Scott Benner 3/6/23 Scott Benner 3/6/23

#862 Perry Como

Kim has type 1 diabetes and was diagnosed as an adult.

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

+ Click for EPISODE TRANSCRIPT

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

Scott Benner 0:00
Hello friends, welcome to episode 862 of the Juicebox Podcast.

Today's guest is Kim or Kimberly, you decided what you want to call her. She is a type one diagnosed as an adult. She's a nurse, and she had a slow onset. These are the things you need to know. None of them will tell you why the episode is called what it is, but me me we'll get to it. While you're listening, please remember that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, always consult a physician before making any changes to your health care plan or becoming bold with insulin. Consider this if you would, if you are a person who has type one diabetes, or is the caregiver of someone with type one as a US resident, consider going to T one D exchange.org. Forward slash juicebox. Join the registry. complete the survey. When you complete the survey. Your answers help type one diabetes research. And that great super simple takes like 10 minutes completely HIPAA compliant, absolutely anonymous. And it's easy. T one D exchange.org. Forward slash juicebox. This show is sponsored today by the glucagon that my daughter carries. G voc hypo Penn. Find out more at G voc glucagon.com. Forward slash juicebox. today's podcast is also sponsored by ag one from athletic greens. Visit athletic greens.com forward slash juice box. When you get there, you'll be taking ownership of your health and choosing to start your day the same way I do with one delicious scoop of ag one from athletic greens. Athletic greens.com forward slash juice box. I'm gonna start the recording if your heart's racing, tell me what's going on now.

Kim 2:10
I don't know my heart's racing a little bit. I'm a little nervous.

Scott Benner 2:17
Let's talk through that, shall we? Sure. Are you up for it? What What? What you're like, No, I might not be up for it. But let's do it anyway. So

Kim 2:27
um, I don't know. I've just like listened to you, like so much the last couple months that like, I've had, like a conversation with you in my head so many times. And now I'm like, Oh my gosh, what if it doesn't come out? Right. So,

Scott Benner 2:41
okay, wait. So a conversation in your mind, like walking through this moment? Or just other?

Kim 2:49
A little bit like sometimes, like when I'm listening to you talk to other people. I like kind of thought about, like how our conversation would go.

Scott Benner 2:58
Okay. Let's start with that. Okay. Okay, we'll introduce you in a few minutes. I don't want to lose the thread here. Plus, you know, your name will be in the show notes and stuff like that people will understand. Okay, well, what do you think's going to happen?

Kim 3:17
Um, I don't know. I guess I'm just gonna tell my story. But I mean, I've heard you talk so many times that I know it's just gonna be like a conversation, but I don't know.

Scott Benner 3:29
You have no, you have no expectations of where it's gonna go. Are you? Are there things you're concerned about?

Kim 3:36
No, not at all. But I guess I have like the idea of my story in my head and I just hope it comes off, right. I don't know.

Scott Benner 3:45
All right. Are you from the Midwest? I am. I heard it when you said North Pole.

Kim 3:52
I'm from like, the suburbs of Chicago.

Scott Benner 3:54
Yeah, I was gonna say, Chicago. Ish. With my guests. I didn't want to be too specific. But that's alright. Well, okay. Let's go slow. How old are you?

Kim 4:06
I'm 31.

Scott Benner 4:07
Okay, are you married? I am newly married. Congratulations.

Kim 4:13
Thank you. Well, actually, oh my gosh, it's gonna be here next month. So I guess not that I mean, it's still nearly but yeah,

Scott Benner 4:20
stop playing that card. I just got married still time. There's still some lemon coasters on my registry. Nobody bought me. I love the lemons. Anybody. Longtime sweetheart met them on Tinder met her on Tinder. What do we got? Oh, yeah. Hi,

Kim 4:39
high school sweetheart. We've been together for 15 since 2007.

Scott Benner 4:46
Okay, hold on. It's 2022. Yeah.

Kim 4:52
We were together a long time

Scott Benner 4:53
you were together. That's a very long time. So if I subtract seven from 22 That's hard to do. because you have to carry on one. So I'm going to subtract 10 instead. And get me down to 2012. And then Riyadh set three. Does that verse? I don't Yeah, right. Yeah. So 2015 You got together?

Kim 5:13
No 22,000 sevens

Scott Benner 5:17
went the wrong way. It's okay. Nevermind 15 years. And you got married today. Now what happens? Is it camera Kimberly?

Kim 5:26
How do you like it? Um, either ones Fine.

Scott Benner 5:29
Listen, what are you doing to me?

Kim 5:33
I go by both. That's actually a funny part. My family only calls me Kimberly. But then most of my like friends and co workers call me Kim.

Scott Benner 5:41
Can I call you him? Yeah, that works. Great. All right, Kim. Where you hold now for somebody better? Why did you wait so long?

Kim 5:50
I'm mostly on him. But I mean, we were young. So I mean, that adds to the time. And then we went to college, he went to law school. And then he didn't propose until after law school. And like he went, you know, we went to just do everything on our own. So like, he wanted to buy the ring on his own. And so it just took them some time. But I mean, we were, we just had a good relationship the whole time. So it really didn't seem to matter too much. But then we had a COVID wedding. So we ended up postponed a year. So that added a year and to

Scott Benner 6:25
finally pull it together during a pandemic. Exactly. You don't need to be honest with me, but it'll be more fun if you are at times during the process where you just like, just let's What are you doing, like get to it? Or were you happy with the pace? Um,

Kim 6:43
I would say like the last year leading up to the proposal, I definitely was like, Alright, come on, is it gonna be this weekend and like, and I would, you know, ask them like, Alright, are you Let's go. Was there ever for the most part I was, I was fine with it. Did you ever have any

Scott Benner 7:01
concern that it wasn't going to happen that you'd wake up one day and be like, Oh, great. I'm 36. And this guy just left me. Oh, no, not at all. Okay. Well, then I see being well then then good for you. And you probably have your own little, like, you have like a career or a job or what do you? Yeah,

Kim 7:19
I'm a nurse. Okay. I'm a nurse. So I mean, I feel like looking back, like we definitely did it the right way. Because we we have like a nice house we bought on our own and we have you know, we both have good careers. We have nice savings. We are built to do like wedding the way we wanted to honeymoon the way we wanted to that any of that want to really have happened if we just got married younger. Yeah,

Scott Benner 7:45
she has plenty of good stuff to split up when you get divorced. Exactly. What a great thing to look forward to. Are you already looking around the house thinking like that table? How's the first year going? Is what I mean?

Kim 7:58
I'm actually it's it's going great relationship life. But it's been a very interesting year for me personally. So I don't know. It was a very interesting first year of marriage. All right. Tell me why. No, I mean, that kind of goes into like my whole story.

Scott Benner 8:18
I didn't know you were producing. Okay, hold on. Excellent. We'll go with your thought. Alright, so let's do this first. You're Kim. You're from Chicago. You're 31 How old? were you when you got type one diabetes? 27. That's four years ago. That math I can do for some reason.

Kim 8:36
Yeah, so it was four years ago. But I think the unique part and the part that like kind of goes back to me saying the last year or first year of marriage was difficult, because I only really started on short acting insulin. In September, so not even a year ago.

Scott Benner 8:53
Oh, so you had a very long honeymoon. Did they call you a lot? Or did they tell you you were tired? Yeah. So

Kim 8:58
they called me Lada. And yeah, I guess it was a honeymoon. But it was definitely prolonged by myself.

Scott Benner 9:08
And you do a lot of cinnamon burpees

Kim 9:13
did you know I did. I did like low carb, like extremely low carb and a lot of exercise. I mean, I was on Metformin. And then I also was on Lantus, so I wasn't like, completely like nothing. But yeah, I was not on short acting insulin until September when I finally was like, I can't do this anymore.

Scott Benner 9:37
So you drove your body like an electric car that had 20% left? Pretty much yeah, I'll just go real slow and see how far I can get and that and that you feel like you had an impact on it.

Kim 9:50
I did. And my doctor was telling me like, oh, it's gonna happen anytime like you know, your pancreas is eventually going to stop and I kinda like knew Whew, that I was like prolonging it. So it kind of felt like a, like a failure kinda if I didn't keep my sugars where they were at, like, on my own because I kind of really resisted the type one diagnosis, not that I didn't think it was accurate, but I just didn't want it because it is a whole different lifestyle.

Scott Benner 10:25
Yeah, did you begin to have what they call magical thinking? Like you were having more of an impact on it than you were? Or were you pretty consistent and understanding the reality of it?

Kim 10:34
No, I definitely was actually managing it, like my A onesies were like in the fives. And, but I just wasn't like, at the time, I thought I was being healthy. Because, you know, I was active, and I was eating healthy. But my body actually gave me signs that I wasn't actually healthy. And how so it just got to be? Well, I mean, I know you talk about artists period. So I'll just feel comfortable saying it. I lost my period for like, over a year. So that was like one sign that, you know, obviously, my body wasn't getting enough nutrients or everything it needed to have balanced hormones.

Scott Benner 11:20
Okay. And did it actually come back at some point?

Kim 11:25
It came back in December. So in September when I was like, Okay, I'm married. Now, I can't live this lifestyle. If I want to have kids, I'm gonna have to have a period and I kind of knew all along that, you know, to get a period back, I'd have to stop my intense exercise, I would have to eat carbs. So then that's where it kind of all unraveled where I was like, Okay, I need help, I need to go on insulin. I need to be able to eat normally I need to like not have to work out because there was i i love exercise. But there were plenty days in those years that I worked out to lower my blood sugar because I knew I was going to have more carbs than, you know, unlimited amount and or I knew like the night before I eat too much. So I would just like not eat breakfast do like an intense workout. And that's how I kind of managed and obviously my body didn't really respond well to that

Scott Benner 12:23
are two questions based on what you just said? How severe was your diet restriction?

Kim 12:29
Um I don't know. It's hard to like, quantify like, I like I still look back and feel like I was pretty healthy. I was not starving myself by any means. But I ate so much like salads and protein. Like I had so much protein a lot of like, low carb yogurts, a lot of vegetables. Fruit was like, yeah, if I could have some fruit, but I didn't have any, like substantial carbs for those four years. Like,

Scott Benner 13:04
did you find it restrictive? Or were you okay with it?

Kim 13:08
Um, honestly, I feel like 80 90% of the time I truly was okay, but I think I convinced myself like, Oh, this is healthy. Like, I'm eating like salads. I'm eating like I found so many, like low carb options like egg white wraps. And I mean, it's actually still stuff that I really like. It wasn't like, I was like, oh, like forced feeding myself like this food. I enjoyed what I was eating. And I was like, eating a lot, but I just none of it was carbs. And then I also kind of went a little bit like low fat too. Okay. Well,

Scott Benner 13:44
I'm not insinuating that you somebody can't eat low carb. I'm just trying to understand from your perspective, if this was something you were doing, because you were like, I enjoy this, or if you were doing it, because you were like, I have to do this or I'm going to get diabetes worse. And in that kind of pressure that might come along with that. Did you get super skinny? Were you ripped? How did it affect your body? Oh,

Kim 14:04
yeah, I was ripped. Like people were like, Oh my gosh, I never looked like super skinny. Like, I wasn't like anorexic looking. I might be um, I was actually normal, but it was mostly muscle. Like I started work like doing weight training and stuff too. But like, on my wedding day, like my arms were just like, super toned. Like that's what everyone said like, oh my gosh, what happened? What do you do? Like, you know, I just like, Yeah, I was pretty in shape.

Scott Benner 14:33
I'm just here to embarrass this guy next to me. Look at these guns. Yeah, exactly.

Kim 14:36
He actually though was like, you're getting to tone like and like when I started gaining weight back he's like, Yeah, I like that.

Scott Benner 14:45
Oh, look at somebody now somebody has an opinion not about me getting married that he was okay. drifting through I.

Kim 14:53
But yeah, but then I kind of went in the opposite extreme a little bit because I think once I started eating carbs and fat, my body was like, Ooh, what's the So I'm gonna hold on to it.

Scott Benner 15:01
Okay. All right. Yeah. Okay, well, so you found a balance your period came back, did management get more difficult at that point?

Kim 15:10
So it just like completely changed. Like, I felt like I described it as kind of being read diagnosed. Because like, now I had to learn like this whole new thing of, you know, insulin and mealtime, insulin spikes and highs and lows. Like I really didn't have many lows. Like, it wasn't like a concern. I mean, like, I didn't bring like low, like, treats with me everywhere I went, like, I was never really that worried about it. And then like highs, I kind of knew, like, it was based off of something I did, like, oh, you know, I ate a carb heavier meal that night. So now it was, you know, this time where it was like, Okay, I really have to find out this whole new management.

Scott Benner 16:02
Yeah, sure. No, it starts over again. I mean, you're not being helped by a slow onset, you're not being you're not being you're not being helped by ultra low carb, or all the benefit you get from the crazy working out. So did your workouts go back? I mean, they must have already if you softened your body up a little bit. I mean, that like, you know, I probably mean that in a way you're not supposed to say in 2022. But like, you kind of feminized your body a little more, right, like classically,

Kim 16:28
yeah, so I actually just like completely stopped working out for a month. Because I was so fed up with, like, not getting my period back. Because I was like, a couple months in to trying, you know, eating the carbs and fat and then still not getting it back. And then it's funny, because it's kind of like you in the sense of like, diabetes management, I found, like, online, I also found like, it's called like, period recovery. Like, I found that online too. And that's how I ended up getting my period back as compared to like, I went to a gynecologist, I went to my endocrinologist, I said, Hey, I'm not getting my period, like, this is abnormal. They decided to like, just put me on the pill. I mean, they did a lot of tests, and all of them were like, essentially normal. So they were really no help. They're like, just keep monitoring like care, go on the pill. And I just knew that wasn't right. So I kind of found my own way to recover.

Scott Benner 17:25
Okay. With when your period finally came back real like, oh, oh, this I remember this. What this part?

Kim 17:36
So happy about it for a while? Yeah, because I was just like, I felt accomplished that I like got it back.

Scott Benner 17:43
Good for you. Did you tell friends be honest, did you text one person you're like, Oh, my God, my period. Today is so exciting. Oh, yeah.

Kim 17:49
Several people. Three, my mom, my sister and then actually my sister in law, so they all kind of knew what I was going through. So I was really happy

Scott Benner 18:00
when I got it difficult to write. It wasn't easy. I'm not I don't make any like, but it's a it's a serious situation.

Kim 18:06
Exactly. And I just knew, like, obviously, having kids on my future is like, something I really really want. So it was kinda like, feeling like, that wasn't going to happen if I didn't figure this out.

Scott Benner 18:21
Kim, are there other autoimmune issues in your family line?

Kim 18:27
I'm not really at all. My dad's cousin does have type one so I guess Yeah, but you know, when someone's like, distant from you, you just feel like

Scott Benner 18:38
like it doesn't count. It counts. Yeah, exactly. Because this podcast accounts do you have any other stuff? Celiac or hypothyroidism? Hashimotos stuff like that?

Kim 18:50
No, and I've been tested for a lot of it

Scott Benner 18:53
too. You have other issues that you were that you would you were trying to get tested to find out what was going on

Kim 18:59
related to my eating habits but like no doctor really realized that but like, I would have like bloating but that was usually because of like constipation and because I wasn't getting like enough nutrients and then like my thyroid like they just tested a lot of things with like my period missing.

Scott Benner 19:20
Gotcha so so are you are you here to tell us that you poop more regularly now?

Kim 19:26
I do which is also another exciting thing actually. Your normal actually

Scott Benner 19:32
you know what plus not for nothing everybody can use a break once a day or more depends on your situation I guess where you just go in a room and close the door and you're by yourself for a second sometimes you're like oh, I have to go to the bathroom but this is great because I can get away from all these people. Oh, okay, well alright. What do you how do you manage now like before it was just this Lantis the Metformin the exercise, the you know, etc. But what do are you doing in the in, in present day?

Kim 20:05
So I'm on an omni pod. And I actually just started looping. And I listened to all of your tips. So I feel your management style is mine. And I work with Jenny. So I kind of just like went all in. But that's kind of my personality. I just when I like have something that I want to accomplish, I just go all in.

Scott Benner 20:27
Oh, well, I mean, I think that's obvious from the exercise thing. Because if you told me, I know myself, Kim, if you said to me, if you work out like a fiend, and eat nothing but salad and chicken, we can slow down this diabetes thing by three years, I'd be like, I don't know. I'm not sure I can do all that. And part of it is my age to like, I don't know if my body would keep up with rigorous exercise, to be perfectly honest with you. I tried to start riding a bike six months ago and ended up having knee surgery. So I'm just allowed to start riding my bike again, I bought this bike, it's lovely, right? And I put it, I put it behind me, it's literally right behind me, I had a space in the office, I'm like, I'm gonna put the bike there. Every once in a while I'm gonna get up from this desk. I'm gonna ride this bike. I do that. And then my knee starts to hurt. And then I had to have surgery. And now my knee doesn't hurt anymore. I think my I think they're going to clear me in a couple of days to go back to like, my regular activity, right? So if you were in a different situation, plus, you had a lot of pent up frustration from this boy who would not ask you to marry him for 15 years, I'm guessing.

Kim 21:32
Exactly. focus my attention somewhere else.

Scott Benner 21:35
Anything happen? Did your relationship shift after you got engaged? Was there like any I don't want to say this like this? Because I did either of you have that feeling like Oh god, it's over. Now I can relax.

Kim 21:52
Um, no, not that I and that's not standing out to me. So I feel like no, no. Okay. Well, we just went right into wedding planning but then COVID hit and then we postpone Yeah, no, nothing really changed.

Scott Benner 22:06
Gotcha. And you did you eventually have an in person wedding where people got to come.

Kim 22:10
We did we did it last July, which was kind of like a sweet spot of like, no more mess mandate and no more restrictions before what was that the Omnicon or whatever came back? So we can't we didn't have to make any address.

Scott Benner 22:26
Any chance you did it on my birthday? The 12 July 3. Alright, it's fine. Oh, July 4 weekend. Turn it no whole thing.

Kim 22:36
Exactly.

Scott Benner 22:37
Let's see what you did there. Okay. All right. So is the conversation going? Anything like you expected so far?

Kim 22:46
Yeah, I feel like I've talked about a lot of the stuff I thought I would

Scott Benner 22:51
good. Are you happy so far?

Kim 22:53
Yeah. Has your nervousness way more relaxed,

Scott Benner 22:57
because you're nervous this subsided.

When you have diabetes and use insulin, low blood sugar can happen when you don't expect it. G voc hypo pen is a ready to use glucagon option that can treat very low blood sugar in adults and kids with diabetes ages two and above. Find out more go to G voc glucagon.com. Forward slash juicebox G voc shouldn't be used in patients with pheochromocytoma or insulinoma visit G voc glucagon.com/risk. One of the first things I do every morning is take ag one from athletic greens. You could do this as well. You could build a foundation for better health with ag one. Use my link athletic greens.com forward slash juice box to get started today. When you do you'll also unlock an offer to receive a free one year supply of vitamin D and five free travel backs that's on top of your ag one. Come on. Ag one supports immunity boosts energy helps recovery and promotes gut health. I take it because I'm afraid that my diet doesn't quite include all the vitamins and nutrients that it should and he one helps me to feel better every day. I tried a handful of other green drinks before coming to AG one. One of them I won't mention the name tasted like what I imagined feet would taste like if you made it into a drink at one however, goes down nice and easy and my palate is hard to get along with. So that really is saying something 81 from Athletic Greens contains less than one gram of sugar no GMOs. No nasty chemicals or artificial anything's right now it's time to reclaim your health and arm your immune system with convenient daily nutrition. It's just one scoop and a cup of water every day. That's it no need for a million different pills or supplements to look out for your health. Of course to make it easier athletic greens is going to give you a free one year supply of immune supporting vitamin D and five free travel packs with your first purchase. All you have to do to get that offer is visit my link athletic greens.com forward slash juice box once again, athletic greens.com forward slash juice box links in the show notes. Links at juicebox podcast.com to AG one and all the sponsors

it has for sure be honest with the people listening. I'm famous to you. Is that correct? You are and now I'll be honest with the people listening, Kim that's ridiculous. You should not feel

Kim 25:52
serious like I'm probably like a super fan. I probably I listened to all 700 episodes in like four months. I used to listen to it like two times speed so I could like get through them all. And now I like still go back and listen. And I listed in different podcasts apps just so that I can get you more listeners.

Scott Benner 26:15
Now we're getting to something this is how everyone should be. Alright. Did you have to quit your job to do this? Or were you able to do it with your job?

Kim 26:22
No, it's literally like all I did on my free time as I grocery shop worked out. Anything dishes, anything I just was constantly listening to you. But it kinda like consumed me because I think like this person is I don't even remember that much. I didn't listen to much Christmas music at all and I love Christmas. But I always had the podcasts on instead.

Scott Benner 26:45
I'm the reason you didn't hear Perry Como this year.

Kim 26:48
Exactly. Maybe Christmas day I heard it but that's about it. I killed

Scott Benner 26:51
Perry Como. Oh, Kim. That could be your episode title. Wait, what did you say I killed Perry Como could be your episode title. I don't know what that means. Sure you do. Perry Como he sings all of your favorite Christmas songs that you don't realize because he's he's 100,000 That He's probably dead. Hold on a second. You really don't know who this is.

Kim 27:14
I know. I'm really bad with this but

Scott Benner 27:18
don't don't wear a white Christmas. Do you love a white Christmas song and old standard? Oh, yes. guarantee it's gonna be pretty cool. Now. Hold on second. Definitely, definitely him. He's probably saying song. Oh, song. He probably song. Most of your like favorite like Christmas standards. Okay, all right. In less Are you more of like a car person? Do you like that? See a Christmas album is incredibly good.

Kim 27:51
I'm working Mariah Carey and Celine Dion Christmas.

Scott Benner 27:54
Okay, have you ever tried to see a Christmas?

Kim 27:58
No, I don't think so. Please,

Scott Benner 28:00
in honor of me try it next year. Okay,

Kim 28:03
I will. Well, that means I won't be listening to your podcast. Well, you're

Scott Benner 28:07
pretty caught up. You should have a tiny bit of free time. I actually would like to talk about that for a minute. If you don't mind. I just saw another person online, get on the Facebook page and celebrate that they were caught up. This person was like I just listened to Episode 698 I am caught up and I thought wow, my first thought was I'm very touched. My second thought was I wonder how helpful it was to them. And my my, my next thought was, I hope the advertisers notice this happening. They buy more advertisements, and we keep making the podcast but how valuable was it? Let's let's lit it up a little bit. I'm assuming you found it supportive in a community such like sense?

Kim 28:54
Um, yeah, for sure. Because I don't really know any other type ones or like talk to type one. So definitely listening to other people's stories helps a lot but I for sure started with what oh my gosh, like the defining diabetes and the protests. Okay, so I kind of I listened in a very weird way I feel like I started with those and then like sometimes they would lead into like another episode that was just like the interview. And then like, I don't know, I jumped over around like a bunch and then once I was like, narrowing down to only like some that listen, I started like from the beginning.

Scott Benner 29:34
Did you have an experience ever? Oh, I'm sorry. Go ahead. Well,

Kim 29:38
I was gonna say it was like interesting that like I did not start it like episode one. So like going back and like listening to those are kind of like, interesting like to hear how it's like evolved from the beginning.

Scott Benner 29:51
Yeah, for sure. Did you ever find it a situation where you looked at an episode and you thought I don't think I care about this but you listen to anyway.

Kim 30:00
I think there was like a couple that I was like, not super like interested in, but I listened to them 100% Still worth your time? Oh, yeah, they for sure still worth my time because you just get a different perspective. And then you usually wouldn't throw in a little bit of management each one. So

Scott Benner 30:19
I do do that, don't I? Yeah, that's, I'm very happy to hear that. Also, I think the way you listened is not uncommon. I think many people come through, did you come to the Facebook page?

Kim 30:31
No, I really don't know exactly how I found you.

Scott Benner 30:36
Well, so but some people do that they hear about this thing that has these protests. And then you kind of, you know, do the defining stuff. Because I mean, you get your term straight. And then you go to the Pro Tip series, because you're looking for management. And then hopefully, it leads you to more stuff and you find stories that help and then there's management. I don't know how even how to say it, like people tell their stories, or I recant something that happened to us. And you can kind of pick it up through conversation I find easier than it being like just jam down your throat it to me, I love the Pro Tip series. I love that the I love all the series, actually. But I think if the podcast was just those, I don't think it would be as valuable.

Kim 31:21
I agree. I think listening to like, the interviews and stuff like really makes it very interesting. Like I've tried other podcasts and like, it's just a way to like interview style, like, Oh, thank you for saying that. And like stuff like that. And I'm like, Oh, I can't listen to this. I'm totally bored.

Scott Benner 31:39
Kim, I don't want to I don't want to slow you down here. But do you need to badmouth any other diabetes podcast? It's okay. My name can just be vague. They're terrible. Mines grades, something like that. Whatever you think don't let me put words.

Kim 31:53
Yeah, exactly. I mean, I can't even get through some of the episodes. I just have to turn them off.

Scott Benner 31:59
What a review. Okay, great. So I am thinking, one time somebody sent me a review that they saw for another podcast. And the review is hilarious. And it still pops into my head. Sometimes it's I don't I don't openly root for people's failure. I don't feel that way. I genuinely don't. I just want to beat them on my own terms, but I'm not looking for people to fail. I just want to win. I hope you understand the difference. So yeah, so

Kim 32:34
you're definitely winning. I think,

Scott Benner 32:36
you know, Kim, let's not brag. But yeah, okay. And so. So this review is just it's so funny. I, I'll share it with you when we're done recording, because it's like, I'll see if I can dig it up afterwards. Maybe I wrote it. But that'd be something you'd be like, Oh, my God. I'm just kidding. I usually don't write reviews. But this was a couple years ago. I honestly don't think that you would have had diabetes when this happened. That's how long it's stuck in my head for. Anyway, appreciate you saying nice things. And I'm glad I'm just I mean, being serious. I'm glad that the podcast worked for you that listen, there are plenty of people who could follow the path you followed and won't jive with me and and they might not, you know, they might not have the same experience. I'm completely aware of that. But I'm glad that you had that experience. So what did it lead you to do? Like how did because you're, you're a nurse you said?

Kim 33:28
Yeah.

Scott Benner 33:30
What kind of a nurse?

Kim 33:32
I work in the cath lab. So were they do like angiograms of like the heart and legs? Any arteries?

Scott Benner 33:39
Okay, super exciting, Kim. And yeah,

Kim 33:42
so if someone has a heart attack and their

Scott Benner 33:44
does it does it is are you in pressure situations like that?

Kim 33:48
Oh, yeah. Because we'd have to take like call and stuff so sometimes like I can get called in at like till in the morning and someone's like having a massive heart attack and they have to like, go and work and

Scott Benner 33:59
do you don't wire through a thing while somebody's yelling. Billy's Grandpop is dying Kim, do it like something like I'm sure they it's not like on television, but you have to actually feed a wire through something is that correct?

Kim 34:11
I mean, I don't do that part the doctor does but I'm I'm the nurse like in the room giving like the medicines and like, if something goes bad like doing CPR and like stuff like that,

Scott Benner 34:22
how often not you I'm saying but how often do you see somebody push in bed and they go Oh, whoops. Does that ever happen? Like wrong one?

Kim 34:31
Thankfully, no, never. I mean, I think I've heard of stories, but I've never experienced it.

Scott Benner 34:38
How did those situations impact your blood sugar? Does it go up?

Kim 34:44
Um, no, I haven't really seen anything like that maybe like a little bit maybe like 20 points but nothing like us arrow up like type situation. So were you not focus on like, really pay attention to my blood sugar and those mo means other than, like, I tried to make sure I'm going into it not like low or going low.

Scott Benner 35:04
Yeah, sure. No, that makes sense. But so are you kind of, by nature a level headed person? Or does the job just make you be that way.

Kim 35:13
Um, I think it's a little bit of a mix. But nurses definitely like, after you've been through something is the amount of times maybe like the first couple of times you're nervous, but after that, kind of just, it doesn't seem as like scary or intense when you've done it a couple times.

Scott Benner 35:32
So you don't have a bunch of adrenaline going while you're doing it. Know, for the most right now, that's kind of comforting to hear if I'm being perfectly honest, as the person who expects to have a heart attack one day.

Kim 35:44
But it has a lot to do too, with like the doctor in the rooms. Because if, I mean, the best scenarios I've seen is when like, the doctor is really calm and just able to like, give orders and everyone else kind of just stays calm to it's like we all know we have to do and you could only like do so much. So it's like you just have to do it without like panicking and like, running around. So if the doctor stays calm, then everything usually goes pretty smoothly.

Scott Benner 36:09
As the doctor goes, the situation goes. Exactly. It's interesting. And are some doctors panics like newer doctors, or? I guess probably yeah,

Kim 36:18
I've definitely seen that too. Yeah, not all doctors are equal.

Scott Benner 36:24
Definitely not. I. Yeah, let's not get into that. But yeah, that's definitely true. I mean, not everybody is equal, right? Yeah, exactly. So you find the podcast at what point in your management? So where are you? When you start listening? Are you still working out hard eating low carbs? Have you made the switch? Where do you find yourself?

Kim 36:45
I found you like, I think at the end of October, so I started like, insulin in like the middle of September because I kept telling my, my endocrinologist that it would be like really high in the morning, which is like new for me. And then she put me on a libre, which I was very reluctant to go on. Because at this time, I just like, didn't really like, want to accept, you know, maybe all this. So wearing something was not like exciting for me. But I was like, Okay, I just got to do this just to see like, what's happening overnight, or why I'm high in the morning. Then she put me on like a really low dose sliding scale. Like, if a greater than 150 Give a unit. And then if it's like 225 Like, I don't know, just really. So then I kind of like before I even found you was a little bit bold with insulin where like, I just I knew better that I needed more. I mean safely, but I just kind of was like okay, well now I have insulin, I'm just gonna start using it. But yeah, I think I was animali break for like, a couple of weeks. And I was just, it was the whole roller coaster thing. And I'm like, I was just frustrated. I'm like, I don't know what I'm, what I'm doing. And then I found you and things really started to smooth out.

Scott Benner 38:09
Cool. Can I ask a little bit about the not wanting to wear the libre or a device in general? Does it stop you from being able to kind of consciously or subconsciously pretend that you don't have diabetes?

Kim 38:22
Um, yeah, it definitely was a, that was a big part of it. I still like don't wear I'm not one of those people with them like, and they're mostly like, on my stomach or my low back. I'm still not like, loud and proud that I'm type one. But like a lot of people in my life don't even know. But I love my devices so much that I'm getting to the point where I'm about to like, show them off. Or like when I talk to someone about it. Like I'm super excited to show them and be like, Oh, this is what I wear now. And this is what I do. But it's just not like an open thing. It's got to be like the right person and timing, I guess. Yeah.

Scott Benner 39:05
Well, that's exciting. I'm happy for you. Like, yeah, that really is great. So you're getting more comfortable. Going to show more people use the word proud. That was great. So I mean, I That sounds like a, like an obvious trajectory to me. I get it. I mean, like, I mean, there's little kids are more like I got a thing. Look at it. It's stuck to my arm. You don't I mean, but adults. I mean, gosh, you were 27

Kim 39:31
Exactly. I felt like it was like it's a whole new life. You know, I knew life a whole different way. So

Scott Benner 39:37
you're incredibly you're incredibly patient, which we know for sure. Because you waited for, you know, so long to get engaged. So you you're like I can wait this out no problem. Did Did your diagnosis impact your relationship at all? Or did you find yourself concerned that it would,

Kim 40:01
um, I definitely found myself concerned that it would, I think it like, kind of impacted. Like, all my relationships I that, like upset me for a while because I just felt like, I like had this one at like flip my wife was like completely different. And then it's like, everyone else took a while to like, catch up with me or like I just kind of felt like a different person. So like, I felt like, it just changed my relationships. My husband, I, he's, like, always been like, the best person as far as like, understanding that he's pretty smart when it comes to like, medical things like he gets diabetes, like he understands, like, the amount of effort from my management. But he's also been the person that struggled most with, like, it really don't know what the word I'm looking for. But he's like, it upsets him. That's it. Like, he's really upset him like the diagnosis like, he just doesn't want this for me. He knows he's like, see me struggle like a lot with it. And I'm like a little bit of a perfectionist. So like, I need it to be perfect. So like when I'm not I am like, upset and down and like, it's hard for him to like, see me have to deal with all this. And he knows how much effort I'm putting into all this. And it just really like. He just, it makes him sad.

Scott Benner 41:32
No, I understand how you feel, how he feels. When I'm when my wife and I were more newly married when we were younger. Like if she had a problem at work. I was like, Do you need me to go beat someone? Like what do you need? You know what I mean? Like, I see how hard you're working. And I love you know what I mean? Like it's the same feeling really, like I know, you don't want it to go this way. I wish I could do something like obviously I couldn't go to an I mean, I guess I could have but I wouldn't have you know, like gone to an office and like intimidated somebody. But I felt like that. And your husband probably feels similar. Except there's no one to intimidate, right? There's not even anybody to yell at. It's yeah, you know, yeah, there's

Kim 42:12
no like, nothing you can do he just wished to send it in.

Scott Benner 42:16
Yeah, it's an idea. You're, you're mad at really, I mean, it's a reality. But it's, you know, it's a it's a faceless entity that you're that you want to, you know, take by the shoulders and shake. Yeah. But, um, I get how he feels? Did you worry for him, or were you too busy in your own kind of, like, mixed up ness to be concerned about other people around, you?

Kim 42:39
Know, I worried for him a lot. And it was kinda like, I took it on myself to like, worry for him. And then I like, didn't include him in a lot of things or like thoughts or feelings that was happening because I was trying to, like, protect him from being like, even more sad. But I've like worked through a lot of that. I, once again, I jumped all in with like everything and I got a therapist to I'm like, I don't really need one. But you know, screw it, I'm just gonna, like, just get a therapist and, but it's actually like, been so great. She's helped me a lot, like just realize things about myself and why I feel certain ways and she's helped me a little bit with like, you know, opening up more with my husband and just not taking, like, not trying to protect him so much from feelings that I think he's gonna have. Yeah, and the more I have opened up, I do realize that he he can handle it. It's just me always trying to like, foresee, like, his emotions, and then like protecting him from them.

Scott Benner 43:44
Yeah, I understand that. So Well, I think that's a positive step, but very much so. It's It's crazy, right, trying to manage your thing. And another person's thing when I was talking about this, the podcast is so strange. I was talking because things come up and they seem to come up when I'm recording. Maybe I'm subconsciously directing conversations that way. Anyway, I was talking yesterday with with somebody about, you know, I kind of made concentric circles. And I laid them over top of each other like those intersecting, you know, those little diagrams, I don't know, what kind of diagrams and

Kim 44:23
diagrams you think why they call pen diagrams, I don't

Scott Benner 44:27
know, like two little circles, they overlap and you kind of see things intersect in each other's lives. Right. And we were talking about how, how you're having these experiences with another person, and you're doing your best from your perspective to read what they need or one, but they don't, you know, most of their circles not overlapping with your circles. So they're having an entirely different experience away from you. And they may have other circles overlapping in that place and they know people that you'll never intersect with They have relationships and experiences and struggles and successes that you never see even though you're very close to them. And then you're trying to just say manage, but you're trying to interact with them in a way that you think is most positive when honestly, you don't even know the people, you're around constantly as well as you believe you do. And so it's up to them to share that stuff, so that your relationship can become more complete. And that is what you're talking about. But nobody does that. Mainly because who would think to? You know what I mean?

Kim 45:39
Yeah, I agree completely. Yeah, I definitely like putting too much thought into what he thought about instead of just letting do what he thinks about and just, you know, saying what I need to or doing what I need to

Scott Benner 45:51
write, because you're never going to be completely aware of the other things that can intersect his life. You can't be and so you have to give it to him, and hope sorted out, and if it becomes a problem for him, then he has to deal with that in his time. But if you don't have those communicative moments, they'll become both of your problems in the future.

Kim 46:15
Exactly. Yeah.

Scott Benner 46:17
I was a lot of gobbly gook talk, but I think it made sense.

Kim 46:20
It made complete sense to me.

Scott Benner 46:22
Thank you, Kim. Thank you, Ken, I love you. I really appreciate back when you said you listened to all the episodes that I was done, I would send you a certificate of completion. If I had one.

Kim 46:33
I think I shouldn't get like biggest supporter certificate.

Scott Benner 46:36
Do you think I should have like a digital certificate made up that says I've listened to all the episodes of The Juicebox Podcast and send them to people? Yeah,

Kim 46:43
I wouldn't hang that up in my house.

Scott Benner 46:45
I believe you might. I appreciate that, too. Kim, thank you. Maybe I'll just turn it into a t shirt so I can profit from it. How would that be?

Kim 46:52
I would buy it.

Scott Benner 46:57
I just want people to I don't really make that much money off those shirts. Oh my god. That is.

Kim 47:01
That is one thing that I have not looked into yet. I've done everything else. I've gotten the Omnipod the Contour. Next One at Dexcom done the survey for slipping my mind what it's I've done everything.

Scott Benner 47:15
You do the T 1d Exchange survey. And you use Jenny to right. Oh, yeah, I got Jenny. I think it's obvious to people but it's the unspoken part of my relationship with Jenny like Jenny doesn't work for me. I don't pay Jenny to make these podcasts with me. But you know, it's not we're not unaware that she may attract customers. So you know, and she

Kim 47:37
was extremely hard to get into. I only got lucky because I use like the side of it that which I mean, it wasn't Elijah true. I want I went to her because I'm like, when I want to have kids, I want her to help me manage that. So they were able to get me in with her. But other than that, like it was like very hard. They're like to get in with her. Yeah, I sort

Scott Benner 48:01
of the podcast kind of ruin Jenny in a way like, sort of like dating like a superstar. And then you break up and then the next guy is just the guy you met at the gym and you're like, it's not gonna work out like I already might, you know, I think we elevated Jenny to a point where it's hard to get in with her now.

Kim 48:22
Yeah, she's awesome though. Like I'm so happy I invested in that because she's just she's been that like, final like step where like, you know, management's pretty good. But then there's like, just like certain like, final touches that like she helps me like adjust things and I kinda like see where the adjustment might need to be but I don't know exactly what to do when she's awesome.

Scott Benner 48:47
And I used the wrong word A moment ago I said elevate like we I just I was able to shine a light on her so more people could see her that's all she she's who she is well without me you know what I mean? But but you know, just not everybody can know in the podcast has a pretty throws a pretty wide net so people can the who may be never would have known about her can learn about her song.

Kim 49:09
Yeah, I would have never known so I appreciate you for that. What are my shots

Scott Benner 49:13
here like my chances? Give me a percentage of getting a baby named Scott out of this.

Kim 49:21
Feeling you'd ask that? I don't know. I'll have to convince. No. I'll say possibly,

Scott Benner 49:29
but a cat. Can I get a cat?

Kim 49:31
I'm not a cat person. But maybe a dog?

Scott Benner 49:33
Not either. I mean, I'll take a dog. That's fine. No, nevermind. Well, you get a license plate that says juice box on your car. Maybe I would, you know like eight people have done that. Really freaks me out. I love it. But it's like I have pictures here from all over the country of people who got juice box license plates. They just like the letters say juice box. Yeah, in some way. Yeah. And they sent you know, I mean, I say this here because I think the person who wrote the article listens to this. So it's, I'm not bothered by it. But there was an article written by a pretty big diabetes blog that said, Look, people are so like connected with, like diabetes that they're getting juicebox license plates and the it was for the podcast, it wasn't just about diabetes. And pardon me when I read it. I was like, huh, all right. It's okay. And I just didn't I mean, listen, I don't really care. But But those people got those, you know, they sent them to me personally. And then they put them up on social media, they they they got them for the podcasts, which I was really touched by

Kim 50:38
might be some people listening to this, that might be mad that I said, I'm your biggest supporter, I think

Scott Benner 50:43
you might have to, what if we have to have a UFC style Fight Club situation one day, where you guys all fight to see who is the biggest fan of the show. I'll bring bananas and juice boxes so that everybody can stay on their game and really get in there and fight my son by the way thinks it's he's freaked out that their license plates for the podcast. Okay, I see him Look at me, like, why do people care about you? Like, it's funny, while while you're you don't understand, because you don't have kids yet. But 20 years from now, you will completely understand this. But it's, uh, it's funny to watch him look at me and try to regulate in his mind that someone would care what I say. You know, a little disturbing. But anyway, it's all part of having kids. Alright, so you're really not that far into diabetes? You said in in October, you found the podcast, maybe?

Kim 51:38
Yeah, what ended?

Scott Benner 51:41
What made you reach out so quickly to be on the podcast that?

Kim 51:45
Well, that's the funny thing is that I literally just listened to mostly like the pro tip episodes. And I was just like, so inclined to thank you. Because this was like, my first like, sense of relief. Like, I'd been messaging my doctor, I've been getting no like guidance of like, how can I make this better? I knew like, it couldn't be better. And I just couldn't figure it out. And then your episode just helped me like so much that I was like, I don't do this. But I have to reach out and tell him thank you. And I told you a little bit about my story. And then you responded like to come on the show. And I was so like, what I was like, Is this real? And I didn't even like, but then as I started listening to the rest of the episodes, I was like, oh, people do this. People think all the time. Like, I had no clue. I was just like, I was not trying to get on the podcast or anything. I was like, even kinda like, why would I be on the podcast? But then I was like, oh, it's like so many months away. And maybe I'll just sign up and see where I am when that time comes around. And then here I am.

Scott Benner 52:49
And you actually showed up that I say this all the time, the when people are there, like I never miss a recording. And I would say that with the exception of one or maybe two a year. No one misses their recordings. And yet they're six months out. So it takes from the time you say to yourself, I'm going to try to be on this podcast to when it goes live is a year.

Kim 53:13
And yeah, it was November right now it's June,

Scott Benner 53:16
June, it takes six months to actually get to your recording date, and then six more months actually get live. And that's part of the process, really, because if you're actually here on the day, when I open the microphone up, you really want to do this. And yeah, that's why you don't get a whole lot of episodes where you're just like, this is like sucks. You know what I mean? Like, it's people who really have something to say they've put effort into getting to it. And that's sort of part of my plan. But when you sent your original note, you just had so many interesting aspects that obviously you didn't know, were interesting, but I thought were the lot of diagnosis like the slow onset. Definitely people need to hear about that. You know, that you didn't know what you're doing. But you were a nurse, and that you had to go to a podcast when you're in a giant building full of doctors is interesting. Yeah,

Kim 54:08
the hospital setting like just has no idea about type. Right? It's very interesting. I mean, all I knew, too, was sliding scale. If blood sugar's are above 150. Then you give whatever the their sliding scale is. I do have to say, majority of the patients I dealt with, because I did do like the bedside nursing, it's called for four years. So I dealt with like a lot of type twos and like the amount of people's blood sugars, I would check, they'd be like 200 And like the people wouldn't even like flinch, and then they would just eat their lunch before I even came in with insulin and like, that's kind of like all I knew about diabetes, like management and stuff.

Scott Benner 54:53
Yeah, hospital management is not about being healthy. It's about staying reasonably lower. If You can, it's it's interesting how in the one place, you know, it's a conundrum in your head when you look at it, right? Because in the one place in the world, you imagine somebody would just be like, like a ninja with insulin and just know exactly what to do is is kind of the last place. And that's why that's why it's definitely

Kim 55:17
scared of insulin like the hospital like no one's trying to like bring blood sugar's down, like, too far too fast, too low, like see, like a 75. And they're like, scared. They give like a whole amp of like, dextrose. I was like, no, no, no, don't do that.

Scott Benner 55:35
Yeah, yeah, we were talking the other day, Jenny and I are making a new series that by the time your thing comes out, will probably be completed. But we're calling it bold beginnings. It's sort of like an overview for like, really newly diagnosed people. And we think we're going over this one example where somebody with their two year old had experienced this, like, drift down to stability overnight, and they were feeding the kid because they were like, Oh, my God. And I said, it's funny. If this happened to Jenny, she'd call me the next day and be like, Look how good I am at this and send me a graph. You know, but to a person who doesn't know what they're doing? It looks scary.

Kim 56:17
Yeah, it's interesting. And I mean, I definitely when I like started my own management, I felt that way too. But like, from like, doctors and stuff, you're kind of like, not given that guidance that that's okay. And normal. So it was like such a relief to like, come across you and just be like, reaffirm that, like, the way I wanted to manage was the right way. Or, like, you know, doable way.

Scott Benner 56:43
Yeah. Was there ever any thought that you might invite me to the wedding?

Kim 56:49
I see. I didn't know about you till after the wedding.

Scott Benner 56:52
You want to do it again? Just invite me then, oh, maybe I can't come, by the way. But I appreciate the invitation. I'm very busy. Actually, I am too busy. I'm too busy to leave this room. Which is becoming a problem actually. Just because I keep looking up and thinking. I keep thinking like, Oh, I'll get the podcast to this level. And then I'll be able to hire somebody to help with something right. And then it doesn't quite go that way. And people send me notes. I'll you know, the most common note I get after thank you is please don't stop making the podcast.

Kim 57:25
Oh, yes. I'll send you that one next. Right.

Scott Benner 57:29
And so I'm like, Oh, I won't, don't worry. But you have to support the podcast with ads. And so you have to make up and you have to make content like content is. I'm just gonna say king, but that sounds like an 80s movie like Dracula brothers maybe. And with the Coen brothers have been the 80s, they would have been the 90s. You know, you don't know who party como is like, you don't know, this doesn't matter. But but you know, it's a, it's a balancing act, right? Like you want the podcast episodes to be interesting and valuable. And they have to come out frequently enough that they can support the ads, so that the ads can support the production of the podcast. Because that's how you scale like the other like, here's, here's, here's something I'm not afraid to say out loud, that, you know, the other podcast might hear. You don't put up enough content. And they go once a week, if you're lucky, some go, you know, twice a month, once a month, some some put out six or seven episodes, call it a season and then take off for six months. Those are nice, like, that's fine. It's a way of doing it. But it's not a way to grow. And then there's this other thing that some podcasts do, where they'll put out an episode a week. And then a secondary episode, that's like four or five, six minutes long. Because they're trying to bump up their download numbers so that they can sell ads, right? Because think about it. If you have 1000 subscribers and you put out an episode, and every one of them listens, you get 1000 downloads. But if you just throw out this little like, throw away five minute episode, and those 1000 people are subscribed, well now suddenly, your 1000 people have created 2000 downloads a month, you've doubled your downloads. But what if you're really what have you really given them? You know what I mean?

Kim 59:16
Yeah, you never do short episodes.

Scott Benner 59:18
I don't cheat you. So I give you like good, meaty stuff. And I do it like it's a real radio show. You don't I mean, like, yeah, like a radio disc jockey doesn't come out on Monday and give you talk to you for three hours and then go, I'll see you next Monday. Like what the hell am I gonna do on Tuesday and Wednesday, and, and you know, and it's cool if you listen to Monday show, but not Tuesday show. I don't I mean, yes, it breaks. Kim, you're an exception and exceptional. But my point is, is that I don't expect for everyone to listen to everyone. I hope they do. And I actually think it would be valuable for them, but I don't expect it. I put stuff out there so that every week people have a choice, and they can say hey, you know what I don't want to listen to the guy who's a parent of a kid and also an orthopedic surgeon. But I do want to listen to this lady Monica, who's had diabetes since she was three, and she's 61 years old. Now. I'll listen to that one today. And then I like to do one episode with Jenny a week. And even that, is not it's not like, I don't record with Jenny and then give you the episode. They're recorded, like, well, in advance, they're thoughtful and considered, and we have conversations about them. And I don't know, I've heard other people's podcasts. And it seems like they turn the microphone on and just say whatever they're thinking, and I'm like, that's, you know, I don't plan in the in the traditional way, but I plan in other ways. I'm not just talking to talk. And anyway, I hope that comes through. Point is, I need people to listen, so that I can make more content that will help more people, so that the word spreads so that you because the idea of scope is to reach more people and help more people like you. Because I've lost count, I've lost count of the people who have told me privately or on this podcast, some of the things that you said today, and that's heartwarming to know that, you know, people are in a good place and not where they I mean, where would you be, if you didn't find helpful information?

Kim 1:01:17
I have no idea. I'd probably just be on roller coasters. Very frustrated every day. But now I can have my close to everybody calm rolling hills and flatlines. And I mean, most days, not all the time. There's still ups and downs sometimes, but for the most part, it's just like a peace of mind to be able to like eat what I want to eat and be able to just manage it.

Scott Benner 1:01:42
Do you find that? Like, psychologically, are you in a calmer place, not just your blood sugar line calmer?

Kim 1:01:49
Yeah, I think the two correlate a lot when when, you know, when you're up and down, you physically don't feel well. But mentally, it's just like, exhausting.

Scott Benner 1:02:00
Yeah, I understand how I see it here. And I hear other people's stories. So I'm happy. I'm happy for you. I really am. It's funny, because Recently someone asked me to, like do a talk, I could do it in my sleep. It's like 45 minutes long, I could give it to you right now, if you said do the talk, I'd be like, boom, I can pop it into. And it's not like I somebody asked me to give it to an organization privately. And I did. And days later, I sent it out. I said, Hey, what did you think? And it was given to somebody in the organization and some younger people who had diabetes. And the older person said, Well, you know, you didn't really say much that I didn't know. And I said, No, I recognize that you are your sleep steeped in this, you You understand all this, but these are the things that that people don't hear from doctors or or share with each other, even when they sometimes figure out how it works. And it's still great information. It really is. It's not this, you know, it's not, it's not where, I don't know, you know what I mean? It's not where we're at treasures buried or anything like that. But, but it's stuff that people need to know. And nobody tells them and when they do tell them, they often do it in a way that is so freakin boring that nobody can listen. And you know, so I think that's what this did. But it was interesting. I'm sorry to hear

Kim 1:03:21
it all throughout your podcast, so it's like it just really like sits with you. And it just, I don't know, it's easier to just incorporate it when you hear someone else like kinda just saying it as part of their daily life.

Scott Benner 1:03:34
Yeah, I did say to the person those like the talk is not meant to fix you. It's meant to make you interested enough to check out the podcast. I can't in an hour explain diabetes to you. I've done it before. I've said it to people who had type one for so long that you know, the talk kind of like connects a bunch of circuits for them and though all the lights come on, I have seen that happen. But for the most part, most it's just going to make most people think hmm, so that's possible. I should check into that. You know, so anyway, I feel like it. I don't know, this is the best format I can figure to do it. I agree. Like you. What have we not talked about Kim that we should have

Kim 1:04:20
I feel like we talked about mostly everything. I did have like no bad experience, but like changing my endocrinologist I guess just like talking about endocrinologist and like how sometimes they just don't really know how to manage and you have to like just find the right one. I had an endocrinologist like the one that I was with for the three years it's just like frustrating looking back that like she didn't see that okay, she lost her period like she never looked into like I went to her for that and she checked my like, you know all these tests, but like never looked into To Hey, like, what are you eating? How are you staying in a five a one C with, with no short acting insulin like she never did any of that she even like she was always trying to like cut things back cut my Lantis back she never like she put me on the libre without like, talking to me about like the Dexcom. And I didn't really know enough yet. And then it was actually funny too. When I went on the Omnipod I like just went through Island New pods. So they like, I guess they contacted her or whatever and got a prescription. I had the Omni pod at my house, went through training through Integrated diabetes had the pump on for like three days and I get a message from her saying, Hey, I got a script that you want to start Agni pad. I don't know if that's the right pump for you. We it was like a very like condescending, like, email about like, this isn't right for me. And I just I was so upset because I was like, already nervous about like, you know, being a pump and trying to figure this all out on my own. And then she doesn't even know that I'm on it already. Like, I don't know. But yeah, it just kind of frustrating. That was like a frustrating part of my management was to not have like the support from a doctor

Scott Benner 1:06:19
Jenny said this to me recently. She said, you know, just because someone's an endocrinologist doesn't mean that they manage diabetes all the time. Yeah. And I was like, oh, geez, I never think of that. She's like, you know, endos do a lot of different things. You got to find a practice who does diabetes, that's the first thing. And then the system, which is listen, every system is really just people, right? And things get set up in a certain way. Nobody can. Nobody can imagine everything the system needs, right. So a system gets set up and then you build onto it slowly, you add a piece, you add a piece and before you know, years later, it's bastardized, it just you're involved in this system that doesn't work. Everyone who uses it knows it doesn't work, but there's no way to fix it either have to blow it up and start over. or live with it. And what you just described as people living in a in a, in a system that's been added on to too many times, like how could you have the pump on and your doctor be like Hey, I hear you want to get a pump?

Kim 1:07:22
Yeah, I was I was seriously shocked by that message. I just was like, another funny thing about her was the first like I it was like a Zoom meeting with her and she was like looking at the my libre. And she wasn't like happy with the amount of lows I was having. Even though I wasn't having a lot the libre just like bounced around a lot. And it counted like a 67 is low. So I think my percent was like 6% low or something like that. But I was never having like severe lows. I was just you know what dip into the 60s sometimes before dinner. But anyways, she pretty much like you know, like, did the whole like thread about insulin and how it could kill you and she's not gonna be able to prescribe me medicine if like, I have too many lows. And then it was just it was ridiculous, but and then I just was like laughing to myself when I got off the phone with her because I was like, this woman's so worried about my lows, and she's never prescribed me glucagon

Scott Benner 1:08:33
these lows are gonna kill you, honey. What are we gonna do about it? What are we gonna do about it? You can't

Kim 1:08:41
it's just so upsetting because I'm like, the type of person that like, I want to, like, you know, do the best I want like A's I want like to make the teacher happy. So like, even though like I can rationalize that I knew my management was fine. I knew I was not in any danger. Like, I had the mind the CGM. And so like, I wasn't worried, but it's still like a bad feeling to like, hear that from a doctor and I feel like I felt I had being an adult. I'm like, whatever it is what it is, but like it made me feel bad for like these parents and like, if they have that when they have like a kid. I feel like that's just so like, more traumatizing and it's like, it's scary. I feel bad.

Scott Benner 1:09:21
Yeah, no, I mean, it's nice of you to be concerned for other people. And trust me that's like a common feeling around diabetes when people figure things out the next thought, a lot of peace and people have as well what about everybody else? But I mean, how fascinating is that? That her answer for stopping your lows was not giving you insulin? Yeah, you know, if you don't stop having these 67 blood sugars, I'm going to murder you. Oh, thanks. A lot. What a clear thinker Kim.

Kim 1:09:50
Yeah, so I found a new entrepreneur. Yeah. How

Scott Benner 1:09:53
long did it take you to actually leave?

Kim 1:09:56
I'm pretty much left quick because I mean, I stayed with her throughout this whole like honeymoon phase. And then she prescribed insulin in September. And I got to I saw her like one more time after that tried to message her a couple times in between about like still having highs in the morning. She was like, no help at all. Until then I met with her and like January, and that's when she gave me the low conversation. And then by April, I had a new endocrinologist. And she was she was awesome. I mean, I've only met her once so far. But she was happy with my management. I was 5.3. And she didn't say anything about lows. I mean, she could see my Dexcom and she was like, You're doing great. And she gave me she gave me glucagon. She so yeah, she was good. I am a little bit nervous, though. Like, I still do get like nervous about like, I don't know, like so I started looping and I'm like, oh my god, I never talked to the endocrinologist about this. Like, what? What am I going to tell her? Like? It's I don't know. I don't know why I have those thoughts sometimes.

Scott Benner 1:10:59
What's the saying? It's easier to ask for forgiveness than permission. Isn't that right? Yeah. There you go. All done. Perfect. All right. Well, I'm so afraid that your your episode is gonna be called something about Perry Como but let's see what happens. Are you happy with how this one?

Kim 1:11:22
Yeah, I'm extremely happy. I feel like we, we talked about everything I want to talk about

Scott Benner 1:11:27
good. Sometimes I get letters from people afterwards. Like I really should have said this. And I'm like, Okay, we said a lot. You don't need to say everything. It's fine. Some people like I have to come back on. I'm like, No, you don't. You're good.

Kim 1:11:39
Now, think about it, though. Actually, that might be a good title, because this will probably come out around Christmas. Right?

Scott Benner 1:11:45
See, yeah, I killed Perry Como. It's perfect. Perfect. Kim, i i Thank you very much for coming on and doing this. I really appreciate you sharing your story. And I hope that you know, he didn't mind that we talked about your your wedding and stuff like that to help you get like I was using that to calm you down. You know that right?

Kim 1:12:05
Oh, yeah. No, I appreciate that. Uh, did call me down. I just wanted to thank you again, for all everything you do, because I really wouldn't be where I'm at. Without you and your podcast.

Scott Benner 1:12:16
That's very kind. I appreciate it very much. You're You're welcome. I think I'm supposed to say You're welcome. You're welcome. Yes, yeah. I I'm trying so I still struggle a little bit with it. Like, you know, you're like, Oh, that's nice. What you mean is Thank you. Thank you. Seems weird. So why don't I just go the other way with sarcasm Kim, you're I am terrific. I agree with you. How's that? I

Kim 1:12:40
like your sarcasm. I feel like the first couple of times I heard it. I was like, not really sure. But I still like the episodes. But like people who complain about you, I just don't think that they've listened to enough episodes. If they listen to you and understand your sarcasm, then everyone would just love it.

Scott Benner 1:12:57
Are you saying to my wife that if she just listened to me she'd be happier. It feels like Yeah, I hear you too. I'm gonna play this part for now, but listen, sarcasms that we went over it right? The podcast is enjoyable for I mean, listen to for a great many people. I can see the numbers. It's a lot of people. So it's, I know it works. And you talked about how getting fed information dry ways is it's hard to get through. And that when people are fake and phony that's hard to listen to. Like I know what you're talking about this big voices like Oh, thank you so much. And you are wonderful. Oh, no, you're wonderful. And before you know it, we've been talking about how wonderful we are for three minutes. Like are we gonna say anything substantial here ever, please? Yeah, yeah. Oh, I'm gonna stop the recording now. And then I'll find you that funny review about the other podcast. Okay, yes.

A huge thank you to one of today's sponsors, G voc glucagon. Find out more about Chivo Capo pen at G voc glucagon.com. Ford slash juice box. You spell that? G VOKEGLUC AG o n.com. Forward slash juicebox. I also want to thank Kim or Kimberly, it's up to you and ag one from athletic greens, reminding you again athletic greens.com forward slash juice box head over get started. And if you're looking for community around diabetes, check out the private Facebook group Juicebox Podcast type one diabetes. Thank you so much for listening. I'll be back very soon with another episode of The Juicebox Podcast. Who is Perry Como come on

#861 Best of Juicebox: Diabetes Concierge with Katie DiSimone

Episode 227 Diabetes Concierge was first published on April 30, 2019. Katie DiSimone is on the podcast to explain what the heck looping is and how it can change your life with type 1 diabetes.

+ Click for EPISODE TRANSCRIPT

Scott Benner 0:00
Hello friends, and welcome to episode 861 of the Juicebox Podcast.

Today, on Best of the Juicebox Podcast, we'll be revisiting episode 227 was called diabetes concierge and aired originally on April 30 2019. Back in 2019, I had been approached by a listener of the podcast, who asked me if I had ever considered looping for my daughter. And I wanted to learn more about it. And Katy De Simone was kind enough to come on the show and explain it to me. I didn't keep up with Katie after that, although I was very aware of all the hard work that she put into the looping community. And then I remember one day, I think in 2020, probably spring of 2020. I noticed on Katie's social media that she had like gone on this health kick and was working out and doing so like wonderfully in it. It made me track her progress. So I was keeping up with Katie on Instagram. And then one day the pictures went from workouts, to a brain scan. And that's when I learned that Katie had a tumor. She shared her experience right there on Instagram. And I'm looking now at her account. And that post was put up just at six weeks ago. I heard the bad news yesterday that Katie had passed away. And while I didn't know Katie personally and just had this one interaction with her, she was always just a very impressive person from afar. The work that she put in for loop for everybody, including her daughter, who has type one diabetes is immeasurable. Her impact on my life, my daughter's life and have many of you. It can't be properly accounted for. And so I wanted to run this episode today in honor of Katie, her family, and her her good work. Hello, and welcome to episode 227 of the Juicebox Podcast. Today's episode is sponsored by the Dexcom G six continuous glucose monitor, by real good foods, and of course dancing for diabetes, you can go to dexcom.com forward slash juicebox. Dancing the number four diabetes.com or real good foods.com To find out more about the sponsors. Now when you go to real good foods that calm and you place an order, you use the offer code juice box to save 20% on your entire purchase.

As you well know nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise. And you should always consult a physician before becoming bold with insulin or making any changes to your health care plan. Today's guest is Katie De Simone. And you're going to want to hold on to something because I think what I'm about to say next is going to take you by surprise. But one of our listeners Gina brow beat me browbeat me online into trying the loop now that it's available for the Omni pod. And so I got Katy on the show because she is about the loop easiest person. That doesn't sound right. She's really entrenched in the world of looping. She's not loopy. She's actually delightful. Anyway, Katie came on. She explained to me everything about looping and I had a bit of an epiphany that I thought it might actually help me help you. So I said, All right, let me try it. So sit back and relax and listen to the conversation that I had with Katie that made me think. Alright, I'll give this a shot.

Katie DiSimone 4:15
My name is Katie De Simone. And I work for tight pool now. And I'm also part of the DIY loop group. So I have a little bit of dual hats in that respect. And so sometimes I try and clarify which hat I have on.

Scott Benner 4:31
Which one are we wearing today? Both one?

Katie DiSimone 4:34
I'm imagining probably mostly the DIY Katie hat. Because loop has had a very exciting announcement this week that it now integrates with the Omni pod.

Scott Benner 4:45
Okay, so if you have to change hats, just make an announcement before it happens.

Katie DiSimone 4:49
Yep, we'll do.

Scott Benner 4:51
Katie, I'm gonna give you a tiny bit of background on me and what I think is probably the feeling of more people than should be and And then we'll move from there. So my daughter is going to be 15. This summer, she has been using it on the pod since she was four. And because I think greatly, because of the things we talked about here on this podcast, her agency has been between five, two and six, two for over five years. She doesn't have any diet restrictions whatsoever. And we just kind of, you know, figured it out a little bit. But I also want to stay, I want to ride the wave, you know, on the crest of the wave, I don't want it to crash down and then just be, you know, going back out to see you. And I'm like, What's the loop? So I'm excited. I've said before that the documentation scares the heck out of me. But I got cajoled harshly by somebody online. And they were like, try, just try it. Just try it. And then she finally said to me, look by the Reilly link, and if you don't like it, I'll buy it from you. So Gina, this episode is for you. And for everyone else. I think we need to just first kind of it as simply as possible, let what loop means make sense to people? Can you do that?

Katie DiSimone 6:09
Yes. Basically, loop does what most of the general population I call a muggles, the people who aren't living with tea, Wendy, what most of the Mughal population thinks happens for tea Wendy. That's what loop does is that they see if you explain to a muggle that you have a continuous glucose monitor that provides you information about your blood sugar every five minutes, and you tell them that you dose insulin off your insulin pump based on your blood sugars, they assume that those two systems talk to each other. And that's, as we all know, pretty much not the case on any commercial product. These days, with the exception of very recent developments, relatively speaking of the 670 and Basal IQ, which does half of that equation, it responds to low blood sugars. So what looping does is that it takes that and closes the loop. In other words, your insulin dosing will actually be based on CGM data without having your brain involved in that or your fingers involved in making pump button pushes. So in the simplest form, that's what it's doing is that affecting any given time, you would have looked at your CGM data and known that you had eaten and thought, maybe I should give a little bit more, or I should suspend. Or I should decrease my insulin. That's what loop is doing for you. Now we're loop itself with a capital L. As opposed to a little case L of sort of the general concept of looping. What loop app itself does is that it puts all of that into a really simple, wonderful interface of an iPhone app. In all the traditional ways you love Apple products for their ease of use that you can just look at it. And it makes sense for what you're looking at. That's what loop is. It's an iPhone app that sits on your app where you can easily enter all of the information about the food you're eating the Bolus is you want to give where you're headed, what your settings are, it's basically all moved off of a device that you have to fetch out from underneath your sweater under your dress. It's all now on your iPhone, where you interact with most of your day anyway. And for my kid, the iPhone is almost an extension of her hand, because she's 16. She is on Spotify and Instagram and all of those other kinds of things. And so bolusing from her phone is a really natural place to put her diabetes management. For adult users, most of them are really psyched on the watch for bolusing and entering carbs. It's super discreet. You can do it at a professional meeting, and nobody's going to ask you, are you being rude or somehow ignoring things you can take care of it all on the watch.

Scott Benner 9:11
So most of you know that I'm speaking at the dancing for diabetes touched by type one event on May 18. in Orlando, Florida. If you're in the area and you'd like to come, I don't think it's too late. Check out dancing for diabetes.com. But if you can't make it, dancing for diabetes is like I don't know auctioned me off or something. All you have to do is go to dancing for diabetes.com Hit the Donate tab, make a suggested donation of $10. And when you do that, your name will be like in a hat. I'm gonna pull from that hat while I'm down there on the 18th. And I'm gonna pull up three names two of those names. I'm gonna have a 45 minute phone call with you. And one lucky name, one hour phone call and a 30 minute follow up and if you don't want to use the phone, we could FaceTime we could Skype, I could be out the window smoke signals. I don't care. Now listen, if you don't want to talk to me on the phone, I appreciate that but don't embarrass me okay, you hear what I'm saying? You guys gotta get on there and do this so I don't look like a schmuck. The expected numbers out of this the whole like Scott phone call thing Imagine if three of you do this I'm gonna look like an idiot. Alright, so don't do it for me don't do it for the cute kids dancing for diabetes. Oh, you know, do it for me do it for me so that I don't look identity. To have your name including this opportunity go to dancing for diabetes.com click on the Donate today button between now and May 17 2019. Make a suggested donation of $10. And be sure to mention juicebox in the notes. If you don't have internet access, or flat out just don't want to make a donation but you still want to submit your name. You can do it by mail. I mean, God bless you if you're gonna do that that's like a stamped envelope and I don't know what you're even writing there juice box and the thing and it's got to get there by this. I mean do it if you want. I'm just saying a lot of work. I hope to see on the 18th but if I don't, I hope we can talk

in its very basic form, all the things that we all sit around thinking are always simplified for us right like I think much like most people like artificial pancreas will come one day and what that means is my glucose monitor will talk to my insulin pump it will make decisions for me and I won't have to think about it. And that really is this it's this in real life. It's It's your right now it's Dexcom right you loop works with Dexcom CGM

Katie DiSimone 11:28
correct loop works with all the Dexcom CGM, so long as the g4 has share capability. It also works if you're on one of the older Medtronic pumps, it works with the older Medtronic CGM systems.

Scott Benner 11:42
Gotcha. And this is quite literally something that was done. I don't know what the word is. Is it a consortium of people like how do you think of it when you Is it a a cabal? Are you guys which is like what is? What is it exactly? Like? How did this how did this begin?

Katie DiSimone 11:58
The story started long before I ever got here. And it's a web of people in the most simplistic of forms, and it'd be too hard to name everybody who's been involved. But basically people across the nation were frustrated with where the state of diabetes gear was that it wasn't collecting information for the patient that it was residing in silos separate from each other and not being integrated. And so people started taking actions smart people who had the capabilities of and I use the term hacking, because that's what comes to mind for most people. But not hacking in the nefarious way. Hacking, as in I know my information is in here, I just want to see it, I want to use it to better. Basically all these people across the country, we're all working on separate parts, that all ended up through the wonders of internet, finding each other and they all moved closer together. So people who are working on understanding that Dexcom and making that more available before share was around, met with the people who were decoding the pumps and people who were doing algorithms, and they all started to form together till eventually, these closed loop components were all close together, okay, where my involvement came in, was my daughter was on Omni pad for about a year and a half after diagnosis, and was doing great with it. And then she started high school. And when she started high school, she told me Mom, I want to wear tube pump. I said, Well, why do you want to wear to prom? This is the opposite of where most kids go. She said, I want my diabetes to be more visible. Okay. It's an odd thing to request at high school time, but I'll go with it. And I said, Well, I've been stalking the internet. And I saw that these really smart people over here who are working on this open APS system will get on an older pump and I'm gonna have to get an older tube pump. So if I could find that maybe I could get two birds with one stone and automate some insulin delivery and that might help make our lives easier. So that's what that's how I ended up here was that my daughter wanted it to pump I knew I was gonna have to buy a used one mine as well. But the problem at the time was that the US pump system this open UPS system at the time was really bulky, and would require a lot more than a teenager was willing to give it time and attention to at the time. It's gotten better. So I was looking for small open APS systems and I was searching the internet frantically going, somebody must have worked to miniaturize this. And that's when they came across loop, which is a different system than opening EPS, but conceptually still the same automated insulin delivery based off your CGM ratings. So when I saw that it fits on a phone and it's a really small sleek form factor, it's that, yeah, I could do that. And when I got there and found where the project was, didn't have a whole lot of information about how to build it. So I spent a lot of time with Google, and putting myself out into uncomfortable spaces of trying to figure out how to build an app onto a phone when I've previously never done that. And with some help of some very nice people on the internet, who answered my questions, and Google, I got a built. And I was so excited. And it worked so well for us that my involvement that I committed to as a kind of pay it forward movement, is that I would write the documentation so that other people could come after me and be successful with it. So

Scott Benner 15:43
you're the translator you Yes, you took complicated, technical, almost geeky and weird and turned it into something my brain can absorb? Yep. Is that what's at the loop kit? Dot GitHub dot whatever dot fours? Yeah,

Katie DiSimone 16:01
even that, even that I wanted to simplify. So it's, it's loop docs.org LOPDOC s.org

Scott Benner 16:11
O P, I'm gonna write to a DSC s dot o RG

Katie DiSimone 16:15
and be intact. It's really, you know, honestly, I totally get it like when you when you come into something technical. From the first start, as soon as you tell somebody, you're gonna build an app onto your iPhone, half the audience leaves the room and goes, I can't do that. And what I promise you is that you absolutely can, it is really, really not as hard as hard as it seems. It's super, super simple.

Scott Benner 16:42
My understanding here would be that this is not, I mean, this is not a medical device company, right? That's giving you this, basically an algorithm that's going to tell your CGM gonna tell your pump what to do with the information from the CGM. So no one can take responsibility for this. If you do this, it's it's on you right now. It's it's do it yourself in the most most meaningful way you are doing it yourself, no one is helping you if something goes wrong, it's all on you. It's a decision you're making on your own. And it says that very much, right? I'm just saying now, it's the first time I'm looking at, at loop. docs.org says you take full responsibility for building and running this system, and you do so at your own risk. So if you want to get involved in this right now, Katie is going to tell us now about how to get it set up because and I know everyone who listens is going to be thrown off by this. I'm going to try it. And that trust me, Katie, you have no idea. Everybody's just like no, Scott said he was scared and he can't do it. And trust me, I am scared and I can't do it. But I think that by having Katie on the podcast, I now have a Sherpa that I can bug. I am going to figure out how to do this. And then I'm going to report back to you guys how I did it. And then I'm going to report back to you if I like it and whether or not we're gonna stay with it or not. Because Katie, while I believe that this is incredibly important for the large majority of people with type one diabetes, I think they're going to have results that they've just never seen before. We already have really good results. So if this improves my life, then I'm all for it. By the way, like I'm not I have no, I have no ego about this. I don't need to be making decisions about Temp Basal increases and Temp Basal decreases, like you know, throughout the day, I don't care if I would like it to just work. And so I'm super excited to try it.

Katie DiSimone 18:32
That's, that is, you know, you you just said something that kind of triggered in me. A funny part. But it took me a long time. We've been looping for two and a half years, roughly. And I've had an evolution and how I appreciate the system. When we got on it. We were fairly low carb only because it was the only way we slept at night. We just you know, we were going through an evolution we were only a year and a half in. It's a teenager, she's changing. We're changing. It was very, very hard. So we got on loop. And it was at the time, we were mostly focused on E one Z and blood sugar control and all of that kind of mindset. And then she became a tea and she wanted more independence and I wanted more independence. I didn't want to keep talking to her about diabetes. This was silly. That's just we had a life to live. And what looping has done is is made me realize just how much potential damage I was headed into with navigating that very complex transition of an independent type one team. And loop gave me back the ability to understand how to let her live her life and how capable she was and how she could do this and that the other Part of relieved for me is part of the reason I was doing so much help on it was I felt like if I shifted that responsibility that she was asking for even though she was asking for it, I still felt a huge, enormous guilt that I was somehow saddling her with now this enormous responsibility. And seeing Loup work for her literally like a like a, like a nanny, like a personal assistant that carries the umbrellas of the rich and famous stars. And, you know, the movie festivals kind of thing. Like, who can afford that? That's how Lupe has been for us is that it's this umbrella carrying personal assistant for her. That makes that shift over so much easier.

Scott Benner 20:41
Yeah. Insulin concierge? Yes.

Katie DiSimone 20:44
That's a great, that's a great term for it. And so,

Scott Benner 20:48
Katie, patent pending?

Katie DiSimone 20:49
I think you should. That's your new that's a new hashtag, you should, should do that. Because it really, it redefined how our relationship was. And it took a lot of diabetes conversations off the table, which I'm so grateful for. And it wasn't at the expense of good. Anyone see results or all of that kind of stuff. It was less effort, less lows, great a onesies and less conversations. It was win win win all the way around. Yeah.

Scott Benner 21:16
So we have. So here's where my excitement lies as I sit here and just look at this image that you guys have up on the screen of the the loop app on an iPhone. So I'm not even though there are a couple of people who like to say that I have a lot of ego and I brash about, like how well we're doing. What I'm saying here is, I have gotten this figured out, my daughter doesn't go over about 151 70, more than about twice a day, she doesn't get dangerously low more than maybe about once a year, you know, we don't get under 70. Very often, she's mostly between 70 and 120 give a lot of stability. But it's come through these things that I'm now realizing as I'm staring at the algorithm, there are these things that the algorithm understands mathematically that I understand. In English, I don't know if that makes sense or not. And, and so I'm super excited to see the feedback from the app as far as like active insulin, insulin delivery, and glucose levels. Because I actually think that this app can take me farther in my understanding that I am and I really thought I was about at my peak. Honestly, I didn't think there was much more I can understand about this. But seeing this information, I think I can mine a lot out of it. And and, and really go on to be able to describe to people who don't have this app, my ideas but in better detail, and maybe more easy detail to understand some bumps. I'm getting excited. So this is good. Okay, so let's go through a couple of things

I need a Dexcom I have that. I need Omni pod because it works with Omni pod. Now I have that and then I need something called a Reilly link and as soon as you say that in the past my brain would go okay, I'm out Forget it. Right. But but but let's let's make it let's take away Riley link. And I don't know did you see Spider Man into the spider verse by any chance? No, I have a tastic movie you really have to make time in that one of the Spider Man men Spider Man's one of the guy's calls something electronic a goober he says there's always something like this in every one of my problems. I just call them all goobers. So let's call the Riley Linka goober. Okay, and so. So the pump has to get information from the CGM and your phone needs to talk to everything. The problem is, how does a phone talk to an insulin pump? It talks through the goober so that's it the goober is the bridge the Riley link is the bridge. Don't be scared by it. It's a thing that makes a connection in the future. There'll be there'll be some the I guess the Bluetooth pods right when for Dash comes out and then you guys will come out with something where that's right in the app and then the Riley link will be gone at some point, right?

Katie DiSimone 24:20
Yeah, so the DIY Katie says the Riley link is necessary because the pump speaks one language and your CGM and phones speak a different language. Gotcha. Your your phone and your CGM are speaking Bluetooth. There are over there speaking that one language your pump is speaking with radio. And so those two languages need a translator. And that's what the rilink does is it bridges or translates between those two different languages. So what tide pool Katie's hat is saying is that the next phase of looping will be when you don't need that translator and that the pump is speaking Bluetooth. and the phone is speaking Bluetooth and your CGM is speaking Bluetooth you don't need a translator anymore. And so the phone will be able to directly communicate with both devices. And so tide pool loops development is focused on insulin pumps that have an eye pump designation and Bluetooth capabilities built in.

Scott Benner 25:24
And can I ask tight poke at a question real quick? On the pods all for this right? Like I've spoken to them, they're super excited to have a relationship with tide pool.

Katie DiSimone 25:34
They are incredibly supportive. And kudos to them for recognizing a community need and stepping up and partnering with tide pool to do that I I am as a parent of a team Wendy actively involved in the DIY community incredibly heartened by the commitment they've made with title to bring that forward. Yeah,

Scott Benner 25:58
because at some point so that people understand, you know, let's say that we don't I obviously Katie's not gonna tell me timelines, and because you need to be able to hit timelines and their company and all that stuff. But let's just make up a day and say that a year from now, tide pools going to have this setup. So you don't need your grouper. And it's just going to talk to the Bluetooth pods right? On the pod might not be ready with their horizon system by then. But you can use you'll be able to use basically tide pools algorithm with loop to do that. If one day or when one day, excuse me on the pod comes out with their horizon, you get to decide you get to use their algorithm, then try the loop algorithm and say, well, listen, I this one works better for me, I'm gonna use this one on the pod completely okay with that, for those of you who are who are newly diagnosed, and have not been around diabetes for a decade, or more, like like I have, that's unheard of, for a company to just be like, hey, you know what, if this works better from you, and it's not from us, we don't care. Just we want you to be happy. That's insane. Like no one says that. Everybody always wants you to tie down and locked into their thing. But this is the beginning of a whole new world. Super exciting, you should be genuinely jacked up that Omnipod Zed on this, because this is just, I think the beginning of a lot of good stuff.

Katie DiSimone 27:16
It's a monumental shift. And it really can't be oversold or overstated. How big of a shift this is towards understanding the needs of the community. And saying, I believe that the marketplace can

Scott Benner 27:34
absorb this decide for themselves too.

Katie DiSimone 27:37
Exactly. And there's so many people that aren't on pumps. And I think there is a huge portion of people that aren't on pumps, not just for access issues, but also for choice issues is that there's not a product that offers them a lot of choice, you're locked into one. And for Omnipod to say hey, listen, we support our product, we support this new tide pool, whatever the system is, like you say there into the interoperability and you can choose and it's amazing, it really, it's it's visionary, and I'm completely supportive of that kind of vision. I think tide pool has that vision to putting on a little bit of a toot their horn here, but really a nonprofit coming in and saying we're gonna take on this, this huge task, it really is a lot of work. If it's amazing, and we have JDRF support for tide pool and Helmsley Family Trust is sponsoring a job observational study for loop users in the US, that's going to provide a lot of insight into how the system's working for people. So I really look forward to kind of getting this project down the road and showing what it can do for a lot more people who perhaps like you mentioned at the start, look at building an app on their phone and say, That's just not for me. Yeah.

Scott Benner 29:03
Okay, so we're gonna get to the building part in a little bit. But I wanna understand the using part. First, I want to talk about the fun part before I talk about the heart. Okay, so, Katie, you don't know me. But when my daughter gets a plate of food, I look at it. I think that's 12 units. And I'm gonna break it down into an extended Bolus. I'm gonna do 30%. Now do the rest over half an hour, we're going to do a Temp Basal increase of 75% for an hour and a half. And that's that. And then if I'm right, great, and if I'm wrong, I adjust. I don't count carbs. I don't know my daughter's insulin to carb ratio. I don't actually believe she has one. I don't believe any of us have one. I don't think there's a static insulin to carb ratio. And I don't think there's a static Basal rate. I think all of that some old timey BS way before this stuff was available to us before this technology. I think that was just the best people could do. And so how different is it going to be for me now? When that plate of food comes out, do I still get to guess at how much insulin is? Or do I now have to count the carbs? Or what's the real? Like how does it work in a real life situation plate comes out. What do I do? Are you looking for delicious low carb snacks and meals? Well, if you are, look no further than real good foods. You ready? You want to hear it. They have newest offerings, breakfast sandwiches that come and sausage and bacon of course they have the chicken crust pizzas, and personal supreme personal pepperoni and personal three cheese. Cauliflower Crust Pizza lovers. Do not miss the vegetable pizza, pepperoni pizza margherita pizza and cheese pizza. All of these come in delightful variety packs as well as one at a time. Have you had an enchilada for lunch lately? How about a pork enchilada chicken enchilada beef cheese, or go crazy and get the mixed case. Real good foods also has real good poppers bacon and cheddar, jalapeno, white cheddar, artichoke and cheese and pepperoni and mozzarella. Maybe you want the chicken crust pizza, but you don't want the personal size, go to the seven inch, again, cheese, supreme and pepperoni. And if you go to their website, they got a pro tips area. Now it's not like our diabetes pro tips. These are pro tips about how to cook the real good foods to perfection. Because real good foods want you to have a real good experience. Now what could make your experience better, better than having what I've just described you sent right to your home is having it sent to your home and paying 20% Less, you'll see other coupon codes out there for real good foods for 10%. But please, I told you a good foods for the Juicebox Podcast listeners 20%. I demand that and so it will happen real good foods.com use the offer code juice box, you can also find a link to real good foods in the show notes of your podcast player and at juicebox podcast.com.

Katie DiSimone 32:01
Yeah, so for you, it will be an adjustment because conceptually, the same statements that you just made all still apply. The difference is, instead of knowing your insulin dosing, you're going to be refocusing on carb entries, because you will have to use a carb ratio still, the whole premise of loop is that it makes a prediction of your blood sugar over the next six hours, and it says this is due to these factors. And one of those factors is your carb entry that you put into it, you say I'm going to eat 12 grams, this is what based on my carb ratio and my insulin sensitivity and how much I have on board, this is where it's gonna go. So the carb ratio is still an important part of making that prediction line. That said, it's, it's not an insurmountable shift, because I actually was much like you prior to going into looping is that I knew these things needed to extend a Basal and these things needed. Or extendable as, excuse me, or maybe these ones get an extra hit of insulin in two hours. Those kinds of things all translate and instead now instead of saying I need two units here, you get a carb ratio, and you say, Okay, if that previous thing needed two units, and my carb ratio is one to 10, you just do it now as a carb entry instead of an insulin entry. So well, it will be a shift,

Scott Benner 33:38
okay. And on the image I'm looking at right here, there's like pictures of like, I see a taco, I see pizza and I see candy, do I tell it 15 grams, and it's this kind of food?

Katie DiSimone 33:47
Yeah, see, that's the really cool part loop is the only system that does this. So for people who know after, after you eat a pizza for the first time, you know, if you gave everything that you need all upfront, you'd be low, and you'd be incredibly high later. So what loop dies, it's got this really amazing ability to extend your carb absorption and say this foods going to be a really long, slow burner, I'm going to be fighting the impact of this meal for six hours, or four hours, you can tell it that and the way that as you described, you know your meals, you know that this meal impacts your daughter this way. And it might not be the same for everybody. But everybody kind of has a sense of this particular plate of food kind of does this. And you can tell loop that ahead of time and it will watch for you. So for pizza, for example, let's say you have 100 grams of pizza, and you know that you need about 60 grams worth of that bullet up front. And maybe 40 grams of that later. And you think a bit in terms of your Temp Basal is that you send stuff but you could say I need about two thirds of that upfront and maybe a third of that whole Will insulin amount later loop actually has that built in, when you tell it your food is going to take a long time to absorb, it knows that if it throws all of the insulin on board early, you're gonna go low early. So it will withhold some of that Basal some of that Bolus recommendation, because it's going to keep you from going low early. And by withholding it early. It also knows that you're going to need some later and it will automatically add that as high Temp Basal as soon as your danger of going low, has passed. So it basically functions as an extended Bolus for you when you push that pizza button. Yeah, so

Scott Benner 35:42
I have to tell you that I had I'm so bad with names. But like two years ago, I had that that woman on the girl who like made her own AP, like, you're gonna know who exactly what she has? Yes, Dana, I had Dana on. And I had Dana's husband on, they did him in two different episodes. I don't know why I did that back then. But I thought it was interesting. And what I took away from those episodes where I just asked, that still is like a silly question. I was like, So how often does it Bolus she was really most of it's handled by Basal rates. And I thought to myself, like, it was like, somebody clocked me in the head and the light went off. And I was like, That makes so much sense. And that's it, that conversation helped me, you know, supercharge what I was already doing. I was like, oh, okay, I'm going to use more basil. As I look at this, my next question is, does it learn? Does it learn?

Katie DiSimone 36:34
Yes, and no, it doesn't learn long term. So for example, it's not looking at your last day or week and say, Oh, you look like you're running a little sensitive. It doesn't do that. But it does do some near term looks at how it itself has been doing. It looks as its own predictions. So basically, it looks over the last hour. And it says How close was I and if it thinks that it was really far off, it will wait the next 30 minutes of data and say I've been off a little bit, I'm going to help you out a little bit more, because something's going on in the near term. And we'll fix that. So in the short term, yes, it looks at its data, but it's very short term, in the long term. So there's this one thing you're talking about, like learning systems within loop, there's a really incredible line within loop. That's called insulin counter ACTION EFFECTS. It's a big name. But basically, what it means is that loop has a screen that you can tap on. And at the end of the meal, it will say you told me this was a 50 gram meal, actually, based on your blood sugar response and how it handled it, it actually hit you more like 63 grams. And so you can actually learn a lot from loop. When you look at your food at the end of the meal, you can go, wow, you know what? I see what it's saying, based on my blood sugars, that meal treated me as if I was 80. So you know, nutritional labels aren't right. And sometimes you're at a restaurant and you're like, I'm still trying to learn this meal. How, how much do I give up front? How do I, how do I Bolus this meal loop will provide that imp that impactful statement towards you, or for you at the end of the meal and say, Hey, that meal treated you like this. So the next time you go back to have that meal, you'll be better informed.

Scott Benner 38:25
So this is like a blown up idea behind all carbs aren't created equal. And yeah, and it's an extension of what I told you where I say I stay flexible, I put the insulin in and I see what happens. And then I stay flexible. So in for your knowledge. If I were to do a you know, do the regular Pre-Bolus that we do you know as far as time goes, and Arden starts eating and 30 minutes later, I see a diagonal up arrow, I do what I call stop the arrow, I stop the arrow from from going up, I use little bits of insulin to make a stop. And then the next time I would say to myself and I preach it to people all the time. You look at a meal and you think oh that's five units. And then you later use a half a unit to correct it. Well then next time don't look at the same meal and go that's five units say to yourself, that's five and a half units.

Katie DiSimone 39:14
You can't see me I have my hands in the air gone. Yes, yes. Yes, exactly. is dynamic thinking is probably the biggest tool you have in your tool belt for a successful

Scott Benner 39:26
career. I wish I knew what a moron I was that anything in life has struck me well is is absolutely a miracle but that I figured this out, you have no idea that it was me. Doesn't make any sense. Like this is not something I should have figured out. And I don't know how I think I A lot of times give a lot of credit to writing on my blog for so long and wanting to help people and seeing that I had to find out what worked for me. And then I would wait months I would never share anything right away. I'd like let me make sure this is really valuable before I tell somebody about Got it. And then I would tell them about it. And I kept building. And before I knew what I realized I had like these, like 10 basic tenants of how to keep a blood sugar stable. And I was like, wow, this is like a system. Like, it's a way. Like if I put it all together, it makes sense, you know? And still, I swear, I really wish you knew me because that I figured anything out is just hilarious.

Katie DiSimone 40:20
No, it is it is absolutely huge to have a dynamic attitude. If, if I always put it as respond to the information you're seeing, not the information you thought. And so if you're seeing that a meal is actually cheating you like 10 grams more than what you thought you had to give more, take that into account the next time

Scott Benner 40:42
and if the people who are listening aren't thinking right now, trust what you know is going to happen is going to happen, then you have not been listening closely enough. Okay. So you have to trust that what you know is gonna happen, it's gonna happen, you can't get high every morning at 8am. And every morning at 745 think, Oh, well, I hope it doesn't happen today. It's gonna happen. Give yourself insulin now. Right? Like so? Oh, I'm not see. All right, okay, let's calm down. Because I think we're coming up to the point where I'm gonna get upset and sad. So I see how it works, I see that my daughter will be able to, you know, count carbs and do things like that. I also, by the way, believe, holy that people eat mostly the same thing over and over again. So it's not like you're counting carbs forever, or trying to figure out how much insulin a meal is forever. Usually, you eat about the same 20 or 30 or 40 things, eventually you'll figure out figure them out. Dex, calm, you want a Dexcom, you might not know you want it or maybe you do know you want it one way or the other. You'll want it dexcom.com forward slash juicebox. Here's what you're going to get when you have a Dexcom, a G six continuous glucose monitor, you are going to get information. And as they say information is what do they say about information? There's a saying about homozygote? I know there's a saying about information. I got a right here. There's 486 sayings about information. It's not helpful. No, that's not it. Hmm. That's kind of deep from Albert Einstein, but not the one I was thinking of. Not that one. God, turn DNA is like a compute now. Or maybe there's not a saying about information? Well, I'll tell you what, I'll make one up right now, when you get the information back from your Dexcom, you make better decisions about your insulin. That's all. There's nothing else to say that information can come to you with a Dexcom. And a couple of ways. One way, share and follow available for iPhone and Android. You know, that means share and follow. Like there's an app share, and there's a app, you know, share app follow up. One of you probably like the person you love, who has diabetes has to share up and then another one of you, like a person who cares enough to pay attention to their diabetes has the follow up. And then there you go there diabetes does something that goes up because the ad is trending in one way is trending in the other. It's moving, it's dancing. As you can tell, I'm making this episode late at night. And I'm completely dopey. So just by a Dexcom dexcom.com, forward slash juice box links in your show notes in a juicebox podcast.com. You will not regret making the jump to continuous glucose monitoring with Dexcom. So here I am. I'm Scott, I'm standing in front of my microphone. And I have ordered my Reilly link, which is on backorder. And by the way, if you know anybody who can help me with that, Katie, I would appreciate if you put in a good word. It's going to come to me, my goober is going to show up in the mail. And there's other things I could probably be doing before it gets here. Is that true?

Katie DiSimone 43:48
Yes, you can do everything before it gets here. Except actually, you can build the app, you can get other things set up. If you're ready for it. If you're a Nightscout user, you could get your Nightscout set up you can you can do everything you can except for turn on the right link and

Scott Benner 44:09
Okay, and this is not going to get in the way, by the way of my Dexcom share, that's still gonna work fine. Everybody's gonna be able to see that stuff.

Katie DiSimone 44:17
Totally. It's still you can still actually use your exact same Dexcom app, your Dexcom alarms are all still the same. Basically what Luke does is it eavesdrops on your dex comms communications, and so it doesn't interfere with your Dexcom.

Scott Benner 44:31
Okay. All right. So, if you were me, what would you do first?

Katie DiSimone 44:38
If I were you, what I would do first is kind of conceptualize what your game plan is. Number one is, get your computer up to date and also kind of let me take one step back on my Instagram account. I do have a loop advent calendar that I did just kind of on this topic, as I was trying I need to prepare the community with this is coming. And here's a really small digestible day by day. Advent Calendar of day one, make sure your computer is up to date. Do you have Mojave macOS? I'm kind of explaining what starts to sound like technical stuff, just pay make sure your computer is up to date. And it has my Mac, is that right? It does have to be a Mac, yes, it has to be a Mac running what they call Mojave operating system, which is their latest one.

Scott Benner 45:30
Oh, I see your Instagram account. Look at you. You're delightful. Look at this. Very nice.

Katie DiSimone 45:36
So yeah, so you can run through each of those admins day by day and just sort of take it in tiny digestible chunks. And do each of those. Basically, you prep your computer and and this is the part that looks intimidating on the website. But it's actually not is that each of these are natural stopping points as I've tried to lay out the pages in the building the app section into natural stopping points. And so you prep your computer, basically, you want to make sure your OS is up to date your operating system and that you download a free app from your app store that comes from Apple is called Xcode. And basically what Xcode is, is like you present that code for the application for the loop application. And it compiles it all and builds it into a nice little package, you plug your phone into your computer, and Xcode puts that app onto your phone. So you're literally downloading the loop code from us online. And you're using a free app on your computer. You press like four buttons, and the whole thing builds by itself. That's how easy it is

Scott Benner 46:43
fancy as now, yeah, I have already while Katie was saying that, even though I swear to you, I didn't know she was gonna say it. I've already downloaded Xcode onto my computer. Yes,

Katie DiSimone 46:58
that's step one. If you get that on, it's actually a pretty big download. And believe it or not, that's the longest part of building a loop app is downloading. Okay, and then I have a cup of coffee, and you're good.

Scott Benner 47:10
Okay. And I need a developer. I have to be like an Apple developer. Right? Yeah. Because Because for everyone listening, I am technically making my own iPhone app right now. And they're gonna give you obviously all, you know, Luke gives you all of the instructions and the you know, and the code and everything you need for it. But you have to do that because it remains your responsibility. And yes, right. And in the future, if I want everything, you know, work in the way we want it to work, but tide pool and everybody's got their Ok's and their FDA clearances and everything like that, I will just download this app from the App Store I'm assuming or downloaded from tide pool.org or something like that. And it's gonna go right on my phone, I'm not going to need to be a developer or have Xcode or anything like that. Is that right?

Katie DiSimone 47:52
Correct. The tide pools project is basically taking the fundamentals of the DIY loop system, and taking that through FDA approval. So the study is going to help solidify what needs to be done to make that app able to be distributed as a medical device under FDA approval through the App Store. So yeah, that's where the that's where the two projects between DIY and type lube start to diverge is that concept of being able to download this on your app store on your iPhone, and what needs to be done to make sure that all the FDA clearances are done.

Scott Benner 48:32
So yeah. So so tight pull Katie, eventually, this is just going to be checkboxes and drop down boxes on an app.

Katie DiSimone 48:41
Yeah, what we envision is that you'll as type hello, Katie, I'll speak now is that you get to go to your endocrinologist, talk to them about your settings and your carb ratios and make sure that you have some reasonable settings, they prescribe a type of loop for you. You have your components, and you get to go to the App Store with your prescription number and download it.

Scott Benner 49:05
Okay. All right. Let me think. I'm thinking that it's coming in my head, I'm figuring it out. So it's going to look, it's going to look like a lot but Katie has as a person who's done this, not knowing what she was doing and getting what would probably be the best expert advice that she could as she was going along, has turned it into the simplest steps you could possibly have now. I'm going to do this and I'm going to whatever my Reilly link comes, I'm going to I'm going to be ready. I'm going to be set up and I'm going to go and I'm going to try it and see what happens. What is my expectation for a person who lives between 70 and 128? Like, in my mind, I think my first excitement is going to be sleeping soundly overnight. Is that is that the simplest win that I get from Luke, do you

Katie DiSimone 50:01
Yes, for sure sleeping through the night is unbelievable. I think I didn't know what I had started missing until I started sleeping again. Good example last night, my daughter was out to the movies with their friends and needed a ride home at 130. In the morning, it was a drive in double feature far away. And so I was up until 130. In the morning, I can't even tell you how tired I was. Because I've gotten used to getting a full night of sleep all the time. Now, it really was daunting to have to go back to the olden days of missing hours of sleep.

Scott Benner 50:37
You're making people cry right now you don't realize that but there's like 1000s and 1000s of people listening and they're like weeping in their cars. And while they're working out at the grocery store and stuff like that. So that's, yeah,

Katie DiSimone 50:47
I'm a I'm a different person. When I sleep. I'm a nicer parent, I'm a better spouse. There's like a lot that goes with sleep. Yeah.

Scott Benner 50:54
There's plenty of conversations in this podcast where I tell a story about I was so exhausted at one point, and I didn't know it. And then I went away for a week without my daughter. And about the third or fourth day into the trip. I thought to myself, Oh, my God, this is me. Like I remember having thoughts like this. Yeah. You know, like, and being clear headed and that sort of thing. So that's my, that's my excitement. Can I ask you something? Yeah, say I decide I like loop for sleeping. But I want to just stick with what I do for eating, can I do that

Katie DiSimone 51:26
100% You can turn loop has one slider, it's super simple. It's called I opened or closed loop. If you open your loop loop will let you just get the recommendations but not automatically put them in. So it will use your scheduled basil just like your normal pump therapy would, it would just give you your basil that you have programmed in. And you can choose to deliver the insulin any way that you want to, you can enter the carbs, and you can choose your particular Bolus sport. So let's say during the day, you want to say, You know what, I still am working out my carb ratios, I'm still figuring them out. I just kind of want to do it one meal on a convenient Saturday and see how my settings are. But in the meantime, during the week, while she's at school, I just want to keep to our old paradigm until we can get to, for example, right now I'm thinking summer, you know, summer, I'll be home, this will be easier. Absolutely. You can go to school, keep it an open loop, they can enter their carbs, provide whatever Bolus number they want, and loop won't be taking any extra action. And then when you come home at night, you can go ahead before you go to sleep at night, you can turn on the Closed loop switch, you just toggle it right over. And it'll be looping overnight.

Scott Benner 52:43
So being an open loop would show me what the algorithm is thinking because it would say to me, Hey, right here, if I was you, I do a Temp Basal increase of

Katie DiSimone 52:52
absolutely, oh, every five, every five minutes across the top, you'll see the recommendation update. And I'll say this is the new Basal rate I think you should set so you'll be able to see if it's greater than or less than where your existing settings are. And you'll see the prediction too, as well. You'll see the prediction go up and down. I think that's one of the first things that kind of freaks people out as they see that prediction. They're like, Oh, do I cheat a low now because it's chosen six hours, I'm going to be low. That prediction line is always as if no other actions are taken. And that's the whole thing is that loop is going to take actions to prevent or change what is in the future. So if you see a low coming in six hours, you don't need to treat it right now. loops going to be cheating it for the next six hours and staving that off.

Scott Benner 53:43
And so that never happens. It's just like a time travel movie. In a time travel movie, sometimes they show you what's going to happen in the future. But then the people in the past make better decisions in the future never happens.

Katie DiSimone 53:56
Yes, that's exactly what loop is doing for you. Is it saying? Oh, wow.

Scott Benner 54:00
And Katie, by the way, now you know why the podcast is popular because I can take incredibly complex things and turn them into moron talk that everybody can understand.

Katie DiSimone 54:10
I have tried to do that with loot building instruction. So I think you're I think you're my kind of people

Scott Benner 54:15
like seven year old in my mind. So okay, so I also just realized I might be more people are gonna laugh because I don't think I knew this about myself. I think I'm more of a diabetes geek than I thought I was. Because when you said you could open the loop, and then see what it was thinking. That to me takes me back to back before CGM when I used to test on it all these wacko times that my endo would be like, Why did you test 45 minutes after she ate and I was like, Don't you want to know what's happening? And she was like, No, and I was like, No, I think we should know. You know, like, I'm gonna keep testing. She'd always be like, I don't understand how you're a one sees her like this. But you're showing me all these weird blood sugars that don't make sense. I'm like, because I'm tracking what her blood sugar is doing so I can make better decisions. I really think I really think that with six months with loop, I might have to have my head made larger, not for my ego, that one person that left the review, but for my knowledge of diabetes, because I really think this is going to just kick it into another stratosphere.

Katie DiSimone 55:14
It really, it's a truth serum, it really tells you a lot about your settings, your understanding how you conceptualize, reacting to things. For example, a lot of people as they're getting used to this are impatient with insulin, they'll say, I don't want to wait it out. And they'll rage Bolus or or they think the rage Bolus, and they're actually not even bold enough with insulin, you know, and they say, Oh, I'm so scared of going out, having the feedback from a loop constantly telling you, hey, here's what I would do. And here's oh, by the way, your meal absorbed 20 grams more than you initially told me it would be and lasted, it also tells you the time and took two hours longer to digest than you expected. That kind of information is so powerful to relieving the diabetes burden, because it's fine tuning your expectations. And when you change your expectations for going into it and say, Yeah, you know what, it's okay that this meal choose me as 65 I feel comfortable, something has helped me learn better.

Scott Benner 56:21
Okay, I'm so proud right now. And I don't know if you did that on purpose. Or if that was by mistake. Either way, I'm proud. You said bold with insulin, which is really the whole tagline for this podcast. It's that's my hashtag. It came from here, if you don't know that, I'm just thrilled that those words are somehow in your brain, which means it's getting out in the to the stratosphere. And if you did know that, I appreciate you listening.

Katie DiSimone 56:45
Well, I actually heard that from a podcast interview you had with T one Junebug because she's a good friend of mine for several years. And I saw her use that phrase and I thought yes, that rings true. People are scared to dynamically think they'll see the same blood sugar rise, the same blood sugar rise, the same blood sugar rise, and yet say but the label told me it should be 10 grams or my endo told me it should be this and, and stringing that along. And and being a more dynamic thinker. And being bold with the insulin taking the insulin you need for what you've seen over and over again, is really good dynamic thinking.

Scott Benner 57:29
Yeah, I appreciate that. I was just speaking with a mom last night. And I said to her, you have to I said, I know that. You know, I haven't given you any advice here because I don't give advice. I just pass on my own stories. But I told her I was like, I can give you this one piece of advice. I said, I would stop thinking about all the things that people have told you to do, and told you not to do and just apply a little more common sense to this. You know, like, like, stop overthinking it, your blood sugar's high, you need more insulin. That's kind of just I'm down to like, if I see something online, people are like, look at this graph, and I go and I type more insulin. And then I hit Enter, because I can't I can't explain it any more. We do it here enough. But sometimes I'm just like, how can you look at a 300 blood sugar and think I don't understand what's wrong, I know what to do. Of course, you go, what's wrong, you didn't use enough insulin. And so

Katie DiSimone 58:21
it's not going to be it's not going to be the same and it's not going to be perfect. My daughter gets nervous around certain situations and her blood sugar spikes. And Luke doesn't know that's coming. Nobody gave it an announced warning. Nobody gave me an announced warning or my daughter. And so there's ways that you can help correct that faster as well. You can still override and give more insulin and give a correction. There's a lot of information built into loop to help you with that decision making process if you choose to take that interactive Step. If you're the type of person that just says you know what? I'm happy. I'm happy with a little wider range. And I just want less cognitive burden of interacting with it today and or longterm. You can let Luke do that as well. It has all the information put in there that it will meet you at your comfort level and help you make the most of where you are. I'm gonna say

Scott Benner 59:17
something real quick. And then I'm gonna ask you a question. What I'm going to say first is for everybody listening who has come to count on the podcast, I just want you to know that even if I do this and stay with it, I think it's only going to enhance my ability to talk to those of you who aren't doing this. So don't worry about that. I think I want to ask, are you comfortable telling me what your daughter's a one C is on loop?

Katie DiSimone 59:38
Oh, yeah, totally. She started loop at 449 I think and again, we were low carb heavily intensively, lots of work, lots of communications, lots of texting, lots of less sleep. So we are working hard. She is now Got a five, six? What was her last 156? I think, and she is as high carb as they come has become a vegetarian. So we have no, no like low carb meals ever. And she is completely independently operating and bolusing and doing everything through loop. I have not told her how to split a Bolus in, I'm gonna say a year. She is completely handling all of that just by loop recommendations and putting it into loop. I hope I don't tear up, it has changed everything. I now have the space reclaimed for what used to be diabetes conversations I now hear about her friends at school, I hear about the things she wants to do I hear about going to the beach, and can I go on a date? And I hear the things that I'm supposed to be hearing and they're not laced with? Don't forget to bring diabetes into this conversation. I don't have to do that.

Scott Benner 1:01:04
Don't forget, did you I start too many sentences with Did you? Or you know, can you tell me or what does the say? There's, there's still listen, I'm gonna be honest with you. We don't talk about diabetes around here very much. Because we really are, we just have a rhythm. Like I don't know another way to put it. But at the same time, it still happens. And if it could be less, that'd be amazing. And if it's less for me than I imagined, it's going to be much less for a lot of other people. I have to say that this is this is the future that I always imagined, I always thought it was going to come more in like 2020 like writing that was my kind of estimation. And I was always happy with that because I thought well, that's still a couple of years before are no go away to college. So I'm okay with that. But just the idea that it could happen sooner.

Katie DiSimone 1:01:57
It's got me It's amazing. I'll give you an example. When my daughter goes to summer camp, we always talk well, do you bring lip? Do you not bring loop? And, you know, I realized that sending her to camp with a non FDA device puts a little bit of burden, an ask on those camp staffers. And, you know, so I'm cognizant of maybe we don't loop when we go to camp and certain camps even don't allow it. But our particular camp is supportive. And but it's always, it's always funny, she goes to camp because she doesn't want to feel different, right? She's got her her crew, her tribe. And she doesn't feel different around them. But she does feel different. She's perceives this if we talk about it in April, or may have going to camp using loop because she's worried none of her other friends will be using the loop. And so we have this conversation every summer for the last two summers about whether or not she's going to live there. And every summer, she goes into it telling me, Well, I'll probably take it off while I'm there. I'm taking it now. But I'll probably turn it off because I don't want to be different. And she never turns it off. And she comes back to the pickup station after two weeks away. And all of her friends are around her and I'm telling you it's like a little gaggle, there'll be five teenagers with her that I'll go. Katie, can you get us on loop too? You want to use it too? And so, you know, I kind of take that, as my bellwether of how good the system is, or isn't is if adults weren't involved and parents weren't involved, what would the kid decide to do? Because I think that's a really important aspect is the informed decision making process involving the kid and letting the kid be a part of that? And so when she comes back from camp, and there's five kids with are saying, Can you help us? We want to do that, too. I think it's a good sign that the system is well designed and helpful, as opposed to an extra burden that just isn't useful.

Scott Benner 1:03:52
That makes a lot of sense. Can I pick your brain about something else as a as Yeah, as a person who's obviously given a lot of their time and effort to the diabetes community? I think that overall that shows the your concern for people who you know, who have type one and people who you don't know who have type one, I feel similarly. I don't ever have this feel fear. But I know some people do that if you take away the idea of how to manage diabetes, that if the technology is not available, you'll be lost. And I don't talk about that here. Because I think it's silly to make somebody struggle and cry and be upset and exhausted just so they can understand how a Bolus works. I don't think you need to do that. I have dedicated this podcast to fast forwarding people through that whole process. But I'm now I'm projecting into the future. Right. I talking privately and have been for weeks and months with a mom of a little girl who is so newly diagnosed that she is honeymooning to the point where she doesn't need insulin some days. And it's really going on for a long time. And I'm imagining her right now. And I'm thinking I could put this on her. And she would never know all of the tragedy that I've lived through, and that so many other people have lived through, like figuring out diabetes. And is that a good thing? Obviously, it is. It seems like it is at the onset. But what would happen if that technology like if her insurance changed or something happened, it was just taken from her? Do you think that she'd be gobsmacked blindsided by what diabetes really is without the technology? Have you ever thought about that? Like, I'm just interested in your in your like off the top of your head thoughts?

Katie DiSimone 1:05:39
Oh, yeah, I think I think people would be if it disappeared from us. For us. Would it be impactful? Would we notice it absolutely. Give you an example. We switched to Omni pods because we were having problems with sites on NEOs and Medtronic. So one day during a particularly painful yet again, cannula failure kink kind of issue day. She had to turn off loop, we were just perfect storm CGM fails. Me Oh, failed, we were flying blind. And she had to give herself a shot for the first time in two and a half years almost. And I was away from home, she was home alone. And I said, Can you do it? And she's like, Yeah, yeah, I think so. And she did. And it was daunting, and all of that. But that said, you do what you got to do. And I don't believe in keeping the covers on the couches, and not using the things that are great in life, just because something might fail later.

Scott Benner 1:06:54
I don't, I don't like it when there's fear mongering around advancement. And and I think it happens a lot. I think when Dexcom first came out, there were people running around going, you're not going to understand your diabetes. And I think there are people that tell people, you have to have a do shots for a year before we give you a pump. I think all of that, and I'll bleep this out later. I think all of that is okay, I think that you need to understand how insulin works in your body, and then you're good. And it seems to me that this algorithm is going to understand how insulin works in my body. Now should I still understand it? I should but I but what I'm foreseeing in the future is, is that you're going to go on this and write on the screen, you're going to see what's happening. And you will learn how insulin works in your body without ever having to fumble around with the algorithm is not just going to keep your blood sugar where it wants to be where it wants it to be. It's going to teach you how it's doing it visually. Yeah, that's what I'm seeing here. So now you'd have to translate that back to a pump without a loop or injections, if you got stuck in that situation, but you wouldn't be starting from zero, you'd actually have a fairly fast forwarded understanding of it, you're gonna put this podcast out of typo, you're gonna need to hire me if I can't get downloads on this podcast anymore. Because your loop seriously a fluke puts my podcast out of business, Katie, I'm gonna be pissed.

Katie DiSimone 1:08:16
I tell you what, it really died. That's like a truth serum are the assumptions that people had about their diabetes understanding is

Scott Benner 1:08:24
wrong, guys. You're always wrong. Everybody, I'm sorry to cut you off. Everybody who sends me an email is like, I think this is what's happening. I'm like, No, that's not what's happening. Your Basil is wrong. You know, like, like, no one ever really knows. Because it's, it's, it's, it's this false idea. And there I had somebody on recently who said this thing that just struck me. He said, You know, if you put a pencil in your back pocket, and you rob a bank, pencils don't cause bank robbery. But But somebody thinks it does. somebody sees this cause and effect, and they just say, I saw this, then this happened. So that thing must have been the reason why and we make that mistake so often. And diabetes, it's not funny.

Katie DiSimone 1:09:00
It really it's such a true serum is that people get on when things are automated. That means it's using the same assumptions you put into it. And when those assumptions show, hey, you're trending high, or you're trending low, consistently, people are like, what, but these numbers were set in stone, i These were fine. I was doing fine. And what they don't realize is No, you weren't doing fine. You were you were taking a lot of manual actions to make it fine. Or you were adjusting in other ways that you hadn't realized. And so when it to two wrongs can make a right and diabetes, you can overlook things very easily by having two wrongs equaling a right. Yes,

Scott Benner 1:09:48
there are so many times that people are having a good outcome at 3pm. That's really just from mistake at noon and they have no idea. Yeah, it's really it really is. Once you see it It's I joke about that it's a little old of a reference. But once you see it, it's it's like at the end of the matrix when the bullets start moving for Neo, and he's just kind of like walking in between them and moving away like once you can see it, it's fascinating

Katie DiSimone 1:10:12
loop provides that visual, that visual interface to be able to see it. So one good example. So for example, let's take your correction factor or your insulin sensitivity. A lot of people have a wild guess at that, but they don't really know and they haven't tested it. When you see your blood sugar's on an automated system, kind of roller coastering, up, and then down and up, and then down, you're also probably gonna see what I called lightning bolts of Temp Basal. So you'll get a lot of Temp Basal action trying to correct a rising blood sugar and then suddenly, you'll turn low, and or not low, but you'll start heading down and then you'll come back up, and you kind of get on this oscillation of roller coaster. That's usually because your ISF is, needs to be higher number. So I don't know I'm avoiding using the word weak or strong because people have different impressions of what that word means in terms of where the actual number needs to go. But if you had put in, if you told loop, each unit of insulin will drop my blood sugar 50 points. And you start seeing that roller coaster pattern, that's a really good indication that your your value of 50 actually might need to be up near 70, or a different number higher than 50. Because you basically undersold insulin to loop, it's actually doing more than it expected. And so some of these things about loops, ability to inform you of your diabetes assumptions are really like strikingly obvious. As soon as you start using it, as you start seeing that you go Holy smokes.

Scott Benner 1:11:52
Okay, so I have a couple of just like, like fast paced questions here. So first day of a Dexcom sensor in the first few hours, I don't really lean on it for like, you know, I don't want to put a time on it. But until it's right, like until it's soaked in, it's really working. So do I just go into open loop during that time? Is that what yeah,

Katie DiSimone 1:12:10
you could? No, it's not what I do. But you could, my daughter basically usually ends up changing her sensor at night, which is, I think, the worst time to change a G six. And so the whole first night, we basically get a lot of false lows or compression lows. And what we have found is that basically, loop still does, okay, it doesn't. And in essence, what happens is that you get some higher Basal rates, you get some suspensions, and they all evened out over the course of the night to be okay.

Scott Benner 1:12:44
hammers out the kinks and gets it gets you Yes,

Katie DiSimone 1:12:47
yeah. And then when she wakes up in the morning, finally, the Dexcom is back on an even path, and everything's fine. So for the first 12, for us, it's you know, it will depend on the person, but for us, the first six hours of a new sensor are kind of jaggedy. If it's really far off, we can go into open loop mode, and it's no problem.

Scott Benner 1:13:09
Okay, what about different insolence? Do people see different or does it not like we use a pager? That's gonna be good?

Katie DiSimone 1:13:15
You send me up on that one. Yeah, actually, within loop, we have three different insulin models. So there's four, but three are based on the type of insulin and the user. So there's a rapid acting adult, which is like Novolog Humalog. For adults, there's one setting for children. And then there's another setting for fiasco. So and then each of those settings basically describe how the insulin curve works. If you after knowing your daughter and kind of looking at how things work, say, wow. On our particular insulin, we think it peaks at this amount of minutes, that's actually something you can customize within your loop to say it peaks at this time, we have numbers put in there that are based on the published data of how these things behave and clinical trials and all of the published data. But if you find that for you, your diabetes is different, you can actually tweak and customize some of those things.

Scott Benner 1:14:19
Okay, and so a lot of it's customized Like for instance, can I pick her target blood sugar?

Katie DiSimone 1:14:24
Oh 100% Awesome. That's

Scott Benner 1:14:26
the one thing I would just not like I don't I would I want to sleep more but not at the you know what I mean, not not to say that I don't know what the Medtronic artificial pancreas but it's like at 120 or 140 or something like a target up there. Like I couldn't do that. I wouldn't be able to make that decision.

Katie DiSimone 1:14:43
I'd say out of all of the feedback I consistently hear on the development of closed loop in the commercial market. That target setpoint is is the real critical piece for a lot of people. And on this one, you can set it anywhere you want. We have people setting At that are ultra low carburetors and have a single number target that they really aim for. And there's other people that are doing a much wider range and are. So yeah, it's totally up to you what you want to set it up.

Scott Benner 1:15:12
Okay, is it my so my last kind of nuts and bolts question is do I tell it when a new pumps going on? Like, how much does it care about how old the infusion set is?

Katie DiSimone 1:15:20
If you're on Omni pod, it keeps the theme, Standard Change cycle as Omni pod, it will alert you it's well at 72 hours. Omnipod tells you just pods done but at 80 hours, it really makes you change it and it says you're done done. Loop has the same things. And you can set a custom notification for when you want it to tell you hey, it's coming up.

Scott Benner 1:15:42
What about this? Here's another I said I wasn't gonna ask any more nuts and bolts questions. I have one more. What if a cannula like comes out a little bit? I'm getting some of my insulin but not all of my insulin? Does it know that? What's that? It's not seeing what it thinks it should be saying?

Katie DiSimone 1:15:57
That's a great question. And the answer is no, in a way is that basically, if it thinks you delivered a whole unit, but the cannula actually only managed to get half of that under your skin and absorbed, loops calculations will be a little off, it will think that you have more insulin than you do. And so what you can do is there's a couple of different options, you can open your loop, until that discrepancy wears off, and you get it all changed and figured out, you can open loop and just go back to normal pump therapy. Or you can enter in a fake carb, where you say, Hey, I'm going to eat five grams Bolus mean for these five grams. And basically you're tricking the algorithm to think your blood sugar will rise because you were eating. And so therefore, it will offset some of that it's a more advanced technique. And people kind of start using that in those situations once they become a little bit experienced. But that is an option as well to kind of say, Hey, I'm going to need extra insulin that you think is there. But wasn't there.

Scott Benner 1:17:03
We call that stuff ninja level. So yeah, okay, so All right, so here's what I'm gonna do it because we've been going at it for a while and I want to make this digestible for you. We're gonna stop, I'm going to say thank you. I'm going to ask you, after I get this back, when you come back on and talk with me after I've been using it for a little bit,

Katie DiSimone 1:17:20
I would love to, I think that would be great. And can I have an ask of you?

Scott Benner 1:17:24
I guess so. But I'm not taking my pants off.

Katie DiSimone 1:17:28
So that the ask is that I want to make this system better for everybody else. And make sure it goes there, you know, is able to incorporate all of these things like soliciting impact, feedback. And that job loop observational study is a really important part. And it's the best way that people have to pay this forward and provide meaningful impact. I would love it if people would take a look at the study and donate their data, it can all be done from home. It's super convenient. It's very fast and easy. And it provides important user information, especially from new users, or like just getting on the loop. You're asked questions about like, how did the setup go? How hard was it? Are you technical? Are you not technical? How do you view diabetes, all of that's going to paint this incredibly awesome mosaic of what kind of user experiences have been and just take the system into a better place.

Scott Benner 1:18:27
Okay, so when we've talked about it here, but the next time we talk, I'll give direct, you will be able to give direction instructions to people about how to donate their their data to that. That'd be great. Excellent. Okay, I don't want anybody to worry. I still understand how to be bold with insulin after a day and a half of looping. As a matter of fact, that loop, just like Katie said, is showing me things that I don't think I understood. But I'm starting to, and then I'll be back here to report to you. So whether you want to loop or not loop or lose skipped your Lu, or just keep doing what you're doing, or do what I've been doing for years, which might be what I'm doing again, I don't know how long we're gonna do this loop thing. We're trying it. I can't do a podcast of it don't understand looping. I mean, it's 2018 Wait, is it 2019 Wait, I mean, it's 2019. It is so late at night here. I'm out of my mind. I hope you found this episode interesting. And what Katie had to say intriguing. I certainly did. It got me off my butt to try looping. And as soon as I know what I think I'll report it back here. Huge thanks to the sponsors Dexcom real good foods, and dancing for diabetes. The links to everything you want to know about them are in the show notes of your podcast player or at juicebox podcast.com. But you can always go to dancing the number for diabetes.com Real good foods.com use the offer code juice box, or of course dexcom.com forward slash juice box. I'll see you next week.

Thank you so much for listening today. Please keep Katie and her family in your thoughts and prayers. I'll be back very soon with another episode of The Juicebox Podcast.

#860 Type 2 Diabetes Pro Tip: Series Intro

A series for people with pre and Type 2 diabetes.

+ Click for EPISODE TRANSCRIPT

00:00:22 Type 2 diabetes pro tip series.
00:06:03 Understanding type 2 diabetes medications.
00:13:34 Importance of education and technology.
00:18:12 Individualized approach to diabetes management.
00:22:39 Diabetes podcast helps educate and support.
00:29:38 Food can be medicine for anyone.
00:33:54 Understanding the impact of diet
00:39:59 Guilt and shame in diabetes.
00:45:43 Misdiagnosis and stigma in diabetes.
The timestamp in the podcast where it starts to say "Standard of care for type 2 diabetes needs improvement" is 00:51:32. Standard of care for type 2 diabetes needs improvement.
01:00:03 Exercise is often overlooked.
01:04:22 Helping people with diabetes.
01:08:28 Nothing is impossible with persistence.

Scott Benner 0:00
Hello friends, and welcome to episode 860 of the Juicebox Podcast.

Welcome back, everybody. This episode of the podcast is going to be a little different than you're accustomed to. Jenny Smith and I are going to be talking today about type two diabetes, we've decided to put a type two series together, not dissimilar from the other series within the podcast, but focused on type two. This is the first episode, it's an introduction episode, and it's going to lay out what the series is going to be. While you're listening, please remember that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, always consult a physician before making any changes to your health care plan. If you're a regular listener of the podcast, I hope you check out this series and then really think about who in your life could benefit from it. If you're a person with pre diabetes, or type two diabetes who finds themselves here, welcome. I hope you enjoy this. And I hope it helps you. I really think it will find the Juicebox Podcast and your favorite audio app and hit subscribe or follow to get the next episode of the podcast and to continue to get this series.

These episodes are available, of course in any audio app by going to the Juicebox Podcast and searching type two diabetes pro tip. And of course, they're available at juicebox podcast.com, and diabetes pro tip.com. At the end of this episode, I'll introduce myself and Jenny to you. So you know a little more about us. This episode is being brought to you today ad free because of the generous support of Dexcom on the pod. The Contour Next One blood glucose meter, G fo Capo Penn ag one from athletic greens, US med touched by type one and cozy Earth. If you're interested in learning more about the sponsors, there are links in the show notes of the podcast player that you're listening in right now. And links at juicebox podcast.com. So, Jenny, it's good to see you again. I feel like I haven't seen you in a while.

Jennifer Smith, CDE 2:35
It has been a while. Yeah,

Scott Benner 2:37
I agree. Now, for the people on the podcast, they hear you all the time, but I haven't seen a little bit. So we're gonna undertake something, something it's been in the back of my mind for years. And I know you've talked about it a lot as well. And so I think we're a good match for this. So I'll just share with you that my initial idea around type two diabetes conversations. I thought to myself, like I have this podcast and this outlet, I can find people. But I'm not a doctor. And I don't know anything about diabetes, type two specifically, right? How would I help people with type two diabetes? Like how could I use the thing I have to do that. And what I kind of came up with is like, well, I could be the person. Like I could be the stand in for the person listening because I find that more and more of the people I talked to who have type two diabetes seem to sometimes have a very, I don't know what the way to say it is they they have a small understanding of what it is they're expected to do. And even what is happening to them, right. So while I might not have a lot of answers, I'll be I'm going to be your avatar. Listening, I'll be their avatar, I'll be the guy going I don't understand this. Explain this to me. And you'll be the person who understands that who says, Well, let me explain this. So but we have to figure out some bones for this series, like some structure, right? And because you and I don't work together, like every day, we're not sitting across from each other, something like that. It's not like we can talk at lunch and things. Right. So what we did was

Jennifer Smith, CDE 4:12
we don't have cubicles next to each other,

Scott Benner 4:14
right? So we're going to do the basically we're going to do the the setup part on this episode like we did with the ball beginning series. Yes. All right. So what I did was I went back to my private Facebook group, and I asked people I said, Hey, if you've got to type to list some things that you'd like to see in a type two Pro Tip series, I figured that would be a good place for us to start the conversation. I would

Jennifer Smith, CDE 4:41
expect there was a lot of feedback and I think if it if it reached the broader community of people with type two diabetes that are not listeners currently, but who are searching online for some type of tidbit of information to help i could imagine the Questions number in the hundreds. It was because of the lack of information given

Scott Benner 5:06
it was really something to see how many questions came and you know, my groups a little more. I don't know, sometimes they're a little more dialed in, but it's also a good mix. It's also a lot of people are like, I don't know what I'm doing versus I have some ideas. So I sent you that. Do you have the list? I do. Okay. Yes, yeah. So, thanks to Isabel for putting all these questions together for me,

Jennifer Smith, CDE 5:26
Isabel, in order of like category, which was lovely to see,

Scott Benner 5:32
Jenny saying that because she knows if I was in charge of this list, it's just,

Jennifer Smith, CDE 5:36
well, we can originally for the original pro tips, you know, we collected a list, and then I was like, we need to do these orders. Like, we need to start here and move here and go here. So this is very nicely organized. And

Scott Benner 5:51
I was like, here's a couple of ideas. And Jenny's like, this one would make more sense in front of this one. I was like, whatever. That's good with me. But let's go through and together. Let's mark things as stuff we want to do. Stuff we want to do and stuff maybe we want to do later. Does that make sense? Give it three orders. Alright, so let's go through this list. Of course, the question was, what topics would you like to see covered in a type two Pro Tip series? So the first thing here we're looking at is meds. Meds such as S G, l two Lt. Two GLP. One and they're multifunctional use? Well, there we go. I'm, I'm already the I'm already the avatar for people who don't know what they're talking about what the hell does that mean?

Jennifer Smith, CDE 6:36
Yeah, and I can tell you that this, the meds at least from what I can see in here, the meds list is it will be extensive. And there are different categories of meds, both oral and injectables that are not insulin that are used in the type two world and the list, the list continues to grow. So it becomes even a little bit more confusing for many people, because manufacturers have figured out ways to kind of put some of the meds together in one pill form so that people don't have to take like four pills at one time. Right. So there are multiple combinations and some things get used with other things. And so yes, the meds list, this is a really good starter, but there are there are a lot of meds.

Scott Benner 7:29
Yeah, the list so I'm seeing here GLP one is a is a category of drug right? That could be like trulicity correct by Yeah. ozempic Victoza, like okay, and,

Jennifer Smith, CDE 7:40
and the same for the stLt, twos. All any of these even things like the oldest, you know, being Metformin. There are even combinations that include Metformin, but are not just solely Metformin. Okay, so,

Scott Benner 7:54
alright, I'm seeing STL T to lower blood sugar and adults with type two in combination with that exercise. Okay, so we're this one is a yes, we're keeping that one that one's going to in the medical category. Oh, okay. This person wants to talk about GLP meds, that insurance company is still putting barriers on, we're going to make that a secondary question. So I'm gonna go yes. Why would I not? Why does my brain work like this? Why do I just put Yes, and then secondary? Why did I not put?

Jennifer Smith, CDE 8:28
You just move it underneath?

Scott Benner 8:31
Yeah. Anyway, don't worry, the series will be terrific. Don't Don't worry about how my brain works the conversation with Okay, somebody here just says, I want to talk about all the meds so we don't need to consider

Jennifer Smith, CDE 8:43
that. And I think that's a I think that might even be a good first one in terms of starting the med. list list is all the different categories of meds being used for type two diabetes. And then kind of maybe we can break them down into each of the categories and have an episode on each of the different types potentially, or if there's, if they're easy enough to discuss, we could do multiple in, you know, certain.

Scott Benner 9:15
So I'm going to, I'm going to combine these two thoughts then. Cool. All right. And new medications. Oh, why? To increase protein during weight loss with ozempic? Oh, I might know about Ha, see, this is how this always goes.

Jennifer Smith, CDE 9:32
I saw your light bulb go on.

Scott Benner 9:34
I know something about this. I think there's been some studies that say that when people use some of these drugs for weight loss, you're not just losing fat, but you might be losing muscle and bone density too. Have you heard that?

Jennifer Smith, CDE 9:51
Um, yes, in in some things.

Scott Benner 9:56
It sounds like this person heard that is what I'm saying. Yeah, and

Jennifer Smith, CDE 9:59
I think that goes along with some education, which we will obviously get to I'm sure it's a category within here that was that contained a lot of questions. It's all about food and like the piece that works and why it works and why some meds work a certain way and why you should aim for more protein or leaner quality proteins along with lower glycemic or even lower carb type of meal plans. So yes, okay.

Scott Benner 10:28
And this next one is just about the weight loss drug. Now Metformin, obviously, we're going to talk about Yeah, so that just that that gets up to the top, basically, Metformin is the go to right, like you get type two diabetes, and somebody's handing you Metformin.

Jennifer Smith, CDE 10:47
Metformin is often an initial go to I mean, there is protocol, depending on where glucose levels are wearing a onesie level is at diagnosis may give the doctor some ability to navigate starting medications, many times, yes, Metformin is one of those first starting ones. And it's one of the oldest on the market, it's well studied. It's well accepted by most bodies, meaning it doesn't cause other issues. And the initial side effects of it, they usually go away within about the first two weeks of starting to use it. As you kind of titrate up doses, which is common for some of these other meds as well that are used for type two. So

Scott Benner 11:34
yes, are those things mostly gastrointestinal?

Jennifer Smith, CDE 11:36
Most of them are? Yes, yeah. Okay.

Scott Benner 11:40
wish someone would have I wish someone had acknowledged to me that Metformin made me feel sick, and alternatives, okay. I'm understanding what your blood sugar is supposed to look like, and what the medications precisely are doing and helping with? Oh, see, I think this is every place. But I think we should talk about this too. I think people hand you something like here, take this. And you don't know why. What it's supposed to be doing? What is it you're looking for? Absolutely. So we can, I think,

Jennifer Smith, CDE 12:12
I think the biggest thing that came out of prior to working for integrated, the endocrine that I worked with previously. I ended up working with a lot of the type ones eventually. But I also helped to teach the type two classes. And many of the people that were brought into the classes on that initial class, were often very hesitant whether they had had type two for a long time, or it was a very new diagnosis for them. They came into the class, almost like what am I really here for? Like, is this even going to do anything and by it was a four Class series. And by the end of the fourth class, they were so they were so appreciative to now have the information to go forward with and the unfortunate thing is that, I mean, we had room in the classes for upwards of, you know, 10 to 15 people. And oftentimes, our classes, maybe had eight, right. And I think it's unfortunate, because the classes aren't emphasized enough they are available insurance will cover a certain number of classes upon diagnosis with type two, over a year's time. But many people aren't given the opportunity, or they're just not sent to the right place, or they just aren't given the information that, hey, this is really important. I'm telling you to use this thing and telling you to act get active and telling you to change your diet. But I as a doctor can't tell you exactly the specifics of that. Please go here. So you can get the specifics, right. So

Scott Benner 13:55
well, people are so adaptive. You know, I saw a guy in the grocery store the other day, and his gait was, like bizarre, the way he walked was it was just strange. He was a young guy. And it looked weight related. And what I noticed about him was that it was just his life like he, you don't I mean, he was just doing it. And I think that just happens to people, I think you get some news, hey, you have type two diabetes and a heart. Well, I got type two diabetes, and you just kind of people just keep going. And they You said something earlier, that was interesting, like the idea of like, believing that there's something you can do about it. I, you know, maybe they're not even left with idea, like, Hey, you could impact this.

Jennifer Smith, CDE 14:35
Right? Or they've had a strong enough family history of type two that it wasn't a surprise that they were then diagnosed with it. And they have historically, there's not been grade education for those with type two. I mean, a lot of people with type one complaint about their education, but quite honestly, for the most part, it's better than type two. Yeah, no, I understand. And so they've had this history of Looking at family members, and even maybe friends, and they say, well, they really talk very much about it. They look like they're just going about their life the way that they should or, you know, my brother never did anything. And he's seems to be perfectly fine. He doesn't talk about

Scott Benner 15:16
the other side of everybody. Everyone dies. And it's all mess. And I've been waiting for this my whole life. And here, this is just what's going to happen. Yeah. So I'm going to call that generational apathy. I know, I joke that I'm not helpful, but I'm kind of helpful. And putting that under a list here. I'm making my own while we're talking under Education. Okay, so moving on to technology. Yes. person says how helpful would a libre or Dexcom be just for the knowledge because no matter what type of diabetic you are, knowing what is going on in your body is the greatest benefit. I mean, I have a person close to me who has type two. And I think I bother them about once a month about getting a CGM. So yes, yeah,

Jennifer Smith, CDE 15:58
absolutely. I mean, if there is a teaching piece that is valuable, especially if you've left your doctor's office with very little information, but on asking, you say, you know, I'm going to try to do what the doctor said in the in the littlest amount that I can, but I need information and more than these finger sticks that are cumbersome to add into my day or whatever. If somebody has just given us CGM, the ability to see the impact as we know about what things you're doing in a day, and gosh, I did this today for breakfast and did it tomorrow. And it seems better than what I did three days ago, maybe I should keep doing this kind of thing versus the other. Right? Because that's it can be really motivating, then you're blind to information, you're less likely to make a change.

Scott Benner 16:53
And it's easy to not know any of the impacts of your diet to absolutely just, this is what we've always eaten.

I know people who just grew up a certain way. And some of the foods that they think of as healthy are fascinating. And and it's I don't know, if it gets commingled in your head, the difference between health and oh, this is good. But you know, how people talk about, oh, this is a good dinner. I love this. It could just be something from your childhood that you're like, Oh, I remember this fondly. Right. Yeah. Yeah. And I think that I want to do a blend here with this, right? Because it's my belief, not around type two diabetes, but around everything, that you don't get anywhere telling someone that they're wrong, or the way they feel is invalid. Or you should make some grand change in how you do things. Like no one's doing that. No, you know, and I think that's where type twos get screwed, honestly, is that they go into a room and a doctor says, Hey, listen, it's nothing diet, exercise won't help. And you're like, great, well, I'm 53 years old. I haven't dieted or exercise that my whole life. I'm sure I'm gonna go home and do it right now. Not that that doesn't make a great advice. Like I'm not saying that. It's just not actionable for that person.

Jennifer Smith, CDE 18:29
It's not because it's not been individualized. And that's across the board and diabetes, regardless of the type of diabetes you have. There's a lack of ability. For many caregivers, not all but many practitioners to sit down and really get to know the person. Yeah. Right. You have to get to know what they are doing in their life. And what is what's their why. Why should they do this, like what in their life is so important to them, that will be better that they can continue to enjoy? If they learn how to do some of these things that you're just giving almost like a rip off sheet that's like, do this and do this and you'll all be fine, right? It'll all just magically like, work out it for itself.

Scott Benner 19:16
Here's the list of five things you've never done in your life you have no context for and you don't want to do and you don't have time for just do those and everything will be fine. And then most people are like, Oh, I guess this isn't gonna I mean, listen, you and I are seeing each other over a camera. I don't know that can you see that? I'm losing weight by any chance are probably not right.

Jennifer Smith, CDE 19:32
Probably not you and which is funny because you and I also haven't seen you in a bit of time. So usually people lose weight like facial structure wise first or within their neck. But I've only seen you standing up in person a couple of times.

Scott Benner 19:48
What's going on for me is that my daughter went back to college, and my son got a job and moved out. And you know what I have all of a sudden, more time. And, and I'm using that some of that time to cook better for myself?

Jennifer Smith, CDE 20:01
Yes, that's it and to use the machine that's sitting behind

Scott Benner 20:04
you able to get on my bike more frequently. But that's just the point is that it's just the only thing that really changes that I suddenly had a little more time. Yeah. And you can say, well, there's nothing more important than your health. And you're going to be right when you say that. But people have bills and responsibilities. And if you don't have enough time, you don't have enough time. And so that's why I want to do this, because I want to give everybody everything they need to know. And then they can cherry pick from it, because I find that's how that's how the Juicebox Podcast works. So well. Is it like I used to think, Oh, I'll lay it out here for them. And they'll follow it like a roadmap. That's not what happens. Like, yeah, you give people a ton of options, and let them go through it ala carte. So this isn't an ad, I just wanted to let you know that as of this recording, march 1 2023. The podcast already has three episodes with people living with type two diabetes, these people all listen to the Juicebox Podcast prior to coming on the show. And they shared the really amazing transformation that they went through. Right now you can hear Leanne story at episode 665. John story in Episode 688 and Michael story at 799. And just like this episode, which is called type two pro tip, and then intro, right, there's like a prefix type two pro tip intro. There are type two stories, Michael type two stories, John, type two stories, Lian. And I'm looking for more people with type two diabetes to share their story. You can find the link on the website juicebox podcast.com. To contact me if you'd like to share your type to journey with everyone else. Also, I know it's gonna sound strange, but find our private Facebook group Juicebox Podcast type one diabetes, but there's 35,000 people in there. Each one loves someone with diabetes or has it themselves. And there are so many people in the group who have type two diabetes, this is a private group where you can hang out, watch people talk, ask questions, and it's a private group, private. So you can feel confident sharing your story there as well. Oh, and I didn't mention it's absolutely free. As a matter of fact, nothing about the podcast will ever cost you money. And I don't believe that your health should cost you something. It's not right that you should have to pay a coach or a mentor, or take some sort of a class or pay for some content that's behind a paywall. I don't believe in any of that. Everything you need to know is here in the podcast. If you want to ask somebody a question, you go to the free Facebook group where there are 35,000 people waiting to answer your questions. It's not cool, when people take your money to learn about diabetes, I'm not down with that. It shows that supported, I'll take care of paying for it, you just go ahead and help yourself to whatever information you need.

Jennifer Smith, CDE 23:10
You know, what I've I've kind of seen is that the more newly diagnosed who've joined your group and started listening, they seem to be the ones that are going through it in a in a way that moves from one topic to the next. It's more those who have had diabetes a long time and are no coming. And they're like, Well, I know how to basil test. I'm having a problem with this. Yeah, so they pick that topic, they go through it, they get the answers they want, and then it might drive them to another episode about something that's also relevant. But that's, that's the benefit of being able, you know, to go through a list that's very clearly defined.

Scott Benner 23:49
And I want this to help people who not only are in a situation where they're like, Look, I need to use insulin, right? Or maybe I'll try some of these other injectable meds and see how that goes first. I don't just want to help those people. I want to help people to who might hear something and think, Wait, potatoes, I just don't eat potatoes. Like you don't? You don't know, like you don't know what people don't know. Right? And so laying it all out there for them. And I I'm gonna tell you this right now, like if this is popular, I don't first of all, I don't care if it's popular or not. I'm gonna put it out because I think it's the right thing to do. And I'm going to put it within my within the Juicebox Podcast. But when you and I get done, if we ended up with something that is so just iron clad helpful. I might open a different podcasts up for type twos and just drop the information in there and leave it like a binder for them. Yeah, you know, and maybe I won't put episodes into it very often, but at least they'll be able to get through it easier.

Jennifer Smith, CDE 24:50
And I think that would be beneficial because from a from a one site access point. I think it would be fine to have both groups of information in one place. But I think if there is the potential that another group of interest is going to end up coming out of it, then there are a lot of topics and things that gets discussed, that are not specific, they're not worth the time of someone with type two is not all of them are. They're not as usable for that population. And or, like I said about the medications, there are so many different medications that are not going to be discussed in the type one world, but are very relevant for someone to be able to discuss with other people with type two, in you know, in that category, so

Scott Benner 25:39
am I also I bring this up under the technology banner here of our conversation, because sharing online is also technology. And there are going to be type twos who can get into that type one group. And I've almost stopped thinking of it as type one group, if I'm being perfectly honest, I think of it as a diabetes group. Because I, what I've noticed is that if you're have type two diabetes, and you're using insulin, it's pretty much the same game as having type one. And so it a lot of this stuff translates and as valuable. From both sides,

Jennifer Smith, CDE 26:17
I think to this technology category to what I see there's a lot about CGM. But I think in terms of a gadget, quite honestly, there's a lack of education about glucose meters. Yeah. Right. And that may be something in fact, it it is along with medications, it gets prescribed. But there's no education in the office about what to do, what the proper time of checking your blood sugar is. And even it may be this is further down. Somebody may be asked about it, but like, what do you do with that information? Yeah, great. My blood sugar is 133. Is that right is do I have to do something about this? Should I even take my medicine, it looks like it's it's a number where it's supposed to be. And I think, you know, years ago, when I worked with with more type twos in our endocrine practice, we often used to do around seated around glucose meters, teaching people the right times to check, okay, and what that then means and what they can do about it. So I think that's an important piece to bring in. Because while a CGM would be kind of pie in the sky for anybody who has diabetes.

Scott Benner 27:34
It might be because it might be a cash option when you're type two, right? Unless you're using insulin,

Jennifer Smith, CDE 27:39
depending on insurance coverage, and all of the things that have to get checked off in terms of prescribing it, and then what the coverage would look like. Yes, it may be a question of even being able to get

Scott Benner 27:52
it. So I added BG meter when, how and what do I do with the info? Yes, okay. Yeah, because the rest of it is like you said, people, I mean, it's not wrong, that CGM would be an amazing benefit for you if he had type two diabetes, but your insurance might not cover it as what like right

Jennifer Smith, CDE 28:10
here. Right. And there is, I mean, in terms of technology, and this kind of goes with meds and technology, quite honestly. There, there's something that bridges into both, and that would be the insulin pens, right, that if somebody with type two does use insulin, then there is actually technology that can help them use it better, and to collect the information better and make more even, I guess, evaluate their information to go back to their doctor and discuss. I mean, there are even some insulins that work with a prescribed type of device or app that allows the doctor to discuss back with the person how to titrate their doses, which is quite nice. And again, I would expect that many people don't even know that that's an option. Yeah. Okay.

Scott Benner 29:09
So yeah, alright, so diet, diet discussions, including by the way, diet, to me means what you eat, I'm not saying you're on a diet, like so. I hate the word diet. Yeah. I don't know what to say here. Give me a better word.

Jennifer Smith, CDE 29:25
Well, what are you putting in your body when you eat? You're putting fuel in, right. So I I call it fueling plan.

Scott Benner 29:33
Jenny, I've changed the fueling plan. So yeah, I'm not going to be able to change everybody's I'm not smart enough to read this and change out the word diet for fueling discussions, including Whole Foods, plant based options, intermittent fasting for weight loss and reduction of insulin resistance. Food, if it is good for you can be medicine for type twos. I mean, food can be medicine for anybody, honestly. And so that's a great one. We'll leave that there may be a more targeted how we eat conversation revolving around type two things

Jennifer Smith, CDE 30:07
similar. Yeah, that's

Scott Benner 30:08
I think that's similar. I think I'm going to take that out. So it doesn't get confusing because it's the same as the first one. How to meal prep way foods checking packaging. See, that's a big one. I always ignore that. The people maybe don't know what they're looking at when they look at that information on the package.

Jennifer Smith, CDE 30:25
Right, because it goes along with again, that rip off of eat food, eat better food, or an old one. And I have still heard it as don't eat white food. What does that mean? Right? Right. I mean, the inside of an apple is white. Right? Does that mean I should no longer eat apples? You're saying we're

Scott Benner 30:47
some slight thumbs tight TOS get told don't eat white food? They can't just say potatoes and white bread.

Jennifer Smith, CDE 30:54
Don't eat don't eat white food. Yeah. And really like white food? Come on.

Scott Benner 30:58
Yeah, that doesn't make a ton of sense having the tasty healthy recipes. And info on lower carb alternatives are huge. Well, I'll tell you, I agree and rub up against the idea of great recipes. I agree. Because I think if people had better tasting foods that were healthy, they would eat them. I also think that most people don't cook. I don't think as many people cook, as you imagine, you know, where that cooking, where the cooking is not the thing that I'm watching on chef on Netflix when I'm seeing Jon Favreau and that other guy throw together a thing you don't even like, right? I don't think we all cook like that.

Jennifer Smith, CDE 31:35
So now might be in and of itself. Maybe it's it's a whole kind of discussion is just like what does it mean to prepare a meal? And what does that have to be like, as you just said, it's not like watching Top Chef or whatever, the one where the mean guy talks to people. What's his MC? Gordon, there you go. Yeah, he goes name off the time, like Hell's Kitchen or something like that, right?

Scott Benner 32:07
Like for cooking shows,

Jennifer Smith, CDE 32:09
or whatever. But it's all the same concept of like, I think you're right, people don't think, gotta have to cook up, like cooking becomes this elaborate like, three hour process. And cooking doesn't have to need to be like that. Doesn't have to

Scott Benner 32:25
I also think that that idea stops people and I just I believe, listen, I don't know how, why believe us. I don't believe that many people. I just I think it's time like, I know what it takes to make a meal. The other night, I said to my wife, we're gonna have this in this for dinner. Is that okay? I said it's two or three o'clock in the afternoon. And she goes, Yeah, that's fine. I was like, great. That's dinner time. I'm like, I'm gonna start cooking because I don't want that anymore. And I was like, Okay, what do you want? And she goes, Don't worry about me. I'll figure out what I want you go ahead and make that for you. And I said, Well, you obviously don't cook very well, if you want me to make two meals. I was like, I don't have time for that. We have to go to bed at some point, you know, and I have the luxury of working out of my home. Yeah, and being able to say the days over 15 minutes glass of water, I'll start cooking dinner, right? Like, I don't have to get into a car and drive somewhere. Or go pick up a kid from something or something like that. I just don't think I think there's a way to help people prepare foods that will help them that doesn't leave them thinking I can't accomplish this. Correct, right. That's what I'm so I absolutely want that. Next up next thing here person says low carb makes a big difference. And so I'm just going to say here that because I make a type one podcast, and I have a type one Facebook group. And people who eat low carb and people who don't eat low carb love to argue with each other sometimes. I don't know if I've said this a million different ways. I'm just gonna put it here too. If you want to eat low carb, I think that's fine. I don't have a problem in the world with that. And as a matter of fact, it is. I mean, we can sit here and argue and say, Well, you need this or you need that in your diet. I don't know any of that. You are you have a nutrition background, you'll be able to tell better, but I want to dig into low carb when we're talking.

Jennifer Smith, CDE 34:19
I think it's an excellent topic, especially in diabetes in general. Yes. But I absolutely think type two is a very appropriate place to talk about

Scott Benner 34:31
that for sure. Yeah, absolutely. This next one, what should I be eating? What should I try to avoid? I want to leave that there. My doctor told me to eat lots of fruits and vegetables, but aren't fruit aren't fruits high in sugar. Good question. So I want to put that in with the what should we be eating?

Jennifer Smith, CDE 34:48
I love these are great. They're really they're very thoughtful questions and goes it really goes the distance of the missing information that just telling people to eat better and move their body.

Scott Benner 35:02
Missus Yeah, factors that help a bit I'm gonna reword this, but this person is talking about factors that help manipulate insulin resistance. So we can leave that insulin resistance and carbs sensitivity and how to cope with them. I

Jennifer Smith, CDE 35:18
think those are the kind of the same they are too Yeah, we're

Scott Benner 35:21
gonna lose one of those resistance how diet can affect it? Same thing, explanation of vicious cycles of insulin resistance in the body producing more insulin to manage blood glucose, storing more fat, causing more insulin resistance and on and on, you want to we can can we go over that process and explain it?

Unknown Speaker 35:40
Yes,

Scott Benner 35:41
we can. Can we do it within the the one before that? When we have that conversation? Do you think?

Jennifer Smith, CDE 35:46
I think that this one? I mean, it's not. It's like, it's not really nutrition specific. This is more in like, we don't even have a category of what is type two diabetes?

Scott Benner 36:01
How about if we put it in education? Because I make

Jennifer Smith, CDE 36:03
that would be yes, that would be appropriate. This, this would definitely fit within that. Oh,

Scott Benner 36:10
my God, there's so much here.

Jennifer Smith, CDE 36:12
Yes. That's a good thing. I'm, I'm really glad I'm, yeah, I'm super excited that so many people responded, which were really well thought again.

Scott Benner 36:23
And I'm gonna, I'm gonna say something here. You have type one diabetes, or don't have diabetes at all? I bet you this series ends up being interesting for you one way or the other? Of course, ya know, for sure. Fact.

Jennifer Smith, CDE 36:35
And I, you know why? I think because of the fact that type two diabetes is the most prevalent type of diabetes? Sure. And I guarantee that somebody knows someone, and could refer them or listen and say, hey, you know, I learned this, you've been talking to me about this and complaining about it, or, you know, you're bothered by this, go listen to this. Yeah. Or did you know this tidbit? You know,

Scott Benner 36:59
I'll add this. I hope this won't be controversial. But there are so many influences on us as people from marketing, to food manufacturing, to, you know, whether or not we exercise, whether or not we're supplementing with like things we need to like that kind of stuff. All of those things, impact all of us equally. Some of us get the ill effects of them stronger than others. So just because just because you ended up with type two diabetes, and the person next to you didn't, it doesn't mean that you're both not being impacted by the stuff similarly, and that's why I think it would be helpful for people. Okay, so if you agree with that, then I feel good. Common sense advice, but about not falling for all their net carb marketing propaganda. Ah, all right. That's a great one is that is that like when I go to buy? Shaved ice Italian ice, whatever, you people call it around the country. I call it water ice. And it says fat free. I'm always like, Well, yeah, now. But when I eat all the sugar, well, my body immediately turn it into fat, the story.

Jennifer Smith, CDE 38:14
Now burning it off right away? Yes, no,

Scott Benner 38:17
I got a giant cup of iced tea sugar.

Jennifer Smith, CDE 38:22
In fact, I think that that could be because type two has a metabolic component to it. For many people, I think that besides net carb things like even just label reading, in general in this category, such as its fat free, or the one that came out years and years ago was everything started getting labeled fat free and no cholesterol. Why? Why would oats have cholesterol in them? I mean, from a physiology standpoint, I know why I had the education to understand that. But many people have no idea why a plant wouldn't have.

Scott Benner 39:02
Oh, just marketing. It's just to make you think like, Oh, good. It's the you know, and here's a label that is actually helpful. no high fructose corn syrup. That Oh, yeah, there's one that's not marketing. That one's smart. You know, that one will actually help you. How about this here? Does this belong in education don't get stuck on a sliding scale. It sounds like her father in law got put on a sliding scale? And it just kind of languished there.

Jennifer Smith, CDE 39:28
No, I Well, I don't think it's I think it should be in meds. Okay. Mainly because it discusses that we know more about insulin these days. Now, it also for in this case and for many people who are in insulin who may not have the means to support some of them newer insolence, right. I think it's an important piece to discuss and talk Talk about because we don't know her father in law's story. Maybe he's using sliding scale because it's a monetary or it's a coverage based thing. And or maybe nobody's ever told him that something else is available. Yeah. Yeah, right.

Scott Benner 40:17
Okay, so All right. Next category is labeled guilt and shame. Battling stigma culture is placed upon those with type two. That's obvious now, do I? Do I do that one with Erica? Try to imagine this as a compendium, you and I talking about type two, but then sometimes they're going to be more like, I think they're going to be I think the episodes are going to be a little like a pro tip series. But every once in a while, I think they might be almost like a defining episode. But like, you know, I think I'm gonna package it all together so that people can find it.

Jennifer Smith, CDE 40:56
And then I think if, for a moment, this is a mental health, yeah, it is it and it rolls into how somebody may be managing or maybe seeking additional help or not. Right. So that it might be more of a mental health discussion. Okay. Yeah, because I agree.

Scott Benner 41:18
The second one here is I think a huge factor for type twos is guilt and shame. And it getting in the way of good medical care, I don't know how to compress this down into a snappy little title, she says, or he says, or a buzzword, but it's crippling. So okay, so we're gonna do that. And

Jennifer Smith, CDE 41:37
there are a few we may we may even be able to define a little bit of, of what that might mean. But I think it would be better with a mental health specialist. Yeah,

Scott Benner 41:47
there are so many myths about type two to come down and about shaming people. The only like that only fat people get it or if you eat garbage, you got it. The diet and exercise while he's fix it, and it taking meds but this is an interesting one taking meds is a lazy way out. And that insulin isn't boy, people think of insulin as losing.

Jennifer Smith, CDE 42:10
Absolutely, yeah. Yeah, absolutely they do. And there is, like I said before, type two has a heavy metabolic component to it. And there are some people that do everything necessary. They follow the rules, they do the you know, lean quality foods, and they exercise and maybe they've even lost a large amount of weight. And eventually, they may lose enough data self function, that they may end up needing insulin, and it is from their personal, it's seen as I've clearly not done enough, I failed in this. And now I'm on insulin. And that is it's the place I didn't want to get to or that's what I was working to avoid doing when really as we know, I mean, with type one, we're like, hey, insulin, that's like, like my saving grace, right? Like I take it because I have to take it where I think a big piece that's also not really defined well is prior to diagnosis with type two, how many people have actually had mismanaged glucose levels four years prior to a proper diagnosis. And in that timeframe, what ends up happening is that they are taxing their pancreas, right? They're taxing those beta cells to help Help Help. And in fact, many times those beta cells, they work in overdrive. They try try try to keep up. And so eventually, even with all of those stuff that they may do to get control and keep it for a while. They may have pooped some things out earlier than they realized, where they weren't doing the things that they're now doing. Does that make sense? Yes, yeah.

Scott Benner 43:56
This next one says, I discovered that I was misdiagnosed as a type two when I was actually a type one. And so we're going to talk about that, like just this. But here's the rest of what they said. And I don't think this whole I don't know if it'll call her the conversation you and I have, but it's interesting enough to bring it up here. It was a huge relief for me to be type one, because that meant I wasn't a fat failure. That is that crazy that somebody felt that I mean, it's not crazy. It's horrible. Right? And that is, you know, this person is like, No one deserves to feel like that. No, okay, if I was type two, I didn't deserve to feel like that. If I was type one, I didn't deserve to feel like that. But we do have to. I think we do have to admit that. This is how this is just what happens to most people when they get this diagnosis. Right. They just feel like I blew it, you know, right? Or my genetics blew it or right so I mean, this is I don't know how not to feel terrible about it, you know, like, but I'm gonna I want to keep the first part of it for you and I About being misdiagnosed? Yes, because it's so prevalent, but I'm going to take the rest of what she said and move it up and make sure I talk about it. When I speak with Erica to why their type twos get told insulin is bad for you. We'll go over that. Yeah, I mean, I've I've had three people on the show right now so far that have type two diabetes and have been the whose lives have been changed immensely by using insulin and algorithms by the way people are using like, yeah, like pump algorithms with their insulin everything else this one I don't know that we can figure out why or type two communities foolish shaming.

Actually, for you listening though, I think there'll be an episode of the podcast coming up, where we talk about how people talk to each other online, Eric and I are going to do I think the answer lies a lot less with the topic than you might think. Being rediagnosis lotto or type one is a story we hear more often because it's a because it feels like it's better than being typed to. Oh, so people Oh, I see what they're saying. They're saying people are happy to tell the story. Oh, they thought I was type two. But it turns out no, I have type one or I'm Lada. And that's a badge of honor, almost because you're saying you're not type two. So what this person is really saying is that is how horrible. I think what they're saying is that no one wants to be labeled as a type two type two.

Jennifer Smith, CDE 46:41
Yeah, that's what it sounds like. And I would say that there might be a step behind it that they're reading a surface level of, I'm not type two, thank goodness, I actually have lotto or type one, right? I don't think that that person who was misdiagnosed is actually happy. But what they're what they're actually and I don't even think that they're saying, Gosh, I'm not type two. Thank goodness, I'm not going to be labeled with this like thing that everybody considers is my own fault. I actually think that somebody who is appropriately diagnosed with type one or Lada feels that relief because finally they're they're getting a diagnosis. That's gonna get them the right meds to help. Yeah,

Scott Benner 47:26
relief. That was in my head. I kept thinking, are you gonna say relief? Just yeah,

Jennifer Smith, CDE 47:30
it's relief. It's I somebody's gonna listen to what I've been trying to say. And my blood sugar's aren't coming down. All this medicine you're giving, nothing is helping. I'm eating lettuce leaves, and I'm running 70 miles a week, and nothing is helping and this is the reason. Thank goodness, I have the right answer. Finally,

Scott Benner 47:49
anyone who's ever been sick, knows that. You don't want to hear bad news. But you do want an answer. And yeah, yeah, I think that's what that is as well. Okay, under medical care, how to advocate for yourself. Through misdiagnosis treated, I was treated terribly assumptions that surrounded type two. There's no shame about medication. So I think we're going to keep the AVID I mean, I'm gonna highlight the advocating piece of this. Assumptions I'm going to highlight. And I received the medical field to case owner part of it. I'm sorry, I received from the medical field and the type two online communities I was a part of, Oh, they got shame from that. Okay. Well, we're not going to be any shame in my community. So you can you can go be tight to the Juicebox Podcast, private Facebook group, if we weren't able to control. See, I also think, Jenny, I don't want to get on a tangent here. But I think that some of the things that we just talked about are why I'll give you I'll give the people listening a little inside baseball, I said that I've had this in the back of my head for a long time, and I've wanted to do it. And I plugged away and plug which I have agreed with Thank you, of course you have. And I've plugged away and plugged in by and plugged away and tried to get somebody to sponsor it, so that I couldn't afford to put it up. And finally, it became obvious to me that no one was going to do that. And I was like, Alright, I'm just gonna do it on my own. Right. But here's why. And this is what I think. I think that establishments believe that type twos don't want to be in a community together. I think they think that there's no possibility to build a thing that helps type twos because they don't want to participate in it because they don't want to be labeled. That's what I think the overall feeling is and be I'm saying I have a lot more hope for people than that. And I think that it's a build if they will come situation. I think you can't just To open up a Facebook group and call it type two diabetes support and expect that people are going to flood in because this is the stuff that they think. And then they're going to have horrible social interactions with each other that everybody's going to like everyone's. And that's going to be the end of it. But why does my Facebook group work for type one? I think it's because it began with the core of information that existed in the podcast already that we were able to bring in people who are already thinking, like, this is doable for me, you know, so I'm going to build another place. And dammit, if you all don't come, then Jenny and I just wasted our time, that's fine. But I think I think your

Jennifer Smith, CDE 50:38
wasn't a waste at some point. If you build it, people will.

Scott Benner 50:41
I really think that's what's gonna happen. So okay, I feel medical community judge type twos. Yeah. All right. Well, we'll talk about that, too. I'm sure that is what's happening. A standard,

Jennifer Smith, CDE 50:53
I actually actually think this is a good one.

Scott Benner 50:55
Yeah, I do too. Because I because people are just people. Like, you know, I know a guy who's a doctor, please it just because he goes to his job and puts out a coat, you know,

Jennifer Smith, CDE 51:12
doesn't mean that you are a good person.

Scott Benner 51:15
By the way, it's not my friend who's a doctor, I don't want him here in this and be like, That's not me, is it? It's a person I know, peripherally, who's a physician who's just kind of a jerk. And I could see that person looking at you if you had type two diabetes and being like, okay, you know, like, I really do. So.

Jennifer Smith, CDE 51:32
Right. We're not listening. And I think that's the bigger point that this comment brings up is that this person seems to have been doing everything that was the right thing. And upon entering a medical based, like setting wasn't being listened to. Yeah, right. Which is sad. So

Scott Benner 51:50
we'll we'll dig through that one standard of care for type two globally is terrible. It goes Metformin, long acting. My parents can be oh, gosh, 20 plus millimoles after a meal and they say that's okay. Yeah. Yeah. Okay. We're gonna talk about what goal I think I'm gonna mark this as goals.

Jennifer Smith, CDE 52:11
Yeah, right. Why is that seen as Okay, well, it shouldn't be seen as okay. We all know that. Well, we know that. Yeah.

Scott Benner 52:19
glacial pace of Medicare, Medicare type two seem to get finger wagging and eat better. Boy, you know, who gets hit with that to thyroid patients? Sometimes? Yeah, they just tell him like, oh, just exercise lose weight, you'll feel better. Oh, look at this. As I read down, it reminds me of thyroid issues. Okay, yeah, I'm sorry. I'm just I just like somebody agreed. Hey, hey, I'm type two and I would love to be on the show. Perfect. See that we'll have people who will come on and talk to keep an eye on that. I have. Oh, here you go. I have late stage complications from type two diabetes, and I've only had it for nine years. gastroparesis. I have moderate cognitive impairment, multiple other rare, chronic illnesses. Over the past three years, the Medicare, the medical care I've received has been negligent and appalling. Right, well, we're gonna get this person on the show. And other person. Okay, yeah. So this is, this is a person who has thoughts about how to name it so we can bring people in. When should I get a C peptide test? Oh, all right. We can throw that in somewhere.

Jennifer Smith, CDE 53:37
Yes, it's good under Oh, yeah. This is all test.

Scott Benner 53:39
Testing. Yeah. What other blood panels should be run examples to find out if your iron deficient, vitamin deficient exam, etc? Yeah, we'll do that blood panels. How to know if you have missed I have been misdiagnosed. Is there a way to figure out if you've been misdiagnosed, it's, it's just C peptide.

Jennifer Smith, CDE 54:00
Well, if you've been misdiagnosed as a type two, but you're really type one or ladder, obviously autoimmune diabetes, you are going to have some type of visible difference from that antibody based setting. Right? As many people I mean, there are previous comments in here that I was really happy to be finally diagnosed with latah or type one after having had type two for numbers of years. So there are you have to find the right doctor. And you know, as primary cares could write orders for blood tests to check but really from a, from a treatment standpoint, they really should be going to an endocrinologist. And if you have I guess the answer to this question would really be if you're questioning your diagnosis, ask for an appointment with an endocrinologist. Just because you have type two doesn't mean you can can't see. Right? You don't have to be being treated by your PCP. So

Scott Benner 55:05
yeah, all right. That's a good one. I'm gonna go through the rest of that testing stuff and go down to miscellaneous people are asked about Dawn phenomenon. I guess that happens with type twos as well. How cells you sugar for energy discuss metabolic disorder. This boy, something came up here that I was excited about. I'll tell you in a minute true, some myths about natural supplements. What's the progression of type two with age? Any difference in type two as an adult versus as a child? Is insulin helpful for type twos early on, or only later? What interact, interactions and comorbidities must type choose know about proper education on using a pump? If you're type two, I'd like to see an episode about why does it matter what type I am, I truly don't get that. I'm gonna go this is this is the thing that got I found super interesting. And I think is going to be a big part of what we end up doing. A Mythbusters episode. So the I really started thinking when somebody said that, to me, it well, they just brought it up like this, they said the most hurtful, hurtful myth that you only have tied to because you're overweight. But then I started thinking about all of the inaccurate statements about so many different things. And then I started imagining a Mythbusters series, almost like the defining diabetes series, where we take a list of things that people bullshit things people say, like cinnamon. Yeah. And we break them down about why they're, they're not accurate. Yes, yeah, that's gonna be outside of this, I think. But whoever said that whoever used that word first, you really got my brain moving. So thank you very much. And then there's weird things in here. And I'd look at this Agent Orange exposure as a cause for type two.

Jennifer Smith, CDE 57:00
Well, there are a lot of things with Agent Orange that I mean, that's not it's not a untrue. Yeah. But there are a lot of things that agent orange definitely did.

Scott Benner 57:11
So, yeah, this one says, I think COVID-19 can make type two complications worse. Oh, we can figure that out. And some other stuff here they have listed as maybe it would be interesting. I like so

Jennifer Smith, CDE 57:27
these are laughing about them. Because they're not they're not funny, but like to read them like they they make you like giggle a little bit, because it's amazing. Honestly, what, what is potentially out there in terms of Well, looking for me?

Scott Benner 57:45
Yeah. Are you ready? Is it this one? The there's a second one. There's the secret cure that big pharma doesn't want you to know about? Yes, yes, exactly. Listen, I've I've met a lot of people in my life. And the one thing I'm fairly certain of is they're not very good at keeping secrets. So and what would the cure be?

Jennifer Smith, CDE 58:10
I mean, that's, that's a great question. It really would be because I think I think in terms of the two types of diabetes, there, there a big difference in terms of why you have diabetes, type one or type two, there's even a big difference in terms of why you have gestational diabetes, right? Or any of the Modi, which never gets talked about. Right. So I mean, if there really is a big secret out there, then there are a lot of little secrets within the big secret. Yeah,

Scott Benner 58:46
I listen count on this, some doctor with a big ego would run out and yell, I've figured out the I've done it. But But aside of that, in the 15 years or so that I've been in this space, the amount of times that I've seen somebody say I know for certain that there's a cure for type one diabetes, and they whoever they is, they just don't want us to have it. It's because they're making money. And then I'm like, Look, I don't disagree that diabetes is a big moneymaker it just, I mean, if you look at science, where it is right now, we're just not at that point. You know, like, we don't know how to just turn I I've said this before, but I think we've only actually cured like eight things in the history of mankind.

Jennifer Smith, CDE 59:34
Or stop them from continuing to happen. Things like, you know, immunizations and whatnot. Right. There are things that have been eradicated because of but yeah, it's very, very few.

Scott Benner 59:45
Yeah, yeah. I mean, like, let's not talk about how we fix leprosy. So yeah, that's, I don't think that's the, if you're type one, I don't think you want to. I don't think you want that to happen. So you know, like a lot of different things. So okay, so Alright, let's just wrapped us up. Cool. This is the series we can do this right? Okay, and we're going to break it down into meds. We're going to put it so we're going to do meds education, testing allergy technology, medical care, guilt and shame. Fueling plan. Yes, that sounds right. Oh,

Jennifer Smith, CDE 1:00:21
what about activity?

Scott Benner 1:00:23
Oh, how do we forget that?

Jennifer Smith, CDE 1:00:24
That is something that is not in here? At all?

Scott Benner 1:00:28
Yes. Okay. Go ahead, Jenny. Do you need a soapbox to stand on? Or can you just say this out loud? So what Jenny is gonna about to say is that we asked a lot of people tell me how to help with type one, type two diabetes, and not one person asked about exercise.

Jennifer Smith, CDE 1:00:45
Right? Yeah, I mean, I in any in what? What kind of exercise? How do I get started with exercise? I'm already doing this. Am I supposed to change it and do something different? Or why is it not working this way? I mean, and again, it's sort of an effect of multiple variables. Right, all together. But I do think that it's interesting that there wasn't at least a question of, I've been told to get active. What does that mean?

Scott Benner 1:01:10
I don't think it's that interesting. I think it's pretty, I don't mean, because these because the people have type two diabetes that asked, I mean, just generally people in general, like, there are people who love to exercise, and the rest of us really wish it didn't exist. So I'm one of those people. I am clearly in the other category, right? And he's like, can we get this done? So I can go for a walk right now. And so but, but it is telling, right, it is telling that not one person said hey, is there anything I can do here? Because and I and maybe this is why maybe I'm being flippant? Maybe it's because doctors have so frequently told these poor people? Oh, yeah. Diet and exercise, go home, eat less and go for a walk and you'll be okay. Maybe it's because it's been minimized and marginalized a little bit, you know, same time,

Jennifer Smith, CDE 1:02:00
right. I mean, and rightly so even the information about or the questions about, you know, nutrition are fueling really, they're not, they're not as focused, because I think, again, it's a point that people are told about, but there's been no definition given to it. So many people don't even know what to ask about it. Sure.

Scott Benner 1:02:23
It's similar. It's similar to cooking to like, What do you mean, eat better? Exercise? Okay, well, what does that mean? You know, and I know, listen, other people can listen and go, it's obvious what it means. I don't know how obvious it is to everybody. You know, so, alright, so we'll, we'll put together a reasonable exercise plan for people? Sure. All right. A way to start a

Jennifer Smith, CDE 1:02:48
way to start that would be, especially considering some people might already be doing something, but if not, it's just a place to give you an idea of what to start.

Scott Benner 1:03:00
So I wrote how to start exercising, we'll talk about that. And then maybe it'll like lead from here. Maybe I can have on other people who can talk about, you know, more specific ways of handling things. Sure. But yeah, again, I just think that if you're listening if I'm, if I have type two diabetes, and my blood sugar's aren't great. And, you know, I don't know how I'm like, What am I going to, like, jump up and get on a stair climber, like yummy meals? Like, how, what the hell, you know? Right. So okay.

Jennifer Smith, CDE 1:03:31
I mean, they're, they're simple things. But I think that's a good title for it is how to get started, how to get started.

Scott Benner 1:03:36
And then we'll see what we can get make we can make out of it.

Jennifer Smith, CDE 1:03:40
Cool. Yay. I'm very excited. I

Scott Benner 1:03:43
am to actually I know that just means we're dorks about diabetes. I just think, listen, there were a couple of people in my life, who have type two, and they are just not in any meaningful way impacting it. But if you talk to them about it, they're always worried about it. They are in trying as hard as they can. And I just think that maybe, maybe we could help turn some people. Some people are walking into brick walls, maybe we could help turn them around and let them walk in a better direction. Right. Right. And I think we can definitely do this. Alright, well, we start in three days, Jenny.

Jennifer Smith, CDE 1:04:26
Yes, we do. We've got a couple of days. And then we're

Scott Benner 1:04:29
recording. Alright, we'll break this down into into easier to understand pieces for us, and then we'll get started. Thank you. Awesome. Thank

Jennifer Smith, CDE 1:04:39
you Take care.

Scott Benner 1:04:43
So that's how this is gonna go. And as of this day, when I'm putting this episode online for you, we've already recorded five of the episodes for this series, and there's much more coming. I'm going to put them out every week until the core of the series has been posted. And then we'll be adding to it as needed, Jenny and I are going to talk about the diabetes. I'm going to have a therapist on named Erica, she's lovely. We're going to talk about the psychological side of this, we're going to have more people on to talk about nutrition. I'm even thinking maybe having some chefs on some cooks to talk about cooking. We've talked about intermittent fasting before on the podcast, but I want to bring somebody back on to talk more about that. There's going to be so much here for you. I know you can do this. And we're here to help. If you want to hear about Jenny and I hold on, but if you want to go, this is pretty much the end. Thank you so much for listening. I'll be back very soon with another episode of The Juicebox Podcast. Okay, it's me, Scott. So if you're finding this show, because someone gave it to you and said, Hey, you have type two diabetes. And I'm assuming they're already listeners of the show, probably because of a type one connection. And they're sharing this with you. And you're thinking, why am I listening to this guy, and that lady talk about type two diabetes? Well, here's how you came to this. I began making this podcast in 2015. This is the ninth year of it. Before that, I wrote a very popular blog about type one diabetes. And I come to this by way of my then two year old daughter's diagnosis with type one, my daughter is 18. Now, she is living a lovely life off a college. The podcast began because I think it really began for the same reason that this this series is here. People don't get good direction about diabetes. It we didn't, we certainly did. I didn't know what I was doing. My daughter was diagnosed, my wife didn't know we were left to our own devices. And it soon became obvious that we were either going to figure it out for ourselves, or our daughter's lot in life was not going to be so rosy. So we figured it out. And then I started writing about a long line. And that became popular. And then I started talking about it in a podcast. And I started seeing how well this podcast was helping people live. And it's just bothered me for so long with people in my, my sphere and in my family who have type two diabetes and aren't being helped. And I thought I need to find a way to help them. So then one day, a couple of years ago, I started realizing that there were people listening to the podcast already who had type two diabetes, but we're figuring out how to help themselves through the type one conversations and I thought, wow, this is helping people, we could give them information more tailored to them, and find even more people and help more people. And that's it for me. I'm doing this for the same reason I started doing it. There are people in my life, they're not getting good direction. They deserve better health. And I think I can help you find it. That's pretty much it. I'm just the guy whose 18 year old daughter got type one diabetes when she was two and I started a blog and a podcast and it just took off. Jenny has had type one diabetes for well over 30 years. She is a registered and licensed dietitian, a certified diabetes educator, she is certified on tons of insulin pumps, and continuous glucose monitors. She works at a place called Integrated diabetes, which classically helps type ones with their management. But Jenny is just a good soul. And this means a lot to her. She just wants to help. So that's why she's here. You know why I'm here? I hope you I hope you feel like you're in the right place. There's going to be more. Honestly, if you're listening to this past like April 2023, the other episodes are probably already up and ready for you. I hope you enjoy them. I hope they help you. And I hope one day you'll be one of those type two stories in those episodes I mentioned earlier, I really think you can be. I really, really do. I know this isn't easy, but it's not impossible. And I know you can do it. I've seen so many people succeed with their health in moments when they just thought it was impossible. But this podcast and the people who listen to it have taught me that nothing's impossible. It can seem difficult. It can seem like your life is ending. But there's a way through. You just need to know the path to take. And I think this podcast can help you see that path and light your journey. I know you can do this. I'm excited that you're here. Please come back and listen to a few more episodes. And if you start having great success, let me know about it. I'd love to tell your story on the podcast. I know you can do this. Thank you very much for listening. I'll be back very soon with another episode of The Juicebox Podcast.