#1565 The Great Taboo

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Noor’s sudden DKA diagnosis sparks battle to survive, learn carb counting, and embrace tech while raising two young kids.

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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
Welcome back friends to another episode of The Juicebox Podcast.

Noor 0:14
So hi, my name is Noor, and I have been a type one diabetic for a year and four months. Now, if

Scott Benner 0:23
this is your first time listening to the Juicebox Podcast and you'd like to hear more, download Apple podcasts or Spotify, really, any audio app at all, look for the Juicebox Podcast and follow or subscribe. We put out new content every day that you'll enjoy. Want to learn more about your diabetes management, go to Juicebox podcast.com up in the menu and look for bold Beginnings The Diabetes Pro Tip series and much more. This podcast is full of collections and series of information that will help you to live better with insulin. Nothing you hear on the Juicebox Podcast should be considered advice medical or otherwise, always consult a physician before making any changes to your healthcare plan or becoming bold with insulin.

Today's episode is sponsored by the tandem mobi system with control iq plus technology, if you're looking for the only system with auto Bolus, multiple wear options and full control from your personal iPhone, you're looking for tandems, newest pump and algorithm. Use my link to support the podcast, tandem diabetes.com/juicebox, check it out. This episode of The Juicebox Podcast is sponsored by us. Med, US med.com/juicebox, or call 888-721-1514, get your supplies the same way we do from us. Med,

Noor 1:52
so hi, my name is Noor, and I have been type one diabetic for a year and four months now.

Scott Benner 1:59
Wow. Very recently, how old are you? I'm 34 Oh, so you were just diagnosed. What like end of your 32nd year? Yeah,

Noor 2:10
like January 15 of last

Scott Benner 2:14
year. No kidding. Oh, wow, yeah. How did you make it to me so quickly? I

Noor 2:18
was just searching on YouTube about like, tandem Moby and OmniPods, when I was just, like, diagnosed, checking, like, all the pumps out there, and I found your podcast on YouTube, and I found out, like, there is a Facebook group, so I'm like, I'm on it right away, so learning and giving like advices for people when they need, like, adhesive, or like over patch or Things like that.

Scott Benner 2:41
Just most of the things that come up in the beginning that you're just like, I would have no way to know about any of

Noor 2:46
this. Yeah, yeah, true. Oh my goodness. If, if I tell you what, I hate the ideas I had about, like, T, 1d, when I first was getting diagnosed, you will laugh.

Scott Benner 2:55
Well, let's laugh. So first, let's figure out how you found out you had type one. And then we'll, we'll figure out some of the things. She

Noor 3:01
thought, Okay, so my sister was preparing her wedding, and my parents came over. We were just like, happy to prepare for the wedding and everything. And it happened on November. After November, I started feeling like, really tired. I go drive my kid to school, and I can't remember that I drove her, and I would sleep. And then my mom, after my sister's wedding, she went, and she was sleeping over my sister's house for 88 days before Christmas of last year. So I'm like, I called my mom and I told her, like, I'm not feeling good, and I wish you didn't leave to my sister's house. And I'm I'm just like, not myself, and I want to sleep for a year. So my mom was like, No, don't worry. You're good. Maybe you're just, like, really tired, or you got used that I'm there, like, helping you with the kids, and now you're sitting with the kids by yourself. I'm like, okay, whatever. So one of the days I was getting, like, really sick. I don't like sweets, and I would want to eat sweets, and after I eat sweets, I throw up. And I was just, basically just sleeping in. No one can wake me up. And my mom would every time come and just check on me if I'm breathing or not. I would just, like, forget things if I'm awake. I can't take my shower by myself. I can't even, like, use my legs properly to walk. I would go and pick up my daughter from school with my pajama in my school slipper, sorry, my house slippers, just because I can't, like, lift my legs to put it on the like, winter boots. To that point, how

Scott Benner 4:32
long did this go on for? One month and a half now, looking back, if you were in the mind you're in now, how long would you have let it go on for?

Noor 4:41
Oh, no, right away I would know, like there's something wrong with me. So there's part

Scott Benner 4:45
of what's happening to you that stops you from assessing what's happening to you. Yeah,

Noor 4:49
and I had a problem too. I was losing a lot of weight, and this is indicate that you have T 1d but the problem is, before I was diagnosed with T 1d I had. And sleeve surgery, which means I was not that fat, but I didn't like the way I look, and I was not feeling happy about the way I look after having like, two kids and going to the gym, I'm not losing weight or whatever. So I told my husband, like, see, I'm I'm not in the mood to go buy like, X large clothes or large clothes, and I'm not happy with the way I look. So don't tell me to go out. Because every time he tells me, let's take the kids and go out somewhere, I would cry. So he's like, Okay, let's do the sleeve surgery and check how much is it, and we can do it if this is what will make you feel happy about yourself. Okay,

Scott Benner 5:33
so you got that gastric sleeve? Yes, how long before this whole time of being diagnosed with type one? Did you seven months? And had you been losing weight from the surgery?

Noor 5:43
Yeah, I was losing weight, and I reached target goal of my weight, and after that, I was just going down very fast. I'm from the Middle East, so we do it with kilos. I'm not like good in calculating it with like pounds, but I reached from 60 kilos, which is around like 160 pounds, I think, to 46 kilos in that seven month period. No, in the one month and a half, oh, oh my gosh.

Scott Benner 6:13
Oh, so you had lost some already and been happy with your weight loss exactly then this larger piece happens in just those four weeks. Yeah, did you think, oh gosh, the surgery is still working too well now? Or what did you think when you were thinking about your weight?

Noor 6:28
My mom was accusing me that I'm not eating at all, just to because some people, when they do the sleeve surgery, they think like, I'm gonna starve myself. I'm not gonna eat so they are scared to gain weight. And all what they did and went through was for nothing I see. So basically, this is my was not my point. I tell my mom, like, I have been eating like a cow and drinking water like a cow since I'm just like, feeling like, you know the like, the dka in the beginning, yeah, I'm like, I'm eating and I'm drinking more than I did just like, few weeks ago. And I don't know where the food is going. Why I'm not gaining weight. I'm losing weight,

Scott Benner 7:03
eating and drinking more, losing more weight than when previous Yeah, your mom is older or

Noor 7:09
no. She was born in the 6519 65

Scott Benner 7:13
Oh, okay. Well, she's what, yeah, she's in her late 50s. Then, yeah, okay, so she's not that. I was kind of wondering if maybe you were a late in life baby, and she was just kind of gotten past the point where she could work through this problem, and just was, yeah, but that doesn't seem like that's the case

Noor 7:28
either. No, I'm the oldest, actually, and we are only two, my sister and I, and my sister is younger than me, with only like, three and a half or four years so I'm the oldest, actually. And she got me when she was really young, which is around like, 2122 years old, something like something like that.

Scott Benner 7:43
Is there any illness in your family, generally speaking, like reasons why people would be paying attention and know what to look for in these situations?

Noor 7:50
No. What I know of growing up that my grandmother had type two diabetes, and she was doing good with the medication, but she came to a point in life that she had dementia, and she started forgetting so many things, and she drinks a lot of coke and a lot of chips and all these carbohydrates, and it turned with her to be type one.

Scott Benner 8:12
Oh, eventually her type she had type two for a while, but then they gave her a type one diagnosis.

Noor 8:16
Yes. They gave her type one diagnosis when she started like to lose her Pinker, yes, and she forgets to take her medication. And it was like, at the end of her, of her living years, you know, I remember my mom and her sisters were just like, taking care of my my grandmother. She was not talking. She can't remember who are they. They were trying to figure out, like, how to give her insulin, where to buy insulin. And it was just like, hard to

Scott Benner 8:39
deal with it before she died. Yeah, gosh. How old was she when she passed? You know,

Noor 8:43
around, I think 70s or 75 I can't remember so and she was diagnosed when she was around 60s. So she stayed type two for a long time, and then it started to be type one when she was just like out of the world. She can't remember who is she, or who are they, or whatever.

Scott Benner 9:00
How about other autoimmune issues like thyroid or celiac? Nothing, nothing,

Noor 9:06
nothing, nothing in my family. And surprisingly, I'm the only one also who has a kid with Down Syndrome and no genetic

Scott Benner 9:13
problems in the entire families. You have? How many children do you have? I

Noor 9:17
have two. I have Milia. She's turning eight in September, and I have Adam, my sweet angel, who's turning four next month,

Scott Benner 9:25
okay? And Adam has Down syndrome, Down syndrome, okay, all right, how about on your husband's side? Is there anything going on over there? Nothing

Noor 9:33
at all, just his dad in the past years, because of he was like a heavy smoker, he had the problem with her heart, and that's it.

Scott Benner 9:42
Okay, all right. So how did they get you to the hospital going back to your diagnosis?

Noor 9:46
So my insurance was very bad at that time, so I had to go back to the doctor who did the surgery for me, and I told him, like, what's wrong with me? He's like, I don't know. Like, the surgery is fine. I'm like, I'm eating and. Drinking. I drink like half of the bottle of the water, and when you are having the sleeve, you can just eat, like, you can drink like two sips, and you have to wait because your stomach can't take more sips of water. And he's like, are you serious? I'm like, yeah. He's like, show me. So I hold the bottle of water. And I'm like, he didn't believe it. So he's like, come with me to the X ray room. And he did, like, an x ray on my ultrasound, or X ray, I don't know how they call it, but just to see my stomach and all the stitches and all the rings he put, like around, like the things that he closed my stomach with, he's like, everything in its place, no leakage. So what's going on? I'm like, I don't know. So I used to go to him every Thursday he puts for me, like, banana drip in other like drips and stuff, I would feel good, but I feel so dizzy after that. So after doing that for three weeks, I think or two weeks, he told me, let's do blood work. He did for me some blood blood work. And he accused all the nurses there that I was taking the drips, the IVs, and they took from me the blood so all my numbers are just, like, very confusing to him. It's like the person who did 17 months ago the blood work is not the same person that's standing in front of me. So I'm like, What's going on with it? Why you're screaming at that? It's okay, be kinder. He's like, no, no, no, they did something wrong. Your blood sugar is very high, your sodium chloride, and all these things are really low. There's like, no, they messed it up. So come next week, let's do it again.

Scott Benner 11:25
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Noor 13:59
Yeah, because I nothing is indicated that I am team. Like he didn't believe it. Like, until now, when I go see him, he still can't be, like, he's not digesting the idea that I'm T 1d until now, wow. So I went home and my mom said, like, what were the numbers that he was screaming about? And he doesn't didn't like it, and he accused the nurses and stuff. So I told her my blood sugar was he's saying my blood sugar was very high, like around 500 in my chloride, in my sodium, and everything was just like messed up, like he said, like you're not the same person that I did the tests for seven months ago. My mom looked at me with a look in her face, like her face turned white. She started sweating around, like, her mouth and her like, front head. And she's like, Noor, I want you to buy the blood meter. I'm like, what's that like, the one that he used to use for my grandmother to know her blood numbers. He's like, Yeah. I said, okay, it was a weekend. So I order it from Amazon. She didn't make it. Like, it's a very big. Deal that I need to go and buy it, like now from CVS or something. I order it and it came on the Monday that was, like a link clean birthday or like it was, it was like a vacation in the US. I can't remember. What was it, January 15, 2004 14. Sorry, 2024 so I got it, and she's like, let me do it for you. I was not knowing. What is that? I didn't know the terms for, like, a strip, the needles, the length, like, what are these? I have no idea. So she did it for me, and she's like, but you just ate, so it's okay if the number is a little bit high. I'm like, I don't know. It's okay. So she did it for me, and I was like, 580 and she looked like she looked with a very scary face again, and she's like, she's just looking, you know, and she's not talking or anything. I'm like, whatever I was saying is, am I gonna die? Am I gonna die? Just let me know, am I gonna die? Because the past one month and a half, I was feeling I'm dying slowly, like life is torturing me. They are taking my soul out of me, like, very slowly. So she's like, No, but you're diabetic. My mom even didn't know, like, if it's type one or type two, you know, she's like, You have to go right now to the to the emergency room. So I called also my doctor, again, the sleeve surgery doctor, because he's the only doctor figure in my life at that point. And I told him this and this happened, he was not believing. He's like, how did you know I'm like, from the mirror that you put strips and blood in? He's like, You sure? Okay, meet me at this hospital. So I went, and my mom told me, when you go there, if they tell you they want to give you insulin, no, take pills, because this will mess up with with your pancreas. I'm like, okay, mom, okay. Called my husband. I'm like, I'm diabetic. Take me to the hospital. He's like, what? I'm like, diabetic. Take me to the hospital. He's like, no, no, no, there is nothing wrong about you. Let's go to the hospital and we check. This is how my story started. I was a 1c

Scott Benner 16:49
12, right? Now I'm interested. So your husband doesn't want this to be true, and your mom thinks that if you take insulin, it'll make things worse. Yeah, yeah, okay. He took you to the hospital. What did you find out? Yeah,

Noor 17:01
my aunt also was here from we are originally from Egypt, so she was here visiting to attend the wedding as well. So she went with me, went to the ER, and I told them, like, just letting you know, I'm not gonna take insulin. I just want you to run for me a 1c and stuff. And the doctor of the ER was smirking at me. I'm like, he's like, um, what did you say you're diabetic? I'm like, Yeah, how did you know is any doctor told you so? I'm like, No, my mom told me. The meter at home told me, you know, like, I was still not I didn't even know what a type one diabetic person is. In English, I had to google it before I go to

Scott Benner 17:36
the hospital. Okay, just to see you could say something when

Noor 17:39
you got a 1c I didn't know what's a 1c we have another term for it in Arabic. So I had to call one of our friends who works in hospitals, in in blood work and stuff, and he told me it's a 1c so I had to know my terms before I go and just like, talk to the ER, you know, so the doctor said, like, oh, so your mom told you. And he was smirking at me, and I was standing and I'm telling him like I have been dying, and he's not believing that I'm still standing on my legs. And I'm talking to him that way, and I just telling him, you have to do to me. 1234, yeah, as if I'm giving him orders. Yes, exactly. I'm giving him orders.

Scott Benner 18:13
Your mom, by the way, who did what? Professionally,

Noor 18:16
no, nothing. She was yeah, like, nothing. Medically, actually, she we lived in Kuwait for around, like 20 years before she moved back Egypt, and I moved to the US, and she was sales manager at Kia Motors, and she was like a sales person as

Scott Benner 18:33
well, so everything she knew about diabetes was from the last 10 years of her mother's life.

Noor 18:38
Yeah, actually not 10 years. It's the last like, three years or something with my grandmother. Yeah. Okay, so I went the doctor was smirking at me. He's like, You know what? Sit down. We are gonna do some blood work and we are gonna take care of you, don't worry. And he's just laughing and being very chill. And I'm very, like, being very mad at him. They did and everything they said. He said, like, go outside, go talk to the person on the reception. He she's gonna take some intake and stuff. I'm like, okay, so I went, I told her I'm not gonna take insulin, please. I'm not gonna sign any paper that says I'm gonna take insulin. I'm gonna take only pills. And I'm not gonna do this. I'm not gonna do that. And she's like, but if you are in a late stage in your diabetes, you will take you you will have take insulin. I'm like, no. My mom said, No, I'm not gonna take so my husband was like, let them do whatever they are doing. And just like, shut your mouth.

Scott Benner 19:26
Yeah. Your mom's like, Listen. Your husband's like, I don't listen to your mom at all. I don't think we should be listening to her right

Noor 19:33
now. And my mom just like, when my mom say something or my sister to me, like, you know, go right. I go right, go left, I go left, because they are like, I believe them. I trust them, you know. So. So anyways, they took me back, and the doctor was like, we did your blood work in your blood sugar level is over 700 let me go back a bit sure I was telling him, they kept me on the whole and the whole way of the hospital, and they put for me the IV. And I was very hungry. He was dying. So I told the doctor, Ken, my husband, buy for me. Like, Uber Eats and just like, deliver it for me. Here, he's, like, he bent down on his knees on the floor, as if, like, he's gonna say, Would you marry me? And he said, Ma'am, your levels are 700 and plus your a 1c we can't do here, because you have to be in the fancy ICU. So they are gonna take you in a very private, nice room with private toilets upstairs. And they can, they are gonna run for you. The A 1c, is there. You are not gonna be eating for the first three days, and you're gonna stay here with us for for few days, right? So no no eating. You can't eat. So you're

Scott Benner 20:39
definitely not getting Uber Eats. Just put that out of your head.

Noor 20:43
So what I told my husband is, he's not allowing me to eat. And he said, You're not gonna eat for two days or three days. He's like, why? He said, I told him, like, they're taking me to the ICU. I didn't know what I see. I was not there. I had, seriously, I had black holes over this, like, this period. This is only what I remember from the one month and a half, you know,

Scott Benner 21:01
no, I believe, especially with your, I mean, your blood sugar had been very high for like, a significant amount of time, yeah, that's true. Yeah, that's true. I don't imagine that you're gonna make a lot of good decisions during that time.

Noor 21:14
Yeah, yeah, that's interesting. I just felt so sad that I was not gonna buy, like, Uber Eats and eat because I was so hungry. So my husband is like, are you gonna sleep over the hospital? I'm like, yeah, he said that he's gonna take me to a private room with a private bathroom. He's like, nor can I come in like, my husband was so worried that I'm taking decisions in not knowing what they are saying, you know? So anyways, they took me to the ER waiting list of the ICU, and they started doing like, a lot of blood work and a lot of information they needed from me, and they couldn't find any like, good veins in me just to take like blood work. It was just a disaster in the beginning, until they took me to the ICU. I was in the ICU for five days, I think, and all the doctors came in the next day and they said you're type one diabetic. So I was standing there with my husband, and husband was like, what? My gosh, yeah, so I'm like, how he's they are, like, they also didn't have the full information of, like, how an adult in this age would have type one diabetes, and they don't have anyone in their family except the example of my grandmother. So they're like, We are running a lot of tests, and we have one of the doctors said, like, you are one of the few patients, or maybe the first patients to put a lot of resources and a lot of exams on her, like blood work that's traveling like this estate or this here, or that, or whatever, and just trying to figure out why you have type one diabetes. Am I gonna take, like, medication or take insulin? Insulin like injection? They're like, No. Definitely are gonna live on injections. Okay. I'm like, okay, so I just, like, had it as if, like, someone slapped me on the face. I was okay. I was not crying, nothing. My husband was the one who was crying. Because, of course, like, you know when, when a person just feeling vulnerable at that time? He was like, sure, like, God sent us Adam and and we didn't know how to do it, and you're the only one who knows how to do it, and doing it all by yourself, and now you have diabetes in like, I don't know why, why God is doing that to us. I'm like, the problem is not why. The problem is how. Now it's how. And I didn't know anything about T 1d at that time, so yeah, your

Scott Benner 23:27
husband was more focused on, how did this happen to us? Yeah, and you were more focused on, how are we going to manage all this? And what the hell does this even mean, any of it? Yeah, because it's not a thing you understand at that point like you're literally calling people and saying, Hey, what's the translation for this? I have to go to the hospital. Yeah, true, right, right. Wow. Did he come around, or did he stay in that space?

Noor 23:51
No, my husband would act like he came around, but it's gonna come out eventually that he's not feeling okay with it. So he was okay with it, until I would be like, really sick, or my blood sugar is really down, and I can't, like, reach to the to anywhere, because, especially in the beginning, I came out of the hospital on a walker because I couldn't walk. And I didn't know that when I was there until I left the ICU bed, and when I came on a walker, he was feeling sad that me, the strong person, the mountain of the house, that nothing would blow it away, is not knowing how to walk, and she's learning how to walk again, and she can take showers by herself. She's waiting for for me to come home, or her sister to come like from one hour and a half drive just to take to give her a shower, so he felt sorry for me, and he doesn't want to show that I'm he's feeling pity on me, you know.

Scott Benner 24:47
Okay, no, I understand. Yeah, I do. I mean, how long were you in the hospital for a week? Yeah, like five, six days, as I remember, and then you get home, you're pretty out of it for a while. Yeah, I was

Noor 24:58
still can't walk my leg. Were not strong enough diabetes eventually, like, ate a lot of muscles around my house, my around my body.

Scott Benner 25:06
What did they tell you about the the extent of your diagnosis? Like, were you obviously, you were in DKA, but did they tell you things like, wow, you're you were close to being in a coma. This was close to death. Like, what was the feeling for how far along this all was

Noor 25:21
no, they told me, We The a, 1c, can't indicate if you were, like, having these numbers for three months or not, but we are so sure it's for the past month. And they said, Thank God, you came on the right time, because I was on the last bit of symptoms before. And actually they told me, like, when I was sleeping and I couldn't wake up at all, I was going into high comas, and thank God, I was waking up from it. Oh my gosh, yeah, because I remember one of the times that my mom was sleeping over at my sister's house. They called me from my daughter's schools that my school that I am late to pick her up one hour, and they have been trying to reach me, and they couldn't reach me, and I woke up, went to pick her up, and I came back home, and actually, my my son was home in his crib sleeping, and I forgot all about him. Yeah, you

Scott Benner 26:10
were just out. You were completely just Yeah, wasted, yeah.

Noor 26:12
So this is what scared me, bad, of course, like, I don't know what's happening. Maybe the surgery was a bad idea. Or, like, I'm dying because of the surgery. Or, you know, like, I all, we all blame it on the surgery. Yeah, there's so many

Scott Benner 26:23
possibilities happening in time. You have no idea what's going on. You're just trying to sleep and just and try. You feel like, Oh, I'll sleep and I'll feel better. Yeah, exactly. And your husband, he's having that thought. I mean, I heard earlier your mom was, you know, saying like, Oh, you just need to get rested, and things like that. So, wow. Well, it's lucky you, you know, I guess it's lucky your mom knew exactly, yeah, it really is, what, where is the hospital? Like, what state

Noor 26:48
we are in, California, Orange County,

Scott Benner 26:51
okay, all right. And okay. And they were still confused by it like that too.

Noor 26:55
Actually, what happened is, when they were trying to dismiss me, they got this nutritionist to tell me how to eat, you know, like, this is your plate. Half is this? Quarter is this? The other quarter is that? I'm like, I have this leaf surgery, so I can't eat that much. I have to eat only, like, two, three bites, and I have to survive with diabetes. So how to do that? Yeah, they would look at me confused, and that's why they all told me my case is complicated, even the first endo I saw, Wow. So I was all by myself, yeah,

Scott Benner 27:27
no, no. I was gonna say, like, you know you're in DKA and you're on your way dying because you have type one that's undiagnosed, and they're busy telling you about the food pyramid. Oh yeah, you're in trouble.

Noor 27:37
Exactly, exactly. Wow. And they made me starve, actually. And of course, you will have like, other complications during the process, because they put me a lot of insulin. And then I remember one of the amazing nurses I dealt with, he came in and he's like, wake up, wake up. Your blood pressure is going down. Everything else is going down. I want to make sure that you're alive. So I had one of my best friends died many years ago because her blood sugar went down, they were trying to put it up, up high, her potassium, magnesium, all that went down. Both of them went down, and then she died. I lost her. Jeez. So of course, I asked him, am I dying? Am I dying? He's like, if you were not here in the ICU, probably you would. So I'm like, Okay, are you gonna take care of me? I'm so sorry. I can't remember his name, but he was the best person that he sat with me at night and he would talk to me, of course, I couldn't move, so I would ask him to help me, like, sorry to mention that, but to pee while I'm sleeping there, and it was so embarrassing. But you know, you have to do what you have to do.

Scott Benner 28:34
Yeah, you just couldn't. You couldn't. You were really, I mean, we got to figure out how much weight you lost. So hold on one second. I'll okay. So you were at 160 kilo. What were you at? No, 6060, kilos. 60 kilos. To how many? 4046, how tall are you? I am five five. Okay, so you lost your five five. You lost like 30 pounds in a month? Yes, jeez, they're a little more than a little more than 30 pounds in a month. On on a five, five frame, and you didn't have, what were you before the surgery? I was like

Noor 29:11
85 kilos. I think, okay,

Scott Benner 29:17
so in seven months, you went from 187 pounds down to 130 pounds. So you lost, like, you lost like 55 pounds, just a pretty significant amount of weight, and then especially on your frame. And then, yeah, even 30 more. So you were down 85 pounds. Yeah. I know. Excuse me, 85 kilos. Yeah. Basically, yeah, yeah. Well, that's insane, yeah. I mean, you lost 80, I'm not wrong, like 8586 pounds in in seven or eight months, yeah, oh, geez. And the doctor's trying to, I'm right, right. He's giving you IVs to try to bring your nutrition up. That was his concern.

Noor 29:59
Yeah. Yeah, like they are giving me IVs because they kept me with no food for three days. So they were trying to, I can't really remember what they were trying, but I remember that this point I was gonna die. And the nurse himself came in just to make sure that I'm awake, because my my blood pressure and my heartbeats were like fading away, something like that. He says I would what I would remember in and I was feeling so lonely, of course, just like doing nothing, sleeping and waking up. So he would sit with me and talk and stuff. And for them to I had, like, around four IVs in my two hands, and one of them are getting blocked in blood out or whatever. So they were trying to figure out, like a spot in my body to give me IVs from and they take, like, blood work every, like, two hours, and, oh my goodness, my hands were abused to the point like they were taking blood from my, like, between my knuckles.

Scott Benner 30:50
Oh my gosh. Oh yeah. Listen, and I know you're out of it. Like, I know you're beat up, and you've this crazy weight loss. Nutrition is a problem. You're in. DK, the whole thing, like, I understand why you don't, but like, Does no one else stand up? Like, I don't mean this is an attack on your family. I'm trying to understand big picture. Like, for all of us, not just you, you're in the middle like you're dying, you're dying, and no one's noticing beyond, well, we'll ask the doctor, and then the doctor says something, and it doesn't stop you from dying. But nobody throws up a hand and says, Well, we have to do something else, because whatever the doctor's saying is not helpful. Like, I'm very fascinated by that part of all of our stories, of the point where something egregious is happening, it's obvious, and yet we don't push past whatever advice we end up getting from a doctor. Like, you don't. I mean, by that, like, it's yeah, I get you, yeah. It's like you're drowning, and I'm telling you you're not,

Noor 31:47
yeah. Basically they, like, was just pushing me to go to the hospital. But at that time, my insurance was only covering to go to an, er, okay, nothing

Scott Benner 31:58
else. So money and insurance is a part of it, yeah?

Noor 32:01
Like it was part of it in my head. Like I told him I would go to the hospital in the ER and sit there for like six, seven hours. At the end, they tell me, take these pills and go home and you'll be fine as usual. So no, I'm not gonna go sit my ass down like for for six hours, just because they tell me you have nothing as usual. Yeah. You know,

Scott Benner 32:21
to go back to my analogy, it feels like you're in a pool, and you could stand up and your head would come out of the water, but instead, I have you with your knees bent. Your knees are on the bottom, your head's underwater. You're drowning. You say to me, Scott, I'm drowning. I go, No, you're not. And you go, Okay, should I stand up? Because, no, like, don't stand up. Just keep drowning. Like that. Part of it really throws me in a lot of people's stories, yeah, when we get to the part where what's happening is clearly not what's being said, and yet we just, like, as people, have just a lot of trouble, I don't know, turning to a doctor or saying, like, Look, you, this isn't helping. Now, again, I get you were in a bad way, but the people around you and the other stories that I hear, I'm always fascinated by by that. And you know, people oversimplify it by saying, like, Oh, you have to advocate for yourself. Like, I hear what you're saying, but like, I think it's more than that. And I don't know how to put into words,

Noor 33:13
yeah, no, I understand. And everyone around me blame it on me that I'm not eating enough. And it was a bad decision to take that, to do the surgery, and I did that. I brought that over myself. Even after I was diagnosed with T 1d some people in my family, they were like, Yeah, of course, you know, like, I don't know if you have the same thing here around the US families or not. By the Middle East, they like to talk about the taboo in a bad way, and they make it like other people's problem, like, they like to blame other things. So yeah, of course, when he was cutting your stomach, he hit the pinker. Yes. I'm like, if you want to see it that way, and it's gonna make you feel happy about it. Okay,

Scott Benner 33:51
a lot of that, like, oh, I told you, or even quietly behind your back, like I knew she shouldn't have done that.

Noor 33:56
Oh, yeah, yeah, yeah. They kept on going and back and forth. And until now, I would still like hear this, these comments, of course, the doctor hits your pinker. Yes, I'm like, if he hit my pancreas, yes, it's not gonna stop working. It's gonna bleed, like, if you don't know what you're talking about. So shut it.

Scott Benner 34:11
Yeah, no. But at the same time, those are the people who you have around you to listen to. In a situation where you're not able to really think straight for yourself, you have to count on the people around you, and that's the way those people are thinking. So, yeah, like,

Noor 34:25
this is the extended family, but my family themselves, like my mom would like, I hear her from the kitchen when I was just awake or something. Like, I'm like, Yeah, I know what she's saying, you know? Like, I know that she's blaming her life for making me do the surgery.

Scott Benner 34:40
I know I, I think all the time. I'm like, you know the I just, I don't want anything to ever happen to me, where I look up and I look around me and I'm like, Oh, these idiots aren't going to be able to help me. Like, like, I'm finally incapacitated, and it happened to me at the Pet Smart, like I'm in trouble and and,

Noor 34:58
to be honest, I don't. Know, I keep saying the Middle East, the Middle East. I don't want to offend anyone who's listening, but I'm talking about, like, the Middle East my family, they don't like to talk about a taboo. This is a taboo, like having T 1d or looking at me taking my injections. This is a taboo. Oh

Scott Benner 35:14
no, no, I listen. I don't think that's just the Middle East, but I have heard, I mean, you, if you're listening to the podcast, you know, I have a fair amount of people on from that part of the world, actually. And actually, yeah, yeah. I know, yeah. I know. I do. I do get it, like, I see that. But I mean, if you think that that's not going on in Missouri or New Jersey, I think you're, you're not, you're crazy too. Like, people just find the strangest things to I have a story that is, I'll leave out all the details of who the person is, but a tangentially related to me. I know a person who got cancer, and they, you know, there's a pool party, and the person with cancer got in the pool, and everybody got out of the pool.

Noor 35:53
Oh, my goodness. Oh, my goodness. These were

Scott Benner 35:55
all family members, wow. And I was like, what lack of understanding about the world, you know what I mean, or how cancer works, or anything. Do you have that? That was what happened that poor person just like, stepped into the pool and everybody just was like, woo, and got away. And I think that's what you're talking about, is that level of misunderstanding?

Noor 36:14
Yeah, yeah. And it happened also with my son. Like, don't talk to her about her son. Don't ask questions. Don't look at him. I'm like, Why is his nose with six openings instead

Scott Benner 36:23
of two? And then you're telling me that now you're alone, right? Yeah, yeah, yeah, yeah, because nobody's willing to talk to you about it, nobody's willing to help you.

Noor 36:35
Because my my parents don't live here, my sister lives like one hour and a half away from me. So when I say, like, I'm alone. I'm just taking care of my kids alone because my husband is working too much so we can afford the Cali life, you know. So this is what I meant by doing it alone. And of course, even the doctors after I was diagnosed, they didn't know what to do with me, and they were all saying, like, Oh, your case is complicated. Go figure it out. Yeah. I mean, listen,

Scott Benner 36:59
if you're living in California, and he's the only one working, he's working 24 hours a day, I would imagine exactly

Noor 37:05
true, true. And man, my son needs a lot of care because he's self severe harm, and he's turning four, but he still can do this and can do that. You know, he's very smart, though, but still, like, I don't want to see it, but he is having a lot of bit of differences between him and a normal kid, sure, even though I am just saying like he is as smart as anyone else, of course he is, but still, I am helping him to do every single thing else. Yeah,

Scott Benner 37:32
you know. And now you're there's a lot more to keeping you alive, too. Exactly,

Noor 37:37
so taking care of my kids by myself and do whatever I used to do by myself as just like so limiting. Now, even though we say like, we are different, but we are not less, no, sometimes it hits me like, No, I am less. And every time I say I can do it, I end up dying, so I'm not gonna do it. You know, I'm and because I felt even the doctors that I was trying to let them help me after I was diagnosed and went to see my first Endo, she said, Oh, I can't help you. I can't give you a sliding scale. Your case is complicated because you don't eat like a normal person, so I don't know how to help you with that. So go figure it out, and then come cry to me to have a pump. Yeah,

Scott Benner 38:22
yeah. Boy. I so they So, because of this, they used your sleeve as an excuse to even help you get your insulin set up.

Noor 38:29
Yeah? Like, they couldn't. They couldn't, like, the sliding scale. Oh, my goodness, I would, I would take the sliding scale they are giving me, and I would end up, like, having a lot of severe lows, to the point I'm like, I'm drowning in lows, and I'm drowning in this more than when I was not diagnosed.

Scott Benner 38:44
Yeah, so what did you end up doing? What helped you?

Noor 38:47
So I end up searching online why I'm having five lows in more in less than, like, two or three hours at night, and I will be sweating. And after after diagnosis, I have been sleeping and not waking up at all. And I was like a light sleeper before. So my phone is ringing, everything is so I felt like it's very overwhelm, overwhelming, and I don't have anyone to turn to to ask. So of course, in this era, you would feel like, Oh, I'm the only one who's diabetic. This is happening only to me. Every other person who has diabetes, they, of course, they are now like professionals in their like, I thought, like other people with diabetes for like, few years, more than me, their numbers are flat because they are taking, this is what I thought. You take insulin, your number stays flat in as if, like, it's a working pinker gas. Just, yeah, yeah. I have this myth. You know, I thought, like, pumps. You just eat the pump. See that you ate. So it's gonna work by itself, and nothing else happens, like, as if you have a working printer. Yes, I'm like, Okay, I want a pump.

Scott Benner 39:51
I'll take the magic pump in the flat line. Let's, let's make that happen. So

Noor 39:56
I That's why I tell you. Like, when I think all the men. I had about diabetes in the beginning, and I didn't have anyone to correct me. I was like, Oh my goodness. And when I went to the first support group that I went to, I thought, oh my goodness, this person had diabetes for like, 50 years. He's he took masters. He's a master in this he's very professional. I wish I learned from them. And I was so surprised that I added him on my social media, and I found that he has highs and lows. I'm like, I'm not the only one. It makes you

Scott Benner 40:25
feel better just to see somebody else had the experience, yeah? Like,

Noor 40:30
I was so surprised that other diabetics go up and high. It's not because me still new to it and I can't control it, right, right?

Scott Benner 40:37
Yeah, no, you just think that. And when you have that feeling too, that the technology is just, it's perfect,

Noor 40:43
oh yeah, I had you just put it and wear it and you eat, in a sense, even my husband, he's like, it doesn't do that. I'm like, No, it doesn't. He's like, are you serious? So why would you put it, like, take injections? I'm like, at least I'm not gonna take injections for three years, for three days. It's gonna only work. Like, I change it every, like, three days. He's like, Oh, and it doesn't stay for you, like, forever. So we had all these imagination like, you know, dreams, yeah,

Scott Benner 41:09
what it all was gonna be, yeah? Well, now that you know what it is, though, are you happy? Like, do you have? Like, what pump do you have now I'm on tandem Moby, and how do you feel about it? I love it. Yeah, it's working for it. That's awesome. Yeah, yeah, I love it. But what did you figure out between the time when you thought it was a magic thing and what you know now? Like, what did you learn, and especially with your sleeve and your eating style? Yeah,

Noor 41:31
so I was on Omnipod before I was freshly diagnosed. They said Omnipod is no tubes and stuff. And I was so scared to have a tube wand, because my son would pull me from it, and he will not get like, don't touch this. Because when you tell him, don't, it's like, yes. So I was on OmniPods, and I went on the honeymoon phase really fast, like I was going still gradually down very fast. So when this started to happen, I started having a lot of highs with my pump and a lot of like, skin abuse and all these that like all these things. And until one of the clinic nurses, he has diabetes too, and he told me, You must count carbs. I'm like, but my case is complicated. I don't eat well. He's like, even though put this application on your phone, and he was on the phone with me for two hours, and have Scott just teaching me how to count carbs. So he taught me how to count carbs. So after I changed from Omnipod to tandem Moby, I was already a professional knowing myself, like if I ate this, this is 30 grams of carbs. If I ate this, this is, let's say, 50. I'm gonna only eat 20 grams of carbs. So I have been mastering it. Now, of course, sometimes I would, I don't like, trying to Bolus, like, really high, because I know I'm not gonna eat that much, so sometimes I under Bolus, but it's okay, like, the pump works, it gives me corrections. And sometimes I let it be I'm just, like, happy with the tandem movie, because it helps. Like, I don't have to go in every time and correct it myself. It corrects itself. You

Scott Benner 42:59
were using Omnipod, but not Omnipod five, not Omnipod five. Yeah, you were using Omnipod five, but on the sliding scale, it wasn't helping. No,

Noor 43:06
of course, not like the doctor said, Go teach yourself how to give insulin and then come back to me. I will then write for you a pump. When

Scott Benner 43:15
you first explained that, I thought that's backwards, because if you're not eating very much, then counting carbs would have been the way to go. From the beginning, like the sliding scale didn't make any sense to me. When you can't possibly eat all the carbs that they're asking you to take to begin with. Yeah, that's it's backwards. It's so interesting that somebody heard your problem and then came up, and there were two options, and they picked the one that was completely wrong. Yeah, yeah. And how long did you stay in that situation before you figured out to count the carbs? That was

Noor 43:44
just like after I went out of the ICU, immediately, I went to this and do she told me that. So I went home trying to figure it out with my mom. So at the hospital, they gave me these like pens, and said, Go home, eat and then give injections. I told my mom this. My mom said, No, we were doing that with your grandmother? I said, like, No, I'm not gonna start like, I'm not gonna believe sorry. I'm not gonna trust your decisions with my grandmother, because after I got diagnosed, she was going through hell, and you and my aunts didn't know that, yeah, and I started explaining for them how my grandmother was feeling, and they all started crying because they were doing their best, not knowing what's going on, sure, and she doesn't talk. So I told my mom, like, I'm not gonna trust your decisions. I'm gonna listen to the hospital

Scott Benner 44:26
well. So what ends up really happening is you have to go online and figure out what to do for yourself.

Noor 44:30
Exactly, yeah, exactly. Until I met, like, the support group, I started going to right? They started helping me. They made me know, like, they gave me this all information about like, Oh, you have to make sure that the DMV knows that you have diabetes. You have to put this in your car that on you, and you have to do this, do that. Of course, no one could help me with the food, because still, when you say this to anyone, they don't understand that my stomach is smaller than my four year old. But I figured this part out. But they were there, like, my support group was there to just, like, help me through it, and they were the best thing that ever happened to me until now. Well, I'm

Scott Benner 45:08
glad, I'm glad you found people to help you, yeah. So it's wonderful. It really, I mean, especially in a world where the doctors were on, they weren't getting you very far, and they weren't going to help you anymore, like you were told, go figure it out for yourself exactly, yeah, no, that's awesome. And you would say Today things are going smoothly. Oh

Noor 45:27
yeah, oh yeah, no, no, I'm seeing myself as a master in T, 1d just like how the other people that I used to see them when I was diagnosed, yeah,

Scott Benner 45:36
oh, that's awesome. It's and it's awesome that it happened so quickly for you too, because it really is. It really isn't that long. You haven't had type one for a while. I mean, as messed up as your story is, you got through it really quickly. Yeah, sure, yeah, awesome, but good for you. So what made you want to come on the podcast?

Noor 45:53
Because I I'm not, like, having a different story than others or anything, but your podcast was one of the things that helped me trying to figure out and search about like things of for like T 1d people or T 1d things or whatever. So I wish someone somewhere would hear it out. Maybe I will give them a laugh. Maybe they will say, Oh, I didn't know this. I didn't know that, just like how I was so surprised and learned from you so many things about T 1d in the pumps, and especially the one for OmniPods, before I was going on it, on it. So I just want people out there just to hear my story, know that you are not alone. Because I thought I was alone, if you still say that you can't do it, part of it is somehow okay you can't, but you still can, because we are different, but we are not less. Just to be with you and hear your voice like in my ears, not like just watching you. Oh, that's

Scott Benner 46:47
nice. Well, I'm glad. Is there something about I don't know, the way the information is delivered, or the information itself, or me, or the people you listen to, like, can you give me, like, some insight on why it was helpful to you? Because it's a thing that I know it sounds strange, because I'm the one that makes it, but I don't really always understand why it

Noor 47:06
helps. Yeah, no, it helps, because you would see other parts of the world, and other people from this world. You are not like alone. You take people from Bahrain, you take people I don't know the other woman that I she was explaining so many things about her son. She wasn't from the Gulf area, but I can't remember which country. So I'm like, also Scott, like, have also people, like different people, not only like here in the US. So that was one of the things I loved about I love it, about it the way you're so friendly to the person in front of you, and you made me feel like I'm talking to my therapist right now. Like, it's not like, oh, I have to be like, oh, like, formal. And I'm like, you know how to laugh, so your prestige doesn't, like, get affected. So no, you made me feel like I'm just talking with my best friend on the phone. You know.

Scott Benner 47:56
Well, I'm glad. I'm glad. Yeah, so, so a mix of information, yes, and community and a and a personal feeling, yeah. And

Noor 48:04
one of the best things ever to be part of your Facebook group, because they were, they will answer right away. It was the only group that I was on after diagnosis. And most of the people, when they tell you, like, most of the information there is right. It's not like just people saying whatever they want to say, even if it's false or true. You know so. And you are on the group all the time, and when someone like tag you, you are there your posts. You have a lot of like fans in this group that they share. Once anyone ask anything, they share your podcast. This is what made me know podcast. And I have a podcast on my iPhone. I can listen to you through my iPhone. I'm like, I was so surprised with the technology I learned

Scott Benner 48:46
how much you figured out. Yeah, I think it's possible I've brought more people into pot to listening to podcasts that would never and were never going to listen to a podcast before. Exactly. Yeah, I think that's that's pretty and I have to tell you that I agree about the group, like, it's always gonna be the internet, and you certainly can't expect that everybody's gonna say something that's completely 100% right every time, right. Like, I get that, but, man, this group of people, I don't know how it worked out so well, but you're right. 24/7, someone's there first of all, and I think that's the podcast helps that, like, you know, because there's people from different countries. So while the time zones are switching, it doesn't matter, someone's always awake, people are motivated to help. And very kind, like, you know, especially for the internet, you know what I mean? Like, very, very kind, yeah, oh, I'm glad, I'm glad it's all working out for you? Yeah, thinking about like, where you're from. Are there a lot of people looking for this information that don't speak or read

Noor 49:49
English? I don't know anyone there that is diabetic, except a person who does also like interviews for people by just like, look, I added him on. My Instagram, and he's very good, actually. So this is the only person I know that has diabetes in my life from the country I live at like I used to live like I'm from, you know. So the unfortunate, you know, like information is I don't know anything about, like, other diabetics there in Egypt,

Scott Benner 50:17
yeah, I just, I always wonder if there's a way for me to make not all the content, like, you know, not not like long form conversations with people, like all the time, but if maybe just the bold beginning series, or like the pro tips, for example, could be translated into other languages. Like, I wonder if that would be valuable, or if it's,

Noor 50:35
of course, it was. Someone is doing a research like how I did, just because trying to figure out, like, What the hell is going on? Maybe it will, because, to be honest, I heard, like, bad, negative things about what's going on there with diabetes, and I thank God that I'm here and I have good insurance. I can pay my co pay for my, like, insulin. I can get whatever insulin I choose to get the case there is very different. And even the sensors that we say OG seven is bad, og six is bad. Oh, my goodness. Replacement there, they have to pay, to pay fortune of money just to get the very old version of like Abbot, like the libre, yeah. And for tons of money, that stays only on for 14 days. So when I saw that, I'm like, I'm now taking care of every drop of insulin in my cartilage, because I don't want to, like, waste any drop of insulin just because people there are just, like, die or go search for insulin all over the pharmacies. You know?

Scott Benner 51:38
Yeah. I mean, obviously you can't fix everything for everybody, right? Like, and it's, it sucks, but I wish I understood maybe more clearly. Like, what do they have at their disposal? And, like, you know, you know I'm saying, like, so maybe you could tailor what they need and look at what they have and try to find a plan for them that works, that's more valuable than what they're getting, like, because it almost seems mean to like, lay out, like, well, here's what you need to do, except that, like, you know, yeah, they can't find that device, or they don't have this thing. Like, I'd love to know, like, this is what we have, and then talk through how to help them with that.

Noor 52:19
Yeah, yeah, I would say this, like, the information I'm going to tell you right now, this is what I heard from people there. May I don't want to offend anyone in my country, because I don't know, like, Sure, back home, like, I don't know what's going on with the situation of everyone. But what I heard is the insulin is so hard to find, and you can find, like, a local insulin, but you have to go and search for so that my friend that I met on Instagram, he told me, like, I have to drive to several pharmacies just to find insulin. And when I find insulin, I don't take like all the insulin that this like pharmacy has. I just take like some because I'm leaving for others. And I would tell others, like, hey, look, I found insulin that where, like, this place, the insulin is expensive. Not everyone can get hands on, even the needles that we use one time and throw away. My mom said, like, we didn't know that you have to use it one time and throw away, like the needles of the pens. My mom said, like, we would use it for so long until it bent. I'm like, why? She's like, we don't know that we can do it like every time to change like, you have to change it every time. And the needles itself are very, very, very expensive, and the sensors and stuff, these things are not like, laying there for everyone to get, only people with money and only people who can get hands on, like, with Egyptian pounds, it's around, I think, I think, if I can remember, well, it's like, 7000 Egyptian pounds just to get the Abbot, old virgin, and you can't find it every 14 days. It's not like, like, here, you take the supplies for 90 days or 30 days. No, it's you get it today, maybe tomorrow, you can't find it,

Scott Benner 54:01
right? And then 14 days. Now, if you're lucky, it lasts 14 days, it doesn't work, and then you have you can't find it again anyway, yeah, my

Noor 54:08
friend that I'm talking to you about, he said, like, this is the only sensor I have, and I can't find any. I'm like, I wish I can send you whatever I have at home, yeah, or buy for you at least, and send it to you. Like I was feeling so sad that he can find a sensor and he has to go the old school.

Scott Benner 54:25
Is this indicative of all healthcare there, or is this a little bit of the taboo part, where nobody's really looking at diabetes? No,

Noor 54:32
it's not like that. It's just like because resources of the country itself is is not good in like, I'm not living there. I can't really see but some of the people, they even don't know if they have type one or type two. When I ask, let's say, like, half type one or type two, I don't know. I'm like, I asked, Do you take pills or pens? Like needles? They Oh, no, no, no. We take, uh, pills, yeah,

Scott Benner 54:56
just yeah. Maybe that's all they can find. Even. I have

Noor 55:01
no idea, Scott, to be honest, but I heard like it was so hard, so because I can't help so many diabetes there, like back back home, what I do is, if anyone here that needs any help, I can afford help, and I can help any person here. I told my husband, I'm not gonna die on, like, I'm not going to sleep sorry, on my pillow, knowing that other diabetic person needs insulin and they can't get because of insurance or, like, money problem, or whatever, I would spare, whatever I can, just to help people here because I can't help my friend back in back home, you know? So at least I'm going to do it here, because people are suffering. No one can know anything about diabetes, except when you have it. Yeah, I'm gonna help people here when I can.

Scott Benner 55:44
That's lovely. I don't know it's such a problem. And not, I mean, not that it's not a problem in America, but like, when you juxtapose it against other countries, you think, like, Wow, it's so much it seems so much worse there, then, then here. But doesn't, it doesn't make anybody's you know, it doesn't make anybody struggle less, you know, but it just really, I don't know how to handle it, like I wouldn't, you know, in a million years. I don't think, I don't think a pile of money fixes it. I don't think, you know, it's, it's obviously the governments of all these different places need to prioritize these medications for the people who need them. And if they're not willing to do that, then there's always going to be deserts where you can't get it. There's going to be gaps where you can get it for some time and not in others, or times when your employment is going to change or something, and something is going to get in the way for most people at some point. Yeah, and

Noor 56:36
people there, so many people are really poor just to afford even strips for each other meter. So, so you can, you can do anything about it. Like, you know, you want to take all the answer in the US and send it there, and it's not gonna still work, because it's gonna be very expensive for the people

Scott Benner 56:53
there. Also, you have people testing, but they don't even know what to do with the numbers when they get the test back, right? Like, yeah, you know what I mean? I

Noor 57:00
have no idea. Like, oh, he, my friend, told me, like he's trying to do all the interviews that he's doing to advocate for everyone else with diabetes and just to teach the diabetic person what you're supposed to do, yeah? So I'm like, Oh, they are way back there.

Scott Benner 57:17
Well, that's, that's kind of what I was talking about, too. Like you could drop, you could drop this podcast onto somebody, but it might go so far over their head that if they're not able to dig through it, like, really spend the time, listen, understand what they're hearing, then look at their situation and think, like, how can I apply what I have at my disposal to this idea? I mean, it's a lot. Yeah, right, yeah, true. I don't know what to say. I really don't. Oh my gosh. I appreciate you coming on and sharing your story. That was very kind of you. And thank you for spending this time with me. Do you think we talked about everything that you wanted to talk about?

Noor 57:51
Yeah, yeah. And thank you for having me and let me talk about it in with someone who speaks the same language, like as I, and the people who are gonna hear they speak also the same language, so they would understand no so thank you so much. If you have like, any more ideas or any more like questions for me, you want me to answer just, I'm here for it.

Scott Benner 58:14
Awesome, awesome. I appreciate this so much. Thank you. Can you hold on for one second for me? Yeah, sure. Thank you. Hold on one second.

Speaker 1 58:22
You the conversation

Scott Benner 58:29
you just enjoyed was brought to you by us. Med, us. Med.com/juicebox, or call, 888-721-1514, get started today and get your supplies from us. Med, today's episode of The Juicebox Podcast was sponsored by the new tandem Moby system and control iq plus technology. Learn more and get started today at tandem diabetes.com/juicebox check it out. I can't thank you enough for listening. Please make sure you're subscribed or following in your audio app. I'll be back tomorrow with another episode of The Juicebox Podcast. The podcast contains so many different series and collections of information that it can be difficult to find them in your traditional podcast app. Sometimes, that's why they're also collected at Juicebox podcast.com go up to the top, there's a menu right there. Click on series, defining diabetes, bold beginnings, the pro tip. Series, small sips, Omnipod, five ask Scott and Jenny, mental wellness, fat and protein, defining thyroid, after dark, diabetes, variables, Grand Rounds, cold, wind, pregnancy, type two diabetes, GLP, meds, the math behind diabetes, diabetes myths and so much more, you have to go check it out. It's all there and waiting for you, and it's absolutely free. Juicebox podcast.com the episode you just heard was professionally edited by wrong way. Recording, wrong wayrecording.com.

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#1564 Smart Bites: Carb Counting & Insulin Timing

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Module 5 unpacks carb counting, insulin timing, fat-protein effects and meal-planning essentials for practical, balanced T1D nutrition.

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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
Welcome back, friends. You are listening to the Juicebox Podcast.

Welcome to my nutrition series with Jenny Smith. Jenny and I are going to in very clear and easy to understand ways, walk you from basic through intermediate and into advanced. Nutritional ideas. We're going to tie it all together with type one diabetes, talk about processed foods and how you can share these simple concepts with the people in your life, whether it's your children, other adults or even seniors, besides being the person you've heard on the bold beginnings and Pro Tip series and so much more, Jennifer Smith is a person living with type one diabetes for over 35 years. She actually holds a bachelor's degree in Human Nutrition and biology from the University of Wisconsin. She's a registered and licensed dietitian, a certified diabetes educator. She's a trainer on all kinds of pumps and CGM. She's my friend, and I think you're going to enjoy her thoughts on better eating. Please don't forget that nothing you hear on the Juicebox Podcast should be considered advice medical or otherwise, always consult a physician before making any changes to your healthcare plan or becoming bold with insulin.

A huge thanks to my longest sponsor, Omnipod. Check out the Omnipod five now with my link, omnipod.com/juicebox you may be eligible for a free starter kit, a free Omnipod five starter kit at my link, go check it out, omnipod.com/juicebox Terms and Conditions apply. Full terms and conditions can be found at omnipod.com/juicebox this episode of The Juicebox Podcast is sponsored by us med. US med.com/juicebox or call 888-721-1514, US med is where my daughter gets her diabetes supplies from, and you could too use the link or number to get your free benefits check and get started today with us. Med, I'm having an on body vibe alert. This episode of The Juicebox Podcast is sponsored by ever since 365 the only one year where CGM, that's one insertion and one CGM a year, one CGM one year, not every 10 or 14 days, ever since cgm.com/juicebox, all right, Jenny, we are up to Module Five. Look at we're rolling right

Jennifer Smith, CDE 2:51
along. I don't even know how many modules there are. What do we have? Eight? I don't

Scott Benner 2:55
know. I thought it was six. It's a list. Don't worry for the people listening. It's written down. I was thinking today that I genuinely like doing these things with you, because, yes, it's a module, right, but and it there. We have stuff here that we want to talk about, but the conversation, it's very organic still, and I think that's hopefully leading to value for the people listening, that they can just kind of hear us talking through it, and not just be, I don't know, like saying, like, here's the bullet points, and these are the things you have to do and and the reason I even bring that up is I was listening to an episode of the podcast today, and kind of listening back. It's something I recorded months ago. And this is mom, and she's got six kids, wow, and she's an engaged person, you know, like, good mom, all that stuff, but she talked about how difficult it is to cook for eight people, yeah. And she's like, I know that I I work out of some packages and I do stuff, but, like, even financially, like, I can't do a piece of meat and two vegetables, and financially or the time every day. And I thought, I you know, so many people have to be in the situations like that of some level or another. So my hope is that the conversation just allows people to pull out whatever bit of value they can find to add to how they actually live and what their lives are actually like. You know,

Jennifer Smith, CDE 4:18
yeah, no, it's a very valid point to bring up. Again, I've worked with all all populations and people of all different, I guess, economic kind of levels, right? And we have to take the information that is valuable or most valuable, and we have to find a way to work it in and down the line then, especially if you live with a chronic condition like diabetes, it does eventually make a big difference in long term expenditure. Yeah, things that you get away from paying for because you've done the here and now, whether it's with you know better food choices. Disease or moving your body by taking a walk, and you don't have to join a gym, or, you know, those kinds of things.

Scott Benner 5:05
But I started to relate it back into my head the way I think about, like, diabetes management. Like, here's all the information. I know your goal is not perfection. Like, some of you will do that. Like, every once in a while somebody listens, they're like, Mia, one sees five, and I just do the stuff you said. I'm like, awesome. Like, that worked out for you. That's great, right? But there are other people are like, Well, I'm five and a half, I'm six, I'm six and a half, I'm seven. They take the parts that either made sense to them or the parts that they were actually able to incorporate, and they improved Right. Like, right? They did better for themselves. And I just hope that this kind of works out the same way anyway. So module five key areas to address in nutritional education for type one diabetes. First step here, blood glucose management, basics. So take it away.

Jennifer Smith, CDE 5:49
Yeah. So we started these modules about nutrition and health from a base to finally move into what every listener, I think every listener has some tie to type one diabetes, right? Or diabetes in general, let's say, and those basics, most people realize we talked about the macro ingredients, or the macronutrients, right? The carbs, the proteins, the fats, building that into diabetes. It starts with understanding those because they impact our blood sugar, and in what way do they impact our blood sugar, carbs, sugars impact most and most immediately when we're working it all together, it's kind of like health in general. We sort of compartmentalize a lot of the health things or health conditions, when truly they all do impact each other, right? So if you are taking the bases from the nutrition pieces that we've talked through, and you're applying them now at the level of diabetes management, hopefully the puzzle is starting to make a picture that's understandable,

Scott Benner 6:59
yeah, but there are pieces that are diabetes, really, just like we talked about micros and macros. There's also this stuff that we're going to talk about now, and I guess it's stuff that people probably imagine they understand, but I don't know if they've ever had to explain to them. The way you're going to is that how you feel about

Jennifer Smith, CDE 7:14
it, kind of, yeah, I mean, and when we talk about, you know, blood sugar basics, what are some of the basics? We've got three big things in managing blood sugar. We've got food. You get the big one that has been discussed and over and over talked about is that kind of the really top of the pyramid is understanding your insulin and how it works. But then when we have the foods we talked about, again, the big nutrients that impact blood sugar, major being carbohydrates, but then the pieces of those carbohydrates that we have to understand timing for, and it all works itself together. So anytime we're considering blood sugar in relative, I guess, in relation to the food that we're eating, we also have to have a defined range. What's the target that you're aiming for? Are you the standard Ada, which is 70 to 180 Do you have a tighter range for that? Do you have a target that's specific to certain variables in your life, such as exercise times or sick day management, or if you are you know more of an aged person or a really, really young person, your targets need to be clearly defined, because then, as you work in foods, to try to figure out which ones work the best in terms of what I'm aiming for, you have to have the range defined? Yeah.

Scott Benner 8:42
Well, what range I mean, I'm happy to share Arden's, but like, what range do you think of? Yeah,

Jennifer Smith, CDE 8:47
so I always really consider fastings, fasting blood sugar, which we often defined as an overnight time, right? We could be fasting sometime else during the day, but overnight is typically what we call fasting. And in that time period, if we're aiming for the range that is for people without diabetes, it's under 100 so if you define something that would be safe, let's call it 80 to 100 or 75 to 100 for that overnight time period. And then in the aftermath of meals, this is again, where some definition that's individualized may become beneficial again, as you're trying to contain things in the target and in relation to the foods you're trying to figure out. So you know, 180 could be 160 which is more, more along the lines of what the Clinical Endocrinology kind of aims for. And then if you're pregnant, it might be under 140 in the aftermath of a meal. So again, defining that as your goal helps you to see whether or not you're meeting it, and your timing and your insulin dosing and this food versus that food are all kind of working out

Scott Benner 9:56
for somebody who's had type one for you know for many years, who. Who might and probably does, remember the ADA telling them, like, oh, 200 is good for a spike or two. You don't want to go over to fit. Like, those numbers have been coming down. They come down with technology, right? Like, I want people to understand that if you were told a number 20 years ago and today, that number is 100 points less, and you're like, well, it's okay. They told me before it was okay, like they told you, what they thought the mass public could accomplish with the technology that existed at that time. That's the way I think of it. I don't actually know if that's what's happening, but, but as technology gets better, and there's better measuring and CGM get better, I see them tightening those tolerances. Is that, do you think I'm right about

Jennifer Smith, CDE 10:38
that? I think you are, but the underlying there is what safety, okay, right? When we didn't have technology, unless, unless, like my mom, I mean, my mom asked for more test strips. There were no CGM. She asked for more test strips because of the things that I did, and we wanted to have more visible what was going on before I went to play, you know, volleyball, or whatever it was. And there was, again, a defined range, but we had less. We weren't finger sticking every five minutes like a CGM can give you at this point. Yeah. So I think it boils down to safety. The targets, as you said, can be they can be tighter, they can be lower targets, and the value there is we can catch things because of continuous glucose monitors, especially, and now with aid systems or automated insulin delivery systems, with algorithms, there's also a safety catch feature there. Not only do you have the visibility of the direction the glucose is going the value that it's sort of within, but also, what has the system been doing to take care of that for

Scott Benner 11:43
us? Yeah, yeah. I guess the establishments aren't going to say even if they knew back then, like, Look, you want to be between 80 and 100 overnight. If they didn't think you could do that without getting low, having a seizure, that kind of stuff, no one was going to say that. I have always disliked ordering diabetes supplies. I'm guessing you have as well. It hasn't been a problem for us for the last few years, though, because we began using us Med, you can too us med.com/juicebox, or call 888-721-1514, to get your free benefits, check us med has served over 1 million people living with diabetes since 1996 they carry everything you need, from CGM to insulin pumps and diabetes testing supplies and more. I'm talking about all the good ones, all your favorites, libre three, Dexcom, g7 and pumps like Omnipod five, Omnipod dash tandem and most recently, the eyelet pump from beta bionics, the stuff you're looking for, they have it at us. Med 888-721-1514, or go to us. Med comm slash juice box to get started now use my link to support the podcast. That's us. Med comm slash juice box. Or call 888-721-1514, you four. This episode of The Juicebox Podcast is sponsored by ever since 365 and just as the name says, it lasts for a full year, imagine for a second a CGM with just one sensor placement and one warm up period every year. Imagine a sensor that has exceptional accuracy over that year and is actually the most accurate CGM in the low range that you can get. What if I told you that this sensor had no risk of falling off or being knocked off? That may seem too good to be true, but I'm not even done telling you about it. Yet. The Eversense 365 has essentially no compression lows. It features incredibly gentle adhesive for its transmitter. You can take the transmitter off when you don't want to wear your CGM and put it right back on without having to waste the sensor or go through another warm up period. The app works with iOS and Android, even Apple Watch. You can manage your diabetes instead of your CGM with the ever since 365 learn more and get started today at ever since cgm.com/juicebox one year, one CGM

Jennifer Smith, CDE 14:10
Correct, right? And we had old insulin. You know, when I was diagnosed, I used a cloudy insulin called L or lente, and I used our insulin, which is that longer, as close to rapid as we had at that point, right? Mixed them together, you're really only taken twice a day, like it was. It was a very defined, structured daily life compared to today's flexibility because of the technology we have and the safety that that brings along with it.

Scott Benner 14:43
I just think it's good to recognize that while we're talking about it, because, you know, I mean to your point, I used to say, like, hey, I need more test strips. And at one point they'd say, Why do you need so many? And I was like, well, because I'm testing her blood sugar, they didn't even expect that. Like, you know. I mean, you get like, a little bottle with 50 strips in it, and I'd say, well, there's, that's five days maybe. And they were like, five days that should last you two months. Aren't you just testing three times a day? And I was like, how's that gonna help us? When I think back on, like, early ads that I used to do for Dexcom, like, how, like, much we were saying, like, you can actually see the direction and speed your blood sugar is falling like that was a it was a completely different idea at that point. You know,

Jennifer Smith, CDE 15:25
absolutely and it again, that safety piece is that it's the kind of bottom line. I just did a breakthrough T 1d summit presentation, and the keynote speaker was a phenomenal guy who was diagnosed as a kid. He was a competitive swimmer had no CGM when he was diagnosed, either he had, I think he said that their their prescription for test strips was like 25 test strips a day, my max, I believe, if I remember, was like 18 or something like that, frequently for testing and getting enough information. But God, like 25 tests a day to be able to have swim for four hours and be able to do it the right way with safety and everything in the picture. And there we had no technology to help.

Scott Benner 16:09
So I'm just going to leave this for people listening. Please don't just test at the times of day that you know your blood sugar is going to be good, right, so that you can go, I don't know what happened. I got 85 I got 120 and I got 113 It was awesome, because you do listen, I have a lot of conversations with people, and they'll say things like, I don't test my blood sugar every day or and I don't have a CGM, or I have a CGM, but I turned off the alarms like that kind of thing. Like, well, then, okay, the same as nutrition, you can be doing something today that is not valuable for your health, that isn't going to make you fall over dead. That doesn't mean it's not worth not doing, I guess. Right? Yeah, changing anyway. Well,

Jennifer Smith, CDE 16:48
and with this technology, what does it roll into? It rolls into understanding not only the food that we eat, but the timing of the insulin for that food, right? What's the Tell me, what's the role of insulin in the body?

Scott Benner 17:01
Scott, oh, well, hold on a second. There's something about a key and some blood and like, Jenny, I forget how you explain it to me that one time, but it's helping the regulation of the glucose in and out of your bloodstream, in and out of the cells, the cells. Thank you.

Jennifer Smith, CDE 17:16
Yep, absolutely. You get sugar your body digest. Does a whole bunch of fancy things, which I wouldn't, you know describe here, but essentially, glucose ended up in your bloodstream. The that has to move out and it has to get to the right places your cells to provide fueling.

Scott Benner 17:30
So the insulin lets it go from your blood into the cells where it belongs. Yeah, your body can use it

Jennifer Smith, CDE 17:36
again. It's the lock and key concept right. The doors on the cells are essentially lacked without insulin. Glucose floats around your blood sugar gets higher and higher in your bloodstream because it has no real ability to get into the cells. So understanding insulin is valuable then, because it moves the food that we eat into the cells for proper fueling, and a big piece that we've already talked a bit about in terms of, like more processed types of foods and quality types of foods, etc, is it leads to the potential for there to be a disruption already in how your body gets energy. But if we have disruptions, and then how insulin works, it disrupts the food moving into the right places in our body for us to use that. I mean, I'm essentially talking about resistance, right? Okay, so those pieces when we're talking about the influence of nutrition on diabetes or blood sugar management. Again, it all ties together.

Scott Benner 18:48
It's almost like you could trick yourself in a number of ways. You could eat very healthy, but not use insulin well, and you still not get the nutrition, the energy that you need. You could also eat poorly and be so great with insulin that you feel like, Oh, look how good my blood sugar is. I'm doing great, but now you're just getting the impact of poor nutrition. So correct,

Jennifer Smith, CDE 19:06
and maybe I would change it there, and maybe not over nutrition, but over the caloric amount that your body needs. There are a lot of people who have way more caloric intake than they need, but they don't have very quality nutrient intake. Okay, so that's kind of a fine line to

Scott Benner 19:24
discuss. What I'm thinking of right now is understanding how important using insulin well is. I see a lot of people think of insulin as it's a cultural it can be like old age, you know, older ideas, maybe. But I hear a fair amount of people say that if you're using insulin, you failed. That's kind of like from the Type Two world, and then that idea is moved into the type one world, which is like, well, if you're using too much insulin, you're doing it wrong. It's so hard to talk about I find for me personally, because I do want people to use the amount of insulin they need. I don't want them. I say this a lot, right? I don't. You having high blood sugars, but I also, once we figured out how to use insulin, I would love it if you ate in a way that wouldn't require a ton of insulin that wouldn't be needed if you were eating in a healthier way. This episode is brought to you by Omnipod. Would you ever buy a car without test driving? It first, that's a big risk to take on a pretty large investment. You wouldn't do that, right? So why would you do it? When it comes to choosing an insulin pump, most pumps come with a four year lock in period through the DME channel, and you don't even get to try it first. But not Omnipod five. Omnipod five is available exclusively through the pharmacy, which means it doesn't come with a typical four year DME lock in period, plus you can get started with a free 30 day trial to be sure it's the right choice for you or your family, my daughter has been wearing an Omnipod every day for 17 years. Are you ready to give Omnipod five a try? Request your free Starter Kit today at my link, omnipod.com/juicebox terms, and conditions apply. Eligibility may vary. Both terms and conditions can be found at omnipod.com/juicebox find my link in the show notes of this podcast player or at Juicebox podcast.com

Jennifer Smith, CDE 21:16
and there's the define, no. That's 100% correct. It's a I see a common thread online about, you know, my child is nine years old, and they're this they're using this much insulin. How much do your nine year olds use? And that should be like a stop right there. While there might be a weight based idea for insulin dosing and approximation within an age range, no similar nine year old is going to be that alike in dosing needs, and you defined it well in saying that eat what you need to eat, for nutrient value, for caloric, for fueling, for all the activities you Want to do. But we can easily these days, have more caloric value, and thus now we're using more insulin, right than we should be using only because we're putting more food in than we

Scott Benner 22:13
need. So using more insulin is not the problem. Using more insulin if you're eating so poorly that you need more insulin, that's the problem, and it's not a thing we say out loud, because we try very hard not to tell people how to eat. Listen, it's an edict of mine. It's one of my rules in my Facebook group, like, don't tell people how to eat, right? But at the same time, we're talking about nutrition right now. So I'm not telling you how to eat, but I am telling you that if you do this, it'll be better for you, and you can do whatever you want. Like, I'm not saying, you know, I think there's a difference. Like, if you want my personal opinion, I think there's a difference between having a bowl of cereal on a Saturday and eating cereal every day, all week long, right? Like that. There's just a difference there. And if you want to know, like, my nine year old uses this much, how much does yours use? Well, you got to ask the rest of the question, what does your nine year old eat? How active are they? You know what I mean? Like, those kinds of things you can't just, it's not apples to apples, unless you have all the apples,

Jennifer Smith, CDE 23:05
right? Yeah, right, yeah. And, you know, in in moving all of the nutrient nutrition, kind of micro macronutrient stuff that we've talked about into this now realm of diabetes, it's like the macros do require coverage. And here we're talking about insulin, insulin from carbohydrates. We typically start with an insulin to carb ratio and figuring that out, defining it really for those who maybe haven't listened or don't realize we tend to have about one unit of insulin that covers a certain number of grams of carb at a particular meal. So if you're a one unit for every 10 gram and you have 30 grams of carb, you'll have around three units of insulin that you need just for the carbohydrate part of the meal. And then it becomes deeper, right? The discussions we've had are about what kinds of foods that are carbohydrate. Are you eating? What's the glycemic nature of those foods? What are the components of the meal? Is it all simple sugar stuff? Or are you eating a really big green salad with two cups of chopped up, non starchy vegetables on it? Right? Yeah,

Scott Benner 24:17
which, by the way, still have carbs in it. You just have to, you have to know how to count those carbs. Like, there's, yes, there are carbs and things that I bet you people don't imagine, you know, and so it's important to count your carbs accurately, like, right, your your insulin to carb ratio obviously needs to be right. But then once you're counting, you know, you can't make a cheeseburger and say, Oh, that's meat, because the roll might have high fructose corn syrup and it might not. You might put ketchup on it, and then just ignore the fact that that might be 10 carbs of ketchup, or, like, right, that kind of stuff, or that you put a bunch of cheese on your burger and there's fat in the burger, like I'm telling you, you got a Bolus differently for a burger made out of 80% lean meat than you do for 90% lean. Me, because there's more fat, the fat slows down your digestion. These are the things that I think we do a good job in the Pro Tip series and other places of explaining to people, but your carb count has to be right. Like, if you're eating and you're spiking and you think, I don't understand what happened. It's not a big secret. There's only a couple of things that may have happened. Your settings are wrong, your carb counts wrong, or you don't understand the impact of your food. You know, maybe there's, if you're a girl, certain week of the month, you might have different resistance, but, like, I mean, sure, other than that, and

Jennifer Smith, CDE 25:30
or different activity levels, or, you know, factors there too, or illness. I mean, there are variables that are in the picture, or that could be but in general, if you have these basics of understanding, okay, as much quality kind of food that we put in, what food category do they fit into? Okay, carbs. I'm gonna count those as well as I can. There's no 100% perfect on it, right? But what's the nature of them? Are they quality, low glycemic, going to be slower in hitting my blood sugar. Do I have an idea of how to cover them with insulin? And then, what are the other parts of the meal? As you said, a burger with cheese. Now we're getting into proteins and fats, and at some point, while protein has minimal effect in this goes to what we were talking about, portion, right? Portion, controlled, well well managed amounts. You should be able to get away with covering carbohydrate at your meal time and not having to factor in fats and proteins. It's when we end up having a meal that is much more complex in fats and proteins, or much higher, I should say you haven't miscounted your carbohydrates, but now you've got this problem happening, happening in the aftermath of the meal, and with fats and proteins, it could lead to hours worth of issues that you're seeing and then it leaves you wondering, well, I thought I counted the package said, you Know, 28 grams of carbohydrate, and that's what I did, and, well, I got low, and now I'm sitting high, and the high won't come down. So there's a deeper

Scott Benner 27:09
level. I think it's important to realize that if you just randomly think of five different foods in your head, rice, bread, you know, like, I don't know, a fruit, like, just picture five in your head, and imagine all of them have been measured perfectly, and they're all 10 grams of carbs. Each of your five things, each of those five things, need a different amount of insulin, very likely because of the way they impact your body. So if you just ate the fruit, and it was, it was 15 carbs of a banana, well that might be a lot of simple sugar, and you might have to Bolus differently for that. If it was bread, it might go and, you know, it might go in your stomach and sit there for a little bit before it goes. So, five different foods, five different impacts, and then you put them all together and stick them in your belly at once, right? Five different impacts and five different foods and five different timelines that they're going to impact on, and etc. And I know that sounds, I mean, it can if you're new, frustrated, oh my God, you're like, What am I supposed to do? Right? But there is a way to like, just to kind of simplify it down to like, well, there's, you know, there's 50 carbs here, but there's some fat, there's some this, so I know I'm gonna have to, you know, but there's also simple sugar, so I'll hit it hard at front, but I know an hour from now, it's gonna start going up again, so I'll make sure that we cover that rise before it happens, and it should be okay. I know that sounds crazy if you don't understand it, but it's not that hard, really

Jennifer Smith, CDE 28:27
well. And when you simplify meals, again, I like to use what eons ago was called the plate method, right? It's the idea of taking a standard size plate, and about 50% of that should be as low glycemic types of vegetables, right? Steamed, grilled, sauteed, salad form, whatever you can kind of fit in. And then the other part of the plate is your your proteins, a healthy, nice portion of protein. And then some type of lower glycemic, if possible. Carbohydrate could be just fruits. It could be, you know, a grain of some kind, or whatever you're choosing to put on your plate there. But in that balance, you're also getting the concept of portion, and then you're also getting a mixed meal that doesn't have such an overload. And you should be able to, in a meal like that have the insulin to carb ratio truly cover the carbohydrates the way that you would expect them to and not having this lingering

Scott Benner 29:24
right kind of later effect, like a fat rise later, or something like that, right? I mean, if you give

Jennifer Smith, CDE 29:30
fat being that other one, that it really leads to a lot more insulin resistance. I like to think of high fat at a meal time, and high fat could be still healthy fat. Like you eat two avocados, that's a lot of fat. Man, it might be good fat for you, right, right? So what are you going to find? You find in the hours after you're not going to spike from an avocado, but you're going to require extra insulin. I think of fat kind of like it sits on. The insulin in your bloodstream, or it slashes its effect by like 50% which is the reason eons ago, we used to set a Temp Basal increase on conventional pumps in the aftermath of high fat, a 50% increase for four to six, maybe even eight hours to compensate for that sensitivity reduction we get from high fat. So again, it's not so much the quality of the fat here, although that can have other effects, but it is really the portion of it and the potential, then, that it could require you to do something different in your insulin, use

Scott Benner 30:37
good food, good portions, good coverage with your insulin should lead to stability. Let me say this Juicebox podcast.com, up at the top, go to guides, fat and protein insulin

Jennifer Smith, CDE 30:50
calculator. Oh, that's a great one. I recommend that one to people all the time. Thank you.

Scott Benner 30:54
This will take you to a pretty technical overview of how fat and protein can impact your blood sugars, but it also takes you to four episodes that discuss it. And I want to just say this, the calculator is not medical advice and nothing is always consult your physician. But I do have a calculator on there that will help you turn grams of fat, grams of protein, into a Bolus amount to help you. And it discusses there how to do it. If you don't understand how to do it, talk to your doctor about it. But I hope that would help you. Awesome. Yeah, yeah, awesome. Okay. Oh, what we got anything else on here? Meal

Jennifer Smith, CDE 31:32
planning, I think we kind of talked a little bit about within all of this, really. It's just, I know with again, as we go back to that talk about technology that we had early on and the benefit of technology, I think what that has also brought in is flexibility, which can have a positive, but flexibility could also lead to not as much regularity in what you're doing, and that could be detrimental, right? It could be that, oh, I know all of my settings are right, so I can consistently do this, but sometimes maybe this is skipping a lunch every once in a while, right? And then what ends up happening is you end up being very, very, very ravenous later on, and then you get an overage. When had you had more regular meal intake, a breakfast, a lunch, a dinner, or, you know, something similar. Your appetite gets, I guess, better regulated, right, right? You have intake your body works through the fuel that you've put in. Oh, now it's four or five hours later. Yep, I'm hungry again. That hunger signal, too is often very disrupted in diabetes, because of how we have to navigate food, and also because there is not the same regulation of insulin use as if your pancreatic, you know, if your beta cells were producing there's a very fine tuned machine in there that we try to mimic as best we can as humans, but we're not doing it the same way.

Scott Benner 33:13
Yeah, there's a lot in there. And I think that, I think the idea of just meal planning is important, because here I'm gonna we did not plan this. But

Speaker 1 33:20
have you eaten already this morning? I have eaten this morning. Yes, I

Scott Benner 33:24
haven't. Who do you think eats better me or you? You? Okay, I'm not gonna make you sit right. No debate. Do you know what you're having for dinner

Jennifer Smith, CDE 33:30
tonight? We have as much of a plan usually in the week as we can, mainly because that's how I shop is for knowing what's in the house and having an idea of what's going to be prepared. So

Scott Benner 33:43
I don't is what my point is, okay? So I think that the a little bit of planning goes a long way. I just really do, like, even, like, back to that. I love that story about, like, what the time I asked you about like, road tripping, and I was like, well, don't you stop at gas stations and get candy bars? You're like, no. And I was like, Well, what the hell do you eat on a long road trip? You're like, I bring food. And I was like, Oh my God, what an awesome idea. I think that a little bit of planning can go a long, long way. I tried to do it more. I'm not as good at it as as other people are. You know, I run a business completely by myself. There are days. The other day was one of them, I just, I don't think I ate. I got up, I started working. I recorded twice. I got hungry. I went downstairs. I actually took food out, put it on the counter. Somebody called me. I ran back upstairs, and two hours later, my wife texted me and said, there's an egg on the counter. And I was like, Oh, I didn't eat. That literally happened to me. So yeah, yeah, you got to put some effort into it, like I'm as guilty as everybody else. But

Jennifer Smith, CDE 34:38
no, and I that effort, it does go a long way. And from the standpoint of being a caregiver for kiddos, I try to keep that planning in place, because I think a big piece of why I do it, not only because I have diabetes, maybe I would have learned it, but my parents just planned that way as well, right? So there was a piece. Piece of influence in the caregiving, or the, I guess the caretaking my parents had for myself and my brother, but I hope to provide that to my kids as well, that if we are out someplace, I try really hard to have things along, because then the idea of, Mom, can't we just stop there, or can't we just go there? Or can't we just grab something from here? So easy, you know, I hope to instill that in them, that they can have some preparation and keep what I've been feeding them in their life.

Scott Benner 35:34
I watch it like my son is a pretty healthy eater, honestly. And yet, if there's no food, like there, what they go to is, it's such a drop off so quickly. Like, no kidding again, it goes right to, we could DoorDash something. We can go here. We can do it's too easy to get credit. I mean, let's just be honest, right? Like, some food is great and some food is just, you know, yeah, it's not great. And then not great food is super easy to get. So it is yeah, entirely, yeah, yeah, absolutely, do your best. I'll talk to you guys later. Okay,

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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 back to another episode of The Juicebox Podcast.

Anna Lisa 0:14
Hi there. My name is Annalisa Bucha and I have type one diabetes, and I'm here to just chat with you, Scott,

Scott Benner 0:23
if this is your first time listening to the Juicebox Podcast and you'd like to hear more, download Apple podcast or Spotify, really, any audio app at all, look for the Juicebox Podcast and follow or subscribe. We put out new content every day that you'll enjoy. Want to learn more about your diabetes management. Go to Juicebox podcast.com up in the menu and look for bold Beginnings The Diabetes Pro Tip series and much more. This podcast is full of collections and series of information that will help you to live better with insulin. Nothing you hear on the Juicebox Podcast should be considered advice medical or otherwise, always consult a physician before making any changes to your healthcare plan or becoming bold with insulin. This episode of The Juicebox Podcast is sponsored by Medtronic diabetes and their mini med 780 G system designed to help ease the burden of diabetes management, imagine fewer worries about Miss boluses or miscalculated carbs thanks to meal detection technology and automatic correction doses. Learn more and get started today at Medtronic diabetes.com/juicebox this episode of The Juicebox Podcast is sponsored by the twist a ID system powered by tide pool that features the twist loop algorithm, which you can target to a glucose level as low as 87 Learn more at twist.com/juicebox that's twist with Two eyes.com/juicebox. Get precision insulin delivery with a target range that you choose at twist.com/juicebox. That's t, w, i, i s, t.com/juicebox. This episode of The Juicebox Podcast is sponsored by the contour next gen blood glucose meter. Learn more and get started today at contour next.com/juicebox

Anna Lisa 2:24
Hi there. My name is Anna Lisa, Bucha, and I have type one diabetes, and I'm

Scott Benner 2:29
here to just chat with you. Scott. Anna Lisa, that's right. Annalisa, like that? Yeah,

Anna Lisa 2:33
it looks like Anne Lisa, but it's Annalisa. It's Danish.

Scott Benner 2:37
Oh yes. It confused the hell out of me, because I was like, I know you said it. And I thought she's mispronouncing her own name.

Anna Lisa 2:43
I know. Thanks, Mom. It's pretty but a little complicated at first.

Scott Benner 2:48
That's okay. So how old were you when you were diagnosed?

Anna Lisa 2:52
I was 22 I had just graduated college, and, yeah, was working at a summer camp. How old do you know I am 44 Oh, wow. Oh yeah, I'm about halfway. Hey, actually, right now, yeah, you

Scott Benner 3:07
didn't know 244, halfway? Yeah, no, that's how you said it out loud, did you Hey? Yeah, here we go. Happy birthday. Any chance it was in June that it happened? Because that would be crazy,

Anna Lisa 3:15
sure. Was it was like exactly right now, this is it, I do not know my diabetic anniversary, but this is it. We're here.

Scott Benner 3:23
It was in June, though. Yeah, you just don't know the date.

Anna Lisa 3:27
I don't know the date. I was working at a summer camp in San Diego. And, yeah,

Scott Benner 3:33
sometime, really, how did you live in San Diego?

Anna Lisa 3:36
No, I'm from Northern California. I went to school up in Chico, and, yeah, I was working down there, and started going to the bathroom like a ton at night, which was really inconvenient, because I was up on a second bunk bed and had to, like, climb down every night. I'm a super hard sleeper, so I'm like, I never wake up the middle of the night. Somebody was like, you have a bladder infection? And I'm like, What is a bladder infection? And somebody was like, Are you like, I'm working at a Christian camp, Scott. They're like, are you having sex? Because that's what happens. And I'm like, No, I'm totally not. And so yeah, I went to a homeopathic doctor, or, like, whatever, which I had no idea. I just was, like, rolling with it. And I went to a doctor had a sandwich before the whole camp was at the beach, so I had to, like, miss out on the super fun beach day. The doctor tested my blood sugar, or the nurse, when I walked in, I had just had lunch, and my blood sugar was, like, 285 and she's like, oh, did you just have lunch? And I'm like, Yeah. And she's like, Okay, we're gonna put you on a more comfortable room. And so I was like, Alright, cool, whatever. Like, I'm just waiting for, like, these pills that people told me I would get, right? And she's like, Oh, we're gonna write you a prescription. You have a bladder infection, you know, we'll get you that, but we're gonna put you in a more comfortable room. I'm like, alright. So the doctor was like, my dad's eight. Could be my dad easily. And he comes in and he's. Like, teary eyed. And he's like, you're just, like, my daughter's age. And I just, I need to tell you that you have diabetes. I'm like, wait, what? Like, I just thought I had been

Scott Benner 5:12
no, my who's dirty? That's all. Yeah, hey, listen, the most important thing I'm getting out of this is, do Christian girls not know to pee after

Anna Lisa 5:20
intercourse? I don't know. I wasn't doing that, so I had no idea.

Scott Benner 5:25
But I'm saying that the you know what you got from the from the choir, when you were like, hey, something's wrong, they're like, you, you must have had sex, right? Because that's what that's not what happened. You don't just get a bladder infection because you had sex, right?

Anna Lisa 5:39
Kind of, like, I don't know, just somebody said that to me, and I thought it was hilarious. And I was like, No, whatever,

Scott Benner 5:46
but you know, now, in your 40s, go pee afterwards, right, right? Oh,

Anna Lisa 5:50
for sure, definitely, that's 101 definitely 101 for sure.

Scott Benner 5:56
Scott, that's intercourse 101, yes. I just want anybody who's listening to? No, it's a, you know, just, yeah,

Anna Lisa 6:03
go pee. Yeah, go pee. The movies do not let you know any of that information. And that is actually one of the funniest things I think about movies, is there's really not a lot of practicality.

Scott Benner 6:14
Yeah, it would probably ruin the flow of true film. Yeah. Okay. So, yeah. So this doctor, can I ask you, like, him being so upset? Did it upset you? I just was

Anna Lisa 6:25
kind of, I'm kind of a roll with the punches in the moment, kind of person, like, all right, cool. I don't usually have like, big reactions in the moment, and so I'm like, I don't even know what. I just think I was in total shock, like, all right, yeah, you know, since I think I was in the two hundreds, you know, he thought I had type two, and I've never been hospitalized. Had keto acidosis. I've never, like, I just had a very gradual onset. I actually have memories for all throughout all of college having diabetes symptoms, but had no clue what they were.

Scott Benner 7:06
Oh, really, that's interesting, like, what? Tell me some examples.

Anna Lisa 7:11
So my freshman year of college, I was walking to my big history 50 class, like 250 people, all the way across campus, and I sat down in class and just started profusely sweating, and was like, I need food. Like, I have I ditched class. Like, I was like, I have to get out of here. And I was super disoriented, and just like, having zombie, got myself to food, yeah, and, and was like, Well, that was weird. And then just like, nothing else happened after that. It was just this rare, like, it just happened.

Scott Benner 7:46
And then one like, crushing low blood sugar after walking, yeah, yeah, you didn't mention it to anybody, and call your mom and say, Hey, wanna hear a weird story?

Anna Lisa 7:55
Not really. I probably told my bestie, Amanda, and like, I don't know. It's just kind of how I am. And throughout college though, they would like, tease me. My friends very you know, we're all kind of a very bantery folk. And, like, if we waited too long to have breakfast, like, some they'd be like, Oh, Anna, Lisa has the shakes. We better get to breakfast. Like, we would all kind of tease like, and I wouldn't always, like, profusely sweat, but it would just be like, Guys, I'm getting shaky. Like, it's time. And so

Scott Benner 8:28
you thought that was going to be you, like, you a person who got hungry and got shaky afterwards,

Anna Lisa 8:32
yeah, before, yeah. Like, and then we would, yeah, we would go, like, we would always go to the Olive Garden right free breadsticks. And like, an hour after Olive Garden, I'd be like, Y'all like, I am hungry again, and I just feel out of it, which come to find out is, like, somebody called it something, but like, high blood sugar, like, you get this false hunger. You think this went on for years? I think four years, I have memories. My first low blood sugar memory was my freshman year of college.

Scott Benner 9:04
About that. So, like, a very slow onset. Are you? I mean, how long did it take before it was there? In totality, was it when you were 22 you're like, Okay, it's here.

Anna Lisa 9:12
Yeah. So when I was diagnosed, they gave me a list of foods to eat, which was like, fruit. They're like, eat lots of fruit. Alright, and so I got to an endocrinologist pretty quickly. When I got home, my mom hooked me up with her local Endo. And I'm in college, so it's like, I don't really have a doctor, like, I, you know, I'm just kind of healthy going through life. And my endocrinologist had type one diabetes and was on the insulin pump, and actually was moving his practice up to my college town where I was living. I ended up going on, we started off on Metformin. We started off on oral medication. I just got very little instruction, and one day I went to a doctor's and they're like, we're gonna start you on Lantis. Let's. Just do this. And I'm like, All right,

Scott Benner 10:02
so, so because you have that kind of like, just roll with it attitude, yeah, and it's a slow onset, and you're still in college, you go see that, like, do you feel like you understood anything that was happening, or were you just doing the like, I'll just do what I'm hearing today. Thing,

Anna Lisa 10:19
a little bit of both. I did do a lot of research. I am a researcher. Like, I am pretty like, get in there. You know, I'm a mathy person. Yeah, I think I really did get in there in research. We thought I had Lada. That was, like, I feel like the easiest thing, like, type 1.5 right? And I knew that that was an elusive diagnosis, so I didn't, like, run with it. I just kind of would tell people, like, we don't totally know what's going on. Like, this is probably going to turn to type one. So that summer, interestingly enough, you know, I was just kind of in a whirlwind. I just had no clue. Like, just was felt pretty up. Ended about it, yeah, and my friend was like, You know what? Come with me. I'm going on a houseboat trip a mutual friend. So I went with her up to Lake Shasta for a houseboat trip, for two nights with Brad's family. And Brad is now my husband, but he is a scientist, and I joke he fell in love with me because he I had type one diabetes. He thought it was just like the coolest thing, like he loved learning about it. And so then we just kind of started researching, you know, learning about it. And that was kind of our initial connection, from friendship to romantic interest, was that I had type one diabetes.

Scott Benner 11:36
So it started off like you were, like a science experiment for him. And probably, yeah, somebody brought along on a trip. How long until it became romantic? The brand new twist insulin pump offers peace of mind with unmatched personalization and allows you to target a glucose level as low as 87 there are more reasons why you might be interested in checking out twist, but just in case that one got you twist.com/juicebox, that's twist with two eyes.com/juicebox. You can target glucose levels between 87 and 180 it's completely up to you. In addition to precision insulin delivery that's made possible by twist design, twist also offers you the ability to edit your carb entries even after you've bolused. This gives the twist loop algorithm the best information to make its decisions with, and the twist loop algorithm lives on the pump so you don't have to stay next to your phone for it to do its job. Twist is coming very soon, so if you'd like to learn more or get on the wait list. Go to twist.com/juicebox. That's twist with two eyes.com/juicebox. Links in the show notes, links at Juicebox podcast.com. Contour. Next.com/juice box. That's the link you'll use to find out more about the contour. Next Gen blood glucose meter. When you get there, there's a little bit at the top you can click right on blood glucose monitoring. I'll do it with you. Go to meters, click on any of the meters, I'll click on the Next Gen, and you're going to get more information. It's easy to use and highly accurate. Smart light provides a simple understanding of your blood glucose levels. And of course, with Second Chance sampling technology, you can save money with fewer wasted test strips, as if all that wasn't enough, the contour next gen also has a compatible app for an easy way to share and see your blood glucose results. Contour next.com/juicebox and if you scroll down at that link, you're going to see things like a Buy Now button. You could register your meter after you purchase it. Or what is this? Download a coupon. Oh, receive a free contour next gen blood glucose meter. Do tell contour next.com/juicebox head over there now get the same accurate and reliable meter that we use.

Anna Lisa 13:58
Well, he asked me out on a date in October. So that was like July that we went on the houseboat trip, and I didn't totally know he was asking me out on a date, because we met at this summer camp, a different summer camp than I was diagnosed at. We met at a houseboat camp in California. He asked me out, and I just had no clue that he was asking me out on a date, because he's just kind of a friendly dude. Yeah, we just kind of hit it off and got married pretty quickly after that. And so

Scott Benner 14:26
were you on the date when you realized it was a date? Or did it take longer than that? It was

Anna Lisa 14:30
afterwards. He wrote me a sweet little note afterwards. And I was like, Oh no. Brad Bucha likes me. Oh my gosh. He took me to get this guy. He took me to San Francisco, took me out to see Jesus Christ Superstar, to a fancy dinner. I spent the night. We spent the whole next day together. We had a blast. We chatted up, and I somehow had no clue we were on a date.

Speaker 1 14:55
And Lisa, poor guy, you spent the night, or you spent the night? Yeah. We

Anna Lisa 15:00
very platonically spent the night. Yeah,

Scott Benner 15:03
I know he's like, I bought that girl dinner and a show. She doesn't even understand I was hitting on her,

Anna Lisa 15:09
I know. And then he wrote me the sweetest letter, and I, poor guy, I responded back and was like, Oh my gosh, you're really nice, Brad, but I am totally not interested in anything romantic. I just got diagnosed with diabetes. I had kind of had a boyfriend before that, and was just like, Yeah, this is just not timing in my life for this at all. I'm so sorry. I had no idea.

Scott Benner 15:34
Did he respond back and tell you how much you're half of the Jesus Christ Superstar tickets would cost?

Anna Lisa 15:39
Oh my gosh. So get this, Scott, this is his response back. His response back, was I totally get it. I think you are an amazing person, and if you ever changed your mind, my door is open to you. And you just wrote me the sweetest response back. And Scott, I was like, I'm all in. This is the person I want to spend the rest of my life with. Like, this is an amazing human being, and I just fell in love with him, and then we Yeah, so I rejected him. He wrote me just this amazing note back, and I'm like,

Scott Benner 16:10
let's do this. All right, how about that? Because his response wasn't like, it wasn't, well, I'm not going away, so I'll just be here. And it was just like, okay, whatever you need, but I'll be here, you know, if you're ever interested, let me know. Yeah, yeah. And then you What did you do? Respond right back and go, all right, you got me, I'm in totally I did, yeah. Like, we were like, all in, yeah, you probably thought you were crazy at that point. He was like, Oh, great. I definitely picked the wrong one. She said, No, then at least

Anna Lisa 16:39
he knew what he was getting into though, because I was like this, that's very me, so

Scott Benner 16:43
I'm not ready. There's nothing that could talk me into this. Okay, all right. I mean, you were so understanding, let's get married pretty much. How long after that were you

Anna Lisa 16:52
married? 14 months to the day of our first date. We'd known each other for like, four years before that, we'd known each other a long time. But yeah,

Scott Benner 17:00
how about that? He and you grew up with diabetes together, really,

Anna Lisa 17:03
we totally did. He was there when I gave myself my first Mantis injection. And actually it was kind of hilarious. It was Brad, my best friend Amanda, were on her apartment floor, and I had picked up this vial of insulin, insulin, and we're all kind of like, so what do we do? We're like, we don't know. Okay, here's the instructions. And we just kind of like, fumbled through it together. And, you know, I was grown so my family was not really involved in my diabetes too much. My mom's an amazing mom. I just think it was just really, it's always been hard for her to think of me with a chronic illness. So it's really just been me, Brad, and my friends doing this since I was diagnosed.

Scott Benner 17:50
Hey, did you get the boat? Yeah, the house, but you got the house both too. It's nice. This is the white this is the whitest story. It's the most Caucasian story I've ever heard in my life. We're very, we're super, Ultra White. There's there's there's a house boat, there's Brad. I mean, Brad alone, you know, like, as, yeah, pretty damn

Anna Lisa 18:05
Caucasian. And, I mean, like, we snow ski, and we're, like, all in on racial justice, and we're all in on that, and we are seriously, like, the whitest

Scott Benner 18:12
people ever, certainly. Well, I mean, yeah, I heard it with the house boat part.

Anna Lisa 18:16
Yeah, yeah. You know, right away, do

Scott Benner 18:19
you get back to San Diego ever? San Diego is the place in the world that if people randomly ask me, where would you want to move? I've never been there. It's just like the stories of the weather make me think, like, that would be the right place to be?

Anna Lisa 18:30
Oh yeah, California is the bomb. That's great here. Okay, all

Scott Benner 18:34
right, so let me go backwards a little bit, like, Sure, you're 22 and you're diagnosed and you know, it was hard for your mom. Were you looking for help? And she just couldn't offer it. Or,

Anna Lisa 18:49
you know, she she hooked me up with doctor's appointments. I mean, she was there, I just don't think like getting in on the wheat right diet, like type one diabetes, especially compared to type two diabetes, is so different. So I think she really was doing the best she could, but I also wasn't living in the same city as her. Sure, I'm a fairly independent person. I think it's always been really sad for her. There's several times over the last 22 years like, where she just kind of bursts into tears, like, Oh, I'm so sorry you have diabetes.

Scott Benner 19:25
You guys do talk about it, or is it just her, like, unburdening herself every once in

Anna Lisa 19:30
a while? Yeah, we sometimes it comes up. Like, so, you know, this is part of my story. I've always really worked to keep my diabetes in the background. Like that was a well intentioned but has actually done me wrong for 20 years. One of my initial goals was like, you know, keep my insulin pump really discreet. I went on Medtronic right pretty quickly after I went on insulin full time, I couldn't but. Shots were just, I was like, I'm just too pragmatic. I'm like, get me a pump. Like,

Speaker 2 20:04
right away. Okay, but

Scott Benner 20:05
you didn't want people to see it though you were thinking, I'll keep this kind of private.

Anna Lisa 20:11
Oh yeah, yeah, super private, which has has its pros and cons. I've ever since I found the Juicebox Podcast, I've started to become more public, being willing to be public about my diabetes. But how long ago was that? Two years ago. This is two years ago. I found the Juicebox Podcast in the summertime.

Scott Benner 20:31
So for 20 years, you've kept the whole thing pretty private, pretty much. Yeah, what are the pros and what are the cons?

Anna Lisa 20:39
It hasn't deterred me from doing a lot of life, things. We've traveled, we're I'm pretty athletic, like I did go to a diabetes athletic training camp probably, like, 18 years ago, after I'd run a few half marathons, totally didn't know what I was doing when I did that. Like, I feel like I'm just lucky that I made it through being an A new athlete and having type one diabetes. But

Scott Benner 21:08
I want to know like, if you're hiding it, like, what were the benefits of hiding it, versus, versus? What do you think you lost by not

Anna Lisa 21:14
telling people? Okay, my endocrinologist, first thing he ever said to me was diabetes never takes a day off. And that stuck with me, like, and I think I had just always hoped, like, if I keep up on my pump supplies, if I kind of just do the right things, that it would manage itself. Okay? And I wasn't super curious about my numbers or trends or like, now I would say, like being a diabetes ninja, I just kind of wanted it to be a background thing in my life, to set it and forget it, and that left me like, at a 7.8 a, 1c, like, pretty, never emergency. Like, so

Scott Benner 22:01
were you hiding it from other people or from yourself? I think

Anna Lisa 22:04
I just wanted to live my life. I just kind of wanted it to be in the background. I wasn't ashamed of it, like I would check in front of people. I would, you know, I would share about it, but I just kind of didn't want it. I did not want to be Anna Lisa with diabetes.

Scott Benner 22:20
Are you pretending it's okay, though? So the like, I mean, like, when you had a seven, eight day one city, were you like, that's awesome, and or did you think,

Anna Lisa 22:29
oh, like, it just kind of was what it was. I think I just didn't identify as being a diabetic. Maybe because I was diagnosed when I was 22 I just was interested in other things, okay? And I think I was just doing well enough, and I would get interested in it. Like, when I went, I think the diabetes athletic training camp is amazing, and the endocrinologist who runs it is fabulous. I just was never interested in, like, fully immersing myself in the diabetes culture. I just kind of wanted it to be on the side, so that I could, you know, we lived in Africa with friends for a while, that I could do things and be prepared.

Scott Benner 23:12
Were you avoiding low blood sugars or you avoiding touching diabetes too much day to day? I think

Anna Lisa 23:18
I just didn't want to touch it. I was really lonely. I thought having diabetes was really lonely. I just don't think I was that curious. Scott and I never found anything. It just didn't it took a long time. I mean, I had two kids. I managed it a lot like I spent a lot of times. Oh my gosh, Scott. I had a great health care but my first son at 37 weeks was 11 pounds, four ounces, a big baby. Big Baby. That was what the doctor said when he brought him out in C section that is a big baby.

Scott Benner 23:50
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Anna Lisa 24:59
I'm. I had, actually, I had a 6.8 a, 1c at the time, maybe even lower, yeah, I just think I've always kept myself busy doing other things as well, like, I'm pretty involved and keep busy. But I just never had enough capacity for it to be like, enough to totally take over my life, even though one of the things you said on your podcast that changed me initially was I'm going to take care of it eventually, even before, so I'm going to take care of it before something or after something. Yeah, I hadn't really wrapped my mind around that for like, 20 years,

Scott Benner 25:40
right? It's like saving money. It's like anything really, just little work up front makes everything much easier, totally. I mean, listen, it's long time ago, but like, a six, eight, a, 1c, while you're pregnant, not is not optimal. But were they okay with it back then, or were they telling you it should be lower?

Anna Lisa 25:58
I think I'm a tough patient, Scott, because I'm really knowledgeable, I'm really friendly, I'm enjoyable to be around, but I kind of do what I want. And so I think my my health care people were just kind of like, let's just do the best we can with her. And I think I'm horrible still to this day at pre bolusing, like I'm getting better and I'm working on it. It's the whole game. It's the whole thing. And from day one, so on your podcast, when people were like, Oh, nobody ever told me to pay Pre Bolus. I like, everyone's told me to Pre Bolus from day one. That was always 15 minutes before you eat from day one, those were my words of instruction.

Speaker 1 26:43
Are you a bit of a pain in the other parts of your life? Or,

Anna Lisa 26:47
I don't know, you'll have to ask Brad, yes and no. I mean, I just think, yeah. I just kinda,

Scott Benner 26:53
are you being difficult? Or are you a free spirit? Like, I mean, like, because pregnancy, like, at some point somebody said to you, Hey, your health is gonna impact the baby's health. Baby's health.

Anna Lisa 27:03
Yeah, but they're also just kind of like, we're doing this, like, and I'm a, I'm pretty good, like, I'm not horrific.

Scott Benner 27:11
No, no, no, no, not at all. I'm not saying that at all. No, of course not. I'm just, yeah, but I mean, you're, you have insurance, you're motivated, you you said, you, you look into things, you understand things. So, you know, I mean, the baby's 11 pounds because your blood sugars, totally, right, right, totally, yeah. So at some point during that process, you it doesn't hit you, like, oh, I should just Pre Bolus. Like, I know it's not a thing I think of, but I'll figure out a way to do it for the next nine months at least. I don't know, yeah, I don't know, it's interesting. That's, that's all. That's the part I'm wondering. Like, that's why I said, Are you paying about other stuff? Like, are you I, I'm trying to be funny, but are you like, resistant to, like, somebody telling you what to do?

Anna Lisa 27:50
I think one of the things that is hard was, is still to this day, hard for me is low blood sugars. Rock Me. Like, right? They're really hard, and so a lot of the times when I go to Bolus, I'll think, maybe I shouldn't, because what if I have a low blood sugar, which I totally understand doesn't make sense. Like, I understand that a really high blood sugar can lead to a really low, like, I get the roller coaster, yeah. Oh, and back then, though I was not on a CGM, and I really hated checking my blood sugar, like,

Speaker 1 28:31
you didn't know, you didn't know what was going on then,

Anna Lisa 28:33
yeah. So I would check, like, not pregnant. I would check like, two to four times a day pregnant. I would, like, painstakingly check, like, eight to 12 times a day, okay? And I was really resistant. I tried the initial a CGM with the Medtronic, and it just was horrible. The beat. I got overwhelmed with the beeping and blah, blah, blah. So I didn't start the Dexcom until after I had kids.

Scott Benner 29:02
You know, a lot of people saying, a lot of people who early adopted CGM, yeah, it put them off it for a while, yeah, yeah. And then they end up being the ones who always tell me, like, oh, it took me way too long to get back to it, yeah. I understand that too. Yeah, yeah. Just a lot of circumstances and the way life goes, kind of stuff. When did you have this second? You had two kids, right? You said, I do how well? How long? How much time in between them? There

Anna Lisa 29:30
was three years between them. I had several miscarriages. So I had a miscarriage before my first one, and then two miscarriages in between my two

Scott Benner 29:39
boys. Was that blood sugar related? Do you think you know it

Anna Lisa 29:43
all of my healthcare professional so even about the boys size? I mean, we all knew that my boys were big babies because I had type one, but nobody would ever say, like, Oh, you're having miscarriages because you have type one. Like, they just say, like, it could be. But people also have MIS. Carriages. So

Scott Benner 30:01
can I say something that is not directed at you, but it's just for the people listening. Sure you don't have big babies because you have type one you have big babies because your blood sugars are higher while you're pregnant. Right? Right, right. Yeah, right, right, right. I know you don't mean it that way. I just want to be clear. That's all good. Totally, totally,

Anna Lisa 30:17
totally, yeah. So there was not a lot of blame in my health, my health care, were just really they were very kind. And so there. But Brad and I did decide after when we got pregnant, the third we got pregnant really easy. We decided after the third miscarriage that we would only try one more time, because they were really hard. They were is really taxing on my body, sure. And so Charles, our last one, we were like, when we got pregnant with him, we were like, Okay, this is it like, if this doesn't stick like, we will figure out, you know, how to have a family or be happy with one kid. So he was a successful pregnancy, and that was an easier pregnancy. Even though he was 10 pounds, he was a much easier pregnancy than my first one.

Scott Benner 31:05
Were there any adjustments made? Anything you can point to to say this is why it

Anna Lisa 31:08
worked. I think I ate less with Charles. I think with James, I was really hungry, and ate macaroni and cheese and these amazing Mexican baby bean burritos. And I just think I ate a lot with James and with Charles. I just think I was too busy to eat as

Scott Benner 31:28
much. Yeah, too busy. Or were you restricting to try to avoid higher blood sugars? Or were you not?

Anna Lisa 31:34
I think I just didn't want an 11 pound baby. That was it with? Oh my gosh, when James, when I was in the hospital with James. My first one, the sonogram just READ ERROR. Scott, so I was 37 weeks I was having pre contractions, and they did the sonogram, and it just read error. And I'm like, please get this baby out of me. I do not want to be on the news. I do not want big baby like anything.

Speaker 2 32:04
Are you naming your kids after Bibles? By the way?

Anna Lisa 32:07
No bankers. Yeah, we wanted them to be bankers. No, just kidding.

Scott Benner 32:12
It's like, King James, King Charles. I'm like, Are these Bibles? I know, yeah,

Anna Lisa 32:16
my husband's name is Bradley, James. And we were driving one day, and we're like, it would be so just flip your name. Like, I love the name, James Bradley. And so we played with several names, but my husband would always turn them into a joke, like, you know, so we were going to name our kid James Bradley, and then I would come up with an idea, like, Oh, what about Devin? Or, I don't know, what about something, and he'd be like, or, what about the original butcher? He could be the original Butcher. And I'm like, Oh my gosh. So we could never get serious about finding another name. So James Bradley, it was, do your

Scott Benner 32:54
boys have like, like, are they the butcher to their friends? That'd be such a good

Anna Lisa 32:58
you know what my husband was, but my boys are not. It's really funny. Nobody messes with my boys last name as much as they did. I think with my husband and his brothers growing up, I

Scott Benner 33:08
would love a nickname like that. Wouldn't you love that? It's like a title, you know what? I mean? Like, I'd love to

Anna Lisa 33:13
I've only had strong last names. My maiden name was armor, like knight in shining armor. So

Scott Benner 33:19
awesome. Um, I want to dig a little more into your note here. So yeah, at some point it sounds like you you transitioned to Omnipod. You said it was frustrating.

Anna Lisa 33:29
Yeah, yeah. So let's see what happened there. Okay, things have gotten better. So I reached out to you, Scott. When I was just in a really low pace place. I had just had my first super gnarly low blood sugar ever in turns out, 22 years, right after I reached out to you, and I just have, I'm on ozempic, and I have had some really highs and lows. I'm a pretty athletic person, but I'm also variably athletic. Like, it's not like, oh, every day I do the same thing, which is a hard thing as a type one, is I'm not super consistent. I don't do the same thing every day. And so when I reached out to you, I one of my goals, too, is I've never wanted my diabetes to like, impact my boys lives. I just have tried for years to keep it discreet, up until a year or two ago. And so a couple months ago, I had, I was getting my youngest ready for a cello performance, and I went in his room to help him, and I had a low. All my stuff was upstairs, out of sight, out of earshot, and I had, you know, a low that just read low. And I just kind of, I guess, in a sense, almost fell asleep on his bed while he was getting ready. And I think it was the first time I'd ever had, like a scary low. And I mean, I've had lows. I've had bad lows before, but maybe, like my first semi unconscious low that I have. Managed on my own, like, I've always managed my own low blood sugars. So Brad came home from work and was like, you know, found me, and I think he, like, forced me to drink and eat something to get me to wake up. And it took like, 45 minutes for me to just kind of come to again. And it was really scary. I was like, oh, no, this is off the guard rails, like, I don't want to do

Scott Benner 35:22
this. Was your son aware something was happening?

Anna Lisa 35:25
Oh my gosh, Scott. He just thought, like, Ah, my mom. I don't know. He was not concerned one minute. I think he was just in his own world, like, getting dressed and you fell asleep, being cute, yeah? Which I've never done before. I'm not like a mom that falls asleep places. So they were never alarmed. Brad also didn't like make it a huge deal to them. He and I just kind of take care of things. And so he just kind of got me back up to our bedroom and let me rest, and he watches my blood sugar all the time like a hawk on his phone. So he just kind of kept getting Charles ready and going on his way.

Scott Benner 35:59
So let's talk about what why you think that happened? So you were using a GLP at that point?

Anna Lisa 36:03
Yeah, I've been on a GLP for a year and a half.

Scott Benner 36:07
Oh, okay. It wasn't new. It wasn't like you just Nope. Had you just gone up in dose? Maybe,

Anna Lisa 36:12
no, no, I hadn't. No, I have stayed at a point five dose for a long time. I actually just went up to a one unit about a month ago,

Scott Benner 36:21
ozempic, or we go, V I'm doing ozempic. How'd you get that? How'd your doctor get you that

Anna Lisa 36:27
I was sitting up at 180 pounds and kind of slowly increasing my weight, despite the fact that my diabetes was really well maintained and that I work out pretty hard most days a week, and I have a feeling she maybe labeled me with some insulin resistance and could justify it. I had asked her for it, just because I have a lot of really loud food noise, and so I think she just was able to justify it. For me,

Speaker 1 37:00
you lost how much in the year and a half? I lost

Anna Lisa 37:03
40 pounds in two months. Wow, good for you. And I've kind of stuck in that same 40 pounds for the whole time. And I love it. I absolutely love the freedom of the food. Noise is

Scott Benner 37:16
the 140 a good weight for you. Yeah, I'm pretty happy because, I mean you can you go up, or is point five the biggest of I forget,

Anna Lisa 37:23
I'm up at one is kind of the I think two is the

Speaker 1 37:27
max, 2.4 2.4 maybe is the max. Oh, okay, okay,

Anna Lisa 37:31
okay, yeah, I'm at one and one is pretty, rocking me, like, I'm pretty. It was a good increase.

Speaker 2 37:37
Are you able to eat?

Anna Lisa 37:39
Yeah, yeah, I eat. I really like food, so I eat, okay, but it's really easy. Like, we were just in Panama last week. It's actually when we travel, like, I could just eat, like, half a portion of everything pretty easily. Yeah,

Scott Benner 37:54
it's kind of it's nice, right? You don't feel like compelled to, like, finish a bunch of food or something like that, yeah, yeah. Did it help with your insulin needs? Do you actually think you had insulin resistance, or did you lose weight so quickly that your needs went down because you had less body mass? I

Anna Lisa 38:08
don't know. I think it's a combination of eating so much less. I think we changed my settings. You know, I keep great data on it, but I think I probably my insulin ratio. So I was on the T slim when we first started, and then I just switched to the Omnipod in November of this

Scott Benner 38:30
year. All right, Were you successful on both of those pumps?

Anna Lisa 38:34
Yeah, I loved the control IQ on the T slim. I absolutely loved it. I'm probably a fool for switching away from it, but I was so tired of the tube and listening to your podcast. I'm like, I there were so many podcasts to support with the Omnipod that I was like, I think I can do this. Okay, Omnipod five worked out fine for you as well. No, I've had a horror I've had a really hard transition to it. That was actually why I reached out to you. No, I've had a really hard transition to it.

Scott Benner 39:03
I was under the impression that the transition was difficult, but you're good now, or is that not the case?

Anna Lisa 39:07
So after I had that really low blood sugar, I just went all in on diabetes. I went into full, okay, diabetes mode. I have since embraced fully having diabetes. Actually, my kids have helped me embrace it. Last year, my son did a t 1d bike ride, and it was really humbling to hear like that. My kids were like, oh yeah, we know a lot more about your diabetes than you let on, mom. And so I over the last two years with your podcast and Charles writing in a T 1d ride and raising money for it and talking to people. And you know, that was just really able to give yourself over to it a little more totally, totally

Speaker 1 39:53
80. You go to therapy.

Anna Lisa 39:55
Well, I'm a school counselor, so that's awesome, I know. So I. I in it okay. This is so my best friend Heather. Has just Heather and Brad have just been my total diabetes. We teach. We joke that they have type three diabetes. I told her I would say this, that on my on the podcast, as they let's see, I totally lost my train of

Scott Benner 40:17
thought because I said that that's okay. I was asking, I actually asked if you had been to a therapist, because, like, I mean, you are resisting this, like, for 20 years.

Anna Lisa 40:26
Yeah, no, my gosh. Heather is also in the psychology, so she and I kind of do, we joke that we do our own therapy. I have seen a therapist, but not directly about my diabetes, but I do a lot of self care with people who get in there and do therapeutic type work. I know that that sounds like a cop out, but it

Scott Benner 40:47
just sounds kind of Northern California. That's all. Doesn't sound like a cop. Yeah. Okay, okay, sounds what they would call a little hippie dippie. But there's nothing wrong with that. I get no problem. Sure, sure, sure. You diagnosed at 22 you, you know you're fickle about the guy that took you out, and then, like, you were like, it's okay, it's okay. I'll jump in. But then you stay fickle about the diabetes for 20 years, until you have a low blood sugar in front of your kid that I'm assuming, makes you feel like, I can't let this happen again. And then you start getting the kids start kind of pepping up and being like, Look, I know you think you're hiding this from us, but you're not like, we know a lot more about this than you can, and you're like, Okay, well, maybe I'll throw myself all the way into it. Was a really interesting thing for me to hear you say that after 20 years, you were like, Okay, I guess I'll figure out this diabetes thing.

Anna Lisa 41:33
Totally, yeah, totally. It's very I think, because my so listening to your podcast, I've done a couple, I've realized a couple things, yeah, I think a well intentioned like, I want this to be in the background. I wish I could just set it and forget it, like, I've just kind of not been able to be bothered by it. Like, I keep, I keep my supplies up, I keep, you know, I I do a lot of the work. And it just felt like that should be enough. Yeah, and two things that I thought were interesting that I really realized so for a long time, I could not listen to your podcasts about parents managing their diabetes. And a podcast that was really helped was there was a guy on there. I think he's come on a few other times, but he called himself, I think the Night Ninja.

Scott Benner 42:20
Oh, it's the control IQ, Ninja, uh, Jeremy,

Anna Lisa 42:24
yeah, yeah. And I think he's been on several times since,

Scott Benner 42:27
maybe twice. Yeah, maybe twice. Okay, yep. Before you tell me about Jeremy, though, like, why couldn't you hear parents talking about

Anna Lisa 42:35
it? I was I didn't realize this, but I was so jealous to hear that people like managed their kids diabetes like and to realize that there is all this work that needs to be done all the time, and that as a parent, you just you love your kids so much that you do that right? Like you get in there, Were you mad at your parents? Not at all. I was not mad at my parents. I was just felt really lonely about it. Like, as much as Brad is in there, I think I'm just too stubborn. Like, sometimes he would be like, hey, you know, did you Pre Bolus and I'm like, whoa, whoa, get in your own lane about pre bolusing, sir, you know, how come

Scott Benner 43:29
you didn't know how to answer me when I said, Are you a pain in the ass about other stuff? How come you were

Anna Lisa 43:35
because I like to think of myself as a really nice person. Scott,

Scott Benner 43:38
so, so you're not mad at your parents. You're mad at me, maybe the situation where you're diagnosed in an in between age where your parents aren't close to you, and people think of you as an adult, but let's be honest, you were 22 and you didn't know what the hell you were doing. Totally, right?

Anna Lisa 43:53
Totally. So I think it set me on this trajectory of just being a good enough diabetic, right? Like it wasn't until recently that I realized I have a whole deeper level of management, like when you and some people say on the podcast, like, I never really think about Arden's diabetes. I never really like the truth is is you're so fluent at it. You've done so much work over the years that it's just second nature. It's like you've learned to walk, you've done that, and now you walk without thinking about it, but you're always thinking about it. And I had to come to grips that I want to be the Ninja, like, I want to be there. So I made an appointment with Integrated Diabetes. I'm meeting with her on Wednesday, actually, because I feel like when I've met with my diabetes educator over the years, like they're just kind of frustrated, like you're not pre bolusing. So then I've never really learned how to because I often don't Pre Bolus. I've never really learned how to get into the nuances of really managing timing, stuff by numbers. And I think that the Omnipod has been hard because it's been really hard for the Omnipod to learn my basal rate, because I only Pre Bolus, like, probably two out of three times. Like, there's probably at least once a day that I don't Pre Bolus.

Scott Benner 45:34
You're changing up the variables that it doesn't.

Anna Lisa 45:36
And so it Yeah, so I think it's really hard. And so,

Scott Benner 45:40
so So are you going to be able to do that? Are you going to hit like, are you going to do the same thing you did with Brad? When Brad's like, hey, maybe you shouldn't. You're like, Hey, get out of my way. Like, do you think you're gonna be able to give yourself over to it the whole way?

Anna Lisa 45:50
I don't know. I hope so. Like, when I meet with Dana and try to do the consulting,

Scott Benner 45:54
yes, is why I mentioned the therapist. I know that's a good

Anna Lisa 45:58
question. I'm gonna have to. I will keep that on my radar and notice

Scott Benner 46:02
you're super interesting, and you're not the first person I've talked to this way, but I know, hold on a second, because you're smart and you know what's going on, and you even see what's happening. But you can't like, there's a part of it where you just like, Well, yeah, but I can't overcome that part of it, going to your endo and saying, like, I need help. And them saying, Okay, we'll pre bullish your food. And you go, I forgot to, yeah, then they give up on you, but you're almost upset with them for giving up totally. Why aren't you upset with yourself for not

Speaker 2 46:32
Pre Bolus? I don't, I don't know. That's the thing. I don't know.

Anna Lisa 46:35
I know. I mean, it's similar when I did a weight loss thing and they I would be like, Well, I just ate. And they're like, Well, why? And I'm like, I just wanted to. That's what I did. And they're like, and so that's what I've loved about ozempic, right? Is ozempic has kind of been set it and forget it, like it takes away the food noise. So then I'm like, Oh, good. Like, I can just,

Speaker 2 46:58
yeah, no, I do that. Are you an only child?

Anna Lisa 47:02
I'm the middle child. I'm an older sister and a younger brother.

Scott Benner 47:05
Okay? Because that, like, that's how I want it is, like, a pretty only child thing,

Anna Lisa 47:11
yeah, yeah, yeah. And I think you're right, though it makes me a tough patient, because kind of, like, Okay, well, we're just gonna stick in good enough. And I think right now, I have a clear goal of, like, well, if I want to be I can stick, keep my a 1c like, I got my a 1c down to 6.2 it's awesome. It was awesome. Yeah, thank you. Thank you Juicebox Podcast. Thank you, Scott, for all your work. You

Scott Benner 47:33
get that from the pro tips or just from listening, like, conversationally,

Anna Lisa 47:38
I think the pro tips were super helpful. Brad and I deep dived into the Juicebox, and so we spent like, a summer just kind of all we did all summer long two summers ago was think about and talk about diabetes, and we thought it was fun, and we got in there, but it's like, then life happens, like, I'm a full time school counselor. We have two boys, and it's just hard to think about my diabetes for the amount that it probably needs to be thought about and looked at. You know,

Scott Benner 48:07
if a kid walked into your office at school with a similar problem, yeah, how would you advise yourself?

Anna Lisa 48:16
Yeah. I mean, I think I would say, Pre Bolus, right? Like, I don't know,

Scott Benner 48:21
would you say you gotta shut up and do the things you gotta do?

Anna Lisa 48:25
Sure? I mean, I think that that includes consistency and discipline. And part of my strength is that I'm spontaneous. Like, our biggest strength is our biggest weakness, right? Like, I'm spontaneous and I'm a gamer and but I think that that makes it hard with diabetes, because I don't so I don't know what I would say too. I mean, I think it comes down to some discipline and being willing to do what I need to do for the results that I want. Maybe

Scott Benner 48:53
you should try not attributing being prepared with not being a gamer like I don't know. Why do those two things? Why do they have to be mutually exclusive? Like, can't you be a person who pivots and still pre boluses? Right? Totally. It's almost like you think that that part of the diabetes management is going to take away from, like, the part of your personality that you love the most. But I don't see that. I don't really feel like it would, though,

Anna Lisa 49:18
no, it wouldn't. And nobody ever cares, except for me. I care like, no, no, no, sorry. Okay, usually I don't Pre Bolus when we're like having chips and salsa, or when it's kind of a bother to stop and Pre Bolus. And I've listened to some episodes on this and and so I think because I also have been so discreet about diabetes, everyone around me forget, right? And so then nobody's gonna remind me, like a parent would like a parent would be like, hey, get yourself. You know, hey, we're all having chips and salsa. Yeah, get yourself. I have wondered if I asked might Yes, might be helpful for somebody like. Need, but if

Scott Benner 50:00
it works for you, could help. You didn't notice a less of a need for a pre bolusing with the ozempic?

Anna Lisa 50:06
Yeah, no, it's helped. It's totally helped. But it's not, I mean, it's not, not a Total Cure. Magic, right? Right

Scott Benner 50:13
now, yeah, it's interesting. Would you talk to the doctor about going up slightly in the dose to see what happens in

Anna Lisa 50:20
ozempic, yeah, I just did, okay, I just went from point five to one.

Scott Benner 50:26
Oh, you did just go to one. Okay. Have you noticed anything different? It still doesn't help. Like, missing your Bolus still is going to be what it is. Yeah, no, for sure. But I mean, I I've seen maybe it's different, obviously different person to person, but the difference between Arden missing a Pre Bolus on a GOP and off a GOP is like 70. It's like 70 points,

Anna Lisa 50:49
totally, no, totally. And I think a missed Pre Bolus for me now might make me 250 to 300 and it usually comes down pretty easily versus a former Pre Bolus probably would have me more like 350, 400 Right? Like I have gotten much better at pre bolusing in the last two years. I have made big improvements. It's just not

Scott Benner 51:13
100% I would I would say just from talking to you, and I obviously don't have all your details, but like that piece right there is probably the difference in like, another three quarters of a point on your A, 1c, yeah, I would think, from what I'm listening to, yeah, yeah, you think you'll get there.

Anna Lisa 51:33
I do. I do. I want to spend some time honing in on the Omnipod. So I'm about to go right now the pd i have the PDM, which I hate, and it just got cleared, I think, last week right for you to be able to use the iPhone Dexcom g7 on my iPhone. So I didn't want to do it last week because we're traveling and busy in the summertime, and I wanted to wait until after I met with Dana on Wednesday before I made any changes, because somebody mentioned that I might benefit from starting over on resetting the five. Yeah, I might as well wait until I meet with Dana and then do that, maybe with her, or yada yada,

Scott Benner 52:14
with her. Yeah, it's a great idea. I mean, it's but, you know, you just went up in the ozempic. You're, yeah, yeah, starting with, you know, coaching. So, like, I think that all works out. Well, yeah, it's a good idea, yeah, yeah, you'll probably pop up and you're able to probably drop a half a point in the next six months. I would imagine,

Anna Lisa 52:31
I think it will. And I do love the Omnipod. I thought about going back to the T slim, and actually my diabetes educator, who also has type one. She was like, I think you would do better on the tea slim. And I'm like, I'm pretty motivated. I really love the pod. I really love being tube free, that I can swim. So I love the Omnipod. It took it when she was looking at it, you know, it takes people, like, usually one to two months for the basal to learn you, and it's taken more like

Scott Benner 53:05
four months, yeah, but it doesn't work that way. And if somebody's talking to you like that, they don't understand it, okay? It doesn't learn you. No, sure, sure, sure, sure. Yeah. Honestly, it's got settings within a pod and a half, and then it's basing what it's doing on what's happening now, plus what happened over the last, like, couple of pods. Like, at this point, I'm gonna guess that. Listen, if I'm gonna guess that, if you're a one sees already seven, your settings weren't great to begin with, right? You're covering from things with, like, probably extra boluses and things like that. Yes, totally round numbers. If you're a you know, if your basal supposed to be a unit an hour, but you're only using point eight, and your insulin to carb ratio should be one to 10, but you're doing, you know, one to 15. That's not enough insulin for you. And you're not pre bolusing on top of it. And then you're telling the you're telling the algorithm, whether it's control IQ or it's Omnipod five. You tell them the algorithm, these are my settings, but that's not right. And then you're saying to go ahead and do it which it doesn't have the right tools to do the job with,

Anna Lisa 54:10
I think with the T slim it. You mentioned that I was hearing this in a recent podcast.

Scott Benner 54:15
It's more aggressive at correcting highs, yes, and

Anna Lisa 54:18
it we had faked out, I think over the years, my medical bulk had been like, okay, she's not pre bolusing, so let's increase her basal in order to kind of make

Scott Benner 54:31
it all work. A time honored tradition among endocrinologists is asking you a few times, realizing you're not going to do it, and then yakking up your basal to overcome the fact that you're not going to do the stuff you're

Anna Lisa 54:42
supposed to do right, right? And so my my educator, said you're going to have a hard time on the Omnipod if you don't Pre Bolus but because I'm me, I'm like, Ah, I'll make it work out. It'll be okay, don't worry. And now all of a sudden, I'm like, it's not

Scott Benner 54:55
working out. Well, it's not just because you're not pre bolusing, though. It's also because your settings aren't right. I think the. Reset makes total sense. You're on one of those empic Now, that's an upgrade, right? You know, it's a little more medication. You're motivated to do the thing, right? I'd sit down with Dana go over all these, you know, basically she's going to look at all the extra insulin you're using, and she's going to put it into your basal and your Bolus, right? You're going to be surprised at how much easier it is. Yeah, I'm hoping, yeah. I mean, listen, that's what's gonna happen it. This isn't like, it's not

Anna Lisa 55:26
magic. It works the way it works. No, yeah, totally, totally. It's science. You

Scott Benner 55:30
get the wrong settings and you're trying to do something that's not going to work.

Anna Lisa 55:34
Yeah, no, totally. I'm excited. I think it'll be really good and and even, like, I'll be home for the next three weeks and able to really key in, and maybe Scott, I'll just look into some therapy about why I have my added, my laissez faire attitude about some of these things,

Speaker 1 55:53
awesome that'd be, I mean, it's a good idea.

Scott Benner 55:56
I mean, you're 44 you know? I mean, yeah, like, it ain't going away. If

Anna Lisa 56:02
some of your gonna deal with it at some point, might as well deal with it. Now, why

Scott Benner 56:06
not like, I mean, what do you what are you busy? You know what?

Anna Lisa 56:10
I mean, I'm sure you're busy. Now,

Scott Benner 56:13
whether it helps you or not, I can't tell you, but at least understanding yourself better, I think, is important, one way or the other.

Anna Lisa 56:20
Totally, totally. And I, I think too, like, I have not yet learned how to also look at my data. And I, even though Brad and I are total data people, I still don't know how to, like, look at the graph on my Omnipod and be like, Okay, I can see for my last 24 hours that I had two Miss lows, and actually, I've been taking screenshots and putting it into chat GPT, trying to learn, like, Okay, how do I look at some of this data and understand what needs to change or what's happening? Like, I still think I need I haven't learned how to fish myself.

Scott Benner 57:02
Let me say something here. I would never tell anybody to do that. But I did do it once recently, and I was, I was really, it was astonishing, the good information it gave back. Scott, it's crazy. It's really good. I was using the chat GPT three Pro, like, the the ultra kind of like reasoning version of it. So what I did was, this person put a graph online, asked me what I thought, and I didn't have any context. I didn't know where the food was, I didn't know how much I knew, nothing. But looking at the graph, sure. So I look at the graph, and I jot down all my thoughts about the graph. And then I thought, let me see. And I drug it over, and I said, like, hey, AI overlords, this is a CGM graph of a person with type one diabetes. I can't tell you how much insulin they used or when they ate. Give me your take. What is this graph? And like, what can you infer from this graph? And the feedback was insane. I know. Yeah, really, really interesting, and I very overlapping with what I wrote down from my high level takeaways, too.

Anna Lisa 58:04
So yeah, I listened to a podcast recently and started to notice, listen to one of your your podcasts, started to notice that at midnight, my blood sugar will go up. One of my reasons, my a 1c is a little bit higher, is I don't have that beautiful overnight,

Scott Benner 58:24
nice, low, stable,

Anna Lisa 58:25
steady, yeah. And I think that that's a huge thing, especially for somebody like me. And that's why the control IQ was doing so well with me, is every night I would have these beautiful overnights in the last couple years. And that's what where I'm struggling. One of my areas of struggle right now on the Omnipod is it's just not quite aggressive at night. It said the exact same thing that you and the person on the podcast had talked about with the that overnight low. And in the podcast, you guys had said, like, oh, try giving yourself like, one unit before you go to bed. I hadn't tried that yet, and I did not tell that to chat GPT or to, you know, the overlords. It told me that. It said you might you're having an overnight spike. It could be delayed from what you ate at dinner. It could be yada yada. Try going before you're going to bed, giving yourself one unit of insulin. And it totally worked. It was crazy.

Scott Benner 59:21
Listen, that thing is going to fix so many problems before it blows up the planet. It's going to be awesome those couple of years, and they're going to be great. You'll try to escape on your houseboat, but that thing won't hold up out to sea. So it's not going to matter, really, it won't matter. I like how motivated you are to change. I want to prove to people that you can change. While you were telling a story earlier about miscarriages, I was able to untie a knot in my sweat pants that I hadn't been able to get out in, like, the last month. And I was so excited, and I did not interrupt you, because I thought this would be an inappropriate time to say this. Yeah, so you're welcome. I've changed too. Everybody can change. I swear to you, I got it undone, and I was like, I have to. Share this with everybody. Congratulations. I mean, I'm so excited. These were almost un wearable because I couldn't I couldn't tighten them anymore. Yeah. Cozier.com, use the offer code Juicebox to check out the Save 40% I also would like to point out that whether you end up with control IQ or Omnipod five, you can support the Juicebox Podcast by using my links that are in the show notes of the podcast player. Yes, so true. It is very true. Tell me. I mean, we're basically done. But like, I really do want to know it's not a unique story. The like, right? 20 years of like, I'm not doing this, but I'll do, you know, hear a thing happen, and now I'm going to do it. But like, once you find the podcast, and you throw yourself into it, like, can you tell me what was valuable about it? Like, so I can make sure more people get that too.

Anna Lisa 1:00:49
I think, you know, I think it right. Here goes. I'm not consistent, so I didn't listen 100% through. I totally jump around the things that were the most helpful you and Jenny talking were probably the most helpful, and I think especially for somebody like my husband, Brad, to listen to. He's super sciencey. He could get in there. It's good science. You never talk about crappy science. We call that BS in our house, bad science. It's honest. You know, it's it takes away the loneliness of feeling alone in your diabetes. So and I have noticed that like when I want camaraderie, I listen to diabetes with an adult diabetic, but when I want to get in there and learn sciencey stuff, I either listen to you and Jenny or I listen to a parent with type one diabetes, because it really is the parents that get in there and get dirty with the diabetes because they're doing it for their kiddo.

Scott Benner 1:01:51
Yeah, the ones that are digging in don't have whatever psychological things are block, blocking you from helping yourself.

Anna Lisa 1:01:57
It's not messy, right? It's pragmatic. I mean, it is, it's emotional. It's hard, right, crying in the shower as a parent, all the things my cousin has type one diabetes, and her daughter was just diagnosed with diabetes, and just listening to her, you know, cry in the shower and just be devastated for her daughter, even though she lives a great life with type one so hard, it is hard. Those were the helpful things. I think having people on, like, two years ago, you had on the glucose goddess, some of her tips changed me of like eating my vegetables first, then my protein, then my carbs. Like so, lots of pragmatic changes. I think the podcast is incredibly pragmatic, but also nourishing, awesome at the same time. And I yeah, I love the tiny bites, like I just Yeah, I listen when I can. I listen a lot. You put out a lot of content. Scott, so one a day, you know, it gets a lot.

Scott Benner 1:02:55
Yeah, you don't have to listen to it all. I don't imagine you would. But, you know, I'll tell people over and over again. The way this social media thing works is that if I put one out a week the podcast, it would die. And no, like, six months, yeah, yeah, it doesn't work totally.

Anna Lisa 1:03:09
No, I, and I, yeah, I love the Facebook page. I love I'm not super active, but I go there and it, it's just that great that it's there camaraderie, yeah, it is. And you can take it or leave it like, it's kind of like you can go there when you need it, and, and it's really cool. I am really thankful for this space. I think it's been the most beneficial space that I've found. You know, I've had great medical care, I have great support, but it was really what I've needed to, you know, it's taken two years for me to really journey with it and recognize the grief that I've had to have. And I think even the grief of getting diagnosed as a young adult has kind of, you know, allowed me to be like, Oh, that's part of what's made it hard. But I can also, there's so many tools to always get back on the horse. So even when I had a really low time when I wasn't doing great a month or two ago, there's so many tools to get you back on. Like, okay, let me go through the Omnipod Pro Tip series again. Like, let me go through that reorient myself. Yeah, there's always a way forward. And the podcast and the fake Facebook page just are really those true, pragmatic tools of people who just don't give up with it because you can't, you can't give up.

Scott Benner 1:04:30
Thrill just helps you. Like, I mean, after talking to you for an hour now, I think it's pretty exceptional, and should be hopeful to other people that you really did just kind of try to say to yourself, like, I'm gonna ignore this a little bit, sure, yeah, and that you did it through your 20s and your 30s into your 40s. But then we're like, Okay, that's enough, and turned it around. That should be hopeful for everybody, like, no matter where you are in your process right now, yeah, you could do that. I mean, you did it. Anybody could do it, you

Anna Lisa 1:04:57
know, yeah, yeah, no. And there. Always tools, and there's always ways to move forward. And I appreciate that you have

Scott Benner 1:05:05
to have good tools and good settings and be a little focused on it, yeah. And then it's just back to where we started in this conversation. Like, I mean, I heard you say it because I'm the one that said it out loud, and you're like, you know that thing you said in the podcast about, like, I'm either going to do some work now or a lot of work later. Like, yeah, big picture. That works the same way too. Yeah? Anybody who tells me I don't have time, you're just telling me you're not ready to do it, yeah, that's all. Maybe you will be one day. Maybe you'll never be. I can't possibly know that. But anything you tell me when it's your health, right, when you're talking about diabetes, anything you tell me that starts with, well, I can't do it right now, or I can't focus on it right now. That's an excuse, right? Like, and I don't mean it like, in an insulting way, like you're making sure, yeah, you're making an excuse to stop yourself from diving into this and figuring it out. This health with diabetes is, like, I think sometimes maybe the most damaging thing you can say is I'm fine. Like, maybe that's mental health too. Like, I'm fine, I'm fine, I'm fine, I'm because you're fine until you're not, and then when you're not, you're going to realize you weren't fine. The whole time you were on a slow slippery slope. You've slid so far down it, now you're in a hole. And if at the first time you thought to yourself, Oh, I'm fine, you would have said, Honestly, you know what, I'm not like, let me stop here and fix it here, because then you would have been at the top of the hill still, and you would have fixed your thing, and you could have gone on your way. But you I find myself down into what, you know, three levels deep, and now you are going to take care of it, yeah? Like, because you're either going to take care of it or you're going to die, right? Going to die, right? Like, so you, so you take care of it, and now you're in that goddamn hole you got to climb out of. Like, just skip the part where you slide into the hole, do the thing at the end first, and then go live your happy life.

Anna Lisa 1:06:54
And I think that comes down to grief. Scott, I think if we don't fully grieve, what, whatever in life, in everything in life, whatever circumstance we have, if it's not what we wish was happening, if we don't fully grieve it, we don't really ever get to the root cause of it, and we can't ever really take care of it, because we're always silently holding on to that grief. We haven't grieved it yet. And I think if you don't get proactive in the grief, like, I think that there's something that, like, really powerful that happens when you get proactive during that grief, because that's when you're really gonna get in there.

Scott Benner 1:07:39
So then let me ask you a question, and if I'm wrong, I'm wrong. But like, going back to you talking about, like, I wanted to hide it a little bit. I didn't want people to see it right, using that, like, you know that diabetes colloquialism, like, diabetes isn't going to stop me. Like, that whole thing, like, yeah, I find when people say diabetes isn't going to stop me, some of them mean it's not going to stop me, and some of them mean, I'm just going to ignore it and do the stuff I want to do. Do you think that's what you did? Do you think that you were hiding it from yourself, so that you didn't so that you could pretend everything was okay because you didn't want to deal with it, and then two years ago, you decided to deal with it? Is that actually what happened

Anna Lisa 1:08:14
to you? I think I didn't know what I didn't know yet. I don't think I got curious enough. I think I got this well intentioned but wrong mindset that I could set it and forget it, and I was waiting or and like I would hear like, Oh, I love it. The I love this technology, because I don't have to think about my diabetes anymore. And I think that that's not true. I think every person who has really well controlled diabetes, think about it a ton. They've just gotten in there and they've gotten fluent at it, kind of like an athlete, right? Like, oh, they're a really natural athlete. Like, that's not true. Yeah, that person who's a really good athlete, they are practicing all the time, and they're thinking about whatever they're really good at all the time. It's just become enjoyable. And second nature.

Scott Benner 1:09:07
You've made this point twice, and I really appreciated it both times you've said it.

Anna Lisa 1:09:11
I really, I do. And I think for me, that has been a realization, like, also that I have to see taking care of my diabetes as enjoyable, like and I'm a data person, which is funny that it's taken me this long, because I do love data, and I'm all about data, so I should have thought it was enjoyable, but I think I was. I didn't totally realize that my mindset was backwards, like that. My mindset was setting me up for some failure. My exact experience, I've always been able to get through because I'm doing an okay job, right, like, and I think also, having never been hospitalized, I think kind of always been a low level diabetic almost did me wrong in the sense, like. I never had, like, an emergency, like, it's always just kind of been okay, like, a privileged person, right? Like, that's fine. Like, I've never experienced that.

Scott Benner 1:10:10
I'm fine, I'm fine, I'm fine, I'm fine. Then one day you're asleep on your son's bed.

Anna Lisa 1:10:14
Totally, yeah, totally. And I think even then it's like, well, I can be thankful, like, I have tools and resources to help me get through and so to help me get go from good to great, but to also grieve, I think, exactly what you're talking about to grieve that this is never going to be a set it and forget it, unless there's a cure, right? Unless that, but this is always going to be something that needs to be number one, two or three in my life, like, it's never going to when I let diabetes be number five or six in my life, that's when things start to go off the rails. Yeah, and I think that that's a wish that somebody like me has to grieve like, Oh, I wish it didn't have to be number one or two, but it does. But once I make it one or two, I can be like you and people who say like, oh, I, I don't really think about that anymore, but the truth is is you do, like, even with Arden right now, you are still consistently, constantly thinking about her diabetes and doing lots of things to make it great. It's just fluent and maybe even framed as enjoyable or framed as like, not bad.

Scott Benner 1:11:35
I'm just going to tell you that like this is, if you've heard me tell this, then I apologize. But you know, when I first became a stay at home dad, you know, for the first bit, I was like, well, just like, make sure he doesn't get hurt. I'll feed him. I'll keep him clean. Like, I'll do all the things you're supposed to do, right? But it's not until you realize that you have to, like, doing it. Want to do it. It has to be a thing. You wake up in the morning and you're like, you know what? I'm excited to do this. And if this means that I don't do another thing that I previously thought of is why I got up in the morning. That has to, that has to be good, right? And yeah, and that's what you're saying, is like, you you have to put some effort into diabetes every day. Yeah. And yes, at some point, you'll gather up enough experiences and enough good tools and ideas that you'll be in that spot that I've talked about, where I'm, like, I don't really think about it, but you are. You're doing it. You're just not right. It's just not burdening you. The word thinks almost wrong. It's almost like, I should say that diabetes doesn't feel like a burden all day long.

Anna Lisa 1:12:30
I think you have to be curious about it all the time.

Scott Benner 1:12:33
Yeah, yeah, yeah. You got to wonder what's happening and want to be involved with it. All right, you're pre that was awesome. I appreciate it. Thank you. Cool. Thanks, Scott. Hold on one second for me. That was great. Okay,

I'd like to thank the blood glucose meter that my daughter carries, the contour next gen blood glucose meter. Learn more and get started today at contour next.com/juicebox and don't forget, you may be paying more through your insurance right now for the meter you have then you would pay for the contour next gen in cash. There are links in the show notes of the audio app you're listening in right now, and links at Juicebox podcast.com to contour and all of the sponsors, thanks for tuning in today, and thanks to Medtronic diabetes for sponsoring this episode. We've been talking about Medtronic mini med 780 G system today, an automated insulin delivery system that helps make diabetes management easier day and night, whether it's their meal detection technology or the Medtronic extended infusion set. It all comes together to simplify life with diabetes. Go find out more at my link, Medtronic diabetes.com/juicebox,

the episode you just enjoyed was sponsored by the twist a ID system powered by tide pool if you want a commercially available insulin pump with twist loop that offers unmatched personalization and precision or peace of mind, you want twist, twist.com/juicebox,

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My grand rounds. Series was designed by listeners to tell doctors what they need, and it also helps you to understand what to ask for. There's a mental wellness series that addresses the emotional side of diabetes and practical ways to stay balanced. And when we talk about GLP medications, well, we'll break down what they are, how they may help you and if they fit into your diabetes management plan. What do these three things have in common? They're all available at Juicebox, podcast.com, up in the menu I know. Can be hard to find these things in a podcast app, so we've collected them all for you at Juicebox podcast.com the episode you just heard was professionally edited by wrong way recording, wrong wayrecording.com. You.

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