time Jenny made me say it out loud. I was pulling it so far out of my butt that I was like, I think I'm saying this right. Yeah, I that really is just about the very slow onset. I'm going to just say you have type one, and we're going to be done with it.

Melissa 3:28
Well go with type one.

Scott Benner 3:29
Why not? Any other type one in your family?

Melissa 3:32
I have no family history on mom or dad side. The only person that has diabetes is type two was my grandmother. She was diagnosed in her 60s and managed it with diet and exercise for 15 odd years.

Scott Benner 3:47
About that. How about other autoimmune stuff in your family? Not that I know of. Do you have anything else? Thyroid celiac stuff like that? Nope.

Melissa 3:56
No. Okay. Well, just the lucky type one, just

Scott Benner 4:00
just this little thing. Are you married? Do you have children?

Melissa 4:02
I am widowed. I have five children.

Scott Benner 4:05
Holy hell five.

Melissa 4:07
Yes, I do. I have five children. I haven't locked them in the basement right now. That's why it's so quiet.

Scott Benner 4:12
Melissa, I'm gonna say something we're gonna get off to a start where either you're gonna love me or not love me. But is that what killed your husband? Or?

Melissa 4:20
Well, it was me or it was the children or actually he did pass with cancer.

Scott Benner 4:24
Oh, I'm so sorry. That's terrible. Yeah, so then it wasn't you or the kids? Luckily, no, not an unreasonable question though. For 5g Even just the the effort to make the five children and keep them alive. Good. Well,

Melissa 4:36
I'm pretty sure he had a good time. Me. It was a little rough.

Scott Benner 4:41
Why was it rough for you?

Melissa 4:44
Five pregnancies doesn't number on your body. Maybe that's what caused day one.

Scott Benner 4:47
You think so?

Melissa 4:48
He just No, actually, I don't know. I wish we had a cause. Yeah.

Scott Benner 4:53
Wow. How long has he been gone?

Melissa 4:55
Five years.

Scott Benner 4:56
Oh, I'm so sorry. That's crazy. Well, you guys similarly aged Yes,

Melissa 5:00
he was one year older than me. Wow. How

Scott Benner 5:02
old are your kids?

Melissa 5:03
My oldest is 19. I have 1918 1614. And my little guy is 11. Wow. How

Scott Benner 5:10
about that? Do you ever consider sending their bloodwork in for trial that or anything like that to see if they have any markers for Taiwan?

Melissa 5:18
I have. I have not yet acted upon it. I am much more concerned about the cancer through their father's side,

Scott Benner 5:25
which tell me what kind of cancer it was. It was colon

Melissa 5:29
cancer. And so his colonoscopy at the time was it's not it wasn't indicated until 50. He was diagnosed at 37. They've now moved it to 45. So I just had my colonoscopy came back nice and clear. But he was diagnosed at 37 with stage four. Wow. Oh, geez. All at once. All at once. Was that our anniversary as well? I should add.

Scott Benner 5:50
Oh my god, what are you trying to make me crazy? She's Melissa. I'm gonna cry in a second. My mom just died of cancer like a month and a half ago.

Melissa 6:00
So sorry, that it's difficult. I'll give you a virtual tissue.

Scott Benner 6:04
Thank you. I appreciate it. Wow, he was so young. And he and he lived with it for a couple of

Melissa 6:11
years. Not hard. Yes, he passed. He actually lasted five years. He fought very hard, very valiantly.

Scott Benner 6:18
That's crazy. Do you get the feeling looking back? Was he doing it? Because he thought it was gonna work out or was he just trying to hang around for you guys? I think it was a little bit of both. Yeah. I mean, your youngest would have been like

Melissa 6:33
he was 12 months old. At diagnosis.

Scott Benner 6:36
Jesus. Yeah. You're gonna make me cry. Melissa. Okay. Wow, it does that kind of cancer run in your husband's side of the family?

Melissa 6:43
No, there was no family history on his mom or dad side. Oh, geez. Does He have brothers and sisters? He has one sister and one brother.

Scott Benner 6:51
Are they very careful now? Yes.

Melissa 6:55
I think we all are after that. Yeah, I

Scott Benner 6:57
would think so too. All right. I'm gonna try to shift this a second. Do my best here. What's the you're in a very unique situation. So do you think about dating ever?

Melissa 7:09
I'm currently in a relationship with my running shoes. And I have been for about 10 years. Well,

Scott Benner 7:15
let's say you sound like you set your voice you have such a lovely voice. The I don't know if you know that or not. And when you think you and you said that or like seriously, are you doing voiceover work on the side? What are you doing?

Melissa 7:25
I wish I'm just one of those pesky attorneys. You're

Scott Benner 7:29
an attorney. I am. No kidding. What kind of law do you practice?

Melissa 7:33
I do corporate law. And I also work for veterans. Disabled Veterans. Nice.

Scott Benner 7:39
Let's see. Five kids. No diabetes, yours is late. You didn't expect it? I guess my big question is is that after what happens to your family? It's only a few years later that you get type one. Is your first thought this isn't fair.

Melissa 7:58
Absolutely. Oh, 110%. Yeah, I

Scott Benner 8:01
feel like that's what I would think to. How long did it take you to process all of that Dexcom G seven offers an easier way to manage diabetes without finger sticks. It is a simple CGM system that delivers real time glucose numbers to your smartphone, your smartwatch. And it effortlessly allows you to see your glucose levels and where they're headed. My daughter is wearing a Dexcom g7 Right now, and I can't recommend it enough. Whether you have commercial insurance, Medicare coverage, or no CGM coverage at all Dexcom can help you go to my link dexcom.com/juice box and look for that button that says Get a free benefits check. That'll get you going with Dexcom. When you're there, check out the Dexcom clarity app where the follow Did you know that people can follow your Dexcom up to 10 people can follow you. Right now I'm following my daughter, but my wife is also following her. Her roommates at school are following her. So I guess Arden is being followed right now by five people who are concerned for her health and welfare. And you can do the same thing. School Nurses, your neighbor, people in your family. Everyone can have access to that information if you want them to have it. Or if you're an adult, and you don't want anyone to know, you don't have to share with anybody. It's completely up to you. dexcom.com/juice box links in the show notes links at juicebox podcast.com. And when you use my link to learn about Dexcom you're supporting the podcast.

Melissa 9:32
Well, I was originally diagnosed as type two. So when I was 44, they had diagnosed me as type two kind of an interesting story. The insulin Gods nudged me a little bit. So I went on to Amazon Believe it or not, and I got a glucose meter. So I didn't have any symptoms that sort of classic symptoms going to the bathroom. You know very frequently I had actually gained a couple of pounds. So I just felt like something might have been off So I bought a meter, my blood sugar was 531. So I make a visit to the doctor. He asked me the list of questions, I say no to everyone and he said your meter is incorrect. Here is a prescription for a meter. And so I get that meter. And sure enough, was roughly the same.

Scott Benner 10:20
That I figured it out. It's the meter you bought

Melissa 10:24
an interest? I wish it were the meter. Unfortunately, it was not Was

Scott Benner 10:27
there some time after he, the doctor said that you thought, oh, I don't have diabetes. I just bought a junky meter.

Melissa 10:33
Absolutely. And I so wished that was the case. Oh,

Scott Benner 10:37
and then you find out that it's not the case? Do they start treating you like a type two? Initially, they

Melissa 10:42
did. My my agency was 11. I was put on Metformin and Jardiance, a combination pill called sin Gerety. So I took that daily, and he said, You can take it what a once weekly injection, and I thought, Oh, no way. I will never inject myself. That is the scariest thing on the planet. And, of course, here we are.

Scott Benner 11:02
Yeah, now you're doing it. Like it's like it's nothing like

Melissa 11:06
it's going out of style. Exactly.

Scott Benner 11:09
Okay. I just had a thought. I don't usually do this at night. By the way, I'm a little thrown off by this. Getting myself gathered, okay, so that the doctor sees you like any type to a mum. Okay. Did you have any big illnesses or viruses prior to your diagnosis?

Melissa 11:31
I didn't.

Scott Benner 11:33
So they say sometimes, that stressors can also be like kind of things. Like the my assumption would be that you've been living with markers for type one diabetes, most of your if not all of your life. And I'm wondering if the passing of your husband wasn't so stressful that it didn't put your body in a in a unique situation?

Melissa 11:56
It may have it very well may have i That's something that I have thought of.

Scott Benner 12:01
Me, there's no way to know. It's just right. Yeah. Interesting to wonder about. So okay, so you. So you have the quick onset? How long did they treat you like a type two, it was

Melissa 12:15
about four or so months, I bought every single book that I could get my hands on thinking if I work hard enough, I could put this into remission. So I read a bunch. I actually ordered my own C peptide and antibodies tests. And that revealed that I my C peptide was terribly low. And I tested positive for the GAD antibodies.

Scott Benner 12:37
You did that on your own?

Melissa 12:38
I did.

Scott Benner 12:39
Is that something that Dr. Fight you want it? Or was it pretty harmonious when you asked?

Melissa 12:45
It was a self test that you I purchased on my own? How much of it was a pretty penny? It was several $100 out of pocket. But I wanted to know, from all of the literature that I had read if I was indeed type one.

Scott Benner 13:00
Did you not think mom trying to figure out why did you not go to the doctor and ask for the that testing, like through your insurance?

Melissa 13:07
I had switched physicians at that point.

Scott Benner 13:12
You didn't like the last one did not like the last one. Does the cancer battle teach you not to put up with bad doctors?

Melissa 13:19
I think it teaches you to be a strong self advocate.

Scott Benner 13:24
Yeah, I agree. I often think that my mom stole a couple of years. And it's because I this is gonna sound strange. But it's because I have all this experience raising a child with diabetes, right? Because there was a moment where doctors told my mom like this is it like, you know, just get your affairs in order a couple of months. And, and it's gonna be over. And I was the one who was like, No, I we could figure this out. Like if we try hard enough. And we got a doctor to perform her surgery, which led to two more years. And but doc, but the doctor we were at and even the institution she was at was not interested in helping her. Right. And so, you know, I really believe in that strongly. Well, it'll serve you well moving forward, I think. I think so. I hope so. Yeah, absolutely. How are your kids?

Melissa 14:20
Oh, they're doing just fine. I've got two in college two in high school for this upcoming school year and one in middle school. Wow.

Scott Benner 14:26
Is it exhausting raising five children by yourself?

Melissa 14:29
Oh, being mom and dad has me very tired. Yes. And then I worked full time as well.

Scott Benner 14:34
What did you find? What did you find the slack that needed to be picked up? Like what did you look at and say this is an important thing my husband would have done? It needs to get done. I'm gonna have to jump into unfamiliar territory here and do this thing.

Melissa 14:53
Really showing up for myself? Because kind of like the airplane analogy you have to put on Your own mask first and then save the littles that is so incredibly important. And then ditch the mom guilt that is so strong and so important. So if I don't take proper care of myself, especially now as the only living parent, my kids will have no one. And that's not acceptable.

Scott Benner 15:17
How did you do that? How did you get rid of the guilt?

Melissa 15:20
I don't know that I've gotten rid of it entirely. But finding moments of gratitude daily is really important. And something that I cherish.

Scott Benner 15:28
It really is a situation where you're owed your feelings as well. As certainly, yeah, and I'm assuming you've, you know, made five children with a person you really cared for. So, and it's such a, I mean, you probably really started. I'm so sorry. I feel like I'm bumming you out. But like, worries. I mean, that really is just, I mean, it's still the beginning of your life. You know, 37 years old, honestly. Right. Yeah. Right. Wow. That's a lot of kids that 37 You've been like, do you guys start early or go fast?

Melissa 16:01
Started in law school.

Scott Benner 16:04
Really? Law school? Not hard enough for you?

Melissa 16:09
Yes, like she's my Christmas break, baby.

Scott Benner 16:13
We've got to do something to get rid of all this tension. Why don't we make more tension?

Melissa 16:20
Simply get out there. They're cute and squishy. So you know what's for more? How

Scott Benner 16:24
do you make it through law school with a baby? Like that's interesting.

Melissa 16:29
Just a day at a time, kind of like, like today?

Scott Benner 16:33
So you've kind of always operated this way. Yes, yes. Yeah. Did you have like family help with the baby and everything? Do you guys get mad? I have so many questions. Do you guys get married right away once you got pregnant and what did you do?

Melissa 16:45
We met in college. And so we got married a year and a half later. And then he went to law school, then I went to law school. Wow.

Scott Benner 16:55
That's really something hey, most Mormon.

Melissa 16:59
We're not Mormon and we're not Catholic. I do get those quite often. Yeah, no

Scott Benner 17:03
kidding. Well, they're obvious. Like you know, generalizations to make. I like how you answer everything like an attorney. Do you know that about yourself? Now I do your questions or like your answers or like you pause, you think your direct you don't say more than I asked, which is interesting.

Melissa 17:25
Like, we don't want to know how many listeners you have. So

Scott Benner 17:28
I just always think of attorneys as people were like, I don't say anything extra because extra stuff gets us in trouble. So we just keep it to what we're doing. Anyway. That's lovely. I on point, I'm also enamored by your voice, by the way, definitely think you could be a mom in a sitcom or something like that. Oh, thank you. Now you, um, you're like, thank you. I'm an attorney. I don't need to be in a sitcom.

Melissa 17:51
Might be a little more fun, a little less stressful. Actually, I love what I do. I've only wanted to be an attorney. So I'm, I'm grateful that I get to do that.

Scott Benner 17:58
Okay, good for you. That's excellent. You talked about having to be there for your kids. So I'm going to try to piece together a little timeline here. Your husband passes. Your your health is how at that point, I mean, your mental health is probably shaky. But how was your physical health?

Melissa 18:14
I was running a lot. So it was I was in pretty good shape. I still am, hopefully in decent shape. I saw Ron, I did a lot of rock climbing. I have yet to do outdoor rock climbing since being diagnosed. So mainly indoor rock climbing. So I've always been pretty athletic. And type line is definitely not slowing me down. If anything, it's helping me to get out there and sort of show the world that you can run a 50k or climb a mountain with type one.

Scott Benner 18:43
I don't know the metric system but 50k Sounds far.

Melissa 18:46
It's a little farther than a marathon. So it's it's not too terrible.

Scott Benner 18:50
So to you. I jogged up the stairs to do this with you. And I was like great. Now I'm out of breath. Wow, that's something so how do you? How are you managing right now? Are you on a pump? Do you use injections? What do you do?

Melissa 19:04
I am now on? Luckily I love it the Omnipod five and the Dexcom G six.

Scott Benner 19:10
Nice. What did you start with?

Melissa 19:12
I started on MDI with Joseba and human log.

Scott Benner 19:17
And what were your needs? Huh? What is the question I want to ask? I'm looking at your age. You're still so sorry. You're getting your period still is what I want to say. Right? So do you see fluctuations? Did you see fluctuations right away with hormones? Well,

Melissa 19:33
it's interesting. I I'm actually on an IUD. Once my husband was diagnosed with cancer, we put a stop to the baby making for obvious reasons. So I had an IUD. So the IUD that I have is the marina and the Marina means I don't get a period so I don't actually get the monthly cyclical changes. So I believe that I'm actually Peri menopausal at this point, just from some other types of symptoms, but I have not no Just my insulin needs varying within the weeks of a given month.

Scott Benner 20:04
Can you spell the name of the IUD? It's

Melissa 20:07
Marina and I Rena.

Scott Benner 20:11
Oh, okay, so you don't see the fluctuations? But what are the things you're seeing that make you think you might be perimenopausal is the

Melissa 20:18
temperature stuff? Temperature? Oh, the temperature? My wife

Scott Benner 20:22
takes something. Are you do you get the sweat ease? The sweats? Yes,

Melissa 20:26
I do. Wait, hold

Scott Benner 20:27
on. I'm gonna text somebody in another part of my house and get you the name of something that stopped it for my wife. Yes, please. What? This is, by the way. Sorry, Kelly. All right. I'll get the name back of that for you. Wow, look at us. Old. Oh, my gosh. All right. So your, how long on MDI before you move to Omnipod five.

Melissa 20:57
I was on MDI for about six months. It was grueling work, I maintained an A one C of 5.4. I counted my injections, because I really wanted to figure out what I ate, how it affected my body, my running my climbing, how that affected. So I kept meticulous records for about the first six months. So I was doing in order to keep that line from shooting up or going too low. I was doing on average, about 10 to 13 injections a day, I had the human log Jr. So I was able to Bolus in half unit increments. I have now a wonderful endocrinologist who writes me the best prescriptions ever. And after six months, I said I'm I think I'm ready to start pumping. And it was the best decision ever.

Scott Benner 21:43
Did you take to it all very quickly. It sounds like you figured diabetes out.

Melissa 21:49
I had done a lot of research. And in fact, when I was diagnosed as type one, I did a search. And it led me to one of your podcasts with a physician herself who was diagnosed as type one. She was loud as well. And that was such an encouraging, encouraging episode to know that I wasn't alone, because I didn't know anybody that was type line. I do have one friend in person to actually that are that I can receive support from that are here in real life. But that was I just recall, and I don't remember her name. But that was just the best episode ever. It gave me so much hope. Wow,

Scott Benner 22:27
that's really something I I have to tell you that. Even though I understand that that happens when somebody says it to me, it still takes me by surprise a little bit. It feels lovely that that, that that all worked out like that. But absolutely,

Melissa 22:41
it was just a godsend. I wish I could remember her name, or had some way to contact her just to say thank you.

Scott Benner 22:48
Yeah. Oh, well, let's just assume that I invited her on. So thank you. Me. It's enough. Do you want to figure out so this stuff is over the counter? It's called estrogen. e s t r o v e n? O yes.

Melissa 23:04
I've heard of that. I have yet to try it complete

Scott Benner 23:06
MultiSymptom menopause relief? My wife says that made her stop

Melissa 23:11
sweating. So I will try that out. No, tell her thank you. Oh,

Scott Benner 23:14
please, I will absolutely pass it on. She'd be thrilled if it helps somebody else. And by the way, if you so if you don't have you don't have any thyroid stuff. So you probably wouldn't have listened to the thyroid episodes. But the doctor that was on to discuss thyroid stuff. Dr. BENITO is the one who told my wife about estrogen. So okay, yeah. Good luck with that. I think it's just like, I think you're probably grabbing it at Amazon to be perfectly honest. Oh, beautiful. Perfect. Good luck. Let me know by the way, seriously, if you stopped sweating, send me an email. I definitely

Melissa 23:42
will stop sweating. I just hope you remember me and

Scott Benner 23:47
please don't give it any context. I just want to get an email like in three months it says I stopped sweating and see how long it takes me to go. What the hell is this about? Right? I really have the worst memory for things like this. I got a note today. Hold on. I wish I could get it up for you. So I'm now I'm using an editor for the podcast now. So like you and I will talk we'll do our whole thing. At the end of this episode after you and I are done. I'll leave myself like a voice note like listen I talked about this and that and blah blah blah and maybe think about naming the episode this like that's pretty much it right? And then I'll upload the file and someone else will go clean it up. Although I gotta be honest, your microphone sounds so good that if we don't curse I probably can save the money on this one. Anyway goes up to an editor and that person like takes like leave some notes for me at the end. And the note I got today was something about like reconstructive surgery on somebody's i don't know I'm sorry most I'm not a doctor, but you know,

Melissa 24:51
they're telling you just play one on TV Exactly.

Scott Benner 24:54
The part between their button their vagina, and then and all this stuff and so Um, and he sent me a note, he goes, Hey, you're gonna want to listen to this and hear and make sure you're okay and comfortable with this and this and this. And I was like, Okay, I don't remember this at all. I said, I can't wait to put it on and remember what the hell you're talking about.

Melissa 25:17
It's like opening a Christmas gift twice. You forget the first time, you know, I'd double gifts

Scott Benner 25:21
or by gosh, I swear to you. I mean, honestly, though, with that set up, don't you think your brain would go? Oh, yeah, well, that's this not I can't, I've just recorded too much. But you you joked a minute ago about I said, I'm not a doctor. I'm certainly not. But I just got surgery on my foot. During the initial consultation with the doctor, we were having a conversation. And I started saying some things. And there's a pause. And he goes, Hey, I'm sorry. Are you a medical professional? And I said, I got embarrassed. And I said, I have a podcast

Melissa 25:56
that is under the medical category. Does that count for something?

Scott Benner 26:00
What is the budget so that I started telling me about it? And he said, Oh, you're you're incredibly knowledgeable. And I said, Oh, thanks. And like, let go of it. Like not a thing that we kept talking about. But then weeks go by and then you get the surgery and then you know, little time goes by and you visit with the doctor and I and I had to come see him because the dressing was just not holding up. And I called them and I was like, I can just rewrap this and they were like, no, no, come in, we'll rewrap it. And I was like, All right, whatever. So I rewrapped it. But I kept the appointment. I think I just wanted to get out of the house for an hour. I was like, Oh, I can still go somewhere. And so I kept the appointment. I walked in, he goes, That looks fine. I said, I rewrapped it and he goes, Oh, that makes sense. You're a doctor. And

Melissa 26:45
I was like, Well, it matters into your own hands. Quite literally.

Scott Benner 26:48
He said that podcast is really coming through. So he looks at my foot and he goes did a really nice job. And I said I all I did was wrap it with gauze and tape. I'm like, I don't know that there's a like a high ceiling here for this. Anyway, it's ridiculous. Okay, so you move from MDI to Omni pod five, after not a long time, but not a short time using MDI, either. You were very diligent about your MDI. I mean, it's a lot of shooting to maintain a number, I guess. So during the MDI time, what was your a one see, like,

Melissa 27:20
it was 5.4. I kept a 5.4 a one C, I'll choose Milissa. So it was a tremendous amount of work. Yeah,

Scott Benner 27:29
no kidding. So you're making small bumps with injections? When you see blood sugar's rising, that kind of stuff. Right, exactly. After CGM. At that point. Are you MDI with the CGM ever?

Melissa 27:40
Yes, yes, I went to my endocrinologist, he gave me the libre, I prefer the Dexcom, it was just a little bit more accurate for my body. So I just actually got insurance coverage, I was paying out of pocket. Okay, but it was well worth it. For

Scott Benner 27:55
you. I liked the way you, you attack this, for the lack of a better word, I enjoy your perspective and how you like you're like, I couldn't get a I couldn't get an antibody test. So I bought one. I didn't like that. So I paid cash. Like it's pretty cool. Okay, so now you what makes you well hold on a second, let me go back a little bit. When you're managing that tightly with MDI. Is that a thing you figured out on your own? Did you hear it through the podcast? Or read it in a book? Like, how did you decide to go after it like that? It

Melissa 28:27
was a lot of being part of the Facebook group, the juicebox Facebook group, there's a huge amount of support there. So that also being just a solid advocate. And then being of course, my kids only living parent, I felt like I didn't really have a choice but to maintain nondiabetic numbers or at least really try put in a solid effort. Wow,

Scott Benner 28:50
I was going to ask you about that earlier, but I just decided to wait to see if it came up. The idea of I gotta stay alive. Right? Right. Absolutely. Yeah. Me. Yeah. I don't know. I don't know another way to think about I think of it like that. And I didn't have anything happen, like you had happened. So it's

Melissa 29:09
really something to be faced with your own mortality or to watch the my husband pass. It's it brings a lot of things to the forefront. So it's important to be strong to be healthy, you know, mentally, physically, emotionally. Just the whole gamut. Yeah,

Scott Benner 29:24
I mean, and the five children, right. So add them to Yeah, well throw them in. Well, here's the question. If, let's say you just disappear, you float away like a balloon. We don't want to kill you. In my scenario, we'll just let you float away. Did they all go to the same person? Although under 18, like who?

Melissa 29:42
Oh, as an attorney, I have that under lock and key and it is well thought out. Yes. Yeah. But my husband was an attorney as well. So we had plans upon plans upon plans.

Scott Benner 29:52
When you told me you had five kids I knew you were both attorneys. Yes. You were guys are like I can afford this. Don't worry. As everyone else gets to and goes, we're in trouble. We got to stop. But do they go to? Like, was that a thought? Like, they have to keep them together? Where was the thought I need to put them where they fit best? Or how do you

Melissa 30:19
stay together? Yeah, they're all provided for. And luckily, I was able to get life insurance pre type one. So there said, I worry about them killing me in my sleep more than I worried about me dying from type one.

Scott Benner 30:33
Son, my son started an IRA the other day, I was very proud of him. He's just out of college. And he's talking to me about like, he started talking to me about like, you know, what am I gonna do when I'm 50? I'm like, wow, okay. We'll talk about this. So we sat down, and we talked, and I said, I think you could probably start, like opening up a simple IRA somewhere and putting an amount of money in every month and having a goal for maybe buying a home or something like that, and then a more long term goal. And so he was he was like handling all that. And I said, I want to give you the first bit of money to put in it to get you started. And he was like, Oh, great. And I told him the number which, by the way, it's not a lot of money. And I'm, you know, it's just a reasonable amount of money to get them going. And we get on the phone that day. And he said, I got the whole thing set up. I gotta sign the paperwork and everything. That guy is gonna get it to me. And I was like, great, that's all great. And he goes, How much money did you say? You were gonna give me again? And I could see that he had a number in his head. But he didn't want to say it out loud in case he was low balling it. And I watched him go, did you say, Uh huh, what did you say? is amazing. He's like, he's afraid he's gonna say five. And I said six. One and two, whatever. He doesn't want to screw himself out of it.

Melissa 31:54
You got to read the room. You got to read dad.

Scott Benner 31:57
Just for fun. Anyway, okay, so you I mean, you're doing a five four MDI. Lot of work by a lot of work. You're injecting a lot. You're watching closely. What kind of Jenny told me to say fuelling plan. Well, but it doesn't sound right to me. How do you eat? I guess, like, what's the style of food?

Melissa 32:18
I love food. I will eat anything and everything. There's two things on this planet I won't eat. That's about it. I will eat anything and everything. I love eating. In fact, my endurance running allows me to really enjoy food. So I'm certainly glad that that hasn't the type one hasn't stopped me from just eating. Yeah,

Scott Benner 32:37
you know, people aren't going to be okay with it. If I don't ask the two things you only

Melissa 32:41
oysters on the half shell And Rob Bell peppers. I just can't. Oh,

Scott Benner 32:45
interesting. The oysters I'm with you. I can't I can do mussels in a pinch. Like if I had to. If

Melissa 32:54
you were on a desert island, talking to you know, Wilson that's

Scott Benner 32:57
been in the bar and had a couple of mussels and gone. That's enough. I don't know what everyone else is going crazy on. I had three um, good. Oysters. I can't do though. That's interesting. But to just things that do not like the way they feel in your mouth or the way they taste.

Melissa 33:14
It's disgusting. It looks like a big pile. It's not I'm sorry. That's just so gross to me.

Scott Benner 33:20
What about the peppers, though?

Melissa 33:21
I don't know, they have such a strong flavor roasted I can do. But I just can't do RAW. Okay.

Scott Benner 33:26
Okay. So you're eating an eclectic mix of food. It sounds like and you're still managing that five, four. So when you decide to go to a pump, is that a difficult decision to make? Because you're doing so well? Or did you just feel feel like you needed the brake.

Melissa 33:42
I felt like I needed the brake. I knew in my gut that it was the right thing. And in fact, it had my insurance had denied it. And my doctor appealed it. And when I got the letter, I just broke down. I was picking up my son from the bus stop. And I started to cry. I showed him the letter, I knew that life was going to be so much easier, which it absolutely has. I wear a Garmin watch. And so I'm able to get my blood sugar on my watch. I'm able to Bolus through my phone, I have an Android, it could not be easier. This is a great time to be a type one if you happen to have the unfortunate fortune to be a type one. Oh, I

Scott Benner 34:18
agree. Jenny and I were talking about the other day. Well, I thought we were recording something. I don't know when you'll hear it. I can't keep track of everything. I were just talking about that. Like just you know, you just go back 100 And some years 100 And some years and Melissa you'd be gone. You don't I mean, like you would have got diabetes and you just would cease to exist. And then somebody comes up with insulin and then you know that's a miracle. And and you think well how can you get better and then it does and then the insulin gets better and then pumping and then the continuous glucose monitors are just they really are the rest of it. As far as I can tell right now. It just it's a it's a hell of a leap and I will tell you if you even go back to when Arden was diagnosed like when Arden was diagnosed it was a meter and syringes. And that was it. That's what you got. So it was just 20 years ago, right? Not even. Let me do the math. She's 19 She was diagnosed when she was two sounds like it was 17 years ago. Yeah. So Yeah. And, you know, it's funny, I really don't even know 2006 She was diagnosed. I really don't. It's not a thing I track. As a matter of fact, I think she was diagnosed in August, but I'm not even 100% sure of that. I really don't like, I don't know, I'm not that person on that stuff. But yeah, it's just it's come so far, so fast. And, and I mean, because the leaps that have happened in the last 10 years are, are really astonishing. Like, you know, really wonderful. The podcast, the Facebook group, gave you all that stuff. Did you use that to transfer your knowledge to pumping? Did you lean on this again? Or did you have it pretty solid by them? I

Melissa 35:54
did. In fact, I listened to the pro tip for the Omni pod. And that helps so much to make sure that I had my settings appropriate that I was able to Bolus in at the appropriate time Pre-Bolus seeing all of that everything is encapsulated in those I think it's four or five episodes. It is it's it's gold. Well, let's

Scott Benner 36:16
go. The diabetes Pro Tip series for Omni pod five is three episodes long. And it is available at juicebox podcast.com, forward slash Omni pod five, or it's in your player, etc, and so on. That was I'm going to take a little bit of credit here. People listening for a long time are laughing It's fine, you gotta laugh at me, I'm just gonna take credit here a number of years ago, when the idea of on the pod five G's back then they were going to call it horizon, it was going to be called Omni pod horizon. And it was in the very early stages, even nowhere near being, you know, even sent to the FDA years away from that happening. But the conversations are happening behind the scenes, we're working on this thing, here's what it's going to be. And I started advocating back then between me and the person that I do business with it on the pod, I was like, we have to make like a pro tip series to help people transition to an algorithm because it's not a thing people understand generally. And when it goes wrong, when they have their settings wrong, or when they fight with the algorithm or something like that, it's gonna go wrong, and they're gonna blame the pump. And not only is that going to be bad for you, as the company, but it's going to be bad for them. Because a number of them are going to, they're going to give up, they're going to think, oh, I tried the thing, the thing doesn't work. And that's not what we want. And I don't mean from a sales perspective. I mean, from like, a health perspective, and, you know, an ease of use and all the other good things that come out. I mean, how much do you love sleeping? Now? You know,

Melissa 37:43
it's beautiful. I love sleeping. I did my do with all of my kids waking up in the middle of the night.

Scott Benner 37:49
You didn't want a six go around with diabetes? No, thank

Melissa 37:53
you. No, thank you.

Scott Benner 37:55
I agree. But it's a different way of it's a slightly different way of thinking not just Omnipod five, by the way, but if you were going to use the tandem control IQ, or probably even the new Medtronic 780 You know, if you're going to loop if we're going to do do it yourself loop, it's all just it's a slightly different way of thinking about it. You want, you don't want to be fighting it, you want to be working with it. You know, right. That's very cool. Beautiful thing. I love it. How do you make out? I mean, it sounds like you're incredibly active. So how do you manage your activity with only about five

Melissa 38:27
if it depends on the time that I exercise during the day. So as is common, I tend to be a little bit more insulin resistant in the morning. So when I run fasted, I don't put it on activity mode, but any other time like after 10 Like today, I I hit the gym during my lunch, and I ran a couple of miles on the treadmill, I made sure to put an activity mode about an hour before to suspend the insulin. And I still actually ended up needing a little bit of sugar. So it's I always carry sugar with me always, always always, especially when I run back country. Yeah. And I of course have a little meter that I take and I do take my boxing as well. That's

Scott Benner 39:07
excellent good for you. Like just being prepared. I just got done making a couple of short episodes with people telling their experiences of using glucagon. And you know the amount of people who are not prepared or don't even didn't prior to it happening even understand why they needed to be prepared was interesting and there's that episode from not long ago. What is it the wife is telling the story of the husband going on a hike with their child he the husband gets low and starts to explain to his I think is pretty young daughter how to get back down the mountain they're on to find their grant her grandfather and have him come back and while the husband was explaining this to the child, he believed he was explaining to his kid how to go find somebody to come back and find his body like he thought he was like he He thought he was really in trouble. And then and then he found berries that he took to help bring his blood sugar back up. That is so scary, isn't it? Yeah, so scary. So if you're gonna carry your glucagon, then you know, you won't have to. You want to think give your children a map to bring back the the people who are going to drag your carcass back. You know what I mean? Right?

Melissa 40:18
Yeah, well, my kids would drive up in a Ferrari. But I have, I have definitely briefed the kids on where everything is located in the house, in my purse in my bathroom, I have the locations listed on my fridge, just in case step by step instructions. I've actually alerted my local police department and fire department. So I have a key so they don't have to do force entry in case I need to call 911. I've really thought about this. Because at some point, I will be living alone. The kids will fly the coop. So I want to make sure that I give myself I sort of stacked the deck in my favor. That's so

Scott Benner 40:58
smart. What it was that like when you contacted like your local municipality, I

Melissa 41:02
am lucky to know a couple of first responders. And so I asked them, what would be the situation if I called I knew I was going low. I just needed emergency services, but I couldn't make it to the door. And they said two options, forced entry. And I thought, well, I like my door. And they said second option is to have a lockbox with a key and then have kind of what realtors have when you do your open house and then have a code and so you can let them know the code. So no problem. They're

Scott Benner 41:34
smart. Hey, the joke earlier about the Ferrari that was that your kids were going to spend the money from the life insurance. Oh, the little stinkers Of course they did this they heard of your past and then come get you. Exactly. It was wonderful. I think this is what she said. I mean, sad.

Melissa 41:58
If you can't laugh at it, you can't laugh at it. You got to be able to take life with a grain of salt sometimes.

Scott Benner 42:03
No kidding. It does. I mean, listen, you've been offered, in my opinion, you've been offered two of the most significant perspectives that a person can have. I mean, the loss of a spouse at a younger age. And then your diagnosis, I think are two things that if you weren't already a person rich with perspective, I would imagine you you leveled up about 1000 times.

Melissa 42:32
I would hope so I think so. I really think as I mentioned earlier that taking moments for yourself doing if you're the meditative type to do some deep breathing or meditation or just revel in those moments of gratitude. The other day, I had my little guy and he brought me a flower. He goes on a walk with my oldest after dinner sometimes, and especially during summer break. And so he brought me back a flower and he said, I love you, Mommy. And so I put that flower in that's on my nightstand. And it's just those little moments. It's the last thing I see before bed. It's the first thing I see in the morning, that keep me I think in a good headspace.

Scott Benner 43:07
Is it possible that without that effort, you could have gone the wrong way?

Melissa 43:12
Oh, 100% 100% Is

Scott Benner 43:16
it? Is it something that you did you feel the draw of it and resist it? Or did you get ahead of the draw? Does that make sense? It's something

Melissa 43:26
that you're faced with, I think when anybody is faced with any difficulty or any hardship in life, it's your choice. There's a everybody faces this, whether it's type one, it's a passing of a family member, it's a loss of a job, but whatever it is, you are faced with a choice, how am I going to handle this, and I was faced with that choice. And instead of picking up something that was going to be detrimental to my health, I laced up my running shoes, I put on my climbing harness, and I just went for it. And so I ran long and I run hard I climb. And I then that's kind of really what keeps me sane. It also helps with blood sugar, a great deal as well.

Scott Benner 44:02
You're getting the double bonus there. You've beaten up absolutely up the road and getting the exercise. Oh,

Melissa 44:08
the best thing today is I didn't have to Bolus for my lunch after my run. So I got to be sort of a non diabetic for one meal. Oh, wow,

Scott Benner 44:16
that's cool. You said something earlier that I want to loop back to oh, that you can run in the morning fasted. I think that's something that you really learn with an algorithm. Because you know, you're not going to be in that situation where your Basal was too heavy overnight, and you wake up and you get low or something like that. If you don't need like, I really don't have a ton of time with this. But you know, when Arden was injecting or even when we were just using pumping, you know without an algorithm of any kind. There are times where you'd be like, well I managed this overnight. I have a nice blood sugar overnight, but you wake up in the morning and then you don't want to eat right away and hours go by If you end up getting low, then with an algorithm taking away basil and with it guessing that in the future you're gonna get low and taking taking away. You really can go. I mean, I don't know how to tell people like Arden didn't eat today. Today's an example she did not eat today until five in the afternoon. That's it. She went to bed really late at night, three, four o'clock in the morning, she got up at noon. And then she wanted to go to lunch with her friend, but her friend wasn't available. So they just she just waited, and then they went to dinner instead. And her blood sugar was super stable the entire day. Oh, I bet yeah, yeah. So no act of insulin on board and runnings not the same as active insulin and running, even if that active insulin is only just like your normal Basal, for example. Absolutely,

Melissa 45:44
the ability to suspend insulin is, is one of the hallmarks of what makes a pump I think, in my opinion, it or at least for me a little bit better than MDI, so that I can make those gameday decisions to go bang out those few miles on my lunch break, because that's the only time I have because I have to get up take the kids here their school work whatnot. So that's the only time and that's my, my sort of me time. And I'm able to fit that in, of course, always have the sugar, but the ability to suspend is something that I think is unique to pumping. Yeah,

Scott Benner 46:18
no, it's one of my favorite. I mean, honestly, I, if people may have heard me say it in, like the Pro Tip series, but being able to start and stop your basil, this is one of the first things that I thought of when we were at a pump class all those years ago for the first time. And because that that feeling of like I put the I put the Bazelon it's in there now. If it's too much or too little, it's too late. Like I already injected, you know, back then it was love Amir for Arden. But that idea, like I remember standing at that pump class and saying to my wife, look, we could like tempt the Basal, like, make it stronger, weaker, we could shut it off. I was like, I think this is like, like, it was like, mind numbing at the moment was like, what that sounds like so much control that we don't have right now. Absolutely.

Melissa 47:07
And it also means that you're not having to ingest extra fuel extra calories if you're on a weight management plan, which is important for a lot of people as well, to stay in that healthy range. I know with running extra weight is extra pressure on your joints. So it's it's definitely something that I'm aware of. And that matters. Yeah,

Scott Benner 47:31
no, it's um, it's astonishing. It's just one of the most important things I can't even say. So what I'm sorry, we're 47 minutes into this, but are we getting to the things you wanted to come on for? Or is there other stuff you want to talk about?

Melissa 47:44
I just am, I just passed my year, my first year. So I'm in year two, I think if there's one thing that I wanted to say is that there's hope this is not a death sentence, you can continue to exercise, you can eat the cupcake that you wanted to eat it, it is not an end of life type of a situation where you have to do this, that and the other, of course, you have to check your blood sugar, you have to maintain good health, but you can live and you can live quite successfully. So it's something that given the current technology today is something that is absolutely doable. You can thrive with this. I've seen it I'm living it and and the listeners can as well. Good for you.

Scott Benner 48:29
I appreciate that message. Honestly, if I can loop back around a little bit, there's this. So there's this thing that happens blesses that people say nice stuff to me. And then if you listen, you know, I get embarrassed, and then I act like an idiot because I'm not good with it. And I say stupid stuff all the time. But there's this one thing, I'm always afraid I'm not giving the right weight to. And it is that Facebook group. It's it's got so much value, but I can't like I can't bring myself to be the one to say it too much. Because I feel like it'll just sound like I'm trying to get people to join my Facebook group. That makes sense. But I wondered if you wouldn't talk a little bit about as it like an adult like a person who's just diagnosed that how was that valuable to you? Yeah, it

Melissa 49:13
was actually a lot more valuable than I was thinking because I was thinking this is probably comprised of a lot of parents, their children, their cute little babies. They're the ones with type one. So maybe this is more parent focused. But when I started becoming more active, there is a ton of adults in there that are just like me that were not diagnosed when they were two. They're diagnosed in their 40s or their 30s or 20s 18. up so there's a there's a lot of support for adults. And then when I ran the LA Marathon this last year, I think I had something like 500 comments saying a great job and almost 2000 thumbs up I mean it was it made me feel so warm and fuzzy and like I had just done something amazing. It the sub chord is there, it's there.

Scott Benner 50:01
I'm glad that I just you know what I mean? Like, it's hard for me to just say, you know, for those of you who wouldn't consider joining a Facebook group, there's

Melissa 50:10
no one to join. Yes, there's, it's

Scott Benner 50:13
there's just a ton of value in it in ways that I mean, you said you didn't expect, I didn't expect. I tried saying it over and over again, I only made the Facebook group because people, people bothered me for it. And, you know, and it was, we needed a group where we can talk about the podcast, and I was like, my first thought was, oh, no, no, no, like, I don't I very much don't want to be involved in that. But then that kind of kept coming, you know, that that pressure kept coming? And I thought, oh, will it hurt? I'll open it up. And I don't know if anybody like, like, now knows this. But I started that Facebook group, I had one rule. And the rule was, it said, Don't be an oral closed this whole thing. I don't need this problem. It was something,

Melissa 50:53
something that's funny. That's what I tell my kids. That's our family motto.

Scott Benner 50:58
You know, my wife and I, when we had kids, we, we really did settle on that as our goal. Like, we just don't want to raise kids who like when they're out and about when they leave a social setting, that they're the ones that people go. Like, exactly, yeah, that was really, that was really the only like, marching orders we gave ourselves and that we were pretty young in the beginning, although you were in college still. So I'm pretty young. So

Melissa 51:23
that's like the one thing that you learned in kindergarten that that should stick with you forever. Yeah,

Scott Benner 51:28
no kidding. Like, just anyway, that's that. If you've if you've ever thought Scott's kids sound like they came out, okay, that was really our marching orders. You're like, we just don't want that to be like, we'd make the joke about like, keeping Arden off the pole, I think because Chris rocks stand up was very popular around that time. And I think that was the joke that really, like right rang out of his standup at the time. But I mean, we really like between the two of us. That's what we said, like, just want them to be nice people. And we'll see good humans. Yeah, yeah. And the rest should work. And so I started the Facebook group, not wanting to be the person running a Facebook group. And now the joke's on me, of course, because there's, there's over 40,000 people in there, and it's like, part of my job, you know, like, a reasonable amount of my day goes to making sure that that place is somewhere you can go and have a reasonable conversation, you know, get other people's opinions without being treated poorly, and, and hopefully come out of it enrich somehow, you know, and that's

Melissa 52:25
exactly what it was. for me. That's exactly what it was. for me. I can't say enough good things about the podcast or the group, the amount of support that is needed, especially in that first year can be astronomical, especially if you don't know anyone, or you are just you're blindsided by this and all of a sudden, you're on Bolus and Basal insulin overnight, like I was, you have so many questions, and you don't know where to turn. You don't know what is credible information, what is not. You need real time feedback from people. And because we're all located in different areas of really the globe, you're going to have a question answered in minutes. It's

Scott Benner 53:04
fascinating, isn't it, like, in the middle of the night, it just like Europe just takes over for the Facebook, or Australia or New Zealand, you know, people just pop in and I that never forget the first time that happened to me that somebody was messaging me from like a South Pacific Island. And, like, it was like three in the morning. And I picked my phone up. And I'm like, You know how some people message in long messages. And some people I say, I can't Oh, if I say this, it's gonna make somebody upset that I correspond with everyday. But some people text like 14 year old girls, like one thought at a time they send sense. And that makes sense or not. But this person was doing that. And so it was ding, ding. And I just I got on, I was like, Hey, this is so nice. But it's like 330 in the morning, I need you to like, just send your whole thought, please. And I'll answer you tomorrow. My wife's like, put your phone on Do Not Disturb. I'm like I can't because Arden has diabetes at all. So you know, anyway, that's a big sales pitch for it. It's probably what it sounds like to some people. But I swear it's the value. I've gotten value out of it. Like, like even some of the things that you've heard on the podcast like ideas about a series or like sometimes I see people talking and I think that we haven't covered that yet. Or that obviously needs to be drilled down on more because look how many people bring this up, and it's just been really valuable. So anyway,

Melissa 54:32
absolutely. Especially just for plain old garden variety, encouragement when you're having a terrible day, or you've been on that roller coaster. You know that you're not alone. And I think that's the main thing that helped me is I I wasn't alone when I felt so alone.

Scott Benner 54:47
Okay, hey, so unfairly. I know what you look like because of all this. And earlier you said having babies was hard on your body, but let's be honest, you have the stomach of an 18 year old girl at this So what did you mean by that? Exactly?

Melissa 55:03
I had. My third was I have big babies. They my third was 10 and a half pounds. So my smallest one, I think was eight, three, and he was a month early. So it just, it was rough. And then, of course, they never sleep. And I nursed them for the first year. So of course, you're up every two hours. So I don't remember it. There's a gap of about 10 years that I it's just, it's all dark. I really don't remember the 10 years of my life.

Scott Benner 55:34
Just making babies and getting them bigger. Yeah, that's right. Yeah, it is. It is really true, isn't it that that time is so like, I don't know, fraught with things to do and decisions to make? And I don't know, the only thing that even compares to it is when they get older, and they have to start going places. And you're you've just basically turned into an Uber driver for children.

Melissa 55:58
Right? Yeah, that's me right now. Yeah, I

Scott Benner 56:01
was gonna say you, you've probably hold on to your kids play sports.

Melissa 56:04
I have a couple that do basketball. My son did play basketball. My other son, I have two girls and three boys played baseball. So they've sort of kind of round robin all the different sports tennis. Wow,

Scott Benner 56:18
geez, it's a lot. It's just a lot of running and being places and how do you make decisions about where you park yourself and stay and where you're like, drop and go and come back?

Melissa 56:28
Well, it has become so much easier now that I have other drivers in the house. And I still have all five living with me. So I offer them free college tuition, if they stay home, and they can live here for free, I will pay for their college. And so it's really the only way that I'm going to be able to pay for five kids and college. So they do that they live at home. So we really do a cost reduction that way. And they help out and my girls help out a whole lot with driving and picking up groceries so on and so forth. So it does get easier. In some ways. You just worry a little bit more because they're out doing God knows what sometimes

Scott Benner 57:06
to try not to figure out what they're doing. I do my only like proviso is I'm I'm always like, if you want a cell phone and you want me to pay for it, I get to know where the phone is. Right? That's one of my things. I just like I get it, I get to know where your phone is. I'm not tracking you. I'm not sitting here watching you constantly or anything like that. But if I get worried, I want to know where your money comes in handy. A little bit I've talked about before, like, like I've seen art and below while she's a college. But But before I've stepped in to say hey, are you okay? I'll look at where she's at. And if she's in the dining hall, for example, I go, okay, she's taking care of this. And then that saves her from one of me pinging her about it, which I think is a big deal. But I liked that also. Yeah, I may or may not have once watched my son on a map drive to work one day. I really missed him one morning. And I picked up my phone and I realized oh Cole must be on his way to work. I have like a widget on my phone like a find my widget. And it seems to randomly show you one person that the other in on the widget screen and it was him and I touched it and it opened up. And his like the picture I use for him in my contacts is him like he's like four years old at a baseball game like running like running to first base. So I watched little four year old him run through Atlanta for like four or five minutes. And I thought I'll never ever tell him I did this.

Melissa 58:39
Well, Your secret's safe with me and 12 million other listeners.

Scott Benner 58:43
Everybody knows what I did that one morning. And meanwhile, there's no way these kids are ever listening. i My assumption is the only way my kids ever listen to this podcast is if I if I die and they get sad. They're like, oh, I want to hear my dad's voice. Because Oh, Melissa, Let's bomb each other out again. Did you keep voicemails?

Melissa 59:01
Yes. Oh, yes. And videos and all of that. Oh, yeah. You have to have that for the for the kids. So

Scott Benner 59:07
once my mom was diagnosed, I stopped deleting her voicemails. And I would even is more but I think but sometimes she'd leave me a voicemail, but I knew I was going to call her right back. So I wouldn't listen to the voicemail. So I still have some I've never heard before. And I do go listen to them once in a while. Yeah,

Melissa 59:32
I don't think there's any wrong way to grieve. Yeah, there's no timeline. There's no way there's no map. It's just you go with sort of your your heart and your heart will always lead you toward healing. Yeah,

Scott Benner 59:48
I get blindsided once in a while. But I feel a little grateful to be the age I am that my mom lived as long as she did too. Because it does feel I mean the thing that I mean, obviously, it's not a spouse but I at least had the feeling that she lived a long life, which is something you don't get to think. But anyway, I anyway, once in a while I opened up a voicemail I've never heard before, and I listened to it. And it's I don't know, it's comforting for some reason. Oh, for sure. Absolutely. Christ now I'm gonna make myself cry. And then I earlier I said, If I don't curse, there won't be any problems. So now I cursed the basically cost me money to curse today, because now I have to send this out for editing. And the guy who's editing it is hearing this right now and go and chit Ching. Right, Rob? Sorry. If

Melissa 1:00:44
he wants to talk about my pole dancing class, it needs to be edited out either.

Scott Benner 1:00:48
Well, wait a minute. We're at the end, Melissa.

Melissa 1:00:53
What's the word on that? Don't

Scott Benner 1:00:54
stop now. Okay, I'm gonna circle back around to one of my earlier questions. Do you think you'll like bait again, to

Melissa 1:01:03
be determined right now it is just really being here for my kids. And it's managing my diabetes and making sure that I can hit that LA with a better mileage time than I did last year. So that's an obviously I want to just do great work too, especially for the disabled vets that I that I represent.

Scott Benner 1:01:24
The disabled vets thing. Is that something you do through you're like, do I don't know how to ask this question. Do you work for a company? Or do you?

Melissa 1:01:30
Are you a nonprofit? nonprofit law firm? Wow.

Scott Benner 1:01:34
Oh, that's you've been doing nonprofit your whole life.

Melissa 1:01:37
I have here in there on a volunteer basis. Okay.

Scott Benner 1:01:41
That's excellent. So you work for a private company where you do something for yourself, and then you do the work for the nonprofit as well. Yes. That's nice. That's a lovely use of your time.

Melissa 1:01:51
It feels fantastic. It's there's just when they look at you, and they say thank you, it means the world. Yeah.

Scott Benner 1:01:58
I never thought. I guess I didn't wonder about it when I was younger. But helping people is really a large part of my life. Which I mean, I guess if people are listening, they think yeah, obviously. But it wasn't that obvious to me. So I didn't know. Like, I started the blog. To try to chase I started my blog because I tried to raise money for the JDRF. And it didn't go well. And the internet was just becoming a thing. Like, I know that sounds weird. And I thought I could use this blogging thing, maybe to tell more people about diabetes. And again, I know that sounds ridiculous. But in 90, munchies, when was it? 2006. Blogs weren't even a thing people exactly knew what they were like, it was all kind of new. And then that worked. And then then there's that drive for like, Oh, what do I put on here? Like, if I'm going to keep doing it, I have to keep doing things. And I went the route of like sharing very, like raw, like feelings. And after doing that for a while, I thought, Well, that's nice. But I mean, I've got people's attention now. Like I should help them. And that's where that all started. Because I was not a person running around helping people prior to that. But it's been one of the most valuable parts of my adult life. And certainly,

Melissa 1:03:17
and it kind of gets you out of your own life. It allows you to connect with other people in a different way that you wouldn't ordinarily connect that connection so important just to being a human were meant for connection. Oh,

Scott Benner 1:03:32
million percent. I'm sorry, I cut you off. I didn't mean to. Oh,

Melissa 1:03:37
yeah. And so that's it. It allows the feelings of the good feelings, the good vibes to come coursing through. So you just it just everybody wins. And

Scott Benner 1:03:47
if you're like me, and you're like a resolution oriented mind, like, like me, you can hear it earlier, like such a ridiculous thing. My mom got cancer, and I was like, there's a way around this. I can't fix enough problems to properly make whatever's wrong with me feel better. So being able to help more people, actually is more helpful for me.

Melissa 1:04:13
Like certainly, yeah, yeah, I've tried great way to help yourself is to help others. Yeah, yeah, I get that. I

Scott Benner 1:04:19
used to say that the podcast helps me more than it helps you. You just don't realize it. So right. Yeah, I love watching. Like, I can't tell you it seems. I don't know. I'm not boasting, but I probably hear from a dozen people a day. You know, in different different ways. Instagram, Facebook, email. Some people who I've made the mistake in the past of texting. If any of you heard that, it's fine. We're all good. Don't worry about it. But a lot of people will text me. I used to be for the podcast. I used to have conversations like like, the podcast is probably just the recording of conversations I used to have with people probably Lily about diabetes. And so I hear from people a lot of different ways over and over again every day. And every time I see them have like a resolution or like an aha moment or something happens for them where their life gets better or easier or healthier or something like that. There's like a small part of me. That just feels like oh, I helped with that. Oh, absolutely. So it helps me a lot. I didn't know this. Absolutely. Gonna go like this when we got on tonight, but thank you. Anyway, is there anything we haven't talked about that we should have?

Melissa 1:05:38
I don't think so. I think we covered quite a bit.

Scott Benner 1:05:41
We did. Okay.

Melissa 1:05:42
I think we did fantastic. Why

Scott Benner 1:05:44
did we move this so many times? Was it for work? I can't even remember for you. It was my work. Yeah. I'm gonna put a couple of nighttimes on the calendar next year. This is I found this nice after I relaxed

Melissa 1:05:56
I certainly hope there's no storms next time. No, no,

Scott Benner 1:06:00
it actually it was crazy. It was supposed to storm the entire time you and I were on but it just it came a little earlier was really violent. And it stopped just as you and I were getting started so

Melissa 1:06:09
I was pretty excited when God's are favoring tonight. Finally,

Scott Benner 1:06:13
finally. Thank you. Alright, well, let's I appreciate you taking the time and doing this. Oh, thank you. Of course. Yeah. What can you hold for me for a minute? Yep, great.

A huge thanks to touched by type one for sponsoring this episode of The Juicebox Podcast. Check them out on their website touched by type one.org or on Facebook and Instagram. You can use the same continuous glucose monitor that Arden uses. All you have to do is go to dexcom.com/juicebox and get started today. That's right, the Dexcom g7 is sponsoring this episode of The Juicebox Podcast. The episode you just heard was professionally edited by wrong way recording. Wrong way recording.com.

If you are a loved one has been diagnosed with type one diabetes. The bold beginnings series from the Juicebox Podcast is a terrific place to begin listening. In this series, Jenny Smith and I will go over the questions most often asked at the beginning of type one. Jenny is a certified diabetes care and education specialist who is also a registered and licensed dietitian and Jenny has had type one diabetes for 35 years. My name is Scott Benner and I am the father of a child who has type one diabetes. Our daughter Arden was diagnosed in 2006 at the age of two. I believe that at the core of diabetes management, understanding how insulin works, and how food and other variables impact your system is of the utmost importance. The bowl beginning series will lead you down the path of understanding. This series is made up of 24 episodes. And it begins that episode 698 In your podcast, or audio player. I'll list those episodes at the end of this to listen, you can go to juicebox podcast.com. Go up to the menu at the top and choose bold beginnings. Or go into any audio app like Apple podcasts, or Spotify. And then find the episodes that correspond with the series. Those lists again are at Juicebox Podcast up in the menu or if you're in the private Facebook group. In the featured tab. The private Facebook group has over 40,000 members. There are conversations happening right now and 24 hours a day that you'd be incredibly interested in. So don't wait. So don't wait. Check out the bold beginning series today and get started on your journey. Episode 698 defines the bold beginning series 702, honeymooning 706 adult diagnosis 711 and 712 go over diabetes terminologies in Episode 715 We talked about fear of insulin in 719 the 1515 rule episode 723 long acting insulin 727 target range 731 food choices 735 Pre-Bolus 739 carbs 743 stacking 747 flexibility in Episode 751 We discussed school in Episode 755 Exercise 759 guilt, fears hope and expectations. In episode 763 of the bold beginning series. We talk about community 772 journaling 776 technology and medical supplies. Episode Seven at treating low blood blue ghosts, Episode 784 dealing with insurance 788 talking to your family and episode 805 illness and ketone management. Check it out, it will change your life. 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.

#1146 Cold Wind: Healthcare Whistleblower E.R. Tech/Nurse

"Mimi" has been an E.R. tech and an E.R. nurse. Her voice and name have been changed to protect her identity.

+ Click for EPISODE TRANSCRIPT

Scott Benner 0:00
Hello friends, welcome to episode 1146 of the Juicebox Podcast

we're calling today's guest Mimi, she's 27 years old was diagnosed with type one diabetes in 2001. And she's been a nurse for about a year before that Mimi was an ER tech for eight years, and this is what she experienced at her job. 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/juicebox Don't forget to save 40% off of your entire order at cozy earth.com All you have to do is use the offer code juice box at checkout. That's juice box at checkout to save 40% at cozy earth.com. I'm talking about T one D exchange again and I hope you head over to complete the survey T one D exchange.org/juicebox. Looking for US residents who have type one diabetes or are the caregiver of someone with type one. They're especially looking for you if you are a male, a male of color, or the caregiver of someone who is T one D exchange.org/juicebox podcast. US med is sponsoring this episode of The Juicebox Podcast and we've been getting our diabetes supplies from us med for years. You can as well us med.com/juice box or call 888721514 Use the link or the number get your free benefits check it get started today with us med this show is sponsored today by the glucagon that my daughter carries. G voc hypo Penn Find out more at G voc glucagon.com forward slash juicebox Hello and welcome to the cold wind series from the Juicebox Podcast. These episodes will feature physicians, nurses and other professionals who agreed to come on the show anonymously to share what they see in the healthcare profession. I've altered the voices of each guest so that they can remain anonymous and feel comfortable telling us what really goes on at their job. Just listen to how well the voice alternative works.

Beth 2:35
My name is Beth and my oldest child has type one diabetes diagnosed in October 2020. My name is Beth and my oldest child has type one diabetes diagnosed in October 2020.

Scott Benner 2:47
If you work in health care and have a chilling story to tell about your experiences in the healthcare field, contact me today. I'll get you right on the show. Your story does not need to be specific to diabetes. Mi Mi tell me what you do for a living.

'Mimi' 3:05
I am an ER nurse.

Scott Benner 3:07
And do you have type one diabetes?

'Mimi' 3:10
I do. I was diagnosed February 28 2001.

Scott Benner 3:15
Oh, that's a while ago. Okay. Yeah. You knew the exact date February 28. Oh,

'Mimi' 3:21
we celebrate it?

Scott Benner 3:22
Do you do the thing where you have like a diversionary party?

'Mimi' 3:26
Ah, no. So much a party it kind of it's just like eating absolutely anything I want all day. That's how it started. And then as I got older, I'm like, Wow, it's really not fun feeling like crap all day. So now it's really just like, I'm gonna have a little treat here and a little treat there and call it a day. Celebrate yourself.

Scott Benner 3:47
So you've had type one for over 20 years. Yeah, for most of my life. I was gonna say how old are you now?

'Mimi' 3:54
27.

Scott Benner 3:55
Okay, how long have you been a nurse?

'Mimi' 3:59
I've actually only been a nurse for a year, almost exactly a year. But before I was a nurse, I was an ER tech. And I did that for just under eight years. What does an ER tech do? So it depends on your hospital and state. But where I was working, I basically did what nurses do, except I wasn't doing assessments and giving medications. So I was starting IVs I could put in catheters EKGs casting and splinting CPR when necessary, but lots of like task oriented stuff.

Scott Benner 4:35
Okay. How long does it take to become an ER tech?

'Mimi' 4:37
So similarly, it's dependent on your hospital and your state, but I just had my CNA, my nursing assistant license, and then everything else that I was able to do, I was taught on the job.

Scott Benner 4:49
Okay, so you went right into like a, what happens after high school you get like an associate's degree.

'Mimi' 4:55
So for CNA, it's just a certificate. So some programs are like weeks summer 12. I think mine was an eight week program. I actually started working at like an assisted living facility as a resident aide. And they were like, Oh, if you go get your CNA, we'll pay you more. And I was like, okay, like, why not? It's not expensive to get. And then once I got my CNA, my best friend's mom, who was a charge nurse at our local er was like, Oh, now that you have your CNA, you can come work for us. And like, we'll teach you all these things. And it'll be really great if you want to go to nursing school in the future. So that's what I did. I it was like, probably six months after I graduated high school, because I wasn't really sure what I wanted to do. I knew I wanted to do something with medicine, but like, I had no idea because there's so many different ways you can go, right?

Scott Benner 5:43
I guess the assisted living place was thrilled, they suggested that CNA and then they lost. So

'Mimi' 5:51
get your certificate, and we'll pay you more. And then I was like, Oh, I'm actually going to leave now. But thanks for the suggestion.

Scott Benner 5:58
They should have said, but you have to stay after you do it. Right. So okay, so you did the ER tech thing for what like, geez. For?

'Mimi' 6:09
Yeah, it was almost eight years, because I kind of went back and forth between wanting to go to like PA school or even med school. But then I was working more as a tech and seeing how those roles, like interact with patients and stuff. And I was like, I don't know, there's really not that much patient interaction. But I really liked the like, hands on tasky skill stuff. So I was like, I can still do that as a nurse and like help providers with those, like skills and tasks and procedures as a nurse and still get more patient contact. So I ended up going to nursing school. Let's see, I actually started before COVID. And then the place that I was working at the time, the ER had mandatory overtime. And I was like, I can't do school and work with mandatory overtime. So something's gotta give. And I took a break in school, actually, because obviously, my job was my health insurance. And I can't go without health insurance. So I took like a year and a half break in school and just did like online, general education classes to stay with it. And then went back. Let's see two years ago now, three years ago,

Scott Benner 7:23
what pushed you down and what pushed you to go back and finish?

'Mimi' 7:27
I loved being a tech. Honestly, if it paid a livable wage, I would probably do that forever. But it didn't. I was on the East Coast and the cost of living was really high. So I was like, I have to finish something to make more money. And I'm really happy with my decision actually to take a break because nursing school is very cutthroat, especially working full time and being in school full time. So full time for like nursing in hospitals, 36 hours, so I was working 36 hours a week had 24 hours of clinical a week, plus probably close to 1012 hours of lecture a week.

Scott Benner 8:04
36 type or 30. And that does like 70 hours worth of work for the degree. Yeah, and

'Mimi' 8:11
that's not including, like sleeping, and eating and going to the gym and like

Scott Benner 8:16
being a human being. And you were working you would have to work to Yeah,

'Mimi' 8:20
so it was a lot it was very time consuming. And most nursing schools, you have to have an average of 80% to be passing. So it's not like C's get degrees like you'll be fine. Do the bare minimum and you can be a nurse. So it was very time intensive. And like if you showed up late to lecture, you don't get to enter the room. And if you don't get to enter the room, you only get to miss three lectures that semester like it's very cutthroat. So taking a break was probably the best thing I could have possibly done for myself and I have absolutely no regrets even though at the time I was like wow, could have been a nurse two years ago but when

Scott Benner 9:00
you say cutthroat you mean unforgiving? Where do you mean there are actually people out there trying to knock you down? US med is sponsoring this episode of The Juicebox Podcast and we've been getting our diabetes supplies from us med for yours, you can as well. Us med.com/juice box or call 888-721-1514 Use the link or the number get your free benefits check it get started today with us med 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 EVO Capo pen and how to use it. They need to know how to use G vo Capo pen before an emergency situation happens. Learn more about YG 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 GE voc glucagon.com/risk For safety information.

'Mimi' 10:42
I think it kind of depends on the program. But it does feel like they're kind of out to get you sometimes. Our clinical Instructure instructors are part time staff so they don't teach like any lecture or anything. They're strictly clinical. So you go to the hospital and you practice your skills and patient interactions with a bedside nurse. And some of those instructors. I think nursing is a very young profession, which a lot of people know a lot of people say they don't like but then a lot of people also contribute to. So it was kind of like they don't want to see you fail. But if you start to go down that route, they're not going to help you kind of thing. Okay, they want you to like figure it out on your own. And that's not the easiest thing to do when someone's life is in your hands. It's really tough. I just I always say cutthroat, but like, there's some professors that Like genuinely want the best for you and will do everything in their power to help you pass. And then there's some that are like, Well, if you can't figure it out, you're not meant to be a nurse.

Scott Benner 11:48
Have you had experience, I guess, with people who take joy in the failure? Or do you think they think they're washing you out and saving the profession from someone who's not prepared and couldn't do it?

'Mimi' 12:01
I would like to think it's the latter. Like they want strong nurses out of school. But a lot of nursing, you don't learn in school, you learn it on the job. So if you can't make it to the job, you're never going to become a strong nurse. The same people are the ones complaining about like being overworked and understaffed because we can't get good nurses and like, you're not giving nurses the opportunity to become nurses.

Scott Benner 12:27
Is it a hazing?

'Mimi' 12:29
I think it really depends on honestly, your geographical location. Because like I said, I checked on the East Coast for a long time. And it's a very densely populated area that I was in. And nursing is much different there than where I am now, which is like, kind of Midwest Pacific Northwest. And nursing here is I tell people all the time, it's so much better, that patients are genuinely nicer. I feel like we have more time to spend with our patients. They're almost healthier here. Because people live such an outdoors, like active lifestyle, it's just almost easier to care for them because they want the best for themselves. So my experience out here has been so much more positive than any experience I ever had during nursing school on the East Coast or even as a tech on the East Coast. Okay.

Scott Benner 13:20
I wonder if your nursing school experience would have been different? Had you done it somewhere else?

'Mimi' 13:25
Maybe right, I would like to think so. We see a lot of nursing students in my current er, and they all seem like very excited to become a nurse. Wow, my classmates were like, dreading it.

Scott Benner 13:41
So yeah, the process is so bizarre. No, it's not the process of going through nursing school makes you just think, Oh, this is going to be if this is what this was, then the job is going to be 1000 times worse.

'Mimi' 13:53
Yeah. And honestly, during nursing school, I thought I was going to be a bad nurse. Because we did all of our clinical like on inpatient units or not in the ER, and the ER was the only thing I really knew. So I was like, I feel like I'm supposed to be doing more things. But I don't know what those things are here. And the documentation was very different. And I was like, if this like my instructor had to keep, like prompting me to do things and I'm like, I feel like I should be better at this. Like I have a lot of clinical experience and very comfortable with patients. So like, why am I struggling so hard with this? And then as soon as I got back into the ER, I was like, oh, okay, I am a good nurse, I'm going to be fine. I don't know why I felt that way in a different setting, but it's not me.

Scott Benner 14:42
During nursing school, how are things broken down? I think people listening, you know, they go to a hospital and they expect the first person that they intersect and every person thereafter to have a complete understanding of what's going on and their needs, which it seems unreasonable to me but at the same time You know, what else am I supposed to think? Because a patient walking in like I come in and I have a disorder, I have a disease. I have type one. And I'm here for that. I feel like you're supposed to know but you don't really know. Right? You do. What is it that a nurse is prepared for in nursing school is my question. In

'Mimi' 15:16
nursing school, we are prepared for taking tests. As bad as it sounds. A lot of nursing schools are just focused on pass or success rate for the boards, which is called NCLEX. I don't remember what that stands for. But it's like your national registry. You take the exam, you pass and then you're officially a registered nurse. So like, just because you're done nursing school doesn't mean you're a nurse yet.

Scott Benner 15:41
So nursing school taught you how to take nursing school tests.

Unknown Speaker 15:44
Yes, okay

'Mimi' 15:46
with understanding of basic disease processes and the human body. So your first semester of nursing school was basically like an introduction to med surg. And med surg is just like general medicine. A lot of the chronic things that people deal with mostly like heart failure, COPD, and basic like taking vital signs and how to do a bed change and stuff like that. Second semester, this is different for every program, it's generally broken down. Similarly, second semester was med surg two and maternal and fetal medicine. So like OB, third semester was med surg three, and mental health. And then fourth semester for us was like critical care, and er, which it wasn't really a ton of Emergency Medicine stuff. But it was just like, really critical thinking and like, disease processes that would lead you in the ICU kind of thing.

Scott Benner 16:50
So you get a background of a general overview of what everyone most likely comes in with. And then it's learned on the job after that. Oh,

'Mimi' 17:00
yeah, I learned way more as a tech being very vocal with my nurses and providers in my er, than I did in nursing school. Nursing School did teach me how to test questions and break them down to where if I don't know the answer, I can figure out the answer from the question and like process of elimination. But yeah, I didn't really learn a ton of information in nursing school other than like, OB and fetal medicine, because like, I did not know anything about that, because that's not anything we deal with in the ER at all. Yeah, usually. But I struggled with that semester, the entire semester, I was not passing until the final exam, I took the final and got like a 90%. And that brought me 1% of passing. It's

Scott Benner 17:50
funny, you're describing nursing school, like an LSAT prep course.

'Mimi' 17:54
That's exactly how it felt. Okay,

Scott Benner 17:56
have you taken one of those LSAT preps?

'Mimi' 17:58
Oh, a long time ago, but

Scott Benner 18:01
I have same idea like this is how you break down a question. This is how you figure something out when you don't know the answer to it. Like, here's how you pass the test. Yeah,

'Mimi' 18:09
that's exactly right. And like I said, it's because they want us to have that higher testing percentage in order to pass boards. Because if you so if I graduated, and like, I think it's less than 70% of my graduating class doesn't pass boards, we lose our accreditation. So they want everyone to pass boards, whether they're a competent nurse or not. They want them to be able to answer the questions correctly to pass.

Scott Benner 18:37
So I'm getting so it's possible, I'm getting a nurse that was just kind of pushed through. Yes, unfortunately, that the institution could continue on. Yeah. Every time we set a rule, it seems that just people find a different way to break it. Like you know what I mean? Like you get understand in the beginning, where somebody's like, Look, you have to pass at least 70% of the people to keep your accreditation as a, you know, a place that's good at teaching people how to be a nurse, but instead, to quickly turn it into a business thing, where they're like, well, we just got to get them through so that we don't lose the accreditation, because that's where we make our money selling nursing to people. Yeah,

'Mimi' 19:13
yeah. And I actually went to an Associate's program. So I have my associates, associate's degree in nursing versus a bachelor's in nursing. And at least where I came from on the East Coast, our school did have a much better reputation of our graduates versus some of the bachelors programs, because we had more required clinical hours. So while they are really like pushing us to just test well, we also were required to do a lot more hands on experience time, which I think is a huge benefit. Even though we have more than most schools. I still think more is better, especially with my background, like during nursing school. Yeah, I had 24 hours of clinical week, but I was also working in addition Not 36. So that's like another 36 hours of exposure to patient care for me. So I think that prepared me more than anything for my current job. Yeah, I

Scott Benner 20:11
once had a nickname NICU nurse tell me that they, they laugh at the kids that come out of like a four year bachelor's program from a private college, you ended up spending 60 $80,000 on their undergrad to be nurses. And they're like, you could, you could have done that in community college for four grand. And yeah,

'Mimi' 20:30
that's exactly what I tell people to like, where I am now, there's not really many community colleges. So it's not really a an option here. But because I was working full time, I didn't pay anything for my degree. My hospital paid for it.

Scott Benner 20:46
Oh, because you can Oh, that's right, because you kind of went back to school while you were a met. So once you were attacked, you told them look, I want to go back and get my RN, and they're like, well pay for it. Yeah. So

'Mimi' 20:57
depending on your hospital, despite what program you're doing, I think they reimburse up to $2,500 a year for undergraduate, and 3500 a year for post grad. But then there's some hospitals that also have like a Nursing Scholarship Program, where they'll pay for it. And you owe the hospital like two years of employment after versa. They say, some people take their chances and leave. And they're like, well, if they want me to pay it back, they can find me.

Scott Benner 21:29
Find me? Well, they did take a risk, because you really screwed over that. The elderly care place. Yeah, exactly. Like I can blow right out of here.

'Mimi' 21:41
I actually did leave before my time was like, due for my tuition reimbursement. It was like, I think one year after the last payout. And I hadn't even graduated before I put in my notice, because I knew I was moving. But the hospital that I was working at, I just was not interested in staying. And like I said, the culture of like East Coast medicine or religious a densely populated area was not a great culture to work in. And I wanted it to be at a trauma receiving hospital versus a hospital that receives a very sick or high acuity from a patient and then ships them somewhere else. Yeah, I had worked in that environment for long enough. And I was like, I kind of want to be on the receiving end and like, see more acutely ill or injured people. I know, it sounds kind of twisted. But I really liked like critical thinking and like more sick patients.

Scott Benner 22:36
Gotcha. My wife once described her job as like King of the Mountain. She's like, everybody below you is trying to knock you off the mountain. Like just, it's nonstop. She's like, it never ever stops. And you know, you're in meetings, and you have to say things in certain ways so that people can take advantage of your words, if you miss speak, and they're always everybody's throwing everybody ever under every bus they can find and all just, you know, ladder climbing, trying to trying to get up there. I mean, you moved halfway across the country, I don't want to tell people where you are. But you move pretty far getting away from getting away from all that. Yeah,

'Mimi' 23:13
I moved, I think it's actually like 2073 miles or something away from where I was.

Scott Benner 23:21
So if I asked you to, you know, blow the whistle on nursing, what are the things that popped to your mind right away that you'd want to share with people that are happening that they wouldn't imagine? I

'Mimi' 23:32
don't really see much at my current job. But as most of my background was that my most recent previous job, a lot of nurses hate being nurses, they do the bare minimum, and they protect their licenses the best they can. And they don't really advocate for their patient. They don't use that critical thinking, like prevent future problems, which it comes from both the nurse and the patient, because a lot of patients don't even want to help themselves. So what are we going to say that's going to help them. So there's just so much burnout, that it's tough to provide really good care, because they don't want it like patients want a quick fix. They want a pill to make their blood pressure better, instead of changing their diet or their lifestyle. And you give them that pill and then they go on their way and you'll see them in six months for some other medical emergency. Burnout is just so severe in nursing right now that it's really hard to want to provide good care. And especially in like an ER you're surrounded by your co workers, and if they don't want the best for the patient and like you kind of just like almost stoop to their level and it's really hard to change the energy in that situation.

Scott Benner 24:50
So going, going back to the first step of that. You said that a lot of nurses you know, don't want to be nurses. So using your story, to try to surmise Are we just becoming an RN for the, because it pays more? Do you think they want to help people when they get there? And they fall into the machine and the apathy? And they're like, Oh, what am I trying for?

'Mimi' 25:11
Yeah, I think it's a little bit of a ladder. But I think a lot of nurses also don't have the like, real life nursing experience that I bring with all of my tech experience. So like, they don't really know what they're getting themselves into. Granted, you have your clinical nursing school, but that is, so it's like not self directed at all. So like, every minute of every day is structured, you walk into clinical, and you have a piece of paper saying, at 7am, you go in and introduce yourself to your patient. At 8am, you go do an assessment, at 9am, you pass morning meds at 10am. You make sure no one needs to go to the bathroom. Like, it's just so programmed into your head that everything is like a timed process. Yeah, that if anything skews from that you like panic, like there's no autonomy in clinical and also when you're forced to use autonomy as a nurse after school. I think people really struggle with that. So they get out into the field, and they're like, Oh, this is not what I've done. And I'm uncomfortable. And now I'm just gonna, like fall into a pattern of what everyone else is doing. Because it works for them. So it'll work for me, you'd

Scott Benner 26:23
like answered an ad that was like, you want to work outside? Do you like having the wind in your hair? Do you like driving, you'd be like, Oh my God, it's amazing that you realize that you're like, gonna ride the back of a garbage truck. And they left out the part where there'll be maggots and hot bags of garbage all day. And like, so yeah. It's not quite what they think until they get there. And they experience it. And they're like, Oh, I didn't want this. But now it's too late.

'Mimi' 26:46
Yeah, and it's really, it's really tough to because people think emergency medicine, they're thinking like trauma and like broken bones and all kinds of stuff. And, as I'm sure everyone knows, there's like a huge mental health crisis across the country, probably the world, but we see a lot of mental health patients. And that's, it is an emergency, it's an emergency for them. And it's a crisis. But like, it's not the like thrilling emergency that everyone thinks they're going to get when they work in the ER, we see a lot of homeless patients. We see a lot of patients who don't have insurance. So the ER is the only place that will treat them prior to payment. Like it's a healthcare crisis, not just a mental health crisis. Let me rephrase that.

Scott Benner 27:32
One of the people who's been on the show already and recorded for this said that she's like a, I forget how she said it. Like I I'm sorry to say this, she said, but there are a lot of nurses who are trauma hoarse. She told me yeah,

'Mimi' 27:43
we can trauma junkies and like, I won't deny that I am not a trauma junkie, I love trauma, but it's also something that will burn you out really fast, too. So you see the worst of the worst. And if you see that, three shifts in a row, you get off and you're just like, wow, that was really emotionally taxing. Like as good as you can be at dissociating, it's still taxing probably

Scott Benner 28:08
like an adrenal overload, right? Like all that. Oh, for sure. The dopamine kick you get from it, and the adrenaline and everything. And then is it? Is it like doing drugs?

'Mimi' 28:16
I don't know, because I haven't done drugs. Very good. Mimi, there you go. But it is very exhilarating. There's a roller it's a good job. Yeah. Okay. There are certain parts of the job that I'm like, Wow, this must be like what cocaine feels like. Like one time, I put an IV in a six day old premature infant who, like the IV team couldn't even get access in I put in like a very small IV in her ankle. And I was just like, wow, they stuck this kid like eight times. I got it on the first try. I am on this high, and I'm gonna ride it the rest of my shift like, I'm unstoppable. But like, then you crash from that, like, I got home and I couldn't sleep. And then I was so tired. Once I like, came down off at high I was like overtired couldn't fall asleep. And then I like barely slept before going back for my next shift. And I was like, ah, was it worth

Scott Benner 29:12
it? Yeah. And then the next day a lady poops on you. Yeah,

'Mimi' 29:16
exactly. Or you have like a patient with bedbugs. or somebody's like, trying to punch you like, it's, it's chaos all the time.

Scott Benner 29:25
They're talking to you and spider man at the same time. And you're like, Oh, this is yeah, great. I gotcha.

'Mimi' 29:31
Trying to like, get the bugs out from under their skin. And you're like, please don't do that in front of me. And

Scott Benner 29:36
then when you get to like a regular old, everyday normal person who's just in there and sick their thing is, like banal and at least it's not insane. And then they don't get the level of care that you'd love to give to them because you have all these other influences bothering you. These variables. You're a real person to you have all these variables pushing on you. And then when you probably get a moment where it's not, oh my God, look at this amazing thing I did or Jesus, please stop pooping on the wall. It's just like, that's boring. It's regular, and you just get it done. And then you go back to this 10 o'clock do you have to pay blah, blah, you go to the schedule, you get them out of there. And that person later probably thinks I did not get very good care.

'Mimi' 30:15
Yeah, and it's really tough. Again, with the healthcare crisis, we're getting all these patients in the ER that need to be admitted to the hospital. And then there's no either open beds, or there's open beds, and no nurses to care for those open beds. So those patients just sit in the ER for sometimes days on end, we call them borders. At my hospital, it's pretty standard that you have four beds in your assignment. And if I have two borders, and then two er beds, that I could be turning every couple of hours with very sick, critical patients. My borders are gonna have to wait, whether it's scheduled meds are getting them to the bathroom. Luckily, we have great Tech's very work that'll help do most of those things. If they can, like, oh, we need to put them on a hospital bed to make them more comfortable or take them to the bathroom or something like that. But like if I get a patient in one of my er beds, it's having a heart attack that requires all of my attention until they leave my room. Right. So then yeah, my boarders will not get the attention that they need for possibly up to like four hours, I say. So it's definitely a disservice to them.

Scott Benner 31:24
I want to go back to the other thing that you said when you were kind of laying out the job, which is people are there because they're sick, and they recognize that they need help, but they're not necessarily the best shepherds of their own health to begin with. Yeah. And so is it like being a lifeguard for a person who's trying to drown?

'Mimi' 31:45
Yes, a lot of times, like I said, people are generally in better health here than they were back on the East Coast. Like people who have COPD or heart failure, they've had these things for a better portion of their late life, let's just say they're like 80 years old, they've probably had COPD, since they were 5560. They've also smoked a pack of cigarettes a day, every day for their entire life really, and they have no desire to quit. So while I am at the room next door dealing with a patient having a heart attack, they're on oxygen, they're vitally stable. They're pounding their call that and because they need their nicotine patch. And then I can't get them their nicotine patch in time. So they're like, I'm leaving against medical advice, because I need a cigarette. So then I have to page the doctor that's taking care of them, because while they're in ER patient, the ER doctors right there, but when the reporter, the admitting physician is usually not in the ER, they're somewhere else. So I need to page them and either get them on the phone or have them come talk to the patient. Because nothing I say is going to change their mind and make them want to stay. They have to hear from a doctor and that's most patients. So like, you're just a nurse, what do

Scott Benner 33:01
you know? Yeah, the addiction is driving them to at that moment. Yeah. And

'Mimi' 33:05
it's the same with like alcoholics to Alcoholics can withdraw and very quickly be an ICU level patient. Despite what we can give them. It's not going to help their withdraws. It's not going to help their their tremors and all of the symptoms are experiencing. So they just want to leave and drink to feel better.

Scott Benner 33:23
I was like 16 years old, my father took me to lunch. And we were heading into this diner. And this a long time ago, so used to walk into a diner and in the vestibule there were two things like Miss Pac Man and cigarette machines. And I would imagine most people don't even know what a cigarette machine looks like, to be perfectly honest, right? But there used to be these things. You put quarters and you pull the lever back and a pack of smokes, which smoke drop out of it. So my dad would go into the diner. He would put quarters in take a cigarettes go in and sit and you could smoke in restaurants. So he'd sit there and smoke while he was waiting for his food. And we walk in and the machine does not have his brand. And it's out of his brand and his backup brand. For old school smokers. My dad smoked Chesterfield kings, which were filterless cigarettes. And then in a pinch, he'd smoke a Pall Mall if he had to. I said, Oh, that there's no cigarettes. And he's like, yeah, he goes, it'll be fine. So we go in, and we sit down. And I don't think we ordered before he broke a sweat. And then his he got red in the face. And you could see the anxiety hit him. You don't I mean, and then the West, and then immediately the withdrawal. And to the point where I was like, I can go across the street to the gas station and get cigarettes for you. And he goes, No, no, don't worry about that. And then two minutes later, he's pulling money out of his pocket. Go get those cigarettes for me. Yeah. Yeah.

'Mimi' 34:50
And that's how it is for drinkers too. Except I feel like the symptoms of withdrawal are like they're much worse. It's almost like having like the flu. Like you'll get a fever. Yeah, you'll be having like the cold sweats, vomiting, hallucinations, like, they are very time intensive patients. And in the hospital, everyone is so worried about falls. Because if a patient is there for something, and they fall, whether they're whether they sustain an injury or not, it's a big deal. And especially when they're hallucinating, they're vomiting. They have to go to the bathroom frequently. They're always trying to get out of bed. Yeah, they're a huge fall risk. So you either need a tech or a senator to sit with them, or you need to be within earshot. They're very time

Scott Benner 35:36
intensive, called on fall. Yeah.

'Mimi' 35:39
Don't fall. Stay with me called

Scott Benner 35:41
Don't sue us. Exactly. Call

'Mimi' 35:45
don't fall and give yourself a brain bleed.

Scott Benner 35:49
So here's what I'm getting. By the way, I don't have we even touched on the things you were going to talk about. No, not at all. Go to that stuff, then I'll go back to my thing. What

'Mimi' 35:58
did you want to talk about? So I tell type one patients all the time that I understand their frustrations and how the hospital does a huge disservice to well control diabetics. I hear that I know it. I, personally, relating to the previous ER nurse that was on the podcast. Similarly, I don't want to be admitted to the hospital. I know it's going to do bad things for my control. But I do trust about 90% of my co workers to take great care of me, including our physicians.

Scott Benner 36:31
You heard the the nurse who said I wouldn't go to my own er, if I had a problem for my diabetes. Correct? Yeah.

'Mimi' 36:38
I would absolutely go to my own er, I don't, it might have something to do with personalities. Obviously, I don't know the other nurse that was on here. But I am very open about my diabetes. I tell everyone I work with please ask me questions. If it's going to help you understand something better or help a patient. I often get text messages and phone calls. While I'm off saying like, hey, my patient has an insulin pump or like a CGM. How do I take it off, which if a patient isn't able to tell a nurse how to take their pump off, that pump absolutely needs to come off, because obviously, they're not going to be able to do what they need to do to manage it. And on the same hand, there's also an admitting physician at my hospital, we'll call her, Dr. Jones. She is a huge advocate for type loans as well. And she has an excellent order set for pharmacy for patients to keep their insulin pumps. So anytime I have a type one patient, and she is not the admitting physician, I message the admitting physician and say please consult with Dr. Jones for this patient's insulin pump orders. And I would say probably 60% of the time it happens. But that's again, only when patients are like alert and oriented enough to tell me like their settings and stuff like that. There have been plenty of instances where a patient tells me that they want to keep their insulin pump, but they have to get in contact with your endocrinologist to find out their settings. And I was like, I've had Omnipod T slim, and Medtronic in my 20 Some years of diabetes. If you don't know how to find the settings in your pump, that's alarming to me. Yeah. And I don't feel comfortable letting you keep your pump if you don't know how to find your settings, right.

Scott Benner 38:25
I wish you wouldn't have said Dr. Jones, by the way, because it made me think of Indiana Jones. And then it made me then it made me think that I wonder if people know that Indiana was the dog in the family. Nevermind. And that's what happened to me while I was listening to you just now. So you're telling me you're telling me that if someone comes in with a complete inability to even understand their device, how are you supposed to believe they know what they're doing? Exactly. Okay. And so they're set up. And they've probably got a rhythm going. And they, you know, they push this button, they say this much for this meal, but they really don't know what's happening is the thing that's been set up for them. And it's running, but they they couldn't be the stewards of it. So this is an interesting problem, because all these problems are multifaceted. I'm going to I'm going to tell you that, you know, the first half hour of this conversation, what I heard was that nurses, people, doctors, and the system are all entities that have multiple bool variables impacting them, yes. And depending on your perspective, like you can go you could go into an ER and be me with my kid. And I'll be able to say that nurse doesn't know anything about diabetes. And I'll be right because I know a lot about it. And then there could be another person that goes into the can't find the settings on their pump who would think that you know a ton about diabetes because you know more than they do. So it's it's varying levels of understanding. Coupled with your perspective, your death desire. And then all these things have to come together over and over again, between you and the nurse, who is also sitting on four other beds and has the pressure of moving people out, holding people who can't leave, but can't go upstairs. And if there is an emergency, abandoning all those other people to get to that emergency, and then on top of that, what you have is that adrenaline, this isn't even the job you wanted. The doctors and asshole, like all the other things that could possibly come with this are impacting you while you're trying to help those four people and three of them probably don't even want to help themselves.

'Mimi' 40:38
Yes, exactly. Okay, there's so many moving parts to being a nurse, being a doctor being a patient, like, it is impossible, like there's no one size fits all, as we all know, like, diabetes is so complex and different from person to person. And like I tell all my co workers, my diabetes is different based on the week of the month, whether I'm on my period, or I'm ovulating or I'm working night shift, or I'm working day shift, everything is different. So if I'm here for like, appendicitis, or I broke my arm, it's gonna be different. Like, I'm not even going to be able to control it. Well, yeah. So why should I expect them to? It's interesting,

Scott Benner 41:19
but you can see the other side of it too, right? Like if I was just an everyday, everyday person, and I have type two diabetes, I'm not doing a great job with it. My a one sees the nines, and I'm having some obvious health issues, metabolic issues and some other things that led me to the emergency room. When I get there. I'm probably hoping you're going to tell me how to keep this from happening again. And you're probably thinking, even if I knew what to tell this person, they wouldn't do it anyway. Or

'Mimi' 41:48
even if we know what to tell this person, we told them and they're still not going to do it anyway. Or

Scott Benner 41:53
even understand at times. Yeah, yeah. The problem is people Yes. But on all sides of the problem, we are having a problem of humanity is what we're having. Yes, we're very stubborn beings. In the past, if you had a mental health concern, you didn't really go to a regular hospital. There were other facilities, we don't really do that anymore. So everybody goes to a centralized place. So there used to be, there'd be a trauma center for trauma, there'd be you know, a regular, like local hospital for, you know, regular old problems, there'd be a mental health facility for mental health problems. These people would mostly be filtered in through EMS, or police so they could take them to the right places. And now everything happens in one spot, and everybody is expected to be able to deal with all of it.

'Mimi' 42:45
So yes and no, okay, there are ambulatory places like you can just walk into a mental health facility. Depending on the type of crisis you're having, they're going to send you to the ER anyway to make sure it's not a medical emergency first. So, like if someone is extremely intoxicated on drugs or alcohol, they can't be in those mental health facilities. Because if they were to withdraw, it would be a medical emergency, and they would be at an inappropriate place. We just had, a lot of people get really bogged down by the mental health patients coming into the ER. But sometimes we find that it's not a mental health crisis, you can have hallucinations because you have a brain tumor, not because you're bipolar or schizophrenic.

Scott Benner 43:33
I say. So you like the idea that they come to a centralized place where everybody where people have like a medical background? Yes,

'Mimi' 43:40
I like it to the extent of medically clearing and then getting them out. As soon as they're medically clear, which doesn't happen. Patients can be medically cleared and then still sit in the ER for 48 to 72 hours before an inpatient bed opens up in a mental health facility.

Scott Benner 43:59
So do we have a lack of facilities or too many people who need them? Both? I never have one of these conversations and feel good when they're over by the way.

'Mimi' 44:08
I know. Yeah. I've

Scott Benner 44:09
never like oh, good answer. I've actually never had anybody give me an answer. I recorded with a seat a CDE the other day, who has type one? And at the end, I said, What do you think the answers are? And they're like, I don't think there's an answer to this problem. I'm like, Oh, great.

'Mimi' 44:25
Yeah, it's really tough too. Because even if there were enough facilities, there wouldn't be enough nurses. So and the nurse shortage is not a shortage of people who want to be nurses. It's a shortage of people who want to be paid appropriately for what we're dealing with.

Scott Benner 44:44
So it's an underpaid. You find it to be an underpaid profession. What's a nurse make?

'Mimi' 44:50
Because I'm anonymous. I started out as it's considered a new grad because I'm fresh out of school despite my years Have Tech experience. I'm still a new grad. Right? I started out at 34. Oh, for an hour, I got a significant lump sum to move as far as I did, and a sign on bonus and housing savings.

Scott Benner 45:15
Oh, okay, slow, slow down for a second. When you were a tech, what did you make an hour?

'Mimi' 45:19
Oh, gosh, around $20 an hour. So

Scott Benner 45:23
about the same age. That's insane. Okay. And then minimum

'Mimi' 45:27
wage where I was living, I did get benefits, but I still had to pay a significant amount out of pocket for, you know, all of the

Scott Benner 45:35
things Yeah. Then you became a nurse, they moved you all the way up to 34. Oh, that Oh, force insulting, by the way, 3404 to be a nurse. And then that was east coast, then you kind of went middle of the country. So the middle of the country would be 3404. That was the day that I received at my old job where I was the tech was, I

'Mimi' 45:55
think $29 Oh,

Scott Benner 45:57
they bumped you up to 29. You said no, I'll go I'm going to take the extra five an hour and go to the move across the country. They also give you a bonus and a moving stipend. Would you tell me what it was?

'Mimi' 46:06
Yeah, so my sign on bonus was $10,000, which is taxed. My relocation bonus was 8000, which is also taxed, right. And then I got a housing stipend of $1,000 a month for nine months, which is also taxed, but still.

Scott Benner 46:21
So they basically gave you 28 $27,000 tax. I'm just gonna knock 30% off of it just for the fun of it here. So okay. And that was to move uproot your entire life versus staying for $29 an hour.

'Mimi' 46:37
With no sign on bonus, no incentive to stay nothing,

Scott Benner 46:42
nothing to get you moving. Do you actually still have some of that money in the bank?

'Mimi' 46:45
Yes. And no, I acquired a pretty significant amount of credit card debt during nursing school because of medical supplies. Because I had to pay rent, which where I was living, I was paying like $2,200 a month for a 600 square foot studio. I actually sold my car and it was like commuting by bike. So I didn't have a car payment. And I was still struggling to make ends meet.

Scott Benner 47:10
So you were working hard and making concessions. And you still had to use credit cards to get through school. Yeah. And then the bonus, you got to move the credit card debt wiped that out, basically.

'Mimi' 47:21
Yeah, that and like, it's expensive to move. The place that I lived in when I first got here, which I actually just move out of, I had to pay first last and a deposit upfront to move it. And then I actually only moved here with what fit and who suitcases and my dog. So the moving like of things was very inexpensive. It was just my flight. Yeah. But yeah, it was like $8,000 upfront to move into where I was living. And that doesn't count furnishing anything. Yeah. So

Scott Benner 47:51
what kind of dog fits into the luggage? He's

'Mimi' 47:55
a miniature Doxon. So he rides in a plane with me, like under the seat in front of me. Okay, that's like, how

Scott Benner 48:00
are we flying with a dog? Okay, that makes sense. Wow. And then you get there. 3404 an hour.

'Mimi' 48:08
Yeah, so that was my, that's my base pay. I've since gotten a raise. Because I've been here, I think it was either a market adjustment or like the annual raise, but the hospital gets, which was a whopping 71 cents. And then there's also shift differentials. So I was hired as night shift. But for my first three months, I was on day shift for orientation. I would work between 24 and 36 hours a week. And then I also had classes. So as a new nurse, you have to do like residency classes, we call them. And it's basically just like learning how to use equipment and like, basically procedures and protocols for different processes. I guess you could say like, there's a whole seminar on, like, blood gases and like our DKA protocol, which is actually I love but a lot of people find very confusing. So there's a whole class for it. And then we have classes for neonatal emergencies trauma, if someone's in cardiac arrest that like process. So there's a ton of classes you have to take right up front when you start as a new grad. So I was doing like 40 hours a week between classes and working at the bedside. And then once I finished all those classes, I was just at 36 hours a week and could pick up as much extra as I wanted. But once I came off orientation on next shift, so it's an additional, I think 460 an hour on night shift. If it's a night shift weekend, I believe it's 760 additional an hour. And then there's we also have like evening shift, so 11am to 11pm 3pm to 3am. That gets a different differential and stuff. So the only time I'm actually making 34 Now 75 is if I work a 7am to 7pm shift which She's not hired for so that's not why are you not making $70,000

Scott Benner 50:03
a year? Even? No. 60

'Mimi' 50:07
I think it's, uh, ah, it might have been 70. Okay, because I looked at my year to date, and that's including all my stipends and stuff, and I was like, around 97.

Scott Benner 50:18
And so and then you're gonna lose about 15% in tax, I'm actually googling this. So in 70,000, you'll lose about 15% in taxes. What's that, like? 10 grand? Yeah. And so, you're gonna, you're gonna walk away with 60 divided by 12. Hold on a second. 5000 a month? How much is your rent?

'Mimi' 50:39
So before when I was getting my stipend, it was 2240 because I decided I wanted a house with a yard for my dog, silly. We're in a cooped up, cooped up apartment before. We're back into an apartment now, but it's a much nicer one way more than 600 square feet.

Scott Benner 50:55
So now I'm paying about 1400 Okay, so you're losing 1400 Off the top for rent. I gotta imagine do you eat food? Right?

'Mimi' 51:04
I do. Yeah. So

Scott Benner 51:05
what do you $400 a month for food?

'Mimi' 51:08
That's what I budget. Yeah.

Scott Benner 51:10
Uh huh. That's what you budget. I heard what you said there. Do you have a car? I do have a car.

'Mimi' 51:14
Is there a payment? Oh, there is a steep payment? Yes. How much? 656 50?

Scott Benner 51:20
Got insurance. What's that? Like? $100 a month for car insurance. 131 30. Gas.

'Mimi' 51:30
I actually don't use a ton of gas.

Scott Benner 51:32
Let's say 100 a month? Yeah. Okay. Electric. Couple 100.

'Mimi' 51:40
Yeah, let's see my utilities. I bought 175 Because most of its incorporated in my 1400 for rent. Okay,

Scott Benner 51:50
so when you are all said and done. You've made what, like two grand left at the end of the month? About? Yeah. Okay. And so you have to work a year of your life to save $25,000. And that's if I get to save it. Yeah, but I'm gonna say you're not really gonna have $25,000 a month at the end of the year. Yeah, right. Okay. Yeah, yeah, we should ask people to be nurses is.

'Mimi' 52:17
Exactly. And like, there is a great appeal. I won't even live with this schedule. So keep in mind, that's an income working only three days a week. So I guess my 97 is actually mildly skewed. Because I work a lot of extra to get to that. Not every single week. But like, around Christmas, I worked 120 hours in 10 days, because I couldn't go home to see my family. My boyfriend went home to see his family and like, my friends hear from work. So I was like, I don't want to sit at home on my couch by myself on Christmas. So I'm just going to pick up extra go to work. Yeah, so yeah, I worked a lot of extra once I came off orientation. Summers are like trauma season. And since I was fresh off orientation, I was like, super eager to learn all of the processes, all of the equipment we use, which I now feel feel very comfortable and competent. And like, I am the most fit person to be in those scenarios, which is a great feeling after only being a nurse for a year. Not to like boast member riches here. But like, I feel very comfortable in my ability and my skill. Yeah, what you're doing. Yeah, so a lot of extra got me to 9070. Yeah,

Scott Benner 53:30
a lot of extra to get to that number. So I have to tell you, what strikes me over and over again, while we were just doing that little exercise is that if you're helping four people in a shift, I'm guessing that the hospitals being is billing those four people. And it's incredibly possible that your effort makes more money for the hospital in one day than they pay you in a year. Yeah, without a doubt. I mean, like he would probably work for a percentage. Yeah. So

'Mimi' 53:59
I don't want to call it to work around. But the way that people are making more is by leaving, like nursing as a hospital employee and going to an agency. So you can do like local travel or travel nursing and you'll make just about double you.

Scott Benner 54:17
That's insane to me, like why does the hospital just pay their good employees and keep them?

'Mimi' 54:22
No one knows. It's a it's a losing battle. We've been asking this question for years, because even before COVID Travel nurses made significantly more than staff nurses do. And you don't even have to travel. One of the travel nurses that I work with currently. He's been at my hospital for over a year, and travelers contracts are typically like 13 weeks. So he has to take like a week off in between and then he just signed another contract with the same hospital.

Scott Benner 54:50
It's not crazy to say either that if you went to your boss and said, Hey, look, I'm a good employee, pay me more money. Give me double. They'd say no, but you said if you said okay, well I'm gonna leave and Go to a become a travel nurse that they'd hire you back as a travel nurse. Oh, and they do it all the time. I'm glad everything makes sense. Nothing makes everyone jump out the window. We're in trouble. That's all. So, yeah. Okay. Yeah, it's not it's not it's a lot. It's a, you know, this is exactly the same when I talk. There's a therapist that comes on Erica, we talked about people's problems. And I this is exactly how I feel at the end of the hour with her to like, oh, just, yeah, it's such a multifaceted issue. Really layers, so many problems with all of it, like healthcare, hospitals, nursing,

'Mimi' 55:42
there's at least 100 Problems per each of those. Yeah,

Scott Benner 55:46
that we could sit here and drill down and talk about a lesson. If you're going to become a nurse, maybe you should want to do it. Maybe we can drill down at the doctor sign goat, maybe you can leave your ego aside and actually, you know, stop acting like you're God's gift of the situation. You could look at the institution and say, Hey, why don't you take a little less money and pay all these people so they could actually give people good service? And maybe you make people healthier? The patient's you could say, hey, what if you had a basic understanding of common ideas about health and took care of yourself a little bit? Oh,

'Mimi' 56:18
my gosh, yeah, the lack of knowledge that I didn't understand, that most people had about their body is absolutely insane to me, like, obviously, I've been diabetic for just over 20 years, I had no idea that most people didn't know how to read a nutrition label. One of my friends is a teacher for a like, they call it a nursing program, but it's for high schoolers. So it's a like, tech center type situation where they go there for their senior year of high school and get, you can get a CNA or nursing assistant, you can do cosmetology, you can do diesel mechanic. There's all different types of like, skills you can go into. So she teaches the I'm doing air quotes nursing program there, and one of her students as a type one. So of course, she like called me and was like, Hey, do you drink, like Powerade and Gatorade and stuff regularly? And I was like, no, like, I think this year was the first time in my entire life, I'd had Gatorade that wasn't like the zero or like G two or whatever it's called. Right? And she's like, Yeah, my type one has been drinking it like almost every day. And I asked her if she was like doing insulin for it. And she said, No. So she took the power a bottle and looked at the nutrition label. And she's like, said 36 grams. And I was like, Yeah, and that's only per serving. And there's two servings in that bar, sometimes two and a half servings in the bottle. Yeah. And she was absolutely blown away by that. I'm like, Yeah, that's like, you have to look at the servings. She was like, Well, I never really thought about that. Like, ah, the luxuries of not being a diabetic.

Scott Benner 57:57
You know, I saw somebody eating like nachos. Right? Em from from a, from a from a restaurant. They give you a bowl of queso. It's like a softball size of, of liquid cheese. And I thought that's more liquid cheese and you're supposed to eat and five years. And yeah, no, no. And they're just in there like dip in and eaten and dip and eat. And I'm like, Oh my God, you're gonna die. Like you're asking.

'Mimi' 58:24
Literally, I went to Trader Joe's has probably been a while now. And I got they have a frozen like barbecue teriyaki chicken. And it has a lot of protein and not a lot of fat. And so I was checking out and they're like, Oh, why do you get this over? Like the orange chicken? Like, oh, it's like 20 grams less fat per serving. And they're like, Oh, interesting. I've never even looked at the label. And I was like, Oh my God, because the

Scott Benner 58:49
orange glaze is sugar. And then the your body metabolizes the sugar and makes it and stores it is fat. And yeah, these are not big ideas. So not

'Mimi' 58:58
at all. And it's so like, I just like, I don't know why anything surprises me anymore. Like, especially working in the ER, maybe it's because in the ER, I expect people to not know things. But like out in the real world. I think like, Oh, these people have made it this far. Like, they know basic things. But they don't. Yeah, and It shocks me every time.

Scott Benner 59:21
Yeah, don't stop being shocked. It's about opportunity to learn things. Yes. And it's the stuff that no one talks like people don't talk about this stuff. They just they don't like the makeup baby, you feed it something you can afford. You know, you make a little more money or you don't you you know that's the way your food goes. You're not a nutritionist you've never nobody's ever talked to you about this before. And all of a sudden, healthy just means you know, we this is what we eat here hopefully means like, alive and not having to see a doctor frequently right? It's the same exact problem. As when I say to somebody hey, like how's everyone seeing they go? Oh, it's good. Like I learned in the Beginning of making the podcast not to stop at that, I'd say what is it? What's the number? Because the astonishing a number of people who told me that their agency was good, but then told me it was eight and a half. And I was like, well, good compared to what they'd say won't good compared to where it started where it started. I was like, on 11. Now it's at eight and a half, I'm doing good. And I'm like, No, you're doing better. Words are important. And you know, like, like, You're doing better, you're not doing good. Good is, you know, in the fives. Yeah, pretty goods in the sixes, I need help is in the sevens, eight and a half. It's not, I'm doing pretty good. You know, you know, eight and a half is I'm going to be in this emergency room one day, with, you know, some sort of, and they don't know that they don't know that if you live if a type two, for example, lives with an eight and a half a one see their whole life, that by the time they're in their 50s, they are 100% going to be in a emergency room talking to you. Without

'Mimi' 1:00:53
a doubt, and it's not even likely going to be a diabetes. Crisis. Right? It'll be going to be a secondary problem.

Scott Benner 1:01:02
Renal? Cardiac. Yeah, right. Yeah. Yeah. And

'Mimi' 1:01:07
a little blister on their foot that's now turning black and they can't feel it. Yeah,

Scott Benner 1:01:11
right. Right. Look at all the stuff that comes along with that, that nobody. You can say nobody teaches you. But you know, when the stuff I know about diabetes, I had to teach myself. And is it they didn't teach you or you weren't willing to learn? And I do want to say, and sometimes people don't have the capacity. I don't mean that in a harsh way. Like, there's some people who just their minds don't work that way. You don't I mean, they're not going to be inquisitive about things they maybe don't have, you know, that kind of desire. It's not I don't think of that as purposeful, by the way, like, that's where I want somebody to step in and do something, right. And it's funny, because in my heart, I want the person that the hospitals step up and go, hey, here are the things you probably don't know about your life and health, except what you're telling me is that even if you did that, you think what you'd get mostly is go to hell give me a pill, I gotta get out of here.

'Mimi' 1:02:00
Exactly. That is exactly right. Like, I am always stunned by people who come to us for help, and then refuse what we're offering, because they read somewhere on the internet that this is a better option. And that's what they want. And we always kind of joke as nurses like, this isn't the drive thru, you don't get to come here and tell us what you want when you're asking for our help. Because if you knew what you needed, and we're capable of getting it, you wouldn't be coming to us for the hair. Like, yeah, this

Scott Benner 1:02:31
is a never ending.

'Mimi' 1:02:33
Yeah, we get traumas that come in all the time. And granted, they might not be the most severe trauma they've ever sustained. But they were transferred to us either from an outside hospital or from seen based on the mechanism of injury. And they decided that they needed a higher level of care of trauma care, which is us. And it's typically with spinal injuries. So this one very specific one I'm thinking of this man was on a trampoline. His two small children were there. I think they were like, five and eight, maybe. And he dove into a shallow pool off of the trampoline, and had temporary paralysis and his kids had to pull him out of the water. Oh, he came to us with a neck brace on me calm see collars, a cervical collar. And he kept nodding yes and no. And it was making me so angry. Because I'm like, if you have a spinal, specifically a cervical spinal fracture, and you keep nodding yes and no, you could be paralyzed forever. And I probably overslept a little bit here, we were over in CAT scan. I told him many times to stop nodding yes and no. I grabbed his cheeks and got really close to his face. And I was like, you have small children at home. I don't want to see you paralyzed because you weren't listening to me. Stop nodding yes and no. And like a tear, just like rolled down his face. And he stopped. And I was like, I'm sorry. I had to say it that way. But we see this all the time. Yeah, you're here for a reason.

Scott Benner 1:04:09
Yeah, it's so funny. It's funny, because I see like both sides have, like you said, like, you know, you're here and you're not going to do the thing. And but that person could easily make the the the argument and a real, very real argument. No one's ever told me that before. I know, you think it's something I should know. But I don't know that thing. And no one's ever said it. So that's where we're at. We're, it's an impasse like, medical people should be telling every person that they intersect the thing that they need to hear. And either that person takes that information and does something with it, or they don't, but you don't have the time for that. So you're going off of what you mostly see. And that's how the people who could be helped get missed. Exactly.

'Mimi' 1:04:51
Yeah. Like he was transferred from another hospital that was letting him like, walk around and like go to the bathroom. And I was like you absolutely will not be getting upright until we have your CT results. They transferred you here because we know more than they know. And we're going to treat you the way that we're supposed to treat you and that I'm sorry is not going to make you very happy. But you have to listen to us. And he was like, Okay, you're right. And I was like, Oh, am I really? So

Scott Benner 1:05:20
maybe what should I ever told me that before I fill up my car with those little packing peanuts, right? That way, if I have an accident, nothing happens to me. And then I never leave the ground floor of my house and get a house with those steps in it. And then I try to stay out of that. And I don't need 17 servings of Gatorade and I tried to stay out of hospital. This is what I'm trying to do this size of melted melted cheese. Ask yourself why does the cheese not coagulate? Yeah. Why? It's liquid? How is it doing that?

'Mimi' 1:05:54
Right? It was solid at one point. Not going back to solid. Like what's happening? Ask yourself what's in it? Yeah, why is it staying liquid like this? Okay, all right. I'm

Scott Benner 1:06:06
done. Good. Thank you. Did I miss them? Did I miss any out of my mind? But this? Why did I think this was a good idea? Why did I think having people on to tell me what was wrong was going to be a great idea. For me. It's bad for my soul. It's

'Mimi' 1:06:19
bad for everyone's thought and our mental health because I can say all of these things until I'm blue in the face and nothing will change. Nothing

Scott Benner 1:06:26
will change. Yeah, yeah. Okay. Well, then this is for the people who are going to take some sort of control of themselves and their lives and and try to avoid this stuff. Yeah, now, I hope so. Having said this, and I do like to reiterate this every time I can think of if I'm having an actual emergency. I should still go to the hospital, though. Oh,

'Mimi' 1:06:49
absolutely. Yeah. And I don't want to like drag anybody but in our Facebook group. For the podcast. There's people all the time, like questioning certain things like if they should go to the hospital. And more often than not, I'm like, Oh, my gosh, is this even a question? Like, I cannot believe that people would think not to. But I've also worked in other ers where I can absolutely see how going to the ER would be doing a disservice to them. But especially adults in the UK, we are not resilient, like children are like when I was diagnosed, my blood pH was 6.9, which is not survivable, like that is not compatible with life. So if my PH were 6.9, now, I would likely be dead. As a kid, you're much more resilient, you bounce back, your body can compensate a little bit better. But as an adult, if I even like if I'm sick, and even if I don't have ketones, my blood sugar is fine. If I follow up, I get very nervous. Like, okay, if my blood sugar goes low, and I can't keep anything down emergency, if my blood sugar is high, I'm giving myself insulin, it's not coming down. I'm throwing up emergency like, I see that all the time. So I understand I have a different understanding of it. But it is frightening. And like, we are very fragile people like not diabetics, but just humans, like humans are fragile. You don't have those compensatory mechanisms that children have. So if something goes sideways, it can go sideways and stay sideways forever. Like some things you just like, can't come back from. Like, I'm always scared, like, oh, one more like running with DKA kidney failure, or retinopathy. Like there's so many irreversible things that can happen. heart attacks and strokes, especially because we're diabetics. Like, we're very fragile.

Scott Benner 1:08:51
For my money, I like being prepared ahead of time, I have a small group of good doctors that are local to me that we have, you know, become patients of so that when we have certain problems, we're not searching. First of all, we know where to go to get somebody to help those same doctors can be helpful for you, when you're going to emergency situations as well. You'd be surprised that calling your GP who is actually a good person saying hey, here's what's wrong with me, I'm going into the hospital, could you call over there and let them know I'm coming, that actually helps getting to a hospital system where your doctor is affiliated with that helps. There's little things that you can do to be ready. You could also you know, do a little bit of research so that you know how things are handled at certain emergency room situations like what what are they going to do for me if I come in there and DK? How are they going to handle this? What do they know about this? I don't know. I just I like to be as prepared as possible without being a prepper I don't have a truck with a 700 gallon gas tank on it that only pulls fresh water in case zombies come or anything like that. But I do know where I would go if there was a problem, right? And you know, even at that you don't realize you could be Three miles from four hospitals and only one of them's a decent hospital. And you wouldn't know that. You know?

'Mimi' 1:10:06
Yeah, I am always done. There's a few very, very, very small hospitals that are not associated with any large or larger hospitals nearby currently, and the transfer patients to us all the time. And I'm like, It's a miracle, this patient made it to us alive. Like, I didn't even know that this place existed. Until right now they're telling me that this hospital down the street was taking care of this patient, and they're like, knocking on death's door. I'm like, how are they allowed to be a hospital? Like, how have they kept their doors open for this long. And God forbid a patient who doesn't know anything about the area has a medical emergency and goes there, like, it is terrifying to me. Granted, we do have a large house, we have two very large main hospital systems here, that span I believe each of the two systems has at least four emergency rooms and two major hospitals. There's plenty of resources around and if you were visiting the area and you good old er near me, it's not going to take you to that little rinky dink one that scares me, it's going to take you either to my hospital or our neighboring Hospital, which will can provide excellent care. It's astounding.

Scott Benner 1:11:25
I would like to remind people at the end here that you are a human being with all the fragility and that comes with that and so is the person you're going and asking them to help you those people are our people, you're a person, you have limitations, they have limitations, the best thing you can do is know as much about your situation as possible. Advocate for yourself till the very end. Never give in. Don't be mean always push. And at the same time. Remember, you're just asking another person. It's not like Mimi's not a magic fairy. She's a girl wanted to make a little more money. So she became an RN. And then she moved across the country to make $6 more an hour. And she just wants to go home with her dog and not sit on her sofa and be bored. Yeah, and have some grass to run in just like you. Exactly. She's not a wizard, you're not going to a wizard and telling them that you you know, Please grant my wish for me. I'd like to feel better now. So anyway, whatever. I'm sure people are gonna hate me by the time this is over. But I appreciate you doing this very much. Thank you very much.

'Mimi' 1:12:29
Yeah, and honestly, note there like the rinky dink Costco I'm talking about that is not an attack towards their staff at all. It's just like a lack of resources, lack of exposure to a lot of stuff. Like they can be very competent nurses and doctors, but they don't have the exposure to what other nurses and doctors have or the resources to adequately treat these patients. So like, they're not bad providers. They're just in a bad situation. And

Scott Benner 1:12:56
but and once you get there, you're in that situation right along with them. Yeah, yeah. Okay. I appreciate this. Did you enjoy being called Mimi?

'Mimi' 1:13:03
Yeah, I do enjoy being called Me. Me. Alright. Well, if I remember grandma go by

Scott Benner 1:13:08
Mimi. Well, you know, first we gotta get you out of that apartment with just you and that dog. Alright, that's not gonna happen. Yeah.

'Mimi' 1:13:15
Alright, thank you so much. Yeah, absolutely. It was good talking to you. You too.

Scott Benner 1:13:26
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 thank you to one of today's sponsors, G voc glucagon, find out more about Chivo Capo pen at G Vogue glucagon.com Ford slash juicebox. you spell that GVOKEGL. You see ag o n.com. Forward slash juicebox. A diabetes diagnosis comes with a lot of new terminology. And that's why I've created the defining diabetes series. These are short episodes where Jenny Smith and I go over all of the terms that you're going to hear living with diabetes, and some of them that you might not hear every day, from the very simple Bolus up to feed on the floor. Don't know the difference between hypo and hyper will explain it to you. These are short episodes. They are not boring. They're fun, and they're informative. It's not just us reading to you out of the dictionary. We take the time to chat about all of these different words. Maybe you don't know what a coup small respiration is. You will when you're done. Ever heard of a Glice See make index and load haven't doesn't matter. You'll know after you listen to the defining diabetes series. Now, how do you find it, you go to juicebox podcast.com up top to the menu and click on defining diabetes, you'll be able to listen right there in your browser. Or you'll see the full list of the episodes and be able to go into an audio app like Apple podcasts or Spotify and listen to them at your pace. Download them into your phone, and listen when you can. The defining diabetes series is made up of 51 short episodes that will fast forward your knowledge of diabetes terminology. Thank you so much for listening. I'll be back soon with another episode of cold wind. If you're looking for community around type one diabetes, check out the Juicebox Podcast private Facebook group Juicebox Podcast type one diabetes, but everybody is welcome. Type one type two gestational loved ones. It doesn't matter to me. If you're impacted by diabetes, and you're looking for support, comfort or community check out Juicebox Podcast type one diabetes on Facebook. The episode you just heard was professionally edited by wrong way recording. Wrong way recording.com