Scott Benner 1/3/23 Scott Benner 1/3/23

#820 The Math Behind Setting Basal Insulin

Scott and Jenny break down the math behind setting your basal insulin. I really wanted to call this the GOZINTAs of Basal.

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

+ Click for EPISODE TRANSCRIPT

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

Scott Benner 0:00
Hello friends, and welcome to episode 820 of the Juicebox Podcast.

In today's episode, Jenny Smith and I will be talking about the math behind figuring out a Basal rate. While you're listening today, please remember a few things first, 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 are becoming bold with insulin. Remember this as well. This is Episode 820, episode 821. And episode 822. Go together with this one. You're going to learn about basil in this episode, in Episode A 21. We're going to talk about insulin to carb ratios and how to get them set up. And then, in the last episode, insulin sensitivity, these three settings are huge and will help you in every aspect of your diabetes care. Listen to the end of all three episodes, for hints about what other episodes of the podcast will build on what you've heard today. If you're a US resident who has type one, or is the caregiver of someone with type one, please head to T one D exchange.org. Forward slash juice box and fill out the survey completely. When you do. You're helping to move type one diabetes research forward without ever leaving your home. T one D exchange.org. Forward slash juice box. This show is sponsored today by the glucagon that my daughter carries G voc hypo pen. Find out more at G voc glucagon.com. Forward slash juicebox. Today's episode of The Juicebox Podcast is also sponsored by Dexcom, makers of the Dexcom G six and Dexcom G seven continuous glucose monitors, get started today, learn more or see if you're eligible for a free 10 day trial of the Dexcom g six@dexcom.com. Forward slash juice box. I've been asked, Can you just tell me what the math is for setting up my Basal insulin for setting up my insulin to carb ratio for setting up my insulin sensitivity? And I don't know why we've just never gotten around to it probably because I have an aversion to math. But as you pointed out right before we started recording, yes, there's math here. But there's also other things to understand. So Right.

Jennifer Smith, CDE 2:33
And I, you know, I think as I said before, it is it's a lot to do with the fact that I would say to the newer people on insulin, I think many people just end up tweaking from where they're currently at. And once they've started learning more about how to adjust their overall insulin. Unless they really are the more I guess, precise, for lack of a better word. I just want to know why I need this much insulin and how to adjust it with a math equation. Many people just, ah, looks like I need a little more I'll add a little more heat. Like I need a little bit less, I'll take a little bit away. And there's not much math that they're considering. They're just adjusting,

Scott Benner 3:21
right? Yeah. And they also don't know where to start sometimes, like where to begin, because we all leave a doctor's office with I guess my assumption is the doctor uses these equations to come up with something for you to get you started to get you close enough, right baseline. Yes. But nobody's telling you that when you're leaving the office, they're not they're not saying to you hey, I made your basil point eight an hour because you know what we're going to talk about now? Yes, absolutely. But but then you get home, and it works or doesn't work. If you come up a few come along this podcast, you're going to hear an episode about setting Basal insulin that's, you know, basically me saying, use a little more if you're if your blood sugar has been high, and use a little less in these situations where you come along and clarify a little bit. And but people are asking for like, where do I really start? So I guess going to basil first? How does your Basal insulin get set on day one, you just were diagnosed and you're sitting in the office and someone's giving you either an amount to inject or an amount to put into your pump probably to inject right so where does that come from?

Jennifer Smith, CDE 4:27
Well in initially it will come from just weight, your body weight, truly just your body weight and some doctors do a 5050 they calculate total insulin estimated need based on your body weight. And then they'll say okay, well 50% of this or so should come from your basil and the other 50% should come from your Bolus insulin and so they work out the math that way right. And in general, some some may set you up by actually asking a little bit more, are you a really active person? Are you really sedentary person, what is your age, you know, as you go through different stages of your life, your insulin needs will shift and change, you may be more insulin sensitive, you may be more insulin resistant at certain points in time. So, if they're doing a really awesome job for you in estimating this initial dosing, besides your weight, they may also factor in your activity level, right. And then in terms of the life, right, the stage of life that you're in, you may be in need of more insulin or less insulin just based on your age, right. So a certain amount of total insulin goes in based on whether you're five years old versus 65 years old, in general.

Scott Benner 5:50
See already, this is this for people listening, this is why there's not just a, here's the math of setting your Basal insulin, because there's so much that goes into it. You just said depending on your age, it's also a lot of that is where you are in your life. You know, people might not understand that, you know, once you get past the honeymoon stage, and your Basal needs, or your excuse me, your insulin needs are pretty stabilized. Right? As a young person, they might be very stable, right up until you get to where you're starting to see hormones in your life. And then that goes crazy. And then your hormones might stabilize. But some of you, for some of you it might not like some women might struggle with hormonal problems, you know, for decades, where there's a lot of fluctuation and then correct, you know, it's just there's so much happening.

Jennifer Smith, CDE 6:39
And in terms of the, you know, the direct math, I guess a good example is that much of much of medical math is based on kilogram weight. And here in the US, we use pounds, right? So to find your weight in kilograms, all you really have to do is take your weight in pounds and divide it by 2.2. And then you have your weight in kilograms, okay? I won't make you figure out your weight in kilograms for everybody to know,

Scott Benner 7:02
I'm not telling anybody my weight, I'm gonna just take 100 pounds in kilograms, so I have somewhere to go from.

Jennifer Smith, CDE 7:09
So you might be like a middle school, or let's say, if you're 100 pounds, give or take, right? That's just an estimate. So you divide that by 2.2. So the 100 pound person of some age is about 45 kilograms, right? And so if you're figuring out let's say, you've got a 45 kilogram or 100 pound kid, right? If they are inactive, that kid could have insulin needs total daily insulin needs of anywhere between like, point six to like, one 1.2 per units per kilogram. Okay? Right. So I mean, and that's a big range, right? That's a big range. Do you need point six units per kilogram if you're 45 kilograms, or all the way up to like one unit per kilogram, and again, this is total daily dose. This is both Basal and Bolus. So right together, I've

Scott Benner 8:06
gotten out a calculator. So your example, point six would then be times 45 kilograms, which 27 units a day,

Jennifer Smith, CDE 8:15
total exam, this is inactive, right? This is like an inactive kid, right? If you have the kid who is entirely like, I do two hours of soccer four times a week, and then a tournament every weekend, that's like four, you got a busy kid. So anytime activity level, most often I should say anytime activity level goes up, you're metabolically using food better, your body is responding better, from the muscle level to the insulin doses. So your insulin sensitivity is going to increase, which means that your doses decrease. Yeah. Right. So a really, really heavily active kid, same way it is, you know, going to need somewhere, let's say between point four 2.8.

Scott Benner 9:05
Okay, so interesting, because we said half of it right at point six for the inactive kid, you're 27 But one, you're 45 for that inactive get. So you could be somewhere between 27 total units a day split between Basal and Bolus and 45 for the inactive 100 pounder. But for a more active one, you're saying more like point four.

Jennifer Smith, CDE 9:26
Right? About 3.8

Scott Benner 9:29
Yeah, so that goes from like 18 to sorry, I'm clicking, doing the math. Yeah. 36 I

Jennifer Smith, CDE 9:37
just don't want to get upset I got my calculator out for you. I could have done it.

Scott Benner 9:40
I just realized I don't own a calculator. So I like the computer has one. But But I didn't want to like I don't want to I don't want to say the wrong numbers over and over again and people be like, Okay, so there's a huge swing, like there is so on the on the high end for that active 100 pounder you're at like 36 but on the high end for an inactive person, you can be up to as much as four 45 or 35 is a lot more insulin,

Jennifer Smith, CDE 10:02
right? So and then it changes based on stage in life, right? Then we've got adolescence, then we've got like more like adult age, and then we've also got older adults, right? So you can see where the math isn't a direct. If you're this age, or this weight specifically, you're just going to need this amount of insulin. And I hear that question often when I work with people. And also I see that question come up a lot in all of the online communities. It's like, well, how you know, Mike, my kid is seven years old. How much insulin does your seven year old use? That's, that's not purposeful. Right? Right. That's not going to help you figure out your seven year olds insulin need, yeah.

Scott Benner 10:44
Also, we just use the example of activity. But you could also use another variable and say, you know, I don't know what if in the household. Here's one, what if there's somebody in the household who has celiac, and you're using gluten free, which oftentimes has more carbs in it, you can be in a car beer situation? What if you're somebody who stops at McDonald's four times a week versus somebody who's, you know, having salads and, you know, a small piece of chicken with, you know, like that kind of thing? Correct?

Jennifer Smith, CDE 11:14
Right, right. Absolutely. So then you're going to, again, from a comparison standpoint, you're looking at total insulin, in a known situation, a very different intake of food, maybe activity level. And also, then the insulin doses are going to be very, very different. Okay, so comparison wise, again, that's why I think this is important to know, like, where did the math come from? Where is a good place that if you're trying to redo things, it could be a starting point? I mean, there are certainly, could you Google it, you certainly could, but I think you're gonna get a lot less directive information. There are a couple of really good books that have charts and everything already set for you to read and manually sort of figure it out. I mean, John Walsh's pumping insulin book is a really good reference to think like a pancreas book. They're, they're awesome in terms of like, this is the math, this is how to sit down and figure it out if you really wanted to, but sometimes they think it's nice to have somebody sort of walk you through

Scott Benner 12:20
it a little bit, instead of looking at the graph and thinking I want to do something wrong here, right, come up. That's got to be someone's fears that I'm going to do. I'm going to do my guest sentence, and then I'm going to use way, way too much insulin. Right, right. Yeah.

Jennifer Smith, CDE 12:35
And I think that actually brings up a good point, actually, that, especially for those newer diagnosed who may be questioning the math and or seeing shifts in their insulin need already and wondering, well, my doctor is telling me to shift it this way. Most often, they're, they're erring on the side of caution and shifting your insulin for you, right. So you may be seeing numbers that aren't necessarily where you really would like them to be, or where you've learned that many people are getting their numbers to be. They're airing, you know, clinically, they're erring on the side of the lower amount before they get some data to show that they can increase safely,

Scott Benner 13:18
right? Because imagine if you are using point six an hour, let's do that for people point six times 24. So you're on a pump, or you're shooting it, I guess. So point six an hour if you're pumping, or it would be 14 and a half units a day if you were shooting it. But that's just basil. That's just basil we're talking about for a second. But you let's say it should be a unit. But instead it's point six. So you should have 24, but you're using 14, and then your blood sugars are high and your meals are spiking. And you start and that coming down. Yeah. And then you start seeing ghosts, which I talked about a lot. Like you know, my example here would be if the doctor told you look, your basil is point six, but really it should be one. Now you're deficient point for an hour of basil. Then you come along and Bolus something your blood sugar goes up. And you think, Oh, my insulin to carb ratio is wrong, but it might not be your insulin to carb ratio might be right, your Basal insulin is wrong. Right. And for every unit you're shooting for food, point four of it is really kind of just going to cover loss Basal because you're right or wrong, right? Correct.

Jennifer Smith, CDE 14:25
So from a from a Basal only standpoint, if you you know, that initial equation was really for figuring what on average should my total daily truly be daily being everything basil Bolus is corrections, everything in the mix. If you really just want the math for doing kind of same example, like a young inactive kid, just Basal dosing is going to be somewhere around point 2.25 upwards of maybe point six. Again, per kilogram of body weight. So that'll break it down a little bit further so that you can just say, okay, my kids getting this much. They're about in that bracket. They're not very active. This is about right. If however, like you just said, you're constantly noticing, well, gosh, we never really get down despite all the work that we're doing. And you plug in the equation, you're like, Well, gosh, maybe we're deficient in basil. You know, the equation is here. We're kind of under that by a unit or two, we'll maybe you could nudge it up a little bit and then be able to see whether that's working.

Scott Benner 15:39
What if I'm a 200 pound grown person? And I got diagnosed yesterday and I'm six three or whatever.

Jennifer Smith, CDE 15:47
And are you Are you pretty active or are you just moderately active Are you just kind of a couch potato? What would you like to be?

Scott Benner 16:00
G vo Capo pen has no visible needle, and is a pre mixed auto injector of glucagon for treatment of very low blood sugar. In adults and kids with diabetes ages two and above. Find out more go to G vo glucagon.com forward slash juicebox G voc shouldn't be used in patients with insulinoma or pheochromocytoma. Visit G voc glucagon.com/risk. You can make knowledge your superpower with a Dexcom CGM, the Dexcom G six can help you to make better diabetes treatment and management decisions. The Dexcom lets you see your glucose numbers, or your child's glucose numbers. With just a quick glance at your smart device or Dexcom receiver get alerted when your glucose levels are heading higher low and share your data with up to 10 followers. The Dexcom G six is covered by most insurance plans. So why don't you head over now to dexcom.com forward slash juice box to get started with the Dexcom. While you're there, you may be offered a free 10 day trial, the Dexcom G six if you get that offer, I try it if I was you free 10 days, that's a that's pretty cool. I am looking at my daughter's blood sugar right now. It's 70 We're about to eat, and her blood sugar feels like it's in a good place. This data we have right now this visual of what her blood sugar has been doing all day and in the last 30 minutes. And whatever else you want to look at, it's going to help us to make a great Bolus for a meal. And to watch for spikes, lows and everything else. The Dexcom is going to give you alarms, wherever you want them to be at Rs go off at 70 and 120 years, maybe somewhere different. You decide how to set up your Dexcom dexcom.com forward slash juice box, you will not make a better decision today than going to that link. There are links in the show notes of the podcast player you're listening in right now. And links at juicebox podcast.com to Dexcom, Chivo, hypo pan, and all of the sponsors. When you click on one of my links, you're helping to support the show and to keep it plentiful and free for its listeners. So if you're gonna get this stuff, just please give us give us a little clip, click on those links.

Jennifer Smith, CDE 18:21
Kind of the couch potato What would you like to be

Scott Benner 18:25
this feels like an attack Jenny? Not I mean, how about just how about a person that gets up in the morning and goes to a job and probably gets around 8000 steps a day and you know, gets the gym twice a week? You know that twice a week?

Jennifer Smith, CDE 18:39
Sure. Yeah, I mean that I mean, I would call that at least mild to moderately active. Honestly, you're getting a good number of steps more than just the daily activity of 5000. Right. So again, an adult fully grown, no more growth hormone kind of stuff happening somewhere between point two to point five per kilogram of body weight and that's just Basal.

Scott Benner 19:02
Okay, so it can be somewhere point two times 90 kilograms already did the kilogram now. You did the weight. Thank you. 18. It's up 2.5 times the 9045. And that's a total daily insulin. No, that's basil. Excuse me. Yep, that's just Basal literally. Yep, you have the word basil six times in front of me. And so again, there's a big swing right at 45. It's, you know, I imagine always like parents thinking about 45 units in a syringe, and they're probably just like, wait, what?

Jennifer Smith, CDE 19:37
Right? Many, many people in a syringe now may actually only have the 30 cc or the 30 unit syringes. So they may think, Well, gosh, my syringe does the amount of insulin I need to take at one time

Scott Benner 19:53
right? Yeah, I just did the math there for the for the larger amount, and even in a pump split up over You know, 24 separate hours? It's 1.8 an hour. Correct? Right?

Jennifer Smith, CDE 20:04
Which could be I mean, when you talk about like, that seems like a lot. But gosh, if you look at what do you think the heaviest age group for insulin needs is?

Scott Benner 20:14
My guess. Oh, gosh, what? What do I think the heaviest group is? Girls who get their periods? In the beginning? I don't know. 15 or 1430? Yeah, adolescents, right,

Jennifer Smith, CDE 20:27
that teen preteen upwards into maybe even early college, right? And really their needs in an inactive state? Or let's call it moderately active. I don't even know what moderately active is for a team these days. Like, what are you doing? It's,

Scott Benner 20:48
it's your finger moving very quickly.

Jennifer Smith, CDE 20:50
Right? Yeah, exactly. So really inactive, let's say somewhere between for adolescents, somewhere between point three and point, it's about one ish. If you're moderately active, like you go to gym a couple of times a week or PE, right. You may bike down to the mall or whatever with your friends, again, so far outside of that age range, but it's like point three, like point seven with some activity. So you can see that the more active you get, the lower overall your insulin needs will be because you're metabolically able to be more sensitive to using and your body using seeing and responding to insulin, better to give

Scott Benner 21:33
a little focus for people like That's why if you are a person who's moderately active, and you have all your insulin set well, and then you decide on Saturday afternoon, you're gonna go play basketball, and an hour into it, you're looking at a stranger going, there's juice in my bag, like, right, yeah, I have helped me, that's going to be because you were set up as an in a more inactive person who suddenly got very active and your settings, you didn't change your settings to go play basketball. Right.

Jennifer Smith, CDE 22:05
So and I think that brings in and of itself a really good point. Like, if you went and did that, like once a week, you're most likely still going to be only moderately active, whereas, and your insulin needs for that day may shift. Yeah, or maybe into the next day, maybe 36, even 48 hours of reaping the benefit of that high activity. But that doesn't mean your overall settings need to be adjusted. Right? Yeah, that's applying another factor. Right?

Scott Benner 22:34
Right. That's just the point of, you know, what stable can look like, right until you throw a variable into the mix.

Jennifer Smith, CDE 22:40
Right. So But over time, if you added more consistently, like you joined, you know, the basketball team and you're practicing a couple of nights a week and you're doing that, like rec league, or whatever, on the weekends or tournaments. Now, over time, you're metabolically going to become more sensitive, your insulin needs may come down. And I see that with a lot of the teams that I work with, you know, in the season versus the offseason shifts in need can happen in a very considerable way.

Scott Benner 23:11
So to make this episode valuable for anybody who trips over it, whether they have a kid, I don't know. Like also, does this count when you're honeymooning, nothing counts when you're honeymooning. Right. Yeah. Does it?

Jennifer Smith, CDE 23:24
Does it count? I think from an from a place of analysis, you can see where are you and as you become more sensitive, because your body is still helping you or has increased if the help that it's giving you in that time period, then some of this math may definitely go out the window. I mean, we've had, you know, many kiddos who can just use a Basal insulin of one unit a day and they're not even bolusing. Yeah. Right. So then, yeah, so then as the math will not be helpful, but

Scott Benner 23:57
as needs shift, you can redo the math and then look at the range and and say, Oh, well, I'm already at the low part of the range. It doesn't seem to be enough. And you can see at least where, at least I guess my point is if you're at point five and point fives not working, but you know, your range based on the math might be point five to I don't know, one, that at least you because some people were like, I don't know how far to turn it. Like I want to give more right, but I don't know, is it point five to three? No, it's not.

Jennifer Smith, CDE 24:25
Yes, no, no, no,

Scott Benner 24:26
no. It's hard to put yourself back into the position of a person who has no earthly idea what they're talking about, you know, because it's hard to know where to go. But okay, so maybe you're honeymooning and you'll be on the on the cautious side, you'll see your needs change. You'll do the math and you're just within the range. But But is this is this episode good for somebody whether they're eight or and just found the podcast. I've had diabetes two years where they're 15 or the 35. Or they're 60 Like this. It works for everybody. Yes, that's it. Okay. Say it one more time. For me, just the math. Just the math. Yeah.

Jennifer Smith, CDE 25:03
Okay. The total daily dose or just the Basal

Scott Benner 25:08
start over Jenny, I walk into the room. I'm like, Jennifer, I need your help setting my Basal insulin. Hi, I'm Scott. I'm 30 years old. I weigh 180 pounds. What do I do?

Jennifer Smith, CDE 25:20
Yeah, so 180 pounds. I'm sure you probably all did already did the math on your fancy computer. You wanted a half kilograms. They are at one and a half kilograms. And we're going to essentially take that you said you're 30 years old, right there and take 81 and your age is 30. And, Scott, how active are you?

Scott Benner 25:39
I have to be honest, Jenny. I've been watching. I've been watching Battlestar Galactica on Sci Fi. I'm Monday, I'm going to season five. And I'm going right from that to Yellowstone. So I'm not doing much.

Jennifer Smith, CDE 25:49
I'm sitting right. And on your side time you're doing a podcast. Yes, I

Scott Benner 25:53
sit when I work, and I sit when I'm enjoying myself. And I eat I eat well, though, I don't eat a lot, I don't eat a lot of junk food. I don't have any, I don't have any processed oils, I stay away from processed food. I eat protein, not a ton of carbs, maybe candy once in a while. Okay,

Jennifer Smith, CDE 26:12
so your overall inactive, age wise kind of were is a nice age to be. So we're really looking at taking your kilogram weight 81 kilograms. And you're going to multiply that if we want to start with just a total daily sort of estimate of where your insulin needs to be. In an inactive adult, you're looking at about point five to about 1.2 point 5.6 up to about 1.2 units per kilogram. And again, this is your total insulin needed in a day.

Scott Benner 26:45
So I'm at 40 and a half. Okay, point five,

Jennifer Smith, CDE 26:49
of which about about half give or take, again, based on an inactive level is going to be basil. Okay? Now, if you really want, you know, dosing strategy just for basil, and then when we talk again, we can see how well that's working for you, then we kind of start with just looking at Basal insulin needs. And from an again, inactive adult gotta get to doing more than Battlestar Galactica or whatever it

Scott Benner 27:13
was it while I'm thinking about going for a walk,

Jennifer Smith, CDE 27:17
you're thinking about going for a walk. Okay. So that would add in some mild activity, but I would still start you on somewhere between point two, five all the way up to maybe point six units per kilogram, and this is going to be just your Basal insulin needs. So if we took, let's say, say middle ground in between there, point four units, okay. So you take your 81 kilograms times point four, gives you about 30 to 32.7. So let's say 33 units of just Basal insulin a day.

Scott Benner 27:49
Okay. All right. So if I'm shooting it, I'm shooting that much. Does it matter if I'm shooting to SIBO? Or Lantis? Or no? Okay, no. And if I'm on a pump, I'm going to divide that number by 24. And make my Basal rate about 1.35. an hour?

Jennifer Smith, CDE 28:04
Yes, good math. Absolutely. Okay.

Scott Benner 28:07
But so is the chart really the important part? Like I know, you mentioned that there are a couple of books there. So I'm putting like, put yourself in the, like, this episode will be downloaded just 10s of 1000s of times. And it's going to be by everybody in every age, and they're going to hear it overall. But where did so where did they go to start? So now I can't tell you how much they weigh, or how old they are. But what should they do?

Jennifer Smith, CDE 28:32
Right? I think honestly, then if they're looking for the math, the books would be a good if they'd be a definite advantage. Because then the charts are, they're very easy to look at that you can say, Okay, I've got a kid who is not like pre puberty or even puberty, they are a kid, my kid is moderately active. And I can look at what should the math figure out to be knowing how to determine what they are in kilograms versus their pound weight. All they have to do is look at the chart and do the math and say, okay, my kid is right here. It looks like we're in this range. And my kid is still sitting high. So that's where then you have to take it a little further. And you have to look at the data from what if you're using a CGM, that's most advantageous. Obviously, you have the most in terms of trends. You can say, we want to nudge this down. It looks like we're staying high no matter what, right? We're not terribly floxie Up and down. But we've got some stability just at a higher level than we want to be. And what we've been using for Bolus is doesn't ever seem to get us to come back down. Right. So could it be Basal it could be could it also be that the Bolus ratios just are not working heavy, heavy enough either. Because remembering that our Bolus doses when we take them are really what's supposed to get us back down to the target that we're aiming for. And it's So if the Bolus is aren't doing that, despite doing some basil testing, and when you're using whether you're using MDI, or you're using a pump, you can do some base Basal testing to evaluate stability. Because remembering that Basal insulin supposed to hold you where you are, and not allow you to drop or rise more than about, let's call it 20 ish points. So if that's the case, and you're holding stable, maybe that's because that's where your Bolus has left you off.

Scott Benner 30:30
I have to I have two big questions. Yeah. These charts? Are they like copyrighted information? Like if we posted them on my like, I'd have a look at that right on my web, I think stealing from somebody if we put it up because I could make a webpage, where this episode sits along with the chart and the math right now.

Jennifer Smith, CDE 30:52
And the math written out? Yeah, I'd have to look in the I'd have to look in my books to see whether or not underneath the charts that are in both of the ones that I have. Again, both John Walsh's and then Gary's book, both of them have charts. I don't know if they have a specific,

Unknown Speaker 31:11
you know, horse

Jennifer Smith, CDE 31:12
noted,

Scott Benner 31:13
like, is something that isn't something that Gary sat down was like, I'm gonna figure this out on my own, or is it something that the world knew when he put it in there?

Jennifer Smith, CDE 31:20
No, that's definitely not I mean, it's not like Gary or John sat down and was like, these are definite used. They're used charts. Right. This is what a peds. This is what an endo may or could potentially look, look at. So the math is a set math kind of rule. Well, no, it's not. It's not their work.

Scott Benner 31:44
Okay, well, then I'm going to just put it down. I am going to make a web page that goes along with this episode, then. Sure, I'm probably gonna ask you for help. So

Jennifer Smith, CDE 31:53
I'm happy to help you.

Scott Benner 31:54
Here's my last question. I'm a person that have had diabetes forever. And I'm hearing this episode and thinking, God, is my basil wrong? Do I just take my total daily insulin go over what I've heard and take a look and see like, oh, maybe my basil isn't right. Like, because? Because it does happen, right, that people get set up one way. And then you just sort of you, I think it's very common for people to get to the right answer the wrong way. In a lot of facets of life, diabetes is an example. So say, one day, 10 years ago, I know it sounds crazy, but 10 years ago, a doctor put you on a Basal insulin, and he gave you too little, and your blood sugars were high, but you found ways around it with, you know, corrections or that. And eventually, it just works for you. It doesn't mean your settings are right, it means that you found a way to work with bad settings. Right. Right. So it's not it is worth going back and looking at a little bit.

Jennifer Smith, CDE 32:53
It is absolutely because as you said, you know, if you really think something is off, I mean, you can go back to what we've talked about in the pro tips, which are all about testing your insulin factors, right? The first one being basil, because that's, that's supposed to be your foundation, it's supposed to hold you really nice and stable. If you just decided all day long. Today, I'm going to fast or it is your fasting time of the year or whatever it might be, you should be confident that your basil is doing a good job. And Could your basil change? Absolutely based on some of the variables that we've already talked about, you've added in exercise, or you've now got a really active job when you used to have a very sedentary job, that could all factor in and you may need a

Scott Benner 33:40
shift. I'll just say it here again, if your basil is wrong, nothing else works. And you really should go find the Pro Tip series and listen to it because I think you would have a better idea of how to use your insulin. Right. Well, thank you very much. I appreciate Of course, yes. A huge thank you to one of today's sponsors, G voc glucagon, find out more about Chivo Capo pen at G Vogue glucagon.com forward slash juicebox. You spell that g VOKEGLUC. Ag o n.com. Forward slash juicebox. Thanks also to Dexcom, makers of the Dexcom G six and that Dexcom G seven that's coming just any day here in the United States. It's already available in Europe dexcom.com forward slash juice box, see if you're eligible for a free 10 day trial of the Dexcom G six. All right, I want to thank you for listening here, but after the music, I'm going to tell you about some other episodes that will help you with your Basal insulin.

Before I tell you about those other episodes, I want you to know that the chart that Jenny and I spoke about is that juicebox podcast.com forward slash Basal if you're new to diabetes, Nice, you should check out the bolt beginning series that's available at juicebox podcast.com. Go to the top, click on bold beginnings, or by looking in your podcast player for bold beginnings. Use that search function. If you're not so new to everything, you may be looking for the diabetes Pro Tip series. These are again available in your audio app, whichever, wherever you're listening right now, or at juicebox podcast.com. But if you just want to drill down on Basal insulin, find episode 237. It's all about basil, and it's part of the Pro Tip series. If all this is too confusing, just go to Google and type in juice box, one word, podcast, Basal. And all this will come back and return. On top of all that, there are lists of all the series available in the private Facebook group in the featured tab. So that's juicebox podcast.com In the private Facebook group under the feature tab, or in any audio app that you want to listen in, this information is here for you. I hope you get your Basal set well. It is really the core of your diabetes care. And don't forget to go to Episode 821 and 822. To figure out insulin to carb ratio, and insulin sensitivity factor these three settings together, they're going to make a big difference for you. Last thing is I just really can't recommend enough that you take the time to listen to the diabetes Pro Tip series. If you're looking for stable a one sees less variability, overall greater health. The diabetes Pro Tip series from the Juicebox Podcast will help you thank you so much for listening. I'll be back very soon with another episode of The Juicebox Podcast.

To caclulate Basal/background insulin dose take Total Daily Insulin Requirement(in units of insulin) = Weight in Pounds ÷ 4

Total Daily Insulin Requirement (in units of insulin) = 0.55 X Total Weight in Kilograms

Basal/background Insulin Dose = 40-50% of Total Daily Insulin Dose

#819 Quadriplegic and Type 1

Kate is the most resilient person I've met in a long while. She is also a quadriplegic who has type 1 diabetes.

+ Click for EPISODE TRANSCRIPT

Scott Benner 0:00
Hello friends, and welcome to year nine. That's right season nine of the Juicebox Podcast. This is episode 819.

Today I'll be speaking with Kate. She is a young person living with type one diabetes for not very long. I recorded this not too long ago but have been saving it especially to start off a new season with Kate's story is one of perseverance and resolve. That's right. It's of perseverance and resolve. And it is uncommon. And I took a lot from it. 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 healthcare plan. We're becoming bold with insulin. If you're a US resident who has type one or is the caregiver of someone with type one, please go to T one D exchange.org. Forward slash juicebox and complete their survey. The T one D exchange surveys supports diabetes research. And it can only do it with the simple answers to the simple questions that you get asked in the survey. T one D exchange.org. Forward slash juicebox help move diabetes research forward, right there from your home, or on your sofa, or wherever you're sitting. This episode of The Juicebox Podcast is sponsored by Omni pod makers of the Omni pod five, and the Omni pod dash. You can get started right now at Omni pod.com forward slash juice box. today's podcast is also sponsored by us med now us med is the place where Arden gets her Dexcom and Omni pod supplies. And you can get those and much more US med.com forward slash juice box or call 888-721-1514 Get your free benefits check today and get started with the white glove treatment from us met.

Kate Brim 2:14
Hi, my name is Kate, I have been a type one diabetic for a little over a year now. Um, and yeah, so it's actually not really where my story started. I had a spinal cord injury in December of 2017. And so it was kind of a kind of had a lead of events that have happened to me over the past five years.

Scott Benner 2:45
We're gonna find out about that. How old are you now?

Kate Brim 2:50
I am 24 years old

Scott Benner 2:52

Kate, you have a an older voice? Do you know that?

Kate Brim 2:58
I do not know.

Scott Benner 2:59
Maybe it's just the headphones. Could just be your microphone. You sound like I don't know, you sound like you? Well, maybe it's not that I was gonna say you sound like you've been through some, like you have kind of gravitas to your voice? You know, you're like my name is Kate. Like you just very Have you always been like a measured person?

Kate Brim 3:20
Um, I would say definitely. Definitely. In the last few years, ya know, since since my injury, especially it's kind of forced me to grow up really fast.

Scott Benner 3:32
I don't mean this poorly. Okay, please take me at my word on that. But if you would have told me, I'm 56 years old. I would have been like, alright, that makes sense. Because Kate's got kind of a low, easy way about her like you speak like, I don't know. Alright, let's figure this out. Okay, so you're 24 G's you were diagnosed a year ago with the diabetes, but you're saying that something happened before that. So tell me about it, please.

Kate Brim 4:01
Yeah, so it was December of 2017 is when the injury actually happened. But prior to that, in high school, I had started experiencing back pain. But I really didn't think anything of it. I was, uh, on the rowing team. So I was, you know, kind of putting a lot put my body through a lot. So I just kind of dismissed it as Oh, you know, you're not stretching while you're using your body really hard. You know, Lottie, Dottie da and I just kept on going with life. And then it was the end of my senior year and I happened to be in a Rite Aid pharmacy. I think that was picking up a script for one of my parents or something. Anyways, I was headed down the like aisle that gets me closest to quickest to the pharmacy line and happened to be a my, my right leg gave out and I fell and I ended up knocking over a whole shelves worth of pills, like supplements and stuff and I was like awesome, perfect, perfect I'll for this to happen too. And so it was that was kind of like the eye opener of like now something seriously going on I gotta get this figured out.

Scott Benner 5:24
So did you're in that moment? Did your legs just give out like what was the sensation?

Kate Brim 5:30
Yeah, it was my right leg completely just buckled underneath me like I was walking and it was like, Nope, you are. You are not continuing.

Scott Benner 5:40
No pain prior or anything leading up to the moment.

Kate Brim 5:44
I had been experiencing pain and I was having really bad like sciatica and stuff. At the time. I didn't know it was sciatica. I just, you know, it's like, wow, I'm getting this like shooting pain down my leg. My back hurts a lot. I feel like an old person. And I'm not even 18 years old.

Scott Benner 6:04
Had you mean I just ask had you been telling your parents about this or no?

Kate Brim 6:08
No, I had not. No, it was just, I completely thought it was no, I had been putting a lot of work in as far as rowing because we had the State Championships coming up and it was my senior year. So I was really putting a lot of work into that. And I just dismissed it. As you know, your body's going through a lot. Right now you're putting your body through a lot of work. Okay, that was I just dismissed those that

Scott Benner 6:36
are on the floor in the pharmacy, vitamin D, zinc B 12. Flintstones chewables. They're all around you. This is how I imagined it, by the way, just like marbles on the floor of my right. Yeah.

Kate Brim 6:48
Oh, yeah, that's exactly what it was. And I haven't Of course, it happened to be in one of those moments when there was a lot of like, a fair amount of people inside the pharmacy. And I was like, a few people came over and they're like, Oh, you're right. And of course, me being the young person. I was like, Yeah, I'm fine. Get myself up quickly start like picking up the bottles with these few other people that are helping me and you can kind of tell that it looks startled, but I just tried to brush it off like nope, nope, I'm fine. It's okay. I just, you know, stumbled or something. So we get it all picked up, I go to the pharmacy pick up the script that I needed to pick up. And then know when about what about my day, the rest of the day. And I think it was a couple days after that where I was like, now I really got to really got to get this looked at. So I told my I think I told my mom I don't even think I really directly told her that I think it was actually I went for one of the sports wellness checks, then my primary care was doing like, all the things he does to check. And he was doing one of the reflex checks in my legs, and I had none of the reflexes and he was like, oh, we gotta get this looked at and then that's what led to me getting. I think it was just an MRI. Okay. And then they saw a herniated disk. So at first, they weren't on the row of like physical therapy. That didn't help. So then they did an injection that didn't help. Continue with physical therapy. This was probably another like six months that you know,

Scott Benner 8:37
can I ask, did you continue to row or did it shut down your activity?

Kate Brim 8:41
I continued to row I wrote all four years of high school. Yeah. I so and leading up to that, like, you know, we saw the herniated disc, and the doctor that they referred me to is like, oh, did you have an injury or anything? And I was like, No, not that I can. I can recall like, oh,

Scott Benner 9:06
yeah, I sit on a thing. And I go back and forth in my arms a lot. But other than that, and throw myself on the floor at the pharmacy. I haven't done it.

Kate Brim 9:15
Yeah, exactly. Yeah. And so I, you know, went through that things weren't resolving the disk did not go back in like they had hoped were hoping it would. So they went in did a microdiscectomy. And it actually ended up failing pretty immediately. Like I've still when I was in the hospital, they're doing all the tests to see if, you know, oh, is that nerve still being pinched? And one of the tests they did with my legs, they it incline them to do another scan, and they saw that the disk had herniated. So we kind of went back through that whole process that I did leading up to that first serve. Free. Okay, still weren't getting

Scott Benner 10:02
give me a second Kate, they did the okay microdiscectomy also sometimes called micro decompression, minimally invasive surgical procedure performed on patients with a herniated lumbar disc, during the surgery surgeon will remove portions of the herniated disc to relieve pressure on the spinal nerve they did that didn't do anything for you. They went back to pt after that.

Kate Brim 10:23
Yeah, so we went back to pt, they were hoping that just because of the surgery, it was, you know, the muscles kind of all got moved around and stuff. And that it would it would go back in, you know, once the muscles are kind of back to their homeostasis kind of kind of point.

Scott Benner 10:42
Like both to you when they said it, or

Kate Brim 10:45
I I was I really young, yeah, young and uninformed and really didn't know what the heck was going on. You know, I'm just like, okay, yeah, I want this pain to go away. Like, alright, let's continue with pt. And I was, at the time, I was still in the mindset of like, okay, you know, little hiccup, like, I'll get, get back to life, you know, here. Just do what the doctors tell me and take care of my body as best as I can. In this time, and I'll I'll get back to normalcy. So yeah, we continued PT. I can't remember at some reason, I feel like they did another injection. Yeah, I had two or three spinal injections. And then, yeah, so it still hadn't helped. They did another MRI, they saw that it was still still herniated. So they went back in and did a revision laminectomy. And within that, he said that, like as he was doing the surgery, that, you know, my disc was, was not like, fully intact, it was kind of just crumbled in pieces. But within that surgery, something happened, we still don't have exact answers as to what happened. But when I came out of surgery, I had lost like all feeling in my legs. And actually, I had lost feeling from about the C four down and a lot of movement from the sea floor down. And so that then led to a long hospital stay of many tests being run and trying to figure out you know, what the heck happened? And to this day, they don't have exact answers, but their best guess is that I had a, either a spinal stroke or a blood clot that traveled up my spinal, spinal canal and damaged, damaged my spinal cord.

Scott Benner 12:58
You didn't get this done behind a Dunkin Donuts, or anything like that, right?

Kate Brim 13:02
No, no, I did not. Nope. It was actually one of the one of the best practices in Michigan. So yeah, no, it

Scott Benner 13:13
was can you describe for me a little bit at that age for good, I guess doesn't matter what age you are, but waking up and having that experience? I mean, just devastating. Seems like the word but can you talk talk me through the days afterwards?

Kate Brim 13:32
Yeah, so that surgery was December of 2017. I had actually I had graduated high school then. And I had started immediately at Ferris State for construction management leading up to them. I was actually like, I was working for a directional drilling company that installed fiber optic internet. And like, I'll tell you, like, I really thought my life was set and like I was on my path, you know, my career path as far as doing construction management, you know, I was working in a kind of indirect path of construction, but like, you know, I was doing what I loved I was working outside you know, doing physical labor. Yeah. And that was that was what I loved. I was very much so an outdoor person. And in that moment, I will say like, probably the first two to three months were like really dark for me. I was just stuck in this like, how am I going to do what I was doing and like, go into Paris and stuff and for what I was going to school for, like my mind was just stuck and in how am I going to get back to that? When in the moment, you know, I was like fully dependent on other people as far as my care, and on top of that I was having, you know, just a lot of health complications from all of it. And so yeah, it was definitely, definitely really dark. In the beginning days, as far as that I was. I will say like, just because I think a lot of it revolved around the puzzle biotrust that I had inpatient at the rehab hospital I was at, he kind of just went real textbook with it and was like, Alright, this is gonna be your life, like, you're going to need a caregiver 24/7 You're going to be confined to a wheelchair for the rest of your life. And you're going to have to figure out how to how to make this work. And I was like, wow, wow, pal. Like, nice to meet you, too.

Scott Benner 15:58
Thanks for sprinkling the roses around before we talked about it, you know?

Kate Brim 16:02
I mean, yeah, exactly.

Scott Benner 16:03
I wonder if I wonder if he was at he had to be Hey, there's no way no way any woman with any reasonable mothering skills said that to you so. So I wonder if he had just seen people fight it for so long that he found the man I don't know. seems weird to me. It's it to me, it seems like the almost similar to, you know, if a person with diabetes isn't managing their diabetes, well start telling him about, you know, oh, you know, if you want to lose a leg, I guess you keep going like this, you know, like, it's really just a rough way to come at someone, you know, when maybe a little more concerning care might help. But yeah, I just want to make sure that I understand everything. So this this injury, that a surgical injury, I guess is how we're thinking of it, right? Yeah, yeah. So we attack this this problem first. There's a surgical injury. And it leads to I want to understand because I don't I'm not good with the terminology. Kate, you're paralyzed. Is that Yeah, that's the word. Yep. From about wear down. Like, I'm sorry. I'm like, is it between the nipples and the belly button? I'm trying to think of a way to say it and I'm not good at it. So is it like midline like your sternum, like where we're at?

Kate Brim 17:23
I'm affected from about the collarbones down. Okay, to some to some degree. So I, I have like, I have no movement in my legs or my core, and then my arms so my hands are pretty affected my triceps are pretty shot. And so it's, it's kind of hit or miss. So it's, they would consider me what's called an incomplete spinal cord injury. So signals are still being sent down this the spinal cord, but they're just, they're fuzzy. They're kind of messed up. They're not complete Yeah,

Scott Benner 18:04
so yeah. Sorry, that was this the most descriptive yet anyone has ever uttered on this podcast. Yeah, so I'm gonna feel like is what you were saying. But but that's Wow. Oh my god and you're 18 years old when this happens 19 at that oh, because they you know, because you had to go to physical therapy six times. So it's so you're so your hands like right now. How did you set this up for yourself today? The the interview where did somebody actually have to help you with this? We all get our diabetes supplies from somewhere at our house. We get them from us med. Why do we do that? Well, US med offers white glove treatment. They are the number one distributor for FreeStyle Libre systems nationwide, the number one specialty distributor from the pod dash, and the fastest growing tandem distributor again nationwide. US med is rated number one index com customer satisfaction surveys is that amazing? Over 1 million diabetes customers have been served by us meds since 1996. And they offer you better service and better care. But they offer you more than that. They also offer you 90 days worth of supplies and fast and free shipping. When you place your order. They carry everything from insulin pumps, diabetes testing supplies, and the latest CGM is like the FreeStyle Libre three the Dexcom G six and I'm hearing that they'll have the Dexcom G seven chest as soon as possible. Guess what else us med is doing through their pharmacy benefits us med dispenses Novolog insulin aspart and humor log insulin lispro How about that? Us med.com forward slash juice box head over there right now and get started. Or if you prefer the phone 888 7211514 Get your free benefits check and get going with us med. Sometime in 2008. When my daughter was four years old, my wife and I had a conversation sounded a little like this. We don't want Arden to go to school. While she's doing MDI, we want her to have a pump. And so we went out and looked at all of the available pumps. And it was easy to decide to go with the Omni pod. It was tubeless, it was small, and it wouldn't hold her back, or get caught on doorknobs, she could swim with it, take a shower, go to gym class, all without being attached to a controller by tubing. That was a long time ago. And my daughter has been wearing it on the pod every day since then, every day since 2008. And here we are standing in 2023 on the pod has been with her through the entire thing. Omni pod.com forward slash juice box so you can make that same decision. Go find out right now if you're eligible for a free 30 day trial of the Omni pod dash. Or if you're looking for something with an algorithm, something that can make some of those insulin decisions for you. Go check out the Omni pod five, they're both at the same link Omni pod.com forward slash juice box. Now you may be eligible for a free 30 day trial the Omni pod dash. So that's definitely worth looking into. But if you're looking to get started with an algorithm, you can't go wrong with the Omni pod five, give it a shot. Maybe many years from now, you'll be able to say that Omni pod has been a friend to you for all these years, just like weekend Omni pod.com forward slash juice box. For full safety risk information and free trial terms and conditions, you can also visit on the pod.com forward slash juice box. If you can't remember the links, they're all at juicebox podcast.com. And when you click on my links to Omni pod, to us med or to any of the sponsors, you're helping to keep the show free and plentiful for the listeners. So please, if you're going to buy this stuff, use my link. Now we're going to get back to Kate's conversation, which is longer than some of the conversations that you're accustomed to in the podcast but but so very worth it

Kate Brim 22:44
so I set it up myself, I will tell you, it's like everything for me, just takes a lot longer. So like I was up, I got up about about six o'clock this morning, got myself breakfast, got myself dressed. But it took me a long time to get to the point where I am, like, I will tell you is definitely a bumpy road. As far as learning how to transfer into my wheelchair by myself and even just propella a manual wheelchair by myself, like I that was the one thing in the beginning. You know, they had told me oh yeah, you're gonna need to be at a power chair. And I was like, like, hello, that is so inaccessible, that big, bulky thing, like, my arms work we're gonna make we're gonna figure this out.

Scott Benner 23:38
So getting out of so do you live by yourself?

Kate Brim 23:42
Yes, I actually do. So up until about a month ago, I was living with my parents. My mom, she comes home on the weekends. So it was primarily my dad and I and, but even with that, like I was, I would say 90% independent. For a long time, I had a nurse coming in a couple times a week to help me with basic ADL things like showering and stuff just because, you know, what surfaces is not always the safest, but

Scott Benner 24:23
you didn't pick up any seal skills after this happened to you? Yeah.

Kate Brim 24:27
So Yeah. So.

Scott Benner 24:30
So okay, so you had somebody coming in? I can't I'm so sorry. I'm fascinated. And I want to get answers. And I don't know how to be delicate just because I don't know the right words. But how do you go to the bathroom?

Kate Brim 24:45
Yeah, so because of my spinal cord damage. I have. I'm on what's called a bowel regimen. And then also I have to use intermittent catheters to relieve my my bladder and stuff. So none of that is voluntary for me anymore. And so it just though that's another step in my life, that it takes a lot a lot longer than the average person and it takes, you know, having a regimen. And so yeah, that was awful. In the beginning days, that was a huge hurdle for me because I was getting a lot of bladder infections. And so that was, yeah, that was probably one of the biggest hurdles for me to get over in the beginning days, you know, they had done what's called, uh, in the beginning days, we started me off on intermittent catheters, I was getting a crap ton of infections, like really bad infections to the point where I was like, throwing up and passing out and stuff. Cuz then they did a super

Scott Benner 25:53
hold on intermittent catheters, like the nurse showed up and gave you a Foley. And that happened every once in a while, or what does that mean?

Kate Brim 26:01
Um, so Foley catheters typically are a catheter that's placed, and it stays in place for you know, anywhere from two to four weeks, and then it's changed out again, an intermittent catheter is essentially a catheter that's inserted, drains the bladder and removed

Scott Benner 26:20
it who would do that for you than ours?

Kate Brim 26:22
I actually learned how to do it myself. But I also had help from a nurse in the beginning days,

Scott Benner 26:28
okay, because I'm because because you said the nurse was only there every couple of days, but you couldn't go a couple of days without urinate. And that's why, yeah, that's why I was trying to figure it out. So you could Wow. So you were to dumb this down for me, you'd like pop a straw in there, let it out. And then that's it. You go back to life. After that, go back to live. Yeah. How many times a day do you need to do that?

Kate Brim 26:51
Um, it varies from day to day, depending on like, how much fluids I'm drinking, especially since I really picked up on the handcycling. I'm drinking a lot more. So me right now. It's typically every three to four hours. Okay. All right.

Scott Benner 27:10
Do you live in a rather small place? Or is it bigger because you need open space?

Kate Brim 27:17
So the place I'm in right now is actually quite cozy, but it's there. It's like, really? It's open. Like, if you saw it, you'd be like, Wow, this is a small place, but like, No, I've made it work. It works. Yeah, yep.

Scott Benner 27:36
Okay. So we got number one, covered. Number two, you said about something

Kate Brim 27:44
in the bowel regimen. So it's, it's kind of like the catheterization it's you know, I have to use what are called suppositories when tonight to help move that along, because essentially, so the, the intestines, they have something what's called peristalsis. And that's essentially what moves you know, the fecal matter through your intestines just naturally in ours is slowed down and paralyzed. A lot. And so essentially, we have to manually evacuate. Yeah,

Scott Benner 28:24
there's that. Yeah. Yeah. Can we just call this episode? Yeah.

I'm sorry. I don't know what else to do. I love your Yeah, very much. So. Okay, so that's how that happens. Does it make you got I can't believe you got diabetes, but hold on a second. We're not even up to that yet. I'm trying to figure out when you when you go to eat or drink, obviously, you need to sustain yourself, but is it in your head? If I eat this, it's gonna have to come out.

Kate Brim 29:00
Um, so in the beginning days, it was definitely hard. Because the really tricky part about it is like, you know, we have to keep things are relatively easily able to move through our system. And so that really included you know, eating a lot of fiber and figuring out what foods might like, Oh, does this food upset you or cause things caused you to get more constipated and stuff? If it does on the beginning? Done? Say that again.

Scott Benner 29:36
If you find a food that doesn't go well with your body than done, you don't eat it

Kate Brim 29:40
again. Yeah, pretty much. Yeah, pretty much except for come

Scott Benner 29:44
okay. What's the one where you're like, alright, I'll take the hit for this.

Kate Brim 29:48
So ah, I think I think it's definitely still it's been hard for me so like pretty immediately after my second surgery, I developed a couple allergies that are like epi pen worthy. One of those being adhesive and skin glue. So that was fun healing my incision after my second surgery because the allergic reaction, but the other one happened to be dairy, which eliminates a lot. So I would say, I was like before I was sensitive to dairy and you know, it would give me really bad gas and diarrhea. But now it's like, it's just out of the question. I can't have it. Like, and so I will say just because of how crappy I feel, I really have not had too many foods where I'm like, Yeah, that's gonna make me feel like crap, but I really want it just due to how crappy it makes me feel. Typically I since my injury I once I found what works best for me. Like, I've stuck to it. Yeah.

Scott Benner 31:06
Okay, I'm gonna tell you something I wouldn't normally do. My daughter just texted me, right. And I'm gonna read the text back that I sent to her. So she's in college, she's been college for three weeks. I can't give a lot of details. But there was a roommate issue that was fairly horrendous. And took a number of weeks though to to get through. So she's not having a good time, but and it's just starting to get normal. Couple days go by and then hurricane Ian decides it's going to hit directly where she's at. So people bug out. She stays behind. They're hunkered down. Thankfully, the hurricane takes a turn, never even touches them barely rains. So I kept telling her I'm like, Don't worry, Arden I was like you're gonna get through this, the hurricane things going to end on Monday, you're gonna go to school and things are gonna start to look up and she just texted me. I forgot my water bottle. It's already a bad day. Now, Kate, if you don't mind, I'd like to respond to her. I'm currently interviewing a 23 year old girl who became paralyzed at 18. Then last year, she got diabetes, she has to put a pillow on her own as to find water. Can I do that? Okay, send. There we go. All right. Now, that's parenting where I live. I mean, holy heck, I forgot my water bottle that day is shot. So I'm trying to think about like, if there's a water bottle across the room, and you're looking at it, you want it you're like, Alright, I guess I can get there in 20 minutes, like good. You know, I mean, like, I It's, it's, I don't know how you can I'm gonna ask you a question. I'm dancing around in my head the whole time. How do you not give up?

Kate Brim 32:55
So you know, that's, that's a question I get a lot. Yeah, I would imagine when I was in rehab, I was in rehab for a really long time. I actually had a dietician at the time come in and for some reason she just like something in her registered like this person just need someone to talk to and something she told me it was a quote that said you know, essentially a said, you know, I can I can sit here and perpetual sadness of and just, you know, mourn in my loss. Or I can make the best of my situation. And just just get on with life, you know, things are going to be yes, yeah, things are gonna suck at times. But like, we just got to find light in this situations and you know, move on as best as we can. So like, I'll tell you like in the beginning days, one of the first things I discovered while This really sucks was I had gotten myself ready for bed and then the time came where I'm like, Okay, I'm gonna transfer into bed and go to bed night get myself transferred. And at the time, I'll tell you like, transfers took me a good probably five, six minutes, okay, just to get myself into bed. And I get myself into bed and I get the covers over and I look up and the lights are still on. Now I'm like, Oh, I

Scott Benner 34:27
would have given up I would have just I would have I would have thrown myself out of bed and tried to jam my head into the floor. I would have I swear to you, Kate, I would have sat there going

Kate Brim 34:39
no, that's quite literally what was going on. Going through my head. I was like, Are you kidding me? Like

Scott Benner 34:47
oh my god, I would have would have been like I would hit myself. Like an ants don't work right. I would just oh my god, I would probably lose my mind. And and you're who helping you, therapy, your parents.

Kate Brim 35:04
So it was at that time I was doing outpatient rehab where I was going into the hospital every day, but staying at home overnight. On that day, I remember it was just my dad and my dad is one of those people. He's he's older, he's kind of hard to hearing and at the time, I really didn't have a lot of lung capacity.

Scott Benner 35:26
Okay, perfect. Keep going. Tell the story. Yeah.

Kate Brim 35:30
So I was like, I can try Yellin, it's not going to get anywhere. And so, of course, you know, I'm like, I'm one of those people, it has to be dark in the room for me to go to sleep, like, has to be dark. So of course, I get myself out of bed. The first thing I did was I went on Amazon and I ordered an Alexa because that was one of the things they told me in rehab was like, you know, be thankful we're in the day we are. And you can order things like Alexa, turn your lights on and off. And I was like, that is so stupid. Like only lazy people do that. I'm not doing that. But that day that that happened. I was like, nope. voice activated lights are happening.

Scott Benner 36:12
Oh, yeah, you would think so. And anything else I can figure out that will help me? Oh my god, I swear to you. Okay, I would have I would about you gotta be kidding me. Because there's gotta be hindsight, right? Like, there's got to be a part of you that thought I could have lived with the pain in my leg?

Kate Brim 36:31
Oh, most definitely. Yeah, there was, you know, I, I will say though, there was never a point where I was like, truly, like, just just take me back, take me back, I will say like, I definitely had points where like, Man, I really, really, really miss my past. And like, This really sucks. But at the same time, I was put in a place where fortunately, like, immediately, I had an amazing support system around me to like, adapt to this new new life. You know, the rehab hospital, I was at Mary Free Bed. They have an amazing adaptive sports, you know, program, getting people involved with doing the things they love, again, whether it be adaptive sports, or just things within the community. And it happened to be for me, it was actually like sports. So I discovered wheelchair rugby, and handcycling. And because of that, you know, I was surrounded by other people who were going through very similar situations as me. And like, getting to see that, you know, life is definitely still possible. Even despite this really circumstance,

Scott Benner 37:55
yeah. Yeah. Wow. It's amazing. I mean, I guess it's interesting, because there is literally no other option, other than that one, right, because just dying is the other option.

Kate Brim 38:11
Yeah, yeah. Yeah, that's exactly it. And, you know, it was one of those things where I was like,

after I had had that, chat with that dietician, it kind of turned over a new leaf where I was like, okay, yeah, this really sucks. But like, we got to do everything we can to make the best of the situation. And at the immediate time, for me, that was just doing everything I can to be a part of community. So at first, the first probably year, it was trying out every single adaptive sport I possibly could. And physical therapy, outpatient physical therapy. And then the crazy hair and me decided, no, I really want to go back to work. And mind you, I was still was going to school. I just transitioned to online. One. Yes. So if I'm not going to school, I don't have health insurance. Because I was on my parents health insurance. I have so I had to

Scott Benner 39:21
like wrap my head around this part yet. Is there? I mean, I just assumed there was disability that covered stuff like this, but is that not the case?

Kate Brim 39:30
It was not the case. My mom's health insurance is very stingy on like, kids, okay, yeah, you can stay on the health insurance as long as you're in school. That's that's how we've interpreted it. Because every year we get a letter having to submit proof of enrollment. So yeah, that's that was definitely definitely fun.

Scott Benner 39:55
How many master's degrees do you have?

Kate Brim 39:58
Yeah, it was So I think I think what we did in the beginning was like, I was just doing one class at the University I was going to because you just had to be enrolled part time. And because the university I was at the classes were accelerated one class covered the credit limit. It was a class every eight weeks. I understand. Yeah, so it was no, I

Scott Benner 40:27
can't you can do this till you're 26. Is that right? 26. Yep. Then what happens?

Kate Brim 40:33
Then? I so actually being on the national team now for handcycling. I have a health insurance opportunity.

Scott Benner 40:45
group purchase for everybody.

Kate Brim 40:48
It's the National Medical network. I not fully understanding it yet, but we're still still kind of looking through all that and like getting a full understanding of that. Because yeah, let me tell you, I'm definitely a deer looking into headlights as far as the day I come off my parents health insurance.

Scott Benner 41:10
I'm sure you're making me think of Hold on a second. This is going to be ridiculous. Okay. But I believe the Mennonite Church, which I built which I you know what that is Mennonites? Yeah. Okay, well, alright. Okay. Well, cool. Was that one of the classes you took? I believe the Mennonite Church has done a I think they have like car insurance and like, like, like insurance for their homes. I don't know if it's health insurance, too. But there's such a large group of people, they're able to purchase insurance. So if you're part of the church, you can get this insurance. Please don't ask me how I know this. It's just, it's one of the weird things in life that I remember. And I was just wondering if the if the handcycling association or if people with spinal cord injuries in general could do something like that. Although I tried to imagine the insurance company it was like, how many people with spinal cord injuries? Do you want us to cover? Yeah, sure. Come on in. But you'd still have to pay for it. You know what I mean, like, and you're not working? Right?

Kate Brim 42:13
I so that's the that was the part I was actually getting to was the crazy here. And we decided no, no, I want to go back into work. Get back back to work. So I went through a resource in Michigan called Michigan Rehabilitation Services, Mrs. Yeah, essentially, what they do is they help people with disabilities find employment. So within that, they found me a job through what was called Downtown ambassador program. And with that job, what I was doing was pushing around all of downtown, you know, essentially just helping people within downtown, find places that they're trying to get to help with events that were happening downtown. We also helped, you know, kind of keep the homeless population at bay. If you know what I mean, their

Scott Benner 43:15
whips and chairs or like, you

Kate Brim 43:18
know, so in Michigan, they do a really, really good job as far as you know, just enforcing upon the homeless population, like, look, yes, you're homeless, but, you know, please keep our city decent and like, just don't make us look trashy.

Scott Benner 43:38
Do you sort of just kind of go around and do civic pride with them?

Kate Brim 43:44
Um, just essentially, like, you know, if you get the homeless people who are, you know, heavily intoxicated with alcohol or drugs, then you know, we have to call the police get them involved.

Scott Benner 44:00
All right, Kate, I have to tell you, I have so many questions. I don't know if I can let you answer any question longer than 30 seconds because I need I need. Do you drink?

Kate Brim 44:10
I do not know you before. No,

Scott Benner 44:14
no, you get high. No. Did you before? No. Do you want to I'm definitely

Kate Brim 44:21
not it. Not an adventurous person when it comes to all that.

Scott Benner 44:26
Okay, that's that's fine. Um, what else? Oh, God. Do you date?

Kate Brim 44:31
Yep. So I'm actually engaged. He and I met when I was at Ferris, so before my injury Yeah, so actually, when my injury first happened, he kind of became a like, stressed mess. And I just had to like, step away a minute and be like, Look, I've got like, a lot happening with me and I'm up You're myself out, I can't figure myself out and help you figure this out, right, just with how bad it was. So we took a pause for a while, but then we started dating again. And now we're engaged. And we have been for about three years now.

Scott Benner 45:19
Alright, Kate, you know what I'm gonna ask you next. Right? Yeah. Okay. As much as you want to answer the question, how do you be intimate?

Kate Brim 45:31
It's, it's different for, you know, different for everyone. It definitely, you know, a lot of it was just figuring out what, what works best for us. We're actually long distance right now. And actually, we have been throughout the entirety of our relationship, just because we lived two hours away. And since I left Ferris, he, he was still at Ferris, at the time, finishing up his degree, but I was back in Grand Rapids. And so, you know, for us, a lot of it has just been like, time to see each other in general, just because of us working with two completely different schedules now. And now that I'm in Colorado, he's actually still in Michigan, but you know, working towards figuring out like, Alright, what's the next steps for me to be able to move out there? So ya know, our relationship through our whole whole relationship has been been long distance but you know, on the grace of God, we've we've really made it work.

Scott Benner 46:48
That's amazing. You're also amazing is your activity life as I'm you don't mind if I'm Facebook stalking you, I imagine while we're talking. So you have like, I see racing bikes. shooting guns. Here. I don't know what this is. Are you ziplining in this photo? Goodness yellow helmet. Seated in a like a look at your like, I don't know I do so much stuff, Scott. I can't keep track of it all. Oh, yeah. It was I got a canoe here. I mean, a canoe, there's wheelchair. Is this like basketball?

Kate Brim 47:33
Am I see? It wasn't the big tank looking chair with this gnarly looking at on the front of it.

Scott Benner 47:40
Huh? Okay, how many things? Why are you making me look lazy? What is going on? This is what I don't understand. Why am I looking at your activity and going I gotta pull it together. And at least do as much as I'm sorry. How do we characterize it peril of what is it? Going? How am I not doing as much as you as what I'm thinking? And I'm feeling very badly about myself. Okay. Tell me about the bike races a little bit. How far are they?

Kate Brim 48:08
So they vary in distance, I do two events, called the individual time trial and the road race. The time trial is essentially a race against yourself. And then whoever at the end has the best time wins. So it's really challenging because you're, you don't see who you're racing against, you know, you're not chasing, chasing the mouse the whole time. And then the other one is the road race. Those ones are typically longer. The time trials that I have done so far have been anywhere from like I'll say eight to 15 miles. And the elevation within them vary greatly. And then the road races are typically a lot longer. And those can be anywhere from 20 to 30 miles.

Scott Benner 49:06
Oh my god. I don't like driving that far. What do you think of that? All right. All right, Kate, I think it's time I think I understand your life well enough to move on to this. I you by God, you get type one diabetes. How Yeah. That probably felt like you left every light in the world on and gotten to bed I'm imagining. So first of all, any autoimmune issues in your family line, etc. Oh,

Kate Brim 49:39
I'm a John Doe when it comes to family history. I was adopted in 2004 when I was seven, three or 2004 when I was four and a half from Ukraine, and we have none of my family history. So so as far as Figuring out me and my health has been like, something happens. Oh, okay, this is this is what we got to deal with now. Okay. Um, yeah.

Scott Benner 50:10
Kate, I'm adopted as well. Oh, are you? Yeah, I know exactly how you feel like you just everything. Well, listen. I don't think it's fair to say I know exactly how you feel. But on this one point, I know how you feel like just everything is a mystery. And you have to figure everything out from step one. No, no aunt pulls you aside at Thanksgiving is like, Listen, if you fart a lot after dinner, here's what you should do. It happens to all of us. Nobody talks about it. Like you don't get any of that stuff you get like, I have a problem. And I have to figure out what it is on my own. Because there's no one there to help. So yeah, you've got that going, wow. How are your parents? Well, I'm going to decide well, from it, how are your parents with this injury? Like? Had they both handle it gracefully? Or was it hard for them?

Kate Brim 51:00
Um, I, I have really, I have yet really to talk about with my dad, he's always kind of been sheltered with his emotions, he's never really been good at expressing them. So he was pretty quiet through the whole thing. My mom, she is definitely a lot more expressive with their emotions. But in a good way, you know, it's, she and I are definitely very close. And so it was definitely hard for her in the beginning. But at the same time, I think I I have had, definitely, and I think this just stemmed from me being adopted and in my really kind of shitty upbringing in the education system in my beginning days due to not speaking English. Um, I have always, you know, if something major happens, like, I definitely want to have a full grasp of it and, like, have full control. I've always been that way. And so I think, I think things have gone as smoothly as they have just because of that, that aspect of things where I'm like, nope, nope, this is yes, this is Cuba. Like, alright, we got to figure this out, you know, keep keep the road as smooth as possible.

Scott Benner 52:29
I can't believe you had to learn English on top of all this, too. But yeah. Kate has already ever been three months of your life where you're like, This is going well.

Kate Brim 52:42
Yeah, it's one of those looking back at it type things. You're like, wow. Yeah, you know. It's, it's one of these things where, like, in a way, it sounds weird, but like, I'm so thankful I've had everything happened to me that I have had happened to me because like, it's just made me so much more thankful for the things I do have. And like, the opportunities that that have come across. Like, I'll tell you, yeah, I've gone through definitely had a lot of hardship, as far as, you know, just making it an everyday society. And I definitely still do to this day have my half my down days, but, you know, it's, it's at the end of the day, it's all been all been worth it.

Scott Benner 53:35
Yeah, I mean, obviously, everyone has not been down. So I imagine you did as well. Like, that doesn't surprise me. But your overall attitude about this is astonishing. And is it something you can take credit for? Or is this just how you're wired?

Kate Brim 53:53
I don't know. It's, that that has had definitely been a question of mine of, like, you know, you know, why? Why I have been able to take this so well. It's kind of like, it's been a question of mine. But I'm like, alright, you know, I'm glad that that I am able to take it as well as I have been, and I think so much of it has just been because of this poor system I've had

Scott Benner 54:23
you must know other people in similar situations to yours that are not handling it. Well. Is that true?

Kate Brim 54:29
Yeah, no, I've definitely definitely met my fair share of them. It's, it's very sad. You know, and I, I have done everything that I can you know, as far as, at the end of the day, you know, you've even said this in your podcast, like, we can do as much as we can to help others. But at the end of the day, it comes down to you and you putting in the work to make the best of your situation or to make make out what You want of your life and of your diabetes or of your spinal cord injury or whatever it be. And so, you know that that message right there kind of has been what I think has helped me get through so much, you know, I still I still want to be able to enjoy life and enjoy joy the times I have with those around me. And so you just have to keep on keeping on,

Scott Benner 55:29
does it? Does your injury impact your life expectancy?

Kate Brim 55:36
Yeah, it definitely can. It's one of those things kind of I kind of, to me, it's, I've looked at it a lot like the diabetes. And, you know, because of the spinal cord injury, I have a lot of nerve damage. And I have autonomic issues, you know, being able to rubber regulate temperature and blood pressure, and I get this thing that's called autonomic dysreflexia. Every once in a while, whenever my body's like, Yo, something's wrong, but I can't directly tell you what's wrong. So we're just going to freak your body out.

Scott Benner 56:11
We'll sit down for a second reboot. Yeah, great. Yeah. Yeah. Kate, I am drawn to ask you, did you sue the doctor?

Kate Brim 56:21
I did not know. Did you think about it? It was no, it was, for me, it was just one of those things that I was like. I just, I guess I just the whole time was like, alright, you know, blood clot or spinal stroke. But at the same time, I think I was in that moment. In the immediate of it happening, I was very, like, alright, you know, okay, it's like a broken leg. You know, we'll get back to live here really soon. All will be fine. I think. I think that's what, in the beginning days, you know, weirdly,

Scott Benner 57:02
it helped me a lot. That feeling that you could get back to normal normalcy. When you when you come to grips with the idea that you're not going to, is it after you work through other stuff? And then you can kind of then think about the next step. Is it more about that, then? Does that make sense?

Kate Brim 57:22
Yeah, question wrong? Yeah. No, I think, for me, a big, big part of it was just, you know, getting involved. Getting involved with adaptive sports, adaptive sports has been a huge part of my recovery, as far as, you know, the mental side of things. And just getting, like being okay, with all right, this is this is my situation, you know, life still can be really, really, really, really uplifting. And there's a lot that I still can do with my life. And so, yeah, for me, it was just the community that I was surrounded with, helped me tremendously.

Scott Benner 58:07
Wow. It's, it's amazing. So I'll just ask you, when you're in your situation, what's the first thing you notice is up, but it must have been crazy being diagnosed with type one, right? Like, what did you notice first?

Kate Brim 58:25
Oh, okay. So I, I'm kind of one of the similar stories of you know, I go on a vacation and then hits the fan. So I have had been working at Amazon for gosh, a little over a year at that point. Okay. I started right at the beginning of the pandemic. So maybe a little longer. Oh, gosh, time flies by too fast. Anyways, so I was working at Amazon, our building was brand new and had literally opened, like, the pandemic happened, our building opened. So we're like figuring out a pandemic, on top of opening a brand new fulfillment center. And so, because of that, I was working a crap ton of hours, like, easily, I would say averaging 60 to 70 hours a week, easily on the minimum, and so and I had just kind of redirected myself because of COVID You know, sports had really stopped and so like that was just that was my new pet temporary path of life right there in that moment was was working at Amazon. Um, and you know, at first I was, it was kind of another like little leaf that turned over for me. It was the first job that I had where I felt like it If I wasn't being limited because of my disability,

Scott Benner 1:00:06
what were you doing there? Or what are you doing there? If you're still there?

Kate Brim 1:00:10
I'm actually not still there. Thankfully, out of there,

Scott Benner 1:00:14
oh my god, the stories about Amazon are true.

Kate Brim 1:00:20
No, it was for us, because in the beginning of the pandemic, you know, when a building first opens, they're going to be understaffed. Okay. So we're understaffed, were having to maintain all the COVID practices of masks, social distancing, COVID testing, you know, all that. But we're also a brand new building that was opening right before Prime Day. Okay, so, yeah, so I was working a crap ton of hours there, I was doing everything from what they call rebidding, which is essentially grabbing these items from this tray. And then you have to put it into the correct spot of the shelf, and the shelf has like 100 200 different little slots that it can go to. So I was doing that at first, then from there, they moved me to what is called Smart pack, which is essentially this machine that packs these items. For you, you have to stick the items into the machine, it shoots down and packs it and then I was there for a very long time, because they really liked my rates. And, but with that, I will say like it was I had explained you, you know, it was the first job where I had, that I had where I really didn't feel like I was being limited because of my disability. Right. And so like I was picking up over time, like I would stay in LA lay, you know, I was I was working all the time. And then at a point it kind of got to where I was like wow, I am like really tired like a we got to the point where mandatory extra time was being called because it kind of turned over in to COVID where like things were opening back up. And then all of a sudden, people aren't wanting to work in physical buildings anymore because they've been working from home all the time. Yeah. And so then our building and still to this day started experiencing like really bad employee shortages causing them to have to call me t weekend and week out like all the time and so then we're working a lot of MBT which is mandatory extra time. And, you know, it was another one of those things all right, you know, it sucks, but I'm just gonna do it. And then fast forward kind of closer to when I took my first vacation from there it was I was going to a camp actually specifically for adults with spinal cord injuries. And it was in Indiana and I actually drove down there leading up to that camp. I I had been extra tired but I just dismissed it as burnout. You know, like burnout from working a crap ton of hours every single week for you know over a year. And mind you that job is a very physical job like on average I was doing around 30,000 pushes a day in my wheelchair. Wow. Yeah, so it was like it was a physically taxing job and so yeah, I just dismissed you know, all my tiredness and lack of motivation outside of work just because of you know, I'm tired and burnt out. So I was like really looking forward to this vacation us step away from work, you know, get back into doing things that you know are for me. Um, so I drive down to the camp. The first few days of the camp, you know, everything's going going pretty okay. I had actually started experiencing about bout of constipation. Like right before leaving for that camp. I still was having issues throughout the camp. And then my body decided that at the top of this really tall rock climbing Wall outdoor rock climbing wall that it had had enough. And I ended up collapsing. So they get me down. I come back to you know, they're cooling me down, it was hot outside. So we kind of just dismissed it as like, Oh, she overheated they did call the ambulance just because the doctors that were there at the camp were like, ah, you know, she's not not had a bowel movement. And over a week, she collapsed at the top of this rock climbing wall as something might be something's clearly up. And so they sent me to the hospital via ambulance get me to the hospital. At the hospital, that hospital, they strictly just dismissed it as like, Oh, yep, you're constipated. Take Milk, milk of magnesia you know up your stool softeners and all that, give me a bag of fluids didn't do any blood work or anything in the hospital and discharge me. So go back to the camp, I still feel like crap. It's we had one more day of that camp. And then I and we all pack up and head home. On my drive home, I something in me clicked where I was like, No, I really, really do not feel good. Like something is not right. And so I I call my primary care office. And I explained to him what had been going on and, you know, all the symptoms I had been having. And I explained to him like, hey, you know, I'm I've been at this camp, I've really not been feeling a lot. I've been extra tired. I've had a lot of constipation. And he kind of asked me a couple of questions like, oh, you know, how's your fluid intake been, you know, thinking I might be dehydrated from just being outside and stuff. And I was like, Nope, I'm drinking freaking gallons of water. Like, we're doing just fine there. And, um, then just within the conversation, something within Pam was like, Hey, I like you need to get to the hospital. As soon as you get back here in Michigan. I think you're diabetic ketoacidosis. And I was like,

Scott Benner 1:07:21
over the phone,

Kate Brim 1:07:22
over the phone. And I'm like, I'm sitting there. Like, what the? Yeah, you know, like, I was just sent via ambulance to a hospital and you're telling me over the phone that like, whoa, buddy, you got you got real problems.

Scott Benner 1:07:38
That's well done. People must be embarrassed for two reasons about the story while they're listening to it right now. First of all, if you have diabetes, and you're not as active as you want to be Kate was diagnosed with type one paralyzed rock climbing. So really, try harder. And the other one is the doctor who was able to look past all of your normal problems, and just look at the symptoms and say, Okay, if Kate was any other person, what would I think this sounded like? That's really astonishing.

Kate Brim 1:08:10
Yeah, he he has been, like, my favorite provider I have ever had. Well, yeah, as far as as far as just general care. Like, the things he has noticed about me, even despite my RDF dog body, like has been on like, holy crap. That's really? No, he is truly an amazing, amazing doctor. Yeah. And so I, I'm kinda it's another one of those like deer in a headlight moment and I'm just driving down the road. I actually ended up pulling off to scream. I'm a truck stop. Like I did. I sat there for a minute, like, holy, what the hell is happening now? Mind you, at this time. I like when he said diabetic ketoacidosis I know. I knew what it was. Just because my family my dad, he was a cardiac ICU nurse. My mom she works in health care, like health care is in our, our family. Yeah. So. So I'm sitting in that truck stop. And like, I didn't even get out of my car. Like I didn't, I didn't do a walk around or anything. I'm just kind of sitting there like, holy, what the hell is happening. So I kind of, I didn't even I didn't even call my mom or anything. In that moment. I was just so shell shocked at the moment. I was like, wow, you know, like, what's next?

Scott Benner 1:09:46
Is it was it just a generalized ringing in your head? Or are you doing the math about your current situation and adding diabetes to it?

Kate Brim 1:09:56
That yeah, right there my current situation and adding Diabetes to it i i very quickly went to the dark side of diabetes and I was like like I this this can't cannot be happening I you know I've already gotten nerve damage I already have wound healing issues because of my nerve nerve damage this the last thing I need, you know, and so I I kind of got myself a little re gathered drove the rest of the way home. Got to the hospital there and I hear my primary said like, okay, when you get here, just let them know, while you're here, I'm gonna let them know you're coming. Lottie, Dottie da so I did. They immediately got me like a bed admitted surprisingly, mind you this is in the middle of another wave of COVID. And so they got me in and they do the the basic, you know, check your blood pressure all that my blood pressure was really high. I think I want to say a lot of that just was due to me being like stressed in the moment. And so they do that. Then they do bloodwork the one nurse, she did a finger prick. She was like yeah, your blood sugar's really high. This is not good. Like, it's one of those moments where you're like, what a nurse is worried in a hospital, you know, it's bad. And I kind of just did a deep swallow. And then I asked her, I was like, Okay, what is it? And she's like, it's an eight hundreds. And I was like, I

Scott Benner 1:11:51
don't know what that means. But that sounds high. Yeah.

Kate Brim 1:11:54
No, I knew what a mean. Oh,

Scott Benner 1:11:57
oh, no kidding.

Kate Brim 1:11:58
Yeah, no, I knew I knew what all this meant. And I'm sitting there. Like, I just drove six hours home with my blood sugar over 800. Yeah, that probably wasn't great either.

Scott Benner 1:12:11
Well, okay, so they get obviously they get your blood sugar down, and they get you set up. But I want to go over just contextually the operation you have of your hands before I asked you about how you you've handled your diabetes. So how are your fine motor skills?

Kate Brim 1:12:30
Not so hot. So

Scott Benner 1:12:33
your arms are really the are the are the best operating part of the system between your shoulder and your fingers?

Kate Brim 1:12:40
Yes. Okay. Yeah. Yeah, so I know she tells me that blood sugar. But in in this whole situation. They're looking at me as an incompetent patient as far as being able to take care of myself. They're not really like treating me. Like I'm someone who takes care of myself. And so you know, they're kind of just doing everything without out telling me and I don't know why. In the moment, I really was not like, hey, you know what's going on? What are you doing? What's this? What's that? Like? Why are we doing this? I just I was really in shell shock in that moment. So I then I stayed in the hospital. I think it was about five days. Yeah, I was in the hospital about five days because I also had a bowel obstruction amongst all that. And so long story short, they give me taken care of and they had I don't even think it was a an endocrinologist. I think it was just a diabetes educator they had in the hospital you know, pretty much just came gave me a little pamphlet of like, alright, this is this is your short acting, and this is your long acting insulin and, you know, this is how you're going to administer it. And I'm like, why now? Like, like, what? And so I kind of still just this whole time, I just feel like a deer in headlights. You know, I'm i i did not get I never felt like I did not leave that hospital feeling like, Alright, okay, you know, we got this. We're gonna figure it out. It's gonna be okay. Like, I felt like I'm holding these two things. Two little grenades that could possibly kill me.

Scott Benner 1:14:45
I'm probably gonna mess this up at some point. And that's that and we're done.

Kate Brim 1:14:50
Yeah, so. So I then the one thing they had directed me to do is like, oh, you know you need to call your Her primary care office to do a follow up admission appointment. I called them they had been expecting me to call and she was like, Oh, yeah. Can you come in? It was it was literally two days later, which that also blew my mind. Because all my other appointments I had tried to schedule since COVID was like, oh, yeah, you're not either not going to be able to see be seen at this time, or you're waiting? Six, seven months. So I was I was very surprised. So he gets me in. And then he then actually had within that appointment, gotten a hold of one of the spectrum endocrinologist, they actually immediately set me up with the Dexcom G six and the TC 1x. Two. And it was solely because of my because of being a quadriplegic, yeah, they pushed, okay, yeah, they pushed it, they really pushed it. And so that was really helpful. But at the same time, I was like, okay, that's, you know, that's one part of the hiccup solved, you know, I'm not having to continue to figure out how the hell to give myself these injections, you know, with not working hands. And so we got that set up. I did did the it was actually in the doctor's office, you know, kind of via the telemedicine the training for it, they got me set up with the Basal and control IQ. And so, you know, they get me set up. And with the person who was training me, she gave me a bit more information as far as like carb ratios and your Basal rates and, you know, as basic of a good understanding as you can get, except, still not you know exactly what you need. So I'm like, Okay, a little bit more information. That's nice. All right. So now, now, I have the insulin pump, and the Dexcom G six. And that was like, that was the beginning of me really? Getting to see you know, what exactly is happening with my blood sugar. And mind you throughout this whole thing, you know, since they had got my blood sugar down, you know, kind of back to a point where I'm like, All right, you know, I feel okay, feeling better, you know, everything's, everything's okay. But then, once I got the Dexcom, it was like, I started to realize like, oh, low blood sugars, oh, high blood sugars. But I wasn't getting any, like, autonomic response as far as my low blood sugars or my high blood sugars. Yeah,

Scott Benner 1:17:55
I have so many questions. So first of all, can you you can apply your Dexcom and your pump on your own?

Kate Brim 1:18:01
Yeah, okay. Yep. It takes a little longer and every once awhile there's a mess up, but,

Scott Benner 1:18:06
but you can get it done. And so you can fill the pump as a T slim use cartridges or do you Karcher? Yes. Okay. Yeah. Yep. Okay, so that is something that's doable. What about your absorption? Like? Do you have to Bolus the same as other people? Or do you not need to? Pre-Bolus Do you need to Pre-Bolus more? When you're low does juice and things like that hit you the same way. Those questions.

Kate Brim 1:18:34
So yeah, so when I, when I first got the Dexcom that was when I really, you know, started noticing me like, was starting to be able to, like interpret how insulin was affecting me. Because up until that point, you know, I was doing I was doing finger pricks, but it was like, All right, I see this number but you know, what exactly is happening with it. So one of the first first moments that I had where I was like, because the one thing they did tell me in the hospital is like you need to like whatever you do, you have to avoid really low blood sugars. Low blood sugar is bad, bad, like really dangerous. And I was like, okay so the first time I got a low with my Dexcom it was actually happened to be I was on my hands cycle at the time, I still didn't understand what the alarms different alarms meant. And I I'll tell you, I was, I guess a little stupid and ignorant in the moment and really didn't take the time to be like, Oh, this alarm means that and that alarm means that there was just I was trying to still maintain you know, my regular life back home. And so I was on my hand cycle I had about two 90 minutes of my workout left, and then I hear the alarm. I'm like, Oh, I've got 20 minutes left, I feel just fine. Like, I'm gonna keep going, you know. So I finished the workout, then I look at my Dexcom. And it says, it's just so low. And I'm like, oh, that's bad. So I get into my out of my bike and into my chair as quickly as I can, you know, sprint up my ramp, get my manual glucometer. And it tells me I'm 23. And I'm like, Oh, that's really not good. Like, I could tell I was, you know, I had the anxiety running through me, but at the same time, I was questioning what like, how, why am I not feeling? You know, deathly sick right now, like, what the heck is going on? And so, you know, I did. I did at that point No, to like, I didn't just shove a bunch of food in, in me, it was because I was very immediately into the diagnosis. I was very scared of high blood sugars. I think in the beginning days, I was more scared of high blood sugars, then I was of low blood sugars just because of that aspect of me not feeling my lows. Yeah. So I did take it really slowly, as far as like consuming carbs. In that moment, you know, it was kind of like, alright, I ate a few. At the time, I ate a few crackers, waited about 10 minutes did check, ate a few more crackers until it came back up. But then it was it was that moment where I was like, alright, so like, we I gotta figure this out. Like, this is not good. But at the same time, what is going on as far as, like me not feeling you know,

Scott Benner 1:21:54
why are you not having any of this? Like, were you sweating, having trouble thinking?

Kate Brim 1:22:00
So I don't sweat due to my spinal cord injury? Okay, yeah. So

Scott Benner 1:22:08
but you didn't have a seizure? You didn't feel dizzy? Nothing, literally nothing.

Kate Brim 1:22:12
That's crazy. Yeah. So yeah, it was that moment where I was like, because I had had the people in the hospital tell me my primary care tell me like I'd had multiple people tell me like, low blood sugar is really, really dangerous. So like that happened. And I was like, what?

Scott Benner 1:22:34
Finally got a superpower. Kate? Finally got one like a real one. So yeah, when you get low now, still nothing.

Kate Brim 1:22:44
Still nothing? Yeah, except for I'll tell you in a little bit. But so I, I had had that low. And that was that was really the turning point of me like, Alright, we've really got to do some digging as far as figuring this out. And so that was when I started getting on the internet. Because he had referred me my primary had referred me to an endocrinologist to actually be able to get into an endocrinologist. And it was, it was four and a half months out from for me being able to see them

Scott Benner 1:23:16
no problem. That's yeah, and I'll just wait four months. What that's not well done. Well, we need your GP back. That guy knows what to do.

Kate Brim 1:23:25
Yeah. So so in that moment, you know, I'm like, alright, you know, we gotta gotta figure this out. I have, thankfully, you know, I have been a big podcast person as far as for me, it actually first started with listening to podcasts for like fitness and nutrition, you know, just dialing in my nutrition to build muscle because I was like, Alright, I've got all these atrophying muscles, like I got to be able to keep some, some sort of muscle on and develop the muscles that do still work. So it started with that's really what started me in the podcast realm. And so then I searched type one diabetes actually was first within Google and I found a lot. I found I found your podcasts I found mastering diabetes, I found the FTF warrior like I looked at all of them. I definitely did not just just look at one route and decide all right, this is how you take care of diabetes. Like I really took it all in I bought a crap ton of books, as far as you know, diabetes, like I just I wanted to be able to figure out every aspect of it. Because I knew, like I knew off the bat, you know, Insulin is the hormone so like, everything under the sun is going to affect that. And so a lot of it was just figuring out All, for me, you know, based upon how I'm living now, you know, what do what do I gotta do to be able to get this part part of me better manage. Right, right. And you're actually your podcast was definitely a huge part of that huge part of that. So you know, I started figuring it out more I, to this day I'm still living in like, I just do not understand, you know why my body has no autonomic cues as far as lower high blood sugar?

Scott Benner 1:25:38
Yeah, well, the thing is that it and I'm sure you know this, you figured it out already. But just because you don't have the cues doesn't mean that the bad thing at the end of the line is not going to happen to you like, there is a low blood sugar low enough where you're just going to shut off. You're just not you're just not going to have any of the lead up to it with the seizures and you know, that kind of stuff. You're just gonna, I'm so sorry to say it's like, you're just gonna die if your blood sugar gets too low. Yeah, yeah, no,

Kate Brim 1:26:04
it's how do you spell that?

Scott Benner 1:26:08
How do you handle that?

Kate Brim 1:26:12
It's been scary. Yeah, like, it's definitely definitely brought out a lot of a lot of stress on my part, just because it's brought on a lot of stress. But I will say, and it's actually more so been in the recent days, because of something I had happened recently. What happened? Well, leading up until then, you know, I had actually started to get really good at managing, like my time and range and stuff on my standard deviation had been doing really good. And then the instance that I had recently, so I just moved to Colorado. It's almost been a month now, God times flying by. So I just moved to Colorado. And I will tell you, the one thing I for sure took for granted back in Michigan was I knew where I was going, because I lived in the same house for over 20 years. From the day I was adopted up until I moved to Colorado, I lived in the same house like I knew everywhere I was going like there really there was not getting lost for me. Um, so now here in Colorado, all of a sudden, you know, I'm like, I'm a coward in the middle of the field like, Whoa, we're where are we? And so the Gosh, when was it last Saturday? Not the sprint Saturday that we just had, but

Scott Benner 1:27:49
it's a week ago.

Kate Brim 1:27:51
The 24th. Yeah, yeah. I, so all of my long rides are typically on Saturdays, because Sunday is a rest day where I don't do any exercising. So I've always planned my long rides on Saturdays just because of it being arrested on Sunday. So I had been sent this route from another hand cyclists that lived here a few years ago. And I was like, Cool, sweet. It's a nice, really, really easy loop and happens to actually be a loop that doesn't have a lot of climbing because up until this route, I had been doing a crap ton of climbing. Oh, yeah. So happened to be I had to drive to the road. Excuse me, I had to drive to the route. And then it was actually kind of out in the country, like really out in the middle of nowhere in this little city called fountain. So I get my bike out, you know, all is going well. I get to about the 40 mile mark. And the my bike computer tells me to turn on to this road book drive. And I look over and it's a dirt road. Mind you the weekend before the same thing happened where it wanted me to go on a dirt road. I went on the dirt road but then ended up with a flat tire. So this time when he wanted me to turn on to book drive. That was a dirt road. I was like yeah, no, that is not happening. So i i At first I did actually turn on to the dirt dirt road, but pretty immediately, like probably 10 seconds. And I was like yeah, this is not going to work because it was a very loose, loose dirt road like it was a sandbox dirt road. And so to get back onto the pavement, i Then stop looking on my computer to see if maybe there's a road a little further up that I can turn on to because mind you I was like 10 miles from being back Back to my my van. So I was like, pretty close to being done. I'm not seeing anything. So I start backtracking the way I had come in every road it's wanting me to turn on to was a dirt road. So, up until this point, you know, I was doing really good with fuel and it happened to be right before that road that I turned on to though that I had to turn on to that book drive. That was dirt, right, I had taken my last pitstop to get in fluids and get in my gels that like carb gels that I had happened to be right and now at an alpaca farm. So like I'm having the time of my life, I'm out in the middle of nowhere hanging out with alpacas, which happened to be my MO one of my mom's favorite animals. So like, I'm smiling from ear to ear, taken in some videos from my mom. Then pack things up and go to go to book drive. And it's like, oh, shoot, here we are again, like, lost again. Good job, Katie. So I start backtracking. Every road it's wanting me to turn on to is a dirt road. So I'm like, okay, all right, I'm doing fine. So I backtrack the whole way. I'm, I'm at this point. Probably about, like 53 or 54 miles in, and then I'm kinda like, all of a sudden, where I'm like, Wow, I'm not feeling so hot. Like, I'm tired. So I take I take another stop. This was about about seven miles from my van. Okay, I take another stop. Drink the rest of the fluids I had, which, at that point, I had probably gone through about a liter and a half of fluids. Okay. Took the one last gel I had I had gone through three gels each of those gels have, what is it? I think it's like 22 carbs, or something like that. Had had three gels. And I had had one of these bars called a grab the gold bar, which is just a really densely filled calorie, dense bar. It's like almost 300 calories just for the bar. To like, really, in reality, I should have been fine. And I had noticed my Dexcom alarm went off and said I was 55. And I was like, Oh, it was in that moment. I was like, Okay, I'm low. But at the same time kind of question like, wow, I really don't feel good. What is like, this weird took my last job because I said I was 55 took a big drink of the fluids I had, which also had carbs and like it was a carb mix, right? So I had had a lot of carbs on board. And I keep going get another couple miles and I'm like, I really don't feel good. And like, what I had noticed would have been like no, I'm in trouble was I was going down a hill. And you know how when you start biking down a hill, like it gets easier to pedal. Well, that wasn't happening for me. And I was like, something's up. So I stopped. I do a manual check. And it says I'm 19 Okay. And I'm like, how I'm like, shoot, I'm really in trouble. And like, at this moment, you know, I will say I was definitely a bit bit foggy and like, trying to figure out like, Alright, what do I do in this moment? I, for some reason, thought of everyone that I knew in Colorado Springs and was like, well, there no, I'm 30 miles away from Colorado Springs,

Scott Benner 1:33:47
you think the call 911 Just Just hold on. Hold on, let it happen.

Kate Brim 1:33:56
In this moment, while I'm like trying to think of what to do at the same time, I my body was just like, so tired and so out of it. So like I didn't know to like every time a big truck went by, I was trying to get my hand up to like try to wave them down. Because I was like I have this huge asked like not gonna fit a little tiny Sudan to help me. So like I was trying to get help wasn't getting help, but then it happened to be like, I felt my eyes getting really heavy in the moment. And I was like, no, no, I really need help. I really need help. And then it happened to be something happened and I happen to have enough vision in me that I saw straight ahead like I'm talking, you pull in, you'll be there within 20 seconds of walking happened to be I was literally right by a fire department, the Hanover fire department and I was like, immediately I was like, Oh, they're my help. So I put All in. And they had this sidewalk. Like, I'm so thankful for how their sidewalks was constructed. It wasn't a 90 degree turn to get up to the building. It was an angle I see. And then it came straight. So I was actually able to get right up to it with my bike, and I knock on the door and ask the the lady for help. And so then she gets me taken care of as far as like getting me more food and fluids. Like she answered the door. Her name was Joe. And I was like, hi, yeah, I got I got really lost and ended up having to backtrack my route, which added a lot of extra mileage. And I like I really need I need any fluids and food. And that's, that's what came out of my mouth. And she saw my pump on my waist and she was like, Oh, do you need any medical attention? I was like, my blood sugar's low. I just need food. Like, that's all I was thinking about was like, I need food. So she got me the food. Got me, you know, got me into their truck, my bike into their truck, you know, back to my van. I just kept consuming food for probably another couple hours. Got back to Colorado Springs. And kinda in that moment, I was like, wow, that was that was really not good. That was it was it was a huge eye opener for me like, yeah, that was that was a little too close for comfort. Like,

Scott Benner 1:36:44
yeah, yeah, there are a lot of people listening right now who wouldn't have gone on that bike ride who aren't quadriplegic. So those who have diabetes have been like, that sounds like a lot of work. I probably wouldn't have done that. And you so is it. Partly? I mean, you said ignorance earlier, just because you're new to it, you don't really know. But also, I'm assuming because you've never had the feeling of being low. You haven't had that. That fear kind of come to Jesus moment where you're like, Okay, this is the thing I have to worry about. And so yeah, you can be low, low, low all the way to 19. Where you really were, yeah, you were you were on that store. That's amazing.

Kate Brim 1:37:25
And here's the thing is, I really think I was lower than that. Because like, I pulling into that fire department, like, holding the fire department, they got me taken care of. And I will tell you like it's stressed me that out as far as like being scared to get back on the bike and stuff.

Scott Benner 1:37:48
Yeah, I might, I might think.

Kate Brim 1:37:51
But I don't know if it's just the like, stubborn part of me. I was like, you know, all right. You know, you love love handcycling you're not gonna let this stop you. So for some reason, the next day. For my ride, I had an easy recovery ride. I went back out there, like, because I just had so many questions like I needed to see all again, as far as where I was what, you know, what was all going through. So when I had seen the fire department, I thought it was Hanover Fire Department station 325. And the only thing I had seen was their main building, like where their little kitchenette and stuff is. I didn't see any of the garage or anything. This place was flippin huge. But me in that moment, I it just seemed like one tiny little building where the help was.

Scott Benner 1:38:50
You're lucky you went to the right door even. There was also isn't a paid fire department or volunteer department. Because I'm I'm wondering if you're lucky if there was even anybody there.

Kate Brim 1:39:06
Well, so that was the other thing is she told me she was like, You got really fortunate. You came in just the right time because I was about to head out for the day. And I was like, Don't tell me that I was 19

Scott Benner 1:39:18
Yeah, no, I'm gonna say I looked online and I think it's possible. That's a volunteer place there. That means there's probably not people there in the middle of the day. They probably just because when there's a fire, she was there doing something. Now you really did get lucky. Well, I mean, yeah,

Kate Brim 1:39:35
it was it was definitely I got very lucky. So what

Scott Benner 1:39:38
what are we doing now? Like, are people now aware of where you are when you're writing and things like that? You have backups?

Kate Brim 1:39:45
So yeah, so the next day I went back, you know, I was like, holy shit. You are really in a dangerous situation just because going back in a fully conscious state like this. Look, everything looked completely different there. was for huge stalls for the truck was two main doors, and I just happened to choose the right door. Yeah,

Scott Benner 1:40:09
that's a good That's really incredible. I looked online, it's a big building. And it's long and expansive. It's not like two stories, right? It's one like kind of spread out. Yes. Level. Yeah, that's really Yeah, yeah, you got lucky. Well, okay, hold on a second. We I am so sorry to say this, but like, I'm up on another appointment and a little bit. So I have to I have to wrap up. But let me start by asking you if there's anything we didn't talk about that you really wanted to get to?

Kate Brim 1:40:39
No, not really. Yeah. Yeah.

Scott Benner 1:40:44
It's an astonishing story. Yeah, it just it really is. It's, it's crazy that your life is that. That it's that big. And I'm wondering if I mean, that bikes got to feel like freedom to you, right?

Kate Brim 1:41:02
Yes, exactly. It. Yeah, that's the first race I did. And hand cycling was like, it was the first moment that I had where I felt just truly unstoppable. And, you know, like, the limits are endless,

Scott Benner 1:41:19
better than driving a car even.

Kate Brim 1:41:23
Yeah, I think so. Because, you know, for me, it was like, I'm exerting physical energy and just get to feel super strong in that moment. And yeah, that was, I think that was just my true love for handcycling was, you know, big reason why I went back out to that, that fire station the next day, but like, that moment was, it was a big eye opener as far as like, alright, you know, we got to figure figure out more better safety protocols. So I did buy this like, little satellite GPS thing that I can have things sent my load, send my location, every so often. So I got that. And then also had some people show me routes that are like, actually saved, so I'm not having to backtrack. And it's so

Scott Benner 1:42:17
interesting, because at the core of all this, Kate, you're still 24 Like, you have the you have the attitude of a 24 year old single girl, like you're like, Oh, I'm gonna go for a ride now. And just not thinking about I guess, I don't know, it's just, like, if you put me I'm a parent, right? And I'm older. And so if you said to me, I'm gonna go for a bike ride, my brain immediately comes up with 15 reasons why you shouldn't or things that we have to do before you do it. But you don't feel that way. You feel like I'm gonna go for a ride now. I mean, that you went out the next day. It's, that's astonishing. Like that's, that would that would have stopped most people, most people would have been like, No, I'm good. I'm not going to ride my bike for a while till I figured out something but you just so so the control IQ was taking your Basal away, but it wasn't helping. Right?

Kate Brim 1:43:07
Well, so actually, I've actually not used the control IQ in quite a while just because I've not in normal circumstances, I've not had as good of control as I like, okay, um, so I had set a temporary for that right? Ride, okay, but because I had to backtrack my ride, and I was so focused on trying to figure out how to get back without having to completely backtrack. I forgot about my temporary expiring it's the one thing I truly hate about tandem is if you set a temporary it does not notify you when that temporary it expires. It doesn't just expire it

Scott Benner 1:43:46
just sends it doesn't beep and say okay,

Kate Brim 1:43:49
yeah, so that's what happened is my temporary I had set it to 25% of what my normal Basil is. And it went back to my my normal basil. And so I'm getting a crap ton more insulin while I'm out here exerting energy and mind you it was like 8687 degrees in dry Colorado. Hey,

Scott Benner 1:44:12
Miko makes me wonder how much do you weigh 110 pounds and what is your Basal rate?

Kate Brim 1:44:19
My Basal rate right now for like, just strolling about everyday not doing exercise is about 1.7.

Scott Benner 1:44:26
Okay. Okay, yeah. And so part of that's probably because you have your digestion slow. I imagine foods days and you longer that kind of stuff. So you're getting impacts along the way from that because 1.7 for your weight. I mean, listen, you're the first quad Can I just say quad? I don't know what to say it's okay. You're the first quad that I've ever spoken to. So I don't have any context for how insulin might work and you do need to Pre-Bolus for meals. Yep, you do. But how long?

Kate Brim 1:44:55
Me I do it about 20 minutes like 20 minutes is the minimum Usually, what's your Excellency? My aim once my last day once he was 5.1?

Scott Benner 1:45:05
And what range do you look for? Where do you try to keep your blood sugar?

Kate Brim 1:45:10
In a happy place? I say between 80 and 150.

Scott Benner 1:45:14
Okay, what do you call it? What do you call spike after a meal? Like, where do you go? Oh, I really messed this up.

Kate Brim 1:45:21
I start looking at it for me at about 130 I start looking at it at about 130. And if it's like, either creeping up or staying up there, I'm like, okay, you know, let's get this back down. And then, like, as far as my homeostasis point, it's definitely you know, that the high 90s Low one hundreds for me.

Scott Benner 1:45:46
Okay. How often do you get low under 70?

Kate Brim 1:45:52
Oh, not that often, really. So my last looking at Dexcom clarity. Like, my, my time and range has actually been the last seven days has been at 9%. Which I'm really happy, happy with 2%, low 4%. High 1%. Very high. It's in so I have liked keeping that tighter range, just because for me, I like I've been thinking long term, you know, I've already got these impacts that are affecting me. And so I've got to do my best to, to keep on top of it.

Scott Benner 1:46:42
Yeah. What What's your diet? Like? What do you eat in the course of a week.

Kate Brim 1:46:47
Um, so I, I would say I stick definitely just naturally stick lower carb. But recently, we've been trying to figure out like, trying to really figure out my carb ratios, and I'm trying to figure out the Pre-Bolus is for certain types of carbs. Just because with how physically demanding cycling is you need carbs. Like. So we've recently been trying to figure that out. And it's definitely had some, some great successes. And then there's moments where it's like, did I even give myself insulin? What the

Scott Benner 1:47:24
hell? What? What's your carb ratio for meals?

Kate Brim 1:47:28
Ah, so I actually just recently adjusted right now it's about a one to eight.

Scott Benner 1:47:33
It's interesting, because Excuse me. Sorry. Sorry, your Basal is more than I expected for your weight. But yeah, but your carb ratios? Well, it's heavy, but it's not crazy.

Kate Brim 1:47:48
Yeah, it's no, I will say so. Like, the Basal rate that is, as far as when I'm, like just pushing around in my wheelchair. It's kind of expected just because of how few calories we burn sitting in a wheelchair. Like it's so much less, you know, walking around and doing day to day we're burning a lot more. And so that's the only thing I can think of just me naturally having really low blood pressure because of my injury. I'm just not burning a lot at all.

Scott Benner 1:48:21
Yeah. Hey, is there any certainly high side to this? Do you not get your period anymore? Is there anything good that comes from this at all?

Kate Brim 1:48:30
Like Fortunately, no, that's still happens.

Scott Benner 1:48:33
Unbelievable. That's a kick in the ass right there. I'll tell ya. So, yeah. So if you got pregnant, it would it would kill you. Right?

Kate Brim 1:48:46
It would not kill me. No. Um, but it's definitely a very high risk pregnancy just due to the the aspects of autonomic dysreflexia. And being in a wheelchair. Yeah, no, definitely very that people have done it. I might not have injuries have

Scott Benner 1:49:07
done it. I didn't know that I might not have met killed literally, I just meant like it would kick your ass like, so. Yeah, more than maybe usual. Do you think about that? Do you have any thoughts about that at all?

Kate Brim 1:49:20
I personally have decided, you know, I am 100% okay with adopting, like, I'm so thankful I was. I was adopted, especially with just everything going on in Ukraine. Now say

Scott Benner 1:49:32
we didn't talk about that. But you're having your own personal war while the country you came from is in a war. And that's evil. Yeah. Insane.

Kate Brim 1:49:39
Yeah. And so, yeah, just there's been many, many people I've met that have been adopted and thinking about myself being adopted. I'm like, you know, I would love to be able to provide a second chance for an innocent child who didn't ask for that central situation.

Scott Benner 1:49:57
You think you could do it? You think you could raise a baby or would you adopt a or older?

Kate Brim 1:50:02
I don't know. I haven't thought that thought about that yet. It's a it's a

Scott Benner 1:50:06
young Kate. Surface Young.

Kate Brim 1:50:08
Absolutely figuring out how to function.

Scott Benner 1:50:12
I don't I don't know what to say. I'm really thrilled that you shared this with me. I I don't know if I did a good job of talking through it with you or not, but I feel like I learned a lot. So it must have done okay. Yeah, yeah, I just, I mean, your life is, is incredibly different from anybody I've ever spoken to.

Kate Brim 1:50:31
Yeah, it's no, it's definitely been a roller coaster of adventures. That's for sure.

Scott Benner 1:50:39
What do you do for fun? Be set forget the writing and all that stuff. Like I figure that's part of your probably part of your mental health routine, the writing and everything, but like, just like, do the I guess my question is do the days get long? Or do you have them filled with things when you're just at home?

Kate Brim 1:50:57
So this is actually since moving to Colorado, this has been the first time where I've actually had like, free time to just do things. Because up until Colorado, I was working a crap ton of hours going to school full time. And cycling. Yeah. So like my plate was jam packed. As far as schedule. So since moving to Colorado, it's been filled with, like just going to check out new places finding hiking paths, there's this one called hunt falls that I've done a few times now. And also just finding new areas to cycle and hoping to God I don't get along.

Scott Benner 1:51:44
How about this? There's two things I wanted to ask you one thing I'm gonna ask you one thing at a time. Did you have friends in Colorado when you moved? Like were you moving to a place you knew people?

Kate Brim 1:51:53
I know a couple of people but I've only recently met them since the since going to the World Cup and World Championships.

Scott Benner 1:52:01
What made you move to there?

Kate Brim 1:52:03
There. I was offered a residency program here at the US Olympic and Paralympic Training Center. Wow. No, it's

Scott Benner 1:52:14
are you going to try to? Are you trying to compete in the Paralympics?

Kate Brim 1:52:19
I am keeping my doors open as wide as I can as far as opportunities with whatever I do. I would love to believe that I can get to that point, I actually took first place in all four races I did between the World Cup and World Championships. And so, ya know, the World Cup and World Championships was a really good, really big eye opener to me as far as like, where you are. Yeah, yes. Where I was and like, how far I've come with myself and how far I still have yet that I can go. Well, good

Scott Benner 1:52:58
luck. And the other thing I wanted to tell you is that people report all the time that higher elevations can lead to lower blood sugars. So I just wanted to tell you that.

Kate Brim 1:53:08
Yeah, it's no actually it's weird. So I've had a little bit of the opposite I, of course I rates, my rates have gone up as far as insulin needs since being here. Yeah, it's been really interesting. And I don't know, I think I'm hoping a lot of it is just due to stress, just because I'm, like, in a completely new area and don't know where where I'm going.

Scott Benner 1:53:35
Yeah, I could be right. You could just be stressed out. I noticed that when my daughter moved to school, that she had different needs while things were going on. So yeah, I mean, maybe you'll find a settling in point after you've been there for a while. Yeah. Okay, Kate, my last question and I'll let you go. I've kept you over time. I significantly I'm sorry. I normally ask this person, this question of people. And I always think I know what they're going to say you're the first person I thought not to ask it to because it seemed obvious to me, but maybe it's not. So let me just ask. I give you a magic wand. You walk again or get rid of diabetes.

Kate Brim 1:54:16
Oh, goodness. You know, it's weird and I think I'd honestly say like neither, you know, well, I've both of these really shaped actuations have brought so much opportunity and just like growth in my life like in a weird way I'm so thankful that they've happened to me. I I think it's it sounds like it takes it's taken me getting knocked on my ass to really, like really get a full understanding of like the consequences of our failed efforts and just, you know, the work that that we can put in the opportunities, I have the strength to that I have all of that.

Scott Benner 1:55:15
It seems to me that the removal of extraneous distractions from your life has allowed you to focus on what actually matters to you, and that your physical state is not as important to reaching those things as maybe other people would expect. Is that fair?

Kate Brim 1:55:33
That is, yeah, you hit the nail on the head. Would that 100%?

Scott Benner 1:55:37
Okay. Wow. Well, thank you so much for sharing this all with me, I really appreciate you taking the time. This was wonderful. You know, I don't know if you're aware of this or not. I record almost every day. So when you and I began talking, I didn't know you, were you. Oh, really. Which is why when I mean, I obviously know, I'm going to interview you. I know that. I know that coming up on my schedule. There's a young girl that sent me a really cool note, and popped up on my Facebook page, who was quadriplegic in a chair and was gonna come on the show. But as I came in here and sat down today, I didn't know that you were that person. And so when I said initially, that your voice sounds very mature, like you've been through some, I did not know I was talking to you at that moment.

Kate Brim 1:56:25
I've gotten that from a lot of people. I seem a lot more mature than my age, and I definitely attributed that to the injury.

Scott Benner 1:56:35
Yeah, yeah. I don't think we're gonna be seeing you on Tik Tok shaking your boobs, is what I'm saying. Yeah, no, yeah. You've you've transcended past that part of life. That seems like, do you think if none of this happened to you, do you think you'd be dancing on Tiktok? Do you think you'd be doing what they do? You know, I mean, they are you didn't? You didn't sound like that kind of person to begin with. But

Kate Brim 1:56:55
no, I really don't. I very quickly got myself into employment and like, figuring out my path of life. Yeah. Which was construction management and doing the working for the directional drilling company.

Scott Benner 1:57:10
Right. You were you are pretty focused right away. Oh, yeah. All right. Well, Kate, you're spectacular. Thank you very much. I appreciate you doing this. No, thank you. Yeah, my pleasure.

First, of course, I'm gonna thank Kate for coming on the show and telling us her story. And then I want to thank Omni pod makers of the Omni pod dash and the Omni pod five, head over to Omni pod.com forward slash juice box to get started and learn more. I also want to thank us Med and remind you that you can get your diabetes supplies the same way we do at US med Call 888-721-1514 or visit us med.com. Forward slash juice box. Today, Kate taught me that I can do more than I thought was possible. And I hope that's what you took from this as well. Thank you so much for listening. I'll be back very soon with another episode of The Juicebox Podcast. If you're looking for community look no farther than Juicebox Podcast, type one diabetes on Facebook, a private group with over 33,000 members. There's something there for you. I promise. A question a comment, a conversation, support, whatever you need. You'll find it at Juicebox Podcast type one diabetes on Facebook and don't let the name fool you. There's plenty of people in there that have type two diabetes, moody Lada are caregivers of people with diabetes. There's It runs the gamut over there. You really should check it out.

#818 Defining Diabetes: DKA

Scott and Jenny Smith define diabetes terms In this Defining Diabetes episode, Scott and Jenny define DKA.

+ Click for EPISODE TRANSCRIPT

Scott Benner 0:00
Hello friends, and welcome to the last episode of the eighth year of the Juicebox Podcast. This is episode 818

Welcome back everybody. In this episode of defining diabetes, Jenny Smith and I are going to define DKA diabetic Kido acidosis. While you're listening, please remember that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, always consult a physician before making any changes to your health care plan, or becoming bold with insulin. If you're enjoying Janney and you'd like to hire her you can she works at integrated diabetes.com. Are you a US citizen 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. And fill out the survey when you complete the survey. You have helped somebody living with diabetes, you're moving diabetes research forward and you may just help yourself T one D exchange.org. Forward slash juicebox. I have a little bit of time here. So I'm gonna say thank you so much for listening to the eighth year of the Juicebox Podcast, it was absolutely record breaking as far as downloads go. I can't thank you enough. If you're looking for a New Year's resolution that's achievable. Listen to a Juicebox Podcast series. If you're newly diagnosed, find the bulb beginning series. Trying to understand what all these words mean. Defining diabetes has over 50 episodes at this point, you're listening to one right now. And if you're really ready to dig in the diabetes Pro Tip series is the way to go. You can subscribe or follow the show for free on Apple podcasts, Spotify, Amazon music or wherever you get your audio even audible. Melissa says Pro Tip series set us on our desired path from the very beginning from a 12.9 a one C A diagnosis to a 5.2 in one year with a no honeymoon. You can find the series and more at juicebox podcast.com. Right at the top in the menu. Or you can go in the audio app you're listening in and just do a search Juicebox Podcast bold beginnings defining diabetes, diabetes pro tip, or how about the diabetes variable series, you think you know what's impacting your blood sugar, maybe you don't completely understand the diabetes variable series will help you to there's a mental wellness series defining thyroid, a collection of episodes about algorithm pumping. And don't forget the after dark series where people tell stories that most won't share. And finally, if you're looking for support, or community, the Juicebox Podcast private Facebook group is absolutely free, has over 32,000 members. And it's just waiting there for you so much good information. You can dive in and talk or just kind of sit back and watch. Whatever you need. That group has it. Alright, it's the end of the year, I did all my ads. So there's no ads in this one. Let's get right to Jenny and I talking about DKA. At the end, I will leave the links for all the advertisers if you need them. Just since you're so excited, I'll start the recording and then I'll tell you, so it's it's Friday. And I have two options today. We can either record for short defining diabetes episodes, which would be DKA MDI, meet the need and maybe something else. Or we could do this one, which I'm not going to be much help on. So that's why I'm asking you first I'll be able to like kick in with like, Oh, I remember doing that. But I need an episode. The people need an episode about the maths. I shouldn't say it like that. But the mass setting up Basal carb ratio insensitivity, like the real math behind that. Are you up for talking about that? Or do you want to do the emptyeyes?

Jennifer Smith, CDE 4:14
Let's do the let's do defining today. That's where my brain is today. I am just

Scott Benner 4:21
that's what I wanted to know. I didn't want to like spring on your like, we're gonna talk about math now. We'll do it later. The people will get it later. All right. Yeah.

Jennifer Smith, CDE 4:29
No, and I think I entirely agree. I think it's a big piece that you know, most people are just given these doses. And they're like, okay, because that's all they know, to say is okay, I got this new thing, you know, so you tell me and then eventually they learn more and they're like, why am I using

Scott Benner 4:51
and how do I come up with that number, but I just see people all the time, say like, my they told me this was my insulin to carb ratio, or they told me this was my insulin. sensitivity or whatever I I don't know where they came up with that. So okay, so if people are hearing this, you're about to hear a defining diabetes episode. But I imagine that by the time you hear this, our math episode will be up. So we will have Yes, we will do pick around, you'll find it.

Jennifer Smith, CDE 5:16
Good choice. Thank

Scott Benner 5:17
you. Do you see why I asked you? Because it's

Jennifer Smith, CDE 5:20
because it's more, it's definitely more in depth.

Scott Benner 5:25
It's mathy. And this Friday, I don't know where you're at. So

Jennifer Smith, CDE 5:29
yeah, I'm not at that on this Friday.

Scott Benner 5:33
Exactly why. And I think this is an exciting moment. Because, as Jennifer will tell you, I've never once told her asked her if she was up for doing what we were doing. Well, this is what we're doing today. And she's like, all right. Yes. So thank you for asking on this. Friday seemed important. The other stuff is, is conversational. Like, it isn't to the people listening because they don't have the knowledge. But for us, you know, if to pull the curtain back, you know, I'm gonna say in a minute. Hey, Jenny, let's talk about, we're gonna define DKA. And I'm gonna say something. And then, before you know it, it'll be 15 or 20 minutes later, and we'll have a clear explanation of the Hey, in a short conversation, because that information is in our head already. And we don't we hope that it's clear. Listen, better be clear. Have you ever listened to one of our episodes and thought, oh, we should have read on that?

Jennifer Smith, CDE 6:26
No, of the ones that I have. I've listened to most of them, I think, at least once? And I don't think so. Although, sometimes some of the older ones, as we've talked before, I think there's more to some of them now. Yeah. Because of other things that just weren't there to talk about or include.

Scott Benner 6:47
Previously, I'm trying to get I'm trying to clean up some of my list right now at the end of the year. And then I assume you and I are going to talk more about adding on to to the previous stuff. So okay, well, I love the defining diabetes series, because almost every time I say to you, Hey, Jenny, let's define blank today. There's a voice in the back of my head that says, you don't need to do that people know what that is. But then that's never the case for everybody. Somebody always doesn't know what a CD is. Or, you know, my favorite example is that I got a letter one time where the woman was like, I didn't know I was MDI until you told me. Right, but I absolutely, I've been doing it for years, like so. Anyway, so today DKA, diabetic ketoacidosis.

Jennifer Smith, CDE 7:35
Yay, define it. I think even defining it in terms of what the acronym is, is important, because most people just know it as DKA. And they're like, Well, I don't know what that means. Not only do they not know, it means like in words, but they just don't even know what it involves. Right?

Scott Benner 7:52
They just know they don't want it. Right. Yeah.

Jennifer Smith, CDE 7:55
No, nobody wants.

Scott Benner 7:58
I know, I don't want it. And I might have to go to the hospital if I have it. And I don't think so. Okay, so let's go through it. Yeah. I'll start with the Mayo Clinic. I like them. Oh, yeah. Okay, diabetic ketoacidosis is a serious complication of diabetes. That condition develops when the body can't produce enough insulin. Insulin plays a key role in helping sugar, a major source of energy for muscles and other tissue entering cells in the body. Without enough insulin, the body begins to break down fat as fuel. This causes a buildup of acids in the bloodstream called ketones. If left untreated, the buildup can lead to diabetic ketoacidosis. If you have diabetes, are you at risk of diabetes? Learn the word we know that part. Okay. You want to talk to me to give you the symptoms of decay?

Jennifer Smith, CDE 8:46
Well, the symptoms I can certainly do that unless you would like to

Scott Benner 8:50
roll through Jenny,

Jennifer Smith, CDE 8:51
let's go. Yeah, absolutely. Some of these can come even if you're not technically in DKA, but are definitely something to consider thirst. Like, I always say this is like extreme thirst. I still to this day, remember how thirsty thirsty I was before my mom took me to the hospital. Okay. It's like parched to the degree that you could just have like a water fountain attached to your mouth and you still would not feel like you're getting enough water.

Scott Benner 9:25
Someone just yesterday was talking about the diagnosis of their young brother nine months old. And he said something I don't think I'm ever going to forget. My brother was sucking the liquid out of the wet wipes. Oh, wow. And I thought that's so clearly illustrated. The just it's not just an urge, you know, right. Yeah, like just Yeah, just a primal thing. Like your brain is just find liquid put it in your mouth because I've heard people say, I caught my kid drinking out of the toilet. And that's shocking because If the toilet but it's not rocking, it's also a big bowl of water and the kids thirsty. So you're like, Okay, that makes sense, right? But sucking the liquid at nine months old out of a wet wipe, I thought that really, that puts a clear description, right.

Jennifer Smith, CDE 10:14
So I think to define that symptom even a little bit further from an understanding of like biology, what's happening in the body is the high levels of glucose, your body again, tries to do what it can, right. And so it tries to clear that excess glucose out. And that pulls fluid from other areas in the body. And so you get dehydrated with the high levels. And the thirst just keeps going. Because a second symptom that goes right along with thirst is going to the bathroom all the time, like, all the time to the degree that you can't wait to have five minutes to just leave whatever you're doing and go to the bathroom. Again,

Scott Benner 11:00
it just keeps happening. And this is your body's kind of way. It's it's last, its last ditch effort to try to remove these toxins, even though this isn't going to work. Right? Correct. Yeah,

Jennifer Smith, CDE 11:11
right. Right. Because of the extreme deficit of insulin, right? There's only one way to get the body to kind of shift gears. And in the whole grand scheme of things besides insulin, there are electrolyte imbalances and things that are also going along with the ketoacidosis, too, that need to be righted, obviously. But definitely thirst and extreme urination. I you know, for little, little kids. It's really heavy, consistent wet diapers, as well. Okay. For little kids who've been potty trained. It's often that they sort of revert back to wetting the bed, or not being able to get to the bathroom fast enough during the daytime and wetting their pants. Yeah.

Scott Benner 11:59
I was gonna go down a different road. But I want to keep I'm not going to Oh, yeah, so I'm gonna stomach pains, the feeling of throwing up or needing to throw up or to actually throwing up. It really is. Can you hear that? I can buy your truck just went by and I was like, I can't believe you can't hear that. It's just for you. Apparently, sorry. I'm hearing voices. Jenny. This is it. So, you know, shortness of breath, fruity scented breath, which is the thing that finally pushed us over the edge with Arden. And confusion. But now is the initial DKA at diagnosis and a DKA that you could run into after you're diagnosed and you're getting insulin. They're the same thing. But do they Yes, but they present. They can present differently? Because? I mean, why do I mean that because when you're being diagnosed, it's not everybody. But you could be experiencing a slow shutdown of your insulin production. So this thing could come on more slowly.

Jennifer Smith, CDE 13:07
Where that yeah, that's a good I guess, description of the difference, because I remember I was thirsty for a good two weeks prior to actually, my mom's like, we're going to the hospital, right, you know, I was thirsty, thirsty, thirsty enough to keep asking my friends for their milk at lunchtime, thirsty enough to stop at the bubbler? There I'll use a local term, the water fountain, in between classes, going into the bathroom in between classes, all of that kind of stuff. I remember also getting up overnight to go to the bathroom. I remember the week before also having thrown up overnight. But you know, at that, like early teen, I didn't really tell my mom Hey, I got sick overnight. Yeah, just I don't know. It was just whatever it is the brain at that age, right. So yeah, I mean, all of those, all of those kinds of things are a lead up in kids or even adults. Sometimes I think the adults who are diagnosed as type one in adulthood. It's even slower progression. Right. So well, in in the time when you are already diagnosed, though. DKA is more of a, as we've already talked about ketones, right. DKA is more of a it's a quick development, I guess, for lack of a better way. I hope that makes sense.

Scott Benner 14:39
Yeah, that's kind of what I'm saying is that if you're being newly diagnosed, you know, you might not even be listening to this. To be perfectly honest, this might be something that people only find after they found that they have diabetes, but my point is, is that if you if your recollection of it is that it came on slowly, you know, and then you found yourself in the hospital with somebody telling you you have diabetes and you're in decay Once you're on insulin, and your pancreas isn't helping anymore, if you lose your insulin, it's going to happen fast like, and it's going to be serious quickly. And that's that changes. You know, I think how you have to handle it, and we have that whole episode about dealing with ketones. So it's why I'm doing this after that one. I wanted to make sure that one was up before before this.

Jennifer Smith, CDE 15:22
Well, and I think people who also have type one in the family, I think this episode is important, just as even reminder of the common symptoms, because some people or kids may present with a few. Not necessarily all of these things at one time. So even though you may think you have eyes for watching for this, it's important to still be reminded,

Scott Benner 15:50
yeah, I think that based on what the doctor said in the hospital, and my being able to, you know, look back on the situation, I think if we don't go to the hospital when we do, I mean, I don't know what happens the Arden in the next 24 hours, really, you know, like she was in a bad way. Yeah, like they seem surprised that we've bit and to feel good about it. We they seem to surprise that we got her they're conscious. And they said so many kids at this age because Arden was too. She's like they come in unconscious or comas, you know, like really terrible stuff. And, and then when they asked like, how did you know? I said, I her breath smelled weird. And then I said that to my wife, and it sort of set off a chain reaction of us, like brainstorming together for five seconds and going oh, God, she has diabetes.

Jennifer Smith, CDE 16:44
Besides the breath. Did she also I know we defined this to the crucible. Well, she had those for sure. Did she have that too? Yep.

Scott Benner 16:51
We were sitting in a vacation home with a full family. It must have been like 16 people there. It was late at night. And we were playing a board game. And Kelly was still in her bikini I think in a rap like a sarong. And Arden was like draped over her lap. fall asleep, having those respirations and I guess it was just a pause and it and we just thought she was sick. You know, like and, and there was a pause in in the in what was going on? And I don't know why. But I said I said hey, I meant to tell you that Arden's breath smelled weird today. And she goes, What do you mean? I said it was like fruity or maybe metallic. Like that was what I remember saying. And then she gets this terrified look on her face. And then I think we both kind of like quietly in our head start doing the math. And I don't know who said it first. It might have been Kelly. And she's like, Oh, god, she's got diabetes. And this was before the internet, like the way you think of the internet now. So someone had a laptop, and we had to hang over the balcony of the vacation home to steal Wi Fi from another house to Google signs and symptoms of type one diabetes. Yeah. And then we saw like, there were like five things in a list. And then we called my buddy who's the kids pediatrician. And then he found a the closest Children's Hospital and kind of sent us to it. I mean, this is before you could get in your car and be like, I want to go to this like we were like in the middle of the night in a city we didn't know.

Jennifer Smith, CDE 18:20
Right, like driving and hoping you're following the right street to get there swear to

Scott Benner 18:24
you. None of you listening there were under a certain age understand that. But like, we didn't just get in the car and go oh, go to the hospital car. And the car was like, Okay. wasn't like that. It was really just a sad moment not to get too far off the path. But I remember I remember sitting at a traffic light on this, like, desolate Street. And Kelly and I like staring forward like almost on purpose not looking at each other. And I said, Hey, right now before we get there, like she's got diabetes, like get yourself. Right. I was probably talking to myself, but talking to her, you know, I'm like, because this is going to be this is about to be horrible, you know, and we need to hold it together. We were still pretty young. And you know, so far our life had been fairly ideal. Like, honestly, like, we grew up hard. We got good jobs, we bought a house like we thought things right, working, you know what I mean? And then suddenly, I'm just like, we're gonna go into a hospital and someone's gonna say this to us, and then all the things that come after it that we don't know. Right, you know, so instead of being tough, we went into a family room and cried after they took her they didn't go the way I thought we weren't all like it's gonna be okay.

Jennifer Smith, CDE 19:39
I'm surprised you sat at the stoplight. Those are the stoplights were like there's nobody around and I'm in a hurry. o'clock in the morning. I'm like, why am I sitting at a red light when there's nobody here? I can tell you why. And am I admitting to bad thing? No, no, not

Scott Benner 19:58
in any other situation. I would Look left look right and been like Scott's gone. But although nowadays they got the cameras everywhere. Right? Right. But But I did that twice that night. The first time was after we realized what was going on, I went to a, um, a pharmacy, a 24 hour pharmacy to buy a meter. And I stood in the meter, I'll I think, on purpose not choosing a meter. Because I had this conscious thought standing there. And I thought if I don't get one of these meters, she doesn't have diabetes. Like, that's how it felt I was gonna cry. I've never cried while I was doing this with you. I'm sorry. I thought like, I thought I'll just stand here forever. And she'll be okay. I'll never see her again. But at least you won't have diabetes, you know. And I made myself by the meter, I drove back. And then I think that stoplight was the same thing. I was like, I could go, but let's just sit here.

Jennifer Smith, CDE 20:53
Let's just give it some time before we get someplace and get news that we don't want to get. Yeah, give me

Scott Benner 20:59
two extra minutes of art and not having diabetes, I think is at the time. But anyway, that's nothing to do with DK and I need a tissue Hold on.

Jennifer Smith, CDE 21:07
I'm sorry. Well, it does have to do with DKA I think it's because these are all the things that go along with it, that it's not just defining something, it's it's important to know that all these emotions and these things, they're going to be there too. And that's, that's not wrong.

Scott Benner 21:27
I mean, so it's just it's one of those things that I mean, DKA could happen once you have diabetes, it could happen at any time. You can a bank cannula could send you there.

Jennifer Smith, CDE 21:38
You know, forgetting some people faster than others. Yeah, right. And so

Scott Benner 21:41
when you see these being very thirsty, urinating stomach pain, throwing up weak or tired shortness of breath, that you know where that fruity breath being confused. I mean, please, first of all, get yourself a ketone meter, there are blood ketone meters, they're way easier than peeing on sticks. And probably sitting there much more accurate, more accurate. Yeah, yes. And then you've got to go into your, into your sick day care. And you clear those up, they're going to clear those ketones, so you're going to end up in a hospital where they're doing it for you. And I don't know, I should find, as we're wrapping up, and you tell me if there's anything else we need to put here?

Jennifer Smith, CDE 22:19
I don't think so. I think that defines it in a, I mean, a simple way, the symptoms and why it's happening. That's the important piece of it. Yeah, what to do about it is clearly if you think that this is a new diagnosis, obviously, you need to just go get medical care. That's the you need the help. If you're at home, and you have really high ketones, like we've talked about in the ketone episode, you either give it a time to clear it, or if it's not clearing within, you know, a defined period of time. You go to the doctor, don't play with it.

Scott Benner 22:53
That's episode 805. It's inside of the bowl beginning series. It's called Bold beginnings, illness ketone management. So there you go. Oh, Jesus. I have to be honest. Yeah. I didn't think I was gonna get upset talking about you tricked me. That's sorry, don't worry. Oh, thank you for doing this. I appreciate it. All right. Holy crap. I didn't know he's gonna cry. Sorry. No, don't be sorry. I make people cry all the time. So don't worry about I was interviewing a guy yesterday, he got choked up talking about his brother. Next thing I know, I'm like, god dammit, I'm crying. But he just told this crazy. Uh, you'll you know, if you catch it, when it comes out. It's going to be an after dark. This guy and his brother were, they lived. Like, hold on, let me I'm gonna stop the recording for a second.

Sorry, I cut that off. I didn't want to give away an upcoming episode. This is pretty much it. It's the end of 2022. I want to thank you so much for listening to the show for subscribing in an audio app for telling other people about it. For participating in the private Facebook group. It's all very much appreciated. I hope you have a very happy new year. Let's say alright, I'm just gonna at the end here, I'll list all the advertisers their amazing support that they've given to the show for some of them for many, many years. If you need an insulin pump or a glucose monitor glucagon or something, it's a huge help to the podcast if you click through my links, so thank you for taking that extra step.

These links I'm about to give you are right on the front page of juicebox podcast.com And they are on every episode page for the specific episodes meaning like this episode here has a page on juicebox podcast.com. Okay, let's go with the first ever advertiser, Omni pod, bought an ad in 2000 wasn't in 15 when in a month, there weren't as many people listening as there are in an hour now, that's pretty much right. Yeah, took a month to get the amount of listeners in 2015 that in 2020 to happen every hour so on the pod was in early and supporting the show back when they really were just supporting the show. I mean, I don't think I was selling a lot Omni pods back then. Anyway, now you can get the Omni pod five or the Omni pod dash through my link Omni pod.com forward slash juicebox I think the next advertiser was Dexcom I think Dexcom was next Dexcom Of course, makes the Dexcom G six and the Dexcom G seven, you can find out more about that you may even be eligible for a free 10 day trial of the G six@dexcom.com. Forward slash juicebox I should throw in that I think you may be eligible for a free 30 day trial the on the pod dash at my link. But now that I said that I have to say for full safety risk information and free trial terms and conditions also visit omnipod.com forward slash juicebox. Alright, I didn't mean to get into that sorry. I think touched by type one was the next advertiser. Great organization helping people with type one diabetes touched by type one.org They're just looking for you to learn more about them go check out their websites very cool. They have a lot of offerings for type ones. I'm gonna say after that Contour Next One, I think the Contour Next One blood glucose meter fantastic meter contour next.com forward slash juice box may be cheaper in cash and you're paying right now through your insurance. One way or the other. absolutely accurate and amazing meter. We've been using it forever. It's fantastic. I'm gonna say that. Then it was je voc hypo pen, je voc glucagon.com forward slash juice box that is the glucagon that my daughter carries. In 2022. The in pen was a sponsor. They are not going to be back in 2023. So I'm not going to give you their link. And what else us med came on? It's 2022 They're sticking with us. Absolutely fantastic. This is where we're getting Ardens diabetes supplies from us med.com Ford slash juice box or call 888-721-1514 If you're sick of that place that you're getting your stuff from now, you don't want to bang your head against the wall like you are with some of the other distributors check out us med T one D exchange is not an advertiser, which might be confusing for you. I actually get paid every time you fill out a survey but I love what they're doing. T one D exchange.org forward slash juicebox. Go take the survey. You'll help move diabetes research forward and you'll help the podcast I think that's it. Oh no, no, no, no. Excuse me. In October Athletic Greens came on board. And they're going to stay for 2023 Thank you athletic greens. So if you're looking for ag one from athletic greens, it's athletic greens.com forward slash juicebox. I'm using it every day and really enjoying it. Alright, if you're still listening Europe, you're a great fan and I appreciate it very, very much. That's all I have for you Have a Happy New Year. I'll be back very soon with another year of the Juicebox Podcast