Scott Benner 7/11/24 Scott Benner 7/11/24

#1250 Resilience: Connection, Critical Awareness, and Hope

Psychological Impacts of Diabetes with Erika Forsyth, MFT, LMFT

Erica Forsythe discusses trauma and resilience in diabetes management. They explore the importance of connection, vulnerability, and critical awareness in overcoming adversity. Offers valuable insights and practical advice for those living with diabetes.

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

Scott Benner 0:00
Hello friends and welcome to episode 1250 of the Juicebox Podcast.

For those of you who have been enjoying the resilience series, this is the fourth and final part. And if you're just tripping over now go back there's three other parts. This is resilience in four parts with Erica Forsythe, Licensed Marriage and Family Therapist in person with type one diabetes. Check out Erica at Erica forsythe.com. I know that Facebook has a bad reputation. But please give the private Facebook group for the Juicebox Podcast. A healthy once over Juicebox Podcast type one diabetes. The group now has 47,000 members in it, it gets 150 new members a day, just 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.

Touched by type one.org touched by type one is sponsoring this episode of The Juicebox Podcast and I'm going to be speaking at their big in person event in Orlando, Florida coming up very soon. There are still tickets available. They're absolutely free. It's a wonderful event touched by type one.org. Go to the program's tab and get yourself your free tickets. This episode of The Juicebox Podcast is sponsored by the ever since CGM. And sure all CGM systems use Transcutaneous sensors that are inserted into the skin and lasts seven to 14 days. But the Eversense sensor is inserted completely under the skin lasting six months ever since cgm.com/juicebox. This episode of The Juicebox Podcast is sponsored by the contour next gen blood glucose meter, learn more and get started today at contour next one.com/juicebox. Erica, we're back. This is the fourth part of our resilience series. You and I were just talking Off mic a little bit about this first little bit is is it going to stay here in this episode? Are we going to put it in the end of the third one? So let's get started and just see how it all flows first. Yes, that

Erika Forsyth, MFT, LMFT 2:43
sounds great. Okay.

Scott Benner 2:45
Why did you say that? Like what what about this part that's coming up made you go? Ooh, should this have been in the third one?

Erika Forsyth, MFT, LMFT 2:51
Great. That's good question. Yeah, I think because in our last episode, and the previous episode that we recorded, we were reviewing kind of the different layers, so to speak of trauma, whether it was a first, you know, a one event capital T trauma, a kind of repeated pattern of small t trauma, or were you experiencing pain as a result of doing something for the first time. And then this next part, I think we were debating whether to include it last time or not, because we had talked about a lot of different things is really thinking about that the formal diagnosis of PTSD, Post Traumatic Stress Disorder, in response to a diagnosis of diabetes or any other chronic illness. That's why I'm wondering, would it be fit better? In our previous recording

Scott Benner 3:38
session? Okay, so we'll see. Yeah, we'll jump into it. We'll see how it flows. Okay, go ahead.

Erika Forsyth, MFT, LMFT 3:42
So we have discussed and research has proven that PTSD or trauma or long term adversity does impact your systems of your body. And that does increase your risk of health issues, right, and no mental health issues physical illness and mental health issues. But if we look at that, inversely, medical diagnosis of illness or disease, and we talking about cardiovascular disease, lung disease, cancer or autoimmune diseases, obviously we know that can be traumatic and leads to true experiences of PTSD. And as I thought it would be important to recognize research that was done by Donald Edmondson in 2014. And his research showed and highlighted that an estimated 12 to 25% of people diagnosed with a life threatening illness go on to develop PTSD. And so in that category, he created what is called the enduring somatic threat model of PTSD. So ESD for short, so I thought it'd be interesting for us to kind of understand what does that mean, what does that look like and how is it different from typical PTSD Okay, yeah, okay. Okay, so here's some differences. So, PTSD results from a discrete and external event that we've talked about the war example, we've talked about, you know, whether it's an abuse or a one time rape incident or assault. So the source of that threat is external. And it's important to know that has a beginning and an end. Okay. So with the enduring somatic threat model that results from the diagnosis and treatment of a life threatening illness, such as we know, cancer, heart attack, diabetes, and the source of the threat is internal versus this external thing that happened to you one time, it's an internal somatic threat that is entering and without a definite end. So he really, through his research, recognize that kind of validating all the things that we've been talking about, that you can experience PTSD from this threat that is internal, and doesn't have an ending. So those are kind of the major differences of kind of classic PTSD versus this ESP model. Okay, should I keep going?

Scott Benner 6:08
Yeah, I Okay, I just want to make sure I understand the internal somatic threat. So I just asked our our chat GPT overlord about it. Let's see, the concept is often associated with various physical sensations or symptoms that the individual interprets as signals of a serious medical condition or health threat. Internal somatic threats can trigger anxiety, stress, fear, particularly in individuals with heightened health anxiety, or somatic symptom disorders, key aspects, physical sensations, perception of harm, physiological impact, behavioral responses, underlying conditions. Okay. I just wanted to like, give that a little more of a definition. But yeah, no,

Erika Forsyth, MFT, LMFT 6:50
that's good. So the occurrence and the time perspective is significant, right, because we have this past, present and future experience. So from the diabetes perspective, you have the diagnosis, and we talked about how that is, can be a capital T, one time event, trauma in and of itself. And then we have the past, present medical intervention, and the fear of when we talk about future recurrence that can be we often think about, like, you know, you go through cancer, you go through the treatment, you are in remission, but then you're living with this anticipation of future recurrence. But I'm also I know, this can happen with diabetes of, for example, having a seizure, right. And then you're experiencing all of these symptoms, and doing your best to prevent it. And we'll get into that a little bit more. So your experience is hyper vigilance, where we think about hyper vigilance with PTSD. And we talked about this example, in one of the previous episodes, have you hear that the boom of the motorcycle blast or a car like, what is that like backfiring, and that instantly, if you have PTSD from war combat, that sound instantly takes your mind and body back to that one time past incident of being in combat. In this E at the ESP model, the vigilance is to the internal sensation or symptom in one's body. So if we're going back to the seizure example, you start to either you see the low, you see the arrows, maybe starting to go diagonally down, you might start to feel the low symptom. And you're hyper vigilant to that. And then you start to experience the anxiety and the fear around oh my gosh, am I going to have a seizure? That also contributes to your decisions traces? Can you be alone? Can you go out in a car? Can you go to public places? Do you let yourself go below a certain number because you are near that number?

Scott Benner 8:46
I interviewed a woman the other day, who's had diabetes for like nine years. As soon as she was diagnosed as an adult, they just gave her insulin. Roy didn't tell her what she was doing with it. And this one time, she's sort of alone in our house or husbands with their kids somewhere else. She starts getting a low, you know, goes in the kitchen, eats a bunch of stuff sits on the floor is panicking sitting on the floor. She talks about it like it happened yesterday. It was like eight years ago, and she still won't try an insulin pump because what she told me was I figured out how to control this now I don't want to change anything. But what I felt like I was hearing from her was I was slightly anxious person before diabetes, but then I got it. And then this low happen, and now I am scared for anything to happen. That is not something that I feel like I'm in control of. She's in therapy trying to figure it out like consciously she understands it, but she can't make good decisions for herself. Anyway, like that seems like what you're talking about here to me. That contour next gen blood glucose meter is the meter that we use here. Arden has one with her at all times. I have one downstairs in the kitchen just in case I want to check my blood sugar and or Arden has them at school, they're everywhere that she is contour next one.com/juicebox test strips. And the meters themselves may be less expensive for you in cash out of your pocket than you're paying currently through your insurance for another meter, you can find out about that and much more my link contour next one.com/juicebox Contour makes a number of fantastic and accurate meters. And their second chance test strips are absolutely my favorite part. What does that mean? If you go to get some blood, and maybe you touch it and I don't know, stumble with your hand and like slip off and go back, it doesn't impact the quality or accuracy of the test so you can hit the blood not good enough, come back, get the rest without impacting the accuracy of the test. That's right, you can touch the blood, come back and get the rest. And you're gonna get an absolutely accurate test. I think that's important because we all stumble and fumble at times. That's not a good reason to have to waste a test trip. And with a contour. Next Gen. You won't have to contour next one.com forward slash juicebox. You're gonna get a great reading without having to be perfect. How many times have you thought it's time to change my CGM? I just changed it. And then you look and realize I got it's been 14 days already a week, week and a half. Feels like I just did this. Well, you'll never feel like that with the Eversense CGM. Because ever since is the only long term CGM with six months of real time glucose readings giving you more convenience, confidence and flexibility. So if you're one of those people who has that thought that I just did this, didn't I? Why? Well, I don't have to do this again right now. If you don't like that feeling, give Eversense a try. Because we've ever since you'll replace the sensor just once every six months via a simple in office visit. Ever since cgm.com/juice box to learn more and get started today. Would you like to take a break? Take a shower you can with ever since without wasting a sensor. don't want anybody to know for your big day. Take it off. No one asked to know have your sensor has been failing before 10 or 14 days. That won't happen with ever since? Have you ever had a sensor get torn off while you're pulling off your shirt? That won't happen with ever since. So no sensor to get knocked off. It's as discreet as you want it to be. It's incredibly accurate. And you only have to change it once every six months. Ever since cgm.com/juicebox.

Erika Forsyth, MFT, LMFT 12:37
Podcast? Yes, it's the hyper vigilance, the hyper arousal that the mood shifts the cognition around like I know, I know why I'm doing this or choosing to not do the certain thing. But the fear is keeping them paralyzed. Because you're trying to do anything you can to avoid that trauma.

Scott Benner 12:57
Oh, she told me that her husband will text during the day and ask how her blood sugar is. But he doesn't really care about her blood sugar. He cares about her mood. He attaches to how her blood sugar's doing. And it's not because if she's high, she's cloudy or if she's low, she's shaky. It's because Oh, I didn't you're actually tying together that conversation for me when this Okay, all right, I got it.

Erika Forsyth, MFT, LMFT 13:21
Right. So do I feel safe and secure? Because I'm I'm going to make up a number 150 or 200 and stable? Or am I feeling really nervous? Because I'm below a certain number, right? Yeah, those numbers are arbitrary. People who have this experience that it is really common when they have a traumatic incident around insulin and particularly low blood sugar seizures. They can't figure out why it happened. So then you're going to be super vigilant to try and protect and prevent it from happening again. The

Scott Benner 13:52
other thing she talked about, is that something Wow, where were you yesterday when I was talking to her? She was talking about the she needs to know why it's happening. It's very important to her to know why what's happening is happening. Oh, that's interesting. Okay, okay, cool. Wow, look at me. I'm learning. Yes. Yes. Go ahead.

Erika Forsyth, MFT, LMFT 14:11
What else? Okay, so, in the case of what we're calling the, or how Dr. Edmondson says, the medically caused PTSD, we're considering in terms of an ESP model avoidance not only precludes emotional integration of the trauma, so this that means like, okay, so avoiding the emotional integration meaning, okay, you starting at diagnosis, like what is this mean? I don't know, and wanting to maybe even deny what this actually means. And this is, you know, any kind of chronic illness diagnosis applies to this, to then the actual dealing with it. Right, you might go through a period of shock, denial, not quite sure what to do, how to manage Who do you tell, do you keep it to yourself? Are you including people in this journey? And also, the actual treatment, right, like you might start avoiding, because of this traumatic experience that you have, you're avoiding the doctor's appointments. You're avoiding treating, you know, kind of insulin management or any kind of medication management for the illness. Yeah. So it has this, you know, replica, we've talked about this again, but really try I'm trying to do it from this ESP model, how this can into effect your experience with your diagnosis. Okay.

Scott Benner 15:27
Yeah, I'm so interested, are you going to? Is there I don't want to read ahead. Are we going to find out that there are big things like, big T, little T in this scenario to like, Are there going to be because what I'm sitting here thinking is, I had a recent conversation with an endocrinologist and we talked a lot about how some people just don't get it, or they're not motivated, or they don't try or whatever. And I'm sitting here thinking, is that just maybe their situation did they have or upbringing? Did they have an alcoholic parent? Like, did they did they have, you know, two or three things off the ACES list? That is it a money thing is that they live in a dirty house, and they don't know where to put their stuff down? Like you don't? I mean, like, is it more? It's got to be more entailed than just I don't know, I met a guy today, two o'clock, and he don't seem to care. Like nobody doesn't care about staying alive, right? You don't I mean, okay, okay. Okay. All right. Good. Yes. I'm sorry. So

Erika Forsyth, MFT, LMFT 16:23
I think that the challenge, like let's say, if you were the end, Joe, and you were presented with the case, such as someone who was avoiding, treating, managing their diabetes in the way that it's expected, or, you know, kind of doing the bare minimum, to stay alive and be healthy. There's, there's always more to it. So I think the challenge is when you let's say you had this case in front of you, is it is that person in a season of diabetes distress. Are they in a season of diabetes, burnout? Do they has their distress manifested itself becoming depression? Is it because right, everyone, most everyone in their lifetime is going to experience either diabetes, distress or burnout, if you're living our caregiving, it just is natural and normal? Yeah. But with the difference that we've talked about before is if you are still functioning pretty well, in your relationships in your job, and other aspects and areas of your life, then that is diabetes distress, we know that it evolves and becomes presents itself depression when your impairment, your functioning, is impaired across multiple areas of your life. Okay. So then or is it you are experiencing medical induced PTSD? Is this the way that you are interacting and experiencing your chronic illness? Is that because of your experience of previous aces of previous trauma? Is it you grew up in a very stable household, but over time, for whatever reason, the genetics of your brain, the genetic, the generational history, other things that are going on your life, you get this diagnosis, and you are experiencing it and living with it? As if you had PTSD? And to his case, saying, yes, you might have with this enduring somatic threat model? Yeah, to answer your question. Yes, it could be all of these things. It's usually layered. And it's called and that's why it's complicated to to help people when they are struggling with their diabetes,

Scott Benner 18:30
and may be difficult to talk about. Because when people it seems to me, when I see a group of people together, often the people who have awareness about what they're struggling with, look weak to other people. Does that make sense to you? When I'm saying like, when somebody's like, you know, I had this happen to me. And I know that's why I feel this way and I'm trying to get past it. And then people are like snowflake. Meanwhile, the person saying snowflake, they had stuff happening to them, too. They're just keeping it down and not talking about it. You're not obviously a weak person to understand what's happening to you. But I think that when they try to talk about it in a world where everyone's not on the same page, they come off as like a hippie or complaining or like that, do you know what I mean by that? Like so it does that make it difficult to like voice this like, where do you find a safe? Oh my god, am I gonna say safe space? Yes, you are Jesus, cliquish? Look what you've done to me. Where are you going to find a safe space to open up about that so that you can get some support and get yourself through the next piece? All right, there's no question in there. I just want to say that out loud. That

Erika Forsyth, MFT, LMFT 19:35
was that was yes. Yeah. Yes. Because there there is. And I think what you were kind of looking around in the area of like, are you using this to justify or even make excuses for why you act a certain way and for pull this out in a bigger perspective? Yeah, go ahead.

Scott Benner 19:52
Are you just onto something here and you're figuring out what's going on with you? You know what I mean? Yes,

Erika Forsyth, MFT, LMFT 19:56
yes. And so there's there's a difference and that's depends on where you are. in that journey, right of, of understanding,

Scott Benner 20:02
I'm gonna say right here in case you ever listen to this, I have this struggle with my wife, because I have you see it with me like I Aha, sometimes I'm like, oh my god, like, right? And I start like understanding something. If I say that to Kelly, sometimes she'll go, don't make up an excuse. And I'm like, Oh, she wants me to apologize here for something or she wants me to admit something or something like that. And I'm in the middle of going, Hey, I used to be here, but I think I'm here now with my understanding. And oh, and she's like, No, no, we haven't gotten Oh, I see what's happening. Okay, like, so she, she and I are having some sort of a thing doesn't matter what it is. And I kind of get my thinking together and elevate past it. But she's still back there where she might have been, like, I told you this as what was happening, and you said it wasn't. And so she wants to finish this. And so if I try to just jump past it, she kind of goes, like, don't make up an excuse. And I'm like, oh, no, this is not an excuse. Like, I've had like a real revelation just now. And oh, okay. I'm sorry, that was probably too personal. Sorry.

Erika Forsyth, MFT, LMFT 21:07
No, it's good. I think you're giving shedding light into the Yep. The process of understanding and then integration of that understanding, and then how it impacts your communication, your relationships, all of that, because

Scott Benner 21:19
what we're going to talk about next to me feels like this is where it starts. So I'm sorry, I'm putting the cart ahead of the horse a little bit. But yes, yeah, go ahead.

Erika Forsyth, MFT, LMFT 21:27
Yes. So I think, and we can we can skip, do you want to move into the resilience piece?

Speaker 1 21:33
Sure. Yeah, that's fine. Okay. Because I think I think we've we've

Erika Forsyth, MFT, LMFT 21:37
understood and highlighted the connection between peace to PTSD, chronic illness and vice versa. And in the world of diabetes in general. There's also tons of research around adversity, and trauma and how that connects to diabetes diagnoses in general. Okay. So

Scott Benner 21:56
so we've talked to all about this. Now we know what it is, and we know how it's hurting us. What do we what do we do about oh,

Erika Forsyth, MFT, LMFT 22:01
what yeah, now what? How do we become more resilient in the face of this understanding of how trauma impacts us? Okay. So one of the biggest things that we want to spend a lot of time on is connection. And one of all of the research says that one of the biggest protective measures and things to address and identify is your connection. Who is your support system? Where do you feel seen, validated and that you matter? Where do you feel safe? Who are you connected to in a way that feels like it's a reciprocal relationship? So those things I encourage you to think about? If you're feeling if you're struggling and feeling like, Okay, I'm stuck, I understand I have this trauma. And now you're telling me to connect to people? What do I how do I do that? Yeah. Okay. So when in one of Brene, Brown's books, the Gifts of Imperfection, where she focused, she's done 20 years of research, and out of this research, she picks up themes, and she identified five things that are the most common factors of resilient people. Okay, so I'm gonna list these and then we're gonna gonna go into like, Okay, how do I, what do I do with this? How do I get into these, how to become more support, okay, I'll just go, they are resourceful and have good problem solving skills. Number two, they are more likely to seek help. Number three, they hold the belief that they can do something that will help them to manage their feelings and to cope. Number four, they have social support available to them. Number five, they are connected with others, such as family and friends. Okay, so one of the themes, there are connection, resourcefulness hope. Now, that's really hard to do. If you are living in a place of stuckness, right, because of your trauma because of maybe depressive thoughts and feelings, maybe because of anxiety. So it's, it's hard to make the sleep. So I'm hoping that through our conversation, we can kind of shed some light into how to get to that place. Okay, so duct. So going back to Dr. Perry, who I've referenced a ton he also agrees with that the best predictor of your current functioning is your current connection. And he says independent of how bad things were in the past, how bad your trauma was adversity, how bad things are right now. If you are in connection, you are in an environment where you will have many opportunities for healing. He talks about how you might you might see the best therapist in the world once a week, and that will help you process some of your past pain and trauma. But if you aren't in connection and seeing other people in really in a reciprocal relationship, it's really challenging to get better. Okay. So with that,

Scott Benner 24:57
I'm sorry. Yes. If you don't see me People are in a reciprocal relationship where you don't have one, or both. Both. Okay, because

Erika Forsyth, MFT, LMFT 25:04
that gets into loneliness. Oftentimes, when people have experienced, will pretty much I'd say all the time, when people experienced trauma, they experience a sadness that can lead to a sense of loneliness. And oftentimes when people and we and we, that's why, you know, there's people find support and connection and Facebook groups, and we're so hungry for that, because people are lonely, there's a risk to that, which we'll get into, right. But people experienced loneliness as a result of a diagnosis of a chronic illness because nobody understands it initially. And when people so loneliness, what you just got into what you just reflected, Scott was really interesting, because loneliness is a feeling of sadness, due to perceived lack of companionship, friendship, or any social bond or relationship. So it's, it's a perceived lack of reciprocal relationship, right? So if you enter in to a conversation with someone, and you're anticipating to get something back from them that you didn't, you're gonna you feel lonely. Yeah. Right. Like, like, Oh, I feel I feel really close to this, even the checker at the grocery store. But maybe the checker is having a hard day, and they keep their head down. Like, oh, I don't I don't, I didn't feel like I had that connection that we used to do. That's a really minor example. Okay, so because when you're lonely, you're in self preservation mode, which prevents healthy social interactions. So you're in that it's like this vicious cycle, right? Where if you're feeling like, no one understands me, I'm suffering. I'm going to preserve my myself. So I'm not going to engage in conversation or connection with people. And then that perpetuates that that perceived lack of friendship and connection.

Scott Benner 26:57
You can feel lonely, but still be around people, right?

Erika Forsyth, MFT, LMFT 27:00
It's different from alone, right? Like you can, you can be, you know, the common example is like the billionaire, and everyone wants to be their friend, and he's talking to people, or she's talking to people all day long. But she can go home and feel lonely. Yeah. Right.

Scott Benner 27:17
So I'm having just so you know, before we move forward, I'm, I feel very sad right now, because there's a person that I'm connected to who I've seen in crisis, like two years ago, now, they're doing much better now. But I was there during their crisis. And he kept saying that people don't care about him. But he was full. He was in a room full of people who were trying to help him. And I think I realized, over the last couple of years that he had put himself in such a position with all these people, that they all had some trouble with him to the point where he felt like they didn't care about him anymore. Like, and I think he knew he put himself in that position. But yet he didn't do it willfully. If I look at that aces list, he's got five of those contributing factors. He was on this collision course probably since he was five years old. And to watch it as an adult, happened to him. Like as you're talking, I'm thinking about him, I feel I almost cried a minute ago, just like having a memory about him. Because I thought, Jesus, this is all about how he grew up. He's a good person, he loves these people like you don't he mean? Like he didn't, he didn't do any of these things maliciously. And it's really, really something and I'm watching him work out of it. Now. I'm proud of him. But it's taken a long time, to interesting to, to reflect back on it just now. Also, I can't cry in the middle of this. I did tell you

Erika Forsyth, MFT, LMFT 28:42
know, I saw you going you were in a place of reflection, I could tell

Scott Benner 28:46
I needed to let it out so that I could keep listening to you. And talking so sorry. But no,

Erika Forsyth, MFT, LMFT 28:52
that's good. But yeah, and I have to bring up this I wasn't going to this is from a quote from Brene Brown that I wasn't going to talk about today. But I have it up that I have to just quote right now because it summarizes exactly what you were just describing with your friend she says out of our woundedness we protect ourselves by being as unlikable as possible. So we beat people to the punch from hurting us. And then we ensure our demise because the thing that we need to overcome our woundedness is relationship, but the risk of hurt and the risk of having the old tapes reactivated is too great. So that is how loneliness is this kind of vicious cycle, right? Where you're trying, you're preserving yourself. You're gonna end up because you're you're acting out of your woundedness your trauma, all the things that you were have been exposed to in life. You ensure the demise because you're just gonna be like, nope, nope, I'm not gonna engage and I don't want to get hurt. Just

Scott Benner 29:51
simply said, I'm gonna make sure you break up with me before I break up with you before you break up with me. That kind of thing. Yeah, yeah, yeah, that can For sure, yeah, you see that happen a lot. But, but that's the same idea. So I, oh, that's so horrible. She's okay. Or do you know where that quote is from

Erika Forsyth, MFT, LMFT 30:11
that is from it's probably from the Gifts of Imperfection, okay? That she in one of her? Yes, I'll have to look exactly or it's from her podcasts talking about her book. But it was around, you know, the theme of, of loneliness. And she also, she also quotes John Cacioppo who I can't remember if we referenced this in the beginning, who did a bunch of work and research on loneliness. And he says, loneliness is like an iceberg. It goes deeper than we, then we can see. And loneliness is a better predictor of early death, and smoking, obesity, cancer, it just is another reflection of all the things we've been talking about that everything matters, and everything is connected. And so if we've experienced trauma, we can feel lonely, it can become the self perpetuating the vicious cycle, where you feel like nobody understands you don't have any kind of reciprocal relationship. And that is really hard to then hear me say, I just want to spend, you know, it's why I'm spending some time here, I understand the challenge or cycle, all you have to do is just get connected to people to become more resilient. So it's really important to understand if you're kind of feeling connected, or an agreement with some of these things that you are lonely to understand how, what is the source of the loneliness? And has that manifested itself into depression? Or is it a response to trauma? Is it a response to a loss, which we talked about diabetes, there is a loss, right? Yeah. Did you have a move? Did you change jobs, it can be something that we owe a major stressor, like a change in relationship, a change in Job, a change in your environment, we all have moments of loneliness in our lives. But if we don't pause and look around and note that that's happening, it can very quickly develop into a prolonged issue and challenge. Okay, do

Scott Benner 32:13
you think there's a spectrum of this? Like, we're talking about these kind of big examples of people having like big problems, but could people be going through this oil, high on a smaller scales and not seeing big problems? So they're not aware of it? Like, do you think that some variation of this happens to all of us?

Erika Forsyth, MFT, LMFT 32:33
Yes, okay. Yes. So we all we are human, we are, we are created and built to be in connection and relationship. That's kind of an understanding. Consequently, we also because we have this human need to connect and relate, because of life, and stress and change, we are going to experience moments of loneliness. It's not abnormal to have that. But if we continue, I'm thinking like you, there's a move, you move cities, states, and you're going to experience some loneliness initially, but maybe because of other factors going on in your life, it's hard to start reaching out connect, or

Scott Benner 33:14
you don't even notice it right away. Maybe that's right. Yeah. Feels like Oh, I'm so busy. I can't meet anybody or something like that. And you're lonely, but you don't I call was I know, Cole was lonely when he went to Atlanta. And I asked him about it constantly. And he always said, No, but I don't believe that he wasn't honestly. So you know? Yes.

Erika Forsyth, MFT, LMFT 33:33
And it takes, it takes time. Like if it if it's one of those external, you know, changes, it takes time to adjust. But even in that space, to get connected with people is hard. And that's where that the vulnerability piece comes in. So what do you do? If you think, okay, gosh, I'm lonely. Oftentimes, they say, you know, a lot of people will say, well just go out and meet people go to the group things meet, join groups online, those things can help. But it really, if it's become a struggle for a long period of time, the duration of your experience of feeling lonely has been so long, and it's impacting all your functioning. That's when it's time to say when did why did I start to become lonely? What was the kind of the circumstance that triggered this experience? And kind of start to unpack that, and then you start to kind of relearn how to connect, trust, relate and be vulnerable with people. And it's a journey. It's a process, it's hard

Scott Benner 34:35
to find people even jive with sometimes, you know, like sometimes finding people is not the problem finding the right people's the problem. And how do you do that? Even especially as an adult once you're working and everything it's, you know, I'm sorry? You're painting a hopeless picture.

Erika Forsyth, MFT, LMFT 34:52
Okay, okay, but we're gonna come we're gonna Yes, great work. Okay. So how can you support We now know Okay, those are the factors of resilient people. Now, how do you develop those factors? How do you develop resilience? Now, one of the things that Brene Brown, and I know I've mentioned it a ton is the vulnerability piece. And she defines vulnerability as experiencing uncertainty, risk and emotional exposure. Now, if you're operating from a place of grieving trauma, you're like, Heck no, am I going to go and be vulnerable? Because I don't feel safe. That and that, again, perpetuates itself. Yeah. So understanding that I love this, this quote that she says, if we are brave enough, often enough, we are going to fail. And this is the physics of vulnerability. So if you're in this place of like loneliness, and you're like, I can't risk anything, I don't want to be winded. I'm not going to be vulnerable, you stay there. But if we lean into as a society as a culture, that we are going to make mistakes, we are going to fail. But we have to take this risk to be to expose ourselves,

Scott Benner 36:12
because you're failing now. So you might as well fail moving forward and see if something doesn't work out. Yeah, if I stand here, and I don't move, this is always going to be like this. If I move forward, it might still be like this, but at least I can keep moving forward. And then one day, oh, my God, this work this time, but it's never going to work. Sitting on your sofa, I guess is the way to put it. Right. Like you gotta get up and go. Yes,

Erika Forsyth, MFT, LMFT 36:35
yeah, yes. So how do you how do you do that? How do you get up and go? Okay, so these four things, according to Brene, brown, is the first thing is to develop hope. Now, if you're if you have depression, it's one of the key symptoms and experiences is despair. So again, we're holding these things in like, Okay, if you are experiencing depressive anxiety, traumatic symptoms and behaviors, there needs to be a component of treatment of, you know, real, professional help in conjunction with these other things. Okay. So developing hope. And oftentimes, when you've talked about this, you've had, you've always had hope and positive mindset. Is that because of your genes, maybe, but it's also a choice, I think we often think of like, it's a feeling like, Oh, I feel really hopeful today, but it's a joy. Yeah. And psychologist, Dr. Schneider says, There are three steps to that you got to set goals that are realistic, you have to plan towards those goals, and then have the knowledge and the understanding that you're going to achieve them. But with the caveat that you're going to fail, there's going to be moments of disappointment, and increasing that tolerance, to the disappointment is part of that journey. So I think so often, we when we're feeling stuck, and hopeless, it's hard to say, Okay, today, I'm gonna get out of bed and brush my teeth. Like, what's the point? Right? And, and some days, you might, you might not get out of bed and brush your teeth. But setting that first goal of like, I'm gonna get out of bed, I'm going to brush my teeth, and I'm going to change out of the shirt I was wearing yesterday to shirt I'm wearing today. Yeah, that's, that's a goal. That's a plan. And know you're going to do it with with the understanding that you might fail. And that's okay. Some of the days,

Scott Benner 38:25
my son's been having these conversations with me about time and memory. And I was talking to him the other day, and I said, you know, everything you're telling me really makes me think over and over again, that life is just now it's a super simple thing to say. But like, if I'm not actually remembering my memories, exactly right to begin with, right? You don't mean that that means that in its best moment, that memory is when it was happening. And so that means that right now is my bet is my new best moment, I'm going to continue to have new best moments, I can't live in the future. Although I can I can set up hope for the future. I definitely can't live in the past, because the past isn't even exactly how you remember it to begin with. So now is life. That idea of like, what's gonna get me up and get me moving to me is I don't want my life to be sitting here. I would just much rather die trying. I guess. Like that's sort of I know, it seems like too heavy handed. But it's I mean, it's right. It's a it's a common saying, like, I just want to get moving and then see what happens. If it doesn't go well. It's no worse than sitting here not trying, in my mind. And you're saying that there are going to be some people in that in a situation that is so maybe dire. They're going to need professional help to get back to that idea.

Erika Forsyth, MFT, LMFT 39:39
Yes, yes. And sometimes even that's when made them medication could be beneficial to antidepressants and I you know, anxiety medication to get you back to that baseline, right. Oftentimes, I think we think about medication is like, Oh no, it's gonna be this lifetime thing that I need, but most Often when psychologists psychiatrists prescribe medication, it's to help people get back to that place of being able to have hope to get up and brush their teeth and get out of bed. Yeah, okay, right. Yep. Okay, so having hope, which is the choice, it's a way of thinking. The second thing. This is, again, these are ways to help, how to become more resilient. Number two, use critical awareness to combat societal pressures. So societal pressures, this means evaluating the media that you observe, you read you intake and consume, and the expectation is that it communicates. So this is really a critical piece, because from the moment you're born, and now to present day social media, TV, back in the day was like commercials right? magazine covers, right. Yeah, right. Yeah. Yeah. When I grew up, it was like, Yeah, you're you're not the magazine cover. But it's all of this input. And messaging, that you are not good enough, unless you look this way, buy this thing, do this exercise. Eat this way. Yeah. It's really easy, though, when you're lonely or feeling hopeless, or in despair, to scroll to be influenced, and be influenced by the societal pressures. So this is where, you know, we we talked about the pros and cons of any kind of diabetes online community, it could really help decrease that feeling of isolation. Yeah, and find support. But you also if you're finding that you're looking at this and scrolling and saying, Well, I can't become it, I can't get a 6.2. And I am not a good enough caregiver. I'm not good enough diabetic, I'm not a good enough Pre-Bolus. Or that messaging becomes really easily ingrained. If you are not aware of how that is influencing your mindset. Okay, the

Scott Benner 42:02
scrolling ruins everything. By the way access to access, I can't believe I'm saying this. Yeah. Some access ruins. Yeah. Like, look how my examples are not going to be palatable for some people. But this social media has ruined boobs for me. Like it was used to be so exciting to see a lady and now it's just not anymore. You're like, oh, yeah, look, this one's breastfeeding in the Walmart, like, hit like, you know, like, okay, and movies to access to like entertainment. Everyone has sat in their living room for 90 minutes, scrolling through choices and not ended up watching something. Because you're like, I can't pick anything back when you were like, hey, guess what? Indiana Jones is out. You want to watch a movie? That's the one we're watching. There is no other one. Well, what about Star Wars? That's not the theater anymore. You can watch that again in 10 years, when that used to exist you You took advantage of what was there? Now there's so much there, it overwhelms you, you get frozen. And so I think you're talking about something similar, honestly, it's like, there's so much access to so many images and ideas that your brain just goes I'm not those things. And then you can't move you know, and meanwhile, I know this is over stated, but everybody's not beautiful. A lot of beautiful people put themselves on social media, but there are far more people like me, and you know, and like you listening and we're like, Look, I'm not perfect, but I don't need to be perfect. I can't be perfect. But back in the day in the 70s. It was like, Well, I don't look like Cheryl Tiegs. But she was also the only one you knew who looked like that. I mean, Erica, you know, right? You go on Instagram. Every person looks like a model. You're like, oh my god, is the whole world. Beautiful. No. But Instagram is that going where those people are and then judging yourself against them. It just, it's so funny. Like, we don't do it with anything else. I don't watch a baseball game and go, I can't believe I can't hit a 420 foot homerun. I just think those are special people who can do that thing. I'll watch it. But when it happens in these other spaces, it really does make you feel terrible. Sometimes you're like, Oh, God, I'm never gonna get to this. You were never trying to get to that. But all of a sudden now you're now you're in a race. You didn't even mean to be running anyway. Yes.

Erika Forsyth, MFT, LMFT 44:15
Because Because that tape that's being so easily triggered and replayed over and over again, I'm not good enough. You it's really it's hard to come out of that and say, Well, I'm gonna go build hope and follow my goals that I just set for myself. Right? So just having and I know it's Thankfully we're talking about it more and more. But just having that awareness around how much it's influencing your mindset, your choices, your thoughts about yourself and others is really, really important. You can

Scott Benner 44:45
start feeling like if I can't be that, then nothing's worthwhile being which is ridiculous, cuz there's four of those people. Yeah, yeah. You know what I mean? Right. And

Erika Forsyth, MFT, LMFT 44:55
and it could say, you can kind of catastrophize it To end globalize it, right like, oh, I can't, I didn't nail my my Pre-Bolus or my a one C, I must be a really terrible mother, or my whatever it is.

Scott Benner 45:11
And other things. Yeah, yeah. If I can't do this, I must not be good at that either. Yes.

Erika Forsyth, MFT, LMFT 45:16
As opposed to, oh, you know what, Gosh, I really I kind of goofed today. But I'm still really, I'm still doing the best I can. And I'm a great person, you know, if

Scott Benner 45:26
you can't figure out a way to stop looking at it, I would go from the aspect of somebody is sitting in a room right now, who knows, you're gonna feel like that. If they tune their algorithm the right way. And they're doing that to make you feel that way to keep you in that algorithm longer. Be mad at them and just leave. Like, for that reason. It's like, it's almost like smoking to me. I know, I've told you this before, but I told my brother one time when he was a little kid, I was like, there are 10 really rich people sitting in a boardroom right now laughing that you bought those cigarettes. Now and so you know, go ahead and make them rich if you want to. But yeah,

Erika Forsyth, MFT, LMFT 45:57
power, power and money. Yep. Okay, I'm

Scott Benner 46:00
sorry. Okay. Okay. Can I read one? Yeah, I never get to read anything. Well, yeah, read the next one. Read number three. Number three, refuse to numb your negative emotions. Avoiding feeling negative emotions such as sadness, disappointment, shame, anger, via alcohol, drugs, shopping, scrolling, it may eventually look like avoiding looking at numbers avoiding Pre-Bolus saying avoiding calculating or even guessing the, the best you can about your diabetes. So wait a minute, how does that do that? Go ahead and refuse

Erika Forsyth, MFT, LMFT 46:31
to numb your negative emotions. This is a really big one, okay? Because when you're trying to build resilience, which is right, like overcoming adversity, having the hope that you can achieve your goals. Once you start to feel like from going from number two, you starting to feel I'm not good enough. And you're starting to feel that sadness or disappointment or shame. We are a society that numbs those hard to have feelings. So you're numbing often with alcohol drugs, going back to the scrolling, which is perpetuating that I'm not good enough feeling or thought. And then you're starting to numb everything. And avoiding, right so I can even play out to like, what's the point? I'm going to numb and avoid taking care of my diabetes through that is a you don't even want to feel it right. So you're going to avoid looking at the numbers. And this happened. It's easier. It was easier to do when you didn't have your, you know, your apps with your numbers all the time. But it was like I'm not going to take my blood sugar. But now people might not look at the number on the app, right? I'm just going to avoid it. I'm going to not engage, because I don't want to feel, yeah, that feeling that I've associated with. If I have a disappointing or shameful feeling corresponding to a number, I'm going to avoid it. Does that make sense? I had a

Scott Benner 47:56
woman telling me that she couldn't say the number out loud when her parents asked her she'd like throw the meter at them so they could see it. But even if the number was good, bad or indifferent, she couldn't bring herself to like utter the words. She didn't want to say it out loud. And this, again, is rolling back into this conversation I had with a doctor recently. Because she goes, I had this one patient, I'd look at their clarity report, they were 400 for like days, which just indicated to her, they didn't even look at their CGM. And that's what you just said like so like, even though the data is right in front of their face, they'll just willfully ignore it through this numbing process. This is interesting, right?

Erika Forsyth, MFT, LMFT 48:35
Because you because you don't want to feel that. And that's if you have that association of shame connected to the numbers, right? So you're going to, and I'm kind of loosely connecting numbing to avoiding Yeah, but you're trying to avoid feeling those negative feelings. And so I'm saying you're kind of numbing, but really you're avoiding management. But does that make sense? Does

Scott Benner 48:59
I want to roll backwards for half a second, back to number two, the critical awareness like about those societal pressures? So there's a difference for people. If someone goes online, it's like, hey, look, here's my one. See, it's five, eight. Here's how I did it. I just you know, you guys should try it if you want. There are people who will see that and go, Oh, I'm gonna try that. That's fantastic. And there are people we're going to try that we're going to fall into this trap here, or we're already in this trap. Right? Then that becomes an argument because this is a place where I had to make a decision a long time ago, like who am I going to be in this space? Am I going to be the woe is me person who just goes up to people who don't feel well and go, Oh, I know. It's terrible, you know, or am I going to be the person who goes I think this is possible, like here, look, someone's doing it like a spider. Because you kind of can't be all things to all people, but being one or the other. No matter how you present your information in this in this diabetes specific situation. Some of the people are going to be pissed at you because they're going to say you're making me feel bad or they're going To say, God, you knew the answer to this and you didn't share it to me like, like, right? Like no matter what I do, someone's gonna hate me for it. And so I decided to go with hope, because that's just kind of how I'm wired. And I thought I'll bring people along with me. And hopefully, we won't hurt too many people along the way. But I don't think shifting this to me for a second, it gets us off track. But that's not my responsibility. Right? Correct. Because like, how you how you're going to respond? Yes,

Erika Forsyth, MFT, LMFT 50:28
because we're only in control of our own thoughts and feelings, responses, we can't, you know, control other people's reactions. However we can we can be that's not an excuse to be a jerk when I know that's not what you're

Scott Benner 50:41
obviously not being a jerk about it. But so but my point is, if you're a person who's going to be triggered by that, it's incumbent upon you not to look at me, then is that right? You don't get to tell me I'm doing it wrong. Which

Erika Forsyth, MFT, LMFT 50:55
is right, well, it's like you could, but then you can also choose to, like, not engage with it. Yeah, just be

Scott Benner 51:00
done with it. Right. Like, yeah, like, that's what I would do normally, but but do people who end up doing that? Are they predisposed to doing that? Because they're so into this trap. Like they're already so far in this pit already, like maybe lashing outs, the only thing they have left?

Erika Forsyth, MFT, LMFT 51:15
Perhaps that's the way that you're trying to kind of make yourself feel better, make yourself feel better. But also, I think it's going back to the sense of like, where are you in your journey of resilience? To say, you know, what, in this example, okay, Scott is giving you the Pro Tip series, right? Or beginning series, one can look at that and digest that and say, well, good for him, I'm never going to be able to get that it's more like an all or nothing thinking, yeah. Or the alternative is to say, with some hope, there's so many things, I'm so overwhelmed. I'm going to start with trying to Pre-Bolus just for my breakfast meal. And I might forget every other day, but I'm going to try this one thing. And I'm going to expect that I'm going to do it and have hoped that I'm going to do it and have that mindset, but I'm also going to hold that I'm there's this tolerance for disappointment in it. So your question of when people are lashing out and saying, Why are you telling me

Scott Benner 52:22
Don't show me your great success? It makes me feel bad. Okay. Yeah.

Erika Forsyth, MFT, LMFT 52:27
Yes. And that is a hot topic in the Facebook group. I know.

Scott Benner 52:30
It's a hot topic and diabetes since the day I've been involved. Well, yeah,

Erika Forsyth, MFT, LMFT 52:34
diabetes. Yeah. So I think it goes back to the delivery. And we've talked a ton about this, the delivery of the information, to be mindful and compassionate. But also holding that you can't control other people's responses. And then if you are the digester, you're consuming that information, being mindful of Why am I being triggered in this way? Is it because it's is it triggering this old tape in my brain? That I am never going to get this? I am never going to be a good enough diabetic, right? So be mindful of like that those three things, the delivery, the tone? And then how how are you being? How are you consuming it? And is it triggering the tape? And for those of you Yeah, I don't know, tape is such an old

Scott Benner 53:18
thing. No, but no, you're making it listen, I asked the question, because I think that's the answer. And like, and this will sound pejorative for a second. But I don't mean it that way. Like, if you make nerfing the world my responsibility, I'm not going to have any time to help all the people that have been helped by the podcast, like there's got to be a point where I say, not everybody can, can accept this right now, some people are going to be in this position that we're talking about. But that's why if you hear this and you feel that way, the reason I brought it up right here is if you hear this and you feel that way, go back, develop hope, use your critical awareness, like do these four things that we're talking about here it because you're in that position right now, whether you know it or not, if you're busy telling me I'm the reason you feel bad, then or anybody doesn't have to be me, I put it on myself for this. But if you're busy telling yourself, they're the reason I'm not doing well, please hear me, you're probably trapped in a situation you might not even be completely aware that you're in. Yeah, that's how I feel. I don't know if you'll agree with me or not. But well, I

Erika Forsyth, MFT, LMFT 54:22
think it's a little bit different if we're sticking into this very specific example of you are very clear in your messaging and goal of helping people manage their diabetes, right? So maybe it becomes more confusing in that concept or that conversation when other people are saying this works for me or do it this way, or when

Scott Benner 54:45
it's more and more social media manipulative, or that kind of thing. Okay. All right. Like when they go they say stuff like do you feel like this? Oh, my God, I do. And you know, and then the next thing you know, you're three swipes over and the Instagram story and they're offering you Coaching for just $300 a month, you're like, Oh, yes. All right.

Erika Forsyth, MFT, LMFT 55:03
I mean, this, we're going into, you know, the boundaries conversation, which I think is a really fascinating one of how you are communicating with somebody else. How are you receiving someone else's communication? How is that impacting you? Is, is a whole other conversation around emotional physical boundaries? Let me

Scott Benner 55:23
drop that so you can finish and maybe we'll talk about later.

Erika Forsyth, MFT, LMFT 55:26
But yeah, yeah. Okay. So the fourth thing that Brene Brown had identified through her 20 years of research is embracing spirituality. And she is very clear, and that it's not about when she says spirituality, I know people might think of church or religion, but it's actually a really different concept. And so she defines spirituality, as recognizing and celebrating that we are all inextricably connected to each other by a power greater than all of us. And then our connection to that power into one another is grounded in love and compassion. practicing spirituality brings a sense of perspective, meaning and purpose to our lives. So again, she goes through all different examples that people talk about, you know, practicing their spirituality in houses of worship, like churches and mosques or at the fishing hole that most people do reference God, but it doesn't have to be. So it's this larger concept of interconnectedness that was identified as people who were resilient or working on becoming more resilient, which I think is a really important component, particularly as I think there's a reason why there's so much power in the diabetes community. Yeah. Because even in that essence, of whether it's online or in person, however it is, you feel that connection, right?

Scott Benner 56:47
No, I'd say it's like, when I can't do it, we can do it. That sort of feeling like you're not really with me, but I feel like you are. And whether that's a person on Facebook, or, or God doesn't really matter, as long as you have that feeling.

Erika Forsyth, MFT, LMFT 57:00
Yes. Yeah. And and wreck it Yeah, recognizing it, celebrating it. And I think it becomes, it is so painful when we see within the context of even just the diabetes community of people kind of going after each other. Because there's beauty in that, like, No, we're all here together. We're all in this together. Yeah, let's let's offer this compassion to one another, we all have different experiences of living with it. We all have different challenges because of our past because of how we function and because of how we process challenges. But to embrace that concept of like, we are connected, let's offer compassion to one another, breeds that sense of resilience. This is

Scott Benner 57:43
such a lovely ending, because I don't even know if Erica knows this or not. But I just got out of the shower one day and texted Eric and said, I'd like to talk about resilience on the podcast, then she weeks or months later sends me back this document. She's like, I think this is the outline for maybe a four part series about resilience. And we're here at the end. And I'm like, oh my god, it's the things that that are always important. You know what I mean? Like these always important things, I found them at the end of this path. And the part you may or might not be surprised by is I didn't read your document when you sent it to me. Like I wanted to experience it as we were talking about it. And so like, while you were building the, you know, building the story for people. I mean, I think it's pretty obvious how we do it, you build the story, I have realizations, we chat through them, etc. But I swear to you when we got the end here, and it was like I was like, oh, it's hope, critical awareness, not giving into pressure. Don't numb yourself find community. I was like, God damn, how about that? Like, I actually like at the end, I was like, I didn't think this was going to be how this ended. It makes a lot of sense that this is that this is the end of what we're talking about. Truly. Yes. Wow. Wow.

Erika Forsyth, MFT, LMFT 58:55
Yeah, they're hot. They're like, as you said, kind of hallmarks hallmarks. And like, yes, of course, that makes so much sense. Yeah, and yet it's so it is hard to implement. But I think it's so important to end on this on this hopeful piece that this is what is identified and recognized in the in the research and the literature and can be implemented. And if you if you are feeling stuck, or challenged even through these last four notes of of hopefulness, awareness, refusing to numb for seeking spirituality that you're there's, you know, there's something greater than just yourself, yeah, to reach out for help, again, to whoever may be and if even that part is feeling challenging. Starting with, whether it's a therapist or an email to I was gonna say to you, don't

Scott Benner 59:48
don't email me I'm very busy. But listen, develop like, Be hopeful. Believe in yourself. Don't listen to other people. Believe in yourself. Don't put your head in the sand. Go and You find some community because you're going to need help. That's it. Yeah, that's fantastic. And

Erika Forsyth, MFT, LMFT 20:00:05
community again, the community doesn't have to be you don't have tons and tons of relationships if you're experiencing that loneliness, starting with one career person. Yeah. When? Yeah, when another person I

Scott Benner 20:00:17
see people in the Facebook group become friends all the time, like, I don't, I don't like pry into their business. But like, I know, I'm thinking of this one person right now. I did a live thing the other night. And I was like, Oh, I wish this person was here. And somebody goes, I'll text them. And I thought, how the hell do you know how to text them. And then I realized, as I called, they became friends to my little podcast. And that looks like you don't even like that. And even if it's just the two of them, and I'm sure it's not, but even if it was just the two of them. Now they've got the connections, the right word, but it seems lame to say but like, there's a synergy, like you can feel each other's energy this way. And when yours is waning, there's can kind of make up for you. Like being hooked to a lot of different batteries, almost and one starts to go down. And maybe, you know, you steal a little charge from the other one. Wow, this was great. Thank you that I'm gonna text you more when I'm in the shower. It's working out really well.

Unknown Speaker 20:01:10
You're welcome. Thank

Scott Benner 20:01:11
you, please did not go anywhere. Like I thought it was gonna go. I'm so pleasantly surprised by what you did here. Congratulations, and Bravo. Thank you. Oh, thank you while we're recording, so I never say nice things to you until we're done recording usually. I don't know what I thought was gonna happen. Yeah, I

Erika Forsyth, MFT, LMFT 20:01:29
was just going to ask you what, what did you anticipate?

Scott Benner 20:01:32
I mean, I don't know, I'm a boy. Like these things that I do naturally, I don't see them thoughtfully like this. Do you know what I mean? Like, I just figure, I don't give up. And that's why stuff works for me. And I'm thoughtful about stuff. And I pay attention. And I move away from things that don't make sense to me. I don't let people tell me no. But in the end, if you asked me to quantify that, I just be like, I don't know, man. I'm just hard headed. Like, that's pretty much how it feels to me. And it's not true. Because as you were going through all this, I was like, Oh, that is who I am. Or that is what happens to me or that is why I feel like that. And it's nice to have that feeling because it resolves tension, and makes me feel lighter when it's over. Like that's literally what I would hope people get out of these four episodes. If they listen through them. I hope when it's over, they're not gonna have an answer to their problem. But they might feel like it's more doable. And, or they can at least understand the reason why it's happening to them so they can stop blaming themselves, or somebody else. Yes. Oh, wow. Look at you. You're doing the Lord's work. Good. I kept you over. I'm so sorry. It's so good. Thank you hold on one second. Want to take another moment to thank Erica for all the hard work and preparation that she put into the resilience series. And I want to remind you that you can hire Erica to be your therapist at Erica foresight.com. Or if you're in California, you can see her in person. A huge thank you to ever since CGM for sponsoring this episode of the podcast. Are you tired of having to change your sensor every seven to 14 days with the ever since CGM, you just replace it once every six months via a simple in office visit. Learn more and get started today at ever since cgm.com/juicebox. Arden started using a contour meter because of its accuracy, but she continues to use it because it's adorable and trustworthy. If you have diabetes, you want the contour next gen blood glucose meter. There's already so many decisions. Let me take this one off your plate. Contour next one.com/juicebox Are you still here? Why are you not getting your tickets to the touch by type one event or at least checking them out on Facebook and Instagram touched by type one.org. If you or 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 dietitian 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, or 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

#1249 Grand Rounds: Dr. Nader Kasim

Dr. Nader Kasim, a pediatric endocrinologist diagnosed with type 1 diabetes at 18, shares his personal and professional journey. They discuss managing diabetes as a student, the importance of understanding insulin use, and the challenges patients face.

+ Click for EPISODE TRANSCRIPT

Scott Benner 0:00
Hello friends and welcome to episode 1249 of the Juicebox Podcast.

Today on another episode of the Grand Rounds series, we talked to a Pediatric Endocrinologist, Dr. chasms gonna pull back the curtain and share his perspective on endocrinology. 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. T one D exchange.org/juice. box you want to help, you can go to that link, join the registry, complete the survey and just like that, you will have helped with type one diabetes research that's T one D exchange.org/juice. Box, do it do it as a favor of me please take you like 10 minutes. Let me pay back that favor. If you like comfortable and quality, you're going to love cozy earth.com Go there, buy whatever you want. Save 30% off of everything you get with the offer code juicebox. And don't forget the private Facebook group Juicebox Podcast type one diabetes on Facebook. It's the greatest community there is bar none. It's a private group. So you have to answer a couple of questions to get in. But after we know you're not an algorithm. We're a evildoer. We'll let you write in there and you can meet 51,000 Other people living with diabetes Juicebox Podcast type one diabetes, no evildoers allowed. Did you know if just one person in your family has type one diabetes, you're up to 15 times more likely to get it to screen it like you mean it. One blood test can spot type one diabetes early tap now talk to a doctor or visit screened for type one.com For more info. Today's episode is sponsored by screen for type one. And also us med is sponsoring this episode of The Juicebox Podcast and we've been getting our diabetes supplies from us med for years, you can as well us med.com/juice box or call it 888-721-1514 Use the link or the number get your free benefits check it get started today with us med The podcast is also sponsored today by Omni pod five that's on the pod.com/juice box get over your FOMO fear of missing out on Omni pod and get started today with the Omni pod five using my link links in the show notes links at juicebox podcast.com. to screen for type one.com us med Omni pod and all of the sponsors when you use my links, you're supporting the production of the podcast and helping to keep it free and plentiful. My

Dr. Nader Kasim 2:44
name is Nadia Kasam. I'm a person who has type one diabetes diagnosed when I was 18. But I'm also a pediatric endocrinologist. I just like diabetes a lot. From the sense of an academic perspective. I think it sucks as a disease. Yeah,

Scott Benner 2:59
let's pick through it a little bit. So you're 18 When you're diagnosed?

Dr. Nader Kasim 3:03
Yeah, so as at first semester of college, it was when I was getting ready to learn medicine. It kind of hit me like a brick wall presented in decay. In the hospital for like a week. I had all the symptoms I lost like 20 pounds. Yeah. Didn't know what was going on.

Scott Benner 3:21
Not in your family. Nothing you were expecting.

Dr. Nader Kasim 3:24
Not really a distant relative with presumably type one. But everyone else has type two,

Scott Benner 3:31
presumably type one means they don't know. But that's probably what they have. Yeah, yeah. Just so old. They don't talk about it that way. Yes, yes. Gotcha. I have diabetes, I can't drink soda, something like that. Ah,

Dr. Nader Kasim 3:45
more so, you know, several generations ago, so I really can't explain what was happening at the time. How

Scott Benner 3:53
about other autoimmune issues, anything like that in your family or for yourself?

Dr. Nader Kasim 3:58
Alright, no, actually, no thyroid, no celiac. No inflammatory bowel disease or anything like Pernicious anemia or anything like that. Nice.

Scott Benner 4:06
I'll knock on wood for you. That's very good. Keep that going for you. So you're diagnosed the date teen you're away at school or somewhere local to your family.

Dr. Nader Kasim 4:17
So I was kind of both I was actually at school. I was living alone, but my family lived in the area. They were there. I had support, but I didn't see them often enough to really get their input on how to deal with things.

Scott Benner 4:32
Okay. How long ago was this? How old are you now?

Dr. Nader Kasim 4:34
I guess is my question. Yeah, some 3719 years. Yeah, you can do the math. Yeah,

Scott Benner 4:41
look at me. It's pretty impressive. Yeah, you saw me, not her. I was like 38 would have been 20. I'll just take one off of it. And that's exactly how my brain did it just now.

Dr. Nader Kasim 4:53
I do the same. Yeah, of course.

Scott Benner 4:54
So okay, so you it's an interesting time, right? Because you're diagnosed people We'll know you're a kid still, but you're away at college. So there's not a lot of, you know, there's not a lot they can do. If you want to keep going to college, they're not going to know, you also start learning about diabetes, presumably, or hopefully, while the rest of your family is not brought up to speed. So is that was that you're finding like, there was no one to help you?

Dr. Nader Kasim 5:21
I don't know if I would say it that way. There are people there. It's just, even though symptoms happen relatively rapidly. Because it's progressive, it takes a while for someone to say something. So you know, even it took 20 pounds of weight loss, falling asleep in the middle of class, for someone to say something. And it really took someone who hadn't seen me for a bit to say, You don't look well.

Scott Benner 5:51
It's hard because not everybody, you know, I just had a personal experience. I've lost 40 pounds using GLP medications in the last year. Nice. And I I'm looking for 20 More, by the way. But then I'm done. I was out in public, I saw a person I hadn't seen in years. And we're talking back and forth forever. And at the end, I said something about that. And the relief that came over them was really something because she said, Oh, I didn't want to say anything. I thought maybe you had cancer. Like it was that I looked that different to somebody but still, she wouldn't mention it. So like, it's it's interesting that it did a it takes a person who hasn't seen you in a while to notice enough of a change, but they also have to make the leap to say to you not are you okay? You know, it's really it's really something from your perspective. Did you notice the weight loss?

Dr. Nader Kasim 6:41
Yes. I mean, you do notice it, it's just you don't you find other explanations for it. And I mean, we've all heard this, right. Like, it's, you know, I, I thought I was getting sick with something else or had a stomach virus or, you know, so it's you play mental games with yourself. And because it's, although it's rapid, it's progressive. It's really hard to draw a line in the sand to be like, alright, nothing's right. I need to go seek care, especially as an adult,

Scott Benner 7:10
then how was your care? What did it look like for you 20 years ago is that I mean, that's faster acting insulin time, right? You were, you were doing I would imagine you started with MDI with something like love Amir Lantis.

Dr. Nader Kasim 7:23
So I was in DKA. So I was basically taken to the emergency room

Scott Benner 7:29
by a family friend. And, you know, I

Dr. Nader Kasim 7:34
started out in Saundra, and I was in the ICU for several days. And then when my dk or my diabetic ketoacidosis resolved, they switched me to injections. At that time, it was Lantus by vial, if I remember correctly, and rapid acting insulin was also by vial. Pens came out. It became more prominent shortly thereafter, so I switched relatively soon.

Scott Benner 8:04
And were you told taught to count carbs at that point. Getting older means a world of change, but some things still stay the same, like being at risk for type one diabetes. Because type one can happen at any age, so screen it like you mean it. If just one person in your family has type one, you're up to 15 times more likely to get it too. And 50% of type one diagnosis is happen after the age of 18. So screen it like you mean it. type one diabetes starts long before you need insulin and one blood test could help you spot it early and lower the risk of serious complications like diabetic ketoacidosis, known as DKA. So don't get caught by surprise. Screen it like you mean it. Because getting answers now can help you get prepared. The more you know, the more you can do. So don't wait. Talk to a doctor about how to get screened. Tap now or visit screen for type one.com. To learn more. Again, that's screen for type one.com and screen it like you mean it. This episode of The Juicebox Podcast is sponsored by Omni pod five, and I'm here to help you get rid of your FOMO fear of missing out on Omni pod. I see people all the time in my private Facebook group talking about their love for Omni pod five. Have you seen those posts and thought oh, I wish I could have that experience with an insulin pump too. If you answered yes to that question you might be experiencing FOMO fear of missing out on Omni pod. Now if you have FOMO it could be impacting you in all kinds of ways. Maybe you look at a body of water like a pool or a lake and think oh, I can't go in there. I don't want to have to like undo my pump and take off the tubing and all that stuff. I wish I could just jump in. Well, you could with an omni pod five. You might also just be scared. You look at a doorknob and you think oh it's coming for me. Can I take my two Being off, you won't have that thought with Omni pod five, I want to get rid of your fear of missing out on Omni pod by getting rid of these concerns. fantasizing about jumping into a swimming pool without disconnecting, or just wishing you could wear outfits without pockets. You're dreaming about Omni pod. The good news is you don't have to suffer from FOMO any longer. You can see all about Omni pod five, see what you're missing at Omni pod.com/juicebox. So no,

Dr. Nader Kasim 10:30
I was a carb exchange guy. The hospital I was diagnosed at was effectively a community hospital. So from my diabetes education perspective, you know, I got everything that I needed, but I wasn't really given the whole picture. You know, I was basically told, this is how you dose insulin. You know, you're supposed to, you know, one, one carb exchange equals this, you know, the multiple carb exchanges, you take this amount of insulin. It's given a sliding scale. I remember on the discharge summary, the sliding scale wasn't complete, it was all handwritten, and it wasn't completed. So remember, I had a high blood sugar. I was like, Oh, snap, I don't know what to do next.

Scott Benner 11:10
But, uh, yeah, how long? How long did you manage that way.

Dr. Nader Kasim 11:14
So the way it worked, then was they would actually refer you to your primary care provider, and then your primary care provider would refer you to an endocrinologist. So I'd say it took me about half a year to connect between the two. So I don't know if I really got any formal education or you know, kind of like a, like a medical home for a bit. Okay. It's really unfortunate. Yeah,

Scott Benner 11:41
so the healthcare provider just turns into the person who gives you like, here's needles, and you need a prescription for this and that kind of stuff. Yeah, yeah. And I,

Dr. Nader Kasim 11:51
I think from a medical perspective, like I was, I was given enough to, to kind of deal with the circumstance at the time. But you don't you don't get any of the nuanced stuff that you know, you kind of wish that someone told you later, like, this is how insurance works. You know, like, half your supplies might not come through the pharmacy. This thing costs a bazillion dollars.

Scott Benner 12:12
Yeah, Pre-Bolus. But now, I'm always high. If it doesn't come back down. It does, then it's fine. Yeah, that's the extent. So do you know what your outcomes were? Like? Like, say through your undergrad, for example? Yeah, so

Dr. Nader Kasim 12:31
I was pretty well controlled. So I honeymooned. So that helped a lot. And I kind of honeymoon for a bit, probably say, close to two years. I think it didn't take me long to figure out the impact of nutrition and activity and whatnot on blood sugar control. It did take me a while to understand what the big picture

Scott Benner 12:55
would be, as far as you know, what

Dr. Nader Kasim 12:57
the point of treating diabetes is. I'd say I lived a big portion of my life. genuinely having the goal of not being back in the hospital in the UK, when in all reality, that really isn't your primary driver. Right. You know, it's not not to have a heart attack or stroke or so, but I think for the most part, I did well, I did a lot of self learning. You know, I I wish that there were podcasts at the time that, you know, that would effectively you know, supplement. Whenever care, I did not get or supplement the care that I actually got their books. You know, I was I was in college, I was able to read medical literature. I I fared

Scott Benner 13:40
Yeah. Okay. It's interesting that you would say no, I mean, not interesting. Like, oh, I can't believe it. I hear people say it all the time, but that you didn't even have a goal in mind. Is is kind of fascinating, right? I mean, they 20 years later, doesn't that throw you off as a pediatric endo that, that people would that an 18 year old kid would be out in the world at college and not know why he was doing what he was doing?

Dr. Nader Kasim 14:05
Yeah, yeah. i And honestly, I still see this all the time. You know, in between transfers of care that we read, and people who've had diabetes for years, I asked, I asked that question. I'm like, what's going to come see us every three months? What's the point?

Scott Benner 14:21
And if I could tell you

Dr. Nader Kasim 14:24
how many I don't know how I was or, you know, I don't want to be in DKA. Or that again, no one really talks about the long term outlook.

Scott Benner 14:35
It's really common. Is it so common that it's not upsetting?

Dr. Nader Kasim 14:42
It really bothers me because you know, as an it's tough because I'm a pretender. So it's, it's hard. It's hard to expect a child to you know, to say this, especially if they're younger. But especially with like the older kiddos, just get them not knowing

Scott Benner 15:00
feels like, feels like feels like a big, big

Dr. Nader Kasim 15:06
gap in knowledge. And it's, you know, that's it's a place where emphasis should be placed, I think, do

Scott Benner 15:12
their parents know, generally speaking, where are you dealing with an entire family of people who just they're taking the steps, but they don't know why?

Dr. Nader Kasim 15:20
I would say, Yeah, I would say families as well. I think parents know, they just don't confidently know. So they're, they're aware that they're at risk for long term complications, you know, but it's, it's typically along the lines of I'm afraid of getting nephropathy or retinopathy. So like kidney disease and eye disease, because it happened to another family member, or it's because of, you know, to happen to someone that they knew,

Scott Benner 15:48
or I thought on a television show or something like that. Yeah.

Dr. Nader Kasim 15:52
Well, and just because it's, you know, you're talking mostly diabetes is type two. So, a lot of a lot of people who have type two, they can even get those complications early on, it doesn't take a long time, per se. Yeah,

Scott Benner 16:06
it's, um, I don't know, like, it just seems to me that, even while we're talking about it now, it wouldn't take me that long to explain type one diabetes to a person and why what they need to do is important, and then what those things are, you see it happen? I mean, you're in a position to do something about it, obviously, like, what's the, what's the thing that stops it from happening?

Dr. Nader Kasim 16:28
I think it's, it's partly because of our taught, like, as medical providers. But I also think it's part of human nature in the sense of how we think about things. So when we compartmentalize the two types of diabetes, so making generalizations here, but you know, we think of type two as the,

Scott Benner 16:50
you know, diabetes that's,

Dr. Nader Kasim 16:54
you know, heavily impacted by lifestyle choice and whatnot, when in all reality, that's really not what type two is, you know, for type one diabetes, we effectively remove the life style choice component of it. And we kind of put it in this box of, you know, we take insulin, and insulin normalizes our blood sugar. And that's how we treat it. That's correct, to an extent, because, you know, the most impactful thing you can do to reduce your risk of heart disease and whatnot, is to normalize your blood sugars, but there are many other aspects in life that impact your risk of developing these problems. I think if we can't convey this, then we're doing a huge disservice to, you know, people who are generally trying to lead healthy lives with diabetes, and they're not going to realize the impact of lifestyle choices until later in life. So it's going to be one of those too late circumstances. Um, but I think, on the medical side of things, we do the same thing. So when we're taught, you know, we, we oftentimes put a lot of emphasis on making lifestyle changes, or type two diabetes when you know, and then for type one, diabetes, there's a tremendous amount of focus on dosing changes, and, you know, the technology aspect of things. And when we kind of put the other things, I guess, to the side,

Scott Benner 18:25
it feels like, what you're telling me is that physicians are going to say, lifestyle, lifestyle lifestyle, and that's the last thing that patients are going to focus on.

Dr. Nader Kasim 18:36
That's also true, I think, I think it's, it's a harder thing to, it's a harder to harder sell. So if you have a short duration of time to meet with a patient, it's going to be very difficult to put a lot of focus on diet and exercise. And mental health is very similar to that, you know, and they're, they're very hand in hand, right?

Scott Benner 18:56
So the way I think about it, and the I guess the footing that I started off on with the podcast was I thought, well, I know about how to use insulin, and I know the good outcomes that come from it. And I'm pretty good at communicating those things. But here are the things that I can't control like I can I can put that information into people's minds into their ears and let them hear it. I can't control what they eat. I can't control if they exercise, I can't control if they're mentally healthy. Like there's so many things that I can't impact. What could I give these people? And I thought, I'll give them the knowledge of how insulin works, and they can apply it to their lifestyle, and at least have the healthiest outcome possible. No matter what their lifestyle is, like. I think that the things I talked about on the podcast would work as well for you if you had 20 carbs a day is if you had 200 carbs a day, then But moreover, the idea that you can tell somebody just eat differently, that'll help and that you should expect them to go Go home and do that is kind of insane to me. Like I know they should. I know we all should. But I don't think that's what happens. So I started with Well, let me give them something that's rock, solid and concrete. And then they can do what they're adults or they're the parents of children like they can do what they want to do with that information. And hopefully, they'll see the benefit of it, and make these adjustments along the way. I very steadfastly do not tell people how to eat, it is not in my purview. I do not care how you eat it, it's not up to me. But privately in my mind, if you don't think that I don't hope that you Bolus for a cheeseburger and fries with ice cream later, and then see what that's like. And then maybe the next day have you know, something a little more low carb, something a little more, a little less processed less oil, stuff like that and see the difference. I do hope you see that. But I don't think it's up to me to help you do it. That's sort of how I think about it. But you're in a different position. Like, you get the end of the stick if people don't have good outcomes, right, because they're gonna blame you at some point. diabetes comes with a lot of things to remember. So it's nice when someone takes something off of your plate. US med has done that for us. When it's time for art and supplies to be refreshed. We get an email rolls up in your inbox says hi Arden. This is your friendly reorder email from us med. You open up the email to big button it says click here to reorder. And you're done. Finally, somebody taking away a responsibility. Instead of adding one. US med has done that for us. An email arrives, we click on a link and the next thing you know, your products are at the front door. That simple. Us med.com/juice box or call 888-721-1514 I never have to wonder if Arden has enough supplies. I click on one link, I open up a box, I put the stuff in the drawer. And we're done. US med carries everything from insulin pumps, and diabetes testing supplies to the latest CGM like the libre three and the Dexcom g7. They accept Medicare nationwide, over 800 private insurers. And all you have to do to get started is called 888-721-1514. Or go to my link us med.com/juicebox. Using that number, or my link helps to support the production of the Juicebox Podcast, even though they're the one having the fries and the ice cream.

Dr. Nader Kasim 22:33
Well, so I think you're spot on. And I it's really the intention is not to necessarily dictate or tell people how they should be eating. But in all reality, it's it's to educate. It's you know, and even even when you look at the diabetes guidelines, like the recommendations, just a regular general pediatric diet, yeah. So but if I can tell you how many people are not aware of just aspects of eating. So like the differences between food types, you consider the processed food versus a whole food, the impact of protein, the quality of the protein, same with fats, you know, the quality of your fat and how that's actually really relevant. None of that is very well known among I'd say most, most people who have diabetes, as a medical provider, I think that's really how we should approach it is to teach people, I think, similar to many other things that involve behavior, you kind of need to gauge where people are at and whether that that advice is welcomed or not welcomed. But I think as a medical provider, it's important to at least broach the subject and at least get a feel as to where people are at just because of how relevant it is to

Scott Benner 23:47
know everything delve into that idea of welcome or not welcome for a second because I think if I can stand away cold and calculated off to the side, third person, it's your job to tell me whether I'm gonna listen to you or not. But you're dancing, a different dance, because if you lose the group, what is that going to have? It's going to put it that's like, it's like you're a head coach. If you lose the team, if you lose the locker room, you'll lose the team. So like, so if you come at somebody the wrong way, and build a wall between the two of you, you might never get that wall down again. But if you don't broach the subject, they're going to end up having trouble. And so you're left to decide how to deal with that. And I want to ask you your opinion, but it's been my, you know, my experience so far. A lot of times the brain that makes a good doctor is not the same brain that makes a great communicator. Is that fair? I think that's I think that's true. Okay.

Dr. Nader Kasim 24:42
But I mean, it's, it's someone walks in to the office, right? You

Scott Benner 24:47
have half an hour with them.

Dr. Nader Kasim 24:51
Entire half an hour is not going to be about eating or activity or you're not going to know exactly where they're at in life. You don't know what their stressors are. or you can certainly get a vibe for it. It's kind of part of your mission, you kind of need to figure out, Is this the right time? What's the level of interest? Someone willing to actually share their knowledge about that particular subject? And then really give them what they're, what they're ready for what they're asking, if they're receptive to feedback. You know, we see this oftentimes in kids that are active, that are involved in sports, you know, they're coming to you with questions, that becomes the theme of the visit, because the next time they come around, something else might be happening might not be a priority. So I think that's a really good way to

Scott Benner 25:37
kind of attack it from, you know, from that perspective, is it possible that the medium that I have to speak to people is just better suited to disseminate this information than an office visit? Or a doctor patient relationship?

Dr. Nader Kasim 25:53
Yeah, hands down on the table. I mean, it's just like what I told you about myself earlier, like, I needed to fill knowledge gaps, you know, when I got diagnosed, so I went ahead and sought out information, I was ready for that information I wanted to learn. So I think that's one of the pros of, you know, a podcast or a book or, you know, an online article, whatever is that you can seek it out when you're ready. Yeah, you know, but I think, you know, but even as a provider, we can still get a vibe, as to where someone's at in this conversation and potentially provide these resources. So I think there's a difference between going and seeking it out yourself versus, you know, being able to provide information when someone is actually ready for that, or if they're interested in it, is

Scott Benner 26:39
it possible that that may be should be communicated to a person, the the kind of idea that, look, there's this information here, you need it, if you have it and understand it, your life is going to be happier and healthier, and probably easier. But there is no way for me to rush you to the place that you need to be to absorb all this to want to absorb all this, I need you to know that it's here. I need you to know what it is. And I'm willing, as your physician to sit back and wait for you to be ready to take it up. Because that's the truth. Right? Like, that's how me You've described it. I've seen it here for 1100 episodes, and all the conversations I've had, this is exactly right. People do not take care of themselves until they're damn good and ready to. And often they won't do it unless it's for someone else. Like I'm getting married, I want to be healthier because or I'm pregnant, or I want to have a baby, or I want to be around for my family or I saw this thing happen. And I don't want that to happen to me. Like that's generally speaking how most people make the leap. Maybe it's important for them to know that this is a very human reaction they're having right now, I know, you don't want to hear about Pre-Bolus I know you don't want to learn that, you know, the French fries have fat in it, it slows down your digestion, and therefore, you know, you're gonna spike like 90 minutes after you eat them like, and you're gonna think I don't know what happened, I already covered the carbs. And you know, they need to know all that stuff. But is it not? Maybe incumbent upon us to tell them because as far as humanity goes, I don't know that we know a lot about ourselves. Like, you can stand back as a physician and say, I know how this is going. As a matter of fact, I bet if I said to you, right now, think of a patient that you don't believe is going to do well. These people start popping into your heads, you know what I mean? And then there's probably people who think, Oh, if they just make this one leap, I know they're going to do better. I bet this person figures it out when they're in college or when they become I'm sure these people all present you like different parts of this path. And but we don't know that about ourselves. Like, you know what I mean? Like, you always need somebody to tell you who you are, it's hard to figure it out for yourself.

Dr. Nader Kasim 28:51
Yeah, I I agree. And I think I think it's more so it's almost like a reminder, just like how you get spam, emails, advertisements that pop up, like they stuff like that just triggers you mentally. So I think I think if you engage in conversations repeatedly, your interest kind of shifts, and it's part of that is based on life circumstance, what your personal goals are, but also, if it's on top of mind more frequently, I think it's more likely to change. It's very similar to smoking. So if you think about people who smoke, you know, the more you ask them about quitting, you know, engaging where they're at better than they typically do. So I think it's kind of similar. I don't think it's remotely close, but kind of the same. Well, it's

Scott Benner 29:40
actually fascinating that you brought that up, because as you were talking, I thought, if the conversation keeps going the way I think it's going to, I'm gonna make a joke that we should get those PR people from the 50s who sold cigarettes to everybody and retask them with teaching people to Pre-Bolus or pay attention to like their foods or I I actually thought that Oh, like, let's get great marketing people to tell us good things that we need instead of the bad things. Maybe that would work. You don't mean like, there's something to that. I mean, there really is, like you said, you have to hear it over and over and over again, I've learned from making the podcast and even just getting someone to click on a link is an excruciating task. Like you have to first tell them that the link exists and explain to them what it is. And then sometimes you have to do that sometimes up to 10 times before they remember the link, and then think, okay, maybe I'll check it out. And that's just how we work. And so it makes sense. You know, it's interesting, because I'm doing these two series at the same time. And you and I spoke about this before we started to record because we weren't 100% Sure, and maybe still aren't. Which app which series this episode belongs into, but I'm doing this grand rounds thing, which is, it's aimed at doctors to tell them look, this is what people who have type one diabetes want to know, it's what they told us they wish somebody would have said or how they would have said it, etc. Here's the reasons why. You know, and Jenny and I are going through and discussing all of them. And at the same time, I'm doing another series called cold wind, where people are coming on health care providers, other professionals, completely anonymously. And they're basically blowing the whistle on what they see at their jobs. And, as I'm recording these episodes, I am stuck in this paradox where I both find myself vehemently defending the doctors, because they seem like they're in an impossible situation. And at the same time defending the patients, because these doctors are the only thing that they have. And it's just it's just a it's a situation that I don't like, the more more conversations I have about it, the less answers I say the fewer answers I say my wife would be so upset if she heard me say less answers, the fewer answers I see. But you know what I mean? Like you're in a, it's you. You're the one they're counting on. But you're in a human situation that that's almost unfair to ask, have you because it's probably not going to go well, unless they're in the right place to receive the information and then put it into practice? Yeah. So what do we do?

Dr. Nader Kasim 32:14
It's one of those things where I think

Scott Benner 32:17
you just you keep, keep pressing, you don't want to press too hard. You want to give them

Dr. Nader Kasim 32:26
you know, information that's relevant to them at that moment in time. I think that's all you can do. I mean, really, the the other thing that I've personally seen, that helps a lot is, and I think this goes to human nature, is that we learn from each other. So there's a big difference between telling someone to do something, or even effectively planting an idea, versus having someone learn from an experience or like a role model. Yeah. So as an example, like I do, diabetes can. And I can tell you, how often things change when, you know, children interact with other children who have diabetes. And it's not just from a dosing perspective, it's all the other behaviors that go into diabetes, it's all the other coping mechanisms that you have to basically feel normal in your skin. That's, that's not from anyone telling you anything, it's from seeing other people do the exact same thing, see them succeed, see them fail, see them get mad. So I think that's really valuable, too. Unfortunately, in the office, we can offer that. So I think that's where, you know, being engaged in diabetes outside of an office becomes really, really important. And I think it's eerily similar to things like your podcast, because it really does give a sense of community. And I think that's, that's a way that we learn as humans is to kind of emulate and, you know, mimic other human beings.

Scott Benner 33:55
You know, I've said this a number of times in the podcast, but I feel like it fits here as well. There's times when I think there should be mass appointments that are management specific, like not every time you come in, but what if twice a year or three times a year there, you know, there was a you guys did seminars instead of you know, and I know it turns into a billing issue and an insurance issue and like all this stuff, like it's the doctors don't have time to do it. But I've given talks, like to hundreds of people at a time, and then received back emails from a large portion of them, saying, Hey, I did better the week after I heard you speak. I don't even know why. I couldn't even begin to tell you what I did. But we talked about diabetes for two hours and my blood sugar's were better than next day. I think that's important. And I don't think people like it's nice to say that you went out and found the information, but you're who you are, and there are plenty of people who aren't going to go they're going to hear, count my carbs, shoot the insulin. drink a juice if I get low Don't be high for too long, because I don't want to be in DKA. That's it. And they'll do that every day, they will not change, they won't wonder about if there's more, they'll think that's the whole game. If their health gets bad, they'll say things like, well, that's just diabetes, or you know, it's my lot in life, it happened to me, never thinking like, this is a thing I could impact. And not not like, with information that's so hard to get or tools that, you know, I can never find like just understanding how insulin works, you can make a significant dent, like I say it on the podcast, because I want people to hear it and believe it, but just Pre-Bolus in your meals could bring your agency down a full point. But just that without even understanding the rest of it. And yet, people won't wonder about that. And it isn't until they get into a terrible situation, and go out to find a thing, that they even hear some of these ideas, but you have no idea how many notes I get from grown adults who have had diabetes for 20 or 30 years. Who will, they're praising me in this email, on and on and on. And when I get to the end, what are they praising me for? I taught him to Pre-Bolus their meal, they have 30 bad years, because they didn't know that, like, that's insane. Yeah, yeah, I'll say it again, I'm not sharing any special knowledge that I have, that the rest of the world doesn't have. I just found a way to communicate it in a, in a form that people can take up easily. And I've scaled it, which, uh, you know, if you're looking for things I'm proud of just scaling the podcast is a big deal. Like I was back, I'm like, Oh, I'm helping 10 people, that's really amazing. Like, you know, this, but a lot of people don't know the feeling of helping 10 people. It's amazing. 100 people, it's amazing. It doesn't really change the good feeling, whether you help one person, 10 people or 100 people, it's exactly the same. But once you realize that you have this knowledge that changed someone's life for the better. I almost get into a panic. I'm like, Well, how do I reach all the people who need to know this? And so I put a bunch of effort into scaling. And all it did was prove out over and over again, that this basic kind of baseline information, communicated well helps people on on a mass scale. How do we get that to them? In a doctor's office? Because most of them, believe it or not, are never going to find the podcast. Listen, here's what I'm Yes. My question is, you're diagnosed when you're 18, you're already on your way to becoming a doctor, did you become an endocrinologist? Because of your diagnosis? Yes,

Dr. Nader Kasim 37:28
basically. So I was going into as going into medicine at the time, so I did kind of like, you know, I'm going into med school, knowing, knowing freshman year of college, I didn't know what type of physician I was going to be. And then, you know, it's kind of threw me in the door.

Scott Benner 37:42
Can I ask you a cultural question that everyone's not gonna understand, but you will, and some people will? Sure. Did you want to be a doctor?

Dr. Nader Kasim 37:52
Oh, yeah, you did. And hence, hands down on the table. This

Scott Benner 37:54
was a family thing where you're gonna go be a doctor? No, okay.

Dr. Nader Kasim 37:59
No, both of my parents are like, math people and statisticians. And you

Scott Benner 38:03
know why I'm asking, though, right? Just because most physicians have family members that are? Well, I was actually thinking culturally, I see a lot of you're going to go be in medicine. Like, that's a good paying job. It's, it's a respectable job, go be in that job. And I just I know, a lot of kids who are currently trying to be nurses and doctors who don't want to be but their parents pushed them in that direction. I was just wondering if you were pushed by parents, or if it was the thing you actually really wanted to do? No,

Dr. Nader Kasim 38:35
I wasn't pushed by anyone. And actually, it's kind of funny, I was given advice not to go into medicine, because of the effectively the commitment and the debt burden and the high risk of not making it through the entire pathway and getting stuck with that. But I think, at least for me, just mentally, I'm a very

Scott Benner 38:57
sciency you know, type of person,

Dr. Nader Kasim 39:01
I geek out on technology. So just by by nature, I, I needed to be in a science field. And I was originally planning on doing computer science. And I actually did web design for a short bit and quickly realized I did not like it. When it wasn't for fun. So then, you know, that's how I basically landed.

Scott Benner 39:24
Okay. Oh, that's amazing. Are you more of a people person doctor or a medicine? Or do you try to straddle the middle? To be honest, I don't know what that is. So I think some doctors can be can lack people skills, and but still very passionately feel about what they're doing because they love the medicine of it. And I think there are some people who just want to help people, and they've learned the medicine so they could help the people. Does that make sense? Yeah.

Dr. Nader Kasim 39:51
I don't know. I don't necessarily think I do well, with people like in other words, I probably not well said but it's it's More so that, in general, I'm typically laid back. And I think, you know, through a care perspective, that also shows like, I am pretty conversational, really, my intention is to walk in, you know, get to know you as a person, that type of thing and troubleshoot things that are meaningful to you. So that's, that's how I roll. I've just taken my experiences from past medical providers, and I basically figured out that that's how I vibed well, with others, so I tried

Scott Benner 40:30
to try to do that. Yeah, I think if I was, if I was an endocrinologist, I've never thought about this before, but just now it started running through my head. I think if I was an endocrinologist, I would be like, of the camp of like, listen, we're all gonna, like, talk and be nice and have be friendly and everything. But by the time a year goes by, you're gonna know how to handle how to handle your insulin and your meals. And then we'll branch out from there, you know, if you want to go talk to a therapist about how you feel you should do that, you know, if you want to talk to a nutritionist, you should definitely do that. Here are all your other options of things that you could be doing. But in this office, we're going to talk about how to functionally use insulin so that you have outcomes that are repeatable and desirable. Because I think it's like teaching somebody to throw a baseball. You know, like, when you when you show up? You're pretty young. Still? I don't know. Do you have any kids? Yeah, yeah, two girls, oh, two girls, okay. So they're awesome. Excellent. So you go out there the first time you try to get those girls to throw something to you, and their elbow flies the wrong way, and the ball goes eight feet to the right and everything. And it's demoralizing. You can see it on children's faces, like, Oh, my God, I can't even get this done. You know what I mean? And then you teach them technically how to do it, whether they love softball or baseball, when it's over or not, who cares? What you can see is the confidence that comes from picking that ball up not thinking and putting it where you want it to be. And I kind of think about the diabetes like that, like, I want you to be able to no matter what your situation is to be able to pick up that ball, throw it, it goes where you want. And then you have a tool, that you have an actual skill and a tool, and you can go put it to work wherever you want. And it comes with confidence. And I think that once you have that, then the next meal, it's a little more difficult, or the high blood sugar that you know doesn't come down and and at first, you're like, there's no reason for this, you can actually step back, apply your knowledge and your tools to it and come up with a reason why fix it and move on. And I don't know, I just think that that would be the way I would roll. I've seen it happen. I've seen people send graphs and they're out of their minds like you can you can sometimes read in an email a person who's about to like, just flip out, you know what I mean? Like I've they've done that they've beat their head against the same wall over and over again, nothing's changing. Their diabetes is not where they want it to be. They feel like apps use emojis. Oh my god, they just they're just like, I need help. Like, and by the way, you know that a person needs help when they're writing to a stranger that they heard on a podcast. Like that's when you know, somebody's in trouble. Me because there's a lot of like, leaps in there to make you know, and then I don't know them. I don't know their trials or tribulations. I don't know their IQ. I don't know their financial situation. I just go you got a pump or no pump. What insulin are you using? You have a CGM. You do Can you show me a graph? Great. I see a 24 hour graph. Great. This looks like you don't have enough basil. This looks like you have too much bass. It looks like you're not Pre-Bolus In your meals. Are you Pre-Bolus In your meals? You're not you should try that. Have your basil tested now? Well, I see. You seem real stable, but your stable 180. Let's get your basil right. And it doesn't take. I just did it with a lady. I don't know her. She just sent me a graph like she panicked, sent me a graph, like through a direct message. I think I message back and forth with her for four days. And like five days later, her doctor was like, my god, how did you fix all this? And she's like, I messaged the guy on the internet. Like, that's awesome. Yeah. But I didn't tell her what to do. Keep in mind, I asked her questions. And I let the answers that she had informed what she thought she should do next. Then if she wasn't sure I'm like, What are you thinking? And she's like, I think it might be basil. And I'd say I tend to agree with you here. And she said, How much should I move it? And I said, I can't tell you that. But I can tell you that based on your kids weight. I think he needs about 22 units of Basal insulin a day. But she was at like 16 I was like don't just like crank it up to 22 Just know that I'm thinking that the high end of the possibility is 22. But let's go slow. It took her like three days to fix it. Once she had the basil right? Boom, everything was like magic. And then she went back looked at her carb ratios. She started having these thoughts about like, Oh, I was covering for my basil with the Bolus is for the meals. And because I so I said to her now that your basil is right. Be really careful at meals and corrections because the way you do it is probably now Oh, maybe a little heavy handed. So let's be careful that. And if that ends up being so then let's reevaluate those things too. But I'm telling you, they're back and forth and a DM with a person I don't know. And they it's not maybe more than 15 times back and forth, and everything's fine now. So like, when that's possible, can you see why people are upset? And why they say my endo doesn't help me? Yeah,

Dr. Nader Kasim 45:25
I think that's a struggle, in general, and it's hard. I oftentimes feel that's because a lot of people are also overwhelmed with everything that goes into diabetes, just in general. And when that happens, there's oftentimes no conductor. So good example is, you know, patient, you know, is newly diagnosed at the point where they want to start pursuing tack, you know, the reading about CGM and insulin pump therapy and automated insulin delivery. And you know, 90% of their time is going into figuring out how to obtain these doing all the necessary trainings and education. And finally, they have everything in hand. And they're like, oh, wow, I have like, two apps I need to look through. I don't even know which one I need to look and people can be overwhelmed. Yeah, like one doesn't go to my so a lot of a lot of the same kind of behaviors that would go into injection, kind of the simplistic, you know, Basal testing and whatnot, people are hesitant to, to kind of rediscover that. I don't know if that's the word. But so there's a lot of hand holding, at least what we do in our clinic. And I think it works relatively well say that it doesn't work for some, but we typically have, we put strong emphasis on gauging where they're at, like glycemic control. Yeah. And then we teach pattern recognition. So we basically tell people, all right, you know, remember, you know, you're, you're effectively have a Bolus and a Basal dose, and you're running high post meal that's oftentimes reflective of your Bolus, etc. And then we effectively try to connect dots so that if they understand that they're not in range, they can go and see where they're running high, to effectively understand what dose change needs to be made. And I say it this way, because some people are not, they will never feel comfortable changing their own dose. Although we are huge proponents of doing that, like literally, the last diabetes ed class that we talked about, is to effectively empower people to change their doses, to whatever comfort they have. I think that works really, really well, because it effectively tells people Alright, this is the goal, this is where we want you to be this is what's going to minimize, you know, your risk of complications long term, this is how you go and look for highs. And then this is how you're gonna identify for those change needs to happen. And then they reach out to us. And then eventually, once they start reaching out to us, regardless of the degree of help they need,

Scott Benner 47:58
that's when we can

Dr. Nader Kasim 48:01
basically, layer on top of that we can talk about, you know, bolusing strategies, split Bolus, you know, timing of insulin impact of certain food choices, how to, you know, cover proteins and fats. And yeah,

Scott Benner 48:15
when they know how to keep adjusting their settings for these things actually have a shot at working, right? Because a lot of times they know the tools, but their settings are so off, they still have bad outcomes. And then they're like, it doesn't work. Yeah, like, yeah, I tried to do a Temp Basal, but it didn't work. Well. Yeah, what your Basal is point five, and ours should be point nine and our, you know, tamping it up 10% isn't gonna change anything. It's, you know, it's 40% Too weak to begin with. So for me, again, I think it's, you teach them how to get their settings, right? You teach them how to make adjustments. And I know this is gonna sound silly, but I think most people listen to this podcast know how to adjust their insulin because I say, if your blood sugar is too high, you don't have enough insulin. And if it's too low, you might have too much insulin. It's just, it's just that that kind of stuff that's so simple, that a doctor wouldn't say because there's, you know, 8000 caveats that go along with that, and you don't have time to explain them all are you know, but the truth is, that's about right. If you're high all the time, you don't have enough insulin. Like it's not like turning it into something that sounds like, oh, you know, the problem is your insulin to carb ratio might be off like, great. You just lost people. You know, you know, your insulin sensitivity. By the way, when you start telling people insulin sensitivity, and then turning the number down, makes it stronger, and turning the number up makes it weaker. I think you lose people there too.

Dr. Nader Kasim 49:39
Yeah. And then the next sentence, you said correction factor, and they're like, why?

Scott Benner 49:43
Yeah, what are we? I don't know what we're talking about. And, and that's why I don't talk about it that way. Yeah, no, you're you're 100%

Dr. Nader Kasim 49:50
Correct. I mean, like, exercise is probably the best example of what you're saying. Like if I can tell you how many people walk in and they're like, oh, All right. You know, I keep going low during activity, my doses are off my, you know, and then I tell them, the reason you go low is because of insulin. You know that right? Yeah. And they're like, Oh, yeah. And then they finally it clicks. They're like, Oh, snap. But you know, I took I took in like, you know, six units of insulin an hour ago for lunch. Yeah, that didn't even cross my mind that I had insulin on board. Yeah, but perfect example of, you know, people just need to be told that this is what

Scott Benner 50:29
you want to exercise. Don't have active insulin going. And you're probably going to be okay. Yeah, if your settings are right, by the way, if you're, by the way over basil, because is that a thing? Will you admit to do endos over basil people because they're afraid they're not going to cover the food? Well?

Dr. Nader Kasim 50:45
Oh, yeah, absolutely. And I think I mean, we see that less, because most people are on AI D now. Yep. And you know, with a significant portion of AI D, you kind of lose control of that, even. But yeah, we still see it.

Scott Benner 50:58
Do you think automatic devices, and you know, like, something paired with the CGM that's making the insulin decision for you? Do you think the greater the prevalence is with them? Do you think the less people are going to know fundamentally about their diabetes? Do you think they're just going to lean on it and say, I'll just let this thing do it?

Dr. Nader Kasim 51:17
I don't think so. And medically, there's evidence to suggest that that's really not the case. So they've put insulin pumps on newly diagnosed patients, even before learning how to do injections. And they were effectively taught injections kind of like after the fact, um, kind of as an on an as needed basis. And those people do well. And they they do, you know, arguably better, and not necessarily the right choice for everyone. But the point that I'm making is that you might be losing a skill, you might not be taught a particular skill that could potentially be valuable, but getting it taught later. Might be a reasonable idea. Yeah.

Scott Benner 51:55
So I don't I don't think so I'm

Dr. Nader Kasim 51:56
glad that I kind of superiority of the devices are really evident. So taking it away from someone with the intention of, you know, quote, unquote, teaching them how to drive a manual car, I think it's kind of silly,

Scott Benner 52:08
I find it to be an old idea as well. Yeah, I'm just worried that if something becomes so automated, that if you took it off them, they wouldn't know how to help themselves. I do think that's true. I mean, you know, I look at my daughter's Basal insulin, you know, overnight last night, even, you know, just absolutely, like, you know, the, the algorithm took her basil away for an hour and a half, and then it gave it back, and then it almost immediately was like, well, I shouldn't have done that and took it away again. Right. So like, that's not a thing that if you just go back to shooting love Amir for example, or Lantos, or CB, even, that's never going to happen. And they're not going to know, because they're going to think Well, when I was on a pump, everything worked. And now I'm injecting it doesn't work anymore, because they don't see the impacts of the insulin. And that's again, why I'm gonna go back over and over again, I'm gonna sound old. At some point, if people don't know that basil is first, and without a good Basal insulin, you're lost. And they don't know about the ratios, they don't know how to attack different foods, because they those foods have different needs. They're never going to understand what they're doing. And it's going to be a problem, even on an automatic system. Because if you don't know how to Bolus for something, if you look at Chinese food and say, Oh, this is 50 carbs, and think it's going to be the same as bolusing. For you know, another thing that's not deep fried, doesn't have sugar on it, and isn't like breaded. But it's also 50 carbs, you're going to be confused forever, because you're gonna say 50 carbs, 50 carbs, why didn't it work the same? Because of all these different impacts on your digestion, and, and all these other things that no one talks about? But it's not that hard to talk about, in a way. You know, what these conversations are, they depress me, and they get me excited at the same time, because the part of what I feel like we're saying is, if you get lucky enough to find a doctor who understands and can communicate it, you're probably going to be okay. Yeah, but what if I don't get that? Yeah,

Dr. Nader Kasim 54:03
I am going to add to that, because I feel like part of the benefits to these types of conversations is that it's empowering, right? So like, you know, if you go and you slam Chinese food, and you run a high blood sugar, you're going to feel defeated, and you're going to feel like your your treatment isn't working and you're failing and, and all that. So if you can give people pieces of knowledge, to effectively really take the reins and take control over their diabetes, then I think that makes it very empowering. So if you're able to make decisions about how you eat and how you dose and have a good outcome after that, you're gonna want to do it again. Yes. Because you know, you're not going to wake up in the middle of the night treating a low, you're not good exam. That's actually a great example, right? Like, for example, if you're gonna go go into eating Chinese food at like 10pm with like a bazillion units of insulin because you inflated the dose knowing that your blood sugars are gonna get demolished, but then you deal with a low you know, if you chose Maybe a Thai Chinese food a little bit earlier in the day. So you didn't have like a morning, I mean, an evening low, you're gonna feel awesome about that. Because you made the choice you thought it through, you know? So I think that's the value of talking to people about insulin as well, is that it really changes attitudes around. Really what's what's happening? versus you know, here's a machine, I hope you fare well on it. And if you know, if you keep typing numbers in it, you should do okay. I mean, that's, that's, that's really what would happen if you didn't have these conversations, right? Yeah.

Scott Benner 55:36
Now, yeah, I would tell you that one of the bigger surprises for me when I start, I mean, this podcast is I'm in my 10th year right now. So I've been doing it a long time. But when I first started doing it, I thought, Well, I'm really good at insulin, I'll explain it on the podcast. And that's what the podcast will be. And it has been very beneficial. I think anybody who's heard the Pro Tip series, or the, you know, the ball beginning series for really newly diagnosed, people would probably agree with that about the value of it. But it's the conversations that really just, I don't know, supercharge it. And I did not expect that. I really didn't, until I started having them, and listening and thinking, there's a ton of value here. Like they're, you know, I'm talking to a 24 year old person, thinking of a conversation I had recently this 24 year old girl, and she struggles, you know, it just it doesn't go her way. And she's real active during the day because of her job. And she's got a little vacillation, or you can hear in her voice, that she's beaten up. You don't I mean, like, she's just she's fought one too many wars, and they haven't gone her way. But at the end of the conversation, she's invigorated again. And that's great for her. But that's not really the way I think about it. While I'm talking to her, like, I'm happy to have a conversation with her, and I am speaking directly to her and about her. But in the back of my mind, I'm thinking 10s of 1000s of people are going to hear this, and they're going to think, oh, that's what's happening to me. And then they don't feel as alone. And then it feels more possible. That's the kind of stuff that we we can't value that enough. And it's almost impossible to explain to a person, the value of it. You know what I mean? Like, I've tried to tell somebody, you don't know, go listen to this, like, just go listen to somebody talk about what went right for them, or what went wrong for them. It'll help you earn ritual. And some people look you a lot of people look at you cross, like, you know, hearing someone's story is not going to fix my low blood sugar. But it is, it actually will. It's it's not a thing I expected, I didn't realize it when I started doing this. I also don't know how you're supposed to do that as a physician, either.

Dr. Nader Kasim 57:48
I think I think this goes full circle, right? We were just talking about, you know, experiences in terms of, you know, counseling, you know, people have diabetes, you know, it's, it's just like camp, right? Like, that's how we learn as humans, it's, there's a difference between being told something, and experiencing it with someone or learning it from someone in the sense of hearing a story. Like I think I think that's the value of those types of things. So I think it's just, we're, we're back to where we started.

Scott Benner 58:17
And you can do that purposefully. And I'm gonna pull the curtain back a little bit. It's almost an hour, you and I have been talking. We didn't come full circle by mistake. You understand? Yeah, yeah, I do this for a living. But doctors, you do it for a living to you do your thing to like, be purposeful about it. I had a real honest conversation for the last hour. But at the same time, I had half a mind on not just having the conversation, but leaving it behind for other people to follow as a roadmap. And I, you know, I think that's it, I think you can do that. I'm gonna just come out and say, and I hope the doctors don't take this the wrong way. I'd be a terrific endocrinologist about diabetes, I'm sure I don't know anything about anything else. Although I'm not bad with thyroid stuff. I have a lot of thoughts about anemia that I think are valuable. Also, I think I'm undecided. GRPs, by the way, and what they're going to do in the next 10 years for people, that aside, I think I could do your job. I actually think I do it every day. I do it in small chunks in personal conversations. And I do it in bigger chunks by teaching myself from other people, and learning how to talk to the next person because of that, and you have to make some generalizations when you do that. That's not a bad thing all the time. Like you don't want to generalize, put somebody in a box and be wrong about them, obviously, because that's a disservice. That's pretty infuriating. But I mean, bigger generalizations like, people forget to Pre-Bolus or people forget that they have diabetes where they don't want to be bothered by this. Some people don't want to think about it. Some people like so talk to that person that way. Like here's how you can tell I tell my daughter, I'm like, you don't want to think about this, do these things. And then you won't have to think about this otherwise because my daughter is not one of those like, like you guys, like her Jenny talking Jenny is a healthy person. She eats healthy on purpose. I once asked her when you go on a road trip with your family and like, where do you stop to eat? And she goes, we don't stop to eat on a road trip. I was like, What the hell? How do you eat? You know what she said? She brings food with her. I was like, God, damn, I never thought of that. Like,

Dr. Nader Kasim 20:00:24
I was like, why would you do that?

Scott Benner 20:00:25
Oh my god, where you could get like a Milky Way bar at the store, like, like, you know, and I'm like, Oh, she's an actual healthy eater. Like, she would never stop at a gas station. Like they, she just wouldn't do that. So when you're talking to Jenny, you talk to Jenny about who she is. When I talked to my daughter, I talked to my daughter about who she is, right? My daughter is not a person who wants to be involved with diabetes, but she also wants to be healthy. If you ask her personally, and I say, Why do you do this, she'll go because I don't want to die. Like that's she's motivated by her own health, about the longevity of her of her existence and, and her ability to do the things that she wants to do while she's alive. She doesn't give a shit about diabetes. When I tried to explain something to her. She's like, I don't care. And I'm like, I know you don't. But this parts important and she knows if I go this parts important, she stops. She's like, he's gonna tell me something I actually really need to know if I started telling her something that's extraneous, or like, you know, like the geeky stuff that you enjoy. And actually, I guess, oddly enough, I enjoy by the way, how weird is it that we anyway, like, like, she gets lost. She's like, don't care, don't care, don't care. And I'm like, okay, so I don't bother her with that stuff. I gave her the tools she needs. I gave her the knowledge she needs. Could she have more? She could does she need them? Not right now. That's how I put her. I mean, my daughter has a one C, she just she just left. She just went back to college. She was home for like, seven weeks. In the seven weeks she was home or when she was 5.6. Right? And that's her managing herself completely by herself. And when she was this awesome. Oh my God, when she was in college, the first year as a freshman. I said just do the things you know how to do. And she struggled a bit because the food was crappy. Now when I say that, processed and fried, okay, just when you hear crappy here, processed and fried, not real ingredients, fried food. And she was using insane amounts of insulin. And like and I don't mean insane, like the number I mean, versus what she would have used at home eating the way we eat here, which is not like super clean or anything like that. It's just much better. But she stuck with it. She did not give up. And she came home with I think of a six five a one C after her freshman year. All I did when I saw how bad the food was and how it was impacting her as I told her look above all else Pre-Bolus. And don't stare at a high blood sugar. Do something about it. Those are the two things I told her and she came home her freshman year with a six, five. Now she left with a six one I think, but okay, bad food, different variable. We fix that she came home. I said what fixes this problem. She said if I had my own place with the kitchen, I could eat better. We petitioned the school, we got her a place to stay that had a kitchen. She came home the next time or he once he was six one. She got it back down to where it was before she left. Then we got her home. And I watched it come down a little bit. But she was fighting and I said Ah she's just like a longer story. But we think Arden probably has PCOS. Right. So she sees a little bit of insulin resistance, tough periods, acne, stuff like that. I don't sit back and go, Oh, well, that's her a lot in life. I get in the game. And I figure that out. So right now, and I think this is the first time I'm saying this on the podcast. Arden is shooting point two, five of ozempic a week, just that she's never going to titrate up, it's going to stay just like that. Her Basal went from 1.1 an hour to point seven an hour. She's using seven units less insulin a day in basil. And based on her total daily insulin, I think it's completely possible that in 2024, Arden will use 11,000 fewer units of insulin for point two, five of us Olympic once a week. And I don't know if that's right for everybody. I don't know if you can get your doctor to be on board with that kind of stuff, etc, and so on. I just tell the story to tell you that when I see a problem, I fix it. And I tried to explain to RT and what the ozempic did, and she went okay, I got it. And then I tried to get a little deeper into it. And she went, I don't care. And I was like Gotcha. So I didn't burden her with more. But if she sees it helping her, like she's seeing it, she'll keep doing it. So I don't know, and I don't know where you fall on that but I think GRPs are going to become as soon as insurance companies pull their head out of their formulary s you're gonna see GRPs for type ones pretty quickly. Yeah,

Dr. Nader Kasim 20:04:53
I've so I use it situationally and it's it's amazing like, you know, there are people that are just insulin resistant, and it's really evident. And, wow, just a whiff of with almost any GLP. One will, will help. It's

Scott Benner 20:05:09
insane. Yeah, like, I mean, honestly, I'm about to interview the mother of a little girl, I think she's like 12 or 13, who's had type one for three years, and is now not even using Basal insulin anymore. Because of this, she got put on we go V for weight. And they, her insulin is just kept dropping and dropping and dropping. Yeah, I'm not saying it, you understand kids got type one diabetes, I'm sure at some point. But it turns out this child might have been in like an extended kind of like lotto situation, that this was enough to help along the way. I mean, it's just, it's fascinating stuff. I mean, the reason we started Arden for was, you know, the really painful long and excessive periods, and the and the pain in the stomach. And we got on that my wife was on a Facebook group for for GRPs. And she said, Scott, I keep coming every time I come back as a new woman who hasn't been able to have a baby for 20 years is pregnant on a GLP medication. And I'm like, Get out of here, really. And she's been telling me about that for six months, I started Googling it. And there's already some testing going on that women are just like, who could not get pregnant before are seeing like pregnancies on GRPs. And that spurs more conversation that tells you like, Oh, I'm taking it for PCOS. And it's really helped with my PCOS symptoms. And I'm telling you Arden's acne cleared up 80% on it. It's an I don't think we're not sure where her her dose is going to be yet. So I'm not sure that we're there yet on where it's going to be. But her acne cleared up 80% her insulin needs went down the way I just explained. She lost 10 pounds. And she just generally looks better. I saw I don't know if he's this. Listen, this is a little weird, but I saw a thread on Reddit. And hey, read it. I appreciate how cool you guys are about the podcast. Thank you. I saw a thread on Reddit where people with I'm gonna mispronounce his ears. danlos? Can you tell it say that for me? Oh, yeah, there's downloads. Okay. There's a whole group of people that have that connective tissue disorder, who are saying that a lot of their symptoms went away on a GLP medication? Ah, yeah.

Dr. Nader Kasim 20:07:19
I don't know if I saw that. Just insane.

Scott Benner 20:07:21
I you know, I'm on the internet. And so like, I don't know, like, like, look, who knows, if that's a real thing. Maybe they have it. And they were heavier, and they lost weight. And it's easier on their joints. Like, I have no idea what it is. But like, that's the kind of like, thing where the community stuff really does help. Because like, someone hears that and goes, maybe I should look into that, like, maybe I should find out about this Pre-Bolus ng thing. You know what I mean? Like, and I don't know, to me, I appreciate this conversation greatly. But in the end, what I hear is, the model that set up right now works great for some things and doesn't work right for type one diabetes in a doctor's visit with with a physician, like there's not enough time, there's too many variables. There's doctors who aren't great communicators, there's doctors who don't have a lot of good information. There's patients who aren't good communication communicators, patients who are not interested in doing well for themselves and everywhere in between. And with all these different variables, how can this static system work? It'll work for some people, and it won't for others. And that's just what it's going to be your smart young person who has type one, I didn't hear you go, Oh, my God, I have a great idea. Let me tell you how we can fix this? Well,

Dr. Nader Kasim 20:08:36
I mean, the way I look at this is that we're effectively like cheerleaders. So I was, I was gonna disagree with you at one,

Scott Benner 20:08:43
at one point, please do. And that is, you know, we will never ever

Dr. Nader Kasim 20:08:49
know the person who has diabetes as well as they know themselves, we will never understand the child and the parent will eventually know more about their child's diabetes more than us. So we are effectively like cheerleaders, what makes us useful to most people who have diabetes, and I say us as in like, endos, and other diabetes care providers is that we see the gamut. So you know, we were a clinic have to close to 2000 Yeah, we see the stupid we see every walk of life, we can kind of get an idea of what would be average, what would be an outlier, what would be and we can kind of augment your, the person's expertise in their own diabetes. So I think as a medical care provider, that's how we become valuable. So I think you're right you can you can you know, diabetes, this as well as, you know, any endocrinologist just you probably don't see, you know, as as many different people as us well for you because they have a podcast maybe but I don't

Scott Benner 20:09:52
disagree with you, because I do find myself wondering because I do work in a room. I don't actually see any of the people I'm talking to. Am I just attracting? And I'm sure you can think this, am I just attracting a certain segment of the population who works well with what I'm doing. And that's completely possible. And if that's the case, and I'm happy to help those people, but, but I would share this is that if you've ever heard the Pro Tip series, at some point, the Pro Tip series, you'll hear me describe Pre-Bolus thing as a tug of war. I don't know if you've ever heard me say that before. And the explanation has been told back to me by clinicians and people the same, that it's the clearest explanation of bolusing insulin they've ever gotten in their life. And I came up with it on the fly, gees, a long time ago, maybe over 10 years ago, because I used to be this person who wrote a blog. And once in a while someone would get on Facebook and have a problem or somewhere online to have a problem. And someone would say, you should find this guy, he can help you. But back then what that meant was, is like, they'd call me on the phone. And I'd be like, Hey, what's going on, and we talk for 3040 minutes, and I hit, you know, what I think of is the most important pieces that would kind of get them going in the right direction, hopefully let them find their own path. But I was talking once this very young girl, she's in her early 20s. But she had had, she had a baby that was already four, four years old, I think. And it was clear to me she had dropped out of high school to have her baby, she was waiting tables. And you know, I don't think she was, you know, I hate to say this out loud. But she was not the brightest person I've ever spoken to in my entire life, I guess I'm just gonna come out and say, and I explained Basal insulin. I think she got that I explained bolusing. And she was, she was concerned enough for her child to stop me and say, I don't understand what you're saying. And in that moment, I recognized I was either going to tell her, I couldn't help her. And she was going to go struggle for her whole life. And that baby was going to live with anyone see in the eights and nines, where I was going to find another way to say it. And I said to her, have you ever been in a tug of war? And she said, Yes. I said, you can picture the rope with the flag in the middle. And she said, I can I sit? Okay, well, instead of like, one team on one side and one team on the other side. And the goal is for one team to pull that flag on their side. And when, let's imagine that on one side of the rope, it's carbs. And on the other side is insulin. And the new goal is for the flag never to move. And then I just explained it from there. And I got done. And she said, I got it. And I was like, oh, that's terrific. Thank you. And like months later, I get a message from her. She now has my phone number, right? So I get a text from her Can I call you? And I'm like, okay, so she calls me and when we say hello, she's crying. And I swear to you, my first thought was this a really long time ago, my first thought is God, did I say something to her that caused the problem? You know? I'm like, are you okay? What's wrong? And she just says, Thank you. I want to thank you through tears and choking and snot and crying. I want to thank you. Well, Mike, what are you thanking me for? And she says, My daughter, she's sitting on the floor playing for the last hour. And this is how I remember her from before the diabetes. And I was like that I'm crying. You know? Now I'm going to cry now, actually, if I'm being honest with you, and such a real memory for me. And I said, why I actually had to break it off because it was too much like actual emotion. I was like, Why are you calling me for call somebody else? She's like, No, she's like, You did this. And I stopped her. I said, I didn't do this. You did this. I just told you how insulin works. And she we talked, we chatted for a little while and we got off the phone. That was that. She said my daughter was sitting on the floor playing for an hour or more her blood sugar never got too high. Never got too low. She kept saying like, you should see how steady it is. And I was like, Yeah, I know. Like, it's, it's how it works when you have your stuff, right? And she's like, but everybody told me she was brittle. And I said, Yeah, that just means you aren't using insulin correctly. And I think older type ones would disagree with this. But I don't think brittle is even a real thing.

Dr. Nader Kasim 20:14:05
I hate I hate that word. Yeah, yeah, I

Scott Benner 20:14:07
think people don't know how to use insulin, and it makes you look like you're all over the place. And somebody says, and then some at some point, a doctor says Oh, uh, you know, you must be brutal. Nothing we can do. You know, and I get that back then no monitors, no, sometimes no meters and their CGM. So for sure. I can see how they might think that. But that's how I think of this job. So I think of that girl who's now in her 30s and her kids probably 15 years old. And I think that kid's life might be better, because I took 15 minutes to explain to her mom how like insulin works. You know, that's amazing. Yeah. So I it's what I hope for everybody. I hope everybody gets something out of these conversations and goes forward and does this. I mean, there's part of me that thinks that doctors are just going to be pissed at me for talking like this. And there's part of me that hopes that they'll listen, I don't know what's going to happen, but I'm just going to keep telling the story.

Dr. Nader Kasim 20:14:58
I think you should. Thank you is there's definitely a void. And I think, just like I started out, I mean, I, this is this is how we learn. So and you're, you're, you're contributing to that. So don't stop. No,

Scott Benner 20:15:10
no, no, please don't Don't worry, I'm, I love this job. I tell people all the time. I am 52 years old, when I was 16, my grandmother forced my uncle to give me a job in his sheetmetal shop. With the day I graduated from high school. When everybody else went out to a party after graduation, I went home and went to bed because I had to get up at six in the morning and go to my uncle's sheetmetal shop and work there full time. I'd already been working there for three years part time, and I honestly thought that was my whole life. And if you go find that kid and tell him one day, you're going to make a living, you're going to enjoy what you're doing, and you're going to help people, that kid would not have believed you. So um, I have no plans on not doing this. This is the maybe the greatest thing I've done outside of my family in my life. So you know, but I use that that girl, like she sits in my heart when I do this podcast, and her story about her kid, and everybody else's that I've ever bumped into. I just get sad when I hear. When I hear doctors say there's nothing I could do. They didn't understand. And I'm like I think everybody can understand. You just have to distill it enough that it works for everyone. I think that one of the biggest mistakes we make, I'll leave you with this. I think we teach to the least common denominator. And I think that's a bit of a mistake, right? I think you should just assume that everyone can absorb the information and wants it, you just have to find a way to say it. So that the least and the greatest of us, as far as our ability to understand that we can all hear it. And I think that I think that's what I've done here really is I've just found a common sense way to talk about diabetes in a plain spoken manner. And it doesn't matter if you've got a master's degree, or you had to drop out of high school to have your baby, I think you can understand it. And that's all I think the doctor should be striving for honestly. So anyway, that's said, I agree. Thank you. I appreciate it. I appreciate you doing this very much. So back to our original question at the beginning. No reason to make you anonymous and this right.

Dr. Nader Kasim 20:17:17
No, no, I don't mind at all. Good.

Scott Benner 20:17:20
Thank you. I really do appreciate it. Yeah, it was lovely of you to do this, especially on a late on a Friday afternoon. And I have to tell if you want to come back sometime. I'd love to have you back.

Dr. Nader Kasim 20:17:28
Hey, thank you. I appreciate it. Yeah, and I honestly, if you ever want to do anything speaking wise, I'm involved in camp here in Michigan, both kids and adults. So it'd be awesome to have you as a talk. I

Scott Benner 20:17:41
appreciate I would love to do that. I can't I can never wrap my head around. But you know what? Let's stop the recording. And we'll talk about it privately. Do you mind?

Yeah, by all means, thanks so much.

type one diabetes can happen at any age. Are you at risk, screen it like you mean it? Because if just one person in your family has type one, you're up to 15 times more likely to get it to screen it like you mean it. One blood test can help you spot it early. And the more you know, the more you can do so don't wait. Talk to your doctor about screening. Tap now or visit screen for type one.com To get more info and screen it like you mean it. Arden has been getting her diabetes supplies from us med for three years. You can as well us med.com/juice box or call 888-721-1514 My thanks to us med for sponsoring this episode. And for being longtime sponsors of the Juicebox Podcast. There are links in the show notes and links at juicebox podcast.com. To us Med and all the sponsors. A huge thanks to Omni pod, not just my longest sponsor, but my first one Omni pod.com/juice box if you love the podcast, and you love tubeless insulin pumps, this link is for you. Omni pod.com/juice box. If you enjoyed today's episode, go check out the rest of the Grand Rounds series. There's links let's see where you can find them. Well, here's the easiest place go into the private Facebook group go up to the feature tab. There's links of all the series in there you'll see every episode of the Grand Rounds series, you'll be able to go back into your podcast app and listen until your heart's content. 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

#1248 Dill Pickle

Stacie was diagnosed with type 1 diabetes at age 10. She shares her story of managing diabetes, overcoming a challenging family background and surviving a serious car accident.

+ Click for EPISODE TRANSCRIPT

Scott Benner 0:00
Hello friends welcome to episode 1248 of the Juicebox Podcast

Well, here's one for you Stacy's 55 years old she was diagnosed when she was 10. She spent three days in a coma from her blood sugar at diagnosis. Her father was an alcoholic. Her mother was bipolar. She found out she was adopted later in life. She got into a car accident while she was pregnant with her son. This story has a little bit of everything. 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 healthcare plan or becoming bold with insulin cozy earth.com use the offer code juice box at checkout to save 30% off of your entire cart. Those are the towels, the sheets, the clothes, anything you can find at cozy earth.com You'll save 30% with the offer code juice box at checkout links in the show notes links at juicebox podcast.com. 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. Don't forget for community you want the Juicebox Podcast Facebook group is called Juicebox Podcast type one diabetes there are currently 51,000 members it grows by 150 Every three days. Go over there and check it out.

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/juice box or search the hashtag Medtronic champion on your favorite social media platform. This episode of The Juicebox Podcast is sponsored by Dexcom dexcom.com/juice. Box get the brand new Dexcom G seven with my link and get started today.

Stacie 2:13
So my name is Stacy and I was actually diagnosed with type one diabetes. Exactly 45 years ago yesterday. Good to hear. Yeah.

Scott Benner 2:27
December 27. Hold on a second 40. You want to see if I can figure out what 45 years ago was? Sure. It shouldn't be hard, right? shouldn't be because it's 20. The end of 2023. So we're working with a pretty clean number here. So we use 2024. We take 24 off that takes you to 2000 Right. And we take 20 More authentication 89 up to 4479.

Stacie 2:56
I believe it's 1978.

Scott Benner 2:59
So close. All right. So I should have started with 2023. Not 2024. Yeah, that was my Mr. House. That's not my fault. Yeah, I was educated poorly. Okay, so December 27. And by the way, yes. I'm working a couple of days after Christmas. That's fine. By the way, most people are like, yeah, so sir. Wait. Podcast guy doesn't think we work after Christmas. No, no, I know. What do you find us? My goodness? How old were you?

Stacie 3:27
I was 10. Wow. Okay. Well, gosh. But yeah, that was surprised,

Scott Benner 3:35
huh? Yeah,

Stacie 3:36
it was a surprise. I was a really sick little kid. I really, you know, looking back on it, I can see it happening for a long time getting up in the middle of the night. You know, three, four times to go to the bathroom. I would cut my hands underneath the faucet and let water run into my hands and stick my face into that little pool of water in my hands and just suck it out like a straw. I was so thirsty. And Christmas came and my sister was home for Christmas. She was 12 years older, and lived on the other side of the state. And I wanted to go back with her so badly to spend some time with her, which I often did as a kid. And it was a three hour drive. And it was Christmas Eve or Christmas day when we we took the drive and my parents were like, No, she's not. She's not feeling so good. She doesn't look so good. And I'm like, I'll be fine. I'll be fine. I want to go so bad. So they let me go. And I remember I mean it was dark out. Everything was closed. I had to go to the bathroom so bad. We stopped. I remember stepping once at a police state Shouldn't along the way, because there were people there and I could use the bathroom and then another step at I think it was like an assisted living place. And then we made another step at her aunt's house. And then we finally get to her house. They thought I had the flu. So of course, I'm drinking orange juice. She had to work during the day. And so her roommate would come home and I just, I wanted a 711 Slurpee so bad. So she'd take me down to 711 and I get a Slurpee. My parents called one night to see how I was doing. And I remember they put me on the phone. And I could hardly talk. I was so sick. I remember just being so tired and weak. They said to my sister, get her to the emergency room. So we went to the emergency room. I remember her carrying me into the hospital. And then I went into a coma. I remember going into the, to the room. They walked in and they knew right away. I had type one. I passed out and I was in a coma for three days. Oh my gosh. Did a blood sugar of 12 180. Can

Scott Benner 6:17
I ask you, Stacy, you said you were a sick little kid. Did you mean in that moment or for your whole life?

Stacie 6:22
No, in that moment, okay. Yeah, I think I had been sick for a while looking back on it. You know, looking at pictures. I just remember being really thirsty all the time and peeing all the time. And I think that was going on for a while.

Scott Benner 6:39
Younger people have to appreciate that in 1978 if they thought you had the flu, you got orange juice, and that was it.

Stacie 6:45
Oh, yeah. Yeah. Orange juice.

Scott Benner 6:50
Is their stomach upset. Give her ginger ale, ginger ale and orange juice. See you people you complain about life, but I was alive back then. We had I got the what I have the one time bronchitis. Can you imagine bronchitis? Do you know how I got through bronchitis? I sat on the sofa and watch television. Oh, yes. That was it. I was in immense pain. I could not breathe horrible. Like you know fevers in and out, like passing out for hours at a time waking back up. I got ginger ale are introduced and television. There's no medicine. No one took you to a doctor. No, they were like, I wonder if this one will live. Let's find out. Oh, gosh. Parents are like, by the way, also 1978 This isn't in your Toyota Camry. This is some rust bucket with air blowing through the doors and you can't hear a damn thing when you're on the highway because it's so loud in the car. And you're lucky if the thing stops when you step on the brake. It's a car from the 70s You guys don't even know. God. Damn, Stacy. You're lucky to be alive. Oh, yeah. No, you really are lucky to be alive. So you were in a coma for three days? Yeah, get out of here. Oh my gosh.

Stacie 8:04
I remember coming to and hearing voices all around me. My parents were there. And all of a sudden, I was laying there my eyes closed. And I'm like I smell dill pickles.

Scott Benner 8:17
Dexcom g7 offers an easier way to manage diabetes without finger sticks. It is a simple CGM system that delivers real time glucose numbers to your smartphone, your smartwatch. And it effortlessly allows you to see your glucose levels and where they're headed. My daughter is wearing a Dexcom g7 Right now, and I can't recommend it enough. Whether you have commercial insurance, Medicare coverage, or no CGM coverage at all Dexcom can help you go to my link dexcom.com/juice box and look for that button that says Get a free benefits check. That'll get you going with Dexcom. When you're there, check out the Dexcom clarity app where the follow Did you know that people can follow your Dexcom up to 10 people can follow you. Right now I'm following my daughter but my wife is also following her. Her roommates at school are following her. So I guess Arden is being followed right now by five people who are concerned for her health and welfare. And you can do the same thing. School Nurses, your neighbor, people in your family. Everyone can have access to that information if you want them to have it. Or if you're an adult and you don't want anyone to know, you don't have to share with anybody. It's completely up to you. dexcom.com/juice box links in the show notes links at juicebox podcast.com. And when you use my link to learn about Dexcom you're supporting the podcast. This episode is sponsored by Medtronic diabetes, Medtronic diabetes.com/juice box and now we're going to hear from Medtronic champion. Jalen was

Speaker 1 9:53
going straight into high school so it was a summer getting into high school was that particularly difficult, unimaginable Oh, 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, outside of that I didn't have any type of support in my hometown.

Scott Benner 10:26
Did you try to explain to people or did you find it easier just to stay private?

Speaker 1 10:31
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. Did

Scott Benner 10:46
you eventually find people in real life that you could confide in. I

Speaker 1 10:51
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 11:11
diabetes.com/juice box to hear more stories from the Medtronic champion community.

Stacie 11:17
And I heard my mom's voice and my Mom, have you been eating dill pickles? I want to dill pickle so bad. Wait, why is she eating a pickle? Well, she they had been to lunch, and she had added dill pickle. And I could smell it on her breath. And I wanted to dill pickle so bad. Everybody was so excited. I was awake. Yeah,

Scott Benner 11:45
no kidding. Three days, they basically thought they were like, how are we going to get the orange shoe center when she's sleeping? By the way, Stacy really quickly. Let's get back to the dill pickle in a second. But do you think people listening heard air blowing through the doors of a car and thought that's not true?

Stacie 12:03
Oh, gosh. Well, yeah, probably. Yeah. Yeah. It

Scott Benner 12:07
is true. By the way, for those of you listening, they didn't seal that well. And air like cold air. Like in the middle of the winter. You have to wear your jacket, the damn car, the heating barely worked. Air conditioning.

Stacie 12:18
I think my sister brought me across the state in Nova. Yes, it was exactly that. You could hear the air and it was freezing in there. You

Scott Benner 12:28
can hear the air blowing through. It's freezing cold. The defroster doesn't work. The brakes are for crap. There's no you know, power steering sometimes. And cars. People are like cranking on the wheel to make a turn. And above all that the motor is going like this the entire time you're driving. Oh.

Stacie 12:47
And vinyl seats. Yeah,

Scott Benner 12:48
but don't worry, because the radio works once in a great while you all complain your joke. I'll tell you right now, by the way, and go back 50 years before me. And that Nova looks like a leather sofa. Oh my god. No one knows. Anyway, this is not the point. The point is dill pickles saved your life. That's what I'm hearing.

Stacie 13:09
Oh, I'm pretty sure that's it. And I've been obsessed with them ever since. So

Scott Benner 13:15
yeah. You've had you've had your fair share of dill pickles. Oh, yes.

Stacie 13:19
Did they go get yourself? I don't remember that. I'm sure eventually they did. Yeah, no.

Scott Benner 13:24
Oh, that's amazing. You just kind of popped open asking for pickles. Huh? Yes. And no, no. deficits. Nothing, right?

Stacie 13:33
No. Wow.

Scott Benner 13:35
It's just dumb luck. That's really dumb luck. Because if you hadn't gone with your sister, your parents would have figured it out sooner. I imagine.

Stacie 13:42
If I hadn't gone with my sister. They said I would have died within an hour.

Scott Benner 13:48
Oh, wait, when you went to the emergency room? Yeah, no. Yeah. No, you were on your way. Yeah, for sure. Because you you probably use the last little bit of Will you had to make it to the hospital. And then you pass out when you got there. Yeah, gosh, boy, that's crazy. How long do you remember how long you were in the hospital after that?

Stacie 14:04
Two weeks. Geez. I was in the hospital and one side of the state and I lived with my parents on the other side of the state. So I was in that hospital until after the new year. And then they transported me to the hospital in my hometown. That was there for quite a while to just trying to get regulated and teach me what I needed to know. They wouldn't let me leave the hospital until I gave my own shot.

Scott Benner 14:35
Yeah. Isn't that something that was that was what you needed to know back then. Oh, yeah. It was so important. Did you get this needle and you can you're good. Gosh, what insulin Do you recall? It

Stacie 14:47
was the beef and pork insulin. It was two different kinds. Mix them in one syringe in the syringes. Oh my gosh, the needles were ginormous. that's in the head. Visible birds on them. Yeah, they

Scott Benner 15:04
tear through your skin right? Oh, God, they were awful birds. Yeah. So tell people did you have like a sharpening stone that used to have to sharpen the needles with?

Stacie 15:14
No, no stone just had the burrs right in, I think. And I swear the needles were an inch long.

Scott Benner 15:24
They were big. Do you recall? Like the discomfort from it, you recall it still are now? Yes, you do.

Stacie 15:32
Well, and not only that. So once I was discharged from the hospital, my dad had to take me to the hospital every single morning for a couple of weeks to get a fasting blood draw. Because there was no other way to tell what my blood sugar was running. So every morning, we would go to the hospital, and I get a blood draw. And at that point, after spending two weeks in the hospital, and then another two weeks getting poked every morning, there was nothing left, like my arms. I remember my arms were black and blue. My hands were black and blue. It was pretty traumatic. And after that, and to this day, I have a tremendous fear of needles.

Scott Benner 16:20
I bet you do. What do you how do you manage today,

Stacie 16:24
I use a little self hypnosis. I go to the same lab every single time to get my blood drawn. Because I am familiar with the environment. And the people there are really good at doing it. I made a mistake once of going to a different lab. There was this newbie, drawing blood. She had a nerve in my arm. And I got the tunnel vision. I was throwing up passing out it was a terrible experience, like a panic attack. Yeah, I knew it was coming. Like she hit that she had the nerve. And, you know, it was a little nervous anyway, and I said, I just I freaked out and get it out. You hit a nerve. And I sat there and I was trying to relax and do the deep breathing. And then all of a sudden tunnel vision started and I'm like, well, here it goes. I knew this was gonna happen

Scott Benner 17:25
to you have to look at the needle or do you have to look away from it? Oh, I

Stacie 17:29
can't look at it. No. Arden stares at it. Oh,

Scott Benner 17:32
like I'm just gonna say like a mental patient but I don't think that's the thing we can say anymore. But she stare she does. She stares at it like a mental but she stairs and stairs and stairs, the stairs and I'm like Arden. Why don't you look away? She was I need to see it happen. I'm like what? Oh, she hates it, too.

Stacie 17:47
I can't even watch a movie that has sharp objects in it. Yeah,

Scott Benner 17:51
no kidding. Well, I mean, you spend enough time being stabbed by by the way. Do you think people know what a bar is? Like? Like the needles would tear a little bit and then they get these little bumps of metal on them. And a lot of people that I've talked to you from back then sorry, Stacy. But back then, like they would talk about like a whetstone where they'd sharpen their own needles, but it sounds like they were just like, you'll be fine. Just shove that in there. So Oh, and you're not fine. You have a Arden's taking ozempic Right now, like really low doses of it. She's only been doing it for a couple of weeks. And we've been seeing about by the way, it's cut her insulin use significantly. Oh, wow. But she's kidding, like a quarter of a milligram in, you know, from a pen. And my God, she's like, Dad, I'm allergic to needles, and I'm like, what? And she goes, it hurts. And I was like, I don't disbelieve her. Oh, by the way, because she's pretty tough kid about a lot of stuff. And she's like, I just really I hate getting poked like that. And I mean, you guys know, at this point, like it's an insulin pen. It's not a very big needle. Boy, she's like, Oh, it hurts afterwards for a while and like, interesting, you know? But yeah, she not a fan. And she was doing okay, for the first number of like, years actually with diabetes. But I will never forget the time in the office. They came in to give her a blood draw. And she was little they used to, they didn't take her to the like the phlebotomist room at the end of they used to do it right there because it's kind of friendlier in the room and everything. And one day after years of it being okay. She just recoiled into a corner and I thought she was going to climb right through the ceiling to get away from them and she has not been okay with them since then. So, yeah, something actually alright. So I feel for you because I've seen it. You're not MDI though. Now?

Stacie 19:41
No, no, no. Okay. Interesting. You know, my parents were told I wasn't gonna make it out of my 20s Oh, really? I can't even imagine. You know, being a parent and having them say that. You know, when I was growing up, we never we never talked about diabetes. We never do. talked about my care. We just lived life, I took my shots. And my mom was a really good cook. You know, she would cook a really good dinner every night. But I just took my shot before breakfast, went out to play, came home for dinner. And that was that we we never talked about it. And I think they just wanted me to live the most normal life that they thought I could live. And it was, it just was never discussed, because they thought you were gonna die. I believe so. I think that was the reasoning behind it.

Scott Benner 20:38
Like, if this is what's gonna happen to her, then we'll just make it as good as it

Stacie 20:44
can be. Yeah, we want to give her the best life she can live and we're not gonna live under this stress.

Scott Benner 20:51
Are they alive? Still? No, my

Stacie 20:53
dad passed away when I was 23 When my mom passed away four years ago.

Scott Benner 21:02
Oh, wow. Your dad had a heart attack?

Stacie 21:05
Yes, yeah. Well, he he had several heart attacks. And then what finally took him was a stroke.

Scott Benner 21:13
I'm not a soothsayer. It's just that time, man. It's about what would happen if you died early. You know, a ton of

Stacie 21:19
he smoked. Oh, two three packs of cigarettes a day and he had chronic alcoholism.

Scott Benner 21:28
I will. I'll tell you what, I might be an alcoholic. If you told my kid was gonna die. In their 20s Yeah, my father used to smoke three packs of cigarettes a day too. So I mean, it was just like non stop. It was one after another. I've seen my dad. Yeah, I've seen my dad smoke in the shower.

Stacie 21:44
Oh, yeah.

Scott Benner 21:48
So not uncommon. Anyway, next time beer like nobody should tell me what to do. I don't need to be told that vape pens aren't good for me. Yeah, apparently we need new people to tell us sometimes what's okay. Because when no one was telling you it was bad. My father was smoking in the shower. Please wrap your head around that for a second. He was up lighting a cigarette at the side of the bed. had it done before he got in the shower lit another one while he was in there because he couldn't be away from it too long. was smoking while he was eating while he was eating. I can't believe I'm alive. Actually. him leaving my mom might have saved my life. And my brother's perfectly honest. Because the house secondhand smoke. Yeah, no kidding. Yeah. My mom did die of cancer eventually. So I don't know. I still might not be out of this different time for sure. Also, they were probably like if she's not going to live much longer. Let's not spend money on extra needles. Well, how did you how did you read

Stacie 22:50
those bird needles?

Scott Benner 22:52
I mean, listen, we love her and all but times are tight and booze isn't cheap. Other brothers and sisters?

Stacie 23:02
Yes, I have. Let me figure this out. I have two half brothers and three half sisters. Okay.

Scott Benner 23:12
Two half brothers, three half sisters. Do any of them have any autoimmune issues?

Stacie 23:17
On my mother's side? So my grandfather, my mother and my sister all have or had lupus. My sister was recently diagnosed with shrunk grins. Yeah. My dad's side I have a sister with Ms. And ants with rheumatoid arthritis.

Scott Benner 23:47
Do and you're

Stacie 23:51
up in that like

Scott Benner 23:54
Viking part of the country right? Like in Wisconsin II Michigan Guinea like in that space up there. Michigan Yeah. And now where the Vikings landed something like that. Yeah,

Stacie 24:05
probably somewhere in those lakes. Yeah,

Scott Benner 24:09
well they wanted the water they liked the water they got inland they were like where's the water? He said those boats with the big things in the front now there's no water. So they probably went to a lake that's what I'm getting that but a lot of like, European background. Yes. Yeah. Yeah. Wow. You bet you're the only type one tell me about your A onesies growing up and

Stacie 24:30
and how they went? Okay, so I don't remember there even being a one CS until I was maybe late high school. Definitely. In college. I remember even when CS being discussed. Again. It was just it was a fasting blood draw in the morning and that's that's how they made treatment decisions. If I was blood sugar was high then the doctor would up My insulin, I was expected to bring in numbers and a booklet. Like I know a lot of people had to do. But I fed the numbers all the time, I didn't want to disappoint anybody. And I didn't want to look like I was failing. And at the same time, didn't know how to take care of myself. I don't think my parents knew how to really follow. We didn't count carbs or anything like that, right. So they just fed me good food. And I took my shots. And that was it. I was extremely, and still athletic, into all the sports, a lot of activities. And I think that's what's saved me all my life. I've been very active. I don't sit still much. The funny thing I was thinking about this the other day, you know, looking back on my whole life, I never experienced a low blood sugar ever, up until into my late 20s. Because

Scott Benner 26:06
your blood sugar was always high. Yeah, yeah. Yeah. How high do you think it was most of the time. I'm a big fan of starting every day the same way. That's why I enjoy my morning routine that includes ag one. I put my trust into ag one because unlike so many products, their entire formula is backed by research studies. Ag one has been third party tested for safety for years, and it is trusted by experts and medical professionals, giving you one less thing to research on your own. In one study at the 30 day, Mark 80% of people in this study noticed the less gas and bloating How about that? And 97% of people in that same research study felt more energy at 60 days. 82% of people in a research study feel less stressed, we can all use with that. Are you kidding me? Less stress, fewer farts, ag one baby. If there's one product I trust to support my whole body health and to keep me from farting. It's a big one. And that's why I've partnered with them for so long. This episode of the podcast is sponsored by ag one and it's easy and satisfying to start your journey with them today. Try ag one and get a free one year supply of vitamin d3 k two and five free ag one travel bags with your first purchase at drink ag one.com/juice box that's drink ag one.com/juice box, check it out. Well,

Stacie 27:32
when they started doing the E onesies. I was 1415 pretty consistently. And I would go to the doctor and now this was back in college. I go to the doctor and the doctor would say you gotta do better. And you know, you've got this a one C A 14 And that's not good. And you got to do better. And I'm like, okay, whatever. You know, I, again, I wasn't given the tools or the resources when I was younger. And neither were my parents. And we we just kind of ignored it.

Scott Benner 28:12
Do you think they ever looked at you and we're like, oh my god, she's still alive. We not think we're gonna have to send her to college. Or,

Stacie 28:18
like I said, my dad had a problem with alcohol. My mother had an untreated mental illness. It was a very stressful environment. I think the two of them were very protective of me. They they loved and adored me. They were great people. But there were certainly a lot of issues. And I found myself as I was getting a little bit older, kind of becoming the parent. When I went off to college, like I couldn't wait to go off to college because I needed to get out of that environment.

Scott Benner 28:58
What did your mom have that wasn't being helped? I

Stacie 29:01
believe she had bipolar. But she she had a lot of auditory hallucinations and little delusions of grandeur. And my dad felt like he couldn't do anything about it because she was extremely opinionated. And she would make your life hell if you tried to tell her that. She needed some help. To her. She was fine. Okay. Yeah,

Scott Benner 29:36
that's a lot to deal with. For sure. So a onesies fourteens in college. How long did that continue for?

Stacie 29:44
Let me think when I got out of college, I went to work. I got married right away. I got pregnant and that's when you know, the doctor said no Have you really, we really got to get a control on this. So that's, I started checking my sugar with a glucometer, which I had never done and taking more injections. You know, I was taking, you know, two to three shots a day. How old are you when you're pregnant? I was one, two. And then I had my first child when I was 23. And then I had my second one, I was 24. So my kids are 12 and a half months apart.

Scott Benner 30:30
They see got pregnant before it got married or got married, then got pregnant, got married and then got pregnant. Okay, so that's like, at, like, 1990 ish.

Stacie 30:42
Around there. My daughter was born in 90. Okay. No, my daughter was born in 92.

Scott Benner 30:48
But you got married around it.

Stacie 30:52
I got married in 91.

Scott Benner 30:54
And right out of college, so was this a hate? Are you still married? To somebody different? Were you like, I will marry the first person who makes it? I don't have to go back home with those two.

Stacie 31:06
You know, kind of Yes. Yeah. Yeah.

Scott Benner 31:10
So married a college sweetheart. No,

Stacie 31:13
I married an older man that I met where I was working. And oh, that's a whole story in itself. Let me tell him. I mean, we don't want to go down a rabbit hole. Because what

Scott Benner 31:28
do you see like Security money, like Security money, a guy who wasn't drunk like that kind of stuff. He was

Stacie 31:34
narcissistic, manipulative, made everything look just wonderful. The outside and at the beginning. I became pretty codependent. And it was it was terrible.

Scott Benner 31:50
And but your child is with him? Both of them. My

Stacie 31:55
two children are with him. Okay. All right. Got it. How long did that last? That lasted until in 97. So the kids were just three and four. Gotcha.

Scott Benner 32:11
So the doctor says we have to get this better. Speaking about your agency when you're when you're pregnant? And the answer was take a couple more injections a day. And we're going to start using a meter in in the night. God 12 years after you've had diabetes. You started using a meter? Yes. Wow. That crazy, isn't it? Now when you look back at it, don't do you not see that and think

Stacie 32:35
that's insane. Oh, god, yeah. You have no idea how I feel.

Scott Benner 32:42
Ya know, just oh my gosh, how did that happen? Right? And why did somebody not tell you sooner?

Stacie 32:49
Oh, my word. They just assumed it. I knew

Scott Benner 32:52
where they're not meters, or where their meters and you just didn't have one. When

Stacie 32:57
I was pregnant with my daughter, my first child, my doctor and he was a PCP. He's like, we got to put you in the hospital. You got to we got to get some better control over this. So he had mitad me to the hospital where I sat in a bed, you know, I'm feeling I felt I wasn't sick. And you know how it is you any everybody talks about it, you go into the hospital. And nurses can't do anything without doctor's orders. Doctor's orders don't come in until like two in the afternoon. I'm sitting there. I'm asking for insulin injections. They're not giving them to me because the doctor didn't order it. I need to move because I can't sit still I like to go on walks and hikes and exercise. And I was confined to this room. And I remember arguing with them going saying this is making it worse I need to exercise. Anyway, that's where I get my first glucometer was in the hospital. Then I discharged myself from the hospital without any support from the doctor. So I signed papers and I left

Scott Benner 34:18
by the way at that point still are using regular an MPH at that point. I'm just guessing because early 90s Yeah, I

Stacie 34:25
think I was and

Scott Benner 34:27
so they had you injecting a little more insulin to try to bring your blood sugar's down somewhat and test a little bit still are not coming down much I would imagine because you still haven't experienced a low blood sugar

Stacie 34:37
to be honest with you now that think back on it. I was I wasn't better control. I did experience some low blood sugars while I was pregnant because that was my second pregnancy. I get into a terrible car accident.

Scott Benner 34:53
Oh, so not in the first one. But in that way in your second pregnancy. You had a car accident? Yeah. Oh my gosh. That's scary. Especially because, yeah, so were you in the hospital after the accident?

Stacie 35:05
Yeah, yes, I'm pregnant. I was three months pregnant. And I had, I had had my daughter with me and I passed out at the wheel and slipped the car like five or six times, and ended up in the hospital.

Scott Benner 35:23
You know, it's almost impossible to roll a car over nowadays are engineered so well.

Stacie 35:30
Not in the 90s. And

Scott Benner 35:32
the doors, they keep out air and everything. They're very, very fancy nowadays. You right? Wow, that's insane. So low blood sugar. You passed out? Yeah. Oh, gosh. And that everyone's okay.

Stacie 35:46
My daughter, who was, gosh, she was seven months old. She broke her collarbone. And that's it. I had a concussion and a bunch of bruising. And son who I was pregnant with was fine.

Scott Benner 36:02
Was she in a seat? Did they have Did you have a car seat?

Stacie 36:05
He had a car seat. But they didn't make those the way they make them now, either. She, oh, this is so scary. I remember. It was a very warm September day. And I had the windows all partially rolled down because I was my blood sugar was low. I was trying to get home. I wasn't thinking right. I had some sugar. Like I taken some. And I thought I am almost home. I'm gonna get there. I'm almost there. I passed out. And I remember flipping through the air and landed in a ditch. And my daughter had flown out of the car seat out the window and ended up in a cornfield about trying to think 100 feet from the car. She's She just broke her collarbone. She just broke her collarbone.

Scott Benner 37:11
She's not weird or anything when you talk to her. I'm just kidding. That when you see there's never a moment when you're like, oh, maybe it's not the more happened in that car accident. Nothing like that.

Stacie 37:20
I can't say that. Oh, you're the way you weren't because I dropped you on your head. You are the way you are because you flew out of the car window. I

Scott Benner 37:29
flung you into a cornfield. That's why yes, that's insane. Like, God, that's crazy. Did they wake you up with dill pickles? By any chance at the accident scene?

Stacie 37:40
I probably would have come to faster. I'm just gonna say

Scott Benner 37:43
if they if they knew that. They knew to use that as smelling salts for you then. Probably. So I'm sorry. You wake up your blood sugar's low. Do they know you have diabetes? Yes.

Stacie 37:55
Because the volunteer firemen. That was the first on the scene. He was who we rented our house from. And he knew that I was type one. Oh

Scott Benner 38:09
my gosh. And so they revive you? Do they have the baby at that point? Or?

Stacie 38:14
Well, like I remember coming to and, you know, in and out of consciousness. And all I could say was my baby, my baby. And he knew I had a baby too. And he's like, the babies with you and like, is she not in the car? And then all of a sudden people were, you know, lined up and walking through the cornfields looking for the baby Jesus Christ.

Scott Benner 38:41
Do you call her Children of the Corn? When she acts? Oh, that's

Stacie 38:45
a that's a good idea.

Scott Benner 38:47
If I was there, that's what would happen. So it's too late now. I mean, she's probably Yeah, she's probably she's probably in her 20s now. Yeah,

Stacie 38:56
she is. 31 Wow, gosh, that's really

Scott Benner 39:00
something got dim as white people come on telly. There's no way you thought you're going to tell that story when you got on the podcast today.

Stacie 39:06
No, I I had like I had a whole outline of other things. Yeah,

Scott Benner 39:11
no, I don't care about that stuff. That's incredible. Now, in your note to me, you say that you're a onesies now, but in the sixes forever. So at what point? And what tools did you get that changed all that for you? After

Stacie 39:26
my divorce. I went back to work to where I was previously working, which was a vocational rehab workshop for people with injuries and developmental disabilities. And there was this young man, I believe he was like 22 or 23 years old. He had had his leg amputated because he was a type one and didn't take care of himself. And all my co workers were like, Oh, you got to talk to this guy. You got to talk to him, You got to knock some sense into him, you got to tell him how to take care of himself. And I just remember thinking, I don't even know how to take care of myself, How can I tell somebody else? How to take care of themselves. At this point I was maybe 28 years old,

Scott Benner 40:21
you're probably thinking I should ask him advice about how to get around with one leg because I, you're probably closer to him than he is to be in you. Exactly. And you weren't, you're no great shakes at that point. So that is that what scared you

Stacie 40:33
I was a single parent. And I'm like, I have got to figure this out. I, you know, the doctors and helping me. Yeah, it was it was a scary thing. I went home, and I pulled the glucometer out of the drawer and wipe the dust off of it. And I'm like, you're here I go, I'm going to see some bad numbers. And I just started poking my finger. And making adjustments on my own. I was still exercising all the time, extremely competitive in sports. And I just made it a new challenge for myself. I'm going to get good at this. I started ordering magazines and read them all the time and you know, learn some new tricks, eating better. And that's what I just did. And over the years, I just continued to do that. Cuz I wanted to get good at it and be proud of myself for it. Eventually, an MDI, I was consistently in the low sixes. And I've been probably for the last five years, I haven't had an A one C over 5.6.

Scott Benner 41:50
That's amazing. Did you know that that meter was just for pregnancy? The minute you Yeah, the minute you were done having your son you're like, Oh, thank God and put that thing away. Yeah, yeah, I know. Right. back to it again. Do you have any complications? Zero. That's great. Yeah, one that's even insane about how you feel like did you notice yourself feel better eventually? Well, yeah,

Stacie 42:14
that was that was the thing like I had lived so long with high blood sugar's I had no idea how terrible I felt. Until I got those sugars down. And I had so much energy, I couldn't think clearly. You know, I think of like, back in school, when I was in college, I was a good student, but man, it took me a long time to get it. Like, I feel like I could have done so much better in so many things. If I had stable blood sugars in once I was able to get all of that under control. Like I got more motivation for myself, I wanted to take good care of my kids. I saw things just much more clear. And I didn't want to feel crappy anymore. Like I learned, you know, how I felt when I was stable, compared to when those sugars were high. I never wanted to go back there. That's how I am now to like, I have absolutely no desire to eat poorly. I do once in a while, because probably everybody does. And I regret it. And it's just not worth it to hear.

Scott Benner 43:34
I had a couple of cookies over Christmas, and I put a pound on and I had that same thought this morning. I was like, I could have just not had those cookies. Yeah, what's it worth? It? Really doesn't because now I gotta get rid of this pound again. And then I'm like, You know what I'm like, and that's not a thing I was paying attention to until I was paying attention to it. Really? Sure. Yeah. So similar for you. So not really so much about like, I gotta be here for these kids. But more about like, I want to be proud of myself. I want to like, take take over. Is that how you felt? Yeah,

Stacie 44:08
I wanted to have control. I felt like I there were so many things leading up till that I had no control over, you know, thinking about how I was raised and you know, dealing with my parents issues. My whole first marriage was very disappointing. I totally lacked any self control in that relationship. He had total control. Yeah, once I was on my own and I could see all that. I'm like, that's it I need to get control of my life and, and do better for myself and feel better. And I want to excel at this.

Scott Benner 44:52
Yeah. And you used magazines and any information you could find.

Stacie 44:56
Yes, because the internet wasn't really

Scott Benner 44:59
it. Oh, yeah, no, it's so interesting, right? Like the internet's not going to help you, at some point doesn't exist. And I just, it made me feel like 25 years from now someone will be on whatever the equivalent of a podcast is gonna be like, I just wanted to take control when I started listening this thing called the Juicebox. Podcast, like, you know, and it'll sound so old the people like when you just said magazines, people big oh my god, do you remember podcasts? So quaint? They used to come on your phone. Do you remember phones? Before our brains could talk to each other? Yeah, we used to have these phones in our hands. They were such a relic. Maybe? I think there's one in the Smithsonian, if you want to go see it still. Oh, my God, that's crazy. Good for you. And never turned back? Do you have an eating style that you use? Or do you just kind of eat what you want, but in reasonable measure,

Stacie 45:52
I stay away from processed foods. I have a low ish carb diet, like I stay very consistent. So you know, breakfast, it's 15, carbs, lunch, it's 15 to 20, carbs, dinner, I won't go over, you know, 22 to 25 carbs. It's just very consistent. If we go out to eat, we only go out to eat like once a month. And we'll go to the same places where I am comfortable. Knowing what to you know how to dose because I don't like plan that chasing game. Don't want to, you know, eat something and then be chasing the sugars up and down. Yeah.

Scott Benner 46:37
Well, I think it's fantastic that you that you made it through all this and your second marriage went okay, this guy's better.

Stacie 46:43
Oh, gosh, yeah, we've been together over 25 years. And yeah, he's, he's awesome. We have a lot of fun together. We have my kids. Well, my my son has two boys. And so we're grandparents. And my daughter recently got married and she's got a baby on the way. So that's how you girls do it. Apparently. Quick. She's She waited a little

Scott Benner 47:15
longer. Yeah. I was just teasing. Do you to have children together? Or you have the twofold first just to to Okay. Yeah. Yeah, well, also everyone in your life and set the bar so low that this guy could be a pretty big jerk. And you wouldn't even know it.

Stacie 47:34
Oh, no, I had pretty high expectations when I met.

Scott Benner 47:39
You did? I bet you set the bar pretty high. You're like, I'm not doing that again with those people. Oh, yeah. Nice. Your mom to hang on so long to get help for the bipolar?

Stacie 47:52
No, she didn't cut my story with My poor mom is another long rabbit hole. No, she was pretty hard to deal with for for many years. And at one point, I kind of walked away from the relationship because it it just wasn't good. For me. It was very stressful. Sure. Then maybe about eight years later, I, you know, she hadn't seen the kids since they were little. And they were, you know, senior and junior in high school. And I'm like, This is ridiculous. Like, she just loved those kids so much. And she was missing out. And we I've finally slowly developed a relationship with her again. And at that point, I tried to learn how to see things from her point of view and why she was the way she was. She had a terrible upbringing, mental health issues in her family. I just tried to be more understanding even though I didn't believe the way she believed or thought the way she thought. I just became more empathetic and sympathetic with her and she softened up a lot as she got older. And by the end, we had a really good relationship. I'm

Scott Benner 49:19
glad. That's lovely. Yeah, wait for you. It's nice to have you to go back and try again. Honestly. You did it for your kids, or you did it because you thought about how much your mom missed. It's the kids what pushed you? I

Stacie 49:32
felt like my my mom had pushed everybody out of her life. She had no relationships with anybody. She was pretty much homebound. And I was she was missing out on her family and her kids that she adored. I wanted her to see the kids and I was proud of my children and how they grew up and You're not the kind of people they turned into. And I wanted her to see that. That's nice.

Scott Benner 50:05
That's really nice. Oh, wow, you've been through it. Here. Oh,

Stacie 50:10
you have no idea. I didn't even tell you about the whole attraction thing.

Scott Benner 50:14
Wait, that's right. Okay, hold on. Let me let me focus myself. I want to say that when you said you thought your mom might be bipolar, that didn't shock me when you said because you had said mental health concerns then went back to perhaps bipolar. When I asked people about other autoimmune stuff in their life, I usually say How about any, like, bipolar stuff, and really unbalanced amount of people say oh, yeah, my aunt, my mom, my grandmother was bipolar. Like, I think it's all

Stacie 50:48
inflammation somehow. Oh, yeah. Yeah. You

Scott Benner 50:52
know what I mean? Yep. But as everyone's listening, your dad's an alcoholic. Your mom's bipolar. And you sound so like, not those things. And you could wonder why you're listening the whole time. How is that possible? But here's how it's possible. Go ahead.

Stacie 51:09
I was the most stable, emotionally stable person that my entire family. You were adopted. But I was adopted.

Scott Benner 51:18
It was screwy in my head that you were 10. And your sister was 22. And so I thought like late in life baby or something late in life adoption?

Stacie 51:27
No, I was adopted as an infant. My adopted dad had been married before and had two kids. And my adopted mother was younger than my dad didn't have kids, but didn't want to have kids. Like she was scared to death of childbirth. So they wanted to adopt a baby. They're best friends. He was a doctor. And he knew this, you know, this woman was coming in to see him for her pregnancy. And she wanted to give her baby up for adoption. And this doctor said, I've got the perfect family for you.

Scott Benner 52:17
We've got a bipolar lady and a drunken guy. We're gonna slide your kid and it's gonna be fine. Welcome to 1978 A right actually 1960 1968 Right. Yeah, yeah, yeah, we've got the perfect people. They're upright.

Stacie 52:35
Well, they were sky. I mean, really, they they were like my dad, other than the motional stuff. Like they provided a fantastic home. We get a good family business. The finances were there. They were very involved in the community. I mean, they the issues came a little bit later. Okay. Well,

Scott Benner 53:01
yeah. Also, I guess you'll never really know their whole story, either. You know, without without really sitting and talking to them. I don't know, how you feel like when you stop and look at like, where the zigs and zags come from, like, Oh, I just wanted to be proud of myself. So I took care of my diabetes, where I use the meter, because the doctor like foisted it on me, but they tried to stick me in it like those little stories, those moments that, that reframe things for people, we don't know what they are, you know, it's not until you sit down, you might talk to your mom and find out that she had all kinds of like, problems, you know, growing up, and she might have been lucky to be as together as she was. Yeah, yes. Right. And maybe your father started drinking because your mom was bipolar. And he loved her so much. He didn't know what to do. Like I haven't.

Stacie 53:45
Yeah, you can look at it right there. Yeah, that's definitely what happened.

Scott Benner 53:50
Yeah, I know, trust me. I've had a lot of these conversations. I know what happens. Actually, it's frustrating. Sometimes they see because as I feel like a historian of humanity, on some level, and like, like having had so many conversations with people, you can see the bellwethers. And you can see the detours, and you can see the stuff that derails people and that what brings them back. And as it's happening in real time. I sit there sometimes listening to people talk in my real life. And I think, Oh, don't do that. That's like that story where this lady told me that Bob, like if you just do this, instead, you'll get around that and you'll never have to bow they're gonna do it, though. Yeah, they're gonna do it. And it's just, it's fascinating sometimes. How repetitive people stories are interesting, you know, and I feel like sometimes I can see them and say, like, Oh, if you just don't do that, you'll avoid this whole thing. And I know that's real because 75 people have said this to me in my life, like while I'm interviewing them, and they don't realize they're doing it, because we sit down. It's a little bit of a things they see but we sit down and You're like, oh, it's Scott, the guy who has been talking in my ear for a couple of years. I'll tell him about my car accident where my kid flew into the cornfield, and my mom's bipolar, which are not things she would tell people normally. So we have this kind of relaxed conversation about things that people don't talk about, usually. And, anyway, I might, maybe I'm having feelings of grandeur. But I feel like I've heard enough stories and seen enough of the building blocks of stories, that you can kind of look at a person's life in motion and go, Oh, that's not a thing they should be doing. And I know, because that's going to lead to this, okay. That's why I keep asking people about their stories so that other people can listen to them and eventually go, oh, I should be taking care of myself better. Or, you know, like, maybe it would behoove me to take three days to figure out how fats impacting my meals, you know, how do you talk them into doing things for themselves that, that nobody really either knows to do or cares to spend the time on? I mean, I still every day somebody says to me, I don't have time to listen to that. And what I think is, oh, okay, well, I know exactly what's going to happen to your health. You don't know because you have that human thing where you think it's not going to happen to me, I'm going to be the one that's okay. Right, my dad and your dad did the same thing. Three packs of cigarettes, no big deal. This won't be a problem at all. You know, my dad died of congestive heart failure eventually. And your father had a heart attack and then a stroke, which is directly relatable to the, to the, to the cigarettes, you know, while they're doing it, they're not. They're like, Nah, that's fine. I'm fine. Which is what you were doing with your blood sugar. Like, I'm fine, I'm fine. Until Yeah, it's just anyway, Stacy, I see it. I feel genuinely lucky to be able to have the conversations of pulling things out of people to make them available for other people to hear. So maybe they'll have an aha moment move forward. But you know, still in my own life, it doesn't always help me. So yeah, because

Stacie 57:02
you're, when you're talking with other people, you're listening to their story and helping them and helping other people. But when it comes down to looking at yourself, that's, that's hard to do. Yeah. And who's got the time? Honestly,

Scott Benner 57:18
it's a lot of work it is. So I make a podcast that you listen to it, so that along the way you go, alright, I'll do it. That's pretty much the whole thing. It's my my lot in life, which I don't mean it that way. But it's my responsibility to find an entertaining way to tell people's stories about their diabetes. So people actually listen to it and then end up end up helping themselves. That's pure. Yeah. So anyway, alright, so how did you find out you're adopted?

Stacie 57:46
Well, surprisingly, after hearing a little bit about my parents, they never told me

they expected my after hearing stories over, you know, afterwards, they wanted my brother to tell me now. My brother was is 11 years older, a psychologist, and he's, he's been the one rock and my family loves him. Smart man. Anyway, I can't say more about my brother. But they wanted him to tell me I was adopted because he'd be able to deal with the emotional Fallout, I'm guessing. She's like, that's not my responsibility to tell her. My dad wanted me to know, but my mother absolutely did not want me to know. My guess. It was because she was probably afraid I wouldn't love her. Or it would change the relationship or who knows. So life went on. And nobody told me when I was in college, it was, Oh, I was going into my senior year and I decided I'm not going to go back home for the summer. I'm staying here. I'm going to work. I'm done with going home. And so my sister was helping my friends and I move and they were in the moving truck with her and I was in a in my own car. And she kept saying to my friends, I am so glad Stacy's doing this. She needs to get away from home. She needs to get away from the parents. And my friends were like, yeah, yeah, we know. We know. And she's like, No, you don't understand. She needs to get away. And they're like, we know. And then she's like, No, you don't understand. She's adapted. And they're like, What And then she realized she let the 21 year old secret out of the bag. And she said, You can't tell her. Please don't tell her. She's not supposed to know. So I was really close with these two friends. You know, when you're when you're best friends with people and you live with them, you know when they're acting different. Like what's wrong with you guys? Boy, you're acting weird. Nothing. Nothing's wrong. One night, we went to a party and had some drinks. And I'm like, come on you guys what's going on? We know something about you. And we can't tell you. And like, it just pissed me off. Yeah. Also, how

Scott Benner 20:00:41
do you know something about me? I don't know. That's insane.

Stacie 20:00:45
Yeah, exactly. But we promised we wouldn't tell. I remember getting pissed off and leaving. And then a couple of days later. I'm like, you guys, come on. You're acting weird. You know something about me that I'm not supposed to know. It's terrible. And they're like we we just we promised we can't tell. So well, what if I guess it? Would you tell me if I guessed it? And they looked at each other and said, I guess that wasn't part of the deal. Okay. What

Scott Benner 20:01:17
is wrong with everybody? Stacy? Can I give a piece of advice, everybody listening? Don't keep secrets. It's always worse. Just always, it's never the right thing to do. If you find yourself saying I wonder if she would tell what you should be saying is I should immediately tell this person this thing. Because I it's not my responsibility to like, hold the secret inside. They get to deal with their thing. It doesn't matter if it goes well or doesn't go well. It's their information to have not yours. Like one of my kids recently, where they knew something about a friend's thing that impacted another friend. And they were faced with this opportunity to keep a secret. And I said, Arden What'd she do? She's like I told her right away. And I was like, good for you. Like, she goes, this is my problem, but she deserves to know. And I was like, right. Everyone deserves to know their thing. But now you're playing a goddamn guessing game. Like, it's like, it's like 20 questions. Oh,

Stacie 20:02:19
there were 20 there were only two. Yeah, I said. I said, Well, my dad's sick and he's dying. And they're like, No, that's not it. I said, Okay. I'm adopted. And the look on their faces was priceless.

Scott Benner 20:02:35
Did you always think you worse they see.

Stacie 20:02:39
I always questioned it. Because I was so different than my parents. Like I was extremely athletic and active and love to be outside. I was a tomboy. Like, I played boys baseball and every sport imaginable. And these two people had not an athletic bone in their body. Yeah, I felt like I didn't look like them. But I talked myself into thinking that maybe I looked a little bit like my dad. But I just I just remember, all my years growing up looking in the mirror going. Do I look like I don't get it and then I would just kind of brush it off.

Scott Benner 20:03:25
I never wondered, like we all look similar enough that it wasn't like crazy. You don't I mean, like I wasn't like redheads and thin and they weren't like round and like had dark hair or something like that, you know, but we all look similar enough. But it's funny. I never thought about it deeply. I always knew I was adopted. They told me like right away. But I don't think about when people tell me Oh, you look like your son or your daughter has these features that I don't see that about my own kids. And I wonder if it's something to do with how I grew up? Because they obviously my my children are obviously mine. And my and my wife's like they look like us in ways Arden's faces very unique. So you can you have to pick out features, but my son looks like me. You know, he looks like me and my wife smashed together. Like he just does, but I never think about it that way. And I wonder if it's something I'm not blocking out from being adopted and growing up, to be perfectly

Stacie 20:04:23
honest. So it's funny you say that because I've thought that about my own kids too. Yeah, I mean, people will tell me my daughter and I look so much alike. And I look in the pictures and I'm like, I can see that we're similar in a lot of ways, but I don't know. Yeah,

Scott Benner 20:04:41
we just don't have that like feeling from growing up. Yeah, that we can now like sort of tacked on to for this. i It does seem. It doesn't seem crazy to me at all. So yeah, although my kids are much more athletic than I am, or my wife was and they were retiring. Seems like you've heard me joke on the podcast. I'm like, I must have an incredibly athletic mailman or something like that. But but but at the same time, I wasn't not athletic. I just was not as as they are. So both of the kids are really, so much so and it's funny Arden's gotten so far away from playing softball at this point. She doesn't do stuff like that anymore. That when she meets new people, they were like, when she was a freshman in college, they were all sitting around one night there her roommates talking about like sports, and one of the girls played soccer. And the other girl did this thing and everything and Arden's like, I played softball, and they're like, No, you didn't. And she goes, No, I did. Like I was really good. And she's like, that's not possible. And she's like, she's like, they didn't she called me. She goes, Dad, I'm like issues. I'm here with everybody. And I'm like, Hey, girls, and they're like, Hi. Can you just answer a question for me? And I was like, yeah, she's like, did I play softball? I was like, yes, she goes, was I any good at it? And I was like, oh, Arden was like a fantastic third baseman, she could pitch a little bit, she could play the outfield if she needed to crazy arm like Arden could throw a ball, throw a wall. And the girls were like, what? And so she's so changed in the last couple of years that, like they couldn't even bring themselves to think that about her.

Stacie 20:06:13
Oh, my word.

Scott Benner 20:06:17
Stacy, is there anything that we haven't talked about that we should have? I

Stacie 20:06:20
really can't think of anything, I can say that. You're never too old to learn new tricks. I did eventually go on an insulin pump. I went back to school and got my master's in social work. And during that time, I was in school, I had been ashamed of diabetes my entire life and afraid to share it with people. And while I was working on my master's, I got an epiphany that I was going to do all my research and type one diabetes. And I did all my presentations, and papers and research and type one, just wanting to educate others, and type one. And I became an advocate, and no longer ashamed and got a Dexcom. Because during my research, I met other type ones I'd never known other type ones when I was growing up, had no support system. But while I was working on my Masters, which I didn't start doing until I was 45. And learned all about the Dexcom and met other type ones, it was really another game changer for me, and started listening to your podcast a couple of years ago, I learned how to Pre-Bolus and bump and nudge and do all these little fun tricks that have just made life with diabetes a little more tolerable.

Scott Benner 20:08:02
That's great. It's fantastic. You put a lot of effort in you deserve a ton of credit. And at the same time, I think anybody could do it. You know, you just have to kind of carve out a little bit of time. And, and, and be be purposeful about it, you know, not just say I want to get better at it. But do something, take a step order a magazine, right? Like, you know,

Stacie 20:08:25
little tiny baby steps. Yeah, they don't have to be huge, just one little tiny step at a time.

Scott Benner 20:08:32
Yeah, at your own pace, I actually found myself telling somebody that last night, we put up lists, one of the most frustrating things about doing what I do is that you put this information in the world. And then you realize that three days later, it's as if it's not there, and you have to do it again and again and again, and over and over. And so we were sharing on the Facebook group, this list of lists, basically, it's all of the different collections inside of the podcast. And people came along with like, Oh, I'm so glad you made this. And all I could think was this, we've had this for two years. And then you know, like, it's okay, it's alright, here it is, again, you know, and, and one woman said, I don't think I can listen for more than about a half an hour at a time, I have a pretty short extension span, I said, that's fine, that information is always going to be there for you. You can, you know, at your own pace, just do it at your own pace. Don't feel like you have to sit down and hammer through 10 episodes to magically be better at something just listen as you can. And you'll wake up a year from now and be in a different situation. And that's hard for people to to I think to use as a goal. You know, a year from now, you know, I'm now in December. Having started using we go V for weight loss in March. And you know, on that first injection when you put it in, you're like I'm not thinner. You know, like like it's you have that feeling of like oh, when's it gonna happen? And you know, a half a pound around a week or so, you start to realize it doesn't matter. Like, as long as I'm moving in the right direction. That's really what's important. Because one day I'll look back and think, Oh, I did it. Like I'm gone. Now I moved out of that space. I'm into a different space now. You don't get to see it happen. Yeah.

Stacie 20:10:14
We live in a we live in a world of instant gratification. No, of course. Yeah,

Scott Benner 20:10:21
things happen so quickly now for you that you're just like, well, it didn't work and three days into it, you're like, ah, vitamins don't work. Like, you've only been taking them for three days. Don't feel magically better. That's not how it's gonna be. So I mean, I was taught that patience. Because you start thinking, well, there are 52 weeks in a year, I only want to lose 40 pounds. So a pound a week. Great. And that even leaves 12 weeks there, where if I don't lose weight, it doesn't even matter. Sure. You know, if you think about it that way, then suddenly, you know, it all makes sense. But when you're looking, oh, I have to lose 40 pounds. Why is it not gone already? Like, you know, you can tell people all you want, well, you didn't gain 40 pounds in a day, you're not going to lose 40 pounds in a day. And you didn't get to this situation with diabetes in a day It took years of people not giving you good tools, or you ignoring it, or whatever you ended up doing along the way to get you where you are, it's going to take some time to get out of it too. So yeah, it's all about, it's all about not wanting that gratification today. Like you have to be and by the way, here's how I do it. I keep cactuses. They grow so slowly, that a year after you have one, if it's an inch taller, you're like, Oh my God, look how much this girl that actually taught me patience, like trying to keep a cactus to grow. So you guys should find something that helps you with that. Anyway, Stacy, you were terrific. I really appreciate you doing this with me. I know how long it takes to get on the show and all that stuff. So I know it's a big effort. And it's just a couple days after Christmas. So I appreciate it very

Stacie 20:11:56
much. Well, I appreciate being able to talk to you and it was was great. And

Scott Benner 20:12:03
we can call this one dope pick all

Unknown Speaker 20:12:04
right. Oh, heck yeah. Okay,

Scott Benner 20:12:07
well then that's done. That one was easy.

Stacie 20:12:12
I was curious. I was sitting here thinking I wonder what he's gonna call this Oh,

Scott Benner 20:12:16
it's clearly dill pickle. You know, although Children of the Corn strong No, I thought maybe go children strong second, but it really it's talking about a child flying for cars. So I don't think there's a lot of joy in that all mean that she lived through it is joyful. But even that, like do you think people right now are like thrown out of a car happen all of the time? Oh, my God. Yeah. No idea. You're just so lucky to be alive now. You have no idea just anyway. Right? All right, Stacy. Hold on for me. Okay. Okay.

A huge thank you to one of today's sponsors. Ag one drink ag one.com/juice box. You can start your day the same way I do with a delicious drink of ag one. Jaylen is an incredible example of what 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. A huge thanks to Dexcom for supporting the podcast and for sponsoring this episode dexcom.com/juicebox Go get yourself a Dexcom g7 right now using my link. If you are a loved one was just diagnosed with type one diabetes, and you're looking for some fresh perspective. The bold 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 dietitian 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, or 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