#1259 Grand Rounds: Gas Passer

Diagnosed with type 1 diabetes at 41, Courtney, a nurse anesthetist, discusses the impact of her diagnosis and managing her condition alongside her career.

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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 1259 of the Juicebox Podcast

Courtney is a nurse anesthetist anesthetist enough for her boy, she's a gas passer. She's also, she also has type one diabetes, and she was diagnosed at 41 years old. She's now 46. She has Graves disease, and antibodies for Hashimotos and today we're going to find out what she sees that her job. Please don't forget that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, always consult a physician before making any changes to your health care plan, or becoming bold with insulin. Don't forget, if you use my link drink ag one.com/juice box you'll get a free year supply of vitamin D and five free travel packs with your first order. And if you go to cozy earth.com and use the offer code juice box at checkout, you're gonna save 30% off of your entire order. Subscribing to the Juicebox Podcast newsletter is this easy. You type juicebox podcast.com into a browser. Scroll to the bottom put in your email address, click sign up. I was looking for a way that we could all get nice and tanned and meet each other and spend some time talking about diabetes. How are we going to do that on a juice cruise? Hang out at the end of this episode to learn more.

This episode of The Juicebox Podcast is sponsored by touched by type one. This is my favorite diabetes organization. And I'm just asking you to check them out at touch by type one.org on Facebook and Instagram. This episode of The Juicebox Podcast is sponsored by the Dexcom G seven, the same CGM that my daughter wears. Check it out now at dexcom.com/juicebox. Today's episode is sponsored by Medtronic diabetes, a company that's bringing together people who are redefining what it means to live with diabetes. Later in this episode, I'll be speaking with Mark, he was diagnosed with type one diabetes at 28. He's 47. Now he's going to tell you a little bit about his story. To hear more stories from the Medtronic champion community or to share your own story, visit Medtronic diabetes.com/juice box and check out the Medtronic champion hashtag on social media.

Courtney 2:26
I'm Courtney, I'm a nurse anesthetist, which is an anesthesia provider. And I was diagnosed with type one diabetes about 15 years into my career. And I think there's a lot patients can learn to advocate for themselves. And I think as health care providers, especially in the perioperative period, there's a lot of finesse to be learned as well. So that's why I'm here.

Scott Benner 2:52
Cool. So 100% This episode is going to be called gas pastor just so you know. And

Courtney 3:00
love it. Yeah, it's gotta wear it proudly. My coworker actually has a hat that says I have gas. Yes,

Scott Benner 3:06
Pastor, by the way, a phrase I know from the TV show mash. I love that show me where I know that that phrase. How old were you when you're diagnosed with type 141

Courtney 3:17
or 2912? Tightens I like this

Scott Benner 3:22
nice track. How old are you now

Courtney 3:24
46

Scott Benner 3:26
years ago, any type one or other autoimmune issues in your family line.

Courtney 3:31
I personally have both that I had Graves disease and the antibodies for Hashimotos as well. So me and I have a cousin with graves but nobody else with type one or other autoimmune that we know. No celiac. No celiac. Here's a weird one for you. Bipolar disorder. No, not that we not that I know of nothing. Anybody claims

Scott Benner 3:55
out loud out here. You know, okay, great. That's what I want to know. So

Courtney 3:59
And guys, both my kids have done the trial net, which is great and currently negative. And then I just got my sister and all my nieces and nephews to test as well.

Scott Benner 4:07
So oh, you're a bit of anomaly about that. Okay, I know so safe to say you were shocked.

Courtney 4:14
Absolutely blown away. So I graduated nursing school. So for those who don't know, a nurse anesthetist has to be a registered nurse first and then you do ICU experience for a few years and then you can apply to go back and get your Masters now it's current when I went to school is a master's it's a doctorate now. I was an ICU nurse for three years and then a recovery room nurse for a year before I went back to school. And I remember sitting in lecture about our endocrine lecture thinking back in, you know, 99 2000 thinking I really don't ever want type one diabetes like that would be really a nightmare. And granted the improvement is shocking compared to how we used to treat type one but it's Yes, I had had knee surgery and got the flu and went into the ER and was shocked to spend a few days in the ICU with a type one diagnosis. No idea.

Scott Benner 5:13
Wow, knee surgery brought on by an injury or degradation of your knee. Yeah,

Courtney 5:18
just trying to avoid a knee replacement. I've been really hard on my knees in my lifetime. And at the time when I went to the ER, my agency was 9.8. So I'd probably been limping towards that diagnosis for at least several months, I'd had a fasting sugar. I got diagnosed in March and October as part of my annual with a fasting sugar of like, 105. So not great, but obviously I wasn't severely impaired at that time. But at diagnosis in full blown DKA my blood sugar was only 262. So I think it was the flu just made me so insulin resistant, and I wasn't really eating, because it was on crutches like I was

Scott Benner 5:57
asked your question before we get too far past that. Are you some sort of a like, comic genius? No. Did you hear yourself say I limped towards diagnosis? I did now. Yeah, I've been You mean after telling me about your knee? And then I was like, Oh my God, she's so deadpan when she's doing this. She's either a genius or doesn't know. She just said that. Oh, my gosh, I would have stopped to congratulate myself for making that joke. If I would have said it. I would have been like, Hey, did everyone hear that? I'm so good at this. My god. I'm so good at this. Did anyone hear? No, no? Wow. Okay. So that diagnosis, are you. You're married at that point? I imagine. What two kids two kids already? What's your remembrance of the diagnosis time in the hospital stay.

Courtney 6:46
I mean, the first night was a blur. I was. I mean, everybody in DKA sick I was, you know, I was right along with everybody extremely sick. Ended up in the ICU for five days, I got pneumonia. I had pneumonia flew a and I was in this locked knee brace. I was pretty pathetic, like on the unit like jumping around. I actually missed my son's sixth birthday party because it happened. The second day, I was in the ICU. And I was like, I can't imagine rescheduling this with everything that is on my plate. So just the grandparents came down and ran the birthday party. But it's all it was all a complete blur. Yeah. And I was at the hospital that I work at. So people were coming and going because they were worried and I really appreciated the visits. But I can't say that I remember who.

Scott Benner 7:38
You know, there was a diabetes educator here once who told me they were diagnosed as a child, and had a big birthday party planned for themselves. And the parents didn't have the heart to cancel it because of all the other kids so he was the only one that didn't go to the birthday party. He felt it's a nice memory for him. He's like, I thought it was nice to my parents not to ruin it for everybody else. True, but my response was your recording. I was like, Oh, that's cold. Yeah, but apparently not. He doesn't remember it that way. Anyway. Okay, so people were in to visit with you. You don't have a lot of memory of it. Do you think it's a blur? A blender blur of the flu and the diagnosis at the same time?

Courtney 8:18
Yeah, I mean, I'm sure I got you know, the typical insulin resistance and needed more, you know, I'm sure I have some degree of plateau. Right. So that's just a slower onset of type one. So I'm sure I had some pancreatic function that was keeping me out of DKA until I got the flu, and then it just couldn't

Scott Benner 8:36
the rest of the game. Yeah. Well, I'm glad your kids don't have markers. That's, that's terrific news.

Courtney 8:40
Yes. And my sister was super my sister is a PCR nurse. And she's amazing. And I was calling her from the ER being like, I'm getting sicker. And I don't know what's happening. And so she drove down in the middle of the night and was kind of instrumental in in helping us through that. Since she sees a lot of DKA

Scott Benner 8:57
how many nurses did your parents make? Just to just 200%

Courtney 9:01
of their children, but to

Scott Benner 9:05
say helvar ratio? All right, so So you come out of the hospital. And you know, you're now I'm we're gonna jump around a little differently than we usually do in these episodes. Because of your background, we're going to talk a lot about what you see, you know, as a gas passer. So you learn about type one I heard you say like in school, I was like, I don't want that for sure. It's not weird that you chose that to like, say, I don't want that of all the things you were learning about. Right now we're going to hear from a member of the Medtronic champion community. This episode of The Juicebox Podcast is sponsored by Medtronic diabetes. And this is Mark.

David 9:40
I use injections for about six months. And then my endocrinologist at a navy recommended a pump.

Scott Benner 9:46
How long had you been in the Navy? Eight years up to that point? I've interviewed a number of people who have been diagnosed during service and most of the time they're discharged. What happened to you?

David 9:56
I was medically discharged. Yeah, six months after my diagnosis. Was it

Scott Benner 10:00
your goal to stay in the Navy for your whole life? Your career? It was, yeah,

David 10:03
yeah. In fact, I think a few months before my diagnosis, my wife and I had that discussion about, you know, staying in for the long term. And, you know, we made the decision despite all the hardships and time away from home, that was what we loved the most.

Scott Benner 10:17
Was the Navy, like a lifetime goal of yours. lifetime

David 10:21
goal. I mean, as my earliest childhood memories were flying, being a fighter pilot,

Scott Benner 10:26
how did your diagnosis impact your lifelong dream?

David 10:29
It was devastating. Everything I had done in life, everything I'd worked up to up to that point was just taken away in an instant. I was not

Scott Benner 10:37
prepared for that at all. What does your support system look like?

David 10:41
friends, your family caregivers, you know, for me to Medtronic, champions, community, you know, all those resources that are out there to help guide away but then help keep abreast on you know, the new things that are coming down the pike and to give you hope for eventually that we can find a cure, and you

Scott Benner 10:55
can hear more stories from Medtronic champions, and share your own story at Medtronic diabetes.com/juice box. You can manage diabetes confidently with the powerfully simple Dexcom G seven dexcom.com/juice. Box. The Dex Dexcom G seven is the CGM that my daughter is wearing. The G seven is a simple CGM system that delivers real time glucose numbers to your smartphone or smartwatch. The G seven is made for all types of diabetes, type one and type two, but also people experiencing gestational diabetes, the Dexcom G seven can help you spend more time and range which is proven to lower a one C, the more time you spend in range, the better and healthier you feel. And with the Dexcom clarity app, you can track your glucose trends. And the app will also provide you with a projected a one seen as little as two weeks. If you're looking for clarity around your diabetes, you're looking for Dexcom dexcom.com/juicebox. When you use my link, you're supporting the podcast dexcom.com/juicebox head over there now.

Courtney 12:07
Absolutely. I think about it a lot. Because sometimes I'll see like our ad on Craigslist, and I'm like, I don't want to do that. And it's the second it enters your mind. You're like, yep, that's going to be my case. So now in hindsight, I'm like, I should have never thought that I should have just embraced the knowledge,

Scott Benner 12:22
you should have just picked up the Daily News looked at the lottery winners and said, I don't want to be like that, I would have definitely I definitely would have been the way to go. If you were gonna Jinx yourself, I guess. But now you've got this different understanding right now you're five years into it? Um, well, let's figure out what your understanding is right now. Like, where's your agency?

Courtney 12:38
Since diagnosis, the highest agency I've had is 5.20.

Scott Benner 12:43
My goodness, are you eating low carb? Or are you just very good at diabetes? Yeah,

Courtney 12:46
I mean, I tend to eat lower carb when I'm at work, just because I have no time for Pre-Bolus. Like my break is when my break is. And so I tend to eat a little more low carb there just to try and maintain but no, we don't adhere to a low carb. Okay, I have just really tried to embrace what you teach on the podcast. And I actually have a friend who's, you know, likely going to get a diagnosis in the next few days. And he's started listening as well, I recommend that as I said, there's just so much they're not going to teach you in class, there's not time. But there's also just you have to teach to the very minimal, you know, the lowest, the person coming in with the least amount of knowledge, and you're starting with a much higher knowledge. So just embracing, trying to do better on your own.

Scott Benner 13:38
I didn't know this was going to be a story about how terrific I was or I would have gotten to it sooner. Yeah, no. How long? Have you been listening to the podcast?

Courtney 13:45
Somebody recommended it pretty quickly in to diagnosis, I would say within the first four months. And so I tend to focus more on the episodes of management versus storytelling, I guess. But I mean, nobody taught me about Pre-Bolus, or protein or any of those things in, in education, it was carb counting, and which is a great foundation, a great place to start.

Scott Benner 14:13
I'm thrilled I and listen, if you aren't the kind of person who likes to podcasts for the chatting, like I get that I support both sides of that coin with the other. I put all that like, I think great management content in there. Because everybody wants that, you know, on one level or another. But there are plenty of people who love the stories and they get a lot of community out of it and a lot of good feeling out of it. So I figure if we order, you know, offer a kind of a 5050 of that. You kind of make both sides of that coin happy. I love it. Yeah, so yeah, I'm thrilled about it. I mean, before we started recording, I mentioned something from another episode and you were like, Oh, I haven't heard that. But be honest. You wish you did, don't you?

Courtney 14:53
Oh, absolutely. I'm gonna go find it. Well, no, no,

Scott Benner 14:57
you're not allowed. You can only listen to the management stuff. I seriously didn't know that the podcast was valuable for you and had been. So that's fantastic. So Pro Tip series, that kind of stuff. real helpful. Yeah,

Courtney 15:08
exactly the bold beginnings. You know, the one episode that really rang true was just being that being diagnosed as an adult. And while there weren't tons of management tips that I went away with, I remember being like, it is my life was flipped, I felt seen. My life has been completely flipped upside down. And I remember just feeling part of it community and seen at that moment. Like, yeah, this is hard, and no one really understands it. Yeah,

Scott Benner 15:38
see, now I could call this episode Princess of Bel Air. I love gas pasture, though. It's gonna be hard to get away from it for me. Yeah, I'll take it. Yeah. So all this, this knowledge that you have about diabetes has informed your work. And that's why you're really here. I want to talk about that. So can you just kind of open up about that for me and fill me in?

Courtney 15:59
Sure, feel free to like, slow me down. If I get going too fast. I'm gonna touch quick, quickly back to like, when I talked about nursing school when I went to nursing school, which, you know, like I said, was late 90s. You know, the fast acting is the Nova log and humor log had just been patented, and they were not part of education at all, they weren't even rapidly adopted. So we were learning about mph and 7030 and regular insulin, and managing diabetes from a you take this insulin here, and you eat exactly four hours later, because that's the peak that we're talking about. Glargine was barely being adopted into practice. And so that's part of being like, Oh, you really had no freedom to eat, then because you were trying to match an insulin profile that had nowhere close to a carb uptake profile. So moving forward, a lot of people my age, which make up a huge chunk of medical providers, right, the the 40 crowd, you've graduated residency, or you've gotten your masters or you're a nurse at the bedside, but you haven't yet retired, or part of this group that went through education that didn't ever even learn about human laga Novolog as part of our basic education, let alone clergy. So now you come to today were upwards of 60, like so. And then 96, less than 1% of patients were using an insulin pump, we didn't I mean, we knew they existed, they were like the Zack Morris cell phone attached to your waistband, but people weren't using them, because what's the point and continuous infusion of regular insulin sub q. So now we fast forward to upwards of 60% of type one patients are using insulin pumps, and none of us ever learned about these devices, let alone that they only have rapid acting insulin. We don't We never talked about Basal Bolus insulin, because that wasn't really how insulin was given back. Back in the day, you had sort of insulin that you had to eat to protect the peak, so that you didn't bottom out. So when you come in with an insulin pump that someone's unfamiliar with their gut is sort of like I don't want to deal with that. What they're not recognizing is if you take an insulin pump from a tape, one patient, you have removed all basil or background insulin. And it's not the standard of care. But I think it's hard to re educate everyone on on the technology today. In one mass.

Scott Benner 18:36
I mean, I guess the basic problem is, is that people are where they were taught to these positions, like in med school got one level on one idea, then they moved out into the world, and the world changed, and nobody came along and told them. So they're just doing everything they do, right.

Courtney 18:53
And so specifically, like I don't want to like toot my own horn or my professions own horn. But if you think about any anesthesia provider in any sense, they have to be so knowledgeable on hundreds, if not 1000s of surgeries and what's going to happen during that time. They have to be knowledgeable on hundreds and 1000s of different medical problems and medical history and how anesthesia drugs affect them. And for instance, like the top drawer of my anesthesia machine has 25 different drugs just in it with that doesn't even talk about the you know machine that I can go get almost any drug I want out of in the hallway. So it's just the knowledge base is vast and trying to keep up on every knowledge. You know, every disease process is difficult. And then you talk about type one whose management has drastically changed in the last 30 years. Yeah, it's it's crazy. You

Scott Benner 19:52
have those drugs because there could be drug interactions that you have to counteract and that's what they're there for. Is that right?

Courtney 19:57
Yeah, so almost every anesthetic If drug is what's called a cardiac depressant, so your blood pressure drops, you're you may have those things that we have to have counteract or your heart rate may be fast, or it may be slow, or you may need pain medicine, or you may need pain medicines that not narcotic, or this particular surgical procedure, you know, causes less blood to come back to the heart. So we need to supplement that with a different type of IV fluid. It's, you know, it's just a complex thing. So then you have someone who for years came in with either this background of regular insulin or mph is their Basal, then we moved to Glar gene, which is beautiful for a MDI. Because it really does have almost 24 hours, so you didn't have to do anything, you were like, you took that check, okay, I don't need to give you insulin it's taken care of. And so now we have to come back to many hospital policies, say your insulin pump is not allowed in the O R. And while patients are advocating for themselves to take to their pump to the O R, it would be against policy. So then it becomes removed at some point in the beginning in the in the pre op area. But are we replacing that with? The big question is are we replacing your Basal insulin and we need to be that's the standard of care. So how do we do that in the perioperative period, there's really only two ways to do it. And that is to allow the insulin pump to run if it's within hospital policy, or you need to start an IV insulin infusion,

Scott Benner 21:30
why would they not want the pump to stay on? Well, a turns

Courtney 21:34
out anesthesia providers know nothing about an insulin pump. Like I could hand my insulin pump to my friend. And there's, it'd be difficult for them to figure out. Maybe not difficult, it would make them uncomfortable to try and Bolus from a pump. Also, during surgery, you tend to get steroids, there's a stress response, fasting in and of itself can make so the risk of hyperglycemia is actually higher during surgery than hypoglycemia. So to have to Bolus from that with a not be something in the wheelhouse of any anesthesia provider, they've probably never done it, it's not to say they can't learn I'm just the reality is it's unlikely that they've ever done that. And two, it's a very dynamic period, so your blood sugar could change rapidly up or down. More often than not, it's up. And when you Bolus from a pump, as we all know it takes time, right? So it's sort of behind and then you have a change in blood pressure and perfusion to your subdue tissue. If your blood pressure's low if you're cold if you're warm, so it's a lot less predictable to give sub q insulin in the perioperative period, versus IV insulin. If that makes sense. Though, we are starting to see studies come out with very good results for insulin pumps in especially like your smaller everyday run of the middle of surgeries versus your bigger surgeries that have high dose steroids or dramatic fluid shifts, the data doesn't exist. So adopting a pump to is like, I think it'll work fine. But there's very few controlled studies on insulin pumps, because we're not a very populous group of humans.

Scott Benner 23:19
So I get it, I understand how we get to where we are. What are people need to do to use them? Like what what can I do going into a surgery to say to someone look, this pump, I'll make sure that it's new, that it won't run out. But it's not so new that it's not working? I'll put it on 12 hours before the surgery, make sure it's nice and settled in and it's working? Well. I'll come in, show you where you can push the buttons if you have to shut it off. But in the end, I mean, it's just the insulin pump. Like if if it was really I mean, I don't know what they're concerned about. But if you weren't getting really low, they could just rip it off you. It's not like you don't I mean, it's not like not knowing how to push the buttons would stop you from stopping it if you needed to. It's just it's really, yeah, it couldn't it feels like there's a lot of not thinking that happens around stuff like this.

Courtney 24:05
Sometimes, and I you know, I feel strongly that we're missing an opportunity to embrace more insulin pump usage. And in fact, like the anesthesia Patient Safety Foundation, put out a piece a couple of years ago advocating for more use, and there's some interesting studies coming. There was a really fascinating one out of Switzerland that they put insulin pumps on a large group of type two patients that utilized insulin, and they had far better control with less hypoglycemia, shocking, they put it on in pre op and they were at their entire hospital stay so the data is starting to leak out. I guess my concern is, I think if an anesthesia provider feels good about the insulin pump, the surgical site is far from the insulin pump site. So if you're having an operation on your belly You really should probably have your insulin pump on your leg if you want to have any hope of it standing. Yeah,

Scott Benner 25:04
yeah, I mean, she's do people not think about stuff like that would

Courtney 25:08
be so surprised at the things sometimes you see. And I think that's the other reason you have somebody who comes in and rides their pump in a way that is probably, you know, they're a one sees still 11 And you're like, this really isn't doing a great job for you. And then you have someone like me and lots of your listeners who come in with super tight control and are very knowledgeable. But you don't know who you have in a 10 minute interaction, necessarily. I

Scott Benner 25:35
understand. Also, it wouldn't take that much more insulin to turn an 11 a one c into an eight, a one C and you still wouldn't be really tightly controlled, but it's you know, yeah. Well, that mean, listen, that goes to show, what it shines a light on is the vicious circle, there is just no reason in the world that a person should have an insulin pump, and an A one C of 11. That somebody's not understanding fundamentally how to use their insulin. And a doctor should be able to like step in and give them the information that they need. Yes, you know, it's not just it's not that hard. So then what it points to is either a person who doesn't understand or is unmotivated, or some, you know, somewhere in between that scale, having diabetes showing up in a hospital where another doctor looks and says, Oh, an 11 a one C, you don't even try, you don't even care. So then you kind of get written off at that point. You don't mean like, you shouldn't have to be you coming in going, I have a 5.2 I want to see and I really know what I'm doing. It's okay, if we take good care of me here. Yeah. You know, I'm saying like, take, why don't we take good care of everybody? Crazy thought, like, some people just aren't going to know, like, you've just explained why. You know, long time ago, there's not really that long ago, there weren't insulins that worked, as well as the ones to do today, the standard of care was much different. There are still people out in the space, who grew up with that. And there are people who are learning from those people. So that's why you can't get rid of it, if you would just think of a generation of doctors would just retire would be okay. But that's not so that's not the that's not going to work, you know, not completely. Yeah. So I don't know it's a it's hard to, it's hard to hear about. Yeah,

Courtney 27:10
I mean, I guess at the end of the day, I think if we want to provide safe care in the perioperative period, I want people to understand that Basal insulin is not an option. It is a requirement. And so for patients on MDI who took their long acting insulin, it's often simpler for us anesthesia people, Basal insulin requirements are met, right, we should be checking blood sugar every hour and treating hyperglycemia and hypoglycemia appropriately. If a patient comes in with an insulin pump, I think I have to say you need to work within your hospitals policy. My hospital allows patients to keep their insulin pumps for day surgeries. But those surgeries that are going to the ICU or bigger surgeries, they want their insulin pumps removed until the patient is awake and can restart them. And in those cases, our hospital dictates that you start an IV insulin infusion at the Basal rate that set in the pump. So we are meeting Basal insulin requirements. And then our life we have a glycemic team meets with the patient postoperatively. And some patients are NPO, or they're going to be on high dose steroids. And it's just easier to stay on an IV insulin infusion for a few days. And sometimes they move them right back to the pump and patient. Does

Scott Benner 28:27
the IV insulin give you like insane control.

Courtney 28:32
So the difference with IV insulin versus like a sub q, insulin is a is IV. So all IV insulin is regular insulin. So the same regular that people sometimes inject back in the day, but some of the low carb people, I think advocate for that still. But it is a completely different profile when you injected IV, so it's half life is seven minutes. So if you're running high, I can give you a Bolus of insulin and it is acting within seven to 15 minutes. And so then it's also completely gone. We say things about seven half lives, you can consider a drug kind of out of your system. So if you were hypoglycemic on an IV insulin infusion and I turned it off or cut it in half, it would be gone within an hour. So we're dealing with things that can we're dealing with a drug that can react or faster to the changing glycemic environment of surgery. So while I think we're missing opportunities to move forward with insulin pumps in multiple cases, I don't think every case can be done with an insulin pump. And I think we can safely use IV insulin. My big thing is we need to start IV insulin and so some patients unfortunately do get removed from their insulin pump and you hear horror stories. And then they gave me a Bolus of insulin through the IV because I got high Poor glycemic Well, no. Yeah, you had no basil. It'd be like a site going bad or whatever. And then they see your blood sugar at 200. So they give you a unit IV. Well, it works to drop you down to 180. But it's gone. Again, in less than, you know, it's affected this site, it was probably even less than that. So then they recheck and they're like, Oh, you're 200 again? And you're like, Well, yeah,

Scott Benner 30:25
I don't have any. And so my pancreas doesn't do anything. I mean, it does some stuff. It doesn't do insulin anymore. So

Courtney 30:31
the patient comes out, and it's like, what the hell? And I'm like, exactly. And so I've given a couple of lectures on this topic. And my girlfriend the other day was like, You should change it from type one diabetes in the perioperative period to its Basal baby. And like, that's just your mission. Does the patient have Basal insulin? Does the patient have Basal insulin? Like that should be what my hat says not gas passer. But does your patient have Basal insulin? But Courtney,

Scott Benner 30:57
is is the way you're talking about this right now, from a professional perspective? Is that only because you got type one diabetes five years ago? Like how would you have talked about this seven years ago?

Courtney 31:09
Totally different. So what there's about 5% of all patients with diabetes have type one. So I like to look at the flip side of that meaning 95% of patients with diabetes do not have type one. And so I think that's a common thing is people get diabetes, which I really want them to have two different names, but so that the confusion is less, but patients come in with type two, and we think about that different, right, they have insulin production, their risk of DKA and acidosis is far lower during the surgical period than somebody with type one. And I absolutely would like if an insulin pump came in, it gave me like a quiver in my gut. I'm like, I don't like I don't know what to do with that. And and every time it was like, Okay, I have to look it up. Do I keep it? What do I do? And so I think people, I really, really think many professionals don't realize that the insulin pump has only rapid acting insulin and that they're taking no Basal insulin. So that's where the mistake happens. I think I fell into that idea of like, oh, it's not regular insulin. Oh, that's weird. And then learning that, once I, I was just like, the second I was diagnosed, I'm like, I want to pump and I want to CGM. And they're like, well, your insurance is gonna make you wait for your pump, but you can get a CGM tomorrow. And I remember learning about my pump in the six months, I had to wait. And I was like, Oh, I like it's not. I get rid of clergy. I'm like, holy cow. Like, that was a moment for me. And it's sort of embarrassing to admit that I didn't even recognize that. And so I think that's a big part of why I'm here. Like, it's embarrassing. What I didn't know. And I also watch other people not know that, I

Scott Benner 33:01
think that it's the most disappointing thing I'm going to hear in the next four days. Honestly, just the idea that that a medical professional might not understand that basic idea about how an insulin pump functions. That's really like BS, you have to put yourself in a position of someone who's just going to the hospital to have their you know, I don't know, have their

Courtney 33:23
super Yeah, important conversation is that I do think that knowledge deficit exists. I'm unfortunately, and I think someone coming in to have surgery and has been told that their insulin pump needs to be removed, I want them to have the words to be like, That's my only Basal insulin. So what are you going to do to provide me Basal insulin while I'm in surgery? But don't

Scott Benner 33:49
you think that people have an X of reasonable expectation that that's not a thing they have to say? They should? Yeah, if you couldn't eat if you went to take your car to get four new tires on it? Do you think the last thing you should say to the guy at the counter when you hand them the keys is please tighten the lug nuts back up when you're done?

Courtney 34:07
I mean, yes, but I'm, I'm not. No, I

Scott Benner 34:11
know you're not. I'm not calling you. I'm just saying I'm just having a conversation with you. But like, I'm trying to put the conversation not you in the perspective of everyone else. Who has no reason in the world to expect that a medical professional wouldn't understand how an insulin pump work. You don't I mean, like I understand your description of why that's the case and I'm not even arguing with it. It makes complete sense to me I'm just saying that if you're just like I was gonna say Joe Blow do people say that anymore if you just the average guy on the street but his Joe Blow even mean we'll look into it later, Courtney, if you're just an average guy on the street, going in for a procedure a you're probably not thinking about it because you're probably worried about having your appendix out or something like that. But at the same time, like, I'm at the doctor building now, with all the doctor people in it. This is a medical thing. My device is a medical thing. They'll know like I don't even think it gets up Well, no, I don't think you even think about it. That's what I'm that's my point like, so I know people have to that's why it's important to talk about this. For people with diabetes, they need to go in there without acting like a lunatic or seeming strange and say, Hey, who do I talk to and explain this insulin pump? And then you know what happens when you say that somebody is going to want to reassure you? That's a famous thing in all professions. Oh, absolutely. Oh, no, we know what we're doing. Sure you do. I don't know. 10. Let me just say this. Now, I want to be clear. I don't know 10. People that know what they're doing. Okay. Like, forget about it. Forget about medicine in my life. I read I know, a few people who've got everything together. But I know way more people who would say, oh, no, don't worry, don't worry, don't worry, I got it. I got it. I got it. But what their brain is thinking is I don't know what I'm doing. So it's human nature. You don't I mean?

Courtney 35:52
No, I agree. But I also think I'm not. Yes, I think people come in and expect people to be knowledgeable, and I want them to be knowledgeable. And I believe that they should be how do we do that? Yes. I mean, I'm doing my best. I'm talking to you multiple times. And I, you know, I don't have a great answer.

Scott Benner 36:16
Is there not continuing education in the, in the facility? The like, all the, you know, do all the gas pastors not get together once a week for a 15 minute lecture on something? Or is there not an email that goes around and says, hey, don't forget, insulin pumps work like this? And then like, why is that not a thing? Would that be so simple? It

Courtney 36:37
is a thing? Oh, it is a thing? You told me that I work at a huge academic institution. Right. So we are very geared towards education. So I lecture at my own institution to our residents, once a year. So their first year, here's this, I give, I've given Grand Rounds, a full grand rounds where I just went through everything type one related including CGM and insulin pumps. And then I talked about insulin pumps, usually about for 15 minutes on what we call a CQ AI meeting, which is also Grand Rounds, but it we go through like, Hey, we're not doing this great. You need to do this every time. Here's our policy, this is what you need to be doing. So that exists in my institution. It does not exist throughout, you know, we have places that you know, are tiny, they're one anesthesia provider, and to try and stay up on every last detail in medicine is difficult, because anesthesia touches in every you know, high blood pressure stroke, blood clots, cancer, you know, and then the surgeries that go along with it. I'm not justifying not having the knowledge base but staying on top of every single change in medicine is is not I want

Scott Benner 37:56
to do an exercise with the coordinate Tell me Tell me again. What is your actual like job title?

Courtney 38:01
I must CRNA or a nurse anesthetist?

Scott Benner 38:04
Right? Spell anesthetists for me.

Courtney 38:08
My my Dexcom is going off. Did

Unknown Speaker 38:10
you hear it? Don't, sir.

Courtney 38:12
It's a n e t h i s t. Okay.

Scott Benner 38:20
Here's what I'm gonna do. Because I think the world's simpler than we make it. Okay, I'm gonna ask Chad GPT explain how an insulin pump works to an N S. Say that again. We How come it spelled like that? Why does nothing like me today, anesthetist? Or

Courtney 38:36
you could say anesthesiologist, it's all I have it. I have a different path to education, but we both provide the anesthesia.

Scott Benner 38:43
Let's do that. Because that I can spell include what they need to know about help about managing

Unknown Speaker 38:55
a person

Scott Benner 38:57
with type one diabetes, I've never done this before my wife. Okay. insulin pump is a medical device used to manage diabetes specifically type one diabetes, which is characterized by the body's inability to produce insulin. Insulin is a hormone almost second it is not stopping Insulin is a hormone that regulates blood sugar levels by allowing cells to absorb glucose for energy and type one diabetes the pancreas does not produce enough or any insulin requiring external insulin administration to maintain proper blood sugar levels. Here's how an insulin pump works and what an anesthesiologist should know about managing a person with type one diabetes, and the LIS function of the insulin pump continuous insulin delivery Bolus dosing adjustments during surgery and monitoring adjustments during surgery during surgery or any medical procedure requiring anesthesia. It is important for the anesthesiologist to communicate with the patient about their insulin pump. Depending on the duration and type of procedure adjustments may be may need to be made to the pump settings for instance, the Basal rate may need to be temporarily reduced or suspended prevent hypoglycemia, or low blood sugar. Okay, that's a browser window My computer coordinate, like, how come someone can't do that? And go, Oh, I'll be in charge of sending out the daily reminders to everybody. Like, I mean, did I just fix the whole world? You see no saying like, I love how everybody says, Oh, this is how it is, or here's how we got here, or it's so hard to fix. It's not that hard to fix. One focused person could fix this in every hospital. Do you really mean? Like, am I being pity? I don't know, if I am,

Courtney 40:28
you're not here today. What I'm gonna say is, I tend to be that person a little bit, you know, people

Scott Benner 40:35
know who you are, I have a document because we all got lucky and you got type one diabetes. But what I'm saying is,

Courtney 40:41
even as somebody who tirelessly advocates, I can't force someone to absorb that information.

Scott Benner 40:50
Let me say this to those people do your job there. Okay, you're getting paid. You know what I mean? Like, just do the thing you're doing, I don't know, it makes I get very upset very. So you're even keeled, which is lovely for the conversation. But this seems so basic to me. And the fact that it has to be rehashed over and over and over again. And that a person like yourself has to get type one diabetes, and take it upon themselves to educate other people in a professional setting. None of that makes any worldly sense. It feels like to me that people see problems and then go, oh, problems instead of going, Oh, that's a problem. Why don't we make an adjustment, so it doesn't happen again, like because this is not a new story. You can put a whiteboard up in a room and say to the anesthesiologists, which I can spell, you could say to them, there's a marker in there, every speed bump, we hit for a month, we're going to write it down. And then we're going to create a list of things that happen most frequently. And then we're gonna go ask Chad GPT, to explain it to us all, and then we're gonna put it out into an email, and it is part of your job to read the email. And that's that, like, I mean, honestly, this is 45 days worth of effort, fix everything. I don't know, that's the part that confuses me all the time. Why do smart people not do smart things?

Courtney 42:05
I mean, those things happen, right? Those happen all over the country that we talk about these things, but then how

Scott Benner 42:14
does it keep happening, then you're just saying it's a it's a failing of human beings?

Courtney 42:18
So if you think about, I mean, yes, it's a feel of human beings, right? We all forget things day in and day out. I mean, half the time I forget my anniversary, right? Which it's not that long. You know, like these are, that's part of my job as a wife, I'm not saying it's acceptable. I'm saying we're human. And our brains, I will tell you in healthcare are bombarded constantly with emails of how we can do better what we did wrong. And I would tell you that failing on an insulin pump would not show up on that whiteboard. Why? Because they're extremely rare, even though we deal in this community, where they seem like every day, things, the fact that that person makes it to surgery with their insulin pump is we, you know, so rare for you. Extremely rare. So maybe we see one insulin pump through my institution that staffs 50 plus operating rooms a day, and anesthetizing. Say maybe we see one, and we have 167 people providing anesthesia, or more, you may see an insulin pump on a patient once every two or three years. Yeah.

Scott Benner 43:33
Well, listen, coordinate between you and I. Some you motherfuckers wouldn't want to work for me. That's all I'm saying. I'd fire you. That's never been. It'd be no one left. I'd be like you're gone. Did you read the email? No. Goodbye. And lay good. I just didn't. Go ahead. How are you going to improve people? Can I say something about people? Yeah, I don't think they really want to work.

Courtney 43:57
Oh, I mean, right. Yeah. When Powerball I'm out.

Scott Benner 44:00
I think everybody wants to, like, get up around 11. You know, move into the day slowly, maybe hit their Bong, have a little lunch. And I mean, maybe watching Netflix, who knows? And then he's into the evening and you're on your way. Like, I get it like it sucks. It's, it's a lot. I don't mean to be flippant about. It's a lot of it's a lot to remember. You know, there's a scarcity of how many times it happens, which makes it I imagined even more difficult to remember. It still happens. It does. It feels to me like there's a hole in my backyard. I only walk in my hole in my backyard every few weeks. But somehow I fall in the goddamn hole every time I go out there. And no one goes, Hey, we should put a sign next to that hole or Let's get crazy and fill it in. That to me is what it feels like. I know it's not often I know it's kind of silly. I know it feels like a thing you should be able to remember and it doesn't need to be addressed. But I don't know how long we have to live and watch the same thing happen over and over again before someone says hey, you know what? Why'd this is a problem? Listen, I'll ask you. Let's take diabetes out of it for a second. Are there other topics specific to your profession that reoccur all the time that are an issue?

Courtney 45:11
Well, let me just clarify. I want to say that this does not happen every single time. But I do think it does happen. I hear about all the mistakes because people ask me how to fix them. I never hear Hey, everyone. Use your provider. Yeah, nailed it. I

Scott Benner 45:31
was the I was put under six months ago, it went perfectly I. But that's not. I mean, listen, that's not a thing we have to talk about. Like, we're all adults, we don't need to be celebrated for doing it. Right? I hope not. Right. But I take your point, we're not saying everybody is in this situation, it's not going to happen every time. It's not going to happen. Every institution. I'm not saying that either. But we're just drilling down on the problem. So Okay, Let's lighten this up for a second. Okay, we have like 10 minutes left, I have a real serious interest here. First, let me ask you, do you think we got through everything you wanted to talk about?

Courtney 46:03
I mean, I think if I had to say one thing to any health provider, like anesthesia provider listening, if they're listening, they already know this, but they have to have Basal. You know, I'm not going to tell you to go against your hospital policy and leave an insulin pump running. If that's not in your hospital policy, start an IV insulin infusion. There are plenty of journal articles that talk about and I'm happy to send you a link. Scott, if you want to put it in the notes to the one that I think is the most comprehensive, please do. Insulin pumps have not been well studied in the anesthesia literature, there are studies that say I think you can use them safely. There's not one study that says this is the end all be all, what the literature does say is you have to provide Basal insulin, it's about the Basal insulin. And I would encourage any patient going into surgery to a know their pump settings so that you can communicate clearly. And know that if your pump is being removed to advocate for Basal insulin, you may be falling on, you know, repeating what somebody already knows, but just say, you know, my understanding is if you remove my pump, I should be started on IV insulin at my Basal rate. Yeah. Is that your plan that I think oftentimes patients a don't think to have that conversation. But there's still something intimidating about medical providers. They're the knowledgeable ones, and we're not, but I think it is perfectly acceptable to advocate for yourself in any way, shape, or form, especially in a way that's open to conversation in the sense that you're not attacking someone just say, right, everything I've ever read is if you remove me from my insulin pump, I should be started on IV insulin before you remove it. So is that our plan? And I can give you a copy of this for you know, bring it in with you. Um, you know, just if you avoid one time where you have a hiccup,

Scott Benner 48:07
it's valuable, for sure. It's, yeah, and know what you're talking about. Don't just go in and say, Hey, fix this for me, you have to have some information about what is working well for you as well. You know, because the doctor is not good. I mean, in that situation, like somebody in coordinates position is not going to sit down and help you figure out that your Basal is too strong or too weak or something to that effect. Yeah,

Courtney 48:25
I mean, our recommendation if we remove the pump, we were starting to use a tool called endo tool, which is sort of like control IQ or Omni pi five, insulin decision algorithm that doesn't, it relies on the provider to input the data, and then into a computer program and it tells us at what rate to run insulin and how often to check the blood sugar to make adjustments where

Scott Benner 48:49
this stuff is headed, right, Courtney? Like eventually, you'll be a technician and a computer will decide what to do. Yeah,

Courtney 48:55
so it tells me it's best guess and then we are we're moving towards that an algorithm that helps learn the patient and make decisions based on the patient. Yeah, anybody being removed from an insulin pump should have Basal insulin in some form, and that in the perioperative period, the most recommended by far is IV insulin infusion at the patient's Basal rate in the pump. And so Omni pipe five, you're probably going to have to you know, it's not a set rate, right, so that we run into that problem, even people doing it right. They're like, I have to remove your pump for this reason, and the patient's like, I don't know what my basil is. So maybe take a little time on an algorithm and figure out what kind of your pump is running at basil wise you're gonna have to do some calculations or dig a little bit deeper but that will really help your anesthesia provider as well to be like, you're removing that this is where I would start. And then sometimes we recommend like an exercise mode if you are keeping your pump especially for a short surgery because we as anesthesia, people are death li definitely definitely afraid of hypoglycemia. It's rare during surgery,

Scott Benner 50:04
is it a bigger problem because I'm unconscious already.

Courtney 50:07
It's not a bigger problem. It is not more common but it unrecognized hypoglycemia. So you would say I feel like and we would do something we check your blood sugar but no one's there to say I feel like so it relies on an anesthesia provider checking your blood sugar at a regular rate at very minimum is once an hour, literally with a finger stick. Yes, yeah. So

Scott Benner 50:33
what we really want is people to wear a CGM during a surgery that would be really valuable. So

Courtney 50:38
CGM are not validated in the hospital, any patient of mine that so they got an FDA approval during COVID. And emergency FDA approval, which was really fascinating some of the literature that came out of that like how they were used, and I think there's going to be a data spill that probably comes out. By hospitals policy on CGM is the patient may wear their CGM, and I may use it as a trending device. But at minimum, I have to use a finger stick machine in surgery at least once an hour.

Scott Benner 51:08
Yeah, that's fair enough. Plus, you really want to charge them the 50 bucks for the test strip. So

Courtney 51:13
true, true story. So in other the data is signal loss is common on CGM. And if they're not in the surgical field, you should ground away from them. They've never again been well studied in the operating room. So the Bovie pad in the grounding is always a question mark. Because you're putting metal you have metal in the patient's skin. And you know, it's coated in plastic, but sitting on top for the Dexcom. But I think you could advocate to leave it on even if your anesthesia provider chooses not to use it. I never make somebody remove it because they're expensive. And I know that and I've tried to educate people on that, but advocate for

Scott Benner 51:48
yourself. I have a story about what I did for art. And once that I'm not going to add here because I think it'll take away from people believing in me in this conversation. But I, I remotely managed artisans on during an exploratory surgery once so, and they didn't know I was doing that. But you know, Wi Fi, it's all magical. Now, here's my question, right? Because how I want to finish up because I really appreciate you doing this. First, I want to thank you very much for lending your expertise and your knowledge in this blend of you having type one with your years and years of service. As an anesthesiologist that's really valuable. And thank you I'm actually going to make this episode part of my grand rounds series. So now I can't collect maybe I'll just call it grand rounds. gasp passer. Probably gonna say anesthesiology. You know, normal. But But here's my question. I've been out a number of times, right? I had had a colonoscopy, they'd make you sleepy for that. Had my knee scoped and cleaned out. I've had enough surgery and my toe. They give me what they call the Jackson juice. That's propofol, right? Is that what that is? Yep. I want to understand the mechanics of that. And I'm going to start by asking if you get a bed. Bed is not the right word. But if you get an anesthesiologist that doesn't know it burns like a mother, you're going in. And it's the last thing you remember before you're gone is Why does my arm burn? Oh my God, my chest burns, then you wake up and it's over. But I had another anesthesiologist I told him I said hey, the last time I got this it burned really bad. My chest and he goes, Oh, don't worry, I can fix that. And then I think he tourniquets my arm and hold it there for like, tell me all about that. Like first of all, how do you get it in without a burning? Okay,

Courtney 53:26
so there's no guarantee, but propofol is very alkaline and so then it causes a pH change and it makes your vein really angry and it burns like mother. Like you said, it really does. So most anesthesia providers, especially for a general anaesthetic, so in the operating room, numb up your vein with lidocaine, IV lidocaine, so numbing medicine. Oh, that

Scott Benner 53:48
was all he did, okay. And then but he holds it there for a minute, right? That's how he he like the Lidocaine goes into the tourniquet my arm, I'm trying to remember what happened. So we

Courtney 53:58
we say there's a lot of science and a lot of art and anesthesia. And so that is one of the art things some people believe if you put a tourniquet and put lidocaine in there, it has a chance to numb longer because that blood is not moving away from the site. Other people just believe the act of giving lidocaine before and kind of with the propofol is enough. I gotta tell you sometimes, despite everything we do, well, I always tell people it's spicy. I'm sorry, I'm doing my best to make it not. Yeah. But that is completely normal. And it's going to be gone when you wake up. Yeah. So

Scott Benner 54:34
then okay, so that well, first of all, I want people to know that in case they ever kept can ask for it. But my book, the rest of my question is, what is the mechanics of it? Like how is it shutting me off like that because it happens. In US, it's less than 10 seconds.

Courtney 54:49
Light works on a GABA receptor in your brain, which is a receptor that can cause this sort of sedation and then it hyper debating it makes you go to sleep. But don't ask me how anesthesia gas works because we don't we don't really know we have theories, but we've never, we don't. And so that's usually you go to sleep with propofol and mostly anesthetics, your cap asleep with anesthesia gas once the propofol works, propofol just worked so fast, that that's how we call what we call the induction of anesthesia. So

Scott Benner 55:21
you put me out with the pro ball, then you keep me out with something else, typically, then you back it off, and I wake up, but this is why I asked the question because I know this and I was well, I just wanted you to I wanted to I wanted to know if I was right or not from what I had heard, but medicine doesn't actually know why it works, right? We

Courtney 55:39
have a much better idea on propofol but the anesthesia gas we do not know that fantastic.

Scott Benner 55:44
Like we can shut people off and turn them back on. And we don't really know how it's exactly happening. That's

Courtney 55:52
insane dose. We know what's appropriate. But yeah, we don't think

Scott Benner 55:56
crazy gortney is it's crazy. It's like mad. It's like, I

Courtney 56:01
love love, love my job. Yeah, it is the coolest job. I get to practice medicine edit, like cellular level, like I'm giving this drug that I know which receptor it works on. And I know what should happen when I give that. But bio bio hacking to some degree history in front of me too. And humans are medicine is you can do everything right and things go wrong, and you can do everything wrong. And things go right. I have a really cool job, but it is definitely stressful at times.

Scott Benner 56:30
Hey, have you ever? Um, so if this is something you'd want to talk about or not, but have you ever put somebody out that didn't come back

Courtney 56:37
and work at a trauma center? So yeah, that does happen. Yeah. No. I mean, it is extremely, extremely rare for somebody to die on the operating room table. You have some of the most experienced emergency managers in the hospital there. And we have a lot of drugs on hand. It's extremely rare to die in the operating room. But it happens.

Scott Benner 56:57
I tried to remind myself the last time I just had my toe fix, right. And before I went under I said to myself, like when you wake up blurt out, not today, Jesus, right. But I didn't remember to

Courtney 57:10
like on the way home and you're like crap I forgot

Scott Benner 57:12
to do because it's a room wins again. There's a room full of nurses there. And they're all sitting around charting and everything. And I was like, How great would it be if I just burst awake? And I was like not today Jesus. But I you know, you're very out of it when you first start waking up. So but yeah, also fascinating how quickly you're not out of it afterwards.

Courtney 57:33
I love it. I love it when it's a sign of a good anaesthetic when I'm wheeling into the recovery room and the patient's like, Wait, we're done. Yeah. It happened. And I'm like, yeah, they're like, but I'm awake.

Scott Benner 57:45
to It really is I wake up very relaxed afterwards, like, Oh, my God, but rest of my day is gonna be fantastic. Anyway, I see what happened to Michael Jackson, I honestly see how we could get hooked on and if you had trouble sleeping and had access to a shady doctor, like I get it. You don't I mean, like, Jesus, I really appreciate you talking about this. I appreciate you going over that with I am. Like, I'm not much of a geek about stuff like this, usually. But this one really is fascinating. Like we are shutting people off in a medical situation that we do not actually know why it's working. Like that's fascinating. You know,

Courtney 58:18
it's sort of Yeah, it's like one of those things that like, probably wouldn't get FDA cleared today. They'd be like, figure it out, but it's been around and use safely for so long that you're like, all right. Yeah,

Scott Benner 58:30
they say peanut butter is one of those things. You know that? No, I don't think peanut butter could get through the FDA today.

Courtney 58:39
I mean, that would be a sad day.

Scott Benner 58:41
I don't want to freak anybody out. But don't google why

Courtney 58:46
we actually like in our break room just we have peanut butter for like it when you're just running behind and you need a quick snack and I eat a lot of peanut butter. But they switched over to the natural little cups and I was where's the sugar? Really? It's the oils on top and I'm like I'm trying to eat quick. My cracker doesn't dip

Scott Benner 59:07
its own natural. Great, great, why don't we try to help I tried to live so I'm 100 right Courtney the peanut butter can be a little sweet but the hell

Courtney 59:17
are mixed like at least anyways landed

Scott Benner 59:20
so that oils not floating on top of it because you know you look at it like this is like sucking on a peanut for a whole day and just squeezing it my teeth slowly.

Courtney 59:28
I know I'm sure my patients appreciate the oil spill down the front of my scrubs when I go

Scott Benner 59:32
professional. Everything's gonna be fine. Anyway, good luck to all of you. We're all we're all live by a wing and a prayer. Just all things being held together by spit and duct tape. Good luck. The seriously this was really wonderful. I appreciate your time and you and your good natured about it and I got upset in the middle and you you stay deep.

Courtney 59:51
I mean, I I want everyone to be experts at everything. But if at the end of the day, if you're not an expert Just know a type one patient needs basil if they you take their insulin pump off, and I think, you know, it's it's pretty rare that that things go wrong. But I think that understanding is really an important, important piece. I could nerd out all day on it.

Scott Benner 1:00:15
I agree. Yeah. And currently Listen, I'm not a I'm not a Pollyanna person, like, I've been making this cold wind series, which is healthcare providers are coming on anonymously and talking about their jobs. And now I'm getting notes all the time from people like, Were you just shocked when they said that? I'm like, No, wait.

Courtney 1:00:30
You're like, wait, I started it on for a reason. Yeah, I

Scott Benner 1:00:33
started because I knew what they were gonna say. Like, I'm just giving them a platform to say that I'm like, You're shocked that this is how the world works. I'm like, oh, that's fascinating, then I'm not shocked. Yeah. So I will

Courtney 1:00:44
say, the vast majority of people in medicine want to do right. And if they don't do right by you, it is not intentional, I believe not saying it's not their mistake to own. It's just, I think, unless you're really like in it, like the the amount that you get bombarded and like the burnout rate is high. Yeah. But we do need to own our mistakes and own our knowledge deficits. But I do think and I do think there are people out there making the same mistake over and over, but the need to learn, but the vast majority of people really are here for the right reason why

Scott Benner 1:01:21
Yeah. Oh, Courtney, I believe wholeheartedly in what you just said, and that people's good intentions and their desires and everything like that. And when I even when I say like limitations of human beings, I don't mean that pejoratively. I just it's a limitation. Like we just can't keep it all straight, where we are thinking about going home and watching Netflix, like we are like worried about a fight we had with our girlfriend, people are still people. I'm just saying if you're Yeah, what happens is that when you come in from the other angle, when you're the patient, you get lulled into this sense that like it's all going to be fine. Because the Magic Man in the white coats there, it's going to be alright, this lady went to school like I mean, she got a master's degree for this. You said, right. And now it's

Courtney 1:02:02
a seizure. Yeah. And now it's a master's degree in anesthesia. Right. I'm not an endocrinologist. And so oftentimes, a type one patient that comes in to me, obviously, I'm worried about their type one and in a certain way, but we've heard about the side effects of type one, right? So often people who had poor management at some point in their life have kidney disease, or they have coronary artery disease are perfect. Oftentimes, your hypertension or your kidney disease is more concerning to me than your type one. And because that will affect my anaesthetic in that moment, right? Or more than your type one, even if I'm not treating your type one. Yeah,

Scott Benner 1:02:39
see, now my perspective, though, Courtney is because I get to have all these conversations and see all these things come full circle is back to the vicious circle I brought up before, like someone's got to step up and put a stop to this, like the idea that people with type one are going to have these problems. Not everybody but more of them than we hope. And that begins at diagnosis. That's where my grand rounds series comes from. It begins with diagnosis and having a learned person explaining this to you from step one. And so that you don't end up a person in an ER 30 years from now that you look at and go I'm more worried about her hypertension than I am about her diabetes. You know what I mean? Absolutely,

Courtney 1:03:16
yeah. Thanks. I mean, we have the tools now that we shouldn't we shouldn't be a living with a one season the nines. Like

Scott Benner 1:03:27
we're gonna agree with each other. You and I are this is a society of people who are like, probably wish medicine

Courtney 1:03:32
paid for, like, you know, every few months, like go home with the basics of carb counting, and then you have another, you know, education appointment, like how are we going to do better? Where do you feel like you're lacking? I noticed this, but our healthcare system is not designed for that. Yeah. Which is where you come in? Apparently,

Scott Benner 1:03:51
it's why. Hey, listen, here's the truth of it. All you shoddy doctors. You set me up with a nice life here. You know what I mean? Like I got this podcast that helps a lot of people pays my bills. I should thank you for being so bad away. I'm just joking. Am I joking, Courtney? A little bit. All right. I'm gonna go Hold on one second.

The conversation you just heard was sponsored by Dexcom. And the Dexcom G seven. Learn more and get started today at dexcom.com/juicebox touched by type one sponsored this episode of The Juicebox Podcast. Check them out at touched by type one.org on Instagram and Facebook, give them a follow, go check out what they're doing. They are helping people with type one diabetes in ways you just can't imagine. Mark is an incredible example of what so many experience living with diabetes is 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/juice box. I was looking for a way that we could all get nice and tanned and meet each other and spend some time talking about diabetes. How are we going to do that? On a juice cruise? Juice cruise 2025 departs Galveston, Texas on Monday, June 23 2025. It's a five night trip through the Western Caribbean visiting of course Galveston, Costa Maya and Cozumel. I'm going to be there. Eric is going to be there. And we're working on some other special guests. Now, why do we need to be there? Because during the days at sea, we're going to be holding conferences. You can get involved in these talks around type one diabetes, and they're going to be Q and A's. Plenty of time for everyone to get to talk, ask their questions and get their questions answered. So if you're looking for a nice adult or family vacation, you want to meet your favorite podcast host. But you can't figure out where Jason Bateman lives. So you'll settle for me. If you want to talk about diabetes, or you know what, maybe you want to meet some people living with type one, or just get a tan with a bunch of cool people. You can do that on juice cruise 2025 spaces limited. Head now to juicebox podcast.com and click on that banner, you can find out all about the different cabins that are available to you. and register today. Links the shownotes links at juicebox podcast.com. I hope to see you on board. Thank you so much for listening. I'll be back very soon with another episode of The Juicebox Podcast. If you're not already subscribed, or following the podcast in your favorite audio app, like Spotify or Apple podcasts, please do that. Now. Seriously, just to hit follow or subscribe will really help the show. If you go a little further and Apple podcasts and set it up so that it downloads all new episodes. I'll be your best friend. And if you leave a five star review, oh, I'll probably send you a Christmas card. Would you like a Christmas card? Hey, what's up everybody? If you've noticed that the podcast sounds better, and you're thinking like how does that happen? What you're hearing is Rob at wrong way recording doing his magic to these files. So if you want him to do his magic to you, wrong way recording.com You got a podcast you want somebody to edit it. You want Rob

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#1258 Weekly News 7/15/24

Weekly News 7/8/24

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

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

Scott Benner 0:00
Hello friends and welcome to episode 1258 of the Juicebox Podcast

Welcome back, everybody. This is all the diabetes news that I found interesting for this week. I hope you enjoy it. 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. I was looking for a way that we could all get nice and tan and meet each other and spend some time talking about diabetes. How are we going to do that? On a juice cruise? Juice cruise 2025 departs Galveston, Texas on Monday, June 23 2025. It's a five night trip through the Western Caribbean visiting of course Galveston, Costa Maya and Cozumel. I'm going to be there. Eric is going to be there. And we're working on some other special guests. Now, why do we need to be there? Because during the days at sea, we're going to be holding conferences. You can get involved in these talks around type one diabetes, and there are going to be Q and A's plenty of time for everyone to get to talk, ask their questions and get their questions answered. So if you're looking for a nice adult or family vacation, you want to meet your favorite podcast host but you can't figure out where Jason Bateman lives. So you'll settle for me. If you want to talk about diabetes, or you know what, maybe you want to meet some people living with type one, or just get a tan with a bunch of cool people. You can do that on juice cruise 2025 spaces limited. Head now to juicebox podcast.com and click on that banner. You can find out all about the different cabins that are available to you. and register today. Links the shownotes links at juicebox podcast.com. I hope to see you on board. sup everybody, it's July 19 It's time for the weekly news. I wish we have weekly news music, like old 50s music was I beat ePdP names like hey, there's gonna be news now like something like that. Anyway. I got for you. That wasn't fun at all. Okay, let's start with some mouse news, shall we? They're helping mice with diabetes again and that great. This is kind of interesting. Let's see. What do I got here? Well, I want to go back to what I wrote. Oh, here it is. Now this is from news atlas.com. Scientists Oh, scientists have developed a new drug therapy this significantly boosts insulin producing beta cells offering potential for reversing diabetes. Here's some key points from the article. Keep in mind this is work they're doing on mice. This involves harming inhibiting the D yr k one a enzyme and beta cells end a GLP one receptor agonist like ozempic in diabetes in diabetic mice, it says human beta cells increased by 700% Within three months reversing diabetes symptoms. Let's see future research. Combine beta cell regenerating drugs with immune system modulators to prevent immune attacks on new beta cells interesting. Harmon alone has undergone phase one clinical trials with more trials planned. I'm going to find out more about that a section a section in a second. The procedure involves a combination of two drugs hormone which inhibits the enzyme dy RK one a in beta cells and the GLP. One hormone stimulates the proliferation of beta cells while the GLP one receptor enhances this effect and supports beta cell functioning studies with diabetic mice. This combination lead was 700% increase in human beta cells within three months. Wow, that's pretty great. It says here our mind has undergone a phase one clinical trial. Tell me more about that. Tell me more. Tell me more Tell me more. phase one trial assesses the safety and dosage of the drug in small groups healthy volunteers or patients. Trials involve close monitoring to observe any adverse events, effects, excuse me and to establish a safe dose to drain for harm I and Phase One trials likely focused on its safety profile to determining how well it is tolerated in humans, and identifying any potential side effects. how our mind works by inhibiting the dy RK one a enzyme and beta cells we know that. Okay, current status and next steps. After successful phase one trials the next steps would involve phase two and three of course, that's how counting works. These phases will test the drug efficacy in larger groups. patient's further valuing its safety and impairment well, so there's like two more rounds of safety. And then then you're looking for regulatory approval if these trials demonstrate that hormone is safe and effective, that drug could eventually be submitted for regulatory approval, and if approved, become available for clinical use, which is how that works. Anyway, I thought that was interesting that they're mixing one thing with the GLP. That was kind of cool. Two bits of news from Novo Nordisk one good one not so good. Let's start with not so good. Novo Nordisk is working to address FDA requests regarding the approval of their once weekly Basal insulin insulin I codec. The FDA has delayed approval pending further information on the manufacturing process and the type one diabetes indication. Novo Nordisk is actively working to meet these requirements, but does not expect to complete them within 2024. But here's the good news side. This is very interesting. Novo Nordisk recently received FDA approval for an additional indication of their drug we go V at the 2.4 milligrams semaglutide. The new approval allows we go V to be used to reduce the risk of major adverse cardio vascular events mace such as cardiovascular death, nonfatal heart attack, and non fatal stroke in adults and established cardiovascular disease and either obesity or overweight. So there you go, kids. There's another way to get your we go V. Break that. We go V story down. A little more need details. Let's see what our overlords say about that and show me

there was a trial randomized, double blind placebo controlled trial participants 17,604 adults aged 45 years and older with a BMI greater than 27. The duration of this trial was over five years across 41 countries. The objective was to demonstrate the superiority of semaglutide 2.4 milligrams versus placebo in reducing mace, which includes cardiovascular death, nonfatal heart attack and non fatal stroke results significantly reducing may supporting the use of weego V for cardiovascular risk reduction. Hey, well, it's nice. We go V indications for this mace thing now and of course for chronic weight management for adults with obesity BMI greater than 30 or overweight greater than 27, with at least one weight related comorbidity condition and for pediatric patients ages 12 or older with obesity. All right, then that's another way to get you some wheat go V. Hopefully you don't have any of those problems. I wouldn't wish them on you. But anyway, new news. You don't I mean stuff that's new in the world. Now you know about it. Last thing for today, there is a significant legal battle is unfolding against Pharmacy Benefits managers, which are colloquially known as P VMs. Over their business practices and pricing schemes that allege inflate that allegedly inflate drug costs and negatively impact patients and pharmacies. multiple lawsuits have been filed aiming to address these issues and seek restitution. Keep in mind, I just said to Chet GPT tell me about the PBM lawsuits says here class action lawsuit has been filed by ncpa member Matt Astron house against CVS Health Care mark, and Aetna. The suit challenges the legality of direct and indirect remuneration, fees and other practices under federal antitrust laws and state contract laws. The lawsuit also contest the fairness of CVS is arbitration agreements. I feel like I said that word wrong. It should be remuneration. Okay, what she said, let's see the Oklahoma Attorney General getting her getting her what a name Drummond has filed a lawsuit against several major insulin manufacturers and PBMs alleging an unfair and deceptive pricing scheme. The lawsuit claims that despite the reduced production cost of insulin prices had been raised exorbitantly, causing significant financial strain on patients. This lawsuit seeks restitution and aims to bring transparency and fairness to insulin pricing the lawsuit. Both of them underscore the ongoing struggle between independent pharmacies and PBMs over practices like dir fees, which are often seen as unfair and harmful smaller pharmacies. These legal actions aimed to highlight and rectify these practices potentially leading to significant changes in how PBMs operate and improve conditions for both pharmacies and patients. Ah, well that would be nice if things got better for us. I'm going to end today shining a light on Australia. You say Australia, Scott, why? Well, they're doing something cool down there. So July 14 through the 20th is National diabetes week in Australia. And the theme is unite in the fight for tech, expanding subsidized access to continuous glucose monitoring, and ensuring equitable access to diabetes technology across the Australia. Good luck, everybody. I love that you're down there fighting that fight. There's some awareness campaigns highlighting disparities and access to diabetes technology and advocating for changes, launching events and discussions featuring health leaders and political figures to raise public awareness and support for policy change. Australia and diabetes society seems like they might be involved. Looks like diabetes Australia, along with Australian diabetes Educators Association, and the Australian diabetes society will engage in advocacy efforts aimed at implementing recommendations from the parliamentary inquiry into diabetes. This includes increased access to diabetes technology and support for credential diabetes educators Good. Good for you guys. Good. If those spiders don't kill you, I hope this works out. Tickets for the 2025 Juice crews are limited. I'm not just saying that they actually are limited. We have a certain window to sell them in. And then that's it. juicebox podcast.com Scroll down to the juice cruise banner, click on it. Find a cabin that works for you and register right now. You are absolutely limited by time on this one. I'm so sorry to say that it sounds pushy, but it's the absolute truth. Juice cruise 2025 I hope to see you there. We're gonna get a tan talk about diabetes and meet a ton of great people who are living with diabetes. It's kind of going to be like floating diabetes camp. But you won't have to sleep in a log cabin. You'll get a tan. And it's not just for adults or kids. It's for everybody. Hey, kids, listen up. You've made it to the end of the podcast. You must have enjoyed it. You know what else you might enjoy? The private Facebook group for the Juicebox Podcast. I know you're thinking Facebook's got please but no beautiful group, wonderful people a fantastic community Juicebox Podcast type one diabetes on Facebook. Of course, if you have type two, are you touched by diabetes in any way? You're absolutely welcome. It's a private group. So you'll have to answer a couple of questions before you come in. We'll make sure you're not a bot or an evildoer. Then you're on your way. You'll be part of the family. Hey, thanks for listening all the way to the end. I really appreciate your loyalty and listenership. Thank you so much for listening. I'll be back very soon with another episode of The Juicebox Podcast. If you're newly diagnosed, check out the bold beginnings series. Find it at juicebox podcast.com up in the menu in the The featured tab of the private Facebook group or go into the audio app you're listening in right now and search for Juicebox Podcast bold beginnings juice boxes one word Juicebox Podcast bold beginnings this series is perfect for newly diagnosed people

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#1257 Loose Wire

Jon has idiopathic type 1 diabetes.

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

+ Click for EPISODE TRANSCRIPT

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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 1257 of the Juicebox Podcast

this is John he's 43 years old, he's had type one diabetes for a handful of years he was misdiagnosed type two. And he's going to tell me today about how he's type one b He explains that at some point during the podcast, but this is just a lovely free flowing conversation for a Friday. Please don't forget that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, always consult a physician before making any changes to your health care plan or becoming bold with insulin. Okay, if you love vacation, and you love sun, and you want to meet people with type one diabetes, check out juice cruise 2025 Go to juicebox podcast.com. Scroll down a little bit, click on that juice cruise link. It'll take you right to the website where you can get more information about my cruise, cruise information itineraries and your registration register now to save $25 Whatever. Let me see what happens if you register. Yes, Early Bird registration by August 1 receives a $25 onboard credit per stateroom. There's going to be conversations about type one plenty of camaraderie and plenty of sun. I hope to meet you on the cruise

Arden has been getting her diabetes supplies from us med for three years. You can as well us med.com/juice box or call 888-721-1514 My thanks to us med for sponsoring this episode and for being longtime sponsors of the Juicebox Podcast. There are links in the show notes and links at juicebox podcast.com to us Med and all of the sponsors. 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 Jaylen, 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 show is sponsored today by the glucagon that my daughter carries G voc hypo penne Find out more at G voc glucagon.com. Forward slash juicebox.

John 2:38
My name is John. I am a type one diabetic. Basically my story starts back in 2018. And I am currently 43 years old. I just had a birthday. So I am a newly diagnosed type one diabetic. As far as a lot of other people's scenarios go

Scott Benner 2:57
Yeah. What are you about? Are you five or six years?

John 3:01
Yeah, somewhere in there. Alright. So in March would have been where you 42 When you were diagnosed? No when so I'm 43 now. So in March of 2018 is when I was first diagnosed. But I was diagnosed as a type two diabetic. In your late 30s. Late 30s. Yep.

Scott Benner 3:20
How long did you live with a type two diagnosis?

John 3:22
So it went for about three or four years? Really? Yes. Howto?

Scott Benner 3:31
Yeah, I want to hear about that. I want to hear about living for three or four years with type one diabetes be treated as a type two.

John 3:38
Okay. Do you want to start in the beginning? Oh,

Scott Benner 3:42
yeah, this is in Pulp Fiction. I don't need to start in the middle, then go back to the beginning and then go to the end.

John 3:45
Here we go. There we go. Okay, so. So I was actually, for about a week leading up to my diagnosis. I thought that I was having problems seeing, like, I couldn't read mailbox numbers. I couldn't see license plates, things like this, that were just always normal to me, I don't wear glasses. I've never really needed glasses, except for maybe close up when I was working on the computer. And that was probably three years prior to that is when, you know I had an eye exam. And you know, I started needing things to see close, but not all the time it just to relax my eyes a little. Okay. I went on a ski trip with my family. And I was talking to my wife on the drive up and I said you know, I really can't see anything. I don't even know if I should be driving. And I'm like, wait a minute, give me your glasses because she wears glasses for driving and I grabbed her glasses I put them on and I was like, Ray, I can see everything I just did not exam maybe I need glasses and it snuck up on me. went skiing for the weekend came home. I had an eye exam set up for Monday morning. I spoke to my father who calls me all the time and you know, he asked me how the weekend was and I'm like good but I gotta go get an eye exam and he goes, Hey, just out of curiosity. He's off. He's a type two diabetic. And he was diagnosed around the same timeframe of life as I was. And he goes, Hey, do you ever check your blood sugar? I'm like, no, because you really should he goes, I gave you a meter. Like, all right. I pulled out the meter. And I'm standing in my kitchen to test my blood sugar, and it's 420. So he's like, that's not good. You're start drinking some water and start walking around, because that's going to help. I said, Okay. And at this point, I really didn't know anything about diabetes at all. Yeah, except for, you know, I have a cousin who's a type one and things like that. And I know what a type two does because I, you know, my father for so long and called my doctor right away. Make it said, Hey, listen, this is what's going on. This was what I found. You have any openings today? She comes to you? No, no, no, you'll be fine. Wait till Friday. Come and see me. I have an appointment on Friday. Come see me. You'll be fine. Don't worry about it. Like, well, everything I'm reading online says I'm out for something. I shouldn't be in the emergency room right now. No, no,

Scott Benner 6:06
I think I shouldn't be worrying. Thank you. Yeah.

John 6:08
Like, no, no, you're fine. I'm like, Okay. Well, fast forward. That week, I get to him, and I'm reading taking readings and this and that. And, you know, and that for 420. That was fasting. So that was about nine in the morning. I hadn't eaten since seven the night before. Okay, so it's not like I ate a doughnut. Yeah. So then I was eating and in while I was eating, I was noticing, depending on what I ate, I would shoot up to five 600. And I'm like, Well, this is not good. Like, kept the log short log, and went to him. And he set me up with, you know, he's like, okay, so you're a type two diabetic. And this is going to be your life now. And I'm going to get you some training maybe and, you know, this and that. And I said, Okay, he goes, you're gonna, I'm gonna start you on a long acting insulin. And I think it was true Stiva at the time, okay, so he put me on that. And things seem to be a little better. I still saw spikes when I ate. But, you know, he told me that that was just a normal type two thing. And insulin was only a temporary thing just to get my pancreas back to, you know, whatever. And I said, okay, and about a couple of weeks went by, and I told him, I was experiencing a lot of papers. And he's like, Well, let's just stop the insulin, then. Fine. You're gonna take the Metformin now and this and that, and which I had started with, and then it was, seemed to be okay for a couple of weeks. And I was talking to some people and decided, you know, I don't know if I want to, I had an appointment with my doctor the following week, he said, I don't think I want to see you anymore. For my diabetes, I'd like to see an endocrinologist. And of course, then you get the, ah, don't worry, I treat tons of type two diabetics. Now, mind you, all these diagnosis was done without a blood test. Okay, this guy standing in his office telling me I know what's wrong with you? And to me that seemed like, well, you know, I'm an electrician by trade. So, I know diagnostic, right? And I'm like, well, that doesn't seem like you did anything except stand there and telling me this is what I have and throw some drugs at me. And hopefully, we can fix this, right? So he reluctantly finally agreed to say, Okay, well, you can go see somebody if you really need to. I said, Well, I would feel more comfortable, started seeing an endo. And, again, she just went off for his diagnosis. We never really did any testing.

Scott Benner 8:37
You went to a place where you thought you'd get better care, but they just trusted the doctor before you

John 8:43
kind of well, they ran the I take that back. She did run some tests. And those tests came back. And I'm not sure what tests he actually ran. And then those tests came back, and everything was okay. And we were still doing the same treatments, no insulin, just the Metformin added a couple of things for you know, whatever. I think we added maybe a cholesterol pill or something just for safety precaution. And that went on like that for almost three years.

Scott Benner 9:14
So in hindsight, were you Lada you're just having a very slow onset of type one or were you well actually they if you take insulin or sulfonylureas you are at risk for your blood sugar going too low. You need a safety net when it matters most. Be ready with G voc hypo pen. My daughter carries G voc hypo pen everywhere she goes, because it's a ready to use rescue pen for treating very low blood sugar and people with diabetes ages two and above that I trust. Low blood sugar emergencies can happen unexpectedly and they demand quick action. Luckily jeuveau Capo pen can be administered in two simple steps, even by yourself in certain situations. shunts show those around you where you store Chivo Capo pen and how to use it. They need to know how to use Chivo Capo pen before an emergency situation happens. Learn more about why G vo Capo pen is in Ardens diabetes toolkit at G voc glucagon.com/juicebox. G voc shouldn't be used if you have a tumor in the gland on the top of your kidneys called a pheochromocytoma. Or if you have a tumor in your pancreas called an insulinoma. Visit G voc glucagon.com/risk For safety information.

John 10:35
So I'm not sure exactly how it happened. I now have to all those years went by everything was semi Okay. Same time a year. We're going skiing again. Same symptoms. I'm like something's not right, because I I wasn't wearing a CGM. I had one for a little while then insurance was the thing. And back then they weren't enough. Not even that long ago. They didn't want to give you a CGM. If you weren't a type one they weren't going to cover Oh, for sure. And I, I wasn't paying the $300 a month when I could do a finger stick like at that time. I'm like, That's ridiculous. I don't really need to monitor it that closely. Fast forwarding got same symptoms can't see again, something's weird. I told my wife. She's like, we're going skiing. So you got to figure this out. Like now, because we're leaving without you. And I'm like, Okay, fine. So I go to the doctor on that Friday morning. I called her up. I said, Listen, I'm not feeling well. Coming right now. So I go in. I'm going to send you for some more bloodwork. Now, mind you, the doctor changed. So my endo was originally a not a physician's assistant, but she was a nurse practitioner, okay. And she was fantastic. But she retired to go spend time with her grandchildren. And I got this new Doctor Who is, in my opinion, phenomenal. She's a no nonsense, right to the point. Like, I'm not your friend, I'm here to help you stay alive. So, you know, I never saw her smile for probably three years. I didn't even know she had teeth. It's hilarious. But she's just, this is what we're going to do. Let's move on. So I go into your that morning and she's like, I'm gonna send you in for some blood work right now. Did you eat? I said, No, not yet. Fine. I go in and my numbers had been under control. I mean, my agency was, you know, at that time, I was in the high sixes. original diagnosis. I started at like nine point, I think 9.8. Okay, was my original agency. And I had brought that down into the sixes. And I was doing that with diet basically in Metformin, right. And then I she sent me in, had these tests done. Monday morning, I get back from my trip, I get a phone call. Okay, so there was some something happened and you are not a type two diabetic. I'm like, Okay, you're a type one. And you need to start taking long acting insulin today. So here's a prescription. I want you to go down to your pharmacy, pick that up, and then bring your prescription to me and I'm going to show you about injecting I said, Well, I'm already good. I did that in the beginning. She goes good. That's how many units you take every day. And then we're going to adjust accordingly. And and that long acting went on for about two or two and a half weeks. In the spikes were still there. Like there was nothing stopping by mealtime spikes. They were crazy. Then she said, Okay, let

Scott Benner 13:26
me stop you there. Gentlemen. ask a couple questions. Okay. Sure. Yep. At one point you said, you know, it's kind of like it settled in and for years, it was okay. Yeah. What did okay mean? Were you getting a one CS tested? I

John 13:40
was in they were steady, like in the mid to upper 60s. And they were telling me well as a type two, that's not bad. So you you're okay.

Scott Benner 13:50
And that's just metformin and a statin? Right. That's what you're taking at that point? That's correct. Yep. You still take the statin?

John 13:57
I still take both. What do you need the statin for? They give me that because my cholesterol levels were a little elevated. So they want to make sure that that stays under control. At

Scott Benner 14:09
some point I'm gonna get I'm gonna get an honest doctor on here to talk about that. Yeah, yeah. They're gonna tell you that. Statins became standard of care for people with diabetes and so doctors just blanket prescribed the wrong people. Yeah, I got it seemed to me The fascinating part is that you didn't die. Do you know what I mean? Yeah, yeah. So

John 14:29
now so the after that, like, the crazy thing is, when those tests came back, I'm not a standard type one diabetic. So they classify me as a type one B. So when you asked about Lada in, you know, things like that. Mine is technically not an autoimmune disease. I don't have the autoimmune markers in my blood, okay. But my C peptide is that zero, whatever, that as low as you could get. So They think that something happened somewhere along the line in my life where I must have gotten sick, like, you know, they call it idiopathic type one diabetes, which fits me perfect because my whole life people have been telling me I was an idiot. So, Greg, there we go.

Scott Benner 15:16
I didn't know that if I made this podcast long enough that people would start telling the bad jokes and I could relax. That's fantastic. Thank you. That's true. That's just true. Okay, so in type one diabetes, B cells are typically understood to be I don't know, type one diabetes B.

John 15:31
Yeah, so it's idiopathic. type one, type one, the type one B is what they classify it. It's even in my chart written that way.

Scott Benner 15:40
Okay. So very simply, let me read this. Type one B, other forms of diabetes with severe insulin deficiency, but without proof of auto immune are also known as idiopathic. Okay. All right. Yep.

John 15:54
And the funny thing is, if you read what nationality of people usually get this

Scott Benner 16:00
disease, is it idiots? No, I'm just kidding.

John 16:03
No, it's actually it's of African descent and Asian descent. Which one, are you? I'm neither one of those. There's German, German, and polish. Some other stuff, but not that. All right. So I'm like, Oh, lucky me.

Scott Benner 16:18
No kidding. How do they prove this?

John 16:21
I'm not sure I guess through the C peptide test, because I don't have the auto immune markers. But the C peptide, is telling them, Hey, your pancreas is making zero insulin, have something damaged your pancreas other than an autoimmune disease? Here's what they told me.

Scott Benner 16:40
Right? So listen, I'm just listening to your story. You just it's very new to me. So that's weird. Dr. John, two different women have told me that they tried to get pregnant by putting a friend's semen into a turkey baster and inserting it in themselves. But you're the first person to tell me that you have type one B diabetes. Yeah.

John 17:02
And that was kind of my whole thing was sharing this story with you. When I had sent you that email quite a long time ago. And I think during an episode, you had said, Hey, share your stories, I'd love to hear different things. So I did. And I'm like, I got to tell somebody because I don't know anybody like this. Because

Scott Benner 17:21
saying that to go on to CDC to type one diabetes is thought to be in effect, it doesn't. When you Google questions specifically about type one, B diabetes, you don't know nothing there, you ask you, you often don't get information back about it. It almost redirects you to a similar website, but not about that, specifically.

John 17:41
Exactly. And that was my problem for a very long time trying to learn well, how could I have gotten this? And they have no idea. But the odd thing is I do have an I know you always ask people, well, what about in your family? So there's a lot of type two in my family. And I have one cousin that is a type one who has been a type one since I think she was like 13 years old. Okay. And that makes sense to me. But for me, where it happened was so late in life, I think I also during those couple of years, I may have been in quote unquote, a honeymoon stage where yes, the Metformin was kind of giving my pancreas a little bit of a kick and I was still getting some insulin. And then it just decided it was given up the ghost and it wasn't going to do anything anymore and it was just going to chill hanging out in my stomach and or my abdomen and to do nothing. So that's kind of where we're at. Started taking the mealtime insulin and did that for with a I did it with a pen and just tracking stuff that way, or probably, I don't know, three months. And the stories I hear of people with their doctors never want to give them a pump or they never want to do this. My doctor, for me was fantastic day one. She said you want a pump. This is forever so I'll give you a pump today. If you want one. I'll get you set up. We'll get you going. We'll get ready to go and I said well I don't know if I want anything attached to me. Not sure I want to do that yet. instantly got the ducks calm. And I started on the G sex love that. I am now currently on the g7 Couldn't wait till that came out that finally came and you know it works pretty well like in saying I was living okay with what the doctors were saying at six and a half. Yeah, almost seven. I my last checkup I was at five seven. And it was a little better than that previous but kind of got a little carried away with the eating.

Scott Benner 19:46
Now you're doing terrific. What What a story of of getting involved in it. It's really something Did you ever say? I have a cousin with type one diabetes, or did you mostly tell Have a story about my dad has type two diabetes when you were in office?

John 20:03
No, I had mentioned that I had a cousin with type one. That didn't really seem to, you know, do anything but I also have hypothyroidism, too. You have other autoimmune issues? Yeah. Yeah. And I take Synthroid for that.

Scott Benner 20:20
Yeah. What's your TSH? Do

John 20:21
you know, though? I don't know. I? Honestly, I don't pay attention

Scott Benner 20:26
to that your boy, John, I don't expect you to know these things. Don't worry. Do you take it every day?

John 20:31
I do. Um, how do I take that religiously up? Do you have

Scott Benner 20:36
any thyroid symptoms, even though you take it?

John 20:40
Not really, other than I was really tired for. And that's kind of where the testing went. You know, I was just exhausted all the time. I couldn't have it. I'd had like, no energy. And I'm not sure if that that is it. That's the thyroid. Yeah. Yeah. So then they they started me on this stuff. And it seems to work well, but that I mean, that's been going on now for I would say 12 years, I've had

Scott Benner 21:04
much longer. Yeah. How about throughout your families or more thyroid through your family or celiac or anything like that?

John 21:10
See that? No, not that I'm aware of. No, just a lot of type type two diabetics. Okay. Okay. And then one cousin with a type one and then me with the nobody knows what, a

Scott Benner 21:23
lot of type twos with the German side.

John 21:26
Yeah, it's all on my father's side. Yeah. Okay. You close to your dad. Yeah, very, yeah. Yeah,

Scott Benner 21:32
he must have been so upset when you didn't use that meter. And he gave it to you anyway. He's, you have to really think about that. Like, he went to the trouble of like, I'm gonna sprinkle a blood sugar meter on this kid, because we all have type two diabetes, and he's gonna get it to one day, and this is gonna help and then you call, you know, like, I don't feel good. And he's like, you can use a meter. Right? It's one of my biggest concerns. Not something that's in my head constantly. But then I spent all of this time understanding all of the things impacting the people in my family, and I know they're gonna move out of the house and ignore all of it. Oh, yeah. Yeah, absolutely. Sons of bitches. I know it's gonna happen. And so sorry, okay. Okay. So once you get that all straight and you start using insulin, things sound like they they're going okay. Is that fair? 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 as high origin. This is your friendly reorder email from us med. You open up the email, it's a 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 are called 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 ducks comm G seven. They accept Medicare nationwide, over 800 private insurers. And all you have to do to get started is called 888-721-1514 or go to my link us med.com/juice box using that number or my link helps to support the production of the Juicebox Podcast. This episode is sponsored by Medtronic diabetes, Medtronic diabetes.com/juice box. And now we're going to hear from Medtronic champion Jalen. I

Speaker 1 23:53
was going straight into high school. So it was a summer heading into high school was that particularly difficult, unimaginable, you know, I missed my entire summer. So I went I was going to a brand new school, I was around a bunch of new people that I had not been going to school with. So it was hard trying to balance that while also explaining to people with type one diabetes was my hometown did not have an endocrinologist. So I was traveling over an hour to the nearest endocrinologist for children. So you know, I outside of that I didn't have any type of support in my hometown.

Scott Benner 24:26
Did you try to explain to people or did you find it easier just to stay private?

Speaker 1 24:31
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 24:46
you eventually find people in real life that you could confide in. I

Speaker 1 24:50
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 They're trying to 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 25:11
diabetes.com/juice box to hear more stories from the Medtronic champion community?

John 25:19
Yeah, yes, things to me are on the diabetes side of things, I feel that I do a fairly decent job of keeping myself alive, I use your terminology of my endocrinologist has now become my drug dealer now, and not so much a doctor because we go there, or I go there, and I see her. And the last time I was there, everything was good the time previous to that I had gained a little bit of weight. I'm a small guy. I'm five, eight. And I've always weighed, you know, under 170 pounds. Well, I was up to like, 189. And she's like, okay, we're not talking about your diabetes today. Because that point, my agency was still at like a 5.4. And she's like, you're doing great. Keep up the good work. But you're fat. I'm like, Oh, thank you. So what she said, he literally said, You're fat. And this is not good in you're gonna have other problems. So can we please get this under control. And then I did, I lost a bunch of weight. And I went back a once he went up a little bit, but the the weight and so she asked me how I do in how I'm controlling it. And I kind of explained it, and I said, if I see my numbers are creeping up, or I see this, I said, I adjust my pump and listen, that listening to your show helped me really take control of it, and not be afraid to go and ask my doctor and say, Oh, if I touch this, I'm gonna die. Like you're not gonna die. Just a little bit more candy or whatever. If it's a little high, then you know, you got to add a little more and you know, nudge it and pump it and do what you got to do to get it to there. And she told me Listen, it's like a driver's license. She goes, I gave you a pump. I set you up with training. Now you have your license. You're on your own now. Like, do it. Yeah, do what you got to do. If you have big concerns, call me but don't call me daily and ask me how to adjust this work. Should I move my numbers? Just do it.

Scott Benner 27:12
I think we need more doctors who call people fat because that I like the attitude. Like I don't listen. I'm a little stunned. They called you fat like, but like, it would have been a nicer way to say that. But I like the assertiveness that I hear in the rest of the story.

John 27:25
Yeah, she's very, she's very good. But I think I can handle her type of bedside manner. And I'm sure a lot of people can't.

Scott Benner 27:35
What part of the country you're from.

John 27:36
I live in the Northeast. Yeah, I

Scott Benner 27:38
was gonna say you're around here, right? I'm in New England. Yeah. And I can I can almost hear that. You think Tom Brady's a good person? I can. I can hear in your voice. I don't

John 27:47
watch football. I know who you are. Yeah,

Scott Benner 27:50
trust me. Wade Boggs. I can get to where you live. There

John 27:53
you go. Yeah, well, a little south. But yeah, actually, I would, I would say a little. It would be a little west of Wade Boggs territory.

Scott Benner 28:01
I'll tell you, John. I think it's nicer living like this. I love your response to it. You know, like you're walking, you're up 10 pounds. Hey, we're not talking about your diabetes today. Because you're fat. And we got to fix this. And let's go and you don't go Oh, no, don't call me fat. That's mean. Like, you're just like, Alright, okay, you know, right into it. And then the same thing with the diabetes. Like, look how valuable that directness did you lose the weight?

John 28:25
I did. I got down to I'm at a comfortable 174 right now. So

Scott Benner 28:32
I'm going to tell you, I wish someone would have looked at me at some point and said, Hey, Scott, you look fat. Yeah, yeah. Would have been nice.

John 28:38
You're gonna have other problems. So can you just fix this? I'm like, Yeah, okay. Well, then I just cut out some stuff that I was doing that I probably shouldn't have been doing anyway. And, you know,

Scott Benner 28:47
can you imagine being married to her?

John 28:50
Oh, I don't even know. I mean, she's a great doctor. But again, like, we're, we're at the point now, I've known her long enough. How I had said, I never saw her smile before. Yeah. He was laughing during our last meeting, because she's, you know, she's starting to open up a little I've known her long enough. You know, now like, she gets my humor. I get heard. And we have a really good doctor patient relationship. And she's, she's great.

Scott Benner 29:17
Sounds perfect. Honestly. Yeah, it does really sound perfect to me. Yeah,

John 29:23
it works well. And, you know, I can too. I think I drive my wife crazy. I tend to if there's anybody who's willing to listen to me talk about diabetes. I do. I know that my kids look at me and they're like, Ah, here we go. He found someone they

Scott Benner 29:39
were gonna think that no matter what, John don't worry about that. Yeah.

John 29:42
I got it. I got it. Being so late in life and having you know if I'm gonna have this disease in live with this, I'm glad that number one. It happened in this day and age, not 1970 Because technology I I don't know how people did it and how people can sit there and their endos will tell them to wait. And they don't want them to have a pump. They want them to learn how, why would you do that to someone? It's horrible to me. I don't understand

Scott Benner 30:08
either. So when you find yourself wanting to talk to people about it, what's your driver there? Are you hoping to find somebody who needs help, like you did. And maybe you can say something to them, that will make them think, oh, I need to help myself, or you just trying to spread awareness.

John 30:24
Both To be honest, I would love to get involved in more, you know, helping people, if I could, my time does not allow that right this moment, but with work and kids and you know, sports, but I would love to be able to help more people, or just even if telling my story of how this happened to me, get someone to think, Hey, maybe I should have something looked at, then. That's great.

Scott Benner 30:48
That's nice. It's very nice. You're worried for your kids.

John 30:54
You know, I do worry about them. And maybe getting this. I'm a little less worried because of what my diagnosis is. Being that it's from what they tell me, it's not autoimmune. I'm not as concerned with it. And it's not like, you know, hey, I had the COVID shot. And then I got diabetes, like this was well before COVID When, when my whole journey started. Yeah.

Scott Benner 31:24
Do you think you were sick before it happened? Do you think back or is it you probably don't even really remember, I would imagine. Do you have any virus, a virus of any kind? I've

John 31:34
never heard the story except for once my mother told me when I was a baby. So I was born in 81. So it was the beginning of Lyme disease back then it was, you know, kind of a big deal. And you never hear of it really anymore. But they claim that I had Lyme when I was probably two years old. Okay. Now, did that do it? I don't know. I don't know of any other type of situation that I might have been in where I had a virus or anything crazy. I mean, like every kid chickenpox, right? You had that? In? You know, the Lyme disease went away. Apparently, after they gave me all kinds of, you

Scott Benner 32:12
know, stuff back then a lot of antibiotics. Yeah,

John 32:15
probably. Yeah. I don't remember that. I remember 90% of my life, and I don't remember anything about that.

Scott Benner 32:21
You think you were beat up? Did you ever talk to your parents about that time? As far as why do you not remember that portion of your life? I

John 32:30
have no idea. I bet that I don't I mean, at two years old. I do remember things

Scott Benner 32:34
but because your age? No, I'm sorry. Okay. Huge. Yeah. Okay.

John 32:39
It's an interesting, I kind of have like a unique story. I'm not really that unique of a person. But I think in this case, you know, talking to a guy like you, you've heard 1000s of stories of people, right? Yeah. Have you heard this one? Like, I mean, this is new.

Scott Benner 32:54
I told you. I've heard two stories about Turkey base. There's one story about type one B in less. I've heard it and I forgotten it. And then I'm going to get somebody online is going to tell me a Scott, that was another this other episode, but I really don't feel like I've ever heard that before. Yeah, so

John 33:08
yeah. So you just you kind of get your roll with it, right? You do what you got to do. And life goes on. You can't let it kill you. You can't let it get the best to kind of just, and that's how I try to look at it like, hey, this really sucks. Like, it really, really sucks that I have this can't stop you from doing things, either. No,

Scott Benner 33:29
I appreciate that.

John 33:30
I've been doing these things my whole life. Like, you know, but again, I'm fortunate that I wasn't well 13 years old and develop this disease of

Scott Benner 33:39
course. So you manage now with you have G seven and what do you what pump? I'm

John 33:43
sorry, I used a tandem?

Scott Benner 33:45
Is that the x 2x? Two? Yep. Nice. Do you enjoy that that algorithm? You know,

John 33:52
I do. I don't really watch my pump the way that some people do. I kind of set it up and then I'll watch the trends over the few days. And then if I need to make an adjustment to my, my basil, I will. It seemed for a while that that was working great. And you know, I was having a nice smooth line. And I had my Basal dialed in where it needed to go. And then all of a sudden, I don't know if it was stressed at work or something. stuff got wacky, you know, all whacked out and now my line is like I can't unlife me get it to move back out the way that it used to

Scott Benner 34:31
be. I mean, are you do you weigh more than you did when it worked better?

John 34:36
No, I'm about back to where I was when I started. Yeah. Okay. So I didn't know what that was. And I you know, I was fighting a sinus infection for a little while and stuff and I know that I'll do it. I know you always say, Oh, you got to change your Basal you got to do this. You got to do that. And I have been trying to do that. But I also think the other thing I noticed is the g7 Their algorithm. And

Scott Benner 35:01
that is horrible. Tell me what you don't like about it. So

John 35:05
in talking to, actually, there's a local guy who's a rep for Dexcom, in my, he lives in my town, and he was the first guy I talked to, once I was diagnosed, and they, you know, I was gonna start using the G six at the time. And what had happened was between the G six and the G seven, they removed, I believe, and I may be talking out of turn, but the flattening algorithm, or the flattening portion of the algorithm, where it makes your line look smoother. And they took that out. So the G sticks, wearing that neck to the g7. You can tell that that one had a smoother line, because I did it for 10 days, I had an overlap. Can

Scott Benner 35:50
I ask why that matters? It doesn't matter to me, I guess

John 35:53
as much as I mean, I like to smoother line because it made you feel better. It was a false a false sense of security. Right? Like, wow, look how good I'm doing. And now it's like, up, down, up, down, up, down and, you know, jumps around all over the place. If

Scott Benner 36:07
that's more accurate. Would you not prefer to know? Oh, no.

John 36:11
Yes, I do. Okay, I kind of do like the fact that it shows but I think that's where some people, because you see it on online on the Facebook groups and things and people complain about the G seven. It's not as good as my G six. I'm going back. And it's like, well, it is as good. It's better. Yeah,

Scott Benner 36:30
it's just the way people talk about things is very interesting to me. Like you said, it's worse. But it sounds like to me that they were like, look, we're gonna give up the smoothness of the visual of the line for a representation of what your blood sugar is. And people are like, this thing don't work is good. I'm like, that sounds backwards. Yeah,

John 36:49
it does work good. It's working better. It's just, you're at the point now where, you know, it doesn't make you feel good. And people want to feel good, that facade

Scott Benner 36:59
that your blood sugar is just dancing around like a ballerina very slowly from 156 to 154. You know, like, yeah, where it might actually be that you are, I don't know, 120 and then turn around a corner and somebody jumps out and scares the hell out of you. And then you're 140 and then it goes back to 120 again, or something like that, you know? Yeah, yeah. Well, it's just it's funny. Language is so funny. Like, it's worse, it works better. But I was like, Wait, stop. I'm not sure what we're saying. I

John 37:29
was a little confused. But it seems to be worse, because it doesn't make you feel good. And I think a lot of people need to feel good.

Scott Benner 37:35
Interesting. So you know, there's value in in the lie a little bit.

John 37:42
Probably, if you want to believe that, right? If you want to believe who you are. I think it's great. I love the warmup time. I love the I love the grace period. That's a that's like, amazing.

Scott Benner 37:54
I watched my daughter chew up every second of that grace period yesterday.

John 37:59
Yeah, yeah. And you're like, okay, okay. Are you doing okay, what, what are we doing?

Scott Benner 38:04
I texted her. I was like, Hey, are you gonna change your CGM? She was why. And I said, Well, there's three hours left in the grace period. And she goes, Oh, I guess I will then I was like, okay, so she's in the middle of her finals. Today's her last day. Okay, we talked to her last night. She sat on a sofa in her dorm room, with the camera on us with her knees at her face rocking back and forth going, I say, Oh, my day is over. And I'm like, we're like you alright? Their kids. She's like, I'm not sleeping. And so she told us that in the last like, she expects to sleep for 15 minutes at a time, maybe for a collection of just a couple of hours over the last two days or finals. Well, that's wrong. She's not sleeping at all. And her blood sugar's are stunningly good for what's going on. Yeah, like genuinely. I don't know how people like if I showed you Ardennes last 24 hours right now. It's not pretty. Okay. But it is mainly between 70 and 130. There are there for excursions over 120 There are two excursions over 200. But she is literally not sleeping. She's like, I'm not sleeping. I'm barely eating like, everything's a mess. Like, I just need to get through these next couple of days. For the life of me, you know, when she was in high school, she was like, I'm either gonna go to take a pre law track. Yeah, or I want to learn how to make clothing. And somehow she ended up in art school learning about fashion design, and it seems like it would have been easier to become a lawyer. So it's very, very interesting. But anyway, I heard craft looks choppier, but I don't care. And but the rest of it's amazing because now she's in the middle of class. She's like that I'm in my car. She's calls me she's like, I'm on my way home. I'm was killed no lady wasn't my fault, but she's okay. And then by the way that story is going, isn't it a different episode? If you want to hear it, it's, it'll be out around the time Jonathan says, oh, okay, and then she's like, I have to go home. And then I'm like, I'm gonna do this. And I'm like, and you're gonna change your CGM. She's gonna change my CGM. And bah, bah. And I put she took it right. What is it? It's 12 hours past 10 days right now. Right? Okay, she wore that thing. Like the math the Oh my Oh, my God, I was I kept looking like is she going to forget that she fall asleep that she dropped dead? Like what's happening? You know, and boom, she changed at the very end. And I know that'll piss some people off that she worked for the entirety of the time. It was never that sensor was terrific.

John 40:39
Like, yeah, see, I had some problems with that, though, in the beginning of the g7. That was my only complaint truly was the first four that I put on? Well, the first one I put on, I couldn't even get it to connect to my on my phone at all. It would just not nothing. So that one got ripped off through I put that one aside. I put on the next one. That one worked. And that worked for four days, and then it quit. It was just sensor issues. central issue nothing. I don't think let's see in the past. I'm gonna say I've worn now. Six or seven sensors. And I've had one. Let me like, accurate all the way to the grace period. Yeah, most of them start getting the we're experiencing brief sensor issue for you know, we'll say the last day and it just hour after hour. And after a while I just get sick of it and rip it off. When it gets worried. The great thing with Dexcom is you call them and they send you one.

Scott Benner 41:35
And you're hydrated John? Yeah, yeah.

John 41:39
I tend to be fairly pizza yellow. No, no, no, not really.

Scott Benner 41:45
Listen, I just in the end, I just believe that people's body chemistry is different. And that I haven't said this in a while. But this would be for any CGM technology. Honestly, if cannulas too, but I think it's important to remember that we're inserting a piece of inert material into your skin to measure your interstitial fluid so that you and you know if some of you can only get six days, and some of you get eight days, some you get nine days somebody can go 10. Like, I know, it's frustrating because the box says 10 days, right? Like, I mean, do we not see the magic that it is? Generally mean? Like, like, if you said to me, this thing could last up to 10 days, but for me, it lasts six days, and they replace them. I'd be like, right on like, okay, yeah, that seems fine to me. I don't know. It's a weird not seeing the forest for the trees reaction. I get the frustration though. So I'm not. I'm not downplaying that. And I'm lucky that Arden just as never had an incompatibility with Longwear or

John 42:48
even even the adhesive. nevers bothered me, right. And you see people with these burns and things and you know, and then you hear stories about people. And it really, it kind of breaks my heart to think that there's people out there that need this device to live in. They're restarting it six times. Yeah, it sucks. And they're not moving it. There's a reason why they say 10 days or 14 days, like it's not supposed to be there that long. And you hear it ah, you know, I'm going on day 30 of the same sensor. And it's like,

Scott Benner 43:19
when people were resetting the G sixes. I'm sure they still do. The thing about like, adhesive allergies. It's an allergy, right? You're evident, you're allergic to the adhesive, you have an auto immune issue. It's not crazy that you have allergies to that's the part that breaks my heart about the double unfairness of the whole thing is like, I have this autoimmune disease. So I have to wear this thing. And oh my god, I'm allergic to the tape. Like, you gotta be kidding me is Jesus Christ. So it sucks. Yeah, yeah, no, I hear.

John 43:52
Especially the little kids like, you know, these parents they can afford. Maybe, you know, and you hear it, you know, they can't afford proper insulin, or they need the CGM. But, you know, they're afraid that if, if they take this off, they can't they don't have another one available. Or, I mean, and then they can't afford another one. Yeah, reusing it. And

Scott Benner 44:14
the people that are allergic are like, well, just, you know, can you change the adhesive so that, you know, I'm less allergic The problem is, it seems to me is when they, when the adhesive is whatever less it is, and it doesn't interact poorly with, you know, more people. It also tends to fall off at that point. Yeah. Yeah. Like I've had long conversations with people. I don't know if you ever remember this guy came on from Omni pod one time. And I asked him about that idea of like, could there not be different adhesives like a sensitive one and the the sound and his voice about he's like, he started talking about the things I understand about it. He's have now after working at this job, he's like, it's mind numbing. Yeah, the amount there is to know about this and the formula Relations and he's like I've seen and worn you know, all these different kinds. And when they're more like this, they're less like that. And he's like there's is there's no perfect balance. There's always a trade. Right? You know, then the people who don't have adhesive allergies are like, How can I, you know, what are they going to say when their thing starts falling off? Right? They're gonna say there was nothing wrong with this. Why'd you change it right? You can't win. And it's it's like frustrating, again is a good word. The I mean, it just in the end it is what it is. You know, I just had ever since just came on, they have an implantable CGM, right? And I'm like, oh, maybe you know, now right now it doesn't pair with pumps, but I assume in the future will like so maybe that's, you know, maybe that's an answer for some people. But who knows, you know what I mean? But options are what's important.

John 45:45
I mean, there's still a sticky part part of that with the Eversense.

Scott Benner 45:49
So the interesting thing about that is as I went through a training so that I could talk about it better, because often doesn't use it, but the sensors implanted, right, like you go into a doctor's office. It's interesting, they do a little local, like a little tiny needle to numb the spot as little incision, the thing goes in, it's closed with like a butterfly bandaid. It's not a stitch, right? Yeah. And then the transmitter goes on over top of it. So you're still wearing a thing on your arm. But that thing is, it's every day, I guess there's like, it's almost like a silicone adhesive. So it's very, very much not, you know, you're not gonna see a lot of allergic reactions from it, and it comes off every day. So you just pop it off, toss it away, you put another little silicone thing on the transmitter sticks to it. And the value there is you can pop it off and jump in the shower, if you want to like it, and then throw it right back on again without like, you know, like that kind of thing. It's very able to be removed and put back. Yeah, yeah. Over and over again. So because you take the transmitter off to charge it too, right? It gets a different setup. But very cool. And the transmitter vibrates. Well, if you were going somewhere and you wanted it to be completely quiet, the actual they call it on body vibe. Well, that's interesting. Yeah, you set your levels and it vibrates to tell you high or low. And it's cool. Listen it. I don't know if it's for everybody. But as soon as I started putting the ads out, I started getting notes from people. Oh, I can't believe he took Eversense ads. These are great. I've been using it forever. And I'm like, okay, there you go. Like everybody needs arms. Yeah.

John 47:26
Yeah, that's, that's interesting. I mean, I would try something like that. But the whole reason I wear what I wear is because it works with my pump, and it works well million percent. The only issue and that I have with it is my phone can be 30 feet away, and it'll pick up readings, if I put my sensor on the other arm, because I wear it on my arms fully. I don't like it anywhere else on my body, only because it gets in the way of like, my belt and my jeans. And you know, it just seems to work the best on my arms. But if I put my pump my infusion site on the left side and put like sensor on the right side. Like, it can't get through my palm through my body. It's like how does that work on my phone is 30 feet away, and it's working fine. Like, I don't know. So

Scott Benner 48:11
even that is like a thing that I've said to myself like Arden's never had connectivity problems with g7. But she's also pretty connected to her phone, right? Like so if you're a person who's like a little older, and you put your phone down and walk away from it a lot, then maybe you have different issues you don't I mean, like it's, again, it's a personal situation. And

John 48:31
mine is never really with the phone. Like my phone's always in my pocket because of what I do for work. But my pump is that that will disconnect if my pump is on one side, and my sensors on the other, okay, I tend to try to run the course of, hey, these 10 days, I'm going to have at least three infusion sites. And I'm going to put him on that side. So I alternate sides of my body. Pretend days with my pump. So 10 days on this bike 10 days on that side. And they both work together.

Scott Benner 49:04
Nice. Listen, I think algorithms are astonishingly terrific. Yeah, like really? Like, I mean, using Arden's last 48 hours as an example, if she didn't have an algorithm. I mean, you got to think her blood sugar's would be crashing and flying up and crashing and flying up over and over again. Right. You know what I mean? It just makes sense to me the last I'm looking at her last six hours, never over 17 Never over 110 No, never, never under 70 Never over 110

John 49:37
You know, I could not say the same for myself. Now, this is where trying to dial in my my settings a little more on my own. Like I said before, I had it to a point where I was really good. Yeah, and I was really comfortable living around 100 all the time. I was between 95 In 110, for like six months, it was awesome, okay, and occasionally would go up because you know, I Bolus late or this and that. Now it's all over the place. Like, you know, now that I've adjusted my settings in for me, I'm fairly sensitive to insulin, which is pretty good, I guess, cuz it's better than having, you know, less sensitivity and you need so much more. But point 01 of a unit on the tandem, you can go 1.01 If you wanted or whatever, or point nine, five or, and I think right now I'm at like point nine for an hour. If I went to point nine, five, I would see a lot more lows below 80. I don't like the feeling at 75. Like, that's bad for me.

Scott Benner 50:50
Did you try adjusting your insulin sensitivity? So it's a little weaker?

John 50:54
I don't know if I've ever even looked at that on my palm. Yeah, I

Scott Benner 50:58
as you were talking earlier, this is what it occurred to me to talk to you and talk about it at the end here. Yeah, absolutely. Okay. So if you're having stability with your basil, like, right, like you're not seeing it turn off a lot or a rank ramp up a lot. And you have some, you know, you have some nice stability and a number you're happy with. But then during the day, you know, you think your insulin to carb ratio is good. But you still have these excursions that he's up and down excursions, you're having some lows, and you're having peaks, like maybe you're just not giving the pump enough autonomy to make adjustments, and that would be insulin sensitivity.

John 51:34
Now, I go into my tandem, and I open this up. So right now I'm sitting at like 115 with point three, three units on board. Okay, it did shut off at one point around right at the time of our, our start of our call my Basal shut off for a little while. And then it came back on and I am I'm sitting steady since I don't know, for the last hour, I've been sitting steady at 115 less

Scott Benner 52:06
than that. There's nothing wrong with that. But what's your target? Is it what's 110? Right? That's what it's targeted for

John 52:13
problem with the tandem pump, you can put in your target as 100. But control IQ takes over. And it doesn't really tell if I was at 100. And I went to his I think their target is 110 Regardless of what you set it as if you went at one at 100. And I said okay, I'm gonna go eat this meal, and it's 45 carbs. And I put that 45 carbs in. It will give me a reduced Bolus based on the fact that I am below 110. Yeah, no matter how you set it, or what you do to it. That's the only bad thing versus like looping and everything I've read about looping and obviously Arden's been doing that forever from, from the episodes and everything I've heard, you can set that number, and that's the number, right. It's

Scott Benner 52:59
you can set. I mean, I think the low is there's a low number on all of them, like, you know, but they're much lower, like you can choose.

John 53:09
But I mean, like if you were if he was at 100, it won't lower her Bolus. Because, you know, if you said hey, I mean 40 carbs. And she would normally need, let's say, 5.3 units.

Scott Benner 53:23
And she was 100. No, it wouldn't change anything. I mean, unless it thought she was going to get low in the future. If it predicted that then it would but if it didn't predict, if it didn't predict a low, then it I mean, Arden's target, I think right now is 85 or 90. So,

John 53:39
so my settings right now just for whatever, like my lowest that at at my highest set at probably too high, because I have it at like 180 but it would be on off all the time until like, I kind of moved that I had it at like 160 for a long time. But I mean, right now I'm at my Basal is point nine, six an hour, My correction factors 148 or one to 48 my carb ratio is one to 15 and my target blood glucose level is 110. And if you click on that you want to change that it never allows you to change that below one time. Yeah, it just says when control IQ is set on your target, blood glucose is fixed at 110. In order to edit that you have to turn off control IQ. They don't want you to be below 110 I guess that's like, you know that doctors magic number, right? I feel great at 100. Like, that's where I feel the best. I don't get sick when I get high either. Some people do my cousin she gets really, you know, icky and gross feeling. She's above let's say, I think she when she gets above like 160 She gets pretty bad. And I'm probably wrong with that number but with me I can be at 220 and I wouldn't feel horrible at all.

Scott Benner 54:56
Do you what's your total daily insulin usually Like 30 Something units? Really? Yeah, let me see. That's total. That's Basal embolus.

John 55:07
Yeah. Are you low carb? No, no. I mean, well, that's cool. I don't know. Does that sound? No,

Scott Benner 55:15
I just do it. I mean, it doesn't. If your point nine, six an hour.

John 55:20
Let me see. So in the last, I can tell you this injury because that

Scott Benner 55:24
means because John 23 of your unit today is Basal. Yeah, you're only using seven units a day for meals

John 55:33
and your one to 15. Well, like so today, for example, my basil has been 7.5. And I only Bolus who for breakfast was like 4.38 units, or point three. And then Yes, yesterday I was at 32.99. And it's almost even yesterday. My Basal was 17.11 units by Bolus was

Scott Benner 55:59
15.8. But your agency is 6.55757 right now. Okay. Yeah. Geez. Listen to John. I. Oh, I don't know. We shouldn't be arguing. I think you're doing great. Yeah, but

John 56:15
yeah, I know. I mean, it's crazy. And then even on like on March 12. So what day was that? That was Tuesday, I had 18.75 units of basil. In my Bolus was 12.1 for the day. 12.1

Scott Benner 56:27
and your one unit for 15? Carbs? Yeah.

John 56:33
Okay. I'm not low carb. And trust me, I don't eat nearly as healthy as I should? or would like to, you

Scott Benner 56:41
know, I heard another doctor talk to you. I'm just teasing. Has your exercise or activity level gone down recently?

John 56:50
Um, would that mean that it would have had to have existed before

Scott Benner 56:55
I even at work? Were you like working on the road? Now you're working in an office or something like that? I've

John 57:00
always know. It's kind of steady, like, depending on how much I'm moving around and walking and Bunker Hill? Yeah,

Scott Benner 57:07
I mean, what are your spikes at meals? Like?

John 57:11
Oh, like so it depends on what I eat. And I probably could Pre-Bolus a

Scott Benner 57:15
lot sooner. That's where I was going with this, John. Yeah, okay. Yeah, no, I

John 57:20
know. And my whole thing is, I get I'm too afraid to Pre-Bolus. And I'll tell you why. So with my job, so I'm an electrical contractor. Okay. I run the business with my two partners. And we have a bunch of guys that work for us. So I don't have a lunchtime, or a break time in the morning. I have a where am I going? And can I swing into here and grab something, whether it's a sandwich or a hamburger or slice of pizza or whatever, whatever you're having?

Scott Benner 57:50
John, I can't get you to pack a meal. No, I know. No, no.

John 57:56
They probably would. Yeah. But so the Pre-Bolus is, if I was to Pre-Bolus, and I've done it, and then something happens, and I have to be somewhere and I didn't have a minute to stop and grab something. Yeah. Then there's an issue. So I tend to not Pre-Bolus As much as I should I try to do 10 to 15 minutes earlier if I can, but it always doesn't always work out. So so it depends on what I eat. Like let's say, let's say I had, I don't know. Like last night I had steak. And probably two cups worth of you know, potatoes. A mashed potato, John, not a mashed potato, just like a Yukon Gold cut up diced with oil. No oil. Good for you.

Scott Benner 58:43
Look at you, John. You're doing oil. Good.

John 58:45
Right. So so but then that if I didn't Bolus soon enough, that could put me up over. You know, one ad?

Scott Benner 58:54
Yeah, no, for sure. I think so. Listen, just Pre-Bolus your dinners at the very least. And yeah, consider packing a healthy lunch and having it with you. Sure. These two things change your life significantly, I think. Yeah. Yeah. Yes. I mean, listen, I also had pizza this week. So yeah.

John 59:15
I had pizza yesterday. So

Scott Benner 59:17
it was so good, too. I had it was sausage on it is like a very thin crust. If you don't live in the northeast, you don't know. But it's amazing. Yeah. Anyway, I mean, listen, I'm not telling you what to do. You're certainly doing a great job. I'm just saying if we're going to talk about these things, these are the little fixes. I always think about if anybody's heard the episode with Jenny, where I asked her, like, hey, when you go on a road trip, like, you know, how do you eat on a long like, say your family who's gonna drive eight hours like how do you eat and she's like, why pack food and bring it with us? I'm like, you don't just pull over on the side of the road and grabs on. She was like, oh, no, I would never do that.

John 59:52
And I was like, oh, but she's different. She's very like, good. Like, she's, she's a healthy eater. She's I'm not that guy. Yeah.

Scott Benner 1:00:02
No forget no for sure. Um, like you've never gotten like a candy bar in a gas station. She was like what? Oh,

John 1:00:09
yeah. My favorite part of

Scott Benner 1:00:11
a road trip is getting a Three Musketeers bar and a gas station. Well, that's

John 1:00:15
the thing like yesterday, I had pizza. Well, there's one Papa Geno's, in my state. Okay, and I don't know if you guys had Papa Geno's, where you are? I

Scott Benner 1:00:24
don't know it. But it sounds like something that when you're near it, you get it because you love it. And it's infrequent. They

John 1:00:29
used to be everywhere now. Okay. Okay. I mean, I live in Connecticut. I don't care if anybody knows where that is. But, but they were everywhere in Connecticut through the 80s. You know, all the way growing up as a kid through the 90s in high school like it was there. Yeah. Then all of a sudden, all but one closed. And, you know, so anytime I have a chance to get to that part of the state, and I haven't something to go look at it a job. I'm stopping there. And I'm having pizza. I

Scott Benner 1:00:56
understand. I was just in Connecticut. Last weekend. I did a speaking thing there. Oh, you did? I was in Stanford. Maybe?

John 1:01:02
Oh, Stanford. That's just about New York. That's far from me. That's that's like, with crazy with traffic. Yeah. I've

Scott Benner 1:01:09
also been to Connecticut one other time. And as soon as I got off the train, they were like, let me get you some pizza. And then they brought me to pizza. That doesn't look like the pizza I eat. And it was good. Yeah. Where were you in New Haven? I want to say maybe that's right, because I got off the train. Yeah, you probably were in New Haven, or Yeah. took me to this little hole in the wall and the Pete I remember the pizza being square was good.

John 1:01:32
Oh, yeah. So that was more of a deep dish probably Haven style. And I mean, we have good pizza. So But see, that's where I'm very fortunate like pizza for some people. If I know a couple of people, they have one slice of pizza. Boom. 300 days over. I can eat if I Bolus for it. I can eat four or five slices of pizza. And it's fine. Yeah.

Scott Benner 1:01:55
Part of me thinks you must have really good digestion. Do you have a Can I ask an uncomfortable question? Are you very regular, take what you would consider to be a lovely crap that you'd be happy to share with other people because of how lovely I would tell you.

John 1:02:07
If you asked my wife. There's always a bathroom emergency in our house. Like I'm always like, Oh, no, gotta go. So it's

Scott Benner 1:02:16
not it's not a beautiful process. You're sometimes you're like, I gotta go. This is like an emergency.

John 1:02:21
Right? Right now, like, we're in a store. She's like, and I'm like, she's like, again, like, Hey, I don't know what to tell you. My doctor always told me that. You know, I have a digestive system of like, a three month old baby. Whatever it goes in. You gotta make room for it. And it comes right back out. Like, I'm more or less rent my food. I don't really

Scott Benner 1:02:41
I mean, it's such a weird question. I don't know how to like, I don't know how to use. I don't know what words are right. Okay. Are we talking about like a, a properly firm?

John 1:02:52
Oh, yeah. It's not like it's not running. I mean,

Scott Benner 1:02:56
yes. Okay. Okay. But that is what I want to ask. I have, by the way, the crazy thing is that in an hour, I'm recording with a gut health specialist. Oh, okay. And so I was very, I very much think that people need this conversation, right? And so like, but how do you make it conversational, so that they can understand what's happening. So I said to the guy, I'm like, you know, I'll tell you what, you come on and talk to me, and help me and then you give me stuff to do. And then you can come back on and we'll talk about it again. And if it helps me, then I'll be comfortable telling other people about it. Right? Sure. And but now, I realize as this day approaches, all I can think about is I'm gonna have to discuss my bowel movements with this guy. And like, all this stuff that I'm like, Oh, why did I agree to this?

John 1:03:41
That is one thing that are somehow at our house. And I don't know why I've made because it's funny. It always leads to, we'll call it potty talk. Like, somehow Christmas dinner will lead to the other day. And it's funny, it's just the vagina. My God,

Scott Benner 1:04:00
can I call this one potty talk? Probably almost.

John 1:04:05
There you go, John.

Scott Benner 1:04:06
You feel like you have good digestion there. Your stomach doesn't hurt effete.

John 1:04:09
Nope, nope. I don't feel that I have any of those other like, just Yeah, sure. Yeah, whatever that other people tend to have. So that's good. But

Scott Benner 1:04:18
you what you're saying is you you offload when you unload? That's correct. Gotcha. All right. Here's my last question. I'm gonna let you go. Okay. I got a guy out of the house because I got some lights outside my house and they stopped work. Yep. And they're, they're these terrible like, you know, the lights that you think are a good idea. Like it gets sun it gets dusk and they come on and the sun comes up and they go fix it. They never fret and work for a long, you know, so I haven't come out of replacement like just put some regular lights on a Switch comes out. He does it works great. Three weeks later, doesn't work anymore. Okay. It's not the circuit breaker. It's not I changed the switch. It's not the switch. Like, I have no idea where to look and I've had a falling out with the person and I can't have them back. Okay. And by the way, I'll never be able to explain. I'm

John 1:05:09
going to ask you a dumb question. Go ahead. And it's not did you turn it off and turn it back on? Again? I'm not the cable company. What kind of a fixture did he put out there?

Scott Benner 1:05:18
I mean, there were put on a number of places on the house, they work everywhere else. It's just these three that are connected don't work all at the same time. It's just it's just the like, it's a ground. Yeah, yeah. Well, they're, they're just like, not not a flood. They're what you might consider, like something you'd see on the other side of her front door or something like

John 1:05:37
that. Okay, so a wall sconce?

Scott Benner 1:05:40
Yeah. Simple. Simple one bulb?

John 1:05:42
Are they led?

Scott Benner 1:05:45
No, they're screw in bulbs. Right. But

John 1:05:47
are they a screw in LED?

Scott Benner 1:05:49
I'd have to look.

John 1:05:51
Because I mean, anything can happen. But are those the only three controlled by that switch? Yes. So it's either the first one in the line? Because they would have had, you know, it's all daisy chained together. Right? Usually, odds are he didn't run three separate lines out there. It's all Daisy. Yeah, so odds are behind one of those fixtures, you could have a loose place. You could have, it could be a whole number of things. So depending on how handy you are, there's a lot of things you can check. You can check right, right in the light itself. You can carefully if you have if you have the prop, if you have a tester a meter, you can go in the light socket, touch the center pin and touch the outside and CPU voltage. There's a bunch of things you can do. Oh, okay, you could definitely call me on another day. And I could walk you through it. I

Scott Benner 1:06:42
need to figure it out. I just I, I'm not usually like a, we were having another thing. Like we had to have an outlet put in outside. Sure. And so I said, Hey, while you're out there, like let's replace these sconces. They suck. You know what I mean? Yeah. And he's like, okay, great. And then boom. Alright, so I'm looking for I'm looking for a loose wire, basically,

John 1:07:02
I would start with check for, first of all, very simple. Take the light bulb out, put it in a known area, that lamp and your house, make sure that doesn't work. Okay, if the light bulb works, then you know, that's not your issue, right? Then you have to check and see, do I have power. So go to the go to the fixture that's closest to the switch. Pull that off. And you can have some, you know, put a tester on it between the black and the white. And that's the important part, don't go to the bare copper wire. Because if one of your blood if your white wire is broken, or not made up good and not a good splice, you'll end up with an issue there too. And if you went from black to ground, you'd be like, Well, I have power. Well, you do. But you don't have a neutral.

Scott Benner 1:07:48
I have to tell you, I know that electricity is a simple concept. But anytime in my life, it's been explained to me. I don't follow it at all.

John 1:07:55
It is it isn't it isn't? I mean, think about it. This is the job that you can do, that I've been doing for about 25 years. I started while I was in high school. And one guy said to me once, why would you want to work with something that you can't see smell? Or feel that will kill you? Every day? Right, so

Scott Benner 1:08:19
Melania insulin, right? Oh, my God. All right, John, I appreciate you coming on sharing your story with me. I really do. This is fantastic. Yeah,

John 1:08:29
no, I, this has been kind of, I don't know, I should say I'm geeking out about this right now. But I it's been such a such an, you know, well, I don't want to say an honor. But kind of exciting for me for for you know, the time that I've when you reach out and hey, you want to be on the show till now. I almost couldn't wait for it. And then all of a sudden I

Scott Benner 1:08:53
don't know why you can't say it was an honor. But okay. Well,

John 1:08:56
I don't want to you know,

Scott Benner 1:08:58
I know it's just like, I was just teasing you. I don't I don't think it's an honor to be Oh, my God, unless, you know, you're at Yeah, at a story to a more to a larger quilt of information and conversations. And I think it's really important. So yeah, I appreciate you taking the time to do it very much.

John 1:09:18
No, thank you.

Scott Benner 1:09:19
I don't know if I'm calling this one loose wire or potty talk. But I want to remind people not to take John's electric advice because you end up dead I don't want to hear about it. That's right. Yeah, that's that should be a disclaimer. Nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise. I feel like it's covered anywhere you go. And I can't wait to dig into more about statins too. I'm glad you brought it up Jenny. I brought up the Jenny recently I don't know if the episodes out yet. But she kind of said like, don't get me started on that. And then she got started a little bit. So was national

John 1:09:52
funny thing too is these drugs that that people are all prescribed? I mean, my doctor, right? I've explained I love She's great. She won't take me off Metformin,

Scott Benner 1:10:02
when he just stopped taking it, although maybe it's helping you, she said that

John 1:10:07
there is because I said, Look, you know, I'm taking this medications and I take like seven pills a day. Okay? All kinds of stuff from, you know, whatever. Stuff that I don't even need to talk about more personal items too, but, but it's like, it's a lot of it has to do with diabetes. And I'm like, alright, but I'm also taking Metformin, which is a type two diabetic thing, and can we get rid of this? And she goes, Well, to be honest, the negative impact or she she's what she said was the positive impact far outweighs any negatives of you taking that medication. Well, she

Scott Benner 1:10:43
might like it for other reasons. Hey, listen, Metformin therapy may reduce the high risk of cardiovascular events and pre DM patients by reducing coronary a deal with Fikile iron dysfunction. Yeah, what uh, but I've heard over and over again, listen, there's a lot of bro science guys that take Metformin because they think it's a pill that helps you with longevity.

John 1:11:03
Yeah, weight loss, I think too, right? Yeah, it

Scott Benner 1:11:06
helps also a little bit. I don't want to say your for your weight. I was surprised about your totally total daily insulin. So maybe the Metformin is really helping you.

John 1:11:15
And it might Yeah, I don't I let's be honest, I I did lie a little bit when I said I take all my prescriptions where I'm supposed to, but the Metformin is the one that I always forget because that alone, that twice a day, I'm supposed to take it in that's an at night all by itself one and I always forget the nighttime

Scott Benner 1:11:36
really cracked me up. I don't know why. All right. Take your pills and find out what your TSH is to make sure you're medicating yourself properly. We'll do all right, man. Have a great day. Hold on for me. Thanks, Scott. My pleasure. Bye.

Jalen 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 us med for sponsoring this episode of The Juicebox Podcast. Don't forget us med.com/juice box this is where we get our diabetes supplies from you can as well use the link or call 888-721-1514 Use the link or call the number get your free benefits check so that you can start getting your diabetes supplies the way we do from us med. A huge thank you to one of today's sponsors, G voc glucagon, find out more about Chivo Capo pen at G Vogue glucagon.com forward slash juicebox. you spell that GVOKEGLUC AG o n.com. Forward slash juice box. Don't forget to check out juice cruise 2025 at juicebox podcast.com. Just scroll down a little bit. Click on that and choose Cruz logo. And you're going to find everything you need. Spaces are limited. I'm not trying to pressure you honestly you could. I hope you come but if you don't I understand but space is limited. Make sure you check it out right now. 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

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