Scott Benner 4/2/24 Scott Benner 4/2/24

#1166 Pump and CGM Overview - Part I

Scott and Jenny look at the pumps and CGMs available on the market.

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

Scott Benner 0:00
Hello friends and welcome to episode 1166 of the Juicebox Podcast.

In this two part episode, Jenny Smith and I are going to do an overview of every insulin pump and CGM that we were able to find on the internet. Nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, always consult a physician before making any changes to your health care plan. Don't forget to save 40% off of your entire order at cozy earth.com. All you have to do is use the offer code juice box at checkout. That's juice box at checkout to save 40% at cozy earth.com. When you place your first order for ag one with my link, you'll get five free travel packs and a free year supply of vitamin D. Drink ag one.com/juice box. If you're a US resident who has type one diabetes, or is the caregiver of someone with type one, please take 10 minutes to complete the survey AT T one D exchange.org/juice. box you can help type one diabetes research by taking those 10 minutes and answering those simple questions. T one D exchange.org/juicebox. If you're looking for community, check out the Juicebox Podcast group Juicebox Podcast type one diabetes on Facebook, it's a private group with over 48,000 members. This episode of The Juicebox Podcast is sponsored by us med U S med.com/juice box or call 888721151 for us med is where my daughter gets her diabetes supplies from and you could to use the link or number to get your free benefit check and get started today with us met. This episode of The Juicebox Podcast is sponsored by the insulin pump that my daughter wears Omni pod learn more and get started today with the Omni pod dash or the Omni pod five at my link Omni pod.com/juice Box. Today's episode of The Juicebox Podcast is sponsored by Dexcom makers of the Dexcom G seven ng six continuous glucose monitoring systems dexcom.com/juicebox. The I have a list here that I think covers most of like what's available. I mean, and couple things that are in development. So we'll kind of pick through it and see what we can find. I have to admit, we are recording. This is not the thing I usually do. Because this seems very close to like a blog post meant to get you to click on it. But you don't I mean, right

Jennifer Smith, CDE 2:49
with all the clicks to the sites to go check it out here. Go look here, go look at this. Yeah,

Scott Benner 2:54
it felt like it always has felt like a blog trick to get you to click as far as I'm concerned. But I keep hearing from people over and over again who think like, I'm getting a pump. I know I am. But I don't know, the first thing about it would be nice if somebody just laid them out for me. And I thought well, we can do that for sure. So yeah, yeah, yeah, absolutely. I'm going to avoid the idea that this feels clickbaity to me, and we're just going to do it because it seems to be necessary. Okay, so I guess we should yeah, God, please do what you gonna do? I

Jennifer Smith, CDE 3:23
was gonna say to and this, I think this is it, maybe it will come up. But I think what I saw when you when I perused your juice box, and I looked at what people were commenting about this and listing some of them. I know, some of the questions that came up are big ones that aren't specific to brands, but they're specific to another topic that I think is important, unless you've already discussed it with somebody. And that's about the aging population. Oh, I did see that as well. Yeah. Right. And also have and what might be available and who can take over. And then another angle of that. I think that none of what we're going to talk about even addresses at all. Is those with some type of either dexterity vision or hearing issues. No one is addressing that. Yeah. Okay. All right. Just that was a second thought. As I was looking through this, I was like, it's not part of this, but it kind of, ya

Scott Benner 4:19
know, we'll find a way to talk about it for sure. And dexterity. Okay. At this point, there are kind of two different kinds of insulin pumps, right. I'm ARE WE ARE THEY JUST automated and manual? Is that the easiest way to think about it? I think that's the easiest way. Yep. All right. So let's start with manual pumps, meaning they're not hooked to a continuous glucose monitor for reasons of making insulin dosing decisions. Correct? Yes, you

Jennifer Smith, CDE 4:45
can use them separately at the same time, but they don't I guess they don't talk to each other. That's the easiest way to describe manual you are manually telling the pump what to do, and then it does it

Scott Benner 4:58
and they're all gonna have Have like Bolus calculators. So they take your settings, you know, hopefully you put it in with your physician and probably fine tune on your own as time goes on your insulin sensitivity, your carb insulin to carb ratio and your Basal rate, most

Jennifer Smith, CDE 5:15
of them, some of the manual ones that we'll talk about. They don't have like ratios in them. They're a very set unit kind of delivery. That makes it really, really simple for those who don't want the extra level of navigation. So we'll go through them all.

Scott Benner 5:36
Yeah, well, why don't we just start with the one you're wearing? That'll be the easiest. So are you wearing Omni pod dash today?

Jennifer Smith, CDE 5:44
I am wearing an omni pod dash today. Yeah,

Scott Benner 5:47
Omni pod is a sponsor of the podcast. I just want to say that upfront, but this conversation should not really delve too far in any of our opinions, just what it does and what it doesn't do. So Omni pod is a tubeless insulin pump. Which I guess the best way to like help you visualize that if you haven't seen it is that everything you need to get your insulin is within this one device that adheres to your body. So it's not connected by tubing or wiring to a controller or to where the insulin is. Everything's self contained. I guess that's the best word right? self contained, right? Yes. Yes. For your money. What is it? Why are you wearing it? I guess why did you choose it over something else? The Dexcom g7 is sponsoring this episode of The Juicebox Podcast and it features a lightning fast 30 minute warmup time, that's right from the time you put on the Dexcom g7. Till the time you're getting readings, 30 minutes. That's pretty great. It also has a 12 hour grace period, so you can swap your sensor when it's convenient for you. All that on top of it being small, accurate, incredibly wearable, and light. These things in my opinion, make the Dexcom g7. a no brainer. The Dexcom g7 comes with way more than just this. Up to 10. People can follow you, you can use it with type one, type two, or gestational diabetes, it's covered by all sorts of insurances. And this might be the best part, it might be the best part alerts and alarms that are customizable, so that you can be alerted at the levels that makes sense to you. dexcom.com/juicebox links in the show notes links at juicebox podcast.com, to Dexcom. And all the sponsors. When you use my links, you're supporting the production of the podcast and helping to keep it free and plentiful. diabetes comes with a lot of things to remember. So it's nice when someone takes something off of your plate. US med has done that for us. When it's time for art and supplies to be refreshed. We get an email rolls up in your inbox says hi Arden. This is your friendly reorder email from us med. You open up the email. It's a big button that says click here to reorder. And you're done. Finally, somebody taking away a responsibility instead of adding one. US med has done that for us. An email arrives, we click on a link and the next thing you know your products are at the front door. That simple. Us med.com/juice box or call 888-721-1514 I never have to wonder if Arden has enough supplies. I click on one link. I open up a box. I put the stuff in the drawer. And we're done. US med carries everything from insulin pumps, and diabetes testing supplies to the latest CGM like the libre three and the Dexcom G seven. They accept Medicare nationwide, over 800 private insurers. And all you have to do to get started is called 888-721-1514. Or go to my link us med.com/juice box using that number or my link helps to support the production of the Juicebox Podcast.

Jennifer Smith, CDE 9:04
So years ago, when I started first using an insulin pump, I was an animus user, which is not even available here any longer. But it was a tube pump. There were no tubeless patch kind of pumps at all on the market. And I'd started doing a lot more exercise, not exercise, I guess triathlons, right where you're in and out of the pool and doing other things and moving on. And I was tired of the disconnection but at that point there was there was just nothing I could do about it. So I had I ran into actually somebody at a weekend conference. They had sort of like a little Expo and I ended up talking to a young woman who was part a of a medical supply distribution kind of company, and she had type one and she was like, You know what, you just wait a couple of months. I'll get you connected with This, you know, representative for him from insolate. She's like, I guarantee this is probably what you're looking for. And so that was a 2005 is when mipad first became available, I mean, it's not the dash obviously the dash is kind of one of the more recent updates to the system, but that's why I chose it. I chose to switch from a tube pump because of the things that I was doing in terms of my lifestyle, and it just met my needs much better. I thankfully at this point, I don't have any issues with adhesive stuff I did. The cannula seems to work really well for me. In fact, I actually have more issues finding the right kind of cannula on a tube pump, kneepads, cannula has never been a problem for me with the angle that it goes in at. Whereas on tube pumps, I actually have to do the best with the steel cannulas. Okay, so that's my n of one as to why so

Scott Benner 10:55
let's see, you can fill an omni pod between 85 and 200 units of insulin. It lasts for 72 hours with an eight hour grace period. Right? What's the lowest Basal rate you can set with it?

Jennifer Smith, CDE 11:09
Point 05. And I believe with the more recent you can also set a zero with a dash, I believe with a dash you can set a zero. Okay. I think that was the I think it was an adjustment from what was called the arrows, which is either phased out or is being phased out or whatever was the previous to the dash. That only allowed a delivery of point 05 was the lowest that you could actually go, oh,

Scott Benner 11:37
yeah, the only pod dash will be able to deliver a 0.0 Basal rate, okay,

Jennifer Smith, CDE 11:43
which for those you know, when you're looking at delivery rates, or insulin needs that are really really teeny tiny, you might have somebody who has several hours that they can go without any insulin dripped in as a Basal delivery, and then they might need a pulse of point 05. And then it might be a couple hours again, have nothing. Some of the little kiddos that I work with have sort of an off on it's like 0.05 0.05 to get that in between rate.

Scott Benner 12:14
I guess people honeymooning as well might need that but little kids actually seems where, where it would make most sense to me. There's a controller that comes with it. And that's where you do all of your good Cynthia's put in your, um, having 40 carbs, this kind of stuff, I believe, Omni pod has approval for a phone controller just isn't out yet. Is that right? Yeah. And I mean, that's it right there. It's tubeless. And it's wireless. That's how I listen, my daughter has been using an omni pod since she was four. So that would have been 2006. Maybe. And I mean, I came to a very similar conclusion, I went to an insulin pump show at the hospital, felt like it felt like a baseball card show for insulin pump. And I looked at all of them and not knowing anything about diabetes. My daughter had only had it for two years, maybe at that point. It just the concept of it not being tethered to something seemed attractive to me. I didn't have any of those other big thoughts. I didn't know enough about diabetes at that point to have those big thoughts. I just was like, this isn't attached to something. This makes more sense to me. Right. And me, she's been using it ever since. So that's it for me. I mean, I don't know, like, what people want to hear about these things. Yeah, it's a tubeless pump bit. You can swim with it. It's got a you know, you can go in the tub, you can go in a pool, it keeps delivering your Basal insulin when you're active. You know, I think the high side of not having a tube pump is that you don't have to disconnect for activity or for bathing or for swimming, things like that. And I think the biggest reason for that is oftentimes people forget to put their two pumps back on after things like that. They

Jennifer Smith, CDE 13:57
can Yeah, absolutely. Yeah, I mean, the manual really is. It's like an easy way of doing injections, right? There's a lot less of the people call it poke the pokes or whatever. Obviously, you only put one pad on every two to three days it lasts like you said 72 hours, but plus that eight hour but some people do find that they might need to change it more frequently than that. But even with that, it's only one poke every two to three days comparative to all the injections. So that's another reason a lot of people might go to a pump to begin with. And then you know, the manual ones again, they really are just, you fill it with insulin you put it on, you are the driver of all of your insulin while the Basal does go in automatically at a set rate. Every Bolus that you take you're you're determining that the pump is not helping you outside of just the calculations with dose settings that you have. Yeah. Today's

Scott Benner 14:55
episode of The Juicebox Podcast is sponsored by Omni pod and before I Tell You About Omni pod the device, I'd like to tell you about Omni pod. That company. I approached Omni pod in 2015 and ask them to buy an ad on a podcast that I hadn't even begun to make yet. Because the podcast didn't have any listeners, all I could promise them was that I was going to try to help people living with type one diabetes. And that was enough for Omni pod. They bought their first ad. And I use that money to support myself while I was growing the Juicebox Podcast, you might even say that Omni pod is the firm foundation of the Juicebox Podcast. And it's actually the firm foundation of how my daughter manages her type one diabetes every day. Omni pod.com/juice box, whether you want the Omni pod five, or the Omni pod dash, using my link, lets Omni pod know what a good decision they made in 2015. And continue to make to this day. Omni pod is easy to use, easy to fill, easy to wear. And I know that because my daughter has been wearing one every day since she was four years old. And she will be 20 this year, there is not enough time in an ad for me to tell you everything that I know about Omni pod. But please take a look. Omni pod.com/juice box, I think Omni pod could be a good friend to you. Just like it has been to my daughter and my family. With all the manual pumps, your settings are in there. So if you tell you know if you tell it, my settings are one unit covers 10 carbs, and I say oh, my meal is 30 carbs, it's going to give you three correct it's not going to back insulin off in the form of basil or make extra boluses or anything like that if your blood sugar should get higher, that's all in sort of the automated side. And honestly, for years, that was the selling point for an insulin pump, you get it in so you don't have to do as many injections and you can manipulate your Basal insulin now because because of manual pump, all these pumps are handling fast acting and slow acting needs in the form. It's all in the same insulin, of course, but you know, you're not injecting a Basal insulin and that injecting your meal insulin like you would with MDI,

Jennifer Smith, CDE 17:12
that's a really important piece to make sure to have, I guess clarify because some people aren't given enough information upfront. And that's not that's not I think disclosed well enough. When you start on a pump, your Basal insulin that you might be using of whatever the various long acting's are at this point, that will sit in the refrigerator in case of a pump failure. But your Basal insulin No longer will be injected?

Scott Benner 17:39
I remember being confused about it. Yeah, yeah, first happened. Now other companies that I think of is kind of the mainstream companies tandem Medtronic, did they make specifically manual pump? Or do they just make an automated pump that you can run manually? Like, do they have any pumps that aren't manual? Do you know I'm saying there aren't automatic. So years

Jennifer Smith, CDE 18:01
ago, absolutely. All the pumps were manual prior to automation coming into the picture with a connection of the pump to some type of a CGM system, right. But I Medtronic, I mean, like I mentioned, animus Deltec. I mean, there are a whole host of insulin pumps that were all manual driven pumps. And at this point, now, there are a couple of other companies that do do manual pumps that have no connection at all, just kind of similar enough to the dash, med tronics, pumps, all of them can be used in manual mode, right? The current ones that are on the market, absolutely. You don't have to use it with the algorithm, if you choose not to, or your life situation dictates that that's not appropriate at this point. So I guess, does that answer what you were

Scott Benner 18:49
I know, you can put a Medtronic pump into manual and you can put a tandem pump into manual but did they make a second? Is Omnipod the only one that makes a here's a pump that's manual. And here's a pump that's automated, like because there's on the pod five?

Jennifer Smith, CDE 19:02
That's a great yeah, I believe you're right. I believe so. Yes. Okay.

Scott Benner 19:06
Because on the pod has on the pod five, which is an automated system. Yes. But I'm just looking at like our list of manual pumps. And I'm realizing I don't see any strictly manual from those other what I think of as the other two big pump companies. Right. Oh, that's interesting. Okay. I

Jennifer Smith, CDE 19:23
never thought about that either. I guess that that is that is true.

Scott Benner 19:28
Listener sent these to me. So there's something called a secure pump simplicity. But that's not that doesn't deliver basil, right? Like that's seems to me to be like a an injection. Like it's a replacement

Jennifer Smith, CDE 19:40
for injections. And really what it provides is, for those who are less than eager to do so many injections a day or it's really become a point of their diabetes management. That's that's not working well, because they're either forgetting or they just don't really want to this past essentially allows the user to deliver a specific set Bolus, with the little Yeah. pinchable bolt Bolus delivery, right on the device. So

Scott Benner 20:10
this was kind of interesting. It looks like it looks like a giant pill shape. It's pretty flat. And then there's two buttons on either side and you squeeze the buttons together, and it gives you two units. Right?

Jennifer Smith, CDE 20:19
Correct. It's empty yet. Yes. 100. And it's a set you you can't change that.

Scott Benner 20:24
Right. So but I could go like two units, two units, two units, if I wanted to,

Jennifer Smith, CDE 20:28
I do believe so. The other interesting thing is that it comes with, I can't remember what your initial supply order is, you do fill it with insulin, just like you would fill in Omni pass 100 units. Yeah, correct. But then it also has an inserter. And the inserter actually is a device that you keep, which I think is quite an interesting concept. Because a lot of people actually dislike all of the discarded plastic that goes into a lot of our diabetes products. So this actually has an inserter that you keep. And it's just the patch. Part of it that gets discarded. Yeah,

Scott Benner 21:08
I'm just looking here, I'm all on their website, but can be worn worn for three days, water resistant, 200 units. This is funny, it takes less than 30 minutes of training. And how much of the training is how to squeeze the button? That's got to be 10 seconds? What's the rest of it? It's probably

Jennifer Smith, CDE 21:27
kind of fill it with insulin. I would expect that's all

Scott Benner 21:29
Yeah, this is not. I mean, we're trying to list them all. But this is not a I mean, this is not a apples to apples comparison. Obviously it doesn't, it doesn't deliver Basal insulin, you can't do 1.5 or point five, you can't do anything but two units direct. So this, this feels to me like they saw a market of people who were just not injecting because they didn't want to inject and thought maybe this would help them okay,

Jennifer Smith, CDE 21:53
correct. And if they were, you know, if the majority of your time you're taking your basil, but where your excursions are happening are around food or stress or whatever, and you're just not willing or you just continued to forget to bring your your insulin pen or whatever along. This takes care of that. So now you're you're really decreasing their time out of range by just providing a product that allows an easy Bolus

Scott Benner 22:19
okay seek your CE qu our simplicity three day insulin patch if you're interested All right. What is Zealand pharma making? Let's see what this thing is. Vigo

Jennifer Smith, CDE 22:29
that's an interesting one. You go oh, the like Yeah, like that, like Vigo from the creepy like Ghostbusters. Oh,

Scott Benner 22:37
I thought I was gonna say Viggo Mortensen. But that's, oh, he's a good after one of our final years not the point. Okay.

Jennifer Smith, CDE 22:46
V dash g o v go.

Scott Benner 22:48
I don't know, the first thing about this. Tell me about why look at it. Yeah, the

Jennifer Smith, CDE 22:51
interesting thing about it is again, I think it's a marriage of a manual path pump kind of like Omnipod. And then the secure because it does deliver basil. And it allows you boluses. But again, there's set parameters. So your basil is, if I remember correctly, your basil is increments of a certain amount each and every day. And I think they have either 2030 or 40 units if, if that's correct, and it's a set incremental. So this doesn't allow, like Omni pads dash allows you to set a higher Basal at a time of day where you need more, and a lower Basal delivery at a time of day when you need less. This pump is just a set based delivery. So if you needed let's say 24 units in a 24 hour day, that would be one unit per hour and you can't change that rate. Alright,

Scott Benner 23:45
I'm looking at it here. It's also filled with you 100 rapid acting insulin worn for 24 hours. It's showing me the little thing just like you said, like you put it on, it gives you a steady 24 hour delivery of insulin in place of Basal injections. Correct and then delivers a Bolus of insulin with meals or snacks with a click of a button. One click equals two units, two units. Yep. Okay, so this is basically the seat cure. But what else Basil, basil, but not manipulatable it's just gonna give you whatever it says correct,

Jennifer Smith, CDE 24:16
whatever it is, whatever you determine with your clinician, you know, clinical team, essentially, you need this much base baseline insulin. This is the so like I said, it's kind of this weird in between but again, for for someone who really doesn't love the shots component and may also have maybe a lifestyle or a job that is really difficult just schedule wise to remember to bring their Basil with them all the time or whatever. I mean, really, because our baseline Basal injected insulins at this point, they don't go up and down based on our physiologic need either. It's a one injection it goes in it covers baseline, this is essentially doing the same thing. It's just you don't have to remember to take A via injection.

Scott Benner 25:01
It's basically you're injecting once a day, because you're poking yourself the once and then, but you're still limited to squeezing the button for two units, correct? Yeah. So let me let me ask you a question. Cuz I'm not denigrating anything, but I look at these and my brain goes to why would I just not worried different pump? Like, where would you suggest this for somebody,

Jennifer Smith, CDE 25:22
if I were still working more heavily in the type two population, I probably end depending, you know, there are quite a number of people with type two diabetes who would want more, they would want more of just manual because that's what they're doing. Or they would want an automated system, if they're already using insulin, knowing what the automated systems can do. Okay. But then there are, you know, certainly people like I think about, again, as I mentioned early on, maybe somebody who is in the later stages of life, and may need something that is just a bit more simple. Not necessarily it is easier, but I think it's the simplicity of it makes it less cumbersome. You know, somebody can say I always have this for breakfast, it always takes two or four units. Great. That's a quick, easy, I don't have to do any calculations, I just know that I'm eating the same meal, and I can dose the same way. The same thing with the Basal insulin. Maybe their lifestyle just doesn't really dictate a need to go up and down and they do pretty well on their flat injected basil. Great. A system like this might work really lovely and maybe less cumbersome. Even for a caregiver. Yeah, of someone who's older to navigate to

Scott Benner 26:36
guess we're also eliminating you needing to use a phone or a controller or something like that for people who don't have that kind of oh, okay, so there's the need for it. Okay. It's not a mass market appeal idea, though. No, no. Okay. That

Jennifer Smith, CDE 26:48
the man I would say not the market that I heavily work in, you know, the the people that I heavily work with would definitely I don't think I have one person that I send this to, right but there is if I was still working clinically, again with both you know, kind of

Scott Benner 27:05
cases Yeah, yeah. Okay. Is what's this? Is it soil? S o il Do you know that one? We I think it's we'll we'll Dana diet. diabetic

Jennifer Smith, CDE 27:16
care? Yes, Dana. Diabla. Care. Oh, yeah.

Scott Benner 27:19
What is that one?

Jennifer Smith, CDE 27:21
So that one actually, again, is a little bit more of a manual. Obviously, it's in our manual kind of comp category. I believe this one has more of a pump. If I remember correctly, this one has more of the typical pump body. It reminds me more of a more of a Medtronic yeah dial if you're aware of the Medtronic body of the pump and this one's tubed this one is to

Scott Benner 27:49
correct and yep, by the way, I don't know who their marketers are but on the front page it says it is real which makes me feel like you're going I can't believe you've and found us Wow, well you heard is true. We do make this insulin. Anyway, I found that funny. Okay, so but it's this is again just like simple buttons. And what does it I'm looking at it right now

Jennifer Smith, CDE 28:15
buttons and if I can't remember is this the one well this is a has a specific there's one that has a cartridge that is prefilled

Scott Benner 28:25
even their website is dicey. Sorry, guys. It's no icon based interface makes the pump intuitive and easy to program and easy to learn is less expensive compared to other insulin pumps half the size and weight twice the outcome that's not specific about anything that it does. So I go down to his technical specifications, Bolus increments. point 05 point 1.5 Or one okay, it's got four basil increments you can choose from, it can do an extended Bolus. Dual pattern Bolus bays that's that's okay. That's Bolus features think

Jennifer Smith, CDE 29:04
it's got a small I think it can go from Bolus doses of half a unit all the way up to is it 40 or 50 units.

Scott Benner 29:13
So I just missed the boat. I'm sorry the Bolus features Bolus features increments. point 05 point 1.51. Bolus duration says 12 seconds per unit it takes the pump in extended Bolus 30 minutes to eight hours and it doesn't dual pattern Bolus now Basal delivery rate point oh four units and hours minimum basil delivery rate every four minutes above point 09 And our basil increments point one or point oh one an hour. That's the increments it moves in changes per profile up to 24 temporary Basal rates one to 24 hours for different profiles. It just doesn't really it holds 300 units of insulin says it's waterproof that's got that IPX eight rating button lock mode. But there's no real like, like, it doesn't tell you on the website specifically how to how it's used. And there's so many different products on this website.

Jennifer Smith, CDE 30:15
Why we have it under the manual category? Yeah. Because it also as none of the rest of these do, I think a missing piece that we didn't say, I think it's just assumed none of them connect with a CGM. Yeah. Right. So none of these actually have that piece to them. Yeah. Not that you can't use them at the same time. It's just that they don't talk to each other.

Scott Benner 30:37
Do you want to go check it out? Absolutely. Do you know, but I just wanted to make sure that the ones that were out there that were the people knew about we talked about, but I mean, switching gears to automated now. I think of them as the big three, right? Like on the pod, tandem Medtronic and now the fourth one beta bionics the eyelet is coming, but it's, it's different. So we'll we'll talk about what all that means. Yes, but let's start back at Omni pod because we started there the first time on the pod five is an automated system. It currently hooked up with Dexcom G six. They have I don't know if you know this, they're in LMR on g7. limited market release on G seven. Yeah, actually,

Jennifer Smith, CDE 31:22
I did know that only because of a client that I work with. So

Scott Benner 31:27
So that's, that's coming. I'm gonna guess that. Literally, you could be listening to this right now. And Omnipod five works with g7. Because this is something people will again, limited. Yeah, but I'm gonna guess that the release gets bigger. Pretty soon after we make this ish. I would hope so. Yeah. So Omnipod five is the and just think of the way we describe the dash. It's a the same exact physical appearance. And, but it's married to a CGM that is now telling you, hey, this is your blood sugar. And it's making decisions about basil, and trying to bring down high blood sugars based on your CGM data. So why don't you talk about Omnipod five a little bit because I know you can speak very clearly about how it works. Absolutely.

Jennifer Smith, CDE 32:15
So Omnipod. Five is its algorithm essentially is an adaptive, which means that it adjusts your overall background insulin need over the course of a couple of pods, based on total daily insulin use. So it does not work off of a set Basal. So what you may have been, may have come from with your manual pump. If you were using that prior, it in no way delivers in the same way you're used to your manual pump delivery, it doesn't give you more at a certain time of day, it doesn't give you less based on physiologic need. That's not how it works. It also has an adapted corrective nature. So based on the predicted glucose 60 minutes out into the future, and each new glucose value coming in from your CGM, the algorithm takes a look at the trend up or the trend down and either suspends your insulin, it doesn't temporarily decrease like some of the other automated systems, it will either suspend based on a drop that dictates is going to get lower than it wants you to be. Or it may on a rise in blood sugar based on insulin on board and what it deems you're needing insulin to be, it may actually give you a bit more automated insulin than your set Basal that he has figured out.

Scott Benner 33:42
So And interestingly enough, these all the next ones we're talking about all do this, you could just switch the Omnipod five into manual mode, and you'd be using it just the way dash works. You

Jennifer Smith, CDE 33:54
could the biggest difference. I think that again, from a clearer of a clarification standpoint is that with the dash pump, manual pumps allow you to set a target that all the calculated boluses are going to aim for that target for that Bolus, right? Yeah. When you're using Omnipod, five, its lowest target whether you are in automated, or in manual mode is 110. Okay,

Scott Benner 34:23
so if I set it lower, how low can I put the dash for target?

Jennifer Smith, CDE 34:28
Oh, that's a good question. I think you can set it. I'd have to look it up. Yeah, but I think it's at least ad.

Scott Benner 34:36
Back when Arden was just doing a manual pump. I never really considered what the pump told me I would just Bolus but I take your point. So if you if your blood sugar's 150, and you say to it, hey, I want to Bolus here because I don't want to be this Hi. Omni pod five is going to shoot for 110 Where is that? You could shoot lower? Okay,

Jennifer Smith, CDE 34:56
correct. Exactly. I know it's much lower because I have He used a manual pump for both of my pregnancies. And the target is definitely much lower than the automated systems would allow the approved automated systems. I'd have to go back to the manual, because I don't honestly remember what the lowest is. Yeah, definitely. No, it's under 100.

Scott Benner 35:16
Yeah, no, okay. Yeah, if we can find it and throw it in, we will at the end, sure. But just the idea is very, is the idea, which is you can target lower with Dash, okay, so on the pod five, has got like an exercise mode, it has a lot of these pumps are going to have this stuff, right, like you put this in. And if you're going to be active, and we'll shoot for a higher target to try to keep you from getting low while you're being active.

Jennifer Smith, CDE 35:40
Oh, I was gonna say as we're talking about targets, that's another piece that is great. While the lowest target is 110, you can have target 110, you could target a 120, you could target a 131 40 a 150. So that's a really nice piece is that you can actually determine what do you want the pump to shoot for? Right? Right exercise mode, the target or activity mode, the target sets it at 150. But the other piece, just like all other manual pumps also have a correct above feature. So depending on where you have that correct above target set, the pump may not give you extra insulin unless you're above that target, to then get you down to the actual target you're looking for. So I know Omnipod five, a lot of people just have it set a 110 target and correct me above 110. So it's always really aiming tight, hard at that 110. However, with somebody who might have a lot more sensitivity, a little bit more variable rate variability, or might need some adjustments that tells the system don't give me a lot more on rises when I'm being active. Because I don't want to drop so then you can adjust that correct above like up to I believe it's 180 so that the system can't really decide to give you some extra unless you're climbing or predicted to climb above.

Scott Benner 37:04
Yeah, I think you used the word earlier, too, that I thought it was important because you you avoided saying learn because I think some people think, Oh, this thing learns. And if it does not do that, it doesn't work like aI like you are imagining it doesn't say, oh, yesterday, we were really high. So today I'm going to you know, it says it basically it looks at the the insulin usage and then sort of makes predictive decisions after that based on what's happened on the on the last pod to this pod. Correct? Again, it's just something worth saying because I do think some people think, oh, I'll just wear this thing for a week or two, and then it'll just magically understand what to do and do it. And that's not the case. And

Jennifer Smith, CDE 37:43
I'll tell you that that's a that's it's great that from what you clarify there, because I think there are a lot of people initially who may have had a system, like segment adjustment in a manual pump that gave more insulin at a particular time of the day. And again, I've had the question enough, well, why isn't it learning that I just need more insulin at three or four o'clock in the morning, because the system doesn't learn, right? It adapts to a certain base delivery. And that's what it's always going to drip in. Once you start rising, it's adapted correction is also going to help overcome that. But it's going to take a little bit more time than your adjusted basil in the manual profile. It's just not the same thing. And

Scott Benner 38:29
I want to say that I know about Omnipod five that the way you set it up is very important to your initial success, sincerely, and so much so that I have like I have a small series about it. They're called Omni pod five pro tips. But if you're going to start an omni pod five, please listen to those three episodes before you set it up. Because you're because if you come in with poor settings, the results you get back are going to be very confusing to you. And you're going to be left thinking this thing doesn't work. And you know, your settings are wrong. And this is not just from the pod five either it's for it's for tandem. It's for Medtronic, it's for all these systems. Yeah, your settings. And I

Jennifer Smith, CDE 39:05
would say that if you come in without optimized settings, will it adapt? Eventually it will adapt as you make adjustments to some of the things that do go into that total daily insulin consideration for it to adjust from eventually you will get there, but it will be a faster. Oh, I like this. Yeah, if your initial settings that you give it to work with are

Scott Benner 39:30
correct, yeah. And just for clarity, they're like, the idea here is if you come in and say I don't know, my total daily Basil is 10. And my total daily insulin is 20. And it's really, I don't know, 15 at the end and 40 or something like that. That thing's trying to do what you asked it to do, but you didn't give it enough firepower. And then you're gonna go in and go and you're going to Bolus more like you're gonna be like Bolus Bolus Bolus and eventually it's going to look and go wow, the total aliens on when we set up was 35. But I'm singing we're really using more like fifth See, and then you'll have a smoother thing. But you don't want to wait all that time to get to that, you know, if you don't have to what else needs to be said about Omnipod? Five, anything.

Jennifer Smith, CDE 40:07
I think the bigger things about Omnipod. Five are things that people are already in the know of. But for those who are wanting to learn about pumps, it does have an app for the Android users right now. So you can control it that way versus the handheld controller. And I think that's a piece that people would want to know that right now, unless you're an Android user, you will have your phone with you for all of your CGM alerts and alarms. And you will have your controller with you, which allows the system to give you a Bolus or to add corrections. I think another piece of that is to understand your controller does not have to be on your person for the algorithm to run. Yeah, pod holds the algorithm and communicates directly with the CGM that you have on your body. So if you forgot your CGM at home today, or not your CGM, I'm sorry, your controller at home today, and you went to work, you're not gonna be able to Bolus the algorithm working? Correct. The algorithms still gonna keep working. It's gonna keep you safe. You'll be able to see your CGM values on your phone or your app, but you won't be able to Bolus but that's I think it's a piece that still a lot of people are. They're concerned I have to carry around this extra thing. Well, not all the time.

Scott Benner 41:27
Yeah. And I and it's a big deal, actually. So to bring that up is smart. And the I think, again, they have I think they have the go ahead for the app. Yeah, for the iPhone device. app, it just hasn't come out yet.

Jennifer Smith, CDE 41:42
So one lovely thing about the iPhone app that I it's not part of the Android app is the iPhone app is going to have a frequent, like a food list. So you can actually have foods in there look up foods from a database, and that populates right into your carb calculator. Oh, which is a really it's a fantastic feature. If anybody is an age old Omnipod user like myself, it usually it used to have in the really old controller. Remember, it had a food diary that you I mean, it didn't go into your calculation, but at least you could look up if you had no idea what was in a croissant. Right, it was in there. And

Scott Benner 42:24
now I'm going to just say Apple this that and it's going to put it into the calculation through the iPhone app. Oh, that's cool. I didn't know that actually. Jenny Okay, tandem T slim x two that's the most that's the newest version so there's some might be some of you out there still using Basal IQ which is tandems automated pump that is just basically taking basil away to stop a low correct it was a like a speed bump has tried to stop you to get low but they pretty quickly came out with control IQ after that, which is another automated system that's making decisions about restricting and adding insulin. Yep, this one works with G six G seven and something else does

Jennifer Smith, CDE 43:05
G six G seven and do they have libre libre

Scott Benner 43:10
I'm looking right now. I think it's libre eight. Libre two? Libre two? Yes, G six Dexcom G six Dexcom g7 libre two, we're currently we're

Jennifer Smith, CDE 43:18
trying to Yeah, so the control IQ algorithm is different than what we just talked about with Omnipod. Five. For many people, I actually really like the control IQ algorithm. I think it's quite lovely. Because as we talked about settings initially getting started on a system. When you use Control IQ, it utilizes every setting that you put in when you enable control IQ. So if your base Basal profile is well set, and it works for you, but you just want that handholding kind of that Butler behind the scenes helping you out with things riot, control IQ, you can change a Basal at 3am to give you more, you can change it at 3pm to give you a little bit less, that's your active time of day or whatever control IQs algorithm will work off of your settings.

Scott Benner 44:10
Okay. So great old school like a manual pump, tell it from this window in this window here, I want my basil to be one. But in this window, I want it to be point eight, and then the but the algorithm still continues to work off those numbers.

Jennifer Smith, CDE 44:22
Correct. So and so it's it's still aiming for the same target, it's still got that 110 target that it is aiming for all the time. But for many people because of the fact that the set Basal profile is your own known amount of insulin, the way that the algorithm works, it tends to work better for some people again, this is where your lifestyle and what you know about yourself and everything kind of comes into the picture. I've seen it personally and you know, the women I work with in pregnancy. I've seen it actually work pretty nicely in pregnancy because we can dictate settings and still have the protection pain of not being too low, right? It does have automated Bolus in normal control IQ mode. As the blood sugar rises, it's either going to temporarily increase Basal insulin. If it looks predictively like the blood sugar is going to get to 160. But if it's rising faster, and the prediction is that your blood sugar is gonna get up to the 180 it's gonna give you automated correction boluses so, there's another little feature to it that's a little bit different for

Scott Benner 45:32
the Omnipod five, okay, to pump cartridge,

Jennifer Smith, CDE 45:36
yep, the to pump the cartridges and it's an interesting cartridge. It's that like, actually, like most people have used tube tops before the cartridge is like, you know, a cylinder sort of that you fill with insulin. It's either plastic, or like a hard plastic control, like you or the tandem T slim pumps have actually like a little balloon kind of like gets filled with insulin, you can't see it, it resides inside of a plastic kind of cartridge holder. But it also is, you don't see the insulin inside of your cartridge. Some people who came from Medtronic and we're very used to seeing see

Scott Benner 46:12
it, okay. So that's a difference. So it's a cartridge with a balloon inside of it. And they come pre filled, they

Jennifer Smith, CDE 46:19
do not come pre fill you fill it yourself. Oh, okay. Yes. And it, it's not advised to use a Piedra insulin in the control like you are not control IQ the T slim, mainly because of crystallization of that type of insulin. So either Novolog or human LOGG. I have had people using like the faster the more Ultra rapid, like fast and whatnot, but just not a pizza. Okay.

Scott Benner 46:44
It's interesting. I don't think a pager is cleared for Omni pod either. But Arden has been using it for 10 years. And it's also Omnipod you have to fill yourself he comes with a you pull out the insulin from the vial and then you inject it into the Omni pod and it's got its own little tank inside of it. And actually, I didn't we didn't mention this, but the only pods like disposable when you take it off the whole little pot just got done. Yeah, yes. Whereas I'm guessing I'm just gonna keep refilling my mighty slim

Jennifer Smith, CDE 47:14
as you get a new little cartridge each and every time you they are disposable. So you don't keep reusing that same exact

Scott Benner 47:23
thing. Gotcha. Do you know what it holds how much they have a

Jennifer Smith, CDE 47:27
200 and a 300. Pump. So they've got two sizes similar to Medtronic. Medtronic has the smaller fill and the larger fill pumps as well. So this one does,

Scott Benner 47:36
too. So if I wanted to next to the hill 300 units, I'd actually have a larger device.

Jennifer Smith, CDE 47:41
You'd have a the actual pump itself.

Scott Benner 47:45
Yeah. Okay. And then of course, you're going from the pump to an infusion set. And so your infusion sets on you somewhere. And then there's tubing from that, that goes back to the pump, and then that pump has to stay with you obviously, because the minute you just kick from it, you don't have access to the shoreline. Okay, correct. But the controller is on the pump itself. Well,

Jennifer Smith, CDE 48:07
that's another neat feature of the control IQ or the tandem pump is that yes, your controls are are on your pump itself, right. But you also have the app, the app now allows you to Bolus do extended boluses with the newest update. So the app on your phone drives the pump as well. So if you really are somebody who doesn't want to ever pull your pump out or or you know you have it like shoved way down in your pants early, it doesn't look nice to dig in your pants. You don't have to

Scott Benner 48:37
he's never seen me dig in my pants Jenny's very

Jennifer Smith, CDE 48:41
efficient your bra I know a lot of women like when I wear a tube pump I actually used to wear it like on the side of my bra because it was easy to clip in there but then to pull that out business meeting digging down your

Scott Benner 48:52
shirt just pulling your sleeve aside excuse me I'm gonna have I'm gonna have a muffin in a second we we win the break so that makes it really nice now listened plenty of people I've heard from love the tea StarMax to these things are all they're never always going to be right for everybody. Right and we say it's like your lifestyle or buy but some people are just gonna like it or not like it for some reason. So I've heard people say like, oh, I'm the pot is too big, or but I've also heard people say I don't care. I'm not wearing tubing, you know, like it's just it's, it's what works for you. Anything else about tandem that we haven't said the

Jennifer Smith, CDE 49:27
software is you don't have to, like essentially get a brand new pump. Whenever something gets updated or upgraded in it a new feature or whatnot. It is a software upgrade to the device, which you know, you get I don't know exactly the how it works, but it's a code your doctor signs off of it, you get it, you essentially sign in, do a little bit of like online training for it and then you download it right to your pump, which is quite nice rather than having to wait for something in the mail.

Scott Benner 49:54
Nice. Alright, let's move to Medtronic. Now Medtronic has, I have to admit I don't know a lot about eyelets but there's a 637 70 and 780 G. These are, by the way US companies that are US pumps. I should also say that Medtronic is the sponsor of the podcast, not for their pumps just for their company. But let's I just want to say that. So what is the difference here 630 G is what the

Jennifer Smith, CDE 50:17
630 The 670 was really the more automated okay of them. When you're looking at like coming from manual upgrading to some type of automation, there was a suspend feature, much like Basal IQ, if you consider it that right, where it just did a predictive suspend prior to the low or a suspend on a low type of feature. Then we moved into the 670. The 670 gave some true automation with CGM data, right, some increases and decreases to the baseline Basal delivery. Again, med tronics automated systems work similar to Omnipod fives automation, it's an adapted insulin delivery based on total daily insulin view over a couple of days. So and it continues to adjust that. It's not AI, it does not learn, but it does adjust based on your total daily needs. So the newest is of course, there 780. There 780 takes it up a step from the 770 in that it has auto Bolus correction. Similar to what I mentioned about control IQ as blood sugar predictively is going to get higher, it may auto correct rather than temporarily increasing your Basal. And a lot of people actually find that the 780s auto Bolus Correct. Works pretty swiftly. Yeah, in comparison to the other systems that have been, you know, looked at. It works pretty darn nice.

Scott Benner 51:51
I've heard a number of people using the seven ATG who are like I like it, and I'm having good results with it. Now this only works with their CGM, though, right their guardian sensor,

Jennifer Smith, CDE 52:01
correct in their newest is their guardian for sensors, which from the handful of people that I've worked with using it do seem to say that it is a nicer sensor more more often that it's consistently accurate a little bit, I guess nicer to use, essentially, it still has all the taping requirements. I think that's the biggest thing that people don't like, who continue to use their sensors, with good accuracy and whatever they are getting. It's that their sensors require a lot of like, taping down to hold them in place. And people don't like the all of the additional adhesive to get it to stay on your body.

Scott Benner 52:44
Gotcha. It's a weird, I mean, the design is interesting. It looks like Uh oh, gosh, I don't think they're gonna like this. It looks to me, it looks like a tick. It looks like it's got like a big round body and it bites you on one side. Like, does that make sense? We

Jennifer Smith, CDE 52:57
call it a BS bot.

Unknown Speaker 52:58
Oh, no kidding. I

Jennifer Smith, CDE 52:59
didn't know. It's like the it's like the abdomen kind of part of the back end of like, a beach, or like a ticket? Actually.

Scott Benner 53:08
I know it's not, they're probably like, Oh, great. I'm glad we bought ads with you. But no, but it's, it looks a little weird to me. But

Jennifer Smith, CDE 53:15
the part that actually when the front end of it as if it's like the head area of the bog, let's call it right. That's the part that has the center and kind of gets inserted. But unless you tape down that butt area, it flops around and it's going to come out interesting. Okay, so the sensor also is not the sensor itself, but that little that little rounded, but area, it actually gets charged. So that piece Oh, much like the Tran let's call it the transmitter on the G six, right, we have to save that part. That's the same thing with the Medtronic sensors is that piece gets charged. And all that gets really thrown away as the little sensor that you pop under the skin.

Scott Benner 53:56
Oh, I see how. Okay, that makes sense. And this is again is another it's to pump. The tube pump. Yeah. I mean, honestly, in the space of automated what's available right now on the pod is the only two books one right the rest of them have tubing. It is

Jennifer Smith, CDE 54:12
the only tubeless currently on the market. Right? Yeah, yeah. So in terms of everything and automation. Yes, yeah.

Scott Benner 54:20
Now, do we have time for you to talk about the beta bionics I letter? Do you want to stop here and we'll do it next time we come back.

Jennifer Smith, CDE 54:28
I would say we should stop here because that's a great one to like, get into and yeah, I only have about four or five minutes.

Scott Benner 54:34
That's fine. Then we'll talk about fun stuff like personal fun stuff when we say goodbye to the peoples. All right, cool. I'll see in a bit for the next part. My pleasure.

A huge thanks to us met for sponsoring this episode of The Juicebox Podcast. Don't forget us med.com/juice box. This is where we get our diabetes supplies from you can as well use the link or call Call 888721151 for use the link or call the number get your free benefits check so that you can start getting your diabetes supplies the way we do from us med. A huge thanks to Omni pod, not just my longest sponsor, but my first one Omni pod.com/juice box if you love the podcast and you love tubeless insulin pumps, this link is for you. Omni pod.com/juice box, 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 Juicebox Podcast is full of so many series that you want and need afterdark s Gutten Jenny, algorithm pumping bold beginnings defining diabetes the finding thyroid, the diabetes Pro Tip series for type one, diabetes variable series mental wellness, type two diabetes pro tip, how we eat oh my goodness, there's so much at juicebox podcast.com. Add up into that menu and pick around. And if you're in the private Facebook group, just go to the feature tab for lists upon lists of all of the series. always free. Always helpful. If you're looking for community around type one diabetes, check out the Juicebox Podcast private Facebook group Juicebox Podcast type one diabetes, but everybody is welcome type one type two gestational loved ones. It doesn't matter to me. If you're impacted by diabetes, and you're looking for support, comfort or community check out Juicebox Podcast type one diabetes on Facebook. If you're not already subscribed or following in your favorite audio app, please take the time now to do that. It really helps the show and get those automatic downloads set up so you never miss an episode. Thank you so much for listening. I'll be back very soon with another episode of The Juicebox Podcast. The episode you just heard was professionally edited by wrong way recording. Wrong way recording.com

Scott Benner 1:21:04
it feels like it almost feels like it's coming from the back of your neck. I don't know. Like another way to say that. But yes, yeah, way more talk about how people's voices sound and most people care about I'm gonna say, so I'm gonna let you go now. Most people are like, I have a thought. I don't even bother to think if it's right. And then it comes out of my mouth. That's talking, you people are overcomplicating this, right. So

Kim 1:21:30
when you do it for your living, you know, you have to take care of yourself.

Scott Benner 1:21:35
Yeah, no, it's it's a crazy thing. I usually record every day of the week. So even like getting sick. Like there's sometimes I feel myself getting sick and I'm like, oh, no, no, no, no, that can't happen. Today, Oh, no. You know when that can happen later when I'm dead. Not now. I'm gonna be time for this. Like so. Yeah, I got sick during the remastering of the Pro Tip series. And I have to be honest, the opens are great because that because my voice was like

Kim 1:22:01
extra. Yeah, yeah. Yeah. I just

Scott Benner 1:22:06
had to record in like shorter bursts. And then then breathe and then record and then edit it together. So anyway, thank you can I really appreciate you having this conversation with me? Thank you very much. A lot of fun. Oh, good. I'm glad. Hold on for me one second. Sure.

A huge thank you to ever since CGM for sponsoring this episode of the podcast. Are you tired of having to change your sensor every seven to 14 days. With the ever since CGM, you just replace it once every six months via a simple in office visit. Learn more and get started today at ever since cgm.com/juicebox. 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 forward slash juice box. They spell that GVOKEGL You see ag o n.com. Forward slash juice box. If you're living with type one diabetes, the afterdark collection from the Juicebox Podcast is the only place to hear the stories that no one else talks about. From drugs to depression, self harm, trauma, addiction, and so much more. Go to juicebox podcast.com up in the menu and click on after dark. There you'll see a full list of all of the after dark episodes. If you're not already subscribed or following in your favorite audio app, please take the time now to do that. It really helps the show and get those automatic downloads set up so you never miss an episode. Thank you so much for listening. I'll be back very soon with another episode of The Juicebox Podcast. The episode you just heard was professionally edited by wrong way recording. Wrong way recording.com

#1165 Cold Wind: Healthcare Whistleblower E.M.T.

"David" has type 1 diabetes and is an EMT.

+ Click for EPISODE TRANSCRIPT

Scott Benner 0:00
Hello friends, and welcome to episode 1165 of the Juicebox Podcast

we're calling today's guest David he has type one diabetes. He also has a child with type one diabetes. And David is an emergency medical technician so we're going to talk about the things he sees as an EMT. Please don't forget that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, always consult a physician before making any changes to your health care plan or becoming bold with insulin. US residents who are type one or have a child with type one can help the T one D exchange by completing a short survey T one D exchange.org/juice. box you can help type one diabetes research by completing that survey AT T one D exchange.org/juice box. When you place your first order for ag one with my link, you'll get five free travel packs and a free year supply of vitamin D. Drink ag one.com/juice box. Don't forget to save 40% off of your entire order at cozy earth.com All you have to do is use the offer code juice box at checkout that's juice box at checkout to save 40% at cozy earth.com 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. Today's episode is sponsored by Medtronic diabetes, a company that's bringing together people who are redefining what it means to live with diabetes. Later in this episode, I'll be speaking with Mark, he was diagnosed with type one diabetes at 28. He's 47. Now he's going to tell you a little bit about his story. And then at the very end of the episode, you can hear my entire mini interview with Mark. To hear more stories from the Medtronic champion community or to share your own story, visit Medtronic diabetes.com/juicebox and check out the Medtronic champion hashtag on social media. This episode of The Juicebox Podcast is sponsored by the ever since CGM. Ever since it's gonna let you break away from some of the CGM norms you may be accustomed to no more weekly or bi weekly hassles of sensor changes. Never again, will you be able to accidentally bump your sensor off. You won't have to carry around CGM supplies and worrying about your adhesive lasting. Well, that's the thing of the past. Ever since cgm.com/juicebox.

"David" 3:01
Podcast Hi. So I'm David. And I was diagnosed with type one diabetes. When I was 16. I was diagnosed I was actually in the UK. So I'm 38 now and that was when I was 16. So we're looking at 22 years ago, no family history at that time of type one at all. And, you know, since then, I have actually a brother in law on either side of the family, like one of my side or one of my wife's side of the family who's married into the family and gotten type one. But nobody at the time when I was diagnosed, but they're not blood relatives, you know, that married into the family. They were not blood relatives at the time. Sure. And since then, one of my nephews was actually diagnosed. He was about 14 when he was diagnosed and my son, which we'll talk about later, it was also diagnosed recently, okay,

Scott Benner 3:54
I was gonna say what next, the next generation is gonna get hit.

"David" 3:58
Yeah, unfortunately.

Scott Benner 4:00
David, how much of your cultural background are we going to talk about?

"David" 4:04
So I'm from the religious Jewish community can talk about as much as you want to talk about it, or as little as you want to talk about it. I

Scott Benner 4:12
just wondered if this was the common thing throughout your community that the autoimmune

"David" 4:18
so that definitely is certain things that run throughout the community, I'm gonna be honest, it might upset some people. I don't think that eating habits are the healthiest. You know, you're going, you've been to that weekend, and you're gonna be going can you see how you eat on the weekend, and it's not like one Thanksgiving dinner a year or something? You know, that's like three times every weekend. You know, and during the week at every party, we're very big into community. So there's always events and parties, and I cannot say that the eating is the healthiest. Definitely a lot of type two diabetes that's prevalent within the Jewish community. Even I have friends that are 45 that already have type two, or they've been told the II diabetes. So there's definitely a huge type two factor type one, again to blame, those types of things wouldn't be first I'm not gonna say, I don't know, you know, just from being around. I've been around for 38 years, there's not a huge surge, you know, of type one. Okay, that, in my opinion, um, from my experience,

Scott Benner 5:21
I have a question about the food, but I want to I made you switch to a corded headset, but the court might be touching your clothing. So if you could be careful about that. Oh, no, no, no, don't be sorry. So this is maybe a loaded question. Do you guys eat that food on the weekends? Because you like it? Because it's what you do?

"David" 5:38
So good question. There's a few answers. Answer number one is, it's good food. We don't eat it because we're hit you know, we're forced to and we had it's definitely good. It has cultural history, you know, it comes a lot of it. It's like Eastern European. And a lot of it was made at the time, because that's what they had available. You know, so oil, and some potatoes, you can make something beautiful. Obviously, it's loaded in oil, but that you know, that fit a family didn't need me. When I actually saw into meat. That's more of a recent thing, a modern thing that the Jewish community got into these meat boards and things like that. Much more into like the carbs, potatoes to that type of stuff. A lot of that is culturally there's no. And it turns out, it's good. I mean, an oil on potatoes. For most people. It's like the good, warm and comforting type of food. Yeah,

Scott Benner 6:26
I understand. I was just wondering, because it's so different than what I've what I eat that when it was presented to me, I was like, I'm gonna go get a sandwich when you guys aren't looking.

"David" 6:35
One of my highlights was hearing it on the podcast describe that food. It was it was great. That was

Scott Benner 6:42
I really did sneak out to a deli. Saturday afternoon, I was like, I'll be back. Oh, great experience. Okay, so you're on the show today, because of something you experienced in your professional life. Is that right? What were you doing?

"David" 6:55
Yeah, so I have volunteered on an ambulance for the last 10 years. And to talk about how I got into that, actually. And then we can go back, you know, which it's all connected. So I was actually wanting one night, I was out with my wife. And we were at this location, it was late at night, it was like 11pm. And some lady came running inside, you know, screaming for an ambulance, her husband had passed now husband has passed out screaming was as much of foreigners then nobody had the right. You know, I called and I didn't know the guy could have been dead, I wouldn't have known the difference. I didn't know he was dead, alive, breathing, not breathing here. Yeah, he's out there. And he's alcohol on the floor. I'm calling the ambulance and they're not there five minutes, 10 minutes 50. I call them back. And I must call them about six times. And they started getting impatient with me how many times when calling, I didn't understand how it works, you know, they have to dispatch someone and someone has to be close by eventually they show up, you know, the paramedics came about 20 minutes later, turns out that this guy actually had diabetes. And his sugars were extremely, extremely low to the degree that he'd gone unresponsive. You know, they gave him an IV of whatever they gave him and some juice. And he after that he was fine. And he was on his way. But it really bothered me the fact that I didn't know anything. And like I could have had I mean, how stupid of me not to think given to check your sugar's you know, in hindsight, I should have that should have been one of the first things I checked. But I didn't. David, I

Scott Benner 8:25
have to say, I don't know about that. I don't know why you would transpose your medical condition on to somebody else's in an emergency situation. You don't I mean,

"David" 8:33
true, I guess now as a medical professional, that would have been one of the first things I would have thought of, especially as someone with type one diabetes, then I didn't, I didn't connect it. But it gave me a strong feeling of I need to know what to do. God forbid a situation like this happens again, I need to know what to do. I'm not the type of guy to stand by iral and watch your burning, building in I'm going to jump in there and help out, right. So right after that I signed up for EMT course, you know, it took about six months. And ever since then, I've been volunteering in emergency medicine for 10 years. And, you know, we'll get to see all sorts of things from delivered multiple babies to midflight emergencies and obviously a lot of diabetes and associated emergencies and illnesses that happen with it. Right. So I do have an inside view of the medical world and I interact with doctors, nurses, hospitals, you know, the gamut. Yeah. in a professional manner, and obviously on a personal manner. Well,

Scott Benner 9:35
it's first of all, it's wonderful. You donate your time like that that's really something that you removed and you actually did something about it and if stuck with it for a decade is is really inspiring, but I don't know, but it's my pleasure. I volunteered for three years as a fireman when I was a kid 16 to 19. And I did it because my father had done it. I you know, I think that's why I started and I just kind of grown up around it. And it's very rewarding. It's a lot of work to the training and the time and time away from your family. All that stuff is very serious. So

"David" 10:06
yeah, I mean, we have to go for monthly trainings in addition to obviously the time we spend on calls. And legally, you know, we have to keep up with the state requirements. And there's tests and every month, we've got to do an evening of training and as practical skills and learning skills and online. So yeah, it's a lot of time, but it's very rewarding being able to help somebody and then a time of need certainly is.

Scott Benner 10:29
How many times have you thought it's time to change my CGM? I just changed it. And then you look and realize, Oh, my God, it's been 14 days already a week, week and a half. Feels like I just did this. Well, you'll never feel like that with the Eversense CGM. Because ever since is the only long term CGM with six months of real time glucose readings, giving you more convenience, confidence and flexibility. So if you're one of those people who has that thought that I just did this, didn't I why we're gonna have to do this again, right now. If you don't like that feeling, give ever sense a try. Because we've ever since you'll replace the sensor just once every six months, via a simple in office visit. Ever since cgm.com/juicebox. To learn more and get started today, would you like to take a break, take a shower you can with ever since without wasting a sensor, don't want anybody to know for your big day, take it off. No one has to know have your sensor has been failing before 10 or 14 days. That won't happen with ever since. Have you ever had a sensor get torn off while you're pulling off your shirt? That won't happen with ever since. So no sensor to get knocked off. It's as discreet as you want it to be. It's incredibly accurate. And you only have to change it once every six months. Ever since cgm.com/juice box. Right now we're going to hear from a member of the Medtronic champion community. This episode of The Juicebox Podcast is sponsored by Medtronic diabetes. And this is Mark.

Speaker 1 12:04
I use injections for about six months. And then my endocrinologist and a navy recommended a pump.

Scott Benner 12:10
How long had you been in the Navy? Eight years up to that point? I've interviewed a number of people who have been diagnosed during service and most of the time they're discharged. What happened to you?

Speaker 1 12:20
I was medically discharged. Yeah, six months after my diagnosis. Was

Scott Benner 12:24
it your goal to stay in the Navy for your whole life? Your Career? That was Yeah,

Speaker 1 12:27
yeah. In fact, I think a few months before my diagnosis, my wife and I had that discussion about, you know, staying in for the long term. And, you know, we've made the decision despite all the hardships and time away from home, that was what we loved the most.

Scott Benner 12:41
Was the Navy, like a lifetime goal of yours?

Speaker 1 12:44
lifetime goal. I mean, as my earliest childhood memories, were flying, being a fighter pilot,

Scott Benner 12:50
how did your diagnosis impact your lifelong dream?

Speaker 1 12:53
It was devastating. Everything I had done in life, everything I'd worked up to up to that point was just taken away in an instant. I was not prepared for that at all. What does your support system look like? friends, your family caregivers, you know, for me to Medtronic, champions, community, you know, all those resources that are out there to help guide the way but then help keep abreast on you know, the new things that are coming down the pike, and to give you hope for eventually that we can find a cure.

Scott Benner 13:18
Stick around at the end of this episode to hear my entire conversation with Mark. And you can hear more stories from Medtronic champions and share your own story at Medtronic diabetes.com/juicebox. What have you seen over the years that made you reach out about this specific series about being on this cold wind series?

"David" 13:38
Let me go back to my diagnosis. Because I think I already started seeing things that I don't even know that was 22 years ago, I already started seeing things then. And I'm still seeing the same things now. So let me just go a bit back to that story and give you there's been some improvement. So I was I was 16 I was paying like, you know, by the bucket. Tons of way everyone was telling me I remember I went to a family wedding. Everyone was telling me how good I looked at my suit fit me so perfectly. I had no idea. I wasn't trying to lose weight. I just you know last way as as happens, I had unbearable first I was drinking like insane. Now I happen to be in a school I was in at a time. They had a vending machine right near one of the study halls. And so that Fanta was my favorite drink at the time so that I was thirsty as anything. Just I was going through a place six bottles of Fanta eight bottles of Fanta a day. Now in hindsight, I know what that was doing to me but at the time, you know, I had no idea. This whole process wasn't stopping. So I just thought you know it's time to go to the doctor. I called my mom and she made an appointment a couple of days later. As I'm actually sitting in the doctor's waiting room. There's a sign on the wall like one of these ads. I don't know what company it was, whatever it Was it just said, paying a lot. And firstly, I'm paying a lot, you may have type one diabetes. So on the spa, I diagnosed myself, I said, I know exactly what I have. So I walked into the doctor's office. And you know, when they called us and I said, I have type one diabetes. So I had, you know, I said, Well, I'm drinking and I'm peeing in a sign out this is that I have it. Now at the time, they didn't even have a glucose meter in the doctor's office. So he said, Okay, let me do some blood work. I mean, he checked out some other things. I don't even remember why. He said, let me do some blood work. That was it. We left, nothing happened from that we weren't home. It was actually it was in the middle of the summer. I was I was a junior counselor in a camp at the time. Two days later, I get a call from the camp office, you know, we were out in there. Whatever activity we were doing that I needed to come in middle to the camp office, my mother's on the way to pick me up. So she comes and she says, We just got a call from doctors. And at first the blood work came back. I don't even remember what number it was, it was some crazy number. We're heading straight to the hospital. So I was like, Okay, no problem straight to the hospital. So I was there for three, four days. And that's where I really started seeing. I mean, the fact that the doctor didn't have a blood glucose meter is ridiculous. I hope that's changed nowadays. I get to the hospital, and they put me on a drip right away. They told me I have type one diabetes to confirm with blood work. They put me on a drip, you know, insulin and sugar to balance things out for the first few days. Yeah. And then they started teaching me and said, You know, I have to know how to use the shots to, you know, to be able to go home. So I started practicing by males taking insulin. I remember like, the first day I'm taking the shots, it's about you know, I don't care. Let's say it's 5pm. The nurse comes with the with the insulin, and she says you need to take five units. I said, this is the quick acting, I said, Where's the meal? She's like the meals coming soon. I'm like, now get my I've been diagnosed like three days at this point. I know nothing, right? And she's like, No, just just bowlers. Now the meals coming soon. I'm like, no, no, no, that doesn't how it works. They told me it's fine. It's acting, not bolusing unless I have the food in front of me, because I don't know what's gonna happen back and forth this all along. When she goes to check that she's like, Listen, this is what the chart says. The chart says 5pm. I like Dude, I'm not bolusing I don't care. Now. I'm a 16 year old kid. And I didn't know anything. But it just didn't sound right to me. Turns out, well, I'm like, I'm not doing it. And you're not exactly gonna hold me down and eject me. So I didn't take it. Well, the mail didn't actually come till 90 minutes later. Now, that would have been obviously a disaster. bolusing five units newly diagnosed, I don't remember exactly what my ratios were then. But I'm assuming they were very, you know, very low. That would have been an absolute disaster that's already there. And I was ready arguing with medical stuff, which is not good. It's not another good to be in an argument with them. But you know, just because the medical authority, and there were a nurse in the hospital, it doesn't mean anything to me. It doesn't mean they know what they're talking about. Yeah. And that was that. And then basically that night, I went home with just about the same amount of info, I knew nothing. So my first few years was pretty much just nothing going on, like no information, nothing. Just Basal Bolus NMD, I have no idea. I didn't even know the concept of a carb ratio. Because they never told me they just said by meals, I didn't know which foods didn't have carbs didn't I started guessing. And this goes on for the first few years. And then one day and the doctor's visits were a complete waste of time, you know, you go into the doctor, and they're like, Oh, well, why don't you just eat better and exercise? I'm like, what I didn't like, like

Scott Benner 18:42
I have type type one diabetes. Do you know the difference between the two? Also, let me ask you, David, that that interaction in that hospital at that first moment, it's funny because the nurse was right and wrong, like it would have been great for you to inject a little sooner before the food came, but not 90 minutes sooner, obviously. But then Did that scare you off or make you very specific about injecting and eating right away.

"David" 19:05
So I was always a little scared of insulin as a general role. And I actually told this to my son who's actually very into Pre-Bolus. And now, but you know, especially in school and things where if you have an unknown, you know, let's say you're in school in your regular schedule, and it's lunch every day at two o'clock, and that doesn't change the whole year. No prom Bolus while you're in class 15 minutes before but if you're in camp, and it's a topsy turvy schedule, and you don't know what's going on, and you don't have lunch is going to be a two to 30 to 45. Don't Bolus till at least you see some food trays and you know that it's actually lunch coming out happened here. So I wouldn't say I was I was scared, but I immediately got the feeling that I was on my arm and I couldn't trust what I was being told by the medical staff around me. And that pretty much didn't change when I got you know, some of my appointments. It was like the silly appointments. They didn't really give me any tools to tell me anything. It was just like okay, let's do some blood work. Let's Whatever, I pretty much went on for a few years. And then and Kim, I didn't have a Dexcom at this time or a pump anything. I always was into checking my sugars a lot, you know, I had this argument with I mean, the only other person I knew at the time had type one diabetes, I had a classmate who had it since he was like four. And I have memories of like being in his house and he had to pee on a on a stick to go get his sugars. Yeah, that was my, that was the only thing I knew about it at the time. And that's it. So I just had this feeling that I was on my own and gotta figure things out myself. And then they it was a few years later, the hospital started offering this thing that was called a Daphne course they call it a dose adjustment for normal eating. And I was it was like a trial pilot program. David, were you in you?

Scott Benner 20:43
Were you in the UK, then?

"David" 20:44
This is the UK.

Scott Benner 20:46
I've heard of Daphne before, but I thought it was still UK. Okay. All right. I'm still

"David" 20:50
in the UK at the time. This is this was like the pilot of Daphne. I was one of the first participants in the Daphne costs locator. And they offered it to me, I actually changed hospitals, because I realized also that the hospital I was seeing were really useless, which is another thing I see people stuck with the same hospital, same doctor for years. Like if you're not happy, find somebody else, find somebody else who's better. So I changed this other hospital that was offering and then they asked me to staff because I went there was a group of I think we were eight or 10. And they taught us the basics. Like when I say Basics, I'm talking about what Basal insulin does, but Bolus insulin does. What carbs are carb ratio, just literally the basics. And I was like, it was mind blowing. I was like, Oh my gosh, this there's a science that is this actually makes sense. And I got really into it. Now even though I didn't have a Dexcom I was checking my sugar's probably 1014 times a day. And I made my own graph, like I, you know, I put what I wrote down literally on a spreadsheet, what it was in the morning, two hours later, four hours later, six hours later. And together with that, and MDI, I managed to regulate myself together with that knowledge that I had gotten him then. And I got very, very good on MDI, to the point that you know, I had it down to a science. But I also got ticked off because I realized, like, they were sitting on this information for you, like, what would they expecting me to without this information. And then I got upset at myself as I'm like, I could have just google this five years ago, I've found out this information. I don't know if your podcast was around them. But I'm sure I could have found something that you know, this that had the basics. So I really realized at that point that there's nobody going to take care of you, you know, you got to be your own doctor, and you got to get on top of it yourself. Nobody's gonna do it for you, you'll go to every appointment. And they'll just make a comment, like, why don't eat healthy and exercise? Or why don't you just this and why is this that or they'll give you an adjustment, and then I can see you again for another six months. So that's really the, that's really

Scott Benner 22:45
put you in that mindset that I have to take care of myself. And I realized

"David" 22:49
that I mean, I was about 1920. At that time, I was like, there's nobody going to take care of me. Nobody. You know, obviously my parents were willing to help if I needed help with anything. But at that point, I was pretty independent. I didn't I actually didn't want my parents with old I never let them get involved from day one. I'm just more of a private person, that there was nobody going to help me nobody's going to work on my car ratios. Nobody's going to tell me how to adjust Bezos and test and you know, all these things. I realized then that, that I've really got to get into it myself and take my own responsibility and that my opinion hasn't changed. It's only gotten stronger over the years being in the medical field. Yeah. Did

Scott Benner 23:26
you rely on your parents for other things? Was it? Was it specific to diabetes that you wanted to be on your own? Or was that kind of Yeah, so

"David" 23:33
I relied on him for everything else. I mean, I was living at home, I was eating at home, I was sleeping at home and they paid for everything to pay for my tuition. They paid for any extracurricular activities I was doing, they paid. They were pretty much doing everything but specifically with this, I don't know what it is. I just I'm like, you know, I guess it's like, a personal thing on your own body. It's like with somebody else being involved. Definitely at that time. That's how I felt. I'm not gonna say I've changed drastically since then. Yeah, I did not let them get involved.

Scott Benner 24:01
How involved is your is your wife with your care if at all? Oh,

"David" 24:06
so that's a great question. So it's changed actually, since my son was diagnosed I would send in the in the first years of our marriage versus the first 11 years before the son was diagnosed. She wasn't involved in anything she didn't follow my share. I didn't I didn't tell her anything about it. Hi, lol. Because I'm also the opinion that don't use diabetes as an excuse you gotta live you every day to the fullest family time whatever it is like there's no like excuses. Oh, I'm low now I can't do this. I'm high now I can't do that. So I almost consciously didn't get her involved because I'm not like oh now I'm high now I'm low now I'm this now I'm that I can't do this. I can't do that. Like it was a family trip. It's a family trip. Doesn't matter what I am I got to work it out around that. Yeah. And she didn't know much because of that she was very good at doing anything that she knew would help me so like she knew like certain types of food that I stay away from or I have preferences on food she would cook any you know, family meals appropriately. Always make us She had, she wasn't not involved because she didn't care. She wasn't involved because I didn't let her get involved in it not in a bad way. It just I just didn't get her involved. Now that changed a little bit since her son was diagnosed. And I have to say, even though I'm the one with type one, she's taken on most of the brunt of it. You know, she's the one that wakes up at night, I go to sleep, you can hurt a bomb, I won't hear a thing. So like, if he goes low in the middle of the night, she's the one that gets up. She's the one that deals with it. And also during the day a lot, I work I can deal with things. You know, he's got questions, he's texting or whatever she's, she's, she's on top of the game with it, right. And then since then, I realized like, it's also stupid, like, it's actually scary. I've never had a low that I needed somebody else's assistance. But I realized that after that, I should probably have somebody following me, God forbid, if something didn't happen. So since then, I've added her to my fall, but nothing much else. But now she understands that she's an avid listener of your podcast now. And she understands a lot more from you than she got from me. You know, in the last two years,

Scott Benner 26:01
I asked a little because it's okay that I talked about the event last year, is that alright? So I know we're keeping you anonymous, but there's no way that people who don't know you know, you wouldn't know this was you by your story, though, right? You're just worried about the larger audience not being able to figure out who you are. Is that correct? Correct. Okay. I don't know if I talked about this in the podcast or not, but I did a caregiver, excuse me a spouse talk. And I scared the Holy hell out of everybody. And I did not mean to, like, I was just going over what I just thought were like some, you know, obvious things to say about like glucagon. And I could see, like, There's horror on a lot of the wives faces. And I was like, you know, everybody should know how to use glucagon. And maybe once the kids are older, we would tell them, like when we would call 911. If like mom or dad, like, you know, couldn't do it themselves. And I saw the looks on their face. They're like, couldn't do what themselves? Why wouldn't they be able to do that? Then I looked at now, I'm not sure how many people have ever been in this situation. But I was in a room where, you know, the women and the children were on one side, the men were on the other. And they were it's a it's a divided room. So you guys can't see each other. So I see the horror on the wives faces. And then I look to the men, and a lot of them are looking at me like, Hey, buddy, what do you tell them that for? And I thought, oh, gosh, did they not talk about this? It's not for religious reasons. No, I

"David" 27:19
didn't think so. By the way, yeah, it's not and you did the right thing. And it is the right thing. And I myself changed my I actually was not by the event. But I heard feedback from it and changed my attitude as a result that actually from that, you're talking at that event. That's when my wife even though I didn't hear the talk, I heard feedback from friends, and other people with it. And I changed my changed my opinion on it.

Scott Benner 27:41
I'm glad because I was, I'll tell you what, for a minute, I felt like I was I wasn't getting out of the room alive. And then, and then everybody was really kind about actually I spoke to the to the Rabbi's wife later in the afternoon. And I said, I'm so sorry, I never would have imagined and she said no, you did the right thing. She was some people she was some people are upset, but but I think they're just upset with this new knowledge they have not necessarily with you for bringing it. And, and it was fine, actually. But it's nice to hear that that was valuable for people. Very, very valuable. Okay. So when you're out when you're out on that rig, and you're interacting with imagining a lot of emergency rooms, what would we be shocked by to learn about medical staff in a hospital?

"David" 28:26
So you'd be shocked by unfortunate I'm not shocked by it anymore. And I don't want to put a bad name on medical staff. No, no, very good people out there. And these people are dedicating their lives to helping other people. But the knowledge and sometimes their stupidity is at a whole new level that sometimes it's just like, now you have good people out there. And I don't think you have bad actors. You know, I don't want to say in that way, people are intentionally, but just because they have a medical badge and a medical title doesn't mean they know what they're talking about. Yeah. And I saw this 22 years ago when I was diagnosed, and the nurse is trying to force me to take a shot when the food is coming 1990 minutes later. And I see this now, you know, and I see the other side as well, I see patients that that just don't take care of themselves. And I've seen patients over the years who would go one time and the sugars are 202 51. Like did you take your insulin No, like, well, what are you waiting for? And then few years later, you know, come back one day and the leg is amputated. And they just you know, they have the attitude that somebody in the medical field is going to take care of them. They're not going to take care of itself and that's not true. It's never gonna happen. And sometimes the adherence to protocol you know, I give an example we got a cold one night this kid equals we don't always get a lot of information when the calls come over, but it came through as something that you know, diabetes related, became then is Dexcom had done this weird thing. It had shown like he was high and not done back to you know, I don't know We're gonna call it range, but relatively, it wasn't showing high and what was showing like 200 to 300 range. And so we did a finger stick, which, by the way, even that it's only a recent thing that we're allowed to do with finger sticks.

Scott Benner 30:10
I know the I've heard that recently. Okay, shocking.

"David" 30:13
Anyway, we do a finger stick, and I don't remember what it was was 250 or 300. But his doctor, they had been in touch with a doctor and the doctor said, they gotta go to the emergency room. I'm like, what the hell this doctor obviously doesn't have diabetes. Why does he need to go to the emergency room? His sugars are 300 Take a bit of insulin, see what happens in the taxi? No, no, now we can argue with doctors because of the level of hierarchy and authority and ambulance is lower than a doctor. Like if a doctor gives orders for somebody to go to hospital, we cannot argue with the with those orders. If we will deliver the patient home, we will need a doctor's permission to leave the patient, especially a minor. So you know, we took that kid to the emergency room, even though in my heart like this kid doesn't need emergency room, he needs a bit of knowledge, the mother needs to know how to Bolus a lot better. Right. And but on the flip side after the mic, you know, I sort of blame them. Because why do you even call the doctor? I mean, I can I have not called the doctor in 22 years? I'm not I'm not here to show up because I don't think they're going to what exactly are they going to tell you? You call it that these people every two minutes that they're on the phone with the doctor's office? I added this how do i Bolus this? I added that should I split it should I Bolus or should I extend it. If your care plan is to rely on your doctor's office, you gotta get a new care plan. That's not a good plan. Just think, you know, your doctor went to medical school 1015 years ago, and when they were in medical school, they learned knowledge that was probably at the time 1015 years old. Half of them have information that's just ancient, and you're calling them in 2024, when he got pumps, algorithms, and all sorts of things that the better ones keep up with it, you know, they sort of get an update from their local reps as to new features and things like that, yes, but they're giving you information on 2005. And you're calling them out of dollars. I mean, that's not a good care plan, you've got to get a better care plan than that, which is really understanding yourself, listen to the prototypes, just understand it yourself and get a handle of it. Otherwise, you're going to spend your life calling doctors and and being whisked off to the emergency room.

Scott Benner 32:10
And it happens more than we think right? Like more than the even I believe type ones that end up at the hospital for some sort of care happens

"David" 32:20
the whole time. I mean, we have a patient, there's actually two patients in the same area, there was a point they were calling every day One day is like, can you check my sugars and like you don't have a machine. But yeah, but whatever, I just call the ambulance to check my sugars. And then the next one, like, was calling every time he needed an injection, he was calling us, you know, so every night it was like almost the same time consistently 11pm. And then you're at the back, that is when the doctor just says that factor between manual for the most part, I just worried about a lawsuit that's that's in the way they think so the way they think about it is if they give directions for this patient to stay home, and then something happens during the night, they've got a bit of problem on their hands,

Scott Benner 33:01
that person is gonna say the doctor told me to do this and put me in a doctor's

"David" 33:05
much better say You know what, put them on ambulance, take them to the emergency room. And then the emergency room does all their due diligence, they normally just throw them on the side somewhere for six, eight hours, give them a bit of insulin Dong given a bit of insulin, and but that way everyone's covered, they call it Cya in, in the medical field.

Scott Benner 33:22
They call it cya everywhere. But yeah. But

"David" 33:25
it's well used in the medical field. And I think there's a big difference than, you know, knowing when you're dealing with a patient I actually dealing with medical information or you see why. And it really depends with the patient, which is, which is why you know, you can always know some people, you can give them a piece of information and say, You know what, instead of calling the ambulance, why don't you just Bolus and see what happens in two hours. Some people wouldn't know what to do with that information. And they have no idea they'd follow us. And then they call you back in two hours, because they don't know now why now I'm dropping, I'm dropping, I'm dropping, I'm dropping. I mean, I like that like 196 Double down like 196 Double Down is great. That's exactly where you want to be. Call me back when you hit 60 double down and you take in juice and it's not working. That's a different story. But yeah, so So this, you know, we see this the whole time.

Scott Benner 34:09
Now I want to go back to something you said at the very beginning, because I've now made a number of these episodes, and I want to make sure people understand. I'm not saying not to go to the hospital, if you have an emergency. I'm not saying that there aren't wonderful nurses and doctors and even hospitals and you know, any number of health care professionals, I'm just saying that when you don't mean you can't be sure that every time you flip the coin, it's gonna land on heads, you have to know that sometimes it might land on tails and what to do. If you're running to a doctor for an answer to kind of echo your thought, and the doctors only going to do cya that's not going to put you on a good path and you're going to cycle over and over again. Then this is your life then this becomes your entire existence. I don't really know what I'm doing. Nobody's telling me what to do. I wouldn't think to go look for this information because I I'm talking to a doctor and they're telling me what to do. If if the right thing to do you know, the thing that doctor told me, puts me in the hospital every couple of months, well, that just must be diabetes. And so they don't believe there's something better for them. And then they run back to the physician, or the ER thinking, well, here's these are the magic people will put me right back again. And you're telling me that those people are thinking, let's just shelf this person for a few hours, get him stable and get him the hell out of here? Exactly.

"David" 35:27
And you'd be shocked. I mean, you wouldn't be because you hear this, you know, more than me how long people you know, people live their whole life like this, like this is their life. Yeah. It's the difference between not dying and living. I think those are the two extremes, meaning you might not die yet. But that's not alive. I know how I felt when I was, you know, out of control in that the way you fit. Like, I don't know, my last a one study, I just actually got it done last week was 6.20. Good, good job. That doesn't really motivate me a bit to manual, the number. Yeah, then what motivates me is how I feel every single day. Yeah, if I'm high, I'm not living a day. I'm not. I'm not a father, I'm not a husband. I'm not I get very pissed off and stressed when I'm high. I already feel when I'm high of 141 160, I already feel started getting frustrated. If I'm 250. You don't want to talk to me, that motivates me much more than than a one see that I see every six months or something, I could leave it I could be 250 every day, and probably wouldn't die or just not yet. But that's not living. To me. That's not living. And I think that's also the big difference between the different attitudes that people take between Are they are they just, you know, gone to the doctor and doing what they needed to do. And I did that I was in that process for years until I till I took care of myself and realized that no doctor, by the doctor is just gonna keep doing and when it comes to time, like, Okay, now it's time for an amputation, you know, today's like, there's no difference for the doctor like today's. Again, I don't want to sound like I'm putting them down. But in that field today, the putting someone on the pump today to amputate in the other person's leg because they didn't take care of themselves for 30 years. They're not going to take responsibility for that person, and the person doesn't take responsibility himself. So I think that's also the big difference. You got to decide, you know how you want to live your life if you want to just not die, but you actually want to be living and feeling normal on a daily basis. Yeah, David, I

Scott Benner 37:18
think I stopped saying don't die advice on the podcast, because I even thought it sounded harsh. But I used to say it a lot like usually the advice you get from a doctor's don't die advice. It's enough to keep you from dying, not enough to help you live well. Correct. I think I brought it up at the talk. And I every time I speak somewhere, I say, you know, you deserve to be who you would be without fluctuating blood sugars. And like you just said, like, you don't want to be around me when my blood sugar's over 250. The other thing is, is that in the middle of that turmoil, you don't really know that about yourself. I don't know if that's something that people can really wrap their heads around like you're altered, and you're acting away that you would not normally, and that if you could see yourself out of body you'd be disappointed with. And yet you don't know what's happening while it's happening. And now you're impacting all the relationships in your life. And like you said, Who else who knows what else? Like, if you're watching a television show with a 250 blood sugar, you may not enjoy it the same way as you would with a 95 Blood shirt. And that might sound trivial, but I don't think it is I think you're experiencing the world differently. And then in turn, the world gets a different version of you one that I don't think you really want to be out there.

"David" 38:28
Yeah, I couldn't agree more. And I've experienced this myself. And you know, so I didn't really talk about my son yet. But he, you know, he went through various stages, there was a stage actually, unfortunately started in summer camp, where I wasn't he didn't give up. But it was very tough. It was his first time going first, it was first time going away from home at all. And then definitely with type one diabetes and dealing with all different foods and his sugars just started getting into 3d for hundreds every single day. And he sort of gave up he didn't he was still bolusing that's why I don't want to use the word get gave up. But he was not me, I would say model like he was more careless. And this went on for a few months. And and he was just, you know, you don't even realize it as a parent because you see them every day. And then thank God, he calmed down. And there was a few things that I think it was attribute it to, and I kind of talk about him more in a minute. But once just to go back to your previous point, once his sugars got back to a normal level. He was so pleasant. We didn't even realize my wife was like, Oh my gosh, do you realize that he's been so pleasant? He's been nice to siblings. He's been participating in family things. He's been doing amazing at school, and we didn't even realize while we're going through it. So it's it's almost like this subconscious effect. And we didn't even realize till he calmed down and it took us about a normal level. Like he's such a pleasure. He's helping around the house. He's offering to do things. So I couldn't agree more. Yeah,

Scott Benner 39:52
I kicked myself sometimes, because I think I saw my son's Hashimotos before I let it register in my head that that is what it would be. And it was all about his behavior. When his thyroids, not well moderated. He has a short fuse. Yeah. And you think, Oh, he's, he's a teenager or he's upset about something. But then I look back. And I think I wonder how many of his life events, did he not traverse as well as he could have? If we would have, like known about this sooner? And I mean, I know there's not much you can do about it. And I don't I don't dwell on it. But it makes the point that when you're altered, you're altered,

"David" 40:31
right? And I think also parents don't realize things sometimes, you know, when you're with your kids every day, because sometimes that gradual changes, and you don't notice them as extreme as, obviously, somebody who, you know, so and I'll give you an example. It's an unfortunate example of this. I had a good friend, who, when he was eight, he was diagnosed with cancer. That was actually my mother that diagnosed and what I mean by that is, he can, you know, we used to have playdates all time, and he came over to my house. And my mother said, no, no, he doesn't look good. And she called, she called his mother right away. And the mother was like, no, no, he's fine. This is, you know, nothing. They're like, Oh, they took him to the doctor that turns out he actually had cancer. But, you know, thank God, he recovered, it wasn't long, there was a long story. It wasn't just, you know, went on for a while, you can imagine all the treatments and everything. But my point being that his own mother didn't realize that because you know, sometimes you're with the kids every day, or you're with people around you every day, and you think you know what, this is how they are, they're just more rough around the edges. But then you realize, they're actually this is how they are when the sugars are 250 100%.

Scott Benner 41:37
Every day, I've lost like 45 pounds this year. So actually, if we see each other soon, I'm literally 45 pounds lighter than I was when you saw me before. Good for you. No, thank you. But if you asked my son two months into the journey, when I was down in the first 15 pounds, I said, Hey, you know, do you notice anything? I didn't notice a damn thing. And he was living away from home. Then I saw him a couple months later, and I walked in now I was like, 25 pounds lighter. I thought for sure he'll notice something now. Nothing really. And then when I asked him, I said, Do you see that? I've lost weight? He goes, Yeah, I guess I can. And now a year later, if you show him a photo from last year, and now he goes, Oh, my God, I didn't realize, right. Like he didn't know he actually said to me one time, one of the kinds of things he's ever said to me, I don't think of you as a fat person. But I looked at the picture. And I was like, I don't know how you couldn't. But the same thing with the mother, like the mothers with a kid with cancer. Your mom sees him in five seconds goes, Hey, what are we doing here? You don't I mean, and the other person like What do you mean? It's that slow drip transition, I'm telling you that can happen slowly. Over years with weight. It could happen slowly over months with your attitude, and it could happen day to day. If if your blood sugars are bouncing around. You turn into this. I had a friend when we were growing up and he's not with us anymore, but I knew him to be very sweet, lovely person, but I knew some people who met him we thought he was cantankerous and unpleasant. But he wasn't he just he was on regular an MPH and his blood sugar's were high all the time, and then not and you know, like, and he got to live his whole life that way people met him and thought his kids a dick. You know, and, and he really wasn't he was lovely. And and now I don't know, I look back in his life was shortened because of it. And now what did he miss out on even in a shortened life? So I you know, it's very important. So

"David" 43:27
like when our when our son was diagnosed, so we didn't even realize till we looked back at pictures, how much weight he had lost. He was stick thin. Like we didn't even notice. Yeah, it was only afterwards once he was diagnosed and started looking back. But seeing him on a daily basis. We didn't you know, we didn't notice anything, right?

Scott Benner 43:47
No, it's something. Okay, what else do we need to know about? I guess maybe why don't we dig into your expertise for a second type one's call an ambulance. What should we be telling people when they arrive? You know, what's on us? You know, I know I've done an episode where I told people, we had an EMT on I think, who said like, you know, don't count on your diabetes tattoos. You know, you have to be wearing the jewelry. Nobody

"David" 44:14
looks at those. I hate to break the news. But now, there is a difference. If you're out called in a car crash and you're completely gone and they cut all your clothes off. Yeah, then somebody's going to notice you're yet to to but on a regular on a regular call. Don't Don't count on that. Make sure you tell someone what's going on? Yeah,

Scott Benner 44:34
so I call right away. Do I want to say to the dispatcher, I'm calling for someone who has type one diabetes, they're unconscious, they're having a seizure, or I'm calling for myself, I think I'm going to become unconscious soon. I've taken too much insulin. I have type one diabetes. Do you try to tell them I'm wearing a glucose monitor I'm wearing like, do you give them as much as you can? So

"David" 44:53
I wouldn't I would definitely go with the first part I wouldn't get into I'm wearing a glucose monitor and I'm wearing a pump chances are That information is not going to convey over to the actual units that dispatch, but the more information about what's going on for sure, because there's different level priorities and emergencies. And based on the priority that it sounds like when it comes through, they'll dispatch accordingly, which means they'll dispatch you know, priority resources, additional resources, more advanced resources, like in most areas, there's EMTs. And as medics, if you are out called unresponsive, you want medics you don't want to just empty is not by default, they only dispatch EMTs. Even, you know, so if somebody calls on the phone and says, I'm diabetic, and I'm having an issue, they'll just send you to EMTs. Now, that's a big difference between saying, I'm diabetic, and I think I'm going into a coma by default, you're rarely going to get medics in most cases, you know, it's not a guarantee. But in most cases, a good dispatcher will hear that and they'll already dispatch medics. So you definitely want to be giving, you know, the most information as you can over there and always open a lot, you know, we had cases where we can't get in the front door, and then there's a delay, because you gotta get the fire department to take the door down. Yeah. And meanwhile, this person's, you know, that triggers a 1020, or whatever, they're down there on the floor by themselves in the bedroom. So you definitely want to make sure to have a plan for that. And this also goes back to you know, what I was saying before, we've had calls, I got a call one night, for, you know, it was diabetes related. It was 3am. And turns out that this girl, she was fast asleep, and we were bashing, knocking, pounding. Eventually, the husband heard us open up the door. Well, her sugars were low, like the Dexcom was just reading low. She was fast asleep, her mother was following her in a different state. And her mother was following her. This goes into what you were saying before about always making sure you have somebody following you. And she called us and you know, thank God, we got there on time, and we woke her up. You know, the husband heard the dog, we woke her up. And you know, she she took sugar, and she was fine. Yeah.

Scott Benner 46:54
I stopped the load for Arden last night that she didn't hear at 3am. My Dexcom alerted me, I woke up. And I waited one revolution of the Dexcom to make sure she didn't like because it was a weird, it was a weird thing. Like she looked like she went from 80 to like 50 real quickly. And I thought maybe she's laying on a lot. Give her a second. And then it held. So I called her. And she didn't answer but she called me right back. She was hey, what's up, and you could tell she had been asleep for a while. It's funny, I was more aggressive about it last night than I might have been because I spoke to her earlier in the evening. And at dinnertime, she said I'm not very hungry. So I thought, Oh, she's not going to eat much tonight. And that actually stuck in my head. I'll be aware of Lows tonight because her algorithms still going to do what it always does. And she's been eating more the last couple of weeks. And so I thought, Oh, the algorithms being aggressive. And then she more recently moved her GLP up a little bit. And so now she's eating a little less, but the algorithm still getting the vibe. So anyway, I was thinking about Alo, I woke her up. I said, Hey, I think you're low. And she stopped. I could hear her focus herself. And she goes, Yeah, I think I am too. And I was like, Okay, I'm like, Are you going to drink a juice? I said, I could stay on the phone with you to make sure you drink it because then I'll I'll do it. And she hung up. Right? So then of course, David, I lose her data almost as soon as she hangs up. So now, so now I'm like, I swapped over to like Nightscout real quick. Nightscout thought her blood sugar was 40. And I know she drank the juice, right? I believe that she did. I spoke to her. She was clear headed. And I waited one revolution five minutes, it didn't come back. I waited another revolution, five minutes, it didn't come back. And I thought okay, like this is the moment here like she either drank the juice, and she's okay. Or she fell back asleep and didn't drink the juice. And she's in trouble. And I did this thing that I don't know if people know, like I sent her a text to reestablish her connection to the internet. So I don't know if you've ever seen this. But if you lose data sometimes coming from someone else. If you ping their phone, then their phone pings a tower. And that's something and then sometimes you get the data back. So I sent a text it just said, Hey, I can't see your data. Are you okay? I'd never thought she was gonna see that. I figured she was asleep still. And as soon as I did that, I swear to you as soon as I did that, boom, she was 95. And she had and I was like and she had an arrow up and I was like okay, go

"David" 49:16
out. Yeah, it was fun. It was now it's fall he it's actually a little scary. I mean, I myself I don't hear a lot during the night like as I sleep like a log. I don't hear nothing. But I do wake up when I feel low. So even I never wake up from the Dexcom and I have sugar may set to call me. I still don't hear it. My wife is it she she wakes me up. But I like if I'm by myself. I don't hear I wake up from a law like I'm feeling low. My son doesn't. It's actually pretty scary. We wake him up when he's low and we give him juice and he normally doesn't know a thing in the morning. Like, you know you're low last night at 2am. And I'll remember oh yeah, really? Yeah. Yeah, as neither Martin

Scott Benner 49:59
was like kicked out, right until she went to college. And then it was like, once she knew it was on her, she started to wake up. Right? Like, I don't know why she didn't last night, or maybe she would have in a couple of minutes more. I don't know. She's been very, very good about it. And she's almost on her second year of college. She's been very good about it. I'm assuming

"David" 50:16
as he gets all the it's something that he'll just write. And I just said, once you have to take more responsibility than it's just something that will, you know, I'll just get into

Scott Benner 50:25
also when she comes home for her breaks, like she announces to me coming through the door, like, Hey, I'm not waking up for Lowe's. Like, like, this is on you. I need to I need to sign Yeah,

"David" 50:35
yeah. So yeah. So we actually had that with our son. Not not not with that. But without, you know, there was a time he was let me I never went through his full story. Let me tell you the basics of his thing. So he was he was nine, and it just was not feeling well. He was looking like, like I said, the weight we didn't notice, but he just was not feeling well. Every day. He was telling me I'm just not doing good. I'm not doing good. And then it was one morning he woke up and started vomiting. And I'm like, okay, something. I don't know what, oh, I know what actually not only did he not he peed in his bed. So I'm like, okay, something's off. He's not and he wasn't doing that for years already. Something is off. He's vomiting. He doesn't look good. I said, let me check your sugars. I check. And they're like, 250 my heart went through the floor. You can't even imagine. And then I'm like, in my head like, this is all in like five seconds. I'm telling you. Maybe he just as virus maybe it says maybe it's that maybe it's that, you know, I went through 1400 maybes not wanting to believe the truth. So immediately, literally still in the hallway right after I just pulled out a Dexcom from my closet. I had a spurt was a G six at a time transmitter. I just stuck it on him. So yeah, the Dexcom running before we even got to the doctor. You know, I called it the I woke up my wife was early in the morning. We went to the doctor and and you know, they sent us into into the Windows Office and we were there. They thank God we managed to avoid the hospital. He wasn't in DKA. We spent all day in Andrews office getting now but of course I had the experience. They weren't so scared to let me home because they saw right away that I knew, you know how to Bolus and what to do. So they weren't. They weren't too scared. He was extremely sensitive to insulin. In the beginning when I say like his Bezos were like point 10 Like an hour point one and like it was impossible on MDI, impossible. He had such swings, like, give him a tiny Bolus, and he went flying down flying in minutes, right. So I got I couldn't handle it. After a week I called the end though I didn't really I didn't need the permission. But it's always better if you can be not to be in a fight with your medical team. At the end of the day, you know, it's better if you're on the same page. And it's not always possible. But if you can be it's always better to be on the same page. So this is only a week after he's diagnosed, I had a spare tandem with control IQ sitting in my closet. I'm like, guys, you know what's going on over here? You see what's going on? Do you mind if I just stick the pump on him? And I'm not waiting six months for insurance, bureaucracy, and whatever, I'm watching these swings, we're not sleeping, you can imagine what every night it was like, Yeah, you know what you're doing, just stick the pump on him. So a week after he was diagnosed, he was already on the pump. And and then, you know, eventually his pump came through I don't even remember didn't you know, however many months later, but you know, once insurance sorted everything out. And that we saw he was like, in the beginning was actually scared to eat. Like he just we realized after a few weeks that he's barely eating and like you were like, he didn't want to get into the, you know, the Bolus thing and the the highs, the lows and dealing with all of that. And then there was a time when he basically just said to us like, even though we never put it on him. He did like voluntarily offer to like, he's like, Oh, I think I can change my pump myself. So I'm like, okay, sure, change your pump yourself. It's a great thing. And the same with a Dexcom. But then there was a stage where he, I want to call it denial. So he got a little fed up. And he's like, okay, it's just on you. Like, I'm not doing this anymore. So no problem. We're gonna change it pumps, we're gonna change it that sounds we're gonna monitor that we're gonna text you if you need to take something. It's not as there should be no worry on your head. When you're ready. You'll let me know if you want to take over any more responsibility. Right. So I think it's definitely important that kids know that, you know, parents are willing to take whatever responsibility they can after her.

Scott Benner 54:25
Has he done that? How long has he had type one.

"David" 54:27
So now he's 12. So it's about two and a half years now.

Scott Benner 54:30
Has he come to you and said, Hey, I'd like to do a little more or not yet, say yes. And

"David" 54:34
interestingly, you'll find it interesting what I attribute this to he's a competitive type. And he's a bit of a perfectionist. Like I'm a perfectionist, which is not always a great a great thing with type one because you know, like, I get frustrated, like, it's like, you know, if I look back like last 90 days, I'm like 80% and rage. I don't like that because I'm like 80 It should be like 98 Interestingly, you started the gees Seven, which I happen to hate. I'll give you my opinion on that in a minute. So personally, I'm still on the GS six, he started the g7. And what I found out about it, interestingly is that, you know, clarity in the g7 is in the same app, like it's not a separate app, even though he had clarity before on his phone, he never actually would go and check it. But now your timing range, and you know, how much a high and how much you love. It's all right there. So when you're checking your tracks now, now that that's the only thing I attribute it to, cause he started coming to me and saying, like, hey, look, this is how much time whenever you don't have those conversations before, it wasn't even like he's gotten really into this and I hope it lasts. I mean, when I say into this, I'm talking about 7:13am This morning, he texts me and my wife a picture showing 96% time in range over the last three days. He's proud of himself, very proud of himself. And we didn't do a thing for this. You know, we've never told him off before we let them eat whatever he wants to eat. I always just want to eat you got to Bolus I can't you know, Tom, I kind of in my right conscious Tom. He can eat without bolusing. But he got into this himself. And I think it's because of the g7 Seeing because there's nothing else I can attribute it

Scott Benner 56:08
to like a video game to him almost. Yeah, yeah.

"David" 56:11
So I think that's been a game changer. And to degree I mean, here's put it this way. When we came back from the summer from campus a once he was eight, when we went to the doctor's office three weeks ago is everyone see was 6.5 Wow, look at him. That's a huge change. And actually before it was, this was actually a nice thing. Before we actually went into the appointment, I went to speak to one of the CDs she She's amazing. They have have some really, really not everyone over there is but they have you know, we've changed around doctors a few times till we got one that we like and the CD and and I told her I said listen, he has been working really hard. Make sure you guys make a big deal out of it. So she and the doctor came in the room singing celebrating like, oh my god, he wants the 6.5 Who is this kid? I made a whole big deal out of it. And his smile, but he you know, he was brimming from from cheek to cheek. So that was really nice. You know, that was nice to see. And it was nice that they got on board. And we have we didn't do anything like he, you know, he talked us online, he started Pre-Bolus thing. And he started he started you know, just taking note of things. And so that's been Yeah, the last few months have been he's definitely get taken on much more on himself.

Scott Benner 57:22
I'm happy for him. That's wonderful. Because they what it means is that he's in an endeavor to get that time and range better. He's bolusing. He's looking at numbers and going I don't want to let this high blood sugar sit here. I'll knock it down a little bit. Correct. Has to be you know what it means to me. It's made him more involved in his in his Bolus. 100%.

"David" 57:40
Yeah. And he has the, you know, we got him, we didn't have it right away. And this one piece of advice. I mean, we'd gotten him the Apple Watch. That was a game changer. I mean, before that we were paying, like $400 out of pocket a week, because we couldn't get it covered through insurance. For somebody to be in school with him just to basically pass on my messages. They weren't like a CD or something. They were just like a messenger we would take because he doesn't want to take out his phone during class. So he can't see what was going on, like cans of water sugars. He can't see if he's supposed to, you know, take sugar or what he's supposed to do to be paying 40 hours a week for some guy to stand there. And basically just pass in my messages. And we didn't have a choice, you know, no kidding. So what why don't we got him an Apple watch that was a game changer, a game changer. I mean, he sees his texture and class, you know, so if he's low, we'll text him, you know, little bit of juice, who responds right? Also, even if he was low, we had no idea if he dealt with it, because he wasn't going to take out his phone in the middle of class and start texting. Now right away, he just sends a thumbs up. So that's, that's also been a game changer. I

Scott Benner 58:44
have a couple of questions before I let you go. Going back to to the rescue squad to ambulance. First of all, can I pass out type one look like an OD? Yes,

"David" 58:54
yes. And they can also look like drunk. So which is why we never had the protocol to test blood sugars. Like I said before, we weren't even allowed to test for sugars. But because of multiple incidents in the last two years where a type one diabetic was passed out was taken as a drunk or taken as an OD. And meanwhile, the shooting would not combat you know, that's the last thing they need. That's why they brought in the blood sugar protocol. And it's pretty much protocol now that anyone that passes it out, or is obviously unresponsive. First thing is check the blood sugar. That's definitely been a you know, a huge improvement that

Scott Benner 59:35
a nationwide thing. How do they communicate that stuff, too?

"David" 59:38
So it's not that's the silly thing, you know, as much as America is, is one country. It's like every state has its own rules and regulations. It's not a nationwide thing. It goes state by state. So I don't know I can't promise that that's in every state. But I know on the East Coast, that's definitely been a recent change in the last few years.

Scott Benner 59:59
My Last question that I'm not sure how long can articulate it, but I keep having this feeling. So let me see if I can get through it with you. Sometimes I feel like the people who listen to the podcast are either people who are taking very good care of themselves or are on their way to doing that, about the person who's struggling every day, who doesn't understand their insulin well, and all the things that we've talked about. But both people are going to end up calling an ambulance at some point with diabetes likely like the the ones who feel like they have it together and know what they're doing and the ones who are completely lost. What is the ambulance crew expect when they get there? Like, who are you being categorized as when someone's coming through the door? Is that or maybe you're not, I'm just being you know, what I'm asking.

"David" 1:00:40
It depends on the crew that you're getting. It's obviously person to person, there's like a personal attitude thing we try not to. And I'm not just saying that to be PC, we really try not to there's always a human being behind that there's always a story. I'm not blaming somebody, because the sugars are out of control, and they don't know what to do, and they don't know how to Bolus I'm not you know, I will never judge them for being in that situation. I have pity on them. Most times, it's pity more than anything else. Now, I'm not talking about people who are abusive and call us every single day and just don't touch the blood sugar. That's ridiculous. It's just not nice. You using public resources, like just just, you know, work that out. But generally, it's much more of a feeling of pity than anything else.

Scott Benner 1:01:23
I don't get a crew of people coming through the door thinking, Oh, this is diabetes, here's another person that doesn't take care of themselves. No,

"David" 1:01:31
I've never seen that. I've never seen that in my 10 years. I haven't seen I'm not saying it doesn't happen again. This shawanna I haven't seen that for the most part.

Scott Benner 1:01:39
Okay. You know, I mean, I think most things go as people go. So if you get thoughtful, open minded people, you get thoughtful, open minded experience. Because sometimes I think about doctors to like, you know, did did that endocrinologist start off in the first couple of years, just with a lot of enthusiasm sitting down in every you know, every meeting with every patient going, alright, here's what we're gonna do. We're gonna Bolus we're gonna do this, we're gonna get your settings, right. And then one day, it just was like it just too many. Too many people didn't do it. And they just gave up, you know what I mean? or lost their ability to be enthusiastic about something they thought wasn't going to go well. And how much of that? I mean, I think that's another thing that people should try to read through with their doctors. It's like, do I have a hopeful doctor? Somebody who thinks we're going to get to a, you know, a great answer for me, or am I sitting with somebody who's been beaten up by the world? And

"David" 1:02:33
I'll never forget, like, I had a doc. You know, this was back in the UK. He was like, 65 350 pounds, and he's lecturing me about cholesterol, something like, are you serious? I think you gotta change your doctors. I mean, I'm not you know, sometimes it's harder when you're out of town. And you're, you know, there's many options, especially within, but if you're living in any big city, chances are there's not the end or down the road. I mean, just within the practice, that's normally all that it does. I changed my son's Endo. I read from the first point, we were not happy. She wasn't going through this appointment. She wasn't talking about diabetes, or struggles or anything. It was always about something else. And this vaccine and that vaccine, I'm not against vaccines, but she was like, every time I'm like, is this diabetes meeting? Or is this vaccine meeting? Yeah. So I went, I actually changed at the head of the department who was much better. And on my personal doctor, also, she used to be in one hospital, I went through three, four doctors till I found. And then I moved over, she actually moved out to another hospital. So I moved over with her. She's amazing. But like, don't sit on stuff if your doctors burned out and not giving you what you need. Don't sit on them, right changes them. Yeah. Now, I know, there's insurance issues and things like that. But most times, you can work that out. I

Scott Benner 1:03:46
mean, sometimes you have to give more to get more, if that makes sense. You know what I mean? Like, you get stuck with a bad doctor, it's easy to say, I don't have time to work this out. Or I can't go find somebody else. But yummy. You can't afford not to honestly, yeah,

"David" 1:03:58
I just saw this very interesting thing this week. It's called functional fixation. And it's essentially the way human beings just take things as they are. And you know, they gave a lot of examples for but one of the examples they gave is that freezes we're always on top of fridges, for the simple reason that it used to be an ice box on top and the ice used to drip down into the freezer into the fridge to keep things you know, now, once they came out with electronic freezes, nobody thought for years, like hey, maybe we should flip it and and put freezes at the bottom. It just kept it like that. Because that's how it's been. And that's how people are with a lot of things. They're just like, This is how it is, you know, this would be my doctor for 20 years. But like if this is your doctor for 20 years, and you're not getting what you need, nothing's going to like you got to change something. Yeah. If you're fixated on that, you know, the one that's going to suffer at the end of the day. Functional

Scott Benner 1:04:51
fixation is a cognitive bias that limits a person's ability to use an object in more ways than it's traditionally used and it affects in in individual's ability to innovate and be creative when solving challenges about that. There you go. That's something, David. Thank you. I really appreciate you taking the time to do this with me. Sure. I hope you had a good time. Thank

"David" 1:05:12
you so much for what you do. And I can say my control is much better thanks to you. You perhaps even recently, I changed my high alert to 130. I'm not at 120 yet, we'll get there. But that's, that's thanks to you and most of the things that I've learned on your podcast, so I really thank you for what you're doing. And you're reaching out, you have no idea how many people you're reaching. I mean, I dealt with a new family that was just diagnosed a few weeks ago, in other states, some right, they knew right away. But as soon as I said something about the podcast has already been told about it. They're already listening to it. You know, that's a far cry from when I was diagnosed. Yeah,

Scott Benner 1:05:45
no, I appreciate that. I have to tell you, I've, I've only been really stung twice, like, the first time when somebody told me you're huge in the Mormon community, I was like, Get out of here, really. And then this, this, when I got the invite to come to the, you know, somebody said, you know, you come and speak at our event, it's very private and everything. And I was like, sure, like, I don't understand how do you know me? You know, because I, I actually, you know, before I got there, I have very closely tied your religious beliefs with like, no technology. And, and then I was like, like, how are they listening to the podcast even. And, but But you guys are really great. Like, if, you know, I don't know, if I mentioned it here ever. But on the last day of the event, I was asked to come up and tell people what I learned while I was there, and, and I said, you know, despite the fact that you dress much differently than I'm accustomed to, and, you know, your religious beliefs are, you know, different than I've heard, you guys are all exactly the same as every other person I've ever met my entire life. And it really was my, my, my experience, you know?

"David" 1:06:46
Yeah, there's definitely a lot of stereotypes. And like, for example, you mentioned about technology. I hear that the whole time. It's not true. It's completely not true. It isn't a version to you know, the healthiness of children having open Internet access, with no filters and you know, accessing things that are completely inappropriate for their age, but the kinds of technology and especially when it comes to life saving and health, you know, we don't use technology on the weekends generally as a as a community as the religious community. That is not when it comes to health. You know, for example, text comes in pumps, and anything like that is excluded. Right

Scott Benner 1:07:22
from that Sunday. Sundown on Friday doesn't take away your Dexcom Correct, yeah. 100%.

"David" 1:07:27
Excellent. And, you know, I have my phone with me on Saturday, and my son has his phone. But yeah, when it comes to the health, so yeah, there is a bit of a misnomer out there about that. But 100% Yeah, that

Scott Benner 1:07:37
was a really it was, I mean, obviously, I said yes to coming back. I had a great time. So it's a you guys are very energetic. I felt like I didn't have a voice by the time I left, because that was the one downside is that there's no microphone from? Yeah, you're projecting your voice. And you guys are so I don't know if this is a like, I actually found there was a Shusher there. Like there was literally someone there. Like if the crowd got loud, that she'd step up and say show everybody she's talking. And I just realized it was so it was kind of interesting, because at first it's off putting because it's not something you're accustomed to it. Yeah. But then you see, like it like I said something, it got people excited, and they kind of broke off into these little coffee clutches and started talking. And they were just really excited to talk about a new idea. I did okay, I thought the guy that I did, I did it with he did well, but he didn't have the personality to be loud for like, 36 hours in a row. He looked a little.

"David" 1:08:32
You have a huge following. Yeah, I said the whole time. So

Scott Benner 1:08:37
nice. Alright, well, thanks so much. Let me say goodbye. I appreciate that. Hold on. Oh, my pleasure.

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. Mark is an incredible example of what so many experience living with diabetes, you show up for yourself and others every day, never letting diabetes to find you. And that is what the Medtronic champion community is all about. Each of us is strong, and together, we're even stronger. To hear more stories from the Medtronic champion community where to share your own story, visit Medtronic diabetes.com/juice box. Don't forget, we still have marks conversation at the very end. It's a terrific kind of mini episode about 10 minutes long, that goes deeper into some of the things that you heard Mark talking about earlier in the show. I want to thank the ever since CGM for sponsoring this episode of The Juicebox Podcast and invite you to go to ever since cgm.com/juicebox, to learn more about this terrific device. You can head over now and just absorb everything that the website has to offer. And that way you'll know if ever sent to feels right for you, ever since cgm.com/juicebox. A diabetes diagnosis comes with a lot of new terms, and you're not going to understand most of them. That's why we made defining diabetes, go to juicebox podcast.com up into the menu and click on defining diabetes, to find the series that will tell you what all of those words mean, short, fun and informative. That's the finding diabetes. 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. And now my full conversation with Medtronic champion, Mark. Mark, how old were you when you were diagnosed with type one diabetes? I was 2828. How old are you now? 4747. So just about 20 years?

Unknown Speaker 1:11:01
Yeah, 19 years?

Scott Benner 1:11:03
What was your management style when you were diagnosed?

Speaker 1 1:11:05
I use injections for about six months. And then my endocrinologist at the Navy recommended a pump. How

Scott Benner 1:11:11
long had you been in the Navy? See eight years up to that point? Eight years? Yeah, I've interviewed a number of people who have been diagnosed during service. And most of the time they're discharged. What happened to you?

Speaker 1 1:11:23
I was medically discharged. Yeah, six months after my diagnosis.

Scott Benner 1:11:26
I don't understand the whole system. Is that like, honorable?

Speaker 1 1:11:29
Yeah. I mean, essentially, if you get a medical discharge, you get a commensurate honorable discharge. I guess there could be cases where something other than that, but that's that's really how it happens. So it's an honorably discharged with but because of

Scott Benner 1:11:41
medical reason, and that still gives you access to the VA for the rest of your life. Right?

Unknown Speaker 1:11:45
Correct. Yeah, exactly.

Scott Benner 1:11:46
Do you use the VA for your management? Yeah, I

Speaker 1 1:11:48
used to up until a few years ago, when we moved to North Carolina, it just became untenable, just the rigmarole and process to kind of get all the things I needed. You know, for diabetes management, it was far easier just to go through a private practice.

Scott Benner 1:12:02
Was it your goal to stay in the Navy for your whole life, your career? It was? Yeah,

Speaker 1 1:12:05
in fact, I think a few months before my diagnosis, my wife and I had that discussion about, you know, staying in for the long term. And, you know, we made the decision despite all the hardships and time away from home, that was what we loved the most. So that's what made it that much more difficult

Scott Benner 1:12:21
was the Navy, like a lifetime goal of yours or something you came to as an adult,

Speaker 1 1:12:26
lifetime goal. I mean, as my earliest childhood memories were flying being a fighter pilot and specifically being flying on and off aircraft carriers. So, you know, watching Top Gun in the 80s certainly was a catalyst for

Scott Benner 1:12:40
that you've taken off and landed a jet on an aircraft carrier,

Unknown Speaker 1:12:43
hundreds of times.

Scott Benner 1:12:44
Is there anything in life as exhilarating as that?

Speaker 1 1:12:47
No, but there there's a roller coaster I rode at. I think it was at Cedar Rapids up in Cleveland Sandusky, and they've got this roller coaster that takes you from zero to like, it's like 80 or something, you go up a big hill and he come right back down. So the acceleration is pretty similar. I would say to catapult shot,

Scott Benner 1:13:06
I'm gonna guess you own a Tesla.

Speaker 1 1:13:08
I don't I I'm a boring guy. I got a hybrid rav4 I get made fun of I get called. You know, my wife says I drive like a grandpa on the five miles per hour over the speed limit person. No more than that. So yeah, in the car. I'm boring guy.

Scott Benner 1:13:23
So you've never felt a need to try to replace that with something else.

Speaker 1 1:13:26
You can't replace it. It's irreplaceable. That's what I thought. So up until the point where someone you know, buys me an F 18 or allows me to get inside a two seater and fly it you can't replace it. How

Scott Benner 1:13:37
did it make you feel when you saw or maybe you haven't seen? gentleman named Pietro has his large aircraft license. He's flying for a major carrier. Now he has type one diabetes. Does that feel hopeful to you?

Speaker 1 1:13:48
Yeah, it does. You know, when I when I was diagnosed, that wasn't a possibility. The FAA prohibited commercial pilots who had type one diabetes, but I think it was 2017 when they changed their rules to allow type one diabetics to be commercial pilots. And part of the reason I did that was because of the technology advancements, specifically in pump therapy, and pump management. So I don't have any aspirations of going to the commercial airlines, but one of my sons who has type one diabetes very much wants to be a commercial pilot. So you know, in that respect, I'm very hopeful and thankful. Yeah.

Scott Benner 1:14:20
Do you fly privately now for pleasure?

Speaker 1 1:14:23
I do. Yeah. One of my favorite things to do is fly my kids to different soccer tournaments they have all over the southeast us so last week, my wife and I and two of our boys flipped to Richmond for their soccer tournaments up there and Charlie who's my middle child has type one diabetes so you know if I can combine flying family and football and one weekend to me that's I think I've just achieved Valhalla. So then

Scott Benner 1:14:47
it sounds to me like this diagnosis was a significant course correction for you. Can you tell me how it affected your dream?

Speaker 1 1:14:54
Well, I you know, if I guess three words come to mind first, it was devastating. Everything I had done in life Everything I've worked up to up to that point was just taken away in an instant. And I was not prepared for that at all. The second emotion was, it was scary. I hadn't thought much about life outside the Navy, certainly not life as anything else, but a fighter pilot. And Heather and I were getting ready to move to France, I was going to do an exchange tour with with the French naval air force. So we're taking French classes. So pretty quickly, I had to reinvent myself. And then probably the most important thing at the same time that all that was going on, I had to learn how to how to deal with type one diabetes and how to manage it effectively. The third thing that pops into my mind, I guess, is challenging, you know, new daily routines, I had to establish first with injections, and then eventually, you know, through pump management, and then learning how to count carbs and recognize highs and lows, how my body reacts to blood sugar trends based on exercise and stress and those types of things. And my goal at that time, and it still is today is to leverage technology and make sure my habit patterns are effective so that I take diabetes management from the forefront to the background.

Scott Benner 1:16:01
Have you had success with that? Do you feel like you've made the transition? Well, I

Speaker 1 1:16:05
have I mean, I believe in continuous improvement. So there's always more to do. I will say the technology since I was diagnosed specifically with pump management, it's just, it's just incredible. It takes less of me intervening. And it's really done by the pump itself and by the algorithms through the CGM EMS. And to me again, that that should be the goal for everybody is to not have to focus so much on the daily aspects of type one, diabetes management, you know, we should let technology do that for us.

Scott Benner 1:16:34
What else have you found valuable? I've spoken to 1000s of people with type one diabetes, the one thing that took me by surprise, because I don't have type one, myself, and my daughter was very young when she was diagnosed. I didn't really understand until I launched this podcast, and then it grew into this kind of big Facebook presence. I heard people say, I don't know anybody else who has type one diabetes, I wish I knew more people. But until I saw them come together, I didn't recognize how important it was. Yeah, I

Speaker 1 1:17:03
think similarly, I didn't know anyone with type one diabetes growing up as an adult up until when I was diagnosed. And then all of a sudden, people just came out of the woodwork. And when CGM is first hit the market, certainly within the last five years. It's amazing to me and my family, how many people we've noticed with type one diabetes simply because you can see the CGM on their arm. I mean, I would say, a month does not go by where we don't run into someone at a restaurant or an amusement park or a sporting event or somewhere where we see somebody else with type one diabetes. And the other surprising aspect of that is just how quickly you make friends. And I'll give an example. We're at a soccer tournament up in Raleigh, this past Saturday and Sunday. And the referee came over to my son Charlie at the end of the game and said, Hey, I noticed you're wearing pomp. And he lifted up a shirt and showed his pump as well and said, I've had type one diabetes since I was nine years old. I played soccer in college, I'm sure that's your aspiration. And I just want to tell you don't let type one diabetes ever stop you from achieving your dreams of what you want to do. And it's the other man was probably in his late 50s or 60s. So just having that connection and seeing, you know, the outreach and people's willingness to share their experiences. It just means the world to us and just makes us feel like we're part of a strong community.

Scott Benner 1:18:23
So would you say that the most important things are strong technology tools, understanding how to manage yourself and a connection to others. Yeah, technology

Speaker 1 1:18:33
for sure. And knowing how to leverage it, and then the community and that community is your friends, your family caregivers, you know, for me to Medtronic champions, community, you know, all those resources that are out there to, you know, help guide away, but then help help you keep abreast on you know, the new things that are coming down the pipe, and to give you hope for eventually, you know, that we can find a cure.

Scott Benner 1:18:53
You mentioned that your son wanted to be a pilot. He also has type one diabetes, how old was he when he was diagnosed.

Speaker 1 1:18:59
So Henry was diagnosed when he was 12 years old, was just at the start of COVID. We are actually visiting my in laws in Tennessee, we woke up in the morning and he had his bed. And several years before that we had all four of our boys tested for trial net. So you know, predictor of whether or not they're going to develop type one diabetes, and Heather or Henry and one of those brothers tested positive for a lot of the indicators. So we always kind of had an inclination that there was a high degree of possibility he would develop it, but we always had at the back of our mind as well. And so when that event happened, at the beginning of COVID, we had him take his blood sugar on my glucometer and it was over 400 And so right away, we knew that without even being diagnosed properly by endocrinologist that he was a type one diabetic, so we hurried home to get him probably diagnosed in Charlottesville. And then we just started the process first grieving, but then acceptance and you know, his eventual becoming part of the team that nobody wants to join. How old is he now? He's 15 years old. Now,

Scott Benner 1:20:05
when's the first time he came to you? And said, Is this going to stop me from flying?

Speaker 1 1:20:11
Almost immediately. So like me, he always had aspirations of flying. In fact, he out of all four boys wanted to be in the military, that was a difficult part of the conversation, and maybe something that we don't talk about as a community. But there are some things you cannot do as a type one diabetic, and that's a hard fact of life. And unfortunately, joining the military is one of those hard and fast things you cannot be, you cannot join the military as a type one diabetic. So it was very difficult for him and for me and my wife to get over. Then we also started talking about being a commercial pilot. And so I saw that same excitement in his eyes because like me, you know, he can be an NFA teen or a 737 or a Cirrus SR 20 That I fly and be just as happy. So he still has that passion today and still very much plans to eventually become a commercial pilot.

Scott Benner 1:20:57
I appreciate your sharing that with me. Thank you. You have four children do any others have type one?

Speaker 1 1:21:02
They do? My oldest twin Henry has type one diabetes, and my middle son Charlie has type one diabetes as well. The boys are twins. The oldest two are twins. One has type one diabetes. My middle son, who is not a twin has type one diabetes.

Scott Benner 1:21:15
I see. Is there any other autoimmune in your family? There isn't

Speaker 1 1:21:19
I'm really the only person in my family or my wife's family that we know of with any sort of autoimmune disease, certainly type one diabetes. So unfortunately, I was the first to strike it rich and unfortunately, pass it along to to my sons with celiac thyroid, anything like that. Not about nothing. We're really a pretty healthy family. So this came out of nowhere for myself and for my two sons.

Scott Benner 1:21:43
That's really something. I appreciate your time very much. I appreciate you sharing this with me. Thank you very much.

Unknown Speaker 1:21:48
Anytime Scott.

Scott Benner 1:21:49
Learn more about the Medtronic champion community at Medtronic diabetes.com/juice box or by searching the hashtag Medtronic champion on your favorite social media platform. The episode you just heard was professionally edited by wrong way recording. Wrong way. recording.com

#1164 Cold Wind: Problems on Both Sides

"Aurora" is an E.R. nurse.

+ Click for EPISODE TRANSCRIPT

Scott Benner 0:00
Hello friends, welcome to episode 1164 of the Juicebox Podcast

Welcome back to cold wind. Today we're going to be speaking with someone who we're calling Aurora. She has type one diabetes is a pediatric nurse in the ER we talk about all kinds of stuff about the hospital, including how parents bring their children in constantly for unnecessary reasons. What is this note here? Also, much to your surprise that a lot of children come into the ER with either fentanyl or marijuana overdoses. Oh, I remember her telling me this. Oh, you're gonna find this interesting. 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. How would you like to help type one diabetes research? Well, if you want to, it's easy. T one D exchange.org/juicebox. Finish the survey. It takes 10 minutes and you've helped. That's it. US residents only you have to have type one diabetes or be the caregiver of someone with type one. Bonus points. If you're male, or the parent of a boy. They're really looking for those people right now. But everybody is welcome. T one D exchange.org/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 juicebox at checkout. This episode of The Juicebox Podcast is sponsored by us med U S med.com/juice box or call 888721151 for us med is where my daughter gets her diabetes supplies from and you could to use the link or number to get your free benefit check and get started today with us met. Today's episode is sponsored by Medtronic diabetes, a company that's bringing together people who are redefining what it means to live with diabetes. Later in this episode, I'll be speaking with Mark, he was diagnosed with type one diabetes at 28. He's 47. Now he's going to tell you a little bit about his story. And then at the very end of the episode, you can hear my entire mini interview with Mark. To hear more stories from the Medtronic champion community or to share your own story. Visit Medtronic diabetes.com/juice box and check out the Medtronic champion hashtag on social media. This episode of The Juicebox Podcast is sponsored by the ever since CGM. Ever since it's gonna let you break away from some of the CGM norms you may be accustomed to no more weekly or bi weekly hassles of sensor changes. Never again, will you be able to accidentally bump your sensor off. You won't have to carry around CGM supplies and worrying about your adhesive lasting. Well that's the thing of the past. Ever since cgm.com/juicebox. You're leaving it to me to pick your name. Oh, yeah. You know, I can't I'm not good at this homozygous. I'm gonna say randomly female name Alright, 1234 you are. Alright, well, we don't want to make you overall I do we

Aurora 3:34
sure we're not. She's a princess.

Scott Benner 3:36
Okay. Aurora. Aurora, what do you do for a living?

Aurora 3:39
I am a pediatric. Emergency Department nurse.

Scott Benner 3:45
Pediatric peds? Er? Nurse? Correct. Okay. Size of the hospital. Big small medium.

Aurora 3:57
I mean, it feels big. I don't know what other pediatric hospitals are. Okay.

Scott Benner 4:01
There's a distinction for the ER right, like trauma levels which what is yours?

Aurora 4:07
I don't know that answer. We are not a truck. We are not a level one trunks and not a level one trauma center. Okay, we are nationally ranked in pediatrics that I know for sure. nationally. So the thing is, is our emergency department is too far from the operating rooms. So we therefore cannot have like a higher standing as an emergency or like,

Scott Benner 4:31
oh, that's how that that's how that gets measured. Like literally.

Aurora 4:35
That's one of the that's one of the measurements is how far the emergency department is from the operating room. Okay, as well as which overnight, providers you have on call in the hospital are within a certain knowledge. And so because we work with three other hospitals within my area,

Scott Benner 4:59
they just did take them there if they think they need that level. No, no,

Aurora 5:02
our providers can be anywhere, our endocrinologist or our endocrinologist, but like, say we need for something like say you come in and your kiddo who has type one has Therapeutics is perfect. Right? So

Scott Benner 5:16
did you just say the name of a hospital?

Aurora 5:18
I'm going to sorry.

Scott Benner 5:22
Oh, sorry. Well bleep that

Aurora 5:22
out. Yeah. So that could be at any of the other hospitals in the area that they could be servicing. So it's not, it may take a little bit of time, if they're not there. Or if there's a weird surgery situation,

Scott Benner 5:34
would they redirect an ambulance to where your thing is more easily helped whatever's wrong with you at the moment? For

Aurora 5:42
pediatrics? It depends. So we don't take traumas. traumas will go elsewhere.

Scott Benner 5:47
If I broke my leg, that's not really a trauma and I end up in a ambulance, would they take me to a certain hospital?

Aurora 5:53
They would take you to us? Okay. Okay. Otherwise broken. A broken leg could be a trauma. If it is, if your bone is coming through your leg, I think the skin is open. Right?

Scott Benner 6:05
Okay. All right, that makes sense. So how long, you know, roughly, have you had this position?

Aurora 6:12
I have been in this position for a little over a year and a half now, year and a half.

Scott Benner 6:18
And prior to that, what did you do?

Aurora 6:21
I was I worked in the same hospital and the medical portion patient side for several years. Okay, too long.

Scott Benner 6:32
So just tell me the progression of education. You leave high school? What do you do next? Yeah,

Aurora 6:39
I leave high school. I start taking prereqs for nursing school. And that takes me oh, gosh, seven years to finish prereqs because I was working full time. And going to school part time because I had to pay for my diabetes supplies. Okay. And so it took me a very long time I finished prereqs summer of 2019. And I was not able to get into nursing school ended up starting a different degree. While I was waiting because nursing school in my area can take several years to get into. And COVID hit. I got in to the program, August's 2020 and graduated nursing school in 2022. May 2022. Okay. started in September 2022. And then emergency department. Yeah.

Scott Benner 7:39
So you basically take six or seven years, you're almost you're probably 25 ish when you get done with your prerequisites. Yeah, yeah. Okay. Then hard to get in because there's only so many slots then COVID etc. But by 20 That's a lot of time to try to get to something. And then okay, so then by 2022, you're a nurse, and you're working right away in ER or No, not right away, right away. Okay. And why did you choose that? today's podcast is sponsored by the ever since CGM. Boasting a six month sensor. The Eversense CGM offers you these key advantages distinct on body vibe alerts when higher low, a consistent and exceptional accuracy over a six month period. And you only need two sensors per year. No longer will you have to carry your CGM supplies with you. You won't have to be concerned about your adhesive not lasting, accidentally knocking off a sensor or wasting a sensor when you have to replace your transmitter. That's right. There's no more weekly or bi weekly hassles of sensor changes. Not with the ever sent CGM. It's implantable and it's accurate ever since cgm.com/juicebox. The ever since CGM is the first and only long term CGM ever since sits comfortably right under the skin and your upper arm and it lasts way longer than any other CGM sensor. Never again will you have to worry about your sensor falling off before the end of its life. So if you want an incredibly accurate CGM that can't get knocked off and won't fall off. You're looking for the ever since CGM. Ever since cgm.com/juicebox.

Aurora 9:27
I come from were in the hospital I was working I would have up to 15 patients a day in the role that I was on and on an acute care floor so like med surg II floors, or cancer care or acute care, so I knew going in the nurses only had three to four patients. And to me, I was like, I'm gonna be so bored. So bored. Right Take these patients for 12 hours a day, three days a week, a lot of them can be chronic, you know, we would have patients on our units for two years at a time. And then they'd come back and forth, or whatever thing going on. And I was like, I don't want to do that. I don't the emotional, social, like, the relationships are great. And you can have really great relationships with that. But it can be, wants to be really taxing on the nurses,

Scott Benner 10:27
being too emotionally invested in people's health.

Aurora 10:31
Yeah, or, you know, and I mean, for most people is like a trigger thing. Like, we don't think in our culture about children dying, and children do die, children get really sick, and they die. And you know, we do everything we possibly can, but a lot of the time, that we really just prolong it. And it's painful for the patient. It's painful for our family. It's,

Scott Benner 10:54
I have a friend who's a NICU nurse. And they, when they first came out of school, and we're working, they'd find themselves being invited to funerals by families. Yeah,

Aurora 11:06
yeah. And, I mean, I'm not saying we shouldn't prolong the life that we shouldn't try to do everything that we can medically, to have let this child become an adult and have a faint, you know, like, and do all the normal people things that we do. I'm just saying that, that to me,

Scott Benner 11:22
it's a lot when you see people die.

Aurora 11:26
It is. And I mean, it was just, I didn't think I would be happy. I didn't think I would find like but growth. And also at my hospital. So nurses have a variability of autonomy based on state based on institution and the policies and autonomy, and then kind of like the breadth of their scope of practice, right? In patient, they do not have a good breath for autonomy for a scope of practice. And I've watched several, you know, so many doctors just snap at nurses for no reason, like an just, I don't do well with that. So the emergency department I did my senior practicum in, I really liked it. And I said, Okay, it's either going to be it's going to be critical care all the way. Because I love to use my brain. I love looking at labs and looking at the patient, how they look and their vital signs and putting it all together and being like, Oh, wow, this is what's going on. And I know what I need to do. Now I know what I need to ask for. Whereas cute care, you don't really have that.

Scott Benner 12:27
Yeah. So you like the speed of it? You like the challenge of it, you like that there's more patients in a shift so you don't get too attached to people? Yeah, if

Aurora 12:40
a patient is in my emergency department room, and I've had them for four hours, I walked into the room and I'm like, I'm sorry, you're seeing my face again. We're trying to figure it out. Like I want them gone by like four hours, because nobody wants to be in an emergency department for that long. Yeah. So

Scott Benner 12:55
what made you want to come on and do this recording?

Aurora 13:00
I don't have a good answer. Let's go with that. But it's perplexing. The things that I hear people say, or the inequalities that I have seen in patients with diabetes who are coming in, and it's not just patients with diabetes, it's all but I mean, this is diabetes podcast. So that's what we're talking about.

Scott Benner 13:25
I'm happy to listen to, to whatever you want to say. It doesn't have to be about diabetes, specifically, what do you mean your it's confusing what people say?

Aurora 13:34
Not it's not confusing. Like it's surprising the crap that comes out of my coworkers mouths, like,

Scott Benner 13:40
Okay, you want to give me some examples? Um,

Aurora 13:44
okay, so yesterday, I was hanging blood. And this is a scary thing, right? But a couple of weeks ago, I had a nurse who was about to give a, a pen injection for insulin, right? And she's like, I'm always so terrified to get insulin. I'm like, why are you terrified? She goes, because it's such a high risk medication. I was like, your body makes insulin. So it's not scary.

Scott Benner 14:10
How long do you think that person had been? A nurse has been here a year? Are there a lot of new nurses right now? Because of the shift after COVID? I'm

Aurora 14:21
gonna say yes, but I know that. This emergency department would always take new grads. Okay, so I don't know the comparison. Okay.

Scott Benner 14:31
So there's there's always new nurses coming.

Aurora 14:35
Oh, always. And if they're not new nurses, they might be new to the IDI or their travel nurses. You know, there's always a variability of like, but I mean, we have staff members who have been on staff for 20 years and in the emergency department for 20 years nursing. So the

Scott Benner 14:49
combat side is their turnover, but not with everybody. Like some people come and go and some people stay long term. I guess once you get there if it's really right for you, then you might settle into it. Yeah. Okay, so something as simple is like, I'm scared to give insulin because it's a dangerous medication. Yeah.

Aurora 15:07
Which is understandable. But I was like, Hey, your body makes insulin, it's, it's totally fine. I was like, if they go low, they go low, which is not at the Met error, right? If they do, but if they go low, you get more juice, I'm not fine. And we do not give enough insulin whatsoever in any form of this hospital to actually make a patient low unless you are way overdosing and not properly getting my insulin. Or there

Scott Benner 15:33
are other things that co workers say that would be off putting, but you're not personally attached to it. Like it sounds like it sounds like a little bit of your response to that was as a nurse, and a little bit of your response to that was as a type one. Like, like you and me, like it almost feels like a little bit. You're like, oh my god, like you don't understand diabetes at all. That vibe, like how did it make you feel when when they said that? You weren't pissed? You were just No, no, just like this another person who thinks that

Aurora 16:04
we give insulin a week of insulin we have. We don't have a day where we don't have a diabetic in the emergency department, whether it's a new diagnosis, or somebody's in sick day or somebody's in decay

Scott Benner 16:14
every day. Every day type twos type ones every day. We don't really have type twos. Type twos don't come to emergency. Not not pediatric. Okay. Oh, I'm

Aurora 16:25
sorry. Usually, like, yeah, they don't usually have type two. Yeah,

Scott Benner 16:29
it's interesting. So you're a pediatric er, nurse. The place isn't just for endocrinology. But there is a good endocrinology department there. So you see a lot of these people is that about how that works. Right now we're going to hear from a member of the Medtronic champion community. This episode of The Juicebox Podcast is sponsored by Medtronic diabetes. And this is Mark.

Speaker 1 16:51
I use injections for about six months. And then my endocrinologist at a navy recommended a

Scott Benner 16:57
pump. How long had you been in the Navy? Eight years up to that point? I've interviewed a number of people who have been diagnosed during service and most of the time they're discharged. What happened to you?

Speaker 1 17:07
I was medically discharged. Yeah, six months after my diagnosis.

Scott Benner 17:11
Was it your goal to stay in the Navy for your whole life? Your career was? Yeah,

Speaker 1 17:15
yeah. In fact, I think a few months before my diagnosis, my wife and I had that discussion about, you know, staying in for the long term. And, you know, we've made the decision despite all the hardships and time away from home, that was what we loved the most.

Scott Benner 17:28
Was the Navy, like a lifetime goal of yours? lifetime goal.

Speaker 1 17:33
I mean, as my earliest childhood memories were flying, being a fighter pilot,

Scott Benner 17:37
how did your diagnosis impact your lifelong dream?

Speaker 1 17:40
It was devastating. Everything I had done in life, everything I'd worked up to up to that point was just taken away in an instant. I was not prepared for that at all. What does your support system look like? friends, your family caregivers, you know, for me to Medtronic, champions, community, you know, all those resources that are out there to help guide the way but then help keep abreast on you know, the new things that are coming down the pipe and to give you hope for eventually that we can find a cure. Stick

Scott Benner 18:06
around at the end of this episode to hear my entire conversation with Mark. And you can hear more stories from Medtronic champions and share your own story at Medtronic diabetes.com/juicebox. diabetes comes with a lot of things to remember. So it's nice when someone takes something off of your plate. US med has done that for us. When it's time for art and supplies to be refreshed. We get an email rolls up in your inbox says hi Arden. This is your friendly reorder email from us mid you open up the email to big button that says click here to reorder and you're done. Finally, somebody taking away a responsibility instead of adding one. US med has done that for us. An email arrives we click on a link and the next thing you know your products are at the front door. That simple. Us med.com/juice box or call 888-721-1514 I never have to wonder if Arden has enough supplies. I click on one link. I open up a box. I put the stuff in the drawer. And we're done. US med carries everything from insulin pumps, and diabetes testing supplies to the latest CGM like the libre three and the Dexcom G seven. They accept Medicare nationwide, over 800 private insurers and all you have to do to get started is called 888-721-1514 or go to my link us med.com/juicebox using that number or my link helps to support the production of the Juicebox Podcast. Yeah, okay.

Aurora 19:44
So a lot of pediatric emergency departments are split with main emergency departments, adult emergency departments. We are not we are a self standing pediatric emergency department. We get an adult there's something wrong with them. We ship them out as soon as possible. Okay,

Scott Benner 20:01
what do you see people most for DKA? Yeah,

Aurora 20:04
I want to say DKA new diagnosis, and we service for different states. So if there is a severe enough new diagnosis, they come to us, as well as the hospitals in the area, even as far as you know, 200 miles across the state well, either lifeflight or to you to

Scott Benner 20:29
a place where there's a nurse who's afraid of insulin, because you guys are the specialists,

Aurora 20:33
as the artists. Okay, we are the pediatric specialists. Yes. And I mean, it's, it's not something to not be afraid of it is a rite of it. They should be well, but yeah,

Scott Benner 20:43
I mean, Aurora, I'm not going to argue with that. But if I mean, that would be like a mechanic being afraid of a lug wrench, wouldn't it? I don't know. I mean, you use it all day long. Every day, it's in your hand constantly. How can you be can be used by it? Well, there is

Aurora 20:57
a portion of it to is like, huge. So you have to take a glucose, right? You put the glucose, there's a freaking calculator. You also have to make sure that the residents because we have med students, we have residents, and they have what three years of residency, then we have a fellow who is above them, and then we have an attending, okay, but the low man on the totem pole is the one putting in the order. So the ones calling into crime. So you have to trust that your resident is putting in the correct order, then you have to double check out their orders are correct. Doing that you're putting in everything correctly, you also have to check the ketones, which we call a bomb because it's a finger poke. So you have to check the ketones and whether or not the ketones are medium, small or large. You have to put in and we have a thing for that. And then it'll calculate, let's say if we're on sick day, what if it's one and a half or double the dose? Right? So you have to make sure that that is all correct. And so that could happen. What she was saying, being scared of getting it. Yeah.

Scott Benner 21:55
So that's why I was getting that like so it's possible that she's not weary. She's worried that the person telling her what to do is messing it up. Oh,

Aurora 22:03
oh, yeah. All the time. Every order that comes in whether it's anything it doesn't, it's not just diabetes orders.

Scott Benner 22:09
Yes. Why am I worried that the orders coming in? might be wrong?

Aurora 22:12
Human error?

Scott Benner 22:14
How often does it happen, though? Oh, all the time. Like, per patient? Or how do we want to break it down? Is it like, every person that walks in there, somebody's going to make a mistake about them? Or in every shift? I'm gonna see a mistake.

Aurora 22:30
No, I'm not saying like a mistake I'm saying, within orders that come in, as a nurse every order that comes in for me to do something I take a look at. And I'm gonna say at least twice with every patient that I have. I have questions on orders, and one or two of them is incorrect. And they have to put it back incorrectly. We

Scott Benner 22:53
can't call that a mistake, a bad order from a doctor or residents not

Aurora 22:57
a mistake, because we're catching a learning process.

Scott Benner 23:01
Yeah, there baby. Sorry, sorry. Yeah, there's a legal distinction. But okay, so you stop it from actually being a problem, but a mistake was made. That gets caught down the line. I say nurses,

Aurora 23:12
the last hand is the last the last person to do anything to touch that patient. So therefore, the nurse is the last stopping point. Okay.

Scott Benner 23:22
Yeah. All right. So I understand. So the resident who's maybe the least qualified is making the decision. And then the nurse is double checking those decisions to make sure they're not messing up. But in your words, twice with each patient, you might find something that needs to be readjusted. No, if I'm being generous. Oh my god. Okay, that's fine. So if I get a nurse that doesn't know, and a resident that doesn't know, that's when I'm in trouble. Yeah. Do they try to pair them in a way that that doesn't happen? Like more,

Aurora 23:55
but the hospital is really good at our my charge nurses are really good at managing patient load. And if you don't, we do have a culture of like, everybody's learning. And there's never there's never a stupid question. There is never, you know, don't not ask the questions, ask the questions, you know, ask for help. And it's there. Yeah. So, you know, giving us insulin. Insulin is always a double check. We go through, she's like, I've already gone through it can go through it again. Let's draw it up. Let's give that insulin right. Okay. Yeah, no problem. And, you know, usually it's totally fine. Getting all of those steps in to be able to do that

Scott Benner 24:30
because it goes through like channels like the residents send something down. It's not right, you catch it? Is it a thing that you put back into the computer? Or do you like grab them on the side and go, Hey, this isn't right.

Aurora 24:42
Yeah. Yeah, or call them or I call their attending? I mean, the good so the residents do talk to the fellow and to the attending as well as the nurses as well. So we all we all sit within, you know, we're in the emergency department. Our providers are not in a room half across the hospital. They're there. bear with us, right? So we can easily say, hey, this order is wrong, please fix it. Right? This is why it's wrong. And they all do talk together. It's not just their residents making the decision, but like the residents, the one putting in orders.

Scott Benner 25:12
What would you be most comfortable coming into your ER with a child with? Like, what do you think? What do you guys do great. Like, you know, you go to five guys that make a great burger. When I come to your ER department. If I brought my kid in there, what would I be best bringing a kid in there with? What do you guys do? Well, I think we do a lot of it well, okay. So is this just a fact of the situation that things get dropped? And other people catch them? Yes. You're not saying this is bad. You're saying this is how it works? Yes. Okay. Are you comfortable? Would you be comfortable taking your child to that? Er, yeah.

Aurora 25:52
Children, I don't have children and I can't have children. But yeah, you'd be comfortable going there. I'm also a nurse myself. So that's a hard question to answer. Like, I wouldn't take my child until they were absolutely dying. You know, why? Why? Because a lot of things don't need to go to the doctor For not

Scott Benner 26:11
because they would do a bad job once you got there. All right. So is a lot of the backup in the yard. Just people go into the yard when they don't need to. Correct. What are things that people go to the ER for that they should have stayed home for?

Aurora 26:25
Your kid has a fever, they have had a cough for two days. They're not eating?

Scott Benner 26:31
Do people ever come in with those concerns that it turns out to be something

Aurora 26:35
very rarely, I feel like in an emergency department, we have levels for care and what you're going to need. So when you get triage, your nurse assigned you it's called an ESI level. That's fine. Do an ESI level. So one is you are back in our recess room and you have you know, four nurses on you all the doctors available a respiratory therapist, and we are putting in lines, we are drawing labs, we are getting scans doing all of the things at once, right? This is the like, Grey's Anatomy, you're crashing? Okay? That's an ESI level one and that can be a breather that can be like a medically complex child who is just like looking like absolute crap. Diabetic who is having cerebral edema. We've had that a couple of times. You know, kids who are coming in seizing and the seizing is not stopping fentanyl overdoses, those sorts of

Scott Benner 27:30
things. But fentanyl overdoses with little kids? Oh,

Aurora 27:34
yeah. Cardiac arrest. That's another one respiratory arise.

Scott Benner 27:40
In the course of a shift. How long is a shift 12 hours? Well, how many heart attacks do you see in 12 hours in children.

Aurora 27:48
It's very rare to have a heart attack and a child they would usually have some form of like birth defect or something maybe react problem or it's a middle of the night they went into cardiac arrest or while they were sleeping. Like I said situation and so we're really reassessing them to get LifeLock. So they come and go, there's not a specific amount in a shift

Scott Benner 28:11
in a month. How many fentanyl overdoses 232 or three in a month. And how many shifts you work a week. Three 312 shifts two or three overdoses.

Aurora 28:26
Yeah, or marijuana overdoses. Which parents please. I know the like marijuana comes in great packages and gummies and stuff, please put them up in your cupboards Far, far away. Put them in a lockbox. Kids get into them. They don't realize your kid comes in and we think it's meningitis. And we find out it's marijuana.

Scott Benner 28:43
Oh my god. So more frequently than I would imagine. Kids get into gummies of their parents. Yes. As kids your eyes, they bring them to the emergency room.

Aurora 28:54
And they look like they're dead. Yeah. Oh, cuz they're like overdose on marijuana.

Scott Benner 28:59
No kidding.

Aurora 29:00
Yeah, we've had three in the last week get really bad.

Scott Benner 29:04
Seriously? How come? All right, hold on, we're not gonna go down the wrong path. But how do people not know not to leave that where their kids can find it? I guess they're high too. Maybe they don't know.

Aurora 29:14
I don't know. I'm just it's a PSA, please.

Scott Benner 29:17
What else should people hit? Maybe this is the road to go with you. Or what? What else do people do where they they shouldn't be doing? Like what else is very preventable that you say? We

Aurora 29:27
get a lot of nausea, vomiting, abdominal pain, or teach teaching kids how to pull their nose, please. I know we went through COVID I get we're not supposed to cough. You can cough into your shoulder. You can blow your nose where people aren't going anywhere and people aren't blowing their nose, children. I have an eight year old who didn't know how to blow his nose and I taught him how to blow his nose. He kept vomiting. We call it post vomiting. If you're coughing, and then all of a sudden you vomit right? Because you get all that mucus that's going into your stomach, the mucus that's going into your stomach from your lungs. problems when you cough it up is an irritant to your stomach and it causes you to vomit. You're

Scott Benner 30:04
saying if your child is vomiting because they can't blow their nose, and everything's backing up down their throat, maybe you should reevaluate your parenting skills. Yeah,

Aurora 30:15
you should teach your child how to blow their nose. Do you put the tissue on their nose? And you block one nasal passage, and you say, now try to close your mouth, but act like you're blowing out a candle? And oh, my gosh, they can blow their nose. Do you think people don't know that? Absolutely. Oh,

Scott Benner 30:34
my God, that's upsetting. Okay, Jesus. All right. So they don't know not to leave weed near their kids. The edibles? Kids aren't eating the actual flower. Are they to the what? The flower the bud? Like? Do they actually know? It's the gum? gummies? The gummies? Right. Okay. And worse, the kids get the harder drugs sometimes.

Aurora 30:55
Oh, yeah. I mean, like, they're people who have drugs and, you know, obviously code on cocaine in their homes and their children. Get around it, you know, and it's really sad.

Scott Benner 31:06
No kidding. You ever seen a baby? Like, really injured from that? What do you qualify as injured? I mean, you know, they just stare at a wall for the rest of their life, or they're dead, something in between those things?

Aurora 31:17
I don't know. Because we don't. I mean, I them after, that's when I was upstairs, we would have like, abuse from those that were afflicted with addiction, we would hurt their child. I don't know about the children are seeing now because I don't tell social situations. Gotcha.

Scott Benner 31:38
But a number of the things you see in the ER are would be preventable. But somebody with an IQ over 80

Aurora 31:45
is somebody who didn't have social determinants of health that were ruling our life. Yes. You're very polite. Okay. I mean, I truly believe this is what that's what it boils down to is social determinants of health like it. And I know other people who have our health care workers that have come on for this, I've talked about it. But it surely is, if you don't have access to your phone to be able to go to my chart and message your provider or can't get into the provider, because they can't see you like, just a PCP visit in my area right now is for monthly time, I have been needing to see a specialist for a new autoimmune disease for five months now. And I'm still one more month away from this new appointment. It's ruining my life, like it's making absolutely terrible, and you can't get on.

Scott Benner 32:33
Yeah, no, I want to talk about that. But that's not what I was kind of what I was getting. And I'm saying like, we don't need to be any special kind of intelligent to keep weed away from babies or make sure they don't get an oxy or something like that.

Aurora 32:45
No, yeah. I mean, like, how do you how do you stop addiction? How do you stop that social determinant of health? What what started that addiction? What NSSM is causing this to be an in product, what percentage

Scott Benner 32:59
of your day is wrapped around stuff that if those problems didn't exist for people, you wouldn't see these people? Like how many people out of every 10? Is it avoidable and not a health like not just a flat out thing that went wrong with their health that they couldn't stop? Does that make sense? My question, yeah,

Aurora 33:17
I'm trying to think, to three to

Scott Benner 33:21
two or three out of every 10 people if they just had better skills, or opportunity. They would not be in the ER. Oh, no, Simon, then. Oh, okay. I wasn't sure how clear I asked at first. That's why I kind of restated it. So three of 10 are like my appendix pop. That was nothing I could do about that. Yeah, I fell over. I broke my leg. There's nothing I could do about that. But the but seven out of 10 are things that if you put a person with common sense, and a reasonable start to life, this probably doesn't end up happening to them. Yeah. Is that frustrating as a nurse,

Aurora 33:58
it can be okay, not all the time. Sometimes it's, you know, new parents coming in. This is their first baby. They've never been around a child and the child was sick for the first time. Okay, sure. Got this not aspect. Patients not breathing very while they're not wanting to eat, they're a little sleepy. You know, we unwrap them. We suction them really nice and well with our vacuum suction. And, you know, we let them eat. We give parents education reassurance, hey, you're gonna suction every three hours, you're gonna section before they eat. And if the warming breathing gets worse, we give them a pamphlet, like this is what we want you to this is where it's looking worse, because you're getting a lot of information out at once. Put it on your fridge, right? So when you have that question when it comes back up, it's right there. You know where it is. And then you can either come back in or you can be reassured by your baby's looking fine, right. So like, that is absolute really needed. That is probably one of my funnest things that I do is like giving those parents that education because it can prolong them not coming into the emergency that they can prolong them not being worried. So

Scott Benner 35:15
what I'm calling common sense, you're calling determinism. I guess this is just me judging things from my perspective. But you've described a number of things so far, that I think with like three seconds, a clear thought I could figure out, but people are ending up in the ER over it. Yeah, yeah. Like, I've had children. And sometimes you're right, like, they get sick, and they get all snotty, and they gets blocked up, and then you like, clear it for them? Yeah, that's it. It's not that hard. But I guess it is, if it is, right.

Aurora 35:46
I don't know what it is. I don't know if it's because we have such a good pediatric hospital in the area. And so everybody's just like, go my hospital. Right. But isn't it expensive to go to the hospital? Well, our our hospital has, everybody can apply for assistance, and then it's based on income. So whatever level and whatever's leftover from the hospital visit, what uh, how did they determine it? I don't know. Okay, but a lot of it's uncompensated incompetence care. I don't know one

Scott Benner 36:18
time when Arden was little, she'll be very embarrassed. I said this, but that's her problem, not mine. She's very little. And she was in the bathroom. And she didn't like the way it smelled. So she rolled up toilet paper and stuck it up her nose. Solid. Yeah, I issues like, I don't know, she was not that old, like two or three years old, right? But this one little wad of toilet paper got stuck so far up her nose. We couldn't get it out. Yeah. And so I sat her down. And I looked at her and I thought with my thinker, and I thought we tried one thing that I'm embarrassed to say that didn't work. We tried, like putting like a funnel on the end of the vacuum cleaner hose to see if we could like grab it that way. Like so there was like a little funnel tip that was being sucked on by the vacuum that didn't grab it. And then it hit me what to do. And I blocked up one of her nostrils kept my mouth over her mouth blew and filled her filter up with air. And the thing shout out and hit me in the face. You can also do that with mucus. Yeah, I'm sure it can. Now, point is, is that at no point during this like, show, which it was? Did I think I'm gonna go to the hospital. But you're saying people would come to the hospital that? Yeah. Oh, I say. All right. I don't know what to do. So you're not here to tell me that the people at the hospital don't know what they're doing. You're here to tell me that the people coming to the hospital don't know what they're doing. Yeah, well. So let's be honest. Let's be honest. So, again, the limiting factor here is people. Yeah, somewhere along the line, someone I don't know, is overmatched. I guess that's the simplest way to say it for whatever reason. And they end up needing help from someone else who eventually sees this so many times over and over again, that they become a little numb to it. And then another person comes in with an honest to god problem. And you don't see people like that anymore. You see, like, you see the confusion and the repetition. So when like the only me like because that's my always one of my, my bigger questions is like, what happens when someone's actually in there with an actual problem?

Aurora 38:35
Oh, I mean, all the resources go towards them, and everybody else waits. That's how it works.

Scott Benner 38:41
But how do they miss things that are actual problems? In the beginning, they miss them because most of the time seven out of 10 times it's nothing? Is that it?

Aurora 38:49
Okay, so can it express? Yeah, so pediatrics, like kids are really good at compensating their body is really good at compensating. And like so there'll be like mail coming a little crummy, little crummy, little crummy, right? And then they just we call it a nosedive. They're on the edge of the cliff and something that just pushes them down. And they're crummy looking. Right? And so parents know. And sometimes those like spidey senses are going off at a time that possibly is not that. And then sometimes they go off a little too late, you know. And so it's just like, there's no balance to it. But of course, if your kid is sick in the event, second week, and let's say they've had the flu, and we know the flu is going around, even though they've been sick all week. And you notice the flu parents don't bring them in and say fix my child. I'm sorry, it's a virus. We can't fix your child.

Scott Benner 39:44
Do you think people get panicked when the illnesses start going on for many days and they think oh, God, something worse is coming instead of realizing that you had to write this virus out. Yeah. And that sometimes people actually do have honest to god problems and everybody thinks that's happening to them. Um, yeah,

Aurora 40:00
let's say that they had a virus and now all of a sudden they're coming in and they have diabetes, then that's an emergency, right?

Scott Benner 40:06
Where you end up doubling up, like you get bronchitis on top of something else, or you start having two problems at the same time. So I don't think he'd mind me saying this. My brother had to go to the emergency room a couple of weeks ago. And he had very terrible pain that, you know, right side pain. And he gets there. And they hit him with the drugs first, because he actually said, my brothers had some pretty, like, painful things happen to him. And he's like, I couldn't talk like I needed like to numb this before I could even explain to them what was going on. So he gets, you know, they, they, they make him comfortable. And he explains everything. They do all the tests, they can't come back with anything. But in his history, my mom has had diverticulitis in the past. And so they kind of ignore all that go over him. And then he said, there was this moment where they told him that even though he was in intense pain that was only being managed by some significant pain meds, there was nothing wrong that they could figure out and he had to leave. He did have a raised white blood count, but they just, they just kicked him out of hospital. So he went home. And the next day, he texted me and he said, I can't take it, I gotta go back. So he goes back again. And he has to stop them from basically just repeating what happened 24 hours before, he has to say, no, no, we just did all this. If you need to see it, there's, I'm sure it's in your computer, but we just did all this. I'm back because the pain is unbearable. You know, even with the medication you gave me everything else sees there for another couple of hours. They're not doing anything. He's texting me. He's like, Scott, nothing's happening. I'm just they're gonna just sit here and stare at me for a while and then tell me to go home again and go see a doctor. And I'm like, right. So I said to him, did they redraw your labs? And he said they did. And I said, tell me if the white blood cell count is still elevated. And he looks and says it's elevated. It's higher than yesterday. I said, grab the nurse and say, Would it hurt anything if I got an IV antibiotic? You know, because my white blood cell counts elevated. It was elevated yesterday. Now today, it's higher. My mom had diverticulitis in the past. She goes, hold on, I'll find out. She leaves talks, the doctor comes back. Doctor will be in to talk to you a little bit. So my brothers are Hey, doctors texted me doctors coming to see me. He calls me afterwards. He's laughing. My brother's laughing. He goes, Hey, I know what's wrong with me now. And I said, well, they figured out he goes, I have diverticulitis. And I go, what? He goes, Yeah, I floated the idea to the nurse who floated it to the doctor who came back and pretended that he had the idea that I had diverticulitis, and they're gonna give me an IV antibiotic and antibiotics to take home with me. And I was like, so I diagnosed you. And he goes, Yeah. Like, I'm the one through a text message. Who told my brother manipulate the nurse. So show manipulate the doctor so you can get the antibiotic? Because obviously, we don't know what's going on. The only thing we see is a rising white blood count. You clearly have an infection somewhere. Let's take care of it. The IV antibiotics not going to hurt you anyway, if that's not the thing, why is this not worth a try? And by the way, three days later, he was fine. Yeah, I did that

Aurora 43:18
manipulations, a good word. A lot of manipulating network. Yeah,

Scott Benner 43:24
that's what I did. I manipulate the nurse through a text through my brother so that she would tell a doctor and then but I think the fascinating part that should not be lost on this is that an hour later, the doctor walks into the room as if he's had the idea. Yeah. And then repeat to my brother. What I told my brother to tell the nurse. Yeah, jump out a window. That's the only thing I can think of when I hear stuff like that. Just give up. Yeah.

Aurora 43:50
That's my every day. Yeah.

Scott Benner 43:53
But you don't see it as bad. You see it as part of the learning process. Oh,

Aurora 43:57
no, that's, that's what I've been conditioned to. Oh,

Scott Benner 44:02
because I see it as bad. I just want to be clear.

Aurora 44:06
is like, awesome. It's hard for me because I had so much experience in our hospital with this population for a very long time before I came down as a nurse, right. So like, I was above and still am. A lot of the nurses, a lot of the nurses who have been there a long time. And I've been told that by management, which is fine. I have a very blunt personality. I'm very, like, this is what we're doing. And we're doing it right. And doesn't go over well with everybody. And so, I have been told you just have to play dumb. Which some days I comply with. Most days. I do not say the smart people say play dumb. Yeah, because you have to ask things in a way that will get the providers to think what you're wanting them to think or give you the orders you need. Yeah. Right you are advocating for for the patient. Yes. I

Scott Benner 45:08
mean, listen, I don't know what to say. I in the last year, my brother and my daughter have been in the emergency room and I have been the attending physician for both of them. Yeah. And without me, nobody helps them. They pretend to help them, they medicate them, then they throw them back out again. Aurora, my daughter was in the ER for 12 hours. And they didn't check her blood sugar while she was there.

Aurora 45:32
I know. I know. I was I listened to the podcast

Scott Benner 45:35
ever once. They never even stuck their head in and said, Hey, how you doing? How's your blood sugar?

Aurora 45:41
And that, to me is surprising. But that's an adult emergency department. And I know I know the nurses get busy. I know there was I saw I am triage train. Now I'm I'm a full fledged emergency department nurse. So I triage patients. I triaged a patient literally a couple days ago, who came and she has type one diabetes, okay. She goes, I don't feel well. I can't keep anything down. I think she came back with a virus. Okay. Not abnormal. Usually it's a day. And she I can't remember she was like eight to 11. Somewhere in that age range. I can't remember. Which, exactly, it doesn't matter. So she's like, my blood sugars have been, you know, two to three hundreds. We can't get them down. Well, the Lantus isn't working dad knows nothing. Nothing about her diabetes, nothing about her care. And she goes, this is how much insulin I take. This is how much you know antiseptic. She goes, but this abdominal pain. It feels like the last time I was in DKA. And I was like, I got you, girl. I know. I know what that feels like. I know the pain you're talking about. And so we got her back to her room, immediately her glucose, they attacked her glucose in the first check in area and it was above 300. I hand her off to the other nurse and the other nurse is supposed to get all the labs and stuff. So they got the lab she was in DKA. At that time by our senior she was in DKA. Endocrine said she's not in DKA do sick day, for whatever reason. And I don't know what happened. You know, a glucose wasn't checked two hours later. And they went in to go do Sick Day and insulin three hours later, and she was further into DKA. And so then we had to start the GK to bag insulin system.

Scott Benner 47:27
Listen, the only direction my brother got in the first day of the hospital. He's my brother has type two diabetes, which is managed very well with diet exercise, and ozempic. So my brother's a once he's in the fives, mid fives from the sevens with ozempic. He's lost, like, I don't know, 35 pounds in the last year or something like that, like everything good about my brother's health right now is coming from his GLP medication. He's in the hospital, they do the tests, then they go, Oh, we don't say anything. And then the doctor says to him, we I think maybe we should take you off the ozempic. And my brother goes, why? And he goes, he goes, I've been the guy. His words were I've heard like, almost like I was I was listening to a you know, podcast, and I heard that they can cause like intestinal blog. There's a lot of problems with intestinal blockages lately. And my brother goes, I don't have an intestinal blockage. I took a shower this morning. And the guy goes, he's like it's on there. My you asked me when's the last time I went to the bathroom went to the bathroom a couple of hours ago, like I don't have an entire not blocked at all, I promise you. And the guy says, I don't know, maybe we may we should take you off of this. So my brother goes, I'm not stopping that medication. So the only medical direction he got was come off your GLP which would have raised as a one C backup two points. And no one ever came back to say to him, Hey, don't do that. So now my brother's a bright enough guy. And he's got me to bounce it off of and other people in his life. Right? So, but there are plenty of people who would leave that hospital that day. And what they would remember is the doctor told me to stop taking the ozempic Yeah, they would have stopped. It

Aurora 49:10
had. Honestly, I don't know if that's because we come from a background of having a chronic illness or taking care of someone with a chronic illness. I'm like, No, you know,

Scott Benner 49:25
how do you not understand it, though? Like, how can you say I don't know, in medicine? And I don't know what I mean, what might be one of the most popularly understood drugs in the world right now. Like everyone that's on everyone's lips. Everyone knows what it is. And yet, you are just guessing based off a thing you might have heard once and then you give somebody medical direction about it, then find out that definitely not what the problem was. And don't go back to them and say, Hey, by the way, I know I told you to stop taking the ozempic but don't do that. Like it's fascinating. Like no wonder people have so many problems. You don't I mean, I think

Aurora 49:59
me It's just the oversaturation of patients to do providers, just too

Scott Benner 50:07
many people searching for help. And it's more than a person can keep straight in their head. Yeah, that makes sense to me, by the way. Yeah,

Aurora 50:16
I have a friend and she's very lovely. I went to nursing school with her. Her son was diagnosed with type one diabetes last May. March, somewhere in there. Anyways, I texted her and I was like, Hey, happy birthday. And she goes, Oh, my God, I was just thinking of you. We are in the emergency department. Not near me, because I went to nursing school in a different states. And she goes, we were just diagnosed with type one diabetes, I was like, Oh, I'm so sorry. And so they like, went home after some insulin because he was fine. And then did training the next day. And so she's calling or texting very frequently, that first few weeks. And in the first two weeks, I was like, listen to this podcast, this is going to tell you more information than they're ever going to tell you. And I was like, get the insulin from the doctor get what you mean, I was like, but do not listen to the doctors. Like they don't know what they're doing. They don't know anything about diabetes. And they're telling you, I'm going to say all the wrong things. Right? She is a nurse. Yes, she has patients with diabetes, she gives insulin on a daily, okay. And so I saw her a couple of months ago, and we went out for breakfast. And she's sitting there and she's complaining about like, these diabetic orders that she had the previous week, and they were completely wrong. And it took, you know, hours upon hours to get them correct. And then she was like, I just don't understand what they're doing. And I was like, um, and so how's your son's able and see, like, what's going on there? Because like, we kind of just stopped asking questions. And I was like, what's going on? She was like, over high, and this is going on, and like, he's taking meals to correct because we can only correct every three hours. And then it's just causing bigger spikes. And I was like, What are you doing? Because, hey, I love you. I love your kid. But I told you a year ago, do not listen to the doctors. So for a year, it goes on like that. You just told me from your nursing experience. You did not listen to the doctors and do not trust the doctors. But

Scott Benner 52:21
when she got put into a position she did go back. Yeah. So there's a person who should know better and didn't, I'm telling you like, what if my brother would have believed that guy? Now all of a sudden, it's six months from now he's back it is his general practitioner guy goes well, I don't understand what happened. You're, you're a one see one way back up again, what's going on? And my brother goes, Hi, I stopped taking ozempic Because the ER doctor told me to stop taking it because I might have a bowel obstruction. It just it's fascinating. By the way they had scanned him to within an inch of his life. His bowel was not obstructed. They knew that. And then the guy still said it out loud. I don't know what I'm listening. I know people are just people and you you know you go to school and you do your best you become a doctor. It doesn't make you a magician doesn't make you a god or a deity or anything like that. But isn't it incumbent upon you to know that when you're talking that I'm just the guy, I'm just the girl. And I don't know everything. And whatever I say out loud, this person across me is going to take like gospel. Yeah, like it's important not to seriously, it's important. It's nobody seems to understand lead. That's the thing that I find fascinating. The older doctors can get it but they're so damn tired. Like, it's like either had people with energy that don't know what they're talking about are exhausted. People who know what they're talking about. It can't bring themselves to do it anymore. Yeah, yeah. So what's the answer? How do you fix it?

Aurora 53:47
We all die eventually.

Scott Benner 53:50
It was gonna get you anyway, Scott. Yeah. So there's no answer. Right? This is just a this is a gray area within living and society that is probably working as well as it can and not working badly. I mean, it's obviously not. It's not where it could be. But there's no answer about how to get there. As far as anybody I've spoken to. So far. I've never had one of these conversations at the end said to somebody, what do you think we should do? And they all have a great idea. They all go I don't know. That, you know, it's the Insurance insurance fault. It's the time that doctors have with them. It's doctors egos. It's, you know, that there's too many people. You know, in

Aurora 54:26
nursing school we learn about in, I think it was the early 1900s. Okay. Nurses would go to people's homes, they would check in, and I'm not putting this on nurses because we already do everybody's job. But nurses would go to they would have a set amount. This was in New York, I believe, that amount of patients that they would see within a week, within a day, right? They had these families that they were like, the mama bear of okay, she would go in and make sure that the moms were getting enough Food so she could breastfeed, they would make sure that the patients who needed the dressing changes would do the dressing changes and make sure that like people, even if they don't have enough money are getting adequate food and just kind of like, being a part of the community that they were that they were supporting. Right. Okay. They were, they were in the community, they lived close to these people. This was their, you know, like, this is what they did, right? There was federal funding for that. And then something happened and that federal funding was lost. But in that timeframe, the health, the disease rates were better people were, you know, like, not spreading sexually transmitted diseases, because they were learning not to, you know, you know, do those things, whatever.

Scott Benner 55:43
You want to stop, go and do something. Yeah. Yeah, I do that. I'll be here. I feel like she was getting ready to say they don't let take your time. Make sure you're okay. I'm fine. I'm just drinking. I was telling the people when you walked away and felt like you were about to say, people do not to let dirty near them. And then you were like, I'm gonna stop for a second. Is that what you're gonna say?

Aurora 56:06
No, no, no, my phone is on. It's on. I put it on airplane mode, or whatever that is, you're not disturbing. So it was just a little alarming me. I was I was,

Scott Benner 56:16
Oh, you got confused in that. In that sentence? You got the alarm? Because you paused I was like, Oh, she was gonna say something hard. And she stopped yourself. But your alarm went off? What's your blood sugar 64. Most people get high when they're being interviewed.

Aurora 56:29
I did initially and I gave myself a Bolus,

Scott Benner 56:33
little too much.

Aurora 56:37
To do. No, I've calmed down. And so I'm no longer speaking adrenaline to keep keep it up. Anyways, so they had these wonderful nurses who would do the actual community outreach. And it was that of course, it was for funding. And we've never gotten back to any state close to that. And I honestly believe we, as a country were to do that. A, our nurses would be so much happier and find so much more fulfillment in what they're doing. And then our we would have less hospitalizations, we would have less heart disease, we would have less type two diabetes, right? Like

Scott Benner 57:19
you think the answer you think the answer is one on one, care with somebody who can talk you on your level and isn't rushing around and actually understands the thing. So especially like they understand the thing they're talking to you about because they don't have to know everything. They only know a few things. Not even just a few things, but like, the things that come up. Yeah, yeah. Yeah. I mean, not a bad idea, right.

Aurora 57:46
I honestly believe that. I would love it's public health nursing is what it is. I would love to do that. Okay. But public health nursing now is not that.

Scott Benner 57:57
Yeah, everything gets bastardized, eventually. Even like, walk in clinics, right? That take insurance, like, you know, eventually they become a like a grind like a mill. Yeah. And but when they first opened up, it was great. It was like you'd show up somewhere. And the doctor would be like, sitting there waiting for you and beg Hi. And now as time goes past, they seem a little more, get them in, get them out. I mean, at least there's a little more time for them, because they don't have as many people there as a as an emergency room. People seem to live, learn how to use, you know, those clinics a little bit, but you can also get a bad one. I've been in one with my son when we were in Florida. And he got sick. And my god, like it just there's just confused people everywhere. And I mean, working there, and very unhelpful. And then there's one near my home, that's actually really good. Actually, there's a type one that works in it, and she's terrific. And if I go there, when I'm sick, I'm like, is she here? And you know, she's really great. Maybe even that's a little bit about what you were talking about earlier, just your opportunity and your availability to good help and good ideas. So maybe I just live in an area that, you know, I don't know, has a better a better emergency clinic to go into not even attached to a hospital. Who knows? It's by like your idea, though. Like, what did what did you call it? community nursing? Yeah,

Aurora 59:18
it's public health nursing with like community specific outreach.

Scott Benner 59:22
They probably can't charge for that. Well, though. I don't know. That's probably the problem. So basically, it's like having a like a Facebook community, but where an actual nurse shows up and helps you. Correct?

Aurora 59:33
Yeah, I see. Which is like it's you know, you become a nurse and like, you get all these text messages from people and they're like, Wow, about, you know, how many phone calls I've gotten in the middle of the night where my sister's kids are doing something funky or they're screaming their head off and she's like, I need your help. She lives halfway across the country. Okay, let's FaceTime them. I'll look at them. Okay, they're okay. This is what you should look for. This is what you should give. If they start are doing this then go to the emergency department. Okay. Yeah. really concerned. Yeah, call your PCP tomorrow and try to get in. Right? But not everybody are good and social determinants of health, like nursing school is very expensive. Having a doctrine family, not a normal thing. Who are you going to call? Right? If you live in an A? In a lower class? Population? If that's where you are? How do you even reach that? How do you have a nurse? And your phone? To know?

Scott Benner 1:00:30
Yeah, the guy you know, to help you when you know, when you you need? When you need a I know a guy situation, the guy you know, maybe not a doctor. And then yeah, then that. All right.

Aurora 1:00:42
I mean, like, I've literally like, my sister has a running tab of how much money she owes me, because I'm like, $30, every time you call me with a question, because this is ridiculous,

Scott Benner 1:00:50
you know, but is it? Is she calling you because she's overmatched? Or she calling you because she really doesn't know. And she'd be one of those people in the ER, if she didn't call you? What do you think? I think a little bit of both a little bit of both taken advantage a little bit and a little bit. She doesn't know what she's doing now, which

Aurora 1:01:05
is why I literally told her and her husband this last week, because I was there visiting. I was like, $30, I'm not kidding. Because my brain and my availability is not just free to you, because I am related anymore. You got a year and a half. No more, you

Scott Benner 1:01:22
got three kids. Now, I know a doctor. And he said that's, you know, it's one of the worst things is that, and when you know him, you have to stop yourself sometimes because you're like, Oh, my God, I could just ask real quick, you know,

Aurora 1:01:32
I mean, I think it's really appropriate to set a boundary. And I mean, I gladly will do it like, sure. Of course, she's not ever gonna pay me. But, you know, like, good. People don't have that. Yeah. We didn't have a nurse in my family until i i became a nurse. You know, we didn't have anybody who graduated high school until I graduated high school. Like, really? Don't have it. Oh, yeah.

Scott Benner 1:01:57
Oh, no kidding. Oh, good for you. Congratulations. Good for your family. So if

Aurora 1:02:03
you come from a background like that, what do you do? Well, you go to the emergency department, and you sit there for four hours until you can see a doctor who's going to tell you? I don't know. I'm back if you need to.

Scott Benner 1:02:13
Yeah, all right. Well, again, I appreciate the conversation. I'm afraid they're all going to mostly go the same way. But everybody's bringing something new and different to them. Your perspective was different than others so far. So I really appreciate you taking the time to share it with me. I'm sorry, you got low in the middle of it. But thank you very much. It's it's interesting. And I will say this, because I say this all the time in these episodes. If you have an emergency situation, just go to the emergency room. Oh,

Aurora 1:02:42
for sure. Please do don't don't act like I'm not saying don't go to Superman, like kids get like I said they fall off cliffs. So go if you think you need to go go. Right.

Scott Benner 1:02:53
And it's better safe than sorry. I mean, correct. For certain, you know, it's just there's a difference between, like, you know, that old like, oh, I shot 10 units of fast acting instead of my Basal insulin, what do I do and and right away someone online, I'd be like, go to the emergency room. And I'm like, you could figure out what your carb ratio is and eat the food. Drink a bunch of juice? Yeah. Like, there's other stuff you can do. And then you'll say, Oh, that's a good idea. Like, yeah, yeah, you don't have to run to the emergency room immediately that that panic that some people have is, is interesting. Like, you know, I'm not saying if you can't get ahead of it, if you you know, if you're, you know, you shot 30 units or something like that, like I get it, you know what I mean? But you got to think for yourself a little bit once in a while, I guess, I guess, unless she can't, and then maybe you need somebody to do it for you. But that just means that people like Aurora are going to be like teaching your kids to blow their nose. And you're going to be using up the finite amount of she has to give before she falls apart in our child like really? Right, like, eventually, you're just going to run out of things to give and then yeah,

Aurora 1:03:58
and then it comes in and dies and you just like actually lose your marbles. Because who knows.

Scott Benner 1:04:06
All right. I'm gonna say goodbye. And thank you very much for your time. I appreciate it. Thank you.

Mark is an incredible example of what so many experience living with diabetes, you show up for yourself and others every day, never letting diabetes to find you. And that is what the Medtronic champion community is all about. Each of us is strong, and together, we're even stronger. To hear more stories from the Medtronic champion community or to share your own story. Visit Medtronic diabetes.com/juice box. Don't forget, we still have Mark's conversation at the very end. It's a terrific kind of mini episode about 10 minutes long. That goes deeper into some of the things that you heard Mark talking about earlier in the show. A huge thanks to us med for sponsoring This episode of The Juicebox Podcast, don't forget us med.com/juice box this is where we get our diabetes supplies from, you can as well use the link or call 888-721-1514. Use the link or call the number, get your free benefits check so that you can start getting your diabetes supplies the way we do from us med. I want to thank the ever since CGM for sponsoring this episode of The Juicebox Podcast and invite you to go to ever since cgm.com/juicebox, to learn more about this terrific device, you can head over now and just absorb everything that the website has to offer. And that way you'll know if ever sense feels right for you, ever since cgm.com/juicebox. Thank you so much for listening. I'll be back soon with another episode of The Juicebox Podcast. And now my full conversation with Medtronic champion, Mark. Mark. How old were you when you were diagnosed with type one diabetes? I was 2828. How old are you now? 4747. So just about 20 years?

Unknown Speaker 1:06:08
Yeah, 19 years?

Scott Benner 1:06:10
What was your management style when you were diagnosed? I

Speaker 1 1:06:13
use injections for about six months. And then my endocrinologist at a navy recommended a pump.

Scott Benner 1:06:18
How long had you been in the Navy?

Unknown Speaker 1:06:19
See eight years up to that point?

Scott Benner 1:06:22
Eight years? Yeah, I've interviewed a number of people who have been diagnosed during service and most of the time they're discharged. What happened to you?

Speaker 1 1:06:30
I was medically discharged. Yeah, six months after my diagnosis.

Scott Benner 1:06:34
I don't understand the whole system. Is that like honorable? Yeah. I mean,

Speaker 1 1:06:38
essentially, if you get a medical discharge, you get a commensurate honorable discharge. I guess there could be cases where something other than that, but that's that's really how it happened. So it's an honorable discharge with but because of medical

Scott Benner 1:06:48
reasons, and that still gives you access to the VA for the rest of your life. Right?

Unknown Speaker 1:06:52
Correct. Yeah, exactly.

Scott Benner 1:06:53
Do you use the VA for your management? Yeah, I

Speaker 1 1:06:56
used to up until a few years ago, when we moved to North Carolina, it just became untenable, just the rigmarole and process to kind of get all the things I needed. You know, for diabetes management, it was far easier just to go through a private practice.

Scott Benner 1:07:09
Was it your goal to stay in the Navy for your whole life, your career? It was?

Speaker 1 1:07:12
Yeah, yeah. In fact, I think a few months before my diagnosis, my wife and I had that discussion about, you know, staying in for the long term. And, you know, we made the decision despite all the hardships and time away from home, that was what we love the most. So that's what made it that much more difficult

Scott Benner 1:07:29
was the Navy, like a lifetime goal of yours or something you came to as an adult,

Speaker 1 1:07:33
lifetime goal. I mean, as my earliest childhood memories were flying being a fighter pilot and specifically being flying on and off aircraft carriers. So you know, watching Top Gun in the ad, certainly a

Scott Benner 1:07:45
weight was a catalyst for that you've taken off and landed a jet on an aircraft carrier.

Unknown Speaker 1:07:50
Hundreds of times.

Scott Benner 1:07:52
Is there anything in life as exhilarating as that? No,

Speaker 1 1:07:55
but there there's a roller coaster I rode at. I think it was at Cedar Rapids up in Cleveland Sandusky, and they've got this roller coaster rotation from zero to like, it's like 80 or something, you go up a big hill and you come right back down. So the acceleration is pretty similar. I would say to catapult shot,

Scott Benner 1:08:13
I'm gonna guess you own a Tesla.

Speaker 1 1:08:16
I don't I I'm a boring guy. I got a hybrid rav4 I get made fun of I get called. You know, my wife says I drive like a grandpa. I'm a five miles per hour over the speed limit person. No more than that. So yeah, in the car. I'm boring guy. So

Scott Benner 1:08:30
you've never felt a need to try to replace that with something else. You

Speaker 1 1:08:34
can't replace it. It's you're replaceable. That's what I thought. So up until the point where someone you know, buys me an F 18 or allows me to get inside a two seater and fly it you can't replace it. How did

Scott Benner 1:08:45
it make you feel when you saw or maybe you haven't seen? gentleman named Pietro has his large aircraft license. He's flying for a major carrier. Now he has type one diabetes. Does that feel hopeful to

Speaker 1 1:08:54
you? Yeah, it does. You know, when I when I was diagnosed, that wasn't a possibility. The FAA prohibited commercial pilots who had type one diabetes, but I think it was 2017 when they changed their rules to allow type one diabetics to be commercial pilots. And part of the reason I did that was because of the technology advancements, specifically in pump therapy and pump management. So I don't have any aspirations of going to the commercial airlines, but one of my sons who has type one diabetes very much wants to be a commercial pilot. So, you know, in that respect, I'm very hopeful and thankful. Yeah.

Scott Benner 1:09:27
Do you fly privately now for pleasure?

Speaker 1 1:09:30
I do. Yeah. One of my favorite things to do is fly my kids to the different soccer tournaments they have all over the southeast us so last week, my wife and I and two of our boys flipped to Richmond for their soccer tournaments up there and Charlie who's my middle child has type one diabetes so you know if I can combine flying family and football and one weekend to me that's I think I've just achieved Valhalla.

Scott Benner 1:09:54
So then it sounds to me like this diagnosis was a significant course correction for you. Can you tell me how It affected your dream.

Speaker 1 1:10:01
Well, I you know, if I guess three words come to mind first, it was devastating. Everything I had done in life, everything I'd worked up to up to that point was just taken away in an instant. And I was not prepared for that at all. The second emotion was, it was scary. I hadn't thought much about life outside the Navy, certainly not life as anything else, but a fighter pilot. And Heather and I were getting ready to move to France, I was going to do an exchange tour with with the French naval air force. So we're taking French classes. So pretty quickly, I had to reinvent myself. And then probably the most important thing at the same time that all that was going on, I had to learn how to deal with type one diabetes and how to manage it effectively. The third thing that pops into my mind, I guess, is challenging, you know, new daily routines, I had to establish first with injections, and then eventually, you know, through pump management, and then learning how to count carbs and recognize highs and lows, how my body reacts to blood sugar trends based on exercise and stress and those types of things. And my goal at that time, and it still is today is to leverage technology and make sure my habit patterns are effective so that I take diabetes management from the forefront to the background.

Scott Benner 1:11:08
Have you had success with that? Do you feel like you've made the transition? Well,

Speaker 1 1:11:12
I have I mean, I believe in continuous improvement. So there's always more to do. I will say the technology since I was diagnosed specifically with pump management, it's just, it's just incredible. It takes less of me intervening. And it's really done by the pump itself and by the algorithms through the CGM is. And to me again, that should be the goal for everybody is to not have to focus so much on the daily aspects of type one, diabetes management, you know, we should let technology do that for us.

Scott Benner 1:11:41
What else have you found valuable? I've spoken to 1000s of people with type one diabetes, the one thing that took me by surprise, because I don't have type one, myself, and my daughter was very young when she was diagnosed. I didn't really understand until I launched this podcast, and then it grew into this kind of big Facebook presence. I heard people say, I don't know anybody else who has type one diabetes, I wish I knew more people. But until I saw them come together, I didn't recognize how important it was. Yeah,

Speaker 1 1:12:10
I think similarly, I didn't know anyone with type one diabetes growing up as an adult up until when I was diagnosed. And then all of a sudden, people just came out of the woodwork. And when CGM is first hit the market, certainly within the last five years. It's amazing to me and my family, how many people we've noticed with type one diabetes simply because you can see the CGM on their arm. I mean, I would say, a month does not go by where we don't run into someone at a restaurant or an amusement park or a sporting event or somewhere where we see somebody else with type one diabetes. And the other surprising aspect of that is just how quickly you make friends. And I'll give an example. We're at a soccer tournament up in Raleigh, this past Saturday and Sunday. And the referee came over to my son Charlie at the end of the game and said, Hey, I noticed that you're wearing pomp. And he lifted up a shirt and showed his pump as well and said, I've had type one diabetes since I was nine years old. I played soccer in college, I'm sure that's your aspiration. And I just want to tell you don't let type one diabetes ever stop you from achieving your dreams of what you want to do. And this gentleman was probably in his late 50s, or 60s. So just having that connection and seeing, you know, the outreach and people's willingness to share their experiences. It just means the world to us and just makes us feel like we're part of a strong community.

Scott Benner 1:13:30
So would you say that the most important things are strong technology tools, understanding how to manage yourself and a connection to others? Yeah,

Speaker 1 1:13:39
technology for sure. And knowing how to leverage it, and then the community and that community is your friends, your family caregivers, you know, for me, the Medtronic champions community, you know, all those resources that are out there to, you know, help guide away, but then help help you keep abreast on you know, the new things that are coming down the pipe, and to give you hope for eventually, you know, that we can find a cure. You

Scott Benner 1:14:01
mentioned that your son wanted to be a pilot. He also has type one diabetes, how old was he when he was diagnosed?

Speaker 1 1:14:07
So Henry was diagnosed when he was 12 years old, was just at the start of COVID. We are actually visiting my in laws in Tennessee, we woke up in the morning and he had his bed. And several years before that, we had all four of our boys tested for TrialNet. So you know, predictor of whether or not they're going to develop type one diabetes and whether or Henry and one of his brothers tested positive for a lot of the indicators. So we always kind of had an inclination that there was a high degree of possibility he would develop it, but we always had at the back of our mind as well. And so when that event happened, at the beginning of COVID, we had him take his blood sugar on my glucometer and it was over 400 And so right away, we knew that without even being diagnosed properly by endocrinologist that he was a type one diabetic, so we hurried home to get him properly diagnosed in Charlottesville, and then we just start Did the process first grieving, but then acceptance and, you know, his eventual becoming part of the team that nobody wants to join? How old is he now? He's 15 years old. Now,

Scott Benner 1:15:13
when's the first time he came to you? And said, Is this going to stop me from flying? Almost

Speaker 1 1:15:19
immediately. So like me, he's he always had aspirations of flying. In fact, he out of all four boys wanted to be in the military, that was a difficult part of the conversation and maybe something that we don't talk about as a community. But there are some things you cannot do as a type one diabetic, and that's a hard fact of life. And unfortunately, joining the military is one of those hard and fast things you cannot be you cannot join the military as a type one diabetic. So it was very difficult for him and for me and my wife to get over. Then we also started talking about being a commercial pilot. So I saw that same excitement in his eyes because like me, you know, he can be an NFA teen or a 737 or a Cirrus SR 20 That I fly, be just as happy. So he still has that passion today and still very much plans to eventually become a commercial pilot.

Scott Benner 1:16:04
I appreciate your sharing that with me. Thank you. You have four children do any others have type one?

Speaker 1 1:16:09
They do? My oldest twin Henry has type one diabetes, and my middle son Charlie has type one diabetes as well. The boys are twins. The oldest two are twins. One has type one diabetes. My middle son, who is not a twin has type one diabetes.

Scott Benner 1:16:23
I see. Is there any other autoimmune in your family? There isn't

Speaker 1 1:16:26
I'm really the only person in my family or my wife's family that we know of with any sort of autoimmune disease, certainly type one diabetes. So unfortunately, I was the first to strike it rich and unfortunately pass it along to to my sons with celiac thyroid, anything like that. Not about nothing. We're really a pretty healthy family. So this came out of nowhere for myself and for my two sons. That's really

Scott Benner 1:16:51
something. I appreciate your time very much. I appreciate you sharing this with me. Thank you very much.

Unknown Speaker 1:16:55
Anytime Scott.

Scott Benner 1:16:56
Learn more about the Medtronic champion community at Medtronic diabetes.com/juice box or by searching the hashtag Medtronic champion on your favorite social media platform. The episode you just heard was professionally edited by wrong way recording. Wrong way. recording.com