Scott Benner 6/27/24 Scott Benner 6/27/24

#1238 Dr. Tom Blevins on GLP Medications - Part 2

Dr. Tom Blevins discusses GLP medications. Part 2

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Scott Benner 0:00
Hello friends and welcome to episode 1238 of the Juicebox Podcast

Dr. Blevins is back today to expand on his GLP conversation from a few weeks ago. Today we're going to be taking listener questions Dr. Blevins is going to do his best to answer them. 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. Hey, if you have type one diabetes or are the caregiver of someone with type one and a US resident, I need you to go to T one D exchange.org/juicebox. and complete that survey that survey helps the T one D exchange to move type one diabetes research forward T one D exchange.org/juice box. If you've ever wanted to help, this is your chance it will only take you about 10 minutes. 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/juicebox 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

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/juice Box. Today's episode is sponsored by Medtronic diabetes, a company that's bringing people together to redefine what it means to live with diabetes. Later in this episode, I'll be speaking with Jalen, he was diagnosed with type one diabetes at 14. He's 29. Now he's going to tell you a little bit about his story. To hear more stories with Medtronic champions. Go to Medtronic diabetes.com/juicebox or search the hashtag Medtronic champion on your favorite social media platform. Alright everybody. So Dr. Tom Blevins is back, we're going to do another episode around GLP medications. If you have not heard his first one, it's episode 1212. But today, we're going to do all questions from the audience. So Tom, welcome back.

Dr. Blevins 2:35
Scott, good to be here.

Scott Benner 2:37
I'm glad you were so good the first time I'm excited for you to be back again. I'm just going to jump right into questions that came from the audience about GLP meds I don't know that we're gonna get through all of them. But but let's do it. All right, so I'm gonna start right at the top, my seven year old is very overweight doctor suggested possibly giving her one to help her lose weight over the summer. Is this safe for young children and effective she's type one. She lost 40 pounds before diagnosis and is gained 60 back cannot stop eating.

Dr. Blevins 3:06
Yeah, that, you know, that is a tough problem that she's lost because of the high blood sugar to begin with. And now she's gained back everything and then some. And she's she's hungry. And hunger is a is a tough deal as possible. Certainly that insulin induces some hunger or promotes it. And she's overweight. Now, we don't know the details. But you know, here comes the summer, you wanted to lose weight? And the question is about GLP. One's a glucagon like peptide, one meds? And I'll tell you, it's important to look at what what's been done in terms of studies. And all that when I answered this question, and the answer is there is no medicine approved at this point for a seven year old. And for for any purpose for diabetes, or for weight loss, and there's no GLP one approved, the approvals are the one called saxenda, which is liraglutide, the once a day injection, that one is approved for weight loss in the pediatric population down to age 12. So that's not going to go and the bottom line when it comes to approvals here is that we just don't have data. So we don't know, the person who asked the question could talk to their, their doctor and ask about that. That's certainly something they can talk about. But I would be reluctant to go that direction. It's a really good thought. And you'd love to get her to lose weight, that's for sure. But anyway, I'd be very, very cautious about that talk to a doctor. And and work maybe with this might be a time you know, everyone that's listening probably has talked to a dietitian before. Dieticians can be very effective. So it might be a good time to talk to a person like a dietitian to talk about the eating.

Scott Benner 4:58
Is there a possibility of so for spa this, this suggestion is coming from their physician. So, I don't know, I can't make you guess about this. But is there a world where you would ever look at a seven year old in a similar situation and have this thought or you wouldn't go this way? Full

Dr. Blevins 5:13
disclosure? I do. Mainly, I see mainly adults, and I don't really see seven year olds. So I couldn't answer that about a seven year old. But, you know, this is a place where the doctor, doctors can use medicines, as you know, off label. And and they can look at the indication. And and they could use a medicine that doesn't kind of fit the indication it's a clinical judgment call. We don't know about safety for young kids. And would it be less effective, more effective? We don't know, I suspect it would work the way it does for older children. So the answer is we just don't have much data there.

Scott Benner 5:50
Okay. Let me jump to the next question. This is I'm going to jump around a little bit on this list. But just a very simple question does GLP medication cause muscle loss? So if you're paying attention in the space, when GLP has became kind of in the, in the limelight maybe two years ago, I think Dr. Peter Atea, pretty famously said that he is his practice, took a look and said that people were losing muscle. And I think that became one of the one of the concerns out in the in the media and everything now. Yeah, I've been on it for 13 months now. I don't feel like I've lost muscle. But as a matter of fact, I feel stronger now than I did before. But does it cause muscle loss? Or is that just part of losing weight? Or what are we seeing? Contour next one.com/juicebox. 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 gonna get more information. It's easy to use, and highly accurate. smartlight provides a simple understanding of your blood glucose levels. And of course, with 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.com/juicebox head over there now get the same accurate and reliable meter that we use.

Dr. Blevins 7:44
Great question. And it is a concern. And there there have been people who said oh, these medicines, the GLP ones cause muscle loss. And that's been that's been an inhibitory kind of commentary or idea for many people when they when it comes to using them. But here's what we know, if a person takes a medicine or of any kind or loses weight for any reason, and they're sedentary, they're going to lose fat and muscle both. And probably preferentially even in that situation. If they stay sedentary, they're going to lose more muscle more that is fat than muscle. And typically the first fat loss is the visceral the abdominal fat. And that's what you want to lose as that rapid turnover fat. So that will go first yet if a person maintains a certain amount of activity. And and I would say it's always important for a person to be active walking like 150 minutes a week or whatever a person does. Many people do much more than that, of course, like lifting weights, that kind of thing resistance exercise, those people are not going to have much muscle loss when they use a GLP one or when they lose weight for any reason. This is really a weight loss phenomena. It is true that when a person loses weight, especially a substantial amount that some muscle areas are just not needed as much not having to carry as much weight, so they might lose those muscles a little bit. There have actually been some pretty good studies done that have looked at body composition with GLP ones and the combined GLP one tip Med and remember we're talking about GLP one glucagon like peptide one. And the GI P is glucose glucose dependent insulinotropic polypeptide. Those that abbreviations we use tip for that one and then GLP one, that's a pretty good body composition data that shows that yeah, people can lose a little bit of muscle but mainly they're losing fat. So I'm not worried about muscle loss. When people use GLP ones and less they're completely sedentary. And one of the first things I'm gonna recommend that people do when they take one of these meds I say be active and burn some calories to these medicines reduce calorie intake, but also it's very important that people burn calories and and use their muscles. I

Scott Benner 10:01
have to say, I've been wondering about this question for a while, because Did someone just say something in public? And it just stuck? You know what I mean? Was it like a knee jerk reaction or one of their first things like even would you go back to them now? Maybe? And they'd say, Oh, I've looked further. And I agree more of what I just heard. So I'm glad you were able to answer that. So completely. Thank you.

Dr. Blevins 10:22
Yeah. You know, Scott, I think some of the studies that have been done with body composition will be published, and will become more common knowledge. And it's an important concept. It's an important question. And it's important that we advise people to, you know, do their own thing about reducing calorie intake and also increase muscle activity when they're using these methods. Yeah,

Scott Benner 10:43
I saw a big difference. Just adding like low intensity like dumbbells from my arms, my chest, my shoulders. Yeah.

Dr. Blevins 10:49
I'm glad you said that, too. Because your experience is very important. You're not you don't feel like you've lost muscle mass. And you're, you're doing activities, you're lifting weights, and that I'm not talking about heavy and you're not either. We're not talking about heavy duty weightlifting, we're just talking about lightweight resistance. Yeah, resistance exercise.

Scott Benner 11:07
I'm also very careful to mix a fair amount of beef and chicken into my diet for protein to Yeah, good. Yeah. I'm going to jump off the list for a second. This is actually a question that came in to me through a there's somebody I know personally. So they start zap bound for weight loss. This person does not have diabetes, yes. But they were pretty significantly overweight. And not just hungry, Dr. Blevins but like ravenously, hungry 24/7, like could eat to being stuffed, and someone could offer them a dessert and they go, Yeah, bring it on. Like that kind of thing. Knowing sitting there thinking I'm not hungry. Not only am I not hungry, my stomach hurts. But yes, I'm gonna eat this, but they go on zap bound. It took a couple of months. And the fruit noise did not go away for a couple of months. And I said to them, just keep going. It will. And one day, I get a text. It's working on me all the sudden, like I'm starting to lose weight. I don't feel ravenously hungry all the time, I'm filling up quicker, it took months for to start working for them. And they're having success, they lost 14 pounds, things were getting better. And then all the sudden, the doctor does the blood work. And they have a significantly increased lipase and amylase. So lipase 394, Emily's 204, Doctor pulls them off the med. And those numbers go back down. So my first question is, are those bigger numbers a reason to say oh, my god pancreatitis is coming get off the med or is that just the thing that happens? Well,

Dr. Blevins 12:42
that is a great question. And I'm not sure I have the the perfect answer here either. But we've done quite a number of studies and I can talk about published information. And it is clear that those enzymes can sometimes go up and down. And and while on treatment. The question is what happens in people who are not on those meds at all on a day to day, week to week, month to month basis? And we don't know there really hardly any studies, if any at all. I don't like that. I can cite one that looks at amylase and lipase and as you said those are for the audience. Those are the enzymes from the pancreas. And they tend to be really high when people have pancreatitis. Well keep in mind that pancreatitis is a clinical syndrome of pain, Amin pain, like bad pain, and inflamed pancreas, and very high numbers. So what does it mean when those numbers are high, and a person is not having pain? We don't know. And, of course, I agree those numbers are are depending on the normal range, depending on the normal range in that lab. Those numbers are concerning. And I do understand the concern of the doctor there. And using a medicine that remember these medicines stimulate the beta cells to make insulin they they affect the alpha cells that make glucagon in the pancreas EndyMed that might affect the pancreas could maybe inflame it, but there's really no clear evidence that these meds do that. So I agree with the concern. It's an unknown and this is going to be a clinical thing there with the person who was on the zet bound. That person I know will be talking to the doctor further. And do they want to re reintroduce the medicine that's there? That's a judgment call. Yeah. Is it pre pancreatitis? Who knows? That's a great question. Do I normally measure lipase amylase? Do we always routinely do that? No. Was there a reason in that patient and the person you're talking about to measure at night where they have in some pain? Maybe I don't

Scott Benner 14:44
know Tom. Absolutely no, no pancreatitis Oh

Dr. Blevins 14:47
symptoms at all. One at all. So it wasn't pancreatitis. Almost certainly. And in that one's going to be a call it as you go, and do I recommend that people check amylase and lipase not really Everybody has a different level of caution. Some practitioners may want to check them along the way. And that's their call.

Scott Benner 15:07
Yeah. All right. So here's another one that's not on the list, person using medication for mood stabilization and anxiety, yes, starts using a GLP medication for weight loss. And then it messes up the absorption of their medication. And their anxiety gets significantly worse. Is there a way to manage that they're already on a large dose of the anxiety? medication, the doctor was uncomfortable giving them more. And that's why they took this person off of the off the GLP. But was there a better way to manage that, that you know, if you

Dr. Blevins 15:47
get that's gonna be very much a clinical thing up kind of between the person you're talking about and the doctor would a lower dose of the GLP one work and make it all okay, maybe would timing help of the medicine? Maybe, but not not horribly likely. Because, as you know, these GLP one meds like the ones we use once a week, and they have a very long life. So there's not really a predictable time during the day that the effect would be less on the stomach emptying, would it gradually improve over time, but not hard to know. As you know, the effect on gastric emptying that these medicines have the slowing down of gastric emptying is something that happens, especially early on when you start the medicine and every time you increase the dose, it kind of recreates itself. But as the gastric emptying kind of goes back a little bit more towards normal, after a person has been on the bed for a while. And after a few weeks, it doesn't go back to normal. That's going to be very much a play about your thing. That's what this is why the people say it's the art of medicine, just the science and that's gonna be an art thing. I

Scott Benner 17:00
asked the question here just so people can hear like if you are taking medications by mouth, you might be seeing absorption changes, it is the thing to take care of. You notice that is true. Take note of Alright, let's stay in that vein a little bit. I have gastro problems when I use these drugs. I have a very low carb diet, which helps me keep my numbers in five, five range, but I need to lose weight. Low Carb means high fat some of the time, which can make me sick with the drugs. Is there anything that can be done to help me use GRPs without so much sickness? This episode is sponsored by Medtronic diabetes, Medtronic diabetes.com/juice box. And now we're going to hear from Medtronic champion Jalen. I

Speaker 1 17:44
was going straight into high school. So it was a summer heading into high school was that particularly difficult, unimaginable, you know, I missed my entire summer. So I went, I was going to a brand new school, I was around a bunch of new people that I had not been going to school with. So it was hard trying to balance that while also explaining to people what type one diabetes was. My hometown did not have an endocrinologist. So I was traveling over an hour to the nearest endocrinologist for children. So you know, I outside of that I didn't have any type of support in my hometown.

Scott Benner 18:17
Did you try to explain to people or did you find it easier just to stay private?

Speaker 1 18:22
I honestly I just held back I didn't really like talking about it. It was just it felt like it was just an repeating record where I was saying things and people weren't understanding it. And I also was still in the process of learning it. So I just kept it to myself didn't really talk about it.

Scott Benner 18:36
Did you eventually find people in real life that you could confide in. I

Speaker 1 18:41
never really got the experience until after getting to college. And then once I graduated college, it's all I see. You know, you can easily search Medtronic champions, you see people that pop up and you're like, wow, look at all this content. And I think that's something that motivates me started embracing more, you know, how I'm able to type one diabetes, Medtronic

Scott Benner 19:02
diabetes.com/juice box to hear more stories from the Medtronic champion community.

Dr. Blevins 19:09
Yeah, you know, this is this a question has many different components in a way and keep in mind that fat does slow down the stomach emptying already. And then you add a medicine on top of it, that slows it down and you get a double slowing and away maybe not double but you get more slowly. And that can lead them to more or not nausea, and even vomiting. And and so one of the strategies of course, when people start a GLP one or GLP one gi P method is to reduce the fat. So those of you out there who are taking these meds, if you have a high fat diet, then you're taking a GLP one cut back because that will help the nausea if you're getting nausea. Low Carb doesn't necessarily have to mean high fat. Low Carb can be accompanied by kind of a lean lean protein type, elite meat type intake, and it can be okay in terms of weight loss. So I would say that, though it's not as simple as I might try to make it here, that the person here doesn't have to go high fat, and I think they could modify down to, and I think low carb, in my mind, is it many different definitions of different definitions of low carb. I think it's low, simple, simple car, but I think vegetables fit very well into a low carb diet. It's the potatoes, pasta, rice bread stuff that I try to get people to avoid more simple carb and other simple carbs to. So I think I think the vegetable lean meat approach would be okay. And so I hope that helps the person. And if they take that approach,

Scott Benner 20:49
I think it might actually, yeah, here's one. I've been on rebel sis. Since mid February. I'm type one, I'm taking it for weight loss, my a one C is six, eight, no side effects. I've gone from 190 to 169 pounds. Now today, my endo said she's really concerned with me using a GLP medication being a type one, and then notes the risk of pancreatic and thyroid cancer. Is that a genuine concern?

Dr. Blevins 21:15
Okay, so a couple things, I'm always going to want to kind of refer back to the idea of the approvals. And I know this is being used off label for this patient numbers, you know that Rob Bell's is not approved and type one, right? We've talked about this before. And Scott, you know, I'll continue to repeat that because it is up to the clinician, and the patient to decide some some of the many of these things is called off label use of a medicine. So that's one thing to say congratulations to the person who has such a great a one C, and weight loss. That's great. So this is gonna be a discussion that's going to be important for the person to have with their Endo, and go back in and say, Hey, tell me more about this. And let's talk about it. And and I certainly don't want to get in the middle of that. I will say that the thyroid cancer issue with GLP ones and GLP one gi P meds, and it's a boxed warning for virtually all of them has to do with a cancer called Med galeri. Thyroid cancer. That's a route that's I'm not going to go as far as say it's rare, but it's really uncommon. And it runs in families many times not always, there's something called multiple endocrine neoplasia syndrome type two runs on and we do see people I'm an endocrinologist, I see people who have immune to and I would never give them GLP one meds because it's contraindicated because their cells in the thyroid called C cells that were stimulated in rodents, when they were given GLP one meds now humans aren't rodents. But we don't know the whole story here in terms of how humans might respond, who have either the cancer or family history, we don't know that we would promote it. So those people shouldn't take it. Most thyroid cancers have absolutely no implication when it comes to GLP. One, there's no sign that GLP one meds can cause the routine, the common kinds of thyroid cancer. So that's something that person needs to talk to their endo about a little bit to try to find out more about that. And if the person has no family history of medi Larry, thyroid cancer, no family history of me and multiple endocrine neoplasia, then they could go in and talk to their endo about that. Pancreatic cancer, there's really no evidence that these males cause pancreatic cancer. So I think the person wants to go back and talk to endo and say this talk about that issue. What are we talking about here? I think that's the best approach. Go back in and talk to the talk to the endo and find out more about the concerns that we know. Yeah,

Scott Benner 23:50
I'm going to read you something then I'm going to ask you a question about how you think about things. So yes, medullary. Thyroid cancer is a rare type of thyroid cancer accounting for about one to 2% of all thyroid cancers in the US, approximately 1000 people are diagnosed with modularity thyroid cancer each year in the United States. So if you're one of those 1000 people, then their odds aren't great. But that's a pretty low number. And that's fair to say, right? 1000 people is a fairly,

Dr. Blevins 24:18
that's pretty low number. Okay. I agree with the concept. I think one to 2% doesn't fit rare, but it's really, really uncommon. I know it's called rare. It's really, most cancers are thyroid cancers are called papillary, or follicular or mixed. Those are the ones that we see if someone has that kind of cancer in their personal history or family history. There is no contraindication to using this method. So you are you're right. You know, one thing to point out is and we don't want to go too far here, but these meds have been around for quite some time. You know, ozempic was approved in 2017. And then true listed He's been out for a long time. And it's been used in millions of people. And we're not seeing a thyroid cancer, med Valarie? Or any other answers signal in it. Now you could say, well, it's not being followed very closely. I mean, how would you know, because there's not a, there's not a study going on here. But people do report these things. There is no signal that showing up. So I think it's very important that a person not take GLP wants to have if a person has a personal history of modularity, thyroid cancer, or that multiple endocrine neoplasia syndrome, but we are right, it's really, really, really uncommon.

Scott Benner 25:35
So my question to you is, because your common sense person, this is one thing I've learned from you. In the short time I've met you and known you, in your own life, medications you might take or as a, as a doctor who's prescribing? How do you think about the problem of Yes, some people die in car accidents, but we need to drive when it comes to medicine? Like, do you know what I mean? Like that bigger, right? Because you hear people all the time, like, you know, I'll post on the Facebook group, hey, you know, we're talking about GLP. Today on the podcast, and 50 people be like, Oh, my God, I've been on GLP. For two years, I've lost so much weight, my one sees down, blah, blah, blah, it's all in one person's like, it makes me throw up and everyone goes, Oh, my God, it makes people throw up. It's a really interesting way our minds work. Like I know, we're, we're risk averse as humans on purpose. And that's a good reason. But But how do you think about it personally, like when you're standing in front of a person, you decide to give them something? And this and whatever else is in that label is out there? How do you make the risk reward decision?

Dr. Blevins 26:39
Yeah, it's what you said it's a benefit risk equation, it's a benefit risk analysis, you want the benefit, the potential benefit, when you start a medicine, when I run a medicine, I want the benefit, the potential benefit to way exceed the risk in risk is a very, very thing too. I mean, some some medicines have a risk of some really nasty things. Some medicines have risk of some fairly mild things. So nausea can be anything from mild to nothing too terrible. It is true. And I tell people this all the time, or if I'm ever presenting this data, I say, Well, some people can't take it, for sure. And that's true of most myths. And that's when I take them out. I know I'm going to try it. If I'm having a symptom I don't like I'm going to stop it. And I'm going to look for an alternative. Maybe it depends on what it's all about the the condition, and the benefit and the risk. And so people need to know going into taking this type of medicine or any type of medicine, why they're taking it, what it can do for them and the risk, and they need to realize it especially with GLP ones that sometimes people just simply can't take because of nausea. Yeah, if one person has nausea and vomiting, and they stop taking it does that is that a clarion call to say everyone should go off of it? Not at all, not at not at all, the vast majority of people have no problems with it, they might have mild nausea, they may have moderate nausea, or even even notable non nausea, which tends to get better over time. It doesn't always get better over time, though. And I'll tell you, if you look at most studies, I'll just kind of ballpark it anywhere from 4%. Up to 8% of people in the studies had to discontinue the GLP one or GLP one tip meds because of GI symptoms. And as we've talked about before, that would be nausea, vomiting, diarrhea, constipation, I tell people, Hey, you may get nausea, vomiting, diarrhea, constipation, and you don't get to choose, you know, one of those and you may not, you may not tolerate it. Many times we can mitigate the we can reduce the side effects by reducing the dose. And in their other things I could go on and on about that can also reduce the risk of that like lower fat. We talked about that while ago. lower volume in the in the food intake. There's lots of things people can do to modify. But yeah, you're right. If one person has a significant side effect, and they can't take it that does has that's interesting. And that's that's it, and I'm sorry for that person. Of course, it doesn't mean other people should go off of the medicine

Scott Benner 29:12
or not try it out either. Yeah, exactly. My mindset is simple. Like, we're here now. Like, the rules have changed. Like I'm not, I'm not standing in front of you. Me personally, super fit and muscular with no fat on me and no risks of heart attacks. I'm 52. I'm carrying extra weight. A lot of it's in my stomach. You give me this medication. I'm not as hungry, I fill up sooner. I'm losing weight, and I have diarrhea feels like the cost of doing business to me. You know what I mean? Now, it wasn't so bad that I couldn't exist. And of course, if it was that would change it. I want to know too. And this is going to call for speculation but how many people have you stood in front of who experienced the side effects and you think yeah, stop taking this and how many of them do you think tougher out, it'll be okay. And like, it's sometimes it's just the resiliency of the person, not necessarily the medication. I know that I'm not blaming them. But I mean, people do have different tolerances for for trouble. Do you know what I mean? By do?

Dr. Blevins 30:16
You know? The answer is it's highly variable. I had a person in the office yesterday who was having pretty bad constipation, connected to a GLP. One method. And we did a few things. First of all, she didn't want to stop the meth because she's had good results. And just what you said, she's had good results, she understands the importance of the results, she's had her sugars are better, her weights down, everything's better, she feels better. But she has pretty notable constipation. So what do we do we cut back the dose a bit, I gave her some advice about treating constipation in general. And there ways to deal with it. Now some people come and say, is so bad, I can't take it. I go, you're the boss, not me. And let's let's go off of it. Or we might try different GLP one GRP. Med. This is surprisingly, sometimes changing the med can change the symptoms. And you wouldn't think it would be true. You would think that I'll be kind of similar in that way. But there are some there are some differences.

Scott Benner 31:14
My endo told me going from Wiko V to zap bound might help me with loose stool. Yeah, yeah. And she indicated that it's possible my acid reflux, which had gotten much better, could actually even get a little better again, yeah, it has been my finding. If I had known enough about the drug before I started, which I think people should, should know that I was very careful to take magnesium oxide every day, when I started the medication, like, I did not want to be constipated. And I also very thoughtfully, even though I am not a high fat person to begin with, I was extra careful not to eat high fat. Now, I mean, truth is, depending on the dose, I've had, you know, it's funny, I've had French fries in front of me at a table with a bunch of people. And I've reached out and had two or three of them, and you get to the third round, and you just like, I don't want this. And it just it's interesting how your brain works so much differently on this med than then it worked for me that my brain worked without it. Because I could have eaten them. But I was just like, I don't I don't want to do this.

Dr. Blevins 32:18
And that is so cool. Because you just saved yourself a few 100 calories. Yeah, that is that is the way those work, meds work. They do such a nice job with that. Fascinating.

Scott Benner 32:27
Yeah, let me ask you one, it's a little generalized, but just so that this information is in each episode that you do about GLP is this question, what specifically? Is it about a GLP? That helps lower insulin needs for type ones? And is there one that is preferred over another specifically for type ones? Well, the so forget, forget, for a minute. FDA approved, right? We know none of them are for type ones. But what's the mechanism of how a GLP helps lower your insulin needs? Yeah.

Dr. Blevins 32:58
And you're right, none of these were approved for type one. And we are doing a study you as we've talked about before, here in Austin, that's looking at one of these people with type one. And I hope that study pans out to show it's effective and safe. And maybe we'll get one approved, we sure hope so. But the way it could reduce insulin needs would be number one, it does slow down gastric emptying, so therefore, anything that goes in, it's absorbed more slowly. So there's less peaking of the carbohydrate, less less glucose flow from the intestine, at least it's delayed. And so that's a better way to put it. In addition, the medicine can reduce appetite a bit, so fewer calories and fewer carbs in lower glucose and lower insulin need. It can reduce then weight as a result of the decrease in appetite or early satiety. And that improves insulin sensitivity itself, as you know. Now, is there one that's preferred? I don't know. And I'm not gonna I don't think so. I will say that the one called terzetto appetite, which is Mount Yarrow. And set bound has the effect that the GLP one has on slowing emptying and reducing appetite, but also seems to increase insulin sensitivity. And so that that's an interesting phenomena to where everybody's still kind of working their way through that one. So it has that effect. So all of those mechanisms together, or intervene individually can help reduce the need for insulin

Scott Benner 34:41
to follow up questions, so ones for me personally, if it's slowing gastric emptying, meaning I'm probably going to bed with food, my stomach, how is my stomach acid going down? How come it's having that impact for the life of me the first time I lay down at night I thought Oh God, I don't think my dinners like through For me at and I expected more gastric reflux and I got less, what's the mechanism there? Yeah,

Dr. Blevins 35:07
you know, this is going to be something that varies from person to person, these meds can cause a worsening of reflux because they slow emptying. And that's what you'd expect. And some things happen that we can't explain, I will say this, when a person loses weight, they lose visceral, adiposity, visceral fat early on, they don't lose it all, they lose some of it. And that reduces then pressure on the stomach, that's just a mechanical thing that reduces reflux. And so and perhaps a person eats less as as they use the med to. And that might reduce volume. And that might actually reduce pressure in the in the stomach, then the pressure is what leads to the reflux into the esophagus, and the acid feeling. So there are a number of possible reasons that your symptoms are better. One may be the weight loss or reduction adiposity, visceral fat, and the other may be that you're eating lower volumes, and maybe not even notice and you are but the possibly you are I know that that's not have intrinsically any anti acid effect. I'll tell you that. Right. So

Scott Benner 36:15
it's more physical structural implications.

Dr. Blevins 36:19
I think so

Scott Benner 36:20
yeah, it makes sense to me, I'm going to ask a very specific question. This is actually for, like an acquaintance of mine. Yes, at birth, this person lost some of their intestine. So it had to be removed their whole life, they basically eat and then dump, right? Like it just That's how it goes. Right? Did GLP be bad for them? With that structural change? Interesting

Dr. Blevins 36:42
question. And this may also more generally be something people who have gastric bypass his might ask or gastric sleeve to in the answer is, well, first of all, the best answer is, I don't know. The other part of the answer is that person if they wanted to explore that would need to talk with their doctor and find out the you know, the pros and cons and whether it's even possible or feasible. And the answer is, it could in theory, because it slows down gastric emptying that slows down the lower intestine as well in many people. So how that how's that gonna work? I don't know. But it's an interesting thought.

Scott Benner 37:21
It's not a question that makes you like, throw up a stop sign up. Oh, hell no, don't do that. No,

Dr. Blevins 37:26
yeah. Okay. No, that's, it's, this is one of those things, you know, it's a negotiation with the doctor, of course, or that person may have a GI specialist, I don't know. But it's a negotiation, like so many things is, well, what about this? Would it be worth worth? worth trying? And that's, that's where I would take it. Let's

Scott Benner 37:43
listen. That's what I told them, especially when you're, this would be for weight loss for them, not diabetes. I said, My God, they're gonna give you a quarter of like, Wiko V to start, like, I don't think you're gonna get thrown into a giant problem. And if it's a problem, you're gonna live through it and stop, you know, so yeah,

Dr. Blevins 38:00
probably, you know, it's probably the only gi history and there's, there's some I might in general, that I would say as is kind of a contraindication to using them as would be if somebody has established gastroparesis, then adding a medicine that slows down the stomach even more, just, generally speaking, not a great idea. Yeah, most of these is recommended. You don't use them and people have gastroparesis hasn't been studied. And people have gastric sleeve or gastric bypass or a person like the person you're talking about. Know. And could it be tried? Possibly, you'll know pretty quickly. If it's a problem.

Scott Benner 38:37
Yeah, I have a note here to myself, because I knew this would probably come up at some point, talking about the difference between a person with type one who starts to experience digestion issues. Maybe because your pancreas has been impacted the way it has been, you're not getting digestive enzymes, maybe correctly from your pancreas anymore. People don't know that. But the frequency that I hear from newly diagnosed people or my son has stomach issues now that they have type one and they've had it for a year. For some reason, a lot of endos. Don't talk to type ones about using a pancreatic enzyme or a digestive enzyme, excuse me to help with digestion, or maybe add a magnesium oxide to help with elimination, and instead they end up eventually at a gastro who just says, Oh, if your stomach's emptying slowly, you have gastroparesis. The difference between that and someone who's had type one for 30 or 40 years and likely has nerve damage if they have gastroparesis, and I do think there's going to be a section of type ones who GLP aren't going to be a choice for because of actual gastroparesis, that that's affected that is a front what does that nerve called the feel like it starts with an F but I can't think of the name of it all of a sudden, Renick

Dr. Blevins 39:53
is one of the nerves but vagus nerve is there and I mean some people with with Type one do you have that neuropathy? The autonomic type neuropathy? Yeah, which leads to gastroparesis. And some of them don't know, they have gastroparesis. And they might find out if they, of course, it would be off label, if they used GLP, one type method. Yeah. And I've seen that, and they're gonna have more notable, and there could be people who have gastroparesis, who have had diabetes a short period of time, but But it's probably not caused by the diabetes. And so there are certain tests like a gastric emptying study, which is kind of funny study where people may have to intake some food that's got some radioactive stuff kind of mixed in with it. And then it's observed the emptying from the stomach is observed after they eat it. Yeah. But that kind of a test is an objective way to look at gastric emptying.

Scott Benner 40:46
I just want to bring it up. Because there's, there's a lot of thinking to be done around this issue around type one and GLP meds, I think, yeah, I think you're right. Scary. Scrambled eggs aside the gift that they give you for that? Right? Oh, stuff? That sounds kind of awful. Yeah. Would it be better? GLP? Is they mean than taking Metformin? I'm asking because my teenager has major insulin resistance and weight gain.

Dr. Blevins 41:14
Yeah. You know, Metformin, has a little bit of there's data in type one diabetes with metformin, and it can help a little bit, but it's not very consistent. Metformin, primarily seems to reduce a paddock that has liver glucose output. Is it an insulin sensitizer? Can it treat insulin resistance very effectively? The answer is well, in general, it's not a classic sensitizer can it lead to weight loss, and not very often and infrequently, occasionally, though, people get sort of almost like anorectic on Metformin. And we have to take them off. And that is very unusual. So I think Metformin has a potential role, it might be worth a try. It is, of course, it's not approved for type one either, but we try it at times. And so I don't think I mean, that for me might have some effect. What was Scott, what was the other part of that question?

Scott Benner 42:14
They have major insulin resistance and weight gain? Yeah. So I mean, let me ask you a different question about Metformin. And then we'll circle back around. It's one of those drugs that's used a lot by biohackers. Like with the idea of like Metformin fixes everything makes you live on like, is there any studies that tell me that just pop into Metformin is good for my longevity?

Dr. Blevins 42:38
You know, there's a lot of theory here. And Metformin may have some anti inflammatory effect. There are people that feel like it has some effect on reducing dementia. And as an effect on longevity, the data is not in on that one yet. And there's some studies going on. Actually, there's a large study going on to look at that kind of thing, but it's going to take that kind of study clearly can take a while to finish. And they'll hopefully be some stops along the way they will get information but the answer is unclear. Does it lower glucose and sugar? Yeah, it does. And is it good for type two diabetes? For sure. Is it is it a strong met? Not really. It's kind of a weak man, when it comes to lowering glucose. It plays well with virtually every medicine that we have in the type two space. And we do use it off label sometimes in type one.

Scott Benner 43:27
Okay. But GLP is are leaning towards packing some similar ideas with like me right away? What's the one that they want to they were trumpeting like heart disease with GRPs is down and and what else kidney disease. But is that? Is that just the function of keeping weight off and or blood sugars lower? You

Dr. Blevins 43:47
know, it's not really clear. I think that's a lot of it. But you know, that semaglutide which of course would be ozempic will go V rebel says the ozempic component that is looked at people went with type two diabetes and with existing heart disease, and found that there was a reduction in what was called major adverse cardiovascular events, and that would be cardiovascular death, and then also non fatal mi heart attack and non fatal stroke. So is it because of the weight loss? Hard to know? Is it because of the consequences of weight loss? Probably, yes. The lowering of blood pressure or maybe improving lipids, other anti inflammatory or other effects we don't even know about? And maybe so but in people with known heart disease, cardiovascular disease, and type two diabetes ozempic has really good data. And you know, that will go V recently, which is of course, the same thing for the weight loss is semaglutide with GAVI recently was approved to reduce the risk of those major adverse cardiovascular events, and people that have known heart disease and either obesity or overweight. So we know that these meds and other meds are the other meds like Manjaro is at bound, they're being studied in the same way. Trulicity showed improvement, you know, truelist, these Dula glue tie the other GLP. One. liraglutide showed that too, so that that whole area is very good. Usually, though I'll point this out. They're looking at people I've known known known cardiovascular disease, they're not looking at people who have type two diabetes and don't have any known disease. And they certainly have not looked at people with type one. Kidney, yes, there's some good data that shows that these meds and specifically semaglutide might actually have a beneficial effect on the kidneys. Interesting.

Scott Benner 45:47
Let's do one for people who are using now what happens if I go up and down on my dose? Because of the shortage of the medications? Is that gonna hurt me?

Dr. Blevins 45:56
And the answer is, it's gonna be really annoying, and it's gonna hurt your feelings for sure. And I don't know, I don't think it's going to hurt you, you're gonna have to chase the glucose is a little bit when you go down on the dose, or you have if if a person, for example, can get one dose, but they could get the lower dose, the pharmacy has the lower dose, they don't have the dose they're taking? Well, the lower dose is gonna be less effective. The person might have to adjust their glucose, sugar lowering meds a little bit. And, and they may feel differently. And then, you know, in a month or two months, they might get the dose, they were on that as now the higher dose, and they might have to reduce their their meds a bit. Is that going to hurt you? I don't think so. Is it going to annoy the heck out of you? Yes.

Scott Benner 46:42
Yeah. It's almost like somebody's going to reach in and change your Basal rates or something like that without telling you. Right? Right. And even if you're just on it, for I'm seeing people who are just on it for weight loss, they don't have diabetes, and the same things happen. And they call their pharmacy and their pharmacies like, Yeah, we don't have it. And you know, but we have this one, and you go, all right, I mean, some is better than none, if it's lower, but you can't just go from like, for example, you can't just go from five milligrams of zinc bound up to 12. Because that's what they have that'll crush you. Right?

Dr. Blevins 47:14
That can be a problem. And I think some people could probably tolerate that. But we don't know. And the whole idea about going up slowly, is just what you're implying is so that you maintain your tolerability of the medicine, and going up too far too fast, could bring out GI symptoms that you wouldn't have had otherwise. So that Euro it's a funny world right now, where the supply is difficult. I think there's been some improvement recently, you know, we're talking right now, late May 2024. And I think by by later in the year, the supplies gonna be better. I will tell you this, though, I said the same thing last year at the same time, and the supply didn't improve that much demand is so high for these meds, that it's been hard for the companies to keep up with supply.

Scott Benner 47:59
I think there's an indication there, by the way that because the demand is so high and consistently high and grows, that should be some indication that it's working for people, because sure everybody might want to try it. But if you try and it doesn't do anything you're not going to keep you're not going to keep doing it. You know, it's obviously at best, you know, just me guessing out into the world. But I don't imagine there'd be this trouble locating I mean, I've run around looking for this stuff, like a crackhead a couple of times. You know what I mean? Like, right, yeah, yeah. Yeah, hard to find sometimes hard to find and CVS Caremark just announced, they're just not going to carry it anymore through mail order. Because it's so inconsistent their ability to get it. But okay, but that explains the the moving around in in doses, I went, I'm into my second week of 10 milligrams is that bound? And I was I had plateaued on Rigo V, I couldn't I just wasn't losing any more weight on the go V. I got moved to that bound. My doctor, I think, started me at what is it two and a half, maybe with that, I quickly went to five. Yes, I lost six pounds. But after I and then they put me on, I plateaued she put me at seven and a half. And seven and a half just nothin. Like I started to gain those five or six pounds back that I lost with a switch. And now I'm on 10 for two weeks, and I've lost those six pounds again, right? And everything's back to where it was meaning I started to have sugar cravings at the end of when I was on lower dose of set bound. Now that it's higher, the cravings are gone. The weight loss is happening again. It's fascinating to watch, but you really do have to pay attention to do Yeah, I make a diary of it. I do it on the podcast, but I think if I wasn't making the diary, I wouldn't even be able to keep up with what's happening to me. Like I think it's that's my by the way, that's my little bit of help. I think you should make a diary about it if you're on it.

Dr. Blevins 49:55
I think that's a great idea. And I think I'm really glad you said what you did about titrating To increase the dose and then that you had results on the weight loss side, and because sometimes people will start at the lower doses, nothing's happening, this is not working. And, you know, hang in there titrate the dose, you get up to 7.5 of zet bound 10 12.5. Sometimes people attend, don't get results and got to 12.5 and their work. And there's a chance. I mean, they're always people that don't respond to any dose, that's for sure. But usually titrating up is going to allow a person to get some results, and that goes for what GAVI that goes for all of them.

Scott Benner 50:35
But Dr. Blevins, you're sitting here with this grand amount of knowledge and you're articulate about it, you know how to explain it in a way that people can understand. A lot of people don't get that from their physicians, a lot of some of their physicians are making decisions based on what they hear on Access Hollywood, you know what I mean? Like I hear it's making people throw up, you don't always get real thoughtful advice. And even the advice I'm getting is from a, from a very learned, like, level headed person, you know what I mean? And, and I have good communication with her as well. Like if I texted my endo right, now, she texts me back. Well, that's great. Like that kind of like, you know, like, if I said, Hey, I'm doing this and this happen, what do you think I should do? I'm thinking this, I'd get a note back. Yeah, yeah. And not most people don't have that, you know, it is

Dr. Blevins 51:23
important to realize that people who are prescribing, there's that thing in medicine called do no harm, and you don't want to make people sick with your medicine. And so realize that, the audience realize that, you know, you may not tolerate the medicine, and and you're communicating many times back and forth, just got, as you said, by text or by phone, or by, you know, Portal message or whatever. And you can't express exactly what's going on. And, and then the person on the other end is going to read, if the person said, Hey, I can't tolerate this medicine, they can say, Oh, you want to stop it. But there may be some middle middle ground there and actually communicating in person. Yeah. Or, you know, more completely can really make a big difference that

Scott Benner 52:06
knee jerk reactions from happening to Yeah, exactly. Here. Do GLP s reduce inflammation in the body? And has it shown any benefits for other autoimmune issues? Yeah,

Dr. Blevins 52:17
that's a great question. And that's, that's the hotbed of a lot of of research and a lot of discussion, and a number of studies. And the answer is, if you look at the studies that are so far available, you can see some reduction in markers of inflammation. Is that going to translate into some really good treatment for inflammatory conditions? I don't know. I don't think anybody knows. Like, if somebody has rheumatoid arthritis, as a GLP. One help? Who knows? I wouldn't predict Yes, because I don't see how that could happen. But it may be there. There'll be something down the road. That'll tell us more if a person has say osteo arthritis, the bone, bone on bone in their knees, hips. Does losing weight help that? Of course it does. And so, lots to learn here.

Scott Benner 53:08
Is AstraZeneca, developing a GLP that you know if I know

Dr. Blevins 53:12
that Boehringer Ingelheim is developing, and also there's some other companies developing company called structure. I'm not aware that AstraZeneca is and I'll just be the first to say, I don't know everything here. And we do a lot of clinical research here. And there may be things going on, I don't know about but I suspect that question was about boy and girl Ingelheim. The bigger answer here is, you know, there are a number of companies that are developing new GLP, one meds GLP, one gi P meds, and even those are dual agonists. And they're triple. And there's a whole wave of new generation meds coming through. And they're going to have different characteristics and they're going to have favorable characteristics we think. So, you know, hold on, and as you might expect, there's a lot of attention in this area in the pharmaceutical research industry. And there'll be more meds coming down the pike. Let

Scott Benner 54:05
me read you this. And I'll tell you what I think cat GPT four o says AstraZeneca is actively involved in developing a GLP medication. They have recently acquired the rights to a promising oral GLP one agonist called AECC 5004 from a Chinese biotech company called Echo gene. So good now, so great, let everyone he

Dr. Blevins 54:24
says AC is a big company. And many of the big companies have have focused a little bit more on on this area. So that is great news.

Scott Benner 54:35
I'm also excited for biosimilars to start popping up because obviously, these things are working for people, it's hard to turn them out. Some of the molecules work better. And you know, for some things, some for others, I think you can only benefit to have options and a fresh set of eyes. Doesn't always hurt either when people are trying to find something that does the job but isn't copying because that's the real problem right now. So people have patents. So you can't like nobody can knock it off as a generic yet there's, that's not going to happen for a while. And so if you want there to be more innovation, you've got to have all these companies looking at this at the same time. So

Dr. Blevins 55:13
that is so true. Yeah. Yeah, you know, this, this thing about these methods and their effect on what you talked about appetite. And one of the people asked a question asked about appetite. And these, these medicines help regulate appetite, which appetite gets people into trouble. And, like, you have three French fries, and you stop, that's great. Most of the time, you know, over the past, if you were me, a few French fries, oh, man, they all that looks good, I'm gonna have that whole basket. And if some cuts, something good tells me to stop that be really good and very healthy. It'd be interesting to see these meds approved just for appetite reduction, although that's probably going to happen, because I don't think the FDA is going to allow that approval for something they're going to want a disease condition. But appetite is frequently the root cause and these medicines reduce appetite, all of them.

Scott Benner 56:01
I'm waiting for Agra companies to start getting involved in trying to put a stop to them. Because you don't I mean, if I made Oreos, I'd be scared. Seriously? Yeah,

Dr. Blevins 56:11
that's a good point. And no carrying. I don't think Oreos have anything to worry about.

Scott Benner 56:16
I'll tell you what, are

Dr. Blevins 56:17
not the only an Oreo, and I'll eat it. What

Scott Benner 56:20
is is there any concern with long term use? Like I mean, for some people, listen, this is me looking online, right? I've seen some people say I lost the weight, I lost the med because of my insurance. And guess what, I'm fine. I didn't get any back. I learned how to eat better. Everything's going well, I'm active, etc. I've seen people say I've lost the med because of insurance. And I didn't change a thing about what I was doing, I put all the weight back on. So some people are going to have to take it forever. Is there a concern a safety concern with that, that you can think of

Dr. Blevins 56:50
Forever is a long time. And we have a lot of data with these meds. And we don't have like 20 year data yet. Trulicity ozempic have been, we talked about this earlier been a long time. And so far, no new signals have shown up like some weird findings. And so they look safe for long term. In general, I would say that for person to maintain the effect of the Med, most of the data says the person has to continue the Med, they might be able to reduce the frequency of administration and the dose to maintain. But they're going to need to continue the Med, they're going to be exceptions to that rule. They're going to be people who can stop and maintain. That is great. And they're going to people, the only people who take it on and on and on and they regain. But in general, if you continue to Matthew, if the effect continues. So we're looking at everybody's looking at the scientific community to look and see if there's anything long term that turned out to be a negative, but so far, so good. So it's not like the duration of time people are on it to the number of people. And they're really millions and millions and millions of people who've been on these meds now and no clear new signals have shown

Scott Benner 58:04
up. Yeah. Do you have a little more time? Are we done?

Dr. Blevins 58:07
Yeah, we can go? How about we could aim for another 10 or so

Scott Benner 58:11
minutes? Okay. I like to know if GLP is used in patients with thyroid concerns, Hashimoto specifically and or hyper cholesterol OMYA. Is that what that is? hypercholesterolemia?

Dr. Blevins 58:23
III, I think is what they're saying.

Scott Benner 58:26
What are their concerns with that?

Dr. Blevins 58:28
The answer is, there's no sign that GLP one meds or GLP. One GRP meds can make Hashimoto as improve, or worse, there's really no evidence there. And there, there is no evidence that these meds would make cholesterol worse. In fact, if you look at most of the data, you would see that the cholesterol levels improve. I could go through each fraction, I'll just say they improve when people are on these meds probably because of the effect on weight loss. There's no sign that there's a direct effect of these meds on cholesterol synthesis or absorption or any of that. But weight loss is magic. When it comes to improving cholesterol.

Scott Benner 59:11
I'm going to ask one for myself. And this is about you specifically, in your practice. You deal with a lot of adults. Yes. If I was your patient, and I came in, I said, Hey, you know, here's where I'm at so far. And you've watched me for the last 13 months. And I said I want to continue to make my my body stronger and give myself the best chance to live longer if I said I don't know anything about this Dr. Blevins but should I be on some sort of a testosterone replacement? Is that a conversation you would have with me or do you not see the value?

Dr. Blevins 59:40
I would definitely have the conversation with you about that. And what I would wind up what do I do? It was I would first of all ask you about any symptoms related to low testosterone. And then I would check your levels. And then if you're low I would I would say you know your About your muscles, your mood, many things in your body will do better if you're normal. Would I put you on testosterone? If I find you to be normal? And the answer is I wouldn't. There's no evidence that putting people on testosterone who have normal levels is going to prolong life or improve things. And, and so it's another one of those benefit risk things. If the benefit, if you're low, the benefit, I think exceeds the risk, there is some risk potentially. So testosterone is not a cure all for everything. And if the levels normal, there's really no evidence that it could could help. And, you know, testosterone given to people who buy either gel injection, pellet, whatever, can have some negative kind of has some side effects and negatives. And like, they can increase the blood count, which could increase the thickness of your blood or viscosity, which could lead to stroke, things like that it gets overstimulate the prostate. That's another possibility. And I've had some people who are given testosterone who get very agitated, and that's not very often but it happens. And then we just we back off, or we stop it,

Scott Benner 1:01:10
you handled it exactly the way my doctor did. So I was just, I'm just, I was just interested in your response. Yeah. And my levels were didn't need addition. But I was in that mindset, I was like, how do I make sure that I'm stronger and fitter and have the best chance of staying alive as long as I can? Okay, so I'm gonna go to what I think is going to be a little bit of a long answer. So we'll finish with this one. Okay. This person says, I want to know the doctor's thoughts on micro dosing. GLP is specifically for people with autoimmune disease. And for people who do not need it to lose weight. My thoughts are that maybe a pharmaceutical version of these peptides, those far too high and too fast for type ones. Maybe micro dosing will negate many of the side effects, and maybe you'll get some of the inflammation, increased insulin sensitivity, and the other benefits that come along with it. I'm super interested in this because I just did an interview last week with CEOs from xirrus and beta bionics because they're working on a dual hormone pump. And I mean, honestly, what are we talking about there? We're talking about micro dosing glucagon in an insulin pump. So Exactly, yeah. So what do you think here about the idea of this possibility with GLP? Yes.

Dr. Blevins 1:02:19
You know, the micro dosing ideas are really interesting idea. And I will I'll be the algo right out and say, I'm not sure exactly what that dose is. But well, I know that means less than normal. And I would think it might be the same frequency or more frequent lower dose? Who knows, but micro dosing less than normal dosing, specifically for autoimmune diseases? And I'll say very quickly, no data? Would I do that before an autoimmune disease? Depends on which one you're talking about? Of course, some are more serious than others the answers for all of them, I guess, so is that independence? The answer is no, I wouldn't do that. I don't know, I don't have data for that. And what I use it for people who don't need to lose weight, well, that would be people who have diabetes, as to who don't need to lose weight, and some people's because it does have an effect on glucose metabolism. So I would use, the concept of micro dosing is interesting data is not available, it's all going to be personal use, and we'll really need I mean, you know, I'm a scientist, we need a study to tell us what to do anecdote is, is going to get people in trouble. And the thought the pharmaceutical dose could be dosed far too high, maybe for certain things, but not for what we're looking at that dose about right for blood sugar, and the weight loss and that, and then maybe people would have fewer side effects of micro dosing, that's true, they also may have no effect. So we really have to have a clear cut target, like, use it in someone who has a particular type of autoimmune, a group of people who have a certain kind of autoimmune condition, and have a placebo control, and use a lower dose and find out. I don't think those studies are being done, but you whoever wants to can suggest that to their people they know in the pharmaceutical industry? And would that increase some of the benefits like inflammation and sensitivity and things like that? I don't know, maybe, I think the current doses are pretty well worked out. These doses are taken from the bench to clinic, and all kinds of doses are looked at, you want a dose that actually has an effect, and it need to have a target like blood sugar or weight loss or something like that. And then you want to be sure that dose actually works. So I think the I think the current doses are effective. The concept of exploring other areas a great idea, and there are studies being done looking at like arthritis, like osteoarthritis, looking at sleep apnea. There's been some positive there already. That's about weight loss, I think. Yeah, and other other conditions, that maybe even some cognitive conditions like my Alzheimer's Could, could these meds help people, people looking at all kinds of things but until we have a good study, I don't think I would jump in and start using it that way. Yeah.

Scott Benner 1:05:03
Do you think you've seen anything? Even just, you know, N of one kind of like returns? Where people have experienced less gambling habits like other addictive natures that you've heard that talked about, but do you actually say it? I

Dr. Blevins 1:05:18
have not had a person come back and tell me that they took it and they were not going to Las Vegas as often, though, I've read about that. And I think it's fascinating cravings. Appetite is a type of craving, gambling as a type of craving alcohol, and alcoholism. I know for a fact some studies are going on looking at that. Do I know results? No. But I've had a few people come back and tell me they were less interested in drinking alcohol about drinks. And there may be something there? If so I sure hope there is. But I want to see a good study, come back and tell me that that actually was true. Yeah. And it may just be it's not, it's not a consistent thing. I've asked some people, do you drink any less? And they say no. So we need something to tell us more about that.

Scott Benner 1:06:05
I've noticed this thing. I'll end with this and ask you if you've seen it, too. I think it's possible that as a society, we've become so used to people's body mass being a larger, that now I'm seeing people use these medications, get down to what looks like a very nice healthy weight. And yet the people around them are shocked and say like, Oh, my God, you're too thin put weight back on, like, bah, bah, bah. And you if you really look at them, like from a reasonable perspective, they're not too thin, they're not to anything, they just look like a healthy human being. It almost feels like that's not what people are accustomed to looking at maybe with you personally or with people in general. But I was wondering if you've seen those kind of more psychological reactions? Absolutely.

Dr. Blevins 1:06:48
That that's true. Change is something that people notice and comment on. And in historically, when people have lost weight, it's because they're sick, and cancer or something like that. And I've certainly had people comment in that direction, or have people tell me, they've, they've been told they look sick, they need to eat? Yeah, their family, their friends, I'd say here, you need to pat yourself, get some get, you know, eat and gain some weight back. Even though what you said is correct. Their weight is now more normal than ever. I would tell people in the audience expect that and understand it, and take it as a compliment. And let people know what you're doing. And if you want to

Scott Benner 1:07:34
don't let it thwart you, I've seen people, it happened to somebody around me recently, they were so pressured by the oh my god, you're losing too much weight, pressure that they started thinking about not doing the medication, I said, Look, between you and me, I need to lose 15 pounds. And maybe more, I don't know, like, I have to tell you like my ability to understand how much weight I needed to lose is completely skewed. Because I started this thing thinking 20 pounds, I'll be great. When I got that 20 pounds. I was like, I don't even look any different. And now, if I said to somebody, somebody says, Hey, you look great. I'm like, thanks, I still have 1520 pounds loose. They go, that's not possible. And I'm like, Well, I can take my shirt off and share it with you if you want. But like I definitely still need to. Yeah, I just don't want people to get thrown off by knee jerk reactions to their visual appearance.

Dr. Blevins 1:08:21
You know what I mean? I agree. Yeah. Yeah, the nice thing about it is people are concerned. And they notice and, and there is a compliment. You know, it's it's people who are concerned, they think, Oh, is there something going on? I care? I want to know, or they may be they just playing nosy, I don't know. But then you could reassure them and say, you know, and now now everybody knows about these methods, almost everybody. And you could divulge or you don't have to you don't want to maybe tell people what you're doing. You could say now that I don't have cancer. I don't have some bad disease. I'm working on weight loss, and, and, or something like that. But yeah, it's a common phenomena. And everybody should just expect it. And it's actually a real big positive, but it comes off as Oh, you look, you've lost too much weight. And of course, the answer is no, you haven't.

Scott Benner 1:09:07
Yeah. And by the way, I don't actually care about the number of my weight. I care about the fat My body's holding. That's yeah, my concern is so exact whatever I end up looking like after I'm carrying a healthy amount of fat on me, is what I'm going to look like. Right. All right. Well, Dr. Bill Evans again, this is terrific. I feel like I could just have a podcast where I chat with you about anything and it would be good. So thank you. I appreciate your time again.

Dr. Blevins 1:09:32
Scott, thank you very much. It's fun. Yeah, I've enjoyed it.

Scott Benner 1:09:35
Great. And we're gonna head back again. Is that right? Yes. Oh, excellent. Great. Great. I'm super excited. Hold on one second.

Jalen is an incredible example of what's so many experience living with diabetes. You show up for yourself and others every day, never letting diabetes define 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 or to share your own story visit Medtronic diabetes.com/juicebox And look out online for the hashtag Medtronic champion. Having an easy to use an accurate blood glucose meter is just one click away. Contour next one.com/juicebox That's right Today's episode is sponsored by the contour next gen blood glucose meter. We're starting to get a nice grouping of GLP focused episodes. There's a full list of them in the featured tab in the private Facebook group. 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. Wrong way recording.com

#1237 Limited Access

Radwa is an ophthalmologist whose son and husband have type 1.

+ Click for EPISODE TRANSCRIPT

Scott Benner 0:00
Hello friends and welcome to episode 1237 of the Juicebox Podcast.

rodeway is an ophthalmologist from Egypt who son has type one diabetes her husband, a surgeon also has type one. Today we're going to talk about access to technology costs around type one diabetes, and much more. 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. Are you a US resident who has type one diabetes or is the caregiver of someone with type one if you are please go to T one D exchange.org/juice. Box and complete their survey. Doing that helps in so many ways. It's hard to list them all here right now. takes you about 10 minutes. T one D exchange.org/juice box you will be helping people with type one. Probably be helping yourself, and you'll definitely be helping the podcast. Thank you so much for listening. I hope you guys do that. Let's get to run one. This episode of The Juicebox Podcast is sponsored by the only implantable sensor rated for long term wear up to six months. The ever since CGM ever since cgm.com/juicebox. Today's episode is also brought to you by touched by type one and they have a huge in person event coming up soon that is completely free for you to attend. Check out touched by type one.org For more information and get your absolutely free tickets to the event that's happening very soon in Orlando, Florida that I'll be at and so will Jenny

Radwa 2:10
I'm Rodwell. Okay from Egypt. This is how I would like everyone to know me. I've been following your podcasts for about a couple of years. I'm an ophthalmologist practicing one and I teach in Korea University. My husband is an orthopedic surgeon and a type one diabetic for around like for my son's elderly sons ages from 15 years. And I have a five year old type one diabetic has been diabetic for almost four years now. And definitely my look at although I'm a healthcare professional, I'm an ophthalmologist. So I'm really oriented with diabetes and its complications. But I've looked at diabetes differently since my son's diagnosis. Like it's been an eye opener for me about what we're missing here in our country, the things that we need to have, but we're not having the proper management of diabetes, you know,

Scott Benner 2:56
let me ask you a couple of questions and we'll and we'll dig into all of it. Okay. Okay, go ahead. So you and your husband have been together for how long?

Radwa 3:03
We've been like together for almost 20 years, like five years before we got married, or four years before we got married. And then we've been married for like 16 years. Okay.

Scott Benner 3:14
And did he have type one when you met him? Or did he develop it after you were married?

Radwa 3:18
No, after we were married while I was pregnant with my first son. I don't know why it was a shocker for him because they have a strong history of diabetes in their family like his mom had this. She's a type one diabetic when she was like 27. This is what we call the maturity onset diabetes of the young moody. And then he had his both siblings are diabetic, like his younger brother had had him since he was two and his sister since she was 10. But he was like, the only one in the family who didn't have diabetes. I think he thought he passed that, you know, you got away with it. Yeah, but he was like, seemed like his mom, you know, like he had the exact same gene.

Scott Benner 3:57
Yeah, in the mid in his mid 20s. He

Radwa 3:59
got it. Yeah, okay. Yeah, he was 26. Okay. All right.

Scott Benner 4:03
And I want to ask you, when he's diagnosed, and you're, you're pregnant at that time. Yeah. And then you look at the rest of his family, do you think, Oh, my kids are gonna get diabetes?

Radwa 4:17
Not really. No, actually, I, we always have that in the back of our minds, even before his diagnosis, you know, like, it's in their family. So they definitely might pass it on. And we always had in mind, like, you know, my elder kids, they don't have diabetes. I have a 15 year old and a 12 year old girl and a 15 year old boy. But whenever, like, for example, they had an accident during sleep, or we think they're drinking too much water, or the pee a lot. We immediately like, check them at home. So it was always in the back of our minds, you know?

Scott Benner 4:50
Yeah. Have you ever had them checked for antibodies? No. And I

Radwa 4:54
don't know why, but I don't want to do that. I'm like, if it happens, it happens. You know, like, well We have to have a healthy lifestyle in general, we don't overdose on sugar as much as we as much as possible. But I don't want to go and check them for antibodies and just make them live with it in the back of their mind. Like, you have the antibody. So we're gonna get diabetes at some point, you know,

Scott Benner 5:14
I hear so. Okay, so he he's diagnosed, what's his care like? And are you involved in it at all?

Radwa 5:22
No, I wasn't really that involved. You know, he's a doctor. His mom is an endocrinologist actually, but an auditor in the criminologist. I don't know why I didn't give it much thought back then. Like he's an adult. He knows what he's doing. His hemoglobin agencies were around six and a half to seven and a half. So yeah, he's doing okay. And his mom is like, all over him. So I thought that was enough. But you know, after my son's diagnosis, no, it wasn't enough. And I'm all over him now.

Scott Benner 5:48
His mother was on him about it. How was her management and her kids even the

Radwa 5:55
went MDI, okay with, he used Lantus and overwrap it and it worked fine for him. And he didn't have a sensor, continuous glucose monitor that didn't have one. He's like, he blood checks his blood sugar like five, six times a day. He can feel the hypose. And he can feel when it's high, but he just checks it five, six times a day. And to be fair, we don't have CGM in Egypt. We just had the FreeStyle Libre two years ago, and only the first generation

Scott Benner 6:24
Oh, really? Just two years ago, just two years ago, you got three generations old leave rice. Yeah,

Radwa 6:29
I know. And we still up till now we only have the first generation. It's not even available all the time. Like anyone. I mean, when I started to get him the labor, when I heard about it, I got it from from another country. You know, like, I have a friend. I'm like, can you bring me this with you when you're coming? And he brought him like two, three. And they were like, eye openers for us? Yeah.

Scott Benner 6:48
So did he learn that those five checks a day are not telling the whole story? Yeah,

Radwa 6:53
he knows. He actually knows. But you know, he's a busy surgeon. He doesn't give it much thought. If I would say that. He just likes to eat healthy. He goes to the gym. He checks his blood sugar, five, six times a day. And he thought it was like it's okay. But definitely when he had the liver, he had much, much better control for her blood sugar for his blood sugar.

Scott Benner 7:16
Yeah, just just wearing a few of them helped him. Okay, but you know,

Radwa 7:20
at that point we never heard like he never thought about he thought having a pump would be a bit handicapping to have it stuck on him most of the day, because also in Egypt, we only have Medtronic and like the older virgins. Okay. Yeah.

Scott Benner 7:32
So there is an access issue for everything. Yeah.

Radwa 7:37
access issue. I tell you, we I flipped over backwards to get my son to Omnipod. You know, you're not going

Scott Benner 7:44
to be the first person I've spoken to, from, oh, wait a minute. I was gonna say from Egypt, but maybe that person was from Saudi Arabia, who told me this story about like, they actually get on a plane and fly here and buy it then fly back again. Oh,

Radwa 7:57
yeah. It's basically like, I didn't even have a prescription for my young. Yeah, my, my husband still MDI till now is like, because you know, we have to pay everything out of pocket, we bring the Dexcom from London, okay, because we have him registered there. And we have several friends who live there. So I just buy it online, send it to their home, and then they I buy like six months altogether. And then whenever they're back on vacation, they bring us the stock. So the Dexcom is easy. The problem is with Omnipod because usually you need a prescription for it anywhere. Okay. There are some few like websites in the states that outsource them. So we found the trusted website, and this is what we've been using for a while. I also order online and sent to my friends and I have several friends who live in the States. But recently, we were on the dash, okay, the low on the stock of that she doesn't have any dash. That was a big problem for us. Until eventually I found that Omnipod have a couple of months ago in Turkey in Istanbul, they have a company that is called Med salads, I think that outsources the Omnipod from the company itself, and they can work with an Egyptian prescription. So this is what we're doing right now. I fly to Istanbul to bring the stock can come back how

Scott Benner 9:12
far of a flight is that? No, it's just a couple of hours. Yes, a couple of hours. You know, you're gonna be extra mad when your kids older and doesn't appreciate anything you did for them.

Radwa 9:23
It's okay, like I take it as a chance to go and have a like a three day vacation.

Scott Benner 9:30
And come back. I have to go get your palm some buy.

Radwa 9:34
Get away from this for a couple of days. But yeah, you do have to bend over backwards. Bring his stuff. Yeah.

Scott Benner 9:39
Tell me why doing that was so important for your child. I hear what you're saying about your husband. Well, I guess maybe the question is, could you afford to do it for both of them if you if he if your husband was interested? This episode of The Juicebox Podcast is sponsored by the only six month where implantable CGM on the market. and it's very unique. So you go into an office, it's I've actually seen an insertion done online like a live one like, well, they recorded the entire videos less than eight minutes long and they're talking most of the time, the insertion took no time at all right? So you go into the office, they insert the sensor, now it's in there and working for six months, you go back six months later, they pop out that one, put it in another one, so two office visits a year to get really accurate and consistent CGM data that's neither here nor there for what I'm trying to say. So this thing's under your skin, right? And you then wear a transmitter over top of it, transmitters got this nice, gentle silicone adhesive that you change daily, so very little chance of having skin irritations. That's a plus. So you put the transmitter on it talks to your phone app tells you your blood sugar, your your alerts, your alarms, etc. But if you want to be discreet, for some reason, you take the transmitter off, just slip comes right off. No, like, you know, not like peeling at or having to rub off at he's just kind of pops right off the silicone stuff really cool. You'll say it. And now you're ready for your big day. Whatever that day is, it could be a prom, or a wedding or just a moment when you don't want something hanging on your arm. The ever sent CGM allows you to do that without wasting a sensor because you just take the transmitter off. And then when you're ready to use it again, you pop it back on, maybe you just want to take a shower without rocking a sensor with a bar of soap. Just remove the transmitter and put it back on when you're ready. Ever since cgm.com/juicebox, you really should check it out.

Radwa 11:37
No, no, he's interested. No. But, uh, yeah, I think it will be like, it will be very tight. And we don't want to go there. Because you know, we buy everything in dollars. And to give you some perspective, we're having a major economic crisis in Egypt nowadays for the past couple of years. And like $1 was around 15 Egyptian pounds. Now it's at 50. I understand. Well, yeah. And it's just and it might get worse, like, there's no stability there in the horizon. Up till now. So we don't want to like get stuck with being having both of them on Omnipod. And then we have to remove him from it. If we go into like a final financial, you can't afford it, you know, so he doesn't want to start there. And he doesn't want to go there. So

Scott Benner 12:24
make sure I understand correctly. If something cost $600. American, that's 600 times 50. For you for 30,000 Egyptian pounds, my currency. Yeah, and your currency. And I'm sorry, this is a weird thing to ask. You can say I don't want to tell you. But I mean, you're a doctor. He's a doctor. How much do you make a year in dollars? Do it? Do it? Do it in pounds? I guess you're not you an average?

Radwa 12:52
Yeah, I can't tell you by year I can give you by month and average. In Egypt. Also, you need to know that the medical field, like most of it is a private. Yeah. Like your work is a private sector. I mean, it's not like in the States, you don't work for a hospital and you have a paycheck every month. No, you work in several hospitals. And it's all depends on your flow. So it's really variable between a month and the other. You know, okay.

Scott Benner 13:16
So yeah, just give me an average month for a doctor. For

Radwa 13:21
a doctor. No, it varies a lot. Like, I could be like, I'm not I'm not working. I stopped doing any surgeries since the diagnosis because we can't You can't have both of us, like scrubbed in, and then the school tries to reach out and nobody answers, you know, so since my son's diagnosis, I've decided I'm not going to scrub in anymore. I'm working only as a clinician, like medical retina and ocular inflammatory diseases. Like I can make like around only this is so embarrassing. The number in dollars is like really embarrassing, but like $1,500 for example, a month, a month. Yeah.

Scott Benner 13:59
Oh my gosh, and that even but my

Radwa 14:02
husband is definitely like, it really varies like it depends on how many surgeries you have this month, but he can be like 10 times that or five times that you know, at that

Scott Benner 14:11
1500 number that 75,000 Egyptian pounds. And, and then the pumps alone and the decks coms could I mean, you could work all month to buy supplies for him.

Radwa 14:23
Yeah, my my husband asked the covers that it's funny. Yeah, we can afford it. Like it exactly costs us around. $3,000 a year. Okay. Are you at $3,000? A year for for the Omnipod? Right. Okay. And $3,000 for the Dexcom okay. Yeah, this is this is what it costs a year for us. Wow, an average. So

Scott Benner 14:45
at the current Jesus, is that right at the current exchange rate? It's 6000 times 50. Yeah, don't go there. No, I'm going to this is kind of fun. Oh my god. Okay,

Radwa 14:56
you can do it like, actually, we have also it's very cool. complicated. It's like in the bank, it's times 30. But in the black market, it's times 50. Because the bank doesn't give you dollars because they have a defect in it. It's very complicated. Like the difference between the banks and the black market is almost 20 pounds. Yeah. All

Scott Benner 15:14
I heard was that you're a doctor, and you made $1,500 in a month. And I think, I

Radwa 15:20
think you need to edit that.

Scott Benner 15:22
I think, Listen, I'm not kidding you. I can't talk my friends listen to them. Well, they know, they listen, they know you can be doing the other work and making more money. But you're doing this thing for your kid, which is lovely. But I'm just saying that people here should like here in America, and they should have some perspective is what I'm saying. You don't I mean?

Radwa 15:42
Yeah, but on the other hand, like definitely, the cost of living here is cheaper. You know? Like, I mean, if you come from America, and you have like, $2,000 on you, you could like, live well,

Scott Benner 15:54
wait, wait for how long? How long? Can I make it on two grand? It depends

Radwa 15:57
on where you go out and what you eat. And it's very complicated. First of all, yeah,

Scott Benner 16:02
my my way. I mean,

Radwa 16:06
you don't have to live you. But I mean, if you come here on vacation, it will be a really cheap vacation for you.

Scott Benner 16:10
Really? Yeah, I'll be I'll finally be able to live like, I'm Rich for a couple of minutes here saying, Yeah, man.

Radwa 16:17
But, but overall, you know, I mean, the cost of living in Egypt is definitely cheaper. We don't we all owe most of the people in Egypt, we own our homes. We don't have mortgage. Okay, or rent? Most of us, what's the home cost? Sorry,

Scott Benner 16:32
what's a home cost?

Radwa 16:34
You know, it's like, went like 10 Times up in the past three years. So also don't go there. Like, right now. You can't afford to own point. But yeah, it's very variable. It depends on how big the home is. And the area. We I understand

Scott Benner 16:49
there's a lot of all about economics. There's a lot of I'm super interested in this. So there's a lot of variables, but what do you think an average person lives in a home that cost them what? Like,

Radwa 16:59
you might have bought the home for only like, I don't know, you do the math for like, you bought it for 1 million, for example. But right now, it's worth six, you know, Oh, okay.

Scott Benner 17:09
And 1 million. 1 million British pounds. Egyptian. Excuse me. Yeah. And so that would be divided by 50. For 20 grand?

Radwa 17:21
Yeah. But you would have bought it for more than 20 grand because $1 was actually seven when you bought the home.

Scott Benner 17:30
But then that's 100 it's very complicated. Don't go there. But then that's $140,000. Basically, I'm telling you right now, you can't buy a box with a broken window here for under $300,000. Exactly. I know. I know that in New Jersey, where I live, like I'm sure it's different in other places. Don't get me wrong, but so I can bring $2,000 I'm just planning for myself. I could bring $2,000 to Egypt and have 50 times that I could have 100,000 Egyptian pounds, I would feel do I carry it in paper in my pockets like Scrooge McDuck or how do I do it? Does that a reference? You know?

Radwa 18:05
I think we could we should start this podcast. No, I'm having such

Scott Benner 18:09
a good time. So we'll get past that. But it's okay. No, love. Okay, go ahead. I just wanted to paint the picture, because somebody who's not a physician is not flying to Istanbul to get on the pots. Right. So most people there are living with MDI. And if they're lucky, a libre one, but probably not. Is that pretty accurate?

Radwa 18:31
Yes. Okay. Yes. If you're talking about the myth, the average human in Niger, in my country, you don't have we don't have insurance. Or actually we like we pay medical care and schools out of pocket. Most of the people that have money, people who don't have money, go to public schools, but they're not really getting like that good education. And they're the insurance would only cover the MDI, not even deep

Scott Benner 18:56
enough to keep you alive. And then what about the care? What are people because if doctors are cash pay, then most people are probably just going getting their insulin and their needles and then they're going off and there

Radwa 19:09
are people who are come like multinational companies are in good companies and they have insurance. We as doctors, we don't have insurance. We have the Syndicate, but the just the cover very little of whatever costs you go through. A lot of people they have insurance companies covering for them, but I think most of them will only cover MDI, okay, we didn't cover a pump or only if you have like a really, really good insurance, they would cover a pump.

Scott Benner 19:34
Is the insulin expensive there are no no it's very cheap, very cheap, okay?

Radwa 19:38
Like, come and buy like Could your stock of insulin and fly with it and you will believe how much it costs. Well,

Scott Benner 19:45
wait a minute, maybe now I'm coming. I come with my 2000 I get 100,000 Egyptian pounds. I spend 500 Egyptian pounds on insulin. I come back here and I'm kept enriched with the insulin I sell it on the black market over here. This is what you're telling me I should do?

Radwa 20:00
You might do that I can't I do that a pen of novel is around was 100. Now it's 160 Egyptian pounds. So you do the math. It's like $3. Right? Damn,

Scott Benner 20:10
that's something else. Okay, now you piss people off now that now they don't feel bad for you anymore. Nevermind.

Radwa 20:17
It's very different to your like the story of my son's diagnosis. I think this would be one that will tell me. That's not a common story. But it was a COVID times he was diagnosed on the seventh of April 2020. And, like I told you, we always had the diagnosis of diabetes in the back of our minds. We had just like, we had the lockdown on 17th, the weight of on 17th of March here in Egypt. And he had a party at his nursery the day before. I think he called the hand foot and mouth disease. Yeah. So we the first week of the lockup, he like had a fever and the vesicles in his mouth, and he lost weight. And it was okay. And it passed. And then the week after he was just so agitated, most of the time, he lost weight, but I'm like, yeah, he wasn't eating for a week. We're locked down. It's a different situation for him. And he's only a year and a half. He can't express himself. So maybe that's why he's not himself. But then what caught our attention was like, his diapers were filling really fast. I was sitting with my husband, I'm like, I can change his diapers like, enough, like, every three hours, and I think he's just full like a balloon. And he's like, Okay, why don't we doing him a test? You know, like we did with his siblings. Like when everybody had an accident, just come in, do a blood sugar, and usually comes out fine. And we're good. So we did that. And oh, my God, his blood sugar was 400. So I'm like, No, something's wrong. Let's like wash his hands and do that again. And it's like, 450 We tried his toes. It's still high. So when you like, yeah, he has diabetes.

Scott Benner 21:54
How did that strike your husband? Do you recall?

Radwa 21:56
It strike him really bad? Like, yeah, I thought it would strike me worse. But no, yeah. I mean, he was he didn't like fall apart. He was very helpful. He was there with me and every step, but no, it hit him really bad. Like he we had a bout a long bout of depression

Scott Benner 22:12
after it. Do you think he feels like it's his fault? No, no, it's not that he's

Radwa 22:17
just look, I'm a very religious and faithful person. And he is to like, he believes in God and everything. But he just like, why did this happen? You know, I have like, in my back of my mind, like, everything happens for a reason, and you just have to live with it. And God will be with us. You know, he's like, no, why did this happen to my son? You know, like, he's too young. He shouldn't this shouldn't be happening to him. You know, this. He was struggling with that, more or less,

Scott Benner 22:44
but he didn't feel that way for himself. What had happened? No, no, no. For him. It was good. God has a plan. I'm okay. That kind of stuff would have happened to his son. He was out. Yeah, yeah.

Radwa 22:55
Yeah, I understand. So what we did was like, okay, his blood sugar is high. So he has diabetes. Should we go to a hospital? What should we do? And then I called my dad and I'm like, No, I called my friends. Do you know a good endocrinologist? I have a friend whose son is a type one diabetic. I asked her who's his following with? Long story short, somebody sent me this pediatric endocrinologist number that they think she's really good. I called her over the phone. And she's like, No, you don't need to go to the hospital. I think you can manage him at home. Check his acetone, he did not have acetone at the time. So she's like, I think you're really early in the diagnosis. So you can do this at home. And I kept texting and talking to this endocrinologist over the phone and on WhatsApp for like, two weeks, she was like living with us. But she didn't see him like the first time she saw him was like six, seven months after his diagnosis, when, like everywhere, it's opened up and I took her took him just for a regular check. She told me all the labs that he needs to do and we had like the lab come over at home and we did everything. But you know, we did not have this dramatic experience of going to the hospital and being admitted with we just did everything at home. She's like, go on by the receiver and the Nova rapid give him blah, blah, blah, do him like a diabetes diary, what he eats, how many carbs and so on. And she started to tell me what a carb insulin ratio is and how I should like try to calculate it. And we did all this at home. Like definitely, us being locked down at that point was very helpful. Yeah. Yeah. I imagine you had nothing else to do. You know.

Scott Benner 24:32
We'll just focus on this since we're just bored out of our minds. Does the insulin need a prescription? Like she said, just go get insulin? Was it that easy? No,

Radwa 24:41
we don't we don't like most of the drugs in Egypt. You don't really need the prescription for them. Okay.

Scott Benner 24:45
I could just roll in there and be like, hey, I want to try this. I want to try this. ozempic make me thin Give it to me. Is that easy?

Radwa 24:52
Yeah. XInput because we're low on stock. You might get the prescription but it's not because you have to have a prescription for it. It's because they're low on stock, so they don't want people abusing it. I

Scott Benner 25:03
am coming to Egypt to be skinny and rich. This zyk you

Radwa 25:07
think that but that's not

Scott Benner 25:10
how it works? Works. I'm making it work that way. That's what I want. Well, yeah, yeah,

Radwa 25:15
you can get Yeah, like, there's this other drug. I can't remember its name right now. That's like those Olympic but came out before

Scott Benner 25:22
it Manjaro No, no trulicity

Radwa 25:27
trulicity Yes. And there's this other one that's cheaper I can remember. Gosh, this one is available, and you can just go and buy it.

Scott Benner 25:34
Okay. All right, I'm coming. I'm on my way. Like, seriously? I mean, what the heck, why you live in? So what's the downside of Egypt? That I don't know what like, what's gonna happen when I get there? I'll be like, Oh, this wasn't worth it or No,

Radwa 25:48
lovely place. Like, if you come on vacation or like, come to live here?

Scott Benner 25:52
I don't know, whatever. What do you think there are definitely a

Radwa 25:55
lot of downsides. Like, I'm telling you, I'm a doctor, and I make $1,500 I'm

Scott Benner 26:00
gonna have to bring all my money outside to bring all my money.

Radwa 26:04
But there's, there's other downsides. A lot of other jobs like, definitely. cooling system, for example, you have to go take your kids to a private school to get a good education. So you have to pay for it. And like, for example, in your in the States, when we went there, if you want to go to a good school, a good public school, you have to live in the area where the allow you to go to the school, and usually this area, the rents are higher, the houses are more expensive, you know. So like, instead, you have to pay for the school here in Egypt, you can go to any school you want, but you have to pay for it. I see. Because the public schooling system is not very, I don't want to go there. Let's focus on type one diabetes.

Scott Benner 26:51
I gotcha. All right, I have to ask, are you expecting your children to be doctors?

Radwa 26:56
No, I don't want them to be How come? I come from a family of doctors, like my both my parents are doctors and my husband, my husband's too. But recently, even in the states, like I mean, everywhere in the world has become very challenging to become a doctor. I mean, you were the working hours, the expectations. I don't know if you're feeling this around. But lately, doctors are not given the respect that they should be having, like the day before, like 20 years ago. No, I don't know if you feel that in your country. But there is a lot of problems with the health care system everywhere. Like in Britain, they're struggling with it in the States, the doctor, our friends, they're struggling like everybody is. So I think to be a doctor, you have to really want it to love it. It's like I don't tell them you, you can't be a doctor. I tell them it's your choice. But they have to really, really want it and ask for it to be able to do the work because it takes a lot of work to be a doctor.

Scott Benner 27:51
What other like professions, like when you think of your kids do you hope for like because here I think kids now I think there's this study that says that young people in America, if you ask them what they want to do for a living, they say they want to be a social media influencer.

Radwa 28:06
Most of them. Yes, like, my son at some point. He's like, Okay, I want to be a YouTuber. I'm like, No, this is not a job. This is something that you can do on the side.

Scott Benner 28:16
I said to my son, at one point, I'm like, if we're all influencing everybody who's making money, I hate somebody, somebody needs to do something.

Radwa 28:23
Yeah, it's something that's going wrong with the world that since the social media opened up that big, and it's definitely frustrating for the kids to watch. Like, okay, my, my dad is a doctor, but this football player, or this influenza, they make, like, they live a more luxurious life, and they make 10 times more money, you know, so it's, it's not very intriguing for them to become a doctor anymore. Like my dad works 18 hours a day. And he's always scrubbed in, and he's not available. And now I can be a YouTuber from the comfort of my home and make more money. You know, eventually that won't work out. Yeah, I think this is what gets into them. But no, I think there's a lot of professions like I'd love for my son to, for example, become an architect. Okay. I think they do. Like he's an artist. He's an art. Yeah, he likes to draw. And I think it's nice that, you know, like designing homes and designing buildings. And I think that's an interesting profession. But whatever I'm not, I'm not giving it much thought right now. Like, I just want him to get good grades. And then we can see what do we do?

Scott Benner 29:27
Well, I just realized I'm never coming because the flight is like 14 hours. So I'm not doing that.

Radwa 29:35
Several times, like, we just I'm jet lagged right now when I'm talking to you because we've just came back from our like, we had a Christmas vacation. Dozens in New York and the flight is not bad. Maybe the jetlag is

Scott Benner 29:49
the problem. I'll definitely throw a clot and drop that on that flight.

Radwa 29:53
And you don't have to take like, you can do transit flights, like if you go through Europe make so you'll have a Seven, eight hour flight and then another one that's like three, four hours and you're here.

Scott Benner 30:04
Okay. All right. I don't know. Practically close. This feels like when people asked me to come to Australia, who seems very far away, I'm not doing that. Like if I could fall asleep in a pod and wake up in Australia, that might be different, but I don't know. put me to sleep. I want to understand when your son's diagnosed. And how do you get from where you described with your MDI and learning at home to I need to find a CG like, where do you even learn about those things? First of all,

Radwa 30:34
first of all, ask for the CGM. We have a friend who was on the Dexcom. So I was like, Yeah, you need to have that for your son. And we had a friend who's in London, and he he mostly did it all for us. He like, registered him. And he brought us the Dexcom like, months later when he was coming. The doctor told me it's preferable to have a CGM. The only thing that we have in Egypt right now is the FreeStyle Libre. But I was like, No, it's not good enough. And then our friend suggested the Dexcom. He was on it. He will he used to bring it from London. Like we had him and duck on Dexcom, like just a couple of months after his diagnosis. And we only stayed on the Dexcom for two years. Dexcom with MCI, with the first week of diagnosis, what I did is like, I sat there and started to search for Facebook groups like Facebook support groups. Like I told you, I wasn't really involved with my husband. And I wanted to know more. I wanted to listen to people talking about it. I wanted to ask some questions. So I just started searching for Facebook support groups, I found several ones I didn't find actually the juice box, Facebook group at that point. But then people kept bringing up the Omni pod. And then one of them said, there's this Juicebox Podcast that's very useful. The podcasts kept coming up, like in the comments from different people. I didn't ask any question. I just kept reading questions and comments and questions and comments, trying to educate myself a bit. So I put that in the back of their mind. But I was at home. And at that time, I usually listen to like audiobooks or podcasts during commute during going to work. So I didn't think about listening to the podcast at that point. But I put it in the back of the mind. I went there and followed the podcast, but I didn't start listening at the point. And then when people started bringing up the Omnipod, I'm likely I need to know more about that. So that's when I started looking into the podcast, because people kept recommending it if you if you're going to put on an Omnipod you

Scott Benner 32:30
know, it's funny, I'm so happy that that worked out. But I don't think of it that way. I don't think I talked about anything on this podcast that you couldn't do with MDI, a T slim pump or Medtronic pumper, or anything else. Yeah, I

Radwa 32:45
know. But they said that it's useful like, because I

Scott Benner 32:49
have those pro tip episodes from Oh, so this was like, two summers ago, like August of 2022. Is that about when you found me?

Radwa 32:58
I found you before, but I started listening in 21. Okay, I guess by the end of 2001. Started like listening randomly. At that point, I didn't want to put on a pump on a two year old who's running around, because the pumps we have available here are the ones that you have to like, have an inner pocket for it and with him, and it's cannulated. And I was like, No, I can't do that. I feel very uncomfortable. If it got stuck in something or hung up on something it would be handicapping for him. So I went along with MTI. And then when I read about the Omnipod, and I felt that he can like go to swimming class with it that there is no cannula involved. And I was like, Okay, this is what I want for him. But I don't want to change the system that his nursery has been used to, like they give him injection in the nursery and everything. And I just keep following with the Dexcom and giving them instructions. This is how it's working like that. Like in the nursery. It's very, it's an open community, you can call at any time it's not like the school premises. So I can drop off anytime I want. And I if I need anything, I just call the teacher and tell her like, Oh, he's going Hi, give him blah, blah, blah, he's going glow, give him juice and so on. And

Scott Benner 34:09
we'll do all that and that nobody fights you about it or says that's not my job or anything like that. No, there.

Radwa 34:14
His nursery was very helpful. The teachers were amazing. And then we have to go to school. And that's when I was like, he can be on MDI in school. He can keep going back and forth between the doctor's office and his class for every injection or for every whatever. The summer before he went to school was like, No, I have to get the Omnipod Oh, I actually did is like I ordered the Omnipod and I had it like since April. I've had like a six month stock that we bought. And I kept looking at it. I'm like what I'm gonna do with that. Like, how I'm gonna do this. So okay, I'm just going to postpone this to the summer. I don't want to change his system right now. And I shut it off. And then when I talked to his endocrinologist, he's like, yeah, the Omnipod is ready. Good. I've tried to help one patient before with it, but I can't really remember all check it out and come back to you. I'm like, No, I can do that. You know? Yeah, yeah. I

Scott Benner 35:10
don't need your help. Yeah, if she's going

Radwa 35:12
to have to check online and ask around and then come back for me, like, if you're

Scott Benner 35:17
Googling I can Google. Also, I'm a doctor, too, by the way,

Radwa 35:22
is exactly what I did. Like a friend. Like she pushed me to do it. She had a, she's somebody I got to know because her her kid is diabetic, too. So we have like the small community, we communicate with each other. So she told me, like, we did the Omnipod at home, her her husband was totally in charge. And he was able to do it. So I'm like, if you can do it, I can do it. So I took a week off, I stayed with him. Totally at home, I read all about it. I watched all the videos. I'm like, Okay, I'm doing that. So I kept him at home. Even my husband wasn't available at the time, he was like, in a conference. And it was only me and my kids at home. I decided to put it on, I put it on. And I had already listened to several video, like several podcasts, and I watched several videos and the instructions of how to do it. And it just it just took me like three days to get his basil. Right, right. I think the most of the struggle was in the basil. It's the dash. It's not the Omnipod five. So there was no algorithm involved. Yeah, and and we got our we got there, and I watched his numbers getting really good. I was like, I kept telling my husband, you have to get some for yourself too. Well,

Scott Benner 36:35
that's what I was gonna ask as soon as you start seeing the benefit of it to turn to your husband and go, Hey, what are we doing here for you? Yes,

Radwa 36:41
exactly. But up till now, he's still resisting. And he's like, just let's keep all the money to like, a steady supply of Omnipod. Because it like, right now, if he doesn't have the Omnipod on him. I don't think I'll send him to school. You know? Yeah, it gets scary,

Scott Benner 37:00
doesn't it? Yeah, it's scary.

Radwa 37:03
And his teachers won't honestly in school, his teachers won't give him the injection. They're not allowed to. So I wouldn't feel comfortable him going back and forth to the clinic every time but his teachers, they would use the Omnipod. Easily your trouble. You have a WhatsApp group, me and the teachers. Yeah. I keep giving there. I told them, I'm totally in control. I'm gonna give you all the instructions whenever I need to. And this is what we do like, right? Yeah, I just send them on the WhatsApp right now he's going a bit low. Can you give him a biscuit or we have his supplies and in class, or Skittles, or juice box or whatever. And if he's going high, I send them like, give him 10 grams of carb or whatever. So it's easy for them to just press Bolus, put a number press OK. And that's it.

Scott Benner 37:49
Is it hard for you to know that you guys are making a financial decision that I don't want to say it's hurting your husband, but is it hard to know that you're making like, like a Sophie's Choice decision? You're like, we're gonna give it the I mean, I guess most people, definitely.

Radwa 38:03
Yeah, definitely. But you work with what you have. You know,

Scott Benner 38:07
they your husband sounds like a good guy. I'll tell you right now this this. You're not supposed you're not able to get mad at him now, because of this. This is very selfless.

Radwa 38:17
Yes, selfless. Honestly.

Scott Benner 38:18
It doesn't work that way. though. You're married, you can still be mme, it's fine. It's not this one. Generally,

Radwa 38:25
like, yeah, it's it's a choice. But like you said, it doesn't feel like we're harming him. It's just like, he has better options that we're not using right now. You know, no, I

Scott Benner 38:35
mean, he sounds like he's on top of his situation. So I don't think he's being harmed. But not I'm not saying you can't do well, with MDI. And testing. You certainly can. It? I mean, it makes the point really, that you're having to make a decision, there's a thing you'd like to do, and you can't and that it's not just, you know, it's not just in one country, there's problems exist everywhere, for the most part. Exactly. Yeah. And they're happening to you to doctors, which is not a thing people would expect, you know, yes.

Radwa 39:02
Yeah, it's not common. But but the healthcare system, like as well, we hear so different. Like, it has a lot of privileges. Like if you want to do an MRI, you just go into an MRI, you know, you like if you know, you need one, you can just go and do it.

Scott Benner 39:16
Are they financially, like, difficult to get? No, no. Health care? So it's not monetized the same way?

Radwa 39:24
Yeah, health care here is very different. It's a lot cheaper. You don't have to, like ask permission, and wait, like, for example, if you don't have an elective surgery bypass, for example, to lose weight. The next day, like I know, the waiting list, and for example, in the UK is around a year and a half to do that. Or if you want to do a hip replacement. You might have to wait for your turn here. You can do it just the next day, even through insurance, you know, because

Scott Benner 39:53
there's availability of doctors or because Why do you think that is why do you think there's that Instant Access,

Radwa 40:01
doctors are much more available. It's not like that where there's a lot of doctors, but the doctors are available. Like I told you, I handled my son at home, and I had my doctor on WhatsApp. And my patients can reach me on WhatsApp anytime. Like if they have an emergency, if they need to ask about something, they can just text me and I answer back. No, it works really differently here. Like, you could just go and book an appointment and go, Yeah, you don't have to go for example, through our primary care doctor, we don't have that here. And then he decides if you need to see an endocrinologist or not, I think there's an episode I was listening to a few days ago. And she was talking about the struggle to, like diagnose her kid. And they kept in the ER, sending her back home with COVID Sending her kid back home with COVID. But like here, you would have not just an ER doctor, you would have like whole specialists available. If you go to the ER at any time, you know, you

Scott Benner 40:59
know, I found myself laughing earlier when the doctor offered to Google on the pod for you and look it up. But I actually thought later, I should.

Radwa 41:07
She knows Omni pod. And she worked with it like once but a couple of years before. So she's like, I can't remember what we did back then I need to recheck. Yeah,

Scott Benner 41:16
but um, I laughed and I shouldn't have because what I should have saw was a person who was willing to tell you, I would like to help you. I don't know what I'm doing. Let me go find out about it. And I'll get back to you. Whereas I think that I hear a lot of doctors here just either pretending they know what they're talking about, or just ignoring you if you ask something that they don't or say. Or they would say something like, Oh, don't use that pump. I heard it's no good. Wouldn't what they really mean is I know how to use this one. So let's stick with that.

Radwa 41:44
We definitely have like, like this person was saying before podcast, doctors are humans, like you can find the mean one and a kind one and helpful one and an egoistic one, you know. So what I was like referring to here, and each of the doctors are more available for the patients like they're not somebody that you have to go through a whole lot of system and people work to reach. You could just

Scott Benner 42:10
call them up. Yeah, call them up and say my ankle hurts. Could you look inside of it and find out what's wrong with it? Yeah,

Radwa 42:14
not all the doctors, of course, are that reachable. Some, some are really more busy. Some, like, their ego makes you go through like his secretary or personal assistant or, like they have a waiting list or whatever. But I mean, you're not. But I mean, generally you can reach a specialist that you want to go to, like, in no time.

Scott Benner 42:37
If I needed LASIK surgery, and you didn't you were still doing it. I call you up and I'm like, hey, I need LASIK. You. Can I come in? You give me the ones over? I definitely need it. We get together tomorrow and do it. I pay cash for that. Yeah, what does that cost?

Radwa 42:53
LASIK is not covered by insurance. I can't tell you that. Okay, very cheap. Oh my god. If you make like, it will cost around 200 to two $50.

Scott Benner 43:04
I spent $99 on dinner the other night. You mean? Oh,

Radwa 43:09
I just came back from New York. I'm telling

Scott Benner 43:11
you, oh, please spend a fortune on food. But a $9 bagel in New York is what you did. That's fascinating. Wow. And can I ask a question? Just please. Oh, head did not. Let's not use the eyes as an example. But am I getting the same level of care as I would somewhere else? And in Egypt? Yeah. versus New York. If I get my hip replaced?

Radwa 43:33
It depends. Yeah, if you get a hip replacement, definitely you're getting the same care. But the doctors here are really good. What we like maybe the fact of intimate is like the nursing, like, you're not always lucky with the nursing staff you have some are really well trained and some are like they're not that well trained. You know, the nursing. They don't have like a system

Scott Benner 43:54
to train nurses. It's almost just a job you get. Exactly yeah. Wow, that's interesting too.

Radwa 44:01
Oh, but the doctors that you like my cousin had a real problem with her back and she she needed to see a neurologist and they gave her an appointment like after eight month I'm like, okay, just come to Egypt I'll book you an appointment with the best neurologist we have go and see him and then go back you don't need to wait eight months to see a neurologist

Scott Benner 44:21
you know I have a friend who needed a just an iron infusion in Canada. And it took like a year Exactly. Yeah. Dragon asked the whole time like exhausted brain fog, you know, blah blah blah. And they just it's just takes forever and the way it was explained to me is that I guess Canada does it on that are you going to die system? So like the the closer you are to dying, the faster you get to a doctor. But then people start with these small problems and by the time they actually get to the doctor, they're in a much worse situation. They're dying like right like it just I was like, that doesn't make sense. Yeah, it's so something else. So access is, it's really great. Yeah. All right, definitely.

Radwa 45:03
Like I think this is a really good thing. Like, if you can see a specialist and if he needs an MRI, he tells you go and have an MRI you can have the next day, and then send him the report the day after, you know, it's that fast.

Scott Benner 45:16
Well, listen, if you have good insurance here, you get treated well to, this isn't going to be a weird example. But I woke up one morning, a couple of years ago, and my toe hurt terribly. Like to the point where I thought did I wake up in the middle of the night and like kick a wall or something and not know it, you know? And I thought it would go away, and it didn't. And it got worse and worse. And I ignored it for a very long time just thinking like, Oh, it's a ligament or something, it'll get better. Who knows. But once I decided I can't take this pain anymore. And this is, you know, stopping me from walking correctly, I have to go do something like that. I called the guy. The guy said, you know, I got an appointment. The next week I came over, he took a look at it, because I can get on the schedule. I had a surgery three weeks after I called him. Okay, that's fine. And that was fine. But it's because I have good health insurance. So when they see my health insurance, they see oh, we're getting paid for this. And now you're on the schedule. You know what I mean? Oh, I wonder what that toe surgery cost? Do? You know, I don't even know. Like, I have no idea what that what the doctor made.

Radwa 46:20
I know any in the States, you don't even look at the bill like the insurance is paying that I don't even

Scott Benner 46:24
know if I got a bill. You know, I already put out enough money with Arden at the beginning of the year that I didn't even know anything for the doctor's visit. Like I just walked. You are out of the deductible. Yeah, it was out of my deductible already. So I'm never bothered. I bet you if I went and looked at that, I bet you that doctor made 40 or 50 grand doing that thing? You don't II mean? Yeah, you gotta come over here. Just do a couple of lasix and go home.

Radwa 46:47
Like I told you live in the States are like a year and a half. Right? Husband has his fellowship there. And in Houston, a Methodist Hospital. And we have good insurance. But thank God within, like, in that year, we're going to use it. Yeah. So we have like limited experience with it. But it was a good year. Like we had a good year.

Scott Benner 47:07
I was gonna say you should come over here do five lasix and go home a king.

Radwa 47:12
Yeah, I guess we should do that. Not

Scott Benner 47:14
that easy. It's not you can't practice medicine outside of Egypt.

Radwa 47:18
No, like in the states to practice medicine. You have to do like what's called the USMLE II, this is what my husband did. And then you have to have like, it depends on the state. Each state has its license, you have to have the state license to practice

Scott Benner 47:32
seems like a scam to me. Basically, you have to come here pay a half a million dollars to get educated so that you can go charge somebody 40 grand to fix their toe. That's what it sounds like. Whatever.

Radwa 47:42
But anyway, this is how it looks here. And I think it's it's been good for us like having his doctor available when we were locked down. And we didn't have to take him to the hospital to give him the care he needed. So I think this was a good thing.

Scott Benner 47:57
Yeah. No, no, it really is. This whole conversation is incredibly. How involved did your mother in law try to get involved when your son was diagnosed?

Radwa 48:07
She tried at first a bit, but right now she's not involved at all. Like in the beginning. She's like, okay, what are you giving him what he's doing? But you know, by that time she's already in pension. I don't know what you retired like, yeah, yeah, she's retired. And she wasn't oriented. Like when I started mentioning Omnipod and Dexcom she's not oriented with these devices at all. Like I told you before, we don't have them in Egypt. And that's very, very interesting topic. Like in the area I live we have like a 13 Starbucks and a 12 McDonald's but we don't have Omnipod in Egypt, you know? Yeah, like how is this more important? How is it more important to franchise Starbucks or and have like 12 just in the block we live and then we can get access to like important medical devices you know, I

Scott Benner 48:57
think that these companies just don't know how to do business in other countries. You don't I mean to go set up somewhere else is a big undertaking I mean, on the pod sent, um, they have an office I think in England now. Yeah, and so you know, but I actually have a number of times Matt, I think I've had dinner once with the person who they who Omni pod sent to England to like set the whole like to get the thing rolling. It's a big undertaking you've got to you know, you've got to move people uproot people send people over there to learn how to do business in another country and then get the entire things it's it's a hell of an undertaking. I

Radwa 49:33
guess the other way would be like, what happened in Turkey where some businessman or whatever, decide to like franchise, the company and be in control of it in his country,

Scott Benner 49:43
you know, on the I've never heard of that before. I'm glad it exists, but I don't know about

Radwa 49:48
it. It does. But but the point is, I think in Egypt, it would be not worth it to invest in something like that because like I told you, most of us will pay out of pocket for it. And by the time we comes here to be even more expensive than the state. So that will be like a financial burden for most of the Egyptians. Yeah. To pay them pay a middleman. Yeah, you need to get the insurance companies on board. So that's when it can, like be financially good for the company.

Scott Benner 50:16
And accessible to people there. Yeah,

Radwa 50:19
exactly. So I think it's a, it's a big thing to do right now. But it's just, you know, it's a struggle for us using the Omnipod. I like I have four or five friends who use the Omnipod for the kids, and we're all struggling together. And whenever we find the source, I keep calling them and I'm like, Hey, I found it in Turkey. So we can go there and get our stock, or we found this website, or that guy who outsources them from the states and whatever. Yes. So it's a real struggle that I feel like, we need to get out of, you know,

Scott Benner 50:50
it's interesting that another country doesn't knock off medical supplies, you know what I mean? Like, copy them, like companies that are outside of like caring about, you know, I'm saying it happens all the time.

Radwa 50:59
I understand. Yeah. But this is like very advanced technology for somebody to just knock it off, because it doesn't work properly. You're killing people.

Scott Benner 51:07
Yeah. Well, I assumed that somebody wouldn't care about that. And they would try it. I just found myself thinking it's interesting that that doesn't happen. Maybe countries stay on top of stuff like that, so that nobody gets hurt. But yeah, there's got to your point, there's got to be a way right. They, they make the damn things they know how to make them. If there was more countries, they could send them to, they could build more infrastructure and make more I'm sure they'd be happy to make more if they could sell more. I guess it's just the Yeah, that's the process of, of actually distributing it. Once you get to the country and understanding all the rules and regulations there and working within them. I guess that's where the hard work comes in. Yes, exactly. Okay. Well, that's something How comfortable are you? A few years later, that you know what you're doing? Like, how's your son's a onesies? Has he does he do better than your husband? For example?

Radwa 51:57
Yeah, definitely. His average is around like 6.2 to six and a half. That's wonderful. But his time and range is not always perfect, because he's really young, and I can stay on top of it. Especially in this last year. He's like, he'd go and eat something and not tell me before, not everything was accessible for him. And maybe when he grows up, he would understand that he has to tell me before he eats, but right now he can just go and grab a biscuit. And not tell me, you know, yeah. So I have to be on top of things. Definitely Omnipod. Five would have helped with that. But it's not available in Turkey. And it would be a more of a financial burden for us right now. So we're waiting on it a bit.

Scott Benner 52:36
Do you ever consider doing one of the do it yourself algorithms?

Radwa 52:40
Yeah, I was thinking about doing it that summer, because I have a couple of friends who has been trying with it. And they did not succeed yet. So I'm waiting for them to succeed. And then they tell me exactly what to do. I didn't have time. Like, maybe in the summer when he's at home with me all the time. We can do that. But it will be very difficult when he's coming and going back. And, you know, like his pens, like half his day in school.

Scott Benner 53:03
Yeah. Yeah, no, I understand. I'm actually aren't using Iaps now. But the truth is, is that if somebody wouldn't have helped me set it up, I wouldn't have known how to do it. It's got so many settings. It's like mind boggling.

Radwa 53:16
Yeah, I heard it's so difficult. So I need to, like take the time off and have them with me all the time. And we can try that.

Scott Benner 53:22
Yeah, I don't even understand like people start are asking me now like to talk about I'm like, I don't even know what to say to be perfectly honest. Because what happened? Yeah, cuz Arden's off at college, and it's working so well that it doesn't need a lot of intervention from us. Wow. And at the same time, you know, I don't know how I got to the settings because somebody Mike who's been on the podcast, he was just like, make this one that make this one that turn this to that make it this number, this this? No, well, let's assess it and it'll work. I think I put it on her and made some changes to her insulin sensitivity. And carb ratio, I think I made her carb ratio weaker and our instance sensitivity, I had to make it stronger. And then it just started working. And I was like, alright, well, okay. But now she's actually using, I don't think I don't know how much I've spoken about this yet. is pretty new. She's using a GLP. So right now it's ozempic. Oh, okay. Yeah, she wants that we want her doctor wants her to switch to Manjaro at some point, but we were having trouble getting it. So she's using ozempic Right now, but not even like a therapeutic dose. She's using like point two, five. I was at milligrams maybe

Radwa 54:35
help her like Did it help? Because I was actually thinking about that for my husband. I was like, You

Scott Benner 54:41
have no idea. Like, I can't wait to do an episode about it to really talk about it. But my oh my god, my rough math tells me that Arden will use over 11,000 fewer units of insulin in 2024

Radwa 54:57
Wow, okay. You know, I have this idea, I used ozempic to lose weight for a couple of months. Okay, and I saw the results, and I went all over my husband, I was like, I think you would really benefit from ozempic. Like, you don't have that his diabetes is not that bad. You know, the one he got a 26. He doesn't go like crazy high. He actually when he started going to the gym, we went very lower with his doses recently. So I was like, if you go on to the Olympics, I think you can just keep up with the Basal and need the noval rapid to a minimum. So I've been pushing him about it. And he's been resisting for a while. But after he said that, Oh, my God. I'm going to be all over him.

Scott Benner 55:39
Her daytime Basal went from 1.1. an hour to point seven. Wow. And her spikes are, you know, when she gets a meal spike, they're much lower. I used to say, I would tell people, right, like, I think of one ad is high. Think of 200 as a spike, we really screwed up. And now I think of 140 as high in one ad is a spike that we screwed up. Wow. Well, she's coming back down more gently, quicker. Like this morning was her first day of college for I don't whatever semester, this isn't some a quarter. This is for her sophomore year. So I watched her. She it's fascinating. She's 700 miles from me. And I knew what time she was getting up and going to class this morning. So while she was heading to class, I sent her a text that said no good luck this quarter. And so I know she's, she's on her way to the building. And I'm watching her blood sugar go from like 110 to 120 to 130. And then the algorithms like oh, what's happening? It stopped her at 149. And it brought her back down in like two hours. So is a pretty big adrenaline rush that she got art and takes school very seriously. So she's like, I think it's stressful for her. So she gets this big push that the algorithm is not expecting it pushed it back down. She went from like 119 to 149 and back down again. And I'm wondering what's going to happen now during the day because schools you know, it's she's back at school, it's different. Now, I don't know what her schedule is like yet, like I gotta let her settle into her schedule a little bit before we can make changes her last 24 hours, I would consider not good. And there's been one spike to one ad, there's been a couple of stretches where her blood sugar's were holding, let me look. So I can really tell you a couple of stretches where they were in the 140s after two different meals. And other than that, it's been pretty much between 120 and 94, actually 120 and 70. For the rest of the time, that's 24 hours. So I would say 20 of her hours are between 70 and 110. And maybe for hours that were up around 140. And then one spike. That was worse

Radwa 58:05
with Omnipod dash with my son, we we don't get these numbers, like he spikes to 220 and 230 sometimes, especially that we can't always do Pre-Bolus thing, you know, I can't be sure if he's going to eat his meal or not. Like he's not that helpful yet, right. So, but definitely having something like the Omnipod five with me with an algorithm will definitely be of much help. I'm looking into it this summer. But those Olympic I'm definitely pushing it in my husband as soon as he goes.

Scott Benner 58:35
I mean, not just that, from March to now to January, I've lost 38 pounds with weego, which is those Empik right. And last week, my endocrinologist who's you know, helping me with this is also the same person that helps them with their diabetes and my the rest of my family with their, with their thyroid stuff. She's like, let's get you on Manjaro if we can, and I was like, okay, which is now called zek bound for weight loss. So she wrote me the script, and we took it off. And they were like, Hey, we can get that. I was like, great. So I shot the first zap bound like a couple of days ago. And I'm assuming there's going to be like a period of time where you know, something. I don't know what the hell's gonna happen. The weego V for me was good, obviously. But I had definitely plateaued. I was not going to lose any more weight. I still had some stomach acid stuff. My Oh god, I can't bother. I'm so sorry to say this. I haven't had a nice firm bowel movement in a while.

Radwa 59:35
Yes. I was asking. I was gonna ask you about that. Yeah. Yeah. It's not

Scott Benner 59:39
enough to like make you go well, I don't want to do this because you're losing 40 pounds, but at the same time, I'm just like, I would like that to go back to normal. Yeah,

Radwa 59:46
to go back to normal. The manzara doesn't have the same side effect.

Scott Benner 59:50
She said that uh, I very well might not see the bowel movement side effect. And then it also has something in it that helps with stomach acid. So she's like, I love this for you. Let's do Try

Radwa 1:00:00
this. Yeah, it does. And it's actually like, from what I heard, it helps you, like those Olympic helps you to lose around 12% of your body weight. But the Manjaro helps you to lose 18%. Yeah,

Scott Benner 1:00:10
that's what I'm stronger. I'm hopeful, like, one way or the other. I need something just for management. And this is not about like, I know people who don't understand it would think, Oh, yeah, you have to shoot something to keep yourself from eating a bunch of food. It's not like that. I met the part with the GLP where I can eat fine. Like I don't, I'm not limited about how much i i can physically eat if I want to. Exactly. I am making different decisions. But I think those decisions are more because I like I like better how I feel and how I look. So that's me,

Radwa 1:00:41
like I told you, I'd had an experience with it. And I was like, this is not bad. I don't feel like I'm not depressed. I'm not like, I don't want to eat something that I can't eat it when I want to eat something I do. I do eat it. Yeah. But it just it helps me with controlling a lot of like, the unnecessary cravings that you get. And it helps you to keep yourself in shape. My wife

Scott Benner 1:01:04
says that it stopped the food noise in our head. Exactly. Yeah. She said she'd wake up in the morning. And the first thing she would think is what am I going to have for breakfast? And then she said, while she was making breakfast, she was thinking about lunch. And she's like, she's like, that is completely stopped for me. Now I don't have that. I actually I think I have some sort of a deficiency that that it made up for it. Because my body is, is operating way better right now. And it's got very little to do with what I'm eating being different. So, yeah, pretty, it's pretty great. But back back there for type ones. To be clear for people who are listening, our insurance is not covering ozempic for art and, and our doctor is helping us get it from somewhere else to so we're paying cash for it. But it's very doable, because it's cheaper where it's coming from. And on top of that, she's not really using much of it. So the pens lasting forever for

Radwa 1:02:00
us. So she uses like a very small dose,

Scott Benner 1:02:03
the smallest dose and it's apps and the doctors like we're not going to move this up if we don't have to like look what it's doing for oh, by the way, also is it cleared up her acne by like 80%. Wow. Because we think Arden probably has PCOS. Okay. And so now we're waiting to see this is her. Again, I feel so bad. And I'm sorry if I'm dead and you're listening to this 20 years later. I'm sorry that I'm about to say Arden is about to get her second period since she's been using it now for like over a month. Sorry hours. And I'm hoping that it's a less impactful period because Arden can have heavy painful periods. So if you bet for our than right now Dad, she don't care. And so so if that if that makes that even better? Well, then hell like now it's and we are seeing that online, which I'm going to keep saying over and over again. There are women online who have not been able to be pregnant for their lives who have PCOS who are using we go view ozempic Those Those GLP medications and they're getting pregnant.

Radwa 1:03:04
So yeah, it's not the first time I hear about that there. I

Scott Benner 1:03:08
know there's a group of women talking about it online. I saw a group of people in on Reddit talking about their, their connective tissue disorders. I can never say it correctly. And that slows me down when I'm about to say ears. Hold on a second. It's the danlos Do you know what that is? It's an autoimmune downloas Ehlers Danlos yes, that I actually saw a Reddit thread of a bunch of people with that, who said that they think their symptoms are getting better on GLP now, I don't know if they're losing weight, it's putting less stress on their joints and maybe it feels better because of that. Not sure or if it's actually helping them with it somehow I have no idea but I mean, when you start seeing 25 people say oh my god that's happening for you to like, that's crazy.

Radwa 1:03:58
You know what I mean? So that's crazy. And the first time I hear about it too Yeah, you

Scott Benner 1:04:02
got to pick her out on the internet to hear people talking a little bit about about things but for I 1,000,000% believe that if terrible people with you know money focus is don't get in the way you're gonna see GLP medications that are given to people with type one in great numbers over the next couple of years.

Radwa 1:04:25
I really hope that because what I've been seeing is like the opposite like every like week I find an article about somebody's like oh simply killed my wife and then you read the article and was impeded did not kill his wife well, he just died she was almost eight but she didn't die from was Olympic. You know? No, I don't know what's wrong, but like, articles keep popping up for me like on Instagram, or from us daily or whatever. And it's always about how side effects of Olympic you know,

Scott Benner 1:04:58
I don't want to be consumed AOC theorists are at Roswell, but I'm assuming that that article is planted by like a sugar manufacturer who's like, oh, that's probably Oh god, these people keep shooting this DLP we're going out of business. Honestly, I mean, I, I don't obviously I have no idea. But if people if their cravings are curbed, and they're losing weight and having the, you know, the experience I'm having, which is, you know, I prefer to feel like this than to eat that, or, you know, even just the quantity. I told you, I spent 100 My wife and I went out to dinner the other night I got this really is a beautiful bowl of pasta with shrimp and crab in it. It's a spicy had a red sauce is really good. I really loved it. I did not finish. Exactly,

Radwa 1:05:42
yeah, but that's good. Like, you get to eat what you like. But you don't have to like overstuff yourself.

Scott Benner 1:05:48
Exactly. And this that overstuffing because there's no way I wouldn't have finished that without ozempic.

Radwa 1:05:53
Exactly. Like when I was on it. I'm, I'm a person who's like, my favorite food is ice cream. And like, my kids always make fun of me. If I get a pint of ice cream, I could finish it while I'm sitting on it. You know, like, I don't stop eating ice cream until it's done. But now I get to eat. Like if I crave ice cream, I eat it. But I definitely can't finish the point. It's like, a few spoons. And I'm done. And I'm happy.

Scott Benner 1:06:16
Exactly. Am I and my joints feel better, too. Because I've lost weight, my ankles feel better, my feet feel better. Like, you know, all that stuff that I before would be like, Oh, I'm old. That's why my heel hurts. That it turns out that my heel hurts because I was carrying around an infant with me on my ass in an Amen. I feel much better. Now. My wife looks amazing and feels much better. This whole thing of people like making fun of it and everything. They really don't understand what they're talking about. So that's probably yes, yeah. But I get I also get them feeling past like, you know, imagine you're skinny and you've been like stopping yourself from eating stuff you want for years. And you're like, wait a minute. That's not fair. I had to have willpower. But, but it wasn't willpower, though. Like, I don't know one other way to say it like it's an unconscious thing that happens. Exactly. Yeah. Feels like you're being drawn by your own chemistry. I don't know. Another way to put it. Yeah. Anyway, is there anything we haven't talked about that we should have?

Radwa 1:07:12
I guess not. I just want like yesterday, I was just listening to your wrap up. How sad you were that day. And all I wanted to tell you like you were talking to I'm just helping the top 10% of the top 10%. Believe me, like you're doing a lot like not just in your country, like everywhere for the type one diabetes community. And I just wanted to get that through to you. I know you hear that a lot. But just hearing the wrap up yesterday made me feel like I have to tell you that very nice. Like I thank you really, when I started listening to your blog, I just listened to the first episode, the one where you were talking about the background music that was made by your like, kids friends. And it went from there to here. And you need to remind yourself of that, like, every time.

Scott Benner 1:07:57
Well, I got a lovely note this morning from a gentleman. And that said something similar. He said he heard an episode recently that just really changed how he thought about his own health and that he was doing better. And it's because of the podcast. And he heard me. So for people who don't know, like at the end of the year, I always do like some episode where like think like last year I talked to Jenny like I realized that never talked to Jenny like she was a person we always come on and talk about like management stuff. And this year, I wanted to just kind of do a wrap up because it's been a kind of a difficult year. Like behind the scenes, Apple made some changes to their, their podcast app, it impacted downloads of back catalogue stuff, which is going to impact my, my overall number and I don't know, it took away my I don't know another way to put this, I need something to get me up in the morning. We all need something to get us up in the morning, right? And so I use helping people and reaching people as my measurements, right? If I'm helping people good. That's our goal. That's our only goal. Actually, that's if anybody needs to know the The Secret to Building something successful. I only focus on helping people. If they give if I help them, it'll grow on its own. I don't have to worry about that. And then but the other side is the growth. And if when I plant toe, or if the growth slows down, I don't see it as Oh, I'm not succeeding. I see it as like, oh, it's not working. Like I have this information that I know helps people How am I not figuring out how to better get it in other people's hands? And I don't know another way to explain it other than winning feels winning makes you feel like playing, if that makes sense. So yeah,

Radwa 1:09:43
but believe me, you're reaching a lot of people even if you can't see it, and when you talked about like for somebody to listen to your, to your podcasts, they have to be educated well, people have to look for it. You know, it's not like people have to really care to start aren't looking and listening to a podcast about their health or about how to do things better. Or, you know, like, we have a lot of diabetics here in Egypt after my son's diagnosis. As an ophthalmologist, I use I used to get a lot of people to check the fundus, for example, regularly because they're diabetics, and I'm like, Yeah, hi. And how long have you been diabetic? I checked the funders. They're good. And I just let them go. Now whenever I see a diabetic in my clinic, I just keep educating them. Like, do you have a CGM on? Do you have a pump on? What was your last moment? Anyone? See, I think you should listen to the, to this podcast. Like if the they have good English. I keep recommending your podcast to them. Like sometimes stuff happens that you can't see.

Scott Benner 1:10:44
No, I know. And the crazy thing is, right, well, I know what that's happening. Like, I'm really aware of it. To be clear, so everybody knows what I'm talking about. They average this is gonna sound ridiculous. The average download for the, how do I say this, I get a certain amount of devices every day that come on to the podcast. They are now downloading, I think it's point seven fewer episodes per device per day. But I have a lot of people listening. And point sevens add up pretty quickly. And so it's the same amount of people listening, that hasn't changed. They all you know, if they're subscribed, they get the they get the latest download episodes, everything works, they don't see the back catalogue as much and and that's going to hit my overall number. Like it won't hit my new some, like, new downloads for new episode number, like advertisers are still going to be happy, is what I'm saying. But I'm not like leaping forward the way I was before and that you're not where you want to be. It was exciting for me. Like, I don't know, another way to put it like it keeps me like it gets me up in the morning. Like I'm gonna go. I'm gonna go win. Like that's how it feels when I get up in the morning. Like, you know, as crazy as it sounds. And I do hope this doesn't sound too. It's not callous. I don't feel callous about it. But when four people a day tell you they saved your life, you save their life. You don't get the same jolt out of it anymore. I really don't know another way to say that. Like I do you understand me irregular. Like yeah, like how many people look at have you in your life and said, Oh my god, I can see again. Thank you. All right. And the first time someone says that to you like you took their cataract out, for example, you're probably like, I'm a goddamn miracle worker. You're welcome. And, and then the 1,000th time somebody says, Yeah, I know I moved the cataract you're fine. You can see now and like, and but it's not dismissive. I don't feel dismissive about it. I'm thrilled. Every time somebody tells me. It's just it's almost like gambling. Like I don't get as much of a telly.

Radwa 1:12:51
It's almost like drugs. Like you have to get a higher dose. Drug.

Scott Benner 1:12:56
Yeah, right. Right. Basically, my I don't get jacked up the way I used to when somebody says my agency was this and that I cry more now. Than then I the excitement. I used to get excited, like I'm doing it. And now it makes me sad. But like, it's almost like I'm feeling their emotions more. Now, when it happens. Like I got a note this morning that you know what I can probably, I'm not going to identify the person, obviously. Okay. And it was from a man which actually, it was interesting. It struck me differently, because guys are not usually very emotional. Yeah. So if you hear this, sir, please just know, nobody knows it's you. But it says, Hey, Scott, I don't normally do this. But I thought I needed to privately message you. When I'm all caught up on new episodes, I scroll through past ones that I haven't listened to before. I happen to randomly click on 1030 to loss of liberty. And I just wanted to drop you a quick line to say that I appreciate everything you do. For me as a type one diabetic, Liberty story of her husband was eerily close to mine. I recently got my health back on track that insulin pump and started listening to your podcast a little over three months ago. Although I don't have nearly as many health issues as he did before he passed away. The mental health issues almost losing my family and some of the medical issues are identical to my story. This episode hit me like a blow to my head of what could have happened to me. And then as I'm reading this right there in bed this morning that made me cry. Like I was I like emotional. I know you must get tired of doing this sometimes. But I just thought I'd let you know that what you do helps me every single day and hearing that episode today gave me more motivation to continue on my path. Thank you again for everything you do. It's much appreciated that made me cry this morning. Before I would have gotten like as like, it would have felt like I don't know what I'm assuming cocaine feels like. Like, you know, like I would have been like, Yes, I did it. I said a thing. It helped the sky. I would have been excited by it. Now I'm just touched by it. I was using the numbers to get my Joel. And anyway, Tim Cook.

Radwa 1:15:02
I hope this year is much, much, much better for you.

Scott Benner 1:15:05
I also want to point out that I did 5.6 million downloads list. So it's not like it was. I feel I feel stupid. I'm not complaining. But, uh, you know, I feel that that's just how I feel like so I got on and that episode and I started talking about it. I wanted to do this episode at the end, it was like, we did 5.6 million downloads this year, and everything was great. And I just I felt solid, and it's how it came out. So I feel bad, because everybody's reaching out to me to tell me, it's okay now, but you're very nice. Thank you.

Radwa 1:15:37
This year is gonna be a lot better. Oh, my God,

Scott Benner 1:15:40
if Tim Cook gets out of my way, is damn Apple app. You know, I mean, what are you doing? Cut me a break China trying to reach people. And by the way, this serious like taking the numbers out of it for a second. The real problem is that I need people to hear those back catalogue episodes so that they're helped. So they have a success, like this person who wrote to me did, and that they see a benefit for their health. And then they tell somebody else about the podcast. If you never get helped, then you won't have the success. If you don't have the success you won't pass it on. And word of mouth. Word of mouth is how this works.

Radwa 1:16:17
A year and a half ago, this is how I came across the diabetes pro tip episode. Like I had tons of episodes in front of me and I didn't know where to start. And then when this popped up, I listened to it. I'm like, oh, there's a diabetes pro tip. So I kept looking for them and listening to them. Like, you really helped.

Scott Benner 1:16:33
Oh, I'm glad that series is. I mean, I know it's out of my head and Jenny's head. But I it's one of the things I'm more proud of like I know you listen to that series, you can get an A one seeing the low success. No problem.

Radwa 1:16:46
It's really good. And it's to the point. So ya

Scott Benner 1:16:51
know, it's just conversational enough, but it's technical enough. It strikes strikes a good balance. It really does. Exactly. I appreciate I'm glad it helped you. And thank you for telling me. Thank you. Yeah, if you would have wrote it to me, I would have cried in my bed. Just so you know. Well, I can at idiot. Anyway, hold on for me for one second. This was terrific. Thank you. Thank you.

Hey, don't forget to check out touched by type one.org. Go to their programs tab and find out about that huge upcoming event. It's an in person event in Orlando, Florida. It's absolutely free for you and anyone else you know who would like to attend touched by type one.org. And if you can't come to Orlando, still check them out on Facebook and Instagram. I want to thank the ever since CGM for sponsoring this episode of The Juicebox Podcast and invite you to go to ever sent cgm.com/juicebox. To learn more about this terrific device. You can head over now and just absorb everything that the website has to offer. And that way you'll know if ever since feels right for you ever since cgm.com/juicebox. 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. If you're living with type one diabetes, the afterdark collection from the Juicebox Podcast is the only place to hear the stories that no one else talks about. From drugs to depression, self harm, trauma, addiction, and so much more. Go to juicebox podcast.com up in the menu and click on after dark. There you'll see a full list of all of the after dark episodes. The episode you just heard was professionally edited by wrong way recording. Wrong way recording.com

#1236 Libby, Libby Libby

Libby learned to cope.

+ Click for EPISODE TRANSCRIPT

Scott Benner 0:00
Hello friends and welcome to episode 1236 of the Juicebox Podcast.

Today we'll be speaking with Libby who 28 years ago was diagnosed with type one diabetes around 13 years old. Libby's done a fair amount of counseling, and she's gonna talk about that her new coping skills, her life with control, IQ, and much more on this episode of The Juicebox Podcast. 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 supply of vitamin D drink ag one.com/juice box. Guys I need you on this T one D exchange.org/juice. Box you're a US resident who has type one or is the caregiver of someone with type one. I need you to take that survey AT T one D exchange.org/juice. Box you are literally going to help move type one diabetes research forward T one D exchange.org/juicebox Take you like 10 minutes. I appreciate it very much.

Today, today's episode of The Juicebox Podcast is sponsored by Dexcom makers of the Dexcom G seven and G six continuous glucose monitoring systems. dexcom.com/juicebox 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. Hi,

Libby 2:15
my name is Libby. I guess I've been type one for 28 years. I'm currently on a Dexcom G six and a tandem T slim x two with control IQ. Oh, excellent.

Scott Benner 2:28
Control IQ. Gonna move to the g7 at some point. Geez, I

Libby 2:33
hope so. I just got a brand new G six transmitter like a month ago. So I'd have to go through that. You know, I would hate to waste supplies. So isn't

Scott Benner 2:40
it funny how something that you love so much the minute they put out something new? You're like, I'm stuck with this G six transmitter for three months? Yep. Can you imagine my life? It's terrible. No, that's that's, that's excellent. How long have you been using control? Like you?

Libby 2:53
Pretty much since it was released to the general public. I believe if I remember correctly, I was part of like the beta testing group. Wow. And I was like, Wow, this was really cool. I freaking love it. Because you know, having diabetes for so long. It just gets so tiring and overwhelming. And just, you know, you just want a vacation.

Scott Benner 3:10
Listen, we jumped right in because you're short on time. So let me just ask you a couple of fast questions to orient my mind. And I know you probably said half of this already, but don't judge me. How old are you?

Libby 3:20
I just turned 41 in December.

Scott Benner 3:23
How old were you when you got diabetes?

Libby 3:24
I was technically 12. It was two weeks before my 13th birthday. So 13

Scott Benner 3:28
any other family members have type one? No,

Libby 3:31
I am the only one in my entire family history. Okay.

Scott Benner 3:35
Any other autoimmune issues in you or the family?

Libby 3:38
I've got hypothyroidism. My mom has that as well. My dad was diagnosed type two later in life. And my oldest brother has had kind of an on and off type two diagnosis. It's very weird for him. And we are assuming that my dad's mom was undiagnosed type two. But that's that's really it

Scott Benner 4:01
that's realized celiac. No people have trouble digesting food. Nope. By health

Libby 4:07
stuff, just nothing. Oh, hold

Scott Benner 4:09
on metabolic attorney bipolar in the family. My mom

Libby 4:13
and I joke that there's undiagnosed bipolar and depression and all that stuff running around in our family, but no actual clinical diagnoses

Scott Benner 4:20
are sometimes hard to get a diagnosis. It is. And you are on the show today because I wanted

Libby 4:26
to talk about mental health specifically related to diabetes. All right.

Scott Benner 4:32
Well, you're in the right place. Libby. Libby, Libby Libby, there's no way that's not going to be the episode title because all your name makes me think of is that commercial? Oh, the birth of vegetables? Yeah, no. Yeah. Libby Libby Libby on the Label Label. That's it right label? Yeah, so this is you're gonna have to say something pretty out of there too. For this not to be called that. We'll find out. That's fine. Alright, so mental health and type one. What's your finding?

Libby 4:58
I'll start off with saying If I didn't, I was never opposed to going to therapy or counseling or that I was never that person was like, oh, counseling is wrong, or it's evil or you know, it's not godly or whatever, you know, people say so many things about mental health that you know, because you're in therapy, there's something seriously wrong with you. That's not at all the case. I've never been in that camp would

Scott Benner 5:17
be hold your thought. I have a question. I'm so sorry. I'm jumping in your 20 seconds. Where are you from? Vaguely.

Libby 5:24
I am currently living in Virginia. But I'm originally from Massachusetts.

Scott Benner 5:27
You've heard people say that therapy is not godly.

Libby 5:31
Yes. I won't mention specifically who but there are people close to me that have said not in those exact words. But they are very, I'll say religious. And they are very much of the pride away kind of mentality Jesus

Scott Benner 5:46
saves. Yeah. Put your faith in Jesus, that kind of stuff. Yes.

Libby 5:50
Okay. And I'm not I'm not saying that that can't happen. But I also believe in science and

Scott Benner 5:56
medicine. When I ask you, did you try praying it away? Oh, there

Libby 5:59
are certainly times I have literally prayed and cried to all of the gods. Everywhere, anything that could help me please take this away. I need a vacation, even just taking it away for a week. But I have yet to get my week vacation.

Scott Benner 6:14
So Buddha did not send you a prescription for anything. No, unfortunately, not be amazing. If you prayed in a prescription for happiness fell out of the sky. That you'd be like, I don't know where to get this field. My insurance doesn't cover. Okay, I just that struck me strangely. I'm sorry. So I'm sorry. Continue on. So

Libby 6:31
I have gone through burnout twice in my, you know, years since diagnosis. And mostly that was in high school. So I was still fairly new to diabetes. I'd had diabetes by the time I got to high school for about five to seven years. And then again, it was kind of like end of college slash becoming a real adult. And everything was so overwhelming to me. And the third time I saw burnout approaching me I was like, if I don't get help this time, I'm going to end up in the hospital or did. That's how because that's how my burnout had been in the past, I stopped caring about myself. I wouldn't dose for carbohydrates. I wouldn't even look at any food labels. I would just shove food in my face. And like, Yeah, I'll pay with it later. You know, Ellen's I'll just later for it. I'll deal with how I feel about it afterwards.

Scott Benner 7:17
conscious thoughts while you're eating consciously. I know this is gonna screw me up. I don't care.

Libby 7:24
Honestly, no, it's just like, there were times where I'm like, I'm just angry at everything. I want to eat this, you know, I was very emotional eater. And I had no coping skills or tools to use to hear me not necessarily away from food, but dealing with those feelings of anger and frustration and anxiety. And why does my life suck so bad? Why do I have this disease? It's just, nobody wants this?

Scott Benner 7:48
Did you have any of that before the diagnosis? No,

Libby 7:51
no, honestly, like, I had a really happy childhood. I was very athletic. I had a very supportive household. I grew up with two parents and to older brothers, I had pets, I had a lot of friends did a lot of extracurricular. So diabetes didn't necessarily put a stop to those things, but it made them more complicated.

Scott Benner 8:11
What do you think? Looking back on those first five years through high school, and then through college, the next four? What was going on with your management that made diabetes so difficult? Like was it an actual function of like, I don't know what I'm doing and I can't get this straight? Or was it just that overwhelming feeling of why me this isn't fair.

Libby 8:32
It was a lot of like, I don't want to throw my parents under the bus because they were fantastic. And I love them dearly. But they from day one, when I was admitted to the hospital were like, This is your disease, you're going to learn how to take care of it. And at that time, I had no idea what that meant. You know, nobody does on day one.

Scott Benner 8:49
Also happy birthday. No, I mean, I mean, yeah, when you're 13 like, Yeah,

Libby 8:54
congratulations on being a teenager.

Scott Benner 8:56
I know you thought You thought you were getting a bike with a basket. But yeah,

Libby 9:00
in a way, it was a backward saving grace that my mom and my dad were so they were very supportive. Don't get me wrong, they would help me with anything I would have a question with, but they're like, this is your disease. You need to learn how to take care of yourself and not 13 That's too much. You don't know. You don't know anything. You don't know anything you don't know about yourself as a person. You don't know what you want to do in the next 10 hours minus, you know, the next five years. And so, the one thing I did not do after I left the hospital was my own injections. I did everything else that I said I was absolutely not doing in my own injections. And again, this was a 1995 way before pumps, way before CGM, so I was totally cool with finger poking, looking at blood all that stuff did not bother me.

Scott Benner 9:43
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Libby 12:02
drying up insulin. The needles themselves didn't bother me. But there was a mental block with doing the injection. I was like, nope, not doing it. And I'm so glad that that my parents were supportive of that and that the medical team was supportive of that they understood. She's not ready to do this. We're not going to force her to do it. Okay. And I've never told my mom, thank you for that. And I feel like I need to. So anybody who's got a parent that took care of them without pushing them. Tell them thank you.

Scott Benner 12:27
My daughter has a fairly significant needle phobia. Yeah, it's it doesn't go away. Yeah, she pushes through it. But it's, it's hard. Yeah, it's really something and she's only Arden's 19, she'll be 20 in six or seven months. And I think she's given herself besides before the phobia hit her. When she did it a handful of times. It's a little like a little child. She's given herself one insulin injection. Yeah. And it took her an hour. It took her now Yeah,

Libby 13:00
I know, I've been there. I've been down that road. The thing that got me to understand, I will have more freedom in my own personal life, you know, as a 13 year old will be learning to do my own injections. And the catalyst for that, honestly, was going to diabetes camp and seeing six and seven year olds having no problem doing their own injection at the dinner table or the kitchen table, whatever, before dinner, and then going off and playing with their friends. Like or like they probably should be able to do this too, right? Yeah, this little kid that literally half my age can do this. And it's not a huge deal to them. Why can't I do it? Yeah. And so it's like reverse peer pressure.

Scott Benner 13:35
Oh, we just did a thing. So Arden's using ozempic. Just a tiny bit, she's using like a what they would even consider to be a non therapeutic dose, ironically enough point two five a week. And it's reduced her insulin needs significantly the best way I've learned to explain to people how by how much is that my calculations say that show us 11,000 fewer units of insulin in the coming year. Wow. If this keeps working the way so it's insane, right. And so nevertheless, it's an injection. Right? So we started at while she was home for the holidays, and we had to do it for and Arden doesn't just like she's just not just like this. She's thinking like her. Her ninja hands come out. She's like, Get away. Get away. Get away. Get away. No, no, no. And I mean, flopsweat like, really upset. It's upsetting to her. Right? Yeah. And, but we got through it. And she toughed it out the first couple of weeks because there's you know, the side effects from those amputate you're like you feel too full in the beginning when you start taking it like it can feel like nausea to some people. It's you have trouble eating until your body gets used to it, etc. But her insulin needs literally started coming down in the first four days. And so she saw the value in it. It helped her with her acne like rethink it's possible it could help her with PCOS symptoms that she has. It's a lot of value here, right. Oh, wow. And so we send her back back to college with this pen, and these needle calves, and I'm like, on Saturday, you've got to give this to yourself. And she's like, okay, okay, well, I made a plan like she she talked to her roommate, her roommate said, I'll help you with it like this whole thing. Saturday rolls around, and her roommate is gone for the weekend. So my wife says, my wife, Kelly says, What are you going to do? And I said, I'm not going to mention it to her on Saturday. I was like, she's got to get this on her own. I was like, it's and I think the fact that she has to do it will lead to her doing it. And you know, so on Saturday, I said, Hey, your blood sugar's look a little weird. If you haven't shot that ozempic, it's going to impact our settings. Let me know what you want to do. And I did not even ask her to respond to me. I just sent it to her. So she knew that. And I know she knew, but I wanted to remind her, I did not quickly get back. And don't worry, I already shot the ozempic. So I figured, alright, she's dealing with it. And Sunday comes and it's more towards the evening now. And I'm watching her blood sugar's bounce around too much. And I'm like, I don't want to change her insulin because if I put her insulin back, she's going to stop taking the ozempic, right? And I get a text, maybe a couple hours later. I haven't taken that injection yet. And I said, Okay, what's the plan? And she said, Do I have to? And I said, Yes. And she said, Kay, and I said, Do you want me to call you and I never heard from her again. And about an hour and a half later, we get this video of her like in her dorm room giving herself this ozempic injection. Oh, and she's so happy for her. Oh, I was thrilled for I really was and she's FaceTiming with one of her like longtime best friends and I can hear the background. She's like a hard you can do it. You're a groundbreaker. Let's go like at artists like why? She goes, she goes you're a groundbreaker. You're shooting those epic in your dorm room, you're like a Kardashian. Assuming that this girl thinks the Kardashians are using a GOP and and so anyway, like there's this funny conversation going on, she puts it in. But the moment of elation after it's like she put the needle in and I heard her go, it's in. She almost said it like she was surprised. And then you saw on her face her go, I have to push the button, and she pushed the button. And then she's supposed to count the 10 afterwards. And she's like, 123456 good enough, and she took it out for her. But anyway, that's its thing. I think that most people, if you told most people that know, Arden wouldn't believe that. Anytime you tell a doctor, like when she goes to the dentist, you're like, look, you know, you might have to put her into a trance to take out this cavity. The doctors will always say the same thing. But she has type one diabetes. As if you having type one means you couldn't possibly have a

Libby 17:55
phobia. That's ridiculous. You must not be afraid of needles anymore. No, that's not how

Scott Benner 17:58
that works. If I'm yeah, anyway, so But my point of that whole story is I think we did in some way or another exactly what happened to you, we put you into a situation where it was literally sink or swim. You had to do it. Right. Yeah. Well,

Libby 18:12
it was funny. Speaking of people not believing that, you know, that wouldn't happen when the camp counselors, you know, my my grandfather ended up passing away while I was at camp, and my mom had called to say, Should we take her out? And then the counselor was like, oh, no, she's doing great. She's doing her own injections. And this that my mother was like, hold up. Wait, wait a minute. She did what? Like, yeah, she's doing her injections twice a day. It's almost like she wasn't doing that when we dropped her off a couple days ago. They're like, well, she's doing great. So excellent. Yeah, Camp camp is 1,000% recommended by me and probably any other person that's gone to diabetes camp. For anybody Yeah. I wish they had diabetes camp for adults because I would go

Scott Benner 18:54
they have some stuff. Have you ever connected emotion does something for adults. I

Libby 18:57
saw them Yeah, I think they're only in Canada, though. In Michigan.

Scott Benner 19:01
There's one in Michigan I know of. There's one in Toronto. I'm not sure where else and Steven who's a group expert in the Facebook group. I think he's involved with a pretty big adult group in California somewhere there must they must exist as my point. Oh, I'm

Libby 19:17
sure they do. Oh, I just have to do some research.

Scott Benner 19:19
So okay, so you experienced burnout for the first time in high school? It's I'm not injecting I'm not even looking at what I'm doing your blood sugar's get very high. Do you give yourself insulin at some point during every day? Or do you let it go days? Well,

Libby 19:33
at that point, yes, I was doing my own injections and I would you know, my parents would help me dose because I was on I think it was still unregular and NPH. Back then I would have a breakfast injection and a dinner injection and then when it bedtime. So my mom would help me figure out okay, well, we're having chicken and rice and a baked potato. We're gonna have this many, you know, carbs, you know, dose for that. So, you know, she would, you know, be in one side of the kitchen and I would be at the kitchen table doing my end insulin shot. And you know, she wouldn't be actively watching me do it, but she would just kind of be in the room, she would see I had all this stuff out. But she wouldn't like I wouldn't give her the needle to double check that I was giving the right dose, okay, so I would consistently under dose, or I would intentionally overdose by like one or two units, not a ton. So I could be like, Oops, I'm low. Now I have to eat a whole package of cookies, my bad, you know, like, you know, intentionally, you know, shooting myself in the foot, so to speak. I knew, you know, moving on when I was an adult living on my own. I had a live in boyfriend at the time. And he knew about my diabetes, obviously, but he wasn't like, super into it. He wasn't like, actively helping me with my care. Yeah. So it was all on me. And I knew if I, you know what I want to burn out, same things happen, I would under dose or overdose, just, you know, deal with it later with my mentality, just deal with it later. And me and this boyfriend about getting married, he's in the military. So we moved down here to Virginia, where I have no family, I have like, I barely just made some friends. And I could see myself approaching burnout again, because I was overwhelmed with my husband being deployed, I was in a new location, I didn't have any really big support system. With me here physically. There was just a lot going on. And I was like, I can't take care of diabetes right now, like other stuff is taken more important in my brain than diabetes, when it really shouldn't. So a coworker of mine was like, You need to go to therapy. And I'm like, Alright, in therapy, I'm fine. You know,

Scott Benner 21:31
I'm gonna pray to my brother.

Libby 21:35
I'm great. I don't need therapy. I'm like, What's therapy going to do? For me? I have diabetes, only you need an endocrinologist. And that's it. That was kind of my mentality. She was like, no, no, you seem really stressed out. The therapist I've been seeing for X amount of years, she's really great. Call her up. So that's what I did. I called up this therapist, I looked on her website, just you know, check her credentials and all that. And, you know, I was like, alright, I'll call them. See y'all go sit with her for a meeting or whatever, and see if it's something that she can help me with, because I'm thinking, this practitioner knows nothing about diabetes, she knows has nothing on her website about treating diabetics or people with any sort of metabolic disorder, she is very much like a wellness coach more than a counselor, right? So I was like, she's not gonna be able to help me. Whatever. I call make the appointment, I go in, and I meet with her, she seems like a nice lady. And I sit down, she goes, Okay, so tell me about yourself. Why are you here? And I broke down. And she's like, like, I was like, ugly crying the whole night. And she says, Okay, well, what's going on, and I was like, I have diabetes, it's so incredibly overwhelming. There's literally no way for you to, to explain it, if you don't already have it. And I think a lot of people will understand me when I say that, of course, there are so many things. And now of course, I've seen I've been seeing this practitioner for 1012 years now. And I started seeing her I went twice a week, every single week for months. And every single time I would go in there and crying. She's like, Okay, we're gonna break it down. What's the main thing that's giving you anxiety today? You know, not even tomorrow, or last week or next week? What's doing it right now? You know? And that kind of really helped me in a kind of obscure way to focus on what's going on right now that I can fix or work on? Or what do I have control of in this situation immediately right now? Not thinking about an hour from now or a day from now? Just what now? Yeah.

Scott Benner 23:24
Were you able to accomplish that? Yes, going to therapy

Libby 23:27
has been so overwhelmingly helpful for me. And again, going in remember, I didn't think she could help me because she knew nothing about diabetes. She even told me herself. I don't know anything about diabetes, or I've never had a diabetic patient. And I'm like, great, this is gonna go fantastically. Like she found

Scott Benner 23:44
out me. I'm sorry, let me say you've got you found out that your problems were about something that's more central. And the diabetes was the thing bringing it to the surface. Yeah.

Libby 23:55
So you could say that yeah, the diabetes was kind of like the catalyst to all of the other things. And diabetes was kind of like the the bullet point that I was like, This is why I'm here. diabetes. Yeah. And she kind of saw through that probably immediately that it's not just the diabetes, there's other things on the peripheral that are impacting that because you know, when you get stressed your blood sugar's go high, when you get you know, overworked in your schedule, you don't have time to eat your blood sugar's go low, you know, everything affects your diabetes, and I wasn't even looking at it as that broad picture. I was just so overwhelmed with having to do my insulin shot, change my pump, make sure my prescriptions were up to date, making sure I had enough snacks in the car, making sure I had enough juice with me making sure my friends knew where my glucagon was. Make, you know, all of these things. Yeah,

Scott Benner 24:38
your coping skills weren't there for that stuff.

Libby 24:40
I didn't have any. You could be fair to say I had no coping skills. Because I was never taught any that wasn't a thing to be taught at my diagnosis, or even through all of the practitioners I had seen. None of my educators talked about coping skills. They talked about how to take care of your diabetes, but not how to cope with living with it and Those are two different things. Yeah, it'd be I

Scott Benner 25:01
think it's funny to say, not funny. Haha. But I think it's funny. It's funny to say I wasn't taught coping skills because I think of it more like, between whoever someone's parents are, and the experiences that the person goes through. You were never put in to moments, situations experiences where something happened, and then a learned person guided you through it, right? Because that's what teaching it is. It's you don't I think it's possible people could think, oh, yeah, I probably should sit my eight year old down and teach them coping skills. It's not

Libby 25:37
even on that level. The household that I grew up with as fantastic as it was, you know, a very nuclear family. My dad had severe anxiety and depression on diagnosed, you know, he holidays were a mess in my house, like leave dad alone. He's having his Jack and his Jack Daniels and whatever else watching football, nobody go in that room, just leave them alone. And then my mom would be anxious and stressed because she's having to post everybody coming into the house. So coping skills for me was like, get totally freaked out. And either internalize it or ignore it, compartmentalize it

Scott Benner 26:11
and any stress aid to is that right? Yes, yeah. 1,000% with diabetes, and then that puts that whole chain of events into Oh, yeah,

Libby 26:19
it's a whole bunch of good stuff.

Scott Benner 26:20
That's something I mean, it's it's very obvious, right? Like it just it's how you're looking

Libby 26:25
back on it. Now. It is 1,000% obvious. And I like, if I hadn't got if I had gone to a different practitioner, things could have been different or not. I don't know. I couldn't tell you. I've only been to this one practitioner. Well,

Scott Benner 26:37
also, Libby. I'm not. This isn't me throwing your parents under the bus. I think it's just an obvious reflection of the conversation. But I don't imagine that your dad with his own anxiety and everything. Heard that you had type one diabetes and thought, Oh, I could definitely handle this. Oh, no,

Libby 26:51
he definitely didn't. The first time that he had to try to give me a shot. He broke down in tears. Yeah, that's not helpful because he didn't want to hurt me. And I'm like, Why is dad crying? Now I'm gonna cry. And then my mom got upset because my dad was crying. And he needs to be like, focused and serious about it. And the nurse had to like, shuffle my mom out of the room. So mom wasn't causing more stress and anxiety on my dad. And it was it was a hot mess.

Scott Benner 27:12
Maybe it took you about five to six minutes to get your microphone set up when we should have been recording. So our episode is going to be a little shorter. But I bring it up only because in that time, you apologize to me a half a dozen times. Yeah,

Libby 27:23
that's yeah, that's been a long term lifelong. thing. I over apologize for a lot.

Scott Benner 27:28
Yeah. No, actually, it's funny. I hadn't opened up your show notes, you then the notes that you sent people like here's what you said, I actually signed up to do an interview for mental health seeking counseling due to anxiety stress due to T one D? Well, you put some more in here, but I hadn't looked at that yet. While we were setting up. And the second time you apologize. I said, Oh, this is going to be about anxiety.

Libby 27:50
What gives it away? I'm

Scott Benner 27:52
thinking What are you sorry for? And you're like, it's um, you didn't say, Oh, I guess this happens to everybody. You said I'm sorry. Again. I was like, okay, she's now apologizing. Because I asked her why she was apologizing. It's just it's very natural. So my point is, if your father had all that going on, he's like, What do I say that I'm sure he loves you. So he's like, What do I say to help her? This is your disease, you're gonna take care of yourself. And your mom, here's your dad say that and go okay, those are the marching orders. That's what we're doing. And by the way, she's over here rowing the boat on both sides. It sounds like so like, she doesn't have time for your your diabetes. She's been she's keeping you, your father, her your household and any other brothers and sisters you might have. It's on heart, right? And so she she does the same thing. Which sounds by the way, on its surface, it's your disease, you need to learn to take care of it. It seems like a very reasonable thing to say.

Libby 28:44
Right? And it's not unreasonable to say to somebody, you need to learn how to carry yourself, but it's like the way it's said and how it's received. I think people internalize that completely differently. Also,

Scott Benner 28:57
it's in the 90s So yeah, where are you going to go? Where are you? Where are you going to the library to figure this out?

Libby 29:04
It's funny because my educator that we had was this fantastic educator she was super blonde like to the point did not have any time for being around or you know, screwing around. She's like you have diabetes now your pancreas doesn't make insulin this does this this does this you need insulin shots for this this and this and she drew little pictures on these handouts. That must have been from like the 70s and that was that was our Bible that was our go to like my even the food that I had my my daily like nutrition plan was you know, I could have two breads at breakfast one fruit one fat and one free food and I'm nobody knows what that is anymore. Also good carbs now. Also

Scott Benner 29:47
that to your parents was figuring it out? Yeah. Because

Libby 29:51
we as a family had to figure out a lot and it was so stressful on everybody.

Scott Benner 29:56
If back then I know the 90s doesn't Sounds like it's that long ago. But for diabetes, it really was, you know, if back then the idea was, you know, you're on the exchange diet, and then you do the math, or something or not even math, you do the amount of injections that the doctor told you, none of that means that you were doing well. Right? It doesn't mean anything, it doesn't mean that your blood sugars aren't vacillating all over the place that you're not by the way, your anxiety is not being, you know, pushed up by that, or just the knowledge of I feel high, or I feel low, or I don't know what I'm doing, or I don't feel like doing this or whatever. All that stuff to your parents doesn't look real because you, you know, they think you're injecting when you're supposed to. And that's all you're supposed to be doing now that you move forward 30 years. And we all have these monitors, and we know what's going on. And you realize that you weren't really addressing 10% of what you needed to look into. You know, so it's not throwing your parents under the bus, they were doing exactly what they thought, and they were protecting their own selves. Because if your dad jumps out of window, he can't pay for the house. So like, you know, like, that's what's going on, really. And then obviously, the anxiety thing is passed to you. Do you believe it was? Oh,

Libby 31:06
100%. I mean, that's what I grew up around. That was my learned coping skill was to be anxious about things. And I didn't even have a word for it. Until I got to therapy at all those i My late 20s, early 30s. I knew what anxiety was, but I was like, Oh, those symptoms aren't me, I don't have anxiety. And it wasn't until I was describing, like my daily routine to this new therapist. She was like, um, sounds like you're pretty anxious about a lot of things all the time. And I'm like, am I bro? And she was like, Well, yeah, you, you know, you always have to carry around your mom purse that you call it with all your snacks and your low treatments and your extra insulin and your extra insulin pump supplies and your blood sugar kids and this. And she's like, you have a physical manifestation of your anxiety in your purse that you carry with you everywhere. And I'm like, dang it, she does know. But let

Scott Benner 31:57
me that's interesting. Because you do need to carry those things with you. So what but is there a way to do it without it making you feel anxious that you're doing it? Right,

Libby 32:05
it got to the point where, like, my anxiety got so bad that I felt I couldn't go anywhere without my bag. Oh, I see. And so it's not that my bag was a safety net, or, or you know, a safety blanket. And that was because if something happens to me, nobody's going to know what to do. So it's like, not only me not only didn't have trust in being able to handle myself, but I didn't have trust in anybody else to be able to handle me if I had an emergency.

Scott Benner 32:32
See, the problem is let me that's all very realistic. So I know. But but the key is, is to live in it better, right? Yeah.

Libby 32:41
So now I've gotten to the point where it's like, okay, I know I can go out and run six errands and just bring my wallet with me and I'm fine. I know. I will be okay. Do you have a juice in your car? Something? Oh, yeah, I have tons of stuff in my car. And now I also have a sensor. You know, when I started going to therapy, I didn't have a CGM. So I had no idea what my friends were doing. I had no idea other than how I physically felt no idea. If I was going high if I was going low, if I you know, also,

Scott Benner 33:09
you're wearing the control IQ. Yes. Which did not exist back then. Right. But let me ask you about it. Now because Arden's, you know, where's an algorithm? And it's my finding generally that for my daughter that if her settings are very good, and we're doing the things that we know to do, even if she tries to get low, the algorithm does a pretty good job of at least stopping it by 50. Yeah, as a blood sugar and that there's some comfort in that, first of all, to know that there'll be beeping beforehand, and that even if it gets low, the likelihood of like, Hey, I'm going over low is much lesser with these, these technologies.

Libby 33:47
Yes, it took me a long time to get used to the algorithm. Because prior to my tandem pump, I was on an animus pump. And before that I was on the Omni pod like the original Omni pod. Yeah. And before that, back in the early 2000s, I was on a Medtronic mini med five oh, wait, which may be a handful of your, the the folks that

Scott Benner 34:07
listen to mini med stone they know. You know, what's your you know, which one's not mentioned as much anymore. That used to be all the time animus ping?

Libby 34:15
Oh, I have a friend that was on that she was so mad that they were

Scott Benner 34:18
all went out of business when it went out of business. But I don't hear people mentioned as much anymore. So anyway,

Libby 34:24
so going on. I mean, when I started taking them, I went on the Basal IQ. And I was like, Oh, this is pretty cool. And when they dropped the info about the control IQ, I was like, Okay, that seems pretty cool. I want to try it. So I think I applied to be in their Beta Test Program, and they put me in it. And it took me a very long time to trust that this system would work how I needed it to work. Like I don't feel for a long time. I didn't feel comfortable with an overnight low at 120. Like a low threshold. I was more comfortable with a low threshold at like 150 and My reasoning behind that is because I actually had a severe low while I was sleeping in where I needed to have glucagon. So I tend to prefer to be a little bit higher. And for me 150 Is not that high. So when I saw that the tandem pump for the sleep mode, at least, you know, it raises your, your low threshold to I think it's 110 or 120. And I was like, that feels really, really low to me. But I'll try it. And it's, it's fine. Now, I do not have any lows overnight. And if I do, it's because I dose too much Bolus at dinner for meals though. Yeah, for meals. And that is a clear reason this is you went low because you gave 40 units of insulin instead of 20. Or whatever the case is, you know,

Scott Benner 35:42
did you end up dealing with the stress eating? Have you gotten that into a place where you're happy about how it works? Yes,

Libby 35:48
I mean, I still do it from time to time, but it's not nearly as bad as it used to be. Now I kind of sit down before I kind of look at my pantry. I want to eat this and this. Am I eating because I'm hungry? Or am I eating because I'm bored? Or I'm stressed? Or I'm sad? Like, why do I want to go in my pantry or my fridge or my freezer to grab whatever it is? Yeah. And I've caught myself now I've had to teach myself to stop and think about what I'm doing. Because for me a lot of the times it was just automatic, go grab something and eat it. Not even look at what it is just grab something. Yeah. And now I'll be like, Okay, if I want to eat something, like if I know I'm eating because I'm bored. Okay? Well, maybe instead of eating, you know, a bunch of Triscuits and cheese, maybe just have some carrots because those are a little bit more healthier than Trotskyist and cheese or, you know, a doughnut or whatever. So I'm still like, feeding that craving of being bored and hungry. But I'm giving it a better option, if that makes sense. So it happens

Scott Benner 36:46
listen, I'm I use zip bound for weight loss I was using we go Vietnamese except bound. I had plateaued on we go V and in the middle of the fourth quarter of watching the Philadelphia Eagles. Absolutely. The bed last night, I grabbed a handful of potato chips that were in my house. I don't even like there was salt and vinegar that not something I even particularly enjoy. And I picked I had a couple and then it hit me. I was like, What am I doing? You know, like I was like I don't and I rolled the bag back up and I put it back in the thing. But I think I was able to do that. Because that craving feeling. And the satisfaction that comes from food doesn't exist as much on those GLP medications. And so like I was able to have a couple of them and go what am I doing this is stupid, then I put it back. But it was like a knee jerk reaction. I wasn't paying quite attention to what I was thinking or what I was doing. There was a commercial, I got up, I took a you know, a lap around the kitchen. And I was like, I grabbed this food. And I was like, I don't even want this. So I know I know how you feel. And jeez, Well, I'm glad you worked on it. Did it ever impact your weight?

Libby 37:53
I don't personally think it has my weights pretty plateau like pretty, you know, within five pounds it stay pretty standard or what I guess? No, when I was seeing my pediatric endocrinologist, he, I remember he sat down with me and my mom at one clinic appointment. He's like, I don't think your blood sugars are matching what your food blocks are showing me and I'm like, Oh, you're a GM. So he, you know, had a very frank conversation with my mom and I about both of our eating habits. Because you know, you learn from your parents. And my mom admits she's like, Yeah, I go throughout the day, and I'll grab some chips or some crackers, or, you know, whatever, just hanging around. And while she's vacuuming or doing laundry, she'll have a handful of chips and crackers. He's like, Oh, so you guys are just a family of grazers. And I was like, Okay, I like that being called a grazer, instead of you know, a fat kid, or you need to lose weight or so my pediatric endocrinologist didn't necessarily like, shame me, per se for eating so much, which may be a good or a bad thing. But it was you know, as I got older, it's like, you know, you might want to start looking at, you know, losing a couple pounds. Of course, the doctors are always trying to be very, you know, kind about how they say that, especially to a female. And so that is always on my mind. But I certainly know as the years have gone by, with me getting these tools from my therapist about managing my anxiety and my stress and stuff that mice just random grazing eating has lessened quite a bit. Yeah. Which is good. I mean, it's it's good to be aware of that. That's a problem spot. Cuz a lot of people don't notice it.

Scott Benner 39:25
Yeah, so you think yours is more psychological than physiological? Definitely. The physiological

Libby 39:31
one is for my lows for that when I have a low I feel like I'm dying if I don't eat everything, but I think that's pretty standard across the board for most diabetics.

Scott Benner 39:38
Yeah. How low do you have to get before you feel that way?

Libby 39:41
I actually start feeling my lows pretty high. I feel them around like 80 or 75. And then I'm like, okay, the algorithm is gonna kick in, it will turn my basil off, I'll be fine. And the next time I look at it, and it's 65 and I'm like, Oh my God, I need to eat everything.

Scott Benner 39:56
Does that feeling is it the number that makes you think that or is that the physical feeling? It's

Libby 40:01
different every time honestly, like, sometimes my low symptoms are super, super intense. And I will feel like I don't have a brain in my head. And the only thing that I'm laser focused on is getting food in my mouth. Yeah, doesn't matter what it is. And other times in my life, I'm like, I can you some crackers, I'll be fine. So it's so weird. I'm sure other people have that similar, you know, thing happened, but I it's like, there's no consistency to if I'm 65 my symptoms will always be this and I will always feel this way. Right. It's I've never noticed it to be consistent. Every, you know, back to back.

Scott Benner 40:35
Okay. All right. Yeah. I mean, I would wonder it's hard in that moment. But if it says 65, but you have that, that crushed feeling like I have to, I wonder if a finger stick wouldn't tell you were lower. Yeah, that's, that was just all I was wondering. Right. Okay, I want to keep going. Because you're short on time. You're gonna do a doctor's appointment today. So we have to have to get you moving. You listen to the podcast. I

Libby 40:56
have a couple of times, my friend actually recommended she had one of her her podcasts recorded a while ago. And I guess she just shared it with me like a month or so ago. And she's like, Hey, listen to this. I'm like, Oh, he's not Oh, I'd

Scott Benner 41:08
like to do this, too.

Libby 41:09
I think I had heard about the Juicebox Podcast, but I'm not a big podcaster to start with. So I was like, Oh, I think I've heard of this. And then I was like, oh, there's a Facebook group. There's so many things. Are you in the group? I am in the lobby,

Scott Benner 41:20
by the way not to call you out. But I'm the podcast or you're the podcast listener? Yeah, you want to know something I won't go deep into but I know for certain. I've created a lot of new podcast listeners. There are a lot of people listening to this, that if they open up their podcast app, it's basically a Juicebox Podcast app, and there's nothing else in there. I do think I found a group of people who otherwise would not have been listening. Right? Well,

Libby 41:45
I mean, honestly, there's not a lot of support, at least from my perspective, I have not seen a lot of support, in general, for type ones doesn't matter if you're a pediatric patient, an adult patient a long time or that's been in, you know, diabetes land for 50 plus years. Sure. There's your clinic, but there's so little support out there. Yeah. And so having it in a podcast or a Facebook group, or, you know, if you're lucky enough to be in an area that has an in person meeting, you are so blessed. Yeah,

Scott Benner 42:15
you just don't know, right? It's just you really don't know. It's one of those things that when you need it, it needs to be there.

Libby 42:19
Yes, exactly. And I honestly wish that all this stuff had been around when I was a kid, specifically when I was a teenager, because I was the only diabetic. In my middle school. I was one of two diabetics in my high school. I was the only diabetic and my college until my senior year when there was another girl who was on a pump showed up. The few friends that I have that are type ones are from camp, and I love them. They know who they are. And I love them desperately.

Scott Benner 42:43
I hear that story all the time. Well, hopefully, you'll meet people online that are valuable. And you can be valuable for them as well.

Libby 42:50
I hope so.

Scott Benner 42:50
Yeah. No, I hope so too. i The group is fantastic. I actually, I'm very proud of it. And it's unexpected. From my perspective, though, how well it helps people I didn't I just I never thought it would. I mean, I just I did it because people asked, you know, they were like, can we have a Facebook group to talk about the podcast. And by the way, the bliss of what they do in there is talk about the podcast. It's pretty funny. But it's cool. It's just grown. It's got already, I think it's almost a 46,000 members. And then by the time it'll go, yeah. And by the time this comes out, you check it, it'll be like 50,000, you'll be like, Oh, he said, 46 in the pocket, but it just grows crazy. 150 people every four days, just keeps adding and adding and adding. But anyway, I'm glad your friend shared the show with you. What else should we be talking about? That we're I'm speeding you up? Because you you're short on time, is there anything we're missing totally

Libby 43:38
fine. I did want to mention one big thing that my counselor therapist gave me to clue in about my anxiety, and I'm sure it will be helpful for others. Take it if you want it and if not just leave it there. And she's like, you know, when you have anxiety, you're thinking about something happening in the future. And when that thing actually happens, you're concerned about it doubly, because you've already worried yourself over at once. Now in the past, and now you're worrying about it again, when it's in front of you. So here's a perfect example on a few random occasions where I have to do MDI, you know, multiple injections because my pump broke or I'm taking a pump vacation, whatever. I have to psych myself up to do my injections. Now that anxiety might be an hour ahead of my injection or it might be the whole day before my injection but putting myself through that anxiety but worried about oh I got to do the shot I have to do this needle I have to do this this that no, it's making me anxious whatever. Putting myself through that anxiety before even have to do the thing is making me go through it twice. Because as soon as I have to start getting my my vials ready to get my insulin in the syringe. I've got anxiety there already. You know it's there at the table with the vials of insulin. Yeah. So I've already wasted so much energy getting anxious about this thing that's happening in the future. Why would I Why am I Doing that, why am I wasting that energy, that precious energy to me that is already taken up by all the technology and all of the monitoring the beeps, the sounds everything. Why am I spending all this energy, getting anxious over something I know is either definitely going to happen, or I don't know is definitely going to happen. And I think that second thing is really, really hard for a lot of people to kind of internalize or understand. Because, you know, thinking in the future, we don't know if our kids in a year, five years, 10 years, 15 years, if they're going to be without complications due to their diabetes. Yeah. And I think a lot of people feel guilt if their kid has a consistently higher a one C or if they are running all over the roadmap on any particular day. And what I have to say to that is, as a diabetic that is for quote, unquote, normal, you know, like to have a completely straight line or line with very little hills and bumps in it. I wish I could have that. I so wish

Scott Benner 46:02
me if you would, what's your one say?

Libby 46:04
My last one was 6.6. That's not bad. What about that? No. And for a long, long time, I was stuck at 8.8. And my highest a one C, I think back when I was a teenager was like 11 or 12?

Scott Benner 46:19
Let me say this to you. Try the Pro Tip series in the Podcast, episode 1002 1026. Just listen to those. And then send me an email in six months, when you tell me your agency's 6.1 I'll have to do that. It's just little like you because I don't think about diabetes, like do this do that I think of it as tools that you just know when to pull out. So you don't have to think about them. And I think that for somebody like you've had type one for 30 years, first of all a 6.6 is insanely good.

Libby 46:51
I know it's It surprises me every time I get that result back. I'm like, How was this possible?

Scott Benner 46:56
And everything you said I was nodding along with, right until you said, but this is how diabetes is. Because if you really know how to use the insulin, and your settings are very rock solid. It's not like that for everybody. Right? Well, everybody's

Libby 47:10
different. You know, and they are

Scott Benner 47:12
in Libya. I'm not arguing with you that everybody's different. But there is a lot to that everyone's different. And that's just diabetes, that feeling it's a lot more about using insulin at the right time. Like I take your greater point, there are spikes, and you'll get higher blood sugars that stick for a while. And that is part of the game, you just you know, I don't think unless you're gonna eat a very ultra low carb lifestyle that you're going to see, you know, a stable 80 to 100 your whole day. Right. Right. I do know that your point. But I get concerned when people hear that that what they think is Oh, spikes are okay. And then they'll see one at 200 years ago. This is okay. Someone totally is okay. And it's okay. If it's certainly

Libby 47:53
not condone that. I mean, yeah, I've sometimes looked at other people's ranges, and like my range of 70 to 120. And like, that's really, really tight. Like, how do you have the time to manage that?

Scott Benner 48:02
So Libby, my daughter's range on my phone is 70 to 120. On her phone, it's 70 to 130. And we don't think about diabetes hardly at all. Yeah. And I'm telling you, it's just the stuff that's in that Pro Tip series.

Libby 48:16
Right. And I'm sure it also could be because you know, 20, this is what I was taught 20 years ago. So this is my, this is my baseline, from what I learned back in the dark ages of no technology, no tools, nothing, you know, two different kinds of insulin that don't even exist anymore.

Scott Benner 48:31
I'd be super insulin interested to hear back from you. If you did listen to that. Yeah, I'll do that. And trust me, it's not like a It's not like you're going to take a test or you know, sometimes just listen to the podcast, when you get a chance and listen to those episodes, start at episode 1000. You'll see them there. And you know, tell me if five you know, a couple months later, it's not it's not different for you? And if it isn't great. Tell me that too. But send me an email and let me know. I'd love to hear.

Libby 48:56
I could certainly do that. Yeah, no, I

Scott Benner 48:57
think I think it would be an interesting experiment. Because you are, you do know what you're doing. And you are doing a great job. And yet, you still have some of the older Oh, you're very welcome. But you still have some of the older thoughts in

Libby 49:09
your head. Oh, definitely. And I don't deny that not even a little bit.

Scott Benner 49:13
I think I could push those thoughts out of your head. Actually, if I if you were my kid would be, which would be weird, because I would have had you when I was 11. But if you were Can you imagine me? Just this lovely little 11 year old out there. I don't see it. I don't say it. But if you were my kid, I would have taught you that worry is a waste of imagination. Oh, and I agree with you. 100%. And that would have been good for you to know, especially because that whole thing you talked about about what your therapist told you. You're not wrong. Hmm, you had to go to a professional to get something that I told my kid, right? Yeah, that when you worry about something, you are literally making up a story about something that may or may not ever happen, and that nothing we do today changes whether or not that thing happens later. I'll tell you where I feel bad for people. The day He's prepping. Oh, yeah, we're there. I actually saw somebody the other day say I have been stockpiling our insulin for when things get upside down. That used to be me. Yeah, yeah. Let me tell you something. If things get that upside down, we're all dead, not just because you have diabetes. 100%. Don't worry about it. You just you'll just go a couple of months earlier. So have yet like, like, yeah, and by the way, the world has been here a really long time. And everything's not falling apart. And when it does, if it does, you're not stopping it. Yeah. And you'll never put aside enough needles and pens and insulin and every you just won't. This is a fact of life. But instead of being upset by that, I embrace it. I'm like,

Libby 50:42
like, the SOC s, as the army says,

Scott Benner 50:45
My daughter came to me one time, this is years ago. And we were talking, I think it's probably back when zombie television shows were very, like, popular. And she goes, Hey, if this really happened, what happens to me? And I turned to her, and I said, You'll be dead pretty quick. And she's like, Yeah, right. And I was like, Well, I said, in honesty, we'd over hydrate you if we could we give you an ultra low carb existence. But I mean, it seems like we'd probably all be on an ultra low carb existence, because no food and everything. I'm like, but we'd keep you very low carb, we'd manage you like it was before 1922. And we'd see how long we could keep you going. I'm like, but yeah, I don't know are, you know, month? Two, maybe, you know, and she found the knowledge freeing, not like, because, by the way, because zombies aren't coming. But she found the knowledge freeing, she's like, okay, that's how I learn. I'm like, and I'll be dead. Three days later, I'll be sad. You're gone. I'll forget the zig and zag zombie will chew on my arm. And I'll be right behind you. Don't worry about it. And I said, but I won't let you turn into a zombie. And she was thanks. Anyway, that worry is a waste of imagination. Really diagnose those words, pull them apart and really feel what they mean. You are imagining something going wrong. It is not. So it's not something that's absolutely going to happen. And you're trying to prepare for it. Yeah. And

Libby 52:10
what you think about you bring about so if you only want good positive things to come about in your life, that's what you got to think about. Think about fantastic blood sugars or a cure eventually, Lord, help God, I hope so.

Scott Benner 52:23
Livia, you and I would have gotten along really? Well. You know what I usually say to people, you get what you expect. Generally speaking, that is true. So, yeah, but you learned all these things from a therapist. I could have told you, if you would have come here and hung out for a living. That's okay. I really appreciate you doing this through Oh, you share what kind of doctor's appointment you're going on? Or is it not diabetes related? Actually,

Libby 52:46
it's not diabetes related, but I don't mind sharing if anybody cares. Let's see, maybe it's something fun. What is it? I'm actually going to see a genetic counselor, because due to my mom's breast cancer she had back in 2009. I'm considered high risk. Okay. So the genetic counselor, I'm assuming it's going to tell me you know, what sort of markers that I might have in my body or might not. And I also want to ask him if I have the markers for getting diabetes, because that's something that's always been

Scott Benner 53:14
very, no one's ever given you a C peptide. Oh, I've

Libby 53:17
gotten that before. The last one I got was years ago. And I was like, You got zero C peptides and like, fantastic. I'm

Scott Benner 53:22
sure you I mean, you're type one you you. I'm gonna guess you're gonna have them. Good luck. Good luck. Get your insurance to cover that, by the way. Yeah, we'll see. But oh, by the way, good for you doing this? Yeah, it's a brave thing to do and proactive. And I think it's terrific. My mom

Libby 53:39
is a very brave woman, and she went through hell. And I hope that I don't have to go through what she did. So if I can do anything to keep that from happening, I will do

Scott Benner 53:47
it. My mom passed away recently from cancer. And you I'm so sorry. No, no, I appreciate that. You. You don't want to answer if you can avoid it, that's for sure. Yeah. Well, I appreciate this very much. We didn't get to dig into all the fun things. This would have been so much more fun if we had more time. Like when you said my boyfriend who was my husband, I was like, Oh, I'd love to hear about that. But we didn't have time.

Libby 54:05
Well, I think what I'd be happy to do another podcast with you. If you wanted. Libby, raise

Scott Benner 54:09
your right hand to God, the one who's gonna save you and you pray to him and tell him that you're going to listen to the Pro Tip series, then live your life for three months, then send me an email. I will do that and then we'll get you back on. Sounds great. Libby. I really enjoyed it. I really enjoyed you have a great day. All right. Thanks, you too, Scott. Bye.

Today's episode of The Juicebox Podcast is sponsored by the Dexcom g7 Which now integrates with a tandem T slim x two system. Learn more and get started today at dexcom.com/juicebox. A huge thanks to Omni pod. Not just my longest sponsor, but my first one Omni pod.com/juicebox If you love the podcast, and you love to Bolus insulin pumps, this link is for you omnipod.com/juice box. 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 are a loved one was just diagnosed with type one diabetes, and you're looking for some fresh perspective. The bowl beginning series from the Juicebox Podcast is a terrific place to start. That series is with myself and Jenny Smith. Jenny is a CDC es a registered dietician and a type one for over 35 years. And in the bowl beginning series Jenny and I are going to answer the questions that most people have after a type one diabetes diagnosis. The series begins at episode 698. In your podcast player, where you can go to juicebox podcast.com and click on bold beginnings in the menu. 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