#832 After Dark: Striving and Grateful

Emily has type 1 diabetes and a number of other struggles.

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

Scott Benner 0:00
Hello friends, and welcome to episode 132 of the Juicebox Podcast.

Emily is an adult living with type one diabetes, and she has had more than her fair share of problems, but she hasn't let them stop her from striving for more. Today while you're listening to Emily's story, please remember that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, always consult a physician before making any changes to your health care plan, or becoming bold with insulin. If you have type one diabetes, or are the caregiver of someone with type one, please take a few minutes to fill out and complete the survey AT T one D exchange.org. Forward slash juice box. Completing this survey helps move type one diabetes research forward and you can do it right from your home. T one D exchange.org forward slash juice box. Just to let you know we're going to be speaking about a number of things in this episode drug use, suicide attempts, depression, anxiety, and things of that nature. Just want you to be aware

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 Podcast is also sponsored today by the Dexcom G six continuous glucose monitor. That's right Dexcom makes the G six and the G seven is coming very soon. So head over now and find out more dexcom.com forward slash juicebox get the CGM that my daughter uses get index comm links to G voc hypo pen, Dex calm and all the sponsors are in the shownotes of the audio player you're listening in right now. And they're also at juicebox podcast.com. When you click on my links, you're supporting the show. So I thank you very much.

Emily 2:18
Hi, my name is Emily. I live in New York, and I've been type one diabetic for coming up on 30 years. Since I was three years old.

Scott Benner 2:30
Wow. Okay, well, that's a pretty long time. Does it feel like a long time?

Emily 2:38
Yeah, it does feel like a long time. How so? I just I can't remember a life without it. And it almost seems like it's been different chapters of diabetes. A little.

Scott Benner 2:58
Okay. Well, two ideas and we'll pick it apart a little bit. Does it bother you that you don't remember life without diabetes? Or is it comforting? Or would you not know?

Emily 3:12
I don't know. It? I think? I think not. I mean, I think both situations are difficult in their, their own way. But at least for me personally, I think it's difficult. I always wonder like, you know, what it would be what it would be like and

Scott Benner 3:40
is it sort of like a sense of, like, loss, like, you know, you lost something, but you don't know what it is? Right? Because you have no, you have no context for not having diabetes. I mean, unless you remember being two years old.

Emily 3:53
No, I don't I don't remember. I see pictures. But I don't actually remember anything.

Scott Benner 4:03
So do you do you think that you there's something to miss or do you think you're imagining something? I don't know if that's I think there's

Emily 4:13
something to miss. Yeah. And you know how it's affected my life. It's definitely impacted my life quite a bit. And it's just always something that's been there and it always will be there. So

Scott Benner 4:33
Right. Well, let's figure out a little bit about it. So have your your family ever share with you how they figured out you had type one?

Emily 4:43
Yeah, it's actually pretty strange. I think my father actually was type one diabetic as well. So he He, so I was three years old. He had type one diabetes. And I was told that his uncle, who was very influential in his own diabetes management, had just passed away. And my father had some underlying mental health issues. And he started having hallucinations after that happened that I was a type one diabetic. And he became very obsessive and started testing my urine constantly. And he brought me the doctor's saying, you know, you need to test her. And they all say, you know, you're crazy like she doesn't have type one. She's not diabetic, she's not showing any symptoms. And finally, he wound up bringing me to the Joslin in the Joslin Center in Boston. In March, my mother was actually giving birth to my, my brother, at this point, so my father was not with her when my brother was born. Can you do it he took me to Joslin and they ran a glucose tolerance test on me. And it turned out that I was a type one diabetic. So he was right, even though it's kind of crazy, but I wasn't showing any symptoms at the time. He just

Scott Benner 6:29
do you think he was seeing things that he recognized? Or do you think he was actually in the midst of some sort of break?

Emily 6:39
I think it was more a mental health thing. And I think he was just like, he was always a very anxious person. And I think he knew there was always a chance

Scott Benner 6:55
he just happened to be right this time when he when he does, yeah.

Emily 6:59
And I think some some things happen that really kind of like, broke him a little bit and being that he had underlying mental health issues that, you know, just manifested itself in that way,

Scott Benner 7:13
what were his struggles.

Emily 7:16
Um, over the years, he was diagnosed as bipolar. He was also he also had major addiction problems for most of my life. I think they started to happen actually more. After I was diagnosed with type one, which I don't know if that is related. I think it really broke him on I was sidenote,

Scott Benner 7:47
anyone else in your family have type one?

Emily 7:52
No, just just my father, one. My brother gets tested every once in a while. I have a younger brother. And but he's never showed any signs.

Scott Benner 8:05
Anyone else have any kind of mental health issues? That you're comfortable talking about?

Emily 8:14
I'm just I'm just trying to put you through a list. I don't have I don't have like a ton of family members. And I also don't know all of their mental health statuses but in terms of immediate family, it's just me and my father.

Scott Benner 8:30
Okay. And what's going on with you?

Emily 8:36
I also have bipolar. And it's an extreme anxiety.

Scott Benner 8:41
Okay, so significant anxiety, bipolar. How old were you when they diagnosed the Bipolar?

Emily 8:50
Bipolar was just recently it was last year, I had always been diagnosed with depression and anxiety. And but the medications never worked for me. So I wound up just going off and going, just completely cold turkey and I was not doing extremely well. So I decided to go back and see someone. And they diagnosed me as bipolar. They also diagnosed me with ADHD. I don't know. I'm not quite sure about that. But

Scott Benner 9:26
I don't think you have time to worry about ADHD. You have a lot going on. Can you can you talk about what what what? Oh, no, it's my question. What was going on in your life that got you to a depression and anxiety? Diagnosis first. Like how did it impact you day to day?

Emily 9:53
Um, well, I think it really started happening in high school. or that's also when I first started therapy, and I started on some medication. My parents relationship was really, like, really dysfunctional. So I was having a lot of issues there. Think the diabetes maybe played into it a little. I also I developed an eating disorder at a fairly young age, but it morphed into other things over the years. And eventually it did affect the diabetes, but not not for a very long time.

Scott Benner 10:45
So you in high school started feeling depressed? The anxiety? Yeah, amped up.

Emily 10:53
Yeah, I was just always nervous. Always very. Just high strung? And, but, but also, yeah, very, like, sad and just not able, I had quite a few friends, but I just kind of, I never really felt like I fit in between my family life and being diabetic. And yeah.

Scott Benner 11:23
Is this something that the people around you would have noticed at the time? Or do you think it was fairly contained within you?

Emily 11:34
I think, no, I think people probably notice, okay.

Scott Benner 11:39
So kind of sadness. The, I mean, does it come across as like, just head down, not involved? Or

Emily 11:47
it comes? I get very emotional. Yeah, it would get very emotional.

Scott Benner 11:54
And that could swing in. Like, happy, sad, angry, anywhere in between.

Emily 12:00
Yeah. And I think it became even more prevalent as I got older, which is why I was probably diagnosed as bipolar. And also having that history in my, in my family with my father. And I think my father and I are very similar in some ways.

Scott Benner 12:17
Did Did your father's. Was your father ever diagnosed?

Emily 12:22
With bipolar? Yeah. Yeah, he was, he was seeing mental health professionals on and off for years.

Scott Benner 12:33
I was just, I was kind of trying to figure out why it took them. I would seems like about 15 years for you to get from these initial concerns to a bipolar consideration, like, were they never looking at your dad's history? As you know what I mean?

Emily 12:53
They always they were looking at my father's history, because I would always tell them that, you know, he was bipolar. I think that the the manic aspect of bipolar wasn't really focused on with me, because I was so depressed that I would always I would pretty much just show sign signs of depression, and I never

Scott Benner 13:22
you didn't have bipolar.

Emily 13:24
I didn't get the like, ups in terms of like, yeah, like crazy, you know, crazy highs and feeling great. I got them in terms of like, this frantic type of energy, where I kind of like it couldn't relax and very poor sleep, just just acting kind of crazy. But

Scott Benner 13:54
did you ever try alcohol and drugs to help you?

Emily 14:00
Yeah, you did, too. Yeah. To a certain extent Not, not. To my father's extent, and maybe I shouldn't compare them but. But I do struggle with my own addictions, whether it's in the past?

Scott Benner 14:20
Do they help? Or do they? Like are you are you self medicating in a way that it's actually valuable? Or is it just making things worse, or making things different?

Emily 14:32
Well, it depends on what it is I. But no, I don't think self medicating really works in the long run. Gotcha. But I also don't, you know, I am on medication for certain mental health issues and they do help. They do help quite a bit. But you know, I just I wonder about the effects of those as well, in the long run to you know, I don't know if he should be on anything like, long term.

Scott Benner 15:09
Well, you know, what the what I've always heard is the biggest concern with drugs that help with mental health issues is that you're having a problem. And then you're not thinking very clearly, and you're suffering. And then you get on the medication, and it alleviates those problems. And now you're thinking more clearly, you're not struggling as much. And you have the propensity to think, oh, okay, I'm better now. I don't need the drugs anymore. And of course, the drugs are the only reason you feel that way to begin with. And then you go off of them. Apparently, that's a pretty common issue. For people in your situation, you start feeling clear, and you're like, Oh, I'm better now. It's like, because you think of it as almost like a cut healing? And then you want to take the band aid off? Yeah. Has that happened to you so far? Or are you have you been pretty consistent with it?

Emily 16:06
No, I'm on and off. Medications, various medications for a long time. Gotcha. And some of them, I didn't go off the right way.

Scott Benner 16:18
So and that it's just like, I

Emily 16:19
don't want to take this anymore. So I'm not doing

Scott Benner 16:22
and then there's the impact from that by not titrating away from it. Is that right?

Emily 16:26
Sometimes, yes. It depends on the drug. But yeah.

Scott Benner 16:30
Are you in a relationship married? Or?

Emily 16:34
I'm in a long term relationship, I think, technically technically engaged for like, five years, maybe? I don't know. But we own a house. And you know, it's just not on my, like, it's not one of my top things to do right now. Being married is not. Yeah, you know, we're, we know what we are. And, you know, it doesn't mean anything to me. And, you know, it would be nice. At some point, we probably well, but

Scott Benner 17:10
yeah, you get a ring, at least.

Emily 17:13
I did. Yeah. It was a very, very nice spring, but was actually his, his mother's engagement ring. So it was very meaningful.

Scott Benner 17:25
That's lovely. Okay, so your My, the reason I asked was because I'm wondering how much a partner has to do with care? I mean, is this something that you sort of take care of by yourself? And you don't look for outside help? Or are you? Are you in it together more? Is he involved?

Emily 17:48
For the diabetes or the mental harm? So

Scott Benner 17:50
I'm still going with the mental health, but I was going to translate into the diabetes in a minute.

Emily 17:55
Okay. for mental health. Yeah, he's definitely involved in, in my health. He because he cares about me, and he cares about the diabetes and the mental health and he's also had his his own experience with mental health and mental health professionals. And, you know, he views it in a certain way. So sometimes he'll just check in with me or ask about the medication and look into that if there's any, you know, where side effects or anything so yeah, it's definitely involved.

Scott Benner 18:35
Gotcha. Okay, so how did all of this uh, now I'm trying to imagine all of this commingled with having diabetes in high school. And as a young adult, did you go to college as well? Yeah. Okay. So high school into college. You're having, you know, depression, the anxiety seems pretty extreme. So how do you, I don't understand how you can make it through a day of worrying about your insulin. What was that like? And, you know, Were there moments where you faltered.

Emily 19:14
I honestly like almost don't even remember the diabetes at that time. I just like, I just remember it. I carried around pens, and I gave myself insulin when I needed it. But I was never as concerned about it as I am now. Yeah, I just don't even think it was like a concern of mine at the time, especially because I didn't really care and I was diagnosed so young, and they told me like, they're going to have complications in 20 years. And I was like, Well, that makes me 23. So like, I mean, yeah, I'll be young. Like Cook, who cares what I do now? I might as well have fun.

Scott Benner 20:04
Because they felt like you were, were they telling you we're gonna have significant health issues in your 20s?

Emily 20:10
Yeah, they were like 20 years you'll have complications.

Scott Benner 20:13
Did you end up having those complications?

Emily 20:16
No, I actually don't have any complications. But I did have well, not long term complications, but because of my eating disorder past and that led into diet bulimia, and I got very, very sick and I went into kidney failure. And so so I did have some health issues because of the diabetes but but not long term yet, so I'm grateful for that. Surprise. I'm really surprised.

Scott Benner 20:54
Well, I mean, if somebody told me for sure it was gonna happen, and no, it didn't happen. And like you're saying, you weren't probably really on top of things to begin with. What was your management like in the beginning? I mean, 30 years ago, is definitely like regular and mph, right? When did you switch over to a faster acting insulin?

Emily 21:13
I have no idea. I have no idea. I remember using the syringes at first and then I don't know when I transferred over to pens. And I didn't get a pump for a really long time. And then I went off of it and on it and then eventually started listening to your podcast and heard about Omni pod and obviously want to try that. And it's been great ever since. And same with Dexcom. Cool.

Scott Benner 21:47
Well, see you made me happy. I didn't realize that you're listening to podcasts now download. Okay, so. Wow, it feels like oh, like, does it feel like a lot to you when you're recounting it? Or does it just feel like your life Chivo Cape Capo pan 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 Jeeva glucagon.com. Forward slash juicebox. G voc shouldn't be used in patients with insulinoma or phaeochromocytoma. Visit G voc glucagon.com/risk. How would you like to know what your blood sugar is, without poking a hole in your finger, you can with the Dexcom G six continuous glucose monitoring system, which is available@dexcom.com forward slash juicebox. Not only does Dexcom offer zero finger sticks, but you can get your glucose readings right on your smart device that's your iPhone or your Android don't have a phone. That's okay. You can use Dex comms receiver. On any of these devices, you're able to set up customizable alerts and alarms, setting your optimal range so that you'll get notified when your glucose levels go too high or too low. And you can share this data with up to 10 followers. Imagine what that could look like your child could be at school, and their data could be available to you, your spouse, their aunt, the school nurse, anyone who you choose, my daughter has been wearing a Dexcom for ever. And it helps us in multiple ways. Around meals, we're able to see if our boluses are well timed and well measured. If they aren't, we can tell by how her blood sugar reacts and then go back the next time and make an adjustment. Without the Dexcom CGM. We're sort of flying blind, but not just at meals. Also during activity and sleep. The Dexcom offers us an unprecedented level of comfort and security, being able to see my daughter's blood sugars in real time. And not just the number. But the speed and direction is an absolute game changer if you're using insulin dexcom.com forward slash juice box head over there today to see if you're eligible for a free 10 day trial of the Dexcom G six. The Dexcom is at the center of how we've been able to keep our daughter's a one C between five two and six two. for over seven years, we've been able to minimize variability and keep her blood sugar's in a stable range because of the information that we can see with the Dexcom these are our results and yours may vary but using Dex coms feedback has helped my daughter without any food restrictions, live a more normal and healthy life dexcom.com forward slash Juicebox

Unknown Speaker 24:59
Podcast it?

Emily 25:19
Feels like a lot. It does feel like a lot, but I don't remember certain parts of it. Okay, as well.

Scott Benner 25:28
At what point? Does the eating disorder come in? Do you recall?

Emily 25:35
Um, it's started probably around like early middle school, I'd say I started having some disordered eating behaviors, and then it one two, it developed into more dangerous behaviors later on in my 20s,

Scott Benner 25:58
does it start with? Or is it a consideration around weight? Or is it a consideration around insulin?

Emily 26:06
It's a consideration about my body, especially at that time and, and food, because that was focused a lot on again, what because of the diabetes, but that became more of like, a focus of mine.

Scott Benner 26:26
So were you eating without using insulin? Or re you

Emily 26:30
know, not at the time, I was just restricting my food intake and exercising more,

Scott Benner 26:36
okay, restricting it about your body, not about not having to use the insulin.

Emily 26:43
Right. At the time, I didn't know about that. I wasn't aware.

Scott Benner 26:47
And then you became more aware in college type years.

Emily 26:55
Um, I don't know when I became aware of it, but I know that I started messing around with my insulin. More in my mid 20s. And then it became pretty severe where I was just not really taking anything and not that I wasn't taking anything. But I would just run my my background and salinity pretty much when Bolus for me.

Scott Benner 27:26
Did that impact your, your body the way you like weather? I'm trying to find the right way to say this. So I don't sound like I'm you don't I mean, so I don't sound like hey, this is a great idea. But did you did you because it's not. But did you see the effect like was their cause and effect like you stopped taking your insulin and the thing you hope would happen initially happened before you got into a situation that was more dangerous. Like I'm trying to figure out if your feedback loop was positive around it, or if it's if it happens for another reason?

Emily 28:02
I'm not quite sure I understand.

Scott Benner 28:04
Yeah, I'm sorry. I need to be more clear. Yeah. So you stop taking mealtime insulin. And then what happens after that physically?

Emily 28:14
Um, I started to feel very sick. My blood sugars were constantly high when I barely checked my blood sugar. So it's like, well, let me there's just going to tell me I'm high. Yeah, and it just it became a really severe health issue. I was constantly running to the bathroom. That actually became an enormous issue, the the constant urination and the excessive drinking. And I just always felt sick. And there were times where I had to leave work early. I was taking a lot of medical leave. I was throwing up I had to go to the hospital a few times. So yeah, it just became it became really bad, and no one really knew about it.

Scott Benner 29:08
And while that's happening, it doesn't. Does it occur to you, I should just start taking my insulin again. Or what's the thing that keeps you in that space?

Emily 29:19
Well, I should have said this before, but I I became very suicidal at one point. And so the fact that I already had the eating disorder, and then I knew about the diet bulimia, and I didn't want to take care of my diabetes anyway. It just it was kind of like the perfect storm where it's like, well, I don't care. I might as well have this eating disorder and do whatever I want and just die because I don't care. Suicide became a very painful way to live.

Scott Benner 29:58
I can't imagine actually, um, suicidal, like, in the, in the, in the sense that you just don't care what's happening to you as it's happening or, or suicidal in the, in the sense that you had a plan and you're trying to enact it. Does that make sense?

Emily 30:18
Yeah. No, I was I was actively trying to kill myself. I didn't want to. It was passive. Like I didn't want to have to necessarily do anything.

Scott Benner 30:33
You just wanted it to happen.

Emily 30:36
Yeah, so not taking care of the diabetes, it's like, Well, eventually I'll die. So I'll just, I'll just do that.

Scott Benner 30:44
And, and what's the end of that sentence? Eventually, I'll die. And this will all be over. Or eventually I'll like, what comes after that and your thought? People what is the goal of, uh, sounds crazy, but what is the goal of dying? What are you trying to accomplish?

Emily 31:03
I was just extremely depressed. And also my mother had just passed away.

Scott Benner 31:08
I see. I'm sorry. Okay. Well, I mean, okay, so we're halfway through. We should probably all just wave err on our face for a second and take a deep breath and start over again. Because you're not in that situation. Now. Is that correct?

Emily 31:27
In terms of not taking my insulin No, I'm very good about taking my insulin and watching my Dexcom I'm, you know, yeah. Much better a WHMCS. Sometimes the endo tells me that I'm just, I'm, you know, micromanaging and just don't be so concerned about

Scott Benner 31:48
it. I think your endo should shut up. But I think I think you're doing good. So does the endo know all this about you? Or do they just know you from the diabetes piece?

Emily 32:00
Um, I let my doctors know my history. But they I was not with this doctor. When, when that was happening.

Scott Benner 32:10
I say, Yeah, because I don't think it's a good idea to dissuade you from doing a good job for yourself. That seems that seems like a bad idea. And your mental health stuff is is currently being managed with medications. Like how would you classify your anxiety, depression? At the moment?

Emily 32:34
Like how am I doing with that? Yeah, how's it going? Um, I think that's a lot better. I still think it's um, I don't know, I've just never had the greatest mental health. I think the anxiety is the biggest issue I have really bad anxiety. But I don't think anxiety can really be managed medication very well, unless you're on anti anxiety, medications constantly, which I don't want to be. I don't want to be feeling like, tired and zoned out all the time. So it's just, it's just kind of learning to deal with it. I've been trying to do more exercises for, you know, breathing meditation. Stuff like that. I do have a PRN if I need it. But uh, I, I think I'm going to talk to my psychiatrist actually about switching me to something else because I don't think it's a it's a good medication for me.

Scott Benner 33:47
Gotcha. Have you tried that? Um, that rapid eye movement? Treatment? What does it EMDR? Maybe?

Emily 33:55
Four? I've heard of it. No, I haven't tried

Scott Benner 33:59
a lot of people who discuss things like you're discussing today. Bring it up to me when it comes up on the podcast. So I don't know if that's something worth talking to your psychiatrist about or not? Yeah, definitely. So explain anxiety to me for a minute so you open your eyes in the morning? And are you like completely consumed with things that you're concerned about immediately? I'm going to be late. I hope the shower is not full like is it down to the minute stuff or does it always just you know what I mean? Like when does it start and and what things I guess rev it up? Is it anything?

Emily 34:40
Yeah, it's it starts immediately when I wake up although again, I am trying to implement some things where that are good in dealing with the anxiety I try not to like, bounce out of bed immediately. Try to take My time and take a breath and kind of wake up more slowly and really be like present when I'm, you know, brushing my teeth, washing my face and getting ready for the day. Kind of get myself up. You know, I have like some rituals in the morning that I'm, you know used to doing and those are kind of comforting. But pretty much it starts the second I wake up, I'm constantly like, rapid heartbeat like frenzy kind of static feeling in my chest, checking off what I have to do today. Am I going to be late like? Yeah, that's. And it's stupid things. It's not like, I mean, some things are big things, right? But But yeah, I also get tied up in the little things.

Scott Benner 35:55
I know, some anxious people, and the closest I've come to ever being able to explain it, from my perspective, is that when I'm in the room with them, they feel like they're vibrating. Yeah. And I don't

Emily 36:07
I can't sit still. And

Scott Benner 36:12
it's almost like the look on their face. Like, like, I feel like they're, I don't know how to explain it. Like, I feel like every cell in them is moving in one direction than another direction and thinking about 63 things at the same time. And they can't they can never be where they are. That makes sense. They can never sort of stop and, and, and just stop. And those people that I know that are like that they seem to drink their way out of it. If I'm being honest, that seems to be not that I'm saying that's what to do? Because it obviously comes with its own set of new problems. But yeah, I can't imagine so you have sort of the anxiety exists all the time? Is any of the medication impacting depression? Do you feel depressed? Or has it been lightened? Or alleviated?

Emily 37:05
Um, wanted to say something about the inside. Oh, I just wanted to say that your description was pretty spot on in terms of how it feels. But in terms of the Depression, I think the swings, the mood swings are definitely more controlled. Now that I'm on the medication. I think I had a bout of depression, but I think it was caused by a medication I was taking, actually. So I stopped that. Talk to my doctor about that.

Scott Benner 37:46
And how does the now that you have a bipolar? Oh my god, this simplest, we're just fell right out of my head. Hold on a second. Give me a second only diagnosis. There's the word I'm looking for now that you have Wow, can you imagine I couldn't think of diagnosis. Now that you have a bipolar diagnosis. And I imagine that's being medicated. Is it? Is it consistency through the month? Or are there still ebbs and flows? Like could you and I have randomly set this up on a different day? And I'd be talking to a completely different Emily or is like how does that all work?

Emily 38:28
Um, there's ebbs and flows. I feel like but I feel like they're not as high. And lows. Lois. I suppose they used to be.

Scott Benner 38:41
So taking the spikes out taking the drops out, bringing you closer to the middle. It's it's a lot like diabetes. You're less Yeah. That's right. Yeah. But without the medication. Could you like what would be happening? Would you just would you be ranting if you were manic? Would you be? If I mean, how does it present? And do you even know what's happening?

Emily 39:08
Sometimes I don't sometimes my partner actually will bring it up. He's like, I think you're I think you're mad right now. Or, you know, you're you're just depressed right now or something like that. Sometimes he notices before I do. But I'm sorry, what was the question? How do I feel when?

Scott Benner 39:30
Well, I'm interested in like, how it would present to me on the outside and if you even know what's happening, like I'm trying to, like me, I think most people don't understand this. They don't have perspective on it. And I would guess that in their mind's eye there you'd be ranting or raving or overly, you know, enthusiastic and shot out of a cannon and then suddenly depressed and quiet. Like is that how it goes or like What's the real life impact of it, not just what we

Emily 40:03
kind of, that's kind of how it is like, I'm really like, I'm doing a lot of things, I'm probably doing too many things and pushing myself too hard. I can't sit still and not sleeping, just really wired. And then in terms, and then I just kind of crash. Because it all becomes too much. And then it's almost like a burnout and I just get really down. And then I don't feel like I can pull myself to do anything. And then I get upset at myself for not being able to do anything. Because I mean, I don't like the anxiety. I prefer mania to depression, at least I get things done. And I'm a very type a person. So you know, I'm always afraid I'm not being productive

Scott Benner 41:00
enough. I say, does the anxiety feel different when you're depressed than when you're manic?

Emily 41:15
Probably a little I think it's more energizing when I'm, when I'm up and when I'm down, it's just

it's just kind of there, although maybe, maybe it's thought. I think the anxiety is there. But at the same time, I'm kind of like, very apathetic about things when I'm depressed. Okay, just don't really I start to not really care.

Scott Benner 41:44
The depression actually can hold down the anxiety a little bit. You care so little, you don't care that you're anxious? Yeah, I knew it was a good question. Because of how long it took you to answer. I was like, Oh, I asked a good question. So I was so proud of myself quietly in my own mind. But then I had to say it out loud. Because I mean, if nobody can hear it, what's the point? Emily? It's a podcast, right? So. But yeah, I just It occurred to me that I wondered if it was different. I mean, you might not even be able to, like, like in a in an in an OP by kind of manic situation. Does the does the mania kind of like, like squash the anxiety? Or is the anxiety just ramped up and faster?

Emily 42:26
It's just ramped up and faster. Okay.

Scott Benner 42:29
Wow. There seems to be there seems like there should be a moment here where I say, I'm so sorry, this is happening to you. Like, it just it seems, you know, exhausting. And I appreciate that. You're, you're taking the time to explain this to people. Because I imagine that that things like this, to some degree impact more people than we think. And it just doesn't get spoken about. It's also incredibly helpful to hear through the story that you're just a person. You don't I mean, like you. I don't know if that makes sense to you or not. But I think it's possible that people who have mental health issues get put into one silo in people's heads. And they're not even people anymore. You know what I mean? And that's just unfair, you're, this is no different than, you know, living with a broken leg for the rest of your life or something like that. Like there's, you are this person, you're a human being whose body is being impacted by something. And it doesn't make you any less of like, Emily, because you have a broken leg than if you are anxious or, or whatever else. So I just think it's great to share with people. I am yeah, I thank you. I'm super interested to know how with all of this going on, how did you grab ahold of your diabetes

Emily 43:51
um, after being hospitalized a few times because of not taking my insulin. I was put into a number of treatment centers, number of different hospitals. And I went through a bunch of them before one stuck. I always left AMA. So I never really pulled through with one I never thought they really understood the diabetes part of it. I really think it was it makes a huge difference. And I did after going to kidney failure. I went to a hospital, their behavioral and eating disorder Ward, I think and it was in it was an inpatient and it was a hospital. Saturday. So they also had, in addition to all the things that a normal Eating Disorder Center has like food, fishnets, therapists, they had an endocrinologist on board for me, as well, where the other places did not. And the endocrinologist just really helped me in terms of the diabetes, and yeah, that's what made me I think, really get hold of it. And it was still hard after that I was only there for a couple of weeks, because they only keep you an inpatient. Or maybe it was more than inpatient, because I've been an inpatient before, and that was actually a few months. But in terms of the hospital setting, it was only a few weeks, and then they released me.

Scott Benner 45:52
So you had somebody you had somebody there who understood diabetes, and could support that while you were going through the rest of it.

Emily 45:59
Yeah, that really focused on my insulin and like, showed me how I would do it and how to eat and how many carbs, and now that you have to count carbs, but but some of the things that the eating disorder places wanted to do, I just, I don't know, I just didn't think it went along with my diabetes. And when I had an endocrinologist there, it was more. The plan they came up with, it's more specified to me because I had this whole other issue as well.

Scott Benner 46:36
You know, you have competing problems, right? Because you have an eating disorder, which begs the idea that we don't want to focus too much on food, but then every time you eat, you have to super focus on food. And right, yeah, it seems just they fight with each other. So somebody was able to come up with a plan that sort of allowed both of those issues to work without them causing a problem. So you could count your carbs in a way that at least kept you close with your insulin without making you super focused on the food you're eating. Is that right?

Emily 47:11
Right. But they wanted to work with me about how I felt about the food, but also in terms about how to control my diabetes around that too, and how to feel. Okay with that, but I had to overcome like a lot of things to even want to do that. Because there were points where I didn't. I didn't want to so

Scott Benner 47:32
yeah, no, it sounds like, it sounds like a lot of moving pieces. And finally, they all sort of lined up with each other, I guess, in a way that allows you to, to meaningfully move forward. Is that fair? Yeah, yeah. No. So is it almost random luck that you that you found a spot that all this stuff kind of came together? Do you think?

Emily 47:57
Yeah, for sure. I mean, I don't. I don't know how I'm still here sometimes. But I mean, I obviously think there's always things that can be worked on. But in terms of everything, I think I'm much better where I am now than I was 10 years ago.

Scott Benner 48:16
This is the best version of you that's existed so far.

Emily 48:22
Um, in terms of my health, yeah.

Scott Benner 48:25
Yeah. Do you think there's a ceiling that you're not at yet? Do you? Do you still have room to grow on that?

Emily 48:32
I think everyone has room to grow. I don't think you're ever really done. So yeah.

Scott Benner 48:37
That's exciting. Do you feel excited about something like that? That idea?

Emily 48:45
No, actually, I, I think I have like a really pessimistic proofs. perspective of things because I actually didn't think of like that I kind of thought of it is like well, there's more room to grow. So I'm not I'm not there yet. So there's not I'm not doing as well as I should be.

Scott Benner 49:05
Oh, I see. So where I see it as this is exciting, because you can still build on this. You see that very same situation as way to go Emily, you're nowhere near the top. Is that Is that how it feels? Yeah, I'm sorry that you know, I didn't mean it that way.

Emily 49:22
Oh, I know you didn't. That was just

Scott Benner 49:26
your being listened. Thank you for saying that. Because that's, that's the parts of the conversation that I love the most. Yeah, just I guess that's just the difference between like the direction my brain goes in and the direction your brain goes in? Yeah. So how do you find this podcast?

Emily 49:46
How did I find your podcast? Yeah. I think I heard about its, I heard about it somewhere. And then I know I just looked it up. Have you started? started listening?

Scott Benner 50:05
What What made you want to listen to a podcast about diabetes, then?

Emily 50:10
I think I felt like really alone in this. And I think I think I might have started listening to your podcast around the time my father passed away. So I'm not that my my father and I didn't have a good relationship. But at the time, we had reconnected, and we're at least speaking with each other and trying to work on our relationship. But um, he was really the only person I knew with type one diabetes, and I guess we didn't really talk about it that much, because I really just, you know, I didn't care. I didn't want to talk about it. But, you know, we did have that in common. And in that respect, like, you know, after that there was no one to ask about anything anymore. Like,

Scott Benner 51:04
you lost your only connection to diabetes when your father passed away. Yeah, well, how did he pass by the way? A checker over this? I'm sorry. He was managing his own problems with that.

Emily 51:22
Yeah, he, he had. He had struggled with that for a long time, but I definitely think that yeah, I think he, I mean, he struggled with a lot of anxiety too. So I think he managed his own anxiety. With with that, and also I think he just had like, don't know, just just sad. Like, no, he had a sad life. So I think he was just medicating with that.

Scott Benner 51:58
Do you think? Did you experience anything in your life? That would be traumatic, prior to high school? Or do you think this is just baked into your DNA?

Emily 52:17
I don't think prior to high school, I had a lot of issues with trauma. I had a dysfunctional family. But like, I wouldn't say it was trauma. Yeah, not not in high school. It wasn't until, like, right after college, that I had, that, yeah, I started having some traumatic events in my life.

Scott Benner 52:43
I wonder about the anxiety if you if you grow up in a family that's just frenetic? And, you know, not I mean, there's a level of normal that a child needs, right. And, you know, if your father's you know, an addict, even just that, that's a, that's a lot. If he's anxious on top of that, or depressed on top of that, there's more and more, I wonder if that anxiety isn't your body's reaction to just expecting for the rug to be pulled out constantly. And then when the rug doesn't get pulled out, it can adjust backwards. Because you just maybe you just grew up in that space that you're and you're and you're more, you know, genetically predisposed to it to begin with, that you just can't adjust backwards for some reason. Like your, your body just won't like allow you to believe that. Nothing crazy is about to happen. I don't know if that makes any sense or not. Or if I, I could be 1,000,000% Wrong. But I just did something I wondered as you were talking. But But okay, so you I'm sorry. You found the podcast. And you sounds like you're listening to it for community did you find the management aspect of it? Almost by mistake. Like you weren't here to learn how to Bolus right you were here to find other people who had diabetes.

Emily 54:07
No, not not necessarily. I mean, I I like listening to other people's stories and kind of feeling, you know, like my sense of community that way, but I think also, that I was really kind of struggling with the diabetes and the diabetes also affected how I felt. So I was looking for a way to get better control and then also just just learning about the technology because I had no idea about Omni pod or I had had a CGM at one point but it was so inaccurate I never wanted to try it again. And just yeah, like let's Listening to you and how you manage Arden's diabetes and that that was even possible then I started really honing in on on things. Well,

Scott Benner 55:11
this is the part of the podcast where you told me what it is I'm doing so that I can know what I'm doing. I know that's a weird statement, but I I'm only putting out a thing that seems like the right thing to me. i It's not so well thought out. The you don't I mean, like, I'm not in the back room with a notebook going tomorrow, I'll say this. And that'll make people feel better. You know what I mean? Like, it's not that well thought out. And sometimes I need people to tell me what the podcast is to them. So that I can understand what it is I'm delivering, if that makes any sense. Yeah, I appreciate that. For you. I appreciate you telling me that. So that is something I've been wondering. You brought something up a second ago. I've been wondering about for like the last hour, which is did getting your blood sugar's more stable, impact your mental health positively or? No?

Emily 56:07
I don't know. I mean, I think I mean, I wasn't trying to kill myself anymore. But I think there was a lot I had to get over. And I think it brought some other

aspects of my personality that I didn't notice as much before out. Yeah,

Scott Benner 56:31
because you know, when somebody's blood sugar's high, or bounces around, you can see here, they can get kind of nasty, they can get short tempered, right? Like, yes, I'm nasty. I'm, I'm, I can be really nasty. Trust me. And so like, when when you get doing, your variability gets tighter, and you know, and you're not bouncing high and low as much those things should go away a little bit. I didn't know if the, excuse me, I didn't know Oh, hold on. The wrong time of year, I get so dry. I didn't know if the I didn't know if the mental side of it. The mental illness side of it was so impactful that you couldn't notice the changes from better blood sugars, but it sounds like you, you may have noticed them.

Emily 57:21
Yeah, and some, you know, some more positive and in some ways, I think some were negative, I think it definitely brought out more anxiety because then I was a little too concerned about the control. So when I went out of range, I got extremely upset. And yeah, just especially having the history that I did, like, part of it was like, if I ever go high again, I'm, you know, I'll kill myself because I've, you know, I can't get away with this anymore. Like,

Scott Benner 58:00
the idea of the diet, bulimia is such a, I was gonna say monkey wrench, but it's worse than that. But, you know, you, you need to pay closer attention to your blood sugars and how food works and how insulin works so that you can have this health success. But the the act of focusing on it is really one of the issues of having a eating disorder. And so but it sounds like you did it like so, just contextually five years ago, where do you think your agency was? Do you even know? Around 1515? And what do you think it is now?

Emily 58:38
Um, right now, I think it's probably around six to 6.5, which is a little higher than I've been running. But I think that honestly has to do with some issues around exercise that I just haven't figured out yet.

Scott Benner 58:59
Okay, well, first of all, good for you. That's amazing. I mean, kudos. You know, like, I mean, honestly, look back. Do you ever think You're welcome? Did you ever think you'd be a person with a six and a half? I wouldn't say,

Emily 59:13
oh, no, never. I mean, I cut it, you know, and, like, two thirds off my one save. So that's,

Scott Benner 59:21
you know, most people can't do that. If most people take two thirds off their agency. I think they're dead. There's no sugar in their blood. You're you had a lot of room to grow. And you really did. I mean, that's just wonderful. Did you have a chance to feel proud or accomplished?

Emily 59:41
Yeah, yeah, I do feel proud and accomplished. But I think I'm just more aware of it now. And sometimes I struggle with

Scott Benner 59:53
the being aware.

Emily 59:55
Yeah, just being aware that I'm diabetic and all the time. extra things I have to do. In order to kind of keep it in control, at least I find, you know, I know you seem to be very good at, you know, just keeping our hands blood sugar under control, I feel like I don't know, I find sometimes structure works a little better for, for me, it's hard for me to just go completely off off track and my number also get kind of crazy. Some things are just easier than others, though. Do you

Scott Benner 1:00:40
follow any sort of eating style that? Or do you eat kind of just a hodgepodge of everything? Or is any? Yeah,

Emily 1:00:50
no, at this point, especially with like, the eating disorder background, I really don't follow any type of diet and I just honestly, I just tried to stay away from that stuff completely. You know, I just tried to eat balanced meals, and you know, enjoy my food. And yeah, it's really about balanced meals. And I still sometimes struggle with the food, sometimes for different issues than necessarily eat eating disorder issues, but just just not being hungry or, or whatnot, or the anxiety, the anxiety, it's feeds a lot into my appetite. So I'm, I'm very aware of food and food around blood sugars. And when I when I do have a meal, like I make sure it's balanced that I don't say, you know, I'm not allowed to eat pasta or anything like that. But I do notice that certain things are easier on my blood sugars than others.

Scott Benner 1:02:04
Tell me about anxiety impacting eating. So do you eat more when you're anxious?

Emily 1:02:12
Do I eat less? Surely it depends. Because I'll swing. I've I've had a history of swinging both ways on this, but right now I feel like you No, I feel like the anxiety needs to be

Scott Benner 1:02:28
okay. So I have you danced around this about 45 minutes ago, but I'm going to ask the does weed help anxiety?

Emily 1:02:38
Not anymore.

Scott Benner 1:02:39
anymore. Emily's like there's not enough weed in New York to come. Did it at some point?

Emily 1:02:50
Yeah, at some point. I think it did. But I I think it became too consistent. And at that point, I was like self medicating. So

Scott Benner 1:03:02
okay, and then it. So it because I heard you earlier, stop yourself from telling me what drugs worked for you. Like what, like, recreational drugs worked for you. It was almost like you're like, Vicki, we're trying to be proper. I don't I didn't. I didn't know you well enough at that point to make the assertion, but I felt like you're like, Well, I don't want to say that to people. But it's just, I mean, it's been in my head the whole time wondering if you try it or not. So that's all it's just, it's funny if you had to if you took anxiety, depression, ready, anxiety, depression, type one diabetes, and I told you, you could throw one of them out of your life. Which one would you throw away?

Emily 1:03:50
I feel like also they go along with each other sometimes. But um maybe the diabetes because? Because I feel like if I throw away the diabetes, maybe some of the other issues with lessons.

Scott Benner 1:04:02
Yeah. fewer things to feel anxious about.

Emily 1:04:06
Yeah, gotcha. Things to feel anxious about.

Scott Benner 1:04:08
I've just been wondering the whole time we've been talking like if I magic if I gave you a magic wand by the way, what a crappy magic wand. It only works on one of three things. But But what you would what you'd want to get rid of? I have to tell you, I if you made me bet I would have bet anxiety. So that was interesting. I said diabetes. Yeah, I wish I could

Emily 1:04:30
say it was close to it's really debilitating. Sometimes. It's really crippling. And I don't

Scott Benner 1:04:37
I'm not asking you where you work, but what kind of work do you do?

Emily 1:04:42
I'm not currently working. But when I I moved, but I used to live in New York City. And when I was working there, I worked for a publishing company. I have a background in art. I'm more specifically in graphic design. But actually I think I'm, I applied to grad school because I think I want to go sort of a different direction with my degree. So

Scott Benner 1:05:12
I was wondering two things. So when you said New York, I didn't know if you meant the city or not. But I heard a siren earlier. So I thought maybe still, maybe you're in a barrow? I'm just guessing. Oh, no, no,

Emily 1:05:24
I was I used to live in Brooklyn and then moved to Upstate.

Scott Benner 1:05:31
But does six years or something? Okay. Does the city itself because the city's frenetic place? Oh, yeah, you step out on the sidewalk? And, you know, there are just countless people and machines and noises and and did that balance out your anxiety? Or did it add to it?

Emily 1:05:54
No, I actually think that bounced out my anxiety, or at least it helped me not notice it as much because that's just the way things were it was always go go go in the city. Yeah.

Scott Benner 1:06:04
Because if you're vibrating in New York is vibrating. Maybe you can't tell is what I was thinking. Yeah, so maybe quiet is worse for you? Because yes, it is. Okay. I'm figuring this out. I'm getting, I'm really getting Do you feel like I'm doing okay with this, by the way? Because I don't know anything about any of your problems. I'm just trying to pick through them.

Emily 1:06:26
Oh, yeah. No, I think you're doing great. I hope. I'm not rambling too much.

Scott Benner 1:06:32
You're not rambling at all. I would stop you if you're rambling. I'm not good with rambling. I would, I would definitely stop you don't worry, though, I'm having a really interesting, good time talking to you. Okay, so I was I asked that initial question, because I was wondering how difficult it was to hold a job with all this going on.

Emily 1:06:55
It became very difficult. And that's why when, at one point, I was taking so much medical leave, eventually, I just we came to the conclusion that I was just gonna leave on my own. Because honestly, honestly, if they would have been able to fire me, I think they would have fired me at that point. Because I just, I was taking so much time off, I really couldn't perform well. And, but but because of the diabetes, and because of the mental health issues, they really couldn't fire me for medical reasons. So I agreed to, to

Scott Benner 1:07:45
tell me this, if you put yourself in their position in the employers position, and we take out all the other stuff that considerations and protections that people have, just based on the work you were able to do because of your situation. Would you have fired you? Yeah, okay. That's what I was trying to figure out. Alright. So you were not a valuable part of the organization at that point?

Emily 1:08:04
Yeah, I don't think so. Not, not with the amount of time I was taken off.

Scott Benner 1:08:09
Yeah. Well, you can't do your job. If you're not at work, that's for sure. Well, that was very, it's very kind of you actually, to not sit there and fight with them and, and create another anxiety point for yourself. You know, it's I think it's kind for you in the business. And I think it was kind for you for yourself, not to put yourself in another, you know, embroiled moment of any kind. What's the so as a person who's been through this whole process, and as we said it pretty, I mean, you're, I think you're your best version of yourself, based on what I've heard, I don't want you to feel like you're like, oh, not Yeah, it's gone. But I think you're doing really well. Not to say there's not more but if somebody's listening to this, and they're at a different part of this, you know, where you were in the past? What's this? What's the secret? Like, how do you get out of this? Or as far as I don't,

Emily 1:09:11
I don't think I'm out of it. I think it's just constantly striving to be better. And some days it's harder than others maybe some days I take a step back but you know, realizing that even though I have the same anxiety pushing through it as is better than then laying in bed all day and not leaving my house and being scared of what's going to happen with blood sugar's or what's going to happen just outside in the world. It's it becomes crippling, so I think it's just Yeah, it's just continuing to work on that stuff. But I would say that it's like, it's a long process.

Scott Benner 1:10:10
Yeah. So is it if I characterized your life as being underwater, but figuring out how to come up above the water, and figuring out how to come up above the water for longer amounts of time? That's pretty much the goal, right? Like keeping your head up for as long as you can. Yeah, okay. And, and those periods of time are growing for you, where you're above the water.

Emily 1:10:37
Yeah, I think so cool.

Scott Benner 1:10:42
When you do something, like when you have this concern, that something's gonna go wrong, or it's gonna be bad, and then you do it, and it doesn't go wrong, and it's not bad. You don't? Do you gain anything from that? Like, does it propel you forward a little bit? Or you don't, I mean, like, I don't know how to put this. You know, if I opened my door and walk out of it, and I do it 1000 times, and nothing hurts me. At some point, my brain just says, walking through this door to safe. And I never concern myself with it. Again, if I was concerned at the beginning, but you don't get that right, you don't get the part where it just stops being a concern.

Emily 1:11:24
I don't think it stops being a concern. But I think I learned how to deal with it better. And I also recognize that when I do when I am able to do those things that I feel better about myself. Okay.

Scott Benner 1:11:41
Is there any aspect of life where this doesn't exist for you? Like, like, Are you like, I mean, I don't know, like, do like parachuting or driving your car really fast? Is there any place I could put you where just this all goes away? Anxiety, everything, like, is there? Where's your happy place? Do you have one?

Emily 1:12:06
I don't, I don't think I've figured it out yet. Honestly. I think there's been like, a lot of things in my life that have definitely really influenced me and changed me. So. I don't know. I think I think there's again, like still work to be done. And I have to find that.

Scott Benner 1:12:32
Well, I I wish you a lot of luck. I think it's amazing that you've come this far. I really appreciate that you came on the podcast and talked about it. I want to ask you if there's anything that we didn't talk about that we should have anything I missed?

Emily 1:12:49
Um I don't think so. I think it was, I think the overarching thing was just you know, that you can go through trauma and and be in bad places and you can still make it out. Okay. Yeah.

Scott Benner 1:13:17
Well, I think you definitely got that across. I that's what I got from listening to you. By perfectly honestly. I, I mean, seriously, like, there's I don't know, I just it there's, there's somehow there's a triumphant story here, even though you don't feel like you've reached any kind of real triumph. But I mean, I see it you started in such a place that, that I think where you are now is a is a significant upgrade for you. And like you said, I don't think there's an end to it, you can keep going. So who knows what's next? I think I, to me that this is an uplifting story. I'm sure you're just like, Oh, God, I just bored everybody to tears, or I just made everybody sad or whatever. But I don't I don't see it that way. I see this as is as explaining something that most people don't understand. And there are aspects of your life, even though they're magnified, that I think any person could listen to, and find commonality with their own life. You don't even get your stuffs just at 100. But everybody has this stuff. There's just maybe up at like nine or 10 on the volume. You don't I mean?

Emily 1:14:31
Yeah, maybe but when I try to put my own struggles in perspective, I mean, they're things far worse and I have plenty to be grateful for as well. So certainly try to remember. Remember that so I don't I don't know if I'm at 10 But I don't know. No, you don't

Scott Benner 1:14:50
I mean, like like, I think to some degree, everyone has anxiety about something. Yours is just like, you know if my anxiety is on a train Sister radio yours is on stage with the Rolling Stones in the 70s. And years has just turned way up. But I'm saying that I think anybody who's really listening, could hear about your life and find similarities in their own life. Maybe it's not to the degree or says that, but I still think they're there. And I think that's valuable because people aren't very introspective. Uh, you are obviously very introspective. Almost a little too introspective. Well, I would listen. Yes, probably. But I understand it. And whereas other people don't spend any time thinking about themselves, and they should, so hopefully they will after hearing. Yeah, thank you very much. I really appreciate it. Thank you. Was this hard to do? It was,

Emily 1:15:52
yeah, it was hard. Honestly. I think. I mean, I was really anxious but also I thought I was going to be like, way more emotional. I definitely thought I was gonna cry.

Scott Benner 1:16:02
Oh, do you want to cry? I could make you cry.

Emily 1:16:06
Cry. Cry in public.

Scott Benner 1:16:09
But no, no. Where are you at right now doing this are you at home? Yeah, yeah, I'm

Emily 1:16:18
at home. Okay. Yeah.

Scott Benner 1:16:18
No, I didn't want you to cry. I'm I'm glad you felt comfortable getting it out. I just, it's um, I don't know. It's it can't be an easy thing to sit there and mine your your soul for your stories, you know? But I thought you did a really good job. I appreciate it. Thank

Emily 1:16:35
you. That's cool. Yeah, it's not it's not easy for me to think about things in the past sometimes or recall things that I didn't go through.

Scott Benner 1:16:47
You certainly did. I thought you were terrific.

A huge thank you to one of today's sponsors, G voc glucagon, find out more about Chivo Capo pen at G Vogue glucagon.com Ford slash juicebox you spell that GVOKEGL You see ag o n.com. Forward slash juicebox. I also want to thank Emily for coming on the show and being so open and honest. And of course Dexcom makers of the Dexcom G six and the forthcoming Dexcom G seven head now to dexcom.com forward slash juicebox. Get yourself that CGM.

If you're looking for more after dark episodes, you can find a complete list at juicebox podcast.com. Thank you so much for listening. I'll be back very soon with another episode of The Juicebox Podcast.

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#831 Best of Juicebox: Bold With Insulin

Episode 11, Bold With Insulin was first published on April 14, 2015.

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

Scott Benner 0:00
Hello friends, and welcome to episode 831 of the Juicebox Podcast.

Welcome everyone to the best of the Juicebox Podcast. Today, we'll be highlighting episode 11 titled bold with insulin. And it originally appeared on the Juicebox Podcast on April 14 2015. I asked listeners via the private Facebook group, what their favorite episodes of the podcast were. And a number of people highlighted episode 11. Lauren said I think number 11 bold with insulin really sets the stage for the whole podcast and it's a must listen. Donna said episode 11 was the one that kicked me into gear about making decisions for my care and changing settings and amounts of insulin I needed. The episode will be presented exactly as it was originally, meaning there'll be music in it that you don't hear anymore. My microphones gonna sound different. You'll hear basil the dog snoring in the background, my chair used to Creek all kinds of fun stuff. Anyway, 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 you make any changes to your healthcare plan or become bold with insulin. And now you know where that came from. Or at least you'll know in a minute. If you have type one diabetes, or are the caregiver of someone with type one, please take a few moments to go to T one D exchange.org Ford slash juicebox. When you get there, join the registry, complete the survey. And when you do, you will have helped type one diabetes research to move forward. It's that simple. It's completely HIPAA compliant. And it's absolutely anonymous. T one D exchange.org. Forward slash juicebox. Though this episode doesn't have a sponsor, please remember that Omni pod Dexcom Contour Next One G voc hypo pan ag one from athletic greens. The T one D exchange, US Med and touched by type one are all terrific sponsors of the Juicebox Podcast. And if you need them or you're interested in learning more, there are links to them in the show notes of the audio player you're listening in right now. And at juicebox podcast.com. Okay, we're gonna get going I listened back to this one I thought maybe I'd be embarrassed but honestly, it holds up. Before we begin a brief disclaimer, the medical information on this podcast and on Oregon state.com is provided as an information resource only, and is not to be used or relied on for any diagnostic or treatment purposes. This information is not intended to be patient education and should not be used as a substitute for professional diagnosis and treatment. You can find the full version of this disclaimer by going to Oregon state.com or juicebox podcast.com scrolling to the bottom and clicking on disclaimer for those of you who have been listening to the podcast since it started, welcome back. And if you were a new listener, thank you for joining us. Let me introduce myself real quickly. My name is Scott Benner. I am the father of a little girl named Arden who has type one diabetes. Arden was diagnosed when she was two years old and is just about ready to turn 11 I write the diabetes parenting blog called Arden's Day, which you can find it on the state.com also on Facebook, Twitter, Instagram, what else? Pinterest, if it's social media, and it's Arden's day, I think it's probably me. Okay, welcome to episode 11 of the Juicebox Podcast. I appreciate you coming by. Today we are going to talk about insulin. So there's not going to be any guests on this episode. Although you may hear basil snoring in the background Basil is Arden's little eight month old puppy who she named after her Basal rate, and he is sound asleep and snoring away if you hear him. I apologize. Okay, so I want to talk about insulin because it's the main component to a lower agency and lower blood sugars in general and going to speak just from my personal experience. Again, nothing here is advice. And you certainly should talk to your doctor before trying anything that you may hear, hear, hear, hear, I hate when I say Hear hear that you may hear on the podcast. Okay. So let's go back to Arden being diagnosed. She's two years old. We're in the hospital. It's of course, incredibly stressful and frightening. And not something you were expecting certainly wasn't something we were expecting. Added Bad news, good news, bad news, good news back and forth all day long, right? Here's the bad news. Your child's just been diagnosed with an incurable autoimmune disease, their pancreas doesn't work anymore. It's no longer making insulin. But hey, here's the good news. There's man made insulin. So unlike prior to the finding of insulin, your child's not just going to die in a couple of days, you're going to be able to manage diabetes with insulin Well, yay, that's fantastic. Small pause from the doctor. Insulin, however, is very dangerous. And if you use too much of it, it could cause dizziness, seizure and even death. Well, what? Uh, okay, great. So let me get it straight, disease. incurable. pancreas doesn't make insulin, but don't worry here some insulin, but be really careful because the insulin could kill you. Okay, I'm clear. Everything's good. Let's go home. Now I've got it. That's pretty much how I felt right? You know, I'm sure a lot of you felt the same way as well. Here's this great medication. It's clearly a lifesaver, but used incorrectly. It's dangerous. But that's okay. They'll tell me what to do. There's probably instructions, right? Except that you know, the instructions that give you a very general and don't work day to day, let alone person to person, it's their guidelines to get you started. And it doesn't take you long to figure out that. Living with type one diabetes is probably just as much about kind of the vibe of it, as it is about the science. It's probably, I mean, honestly, it's probably three times as much. You know, the vibe is such a huge part of how I manage Ardens type one, just my feeling about like, I think our blood sugar is gonna go high here, I think it's gonna go low. You know, yesterday, in a similar situation, this happened. It's trying to calculate, you know, what, not just how many carbs, but what kind of carbs? How long are they going to stay in our system, you know, how much exercise that she got is that going to affect it, it's a little bit more about the magic than it is about the science and the numbers below when you first are diagnosed. Here's the numbers. If this happens, do this. Inject this much insulin, if this happens, if you get low, you want to take in this many carbs. Those those directions from your doctor are starting points. They're jumping in spots. I think the problem is that and very rightfully so you're told to err a little on the side of caution with the blood sugar right stay a little higher. So you don't experience a seizure or a low blood sugar incident. i It's insulting that they call them low blood sugar incidences I've seen two of them their seizures. But the idea right is, you know, stay a little hide or avoid that. Well, I know for me, you know, back then 2006, no glucose monitor technology, not even an insulin pump, just injecting insulin with syringes. I was probably airing more on the side of caution than I probably should have been. And the more you did it, excuse me, the more you let a high blood sugar be because it felt safe, the more normal it got. And you start thinking well, you know, what's wrong with 151 50? is fine. 150 is not fine. I mean, it is but it isn't a my blood sugar right now I don't have diabetes, my blood sugar right now is probably 96. Maybe it's 100. Who knows, maybe it's at the point is, is that there's a vast difference between 90 or 100 and 150 or 200, or wherever it is you're comfortable. So I'm actually going to click over to a website here for a second to talk about this next little bit. So at the moment, I'm on Accu check.com, which is ACC u dash, c h e k.com. I'll put a link in the show notes. But I'm here because they've got this little agency calculator. So what do we just say? What is my blood sugar? Probably right now, let's just say 100? Well, actually, I have to say 100. Because accurate checks. Because that key checks calculator only goes down to 100. So if your average blood sugar is 100 Your average a one C for a three month period should be about 5.1. But what if, like me, you were thinking, well, I'll just stay at 150 Because that seems safer. Well, now you're a one C goes from 5.1 to 6.85. You're almost in the sevens now, because you're erring on the side of caution. But you know, it's impossible to keep a blood sugar stable, you know, without vacillating up and down for very long. So what happens when your 150 becomes I don't know 170? Well, then the a one C

is obviously going to take a leap and you hear me click around on the web page. Now it's 7.55 I. So when I'm online, and I see people who have newer diagnose children, and they say, Well, I, you know, I put my kid to bed at 180, because I'm scared of what's going to happen overnight. And I've seen that that's a number that that people seem to like, right? It's high enough over where they think they're gonna have a problem. But under 200, just enough that it doesn't really kick your guilt in an average blood sugar of 180 is an average a one C of 7.89. So we've gone from 105.11 for your a one C, up to 180 7.89. That is a huge, huge difference. So you can see that cutting out just 10 points from a blood sugar, right seven, let's do 180 at 7.89. I'll change it to 170. And you'll see it's 7.55. Well, that's not bad. Well, that makes you think, well, if I could do 170, I could probably do 150, what's 150 6.85 Things are getting better. I think the problem is that you're you're told to err on the side of caution. And before you know what that becomes comfortable. And before you know it that comfort turns into a habit. And then it becomes difficult to break because of the fear that you feel. So I will tell you that I'm comfortable with art and sleeping overnight with a blood sugar of 80. I don't have a problem with AD. And I can't even on this website how you would add is because because the website will only go down to 100 I'm assuming for legal reasons. So let's just talk about Arden's last day one se Arden's last day one C was after Christmas. So end of 2014 It was 5.9 a different calculator on diabetes.org, which is the ADA website tells me that that I'm a one C percentage of 5.9 is an average blood sugar of 123. So you can see that even though overnight, I'm happy with 80. And trust me Arden will sleep overnight. Most nights at 90, you know down there, why are Dexcom alarm doesn't sound until she's under 80 You can still see that her average blood sugar is still 123. And why is that I sit and I think that's because I think when people think about blood sugars, and I know that we have a Dexcom CGM. And not everyone does. Not everyone has the benefit of that really great technology. But when you think about blood sugars, you think about this rolling graph line, you know, and if you have a great agency, I think people imagined that your graph must be very steady and very low constantly. And I just want to tell you that that's not the case. Arden's graph is not steady. Not nearly as steady as I'd like it to be. And it's not always low. But what I do is I take advantage of the overnight hours, because if she goes to bed and Arden's not a she doesn't go to bed early, she's going to be 11. But I think garden goes to bed between about 930 and 10 o'clock on a school night. And she gets up in the morning around seven. So let's say she goes to bed at 10 and wakes up at seven. So I'm going to just do some quick math here. That sounds to me like nine hours 678 It is it's nine hours I've, I've I've done the math in my head. So for nine hours, if I can keep Arden's blood sugar at, I don't know, we'll say 100 because the calculator says 100 That that's gives me some leeway for the rest of the day to not be able to get a Pre-Bolus on for lunch in time or to miscalculate some carbs at dinner, or to have some sort of a, you know, a hormone induced rise that that ends up taking up, you know, two hours of the day where your blood sugar is up at 150 and you can't do anything about it or it's a 200 and you're pouring on insulin trying to get it down. That's why it's an average. So when we average those 24 hours back together, I will tell you that Arden's are Arden's graph usually gets two blips a day where her blood sugar goes up and it takes us a little while to get it back down. But then we have nine hours at night where it's you know, most nights without you know, listen, growth hormones, things that go wrong could definitely be higher. But on the average every month, most nights at 90 100 I try to keep her down there. I know that sounds scary to some people. But that's a that's a fear that at some point you I think you have to get past because because you can't protect constantly for today and never think about tomorrow. You just can't do that. Because the long term effects and You know, this is something that we don't really talk about a lot because it's sad and uncomfortable. But we all know what the long term effects of, of type one diabetes can be if you have high blood sugars, and they are significant and life altering and life changing and life ending they can be. So you have to find yourself a balance, you have to find a number that that you think I can live with this, this won't make me neurotic, or I'll still be able to sleep. Now, you know if your insurance can cover it, the Dexcom share really does, really does change how overnights happen because now you're getting an alarm back in your room. If your blood sugars are going down or get below or above a certain level. It is a game changer I'm not going to put in otherwise. And prior to having a Dexcom CGM, I was not as bold with these blood sugar's as I am now. And you do have to be aggressive. But cautious. You have to be respectful without being afraid. And the technology helps a lot. So it's a good example of being aggressive. You know, I'll just use today at lunchtime Arden's blood sugar 101 Diagonal down a half an hour before we're going to Pre-Bolus for lunch. So there's a lot of stuff here to think about. But 1030 We Pre-Bolus for lunch when Arden's at school, but she doesn't actually start eating till about 1055. So if she's 100, diagonal down at 10 o'clock, it was fair to say that by 1030, she was going to be a little lower, and wasn't going to give me a lot of latitude to do a big Pre-Bolus Like I would like to do. So I had her eat, like 10 carbs of a piece of candy, just stick a piece of candy in her mouth while she was at school. And when 1030 came along Dexcom had her blood sugar at 85 and steady. Now I knew the sugar from the candy was in there and we were gonna get a bounce at some point. But it wasn't there yet. So I couldn't, you know, I made my calculations like it wasn't there. So I gave her her insulin for lunch 1030 And we didn't extend it Bolus gave her 50% of it right away at 1030 and told the pod the power on the pod give the other 50% as an extended Bolus over the next 30 minutes or so that basically she's getting a Pre-Bolus of half of the insulin and at 1055 when she goes and sits down with her food. The rest of the insulin is in not active yet probably but it's in and it's going not five minutes after 11 i i get a warning on my on my phone from her Dexcom share her blood sugar is hit her high her high watermark when we don't we try not to go above 160. And it's straight up. Now. Okay, that some of that insulin hasn't been in for very long, and the bolusing more right now is probably not what a doctor would tell you to do. It's not probably not what a doctor would tell you to do. It's definitely not what a doctor would tell you to do. They would tell you that insulin is not even live yet. It's hasn't even started working some of it you extended it don't do anything. Don't do anything would be the call the day. But at 169 Straight up which means her blood sugar's rising at two points per minute or greater. I texted Arden I said I want to increase your Basal by 95% for half an hour. And I want to Bolus a half a unit my half a unit is just my blanket. I don't like the way the arrows going up Bolus arrows going up when I don't think it should. Half a unit and y half unit half unit because you know a juice box is for art and 15 carbs about point eight five insulin maybe one unit of insulin. So let's let's Bolus the equivalent of a juice box because I think I'm right history is telling me that she shouldn't be going up this quickly after we've Bolus for lunch. But if she does if it is for you know just a blip and it's going to come back down. Then we'll cover it with a juice box so I don't want to give so much insulin that a juice box wouldn't fix things if your blood sugar went down quickly. But I want to give enough to stop that arrow I want to stop that up arrow I am aggressive about stopping up arrows and you know in the in the Oh what's this one's got Jim's

will be texting in a second if you hear that in the background but her blood sugar is now it's an hour and a half. Excuse me two hours since that Pre-Bolus and her blood sugar is 150 and I know that part probably sounds pretty good 152 hours after her lunchtime Bolus at school, but I really wish it was 130 right now. Now with Jim coming up, I'm going to admit to you probably not going to do much about it. I don't think I would Bolus while there was still active insulin on the way to gym. That doesn't sound not not in a 150 If her blood sugar was 200 Right now, I would absolutely Bolus but not at 150. So does that sound aggressive to you? Does it sound scary? It did to me at one point. And I'm sure it does to you. Now, again, the technology helps having a CGM will make it easier for you. Because you'll see a fall before it happens with any luck. And it's not not as scary. So the doctor tells you to err on the side of caution. It's good advice. But then it becomes comfortable and you probably live inside of those higher blood sugar's much longer than you could, you know, you have to change, you know, you need to be more aggressive. You know, the A one sees up because you're not using enough insulin or because you're erring on the side of caution too much. But you have to find, I think there's a big difference between when you're ready to make that decision. And when you're comfortable making that decision. And I don't know that you're ever going to be comfortable making the decision ready is, when in your mind you say to yourself, I I understand that my child's blood sugars are higher, because I'm not using enough insulin, I understand that the onesies are higher than I want them to be because I'm not using enough insulin. I don't think you're going to be comfortable using more. But I think I can give you a couple of tricks to you know, get yourself there. Because the comfort comes later. Obviously after you do it a number of times and nothing goes wrong, you become more comfortable, you be a little more bold and you're pushing you're pushing your push an overnight blood sugar of 80 I want to be really clear would have scared the crap out of me before a CGM, I never would have done that. But having the ability to see a blood sugar falling or rising is is a game changer. So once you're ready, once you understand that you need to be doing this do it incrementally, you know whatever that means if if you're seeing that a dinnertime Bolus is a certain number, just randomly put a number on it, let's say you're using four units of insulin at dinner, five, six doesn't matter, whatever it is.

And you're seeing high blood sugars. Two hours later, an hour and a half later, we'll just use another half a unit and something like that, and see what that does. You know, just try it. Keep an eye on it. You know if you don't have a CGM test, but but give it a shot. Because I bet what you would find is that after a couple of dinner times, maybe

that half a unit was good. Maybe it was maybe it was what we needed.

Maybe I'll try a little more, maybe you're on a pump, and you can go very incrementally point five at a time. And the next day you try point six over and you get a slightly better result again, and just keep trying to show yourself that it's not the end of the world, show yourself, it's not going to cause some great problem. It's not like your blood sugars are at 90 and you're trying to get them to 85. Those are those are tight tolerances. I'm talking about people who are happy to see a blood sugar of 202 hours after lunch, two hours after you know a meal. People who are looking at a 180 overnight and going hey, it was steady at 180. That's great. Well, what's the difference between study at 180? And study at 130? Go for study at 130. Right? What what are you going to do? I mean, what are you afraid you're afraid it's gonna fall? You're not gonna have time to figure it out. But I mean, everyone's different. But I don't think Arden starts to feel dizzy until she's under 70. So even if you went from 130 to 80, you know, in art and situation, if she goes from 130 to 80 overnight, I'm still in a good space for her. And that's 50 points, 50 points. And we did it before and let's do it again. 6.85 is your average a one see if your blood sugar's 150. If it's 100, it's 5.1. Now, some quick math for me. That's a 1.7 difference in a one see between 150 and 100. So 1.7 for for point for for 50 points, which means that if you can be comfortable at 130 instead of 180 You're That's how far your agency's gonna go down. 1.7 So think about that right now. If your child's a once he is eight, eight, would you be much happier if it was 6.7? What if it was nine would you be more happy if it was seven point And 750 points, we'll do that 50 points will take you down that far. Now that is to me, that's when it hit me. You know, when I started really understanding that I felt well, then I want to shoot for lower. Now, this next bit comes from having a Dexcom receiver, I noticed something. You set a high line and a low line, right? I don't want my blood sugar to go below this. I don't want to go over that. If it does, I want it to alarm. I think when I first got the receiver, it was 250 for the high. And the low was like 130. Like I was like, oh my god under 130. She's low. And one day I realized I do a pretty good job of keeping Arden's blood sugar between 130 and 250. I wonder how much is expectation? That was my question for myself. Except these lines up, these are my expectations for myself. And I'm able to meet these expectations. What if I close the tolerances on my expectations? So I did, I pushed the high number from 250 to 200. And I don't think you're going to need to guess what happened. I was still staying between the lines. Most of the time, I set a new expectation for myself. And I was staying with it. So I pushed it again, I said to myself 190 Just a little bit. What's 190? I could stay there. Well forget 130 is the low let's go to 120. So do you think I could keep her between 190 and 120? Turns out I could. It turns out if you stop and really think about it, the only difference between a blood sugar of 90 and a blood sugar of 190 in your mind is that if 190 starts falling, you have time to do something about it. If 90 starts falling, it's more of a panic situation. Do you want to send your child with a budget of 90 in a car with somebody who doesn't know anything about diabetes? No, you probably don't want to. But if you add education and the ability to speak communication, and Dexcom that you can see the blood sugar as it's happening in case it's beeping away and your kids back and they don't notice it, then all of a sudden 90 is not scary. 90 is completely reasonable. Oh, it's 90 Diagonal down. I'll text the parent, hey, you know what our blood sugar is falling? Can you have a drink half of a juice box? Can you ever take a glucose tablet? Can you do this, you know, whatever your adjustments going to be? It's going to be. So think about what I said there because it's a leap. The only difference between a blood sugar of 190 and 90 in your mind is patting it's time. It's the ability to react without a low. But after years go by, you won't need that much time to react anymore. If you're newly diagnosed, I completely 100% in my heart understand that a 90 blood sugar would could be scary for you. And that you might need that time to make better decisions. But trust me as time goes on, you'll get better and better at this, it's not going to get easier. But you'll get better and better at it. You won't need as much time, it won't seem like a panic situation when a 90 is going down. I don't feel like that anymore. I don't I mean, I don't I cannot remember the last time I panicked about a low blood sugar or even a falling blood sugar. Because I've got so much information right so much time in the simulator that I know what to do to make it stop. I take the information I had from what we've been doing that day, what food we've used, how much insulin we've got going. And I look at historically what it takes to stop but 90 Diagonal down, what it takes to stop is 72 hours down. And I just make that decision, almost without having to think about it and I get if you're not in that spot, you need to be a little higher. But if you just continue to close the tolerances on what you're willing to accept as a blood sugar, then I believe in least in my experience, if you can hit inside of those lines, then just squeeze the lines a little bit. And I bet you'll keep heading. I really I believe you will. Well one second, I have to pause. Before we get back to talking about insulin. I just wanted to let you know that there are a number of ways to listen to the Juicebox Podcast and any podcast. And I want to tell you what some of them are. You can listen through iTunes. That's a simple, easy way to do it. Apple has an app called podcasts that you can download for free from the App Store and you just search for the podcast and that and hit subscribe and you're listening there. You can use stitcher SAP or go to stitcher.com. I have The podcast is also posted on Stitcher. You can listen at Juicebox Podcast inside of each blog post for the episodes is an inline player where you can listen right there. And I'm posting the episodes in Facebook luck with an online player that you don't even have to leave Facebook to listen. So between your web browser and podcast apps, of which there are many, if you have a favorite podcast app, just search us up. There are limitless ways almost to listen to podcasts like the Juicebox Podcast. If you're enjoying the show, I implore you please go to iTunes and leave a review or a rating. It really does help the program be found in searches. Okay, let's get back to talking about insulin, shall we? Talking about this today, because a lot of people on the blog asked me after I write about different things about a one C's and things like that I always hear about like, you know, I always talk about being bold with insulin and being being bold in general with diabetes, and I get a lot of emails, correspondence privately back from people who say things like, you know, I took your advice about being more aggressive, my son's a one C fell, you know, I'm being bolder, it's hard, it's scary, but I'm doing it, I want to thank you. And these are some of the most heartwarming notes that I've received, when I stop and think about when I stop and think about kids who are walking around with in range blood sugars that aren't causing them to feel foggy, because their blood sugar is not high. And I think about their a onesies being more aware they want them in that, what that means for them health wise, and what that means for their parents. Stress wise, I mean, this all, it's just, it's just information that that you want for there to be in the world for people like you to hear. It's more difficult to write about these things, because you feel like everything in writing sort of seems very official. And I don't want people to think that I'm saying do this, and do this and do this and everything will be fine, because that's certainly not true. Your diabetes will absolutely vary from person to person. And it is something that takes time for you to kind of figure out the flow of, you know, to get the vibe of your child's diabetes and, and the things that affect it and don't affect it. But I really felt like the podcast was a place to talk about this, because you can hear my voice when I'm telling you like, look, this isn't advice. This is just what I do. This is how I feel about it. And I believe that if you could try to feel a little bit about this too, in a similar way that you might have some similar luck with with with a little bit of luck. But what pushed me over the edge of the podcast, besides the emails was Arden's last day one see 5.9 right around Christmas time. And we go in and the our nurse practitioner comes in the room with the with a test result. And she says My God, you you decreased not a lot. I think we went from six to to 5.9. But any decrease is amazing. And she says

I can't tell you how many people at the holiday time a year. I tell them oh, it only went up a point. It's okay. You did good. She's like you don't see decreases at the holidays because of all the extra meals and food. How did you do that? And I thought about it for a second because I didn't do anything differently than I did the quarter before. All I did was act aggressively, not wildly and appropriately, but aggressively. Arrow up I want to stop that arrow high blood sugar, I want to get it back down as soon as possible. I would much rather get a blood sugar down quickly than to watch it exist for three hours and bring it down slowly. I mean, the less time with the high blood sugar in my opinion, the better. So that's how we got 5.9 We were just bold we were aggressive we weren't scared. And when the times came where we did use a little too much insulin we combative the insulin with you know something that worked quickly for Arden juice a lot of the time just to kind of go over everything. One last time. Aggressive but cautious. Respectful but not afraid. Definitely have to lean on the technology. I genuinely don't know how to give you advice about doing this without a Dexcom CGM. I feel like it would be impossible for me to do. overnights find a way to be comfortable with a steady lower than what you're used to now because there's so much a one see that can get cut out. Like we talked about earlier difference between 180 and 130 is huge. Difference between 130 and 80. Same difference. Stop and think about that for a minute at some point Arden's blood sugar overnight was 180 and now I'm comfortable with it at 80. It's obviously not always one ad, obviously isn't always ad. But those are our goals, right? There's what we're shooting for 100 points 100 point difference. And that's the story of how Ardens eight, one si went from nine to eight to seven to 5.9. And don't get me wrong, not just insulin. There were a couple of meals that things we cut out of eating. Arden used to eat cereal for breakfast, she doesn't eat anymore. Here's a great blog about Froot Loops on on origins de.com Where Arlen came out of an endo appointment and just asked me one day, how can I get my agency to come down, and I said, you could probably stop eating cereal in the morning that would help and we got a big reduction out of that. So it's not just insulin and being aggressive. There's basil up from his nap. It's not it's not just insulin, and being aggressive is also diet and exercise and a lot of other things. But But anyway, while my my nurse practitioner I talked like she's my nurse practitioner, while Ardens nurse practitioners asking me how do we get a reduction at the holidays. And I explained to her, she paused and she looked so serious and thoughtful and sad all at the same time. And she said, getting people to not be afraid of insulin is probably the hardest thing I do. So then I decided to make a podcast about it. And it looks like we're going to take a little break here while basil finishes barking. And I'm going to come back in a second and just talk about Apple Watch for a second. And a couple little news things. I'm gonna let you out of here and get back to your life. Okay, I'm back and basil is calm again. You know, I just thought this would be interesting, because I recorded this. You know, basically while Arden was at lunch at school, and you remember earlier in the episode, I told you we Pre-Bolus at 1030 in the morning, and at 11 She was 160 something straight up and I actually gave her more insulin than it is now. 110 my larger dog is now moving around. It's now 110 Her blood sugar, I'm looking at my follow up for her Dexcom share to her blood sugar is 97 Diagonal down. And I expect that to level off in the next few minutes. You know, hopefully by the time she's 85. That's That's my goal. But just so you can really see it in real time. You know, she was what I say 100 And something 203 Or so diagonal down at 10. We took in some carbs. By the time it was ready to Pre-Bolus at 1030. She was 85 and steady. I figured that the sugar from the candy hadn't kicked in yet. I did a extended Bolus 50% of the insulin at 1030. The other 50% went in over a half an hour at 11 o'clock she was eating her blood sugar was 160 something straight up, I gave another half of a unit just a blind half of a unit. And now you know 1130 12 almost three hours since the beginning of the extended Bolus, she's at 97 Diagonal down. And I do believe that I that diagonal down will level out. And if it doesn't, then we'll just take a few carbs in here. And her blood sugar will probably stay around 110 For the rest of the school day for the two hours before she comes home. So it's a good look at what aggressive means, you know, the difference between the 97 after lunch and what probably without that extra half of unit would have been more like 150 And you know, we've talked about that 50 points is 50 points is a lot. Okay, so hey, I hope you enjoyed talking about insulin. We can do it again in the future if you'd like to send me an email or hop on the blog and let me know what you thought if you want to talk more about it or about different topics. I'd love to know your thoughts. We are we me it's on by myself. It's a blog I wrote by myself and I said we I have two more interviews coming up for for some upcoming shows. I'm going to be talking to a mom from Canada, whose child lives with type one diabetes and celiac disease. And I'm going to be talking to Karen who runs diabetes blog week about diabetes blog week. So that's that's coming up. I ordered an Apple Watch. Yay. Yay. There it is. It was expensive. Here's what happened. I'm up with a high blood sugar at night. High I think she was like 180 and I couldn't get it to move is one of those like I felt like I could have poured the insulin over Arden's head, her blood sugar wouldn't have gone down. So I'm struggling with this one at trying to get it down. And I'm running out of ways to keep myself amused. I end up on Twitter. And I see on Twitter and there's not a lot of people tweeting by the way at 330 in the morning, but I see on Twitter, that there's some macroom or websites are saying that the Apple Watches are about the stock's about to run out they're gonna push the ship date and I feel like get out of here like I did not expect that. So I went on Apple's website threw my iPad through my like Apple Store app, which works too well, because you can pay by putting your thumbprint on the, on the home button. And I had never really looked at the watches and thought, Oh, I wonder which one I would buy. But there I am laying in bed trying to stay awake 333 40 In the morning, and I'm swiping through watches. And I see one that I think, Hmm, that one looks attractive, I think I would actually wear that watch. And then I go back to Twitter. And they're talking about some watches aren't shipping till June now, you know, it's April 24. With the ship they then they were saying four to six weeks after that. Now all of a sudden, they were saying June and I thought I'm just gonna buy one because if, if I don't want it, like I'll just sell it like I'll probably be able to sell it on eBay and make money. So it didn't scare me a lot to buy it. Anyway, I picked one that I liked. And I stuck my thumbprint on the on the home button and just like that, I'm going to be getting one. They say four to six weeks, I think I'm supposed to get around May 13. So I will be back in the end by the end of May. Talking about Dexcom share to an Apple Watch and how they integrate together. And so I just thought that might be something you might be interested in. My phone is ringing Hello.

Unknown Speaker 41:22
Hello. Hello. Hi, good afternoon. My name is Robert calling you from Green Energy Solar. Am I speaking with the homeowner?

Scott Benner 41:30
You are Robert but I do not have any interest in solar energy for my house. But thank you for calling. And could you while I've got you put me on your do not call us please. That sounds like a no he just hung up. Sorry about that. I'm not against solar energy. I just don't think it's a perfected thing yet. And I'm really scared about putting like panels over the roof of my house because I feel like what happens when like the roof underneath gets weaker. Anyway, I have too many questions about I like the idea of solar. I don't like the idea of putting panels on my house. I don't feel like I have to explain this to you. Okay, so I'm going to be talking about Apple Watch and integration with Dexcom share to probably by the end of May. Hopefully I'll get a little sooner and I can do it sooner. But I have to admit it does look looks pretty tasty. So we'll say You know, I want to mention too that. This past weekend, Arden had a softball tournament, she played three softball games in one day. She got up in the morning at 6am. We drove to the field, she had to be there at 745 It was an hour away. They practiced and worked out until 845. When the first game started, she played a game at 845 then they wouldn't play at the playground. Then we went to lunch. Then we came back they played another game around noon 1230. Then they played another game at five o'clock. And then we didn't get home until eight that night. I think we were out of the house for almost 13 hours. And I can't say enough and I am not being paid to say this but that Dexcom share too. I don't think Arden and I spoke face to face about her diabetes more than about three times the entire day. And honestly one of those times was me throwing a juice box into the dugout and saying to her drink half of it. I saw her rip the straw off. She punched it in, drank half of it. She stuck the other half underneath of the bench. And she went right back out on the field again, I think that was for a blood sugar that looked very steady at 90, which I knew wasn't going to last in the middle of all that exercise. But she had a lot of adrenaline going early on so I wasn't quite sure what to do. And by the time you know she went she went right back out on the field. She was fine. She never got below 75 Ooh, I just watched Arden's blood sugar 91 and steady say 91 in study two hours and 45 minutes after the first Pre-Bolus Two hours and 15 minutes since the point five extra unit we gave her when she was 160 Straight up at lunch. I'm sorry, I'm jumping around but I know if you're listening you're following so Dexcom chair to made the softball tournament. A delight. I really want to say that diabetes was not almost any consideration for us during the day she even when we were at a restaurant at lunchtime. Arden had a season she's a real she's not a she's not strictly a vegetarian, but aren't it's a lot of vegetables. But she also eats a lot of other stuff. So at lunch, she had a Caesar salad. And when she was done she's like, can I the churros with the chocolate sauce? And I was like yeah, sure. When I was thinking like God, no, please don't do that. But she did. And so excuse me we Bolus a completely made up number that I just pulled out of my butt. And I thought I'll be a little heavy handed here and we'll watch She with the CGM. I ended up giving her a little too much insulin and she I think she drank a half a juice box before the second game started. But she had churros at lunch. So, like I said, it was a great day. And diabetes was hardly a part of it. It was in huge thanks to Dexcom Dexcom share to RT and I you know, I never had to walk up to her when she was with her friends and ask you about our blood sugar. I was looking on my phone, saying, you know, by the time we were talking about this next week, I guess I'll be looking on my watch. Really just a game changer. I don't want to call it a lifesaver, although at night I think it is but a real game changer. Okay, so Apple Watch. That sounds pretty cool. We're gonna be talking about diabetes blog week coming up on the on the podcast pretty soon. And speaking to a mom, like I said, Child has celiac and type one, I don't have any frame of reference for celiac disease. So I think that's going to be really interesting to learn about, from somebody who's living through it. You know what, let's make it a short one today. Juicebox Podcast is something that I'm really enjoying doing. And I hope that you are enjoying listening to it. I have every intention of continuing on. I think it is a great standalone piece. And I think it's a wonderful addition to Arden state.com. So, you know, check out my type one diabetes parenting blog, Arden state.com Please leave a review for the Juicebox Podcast on iTunes. And subscribe subscribing might be more important than reviewing. But if you can do both huge. You know what the music for the Juicebox Podcast is written and performed by Sydney Mueller. And I love saying that because Sydney is she is the greatest and I can't believe she was able to write such great music for my for my new podcast. That's it except go to the blog and Arden state.com and check out the tutorial for how to use the podcast if you don't really know how to do it, although you're listening to it now. So that doesn't make a whole ton of sense. Basically, you want to bark again. Anybody? Dogs? sure now that I'm done, everybody's quiet

thank you so much for listening to best of juicebox with me today. If you have a suggestion for Best of go to the blog, and send me an email. I know I just said the blog URL is Arden's de.com. It used to be and still if you type it in the browser, it'll forward you to the website, but the website is at juicebox podcast.com. So if you have a suggestion for Best of go over there, generate an email and send it to me. I'd love to hear what you think. And if you want to include a couple of thoughts about why the episode you're suggesting, should be on Best of include that in the email as well. If you're wondering, Where's this Facebook page that everybody got to do this on? Well, that's Juicebox Podcast type one diabetes on Facebook, over 33,000 members, everyone in there is talking about insulin and diabetes and you would just love it Juicebox Podcast type one diabetes on Facebook

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#830 Defining Diabetes: MDI

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

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.

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

Scott Benner 0:00
Hello friends, and welcome to episode 830 of the Juicebox Podcast.

In this episode of defining diabetes, Jenny Smith and I are going to define m D i multiple daily injections. While you're listening, please remember that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, always consult a physician before making any changes to your healthcare plan or becoming bold with insulin. If you're enjoying Jenny, 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 juice box 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 an unprecedented amount of time before the music stops. Let me just tell you, thank you for listening to the show. And if you're really enjoying it, leave a beautiful five star review and a rating wherever you listen. Great reviews, help other people to find the show. So I'm going to say something really crazy here. Because every time this is so embarrassing. Every time I must have tricked myself out of it. Every time I talk about defining diabetes, what do I say to you? I'm like, I tell a story about the person who said I didn't know that I was MDI until I listened to the show. Well, that experience must have tricked my brain into believing this is so embarrassing that we had done a defining diabetes episode on MDI, which in 46 episodes of it, we have never done do. It's so embarrassing.

Unknown Speaker 2:11
I feel bad that

Scott Benner 2:15
terrible. And so I really think that I just assumed we did because of that one note, until I started listening to your podcast. I didn't know I was doing MDI. And then I've been using it for years is an example of why the defining diabetes series is so important. And yet there's no MDI episode of the defining diabetes. I'm

Jennifer Smith, CDE 2:33
curious where we did define it, then since we clearly since this person was finally like, well, I get what that means now. So we must have defined it within something else.

Scott Benner 2:43
There's an all about MDI episode and protests which people yell at me because they say it's mostly about pumping. But, but I gotta tell you, describing MDI only takes about three seconds. So it's even the management of it, there's not a lot of detail to give to somebody, you know, that really,

Jennifer Smith, CDE 2:59
although I think in terms of detail, I mean, MDI, multiple daily injections, right? Multiple, take it as you will, multiple multiple could be just exactly the way that your doctor said to take it with, you know, each meal, you take your rapid acting insulin, and then you take your Basal insulin one time a day, a defined time of the day, multiple could really be multiple multiple, it could be that you're really on top of it, you don't want a pump, and so you you, I don't want to say micromanage in terms of like a bad connotation to that. But like you micromanage you dose a little bit, you dose a little more. And that's how you learn to manage things. And it works for you. Yeah, so it could be many multiple injections.

Scott Benner 3:46
I would not call it micromanaging. I would say that in the past, there was an expectation for health and outcomes. And if you did more work than that, doctors would have the inclination to tell you that you're micromanaging. And don't worry, it's never gonna get better than this. But that's a different world than this is right now. Correct? I'll tell you. I'll tell you how little MDI has been defined by anybody. Googling MDI meaning gets you with minority depository Institute's, which is an FDIC phrase in the urban dictionary, it says, oh, excuse me, there's another one that says medically determined impairment, multiple Document Interface, metered dose inhaler. You don't get i on the first find it on the first return page of of Google, there's no no mention of it. I have to add the word diabetes.

Jennifer Smith, CDE 4:45
I was gonna say either diabetes or maybe insulin like MDI insulin, I bet it would come up

Scott Benner 4:50
quick. So NIH, has MDI is multiple daily doses of insulin. They're putting in an extra D but not giving it to You double D but single day? That happens to a lot of ladies, doesn't it? Nobody ever knows their bra size really? Right? Don't you always hear women saying I'm never wearing the right bra size? Well,

Jennifer Smith, CDE 5:11
unless you really get like fitted or if you really look at how you're supposed to actually measure to determine what your cup size truly is, then yeah, I mean, that's the reason that many times when you go in, I mean just giving a brand to Victoria's Secret, they will often ask if you've ever been accurately measured for the right size,

Scott Benner 5:36
Jennifer make this the most popular episode I've ever put up until right now. Well, and this is interesting, still, it's limited. And I ah, multiple daily doses of insulin, which is not it's multiple, it's multiple daily injections is how we're talking about it. Most common method for intensive insulin treatment of type one diabetes is also becoming more popular type twos. That's from the NIH from 2017. The next return is from Medtronic. It's interesting, really, yeah, it's really interesting. I guess this is really something that just

Jennifer Smith, CDE 6:15
I wonder if Medtronic has it in there, mainly because, I mean, they're one of the oldest pump

Scott Benner 6:22
companies. I'm gonna look. Yeah, maybe it's just buried on their website somewhere. And it's

Jennifer Smith, CDE 6:27
on their website somewhere in terms of, if you're planning to go for multiple daily injections to a pump, consider the Medtronic pump. No.

Scott Benner 6:36
I'm sure I'll get to that. Again, there's alternatives on the page. But it's iport. It takes oh, by the way, I want to say that in Penn was the sponsor last year and I love them but Medtronic didn't re up with me for in pen so. Oh, yeah. What the hell that's

Jennifer Smith, CDE 6:53
too bad because he pen is a great idea to include in the MDI definition, and I

Scott Benner 6:59
will talk more about it, but somebody, you know, I was ghosted. Oh, so sorry. It wasn't ghosted. They broke up to me to my face.

Jennifer Smith, CDE 7:08
They broke up. They said no, bye. Bye. I'm so sorry. I

Scott Benner 7:11
missed that. I miss Ashley. But anyway, that's just something that only I understand. Okay. So, you know, again, this is them. This is a sales page. They're trying to tell you this is MDI, if you're using it, you might want to try, you know, I port Yeah, the eye port. But I'll tell you a little bit of scrolling says, Hey, there's alternatives MDI, so is this guy, Jenny, is this a money thing? Is this we'd rather you'd be buying a pump and those needles, so we're not going to tell you too much about it. Or, I mean, because it's dark, like the Google returns are stark, not that I can't explain to people what MDI stands for, but

Jennifer Smith, CDE 7:49
it's just in my eye, I would say that there are probably many more people, definitely doing MDI, in the type two realm, then pumps, and because they make up the larger percent of the population of people with diabetes, there still are many more people using injections or MDI. But in, I don't know, is it a money thing? I have no idea. I mean, they have products like in pen, they have products like the eye port, but they don't get a lot of visual. Well, I'm gonna do it all.

Scott Benner 8:29
I'm gonna Google the the actual phrase in a second. But I just want to tell you that, you know, it says, there's other things that people search for that are similar to what yours and I found this so sad. It's got nothing to do with this, but it just says, how much insulin do I need for 300? Blood sugar? It breaks my heart that that's been Googled enough that that's a return just when the word diabetes is Googled. Wow, yeah, that sucks. Okay. Hold on a second, multiple. Daily. Okay, now, maybe this is it. diabetes, UK, well, Medtronic, Medtronic, ensete. I'll be damned. I guess we're gonna have a pretty popular webpage at some point because nobody talks about it. Okay, multiple daily injections. It's like if somebody says, How do you get your insulin? You say I use an insulin pump. How do you get your insulin? I use needles. I do multiple daily injections. So it's, um, is it a viable way, Jenny to live your whole life?

Jennifer Smith, CDE 9:32
Absolutely. Yes. Yeah, absolutely. I think what is missing within it? Is information about how to do that. Well. Because there is in multiple daily injections, there is a lack of precision. Comparative if we're comparing it to a pump, there's a little less precise dosing that you can get, however, can you make it work and have fun Great blood sugars. You can Yeah, absolutely. It's viable. In fact, for for many people that can learn how to use that strategy. Well, you know, you could have really lovely, good control long term, no complications, either just because you're using something that's like, old school or so to speak.

Scott Benner 10:23
Yeah, I genuinely believe the same. And I've said in the past over and over again, that if you're willing to inject a little more, you can do any of the things that we talked about in the podcast with MDR. Absolutely. Yeah. I also think, if I'm being honest, adding a CGM to MDI would would really up your game, you know,

Jennifer Smith, CDE 10:44
absolutely. I think most people, if asked, I'm just assuming here, but it's my, my consideration. Somebody was going to take something technology away from me, I would hand them my pump, I would fiercely hold on to keep she'd be like, Don't

Scott Benner 11:05
I need this, please? I don't know what's happening. You know, I think that I think that if you think about the past, and if I even consider how I was taught to take care of Ardens diabetes, which is test your blood sugar, when she wakes up, give her a correction, if she needs it, test her blood sugar before she eats, use this formula, and don't test her again for three hours. And, you know, I remember back to thinking like, even if like she was like, 153 hours later, like I did it, you know, but Right. But once I got to CGM, I was like, Oh, my God, she went to 300. And then came back to 150. And yay for the 150. But oh, look at that. So I just want to finish by saying that, I think you can manage incredibly well with MDI, but not if you're going to use old school theories and ignore what's happening in between your insulin doses, then, you know, when it's over, and you go, I have a seven a one C, that's not bad. But if your blood sugar was 304 hours in between every one of your meals, then I mean, I know we don't like to use words like this, but that is bad. So you know, you need the right and it's

Jennifer Smith, CDE 12:13
bad. I think, also from a purse from a standpoint, then for that person to think I'm, I'm averaging this number, which is a quality number compared to maybe where somebody was before. But once they have the information, and they see that they're at this number that they've been told is an improvement. But they have this variability that we don't want in the picture, despite an average looking like it's good. I think that information is important to have, and you can only get it with a CGM.

Scott Benner 12:45
Yeah, I agree. All right. I'm also going to wonder for the rest of the day, what the people at Medtronic there who are handling their search engine optimization understands about MDI that I don't understand because it seems very important to them, that when you google NDI, you end up on their website. Interesting. I'm gonna think about that for a while, Jenny, thank you very much for doing this. I appreciate it.

Well, I'd like to thank everyone for listening today. And of course, Thanks, Jenny Smith for being on the show. You can hire Jenny at integrated diabetes.com. That's pretty much it to short episode. And I just wanted to pop back in and say thank you. And Dima putting the ads on this one today. Just talked about some stuff for the podcast or earlier. So please, if you you want to check out other series in the podcast. Go back to the beginning. Go over a number of them for you. Hmm, that's it short and sweet, huh. Thank you so much for listening. I'll be back very soon with another episode of The Juicebox Podcast.

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