Scott Benner 6/21/24 Scott Benner 6/21/24

#1232 Ask Scott and Jenny: Chapter Twenty-Three

Scott and Jenny Smith, CDE answer your diabetes questions.

• How do you keep a straight line on a CGM?

• With so many variables that can impact blood sugar, how do you know when to dose more insulin?

• What are the pros and cons of seeing an endocrinologist versus a general medicine doctor?

• How does diabetes affect a child’s learning? Highs and lows in particular.

• How do you approach doctors who discourage patients from having a tight range, especially when there is no burnout?

• What are the long-term consequences of hypoglycemia?

• How close is too close for a CGM and a pump site to be together?

• How do you train your type 1 kid to wake up for a hypo?

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

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

Scott Benner 0:00
Hello friends, welcome to episode 1232 of the Juicebox Podcast

welcome back to another episode of Ask Scott and Jenny today Jenny Smith and I are going to answer the questions sent in by you the listeners. And don't forget, you can hire Jenny at integrated diabetes.com Nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, always consult a physician before making any changes to your health care plan. Don't forget if you'd like to save 30% at cozy earth.com You can use the offer code juice box at checkout to save 30% off of your entire cart. But if you want an extra little surprise go to juicebox podcast.com and click on the link on the front page. When you place your first order for ag one with my link you'll get five free travel packs and a free year supply of vitamin D drink ag one.com/juice box guys the surveys were down last month at T one D exchange.org/juice. Box I'm not blaming anybody you were probably busy school was ending etc. But now you're just sitting around staring at your kids and wondering when the hell they're gonna leave you alone. So go find 10 minutes where you can be all by yourself T one D exchange.org/juice box take that survey please. This show is sponsored today by the glucagon that my daughter carries G voc hypo penne Find out more at G voc glucagon.com forward slash juicebox. This episode of The Juicebox Podcast is sponsored by us med U S med.com/juice box or call 888721151 for us med is where my daughter gets her diabetes supplies from and you could to use the link or number to get your free benefit check and get started today with us med Today's episode is sponsored by Medtronic diabetes, a company that's bringing together people who are redefining what it means to live with diabetes. Later in this episode, I'll be speaking with Mark, he was diagnosed with type one diabetes at 28. He's 47. Now he's going to tell you a little bit about his story. To hear more stories from the Medtronic champion community or to share your own story. Visit Medtronic diabetes.com/juice box and check out the Medtronic champion hashtag on social media. Jenny, we are pushing through our ask Scott and Jenny questions I think pushing through is not the right phrase doesn't make us sound like we're here willfully.

Jennifer Smith, CDE 2:49
Correct. It does not even remember that I'm always like, what are we doing today? Scott?

Scott Benner 2:54
Yeah, that's okay. Well, we're gonna we're on topic or whatever. Well, there's no topic. We're just gonna go through people's questions. I'm just going through this document full of questions from people who listen to the podcast, so you're ready to jump in? Yes. Let's start with something a little nebulous. How do you keep a straight line on the CGM? Seriously, I am listening to the podcast and we are continually improving. And we've come so far, primarily because of the podcast. That's nice, truthfully, but the line just isn't straight. I just would like it to be straighter. And although our highs are less high, now, they are still higher than I'd like. So how do you keep a flatter graph? I mean,

Jennifer Smith, CDE 3:39
this is the one thing that I hear over and over and over and over in questions. Look at my numbers. They're not stable. They're not flat, and like you kind of standard deviation of 19. And you're averaging a 102 blood sugar. How much more stable? Do you want that to be? Exactly? I mean, I'm not saying this from a you know, it's not judgment, but it's like, we have to look at this as well, without any information about what this person's data or their data for their child. Maybe it is much more variability or much higher standard deviation than they really want. Great. Could you contain that a little more? Probably. And it does take work. It takes effort. It takes some experimentation with sounds like you know, this person is doing but a straight flat line. Even in somebody without diabetes. That's not the goal. The goal isn't straight straight. Yeah. Nobody's I mean, overnight, maybe right overnight, where there aren't the variables of exercise and food and extra Bolus, insulin and everything. Those are the drivers of the up and down. But in that environment, sure. Stable straight. Absolutely. That would be lovely to aim for. During the daytime. You're looking for more gentle rolls through the day, with a lot less variability a lot less. I started at 100 It goes to 190. Maybe it starts at 100. And it only goes up to 150. That's, that's improvement. Again, you're not looking at 100 stays 100.

Scott Benner 5:10
Yeah. So I think what can happen if you're listening to the podcast is that I don't talk about diabetes from like, this is kind of okay situation, I give you what looks good, right? You know, right, golden, and you try to get to it on your way to it. It's not going to be perfect right away. And so what I see in this question is progress. You know, that's, yeah, absolutely. I started somewhere, it's getting better. How come I can't get to it? And I just think that the answer is time and experience. Yep. If you have the, the nuts and bolts, if you have Pre-Bolus thing, and, you know, timing and amount, and using insulin and stuff like that, then it's just at that point, it becomes repetition. Rack, you know, it becomes not getting complacent and saying, Okay, well, when we eat this, my blood sugar goes to 250. And that's just going to be that. Like, it's like, I wonder what would work here? Is it more insulin? Is it a little longer? Pre-Bolus? Do I should I come back in 45 minutes an hour later and try to get ahead of a fat rise, like that kind of stuff. But I do take your point, too, that some people can get overwhelmed with the idea of just this incredibly flat, right line that's supposed to be at I don't know, 85 forever and ever. And I mean, a person who doesn't have diabetes won't see that. Correct?

Jennifer Smith, CDE 6:32
Yeah, right. And even if you look at those who are following more of the low carb or even the ketogenic, their lines are not flat, so to speak. I mean, flat really means almost no, no variance. Yeah, at all. Right. So while their numbers look more stable, and I guess within a smaller, you know, standard deviation, there still is some little bit of up and down to that. So agreed. Sounds like progress has certainly been made for this person who's asking. And the goal again, then is I think it's even more defined by what are your target goals? Yeah. Where are you aiming to be above on the lower end? And where do you really want to try most often, to kind of hit a top end and not really sit there, but to have it come back down to the mid ground,

Scott Benner 7:20
I take a lot of direction from something you said to me a long time ago, about more like rolling hills, getting rid of sharp peaks, that kind of an idea. I mean, obviously, if you have a meal and your blood sugar jumps to 250, and you know, in 15 or 20 minutes, you didn't meet the need, you know, and it popped up. And now our goal was, let's get it back down without getting low, you know, as quickly as we can. I mean, listen, if you're eating a standard diet, right, like, I mean, I'm not talking about that either, unless you're gonna be like, very ultra low carb or something like that. And probably mixing in some old timey insulin in there too, and doing some other things. Yeah. Which is not not doable. I always kind of look at, like, thresholds. So for me, if Arden goes 141 50 and rolls back down again, at food I go, I wasn't perfect, but it's very good. And reasonable. Also, I don't want the 150 to be for three hours. I'm talking about, right, maybe a 40 minute window, you know what I mean? Just like kinda up and kind of down. Okay, right. And

Jennifer Smith, CDE 8:25
the exact in that example, too, if she's starting at 140, she grazes 150. And then over, you know, an hour she comes back down and she lands at 140. Bolus did its job, right. And your timing did its job, something else might not be quite right. If it doesn't get back down to target, which might be 100 instead of 140. Right. But again, your little bump up and down. Yeah,

Scott Benner 8:47
was lovely. My example actually, I'm maybe I misspoke. I'm talking about she's between 80 and 100, or something and she eats and she rolls the 140 and goes back if Arden was 140 all day, I would definitely I would be like yes, I know you're missing something.

Unknown Speaker 9:02
Something's not right. But

Scott Benner 9:03
again, not messing it up. Just something's you said it better. There's something's not right. Basil is not right. We haven't corrected in the right place. There's food we didn't account for somehow with insulin, right? Because if I'm stable at 140, all day, I certainly could be stable at 90. Yeah, you know, it's just somewhere along there, something's moved. So I would say to people, like, if you're on it, if you if you've got a background, you're building your understanding. I think the next goal is just to kind of give yourself some grace and just chill out and let time pass a little bit. Now if it's getting worse and worse and worse, higher and higher. You might have to worry about your weight, what you're doing, I think, correct

Jennifer Smith, CDE 9:41
and doses maybe things have adjusted maybe if this is a child the child is grown or they've added something else into the mix in terms of activities, or stress or whatever it might be right. But again, I know the big bottom line is that flat, completely flat with no variance is really not. It's not the goal that you're aiming for unless you really just don't want to eat anything.

Scott Benner 10:08
Never have a carbohydrate again in your life which is again you want to I'd start with me just you know Yeah. If you take insulin or sulfonylureas you are at risk for your blood sugar going too low. You need a safety net when it matters most. Be ready with G voc hypo pen. My daughter carries G voc hypo pen everywhere she goes, because it's a ready to use rescue pen for treating very low blood sugar and people with diabetes ages two and above that I trust. Low blood sugar emergencies can happen unexpectedly and they demand quick action. Luckily, G voc hypo pen can be administered in two simple steps even by yourself in certain situations. Show those around you where you store Chivo Capo pen and how to use it. They need to know how to use G Bo Capo pen before an emergency situation happens. Learn more about why G vo Capo pen is in Ardens diabetes toolkit at G voc glucagon.com/juicebox. G voc shouldn't be used if you have a tumor in the gland on the top of your kidneys called a pheochromocytoma. Or if you have a tumor in your pancreas called an insulinoma visit G voc glucagon.com/risk For safety information. diabetes comes with a lot of things to remember. So it's nice when someone takes something off of your plate. US med has done that for us. When it's time for art and supplies to be refreshed. We get an email rolls up in your inbox says hi Arden. This is your friendly reorder email from us med. You open up the email to big button it says click here to reorder and you're done. Finally, somebody taking away a responsibility instead of adding one. US med has done that for us. An email arrives, we click on a link and the next thing you know your products are at the front door. That simple. Us med.com/juice box or call 888-721-1514 I never have to wonder if Arden has enough supplies. I click on one link. I open up a box. I put the stuff in the drawer. And we're done. US med carries everything from insulin pumps, and diabetes testing supplies to the latest CGM like the libre three and the Dexcom G seven. They accept Medicare nationwide, over 800 private insurers. And all you have to do to get started is called 888-721-1514. Or go to my link us med.com/juice box using that number or my link helps to support the production of the Juicebox Podcast. Right now we're gonna hear from a member of the Medtronic champion community. This episode of The Juicebox Podcast is sponsored by Medtronic diabetes. And this is Mark.

David 12:59
I use injections for about six months. And then my endocrinologist and a navy recommended a pump. How long had

Scott Benner 13:05
you been in the Navy? Eight years up to that point? I've interviewed a number of people who have been diagnosed during service and most of the time they're discharged. What happened to you?

David 13:15
I was medically discharged. Yeah, six months after my diagnosis. Was

Scott Benner 13:18
it your goal to stay in the Navy for your whole life? Your career was

David 13:22
Yeah, yeah. In fact, I think a few months before my diagnosis, my wife and I had that discussion about, you know, staying in for the long term. And, you know, we made the decision despite all the hardships and time away from home, that was what we loved the

Scott Benner 13:36
most. Was the Navy, like a lifetime goal of yours?

David 13:39
lifetime goal. I mean, as my earliest childhood memories were flying, being a fighter pilot,

Scott Benner 13:45
how did your diagnosis impact your lifelong dream?

David 13:48
It was devastating. Everything I had done in life, everything I'd worked up to up to that point was just taken away in an instant. I was not prepared for that at all. What does your support system look like? friends, your family caregivers, you know, for me to Medtronic champions, community, you know, all those resources that are out there to help guide the way but then help keep abreast on you know, the new things that are coming down the pike and to give you hope for eventually that we can find a cure. And

Scott Benner 14:13
you can hear more stories from Medtronic champions and share your own story at Medtronic diabetes.com/juice box. So with so many variables that can impact blood sugars, how do you know when to dose more insulin? I can imagine this will get easier once I have a pump and I can slightly give my daughter more insulin but today we Pre-Bolus Traumeel or BGB for lunch was 116 but two hours later, it was 350 It's infuriating. And I don't know why this happens or what to do.

Jennifer Smith, CDE 14:46
Yeah, well, that sounds like the wrong dose. Yeah, man. It sounds like they're working on Pre-Bolus Right, that that was in the picture. You had a starting blood sugar that was in a nice place to begin with, especially if this you know, is a child Old that who is eating carbohydrates. And if your blood sugar is in the three hundreds after and I would say that the follow up to that is if you're in the three hundreds or if you're in the two hundreds, and it sits stuck there. Remember the Bolus, his job is to work that blood sugar back down, at least close enough to the target that you're aiming for. And if it does not, then the Bolus is the problem. Your timing, maybe you needed five more minutes. But a blood sugar shift of that much really indicates a deficit of insulin.

Scott Benner 15:30
Yeah. It seems simple to me. But yeah, I think that's the answer. If you if the food is overpowering the insulin to that degree, then there wasn't enough insulin there to resist it.

Jennifer Smith, CDE 15:41
And I will say that, for some kiddos, again, this is MDI. And there is a little bit of a difference, because you could potentially to get rid of those more extreme high blood sugars or to stay under a high value that you're aiming for after a meal, you may end up making the insulin to carb ratio more aggressive. But because you can't get the precision of dosing there, what you may end up having to do is on the back end, as that as that Bolus is bringing the blood sugar down, you may have to have an uncovered snack, in order for that to actually work all around, right? Because the dosing can't be as teeny tiny as might be needed to give just a little more. But on the back end, you have to kind of cover the extra then for MTI to be

Scott Benner 16:30
tougher with little kids, because such a small amount can move you so greatly, but I mean, 350 is to me, like Jenny said, it feels like way too high. You didn't cover the food correctly. Now, if that person was here to say to me, Hey, I counted those carbs, right? Like I did it right, then you start looking at, is there something about this food specifically, that needs more than Yes, other foods that have this carbohydrate count, which can happen all the time, like some foods are just, you know, they just need more. And so you have to do what they what they need not,

Jennifer Smith, CDE 17:02
not me or some little kids to you know, who really have a hard time. I mean, again, it sounds like they're doing Pre-Bolus Here in this example. But some kids, it's really hard for them to wait for that Bolus to start working, right maybe even the length of time that you as the observer or the caregiver knows you should wait. And in those I mean, I think you did you did with the glucose goddess, right? Yeah, interviewed her. That's where some of those kind of hacks if you will really become beneficial. Have your child start with the protein at the mealtime, have them start with the protein and the vegetables if they really can't wait, and especially if there's something more high glycemic, that's coming, put it at the end of the meal, so that you get a little bit of cushion for digestion and letting the insulin start to have a little bit more, you know, pull action. I've

Scott Benner 17:53
heard back from a number of people who have done some of those hacks, just you know, eating foods in different orders that they've they've reported back they've had some really interesting and beneficial experiences. So nice. Okay, what are the pros and cons of seeing an endo as an adult? Who has type one? Alright, hold on, this person has type one diabetes, she's saying what's the point of me seeing an endo? When I already have to see my other provider twice a year? And I'm getting meds from them? What am I gaining from my endocrinologist at this point? I go back and forth about this. So why can't I just get my doctor, I had this diabetes thing for freaking ever. Why can't I just get my doctor to give me some scripts? I know what I need? I think that's the question.

Jennifer Smith, CDE 18:34
It sounds like it? Yeah, it's a good question. I would say if you really feel like there is something that you need some extra help with, in the realm of diabetes, or maybe you have diabetes, and you have thyroid condition as well, or any of the other autoimmune types of conditions, then an endocrinologist really would be the more beneficial kind of person to go to truly, because while a general medicine doctor knows about all conditions, they really have general information about those conditions. When you have specialized needs, a specialist should be able to take the deeper dive with you answer more in depth questions, if there's additional medication, you know, even in the realm of using some of these newer injectable non insulin medications for things, primary care again, no is like the tip of the iceberg of information if you're going to really get the best benefit of some of these alternatives, going to an endocrinologist and not all of them will fit the bill you may have to search around right? And maybe that's the reason this person really relies on their primary care, because they feel like they don't really get anything extra from their endo anyway, which could be a little give and take there. Are you going to your endo and asking questions and they're just not able to answer. Search around find somebody new because you should have somebody like that on your team. However, if you're not really asking any questions you're expecting Um, to like, pull everything out of you, then maybe it's not an equal relationship. Right?

Scott Benner 20:05
I was gonna say that if in the scenario, the endo is just useless to them, you know, like not giving good information, there's still some benefits. For instance, I don't think a regular doctor would remind you once a year to get your vision checked. Typically, like little stuff like that, like, you know, if a new glucagon comes out, yeah, your regular doctor is not going to know about that. That's the little stuff there, I would think about like, I would think my concern would be not being enveloped in diabetes, and then getting left behind somehow, also, I don't know this person's situation. Now if this person is writing to us, and she's got, you know, a five, eight, A, one C, and she's just rolling through life, then my might say, yeah, you probably don't need an endo. Right. You don't have any big questions, but at this same person's rockin and eight right now, right here, your GPS, okay with that? I mean, maybe an endo would at least ping you every once in a while and go, hey, could we wrecked try a pump? Could we do this? Have you considered this? Like, you know, they're gonna know not to be happy with that number? And

Jennifer Smith, CDE 21:08
with that, again, depending on where the management looks like it is, is the primary care even looking at that? Do they have the tech that's available within their clinical, you know, space or their portals? Does it allow them to review CGM and pump data or even something like the hidden pen data or some of the smart device data? If it doesn't, you're really out on your own. Looking at all of that by yourself? Yeah, they may be able to write your scripts and write the labs that you know they think are needed, and you know, that you should be getting, maybe they even remind you go to the podiatrist every single year, right. But outside of that, the deeper things like you said, glucagon, goodness, you know how many people with type two diabetes on insulin are never ever told ever?

Scott Benner 21:55
About glucagon? Yeah, those are people who are going to an endocrinologist.

Jennifer Smith, CDE 22:00
And some of them are, some of them are going to primary care. And that's my point. You know, they may not, they may not know. So,

Scott Benner 22:05
like, I get the frustration. This person is not helping me move forward. Yes. But I think that then your point, go find somebody who will not stop completely. It's it feels to me, like there's more of a chance for something to tumble away from you. Without having that interaction. Now, maybe you're getting that interaction somewhere else. That's fine. Like I, you know, funny. I don't think anybody would think it was odd that I would say this, but I still feel weird about it. Like, even though I'm the one who has and runs a really big Facebook group for diabetes. I get with people think that and go Why would I help? You know, why not a community from it's really helpful. So if you have like community somewhere and you're hearing about things somewhere, that's fine, but I just don't want people to get complacent. That's my, my bigger concern. Okay, right. Well, here's a fast one that doesn't need an answer. How do I adjust settings on loop? We need an update with Kenny. Oh, remember my fox in the loop house episodes. And I am including this little thing here to tell you that there is a series with Kenny coming up at the end of 2024. That's fun. Oh, there you go. You just wait for that. Sorry, the answer is not in here right now. Next question. How does diabetes affect a child's learning in particular highs and lows? I have found my daughter seems to hit a wall. So she seems to hit a wall when her blood sugar gets around. 10 Oh, am Oh, oh, this person's 10 millimoles. That's a 181 80 blood sugar. It seems like anything she learned before she can no longer remember. And everything is just too hard to comprehend. The thing is, this affects my daughter's mostly during math. It stresses her out. When she gets stressed. Her blood sugar goes up more. I don't know how to help her with this. It's like when she's high. She has ADHD symptoms. And short term memory is no good. She can't retain anything I can outperform when she needs to. So Jenny, you and I have an episode about this. It's called altered minds. Maybe?

Jennifer Smith, CDE 24:04
Oh, okay. Maybe I do remember having a conversation about it. I mean, some of the questions and I think it we brought it in that conversation, it revolves around how often are they being pulled in school by a nurse or are being pulled out of that class, or a class to go and take care of something that is blood sugar relative, because then they're, they're kind of lagging in what the other students are actually getting, because they're not getting instructed in it. And they may have to play catch up on their own. So that's not really relative to the number in blood sugar, but it's more relative to the loss of what they're supposed to be getting by sitting in class. If this person seems to be more, I guess, mindful of when their child learns best, and it's When blood sugar is in what they're considering a target range. And, I mean, again, we've discussed the high levels and the low levels, you know, touching a high I level and then turning around and coming down isn't as detrimental as hanging high, right? Because that also means that your brain either hanging high or hanging too low, it doesn't really get the right amount of energy to retain and you know, incorporate all of that stuff on top of what they've already learned.

Scott Benner 25:20
I found it interesting. By the way, the episode we did was episode 485 is called altered minds. God, it was like three years ago time ago. God, Am I old, what's happening? Okay, let's not think about that right now. It came up because I noticed, and I'm sure you've noticed, and everybody else has noticed, too, but people don't believe this. They don't believe that wildly higher or lower blood sugars, impact people, or they don't want to believe it. I don't understand. I can never really wrap my mind around it. But a lot of people act like it's an excuse you're trying to use. Right? Right. My blood sugar's high. I can't I can't pay attention. That's an excuse. Well, it's not. And so we went into some great depths to talk about that in that episode. So I would say to this person's question, I completely believe this. You know, if the kids blood sugars, like you said, if it's like 9180, back to 90 again, then I don't see it as much but one ad for an hour or two hours. I don't disbelieve that at all. I've I've mentioned a million times that watching Arden in sports, her butcher got to a certain level, and she literally slowed down when she was running. Yeah, and her hand eye coordination changed and all this stuff. So here's what I would say. Imagine you've had a big turkey dinner. And you got that dopey feeling, and then someone brought algebra to you. Yeah, that's what it seems like to me. So

Jennifer Smith, CDE 26:41
or is teaching, you know, some type of fact for the first time, that's supposed to be building on what you've already known. But if all those things that you've already been taught, were built in certain levels of glucose, your reception for some of that stuff. I mean, it all builds on itself, what you learn, it builds, it builds, it builds. And so depending on where the blood sugar, even the variability in if you've got a child, or a teen who's got a blood sugar that looks like the Rocky Mountains up, down, up, down, up, down, up, down, and it's all day long. Absolutely, that's going to have an impact on their learning capacity that's happening

Scott Benner 27:18
right now. Don't hear that and go, Oh, I'm a terrible parent, like just No, yeah, go do the like, go to the Pro Tip series and learn how to stop that from happening. That's all, you know, again, get to it as quickly as you can. But at the same time, it is what it is. You're not gonna learn it overnight. I guess, again,

Jennifer Smith, CDE 27:34
this person sort of also brings in the fact that this particular class also stresses their child. Yeah,

Scott Benner 27:41
right in the process of it happening adds to it again. Now. That's true. I don't know how to help with that. But I have been married a long time. And I know just telling her to calm down is not the answer. No, it has not worked out when I was married in the first decade. Yeah,

Jennifer Smith, CDE 27:56
and those are, you know, those are some of the things with school aged kids that we look at, maybe this class is every Thursday, and Friday, or every Tuesday and Wednesday, or whatever it is. Sometimes if you look at your child's class schedule, you can actually tell that there's some pattern to times of day, one in particular that I always see in kids records is their weekend mornings look beautiful, flat and stable. They might even have like, a three times carb amount pancake breakfast on a Saturday, that looks nice and beautiful. And they get right into lunch looking lovely. Whereas their low carb breakfast on their school days, does completely the opposite. And it's the transition into their school day. It's either the anticipation or the excitement, kind of doesn't really matter matter. inch to age. But again, it might be relevant to dosing around a class like that. That's a really stressful class. Maybe that class causes a rise in blood sugar of 100 points, every time they cut goes and sits down. We'll assume that the class is almost like carbohydrate, then I never have to dose for it.

Scott Benner 29:05
You could try to come at it with an increased Basal if you timed it. Well, you could Bolus for the class if that's gonna happen. I you know, anyway, yes. Higher blood sugars can create situations the way you described. And yes, stress and anxiety or excitement can make your blood sugar go up. So I think, by the way, it's worth pointing out as we get away from that question, good on her for noticing it. Absolutely. Because a lot of people just go I don't know what's happening. Magic diabetes came again. Yeah, you're actually seeing what's happening, which is really cool. Okay, I have two here. I like both of them. How do you approach doctors who discourage patients from having a tight range, especially when there is no burnout? They don't seem to believe patients are getting good numbers without it being a huge burden to them. How can we get them to be supportive of having In a tighter range with with fewer lows, especially in front of our kids. This happens Jenny, this happens all the time. It does. Yeah, this is one of those things that I I used to be shocked by. But now I'm just shocked when I don't hear about it. Somebody all, I always get a note that says, Oh my God, listen, podcast, everything got so much better. So excited to go to the doctor, I went to the doctor, Doctor yelled at me for 15 minutes. I was like, what happened? Yeah, you must have gotten to these numbers by having lows

Jennifer Smith, CDE 30:27
in there reminds me too, that a lot of times doctors are still using that average of an E one C as a hallmark of how are you doing. And if you have an A one, c, that is 5.4, let's say pull a number out of a hat, that number to the doctor represents some stress in management, something is too overwhelming, you are on top of it way too often, you're just visually watching it 24/7, or there must be some low blood sugar. So rather than that doctor actually even looking at your data, they just make a call based on that one average that an ANC represents. So if that were the case, you know, for this particular question, then your job is to come with the records that suggest Hey, you know, we're doing really well, I my kid is in multiple sports, he has all the enjoyment of life that he could possibly need. We're doing this, you know, look at our records, we have, you know, 1%, low blood sugars, and they're not lower than 60. And, you know, my kid is not sitting out because we don't want his blood sugar to move. I think those are the explanations that in your mind, you're living them. So you may not have to verbalize them. But to somebody who's just looking at one number, you may have to just explain, hey, we're good.

Scott Benner 31:47
I think you have to have the wherewithal, it's tough to because can you imagine putting all this effort into something maybe for six months. And then you're finally like, this is my day, the person who judges me is going to be happy, then that judge the person is not happy. And it probably throws you off for a second. But I would just be like, Hey, let me stop you here, I get what you're saying. I see that you think it must be I 24/7 I must be staring at this thing. And like, you know, turning knobs and everything. But that's not we're not at that spot. Like it's just going well for us. We seem to know how to use the insulin and how to cover food and activity and we're doing great and so appreciate your, you know, yeah, right. But yeah, gonna be careful. If you're listening to this. Some of you before you can get that out of your mouth, they're gonna snatch the pump from you and start turning dials to take your insulin away to make your blood sugar higher. And then that's a and Jenny, I'm gonna use some colloquial language here. That's a mindfuck of its own. Okay, because now the doctors like let's make your agency higher. Because, right, you're gonna have a really horrible low or you're going to burn out. And everybody's not the same. Like, I appreciate that. Maybe you've met other people who have burned out doing this. That's not our situation. I have a bigger grasp of this. Yeah, right. Right.

Jennifer Smith, CDE 33:02
This might be kind of like a blanket statement. But quite honestly, any doctor who takes your pump from you to turn the knobs and dials, that is somebody to not stay with it. Really, it is, again, my personal opinion. Because to me, my devices, they're like a piece of my body. Right? That's like removing my arm and fiddling with it to make the muscle bigger, because you want it to look bigger, right? Don't Don't take my body part. If you think I should change something, I'll bring up my settings, we can talk about it. And I may make that adjustment. But I'm going to do it myself. Because one, I use this product every single day. I push the buttons by myself all the time. Don't push my buttons for me. Right? Right. That's a really big discussion to have. Because I think it's very unfair, somebody to take something from you that You very well know how to use.

Scott Benner 33:58
And if you don't know how to use it. And they do that. Now you don't know what happened. They probably don't know how what happened. They did either by the way. They're just like, let's see what this does. And now you're both lost, because you were already wasn't going well. Now you've changed something else. If it doesn't fix it. How do you even know where you moved from? Or what did you next?

Jennifer Smith, CDE 34:16
Or why it was fixed? Yeah. Why did you adjust this versus that? You

Scott Benner 34:21
made me think of something? Not to the question. But I'm going to talk about here. I think this is really interesting. Something about the way you just talked about don't take that from me. You're changing my thoughts. I realized like, like, you're basically saying to someone give me this thing that we've attached to you and I am going to decide what's about to happen to your body next. Right? And you won't know because I did it like so the unknown that so I never thought of it that way. Isn't it interesting? I've never ever thought about that way once. If I take Arden's pump from her and I go hey, I'm just going to do this. That's why adult type ones say things like Does she know you made that change is that Okay, it's about autonomy. It's not about Oh, right. It's not about diabetes at all.

Jennifer Smith, CDE 35:07
Oh, wow. Yeah. Because I think, you know, again, life with what is now almost 36 years with type one, I very much feel like my products are part of me. That's a weird thing. Because there are I call them like, my boys always have called them like my robot parts, right? But they even somebody who has a prosthetic limb, for example, like I would never, ever, as a provider, ask somebody if I can take their body part from them to check it out? Like no, that's, that's, it's the same thing for somebody with diabetes feeling

Scott Benner 35:43
that, like it would be as if, if I said to you, hey, give me your insulin pump Jenny, and I'm going to decide to make you 10% happier, or I'm going to make you 15% More aggressive, or less emotional, or like, oh, that's got to be the same weird feeling you have if you go on like an SSRI, and people talk about like, I don't feel my highs or lows anymore in that like, weird, disconnected feeling like you put this thing in your mouth, and then all of a sudden, you experience the world differently. Correct. Okay, well, this seems like a thing that I probably should have recognized 15 years ago. But I made a note to talk to Eric about I think this is a lovely, lovely concept to go deeper into with a therapist. That would be great to hear really interesting. Okay, look at us learning. Well, me, you are probably just, I always tell Erica, when we're doing stuff that every episode should be called. Watch Erica, watch Scott realize something that was taught in freshman psychology that he doesn't know.

Jennifer Smith, CDE 36:43
Because Scott wasn't paying attention. I

Scott Benner 36:45
wasn't even there. I just had that feeling now, like you might have been looking at me like, yes, really never occurred to you. How about you? Okay. All right. Here's the question. Why don't we just tattoo this on people's foreheads? Oh, I hear this so much. What are the long term consequences of having too many low blood sugars? I hear there is a cognitive impact. But I don't know more. But it seems like it's not discussed enough. Seems like it's not as discussed as much as the consequences of higher blood sugars. So what are the long term effects of hypoglycemia? And every time we try to talk about this, the problem ends up very similar, right, like there, first of all, are no long term studies. There's no, right. That's

Jennifer Smith, CDE 37:27
the hard thing. Yeah, it really is. I get this question a lot, actually, again, with the women that I work with in pregnancy, we focus heavily on highs similar to outside of that right outside of pregnancy. But a lot of the doctors also focus on spending too much time low. Okay, then, yes, we could address that. But unfortunately, in terms of studies, there are not numerous published studies about the long term impact of low blood sugars on the cognitive function then of the child Once born, right. And the studies that are there actually define define the the number of lows under a blood sugar of 50 as being the resultant reason for cognitive impairment or assumed connection of cognitive impairment. And so when we're looking at, like, when you're living with a blood sugar 55, that's, you shouldn't bottom line, you should die. Don't do it. Don't do that. But again, the studies aren't, they're suggesting, oh, a blood sugar of 68. That sucks sustained, is that creating long term, there's nothing to prove that it isn't. But there's really nothing to prove that it is, in fact, that's a many people without diabetes, wake up with a blood sugar somewhere between 65 and 95. Right?

Scott Benner 38:46
It would be inhumane to take a control group of people drive their blood sugar down with manmade insulin, keep it there, and then wait to see if it gives them problems. That's why you're not going to see a study about that. Right. And everything else is, you know, to some point up for interpretation, because you can say to somebody like I'm seeing a cognitive decline in you. Did you have a lot of lows when you were young? Like, you know, I mean, what are you going to do? That's not a thing you can really track? So we know, it's 70 the number that we just know, you're okay. Up above it. Like, is that just the

Jennifer Smith, CDE 39:20
why it's the bottom line? Yeah, that's really and you know, in terms of long term, I think we need more long term studies because some of the information that is out there, like if you go to CDC and some of the other, you know, general research reporting kind of databases, they have low blood sugars, in terms of frequency of them length of them over and over types of effect, leading to the potential for a risk of dementia later in life or the earlier onset of dementia. And again, a lot of them also are done in type two diabetes, but blood sugar to blood sugar Diabetes, diabetes, so we kind of put them all in St. Pat's. Are

Scott Benner 40:04
you willing to tell people what number you worry for yourself? Like, where do you go, Oh, I can't let this be.

Jennifer Smith, CDE 40:11
Huh, I'm comfortable. But I think it also, I like to be above 65. That's a, again, an easy statement. If I am sitting and working at my desk, if I'm sitting in like, doing not much reading a book or whatever, and I'm sitting at 68. And it's a nice flat, stable 68, I'm gonna leave it alone. Like, why am I going to do something about that, because I also, and maybe in the past on more of a manual pump, maybe I would have knowing what's coming in the hours ahead, done something correctively. But now that I have an algorithm AI D algorithm based system, it's really not gonna honestly even sit there long, because I've got my target set above that, and it should be kind of bias

Scott Benner 40:56
a little way, it's gonna let you write some natural body function is going to bring your blood sugar back up. And

Jennifer Smith, CDE 41:01
I think because we have enough of those on the market, regardless of the system that you're using, I think all of them are very conservative in terms of the low blood sugar values that, you know, to sit there for a lengthy period of time, likely not going to happen with most of these systems. And a lot of people are still in the know about, well, my blood sugar is dropping, I need to treat it and with an AI D type of system. Do you mean, like, treat it in? It's too hot?

Scott Benner 41:30
I mean, I guess I'll share too. For Arden, I think a lot of it is about I don't want her to get dizzy. Right? That's sort of the way I feel about it. And, of course, so much about it is also just like you said, it's direction like is this a very stable number that's not moving? Is it never gonna go down from here, because there's no insulin on board. That makes a big difference to you know, if I see again, on an algorithm, if I see art and dip below 70 into that, like mid 60s range, I'll just wait and see what happens. I'll go look, and I'll be like, Oh, this thing already knew this was gonna happen. It's been taking basil away for 20 minutes. And so, you know, I think in the next couple of, you know, the next couple of checks, it's going to start to head back up again, based on what I know, but also know that CGM is are still a little behind reality. And so like, there's I don't know how to say that this makes me feel better. When I see the 65. I think, well, it's not 65. Now, it was a few minutes ago, maybe right? And everything I'm looking at makes me feel like it's heading in the right direction. Now, if I saw 65, and everything I was looking at made me feel like it was going to keep going lower than I would react and

Jennifer Smith, CDE 42:43
he would, yeah, absolutely. And I have to say, you know, in terms of asking about like a target, I would say I have targets also based on certain scenarios in my day, right? If I'm heading out to go and do something with my boys in the afternoon, or whatever, I have numbers above which I would really prefer to be or a stability place that I would prefer to be. From a driving perspective, I always like to be at least 80. Yeah. So there are some, I guess adjustments to where I would navigate and make an adjustment to get my blood sugar to start coming up. Yeah, even if I didn't have my algorithm system. So

Scott Benner 43:23
I want to say if Jenny's number sounds like if you heard 80, and you were like, cute lady. Just think of it as aspirational. That's really how I think of the whole podcast, like, if you're not there, just know that that's possible. And then get as close to it as you can and are comfortable with like that, to me is how to think about this stuff. And

Jennifer Smith, CDE 43:43
he's done. You know, I've worked with a number of people, not just guys, but people who are in construction, right? There are some places that you may have to navigate your targets, especially again, if you're eating a typical, like diet, right intake, that we may have to adjust your targets from an overall safety standpoint, so that you don't get that like that dizziness, or that sort of fumbling with your fingers or lack of cognition, you know, to be able to actually 10 stories up in the air. You're watching on the steel beam, right? You're sitting at

Scott Benner 44:18
a desk talking to people about diabetes, so you can just be like, I'm gonna have a sip of juice right now. And you know, and if you get woozy, you're gonna fall off of your stool, not off of a, you know, a building, right? So right, it makes sense. Couple of quick ones here. This is an easy one. How close is too close for a CGM and a pump site to be together? Oh,

Jennifer Smith, CDE 44:37
that's a good question. Most of the systems they suggest about five inches three to five inches is what I what I know. Do I know people wear them closer without any issue? I do. Do I know that? We in our own office space have tried wearing them closer just to see absolutely we have and from our my personal This is not Linux, from my personal experience doesn't seem to matter without. I've worn them close together, especially when I was using when I trialed and was using Omnipod five, because of that very important piece that they sort of hammer into you is that line of sight, right? So I followed all the rules, I was a sheep, I followed them to a tee initially. And really, like I had that that sensor sight on and I kind of moved my pad around that sensor pretty close so that it would always have that direct line of sight. Again, I really didn't pay attention to the three to five inch distance because yeah, what's realistic? actually sat around like

Scott Benner 45:45
that goes where it goes. I don't know, I'm not speaking for anybody specifically, I just know that what they have to tell you in the literature is what they tested during the FDA trial. So Correct. Yes. doesn't always mean it won't work. i The example I will always use is that you're not supposed to use a Peter in an insulin pump. But we've been doing it for like, 10 years. So

Jennifer Smith, CDE 46:07
correct. And you're in a pod? Yeah. I mean, a piedras should absolutely not be used in the tandem pumps.

Scott Benner 46:14
There's doesn't isn't it interesting there. It doesn't work in an omni pod. It's fine. It does. Except it's not FDA approved for that. Correct. Right. Yeah. Which means that on the pod never tried a Piedra in the pumping testing.

Jennifer Smith, CDE 46:28
Right. They just said don't use it. Yeah. They said,

Scott Benner 46:31
We don't have the money to test that. So go to hell.

Jennifer Smith, CDE 46:37
We can't test this piece.

Scott Benner 46:38
time or the money for your pager, which none of you are using except Scott and five other people. So yeah, by the way, you should try it. It's pretty good. Do you? Are you real tight on time? Are we can I have like 510 minutes? I'm gonna give you one last one that okay. I just don't know that there's an answer to oh, how do you train your type one kid to wake up for a Hypo? Oh,

Unknown Speaker 47:00
do you wake up for your hypose? I do. What happens? alarms,

Scott Benner 47:07
you feel it? Jesus talk to you what happens? Exactly because of

Jennifer Smith, CDE 47:11
so alarms? I think a lot of it may or may have some relevance. I mean, adulthood. I'm also a mom, think once your mom and a feather on the floor wakes you up? So quite honestly. Right? Exactly. Like I used for children. I slept, I could have slept, the train could have taken half the house off. And I was like dead to the world. Outside of my alarms, my alarms, I always have woken to my alarms, right? I from a, I guess from a maybe what my brain remembers, I try like on a monthly basis to change the alert sound, a different sound to a different sound so that it's always something different. That's waking me up, right? I also have the volume turned up so that I can hear it from kiddo standpoint. Kids sleep hard. If you've ever got I mean, most people who have kids who have diabetes, go in and have a problem even like waking their kid enough to like, drink part of a juice box or whatever. Some don't even wake their kid they can like put the juice box in and they just suck and they like fall back. And they're

Speaker 1 48:18
still asleep, essentially. A banana in her sleep. Yeah. Right. Yeah. So

Jennifer Smith, CDE 48:23
So it tells you in this question, it tells you how hard kids sleep. And so I don't know, in terms of training, some of it could be relative to using some of the devices that vibrate isn't a sugar pixel has something that connects to the device that you can slide underneath your pillow and it actually vibrates along with the very alarming noise that goes off i That's the sugar pixel, right. Is that sugar pixel? I

Scott Benner 48:52
believe so. Yeah. Like this little vibrating pad. Listen, there's all kinds of things you can try. Here's what I learned. I raised the kid from two years old to she's just about 20. She didn't wake up for anything. It didn't matter. It was on us. Like, right. She left for college, and half of me thought she'll be dead in three days. Like yeah, like, I mean, what's gonna we're gonna leave this. We're gonna hear anything. Oh, she should be dead by Thursday. You know, and what she reports back to me is that once she knew it was on her, she wakes up. And I was I don't know if that's a maturity thing or and now having said that, there have been, I mean, she's been she's half almost completely done her sophomore year. Wow. In college, and there are in the last two years, I'm gonna guess probably 2025 times I've had to wake her up. Sure. You know, like, I've had to call her and be like a Arden you're low. And she's dead. But and trust me, it's this. Hey, Arden. Your love. Low L oh, you're low juice. Drink get juice. Okay. But then she I'm like, stay on the phone. I'll be okay. And then she hangs up, then I sit there in a panic for 10 Min. Like, did she fall by? Numbers? Yeah. Drink the juice? I don't know, what I would tell you is, I don't know how you train somebody to do that, like, people are different in any mean. They

Jennifer Smith, CDE 50:20
are you can try many things. I mean, it's almost like, you know, like the potty train. I like the overnight potty train. Let

Scott Benner 50:25
me throw Cheerios at them when they're little kids, right? Some

Jennifer Smith, CDE 50:28
kids just get it pretty easily. And other kids, you really have to wake them up, like every couple of hours, right? Or the alarm is going off. You hear the alarm? And you know, maybe the training is that you go in the room and you put the alarm right by their ear. I mean, these are all like, I don't know, option as

Scott Benner 50:46
an adult. Have you ever woken up in the morning looking at your CGM and been like, Oh, my God, I was late last night? I had no idea. I'm gonna say yes. But you don't recall it.

Jennifer Smith, CDE 50:55
But I don't recall it. And again, low defined on a term of I was low. Now with an algorithm for like, you know, seven plus years? No, probably before that. Yes. Yeah, absolutely. Before there was anything. Yes. Now I also have a husband who is also a lighter sleeper. And so he hears my alarm.

Scott Benner 51:20
Wake up, wake up. Yeah, I have to tell you, I've had probably three times in my life, woken up in the morning thought, Oh, my God, I slept all night. It's great. To get on my phone. I'm looking through things. And you see that overnight for like 45 minutes Arden's budget or was like 40. And you think, Oh, my God, I didn't know that at all. That's crazy. And then the first thing you do is you look to see if she's still reporting a blood sugar. Because if she is she still alive? And like, Oh, my God, so I get that, like feeling that leg. I slept through it. It's my fault. We're all gonna die. Like, like that feeling. But I just overall, I have not found it to be that much of a concern. I think the most comforting thing I can say that with a lot of planning, don't get me wrong. Right. Yeah. But putting the right things in the right order. It hasn't been that much of an issue. If you don't do all those things. It's obviously could be a huge problem. Yeah. You know, I assume that people will say the show are putting a lot of effort into this stuff. So they

Jennifer Smith, CDE 52:19
are I mean, from what I've heard and seen, and with all the questions that always come in like this, there's a lot of, especially for parents of kids think there's a lot of consideration, you have Forward Look, you're saying yes, I'm doing this now. I'm happy to do it. I'm the parent, they're my child, I will 100% Do this for them. But at some point, they're not going to want to be here with me. Right? Some point they're going to want to be at a friend's house or a sporting event over a weekend or something that I'm not going to be there. Yeah. And I have to be able to have confidence that they're going to be able to acknowledge an alarm or an alert, I understand it. Absolutely. I

Scott Benner 53:00
would say to you're going to feel like that's not fair. The world's not fair. You're gonna have all those feelings. You gotta get past that because this just is what it is. So I appreciate that. Okay. Well, I appreciate you sharing all of your thoughts with me today. Thank you very much.

Unknown Speaker 53:15
Yes, thank you. I'll talk to you soon.

Scott Benner 53:25
Mark is an incredible example of what so many experience living with diabetes, you show up for yourself and others every day, never letting diabetes to find you. And that is what the Medtronic champion community is all about. Each of us is strong, and together, we're even stronger. To hear more stories from the Medtronic champion community where to share your own story. Visit Medtronic diabetes.com/juice box. A huge thank you to one of today's sponsors, GE voc glucagon. Find out more about Chivo Capo pen at G voc glucagon.com. Ford slash juicebox. They spell that GVOKEGLUC AG o n.com. Forward slash juice box. Arden has been getting her diabetes supplies from us med for three years. You can as well us med.com/juice box or call 888-721-1514 My thanks to us med for sponsoring this episode and for being longtime sponsors of the Juicebox Podcast. There are links in the show notes and links at juicebox podcast.com to us Med and all of the sponsors. If you have type two or pre diabetes, that type two diabetes Pro Tip series from the Juicebox Podcast is exactly what you're looking for. Do you have a friend or a family member who is struggling to understand their type two and how to manage it? This series is for them seven episodes to get you on track and up to speed In episode 860 series intro 864 guilt and shame, Episode 869 medical team 874 fuelling plan, Episode 880 diabetes technology episode 85 GLP ones metformin and insulin, and an episode 889 We talk about movement. This episode is with me and Jenny Smith. Of course, you know Jenny is a Certified diabetes Care and Education Specialist. She's a registered and licensed dietitian, and Jenny has had type one diabetes for over 30 years. Too many people don't understand their type two diabetes, and this series aims to fix that. Share it with a friend or get started today. Thank you so much for listening. I'll be back soon with another episode of The Juicebox Podcast. The episode you just heard was professionally edited by wrong way recording.

Unknown Speaker 55:52
Wrong way recording.com

#1231 Grand Rounds: Oncologist

"Alex" is the mother of a type 1 and an oncologist.

+ Click for EPISODE TRANSCRIPT

Scott Benner 0:00
Hello friends, welcome to episode 1231 of the Juicebox Podcast

Welcome back this is another episode in the Grand Rounds series you probably know by now in the Grand Rounds series, we don't use the person's real name and their voice has been changed to protect their identity. Today we're going to talk to Alex. She is a 37 year old medical oncologist from Israel. And we're going to talk about the health care system type one diabetes, and so much more. One of Alex's children has type one was diagnosed just two years ago. There is a lot of spirited conversation in this episode. Please don't forget that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, always consult a physician before making any changes to your health care plan or becoming bold with insulin. When you place your first order for ag one with my link, you'll get five free travel packs and a free year's supply of vitamin D. Drink ag one.com/juice box. Hey, I'm looking for you to give just a little bit of your time. T one D exchange.org/juicebox. Join the registry complete the survey help with type one diabetes research. You just have to be a US resident who has type one or is the caregiver of someone with type one. T one D exchange.org/juicebox. This episode of The Juicebox Podcast is sponsored by the ever sent CGM and implantable six month sensor is what you get with ever since. But you get so much more exceptional and consistent accuracy over six months, and distinct on body vibe alerts when you're high or low. On body vibe alerts. You don't even know what that means. Do you ever since cgm.com/juicebox Go find out today's episode of The Juicebox Podcast is sponsored by the contour next gen blood glucose meter. This is the meter that my daughter has on her person right now. It is incredibly accurate and waiting for you at contour next one.com/juicebox. Alex, what's your job? What do you do for a living?

Anonymous Female Speaker 2:20
I'm an oncologist.

Scott Benner 2:23
oncologist. What is and was your training like to get that job? What did you have to do where I

Anonymous Female Speaker 2:32
live? There's six years in medical school, you get into medical school right away, you don't have an undergrad, and then you do one your internship before you get your degree. And after seven years, you're a doctor. And then you have to do your specialties. oncology is five and a half years it's straight through it's been a sub specialty.

Scott Benner 2:50
It took you from the day you began coming out of out of school until you were I guess certified as a oncologist. 12 and a half years. Yeah.

Anonymous Female Speaker 3:02
Kids in the middle. So a bit longer than that. Oh, so

Scott Benner 3:05
there was a gap of time in there. You took a little time off to wear maternity leave. Yeah. Okay. All right. And now how long have you been practicing?

Anonymous Female Speaker 3:12
I finished my residency about two years ago, two years

Scott Benner 3:16
ago. What would you say? Day to day your job is like what do you what do you do most days?

Anonymous Female Speaker 3:22
So after you finish residency, it's mostly working in the outpatient clinic in the hospital. So it's same patients in the outpatient clinic. And then they get therapy in in the daycare center.

Scott Benner 3:36
So we're talking about like, let's see, okay, clinic, a clinic that does what infusions so

Anonymous Female Speaker 3:44
it's in the hospital. And it's always connected to like a big hospital, okay, like the infusion centers. So it's not like an America that they're also like smaller practices that have their own infusion center.

Scott Benner 3:54
I see. I see. So you see people for chemotherapy? Yeah, yeah. And follow up visits. If I think I have cancer. Are you a person I come to? Or are you in a difficult

Anonymous Female Speaker 4:06
situation when you guys send oncologist, you already have a diagnosis, or there's somebody already found that you have cancer, and then you go on colleges to figure out what the treatment plan should be. And for the follow up afterwards,

Scott Benner 4:17
are you a surgeon as well? Yep. No,

Anonymous Female Speaker 4:19
okay. I'm a medical oncologist, medical oncologist. Great.

Scott Benner 4:22
You said you stopped in the middle there to have some kids. How many did you make? I

Anonymous Female Speaker 4:27
have four kids. One was in medical school. One was in the internship year and two during residency. Geez,

Scott Benner 4:34
I must have made it harder. No.

Anonymous Female Speaker 4:39
But everybody starts University later. And it's all because you do either national service or army before you start. So I started at age 21. And I was one of the younger ones.

Scott Benner 4:49
How long is that army then? Is it one year? No. So

Anonymous Female Speaker 4:52
for boys, it's three years and for girls, it's two years. I did national service for two years instead of doing army. I

Scott Benner 4:59
see national service

Anonymous Female Speaker 5:00
means it's like kind of being like a volunteer in different. Okay, organization

Scott Benner 5:07
go somewhere build a house, they go, Well, something like that. Well, it's more like

Anonymous Female Speaker 5:11
working in schools or working like I worked in the Epilepsy Foundation here for one year and I worked in school, the second year Gotcha. To be like at risk kids,

Scott Benner 5:20
what drew you to oncology what made you want to do that? So

Anonymous Female Speaker 5:24
I really believe in patients making their own decisions about treatments and end of life. And I feel like I'm college kind of incorporates that. I also think that in oncology, there is like you have a long term relationship with your patients that you don't have with a lot of other fields.

Scott Benner 5:40
I see which one of these kids got type one diabetes.

Anonymous Female Speaker 5:44
Number two, how old number two on the lottery. She's nine now she was diagnosed when she was seven. Oh,

Scott Benner 5:52
wow. So a half a year into your practicing. She got type one.

Anonymous Female Speaker 5:59
So she actually got it's been more than two years. So she's actually got type one at the end and end of my residency, I say, but I'd already finished like my board certification. So it's a little easier.

Scott Benner 6:11
Is there other autoimmune or type one in your family? So

Anonymous Female Speaker 6:14
until then, we didn't have like, I would have told you that we're all completely healthy. But she was diagnosed with celiac, but at the same time, it was the same blood test. And afterwards, we were diagnosed me, my husband and another kid with celiac. And I have Hashimoto and my husband had psoriasis, which isn't exactly autoimmune miss out on Flim Flam. Ettore. My youngest might have been illegal. So

Scott Benner 6:41
we're running autoimmune struggle. You didn't know you had Hashimotos.

Anonymous Female Speaker 6:45
Know that. I knew, but I never considered it if you'd have asked me. Am I healthy? I always said yes. Like, and I gave birth and they said, No. Do you have anything, any medications you take? And I was like, Oh, no. And I'm like, Oh, wait, I do have something because it's just something that's so common. How

Scott Benner 6:57
old when you were diagnosed with that? 24? Okay, so how old are you now?

Anonymous Female Speaker 7:04
37?

Scott Benner 7:05
Might you laugh?

Anonymous Female Speaker 7:06
Because I can never remember.

Scott Benner 7:07
Like, okay, so you've had it Hashimotos for a while. And even though it's auto immune, if I would have asked you the day your daughter was diagnosed, are there any other autoimmune issues in your family? You might have skipped right over Hashimotos? No,

Anonymous Female Speaker 7:22
I asked me like that I would have skipped over. But it's not like I thought about it.

Scott Benner 7:29
Okay, so it was a surprise. Obviously, when you look at your family line, your husband's in yours. Do you see any other autoimmune? No, no, just the two of you getting together might have been the soup that made

Anonymous Female Speaker 7:43
like we didn't even know we both had celiac before. It would have been a cute dating story. But it didn't happen like that.

Scott Benner 7:47
So can I ask I'm so sorry. This is a weird, like path to go down. But you just ladder running to the bathroom? You didn't know why or was it not affecting No,

Anonymous Female Speaker 7:57
once you have one kid who has celiac or person in the family? So you do screening for all the like, first degree relatives? So we all did screening? And my husband is symptomatic. And I think it's just people didn't look for it as much when we were younger. Yeah. So he just like lived with it, because that's the way his body worked.

Scott Benner 8:16
I take I mean, listen, I think that's a valid answer. I think that's it, people don't understand I'm older than you fairly significantly. And I'll

Anonymous Female Speaker 8:23
tell people like You're like one half generation, I guess above are wondering, I

Scott Benner 8:27
mean, I'm 52. I don't know what that means. But like, all I know is that no one ever considered my health. Like I was either sick, like with a cold or something broke, but nobody talked about nutrition or how your body worked, or what was normal, or what level like that was just not a thing anybody spoke about, you would have been like a majorly hippie if you talked about that in my family in the 70s. You know what I mean? Okay, so you've had this job now for a couple of years, you're obviously on a cold wind episode. So we usually skip ahead a little bit here. Instead of telling fun stories and stuff like that, what makes you reach out and say, I think I have something to add to this cold wind series. Contour next one.com/juice box, that's the link you'll use. To find out more about the contour next gen blood glucose meter. When you get there, there's a little bit at the top, you can click right on blood glucose monitoring, I'll do it with you go to meters, click on any of the meters. I'll click on the Next Gen and you're going to get more information. It's easy to use and highly accurate. smartlight provides a simple understanding of your blood glucose levels. And of course was second chance sampling technology you can save money with fewer wasted test strips, as if all that wasn't enough. The contour next gen also has a compatible app for an easy way to share and see your blood glucose results. Contour next one.com/juicebox And if you scroll down at that link, you're gonna see things like a Buy Now button. You could register your meter after you purchase it or what is this Download a coupon Oh, receive a free Contour Next One blood glucose meter. Do tell contour next one.com/juicebox head over there now get the same accurate and reliable meter that we use. today's podcast is sponsored by the ever since CGM boasting a six month sensor. The ever sent CGM offers you these key advantages distinct on body vibe alerts when higher low, a consistent and exceptional accuracy over a six month period. And you only need two sensors per year. No longer will you have to carry your CGM supplies with you. You won't have to be concerned about your adhesive not lasting, accidentally knocking off a sensor or wasting a sensor when you have to replace your transmitter. That's right. There's no more weekly or bi weekly hassles of sensor changes. Not the ever sent CGM. It's implantable and it's accurate ever since cgm.com/juicebox. The ever since CGM is the first and only long term CGM ever since sits comfortably right under the skin and your upper arm and it lasts way longer than any other CGM sensor. Never again will you have to worry about your sensor falling off before the end of its life. So if you want an incredibly accurate CGM, that can't get knocked off, and won't fall off, you're looking for the ever since CGM ever since cgm.com/juicebox.

Anonymous Female Speaker 11:35
It's really interesting, because you know, every doctor kind of has like their traumatic patient, like the patient that you feel like you could have saved, she would have done something different. And I'm not even talking about like negligence and getting sued. But just like human error, I guess it could be either or. So mine is actually patient who died of decay. Who had type one. And I think that it kind of shows are like understood from that how much we don't understand type one. And that was even before my daughter had type one.

Scott Benner 12:06
You're helping a person with cancer. Yeah,

Anonymous Female Speaker 12:09
so it was like on oncology Ward, right. So we're just in colleges, and she was getting a therapy that she wasn't eating. During the therapy. It was hard for her to eat and she was in pain. So they gave her a lot of morphine. And then she kind of started going downhill. And they decide to center up to be in the ward so we could kind of watch her give her fluids. They took off her fentanyl patches. And they said like if she's kind of seems like she's in pain, like just give her a little bit of morphine. And I was the on call resident we did 26 hour shifts. When they called me the middle the night and they said, You know, I think she's in pain. So like I went to see her, give her a little bit more fit. And she looked really off. So I took my tests, but sadly, the blood gases didn't. They weren't good. So I never got that back. And then they call me like two hours later that she died there is that she's not breathing. And we went to resuscitated her. And we didn't really know what happened when they checked her blood from the ICU. So she had a lot of ketones and they couldn't figure out why. And then they finally figured out that she was type one. And what happened was is that she wasn't eating. And she her blood sugar's were running low. So she took off her pump, and she wasn't getting an insulin. And that means that her blood sugar's weren't high, because that's something that we would notice in the hospital. She didn't say that she was that insulin was a medication that she had to get. And she took it off before. So it was like normoglycemic DK, which was something that I didn't know existed before that. So she died a few a few days later. And ICU. This

Scott Benner 13:47
feeling you have, there's something you could have done? Was it as strong then as it is after your daughter's diagnosis.

Anonymous Female Speaker 13:56
Now it was really strong. Then I did a whole kind of mortality and morbidity meeting with the doctors bass, I kind of researched it. And they understood that type one wasn't something that was just like, okay, you know, they have they have type two diabetes, or they have high cholesterol or they have high blood pressure, that it's something that you really need to notice.

Scott Benner 14:16
How was she in the system without physicians knowing she had type one. So

Anonymous Female Speaker 14:21
she was brought up like this, she was getting treatment. She wasn't an inpatient, and then she was sent straight to the ward, just like that we could kind of help her out. Yeah, again, they assume that she had an overdose of morphine

Scott Benner 14:36
or fentanyl or whatever. Okay.

Anonymous Female Speaker 14:38
And she, so nobody really did a full intake. But I will say that even if she would have said to me, yeah, I have diabetes, I would have been like, okay, so you have diabetes. You know, like you ask, what medications you take, and like, I wouldn't have thought to say, Hey, if you have type one diabetes, how come you don't have insulin on your medications?

Scott Benner 14:58
You think if you knew she had had type one. And you might have checked her blood sugar but then seen it be at a certain number and then

Anonymous Female Speaker 15:06
they knew she had diabetes. It checked her blood sugar was normal. Okay.

Scott Benner 15:09
Is this the first time you're seeing her when when you interact that night? Yeah, yeah. Okay. Yeah, that's crazy. And no one, it just doesn't click for anybody that you can have

Anonymous Female Speaker 15:20
click for anybody. It's like it's a went through, like, usually you have a lot of people looking at something and then somebody's going to figure something out before something bad happens. Yeah, so I was just like the last one when the really bad thing happened. But nobody realized that. And if I put it in other perspective, and I'm not taking the responsibility off of me, or like, the doctors in general, I feel like when you're tightline, it's really important. Like you have to know about your disease. And you have to know that insulin is a medication that you take, and that you cannot take off your pump for a day or two, you know, you have to know that you always have to have Basal insulin,

Scott Benner 15:56
right, retrospectively, do you know how long she had type one for

Anonymous Female Speaker 16:02
years and years and years? And I think that that's also people who are older, like I find in the hospital, that people who are like in their 70s or 60s and they have a pump? I feel like they don't know quite as much about diabetes, people who are maybe diagnosed today. Yeah,

Scott Benner 16:18
I think that's true. I also can see where if loaded on morphine. She was thinking, my blood sugar is low. I can't get too low. I'll take this pump off for a little while. Then

Anonymous Female Speaker 16:31
she wasn't actually loaded on morphine. And it was just decay. Oh, it was she was? Oh, I don't think I don't think that the morphine issue was at all an issue. She was going downhill because she was starting to be in decay, I think was misdiagnosed.

Scott Benner 16:44
I see. I see. I see. Wow, geez. Yeah, listen, for people listening. Please don't take your palms off. Please, please, please. But isn't it crazy that even a person who has been living with it forever doesn't know, I need this insulin? I have to have it. I can't be without a background of insulin. Yeah,

Anonymous Female Speaker 17:03
and doesn't even look at it as a medication that they have to put on. Like that they have to tell you about. Yeah, it's just like something that they have in the background. And it's funny, because one funny half, I did that. A few years later, I had a patient who had type one. And I went to visit him in the hospital. And also he had been getting chemotherapy and infusion center and his blood tests were off. And so he also he went off to the war to be an inpatient. And I went to visit and just to see how he was doing because he wasn't doing very well. And I knew he had type one. And this is after my daughter was diagnosed, I was super vigilant. And I said, he said to me, Oh, by the way, I don't have infusion sets here. When am I going to go home? Cuz I haven't had my pump on since yesterday. Wait. And I said what? And he said, Yeah, I you know, I came out and it was an infusion center. And then I didn't know that I was going to be admitted. So I you know, when what am I going to be able to go home because I don't pump on that

Scott Benner 18:01
lack of urgency. It fries my mind a little bit. Like I have just beaten into my daughter's head that if that pump runs out of insulin, and you didn't expect it to if it falls off, everything in life doesn't matter anymore, you stop what you're doing head directly to insulin and get another pump on. Right? Right. It's one of the non negotiables of our of our, our existence and to hear somebody say Oh, my thing got knocked off a day and a half ago. And

Anonymous Female Speaker 18:34
again, the reason that he thought that is because his blood sugar's were normal, because he also he was in liver failure. And he wasn't really eating, and his struggles were normal. So he didn't need to get insulin from the nurse. In other words, whenever they came to check his sugar, it was normal. And he didn't feel like he needed to get insulin as a correction.

Scott Benner 18:52
DK is not attached to a number and it can happen very, very quickly. Yeah, yeah. Yeah. And so is it fair to say that? Do you meet more people with diabetes? Who understand it? Or who don't understand it? Or is it very age, or generational? First

Anonymous Female Speaker 19:07
of all, in general, and cancer, like most patients are older, and type one is relatively rare disease so thoroughly, I meet so many type ones. So it's hard for me to say, but I mean, most of the people I meet are 50 and

Scott Benner 19:19
getting away from type one for a minute What are like what are your bone chilling stories that have more to do with I can't believe a physician didn't understand this, then it does diabetes.

Anonymous Female Speaker 19:32
I think I have other things that like stand out to me that like I'll never forget. And again, the reason I don't forget these is because for me the decay patient was like my trauma. Yeah. And afterwards, it's just a habit type one so I'm super vigilant about type one. Yeah.

Scott Benner 19:52
In your intake you the things you want to talk about. I'm very interested because of the perspective you set this up at like B Basically a doctor's perspective before and after having a personal experience with the disease. And but your first thing on your on your list is Doctor bashing. So what did you want to say about that? Well,

Anonymous Female Speaker 20:12
if I did the doctor bashing, by the way, I'll say one more thing about that patient that I had, that I called endocrinologist for the patient who was having normal blood sugars, but didn't have his insulin pump on. And the endocrinologist said, and I said to him, he's type one. And he hadn't had insulin for two days for almost two days. Like, how much basil Should I give him? And he said, What are you talking about his sugars are normal. And the reason I mentioned this is that even Endocrinol she was an endocrinologist in endocrinologist and training others as a sub specialty. And after he talked to his boss, he did get back to me with the number of units. But even endocrinologist don't see type one very often adult endocrinologists. It's more

Scott Benner 20:55
about type two for them. Yeah, yeah, it's diabetes.

Anonymous Female Speaker 21:00
Yeah. And it's hard. Like, even for that, like, it's hard to see. Like, when there's a situation that's super serious, like I was saying to him, like, they're the situation yet. It's super serious. And I need to know, you know, what I should do? And if it would have been anyone else, they would have been said, okay,

Scott Benner 21:15
yeah. But he sees that number and just goes, I don't need insulin. Yeah,

Anonymous Female Speaker 21:19
yeah. And again, I mean, I hope that throughout his training hall, get trained better. And he probably learned from that patient. But most doctors wouldn't have known to even make the call to the endocrinologist. And yeah, many endocrinologist when they definitely want to have, you know, set him know, talk to your attending physician.

Scott Benner 21:39
Doesn't that frees you though? Like when I when you see, it's funny, like when you said that? I'm almost stunned, like to the point where I can't think for a second, trying to imagine all these people out in the world who are counting on all of these physicians. And a basic idea like that. I don't care if they were new or not a basic idea, like that's not understood, like what chance do we all have? You know, so

Anonymous Female Speaker 22:06
I brought that up before the doctor bashing just because I want to say that I do appreciate that doctors definitely need more education, but I feel like the education they need. First of all, it depends on what your specialty is. In other words, there's a difference between family doctors or pediatrician and an endocrinologist, as opposed to an oncologist or surgeon or orthopedic surgeon, you know, people need to know different things. And I feel like most doctors, they don't need to know the ins and outs of diabetes, they need to know when they need to ask. And others. That's how medicine works. Because the specialties, like once I'm an oncologist, I really don't know general medicine anymore. And even within oncology, I'm a GI oncologist. And I can understand about breast cancer. But even now, and it's been three years since my boards, I can't I don't feel like I can treat it well anymore. Because I don't know the new data that's coming out.

Scott Benner 23:00
Let me say this before we go any further, because I've been doing this series for a bit now. And I live in two different hemispheres of my thinking on this by first is on the ground level at a human level, you're the one saying you know, you need to know. And then I pull back. And I look at all the stories that have been told to me. And I've tried to incorporate everybody's perspectives. And I think that doctors are in an unwinnable situation, because there's so much to know. And they're just people. So they have to be able to hear all the things you're saying, connect the dots correctly, then reach into their, you know, computer bank of understanding, pull out the right answers, apply them correctly, somehow communicate them well to you, you have to do them correctly, it's pretty much impossible, right? You're asking a person to do the job of a computer, which by the way, is going to lead me to say over and over again, probably over the next couple of years on the podcast. I think that the nature of being a physician is going to be changed significantly by AI. I

Anonymous Female Speaker 24:05
disagree. Go ahead. I disagree on that. It's not that I don't think that AI is going to be incorporated into doctors worlds. And like I think in general, everybody's going to learn kind of how to use it in a way that actually benefits people in society. I think that with doctors when you meet it, first of all, a lot of being a doctor is being able to relate information. And also to get the information out to the patient. In other words, the patient. Yeah, they can put some stuff into computer, but they forgot to tell you a lot of really important things, for instance, not telling you that they need insulin, or not telling you that like they came for something and you kind of asked him questions. And then like 15 minutes later, they mentioned something that's super serious, but they didn't even think to tell you that before and it's not something that you would have thought to ask. Yeah, so I think that we're very far from like computers being go through that.

Scott Benner 25:00
Well, that's incredibly common. Obviously, it's people just not telling the whole story. I've just recently had, I did this thing the other night for myself, right, I took this long standing issue, I've had my life. And I opened up a chat GPT four o window where I was actually speaking to the computer, and it was speaking back to me. And I said to him, Hey, I'd like to have a long form conversation about a health issue I've been having for 20 years. And I don't know that I'm gonna get all the information out. So let's have a back and forth. And then I did that I actually just talked to the it was my phone actually talked to my phone for 20 minutes. First of all, it was one of the more cogent conversations I've had in the last six months, which was upsetting to some degree. And I started thinking like, maybe I should start talking to my phone about what what I thought about the movie I just saw, because maybe it'll be better than some of the friends I have. It went back and forth. It asked questions. I, as I went along, would go, Oh, you know what, I forgot to mention this. And then I added that. And what I realized was that the the AI, it hears everything I say, it's not biased, and it doesn't forget. So even if I mentioned something, and then I make a left, turn in the conversation, and never get back to it, it doesn't forget that I said that, right. I'm almost trying to say that AI has. I feel bad for doctors now. Because now I'm recognizing more and more. We're asking them to know everything, and then be able to recall it. And that's not fair. And I don't see how anybody could do that.

Anonymous Female Speaker 26:31
Does that make sense? Right? Which is why like, it's, you know, you've mentioned before in the podcast, but if it sounds like a horse, right? That's what it is? Yeah. Because in the end, like you have to go with what's common first. And it's not that you're forgetting that there can be other things is that your first checking or trying to treat what's common? And then if that doesn't work, then you have to go back and kind of ask more questions and reread the notes and think again,

Scott Benner 26:57
what is that? A I had a conversation with your husband? 20 years ago, don't you think it would have come up and said, hey, you know, you might have celiac,

Anonymous Female Speaker 27:04
I think it wouldn't have been hard for anybody.

Scott Benner 27:08
They're like, listen, we didn't want to stop eating bread, leave us alone. But you don't I mean, like, I wonder if and I take your point, like, I'm sitting here trying to be very thoughtful about it. And I'm having this very Intel conversation with the AI. Most people are going to go, my head hurts. And then where do you go from there with that, right? Like they might read my doctor,

Anonymous Female Speaker 27:28
you have the basic questions that you're supposed to ask to try to figure out. What kind of headache is it? First of all, there's something dangerous, you know, or not, and something that's emergent. And then from there, you keep going to try to figure out what it is based on differential diagnosis that you have in your head.

Scott Benner 27:42
But I can't teach the AI to differential diagnosis, know that you can definitely listen, I know it's your job, and you still have like, 25 more years, you got to make money. I'm going to plant my flag in this one for the future. So I can come back to it. If I'm wrong. That's, that's fair. I think that doctors jobs are going to shift to be the human eyes, on the algorithms, understanding of what's going on.

Anonymous Female Speaker 28:07
I will say the beauty of oncology is that it's as opposed to other like to internal medicine, or I'm not trying to diagnose and I'm trying to figure things out so much. I'm trying to figure out what the patient how they want to be treated, and how to treat side effects that they have and how to treat things that have to do with the cancer. Yeah, so I think that my job is pretty safe.

Scott Benner 28:27
Because at no point are we going to put a person in front of a computer screen and say here make her feel better. So like, you know, like,

Anonymous Female Speaker 28:34
this is your prognosis, what would you like to do now?

Scott Benner 28:37
Also, I think Modern medicine is insanely good at some things, right? Like the mechanical stuff, like surgery and emergency care. I think it's it's Nexen. It's second to none. It's amazing. You know what I mean? But it's when you get into that diagnostic stuff that's beyond normal. Or when it gets into, I mean, something like type one diabetes care, which is so much more, what would you call it? Like, it's my it's more art than science? Maybe?

Anonymous Female Speaker 29:05
You know what I mean? And I think also that type one is really different than other diseases. And it's one of the only ones I think are the only one that I know of that it's really like you at home have to make decisions all the time and to change your dose. And what how much you're giving now how much you're giving afterwards. You can't wait the three months to see the endocrinologist to figure out your trends. It's like you have to change it by yourself. Yeah. And I think in most other like I can't think of anything else that's like that, that it's not the doctor actually designed to give you a medication and telling you when to take it and how much to take it. So type one is really different even in other chronic illnesses or illnesses in general. Why

Scott Benner 29:51
I wonder then, why do we try we doctors? Why do we try to give static advice for something that's so clearly Ever changing. So I

Anonymous Female Speaker 30:01
don't, I think there's two answers to that one, I don't feel like I got static advice, good. When she was diagnosed, it was kind of clear, like even the person who did the pump training for us. So she also had type one. And she said, you'll see like, you'll start changing things in your pumps on your company, see, the things are kind of going wonky for your Basal if you're, you know, you'll make changes. And the doctor was also really clear to him in the beginning, I called him every single day, he said, Call me every morning, tell me what her number was when she woke up, and we'll decide on the Basal dose and, and at that, you know, every night call me and tell me what her what her numbers were throughout the day. So in that sense, he was definitely saying that's ever changing. And he was also taking responsibility for him. And I don't know how he does that with every patient. Yeah. And I think different patients at different points feel more comfortable saying, Can I change about myself or I'm going to for

Scott Benner 30:54
you, when the phone calls went away, when it was no longer comfortable to call somebody every morning? Like, where did you get the confidence to keep doing that as things changed.

Anonymous Female Speaker 31:03
So I think it helps to be a doctor, first of all, okay. In other words, like, I never started with, like, not having confidence, I didn't know, I didn't know about type one, I knew that there was basil on it, there was Bolus, like I knew the basics. But I think that, I mean, it's not as scary to use medications to make changes when it's something that you do for other people every day. And I also think it's like, they gave us the basics. And then when I thought we went on a pump, about a month and a half after we were after she was diagnosed, she was on the Omnipod dash. So I just like I knew what he was going to say. I mean, I knew that I was going to say, Oh, she's going up higher, about nine o'clock. So we'll say oh, so change the basil at seven. So eventually, I said, you still want to keep me keep calling you.

Scott Benner 31:53
I think the point is, is maybe at the core of everything, I'll say all the time that the people who find the courage and the knowledge to make adjustments to their insulin, without a doctor are the ones who end up succeeding the best, you know, like it just that autonomy and confidence. I mean, obviously, it's a need. But if you it's almost like telling somebody, like you can make your thermostat 68 degrees. But if you want to change it, you're gonna have to wait 90 days, and then drive to where I am. And then talk to me about why you want to change your thermostat. And for you know, what happens if it gets warm or cold during that time and you want to move the thermostat back and forth, you look at it, you go I know, this thing could make me warmer or colder, but I'm not allowed to touch it without going and talking to the person that I really think that?

Anonymous Female Speaker 32:40
Yeah, I mean, I only have, you know, my experience with endocrinologist that we're with. And that's definitely not the way you know, like, he never had an expectation that we wouldn't change things. And I think the opposite. He has an expectation that if you have the capabilities to do it that you will don't and he only doesn't do that, or people don't change it. Some people just don't have the capability, let's say to do it or to do it in a safe way or to understand it as well. Maybe, right. Sure.

Scott Benner 33:08
Well, don't you think you you got the autonomy? Because you were a doctor? No, no, you think that you think this doctor tells everybody the same thing? Yeah, okay. Yeah. Well, you got a good doctor, then. So then that's the next part of this whole Doctor thing. Right.

Anonymous Female Speaker 33:21
So it's really complicated, though, to say that because I didn't, it's not that I get a lot of information. And I think maybe this goes back to the doctor bashing is that I think that you have to have realistic expectations, like also, with what you expect the doctors to know what you expect them to explain to you when you're first diagnosed and a little bit afterwards. And that doctors have reasons sometimes. And it's not that they don't know necessarily about why they're not saying things, for sure. And in the beginning, you know, you can't have all that information in the beginning. And we left the hospital without a Dexcom. And I have to say that I don't think it's a good thing to leave the hospital for Dexcom, which I know is a minority opinion. Because I think it did two things. One is that it made me not nervous to not have my Dexcom working because we didn't do it for two months without a Dexcom my daughter felt her lows in school. We don't have a school nurse. She was seven and she could still do it and she could fingerprick herself in class if she didn't feel good. And also I think that it was kind of good to just like get the basics down card counting my daughter after she was diagnosed. She would eat five to six bowls of cereal in the morning. Yeah, because she's starting now one bowl of cereal spikes really high hours afterwards. So I can only imagine what those five to six bowls were doing. And to me I checked her you know, before her snack at school, and then we will just correct and move on. Otherwise we would give the correction get the carbs. And that was it. Yeah. And I think that if I would have seen all that data, and I can only imagine that she was sitting Get the three hundreds for those two and a half hours until she went down to 200. And something when I gave a correction, I think it's okay to wait those few months. And to just get the basics down.

Scott Benner 35:11
I'll play devil's advocate because it's fun. I think you have the luxury of feeling that way because nothing bad happened.

Anonymous Female Speaker 35:17
I don't think that something bad happens from having high blood sugars for a few hours. Definitely not for a few months.

Scott Benner 35:25
I don't mean high blood sugars. I mean, like, in the first six months of my daughter's diagnosis, she had a seizure. If she was I just

Anonymous Female Speaker 35:33
I want to say something about that. Yeah, totally different. Totally different if you have a toddler. I'm talking to older kids. Okay. Like, I think that having a toddler is completely different. You can't communicate with them, for them. Definitely impossible at the Dexcom 100%.

Scott Benner 35:48
But let me ask you, let's just again, what if on one of those mornings with all that cereal, your daughter had a honeymoon moment and you had pumped in enough insulin to cover seven bowls of cereal and then she went to school and passed out. Do you think you'd be saying it's okay, not to have a CGM? Because it's good. You get to learn. But

Anonymous Female Speaker 36:07
what I think is that she checked herself and she knew how to treat her lows and it gave confidence.

Scott Benner 36:13
Oh, I agree. Listen, everything you said there's value to like, I 100% agree. Like,

Anonymous Female Speaker 36:18
I don't think that would happen. In other words, it's she went she started honeymooning, right. Like she had anyone for about a month. And in that month, we didn't have a Dexcom. And it drove me crazy. Because we were at the park and suddenly she wasn't feeling good. And she was 40. Like we had bad loads or, you know, she went to sleep and she wasn't feeling well. So I checked her sugar when she went into bed. And she was 30. It's not that we didn't have loads. I didn't. We didn't have it kind of showed me that. Yes, she would feel her low. And yes, we can deal with it. Despite the fact that I don't know how fast she's falling. Yeah, so we gave us carbs. And we checked her again, after 10 minutes. And then we gave more carbs if we needed to know as seizures are few and far between.

Scott Benner 36:59
In general, you think so

Anonymous Female Speaker 37:01
it's not that nothing bad can happen. But I think that in this in the month, usually after you're diagnosed or definitely in the first few weeks, you're usually your blood sugar was so high that until you start hunting money, you're usually not going to have crazy lows. Okay, so I think it's okay to have at least those two weeks of you know, going home, figuring out what you're doing, and not seeing all the data. And again, it's not that I think that it's good to not have the alarms is that I think that seeing so much data, maybe isn't the best thing when you come out of the hospital.

Scott Benner 37:33
It's and listen, I'm not arguing with you. I will say that. I mean, call me back in 20 years, maybe is the way I'm gonna say this, but like, I, my, my daughter has had one. She had one seizure when she was six months old. We just didn't know what we were doing. We had a high carb meal, we thought we did the right thing. She took a nap and had a seizure in her sleep. It happened again a couple of years later on activity. So we were at an amusement park all day out in the heat. At the end of the day, she saw a vendor holding like, like popsicles. She asked for one, we Bolus for it. She had a seizure two hours later. I know now, by the way that I you know at the end of all that. All that it was super, like I didn't need to give her any insulin for it. Right. I know that now. She didn't have another one again until the night of her senior prom. On a day when she heard very little food and had very little insulin was wearing life saving equipment and all that other stuff. What I'm going to tell you is I 1,000,000% believe and agree with your message. I really do. And I think that the only reason you're able to deliver it is because you didn't have one of those random things happen to you because I don't think you were a CGM. For most of the time you were it for the moment that you can't plan for that you don't see coming. That's my feeling. And you just haven't had one of those moments yet when I hope you never do. Like but

Anonymous Female Speaker 39:09
now we're on the CGM. But again, I think that when you're when you're diagnosed and your sugar's are super high, it takes time for them to come down. So I think that you do have a leeway of at least two weeks where it's okay. You don't have to be stressed about getting a CGM because I see people writing you know, like, don't leave the hospital without one. It's okay to leave the hospital without one. You know you you have to

Scott Benner 39:32
Yeah, no, I take your point like it doesn't like I do see your sad one

Anonymous Female Speaker 39:36
after two months. Yeah, we and we didn't have and I would have wanted to have one even before when just when she was honeymooning and I knew that she was having lows. We were no

Scott Benner 39:45
I think it's a good conversation to hash them. I also don't think there's a right answer and I think that the right answer is for whatever ends up working for you. What I'm saying is it also has to do a lot with your personality like for some people were like look, all that data would be overwhelming. There are other people would be like I'd find all the data comforting, like so your personality, the situation you're in, etc. But I hear what you're saying, If you can't get one right away, like, please don't act like it's the end of the world, you can test you can be careful, you can put safeguards in. And there's a lot to learn along the way. You know, I'm agreeing with you, and at the same time trying to have a conversation, right? Yeah. Yeah, yeah. Okay.

Anonymous Female Speaker 40:21
All right. And by the way, like in terms of Outlook, like if my daughter had a seizure, right, what I freak out or not, then and also afterwards, also, in that sense, like being a doctor, I think, and it's possible, it's my personality, without being a doctor, but like, the way that I look at illness and death, and I'm not saying deaths from diabetes, but in general, fatal illnesses and chronic illnesses. I think it's different than like, you were talking before, about, like how modern medicine is amazing in a lot of ways. And I think that it kind of got us used to thinking that everything is fixable. And that, like illness and death is something that's traumatic and not natural. I think that I have a different perspective on that also. So it's also like, if we need to use glucagon, I hope we don't need to, but I'm not sure exactly what my reaction would be. And if it would be freaking out afterwards for the next 10 years.

Scott Benner 41:15
Yeah, I don't know. I also don't think it happens to some people at all. Like, I mean, it didn't happen to Arden. Like she had that seizure a couple of years ago. And, you know, she was shocked for a couple of days, maybe three days, actually, like, she was like, 17 years old, like she slept on our bed for a couple of nights afterwards. And then one day, she just got up, and she's like, I'm gonna go in my room. And I was like, okay, and then we talked and we talked a day or so later, we talked about on the episode where she just said, like, I've thought it through, I didn't do anything wrong. And that seemed to comfort her. For so many days and weeks and months and years, I do the same things over and over again. And I was okay. Yes, there was a variable in here that like, she's like, but it's uncommon, and I don't think it's gonna happen again. So I'm gonna go back to my life. Whereas somebody who's maybe bent towards depression or anxiety that could end up making them scared for a decade, like, and I've seen it happen, you know what I mean? So, it's interesting to talk about blanket statements overtop of such a moving target over top of so many different personalities and experiences and, and that's why there's no like one size fits all accommodation, for sure. Yeah, that's just my perspective. No, I love it. Are you kidding me is fantastic. I need to listen without these conversations. I don't know if you know this. The podcast is boring. And then nobody listens. And then Scott's got to get a real job. And I don't want to do that. So imagine if I worked at a store or something like that, where you came into? I would chat chat. Talking to the customer. Yeah, great. Oh my god, I'd be the most popular cashier. I'd be like, I'd be like, hey, what do you know about this? And then we start talking about something crazy. I heard on a podcast probably. But anyway, so Okay, so on your list now what's the nondiabetic? You? Here's your list, I'll give it to everybody. Dr. bashing, nondiabetic number. Parenting versus body autonomy. I love this one. I want to make sure we get to that. Why don't we do that one next? What do you mean by that? And you say parenting versus body autonomy? Because I have a lot of that. Can I say one more thing about the doctor bashing? You want to do some? He's heard but doctor you want to know, Dr. Bash, but

Anonymous Female Speaker 43:23
I didn't say the other. Is that, like, I tried listening to the Grand Rounds, and I couldn't I stopped in the middle of the of the first real one. Okay. And, and I think that, I think, again, that you really have to take in perspective, like what you expect of a doctor and what you expect of yourself. And I really feel like we talked about a little bit in the beginning, but that like, it's, it's your illness, and it's like, I'm freaked out that my daughter is gonna go to the hospital when I'm old and can't go with her. And nobody's going to know, you know, how to advocate for her. Yeah. But in a normal world, or person, that you're not by yourself. And either you can advocate for yourself or have family member advocate for you. Like, I feel like that's really like where the education needs to be. And education for doctors again, like has to be a kind of mentioned before, like, it's, it's how to not miss something that's important. And that's true about every illness, and not only type one diabetes. And it's knowing that you have to call the endocrinologist if you're going into surgery with somebody who came in with type one diabetes, and they're not conscious, and they can't talk to you and say things are, you know, how you're supposed to do their sugars when they're in the ward and they're getting, I don't know, TPN or they're getting glucose in there, you know?

Scott Benner 44:42
So, I think you being a physician and the nature of your personality, it gives you a certain perspective, obviously, but let me let me ask a couple of questions and see if you see a thru line here. Once a week, three men in a truck come down my street and take my garbage away. If they took To the cans and not the third can do I have to go outside and advocate for them to take all the garbage? I

Anonymous Female Speaker 45:05
think first of all that you could say, maybe they didn't take it because one of them had to go to the hospital suddenly. Yeah. But

Scott Benner 45:11
but you know what I'm saying? Like, it's the I didn't see this once.

Anonymous Female Speaker 45:14
I'm not saying that I that the doctors don't have responsibility. I think that the expectation that they'll have so much responsibility or so much knowledge, that that's not realistic. I agree with you. Yeah. And that, therefore, mostly, you have to have it and they have to know, hey, this is something that we have to check out. And it's also knowing a doctor has to be able to ask the patient. Oh, you have type one. You know, how do you get your insulin? Oh, they have a pump and CGM. Okay, during your hospital stay? Do you want to take care of it? Or do you want us to take care of it. And that has to be a conversation that can be had with the doctors. And it doesn't have to do with them understanding it has to do with them understanding what type one the type of disease it is, right? And that a patient who's awake and take care of their diabetes better than they can. And also in the hospital, generally patients, like when kids are sick, or people I just know about kids, I have a kid and I'm not the one that's type one. But it's really hard to manage blood sugars. And it's really hard to manage blood sugars for somebody else. Yeah. And I think that you also have to have grace in the hospital that in the end they are when you're in the hospital, they're trying not to kill you, if you came in for diabetes, they really know how to take care, right? They know how to take care of DKA really well. But if you went in for something that's not connected to diabetes, they're taking care of that thing that they have to take care of. And they're making sure that your diabetes is decent and decent is decent in hospital hospital, not decent in the life.

Scott Benner 46:38
But how are somebody supposed to know that like, so? If I'm just a family or an adult, and I've been alive for 20 or 30 years, and so far, health care has been one time I got the flu and I went to the guy and he gave me Tamiflu, or I fell in my arm broke and I went to the guy and he fixed my arm. How is all the sudden? How am I supposed to know all the sudden that the All Knowing all seeing magic Doctor Who makes more money than me drives better car than me, went to more school than I did says they know all about medicine. How am I supposed to know they don't know where that they don't have good news

Anonymous Female Speaker 47:10
is in Israel, we make very little money. Public health care system. Everybody thinks that they know the best thing for everybody in this country. And they will tell you that and nobody's GCR speaks with respect. So we don't have that problem.

Scott Benner 47:25
I know a lot of Jewish people, and if I can make everybody Jewish, then I would assume that they can advocate for themselves. But

Anonymous Female Speaker 47:32
what about the people? What about the people who were also very nice.

Scott Benner 47:37
I didn't mean it that way. I just I but but but you know what I'm saying? I'll

Anonymous Female Speaker 47:41
tell you how. Because because when you're in the hospital that flick a blip in your month or your year. And then you go you have a primary care doctor care doctor, and you have an endocrinologist, and they're seeing your agencies and they're seeing the endocrinologist is looking at your trends. But even the family doctor sees your agency went up from I don't know 6.3 to seven. Yeah, they're supposed to notice that they're supposed to say to you, hey, what's going on? Maybe you need to go back to the endocrinologist. Maybe we can talk about and figure out what's going on. But that's not for the hospital that's for your you're not supposed to leave the hospital or at the hospital isn't your primary care and diabetes is really something that has to be handled in primary care.

Scott Benner 48:17
Yeah. But how are people supposed to know that? Because their

Anonymous Female Speaker 48:21
doctor sees it. I see people say once see, it's like, I don't have an oncologist. I'm not taking care of it. I see that somebody has an ailment, see, let's say they're coming, somebody had colon cancer, they're coming to me, and they're healthy. Now they don't have cancer. And they're just coming for a checkup. And they did blood tests for me, right? I care about specific things. And I don't care about the diabetes. So when I see that they have an A one C of seven, I write to their family care doctor, that they need to go see it to diabetes clinic. And I asked them is who's you know, who's taking care of your sugar is taking care of your diabetes?

Scott Benner 48:53
I'm not being clear. I don't think if I go to a hospital, how am I supposed to know that's not where I get this care? Doesn't that seem like the place where you get that care? If you were a person on the outside was not connected to the medical industry at all. You're not a doctor, you're not. You don't go to

Anonymous Female Speaker 49:08
the hospital and you just have a flu, you go to the hospital because you have something serious. So I don't think anybody thinks of a hospital as a place that that's like where you get regular care.

Scott Benner 49:17
I swear to you I think you're wrong. Though I think that people think I don't think they think of the hospital and the doctor's office and an emergency care center. I don't think they think of them as anything different. I think it's I think they believe it's the place they go where people who know better than them are. And when you get there

Anonymous Female Speaker 49:34
better than them about specific issues. Yeah. And again, I find that that's something that that people have to be educated. Yeah.

Scott Benner 49:42
How are we going to do that? How are we going to do that? By

Anonymous Female Speaker 49:47
talking about how about learning about their disease and actually, you know, going on Google and looking, you know, looking for answers asking your doctor questions.

Scott Benner 49:56
I heard an actor on a podcast the other day told me that straight lines aren't a real thing. I heard another I heard a basketball player telling me that the globe is threat flat, you want them to know about this too, like they don't people don't know about anything they don't know, inside of my sphere, the world I've set up for myself, I'm all knowledgeable. If you take me outside of my sphere, I don't know a damn thing about anything. And so what I'm saying is that people have never been sick a day in their life. Just think that when they get to the hospital, everyone they're talking to knows everything that they need to know. And the where that problem comes in, is that obviously those people don't know everything. But if I think they do, then I take what they say as gospel, I also believe there's nothing else because you don't go to the doctor, and he tells you, hey, you have to take one of these pills every day at 8am on an empty stomach, take it Monday through Friday for the rest of your life, you don't imagine that they left something out.

Anonymous Female Speaker 50:51
I think times are changing. First of all, it could be different cultural things. But I think that it's not the same, you know, like they talk about a lot and you know, in medical school, and that people don't come to the doctor anymore like that. Maybe it's people who are older, but not people who are younger. And again, it's not that I don't, I don't think that you need to advocate in the sense of arguing with the doctor on call, or that you need to know what you need them to be aware of. And what things are really important to

Scott Benner 51:21
dig into this for me, what does advocating mean to you? If I have to advocate for myself? What is it I have to do?

Anonymous Female Speaker 51:29
First of all, to me, it's even at the start, the doctor comes and asks how you are so you know, you have to put your type one diabetes, in the front of that conversation, right? When you're sitting in the ER, it's only if you if the doctor is not doing those basic things, right. That's when you have to advocate in a way that's maybe or arguing or standing up for yourself. So in general that in life, you have to stand up for yourself, that's just the way it is, you know, an ER has a million people in it. And in the end, and it's sad, but you have to make yourself heard.

Scott Benner 52:04
So you just said if the doctor doesn't do what they're supposed to do I have to make them do it. How do I know what they're supposed to do? No,

Anonymous Female Speaker 52:11
you don't have to know what they have to do what they're supposed to do in terms of your stomach ache, you need to know your type one diabetes, you need to know your chronic illnesses that if something goes wrong, you can die it. That's, that's you need to know what that means. And then type one, you know what that means, right? You know, you have to be getting insulin, you know that you have to be checking your blood sugar, right?

Scott Benner 52:30
Is there a world where I should expect a doctor doesn't know that.

Anonymous Female Speaker 52:35
Again, I think that in type one, as opposed to type two, that they won't necessarily notice in the same way, if a type two is in the ER, right? For 24 hours, it's not the biggest deal in the world, if they didn't quite get the insulin dose that they were supposed to be getting, right 24 hours, it's not, it's not gonna be the end of the world, I don't think that you can expect that the ER doc is going to notice that your pump is off and that you're not getting your insulin because when you're in the ER you don't, they don't ask you for your like, they don't give you your basic medications, at least not here. That's if you go to the ward. So then you sit down, you know, and you write in all the medications and you have all those orders. But if you're in the ER, you have to tell the doctor if there's something that you need to get that as well. It's not something that just happens.

Scott Benner 53:19
So I should trust the doctor yes or no,

Anonymous Female Speaker 53:22
I think that you should trust doctors. And I think that discussion with the doctor starts from trust.

Scott Benner 53:27
So let me keep going. So I have type two diabetes, I've been told by a doctor already that it's very important for me to take my insulin every day, keep my blood sugar's in a certain place. And then I go to the ER for, I don't know, I can't fart, whatever. And now I'm in the ER and for a whole day, they don't care that my blood sugars are high. And then they're really, there's

Anonymous Female Speaker 53:47
no way that they're gonna let you be riding so high. They'll give you corrections. It happens all the time. You're there for 24 hours. Yeah, you should tell them when it's eight o'clock at night or nine. Whenever you take your long acting, you should say to them, Listen, I actually got my long acting, and then the doctor will put in the orders for that. But you can't expect the doctor to remember that you're tied to and that you're on MDI and that you're supposed to get your land and that you've been in the ER for more than 24 hours. So you have to get some time in that timeframe.

Scott Benner 54:13
Right? No, I agree that the person should say that I agree that the person should recognize that they need to take their insulin on their own. But also, they may be thinking that you're going to take care of it. And also my my bigger point was is that if, if a doctor has told me, Hey, my blood sugar should be between 90 and 120. That's optimal. And then I get to the hospital and my blood sugar's are 180 to 220 and they go It's okay, while you're here, it's fine. How do I not go home then and think, oh, maybe 180 to 220 is okay, maybe the first doctor was wrong.

Anonymous Female Speaker 54:44
I think that I think that there. Obviously there's a lot of space for educating doctors, but I think educating doctors is educating that. In other words like that a doctor should be able to know to say to a patient like when you're in the ER Then as your sugars are higher, you know, when you go home, you'll go back to doing what you usually do or go back to your endocrinologist if it's been working out.

Scott Benner 55:07
I'm just saying that how how do we not expect that that person who's now been through that hospital experience doesn't leave? They're believing that a higher blood

Anonymous Female Speaker 55:16
sugar's Okay, still have a family doctor, they still have somebody who's checking their labs, one every once in a while, and somebody who's been to the ER should definitely their family doctor should know that that happened. So there's always supposed to be somebody who's catching that.

Scott Benner 55:29
Do you really think that happens, though? Do you think people leave the ER and then call their GP?

Anonymous Female Speaker 55:33
I think that's supposed to happen. That's what No, but I think that that's where, like the issue of like, how can you make the healthcare system better? It's not for all doctors to know about type one diabetes, it's to be able to have a situation where, yeah, you go into the hospital, and then you, you know, like, somehow gets sent to your GP or your GP knows, or they tell you, you know, you have to take this back to your GP, you know, you get you got a discharge paper, you know, usually like by us, it says, you know, you know, bring this to your family

Scott Benner 56:04
doctor, you're ignoring the the human aspect of it afterwards, nobody's going to do that. They think they're okay, now they left the ER, the pain is gone. They farted

Anonymous Female Speaker 56:11
there think that the people who think like that are also gonna have a really hard time controlling the type one diabetes, because they're not involved. Well, yeah.

Scott Benner 56:18
Oh, but that's my point. My point is, is that of the like, I don't know what it is now. 1.8 million Americans that have type one diabetes, a very small percentage of them even use an insulin pump where no one is.

Anonymous Female Speaker 56:30
But if you see somebody in the ER, right, who came because of DKA, because somebody like that is probably going to have high sugars when they come right. And they should get an endo consult, and they should get they should get an appointment for them to chronologist.

Scott Benner 56:41
But what if I ended up with the Endo? Who didn't know that the person needed basil? And even though their blood sugar was lower? Well,

Anonymous Female Speaker 56:47
that's I'm saying there is that obviously, like doctors need to, but I think that what you hear here, right, is you're hearing people who have bad experiences, and not as much most of the people who are having a decent or good experience. And that's just the reality of having

Scott Benner 57:04
I think most people are having bad experiences, and few people are having good experiences. And I think the numbers about people's a one sees, like, bear that out. Like, I think that I do a podcast for a very small section of people. And that most people who have type one diabetes are not even hearing this.

Anonymous Female Speaker 57:22
Probably, but I think that that's also why doctors need to be able to give rules that will keep health decent, and not necessarily the best. But even if it's really, really late, so I'm sorry. No, I don't have a problem.

Scott Benner 57:37
I love this conversation, by the way. And I really appreciate you having it with me because a spirited conversation like this is the only way to get the idea into people's heads. Because I'm not certainly saying that there aren't great physicians. And I'm not saying that people don't drop the ball in their own care all the time. That obviously happens. I'm just saying from a human point of view, I don't think you can set up a system that relies on the average person to understand what they're supposed to do for themselves.

Anonymous Female Speaker 58:04
So I think that in America, the system is much more complicated and not good system, right? Because, you know, everybody, you have your insurance and you have the some other nobody's really talking to each other. But I think it works differently in other countries and that there's something to learn. I

Scott Benner 58:21
would imagine there's something to learn from everybody. Yeah. For certain. Okay. Okay. Parenting versus body autonomy. This is another one, I have to

Anonymous Female Speaker 58:27
say I do want to talk about the diabetic goals, though. Save two minutes for that.

Scott Benner 58:31
It doesn't have to be just an hour. Do you? Can you go a little over?

Anonymous Female Speaker 58:35
Yeah, no, I'm fine. I'm fine. Just like that. Did you ask it that? And like, was there anything else you wanted to say? I

Scott Benner 58:40
like that you listen, okay. Okay. So parenting versus body autonomy. What made you say that? So

Anonymous Female Speaker 58:45
I feel like a lot of people, you know, like, they're like, oh, you know, fine. You know, it's been five years, and my kids ready for a pump now. So what are you guys talking about? Or like, you know, we're definitely no, it's, it's her body and or his body and their decision? And I've heard you kind of say it also, I think, but I really don't agree with that. And I think that parenting as a whole is deciding what's best for your child, in many, many aspects, right? We push them to do the things that we think will be good for them. We choose a lot of things for them. And I think that the issue of going on a pump is that your kid can't know what it feels like to be on a pump, and what it can help with if they didn't try it. Now, when you go on a pump, you have to know that whenever you change something, right, going from a pump to an algorithm pump or going you know, back to MDI is always going to take a while of figuring things out. Because different things work differently. And you can't expect to be on a pump for one month and be like, Oh, it does work or doesn't work. So I think that you have to push your kid out there. It's like I didn't ask my daughter she wanted a pump. I said to her, Listen, I didn't even ask her what pumps she wanted. I looked at the pump Um, so I checked what I thought would be best for her. And then I said, Hey, look at this video online, we're gonna get a pump soon. And when you get a pump, you'll be able, I feel like a pump is really important, you know, and diabetes has a lot of disordered eating and eating disorders, right. And I feel like a pump is really, really important for that. It helps you keep your eating just being natural. When you're hungry, you eat when you're not hungry, you don't eat and if you want another bowl of pasta in same meal, you just give yourself a little bit more insulin. Yeah. And especially like now we change to lume. Jeff, so even more, so it's like, we don't have to Pre-Bolus. And that makes it even more natural, except for unless she's high, and we have to bring her down first. So I don't think I think it's not, I think it's the wrong thing to do.

Scott Benner 1:00:46
This is boring. We agree. So this is so boring now, because you and I agree.

Anonymous Female Speaker 1:00:51
We agree that but I feel like I feel like on the Facebook page, but it's a minority opinion. And yeah, maybe to you here, I don't know,

Scott Benner 1:01:00
somehow my body my choice got mixed in with it's their body, if they don't want to wear something they don't have to. That would be nice if they didn't have diabetes, like like, and I would agree with you, you know, but

Anonymous Female Speaker 1:01:11
again, if your kid is on a POM for three months, so you've already you know, you've given it a shot, and they don't like it. So yeah, go back to MDI. Because they they understand, like, my daughter understands that if she doesn't want the palm, then she's going to have to do a lot of injections. Yeah. And that will have to do corrections with an injection. And also, especially for little kids. And definitely during honeymooning when you can only give full units. Sometimes she didn't want to eat a snack that was 30 cars when she was a one to three ratio. And like a pump gives you all all these things besides like actually be able to, you know, change your basil and to do a lot of different things and to have an algorithm, like just having a POM. It makes life a lot more normal. And you can't know what that feels like until you've tried it. Yeah,

Scott Benner 1:01:55
I listen, I agree. I also think if somebody doesn't want to use a pump, they shouldn't. But I don't know that we make a six year old in charge of that decision. I don't know what Listen, my son doesn't have diabetes, but he's 24. And the other day we were talking about software, he's looking for jobs and stuff. And I asked him a question. And he goes through I don't know, in my head. I'm like 14. And I'm like, exactly. I think the way I've said it over and over again in the podcast is I don't know many other big life changing decisions that you let 10 year olds make. Right? Yeah,

Anonymous Female Speaker 1:02:26
I think like it's not only about like a pump. It's also what we wanted to change the type of ends though, when we wanted to start looping. So she was dead set against it. She liked her PDM she knew how to use it. She didn't want to learn how to press other buttons, and she really didn't want to do it. But again, like I didn't ask her like, Hey, do you think we should try this thing? I said, Sir, listen, I found something I think will be better for us. And we're gonna give it a shot. And we're gonna see how it is. And if you tell me later that you don't like it.

Scott Benner 1:02:52
So we'll go back. This is how I do it, too. That's exactly how I do it. I also even now that Arden's older, she's 20. Soon, she'll be 20 in a couple of months. And just recently, she got low at school, and we were texting her and she's like, stop texting me. And I said, answer me, and I won't text you. And she's like, you don't need to do this. And I said, Oh, you don't want me to do this. That's fine. I said, start paying for school yourself. And it'll be fine. I was like, but right now, if you want me to pay for college, when I text you about this, you text me back. That's it small price to pay. Right, Alex? What are we asking for? So you don't have to pay the money. She just has to text me back. Right? And then we had a conversation later where my wife and I explained to her like, look, I understand that it might be it sucks. Like you're sitting down, you're working you're distracted, you know, you already fixed your blood sugar, right? Like it's been taken care of the number just hasn't bounced yet. And now we're bothering you. So the blood sugar, so you got low that sucked. You had to fix the blood sugar that sucked. It took you away from what you were doing that suck. And now all of a sudden, here we come. And it's just it feels unnecessary. Like but you don't know our side of it. I understand your side of it. I understand. It's not perfect. I wish it was I'm sorry. It's like this. But we can't just sit here wondering if you're about to die and not do anything. Right? And so that's what this is. And if you don't want this to be that, then that is to say that you don't want us to parent you anymore. And if that's what you want, then I really don't want to pay for college. If you're if you're that autonomous, that's rock and roll I go get a loan. Okay, listen, and I gotta be honest with you after school's over. I'm gonna look for another reason to be able to like to get her to like tell me she's okay. But be yeah, like I take I

Anonymous Female Speaker 1:04:40
think we kind of split on on the parenting.

Scott Benner 1:04:45
I tried to make a bombastic description of what it is but I don't think kids like don't get me wrong if art and push back hard enough I'd say alright, this is obviously something you don't want them we're gonna but we can't stay in this current setup. If that's not Part of it. So we're gonna have to change the set, which I assume is going to happen over time to begin with. But your points more about younger kids, your kid, you know, diagnostics, I

Anonymous Female Speaker 1:05:09
think that it's really different when you have an older kid. And even in the teenage years, it's, you know, possibly letting your kid to a lot of things that it's not the way that you would do it. And that's still fine. As long as I like basic rules that you agree on. I haven't gotten to the teenage years. So we can talk in five years. And I'll let you know if

Scott Benner 1:05:25
that works, right. You're looking for an equilibrium of safe and healthy. Yeah, that's what you're looking for. Yeah. But I loved your approach. Like, look, I found this thing. I think it might be better. We're going to try it. If it's if because what you know, is that very likely, it's not going to be a problem.

Anonymous Female Speaker 1:05:40
So within within a few days, she didn't care what buttons she was pushing. And it was really nice for her that I didn't text her call her as much when she was high or low because Luke was taking care of it. Exactly. And also, she only needed one device instead of two, which also makes a difference.

Scott Benner 1:05:57
Fantastic. I hear a high blood sugar. What number does that that Beeping?

Anonymous Female Speaker 1:06:01
Beeping? I heard two beeps. Hi, oh, this brings us right into diabetic goals. She Oh, she's 214.

Scott Benner 1:06:11
Now, do you tell her to Bolus? She's asleep?

Anonymous Female Speaker 1:06:15
It's 10 o'clock at night, you know?

Scott Benner 1:06:16
So are you gonna count on the algorithm to try to bring it down? No.

Anonymous Female Speaker 1:06:19
First of all, we changed her. We changed her pump right before we got on.

Scott Benner 1:06:24
Oh, so she's got like a little rise from the change in the cannula. Oh,

Anonymous Female Speaker 1:06:27
I think probably that and I already see that my husband lost quite a bit. I mean, he does like micro bolusing. Cuz when she's asleep, I don't want to crash. Sure.

Scott Benner 1:06:38
I'm a fan of Bolus.

Anonymous Female Speaker 1:06:40
Like we can see like if we think that loop is being aggressive enough or not.

Scott Benner 1:06:45
Especially with like loop or IEPs after a pump change if there's suggested insulin I like to see it in, because the site's not always

Anonymous Female Speaker 1:06:55
perfect. Right. Right. It's hard to say because sometimes it works really well afterwards. It works even better, because the pump site before it wasn't working, and then loop is being aggressive. And then she crashes. Exactly, yeah, let it ride for a little bit.

Scott Benner 1:07:07
So your point is, how are we supposed to expect a document and all that? All right, what's your next thing? What What are you talking about next outcomes? Or what are you going to say?

Anonymous Female Speaker 1:07:18
Oh, about the diabetic goals and straight lines. And we're not going to agree on this. So I

Scott Benner 1:07:22
bet you I bet you think something about me that I don't think about myself, but go ahead.

Anonymous Female Speaker 1:07:27
No, I'm sure. I think that, like there's a lot of talk right about mental health versus health and straight lines or small bombs, or what high alarm should be or if my numbers as a diabetic should be the same as non diabetic numbers to keep your child safe, which that you have said before. And I don't think that that's the right way of looking at it. I think that, you know, in all the studies, and it's kind of like you say with the TSH, right, like how they decide that that's the normal range, right? They did studies and they figured out what most people had. And that became the normal range in diabetes ated studies, and they saw when the when people started having different, you know, retinopathy and nephropathy and different things, right. And that's what they decided, you know, what the goal should be, if you don't want to have complications, and where that starts happening is what became the non diabetic, you know, the pre diabetes versus the diabetes, and afterwards, and those studies are really old. But I still think that you can learn from that you can learn a lot from that. And I don't think that there's a problem with a range of 70 to 180. And I don't think that there's a problem. Again, timing range, I feel like, obviously, you want to have the most that you can, but I think that you know, having, I don't know if somebody posted in so that they had a 6.3, a one C and an 80%, time range of 70 to 180. Those are really good numbers. And I don't think that they need to think or feel like it has to get better. And if they get better, your health is necessarily going to be better. Like my daughter's a one C went from five, six to five, eight less than, let's say, right? So and her title range went down from I don't know, 89 to 87%, or something like that. And I end within normal, the 70 to 180. And it hasn't been shown that that's going to affect your health. And I think that's important to know, like, what's evidence based medicine? And what's things that we think makes sense and a lot of things that we think makes sense, there are trials, and then they find out that it doesn't and that happens in oncology all the time, right? There's this like, amazing Dragon, I'm sure that's going to be amazing. And then they do a phase three trial and it doesn't work. So I think that it's not like being okay with being 200 for whatever that I don't know 7% of the day is or that that's not actually what's going to be causing the complications, or maybe even making your lifespan less and And let's say it is like let's you argue that it is going to make it a little bit shorter. If you're going to live to 84 instead of 86. Do you feel like that's really a shorter lifespan, like when I give somebody chemotherapy for testicular cancer, that's what happens. There's, they're cured. But they do die a little bit earlier than other people. Right? But nobody looks at that as being like, oh, you know, they just lost years of their life. Yeah,

Scott Benner 1:10:24
no, I mean, I agree with what you're saying. I think that the problem becomes the Hey, it'll probably be okay. Is great until it's not, and then there's no time machine and you can't go back. And so don't

Anonymous Female Speaker 1:10:36
think it's so it will probably be okay. Like, it's been, Shawn, that your chances for complications with an agency of seven. They decided even better if you cut that line at 6.5. And again, that's without CGM, and time and range and things that are super important, right? Like you can assume that those people in the trials, that part of the agency was they were having lows that were lower than we have, right. So yeah, some people for sure CGM and highs that were higher. So probably like even that data isn't showing you what it means to be in range now, like what it means to have an agency now of a 6.3. Like ar 6.3 is

Scott Benner 1:11:13
probably better. Yeah, so put yourself in my perspective, instead of yours. You're one very well understood person who's raising a kid with diabetes, right? And I think what you're saying makes a ton of sense. And I can tell you that my daughter has excursions up to 180, or 200. And we don't fret about them and everything else, okay. But if you're me, and you're talking to everybody at the same time, and they can't talk back, and I don't know who they are, if I start telling them, Hey, don't worry, a seven a one C is good. Do you not think that when they get to an eight, they'll be like, it's not bad? It's only one higher than seven? No,

Anonymous Female Speaker 1:11:47
I think that if you say that, you know, the ATA says that your agency should be below six and a half, and you have to work really hard to get there. Right? And that that's what's so important. Instead of thinking that it's, it may be that's for sure, or better. Yeah, I would say the way it sounds is that's for sure. That's for sure better to be in the fives or to want to be in this non diabetic range, right? That, to me is problematic when you're talking to so many people that you don't know, because in the end it like I saw posts on on Facebook, that kind of like, I'm a lurker, I only opened a Facebook account when we all got celiac, because I needed groups to know like, what's gluten free and what's not. And then I just added the diabetes Griffes to it. So I've never posted anything. But like, sometimes I see people who post things. And it's like almost a saying like, for me, this is a good number. No, it's not for you. It's for everybody having a six, three, a one C and having whatever was, you know, above a 70% range. Those are actual good numbers. You know, you don't have to apologize for that. You don't have to feel like people who answer like, Oh, it's a good start. Like it's not a good start. It's a good place to be. And I think that you can understand that without thinking that if I went from my six, three to six, nine, but that's not okay. And that I have to figure things out how to bring it back below that 6.5. So

Scott Benner 1:13:04
you're talking about health, and I'm talking about like psychology a little bit. So like, if you're, if you're, here's your kid gets into school, and they're in third grade, and they're getting a C in their class, do you go, that's great. That's average, you're doing great.

Anonymous Female Speaker 1:13:22
So it depends what I think that they can do, right? Like, my, my son is really good at math. And my daughter is really good at art and not so good at math. And they have like different things that they're good at. So what are my expectations from my son, in certain situations are different. And so you're talking to a huge audience, which I think makes it hard, obviously, to figure it out that I want to give people credit, that they're smart, and especially the people who are listening to the podcast, that are smarter, better diabetes, so that they know that they're trying to be healthy. That's why they're listening.

Scott Benner 1:13:59
Alex, it feels to me a little bit like you are coming at two different ideas from two different. So earlier in the conversation, you said, people need to advocate for themselves, they can, you know, they can handle it, they can do it. Like all this stuff. Like they're the ones that have to take control for themselves. But if I tell them that a five, five a one C is excellent, and a six is very good, and a six and a half is good, and a seven is even good. You don't think that they can modulate for themselves and decide where they want because

Anonymous Female Speaker 1:14:26
I think that you're giving a 6.2 b. And I think they should be getting an A based on I think that they should be feeling like they're in a really good, a really good place. And I find that the more that your numbers are arranged, it's also easier to keep them even more in range. If they're doing a good job in the Pre-Bolus thing. It could even get better and maybe it'll change influence and all get even better but it means that they're doing a good job and if they say six to their entire life. That's me.

Scott Benner 1:14:54
So I agree with you. I think if you had a six to budge, Agency for your whole life, York rocking it. It's fantastic if

Anonymous Female Speaker 1:15:01
you have type one if you don't have to replenish, right, but I also

Scott Benner 1:15:04
take, I take credence in the people who go like, but look, I don't have diabetes, am I anyone sees 4.9? So like, that's two full points over. How do I know that that's not going to lead to neuropathy when I'm 50? And I think the truth is, you don't know that or not. And I

Anonymous Female Speaker 1:15:21
know statistics. In other words, I know that statistically, obviously, there are people, right, who can have really good a onesies with soft some sort of complications. And obviously, there's, you know, the human body is super

Scott Benner 1:15:32
complex, but your statistics aren't going to help me if it happens to me. But you're, you're

Anonymous Female Speaker 1:15:36
telling everybody that it's better to have a 5.6 a one C? Who said that that's that that's better. And that's not making people, like you say people can handle it. But I'm not sure if that's really putting too

Scott Benner 1:15:49
they can handle some things, but not this.

Anonymous Female Speaker 1:15:52
No, you're saying In other words, that it's okay for people to feel like that's not the best and that they should be doing better? And I'm not sure that that's a mental toll. That's correct. When I don't think that you're right.

Scott Benner 1:16:03
Do you think that hold on? Do you think I've told people that if they don't have a five, five, they're failing?

Anonymous Female Speaker 1:16:08
No, I think that when you talk to people on the podcast, and they say their numbers, right, so you're so you're always very, very nice and specific about you know, and even when people post on Facebook, right, like if somebody said, like, oh, they managed to get from a nine to seven. Yeah, that is amazing. And that, that is a place where I would say, That's so great. Like, I'm sure you're gonna also manage to get down to 6.5. But it's when they got down to that below the 6.5. But I think that we have a different reaction to it. I

Scott Benner 1:16:36
mean, I the only thing I can tell you is that this is interesting. For me, obviously, and I'm interested in your perspective. I don't feel like I do that. And I don't think that I completely understand what you're saying. And I don't disagree with it. I reject the idea that I'm doing it. So

Anonymous Female Speaker 1:16:55
I'm I'm not sure. First of all, you know, people talk in different ways, right? And depends on the episode that you're listening to Sure. But I think that you can see in the Facebook group, how people perceive it, or at least the people who are really active on how you perceive it. Know how other people are perceiving it, you've they perceive their own diabetes. Okay.

Scott Benner 1:17:16
So so like if I, if I were to say to somebody like, hey, like, they said, Oh, I I started off at 11. And I have a 6590. My God, what a great start. That's amazing. You're reading that is, there's more to go. I'm saying in six months, look what happened already? What a great start to this whole thing.

Anonymous Female Speaker 1:17:37
Yeah, I think that you could read that comment, either way, or like other comments that you can't read different ways like that.

Scott Benner 1:17:43
So I don't so I genuinely,

Anonymous Female Speaker 1:17:47
like do. Do you not think that it's better to be in a non diabetic range? Because you think that eventually, I see no, I don't think you're out.

Scott Benner 1:17:57
I don't think it's better to be a five five than to be a CICs. Using just two random numbers. I don't think it's better to be a five five than a 6.5, for example, but I think is, is that if it turns out that it is when you find out, it will be too late.

Anonymous Female Speaker 1:18:13
But you already know that if you're below a 6.5, that your chance of complications are small, especially if you're keeping your time in range. So you're doing better than the people who are on the study is

Scott Benner 1:18:23
the chance not better if there's less sugar floating through your blood. That's I'm

Anonymous Female Speaker 1:18:27
saying, like you, you have to prove what you're saying, as opposed to disprove what's already been shown. So I'm sure they're gonna have to do major studies, but it's gonna take years you think that's gonna happen. Even with CGM? Yeah, they're definitely going to be going to be studies about people after CGM 100 People have complications. So

Scott Benner 1:18:45
in between now and then, all the people who don't get the benefit of the new study, if they end up being a person that has complications, oh, well, we didn't have a study. So we didn't know what to say to them.

Anonymous Female Speaker 1:18:58
No, we have a study that says that their risk is super small. If they're, if their kids are a one, C well below 16, I would tell

Scott Benner 1:19:07
you that I've spoken to people who, who exist inside of these agencies. And what I think you have is numbers that they think people can aim for. I'll tell

Anonymous Female Speaker 1:19:17
you, I had a really honest conversation with endocrinologist. Last time we went, we were the last patients so he had a lot of time. And he was asking me stuff about cancer. And I asked him about, like I said, like, what do you really think, you know, like, what? And it was a conversation that was doctor to doctor not doctor to patients? And he he doesn't think that that's correct. In other words, I think there's a difference between again saying that a seven is okay. Right, like good job and not actually looking at first of all, again, timing range and how low do you go when you're low and how high are you going when you're high and are you roller coastering or not? Right? Things that even if your timing range is okay. It's not healthy to be in a roller coaster. You're going from 60 to 200. And your time and range is decent, but you keep going up and down. That's not healthy for your, for your blood vessels. 1,000%. Right. So I think that when you're looking at all those things like he doesn't think that, that it's better to be lower. And also you had somebody on who was talking about that she thinks it's really bad for the brain to be low. But she actually actually also like writes about relevant things like a pancreas. And I think that, like, people should be worried about lows. For sure, yeah. Like even being, even being 60 for a long time might not be good for the brain in the same way as maybe being six and a half a one C isn't so good. Six, we know that 55 Right. 55 chosen because we know that that's a bad number, right? But it's probably not good to sit too low for very long trying to get

Scott Benner 1:20:53
are good numbers. I agree with everything you're saying just so you understand. So you understand that the part that I think that You're disregarding is that people aren't going to come to these things the way you're hoping they're going to like just because that's how they should do it isn't how they're actually going to do it. And I agree, I think

Anonymous Female Speaker 1:21:12
having a conversation about it. In other words, like I think it's that these are things that have to be said and have to be said like, I mean, again, you're talking to podcasters, I see something that gets lost that I see on the Facebook group, that it's like concerning to me, and I think there's things that have to be said, what's, what's evidence based, right? What's what we think the truth is somewhere in the middle.

Scott Benner 1:21:36
Okay, so I can agree with that as well. Let me ask you this question. Here's where you're outside of your depth a little bit. If I made a podcast, where every time, every time something like that came up, we went into a 10 minute excursion to explain it specifically. Do you know how many people would listen to this podcast?

Anonymous Female Speaker 1:21:56
Nobody explained specifically a few times, because the other side of it is talked about a lot. It's

Scott Benner 1:22:03
in the Pro Tip series. It's in the bowl beginning series, it's in all the that exists in all the management series, like both sides of the argument isn't isn't all of that I

Anonymous Female Speaker 1:22:12
don't listen to the management one so much.

Scott Benner 1:22:17
I put it there, like so. I can't, if

Anonymous Female Speaker 1:22:21
I'm saying like people in the end, like they listen to your podcasts, they listen to, you know, a ton of stories and like the end of demand management. I didn't listen to the protests at the beginning, but I didn't listen to the rest of them. But I think that like throughout time, like I've heard it a lot. Yes, I know when I'm in my car, and I'm getting annoyed. So

Scott Benner 1:22:39
it's fantastic. Well, listen, I appreciate what you're saying. And I don't discount it. I think I have said those things before. I think that everybody can't hear every word of this. And so that's where you get into the bigger problem. I can't force you to listen to the whole thing. You may get one episode where you don't get exactly what you need as a as a point of, you know, example, I got a review the other day and somebody's like, you're a misogynist. And I'm like what the hell and and I and so I looked to find out what happened. Some person I was interviewing use the word fan girl, I didn't even say it. Someone else said it. And now I'm a misogynist, because that person said fan girl and bla bla bla bla bla, and I'm like, Oh my God, if you listen to the episode, before that, you'd think I was you'd think I was Mother Teresa. But now today, because you heard that you think this. So there's no way for this is an ongoing conversation. People.

Anonymous Female Speaker 1:23:32
I just feel like that's part of the conversation. Like half I listen to the podcasts a lot on my way to work. Yeah. So it's not that I'm listening to just like what episode. And I think that it's really important that you say, it's important for people to realize that you can get a five point 6.8 A one C with eating everything, my daughter also eats everything, like art and right, and that you can do it. In other words, there are certain things that's really important to hear that, yeah, you can have a really good agency, you can have really good time and range, and you can still eat what you want. And you can still kind of eat like a normal person to think that those are really important things to be heard. And I just think that that also has to be heard somewhere in the middle. So

Scott Benner 1:24:10
I'm gonna, I'm gonna tell you something that I've said on the podcast number of times, I can't say it every day, because then nobody would listen, here's where my thought process comes from this. I think that generally speaking, we teach to the lowest common denominator. And I think that that's a disservice to everybody, not just to the people who are not the lowest common denominator. So my example would be if there's 20 kids in a classroom, and two of them are challenged, and five of them are a little below average, and five of them are average, and three of them are above average. And you know, the rest of them are brilliant. We dumb things down so that nobody gets left behind. But I think what that ends up doing is it's a disservice to the people, first of all, who you think the things need to be dumbed down for because you're treating them like you can't possibly understand this. And then everyone else gets sub standard information because we're busy talking down to people who we think can't handle it. And so I see the podcast as aspirational. Like, when I talk about that stuff there, I think of it as aspirational like you can, if you understand the timing of insulin correctly, and you have these tools, and you have this understanding, and you maybe eat a certain way that to help yourself, you could quite easily have a one C and the fives, and it would be very stable. And you could achieve it without Lowe's. Is that easy? It is not. You know, do I want you that

Anonymous Female Speaker 1:25:35
you can but you don't. You don't have to in order to be healthy. That's your opinion. But I would put on with it. But that's your

Scott Benner 1:25:42
opinion. Yeah. And so what I'm saying is, you're welcome to your opinion, you should share it with everybody you want. If I tell people that, and 10 years from now 20,000 People come back to me and say, I can't feel my feet, asshole. You said a seven was okay, what am I going to do? And so I'm telling you that I think it's doable. I also think if you have a six a one, C, you're doing great. I think if you have a six and a half a one, so you're doing great, I think if you have an eight a one C, and that's the best you can do, you're doing great. Like I believe that all the way through. I'm not saying one of these numbers is better than the other. I'm saying that if you have the right tools and the right understanding, you can probably put your a one C and your variability pretty close to where you want it to be. And then that's up to you to decide what to do with it, I can't come make you do it and or tell you that it's that important to do. And you might be 1,000,000% Correct. Maybe you can roll around a whole lifetime with a six and a half a one C and never have a complication. But there will also people that will have them and we will have complications. And I'm not comfortable saying you're going to be okay, because not everybody is going to be okay. And some of those people will have complications because they kept their agency where they kept it. And so here are the tools to put it

Anonymous Female Speaker 1:27:03
into the five, eight, maybe not, maybe maybe not exactly. Yeah, but we're

Scott Benner 1:27:07
both in the maybe maybe not situation. And in your scenario,

Anonymous Female Speaker 1:27:11
that in my scenario there, there is a lot of data to say that it's a safe place to be yes. And when you look at people, you're never 100%, right? When somebody has cancer, and they say to me, you know, like, What are my chances? I don't like giving numbers. And I usually say to you, it doesn't matter what the statistics are because you're 100% of yourself. Yeah. Right. So it doesn't matter to you if 90 Other people were fine, or if you're in that 10%. And it's also what I think. And I think that that's okay to say also about diabetes, bad things happen for many, many reasons. And there can be a lot of reasons why you're more susceptible to different complications. And it's not only the diabetes playing a role. Sure. And, and the data is there, that your chances of having complications are low, if you keep your agency below six and a half, and I would say more than you, I would say if you haven't ate a onesie, that's not good. And I would want you to be working harder to figure out a way that you can do a little bit better, whether it's talking to your endocrinologist, whether it's I don't know finding somebody else, some sort of coach to try to figure that out. Because I don't think that that's a good place to be. Right? Unless

Scott Benner 1:28:18
you've been in 11 Your whole life and you just got it to an eight, and then it's great.

Anonymous Female Speaker 1:28:22
Oh, then you're doing great, because you're a start. And there I feel like it's okay to say, Wow, great job. Amazing. Alex,

Scott Benner 1:28:28
you would have a very thorough, valuable podcast that no one listened to. And I know that because do you know the ADA has a podcast? That you didn't know that you want to know why you didn't know that no one listens to it. That's why it's true.

Anonymous Female Speaker 1:28:46
The reason that I listened to your podcast is because diabetes is really lonely. And that's the reason I started listening to it. And I hope that there's somebody out there listening to me say that, that's saying, Oh, we can calm down a little bit. Like if we felt if I was that person who wrote that post, and I got those responses. And I felt like oh, crap, like, I have to be crazy right now that maybe you can take a breath.

Scott Benner 1:29:10
I agree that perspective, I want to tell you this too. I think that when you look at the Facebook group, you are mostly looking at newer diagnose people. And so their fear is more amped up. And I do think if they stop and actually listen through the podcast, they would get to the place where you are, like with your understanding, but I think you're at your place because you're a physician. This is gonna seem out of left field for a second. But if you're running a country, for example, okay, you make decisions based on the greater good, right? If I if I can make a decision today as the leader of a country that keeps 90% of my citizens safe. And the other option keeps 80% of them safe. Well, I'm going to make the decision that keeps 90% of them safe, but 10% of the population is going to think I don't care about them. And that is a hard way to live. like being the person in that decision make. And I can see that from an outsider, like, that's a horrible decision to make. But somebody has to make it. I'm glad there's someone there to make it. I think that's the perspective you're thinking about this from, which is like weak. Like, we can put everybody into a situation where most of them will do well. And hopefully, that will be fine. And I'm just saying that I'm okay with that. I understand that big decisions have to be made. But I'm not comfortable being the person who says that in this context, in this context, I think you should know that while there is absolutely no data right now, to tell you that a five five a one C is better than a six and that a six is better than a six and a half. I know there's no data that says that. And it's very possible that you're 1,000,000%. Right. My point is, is that if you're not right, or if that data's comes up one day that proves us wrong, then it's too late. And I would read what happened.

Anonymous Female Speaker 1:30:55
Yeah, what happens if the way that you tell it right causes a fraction of the people to have a lot of anxiety, a fraction of the people to have more lows in the 60s? Not 40s? Okay, then they would have otherwise had, and those things cause complications and those things take years off your life. Also, why do you think that's happening? To be afraid of that? Also,

Scott Benner 1:31:21
why do you think that's happening?

Anonymous Female Speaker 1:31:22
Why do I think it causes people? No, no.

Scott Benner 1:31:24
Why? Why do you think that's happening? As a result of the podcast? Because it's not, as far as I can tell.

Anonymous Female Speaker 1:31:31
I don't know if it's not or not. And sometimes I get the feeling in the group that, that maybe some people do feel like that

Scott Benner 1:31:39
you think people are running around with 50? blood sugar's because they want their agency to be low.

Anonymous Female Speaker 1:31:44
No, but people are more okay with having 5% lows than having 5% highs.

Scott Benner 1:31:50
I think they have 5% lows, and they still have 5% highs.

Anonymous Female Speaker 1:31:54
Maybe Yeah, this is fun, feel worse about the high

Scott Benner 1:31:57
you and I should get married so we could kill each other? That'd be fantastic.

Anonymous Female Speaker 1:32:02
I thought you agree with me this whole time? It's like I told you this last one is gonna kill it. No, no, no,

Scott Benner 1:32:07
no, I don't not agree. So listen, I want to be really sincere. I take your point, I understand your concern. I think if you were me for five minutes, you'd soften it a little bit.

Anonymous Female Speaker 1:32:20
I think that you're right that my physicians outlook, right, my being a doctor. So it helps me maybe to feel okay with that with certain risks, and to be worried about other risks. The

Scott Benner 1:32:30
best part about our conversation is that hopefully, for anybody listening, what they realized is while they're busy fighting in their own lives, about whatever they're fighting about with other people is that neither you nor I is wrong. Yep, a blend of what you and I are saying is what's important. And I can only come at this podcast from my perspective. And in fairness to me, I've also had 1000s of conversations with people with diabetes. And so I do have maybe more than you or maybe even more than other doctors, I do have a feeling about how most people come off and what their concerns are, and what they're like, the bigger more human pictures are like, even when you and I were talking about the ER, like you were coming from a medical perspective, I was trying to come from a human perspective. And it's not that you don't see the human side of it. And it's not that I don't see the medical side of it, it's just that my perspective is more skewed towards. I've talked to a lot of people who go into a hospital, they expect to be faced with people who understand what they need, and very often they are not. And even though you told a story about an endocrinologist who didn't even understand how to Basal a patient, you still argued on his behalf before the other side of it, because that's your perspective. And I think that's very valid, because

Anonymous Female Speaker 1:33:50
I know that his boss, the one who I talk to about my 2k patient Senate, right, super smart. And I don't know if she if that's when he talked to but the person that I talked to after that patient, I saw how super smart she was. Yeah, and how much she knew. And I think that, again, healthcare is different, where you're living, right? You're living in a place that's a big city or not. And the doctors are calm are different. But I think that most most of the healthcare, at least here it's pretty darn decent. Oh,

Scott Benner 1:34:24
I think healthcare is great, right up until you get into these drill down situations where nobody knows what they're talking about. And you think that they do in this series where your episode will be. There is an ER nurse in America who has type one diabetes who said the words I'd be safer having a seizure at your house Scott than in the ER I work in. Now. How is that possible? How is that possible? Did you hear her tell the story of a person who worked in the hospital have a low blood sugar and they tried to send them out for a CTS instead of checking his blood sugar's make

Anonymous Female Speaker 1:34:54
me wonder, Where does she work? Where are these doctors coming from because even all like the stories about misdiagnosed type twos. I mean, that was really basic in medical school. If you have someone who doesn't look like they're type two in terms of the other, you know, their physical attributes and stuff like that. I'm not saying that somebody who's overweight can't have type one. I'm saying we didn't like learn, right that if somebody doesn't look like they would be type two, whether they're young, right there below 40, their weight is in, you know, they're not overweight, they're active, that you should look for something else that you should look for, maybe they should look for type one that you should look for ladder, like those were things that we learned in medical school, and I went to medical school 15 years ago, right?

Scott Benner 1:35:36
She was standing in that er saying he has diabetes, we should check his blood sugar. And nobody, no one would listen

Anonymous Female Speaker 1:35:42
to her. You got to look at the system that's cranking out the doctors because that I don't that I think it's negligence. I don't think that, of course, most of the time. But that's the type of care that people, but that's what you want to believe. And I think I see, it's what I see in two hospitals that have pretty hospitals that I've worked at, right where you are.

Scott Benner 1:36:01
Yeah, but my point is, is if that exists anywhere, it's not okay. Right? Yes. Ah, so, should we act like it's not happening?

Anonymous Female Speaker 1:36:14
No, but I think that doing, trying to educate doctors, as always, you want to educate doctors, right? First of all, checking somebody's blood sugar, right? When they're having seizure, or when they look like they're having a stroke. Like, again, that's basic medicine. But it's not, like, not something weird or crazy, right? So if they don't know what to do that that's really problematic. Yeah. And again, I think that the educating doctors is more educating, like, these serious conditions can become very serious very quickly. And you have to know that they can become very serious very quickly. I agree with that. When somebody says those words, type one diabetes, the first thing you want to do is just check their sugar for a second, just to figure out where they are, does it have to do with diabetes does not have to do with diabetes, and not a whole again, I only listened to half of the first Grand Rounds, but a lot, a lot less, a lot less and a lot more respect, I would say or to what doctors are able to do. And there's

Scott Benner 1:37:13
plenty of good doctors. And I would expect that if they listened to the Grand Rounds series, they'd say, Well, that's not how I do that. But I do see that other people do it that way. If they're insulted by that, I don't know what to tell them. Like go fix your profession, if you don't want people to say this. But you have no idea how many like positive notes, I got back about that series from people with type one diabetes, who have been through the healthcare system and treated poorly and left to die, and all the other things. And they're like, Thank God keep saying this, because maybe a doctor who is bad at it will hear it or maybe a person who has type one diabetes will go into a hospital,

Anonymous Female Speaker 1:37:46
they won't be able to hear her though, when it's stuff like that. They'll be able to hear it when it said,

Scott Benner 1:37:51
how should we say it to them? How do we tell them they're bad at their job? And they don't understand anything?

Anonymous Female Speaker 1:37:55
I think that you don't want to say like that.

Scott Benner 1:37:58
Yeah, no, I don't I hear you. How do you tell? Like I would

Anonymous Female Speaker 1:38:02
want the Grand Rounds series, right to be something that I could send to my colleagues who I do respect and I do think are good doctors, right? And just like as i Hey, like, listen to this, it like really puts perspective on tape. While I'm like I listened to one of the one of the people talk about doing a PET CT with type one diabetes, somebody who had cancer. And then she got diabetes through immunotherapy. Yeah. And it was really interesting to know them and colleges to just like, see that perspective of like, what am I asking of somebody when I'm asking them to do a PET CT, and they have type one diabetes. And I think that that's the like, I want the good doctors to also be able to listen to it and not be like, Oh, that's not me. But to be able to listen to it and say, like, Oh, interesting.

Scott Benner 1:38:45
I could incorporate this, I'm gonna tell you a secret. I didn't really expect doctors to listen to the Grand Rounds series, I wanted to couch the conversation in a perspective that let people know that you may or may not get a learn a doctor, and that it is up to you to take care of yourself. And here are some examples of why. And I did think it would catch some doctors, which by the way it has I don't know if you've noticed, but the series has expanded to include other doctors who have come on want to add their voice to they did listen to right. Oh, I see. And so and and how were they they were pretty good conversations, huh? Yeah,

Anonymous Female Speaker 1:39:19
come off smart. And they come off as doctors know what they're doing.

Scott Benner 1:39:23
Yeah. And I agree with you completely. Except I think people need to know that through randomness. They could land in the ER who doesn't even understand how to treat their hypoglycemia where that they're even experiencing again, but

Anonymous Female Speaker 1:39:36
I don't want somebody to think that the ER is a place where they should be getting health care advice about their diabetes, you should not listen to any doctor who's talking to you about your diabetes, except your primary care in your endocrinologist because people will say incorrect things are you

Scott Benner 1:39:48
just expanded beyond what I said? Do you not think that people in an ER should know if you're experiencing hypoglycemia and how to treat it?

Anonymous Female Speaker 1:39:54
No, no, I'm saying yes. I don't want you to listen if that er Doc's sound too. It's like, Hey, I wouldn't see a seven, you should really be making these changes. Don't listen to them. Because they don't have enough experience. Who do I listen so to your endocrinologist, and you're one of my, and well, and because diabetes is a disease where in the end, you do no more than your endocrinologist and my endocrinologist told me like I asked him for to Moloch to go along with the loom Jeff to sit it went sting as much as I saw that some people do that, but they mix it. Yeah. And I was worried that if it stung that she wouldn't my daughter wouldn't give it a chance. Right? Right. So I asked him for it. And he said, learn new things every day. Right? Yeah. And that he learns more from his patients, you know, like, in the end, diabetes is a disease that it's ours. And we're gonna know more than endocrinologist. And there's nothing you can do about it, right. And what you have to do is to look for places where you feel like you get good information, I agree with you looking for information and reading it, and listening to different podcasts and looking at different groups and leaving the groups where you feel like there isn't good information.

Scott Benner 1:41:04
Well, this has been fun. I've enjoyed this more than many things that I've done in quite some time. Also, I think when you listen back to it, you're gonna hear where I expertly helped you to make my point for me. So. But

Anonymous Female Speaker 1:41:17
I don't know if I want to listen back at all. Maybe I'm thinking that I got you to see my point.

Scott Benner 1:41:26
I know, right? I know, I can't wait to find out what it is. Serious seriously, you and I should make a podcast together where we just argue about my podcast, and I think it would be fantastic. I think I think that would be more popular than this. But being sincere Alex being sincere. I'm doing my best to spread good information to people. And my assumption is they will pick it up and take it where they can and where they can't. And I do. I do imagine that there are some people that hear it, and it makes them anxious. And I hope that they stop listening, if that happens to them, Why

Anonymous Female Speaker 1:41:58
I hope that they listen to this episode, and they say hmm, we don't have to be so anxious, we can take the good and leave the stuff that's not good for us.

Scott Benner 1:42:04
I also as the person who's been making the podcast for the last 10 years, don't think that I've left people with the idea that if they're a once he's not five, five, they're not doing well. And, and so. But what I would say to you, moreover, is that I have done a thing with this podcast that no one else has ever done. I've brought diabetes information to people in a mass and made it entertaining, so that they come back and learn more and stay in the conversation longer and have more experiences that they won't get to have in their normal life. And I've I watched for, I'd say probably seven or eight years while I blogged in the diabetes space. I watched companies try to do it, they tried to build communities, they couldn't do it. Some of them would build a community for five seconds. They couldn't maintain it. They'd fractionalized they'd fall apart, etc. I have a 50,000 person Facebook group, and it adds 150 new people every three days. And that's not because most people are anxious or scared when they're there. And I could show you 1000s of emails from people who write to me saying that I saved their life or their child's life. And I don't think of myself that way. But they do. And so I take your point. But I think that overwhelmingly, that's not what's happening. And I think that partly the reason you feel that way is because you're a newer diagnosed parent. And I imagine that five or six years from now, you won't feel the same way if you're still in that Facebook group. But that's just been my experiencing

Anonymous Female Speaker 1:43:30
watching that I wouldn't feel that other people are anxious.

Scott Benner 1:43:33
You you I think right now your anxiety is helping you feel

Anonymous Female Speaker 1:43:37
super nice, anxious person. Okay. That's

Scott Benner 1:43:41
fine. I'm good. Again, that's just my

Anonymous Female Speaker 1:43:43
I, I get Yeah, it worries me when I see how people answer sometimes, or things that are said for them. I'm, I'm really super calm about diabetes.

Scott Benner 1:43:54
So So here, let me tell you some things you don't know. When you see a Facebook post that has 20 comments in it. I actually know how many people read the post. So yes, you hear from three people who are like, Oh my God, this makes me anxious or whatever, however, that makes you feel. But what you don't see are the literal 1000s of people who read through the post, and don't feel anxious about it. So there are three anxious people and I feel bad for them. And I hope that there's something else out here that helps them not feel that way. But I'll trade those three anxious people for 7000 other people who now No, I'm not talking

Anonymous Female Speaker 1:44:32
about the people who write in the post, the person who posted it, the person posted on a group, right? Yeah, but you really you really want it to be a group of support. I'm worried about that person, not about other people. You should scroll over what you don't want to read.

Scott Benner 1:44:46
Well Wait, what about their post is concerning, like given example.

Anonymous Female Speaker 1:44:51
Like somebody put their graph up and they're like, How can I fix this? I forgot what it was like the spikes or something right and And people came in with like a lot of different things. And I will say the person who asked it sound sounded a little bit more newly diagnosed and sounded a little bit anxious. And the graph with 90 plus percent in range. Yeah. And I think that,

Scott Benner 1:45:15
but they want to make it better.

Anonymous Female Speaker 1:45:17
So it's fine. It's fine. If you want to make it better, I just would have wished that there would have been more than one person who came on to say, Wow, that's a really great graph, just so you know, you know, and they're, you know, there are a lot of different ways to try to, you know, make it even more stable. But

Scott Benner 1:45:33
they didn't ask if this is a great gap Gara, they asked, How do I make this better?

Anonymous Female Speaker 1:45:38
I forget how I was asked, but it didn't sound like that to me. Again, I don't It's not like I don't actually remember each post that I saw and why it felt like

Scott Benner 1:45:47
I don't obviously know the exact post you're talking about. But I know posts like that. And what I'm going to tell you is that you have to respect people and answer the question they ask. Like, you can't sit if somebody comes in and says, How do I Bolus for this thing. And it's a giant cupcake with three cupcakes stuck to it and ice cream on top of it. You don't come in and say if you ate low carb wouldn't be a problem. Like, right, because I totally, that's not the question they asked. So if I come in with a great graph, and I say, hey, how do I improve this graph? My expectation again,

Anonymous Female Speaker 1:46:18
we're talking about something that like I can't I don't actually remember what the posts are let

Scott Benner 1:46:22
you come up with the example. But okay, that's part out. You should No, no, take this part out. You should have your own podcast. He should call it arguing with Alex, I think it would be fantastic. And every week, someone just comes on, you pick a topic out of a top hat and you start arguing about it. Oh, my God, I've listened to that. You were terrific.

Anonymous Female Speaker 1:46:42
I only know a lot about two things. Oncology and diabetes.

Scott Benner 1:46:47
Would that stop you from arguing about something you didn't know about? Yes. Oh, wow. Good for you. I would argue about anything. I think it's funny because great. I so enjoyed this so much so that I have to pay overtime for the editing and I don't even care. So sorry, unless you want to send me a couple of dollars. But I'll make out.

Anonymous Female Speaker 1:47:06
I explained that doctors don't make money here. So

Scott Benner 1:47:11
I so appreciate you doing this. I hope that comes through. I thought this was fantastic discount.

Anonymous Female Speaker 1:47:17
Thank you for having me. Oh, it's

Scott Benner 1:47:18
a pleasure. Hold on one second for me.

A huge thank you to ever since CGM for sponsoring this episode of the podcast. Are you tired of having to change your sensor every seven to 14 days with the ever sent CGM, you just replace it once every six months via a simple in office visit. Learn more and get started today at ever since cgm.com/juicebox. I'd like to thank the blood glucose meter that my daughter carries the contour next gen blood glucose meter. Learn more and get started today at contour next one.com/juicebox. And don't forget, you may be paying more through your insurance right now for the meter you have than you would pay for the contour next gen in cash. There are links in the show notes of the audio app you're listening in right now. And links at juicebox podcast.com To contour and all of the sponsors. If you're not already subscribed or following in your favorite audio app, please take the time now to do that. It really helps the show and get those automatic downloads set up so you never miss an episode. Thank you so much for listening. I'll be back very soon with another episode of The Juicebox Podcast. The episode you just heard was professionally edited by wrong way recording. Wrong way recording.com

#1230 Off Insulin with Mounjaro

Jim, an 8-year Type 1, has discontinued insulin use since incorporating Mounjaro into his regimen.

+ Click for EPISODE TRANSCRIPT

Scott Benner 0:00
Hello friends and welcome to episode 1230 of the Juicebox Podcast

Well, I think today some of you are going to be mad at this episode might even get a little pissed off, but some of you are going to be amazed and some of you are going to think this is a miracle, it's probably not one way or the other. Please don't forget that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, always consult a physician before making any changes to your health care plan or becoming bold with insulin. guys seriously, why don't you hear Jim's story? It's bananas. And I'm talking to like be a Na Na S that is bananas. If you're living with diabetes, or the caregiver of someone who is and you're looking for an online community of supportive people who understand, check out the Juicebox Podcast private Facebook group Juicebox Podcast type one diabetes. And if you'd like to help with T one D research go to T one D exchange.org/juicebox. complete the survey and just like that you'll be helping they're looking for US residents who have type one or are the caregiver of someone who does. I got the opening done so quickly. I ran out of things to say so I'll just wait with you quietly told musicans Dun dun dun BUM BUM BUM BUM BUM BUM BUM BUM here humps nice guys. Today's episode of The Juicebox Podcast is sponsored by Omni pod and the Omni pod five. Learn more and get started today at Omni pod.com/juice box. This episode of The Juicebox Podcast is sponsored by ag one drink ag one.com/juice box. When you use my link and place your first order, you're gonna get a welcome kit, a year supply of vitamin D and five free travel packs. This episode of The Juicebox Podcast is sponsored by cozy Earth cozy earth.com use the offer code juicebox at checkout to save 30% off of the clothing, towels sheets off of everything they have at cozy earth.com.

Jim 2:16
So Hi, I'm Jim D from Boston mass. I'm a type one diabetic.

Scott Benner 2:22
Tim, I appreciate you doing this. You don't know this because you're completely new to the podcast and everything. But you're probably the quickest person to ever book and get on that I've ever talked with. Usually it takes six months to get on to the podcast. Wow, I

Jim 2:34
feel like an Olympic champion and I'm just sitting here at my job. Well,

Scott Benner 2:38
you should, because you have a very specific story that is, I think significant. I'll tell people that you appeared as a new Facebook group member and put up this kind of like not long but detailed thoughtful post about your situation. And it became instantly the most popular, almost polarizing posts that I've seen in a while. I want to work backwards and get back to that post at some point. So before we get to that, tell me how old are you? How old were you when you were diagnosed with type one? I want to hear that bit first.

Jim 3:13
Sure. So first of all, Scott, thank you for having me. I'm glad I was able to bring some topic to the table that people seem to be excited about. So I'm happy to share my story. And so I am about to turn 58 In two weeks, and I was diagnosed as a type one. When I was 50 years old on Valentine's Day of 2020 diabetes doesn't run in my family at all. There's no history of it. I wasn't pre diabetic. This literally came out of thin air for me and I live a relatively healthy lifestyle. I was not a huge snacker not a regular Coke drinker. It just literally hit me like, like a bag of sand to the side of the head out of nowhere.

Scott Benner 3:56
Tim, tell me Jim's Okay, right. Yes, absolutely. 2020 Or did you get the date wrong? Dustin was

Jim 4:03
eight years ago. And so it was 2016 I'm sorry, my room. My bad math?

Scott Benner 4:08
No, no, that's fine. Because I'm like, had it my head. I'm like he's had type one for eight years. Then he said 2020 Oh my god. Did I misunderstand. I'm sorry. Okay. Don't be don't be sorry.

Jim 4:15
So it did happen to people at my age. Listen, I'm

Scott Benner 4:19
52 and I'm not doing the like walk into the room and forget that I came to pee thing yet but I'm getting closer. So you said came out of nowhere. So let's go through it first. Sure in your family, any other type one diabetes, and

Jim 4:35
not nobody who has a close close relative I have some second cousins but their their diabetes runs in the other other side of the family. So you could really argue that there is no biological connection to anybody in my family who had it. I'll explain to you sort of how I was diagnosed. My wife and I were away on vacation. And I've always been somebody I ran cross country in high school. My legs have always had a lot of muscle on them. And I opened up the window curtains one morning and my wife said, Oh my gosh, your legs are so skinny what what's happened? And I burst into tears and said, I don't know what's wrong, but I can't stop drinking water. I'm thirsty all the time. I feel like I have sand in my mouth. I'm sure there's something wrong. And I hope this vacation isn't our last hurrah, but I'm not really sure what's happening. And my wife, who is my non clinical medical adviser, said to me, well, let's call your doctor right now. And we call them we set up an appointment for when we got home. And we got home on a Monday, Tuesday morning, I was in my doctor's office at 830. And by 915, that morning, I was diagnosed with diabetes. They believed it was going to be type one at the time because my a one C was 13.7. I had some other factors. And so they run ran a panel of tests. And lo and behold, I already had the type one antibodies present. So they could confirm that in fact, I was a type one. And starting that afternoon, I was learning how to prick my finger and use a glucose monitor and starting both short term and long term insulin and it just turned my whole life upside down on that. That Valentine's Day.

Scott Benner 6:12
Jim, were you also in the drama club in high school or Turkish humans made me cry? Did you go off on that vacation thinking I'm dying? This episode of the podcast is sponsored by Omni pod five. A lot of people in my private Facebook group talk about their love for Omni pod five. Have you seen those posts and thought, Oh, I wish I could have that experience with an insulin pump too.

Lija Greenseid 6:37
If you have and you answered yes to that question.

Scott Benner 6:39
It's possible you're experiencing something called FUBU fear of missing out on Omni pod. You've heard of the FOMO. Now we're looking at flu. Symptoms of flu Of course, wishing you could wear an outfit without pockets or dreaming about walking past the doorknob without getting too being caught on everything. You know what Oh, yanks the site, right, you've heard the stories. You might be fantasizing about jumping into a swimming pool, on a nice warm day in a nice, cool pool without having to disconnect from your insulin pump first. Think of all the insulin pumps that exist. There's one that you can dump into the pool with you know which one it is. It's Omnipod five. So the good news here is you don't have to suffer from flu any longer. Find out what you're missing. And try Omnipod five for yourself. Just visit Omni pod.com/juice box and give away your fu I get up every day and I make myself a glass of ag one happens every day without fail. Why do I do this? Well there's a number of reasons but how about this 75 vitamins, minerals and Whole Foods sourced ingredients. Ag one supports healthy aging and I'm getting older. It can also help combat visible signs of aging, of which I have a number. I've recommended age one to my family, my friends. And today to you drink ag one.com/juice box feel the boost of energy, that sustained energy that comes with ag one without needing as much coffee How would you like to feel energized?

Lija Greenseid 8:10
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Scott Benner 8:45
I want anything that promotes a relaxed feeling of calm drink a G one.com/juice box give it a try. Yeah, I mean it's I know what you're thinking green drinks. Probably tastes like mud doesn't it's kind of lovely. Just goes down nice and easy and Scotty don't

Lija Greenseid 9:04
like stuff that it's got you don't like you don't I mean?

Scott Benner 9:08
Here's what I'm telling you. If there's one product I trust to support my whole body health is a big one. And that's why I've partnered with them for so long. It's easy and satisfying to start your journey with ag one use my link try ag one and get a free one year supply of vitamin d3 k two and five free travel packs with your very first purchase at drink ag one.com/juice box of course that's drink a G one.com/juicebox And I'm gonna finish up this ad break because you're gonna want to settle into Jim's story nice and comfy and I don't want you to have to break again later. Let me tell you real quickly about cozy Earth cozy earth.com Super comfy these comfy shorts, comfy sweatshirts, comfy sheets, comfy towels. Oh my goodness gracious. Everything I have from cozy earth.com feels good when I rub it on myself. You want to save 30% off of all that stuff. You're in luck because Got has an offer code. It's called do what in the mother? Is this? You heard us. Do you hear this? You do. Don't you know there's a cricket loose in my room. But I will push on cozy earth.com use the offer code juicebox save 30% off of everything you put in your card, I'm talking about the waffle towels, I'm talking about the sheets. I love my sheets. Here's my whole life, I get up out of my sheets bed here that Cricut

Unknown Speaker 10:32
Shut up. Shut up,

Scott Benner 10:35
it won't shut up. I have to throw something. Hold on. I missed it. Geez, guys. If I go crazy, right now, you'll know what happened. But I'm just gonna press on, let me tell you this. I'm going to need my cozy Earth towel soon. Because I'm going to need a nice warm, relaxing shower to get past this noise. Get this buzzing out of my head. And then when I get out, I'm going to pat myself dry with a cozy Earth waffle towel. And it's a good thing. And when I get out of that bathroom dry, like that day, I was born beautiful powdered but dry, I'm going to slip into some cozy Earth pajamas and then get into my cozy Earth sheets. And I own all those things. But I paid 30% less for them because they use the offer code juice box at checkout. That's all I need you to do. Go use that offer code. Shut up. It won't stop.

Jim 11:38
I actually did, I truly in my heart thought there's something terrible going on. And this will be the last wonderful vacation I have with my beautiful wife before you know the hits the fan and whatever we're about to have to deal with, we're gonna have to deal with together. And although I don't keep really secrets from my wife, I felt like this was so potentially devastating that it was important for the two of us to have a nice romantic three day weekend in Miami.

Scott Benner 12:04
How long had you been hiding your symptoms? Probably about

Jim 12:07
three weeks to a month is what I can recall. Now there is Scott a story that I'll share with you briefly that happened about eight months before that, which is I was running a conference in Chicago. And I got the flu the day before the conference started. And I was very, very, very sick with the flu like I had never been sick before. But I didn't realize because I was alone in my hotel room that I was getting very dehydrated and how sick I really was. And so after four days of being stuck in a hotel room, I was talking on the phone with my wife who was in Boston and said either I'm flying to Chicago, or you need to go to the ER and figure out what's going on. And so I took an ambulance to the ER, and they checked me and they told me that I was extremely dehydrated. And that in fact, some of my my core body functions were either on the verge or about to start shutting down because I was so dehydrated. So that experience was in my mind at the time totally unrelated to paying diagnosis. My endocrinologist has a theory. And it's only a theory, of course, but that I was so dehydrated that my body started to become compromised. And your pancreas apparently in your beta cells in particular, are very susceptible to sort of stop working from dehydration, and they don't always come back to life the full way. I never like to say that's what gave me diabetes, because we don't really know. Sure, but they thought that maybe I had a predisposition to it. And then this may have been the trigger for it. Did

Scott Benner 13:32
you have once the testing happened? Did you have auto antibodies for type one? Yes, I don't. Yeah. And are there any other autoimmune issues with you or in your close family like celiac, hypothyroidism, fit a Lago? Anything like that? No,

Jim 13:48
nothing like that. The only thing that that I carry is on a cystic fibrosis carrier. That's the only sort of interesting medical piece about me otherwise I am as plain Jim as you can get. run of the mill. Absolutely. Just normal average run of the mill kind of person. Your mom

Scott Benner 14:06
have arthritis. Ra No,

Jim 14:09
she did not have that. That.

Scott Benner 14:10
Okay. You get the flu?

Jim 14:11
I said she did not. She does not she's still with us.

Scott Benner 14:15
Jim didn't want to write his mom off too soon. No, now she's gone. No way. You know what she's not but when the last time you saw your mom, geez. How old is she?

Jim 14:26
My mother is a very Spry 84 year old. Good

Scott Benner 14:30
fair. That's excellent. Okay, so you go to the hospital, they pump you full of fluids. Is that enough to get you on your feet then that

Jim 14:36
it was so I spent about 12 hours getting pumped full of fluids. They sent me back to the hotel. And then two days later, I was finally well enough to fly home and spent another probably five days of recovery at home, getting stronger and sort of rehydrating getting my energy back. But when I felt better, I thought it was a one and done. I never thought it would potentially have any long term impact. And that's why I say you know, we can't ask absolutely say yes this cause that it's a belief that I have in my life that I was apparently so sick that could have potentially triggered this. Yeah,

Scott Benner 15:07
well, you've never been around autoimmune or type one either. But you know, my daughter had Coxsackie virus before she was diagnosed. Having a virus for instance before diagnosis with type one is incredibly common. Sometimes even stress. I've talked to people who have gone through like traumatic things, then they're type ones come on. But you know, in the end, like you You alluded to, you had auto immune antibodies, they just hadn't been triggered to cause your type one yet. Then after that you have type one diabetes. There's a reason I'm skipping through all this. You have type one diabetes, how are you managing then, like, what did they give you to to deal with this? So

Jim 15:42
I immediately on the day that I was diagnosed, started taking both short term or mealtime insulin and longtime, longtime insulin. So I was taking three shots a day with my meals for about half an hour before I would eat a meal. And then and they put me on a straight flatlined dose. So I was starting with four units of mealtime, insulin. And then I started with six units of long term insulin or over, you know what I would take it right before bed at night, or sometime early in the evening, as well as I also started Metformin at the time, okay.

Scott Benner 16:14
And they told you, you had type one diabetes, nobody misdiagnosed you as type two or anything like that. At

Jim 16:21
the very beginning, like for the first maybe 10 minutes that I was talking to the doctor, in on that fateful day, he said, you know, maybe it's type two, but based on your a one C, which at the time was 13.7, when I had some blood drawn in the office that day, you're presenting as a type one, but let's do the lab work. And so it took a few days, obviously, to get the antibody test back and a few other things, but within short, a very short term. We knew I was a type one. Yeah,

Scott Benner 16:46
lab work, confirmed it. Okay. So now you live, how many years with type one diabetes before you intersected GLP. medication?

Jim 16:59
It was about six and a half years. Okay, so I started Manjaro in October of 2022.

Scott Benner 17:06
Why was it given to you? Or why did you ask for it? So

Jim 17:09
I didn't ask for it. It was nowhere on my radar screen. But I'm lucky enough to live in Greater Boston where we have some of the strongest and best medical facilities in the country. And my endocrinologist who I see quarterly, I would say is appropriately aggressive with both technology and medicine. And she said, You know, there's this new medicine that's come out, it's really designed for type two, she said, but we're seeing some success with type ones. And if you're open to trying it for probably two or three months to see what it could potentially do for you, I think you might be a good candidate for it. And because I trust my endocrinologist implicitly, till the end of the day, I listen to anything that she tells me to do. Follow her guidance. I said sure. I'm happy to try it. And so that's what triggered the initial 2.5 Manjaro shock.

Scott Benner 18:01
Okay, now, let me just go backwards for a second because I really want to hammer this home before we move forward. Every day six and a half years Basal insulin covered every carb that you ate if you didn't your blood sugar went up the whole thing, right? Oh, yes,

Jim 18:15
absolutely. And I would even sometimes think let's say I was going to have a heavy carb meal so maybe I would take six or eight units of insulin before meal and then I would have you know, What would surprise me to be less than carb or someone would serve me whole wheat when I wasn't expecting and so I sometimes you know, would go down based on my insulin into the 50s and even once down as low as the high 40s which was very scary. But yes, I was absolutely taking my excellent as I should my Metformin as I should every meal looking because they had me on because I was in what what we thought was our what was could be described as my honeymoon period. I didn't have to go through the whole calculation of how many carbs Am I gonna eating? And how many does my body need for that yet, it was still kind of a flatline helpful dosage. Do

Scott Benner 19:02
you think that you ever experienced what people call a honeymoon?

Jim 19:05
Yes, I do. And in fact, I think that I was in my honeymoon period for at least a good four to four and a half years before I started to need more insulin, both at mealtime and at night for the long term.

Scott Benner 19:22
Okay, so you probably had, I don't want to call it a lot of light, but you were using a fair amount of insulin already. But it went up about four, four and a half years into it. Then you lived a couple of more years like that with the increased need. Then the Manjaro came on. Exactly. Okay. Did you have any weight issues at the time? As

Jim 19:39
a youth I was always skinny. I was a college kid. I enjoyed donuts and ice cream and cheese burgers. When I hit my late 20s I would say I started to put on weight. But I'm 511 with medium sort of build so I should be around 180 And I got up to as the when I was taking the insulin before I start To the Manjaro, my weight went up almost to 220 pounds. And some of that was because I could eat more with more insulin. And I was trying to live what I quote unquote normally would eat. And so I was probably not quite as self aware of where my weight was going as it should have been. However, I also think that the insulin helped me gain weight. Did you get

Scott Benner 20:23
caught up in that? That feeling of wow, I learned how to Bolus for all this, I can eat whatever I want, and then forget about food as nutrition and calories.

Jim 20:32
It's as if you just read my mind. That's exactly right. Yeah,

Scott Benner 20:34
that's a pretty common jump. So this podcast, which I know you don't listen to talks, you know, when we talk about management stuff, we talk about using the right amount of insulin at the right time and keeping your a one season your variability low by understanding the timing and amount of insulin. But at some point, there are people who lose the you start seeing food so much as this like thing you conquer with insulin that you stopped seeing it the way other people think about it, which is calories that could if I eat too many of them caused me to gain weight. Exactly. Yeah, it's really interesting how it happens. So okay, so you are a couple of years, hot and heavy using insulin, you're gaining weight, etc. and so on. Your life's moving on, doctor comes over and says, Hey, we're hearing about how this drug is helping people. Why don't you give it a whirl? They don't have any problems with insurance, because back then insurance wasn't hassling people about it. Isn't it interesting. And I want to point this out to him, I don't want to make your your episode a political statement. But if Jim would have had this experience two years later, than the rest of the story you're about to hear it never happens, because Jim's doctor would have said, hey, I want you to try 2.5 of a GLP. And his insurance would have said no, he has type one diabetes. And that's not what this is for. So you get the two, five, you start to inject it. What do you notice in the first week,

Jim 21:55
like probably many of the listeners, not only did I start the injection, but I found a Facebook group, I did some research online. And I thought I was going to take the shot and sort of wake up the next morning and not be hungry and maybe be down five pounds, like I had no expectations of what to expect, other than what I was reading about. So I started the shot on a Friday because I did read that people said that the side effects seem to be worse in the first 24 to 48 hours after taking a shot. And so I thought, well, that will give me the weekend to sort of figure out how I'm feeling and what's going on. And I took the first shot with both a level of excitement that thinking wow, I wonder what this is going to do for me. And could this change the my trajectory of how I have to be you as a diabetic, but I was also nervous. And I would say the first week I had 00 impact on me zero, I ate the same I felt the same my body process food the same. My glucose numbers were the same. I didn't see anything. And I thought okay, well, one weekend, we'll see, you know, maybe the second week, something will happen. And so next Friday, again, I took a 2.5 milligram shot. And probably within about 12 hours, I started to feel this slight sense of nausea. And I am not somebody that generally I don't get seasick. I don't get motion sick, I don't generally get nauseous. And I thought oh, this is kind of an interesting feeling in my stomach, I wonder if I maybe ate too much. And now the medicine is telling me Hey, slow down, you know, your digestive tract is slowing down. And so your stomach is giving you a signal. And within another 24 hours, I had lost interest mentally in most foods. And the best way that I describe it, when I've talked to my friends and colleagues about it is it went from like always being hungry and always thinking about what's my next meal? What am I going to have for a snack, but am I going to drink? What am I doing to the flip switch went off. And food just evaporated from my stream of consciousness as always being that number one topic in my brain. And instead, it flipped to everything else that was going on me I felt like it was as if I had foggy glasses on. And then one day I used a little lens cleaner and everything became sharper and crisper. Because the noise from the food and thinking about what my next meal would be what would my snack be? Just went away and everything else came clear into picture in my life. It was just unbelievable.

Scott Benner 24:23
How did you find the experience because you don't know this, but I don't have diabetes. But I began using GLP. April last year. So I've been major and I've been on it like 14 months and I've lost 47 pounds. I would go as far as to say that there was some time where I had to reevaluate how I spent my days because I was suddenly met with extra time in my mind and extra time physically because I wasn't constantly with food. Does that make sense? Like I actually woke up one day and I'm like it almost felt like boredom or loneliness because I suddenly there was more than 24 hours in the day for me.

Jim 25:04
Yeah, I totally agree with you, Scott in the way that I frequently have described it as I felt like I got more bandwidth in my day, that it was as if a piece of the pie of what used to fill up my week or my day was removed. And now I could start to focus on other things and do them in a deeper, more meaningful way.

Scott Benner 25:21
I'm able to better do that thing that that fit. People always tell other people all the time that like foods, just, you know, fuel for your body, and you're like, okay, like, that sounds good. And then I look at them, and they're all jacked up, and they've got abs and stuff. And I go, obviously, it's working for you. So I'll try. And then I tried to think of food as fuel. And I'm like, I mean, that's nice, but I would like a cookie. Now, it's not like that. Now, like when you and I get done recording today, I'm gonna go downstairs, take a piece of steak, probably two ounces, I'm going to slice it thin. Throw it in a pan with two eggs, scrambled it together and eat it for protein. And I don't know, I might put something else with it. I'm not sure exactly what. But I'm going to eat it because I know I have to for nutrition. But it's 1030 in the morning right now. And I am not hungry. I haven't eaten anything today. I got up. But my dog because I did the thing. I got a shout or it's freeing in a way that I think some people would hear that and go, Oh my God, that sounds horrible. And I think if you were to fight it when it happened, it probably would be horrible. If you started lamenting the loss of something, I can see where you could get into like a psychological battle with it. But I just gave myself over to it because I was like, I am healthier than I was yesterday. I want to keep doing this. You know, interesting to hear other people talk about it like that. So yeah,

Jim 26:40
Scott, I'll tell you another interesting nuance for me, which is I used to find cooking, very relaxing. So it would not be uncommon for me to cook, maybe four out of seven dinners for my family, or for my wife or kids are older and moved out. But my wife and I had to sit down and have a relatively nice meal that would be somewhat complicated to make. But I enjoyed that process. To me that cooking was a relaxing process, I would turn on music, and I would enjoy the whole piece of it. And one of the things that really changed for me is that even the preparation of food lost interest to me. And so really anything related to food and nutrition just sort of moved to the back of my mind because it was no longer the joyful experience of eating or the joyful experience of cooking. Yeah, and the other piece, I would say to your steak and eggs breakfast, by the way, if we would look closer, I'd be there for your leftovers. So it sounds delicious, is that I realized that I can't eat salad anymore. I used to enjoy salad quite a bit. But now it doesn't have enough nutritional value in it for me to eat, even when I add some protein because I do still need carbs. Of course, like we all need carbs to survive. And so you know, I'm not a doctor, I'm not giving you medical advice. But to me, I feel like I need carbs to survive. For me, I've had to really think about what is the nutritional value of everything that goes in my mouth. So before it used to be How sweet is it? And how salty is it? Because those are the two flavor profiles that I would sort of lean towards. And now it's all about how much is it going to feed? What I need to keep my engine going.

Scott Benner 28:17
I have the same thoughts. It's really it actually put me where those health nuts wanted me to be when they were saying it to me, you know, and everybody else is Food is fuel. You know, and only so much fits in here. So put in good fuel. Exactly. And yeah, no, it's fantastic. Okay, so, but this isn't even while you're on the podcast, although we'll jump ahead and jump back again. In the how many years have you been on Manjaro?

Jim 28:41
It'll be two years in October October 1 of 2024. So I'm about 18 months or so into it now.

Scott Benner 28:48
How much weight have you lost?

Jim 28:49
I've lost almost 60 pounds good for you. 60 pounds. It's a life changing amount of weight. Yeah,

Scott Benner 28:57
somebody in my family started using it. And they started to they went the other way they started lamenting Oh, I don't like the food doesn't bring me joy. And I'm like, it's funny. It's like I don't think Food shouldn't bring you joy. But we've gotten to a weird place now where the food's so supercharged was salt and sugar and all that other stuff and you know they probably bringing you more joy than it's supposed to, you know, they're having that thing and I said I'm gonna say something I think they used to say in the 70s around like the dieting phase and I don't want to trigger anybody but nothing tastes as good as skinny feels is how I think of how things now I'm like, because the visuals nice. Like looking better. Is nice putting on a t shirt that doesn't grab me as nice not you know, having fat like in places that I shouldn't that's all nice. Like don't get me wrong, but it's the knees don't hurt more energy better sleep, feel healthier skin looks better. Like it's the other stuff that I that I'm happy to have. The vintage part

Jim 29:53
is a bonus. I wonder how you feel. I love that I feel generally more like I have more energy See, I will say, however, sometimes I struggle to eat enough calories to keep my energy level. Okay, so that's the one thing for me, I absolutely agree with you like the whole idea that I'm healthier, I'm lighter, my clothes are tight on me all feels good to me. The thing that feels best to me though, is when I look at my blood work numbers, and know that not only do I physically look better, that I'm healthier now than I was before. And that's going to lead to, hopefully a long life of being a parent, maybe God willing, someday a grandparent and the life that it is giving me too. And the ability to look long term forward, as opposed to short term forward has been a game changer. Because if you're diagnosed with diabetes, and you're in your 50s, or 50, like I was, you know, you tend to read about the bad stuff, because people don't tend to talk about it or write articles about, oh, I have diabetes, look at these wonderful things that are happening to me to me. So I read all the negatives and was preparing for those. And now I feel like this medicine has given me a new a new outlook on life blast time, my agency I don't I don't know, I don't think I mentioned this before. But my last day when Soucek was 5.7. Like, right, it doesn't get much better than that for a type one diabetic. I couldn't hope for more than that.

Unknown Speaker 31:16
Yeah. How were they

Scott Benner 31:18
throughout the six and a half years? Did they vacillate? Were they pretty stable? They onesies?

Jim 31:23
I generally was somewhere in the sixes for most of the time. Okay. Yes. All right.

Scott Benner 31:29
Here's the real reason you're on the podcast, you start doing the 2.5, did you stay at 2.5? Or did you ever go to five milligrams. So

Jim 31:36
I did 2.5 for a month. And then I moved up to five, and then I kept going up, and I've gone up to as high as 15. And now I've gone back down. So we can talk about that, too.

Scott Benner 31:48
What number did you get your most weight loss at? A combination

Jim 31:51
of 10.0 and 12.5?

Scott Benner 31:55
Okay, because I'm on 10. Right now I use that bounce. So same drug. And I know the name is different, but same drug, my doctor is like, I think we gonna try the 12 next. And she keeps saying like you really see a 1012 even up to the highest dose and said the same thing. Like once we get the fat off of you, we'll we'll go back and find a maintenance level. So how high did you you made it all the way to 15.

Jim 32:18
So I went all the way to 15, I will say that I was only on 15 for a month, and I had significant side effects much worse than I had had on any of the other doses. And so we decided to go back down to the 12.5. And so I was on 12.5 for probably about 10 months straight. And I also feel very lucky. Although I know a lot of people have trouble finding the medicine locally, I was able within a 30 minute drive of my house, I was never out of the medicine at any time, I did have to drive half an hour to get it to me, you know, half an hour of my life, I was well worth some time spent to pick up the medicine. So I I did do 12. And now I'm back. So I stayed on 12 for a long time. And then I started having some additional lows. And so my blood glucose was going down to 60 Sometimes at night. And so we thought I should go down. So I've been back on 10.0 for the last just two weeks. Okay. And so we think that maybe 10 is going to be my maintenance dose, but we're not sure yeah, we have to wait and see, you

Scott Benner 33:22
would have laughed extra hard more than other people on Friday afternoon. If you were at my house, when you saw me come out of here after working all day, and I looked at my wife, I was like, I gotta go, I gotta get my medicine. And then I drove, I drove like 45 minutes in traffic to this little pharmacy that I know, carries it all the time. Go in pleasantries, get it taken care of, look at the guy go, I will be back in a month. Remember me? Like you're actually you're actually working out a little system with them where you're like, look, you can trust me, I'm gonna buy a box of this every month. And therefore they kind of hold it for you. There's like a whole back end thing that's going on around this. It's not I'm not doing anything wrong. I've just I've literally had to build a rapport with a pharmacist to make sure that my medications, they're covered by my insurance lovely like, and again, just say you feel lucky is crazy. I paid $25 for it. But here's the big part of your story, though. How much insulin are you using?

Jim 34:17
So I am very proud and happy to say that I am off all insulin, zero insulin. Let me say that again. No long term, no short term. I now take zero insulin on a daily basis, weekly basis, monthly basis and basically annual basis. And that happened. After about six weeks of being on the Manjaro. I started to titrate down. And I'm sorry, sorry, sorry. It started after two weeks, I started to titrate down and by about five or six weeks, I was fully off of all of my insulin.

Scott Benner 34:53
So does your brain explode like you're only you're halfway into a five milligram shot and you're I'm assuming you're on the phone When was your endo going? I mean, we've been moving my insulin down the way I expected. But how, how much further down? Could this go?

Jim 35:06
Well, it was a, it was a great question. And I when I first called and spoke to my endocrinologist and said, I don't think I need this month's insulin and what this is what's going on? She said, okay, you know, maybe you'll have to go back up. But let's, let's start to move you down. And so we moved down two units at a time of both the long acting and mealtime insulin. And because I was on relatively low doses, it happened pretty quickly. And so I was able to get off of all of my insulin. And I have to say that when I meet diabetics, quote, unquote, out in the wild, and you know, I, if I see somebody with a Dexcom on I am just one of those people, I just go and start talking to them. And it happened on Saturday night, I was out poor Friday night, we were out for dinner at a Mexican restaurant. And I saw somebody wearing a G six and went over and said, What did you eat for dinner tonight? I'm just curious. And then we started talking, and she asked how much insulin I take. And I told her my story briefly. And that the look on this woman's face was I have to call my endocrinologist. And if it wasn't a Friday night at nine o'clock, I'd probably call her right now, because it is so unbelievable that I have proven through antibody testing that I'm a type one. And yet, I do not currently take any insulin. Here.

Scott Benner 36:14
I don't know how many people you know, with type one diabetes, but have you been met with like skepticism when you say this to people say things like you don't have type one, you had type two, like that kind of stuff?

Jim 36:23
All the time? Yeah. All the time. I hear that. And what I say is, you know, first of all, you know, you don't know me, you know, I don't know you to the to the stranger that I'm having a conversation with. But I can assure you that in fact, you know, I have the testing to prove that I'm a type one. And we have to live in a world where we, we allow for the evolution of medicines and treatments to take place without punishing the patient. And when you tell me that, you know, Oh, I must have been misdiagnosed or you don't know what you're talking about. You're a type two, I just look at them and say, you know, you can believe what you want. But let me tell you my experience I haven't testing done. I know that I'm a type one diabetic. And yet here I sit in front of you today alive without insulin.

Scott Benner 37:08
And a five seven fair in fairness, you're a once he didn't go back into the like high force or something like that. But are you? Are you wearing a CGM still or do you periodically?

Jim 37:17
I do I wear it every day. So I'm somebody that wants to make sure that I'm doing everything I can for my health. And so to me, a CGM is just part of my life that I accept and willingly wear one. Because it helps me there are times where sometimes I won't realize that I'm going low, and it will tell me oh, you know, you're you're in the low 80s. You're heading towards 70. You know, now's the time to have something because Scott, as you probably know, even though you're not diabetic, sometimes you can when you're on these medicines, and totally forget to eat even sometimes drink. And I tend to try to drink a lot of water. But, but I have gotten an entire from waking up until dinnertime without thinking about food like it is that removed from my brain, that I will just keep working all day long. And even though it's lunchtime, and I see people getting up, like, Oh, I'll go to go in five minutes and five minutes becomes an hour. And then I'm on to my next meeting. And it literally as is as if my brain has said, Oh, you must have eaten already, because we're not telling you you're hungry, but I haven't eaten. And so I'll go a whole long time without eating anything. And then of course, there's a you and probably many of the listeners know, that will drive your blood sugar levels down and so that so that my CGM reminds me Oh, I have to eat. Yeah,

Scott Benner 38:33
it's fascinating. That thing that you that you describe, I still don't know how to completely convey it to people. It's so significant that it's caused me to, like, existentially think about food. And, like wonder, like, how do I spend so much of my life? Just captured by the idea that like, I have to, like plan for my next meal? And what am I going to eat now and I haven't eaten in a couple of hours, I have a snack and I feel hungry and you're feeding the hunger all the time. And your body's getting my body was getting like bigger, you know, slowly bigger and bigger, and I was less than less healthy, healthy. And yet, there's no way like you can say have willpower. It's it's a nice thought. But I did not have willpower. I wasn't like gorging myself or anything like that I just ate when I was hungry. I was pretty reasonable about it. I don't eat like a lot of crazy stuff throughout my life, my body was just going the wrong way. And it's almost like the only way I can describe it and I don't think this is technically sound but like, it feels like I have a GLP deficiency. And and now that I have more, my body appears to work the way I think it's supposed to the one thing that I will tell people and I've talked more about this on the podcast, but you have to teach yourself how to eat again, like how to like say to yourself, I know I'm not hungry, but there's an amount of calories today in nutrition today that I need and I'm going to go take it in and there's an amount of water that I need. I'm gonna go take it in, not because I'm being told by some unseen force, but because I know it's necessary, that's a leap you have to make. And it's not going to be the same for everybody, right? Because everybody's digestion is going to be different. And you know, especially with diabetes, you could, we could run into people who have gastroparesis. And I don't just mean like slow digestion, but they could have damage to the nerve that that, you know, handles digestion. And, you know, that would obviously change things. It's not for everybody, but you have to teach yourself how to eat again on it. I'm in the middle of so my daughter uses that. And she's type one. And her her uses, how much her insulin is gone down. It's not going to stop it like it did for you. But significant decrease, I think 16,000 fewer units of insulin this year, because of the GLP.

Jim 40:41
Oh, that's fantastic. Yeah, I'll tell you going back to that, training your brain that you need to eat. The way that I think about it is I used to eat because I loved food. And now I have to eat because my body is an engine and it needs fuel. Yeah. And so that switch to fun to fuel helps me eat. However, it will sometimes take me two and a half hours to eat a small turkey sandwich for lunch. Because it just won't go down easily. My brain is saying you're not hungry. But my brain is also telling me Hey, Jim, you need to eat you need these calories. You need this protein. This is the thing to do. And so it's a little bit like that Ying and Yang and your brain saying yes, no, yes. No. Yes, no. And your rational self saying, Yeah, I know I need to eat something. I know I need this fuel. But it's sometimes hard to to get get it all get all in what you need. In a reasonable time.

Scott Benner 41:38
You don't you don't stop at the gas station. For fun. You stop because you need gas. So exactly. Right now it's something else. So like I asked you about the CGM. For recent Do you see a spike in a meal?

Jim 41:49
I do. So I'll give you an example. I mentioned Friday night, we went up to a Mexican restaurant, I had multiple blamo, or chicken mole a sauce, rice, cabbage and black beans. And so I estimated that that meal probably had based on my portion size, somewhere between 60 and 70 carbs, because there was a lot of a lot of stuff in that. And about an hour after the meal, my blood glucose was up around 180. And it stayed there for about 30 minutes. And then it came back down to about 115. Within the next, I would say 90 minutes or so. And so I was back at my baseline, I tend to be between 100 and 105 to 115. That's sort of my norm. And I was back in my normal baseline sort of range within, you know, two hours or so of eating the meal. Like it was just, it's amazing.

Scott Benner 42:46
I can't imagine that if you had that CGM on your wife, it would have looked much different if she ate the same thing. I

Jim 42:50
totally agree. And that's actually part of what my endocrinologist said, which is look at these charts, like when you mark that you're eating something and you're estimating your carbs, yes, you're getting that spike, but you're coming back down as if your body was functioning like a quote unquote, traditional pancreas normal person.

Scott Benner 43:07
And if you don't eat Mexican, if you have a more normal that turkey sandwich, do you see any kind of rise at all, as

Jim 43:15
much smaller, so maybe I'll go to 131 40, something like that. If you ever said to me that in my lifetime, I was going to go from taking four shots a day, to no shots a day, or one shot a week. And my eight one C is going to be lower. I'm gonna feel better. You're gonna look better. I would have said, you know, Scott, nice to meet you, but go sell it to somebody else because I'm not buying

Scott Benner 43:38
Oh, no, for sure. It would have sounded like I was like, Jim, do you know what happens? If you take cinnamon and put it on your food? It's gonna make your blood sugar better? Like no, it would have sounded like crazy. And that's see this is where we are right now. June 10 2024. We don't really know what this medication is going to do yet. Like right now out in the world, right, you're seeing it starts off as a type two medication. And by the way, it's been out for years longer than people think like just because the first time you saw that Mindy Kaling was thin. You heard the word ozempic doesn't mean that's when it started happening. Like there's before there's been rebel sis and other other stuff, you know, other like, there were daily shots of GLP s for for diabetes, you know, back in the day is the senza stuff like that. It's been out for a long time, right? They're obviously they've made some new molecules with the ozempic and the Manjaro. They're working better, but there's more coming. And right so now they go okay, type twos it worked for in the studies, they see weight loss, they make a weight loss drug, you said you know, you use Manjaro. I use that bound. It's they're both drugs that Lily make. They're the exact same molecule. They're just one was run through the FDA for type two diabetes one was run through the FDA for weight loss they give I have to give them different names. Now what we need is studies for people with type one like and we need it Fast and and we need to well, because your experience is insane like there's part of me gym that thinks that the government should come and get you and take you to a lab and you shouldn't even be able to say you don't want to go. Because we need to know why this is helping you. Like, why is this doing this for you? Why is my daughter gonna use 16,000 fewer units of insulin this year? She's had type one diabetes since she was two. She's 20.

Like, yeah, like what's believable? Yeah,

Jim 45:30
it is absolutely unbelievable. And for people that are listening to the podcast, you know, go go to the Facebook group and look at some of the comments from some of the people who reacted to my post. And, you know, there's dozens and dozens of people who are telling me I was misdiagnosed, or be that it's impossible, I must be doing something else. Or one person even said that, you know, I'm like a charlatan selling a witch potion, people on the street. What I want to say and if we if there's one message that anybody sort of takes away is, we're at the tip of an iceberg of understanding something new and different. So we can't let our belief system from the past impact our belief system for the future. And we need to accept that there are new medicines that open up new possibilities and seem to do different things in our body than we knew were always possible. And so I sit here, you know, as a type one, five years ago, if you said to a type one, you know, there's something coming out in a few years or something that's going to become more available next few years, that's going to take you off insulin, you know, they would have laughed at you and said, Oh, that poor guy. He's He's a nutcase. Because that's never gonna happen to him. It's

Scott Benner 46:35
possible that five years ago, you would have said that if I said it to you, oh, 100%, I think your point is just so worth, like, shining a light on, we don't know what this is. And we're still finding out. Like, I'm not saying if everyone goes out gets Manjaro and starts taking it, you're type one diabetes isn't going to need insulin anymore. I'm not saying that. I don't think that's true. I don't think that would happen for everybody. But you're the second person that I've interviewed that this has happened for. So

Jim 47:02
I will tell you, Scott, that I know somebody who is a type one diabetic, who it didn't work for. And so he's all upset, right? Like, you know, what, why is Jim getting all of these wonderful benefits? And I'm not. And so you're right, we do need to do more research, we need to understand what is it that makes it work in patient a but not in patient B, right. So that we can try to understand is it about when you were diagnosed? Is it about how far along you are in a honeymoon period? Is it something else that maybe I carry that helps the Manjaro do its job better? Or in a different way than it may for somebody else? Yeah, there's a lot of work to be done to try to understand this. The other thing that I would say is that Oprah did a special a couple of months ago on weight loss. It's available. Now, this is not a it's not a sponsorship plug. But I'll tell you it is available on Hulu, if you want to watch it because I recommend it to a lot of people. She also talks about how, you know, weight loss is very similar to the way we looked at alcoholism a few decades ago, which is, you know, we thought well, why can't you just put down the bottle it stopped Well, we realize it's a disease that your body has. And there are things that we can do to help you mitigate the condition. And weight loss is exactly the same, right? There's sort of three buckets of people. There's some people who diet and exercise work really well for, there's some people that only diet works really well for. And then there's this third bucket of people like myself who diet and exercise didn't work for me. And in fact, that's one of the frustrating things in my life is that for many years, I tried diet and exercise and it wouldn't work for me. And so I felt like I must be doing something wrong. And what a what is it that Jim has to do to apply more effort or more time or more commitment to make this happen, and now I realized it wasn't about my mindset or my energy that I put into it or my desire, but instead it was something genetically sort of miss programmed in my DNA that wasn't allowing that to happen. And now this new medicine is helping to fix whatever was broken in a way that is allowing me to live a more traditional, non diabetic lifestyle.

Scott Benner 49:09
You see people you know, famous people were like, it'll just work hard, you'll look like me, I'm like, well, a you have $9 billion. And your day isn't like mine is I don't you know, you don't get up at six o'clock in the morning and have to like take a shower and take out the dog and then drive an hour to work and then you know, work nine hours and then drive home and like you don't I mean like your life's not the same let's not like pretend that lives also. I've heard you in an interview say you use testosterone which by the way, if that's working for you, I think that's great, but I don't have access to that and I you know, and your body just happens to work with this process like this process that you choose of working out hard and and you know, taking your supplements and doing all the things that you do like it worked for you. Jim's points, right. You could take a different person and make them do those things. And it's still work. workout for them the same way, like everyone's body doesn't work exactly the same way. There's got to be different pathways for different people. Yeah, you're 100%.

Jim 50:07
Right. And not everybody is the same. What works for you may not work for me. And I also tell people don't believe everything you say, I tend to be a little bit of a disbeliever when it comes to some things. And when that person on TV that celebrity is saying, oh, you know, you just diet and exercise, you can look like me, well, I don't have a private chef, I don't have a gym in my house, I don't have a trainer that comes to my house. Oh, and by the way, I'm not having super plastic surgery on the side that I'm not talking

Scott Benner 50:34
likely cries at night, I get up with them. Like, again, all the other things that are happening that they don't tell you about, like 100,000,000%. Like, and moreover, I don't get Jinta. If I if I got preachy for five seconds, I don't I understand, like some of the responses you saw to your posts, like I really do. And at the same time, I don't understand them at all. Like, why wouldn't you look at this guy who's like, Hey, here's my story and go, Oh, my God, tell me everything you did write it down. Please send it to me. I want to go try to mimic this and see if this will work for me. But my big question for you is your insurance started to cover this. I imagine because it was back before they got the before they realized they could screw people with type on over and say no to it. But is it still covering it? Are you paying cash?

Jim 51:20
No. So it still is covering it? I fortunately have not run into my insurance coverage being an issue. Yeah. Now you're grandfathered in. I have no idea. I really don't know exactly how it works. But maybe maybe because it's a renewing prescription they figure you know, it's it is what it is I just, I can't speak to the back end part of it. What I can tell you is that every time I go and pick up my prescription, and it costs me, let's say $20 for a month or $30 for a month, I'm thankful that it's continuing to work. And I appreciate it very much that I live in a world where I have insurance, and I have access to medicine. And it is it. For me, it's life saving.

Scott Benner 52:08
My wife is the one who carries our insurance for our family. And she switched jobs recently. And I would say that one of the main forms of stress that came to us for this like process of when she was applying and looking like she was going to get the job, and is she going to take the job and all that stuff is happening in there, most of the stress was about their health care, versus the one we had. And when my zip bound, got moved over to the new insurance, and it went through. I felt like angels were singing, you know, and I was like, Oh, thank God, because I actually found myself thinking, I can't pay $25,000 a year for this, but I have to don't lie, like how am I gonna do that? Like, am I gonna have to rob a bank? Like, I'm seriously like, I started having that feeling like, like, you know, Jim, if somebody just came to you one day, they're like, hey, there's another $25,000 bill this year, I would have been like, I can't I don't know how to accomplish that. But I actually found myself thinking, but I would have to, like, I don't know how to like, I don't want to be 50 pounds heavier? Again. Yeah,

Jim 53:08
I think your experience is very normal. And I would only validate that I feel the same way. Like I I really feel like you know, every calendar year as the as the calendar moves from December to January, and my company's insurance rolls to the next year. I pray and hope that I don't have an issue. But you're 100% Right. It's, it's not an insignificant amount of money by any share by any stretch of the imagination. But at the same time, for people like me who, you know, you could argue it has changed my entire life of how I look at food, how much energy I have, when I can do what I want to do. I don't know how I would live without it. And so, you know, it's it's a scary proposition, but I figured some some way shape or form. I'm gonna have to figure this out. Listen,

Scott Benner 53:54
my situation aside, you're gonna get insulin dependent type one diabetes back without it. Like that's bonkers. Like, you cannot Yeah, yeah. Yeah. Have you ever missed an injection on the weekly? Yes,

Jim 54:07
I have. I missed one shot. On purpose. It wasn't a forget. Right. It was purposeful. Yeah. So so my son's in a band and my wife and I try to follow them when we can on tour. And so we knew that the travel schedule was going to just be a little bit crazy over a weekend. And so I decided to not take the medicine. And then when we got back, I decided I wanted to go for a week without it just to see sort of how quickly I the feelings would come back both the emotional and the physical and the need for insulin. And what I can tell you is after one week, I didn't see any change, and I wasn't willing to try for two weeks. There was no reason for me to sort of push it. But skipping one dose for one week seemed to have zero effect on me.

Scott Benner 54:49
You didn't need insulin. I did not Damn.

Again, I'm sending the government to your house. You have to I'm sorry, Jim. I know you love your wife. and everything, but you're not allowed to have real life anymore. We have to study you. I'm sending the aliens to get your gym, that's all. But I mean,

Jim 55:08
it is amazing Scott, your your, your reaction is not unique, like people will people who I tell the story to are like, it's hard to believe it's real, it's hard to believe that what you're telling me based on everything I know about diabetes is true. And I'm like, Look, you know, here's my refrigerator, I've got a whole drawer still filled with insulin. And every month, I have to check to make sure that if I need it, and it hasn't expired, but I don't need that. It's just amazing.

Scott Benner 55:33
Has a doctor approached you about a study yet? Not really

Jim 55:38
know that I was asked, my endocrinologist asked to make sure that I signed up for the type one registry and do the surveys that come out through them. So I do that. But otherwise, no, I haven't been asked her approach to do anything unique. Or somebody

Scott Benner 55:51
should figure out what the hell's special about you. So we can duplicate it?

Jim 55:54
Well, I'll tell you what I tell to anybody that's willing to listen, which is I'm happy to have any conversation. And if I can play some small role in helping others deal with their diabetes, I'm happy to do it. That's the whole reason I said, I'd be happy to talk to you today. Because maybe my experience will make someone else's life a little bit easier. And that you personally I would find that very fulfilling

Scott Benner 56:14
in the short term. I feel badly for all the people who are going to try this and not have the same experience. I don't think it's a dialed in experience, obviously yet clinically, I even I have a friend, just a friend who started it for weight loss. And I'd get the texts. When am I not going to be hungry? You know what I mean? Like, and it was weeks into a month, like, this isn't working for me. I've lost three pounds. I like you know, I'm still hungry and sucks. And no, I want I want what you got, like that kind of thing. And we're having this like real conversation back and forth. And one day, she just sends it to action. She's like, Well, that's it, I can't eat. I'm like, okay, she was I stopped thinking about food, it just magically happened for like two and a half months into it. But then she started seeing different issues, which was, it was slowing down the absorption of some of her pill form medications. And her doctor didn't know how to like, She then lost maybe 14 or 15 pounds, she was like on her way. And then her doctor kind of panicked and said, I don't know how to like fix this absorption problem for your medication. So you have to go off to though, off the GLP

Jim 57:17
you're 100% right, it's it's so new. And not a lot of doctors have a lot of training on it, they all focus on the weight loss part of it. But you know, my I'm lucky enough that my endocrinologist was willing to put me on it early and see how it worked and you know, the stars aligned and I wouldn't change anything for it.

Scott Benner 57:35
Yeah, a lot has to go

right for it to work out for you have to have a smart doctor who's on the kind of the bleeding edge of all this, you got to get lucky with insurance, you have to but I mean, hopefully I just did an interview Friday that hasn't come out yet talking about hopefully like some of these biosimilar companies that are going to make GRPs. And maybe they can become more plentiful and cheaper and stuff like that for people maybe get more insurance, but what we really need is for people to do clinical testing on type ones. Absolutely.

Jim 58:06
I couldn't agree more. And I would also say that if you try it, and it doesn't work, you know, it's upsetting. I fully understand how upsetting it could be. But it doesn't mean that there isn't another innovation coming around the corner. And so I think as particularly as diabetics, we really have to be thinking about tomorrow as much as we think about today, and hope, hope for recognize the reality of today and hope for something new tomorrow. Because whether it's Manjaro helping a larger swath of type one diabetics, or it's some new XYZ medicine, you know, there's so much research going on right now. And there's so many people trying desperately to help us type ones and type twos live the longest, most healthy, normal, traditional life that we can, that I have to believe that whether it's a non GLP GLP one or something else, that hopefully there's going to be something that's going to work for you, the person who is not working for today. And hopefully that will come sooner rather than later. Yeah,

Scott Benner 59:05
you also have to take whatever you can get out of it. Like for my daughter, for example, like she made it up to five milligrams, but it was too much. So she lost, like, her weight got too low. And so we're moving her back to 2.5. Hopefully that will continue to impact her insulin use the same way. It's like a science experiment. You're just trying to figure out what it is because her insulin usage was like way down. Fantastic. But then, you know, she's like, she was away at school and we didn't have as much contact with her. I would have been talking to her more about like, Look, you got to teach herself how to eat but she was just like, eating like once a day or something like that. Because it just, you know, her her she was during finals. And she's like that as you know, like, I'm just not hungry. And I'm like, I know but you need to eat something and we kept like, you know, giving her stuff that she would eat like don't get me wrong, she was eating but she wasn't eating consistently enough. But then the other side of The gym was like while she's beating through finals and these all nighters that were going on for weeks and weeks and weeks. Her blood sugar's were incredibly stable and she wasn't experiencing any lows and her spikes weren't bad. And like, you know, like, so it was allowing her not to think about type one diabetes management put more effort into college and like, you know, so there's kind of a now she's home for summer, of course, and we're going to change the dose and try to get it back in I'm hearing about people online. I haven't I haven't heard one doctor yet say this is okay. But there are people online are starting to microdose it to like, just try to like, like, make a dent into their insulin needs without the other stuff because they can't handle the side effects of some of the bigger doses. And I just don't know where this is gonna go.

Jim 1:00:39
It feels like we're just at the very tip of the iceberg of understanding what it can do and how it does it. And I'm sure as that learning happens, they'll make tweaks to it and right you could I make made this joke, but it's true, like you could almost envision a lineup of are you taking it for weight loss? Are you taking it for type two? Are you taking it for type one, and each one being slightly different to kit the right receptors that our body needs? In a way that makes it very meaningful and results focused? Yeah,

Scott Benner 1:01:09
and you and I, because we don't have any real like, idea of what we'd be talking about. Don't don't aren't talking about what you're seeing for women with PCOS and GRPs, which is starting to look like it might be significant inflammation in general. And I've seen some people without ears Danlos Syndrome, talk about their joint pain going away on GLP is now maybe that's because they lost weight. But maybe it's also because of inflammation loss. Maybe your beta cells are working better because of reduced inflammation. It's

Jim 1:01:37
anything is possible, right? We just don't know. I've also seen on some of the Manjaro Facebook groups, I've read some people who say that they've had drug and alcohol problems that this has helped them break that need and that obsession with whenever they're they're viewed was there. They're gambling as well, there. Yeah. I mean, there's there's just it seems like there's sort of no end to seemingly there's no end to the possibilities of this medicine. I'm sure there are, of course, but But for today, it's it seems to be doing magical things for people in magical ways.

Scott Benner 1:02:11
And we don't seem to know what they are exactly. Like so. So this is a time of discovery. And I hope that Listen, I've been talking about it more frequently a because I'm using it be because I saw what it did for my daughter. But then because I had a mom of a 15 year old type one Come on, who is like, almost completely done with insulin went from like 70 units a day. I think she's down to like four units of basil now. And like, that's insane. Like, and she has the same kind of graphs as you're talking about.

Jim 1:02:41
Yeah, it's it's amazing. It's it's a game changer. It's, it's just unbelievable.

Scott Benner 1:02:47
No, I couldn't possibly agree more. But Jim, I appreciate you doing this with me is there anything I didn't ask you about that I should have or anything you wanted to say that we didn't get to,

Jim 1:02:55
I would only say that I encourage everybody to have an endocrinologist that they really trust and love. Because to me when that relationship right now is one of the most important relationships in my entire life. And so my endocrinologist is, you know, core to my, my well being, and somebody I look to for all kinds of support, and ask help questions too. And so if you're unhappy with your provider, find somebody that that's helpful and that you feel like is going to be able to give you what you need. So if you're a traditionalist and you want someone who's more old school, that's great. If you're looking for somebody who's maybe thinking about more cutting edge technology, that's great. Some people focus on the medicine, whatever it is that you think is going to be the right sort of match for you is what you should go and do. Because there are so many possible scenarios by which you may be able to get help, but you can't do it alone. And you certainly can't do it by doing your own research, you really need to partner with a professional.

Scott Benner 1:03:54
Yeah, especially with the landscape of the insurance right now. Like the way it sits right now around GLP. Specifically, like insurance and just getting a doctor to like, consider a medication that's not labeled for your need right now. I mean, you're looking for special people, you know, you really are, I'm glad and lucky to have found a doctor like that for my family. And it sounds like you have a similar situation, because there are plenty of people who will are gonna go to their endos after this and say, Hey, listen, I just heard a guy's story blah, blah, blah, this guy Jim going to tell them the whole thing and a doctor is gonna go, it's not for type ones. And that's gonna be the end of it. Like they won't, they won't talk to you about it anymore. But you think that that's because it's a rule and they can't but it's because they don't have the balls or the imagination or the knowledge or or that kind of a thing. So exactly,

Jim 1:04:43
or they don't have the bandwidth to really learn for the for the medical professional, right? Because our medical professionals are now so taxed with the patient, patient after patient that they don't even have the professional learning opportunity to say, wait a minute, what happens if I do put a type two on it? Excuse me a type one. On this and it's not you know, that's that's writing sort of off script. I forget what they call that but awful

Scott Benner 1:05:05
Yeah, label. Yeah. And you're right, they might not even know like, they might think you're wrong. Like when you say, Oh, you misunderstood Jim story, or he probably has, like, you know, they could genuinely not be turning you down because they're like, No, I'm not doing that they could be thinking like, that's not right. But you know, I don't know I'm in here all day seeing patients I'm not out there listening to the podcasts and reading, reading, you know, NIH articles and that kind of thing. Yeah, yeah, they're busy being clinicians.

Jim 1:05:32
There's one other thought that I'll share with you, which is someone told me when I was first diagnosed, that I had to find an endocrinologist who is a type one diabetic, because they're the only ones who really understand the struggle. My and I've had to endocrinologists in the last eight years, neither one of them are type one. And they're both incredibly passionate and understand my condition and what it's like. And so to me, whether your endocrinologist does or doesn't have type one, diabetes is inconsequential to the care that you can get. What's most important is you find somebody that you trust, who's an expert in the area that you want to be, and

Scott Benner 1:06:06
you can get a good end of that doesn't have type one, if they're Listen, it's just like everything else. There's good ones, and there's bad ones. And some of the good ones have type one, and then you kind of go, oh, it's because they have type one they understand. But that's not a prerequisite. I've met a lot of NGOs that don't have type one, they're astonishingly good at helping people with it. Exactly. I've also met heard stories that are, you know, curl your toes about people who don't understand that at all, and are still, you know, directing people about how to take care of type one diabetes, so it but it's no different than anything else in the world. It's just exactly right. Well, I mean, I can't I can't thank you enough for doing this. And congratulations on, on what's happened to you. It's just wonderful. I didn't ask you. But let me ask you here at the very end, like, what was it like to functionally not have to use insulin anymore?

Jim 1:06:53
To describe it as emotionally freeing is an intense understatement. I used to carry a backpack around with me a little backpack that I would always have sugar pills in and my insulin in and you know, I'm sort of prepared for the crisis at any moment. And I don't carry that bag anymore. Like that is mind blowing to me that I am able to just seemingly live a traditional, quote unquote, normal lifestyle as a type one diabetic and eat what I want to eat. And my birthday is coming up in two weeks, and I used to love to go to the beach on my birthday, and have a salty bag of pretzels and a full sugar coke. And I haven't had it for many years. But this birthday, I was actually thinking, you know, it might be time to do a little celebration, and recognize what I've been able to accomplish and go and have that full coke and those pretzels on the beach and celebrate my birthday. That's excellent.

Scott Benner 1:07:45
Of course, Jim is going to be for pretzels and three sips of the coat before you go. It's enough.

Jim 1:07:49
Exactly. That's exactly right. I can barely finish anything anymore. So you're 100% on the spot. I

Scott Benner 1:07:55
was driving home from the grocery store the other day, and I had bought a bag of like, pretzels. And I was I was hungry. I'm actually I'm hungry right now. But like I don't want people to think I don't get hungry. But I was hungry on the way home and I opened up that bag of hard pretzels. And I might have eaten like they weren't that big. You know, they were maybe like two or three inches across. And I got to like the third one. And I was like woof. Like, that's enough. I gotta stop. Yeah, like I actually I was like I Oh, I feel full. And I think it's completely possible that prior to a GOP GLP I could have eaten half of that bag of those pretzels.

Yeah,

Jim 1:08:32
I think you're you're 100% right, what used to take me an entire slice of cake to satisfy a craving that was a bite or two.

Scott Benner 1:08:40
Yeah, I have this some I have this pint of Mango Sorbet in my refrigerator, that I now eat a half a teaspoon at a time or a teaspoon at a time. Whereas I would have prior opened it up and been like, oh my god, this is good and had to stop myself from like eating half of it. And I get the same satisfaction out of it. Which is really exactly lovely.

Jim 1:08:58
And I don't know about you, but I don't feel like I'm missing anything. It's not. I mean, I miss cooking. But otherwise, the benefits for this just far outweigh any of those kinds of negative side effects that you might suffer with. It's just, it's just so worth it.

Scott Benner 1:09:12
I can freely agree with that. 100% Yeah, no, I mean, like, Listen, I'm sure people are gonna, like I've had people come at me online and say things like, Oh, you're pushing the GLP agenda. I actually had somebody say that to me. And I'm like, Listen, I'm just sharing with you what's happening to me? Like I'm not like I don't have a GLP sponsorship. Although I want to say something right now. Eli Lilly, I would happily I would happily be exempt bound sponsor, but I don't think they need I don't think they need the marketing. It's something that the word is spreading out on its own but I was interested because that person's perspective. To me seemed like this is not a real answer. This isn't how it should be done. Whatever their their, you know, political line of thinking is around Weight Loss. serve whatever, they you know, maybe I should be dieting and running or something like that, or you know, like, and they don't know, I already tried all those things, that's fine. The anger there about like, You're cheating. And don't tell other people that cheating works. Like I was like, Oh, wow, is that how you think about this? I just think about people being healthier and less encumbered. And what a joy that is for them.

Exactly. Right. So okay, exactly.

Jim 1:10:26
Well, Scott, I, before we close, I think that it's important for me just to say thank you to you, I've even in the few episodes of your podcasts that I've listened to, I feel like I've learned a lot, you are a voice for those who need education and are interested in learning more and hearing these stories and sharing. And so behalf of you know, all the type ones that I know, and I'm sure 1000s and 1000s of others, thank you for doing such a great job and keep up the good work. Oh,

Scott Benner 1:10:54
you're very kind. Thank you, I appreciate that very much. I will, I will, indeed, I have nothing else I could do, Jim, I will end up being a cashier, literally at target if I don't do this. So I don't know what else I'm qualified for, except to make a podcast about diabetes and talk to people about their lives. It's been a real pleasure helping everyone so far, and I sincerely look forward to continuing to do it. And I'm trying to morph along with where things are going. And that is why I'm covering more GLP stories, because I've tried to take a thoughtful step back and look at it. And this really looks like it's going to be a large part of how people with type one type two diabetes are going to manage their lives. So I'm just trying to make sure that people understand it. Because as it unfolds, in all the ways that's going to unfold clinically, insurance, you know, all those different ways. I want people to be ready for it when it's their time not have a drop in their lap and do the like Why are you pushing this GLP agenda on me and then miss out on what my daughter is experiencing what I'm experiencing what you're experiencing, etc. So anyway, I appreciate it. Don't worry, I'm not stopping the thank you so much.

Jim 1:12:02
Keep up the great work. And I hope maybe this conversation helped some people understand that you can be a type one and not be on insulin in the new world that we live in. I

Scott Benner 1:12:11
appreciate your story. I really do. Jim, thank you. Hold on one second for me. Okay. Yes, sir.

I was sent back and I realized you might not be able to hear the crickets. So you might actually think I'm crazy. But I swear Can you listen? It's here, I promise you. Listen, if you're in the private Facebook group, there's going to be a post about this episode. And Jim said he check in and answer questions. So if you have questions for Jim, go ask him. If you'd like to wear the same insulin pump that Arden does, all you have to do is go to Omni pod.com/juice box. That's it. Head over now and get started today. And you'll be wearing the same tubeless insulin pump that Arden has been wearing since she was four years old. I'd like to thank ag one for sponsoring this episode of The Juicebox Podcast and remind you that with your first order, you're going to get a free welcome kit. Five free travel packs in a year supply of vitamin D. That's at AG one.com/juice box. And if you like rubbing comfortable, high quality things on your body, cozy earth.com Go there, fill up your cart with towels and sheets and everything they have. And then save 30% using the offer code juice box at checkout at cozy earth.com. I know that Facebook has a bad reputation. But please give the private Facebook group for the Juicebox Podcast. A healthy once over Juicebox Podcast type one diabetes. The group now has 47,000 members in it, it gets 150 new members a day. It is completely free. And at the very least you can watch other people talk about diabetes, and everybody is welcome type one type two gestational loved ones, everyone is welcome. Go up into the feature tab of the private Facebook group. And there you'll see lists upon lists of all of the management series that are available to you for free in the Juicebox Podcast, becoming a member of that group. I really think it will help you it will at least give you a community. You'll be able to kind of lurk around see what people are talking about. Pick up some tips and tricks. Maybe you can ask a question or offer some help Juicebox Podcast type one diabetes on Facebook. If you're not already subscribed or following in your favorite audio app, please take the time now to do that. It really helps the show and get those automatic downloads set up so you never miss an episode. Thank you so much for listening. I'll be back very soon with another episode of The Juicebox Podcast. The episode you just heard was professionally edited by wrong way recording. Wrong way recording.com