Scott Benner 9/19/22 Scott Benner 9/19/22

#756 Swiss Diabetes

Dr. Gurpreet Anand is an endo practicing in Switzerland.

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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 756 of the Juicebox Podcast.

Today's guest is an endocrinologist working in Switzerland. As a matter of fact, she's the Doctor of a past guest from the podcast. While you're listening today, please remember that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, always consult a physician before making any changes to your health care plan, or becoming bold with insulin. If you're a US resident who has type one diabetes, or is the caregiver of someone with type one, please go to T one D exchange.org. Forward slash juicebox. Join the registry complete the survey help people living with type one diabetes while you help yourself and support the podcast. Every time somebody finishes the survey, the podcast benefits T one D exchange.org. Forward slash juice box. If you're looking for the diabetes Pro Tip series, it begins at episode 210. In your podcast player, your podcast player or audio app is where you should be listening to the show and subscribing. The podcast is available everywhere you get audio

this episode of The Juicebox Podcast is sponsored by touched by type one I just got back from touched by type ones. In person event, it was fantastic. You can learn more about it and learn more about touched by type one at you guessed it touched by type one.org. Also, please find them on Facebook and Instagram. The podcast is also sponsored today by us med get your diabetes supplies from the same place that we get our diabetes supplies from U S med. You can contact us med two ways by going to us med.com forward slash juicebox or by calling 88872115140. That's right, we're not in the same timezone our way. That's true. I appreciate you doing this. Thank you very much.

Gurpreet Anand 2:25
I'm really excited to talk to you and my personal thanks for the good work you are doing and contributing to the diabetes community. It's it's a great work.

Scott Benner 2:37
Oh, thank you so much. That's lovely. I, I don't usually start these with people's being so kind to me, your throw me off my game. I am very, very grateful for your words. Thank you.

Gurpreet Anand 2:49
Scott, you are a change maker. You are changing lives of people suffering from diabetes, and it's a great work. Oh, that's

Scott Benner 2:59
very, that's very kind of you.

Gurpreet Anand 3:01
My name is Gurpreet Anand I work as endocrinologist in Switzerland. Originally I came from India, I did my medicine there. And here I learned internal medicine and after why afterwards I specialized in endocrinology. I have been working in this field for the last eight years. And I'm really happy to be able to contribute to the lives of people, especially people with diabetes type one because it is a very, very difficult disease, but a very manageable disease, the patient can really change the course of the disease. If the patient agrees to do that. I have got two daughters, and my husband. We are actually all from India. My two daughters are born here. As a child, I always wanted to be a doctor. Because I my mother, she was a nursing sister. And she worked in a hospital and I saw the white coat. And I was amazed by the way bytecode and I wanted to use this byte code. That's why I became doctor and I have never regretted this choice. I'd love to be a doctor. How old are you? I am now 48 years old.

Scott Benner 4:27
Okay. I'm sorry. You said you live in Switzerland?

Gurpreet Anand 4:31
Yes, yeah. Okay, for the last 20 years.

Scott Benner 4:33
Oh, wow. That's great. So I have to ask first, I guess how you find the podcast.

Gurpreet Anand 4:42
I find the podcast great. I was introduced to your podcast to my patient because I wanted to know how what were the things which influenced life of my patient and she introduced me to your podcast and then then I started listening Do your podcast. And I was deeply impressed. And I recommended this podcast to some of my patients as well. And even they appreciate the podcast a lot.

Scott Benner 5:10
That's excellent. I have to I'm trying to remember. If I'm going to be able to mention who your patient was, I think it's, it's better for you if we don't say who it is, is that

Gurpreet Anand 5:22
right? Yes. But I think we both know it.

Scott Benner 5:25
Yeah. Well, I know who I definitely know who it is. And yeah, any astute listener of the show might figure it out, I guess. But, yes, but, but that's really wonderful. So she came to you? And or I guess, how does it How does it happen? Are her outcomes so uncommon for you that it actually made you ask, how are you doing this? Or how did the conversation begin?

Gurpreet Anand 5:50
So actually, I asked this question to each and every patient who comes to me for the first time, what is their experience with the disease? What are their goals to achieve with the disease? And that's why I came to know her and I came to know what deeply influenced this person to better manage her diabetes. And then she mentioned your podcast, I say,

Scott Benner 6:16
did it? Was it surprising to you, if when she said, it's from a podcast?

Gurpreet Anand 6:27
Not in a sense, because I'm always myself very impressed with the podcast industry, not only in diabetes world, but also other guys, because technology has made a lot of advancement. And basically, everyone can get information from everywhere if the information is useful. This is something which we should appreciate and support. And I was impressed after I listened to the podcast, because I really didn't believe her for the first time, because I wanted to know what is so good about the podcast? And as I listened to it, I was totally convinced that's true.

Scott Benner 7:09
No, that's lovely. Do I? What's the question? I guess maybe to you, it's not so different. But it was it odd to you that I don't have diabetes.

Gurpreet Anand 7:23
Actually, you are a person who doesn't have diabetes, but has a real contact with someone close to diabetes, and who could really with his own interest, learn so much about diabetes, with even patients without the VT diabetes to manage to have it in in such an appreciable amount of time?

Scott Benner 7:50
I think that I've always thought I guess that the mixture of my desire to help Arden and yeah, my loving concern for her mixed with the, I mean, the benefit of me not actually having diabetes, right, like so you get to kind of figure things out without going through them directly. You know, it's, it's easier to philosophize about how to manage a low blood sugar when your blood sugar is not low. Yeah, I can see. I mean, obviously, through the years and the conversations, how difficult it must be for people to not understand how their type one works, not understand how their insulin works, be caught in the situation and then be expected on top of all that to figure out the situation. It's just it's a, almost an insurmountable task.

Gurpreet Anand 8:41
Yeah, you're absolutely right. I think the problem is, in in case of type one diabetes, that there is a person with diabetes to be managed, and there is diabetes to be managed. These are two different things. And it is very difficult to separate one from the other.

Scott Benner 9:02
How frequently are people's personalities? A speed bump for them having success? I mean, what do I mean? Are there just some people who, through the sheer fact that they don't want diabetes, or they have, you know, some sort of I don't know if you would call it PTSD, but they're still shocked from their diagnosis, or angry does? Does that stuff weigh in very heavily when you're helping people?

Gurpreet Anand 9:36
Actually, in my experience, this is the main factor influencing outcome of diabetes because as you know, we have technology we have sensors, we have insulin pens, we have insulin pumps, we have hybrid closed loop systems, we have everything which can manage diabetes, but if the patient who has to To really get to know this technology and invest some time, it's not ready. Nothing works. It is the patient is for me, the main factor affecting outcome of diabetes and diabetes denial is so common. In the beginning at least, that it really it's the greatest barrier people used to call hyperglycemia as the greatest barrier. But I would say, acceptance of the disease, which is potentially manageable is the greatest barrier

Scott Benner 10:35
and not accepting it. There's real no click, there's no clear path to success if you're fighting against this the entire time. Yeah, right. It's going to win, right? It's just, it's got more stamina than you do. You know, diabetes doesn't need to sleep. And it can come after you when you're sleeping. Or, you know, in the middle of things, I'll tell you right now, like, break right now, as we're speaking, Arden is on a class trip. So she left. It didn't start well, and you knew it wasn't gonna start? Well, she had to be at her school at 1:30am. And then they sat them there for an hour, put them on a bus, bus them to an airport, sat them in the airport. And you know, by 615 in the morning, she's climbing on a plane for a three hour flight. Now, she hasn't been asleep, probably for close to 24 hours at the time that the plane takes off. And you know, we had had just multiple conversations and like art, and you're probably gonna get low on the plane when you close your eyes after all this. And sure enough, she did. Her CGM woke her up, she was able to handle it fine. There was no Wi Fi on the plane. So quite literally, no one knew that this was happening. But her, you know, in her seatmate who was a longtime friend, she managed that fine, she got out of the airport fine back on another bus. And then they dropped the kids in the middle of the Disney, I think Disney World, right? That's Florida, Disney World. It's 60, you know, between 50 and 60 degrees warmer in Disney than it was when she left New Jersey. And she's not allowed to go into her room for hours. And they just start marching around this park and the heat. And we did a good job. Like it wasn't too bad, we kept her blood sugars together. They weren't anything like what they usually look like here. But by the end of the evening, she tried to eat something she Bolus for it. And, you know, then the next five hours 10pm 1112 one two in the morning, we were just holding on with our you know, with our fingernails, trying to keep our blood sugar above about 65. And finally, at about one 130 In the morning, it just, it just kept dipping down and we couldn't stop it. And this is with an algorithm like taking her Basal away and trying. We got her stable, she slept fine overnight. And now this morning, with just a few hours rest, everything is much more stable. And I'm learning because this is a new situation. For me. I honestly think that her lack of sleep was the biggest problem in this whole thing. Because now that she's arrested, we haven't changed anything, she's back out in the heat and things are going very well again. I just I'm surprised every day at how this thing can throw monkey wrenches into the system because I'm about as good at this as somebody can be. And we were not good at it yesterday for about six or seven hours. But it is really testing my knowledge today. It's I don't know, I just I don't know how she would have gone and done this without this technology or someone helping her. I mean, without this stuff, she would have been, I would say scary or dangerously low two or three times already in the last 24 hours.

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Gurpreet Anand 16:52
Scott, thanks for sharing that with me. Because I think this is a perfect example of technology working at its best person who knows the technology working at the best. But still, blood sugar has some inherent variability in Saline application has some inherent variability. And we have to learn to accept that, that there are going to be situations where we do have 100%, right. And the result is still not what we want. And we have to be really fluid flexible as you always tell just flow with the flow of diabetes because you cannot manage it perfectly well in all the situations there are situations which are going to surprise you time and time again. And this we can imagine how difficult it could be for people who don't even know what they can do. They can change I would

Scott Benner 17:57
like people to know when I told the story so that I could follow up with this is that when she was drinking the juice overnight, the the school had hired a nurse so there's a nurse living on the floor, you know of the hotel, and that nurses She's lovely. She's following Arden CGM. And I had called Arden to wake her up the nurse would have not known at that time that I was awake watching Arden's blood sugar. And I called out and woke her up, had her drinking juice. And at the same time I heard the nurse come into the hotel room. And she was speaking to her and she's like, are you talking to your dad on the phone and it was happening at that exchange right there. I want to be honest, that is the closest I came to crying in quite some time around diabetes, just that it was the middle of the night and Arden was trying to be on this class trip. And instead, you know, there's a stranger standing in her hotel room seeing if she's okay. I almost cried. I just listening to the exchange over my phone. And instead I reminded myself that without this technology, this would have been much worse that I knew what to do. And she knew what to do. Arden's been doing a terrific job while she was gone, and in the end, she has type one diabetes, and that is the factor I can't impact like that's always going to exist. I can't I can't sit there and be sad about something that I want. That doesn't exist, you know, so I decided to deal in the reality of what was and I pushed on my eyes and wipe the tears away and got her back on the phone and told her you know, I was going to watch to make sure her blood sugar came back up before I went to sleep and she should go ahead and go back to sleep and her blood sugar came back up and leveled off and we were good. But yeah, she's had diabetes since she was two. I don't really remember the last time it made me sad but but last night came pretty close. Yeah, yeah.

Gurpreet Anand 19:59
I can really only share my feelings because I personally have no experience with someone close having type one diabetes, I have patients. That's true, but I never experienced hyperglycemia. On my own I experienced with my patients, yes, but it is an entirely different different experience. If you have this experience in person. It can be a close patient, it can be your relative, and it is absolutely a different reality. Because once you experience hyperglycemia, every patient processes hyperglycemia in his or her own different way. Some people they don't want to have another episode of hypoglycemia. And that's why they keep their blood sugar levels high so that they don't fall. That is one barrier to better management of diabetes. The second barrier is once they even see the blood sugar level is just sinking. They overcorrect because they don't want blood sugar to follow. These are so many difficult issues which patients face. That it really sometimes

Unknown Speaker 21:23
it's very difficult to convince the patients

Gurpreet Anand 21:24
to do the right thing,

Scott Benner 21:26
right? It's paralyzing it stops you. Yes, I'll tell you the most proud I've been in quite some time is this morning when I woke up and saw that Arden had had breakfast, she Bolus for 50 carbs, and texted me later and said I said I got a bagel and ate some mixed fruit. My blood sugar was I forget what it was like 136 When I woke up, and she's like it's going down. Now, I don't know if this is going to go right. And I looked at it. And I said, this looks great to me. I said we've we dialed back or settings about 20% for the day for her to be out in the heat walking around. So because she's on an algorithm, basically, everything's dialed back 20% Her Basal correction factors, carb ratios, everything's just kind of dialed back right now. And I said, I'm looking at the graph, it looks very much like it's gonna level out to me, I think you did a great job. And now this a number of hours ago, she's, she's been very stable about at 115 bout between 112 and 116 for the last two and a half hours. But she did not act scared that she got up in the morning. And she did what she knew was right again, and just went right back to it. She was a little nervous. But I think the nervousness was, it's because she's alone. And she's still about to go out and live a day that is not normal for her trudging around the heat, you know, for however long they're going to be doing this. But I was proud of her that she just she didn't blink, she did it again. And, and did a good job. So I think it's there. You know, I don't think there's any shame in leaving her blood sugar a little higher for today. Yes. And I know that some people might hear that and think, you know, that's ridiculous. I'm saying like 112 is a little higher, but for her it is it's it's probably 20 points higher. You know, which is a pretty big deal for, you know, long term, but for the next couple days is meaningless. So anyway, I was proud of her that she she got back out there and tried it again, like she she doesn't give up. And she's knows what it's like to be low. And you know, so far so good. Nothing's happened. That scared her too much. But I've also spoken to adults that have had such scary. Like you said, you know, such scary situations where they were alone that they just have a hard time trying again, how is it for you to? But I guess my first question should be do you treat all of your patients with the same information? Or do you tailor tailor it to what you believe they can manage and accept?

Gurpreet Anand 24:10
This is a great question. I think it is impossible to treat, all type fine one patients alike. Because every type one patient brings a completely different kinds of resources to the consultation. And I have to accept and respect the values because everyone is going to reach the goal, which he or her self establishes the goal because the diabetes management is management to the patient himself. I am just a coach. I'm just an advisor who can help give basic understanding about diabetes. But the management is left to the patient himself because he has to deal with the diabetes 24/7. And I have to deal with the diabetes every three months. And it's an entirely different situation.

Scott Benner 25:08
Yeah. So what do you give them? Like a high level overview and hope that they pick out the details? Or do you do literally look like? Is that a weird thing to have to do to judge somebody because you are quietly judging their ability, right? So that you can make, I don't mean judging in a bad way. I mean, it like you have to assess them, and decide what they can handle. Is that right?

Gurpreet Anand 25:36
That's right. So it is different in every scenario. For example, let's take the example of someone who has a new diagnosis of type one diabetes and comes to my consultation for the first time. The first reflex from me is to just get to know this person, how this person is coping with the new diagnosis, it is mostly a shock for everyone who has the diagnosis. So it is okay to talk about this shock, shock or believe it the patient tell them that it is a shock for most of the patients. So it is normal, just normalize the shock situation because it is normal for each and every one who is going to have diabetes, especially type one diabetes, and then tell them that it is a slow process to get to know the disease to get to know how to manage the disease, but it is going to get better each and every day, we mostly treat the type one diabetes patient on ambulatory basis. Early earlier patients used to get hospitalized. But nowadays, it is so much ambulatory management, they have to come to the diabetes nurses, they have to come quite regularly in the beginning so that they know how they manage hyperglycemia how they managed hyperglycemia. This is kind of repeated education on on a daily basis in the beginning. And afterwards, we can change the frequency and see the patients every month afterwards every three months. But it is a process they have to go through the process. And I tried to give them the analogy of driving a car, it is very overwhelming in the beginning, because you have to understand that you don't speed up the car, you know how to put on the brakes. These are the things they have to learn in the diabetes as well. Sometimes they have to come off the mark. But there is also a learning and they learn how to apply brake slowly, they learn how to push the gas pedal fast, they learn and it gets better, but it needs time.

Scott Benner 28:03
I understand why you like the podcast you and I think a lot like about these things, don't we have you

Gurpreet Anand 28:11
I can also really say yes to that because I think we as human beings. We want to live life normally. And if we can bring the understanding of diabetes same as how we live our lives, we can get the patients to understand better what what they expect from the disease, what they expect from themselves. But what I mostly end on a positive note is that everything you do has a consequence, if you decide to treat the disease, it is your choice. If you don't decide to treat the disease, it is also a choice. You cannot not decide you have to decide something and you're going to see some results.

Scott Benner 29:00
It's not happening to you as much as you're deciding which path to take once it becomes clear that this is your story and you have to go live it. Yes. This is kind of an odd question. But do you ever walk into a room and just not recognize a patient? Like I'm trying to think of how hard is it to keep everybody's story straight in your head? I realize you take notes and you have charts. But do you ever just walk in and think like I do not remember her and then have to look down? And because if you don't I mean you're in a really interesting relationship. Because you see a lot of people, they see one doctor. So in their minds, you've probably been thinking about them for the last 90 days. And you're just waiting to see them again and help them like that's the attitude you come into a doctor's appointment with like you have questions. You've learned things you have, you know, new ideas to try. And then you look up and this person who hasn't seen you in three months is standing in front of you I was wondering how difficult that is as a physician.

Gurpreet Anand 30:04
So, my personal take is definitely I don't remember all the stories in my head. That's why I take notes. But I try to remember something in their personality, and try to link that something in the personality with the story. So that I just have some basic cues, because each and every human being likes to be acknowledged as a person, without judging them, just just like something, if someone is a good tennis player, I tried to discuss with them their hobbies as well, because so that they just have the feeling, it is not always the disease, it is the person who has the disease, which is in in main point, because if the person is addressed, the disease gets addressed on its own. Because, basically, if managing the disease is so important to this person, this person is going to manage the disease very well. And I have to address to this person who is coming to me.

Scott Benner 31:15
Yeah, you know, I tell people, what, I have spoken to a number of people privately in my life. I mean, as a matter of fact, I think part of what got me ready to make this podcast is that I used to be a person who others would direct people to, they'd say, Oh, you want to talk to this guy, like, maybe he'll call you and talk to you, like he talked to me. And so there probably have been hundreds of personal phone calls, that would have made great podcast episodes, you know, trying to talk people through new ideas and get their, their minds kind of straight. And what I've noticed more often than not, is that the desire to do well, is maybe one of the most important parts of this. And I guess you could like call that attitude or, you know, frame of mind or whatever. But if you if you want this to go well, and you have successfully searched down good information and tools and an understanding of how to use them, usually things do go well, you know, and the level of what well means, you know, you've pointed out very clearly is up to the person. And I tell people all the time when they're talking about like, how do I set my basil, I learned to say, basil, his job is to hold your blood sugar stable at a number you want it at? You know, because the number I want it to sit stable, I might be different than yours for a number of reasons. But I just think that I can't put my finger on it. You know, exactly. I don't think I can articulate it perfectly. But the people who want it did go well. I know this doesn't sound completely clear. But oftentimes, they get what they expect. And I find that to be repetitively proven out. People who have their heads down, or they seem over too overwhelmed at the time, you know, might be a way to say it might be they're not ready for the information. It's just it overwhelms them too much. But there's something about that energy that like I'm going to do this. It's important. You know, I guess the in AAA they call it fake it till you make it. Right. But I think it's important. I think that that attitude is it's one of the tools.

Gurpreet Anand 33:44
You're absolutely right. I can tell you an example from a patient who came to me, he had a bipolar disorder. And he got the second diagnosis of type one diabetes. So it was very, very hard, because he was already finding it very difficult to manage bipolar disorder. So the diabetes was on top of it. He was also the patient I had to take in. I had to admit the patient just to let him know the basics of treating diabetes first. And it was very difficult, but I talked to him, I told him in the beginning. It is difficult, but it gets easier. When you see you can establish a routine. And it starts with the looks like a lot. But if we break all the pieces down to very basic information, it gets easier and easier. And luckily this patient has gone into the honeymoon phase and he's still in the honeymoon phase and he has very little amount of insulin and is so stable, what my motivation is with the new diagnosis of type one diabetes, because I have seen that in so many people nowadays, that I stress the need of starting in Saline, as soon as possible to just make a few beta cells which produce insulin in pancreas to just give them the chance to survive the insult, because in the end, we don't know what kind of insult happens in a patient with type one diabetes, how early are we can we save some beta cells, and if we can save some beta cells, this is like a big, big advantage for type one diabetes patients, because these patients are going to have much better time managing the disease if the start or the end, mostly, people see that it works very well. My second motivation is even though they are in a shock situation, by the new diagnosis, I tell them, the body is going to give them much better fitness segments. As soon as the blood sugar values are not in 20s. So we use the unit's 20 millimoles per liter. And it is in the range of four to seven, they are going to see a difference. And that's so true. It is very important to tell Typhon patients in the beginning, not about complications, but about the quality of life, because that is something they can relate to it in the immediate period, if they really put efforts to it.

Scott Benner 36:53
I wonder sometimes if people's lives have gone, so unlike they've hoped that they don't imagine that this is possible. Do you know what I mean? Like hope is Hope is something that sometimes built from hope. So if your life has gone, you know about the way you've hoped or the way you've expected, and then you run into this diagnosis, I bet you it's easier to believe that this can work out well for you as as you know, too. But if everything has just gone wrong over and over and over again, and then on top of this, you have I mean, think about bipolar disorder, and then type one diabetes. I mean, I wonder where you mind that hope from? You know, and that's where it's obvious it has to come from the physician, or the or the support system? Because they they don't have it to use, somebody has to give it to them. Yeah, that sounds incredibly thoughtful. Have you I've had at least three or four people on the show who have bipolar and type one. auto immune, inflammation, these things. It's a real it's a real scourge on humanity, that, you know, the idea that we have not found a way yet to, to stop that autoimmune response is, I mean, it would just be one of the greatest things that happen to people. There's part of me that's very hopeful that AI sounds crazy, maybe but that COVID has shined a light on the need for research. And I think I think maybe now that COVID is is omnipresent. I really, really think that we might get some more answers about how inflammation works and how to stop it over the next handful of years. But it's just it's terrible. I mean, to have one or two. I mean, they feel like your body's attacking you on multiple fronts is it's overwhelming. Yeah, yeah. Okay, so what? This is the fun part, when I talk to a doctor, what do I do that you think is right? And do you do I ever say things that you're like, Oh, God, don't say that.

Gurpreet Anand 39:11
Do you mean as a patient?

Scott Benner 39:12
I mean, as a as a podcaster? When you're listening to this podcast, do you ever think like, he shouldn't be saying that? Or do you generally speaking, agree how what's your experience like as a listener, I guess?

Gurpreet Anand 39:28
I must say, I generally agree because because you resonate with the people having this difficult to see is and I have the feeling. All your advice comes from a different level of experience, because you talk openly about your experience with Arden. And what I particularly like are your podcasts with Jenny Smith, because she brings some input From her experiences well into the podcast, and I literally love your podcast.

Scott Benner 40:08
Thank you. I was, I didn't know, I honestly didn't know what you're gonna say. But I mean, I would have been interesting. If I was you're like, oh, never say this again. But the wait. So the way I sort of see it, it's, um, you have to understand you mentioned earlier that the medium is valuable. Like, you have to understand that 100 years ago, if I had information that I thought I was going to share with people, that maybe the best I could do is to write it down somewhere and hope they saw it, or stand in the middle of town on top of a, you know, a crate and yell out to them. This, this is, this is the best way we have to communicate right now on stuff like this. And but I shouldn't have said that, I should say, but, but there are constantly new people coming into it. So you have to create this entity that has the information, but is entertaining enough to hold people as listeners. And the reason that's important is because if the podcast doesn't exist as a popular entity, then when new people need the information, it won't be here for them. So so the stuff with Jenny, the management stuff, or when we talk specifically about management stuff, there's an argument to be made that you could just make those episodes. And you wouldn't need the interviews with other people, although I do think communities a huge portion of managing type on but the problem is, is that if it was just the static information, people wouldn't find their way to it. So you have to create this kind of living entertainment that brings people in so that once they're here, they can go find the guy in the corner who's standing on the woodbox yelling with Jenny about Pre-Bolus thing. And it's a, it's a delicate balance. It really is. I think that's where we go wrong. A lot of times helping people with diabetes is that we say things like, oh, that's on a website, or you know, here's a pamphlet, people aren't attracted to stuff like that. And they're already in a bad situation. And now you're telling them go read a pamphlet, go read a book. I don't want to read a book, I just found out my kid has diabetes, I just found that I have diabetes I want I want this to work, I want to be saved, I don't want to feel like I'm getting my blood sugar's going low every four hours, I don't want to be scared to go to bed, I don't want to be scared to put food in my mouth. And that that turmoil is happening for them 24/7 You need to be able to come in and just give them enough that they can make a meaningful step forward. So that they can believe that there are other steps forward to take. And then you just sort of keep layering the information over top of them and they and then they absorb it as they can because then that's the next problem for me is that everyone who's listening isn't in the same place. So I can only put out one set of episodes. And they somehow need to capture the imagination, invigorate the hope of and hold the attention so that people can spend enough time inside of a ticket out of it what they need. It's a it's a unique platform that allows for all that to happen. I'm very grateful for it because I used to write about this stuff, and it's not as effective.

Gurpreet Anand 43:36
Scott, do you know why is it effective?

Scott Benner 43:42
Well, I can start off by joking and saying I'm delightful. And that's why. No, no.

Gurpreet Anand 43:49
That's absolutely right. But I give you another reason. Out of my perspective. We as humans, have not changed a lot over 200 years. We used to value word of mouth, we still value word of mouth. We used to value something valuable for us. We still value something valuable for us. If someone some patient with type one diabetes, find value in your podcast. No one is going to prevent him from listening to your podcast. That is the main important message you want to be of value and you enjoy doing it. And you bring your authenticity to it. And that's why your podcast is so valuable.

Scott Benner 44:45
Oh, that's very nice. I am I do really? I really do enjoy making it. I am genuinely fascinated when I talk to people. I don't think I've ever had a conversation on here where I've But gotten off and thought, Well, what a waste of time, you know, like, I just want to get to know somebody or to hear their specific story for people to get there to get there to be able to get their thoughts out, you know, there's someone else listening who thinks something similar. And there's just such a, there's such a comfort in hearing someone else say something that you're thinking, you know, and to, until be able to give that to people who are in such turmoil at some point, I think it's a gift really, I am, I never, you know, as a as a kid growing up, or even as an adult. You know, I think we all think the same way, right? We're trying to sustain ourselves, I'm trying to make money, I'm trying to buy food, I'm trying to put a roof over my head and help my children. And, you know, there are times when you come to the conclusion, like, I'm going to have to take a job because it pays me to expect that your job would actually help somebody would be a huge win. If you had a job that you didn't like, that helps somebody, it would be a huge win. But to have a job that you like, that helps somebody and puts a roof over your head. I couldn't possibly feel more lucky about that. And that's why I work so hard to keep it going. Because I a see what it does for people. But honestly, it's the best situation I've ever been in. You know, I don't, I don't want this to stop. And the only way I get to keep it going is if it continues to innovate and help people and find ways to new newer people and find ways to to keep older listeners entertained and with value. Like I don't want to just come on here and say stupid. You know what I mean? Like just for people to come on. Like, I want you to leave this hour feeling heard and seen. I want you to feel like you learned something that's going to be valuable to you. And I want you to feel like it wasn't a drudgery to get to that information. I don't know I love this. I guess you're right. I guess if it was a couple of 100 years ago, I think I would probably be doing some form of this get on talking to people, I really do enjoy it.

Gurpreet Anand 47:19
You would have been surrounded by a group of people like a campfire. All Okay, one patient's just surrounding you, and asking you for your advice. I can really imagine that team.

Scott Benner 47:33
Well, that would be nice to do it

Gurpreet Anand 47:35
beautifully.

Scott Benner 47:36
Thank you, it would be nice because I could stand up while I'm doing it. Because I'll tell you the one downside of this job is I am sitting too much. So I do need to get up and move around a little bit.

Gurpreet Anand 47:47
That's, that's important for your health.

Scott Benner 47:49
Yeah, you guys are gonna kill me making this if I if I ever if I go over while I'm making it all, I'll teach someone in the house how to put the episode up so people can still hear it. But But No, but seriously, it's it's a joy. But it really is a joy to do. And you have to be a little single minded about it too. I record this show, I mean, at least four times a week. There are times when I do it twice a day. My schedule is I mean, you and I are talking in February, if you wanted to be on the show right now. I think you'd have to book in November. Yeah. So it's, and that's that's the part of it that doesn't get spoken about enough. It's the people's willingness to come on and share or ask questions. It's the only way other people are going to get the content. You know, if there's no one for me to talk to this ends pretty quickly. You know, you eventually get tired of me talking to Jenny. We're talking to myself.

Gurpreet Anand 48:55
I think as long as you are offering your hard work, you're offering your interest, you are never tired of talking about diabetes. We can feel it in your podcast. That is so important because the way you do it, you bring freshness to the podcast, you bring value for your audience, and that is all which matters in the end. In the end it is the value added to your audience so that they really find it worth listening to your podcast. And that is the biggest multiplier you have. If your audience finds value, it's going to attract even more audience and satisfy your podcast is going to keep on living and I would really wish your podcast to keep on living because it is helping coming community of diabetes type one patients

Scott Benner 49:53
I have to tell you that you know there is an avalanche of notes and letters and even on the Facebook page at this point, I think that's how most people try to contact me. At this point, there's an overwhelming number of people who are a little farther down the road now, and they come back to tell their story about, oh, I found the show six months ago and like, look where I am now. And they're sharing their, you know, their successes. And I think that's great. I think that other people need to see, they need to see someone that's a little ahead of them on the path, having success, telling them, I used to be back there with you. But I really think you could be up here with me. And the truth is about the value. So So sort of a weird business, the side of it is that if people didn't listen, I couldn't make the show. And so it's their support that creates the value. And one specific example is, like we're doing a series right now about thyroid disorder, right? On Fridays, Jenny and I are like putting out these short episodes explaining hyper and hypothyroidism, Graves disease to people, which is something that is incredibly common in a type one, you know, diagnosis, and people don't have the information about it. And oftentimes, doctors are not particularly good at managing it either. But it's not. It's not a it's not at the top of people's minds. So my ability to dig down and do smaller topics, is because I know the listeners will support it. So you know, all of the all of the kindness aside about how the podcast helps people and, and how much I enjoyed doing it and all of that, there's still that component of it, that if it doesn't get downloads, then advertisers go away. And when advertisers go away, my wife is going to ask me to make money a different way. You know what I mean? And then the podcast disappears. So it's people supportive the podcast, their willingness to listen to topics that maybe, maybe they wouldn't believe is important to them. But I think they find the podcast valuable enough that if I put something out, they think, Well, if he's telling us about this, maybe I should listen. And, you know, when we're done with thyroid, we're going to do celiac. And, you know, we're going to continue to pick through things like that there, that are going to come up in a lot of people's lives, and they should know how to look for it and, and how to manage it if it should happen. But again, that doesn't exist without the support of the people listening, you know, if they don't, if they don't download the show and listen to it, then I can't keep making it. So it's really as much about their effort as it is about mine. As far as longevity goes.

Gurpreet Anand 52:45
Yeah, you're absolutely right. I don't know whether we are ever going to come to this. My main reason for coming to this podcast was to tell community of type one diabetes patients one tank, and that one thing is their management of type one diabetes, and their management of their own life is going to be totally aligned. If they are having a good life, they are going to manage their diabetes better. There is no question about it. If they're having difficulties in their lives, it is almost impossible to get the diabetes well managed, because diabetes and life go goes hand in hand. And that is very important for type one diabetes patients to know that means if their life is not going well, they can intentionally put some efforts to manage the diabetes well, because it is going to have repercussions in their lives. The same goes the other way around. If they are managing their life, well, they are going to get the motivation to keep the diabetes well as well. And it is very important. That's why to have good routines. That means if they know how to manage situations with hyperglycemia, if they know how to manage situations with hypoglycemia, and they keep on doing it, they are going to do it almost the same way in difficult situations. But it doesn't happen if the life gets difficult. And they start then to manage diabetes. Well it doesn't go this way. Because in periods of difficulties, we as human beings are at our worst. Only when we we are feeding Good, we are feeling happy we find life worthy living, we are at our best. So that's why there is another reason for type one diabetes patients to just gather enough courage at the maximum diagnosis of diabetes, to invest some time and effort to get to know the disease so well, so that they can manage it. Because ultimately, they are the manager of the diabetes, and they can do it with today's technology, we have so much support. So many things get managed very, very well.

Scott Benner 55:41
Are you also talking about the personal happiness and contentment, calm? Things like that? Are you talking about just a general ease in their life, staying away from people who are difficult to on their psyche? Jobs that make them upset, like how far are you talking about this about having life in a good place, so that the management can be easier.

Gurpreet Anand 56:11
It is actually on a very, very broad face. That means if they each and every one among us, wants to have some control in our life, on this disease, and if we have this feeling of control, a feeling that we can manage the situation, it is a very different feeling of contentment. And it goes so much for life. If if I can tell, I can choose my profession, I can choose my lifestyle, I can choose and manage everything the way I want. That is contentment. It is true for diabetes, as it is true for life. So just imagine if you have to do a job, which you don't like to do, that is almost guaranteed discontentment for your whole life.

Scott Benner 57:10
But when you when you're given diabetes, almost like a job that you don't want to do, then the key after that is to find a way to do it in the easiest, most comfortable way for you, so you're not fighting against it constantly.

Gurpreet Anand 57:29
There again, I try to give an example to my patients, I tell them, Look, this is not a disease, which any human being is going to choose. It just comes and when it is there, there is a choice to be made to manage it. Or let the disease manage itself. And it is far better to manage the disease yourself. Because then you can have phases where you can decide, okay, now I'm not feeling very good in my life. Now I'm deciding to just ignore the management of diabetes, but you have the control, you have already managed it. Well, it would be very difficult, then for you to manage it badly.

Scott Benner 58:26
Yeah. And then from there, then that's when you need to know, like, what's next. Like when you've made the decision, like I'm going to do this well, like I'm gonna put in the effort. And I'm I want these results. The truth is that you can put in a lot of effort in the wrong way. And it just ends up being frustrating. I think that's why I can't believe I'm going to say this year, but I think that's why those pro tip episodes with Jenny and I are so important because you have to know how to let lay down that foundation like okay, I've decided, I'm going to build a new house for myself now. What's the foundation look like? How do I get the walls up? How do I get the roof on? How do I do this in the right order? You know, how do I stop myself from, you know, trying to I don't know, you know, nail in a screw and I need a screwdriver. Like you have to understand the tools for the job, how to build that foundation. And then once you do that everything you're talking about becomes much, much easier. Yes, so I guess cliched to say but you want to put the work in up front so that you can enjoy it afterwards. You know, it's hard to build a house. It's harder to live 20 years in a refrigerator box. So, you know spend three months in the beginning, getting a roof over your head, and then that kind of happiness and ease that you're looking for is so much easier to find and maintain. It's just you got to put the work in I'm always a little saddened when people reach out out to me and say, Look, I hear everybody saying this podcast is helpful, but I don't have time. And I always answer them, like, very honestly, I'm like, honestly, I think you, you don't have time not to like you have to give time to this. Yes, you know, do a little work now. And, and the rest of the time is much easier. Can I Can I ask you a question that might have nothing to do with this, but sort of does? In your culture? I'm, I'm speaking specifically about in the Indian culture, there's a wave of type two diabetes. Is that surprising to you? Is it? Is it something you can put your finger on? Like, why does it happen?

Gurpreet Anand 1:00:42
That's a good question. It depends upon our basic change in eating habits in India now. And the ethnic relationship to beta cell mass. People in Asia, they are from their ethnic built, they are thin people. And nowadays, with change of eating habits, they tend to get more fat deposit on the abdomen. And that's why type two diabetes incidence is exploding in India, China, because these people have changed their eating habits to more or less to the western culture. And their body is not adapted to store fat in healthy places, they store fat in the abdomen, and they get very easily type two diabetes,

Scott Benner 1:01:43
I have to say that I live in a part of in the United States where there's a pretty large Indian population around me. And my daughter has a number of friends who are Indian, so we get to see Indian families. And I think that the one thing I've noticed, is when people immigrate into, into the US, that the availability of food, and it being so everywhere, you know, it's so easy to go to a restaurant or to a store and buy things. They they sometimes people fall into that trap of just Oh, it's you know what I mean? They're always at restaurants, or they're always doing this or that. And it's, I don't know, I see it, I see it a lot, honestly. And I hear all them talking about my husband has type two, my wife has type two. But you know, I just didn't I don't completely understand it. I thought maybe you'd be in a unique position to explain it. So I appreciate that very much. It's a so that you're saying the thing to do is just eat cleaner, eat healthier, and exercise, try to keep that that weight off your abdomen.

Gurpreet Anand 1:02:58
That is true. Yeah, eat healthier, and sometimes also plan some phases with which you just don't eat. Like time restricted feeding. Because in our culture nowadays, it is getting more and more importance because people are snacking almost every time. They have snack in the afternoon, they are having their main course meals. That's too much storage happening in our body, whichever body doesn't need because we have the move of ourselves.

Scott Benner 1:03:30
Yeah, I believe that, that restricted time eating is is helping me a lot as I get older. I try I try very hard to eat between like 11am and 7pm. It's the best I can. And it's a big deal. Like I've noticed a great benefit for myself. So far. Okay, so is there anything that we haven't talked about that you wanted to have I skipped over anything or, you know, do you feel Do you feel a calling to say anything else, I want to make sure that you that you get everything you want out of this experience?

Gurpreet Anand 1:04:05
I just want to tell your audience that in the management of diabetes, the most important variable is not diabetes. It is the patient himself. If he thinks it is verted to manage the disease, whole technology doctors they are available to help you but the first step has to be taken from you. If you tell you want to manage this disease, this disease can be managed very well. Nowadays, a patient with 6% Hva warranty can have 116 years to develop long term complications. That means long term complications out of the picture. Nowadays, it is the question how well we can live despite the stack font diabetes, and it is possible to live an absolutely normal life, but it comes with the price of getting a different routine established and following this routine. Your whole life. That is the hot price.

Scott Benner 1:05:27
Okay. Yeah, I appreciate that so much. I can't tell you I. I have I am so sorry. If you give me a question, hold on one second. It's gonna be kind of strange. But Arden's trying to call me she has a question. So I will hold on to you. And then we'll get back to our conversation for one second, but she's just in an awkward situation. Hold on. Hey, yards, go ahead. So I.

Yep. You can just test one more time. And then yes, just make sure make sure that numbers like not wrong, right. Not right. Do you have other stuff with you? Okay, yeah. So go ahead and just test and then see if have you been sitting on the sensor maybe or something like that? Oh, okay. So go, I'll stay with you while your test, okay.

So I think the thing you're running into is that you Bolus really well for breakfast, but you probably still have some active insulin. And then you're walking around so much. So you might need to do you have one of those bars with you though?

Okay, so you drank the juice when? Yeah, I think so. All right. And then and then just Arden, when you when you go on that ride, stick a juice box in your pocket, make sure you have one with you. Okay. All right, text me when you get back

by. I'm so sorry about that. No problem. I'm gonna tell you what she said in a second. But I also wanted to, I don't want to skip over what you said. You know, I think you're right. I think that for everybody who has access to that technology, they really do hold their own possibilities in their hand, you know, and it is, it's so important not to ignore it. And if you can't get that technology for some reason, I still think that there is a way with targeted testing and paying attention that you can, like you said that you don't need to be running around with a five a one C right. Like a mean what you just said a six a one C is a is a pretty good shot and a long and healthy life. Yeah, so that's important. So where Arden is is that this um, you know, she's, she's in Disney. And she is using their past the the disability pass. So what it allows them to do is to schedule a ride, and then show back up at a certain time to get on the ride. So I think what's happening is she's walking and doing a ton of walking in between, right. So she has this meal this morning, which is a perfect like her Bolus was absolutely terrific for and then they go out and they're walking and then they get the note. Hey, come back to the ride. It's time for you to go. So they're hustling back to the ride and just when that happens, her blood sugar just drops like it just it heads over. So she said to me that I like can I go on this ride still? Because she's, you know, she's like, it's time to go on. Like we've been waiting an hour and a half to get on this ride. It's now our time to go on. And now my blood sugar 65 And I have an arrow down on my Dexcom she's like so I just drank her juice. But I want to know like, Can I can I get on the ride she said I tested a little while ago is 120 and she's like now all of a sudden so she tested again. She got a 60 you know a matching blood sugar on her on her test versus her CGM and She's like, What do I do when I was like, she said, I'm going to eat some gummies, I really want to get on this ride, she's like the juices in, I'm going to eat the gummies. And then I said to her just stuffing other juice in your pocket before you get on. So hopefully, I mean, I have to be honest with this is a real time situation. Hopefully this goes, okay. And I just told her like, you know, get a hold of me when it's over. Now the nurse that's on site actually just texted her to to check on her, it's been very nice that that this person exists. But it's fascinating for me to see, even at a 20% reduction of her insulin, once she's walked around for a couple of hours with any kind of active insulin onboard, it's just, it's hard. It's our settings are obviously are obviously meant for when she's in school. And when she's kind of sedentary, you don't I mean, I'm not moving around very much. It's incredibly, incredibly interesting, I'm going to have her take away another, probably 10 or 15% off of her settings for the rest of the day after she gets back from this. Anyway, it's been a real learning experience for me, I think that um, and her. And I think it's a good example of, you know, you can think you have this thing all together, and then you change a couple of variables, and it almost feels like a completely different existence. Sorry, that'll happen in the middle of your thing.

Gurpreet Anand 1:11:27
No problem. First of all, I just wanted to I just heard your talk. I didn't hurt the art inside, but I heard your talk to the art and she must be proud to have us father.

Scott Benner 1:11:42
Oh, I hope so. I think she is Yeah, I don't know why you're saying that. Because I'm just being myself, but, but I appreciate it.

Gurpreet Anand 1:11:52
You're, but you're just being yourself is so helpful for her. And it relieves her a lot. And she's also actively thinking because it's her disease, she she is managing it perfectly with your health. But you are a great resource for her from the beginning onwards, because she was just too she could not manage the disease at that time. It was you. It is so nice to see such such a good father, who who could learn to manage this difficult disease, and is not only managing that he's offering his help to the whole community. This is worth appreciating Scott,

Scott Benner 1:12:41
thank you. Wow, it's very kind of you, I really do appreciate it. I'm now just sitting here wondering if everything I just said to her is gonna work out. So

Gurpreet Anand 1:12:50
it is going to work out. But one thing I just want you to tell also your community is in case of movement, just shutting the insulin down is not going to help alone, it is definitely going to reduce the amount of further reduction of blood sugar. But there is a need of additional carbohydrates because of a body normally manages also on the basis of two different hormones, which are counter regulating effect of each other. Of a body in case of movement. When our body produces insulin on its own, gets the help of glucagon with activity that means we produce more glucose on our own without supplanting it, supplementing it with food. That's why someone with type one diabetes who is very good managed has to add carbohydrates at regular intervals, especially if there is a lot of activity going on. And this is something which people who love to do sport don't like to supplement every 30 minutes to 60 minutes give themselves some amount of carbohydrates. But this is needed because this is replacing the work of glucagon which of a body can naturally do

Scott Benner 1:14:24
Yeah, yeah I mean there's less than the algorithm does its best right and but taking away insulin taking away and so like you said everything listen, I talked about time, everything about insulin, his timing and amount, right. So as you can see over the last couple of hours, I'm looking at Arden's last three hours 133 101 15 112 112 I mean this goes on two and a half hours, and then all of a sudden she gets a little rise to 125 and then I'm gonna guess and that was a bad About a half an hour ago, I am going to guess that I know what's happening. Her algorithm is set up to auto Bolus. So she hit 125. And it auto Bolus with no concern for the fact that she's walking the whole time. Yes, that's what happened. So I am going to have her turn off the auto Bolus feature. Right think that's going to help her while she's walking around. Okay. And by the way, just for people listening, we're talking about loop. It's just DIY loop that she's using this during this recording. But also, what she called me with was exactly the right thing. She knew what to do. And she did it. She was just looking for confirmation. She was like, Look, can I get on this ride or not. And, and right now we have a diagonal down arrow, which is an indication to me that the carbs hit her. And she's gonna bounce the other way this, this algorithm is going to start bolusing when she gets the 120. And I'm going to let it Bolus a little and then we're going to shut off the the auto Bolus, and I think that might get her through Disney the rest of the way. Okay, cool. Well, I appreciate you helping me with this. And I appreciate all of your insight and your kind words, and the work you're doing for people. We didn't spend any time with it. But someone with your perspective, and your knowledge. And the I mean, obviously, you're just the kind person who sees the, the need for all the things that we talked about today. You know, there are a lot of people who don't get lucky and get good doctors like you. So I appreciate what you're doing as well. And I think it's wonderful.

Gurpreet Anand 1:16:43
Thank you very much, Scott. It was wonderful. Having the opportunity to talk to you and my best wishes for keeping on doing the good work you're already doing.

Scott Benner 1:16:55
Thank you. I appreciate that. I absolutely well, I have no plans on stopping

Well, I'd like to thank you, Preet for coming on the show. This was absolutely terrific. I also want to thank you, us Med and touched by type one, first of all touched by type one.org. It's easy to remember it's easy to type. Go check them out. And then of course us med is that 888-721-1514 Get your diabetes supplies the way we do from us med us med.com forward slash juice box, links in the show notes links at juicebox podcast.com. To these and all the sponsors. If you're enjoying the Juicebox Podcast, please share it with someone else who you think might also enjoy it.

Hey, you can also check out the private Facebook group. For the Juicebox Podcast. It's called Juicebox Podcast type one diabetes. It's a private group that now has nearly 29,000 members in it. You can be one of them. There are people in there with type one diabetes, type two diabetes, there's caregivers, people living with diabetes, all talking together about type one and type two diabetes, how they use insulin, what they eat all kinds of answers to all kinds of questions like if you ever thought to yourself, I don't understand why this blood sugar won't come down. I wish I could ask somebody at Juicebox Podcast type one diabetes on Facebook, you can have as many friends as you like and they'd all be happy to lend a hand. Thank you so much for listening. I'll be back very soon with another episode of The Juicebox Podcast.

#755 Bold Beginnings: Exercise

Scott Benner 9/14/22 Scott Benner 9/14/22

#754 Cattle Drive

Natalie has diabetes but she doesnt know which kind.

+ Click for EPISODE TRANSCRIPT

Scott Benner 0:00
You're listening to Episode 754 of the Juicebox Podcast.

On today's program we'll be speaking with Natalie, who is an adult living with diabetes, she just doesn't know what kind. Why don't you listen and see if we can figure it out together. And while you're doing that, why don't you remember that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, always consult a physician before making any changes to your health care plan. Or becoming bold with insulin. My voice sounds incredibly deep right now. Bold within the Juicebox Podcast O T Wendy exchange.org. Forward slash choose box go head over there and take the survey complete the survey, please. T one D exchange.org. Forward slash juicebox. I know you tell yourself all the time. Oh, I'm gonna do it. And then you forget, but could you please try not to forget this time? Just go do it. Thank you. I don't really have much else here. But there's a lot of music left. What else? Just wasting time. I don't know what to say. podcast is coming. And here we go.

This show is sponsored today by the glucagon that my daughter carries. G voc hypo Penn. Find out more at G voc glucagon.com. Forward slash juicebox. today's podcast is also sponsored by us Med and US med is the place where we get our diabetes supplies. And you could to go to us med.com forward slash juicebox to get your free benefits check. If you don't like using the internet. You could also call 888721151 for getting your diabetes supplies doesn't need to be a hassle.

Natalie 2:11
I'm Natalie, I'm 49 years old, I was diagnosed with gestational diabetes. I've been diagnosed as a T two and labeled uncontrolled and non compliant. I've been suspected to have a lot, which is also known as 1.5. And now we don't know what type I am. So I'm a bit of a mystery at the moment.

Scott Benner 2:32
How long ago did this all begin?

Natalie 2:35
Well, gestational started. My oldest son is now 22. I've had three kiddos. So he was born in 99. And then my daughter was born in 2006. And then my son was 2008. And I think the combo of those two, only 17 months apart, really wreaks havoc with my pancreas.

Scott Benner 3:02
Interesting how nature has devised this amazing thing a female and it's it does this thing, but it didn't seem to plan for what would happen as these little human beings like suck the life out of you over and over. Exactly. You should really have like, I mean, listen, I'm not a deity, but if I was designing the whole thing like after you made the baby you'd be able to go like something like an EV charger situation and like charge yourself back up again. Yeah,

Natalie 3:32
magic wand. Just wave it in the body goes back to exactly how it was. Yeah, great. It really doesn't happen that way. No, not

Scott Benner 3:39
at all. It is fascinating, though, isn't it that you that you're an entity? And in order to make another entity which makes complete sense you have to give of yourself in a way that you don't get back again. It's it's unfair. Honestly, the only thing that balances the scales even a little bit in my opinion, this is just me speaking from my personal relationship is that I have to live with my wife Other than that, I don't see where I'm being tortured the way you guys

Natalie 4:05
well, I've already started brainwashing the youngest that you know, when when mom and dad get old, you have to take care of mom and dad, right? Sure, Mom, I'll take care of you. So I figure if we start the brainwashing now then maybe when I need it, one of them will take care of me in my old age.

Scott Benner 4:22
When my kids were younger, I would just sort of like in passing say, Listen, when mom gets sick of me and kicks me out. I don't want to live above like a pizza place or something. You don't mean like I'm going to need help. So let's say my dad I think yeah, well alright, and so you gave to these ungrateful maybe they're grateful kids? I don't know.

Natalie 4:44
It depends on the day I think.

Scott Benner 4:46
I'll tell you as my kids get older I I'm starting to put them in the same category as dogs. I understand that I've gotten something out of it, but overall, I regret the situation. But seriously, like, so you had these kids, you got gestational diabetes? Did it end after the pregnancy was over?

Natalie 5:09
Yeah. So after the youngest was born, things went back to normal. And I went back and looked at my my readings because I was a nerd and made spreadsheets of my readings when I was pregnant. And, you know, we really, even though it was high, for a non diabetic, it wasn't overly high compared to what I know now, right. So I barely, I rarely got over 200 Even without taking insulin, because at that time, they allowed you to take Glyburide during pregnancy, to help keep your sugar's under control. So things went back to normal, although I did have a doctor at one point tell me that, you know, you're at very high risk for getting type two. And I really didn't want to listen to that. I was in a bit of denial, even though diabetes runs pretty strongly on both sides of my family. So I knew at some point, I would, would be at risk for it, which is why then, about 10 years ago, when I was having a lot of trouble with UTIs. And I went in to have a urine test done. They found glucose in my urine. I wasn't completely surprised. So that was, again, about 10 years ago, diagnosed me as type two because I was very much a stereotypical appearing, type two, little bit overweight. And, you know, it runs in the family. So okay, you've got type two, here you go. Here's your Metformin. So I took the Metformin changed my diet, increase my exercise, but you know, I also had three small kids at home too. So started doing a lot better. Got to the point where I was doing so much better that when my prescriptions ran out for my Metformin, and my test strips, I was just like, Ah, I'm good. I don't need this anymore. And so, I did well, for a while, but then I didn't. And I didn't realize how badly I was doing because I wasn't testing. And I didn't have a doctor checking up on me. And I started to get a lot of not very nice symptoms. I was thirsty all the time, to the point where I would have multiple glasses of water on my nightstand for at night. Then subsequently, I was going to the bathroom constantly. I was crabby all the time, I was hot all the time. And what started to wake me up was I started to wet the bed at night as a grown adult. And my rationale was, well, I'm dreaming about going to the bathroom. So that's why I wet the bed, not realizing that my blood sugar was so high. And the my gums started to bleed. And at that point, I don't know what kind of shook me back to reality. Maybe it was having two accidents in bed at night. And one night. I was like, I can't keep doing this. This is wrong. I know better. And so I called the doctor got a refill of my scripts and my test strips and started taking my Metformin, again started testing my blood sugar again. And by the time I got back into the doctor, I know that my numbers had gone down by the time the doctor saw me. But my agency was 10.2 at that point, with a random number of cloud 260 something and the docs like Nat and pretty sure that you've been hitting five and 600 based on all your symptoms. And we've got to take this serious and that was really a wake up moment for me.

Scott Benner 9:22
Yeah, so I have to be honest, not like the bleeding gums sort of got me. Yeah, but the bedwetting I can see what your I mean, it's fascinating just to go back for a second that you knew about this got on top of it. And then the second you felt better you were like I fixed it or you know, I'm going to ignore it now. So such a common thing.

Natalie 9:46
Well, and everybody tells you right with type two that oh well if you just eat right and exercise, you'll fix yourself. This is all your fault in the first place. Because you ate too much. And if you just eat right and control yourself, you'll be fine. And I was never a, I was never a huge sweets person, I do have a weakness for bread. But so I, you know, I had salty carbs, not sweet carbs, but I was never a binge eater or anything like that, and I wasn't terribly overweight, I was in the overweight category, but not beyond that. So. So yeah, I felt a lot of shame and having it even with my dad having it. Luckily, I have access to all the test strips that I would need. So I had absolutely no excuse for not testing. And funny enough, when I started my career, I actually worked helping diabetics with their glucose meters. So when we talk about, you know, the meters that are big as a brick, I didn't work with with the brick, but I worked with the baby bricks that came after that. And that's actually how we found my dad's diabetes is I had taken one of my meters home, to learn how to use it, so that I could help people on the phone. And when we tested my dad, just a random reading, he was 350. And so he got put on oral meds, that very week, so I knew better. And that's the sad, that's the really sad part of it is I saw the symptoms. I knew it wasn't good. But between the feeling like a failure because I couldn't control it myself, despite the changes that I've made in my lifestyle and my habits, and just denial of not wanting to deal with it. And it was about a year that I wasn't taking meds, and it got it got out of control. Looking back at my numbers, I don't think I was below 200. At any given time, for probably six months.

Scott Benner 12:07
I'm trying to I'm seeing this correlation in my mind, and I don't know how to talk through it exactly. Right. But with a number of things, type two diabetes, a great example. Even COVID is a good example. You know, I think it's pretty obvious at this point, the more comorbidities you have, you know, you have a pretty good possibility that COVID could be harsher on you now, not to say that there aren't people who have, you know, significant comorbidities, and you just make it through, you know, but it's, you know, I think it's, it's, it's showing that direction. The idea that when somebody finds out something that's happening in real time, right now, you have type two diabetes, you you know, you have COVID or COVID 's outside your door, you know what I mean? Like, it's, it's on its way, just to say to somebody, Hey, lose weight, because if you're in better shape, this is going to go better for you. I think that's true. By the way, I think that the better physical condition you're in, the better chance you're going to have to fight off an illness, or the better chance you might have to not develop type two diabetes is an example. But you can't just tell a person, go lose weight. And then six months from now, when that doesn't happen, tell them go lose weight again, like you're not doing anything for them in the moment, I think it has to be a combination of approaches. You know, yet, listen, let's try to get your body in better order. And in the meantime, maybe these medications will help you. Exactly. You know what I mean? I think it's a layered approach, if it's going to work, because most people go through, I mean, you're a reasonable person, I've been speaking to you for 15 minutes. Now you're well thought out, you're considered you don't appear crazy at all. And, and sometimes I sometimes I'm talking to people, I'm like, oh, this person might be crazy. But that's okay. You know, and my point is, is that this happened to you, you went back started strong, fell off, and then then, like, went off a cliff. Like you didn't just slow down a little bit. You were like, ah, like, right, writing it to the end.

Natalie 14:16
Very much so and, and that's a guilt that I carry. Because yeah, my doctors probably could have done more or said something or followed up, hey, why hasn't this patient come in something? But at the same time, I, I knew better but yet, I still let it go on. And then now I feel when I go back and look at that time period, or I look at my numbers. You know, I worry what did that do for me for long term? How can I help other people to not have to go through that? Because yeah, there was a lot of stress going on at work, whatever, but ultimately, if I was testing my blood sugar? I would have known that this is not right.

Scott Benner 15:05
Yeah. I don't know. It's just, I'm endlessly fascinated and not coming to any quick decisions on what I think, by the fact that we are, I think, as a species, very willing most of the time to just be like, Oh, I wonder what will happen? I'll just wait and see, oh, it's too late. No, well didn't work out for me. You know, like, it's a strange thing. I do it like everyone does it, you know, like, I should, I should hang up with you right now, Natalie, the end of this episode should happen right now. And I should go for a walk. I should go ride my bike, there are things I should do. And in the course of a day, it's funny, I've never ignored one of those things. And said to myself, Oh, I'm not going to ride my bike right now, I'm not going to go for a walk, because I don't feel like it. It's because there are a massive amount of things that I am responsible to do. And then when those responsibilities are done, I'm tired.

Natalie 16:10
At the end, you want to take just a few precious moments for yourself every once in

Scott Benner 16:14
a while. And the irony probably is that if I rode the bike first, I could do most of those responsibilities, and maybe not be as tired in the afternoon. Like, I'm caught in this. In this bad decision making, I don't know scheme. You don't I mean, that is set up to kill me.

Natalie 16:33
And it's so easy to say, well, if it was really important, you just make the time for it. True. But I think having the tools to help you make the time for it. Are a luxury that not everybody has.

Scott Benner 16:49
Right? And I'll speak for me, right as a I mean, I don't know how to put this, I guess like, I have some things going for me right like that, that allow me to make time or you know, see a doctor or whatever, like, you know, I have a lot of that. And instead of like enacting it, in my mind, it's always like, if I could just get this stuff done, then I'll do it. Like, I'll take care of myself and like my knee, which people have heard me mentioned probably for six months over the podcast, I gotta go to the doctor, there's something wrong with my knee. But it's not knocking me over. So instead of going the doctor, I'll record with you keep dealing with right, yeah, I'll take something to my son at school that he needs. I'll go watch my daughter do something. Like I'll just keep saying like, well, let me just get this done. I'll get that went off to college, or I'll you know, get this done. And then but I'm telling you right now, when I get them off to college, the next thing I'm going to think is I gotta clean my office. And then after I get my office, like I'm going to like, do that until my knee falls apart and I fall over and then I'm gonna be like, so you know,

Natalie 17:57
go to the doctor and take care of your knees, Scott.

Scott Benner 18:01
Hey, go lose weight, Natalie. So anyway, there's that, that aspect of who we are. I think it's an I think it's a bleed over of what you need to be to survive being alive. You know what I mean? Like, if we didn't have that, that Oh, push forward feeling inside of us? I mean, I think we'd all be, I don't know, at Plymouth Rock wondering how to get over the first river we saw, you know, yeah, yeah. And instead it's like, go, go, go, go, go. And it's easy to step back and see the big picture and go, Okay, well, this is humanity, some people's nice fall off. And you know, they tumble over on the trail, and their friend shoots him in the head with a six iron, and you know, like, and they keep going, and we that's how we're gonna get to Oregon, for example, people are going to be lost along the way. And I get that I really do. Like, I get that when a pack a will to be run away from a lion one of the Willoughby's die so the rest of them can, can keep going. But when I come in and look at a real micro at my life, I don't care about the will to beast. I don't care if we all get the Oregon I'm trying to stay alive. Yeah. And somehow those that that battle inside of us between keep going don't stop and take care of yourself. It's one of the biggest struggles I've seen people deal with.

Natalie 19:32
Yeah, I would agree there that it's so hard to find where the line is between where do I need to sharpen my saw? And and where do I need to keep cutting down this tree?

Scott Benner 19:42
Yeah, look at you. Would you read that? That's smart.

Natalie 19:46
I'm trying to remember what book that was. sharpening the saw

Scott Benner 19:49
took me 10 minutes to say what you said in three words. Now I'm embarrassed. I feel like an idiot. I was like, Why did I go on like that? I could have just said When do I sharpen the saw? And when do I cut the tree? That's really I'm embarrassed right now. This is what embarrassment looks like on me like, Oh, I'm so wordy.

Natalie 20:10
That's why you're good at the podcast. Well, great,

Scott Benner 20:13
except I'm sitting here now going for a walk. I'll be dead you all be better. How's that gonna be good?

Natalie 20:18
Yeah, cuz we can walk while we listen to you. So there's that.

Scott Benner 20:21
No lie. I'm being taken advantage of by all of you. So anyway, so you anyway, so anyway, after 20 minutes, I'm like, Okay, let that all go. Let's keep talking. What a transition Natalie I'm on fire today.

Natalie 20:39
Let's see after I fell off the cliff

Scott Benner 20:49
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Natalie 24:01
Then I really got serious and by serious I mean I was trying my hardest to manage my diabetes. So I did a lot of research, I would ask my doctor about a lot of things. I tried a lot of things I started liraglutide or otherwise known as Victoza about six years ago and that did help me lose a little bit of weight and we'll talk about that here a little bit more in a second. But it really wasn't changing my A onesies. I was living with a onesies in the eights and nines. And again when prepping for this I was looking back at my A onesies and I didn't realize my agency had gone back up to almost as high as what it was when I first fell off the cliff right so at that point, it was a 10.2 I varied anywhere between about seven and a half, and 9.8. Over those years and, and during that time, I was walking three to five miles a day, five to seven days a week, I was doing half marathons every month, five K's were scattered in between, I was exercising a lot on a regular basis. And trying any medication that the doctor suggested with the exception of insulin. I was very, very resistant to starting insulin. Again, partly due to that mentality that, well, if you just work harder, you'll you'll fix yourself and you won't have to go on insulin. The only type twos that go on insulin are the ones that are failures, right. So I tried just about everything I was looking back at my prescription list, I've taken all kinds of oral and injectable medications. I tried intermittent fasting, I read the diabetes code, I read the obesity code, like I said, was exercising a lot. And my agencies were still staying right around the same. And at one point, the doctor even checked, ordered the test for C peptide and antibodies. So that was probably about five years ago. And my antibodies came back negative. And you'll like this in light of our earlier conversation. I never tested my C peptide, because it required a fasting test. And I lived far enough from where they were drying the blood that I didn't want to have to fess that long. So I never checked my C peptide, which looking back, I absolutely should have known what it was then. Because knowing what I know now, I'm suspicious that my pancreas really wasn't working well. Even back then. So about about five years ago, I was only on the the GLP. One, the liraglutide. And my weight was dropping, but my agency was going up.

Scott Benner 27:32
And I was helping your weight or do you think your high blood sugar was?

Natalie 27:37
Well, at the time, I very much thought it was the medicine and all of my diet and exercise. I mean, I'm getting good at this. I'm losing weight, I'm, you know, losing about two pounds a week. So that's perfect. Well, considering that when the doctor then put me on long lasting insulin, because my agency kept creeping up. I gained almost 20 pounds in four weeks. And so all that all that weight that I had worked for two years to take off, came back on in four weeks. And I did not make any changes to my diet, or my exercise routine or anything that would have in indicated that yeah, you're taking in extra calories. And that's why you're getting this way. So I think I was dangerously close to DKA at that point, and just didn't know it right?

Scott Benner 28:30
Because it certainly wasn't your calorie calorie. Wow. Where did that word like I just lost calorie in my mouth for a second. We know how to explain that. It wasn't it wasn't certainly because you were restricting calories to the point where it would create a weight loss. Correct? Yeah. You were eating through decay, basically.

Natalie 28:49
Yeah. Well, and yeah, that that's, that's what it was. And so so so go on long acting insulin. Again, my numbers didn't get great. It was still in the low in the 8.5 to 7.5 range. Which, at the time, they were like it could be better, but they didn't really impress upon me how terrible that could be long term for me. And so you know, I just kept going along with it. Knowing that, well, this isn't working completely, but I don't know what else to do. I'm trying everything that I could try and my endo she did a great job of listening to me and letting me letting me throw theories at her for different things that we could try, but didn't give a lot of recommendations on how to make things much better.

Scott Benner 29:54
Yeah, it's funny. Arden had an appointment with somebody about a month ago and um The person ran a bunch of blood tests. And then yesterday we had to tell him that to go over the bloodwork, yeah. And the initial consultation that led to the bloodwork was honestly like three hours long. As a private doctor, we paid cash for it, we were in a situation where we felt like she wasn't getting answers from other people. And we thought this would be a valuable use of our money and our time. And it was, I mean, the person gave an immense amount of time to us. Tested for everything under the sun. And yesterday during this call, which, by the way, when depends on how you think of it, but all the big things that were tested for Arden didn't have, which was really exciting. But the reason I'm telling you this story is because they didn't the first five or six minutes of the Talmud yesterday, I watched the doctor, remember who we were. Yeah. And so while I had been living in Oregon, and anybody else who was in that room a month ago, had been living for the last 30 days, with this warm recollection of this doctor that gave a ton of time and effort and you felt like you had a connection with. And then that person looks you in the face and goes, Oh, it's that girl on her dad. And then you can see her look down at her papers go, I remember that. I'm like, Oh, my God, like, she doesn't remember us at all, like this love affair that I thought we were having meant nothing. I don't take that out on her or another doctor. Because in a very strange way, I understand that. Like, you and I are going to have a fascinating conversation today that I'm going to take a ton from. And 30 days from now, if you say to me, Natalie, I'm going to go, I don't know who you're talking about. Yeah, and because I have now I will have spoken to 30 other people 30 days from now.

Natalie 31:48
Exactly. Just the sheer number of people that you're working with and talking to on a daily basis. Yeah,

Scott Benner 31:53
but six months from now, when I edit your episode, I'm gonna be like, I'm gonna remember this, like, like it like we're right back on that first date again, and I'm like, I'm excited. And I'm like, Well, I think Natalie's gonna hold my hand. Like, like, it's gonna, like, it's gonna feel like that, again, it's all gonna rush back. I'm gonna put it out. And I swear to you four days later, someone's gonna go online and say, in the episode about blah, blah, blah, and I'm gonna think I don't know what they're talking about. And then I have to go back and make myself right with it. And then I go, Oh, I remember Natalie. And then I can talk about it. So the point is that that happens with your doctors, too. Yeah. And like, you're explaining like, oh, they let me tell them about things and blah, blah, blah. And I'm like you're having you or me or anybody. You're having a relationship with a doctor, that the doctor is not having back with you? Yep, that's all totally agree. Again, again, 10 minutes to say. Alright, well, anyway, I'm comfortable with how this all works. So I'm not gonna stop myself there. So are you a type one being treated as a type two at this point? What do you not even know at this point?

Natalie 33:00
Well, so yeah, so that gets interesting. So back in March of 2021, I decided that I'd had enough I was working really, really hard. It wasn't making any difference in my agency. And I'm like, I think we need to test me again. And so I went and had my antibodies tested, I got my C peptide tested. And my antibodies came back negative again. And my C peptide, though, was like non existent. There was some pancreatic activity, but not very much at all. And so that, to me was a wake up call. It was, Hey, you are working as hard as you can possibly work at this. Your pancreas is not. So we have to give it some help. And so, about this time, I also ended up with a new Endo. My previous endo left the practice. And so I had to find a new one. And I saw her for two visits. And she was awesome. And we'll talk about her a little bit more in a second. But then she also moved locations. So now I have my third endo in the past. Oh, I don't know. 18 months. So that's been a journey too. But the doctor that I saw back in March after I retested my numbers. I told her that I wanted a Dexcom and I wanted an insulin pump. And I want to get on this, you know, as soon as possible, and so she's like, okay, slow your roll a little bit. Let's get you on a Dexcom and then mealtime, insulin, and then we'll figure out the pump. Right. And so I started in March with that with an A one C Have a point three. And then by June, my agency had dropped to a 7.2. So it was, even though I had no idea what I was doing with insulin, they gave me homologue pens, and basically said, take about five units with your meals and keep taking your long acting. Okay? Okay. So looking back at my numbers, there was one time that I took my insulin. And granted, I wasn't below 150, I think ever. But I took my insulin and we'd had Vietnamese food, and I had a boba tea, and my glucose hit 465. Wow. And that was that was on insulin, right. So obviously, I had no clue what I was doing. Started the Omni pod in July. I wanted to start it sooner. But we had an issue with getting a training class scheduled. And they wouldn't let me start it on my own. And I desperately wanted to do it on my own. And I listened to my endo for a change. And she said, No, you really need to wait for trading. And I said fine. And grudgingly waited for training. But I was glad I did. Because my CDE or whatever their initials are, she was really awesome, and gave me a lot of helpful tips and tricks that I wouldn't have known trying to do it on my own. But within about two weeks of starting the Omni pod, I found your podcast, okay. And honestly, Scott, I know you hear this a lot. It truly did change my life. The first episode that I listened to was the was the rough roof, rough episode, something like that. And I wasn't quite sure what to make of it. But I really appreciated some of the perspectives that she was giving. And in that episode, you talked a lot about pro tips and the defining diabetes episodes. And so I went back and I found all of those and started listening to them. And I heard the not that type episode. And a misdiagnosed episode. And those really spoke to me, which is part of the reason why I reached out about being on the podcast because you talked about wanting more type twos. And for me, I've lived through just about all kinds of situations, everything from gestational to you know, trying to manage type two with diet and exercise and feeling like a failure all the time, and having people shame you about what you're eating or what you're doing.

To the point where now I know my pancreas doesn't work. And so I'm on an AMI pod, and Adex calm and I'm on full time insulin and then dealing with the same kinds of things that that type ones deal with without the auto antibodies. So long story short to answer your question. We don't know what type I am. I could be a type one that just doesn't have antibodies, there are a few of those types of people. I could be a type three C that has had some sort of trauma or damage to my pancreas. So my my endo that I spoke about when she was going through all my, my numbers. She goes Natalie, I really think that you would benefit from participating in a clinical study. And like, oh, yeah, what's that? She's like, well, it's for rare and atypical diabetes types. And it's called the radiant study. And she's like, I'd really like to recommend you for that if you're interested. And I'm like, Heck, yeah, if I can find out more about this. Yes, please. And so it's basically it's looking for people that don't meet the typical type one or type two criteria. If if you have antibodies, then you're not eligible for the study, because they know that in one form or another, you're type one. So I have had, I'm in the second phase of the trial now and I'm waiting to get my genomic sequencing results back. Hopefully that will tell us more about what type I am. But in the meantime, I'm treated as a type one. My Chart at the doctor's just indicates a typical diabetes. I'm blessed to have insurance that will cover my my technology. So I don't worry about losing my my Dexcom or my Omnipod like a lot of type twos have to worry. So yeah, it's just a mystery.

Scott Benner 39:57
That is pretty new. How like a year old Maybe the trial, the radian study.

Natalie 40:04
Yeah, it's relatively new. And when I talked to my coordinator, I'm like, I'm gonna be on this podcast. And do you want me to talk about it or no? They told me that I can say whatever I wish to say. My understanding is they are still open for candidates. So if you do happen to have a listener that is antibody negative, or has a really strange presentation of their diabetes, they might look into contacting the study, there's information on the website that you can apply.

Scott Benner 40:43
Okay, yeah, I just Googled three words, radiant study diabetes, and I found it Yeah, no trouble. So yeah, cool. Yeah, I think that's, that's a great idea to try to gain more insight and help people understand, but functionally in your life, it kind of doesn't matter, right, you just need to manage the way that your symptoms indicate they need.

Natalie 41:06
Exactly. Okay, as far as my treatment goes, and how I manage it, it doesn't matter what you call it, I know I need insulin. And so figuring out how best to use it, so that I can stay safe and avoid any long term complications down the road is my goal, right? And honestly, the only reason why I might care about what it's called, is a for insurance reasons, making sure that I can always get the tech I need, and then be, if there's any info that comes out of it, that can help other people or can help my kids, then I'd be interested in that, with diabetes running on both sides of my family, and with me having my kids are at risk. And so knowing what they might expect if there is a genetic component, can be helpful to think those

Scott Benner 41:57
kids are going to listen to you when you tell them that or they're going to act like you did back when you were like it don't matter.

Natalie 42:03
One of them will listen, and the other two will probably not

Scott Benner 42:08
know who you are, where you go. You know, you said something earlier about the first episode of the podcast you found actually, when you said it was that one, I was like, Oh, how do I even keep her after that? Because some of them are just made to be entertaining. You know, there's not much more to them. I do try to sprinkle, you know, goodness throughout. But I always wonder about that with so many episodes, like what happens if a person falls on the wrong one. But there's, I've come to realize there's nothing I can do about it. But but it's it's nice that you held on and you waited a little bit and that all that stuff was actually helpful to you. It's I mean, that's got to be a year ago, right?

Natalie 42:52
Yeah, that was almost a year ago at this at this point. Actually, it was last summer. So again, I I started on the on the ducks in July. And my first podcast that I listened to is one of the ones in the middle of July.

Scott Benner 43:09
I'm just I'm kind of thinking about myself for a second how bizarre it is that basically 18 months ago, I had a conversation with somebody. II mean, that that somehow, like grew out the way it did not on purpose that you've you know, you're recording with me now we're out this 40 minutes already. And I'm you can attest, right, we put no pre planning into this whatsoever.

Natalie 43:37
I spent a fair amount of time thinking about okay, what, what is going to be the important things to get across but knowing that this was just going to be a conversation that flowed and it would go where it went,

Scott Benner 43:48
yeah. Oh, yeah. Well, then on my side, let me put it into a different context. I was sipping water and cracking my knuckles like five seconds before you popped on. And I was not thinking, Oh, Natalie, like I looked at your intake form. And I saw like, I even I don't even know that I read it. I keyword it. And I was like, oh, like she doesn't know what kind of diabetes she has. She's a mom, like bah, bah, bah, like, Okay, well together. Like when you said you were 49 as I go Napoli's 49. So like, that's, that's part of the secret of the podcast is that I'm actually learning about you for real while while you while you're explaining It's, um, you know, like on late night TV shows where you see the host go. So I understand something funny happened to you at the zoo today.

Natalie 44:32
Oh, and it's so fake and contrived. Yeah, I think your methods help keep it genuine.

Scott Benner 44:40
And if we miss something, we missed something, but at least everything that comes out is valuable. Like that's how that's how I think about it. But it's cool that you found it and like how did you find it? So you're kind of outside of the age range for podcasts like seriously, what did you do?

Natalie 44:54
Well, I do listen to a lot of podcasts. Now. Granted, most of my other podcasts are like true crime. I'm podcasts

Scott Benner 45:01
always true crime, Natalie, what do you ladies have inside of your brain that you want to hear about how to kill people?

Natalie 45:07
I don't know. But yeah, it's kind of a joke in the family. Oh, mom's listening to her crime show again. And I do have my daughter listening to at least a couple of them now. So that's kind of funny.

Scott Benner 45:17
I'm just saying, your husband shows up dead. Just go back and listen to this podcast. So you figure out how she did it. That's all.

Natalie 45:26
So yeah, I, before COVID, I had a long commute to work. And so I would listen to a lot of podcasts on the way to and from work and just found it through there. And I'm guessing I was trying to found the podcast, I'm guessing it was either looking for groups on Facebook, and then finding someone that had mentioned it in one of the other venues of the Dexcom, or the Omnipod group or, or something. But like I said, once, you were right, that first one was definitely meant to be more entertaining than educational, I think but I finding the data defining diabetes episodes. And then the pro tips. I've had, I've had diabetes in some forum for 25 years. And yet, I thought that I knew all the things that I needed to know. But yet, there was so much good information or different ways of thinking about things to help me apply it in a better way. And so I took that information that I got out of defining and the pro tips and kind of ran with it, I listened to a lot of the how we eat episodes, because I found those to be very helpful as well, just listening to what other folks have have gone through. But one of the moments, okay, in, there's a few key phrases from the podcasts that really stuck out to me and of course, stop the arrows. And just don't worry about why just more insulin and and being willing to take charge and figure it out with the help of your physicians, of course, right. But being able to do that made a big difference. And one of the episodes with that was talking about pregnancy, talked about how it's so important when you're pregnant to maintain such a tight a one C. And it, it struck me that okay, if it's if it's important for the mom and the baby to do that, while they're pregnant, why isn't it important for everybody to be that well controlled all the time? Yeah. And so striving, having a much more aggressive approach to striving to maintain nondiabetic numbers, has made a big difference. And I don't know that I would have had that mindset had I not found the podcast.

Scott Benner 47:59
Appreciate that. I think that what happens is that I mean, doctors are people living the life they can, they can see what they need. But then they don't. They don't know how to follow through. Like, you know, a doctor can say to you, like, oh, Basil is really important. But then they don't do anything about it. They just tell you, it's really important. They don't then show you how to make it better, or talk you through why it's important. It's just this these like, you know what I'm saying? Like he just like, you know what you got to do, you got to do this. And then we stopped talking about it. And then nothing happens. I think I'm in a unique position, where I've been in the space long enough that I've seen things over and over again, so many times that you know, using like Facebook as an example. I can watch somebody post a question. And I already know how the whole thing is going to go. before it happens. Because I've seen it 50 times I've seen it 100 times I've seen people ask this question in one way or another. I know how low carb people are gonna answer it. I know how people are going to answer it who think like, you know, like, well, I can do whatever I want as long as like Bolus for it. Like I know the whole, like, I you might as well just not do it. In my mind. It's already happened. But for everyone else, it's very important to let it play out. And, and I, through watching these things play out over and over again. And through having all these conversations. You put yourself in a unique situation to understand what people need before they understand what they need. And so you can leave bread crumbs for them, and then hope they follow them. And if and by the way, my bread crumbs might not be perfect for you, that's fine, but you gather up what you need. And if you want to shoot off on another path. That's cool, but people need to understand. I mean, it sounds so trite to say like you need the tools and you need to know how to use them and you need to know when to use them because As your sharp Saul's not going to help you if you need a hammer. Right. So I just I'm very appreciative to know how this helped you. Because all I have is my ability to lay it out there the way I think it works, and then wait to see if it happens or not. And I believe that the popularity of the podcasts hasn't proven out pretty well at this point. I'm waiting for other people to figure out that a siloed approach to a siloed approach to medicine isn't going to work. Like you sitting in an office going Basil is really important. And then I leave the office and you don't tell me why Basil is important. That's never going to help anybody that makes you feel better. The person standing in the office, the doctor who goes I told him, but they didn't listen. You don't I mean, like you didn't tell him anything. And you very well may not know how to do it either. Maybe that's why you're not telling them I don't know. But you need a I'm like there's something I'm very like old timey in my thinking today. But you need like a Sherpa, you need to get a guide you need you need, you need the medicine lady in the camp, who knows the whole camp situation, and has time to sit with you and talk to you about basil because that's her job and she doesn't do anything else. I'm an old lady sitting in a teepee. That's what I'm telling you. You know what I mean? I think that's important. I think that's what I'm seeing working. And this medium lends itself to it. Unlike anything else I've seen so far.

Natalie 51:33
Yeah, yeah. Because I could go and find the episodes that were the that spoke to me the most from the titles and and start with there. And then depending on what was revealed in that episode, you know, you find other breadcrumbs to go to and more information. I know that I really didn't start Pre-Bolus thing until I was listening to the podcast. And and then I could see it for myself with my decks to see, oh my gosh, this does work. And it makes sense. But yet, it's scary sometimes to give insulin for something you haven't had to eat yet, especially when you're talking about a kid. So I understand why why people are reluctant to do it. But it works. Yeah,

Scott Benner 52:23
I so it's funny. I don't know what it is, in my mind that doesn't allow me to trade it at least in my thinking about diabetes. I can't trade like safety now for later. Like I'm I almost think about diabetes, like in that Ben Franklin. Is it a Ben Franklin quote, oh, God, now I'm gonna get this wrong. A little bit of security is that not the first we're gonna find out if it was Ben Franklin. So it's a it's a quote about the those who would give up essential liberty to purchase a little temporary safety deserve neither Liberty nor safety, Benjamin Franklin, it's attributed to him as far as I know, and the Internet agrees with me. So I think it's been said a number of different ways over the years, it's so my point is, you can't let your blood sugar be 200 Your whole life so that you don't get low today. Because something really bad is gonna happen to you in the future, if you do that. So you have to set you have to set your country up with best intentions. And if along the way, you lose trying to do the right thing. I mean, to me, that's the risk, I'm willing to take, like, I want to, I want long term health for my daughter, not just a little bit of security today. You know, like I want, I want the whole thing. And if she can't have the whole thing. I don't know how to put this, like if I'm not saying like I want her to die. Like I'm saying that like I think there's a way to Pre-Bolus meals and to be more reactive with blood sugars and keep blood sugars lower and stable without hurting yourself. And that could give you a long life, a healthy life, because you might have a I mean less than if my daughter lives 75 years with diabetes and stirrups that and it was as healthy as it could have been. I call that a win. Now some people might argue, well, I made it 63 years, but I was sick the whole time. And I never once worried about getting low. And I'm like, All right. I mean, I guess one might make more sense to you. And one makes more sense to me. But for me this makes sense. And then the tools that I had to sort of develop to make that possible. I think other people can learn and if they want to use them than they should and if they don't want to then they shouldn't like I'm not telling any Hey, Buddy how to live their life. I'm just telling you what I did. And you know if it works for you, that's a bonus to me.

Natalie 55:07
And I think part of the problem too, is that, at least when I was being treated as a type two diabetic, the doctors were willing to let those higher averages just ride. I mean, if I would have acted content with it, they would have said, you might try to eat a little better exercise a little more. But they they weren't telling me about, hey, if your results are over 200 regularly, you're gonna have long term complications. They weren't saying those things, right?

Scott Benner 55:42
Because it becomes a management thing like for them, we have to, then you have to look at their situation, you're not the only person they're talking to. So all right, well, I can't believe how this is all coming together. But watch this. So when the water buffalo or whatever I used earlier in, they have a herd of them. And if they lose 10% of the herd, they still got 90% of the herd to Oregon. And, you know, we're cattle or whatever, I don't know, I think I'm watching 1883. Right now, I think that's what's happening. I enjoyed Yellowstone a lot. So I tried 1883. And I'm very much into this idea of moving cattle across the country and people, but not the point. The point is, is that is that they have a herd. And if they save most of it, they did a good job, because they don't think all the cattle are getting to Oregon. And you in that scenario are one of the cows and and if get to Oregon, yeah. And if one of them gets rustled or shot or falls into a canyon, they go, Okay, well, we still have these other ones. And and, again, macro micro is important because when they're sitting in a room with you, they do not look at you like, Oh, if I lose this lady, it's okay. Like, I'm not saying that. I'm saying when they step back, and they look at the scope of their job, they expect that that's what's going to happen. And if you end up being one of those people, then those are, that's just odds, they're not thinking of you as a person in that moment. They're thinking of you as, Hey, I got 90% of them across, you know, and that's important for people to remember, on the patient side. And I don't mean to be angry about it. Like I don't mean like go in your doctor's office be like this guy don't care about me, like cares about you plenty in that moment. He just knows that not everybody's gonna listen, not everybody's going to do what they're supposed to do. And, and that doctor so far, medicine so far has not found a way to compel people to do the right thing. So they know if they can't compel you the best they can do is tell you and then I think the next thing that happens is it becomes It must feel hopeless to them at some point. Like almost like, you know how they say cops can get they start seeing crime everywhere. The longer they're a cop. Oh, yeah. Right. So I think maybe with with police with police, it bleeds into their personal lives. I know cops, it does believe in their personal lives. They're just like, they don't trust anybody sometimes. And I understand why. Right? Because most of the people they meet in the course of the day are trying to get over somehow. And I think for doctors similar situation. I mean, how many people like you have to stop taking their medication and heading the wrong direction before they start thinking? Like, there's no way I can affect all this? I don't know like it to me, it seems like everybody doing the best they can. Whatever the perfect answer is, it either doesn't exist, or we as people don't seem to be able to accept it and, and stay with it, and run with it. I don't know why. So anyway, after saying all this, I'm still not getting on that bike when I get down with you. What do you make of that? Yeah, I'm as fortunate as the rest of you, how's that?

Natalie 58:56
I do wish that, that perhaps doctors would be especially when dealing with with type twos, instead of just simply labeling the patient as uncontrolled or non compliant. could look into it a little more, like instead of just assuming that they're lying about how much they eat, to have an opportunity to to find out more, because maybe they really are trying the best they can maybe they need to have insulin at this point.

Scott Benner 59:32
Oh, I agree. Yeah. 1,000%. And I'm saying that I think that there's a human failing on the doctor side, just like there's a human failing on everyone's side, like that. No one. No one seems to be able to do the right thing. The thing that they know is going to work over and over again, because at some point that drudgery just doctors have the same thing as everyone else does. There's there's a there's trash that has to be taken out of their house to you know, and so I think everybody gives as much as they can. There's times where I think, you know, I don't want to see a doctor right away, like in the morning, but I would like to see them late morning. But not if they're too hungry and not right after lunch and not at the end of the day when they're tired. Like, you know, like, it's, it's just, it's weird. You know what I mean? Like, it's, it's, it's a bunch of flawed organisms trying to help each other. And, but you're right, like, like, functionally You're 100%, right? You can't just look at somebody and go, Oh, they're going to be one of them that I lose. You have to treat everybody like they're the cow that you get over the line. Yeah. And and that's where the that's, I think you're right. I think that's where the failing comes from. And then I think the follow through on their part can't just be hate only the Twinkie, it has to be why, and not just why, but can you afford something better than that? And what is better than that? Because I watched my mom get, you know, started getting borderline type two, a few years ago. And in her earnestness to eat better, she chose foods that were higher in carbs. Yeah. And she didn't know what she was doing. Like she had no idea. And nobody helped her. Because she just told the doctor, I'm eating better now. And the doctor went, Oh, good. That was

Natalie 1:01:15
what really is better? What does it mean to say that your numbers are in control? Because if you would have asked me a year ago, are your numbers in control? I probably would have said yes. But looking back at where my numbers were then compared to where they are now. It's crazy. My last a one C was a six. Oh, and the one before that was a 5.6. No. And I have never, in my diabetes life had numbers that low, you probably feel terrific, though. It feels awesome. I feel so much better. And I didn't realize how bad I felt before

Scott Benner 1:01:46
is your body coming back together with your weight the way you want.

Natalie 1:01:50
It's getting there. It's getting there. We're still working on that. But the it's funny because, again, I have to I'm a weirdo. The doc says that I really don't have a whole lot of insulin resistance, which is what you would really expect if I was a true type two, except when I eat my body seems to have a really hard time processing food. And so if you look at what my like correction ratio is, or my Basal rates, and then take a look at what my carb ratio is, it seems like my carb ratio is crazy compared to what the others are. And it's because I'm so so resistant to insulin when it's food related.

Scott Benner 1:02:29
Ardens is like that i Arden's Basal rates around a unit an hour. Yeah, but her her carb ratio is like one to four and a half, I think.

Natalie 1:02:39
Yeah, that's actually kind of really similar. I run somewhere between point eight and 1.1 on my Basal rates, and then my carb ratio right now is like one to six, or one to eight, depending on the meal.

Scott Benner 1:02:55
Can I ask a personal question? Here? Sure. Can I have your lady parts given up yet?

Natalie 1:03:00
No, they have not interested?

Scott Benner 1:03:04
I thought maybe you were like postmenopausal. I mean, you know, you'd be relatively young for that. But I was just Yes, yeah,

Natalie 1:03:11
yeah, no. And so yeah, I have those changes to look forward to as well. And, you know, before listening to the podcast, I never would have thought that my numbers or rates or anything was, was different based on the time of the month, but I actually have started to notice that I get really it's like, unpredictable. It's, it's not that it's a whole lot more are a whole lot less. It's like, at some moments in the day, I'm going to need so much more insulin, but then later, I definitely don't. And it's all in the same day. So it's like it's like my ratios go crazy. A couple of days a month. Yeah, hormones

Scott Benner 1:03:51
are are just such an impact. It's it's really something. Yeah, it's been a lot of fun figuring all this out over the years.

Natalie 1:04:03
Just probably know, what's more about things that you thought you would never have to know about.

Scott Benner 1:04:08
Trust me if you could meet like 21 year old me and be like, Hey, you have a podcast in the future about diabetes. That person would have thought you were pretty crazy and then got back on their motorcycle and drove away really quickly. So yeah, yeah, it's, uh, I'm happy to do it. I think it's fantastic. I'm doing it for my kid. You know, but it's, it's cool that it's helping other people. Was that gonna say it's gonna say something had a big thought, oh, here it is. I found it. So you are have spoken around on the cusp of an idea that you haven't dove completely into yet. And I'm passionate about it too. So I kind of want to push you there. But the idea of using insulin feeling like a failing and the idea of using more insulin than what I this is a meaningless statement than others. But I think you should be using being something that people have a lot of opinions about or, or that being something that you feel like is a failure. Like, for some reason, you know, using one unit at an hour, Basil seems okay. But if it was two, you'd be like, Oh, I'm using a lot of Basal insulin like like that, that way people feel and we talked about it here as much as possible. I don't like it. Like, I, like, I'm not gonna say, I'm going to seem like I'm gonna come down on two sides of this, like, I get low carb people, I understand them. I understand when their argument is if you eat fewer carbs, you're gonna use less insulin. I think that's right. I think if you do that, you take away a lot of variabilities and things that you need to understand and managing diabetes, low carb is generally speaking easier. It doesn't make it the only answer. And just because those people had trouble for years before they figured out to be low carb doesn't mean that that's not doesn't make that the only answer, it just makes it the answer that worked for them in their timeline I could take them is just gonna sound crazy. But I could lift a person up who's had diabetes for 25 years who lived the through the 80s and the 90s. And then suddenly found low carbon, it straightened everything out for them, which I think is terrific. But if I pick their life up out of the timeline, and move them forward, so that they got diabetes in 2015, and started listening to the podcast, they would likely never go through the things they went through prior to finding low carb. And I'm not none of that makes anybody's experience, you know, any more or less impactful on them or are worth sharing, I think all those need to be shared. But when they start making leaps when people start making leaps and saying, when you use a lot of insulin, it's bad for you. That's dangerous, because then you stop people who need the insulin from using the amount that they need. And so then you're good. You're good intentions, create problems. And maybe you're right, maybe this person should be eating, I don't know, hundreds fewer calories, carbohydrates every day, and they wouldn't need as much insulin. But back to the COVID conversation. Just telling somebody to do something, doesn't mean they're going to do it. And in the meantime, they're still alive, and they still need what they need. So I'm willing to help. Yeah, I'm very much against telling people that using too much insulin is bad. I don't like they need as much as they need. Now, you know, if you need a large amount, because your body just requires it. Versus you need a large amount because you woke up in the morning and drank a Slurpee with one hand while eating like bread dough with another hand like like there's an argument in there. I don't mind having that conversation. But it never gets made that way. It just gets the assumption is you eat poorly. And that's why you need more insulin. Stop it. And that's really I find that to be a dangerous statement.

Natalie 1:08:06
Yeah. And to be honest, Scott, I probably should have been taking mealtime insulin at least five years before I started it, right. And part of it was the doctor really didn't push because my numbers were okay enough. And part of it was I was vehemently against starting insulin, because of all the the type two, I don't know propaganda, but all the type two info that's out there that you can control this with diet and exercise. And if you're not controlling it with diet and exercise, and maybe some Metformin, then you're doing it wrong. You try hard enough. You didn't try hard. Yeah. And I will tell you that the relief I felt when I saw that result from my C peptide test, and I realized that my pancreas for whatever reason, is no longer working. And that it's okay to give it some help. I can't describe that relief. And nobody should have to go through that when they fight. You know, you shouldn't be relieved to find out your pancreas isn't working.

Scott Benner 1:09:16
So those five years create a potential damage for you.

Natalie 1:09:20
Yeah, yeah, because I was. I mean, I wasn't running in the four hundreds all the time, but I was definitely above 150. The majority of the time, most of my averages when I look back, were in the 170 to 180 range as an average.

Scott Benner 1:09:38
And I won't hide the fact that when my mom found out she was like, pre diabetic. I mean, the way I helped her was I put her on an intermittent fasting schedule and and had her limit her carbs. Yeah, like I'm not gonna lie to you like that's exactly what I did. And if it was helpful to

Natalie 1:09:53
her, if that works, if you've got type two, and that works, by all means, go for it and do that. As long as you can, but if you're working as hard as you can work, and your numbers are still not close to a normal range, then you need to do something else. Yep,

Scott Benner 1:10:12
you have to address the symptoms. Yeah. Right. Because you don't have an unlimited amount of time. And you don't get 10 years to make yourself right. Like, this isn't a psychological thing where you're, you know, you don't mean like, how do I mean this, you know, when we're growing up, and we are learning about the world, and we think it's okay, you have time, you'll figure out the friendships important, you'll figure out that kindness is important like that stuff, you have time to figure those things out. This isn't like that, you don't have time to figure those things out. Like you need to understand that you needed insulin and, and five years of you working your way through it. You know, you don't just miss out on a couple of friendships maybe along the way you miss out on longevity, or peaceful or peaceful health in your older age. And in

Natalie 1:11:01
my case, it was definitely health because during that timeframe, I mean, I had all kinds of stuff I had to go in and have an echo and a stress echo because I was having these terrible chest pains that turned out to have no explanation. You know, continued UTI issues that to be honest, since I've lowered my my agency and lowered my expectations for what a proper glucose ranges. I haven't had any. And to be able to say that after, after years of having him is is amazing for me.

Scott Benner 1:11:38
When's the last time you peed on your bed?

Natalie 1:11:40
Oh, gosh. A really long time ago.

Scott Benner 1:11:44
I would take just that as an improvement.

Natalie 1:11:47
That isn't when my husband would say that too.

Scott Benner 1:11:52
Alright, yeah, that must have Did you tell him or did you hide

Natalie 1:11:54
it? Oh, no. Yeah, there was no hiding.

Scott Benner 1:11:58
We need a mattress.

Natalie 1:11:59
It's the middle of the night, change the sheets and hope you've got a really good mattress pad on.

Scott Benner 1:12:06
No hiding it. Just like I'm like, I'm just I don't know, I'm, I'm picturing you just rolling the sheets up and trying to pull them out from under a very slowly, you know,

Natalie 1:12:15
sneakily? Yeah, that's crazy. Is there? I probably could have slept through it. But no,

Scott Benner 1:12:20
I I was just I don't know, it's my point was that if he just fixed that, it's well worth all your effort, you know, but you got much, much more out of it than that.

Natalie 1:12:32
Yeah. And honestly, my relationship with food is better. There were so many things that I wouldn't eat. Or that if I did have some of it, you know, the guilt with with having a piece of birthday cake to celebrate somebody's birthday, or, you know, participating in a family event that involves food and feeling guilty about having that food. Once I started insulin, I'm just like, Okay, well, I'm just doing for my body, what everybody else's body is doing for them. And so it helped me have a healthier relationship with food in general. Now, I'll still decide sometimes, you know, I really don't want to have that food at nine o'clock at night, because I don't want to deal with alarms and corrections, and whatever else I need to do all night. So it's just not worth it for me to have that right now. But it's not that I can't ever eat that.

Scott Benner 1:13:35
You could do it if you want it. So it's your you're making a decision. And it's this lesson, it's the same decision, we should all be making just with slightly different parameters, you're deciding, do I want to do I want to eat this, and then have to deal with what I need to do afterwards for the rest of us should be saying, Do I want to eat this? And you know, or do I? Or do I not save my body? Whatever turmoil it's gonna go through. Because that look, I mean, listen. I mean, this needs to be brought up once in a while by me, I genuinely believe that there's almost nothing that my daughter could eat that I couldn't figure out how to Bolus for. Right. I don't think that means you should eat it all the time. I think

Natalie 1:14:17
of your pop tart example.

Scott Benner 1:14:20
If my daughter never sees a pop tart again and the rest of her life, I'll be very happy about that. Just because I know how to Bolus for cereal without a spike doesn't mean my kid eats cereal constantly. But But I think there's a bigger picture. I think that when you have a five year old that just got diabetes, maybe taking cereal away from his heart, or seems. And maybe it seems cruel to you as a parent, and it's something you want to try to mix in. Now. My hope is that you'll learn how to Bolus for the cereal, but at some point recognize that, you know, crunch berries, probably not the way to go every day for the rest of your life. Right and maybe we'll figure that out and maybe you will Don't figure that out. That's not under my control. But much like with the conversation you're having about your insulin. I think it's unfair for people not to know at least, like, like, because the alternative is, I mean, this whole conversation is just cyclical. Like you're just you're hearing the same things over and over again, if a kid's going to eat cereal is the right answer. Don't eat cereal. Yeah, probably. Okay. But given that that might not happen, or that there might be psychological ties to it, or, or reasonings, or, you know, whatever. You don't just let their blood sugar's before 50. Right? Like, if they're going to eat cereal, they should learn how to Bolus for it. Do I hope one day they figure out that Captain Crunch isn't good for them? Yes, I really genuinely do. And and if they don't, that's not my responsibility.

Natalie 1:15:50
Yeah, because we can't, we can't know all the circumstances for other people. And so to say, Well, you shouldn't eat this or you shouldn't eat that. Maybe there's a valid reason why they want to eat it. And for you to be able to give them the tools that they need to be able to handle the insulin in such a way that it maintains their sugar in a healthy range. And then that's the objective.

Scott Benner 1:16:17
And your point really exploded a little bit to draw it out a little bit. A box of cereals, a few bucks, half a gallon of milk is a few bucks. And now suddenly, I can feed a kid for a whole week at breakfast for five or $6. And a dozen eggs might be two or three bucks. And the time to make the eggs isn't something everyone has. You know what I mean? Like, like, if you are if you live a life where you can get up in the morning and cook, you're lucky. You know, because most people are running out the door at the crack of dawn, trying to go to a job that doesn't pay them very much money. And if they're five minutes late for it, they're gonna get fired. Yep. Right, right. So people situations are a big part of that. And I'm aware of that, even as I'm saying, I hope you don't eat Captain Crunch. But here's the thing, if you have the captain crunch, let's figure out how to Bolus for it. So that you're not eating Captain Crunch and having high blood sugars, let's just pick one. And and maybe your situation will grow from there. And you'll be able to get out from under and maybe it won't put at least your health isn't going to suffer because of your financial situation or the expectations that the world has on you or whatever else is keeping you from you know, poaching an egg. Like right, which is a it's a thing you should be lucky to be able to do if you have that. And the same goes with lunches. And dinners. It's easy to say like, I mean, don't eat things out of bags, don't eat things out of boxes, like that's a pretty easy. I mean, honestly, if you're looking to be healthier, don't eat anything in a bag or a box. That's a pretty that whole food approach. Yep. Pretty fast way to help yourself. I think eliminating oils, like processed oils is a great way to help yourself very quickly. But, you know, if you have 20 minutes to eat in the middle of the day, I get it if you've bought a grab bag of Doritos. Like I understand, so I just don't think you should suffer for with your diabetes health on top of everything else. I don't know that seems like common sense to me, Natalie. But this is a long form conversation that took an hour and 15 minutes. And it's not just somebody ranting at somebody in three sentences online or your doctor visit the last 10 minutes or you know you're at Thanksgiving dinner when your grandmother's like should you be eating that? Like Thanks, Grandma. Thanks, Grandma.

Natalie 1:18:47
In my case, it was thanks to my great aunt but that's another story.

Scott Benner 1:18:52
Great Aunt pain in the ass. I got you. Natalie Natalie's got bread someone stopper.

Natalie 1:18:59
You shouldn't be eating that. And I wasn't even diabetic at the time. It was hilarious.

Scott Benner 1:19:05
Thanks a lot, sweetie. My wife had a grandmother who would look people in the face and go, it'd be so pretty if you weren't so fat. Like literally like a horrible woman, you know? Oh, my goodness. Yeah, just Yeah. And that's if you don't think a lot of people don't grow up with stuff like that. You're out of your mind. You know what I mean? Like there are plenty of people giving bad messages to children and two adults and they're hard to ignore when they're when they're being beaten over your head over and over again. You can try to joke your way through it or you still hurt it, you know? Yeah. So anyway, Natalie, is there anything that we haven't spoken about that you wanted to?

Natalie 1:19:48
I think we covered most of it. I one thing that I did want to mention, you know, we talked about diabetes. I guess I would ask that folks try to just be kind to each other because there are other forms of diabetes besides type one and type two. And maybe just trying to be kind. That's one thing I appreciate about appreciate about your podcast and the Facebook group, it's, you know, for anybody using insulin. So many of the groups get very territorial, if you will. If you're not this type, then you shouldn't be in this group. I think there's, there's room for us to have some understanding with each other, and some kindness to each other. Because not everybody fits into a category. Like me.

Scott Benner 1:20:35
I don't understand why people feel so compelled to be on a team. But God bless them. They really do. I mean, it's like, just make it a different team. If it'll make you feel better blanket team insulin, there are effects that, you know, like, Why do you care? Like I and I don't see it frequently. But when you do see it from somebody, it's fascinating. I've come to wonder to making myself laugh. But there are times when I see people post online, I think I wonder if they're drunk. Get any mean? Like? Yes, we all we all think we're talking to like someone who's upright in a chair having their full form best thoughts, but I'm like, I wonder how many people are like half on the recliner, half on the floor with their phone in one hand and have one eye open? Gone? You don't have type one diabetes, get out of here. You type two person like, I don't know who you're talking to. And you don't either. I would say I see people be very supportive, mostly. But you're right. When it's not supportive. It's vicious. Yeah, yeah. You know, and I don't get I don't understand why you care if someone's getting value from a spacer, and why does it matter if they don't? Exactly if they're not exactly you? You know? I don't know. Completely agree. Yeah. People are out of their minds, some of them, but not most of them. That's the good news. All right, Natalie, let's finish up by saying. I'm incredibly impressed that somehow I took the migration of cattle across the country and related to healthcare. I think I did a great job with that. And if I didn't, if I listen back later and go, Wow, you are not nearly as on point with that as you thought you were. I'm gonna be surprised because I feel really good about it in the moment. What are your thoughts?

Natalie 1:22:19
I think it went well. And yeah, I was quite impressed with how you compare cattle to healthcare.

Scott Benner 1:22:27
As it was happening, I was like, I'm getting so good at this. voice in my head, not like a scary voice, you understand not only where you need to be scared, but I was like, wow, like, I realized Joking aside, that these like, one of the things that will get me struggling to say something nice about myself, I don't want to sound like a jerk. I think that I've been like this my whole life. Like I like thinking about things. And I like seeing connections between things. I think that our minds work very similarly. And for some reason, when you change the color of the conversation, or you change the type of the conversation or something, people lose their minds, not just things have nothing to do with each other. But everything has something to do with something else. And the way people think, or treat each other, or treat people's diabetes or whatever. It's all rooted in the same. I mean, I don't know how many but the same handful of thoughts or feelings or inclinations that people have, like, like, we are pretty common at our core. And the way our, the way our impulses impact. Other things is very similar, like where it goes after that gets different because of variability. But at our core, we're all very similar. And, um, and I think the way we do things is pretty common throughout life. And I think if you could diagnose it in one place, it might make it easier to understand another place. That's all. But I don't know, like that all just came to me today about the migration, actually. 1883 You should all watch it, it's on paramount. Plus, I really like it. And you might look good. Anyway, I'm gonna let this go before I before I say something, I don't mean. So. Thank you very much for doing this. I really appreciate it.

Natalie 1:24:23
Thank you, Scott. I really appreciate it. And you know, again, just reminding people not to be afraid to start insulin if they're in that situation. And just advocating for themselves and their loved ones because that's so important.

Scott Benner 1:24:36
You need what you need. That's pretty much it. Yeah. See, I am able to make things short and sweet. There you go. I've been saying that through the podcast for years right you need what you need. Yeah, all right. I might have been right let's stop the recording and hold on.

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#756 Swiss Diabetes

Dr. Gurpreet Anand is an endo practicing in Switzerland.

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#755 Bold Beginnings: Exercise

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Test your knowledge of episode 755

1. How does physical activity impact blood sugar levels?

2. How should insulin doses be adjusted based on physical activity?

3. Which types of exercises are beneficial for diabetes management?

4. How should one prepare for exercise to avoid blood sugar fluctuations?

5. What is the role of consistent physical activity in long-term diabetes management?

6. How should blood sugar levels be monitored in relation to exercise?

7. How should low blood sugar episodes during exercise be handled?

8. What are the benefits of incorporating different types of physical activities, such as aerobic and anaerobic exercises?

#754 Cattle Drive

Natalie has diabetes but she doesnt know which kind.

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