Scott Benner 10/23/25 Scott Benner 10/23/25

#1660 Kind of Type One

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Julie Davis, 39, is a medical PA and dietitian with Type 3C diabetes. After chronic pancreatitis led to pancreas removal, her islet cells were transplanted—an incredible twist in her autoimmune journey.

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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
Friends, we're all back together for the next episode of The Juicebox podcast. Welcome.

Julie 0:14
Hi there. I'm Julie, and I have no pancreas.

Scott Benner 0:17
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Julie 2:13
Hi there. I'm Julie, and I have no pancreas. Joy.

Speaker 1 2:17
Do you want to hear something insane? Sure. I did an interview yesterday with a woman who is type 3c

Julie 2:25
really, there's not a lot of us.

Scott Benner 2:27
And then I was sitting last night doing my work. I know people think, what work could you possibly have, Scott? But I was, I was I was up late watching the Phillies play and working. And I thought, Oh, let me see what I'm doing tomorrow, because Julie on Friday, tomorrow, tomorrow, yeah, I'm flying out to Orlando to speak at the touch by type one conference. And so I was like, oh, it just hit me. I'm like, if I'm recording tomorrow, which I probably am, that'll be my last one for a few days. Like, I'm gonna get a couple days off. I wonder who I'm gonna be talking to. I'm gonna be talking to Julie, and I opened up your notes, and it's like, and I was reading down, I thought, that's insane. Like, yeah, did I put something online that got people to reach out on the same day or but that doesn't make sense either, because when people go to the schedule, they're not picking, like, the next available day. They pick all over the place. So anyway, randomness of randomness. Here you are. It's wild. Yeah, what happened to you that you ended up in this situation?

Julie 3:27
Long story. We'll keep it long, I guess we have time. I had autoimmune pancreatitis, along with a lot of other autoimmune conditions that I'm sure we'll touch on. And in May of 2024, had to have my pancreas removed because it decided to act up and was not getting any better. And that was kind of the last resort.

Scott Benner 3:50
Okay, so how

Speaker 1 3:51
old are you now? 39 How old were you the first time you thought I have autoimmune issues?

Julie 3:57
Oh, well, I was diagnosed with celiac disease at 18, okay, and so that was the first and then ulcerative colitis was at 21 and then the autoimmune pancreatitis started when I was 25

Scott Benner 4:11
No kidding, and you are married now I am. Yeah. How old were you when you got married? Oh, 30. Okay. You have any kids? I have three kids, three. Wow. Yeah, that's, that's the number of kids it is. Yeah, we have three girls. Oh, wow, congratulations. That's lovely. Sounds hard. May I be honest? That sounds horrifying?

Julie 4:32
Well, you want to hear how it's more horrifying. They're twins, and then another one. So oh

Unknown Speaker 4:37
my gosh,

Julie 4:38
yeah, no, it's great. They're wonderful.

Speaker 1 4:40
It's great. They're wonderful. In case they hear that. Yeah, Arden and I were going to bed last night. We were the last two up. We were just kind of messing around and talking, and she was doing some homework and and I was, like, excited. I was working, and then I was she's like, I'm gonna go to bed. I'm like, me too, but you know, I'm gonna do the dishes for like, I'm the one that's gonna load the dishwasher at the end of the night, so I'm doing that. And she. Comes over to me, and she just goes, Can you imagine if you had another daughter? And I said, No, honestly, I can't I said, You're enough of a problem. I don't know if I could handle more people.

Julie 5:12
Yeah, we're kind of in the thick of it there. The twins are five, and the youngest is three, and so I think this, this stage is hard, and then pray for me in about like, seven or eight years, when they're all, like, pre teens, teenagers.

Scott Benner 5:24
I like that. You think this is the thick of it. You're never not going to be in the thick of it. Yeah. So, okay, so you have this kind of, you know, histrionic layering of different autoimmune issues. Let me ask you, in your extended family, does this also exist? Celiac, etc,

Julie 5:40
you know, I'm the first who was diagnosed with celiac, but I suspect my my grandmother, on my mom's side, may have had something, you know, going on. She had less of GI issues. My mom has dermatomyositis, which is pretty rare, and then my sister has Hashimotos. I also have hypothyroid, which I assume is Hashimotos. We just never checked antibodies initially, before I was treated, I

Scott Benner 6:03
see, I'm sorry, did you say your mom has the onomatopoeia? What does she have? Dermatomyositis?

Julie 6:09
It affects the skin and muscle tissues. It's another autoimmune condition. Oh,

Scott Benner 6:14
is that like a weakening of the skin and muscle? It's

Julie 6:17
inflammatory. It can kind of affect the proximal muscle group, so like, your hips and shoulders, joint pain, kind of arthritis, kind of in the RA, kind of, I say, I say, okay, family, I guess if you will,

Scott Benner 6:32
okay, let's talk about it. Let's go through it. Celiac, what's the adjustment like? What's the impact like, psychologically?

Julie 6:39
So I was diagnosed in 2004 before being gluten free was cool, and now it's much easier. I had GI issues, kind of growing up my whole life. I was baller ballerina. Had issues that I had to kind of work through with that and trying to, you know, navigate bathroom issues and dancing and all of that. And went to the doctors, you know, growing up, and they, they tested me for Crohn's and Colitis when I was younger, and that was negative at that point in my life. But then when I was 18, I got re scoped, tested, and they diagnosed me with celiac. Went gluten free. It was very difficult. At that point, everything tasted like cardboard, and there weren't, you know, gluten free restaurants everywhere nowadays, you can kind of go anywhere and find something, but did pretty well once I got gluten out of my diet for four or five years, and then in college, started having GI symptoms again. And I was like, I swear I'm not, like, cheating on my diet, I promise that. You know, yeah, it's going well. But started having GI symptoms again. They did another scope and diagnosed me with alternative colitis at that point, and so started on some medications for that, and did okay, really, until the pancreatitis stuff started, the UC kind of progressed, and I was started on a biologic medication. And I think that's when it really kind of hit me, oh, this is like, kind of a big deal, you know, going in to get IV infusions and whatnot. And was doing okay, but then I they added on another medication, and I got pancreatitis. They initially thought it was from the medication they gave me, so they stopped that, and then I just kept getting pancreatitis, kind of back to back to back. Over a course of six months, I was in and out of the hospital, and like, four or five times, I think right, ended up going up to Mayo Clinic to get a special biopsy, and that's when they diagnosed it as autoimmune pancreatitis, type two, which is frequently linked with ulcerative colitis. And so it's the more rare type of autoimmune pancreatitis treated with steroids for a while. By that point, it was already chronic. So my pancreas already showed signs of damage. I already had this extra current pancreatic insufficiency. So as you know, your pancreas does more than just provide insulin. Yeah, so I had to start taking pancreatic enzymes, and that helped kind of regain weight and kind of get back to a better baseline. And I did fairly well for a while. I was getting endoscopic nerve blocks about every four to six months, so going under for the pain. Okay, chronic pancreatitis is very painful, so I would get a nerve block. It would work, you know, it would hurt for a few more days, until the steroid part kicked in, and then it would help for about four or five months, it would start to wear off. I would go back and get another one. Did that for about 12 years, and then the nerve block stopped working in the fall of 23 and so I, you know, I started losing weight, couldn't really eat, lots of pain. Got to the point where I was like, Okay, this isn't this isn't cool, because I was doing so well, like I had all three of my girls did well through pregnancy, postpartum, all that, and then just. Really couldn't handle the pain, couldn't keep my nutrition up, lost a lot of weight, met with my GI doctor, and we were kind of like bouncing ideas around. We tried another nerve block just to see if maybe they didn't get the right spot the last time, and it didn't work. And so I started kind of digging on my own, and started reading about the surgery that I ended up having, and it was, it was a big decision to make. I mean, taking a whole organ out, and at that point, I never thought it would be my pancreas that would be removed. I thought, if anything, it would be my colon, because my ulcerative colitis, whenever the pancreatitis started, had progressed to like pan colitis. They were talking about possibly removing my colon during an ostomy, all of this. But thankfully, the the infusions worked, and they have worked for quite some time, as far as that condition that's in remission, so that I'm still on the infusions about every eight weeks now, but yeah, decided to get my pancreas removed, and it kind of went fast from there, met with the surgical team in February of 24 and had it out in May of 24 so pretty quick process, once I made the decision to get it removed,

Scott Benner 11:11
would you describe the pain for me? It felt like

Julie 11:15
there was someone stabbing me between my rib cage, like right underneath my sternum constantly, and it radiated to my back, lots of nausea and just constant gnawing pain.

Scott Benner 11:29
It was terrible, and it would last for how long? When it happened constant,

Julie 11:33
like, it just didn't stop. Like, yeah, once the nerve blocks stopped working, it was just always there.

Scott Benner 11:38
Wow, did the nerve blocks have any unintended consequences that you didn't like or

Julie 11:44
No, I mean, they always made me hurt for a few days after, because you learn I'm a PA. And when you go through any kind of medical training, you learn like, don't mess with the pancreas, and you go in there and you stick a needle in it, you know it's gonna hurt for a few days until the the medications kick in, but then after that, like it, it did its job, it did what it was supposed to do. And not a lot of people get the relief from that kind of procedure, but it worked for me for 12 years, and so I was kind of caught off guard when it stopped working. Yeah,

Scott Benner 12:16
no judgment for me. But were you self medicating anything for the pain, or just sitting there and suffering?

Julie 12:21
No, I mean, I had a PRN prescription for pain medication, but didn't really like to use it. I don't like the way it makes me feel. You know, I got to the point towards the end there, before surgery, that I was having to take it at night, like I would just suck it up during the day and take it at night so I could sleep. I haven't had a lick of alcohol in years. I mean, it's just it wasn't caused by that. A lot of people think pancreatitis is only caused by, you know, drinking too much.

Scott Benner 12:46
But do people think that?

Julie 12:48
No, I think a lot

Speaker 1 12:50
of people do. Okay, no. I just meant, like, did it get so overwhelming that you were like, oh, I'll just take a little heroin or, you know, like, something like that. I mean, because pain is constant, pain is difficult to put into context. Yeah, it is. I mean, it just wears you down after a while, mentally, physically, yeah, emotionally, the whole thing, right? How did you manage dating and all that through that? That's crazy, like

Julie 13:14
did he, you know, during my dating life, I mean, everything was pretty well controlled with the nerve blocks. I met my husband. He's a physician. I'm a PA. We met in med school. PA school, okay? And he kind of knew off the bat, like I told him everything, you know. Because I'm like, Hey, I come with all these problems, you know, you still like me. And ironically, shortly after we started dating, I was, it was in the middle of PA school, I got admitted to the hospital for a little flare up. And I was like, okay, you know, if he sticks around, he's in it for the long haul. Yeah. And that was really the last flare I had. That was, I think, 2016 until everything started going awry in 2023 you could

Scott Benner 13:55
have just said I had him on the hook already, Scott, and I would have understood. But Well, that's, that's like, I mean, a lot of people bail on medical stuff, so that is very cool. Geez. I was struck, I think most, by your story, that you felt like you were preparing to have your colon removed. You've probably heard me talk about us Med and how simple it is to reorder with us med using their email system. But did you know that if you don't see the email and you're set up for this, you have to settle up. They don't just randomly call you, but I'm set up to be called if I don't respond to the email, because I don't trust myself 100% so one time I didn't respond to the email, and the phone rings the house. It's like, ring. You know how it works? And I picked it up. I was like, hello, and it was just the recording was like, US med doesn't actually sound like that, but you know what I'm saying? It said, Hey, you're I don't remember exactly what it says, but it's basically like, Hey, your order's ready. You want us to send it? Push this button if you want us to send it, or if you'd like to wait. I think it lets you put it off, like, a couple of weeks, or push this button for that. That's pretty much it. I pushed the button to send it, and if. Days later, box right at my door. That's it us. Med.com/juicebox, or call 888-721-1514, get your free benefits checked now and get started with us. Med, Dexcom, Omnipod, tandem freestyle, they've got all your favorites, even that new eyelet pump. Check them out now at us, med.com/juicebox or by calling 888-721-1514, there are links in the show notes of your podcast player and links at Juicebox podcast.com to us, med and all the sponsors. Let's talk about the tandem Moby insulin pump from today's sponsor, tandem diabetes care, their newest algorithm control, iq plus technology and the new tandem mobi pump offer you unique opportunities to have better control. It's the only system with auto Bolus that helps with missed meals and preventing hyperglycemia, the only system with a dedicated sleep setting, and the only system with off or on body wear options. Tandem mobi gives you more discretion, freedom and options for how to manage your diabetes. This is their best algorithm ever, and they'd like you to check it out at tandem diabetes.com/juicebox, when you get to my link, you're going to see integrations with Dexcom sensors and a ton of other information that's going to help you learn about tandems, tiny pump that's big on control tandem diabetes.com/juicebox. The tandem mobi system is available for people ages two and up who want an automated delivery system to help them sleep better, wake up in range and address high blood sugars with auto Bolus,

Julie 16:41
yeah. I mean, at one point that was, you know, part of the discussions if the infusions hadn't worked, and they talk about that. I was 25 when I went up there, so I went up there for my pancreas, but I saw the IBD team, ulcerative colitis team as well, and they were like, Yeah, you know, it's not just your pancreas that's messed up right now. It's your colon. It's like your whole GI tract. So they kind of presented options, and they said, if the medications don't work, we might have to remove your colon, but then you would probably have an ostomy until you're done having kids, because if you put it back together, then, you know, there's scar tissue that could make issues, you know, with that. And so, I mean, there were so many things to think about when I was 25 and, you know, just kind of living my

Scott Benner 17:25
life. Yeah, I was gonna ask that you had, did you have any backup from family or anything during this?

Julie 17:30
Yes, I have very supportive family. My mom went up there with me, my now husband, his family has been great through this whole process. So awesome. We've got a lot of support, thankfully. I'm

Speaker 1 17:41
going to ask a bummer of a question, sure. Do you worry about your girls?

Julie 17:45
I do all the time. You know, actually one of them has already been diagnosed with celiac because we started screening early, and there is actually type one on my husband's side of the family. And so I worry, just with the autoimmune kind of history on both sides, and I'm a medical professional, so I kind of, I get overly concerned about certain things, and I am, like, not concerned about other things. So it's kind of, you know, picking your battles and just trying to stay on top of everything,

Scott Benner 18:15
telling me your girls are out of the sunroof doing donuts, and you're like, that's fine. I don't worry about that. I got enough to worry about over here with this autoimmune stuff. You

Julie 18:23
know, actually, one of the youngest she fell off her day, her chair at the dinner table the other night and broke a clavicle. And I just was like, Okay, we're going to urgent care, get you in a sling, and you just kind of like, roll with it. You know, it's, it's terrible. I feel bad for her. She's only three, but, geez, just doing what I do for a living. I was kind of like, okay, what

Speaker 1 18:43
goes next? Talk about, if you would? I mean, I was gonna sound overly dramatic, but would you talk a little bit about the feeling of, like your body, kind of like repelling against you constantly. And, yeah, what does that feel like when you're when you're existing through it?

Julie 18:59
You know, it's, it's frustrating, because sometimes you get to, you know, that kind of woe is me, like, Why? Why do I have to deal with all of these things when other people, you know, all they the worst they ever get is, like a cold. And I'm like, you know, how many things can one person handle? I try to just take it day by day. And, you know, just deal with it, move on with my life. I think that most people you know who know me, they are like, Yeah, I mean, you would never know that you've got all these things that you're managing, because you just kind of deal with it and move on. I think sometimes there's a little bit of doing that too much where I don't want myself just like, accept the fact that this kind of sucks, you know, yeah, I think it's acknowledging, yes, it could be worse, but what I'm dealing with is actually pretty terrible. So, yeah,

Speaker 1 19:51
I interviewed a guy once who had, I don't know the technical term for it, right, but he had his whole, like, that colon and this, everything was just gone, right? And he got the he had. Bag and everything else. And it was from the same thing, like, he couldn't, like, live, yeah, he's constantly, you know, sick or in pain or in the bathroom, you know, like, etc, and just kind of horrifying. It's one of those episodes I didn't know what to say to him half the time, yeah, when he was telling his story, because you're just like, oh God. Like,

Unknown Speaker 20:18
it sounds so like, I think it's,

Scott Benner 20:21
I'm not gonna find the right word, but I think it's hard to, like, see it, because it's about going to the bathroom. And people are like, You know what I mean, like, but you

Julie 20:30
don't really want to talk about your bathroom habits and all that.

Scott Benner 20:33
Yeah, you talked around it. In the beginning. You were like, Oh, I was a ballerina, and I had to, like, you know, like, you didn't want to say, like, you know, I didn't want to myself, while I was like, you know, like, yeah, you're trying to avoid saying those things and yeah, because it all sounds not funny, but like, you know, it's ridiculous, and it's not things we talk about generally, out loud and right? But it's really, really impactful on your life.

Julie 20:54
It is. And I mean, I was a dietitian before I was a PA, and I work, you know, in a children's hospital, and have attended and been a counselor for the Crohn's Colitis camps. I was an adult when I started dealing with all I mean, I guess, you know, the symptoms started when I was a teenager, but when I was diagnosed, I was an adult, but seeing really young kids go through this, it's devastating. I mean, it's just, you know, you just feel for them, because you're like, I'm having to deal with this as an adult. And even seeing my daughter, who's navigating being gluten free since she was diagnosed when she was three, and just the social impacts on that, and just her saying, Mommy, why did God make me gluten free? You know, like, I don't want to be and it's okay for her to have a tantrum and cry because she didn't get a cupcake at the pre K graduation. But as an adult, I can't do that, you know? And I'm like, I go to a meeting and I can't eat anything unless I bring my own food a lot of the times. And I'm like, Man, I really want to have a tantrum right now, but I can't, because I'm an adult.

Scott Benner 21:56
I don't know Julie, I think it might be awesome if in the middle of a meeting you were just like, there's nothing for me to eat here. This isn't fair.

Julie 22:03
Yeah, I know it's, I mean, that's what I want to do sometimes, and I've been dealing with that for, you know, however long it's been almost 20 years

Scott Benner 22:11
now. Yeah, no. I mean, I can't imagine, honestly, I don't, I really don't know how to like to commiserate with you, even it's very, I think it's much more impactful than maybe first glance would say, Yeah, okay. So, so they, they jump in there and take out your pancreas, and now suddenly, you know, those enzymes are gone. Beta cells are gone. Like, there's, you know, you're not making insulin, you're you wake up. I mean, that's got to be the most shocking part, right? Like,

Julie 22:36
so they actually, it's, it's a cool procedure. It's not cool that I had to have it done. They actually, harvested my islet cells. And so they took my islet cells and put them in through my liver. And so now I have, I have some insulin production from my liver through my own, my own islet cells. They told me beforehand, about a third of people don't need insulin for a period of time, like their islet cells work well, a third of people need some insulin, you know, like a low basal rate, you know, some mealtime insulin, and then about a third of people are like a brittle diabetic. And so my surgeon did warn me that ahead of time, that people with autoimmune conditions tend to not have as great of an outcome. So they, they harvest the islet cells, and they, they have this, like goal number to get, and I got a great number of islet cells, but I, I'm on a pump, so I have, like, partial, you know, partial function of my islet cells. They say I have meaningful function, but I would kind of equate it to like a honeymooning diabetic, because it's very unpredictable. Some days I need very little insulin. I mean, I'm on a pump now, so, you know, I have a basal rate, which is pretty low, and then I need more, I think, at mealtime, than I do basal. But then other days I need, like, twice as much. And so it's kind of going back and forth and having different settings and all of that. So it's been an interesting journey. Yeah,

Scott Benner 24:03
also, I would imagine the gluten free foods are a little more carb heavy too. Yes, yeah. So it's an added level,

Julie 24:09
and I'm not one to like restrict carbs. I like my carbs. I eat my carbs, and so I've learned how to dose for them thanks to your podcast. Yeah, it's been a it's been an interesting ride, and I've learned a lot more, and have a lot more respect for type one diabetics than I ever had

Scott Benner 24:23
before. Yeah, right, especially in your job now, it probably is valuable, yeah, can I ask you swapping the pain for, you know, having diabetes, right? And so is there any way for me to ask you, in a way that you could actually answer, if it was worth it, it was, it was okay.

Julie 24:42
Yeah, there are new challenges, as you know, but I could not function. I was not, you know, I was kind of just going through the motions before the surgery, because I got to the point where I had lost 20 pounds, and I'm. Not a big person to begin with. I was weak. I was just tired all the time, which I'm still tired all the time. But who knows? That could just be having three young kids, but we could wonder what your TSH is. Oh, my TSH is great. I get that checked regularly. Yeah. Do you know what it is? It's like, 1.1

Scott Benner 25:17
it is great. Okay, how about how Hold on. We'll help. Maybe you're having trouble picking up the t3 Have you tried like cita

Julie 25:25
mill? I'm on CDE mill. I've actually been on site Amel since I was diagnosed, almost initially, when I was diagnosed with the thyroid issue, I had a great endocrinologist, or not endocrinologist, she was a primary care and she actually put me on both initially and the funny thing is that I was treated. So shortly after I was diagnosed with celiac, you know, on the gluten free diet, I started to be treated for depression. And it turned out it was really just my thyroid, because I was able to get off of those medications

Scott Benner 25:56
as soon as the thyroid meds came quickly, once I got my thyroid, I'm just gonna say, where did you find a good doctor? That's awesome. You know, I

Julie 26:03
think I just got lucky, and I've had good, good ones since then. My endocrinologist that I see now, she works pretty closely with the the transplant. It's, it's actually considered transplant surgery, but the transplant islet cell team and is pretty familiar with the very unique needs of the kind of type 3c I mean, 3c kind of can be just because you have damage, but it can also be because you have surgery on your pancreas or got it removed completely, like I did. So she's been really great at, you know, helping me manage both my thyroid and my insulin needs afterwards.

Scott Benner 26:42
I wish, I hope that everybody listens, because, I mean, thyroid issues, you know, mixed in with other autoimmune is not uncommon. Yeah, it doesn't mean you're gonna have it, but it's not uncommon. And I just helped a guy online this morning, this morning, who put his thyroid labs up and was asking a different question about the labs. And my eye was like, Hey, your TSH is like, over four, yeah. And I said, Are you taking medication? Yes. And I said, Do you have symptoms? What symptoms? I listed, like, I don't know, 10 or 15 of them, all of them. He's like, I got a lot of these. And I was like, Yeah, your TSH is way too high, yeah. And they What do I do? And I was like, yeah, go back to the doctor and tell him, Look, you need to medicate me under, under. Get me under two is what I you know, is what I said, Yeah. And you say, Oh, that's great. Thank you. Like, nobody, like, how is that the randomness that your doctor was not just, like, on top of it was like, also, here, take some CDE. No, do this. Blah, blah, blah, and that person's doctors telling them, like, you're

Julie 27:36
good, yeah, it's interesting. I don't, I don't know, as a medical professional, I know that we go by, like, evidence base and all of this, but I feel like you have to listen to your patients and, you know, okay, you're still having symptoms. And I, we went through IVF for all three of my girls. And they, those reproductive endocrinologists, are pretty good at, you know, saying, okay, pregnancy, you've got to be in this range, because especially if you're doing IVF, like, they're not, those embryos are not going to stick. If your thyroid is out of

Scott Benner 28:05
whack, it'd be nice if they'd share that with other physicians. That'd be great. Yeah, yeah.

Julie 28:09
So, I mean, I always try to keep mine as close to one as possible. And some, sometimes they check it and they're like, Oh, you're getting a little too hypo. I'm like, or hype, you know, your TSH is too suppressed. And I'm like, No, I'm good. I feel good.

Scott Benner 28:22
So if my eyes start popping out, we'll do something. But right now, I like where I'm at, yeah. Okay, awesome. I like that you're on top of this. How has your experience, personally, medically impacted? The kind of PA you are.

Julie 28:36
I am very detail oriented. I feel like having so many issues that have honestly been kind of in that vague diagnostic range, like my my celiac didn't have, like, the super high antibody levels, but it was diagnostic on a scope. And then my thyroid was never really super high, but I had that great doctor that was like, I think it's your thyroid. It's sub clinical. You know, it doesn't meet these lab criteria, but let's treat you. I think it gives me the motivation to, like, really listen. I work in pediatrics, so I'm mostly listening to the parents, but listen to the parents and say, okay, like I hear you. We'll dig into that further, rather than just being like, Oh, well, everything's normal. How do you

Scott Benner 29:24
have the time to do it when all I hear from people is, oh, these appointments are only 20 minutes long, and I don't have time to do all this with them. And how do you Yeah,

Julie 29:31
I mean, I work in the hospital now, so it's a little different than being in an outpatient clinic. I think you just have to, have to take the time it's I can validate that, like being in an outpatient clinic, they're seeing sometimes, like 30 kids in a day, so they don't really have the time, but finding ways to, you know, work it into your practice and improve your workflow in other ways so that you have the time or have the the I don't know. I guess, systems. It up to where you're able to do that, right?

Scott Benner 30:01
Wouldn't it be awesome if there was a person in the room with you doing the more diagnostic stuff, and then once that person came up with a, you know, a root cause, they could hand you off to a different person and say, All right, now I'll put it in that. Like, let's put the thing into action instead of, like, because you don't have time to stand there and go nuts the bolts, you know, A to Z on it. Like, I don't know functionally, why someone, I'm assuming, because they don't want to pay somebody. But, like, if, where you can't bill for it, or whatever it is, yeah, but it sucks that, you know people like struggle so long to get answers, and they're so close to them, and then they don't get a resolution still,

Julie 30:37
yeah. I mean, there are, there are things that they're kind of implementing to try to improve workflow, like they're doing some AI, like, for charting and stuff like that, which is cool. It's cool to see where, like, medicine is going, because it's all about, you know, the bottom line at the end of the day, I feel like with most of the big, you know, companies, is billing and, you know, seeing more patients and all of that, but you've got to have those workflow processes streamlined so that you can be quick, so you can actually do what you need to do. I

Scott Benner 31:09
see some companies developing AI tools. One of them, I thought was interesting, was, when you're seeing your clinician, you're basically you're being recorded the entire time it's listening, and then as soon as it's over, the complete like, notes are there for charts, the note? Yeah, charts, the note. It's pretty cool. And that way nothing gets missed. And you can, you know, have the AI, you know, kind of cross reference things that maybe a human might miss. Yeah, anyway, interesting stuff. You're good, you you're happy, is probably the wrong word, but, but you're, you're happy to be rid of the pain, I guess. And yes, now you're learning about diabetes. How long ago was this? Again, it's a year or so,

Julie 31:47
May of 24 so almost a year and a half. Okay, yeah. I mean, it's been a journey. I can't even remember when I first found the podcast, but I think I found it with the one you had, one other patient who had the same surgery as me a while back. I think it was like, Jen has no pancreas or something like that.

Scott Benner 32:10
I've had a couple, but they were longer ago. Yeah. And

Julie 32:14
so I listened to that, and then I was like, hmm, what else does he have to offer? And so I started just kind of binging the the podcast and learning all about, like, Pre-Bolus thing and, you know, chicken basal rates and all of this. And like I said, I have a great endocrinologist, but I think I've learned more on just the fine tuning listening to the podcast and kind of digging into that

Scott Benner 32:34
awesome, Oh, that's great. And so you're just searching for people with stories like yours, and that's how you found it. Oh, wow, does your husband get involved in your diabetes care? And if not, is that your decision or his? Or what do you think the vibe is?

Julie 32:51
He follows my Dexcom because he and my mom both follow it, just for safety reasons. He doesn't

Scott Benner 32:57
want to raise three little girls by himself. Is that why? Yeah, yeah. I

Julie 33:01
mean, occasionally, you know, Dexcom will be doing its crazy thing. And I mean, last night, I had to laugh. I woke up this morning after my I had a new sensor on, and it was doing the whole like, every five minutes, turning off, and like, having a sensor error. I ended up pulling it this morning. So I didn't sleep very well last night because it kept going off and I got, you know, the sugar pixel, and so that's beeping and buzzing. And I woke up this morning. I looked at him, I said, I'm so sorry that probably kept waking you up too. He was like, it's fine. You're good.

Speaker 1 33:32
It's okay. Everything's fine. We're gonna live you guys are in

Julie 33:39
your, what, late 30s. I'm actually older than him. Yeah, he's 34

Speaker 1 33:44
No kidding, good for you. Joy, yeah. How'd you do that? How'd you pull that?

Julie 33:50
The funny part about that is that before I went on a date with him, I text my friend, and I was like me, I don't know. I mean, he's only 25 I don't know, but he acts like an old man, so he acts

Scott Benner 34:02
like an old man. So it works yeah, it works out, yeah, right now, oh, I can't say this. Can I say? No, I can't say that. Sorry. I don't do that very often. So, you know, it must be somebody close to me, but I think it's funny because I can't say to a guy, Hey, how'd you pull a young girl? Awesome. But when you but you can say it to women and like, I know, right? I did it, yeah, but you have to find that balance right of like, older soul and right and I'm not wrong, am I that? Like, sometimes women in their mid 20s, because I think women can mature a little more quickly they stop, like, maybe it's not easy to date guys your own age. Is that? Is that kind of how it

Julie 34:43
works sometimes? And I mean, so I had a whole, like, two careers before I went to PA school. So I was a professional ballerina first, and then I was a dietitian. And so I went, I started PA school at 27 And I think some somewhere around there. And he went straight from college to med school. And so, you know, when we're starting to, like, do the married thing, you know, get engaged and kind of look at all these things, I'm like, you've never actually, like adulted

Scott Benner 35:16
college the whole time.

Julie 35:17
And so, I mean, I had to kind of go through some of those things, but, yeah, I mean, he's he's great, he's wonderful. So it all worked out

Scott Benner 35:25
for us. That's right, it's really great. What made you want to do this like, I mean, there's not a ton of stories like yours on the podcast, but, but what made you want to add yours to it?

Julie 35:36
I think because there's not a lot of stories out there, and because I've found just being able to relate to people. I think you hear that a lot doing what you do, that a lot of people come on because they found like community in other people's stories, and just knowing that, like, you're not alone, and there's other people dealing with the same things you are, whether it's having your pancreas removed or, you know, being woken up by your Dexcom overnight. I mean, it's, it's nice to know that there's other people out there dealing with the same thing.

Scott Benner 36:05
Yeah, I appreciate doing it. We kind of talked a little bit already that, like, some of these gluten free foods are higher in carbs and maybe a little more difficult to Bolus for so where can I ask you first, like, where do you have your A, 1c What's your variability look like?

Julie 36:18
You know, my last a 1c was 5.4 the highest it got was post surgery was 5.9 so it's, you know, it's kind of a different story than your, you know, type one being diagnosed in DK. And, you know, these a one CS and the thirteens, because I was not diabetic before, thankfully, and I have the islet cells, and so it's different, but it's the day to day. You know, management is similar, I

Scott Benner 36:45
guess is the best way to put that. Yeah, you said you're in a pump. What pump you on? Moby. Moby. Okay, so you got the tandem, Moby, tandem diabetes.com/juicebox Sorry, I just need you guys to click on, keep making the podcast. So you're wearing tandem. And did they help you set up your insulin needs, like, the they like, because I've heard those stories too, about, like, people get the surgery, and then the surgeon, who's the person you have contact with, is like, well, good luck. You have diabetes now, but we don't help with that. Like, what's, what's that initial

Julie 37:12
I mean, like I said, they work closely with an endocrinologist there who's really wonderful. I was initially on MDI novologinlantis or whatever, for like, three months. And she very quickly was like, I think you're gonna, you're gonna be on this, you know, longer term. Because the the first, I don't know, like, two or three months, your islet cells are kind of just like implanting into your liver, and so you don't really know what your ultimate function is going to be. And so initially they had me on, you know, the MDI, but the problem I was having was I really needed those, like, I almost probably should have gotten on, like the junior pens, because I needed sometimes, just like a half unit once she, you know, got everything set up to get me on the pump. And I got on the pump, I was like, Oh, this is so nice, because I can Bolus just like, a quarter unit, or, you know, a half unit, or whatever, one and a half. So she had taken, I guess, the the MDI dose and given me settings to start with. And we kind of checked in about every three months. I think it was little sooner initially, like maybe once a month, and she helped make adjustments. But then from there, I started making adjustments on my own, and she was fine with that, because she kind of knows my background, and, you know, I'm not having a lot of loads

Scott Benner 38:37
sorry to being, like, detail oriented, having a medical background already, like, you were, yeah, well,

Julie 38:42
and I already knew how to carb count. And so, like, yeah, I was a dietitian, like I said, I did a little bit of work in Endo. I mostly work in pulmonary, but did a little bit of work in endo when I was a dietitian, and so I knew how to carb count. That wasn't foreign to me. And I'm I was thinking, people come out of this surgery, and they don't know anything about diabetes, and they do have an educator in the hospital that comes and talks with you, but it's very basic, as you know, and so I think that the fact that I didn't have to learn that on top of learning how to manage the insulin was helpful.

Scott Benner 39:18
Okay, now it makes a lot of sense also, you know, it's funny, you said dancing in the vein, but then you said professional, because if you were a professional ballerina, what are you like, five six, like 95 pounds, like something

Julie 39:28
like that, not quite that small. No, I'm five seven. Yeah, because you're a little

Scott Benner 39:32
tall, I would imagine to be a pro, you'd have to be a little taller, right? And then,

Julie 39:36
you know, it's, it's funny, because you think that they're tall, but actually my height sometimes was a downside, because if, if you're on point, up on your tippy toes, and you're taller than the men that are partnering you, there's a problem.

Scott Benner 39:49
Oh, okay, so, oh, that's interesting. So you were a little taller for the game to begin with, yep, gotcha. But you're a smaller person, like, so not a lot of, I'm guessing, not a lot of body fat, like. That kind of stuff, right, right, right. Okay. And then so your needs are lower to begin with, plus, you've got the help coming from your liver, pancreas, yes, which awesome. And isn't that great that they could just put them in there and you didn't need any? I

Julie 40:13
mean, it's wild, yeah, like, when I read about it, I was like, seriously, they they're doing that. And then I kind of went on this deep dive, just learning more about the surgery. And I can't remember the specifics on how they figured that out, like, oh, maybe we can do this. I think they were trying to test some something for type one, and then they figured out they could do this. And then they, you know, did the surgery. And they actually do transplants, you know, occasionally in these like brittle type one diabetics of a donor pancreas, but then they have to be on immunosuppressants,

Scott Benner 40:43
right? So then there's a different challenge. Almost every person that I've spoken to with 3c says that they eventually just end up telling people they have type one because it's either too much to explain or they find pushback. You get the Oh, you don't really have type one. Have you experienced any of that?

Julie 41:04
Not completely. I usually, I think the way I say it is, I'm a diabetic now I'm treated like a type one, but it's because I have no pancreas. So I don't usually use the terminology 3c just because it's not super well known. I didn't teach us that

Scott Benner 41:22
in school. What about online? Do you have any problems online? You know,

Julie 41:26
I'm in the Facebook group. I don't really post. I kind of just watch and read. Okay, no, I haven't really run into a lot of it.

Speaker 1 41:35
Awesome. I'm good because, yeah, I don't particularly understand it so, but every once in a while, I'll see somebody gets the like, you don't have diabetes, like, and I don't know if it means like, you didn't go through the struggle I went through, or like, I wasn't 100% sure. So, okay,

Julie 41:52
yeah. I mean, I've, I've heard people having issues like that, but I haven't personally experienced it, thankfully,

Scott Benner 41:57
any perspectives or that you can bring to this as a person who doesn't go through the trauma of being diagnosed or misdiagnosed. Is there like when you hear other people's stories, is there anything you'd ever want to share that that you've seen or or see that? Does that make sense, that your perspective might lend itself to? I don't know. That's a terrible it's a terrible question. I'm trying to figure out, let me let me start again. Let me start again. Hold on a second. You're coming at it from a completely different situation, but you're ending up in the same space, right? I need insulin. And other people come on here all the time and tell their stories about like I got sick. I was sick for months. I didn't know. I was diagnosed as a type two, and it wasn't type two, it was type one. When you're listening to that, do you ever think, what's your response when you hear those stories? Does it make you feel any certain

Unknown Speaker 42:47
way? I

Julie 42:48
feel bad for them because they're not getting the appropriate treatment. I think that it's important for them to also share their stories, because I don't know how many medical professionals just happened to listen to your podcast, but you know, the information is getting out there. And I think that, you know, if you're a professional medical professional working with adults who come in, you know, you've got to keep that in your horizon. And I think there's probably more awareness now than there was, you know, five or six years ago. I'm in this pa group that I've seen that story come up a few different times, and there's a lot of type ones that are like, hey, you know, you might want to get checked for antibodies, because I think you probably have type one, not type two. And so it's kind of even in medical professionals to be told like, Hey, you might actually need to get re diagnosed. And they're people who have the knowledge, but it's just, you know, their doctor didn't think of it, or they also go through that misdiagnosis story, and, you know, I feel for them, because I've been through, oh, you just have IBS and, no, I actually had like, three different autoimmune diseases that eventually were diagnosed. I didn't just have an irritable bowel, you know,

Scott Benner 44:00
right, right. Did you grow up near I'm just making things up now, but by power lines or waste dump or do you have any, gosh, no.

Julie 44:09
I mean, I moved around. My dad was in the meetings industry, hotel business kind of stuff, so we moved around a bit. But I don't think I was near anything toxic.

Scott Benner 44:18
I don't want to just like, sound like a, you know, it's not a conspiracy, but there's a lot of autoimmune stuff going on in the world. Yes, and you know, if we go back 75 years, does this not exist, or does it exist in a way that we don't talk about, or that they didn't even talk about back then? Like, I really do wonder.

Julie 44:35
I think it's our food system. I mean, not to be conspiracy theorist, but I mean, look at, look at the way they're producing our food nowadays. And there's just a lot of food that's not food, it's chemicals and, you know, hormone disruptors and all of that. And I mean, I look at, I look at my daughter, and I'm thankful that we had her diagnosed early, and she's on her gluten free diet, and I pray that that's all she'll ever be diagnosed. With, I was looking at an article on, I think it was on the celiac foundation or something, that was kind of talking about how, if you're diagnosed early, it can hopefully prevent your immune system from attacking these other, you know, organs or whatever. And so I look, you know, I wasn't diagnosed till I was 18. Did my gluten free diet did well with it, but still had two other, three other things, you know, diagnosed in the following years. I think that there's a lot going on with our environment and our food system, to be

Scott Benner 45:28
honest. And you're wondering if having celiac undiagnosed for a while maybe led to the chronic pancreatitis and the other stuff. Yeah.

Julie 45:36
I mean, you think about if your immune system is that dysregulated, then it's gonna probably attack other organs. You know, it's interesting. You

Scott Benner 45:46
know, this is gonna sound obtuse for a second, but I guess that for people who listen, they're pretty aware. I have a couple of chameleons in the room here with me, and you know, they eat bugs. When you get into reptile keeping and you go find people who know what they're talking about, one of the first things that they will vociferously pound into your head is that you have to feed the bugs. Well, right? Where the reptiles won't be okay, right? Yeah, I believe it. If you feed those reptiles a shell, a husk with no nutrition in it, then it's not taking any nutrition, and then you are going to see long term problems, not right away, because it's eating and, you know, it is sustained to some degree, but you'll see problems. Their lifespans will be shorter. They might develop metabolic bone disease if they don't have the right amount of calcium that they take in, like little like things like that, that really are what you just said, which is, you know, the food system, if it's tainted or not up the snuff or whatever, you're going to have weird dysregulation down the line that nobody expected. And you also can't be upset, because you have to imagine, like with technology, that's now probably 5075, years old, people had to come to grips with the fact that there's a lot more people here, and we need to feed them, right, right? And they probably did the best they could. And you know, then weeds came, and they were like, oh, we can't have all these weeds. And, like, what are we gonna do? And then, you know, they said, Oh, we spray them, yeah, can't spray the weed killer on it kills the carrots too. Well. What if we genetically cross the carrots that they would be like, blah, blah. And then we'll just spray it everywhere. Yeah, right. And then, boom, then, you know, all that just keeps piling up. And then all of a sudden, some nice girl named Julie is pooping a lot. You're like, whoa. What happened? Yeah, or I'm anemic, or my kids got diabetes, or whatever else, even if, right now, like, if you if Julie, if you had the magic wand answer, and you were like, oh, you know, I know all the reasons. I don't know how the hell anybody would fix it, undo it, right? Yeah, right. Like, I was talking to somebody the other day, and I said, I feel like where we are societally is like, a bunch of extension cords that are, like, twisted up in knots and everything. And at this point, you're like, I don't know how to unknot these, but they're still passing the electricity through them, so let's just leave them in a pile and keep using them. Yeah,

Julie 48:01
yeah. Well. And, I mean, your your immune system is a lot from your gut. And so if you're if your guts not healthy, then, I mean, it makes sense that everything else is out of whack, exactly.

Scott Benner 48:13
Again, you know, going back to, like, what sounds silly to some people when you're talking about it, I think the words gut health make a lot of people go, okay, hippie, yeah, there's no way. I'll tell you the quickest story that I think makes my point about I don't know how to figure out what gut health is right or wrong, or how to fix it, or whatever, but it's super important, and we should figure it out that Arden suffers off and on with acne, and it can be worse or better at times, right? And we've done all kinds of different things to help her with it. GLP, helps her with it a little bit. Other things help her with it. Blah, blah. But she recently gets sick, bad tonsillitis, really, really bad tonsillitis, and the doctor first gives her an oral antibiotic, which doesn't touch the tonsillitis, by the way, but in three days, completely clears up her face. Yeah. What did that antibiotic do? In three days, it killed different bacterias in her stomach, right, right? And in her body and etc, and so on and so forth. And while she was on that antibiotic, four or five days, her skin looked perfect. Then the doctor's like, oh, this. Antibiotics not helping. It's not touching the the tonsil problem. I'll switch you to another one, but I noticed it enough to go take her to a dermatologist and say, hey, look, this is what happened. And, you know, like, so she was able to get help a different way. But, you know, most people aren't going to see that. And I'm not special for seeing it. I'm just in a weird position where, like, I don't know because of what I do for a living, and like, how many of these conversations I had? I'm like, I don't know. I'm just a little more dialed in, probably than the average person, right? I just don't think in a million years, most people would have put that together, right? But there it was, changed her gut, and something you would never expect to be impacted by that was suddenly different. And I just wonder. What else, honestly, you know, like, what else is is being impacted that you don't know about, and what do you do about it when you know, like, I don't think, I mean, honestly, you're a nutritionist. What's the difference between buying, you know, something in the group, a pepper that says, like, here it's a pepper, and this one's, like, here it's a pepper, it's cleaner. Like, I mean, is it like, I don't know, yeah.

Julie 50:20
I mean, it's, it's interesting to kind of be in the dietitian, but also a PA and, like, you want to do evidence based medicine and all of this, but there's not a lot of, I don't know if you will, funding to, like, look at some of the more hippie or crunchy, you know, things I try. I would say I'm sort of crunchy, you know, I practice evidence based medicine, but I also believe in, you know, gut health and feeding your kids well and preventing disease, if you can, things like that.

Scott Benner 50:50
So the details on this are going to be sketchy, because I make a lot of podcasts, so I'm going to be sharing with you a remembrance of how I felt. The guy I told you about earlier came on and talked about, what is it? The How do you what is that when you have your colon again, you get the bag of me? Yeah, it cost me. I'm sorry. All this pain, all this trouble, resolution, but it's not really resolution. He's he's more mobile now, but it's still not a great way to live, right? No, it's the thing he had to choose. And then I talked to somebody three months later, who talked about having his problems and the way they resolved them, and I don't remember the way they resolved them, and I do feel badly about that in this moment, somebody who's a better historian of the podcast than me might, but all I could think about was the guy from the months before. I'm like, Oh God, what if that would have helped him, right? And now it's too late.

Julie 51:41
Yeah, it's hard because I think back, and I've done elimination diets, and, you know, this, that and the other, and I don't think, I think at some point you have to accept and acknowledge that you're beyond the point where that's going to help. Too much damage has been done. But if you can, I don't know, I use my daughter again as an example, if you can prevent or find, you know, root cause and kind of make some changes before it gets to that point. Yeah, I think that's always a good, good idea. No, I

Scott Benner 52:16
really appreciate that. I appreciate your perspective on it too, because of everything you've been through because, I mean, I'm imagining, while you're talking, that you're sitting in a room somewhere making a decision to, like, say to somebody, like, open me up and take out a thing. And this thing's important. It's not my appendix, right? Which, you know, it's not even, like, I'll tell you eventually, Arden had her tonsils out recently, right? Consoles and adenoids, I was so worried about that. Yeah, you know you mean, like, I kept saying to the doctor, I'm like, Well, what is she losing, right? Like, I know what we're gaining. What is she losing? And the guy that takes out the tonsils, he's not some great genius. He's like, You know what I mean? And he's like, Ah, it's fine, nothing. I'm like, No, I don't think that's right. I was like, tonsils do something I do? Yeah, what do they do? And he's like, oh, yeah, protect you from getting sick about but it's okay. And I'm like, what? I'm like, was that part not important? He goes. But then you get to that point, and that's the point you were at, you have to make a decision, yeah, everything's so terrible. We know what this terrible is. I guess we'll take a flyer and find out what that terrible is, yeah, but life is finite, and I need to do something, right, yeah, yeah.

Julie 53:24
And I mean, I not my, not only my pancreas removed, you know, they take part of the small bowel. They have to reconnect everything. Thankfully, I was able to keep my spleen. Sometimes they have to take that out, which I had to get vaccines, just in case they had to take that out. You know, to be ahead your spleen has important functions, all of that. And then I ended up having two additional surgeries after the original surgery, one because a stitch wanted to pop out from inside, and then another one because I developed a hernia on the original incision. So it wasn't like, oh, it's out and everything's better. It's like, you know, it's been, it's been a long road the last year

Speaker 1 53:59
and a half, and you got little kids too, yes, yeah, surgery.

Julie 54:04
I had lifting restrictions, so, yeah, coming home and telling my, my, then two year old, I can't pick you up. Mommy can't pick you up. I had to stay, you know, at my parents house for a while because I didn't want to be tempted to pick them up, you know, all of that.

Scott Benner 54:17
But that must have made you feel like you were 12. Yeah, nothing like going home to see mom and dad. Yeah? And by the way, I'm seeing this for my own kids, and they're old, and you've and it's hard to ignore, right? When you're the kid, you look at your parent, you're like, oh, they took good, good care of me, though, sure. No, I know. But like, I see the kids, like, even if Kelly gets up off the sofa after sitting too long and she, like, is stiff for a half a second, I look at those kids, and they're looking at her, like, she going down, yeah? Like this, this is almost over, yeah, I don't know. It's hard to watch your kids see you look older. I can see that. Yeah. I don't enjoy it. You'll, you'll see one day, yeah, yeah. Or when they start questioning you, and you realize they're right, that's the worst, yeah, especially like on the big shifting stuff. Tough. You know, I don't know, like, a great example, it's just something like, it doesn't matter what it is, but something like, political related that I grew up with, it's in my head. You know what I mean? It's like, it's my reaction to something when it happens and they say, Well, what about this? And I go, No, that's not. Oh, my, that does make sense. Oh, geez,

Julie 55:18
these are actually functioning adults now that they're not

Scott Benner 55:21
just being jerks, they might have a point. Yeah. Okay, so is there anything that we haven't talked about that we should have? Did I skip over anything I didn't mean to? If I did, I don't think so. No, yeah, I'll let you go out like this. I put you in charge. You're a dietitian working for people with type one diabetes. Forget for a moment their feelings. Forget for a moment what they want or how they grew up, or what makes them happy. How would you tell a type one to eat? I would say, eat.

Julie 55:52
You know, well balanced fruits and vegetables. You know, lean protein. Have your carbs, but make sure you know how to Bolus for them. You can have your treats, but make sure, you know, everything's in moderation. I think that's, you know, our society gets so extreme about everything. You know, oh, we're gonna do no carbs, we're gonna do high fat, we're gonna do keto, we're gonna do this like, just eat a well balanced diet. Learn how to, how to Bolus for it. Make some adjustments if you need to. And you know, just know that. I think I said something about the variables when I signed up, you know, all those variables, man, though those could change so many things. And so I, you know, I'm still learning on that, but I think you also have to give yourself grace, because you can Bolus the same, you can have the exact same meal, and it can be a different outcome the next day. Yeah,

Speaker 1 56:41
and you don't know what the other variable was that made that change, right? No, okay, so everything in moderation. Yeah, there you go. That seems pretty reasonable to me. Thank you very much for taking the time to do this. I can't thank you enough. You too. I appreciate it. Did you have a good time?

Julie 56:58
Yes, did you? And I really do appreciate you having me on and appreciate the podcast, because I've learned a lot and I think you're doing a lot of good work. Oh,

Scott Benner 57:07
that's very kind of you. Thank you. Hold on one second for me, sure,

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Scott Benner 10/22/25 Scott Benner 10/22/25

#1659 Pressure Makes Diamonds

Chapman, a 29-year-old pediatric nurse from Charlotte, NC, was diagnosed with type 1 diabetes in May 2024—ironically after serving as his hospital’s pediatric diabetes specialist and anesthesia intake nurse.

+ Click for EPISODE TRANSCRIPT

Scott Benner 0:00
Welcome back, friends to another episode of The Juicebox podcast.

Chapman 0:15
Well, hi, my name is Chapman. I have been a type one diabetic since May 2024 I am a pediatric nurse in Charlotte, North Carolina, and I am excited to be here. If

Scott Benner 0:25
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.

The episode you're about to listen to was sponsored by touched by type one. Go check them out right now on Facebook, Instagram, and of course, at touched by type one.org. Check out that Programs tab when you get to the website to see all the great things that they're doing for people living with type one diabetes, touched by type one.org. This episode of The Juicebox podcast is sponsored by the Omnipod five. And at my link, omnipod.com/juicebox you can get yourself a free, what'd I just say? A free Omnipod five starter kit, free. Get out of here. Go click on that link. Omnipod.com/juicebox check it out. Terms and Conditions apply. Eligibility may vary. Full terms and conditions can be found at omnipod.com/juicebox. Links in the show notes. Links at Juicebox podcast.com. I'm having an on body vibe alert. This episode of The Juicebox podcast is sponsored by ever since 365 the only one year wear 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

Chapman 2:30
Well, hi. My name is Chapman. I have been a type one diabetic since May 2024, I am a pediatric nurse in Charlotte, North Carolina, and I am excited to be here, glad to talk about it.

Scott Benner 2:42
Oh man, thank you for coming. I appreciate it for sure. What's your specialty in nursing

Chapman 2:46
pediatrics? So I did general pediatrics for five years, and now I work with anesthesia for pediatric surgery cases,

Scott Benner 2:53
really? Yeah, are kids just hilarious coming out of anesthesia? Oh

Chapman 2:57
my gosh, it's one of the funniest things you can experience. Some kids are ready to fight somebody when they wake up, and some of them some of them are happy. Go lucky. It is, you never know what you're gonna get, but it's, it's funny and rewarding the same time,

Speaker 1 3:07
I came out of anesthesia one time, and my wife is just sitting there at the foot of the bed. The nurse is standing I don't know that my wife could have been more embarrassed, and I can as I feel like I'm coming to I can hear her apologizing, and I'm like, I wonder what happened. You know, turns out that whatever I said is what happened. And it's a much too friendly, family friendly podcast for me to tell you. Apparently it was horrifying. And then the nurse goes, like, my wife's apologizing in circles. And the nurse says, that's pretty common. And I was like, Oh, I wasn't even uncommon. That was upsetting to me, and there's no filter. Yeah, I said, What did I say? And my wife goes, later, I'll tell you later. So anyway, what does that mean? Like, I mean, you're not the anesthesiologist, though, right? So what's your job?

Chapman 3:53
So I work closely with the anesthesiologist. I work in what's called anesthesia screening, so any child that comes in to have any procedure, whether it's a MRI CT scan, major procedure, my job is to research the patient, you know, be in contact with the anesthesiologist. There's any special considerations for surgeries, be in contact with the family to kind of guide them through the process of surgery, let them know when they need to be here, what time they need to stop eating and drinking, and then kind of walk them through surgery day with them. So it's kind of a tangent point of the anesthesia team, because anesthesiologist isn't going to be the one to, you know, provide all this information to the family. It's, you know, it's a whole team process. So my team is just responsible for, you know, getting the patient to surgery day, and then anesthesiologist and the surgeon team all take it from there. So all minds behind the scenes of surgery.

Scott Benner 4:39
Yeah, you're not the guy that takes the tires off and puts them back on and bounces them your guy at the front that asks me what kind of car I got? No, and we figure out the sizes together, and I send you. I got you? Okay, exactly? Yeah, I ask a question that I always wonder about, because I'm older and I've had a couple of procedures, what's my real risk when I go night night of not waking back up again?

Chapman 4:59
I. Very slim. Very, very slim. Pretty much everything to do with anesthesia is all weight based. So they get your weight before your procedure, and they dose all the medication needed for anesthesia off of your weight. So you're not going to get any more than you need or any less that you need. It's going to be right, the exact amount that you need for your weight base dosing, and you're pretty much good from there. Obviously, there are some risks with anesthesia, but those are, like, the point 00, 1% things that the anesthesiologist needs to tell you about before a procedure. But other than that, pretty well fine tuned process, after years of research and trials,

Scott Benner 5:29
is it true that they don't really understand why we go to sleep? We just know what happens. Like, they don't understand the function of the medication, right? Like,

Chapman 5:36
what? Right? Like, the method of action? Yeah, that's a little bit outside my wheelhouse. I'm sure I learned something about it when I was a nurse. When I was in nursing school, but a little bit outside my wheelhouse now.

Scott Benner 5:45
Okay, so if I've been out a number of times, is there a risk in doing it another time or another time, or like or does the risk go up the more you do it?

Chapman 5:53
No, no, no, not at all. We have, we have some kids that need anesthesia, you know, three times a week for certain conditions and procedures. And it's like, three times a week, every week, for months at a time, and that's children. And so obviously you don't want to be understand under anesthesia too much, because the drugs are pretty, you know, pretty heavy. Yeah, they they flush out your system pretty quickly, long as you're well hydrated and everything. So it's not like it's going to be in your system for a very, very, very long time like some medicines

Scott Benner 6:17
are. I will say, as I get older, it the bounce back from. It takes a little longer. I'm a little more like, not goofy, but it's kind of tired Exactly, yeah, for a little longer. Okay, all right. Well, I appreciate you telling me about that. So last May, so June, July, August, year, 16 months ago. Yeah, is that when you realize something was going on? Or did you realize sooner than that? And it took a while to get to the diagnosis?

Chapman 6:45
Yeah. So everything started happening in January of last year, symptom wise, but I didn't really think much of it until late April, when I was like, I should probably get checked out. Okay? It started in January just with some, you know, mild weight loss, you know, two, three pounds here and there. I was like, Oh, cool. I mean, I guess I'm not trying too hard. But he never, you never complained about losing a couple pounds. It just kept going and going and going. And I, for some reason, didn't cross my my mind to think about that. And then all the, all the peeing, started peeing all, all the time, all the time. And my wife was, you know, seven months pregnant at the time, and I'm getting up the middle of night more than she was. Kind of straw that broke camel's back was I had some paresthesia, so numbness and tingling in my hands, my feet, yeah. And that was kind of like, Oh, dang, this. This is never a good sign. I should probably go get checked out. Being a nurse, you know, you you have all these symptoms, and you think of all the different things it could be, because you've seen all the different things when you're at the hospital. And so in my head, I was going to the worst of the worst. I was going to the big C, I was going to Ms. I was thinking of all the other things. So I was like, maybe, maybe it's just diabetes. Maybe I just have a random, you know, skinny guy, type two case. Didn't think much about type one. I was one of my doctor

Scott Benner 8:03
in January. How tall were you? How much did you weigh before the

Chapman 8:06
start of everything? I'm six 290 pounds. It's kind of my you're pretty lean, then pretty lean, yeah. And so I got down. I saw at diagnosis, I was six to 159 pounds. Wow, yeah. So I lost, um, around 40 pounds. 42 pounds

Scott Benner 8:24
at what weight did you think this is a problem

Chapman 8:26
when I started hitting the 160s mid 160s Why did it

Scott Benner 8:30
take that long? Listen, I'm five nine. Maybe, like, maybe, I think I'm at a pretty reasonable weight for my frame right now. And I think I was 169 this morning. So, I mean, even at 185 You weren't like, Hey, what's going on? Like, when was the last time you'd been 185

Chapman 8:49
oh, man, male college. I mean,

Scott Benner 8:52
I was, yeah. So what do you think I'm asking a hindsight question. But what do you think allows you to ignore that?

Chapman 8:58
I think my wife and I planned to have our first child, everything was kind of focused on that. It was a it was extremely high risk pregnancy. My wife was having some complications, and so my mind wasn't really on myself at the time. Yeah, I was having these symptoms, but looking back now, it wasn't really the forefront. Because, you know, I was worried about my wife and my unborn child, like, are we going to make it to, you know, due date? All these doctors tell us we're not going to make it there. That was at the forefront of my mind. And then all this started happening, and then I was diagnosed, and two days later, my son was born.

Scott Benner 9:29
Wow, what can I Is it too personal to ask what the high risk nature was of the pregnancy?

Chapman 9:33
No, yeah, no. My wife has multiple autoimmune conditions which automatically make her quote, unquote, a high risk pregnancy. And then she had, was called a short cervix. So the cervix, which pretty much holds the baby in, was too small to hold a baby in. And so they had to, you know, do cervical checks, you know, once or twice a week for, you know, five months, which is not pleasant for a wife, no or the service. You know, it's it. Yeah, it just, kind of just like a coin toss, like, like the cervix could hold it, could keep the baby in or, you know, you could be going to labor next week at 21

Scott Benner 10:07
weeks gestation. What autoimmune issues does your wife have?

Chapman 10:12
She has Hashimotos, thyroiditis and

Scott Benner 10:15
chagrins disease. Oh, and now you have type one. And do you have anything else

Chapman 10:18
that's that is my only, only medical condition. I've been a healthy guy my entire life. What about your extended family? My mom was diagnosed later on in life with Hashimotos in her 40s, okay, but other than that, I mean, my brother has some medical conditions, some called Hirsch bronze disease, basically a gastrointestinal disease. But other than that, everybody's pretty healthy.

Scott Benner 10:43
I'm sorry. You get diagnosed. The baby comes, the baby comes. You get diagnosed. What's the two day

Chapman 10:47
I get diagnosed? On May 8. Baby comes on May 11.

Scott Benner 10:54
What does diagnosed mean in a doctor's office, in an emergency room

Chapman 10:59
at the doctor's office? So everything I went through was all done outpatient. Thankfully, I wasn't in DKA. I didn't have to be on a drip or anything. This is kind of caught it relatively early. You know, my a 1c, was around nine, so it's not the crazy 14, 1516, you hear by some patients in DKA. It was around nine, which still is not, not great. I was able to kind of talk to some of my friends who are some of our pediatric diabetes educators inpatient so when I worked on the floor, I worked very closely with our diabetes education team and our endocrinologists. It was kind of my specialty. When I was working at the hospital, I was what's called, quote, unquote, the diabetes champion. So my job on my floor was to educate the staff and patients about diabetes education and things like that. So I worked really closely with that team, and one of them, her son is an endocrinologist, and he I called her right away. I'm like, Hey, anyone sees this? I can't believe this is happening. What do I do? And she said, let me make some calls. So she called her son, was able to get me appointment next day at the end, chronologist, which has a three, four month wait, I was I was able to get in next day, he pulled some labs, you know, a repeat, a, 1c, all the antibodies and everything, and that, that was May 8. So I got the official you are type one diagnosis, diagnosed on May 8. So hearing it from a doctor is what I consider diagnosed.

Scott Benner 12:14
Yeah, okay. How do you go to your wife, who's had a nine month, you know, battle with her, with her short cervix and say to her, Hey, by the way, I think I'm on the way the doctor here. Like, I think I have type one diabetes, and I know the baby's supposed to come any second. Like, was that difficult? It was extremely

Chapman 12:30
difficult. But my wife is extremely gracious and caring, and I don't know how you know she had the strength to help support me during that time as well, but she did so very thankful for her, but it was, it was kind of just the all hands on deck. I support you. You support me. We're doing this together. We got to figure it out, because we don't have any other

Scott Benner 12:46
choice. How's the birth of the baby? Like, are you on, like, injections at that point? Yeah.

Chapman 12:50
So I was MDI at that point. It was a stressful time because he came six weeks early as well. So, you know, we're freaking out. She's like, Oh my gosh, I'm just went to labor. We're not ready yet. We don't have, you know, the supplies. We don't have the room ready, all this stuff. I'm like, I was just diagnosed. I'm still figuring out how to put a Dexcom in and how to give myself shots, yeah, and trying to figure out my dosing, because, you know, they just kind of slap me with a generic Lantus dose and then a sliding scale. And, like, here, do this for this, and do that for that. I'm okay. Well, I have a child coming, and so during, you know, labor, I had just worked a full 13 hour shift to the hospital, I had to drive straight to the hospital to be with her, and then my sugars are in the 50s, and then nurses are having to bring me juices. It sounds like you're my wife. It was slightly embarrassing, but also thankful for medical people that understand.

Scott Benner 13:39
They're saying breathe and they're talking to you, not to her, yeah, yeah. I

Chapman 13:42
don't want to seem like that type of dad that's like, Oh, help me. I don't know what to do, but I was like, my sugar is 45 I need some

Scott Benner 13:48
juice. I'm low, and I don't know what I'm talking about. And I'm the diabetes person at my job, which is I'll ask you more about as soon as I tell you that. Due to a typo, while I was getting background in Hersh bronze disease, I learned that there's a psychotherapist named Hirsch Braun. The typo, right? He's a pleasant enough looking fellow. Just times like, wow, what did I mistype? I'll to go back and look later. Okay, so you, you get the diagnosis. It's simple. MDI set up, but the baby's coming quickly. You're still working. You got diagnosed and went to work.

Chapman 14:20
Yeah. I mean, as a nurse, you don't get much time off for paternity, let alone for kind of medicinal things, unless you take FMLA, which I didn't really have, couldn't really afford.

Scott Benner 14:30
Chapman, if the baby wasn't coming imminently, you think you would have taken a couple of days off when you think of a CGM and all the good that it brings in your life is the first thing you think about. I love that I have to change it all the time. I love the warm up period every time I have to change it. I love that when I bump into a door frame, sometimes it gets ripped off. I love that the adhesive kind of gets mushy sometimes when I sweat and falls off. No, these are not the things that you love about a CGM today is. Episode of The Juicebox podcast is sponsored by the ever since 365 the only CGM that you only have to put on once a year, and the only CGM that won't give you any of those problems. The ever since 365 is the only one year CGM designed to minimize the vice frustration. It has exceptional accuracy for one year with almost no false alarms from compression lows while you're sleeping, 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. Today's episode is brought to you by Omnipod. Did you know that the majority of Omnipod five users pay less than $30 per month at the pharmacy? That's less than $1 a day for tube free automated insulin delivery. And a third of Omnipod five users pay $0 per month. You heard that right? Zero that's less than your daily coffee for all of the benefits of tubeless, waterproof, automated insulin delivery. My daughter has been wearing an Omnipod every day since she was four years old, and she's about to be 21 my family relies on Omnipod, and I think you'll love it, and you can try it for free right now by requesting your free Starter Kit today at my link, omnipod.com/juicebox, Omnipod, has been an advertiser for a decade. But even if they weren't, I would tell you proudly, my daughter wears an Omnipod. Omnipod.com/juicebox Terms and Conditions apply. Eligibility may vary. Why don't you get yourself that free starter kit, full terms and conditions can be found at omnipod.com/juicebox

Chapman 16:42
probably, maybe a little bit of time just to get my head wrapped around things. But like I said, I didn't have to go the hospital. I wasn't, you know, deathly ill. I could still manage and I felt all right. That's the whole thing. This is what I was diagnosed. I still felt okay, okay. I didn't have lethargy, like some patients do. I didn't have all this. All I had was I made some pretty serious weight loss, yeah, and then I was peeing all the time, and then, you know, the numbness and tingling, which kind of happened for a couple days, and then went away. Sure. Okay, so it's relatively mild, still not downplaying type one diabetes as itself, but relatively mild. Initial did the weight come back? Oh, yeah, weight came back. Took about six months, but it came back. Did

Scott Benner 17:19
it come back and stop? Or did it come back and keep going? It came back and

Chapman 17:23
stops? Yeah. So I'm back to my normal 6190,

Scott Benner 17:26
that's great. Go back to what you were talking about about your job. You're that. You're the diabetes liaison. What is that?

Chapman 17:32
Now? What happens on like when you work in an inpatient unit at the hospital? And for my hospital, in this case, every person kind of has part of their continuing education. They're quote, unquote, on a committee and called a champion. So it's kind of some people are champions for, like, eating disorders or behavioral problem kids, or there's, you know, autoimmune kids, or, you know, asthma, respiratory illnesses, and diabetes was one. So mine was focused on diabetes. So I anytime we had, like, a new DKA diagnosis come in that would come to our floor to be on the triple bag therapy. So the insulin drip, my job was kind of to help all of our other nurses understand, because I had done some education about it to be able to help. So I'd be like, okay, are these bags set up, right? Are the calculations correct for the insulin drip and the dextrose fluid and the non dextrose fluid, things like that. So I was kind of all consumed in it, consider even future, considering a job in diabetes education, even before I was diagnosed, you know, I'd been approached to, you know, take one of our educator roles who had just retired, to say, hey, you could be great for this role. But then all this happened. I was like, I need to do something that I know how to do first before jumping into a new career with this new diagnosis, you know,

Scott Benner 18:43
16 months removed from your diagnosis, looking back on what it is you understood about diabetes at that point, how much percentage, wise, if diabetes is a, you know, is a pie, how, what slice of that pie was your understanding and what, what was left over? I'd say

Chapman 18:58
probably 75% understanding, really. Yeah, so I think if you go down to the basics, you know, what a high and low blood sugar mean, what insulin does in the body, how to use insulin correctly, and how to use a sliding scale like that was ingrained in me, because I've been doing it for I was on the floor for five years, you know, doing this day in, day out, with new diagnosis, talking to families, helping them Understand, getting it on simple terms of how to understand diabetes and what it looks like in a daily life. So that was part of my job. Like, you know, Kid orders their food. We sit down together. I say, Okay, how many carbs is this? Here's the receipt that shows how many carbs. I want you to look at all the food groups. This is what happens. This how it works in the body. This is how we dose insulin. So all of that was done prior to diagnosis. So when I was diagnosed, I had all of that in the back of my head. That was one good thing about, you know, being diagnosed right before the baby is I could, you know, just kind of go into nurse mode, check my sugar, give myself insulin, do whatever, and then just put in the back of my head and help take care of my wife and my baby. Okay,

Scott Benner 19:55
you're rock solid on the functional aspect of, yeah, how to manage somebody in the house? Hospital, like when they're when they're diagnosed, and you feel really good about the background information that people need for type one. So now, what have you learned since then that you didn't know? Where were the lessons along the way?

Chapman 20:14
Like fat rises, that was something that I was not ready for. You know, not really something that we paid attention to in the hospital too much, because that's kind of more, you know, at home, type of care. Learning right now in the hospital, I'm teaching you how to count carbs, how to keep yourself insulin, you know, then going home, and especially feeling the symptoms I hadn't really, you know, felt that. So the lows and the high highs, that was something I wasn't ready for. You know, trying to learn how to do, like extended boluses or split boluses for high fat meals. That was something that was really difficult for me in the beginning, and I still struggle with to this day, like trying to figure out how to dose correctly. But we can get into that too, talking all about honeymoon and everything, but,

Scott Benner 20:53
well, let me ask you one more question. Then I'll ask you about your honeymoon. Yeah, so when people tend to feel under prepared after a certain distance from their diagnosis. You know, once the things that they were told in the hospital prove out to not be all the things, then they get into that kind of like almost a panic spiral. Sometimes, what do you think could be done to stop that from happening?

Chapman 21:17
It sounds it sounds good to be able to stop panic from happening. But with type one diagnoses, it comes on so suddenly that you're just so unprepared that you can't be in the mindset to be ready for something like that. You know, I don't know that's a really

Scott Benner 21:32
good question. Don't worry, I'm not like, Oh, I know that's two plus two is four. It's not that kind of answer. But what I'm trying to dig out of your brain is, is you know what they're told, right? And you know what you were told, and then you now have the experience of going home and finding out that those things aren't all of the things that you need to know, right, right? So, and I take your point like you, if you overload them in the beginning, they're not going to remember anyway. You know, if you stick it in a book, nobody's going to read it like that kind of stuff. But is there any, like, big ahas, like, oh gosh, if we just would have also told them this, it really would have taken away a lot of trouble. I mean, is it just the idea of, like, a fat rise that would have been a big, big help for them, or is there something even more, I don't know, like a psychological like, support that would have been valuable, or did you or do you not feel like you went through it in that that way, where you can comment

Chapman 22:27
on it? Yeah, it's hard to relate. Because I think when I was in the hospital teaching families, I was, yes, I was teaching children, but a lot of them were younger and don't really have the, you know, ability to understand all these complex medical things. So I was, I was teaching families, and then if it's me as an adult diagnosed, I had to kind of change how I thought about it, because I was, you know, doing it in simple terms to help educate a child as well. So I think for me, having a support system that understands as well is huge. And I know families are a huge support system in the hospitals, but helping families understand, not just, you know, your parents support you, but community like the Juicebox community and you know, having your educators on hand and your endocrinologist on hand, that community is going to be huge in the success of your diabetes management. That you're not alone in this. I think that's something we could probably push a little bit more, is that you're not alone in any of this. That's the community is massive and so willing to help. And it's unlike any other community around because it is such a, you know, big deal. And to have so many you know, moms, dads, you know, friends that have the same condition as you, walking through the same issues with you is huge, and that's something that I didn't realize, is how important the community

Scott Benner 23:46
would be. Then would it be appropriate, maybe to tell somebody we've given you a lot to remember here, it's certainly probably more than you're going to be able to remember. And the truth is, it's not all of it. So find a place, not just with us. I think you have to say, I know it's just crazy to tell you, like I'm not your only support system as the doctor, right? Like you have to go out and find places where there's a congregation of people who know what you're talking about, so that when you have a problem that at the moment might feel unforeseen, like something we can't prepare you for right now, that you can almost instantly go to a body, you know, a body of people, and say, Hey, this thing is happening. Tell me, does anybody have any input? And then, boom, you're back on track again with some answers to things to look at. Is that

Chapman 24:33
fair? Yeah, absolutely, yeah, even if they don't have answers for you, even just solace knowing that someone is going through the same problems you're having, maybe they won't tell you how to fix it, but like, Hey, I feel you. I'm doing the same thing. We're in this together like that is that was huge for me going through some of that stuff.

Scott Benner 24:50
Okay, all right. I mean, I appreciate you picking through. I know it's so uncomfortable, but you don't have, like, a rock solid answer for something, and people are asking you questions, but I think it's value. Able to hear your perspective because of, because of your background and because of what's happened to you, and to hear that even now 16 months out, you don't have a like, you're not, oh, yeah, it's this thing I should have heard about, like, or, you know, somebody should have definitely told me about how to clear ketones. Or, you know, like, Yeah, you don't have something to point to, to go that was glaringly omnipoded, right? Which I think is helpful, because it points out that maybe, I think there was a time in my progression where I thought like those people have to do a better job. They can't. They're sending you home, and you're unprepared. And then I had enough conversations with the people who were unprepared and the people who were trying to prepare them to maybe realize that between the circumstances, the situation, people's capacity, the rest of life, everything else, like, you know, like, look at you like, you know, at some point you were, for nine months, helping people while you were worried about your wife, you know, and you had an underlying medical condition you didn't know about. So that's happening to more people than you think, who are out there trying to help you? Yeah? And maybe, I don't want to say, maybe, before the statement, I've come to the conclusion there is no answer and there is no like, there's no magic better, yeah, we're just waiting for someone to figure out and implement that used to be how I felt, like some smart person's gonna say, Oh no, this is what needs to happen, and that they would make a change, and it would work so well that, you know, the community at large would adopt it, and everybody who got diagnosed would be better off. But I just, I don't think that's it. Even last week when I interviewed a gentleman whose episode will be up just slightly before yours, whose young daughter, like really young daughter passed away before she could be diagnosed, and he's obviously bereft and out in the world trying very hard to draw attention to it so it doesn't happen to somebody else, which is very kind and a lovely way for him to be spending his time. But as he was talking, my experience left me thinking, you should do this. You should go out and you should bang on all these pots and pans and make people pay attention, and you probably will save somebody. But I don't know that changing the process changes anything like, I know it's simple to say, like, everybody should just get a finger stick when they have flu symptoms. But you know, you know people, yeah, what if you had the flu? And I came at you, and I was like, let me just check your blood sugar, they'd be like, Get away from me. You're gonna be like, What are you doing that for? And like, you'd find a different problem, I guess is my point. So yeah. Anyway, I you know, just like, picking through these conversations, sometimes to get answers and sometimes to get the proof that there is no better answer. Yeah, yeah, I get it, yeah. So what happened with your honeymoon there? Man, it was, it wasn't all simple and fun and easy. No, it's

Chapman 27:47
still going on. Man, is it still going on? Yeah, it is been just totally confusing. I really struggled with it, you know, physically and mentally earlier on, when I was MDI, I'm on a pump now, which has made it 1000 times better. Just constant, constant fluctuations, like, yeah, they say honeymoon is kind of a revitalization of your pancreas. It starts producing a little bit more before it finally gives out, you know. But mine is constantly changing every single day. My basal needs change every single day. My you know, carb, my insulin, carb ratios changes like every single day, and it's really tough to nail things down. I know nothing is going to be perfectly the same every single time, even post honeymoon. But, you know, a fluctuation of 3040, units Difference Day by day is huge. Is your

Scott Benner 28:39
endocrinologist calling it Lada, yeah, yeah, definitely, okay. How I forget? I don't know if I asked you how old you are? I'm 2929 is your first baby. Oh, yeah, yeah. You think you'll do it

Chapman 28:51
again? Yeah? Definitely, yeah. We want to have a we want to have a couple

Scott Benner 28:55
really awesome, the short, the short cervix held up. It did,

Chapman 28:59
yeah, so now we know about it, so next next time, we'll be ready. By

Speaker 1 29:03
the way, short cervix sounded like a humble brag at the beginning, but I realized that it was a bad thing. So I thought you were bragging on your wife, like she's got a short cervix. And I was like, Oh, I thought that was, like a big deal. So you want to have more kids so and you're experiencing this crazy honeymoon. Let me finish asking about the honeymoon before I ask you my next difficult question, we'll do a nice one, and then, okay, okay, how are you staying flexible through a honeymoon that appears to be changing daily?

Chapman 29:29
That's the million dollar question. Sometimes I feel like, I'm like, okay, yeah, I've got this. And then, you know, the honeymoon hits again, and I'm like, oh, man, that that sucks. But, you know, I don't have any other option but to get through it. So like I have, I have two different profiles on my pump. I have on a tea slam. So I have a high and a low profile. My high profile is kind of for my basically non honeymoon style numbers, with certain basal rate and instant carb ratio. And I. Usually expect, you know, 30 to 40 units a day, using that, which is still not that much like I remember giving kids way more than that on a daily basis, as when they're children and I'm an adult, and I'm using 30 to 40 units daily. I have my low profile, which I can tell, because I just have these crazy lows, these crazy falls from high sugars without doing anything, honey was getting back up, I guess switching my low profile, which, you know, cuts my basal into like quarters, and even then, still may not use all of it, it'll just cut off. So like yesterday, I'm in a honeymoon phase right now. Just started last week again, went back into it, and my my total daily insulin yesterday was 6.2 units all day. Oh, wow. So it's it's just constant fluctuation. So I have no idea when this little low spell is going to end, but I'm sure it will next week, and I'll be back to my high profile. So it's just very confusing, but trying to stay positive with it, knowing I have the technology available to help me manage this crazy

Scott Benner 31:00
time when the shift happens. How long do you wait before you believe it and pivot? About a day. Okay, so you're low for a day or high for a day, and then you think, oh, it's time to hit the button Exactly, exactly. Wow. That's fun. How has being a new dad interfered with diabetes and vice versa?

Chapman 31:18
The fear of something bad happening with me having a low or, like, more lows I'm more afraid of, because highs I can function, okay, but lows i I'm scared of, like, being alone with him and something bad happening to me, or like me carrying him down the stairs and I'm low and something happens, or something like that. So that that's kind of a hard thing to manage. So being aware of my blood sugars pretty much all the time, if it's just me and him, being hyper vigilant about, you know, having some low snacks or anything like that. But then if it's us as a family, my wife is very quick to be like, Hey, what are your numbers? Let's, let's try to figure out a plan before we do something. Anything can happen, like driving or what have you. So it's just being hyper vigilant about the worst case scenarios, which is kind of a morbid way to think. But you know, it's the best way to keep your family safe is to just always be

Scott Benner 32:09
prepared. It's just interesting to hear how you think about it. Yeah, prior to your diagnosis, Were you sick at all? Do you have a virus or cold or anything that, you

Chapman 32:18
know, I've actually talked to my endocrinologist about that, about what, what probably triggered this autoimmune response, and I think it was probably stress of work and anxiety of work. I struggled for a long time with some severe anxiety surrounding work. I started right before covid At the hospital, and then worked on the pediatric covid unit, through covid, and then that kind of made things difficult. You know, mentally, I had some, like, severe anxiety, you know, just trying to get out of my car to go to work or try to, you know, stay calm in situations where I, you know, had some, you know, flashbacks from the early days of covid and and then the pregnancy, trying to work through that. It was just all a lot of stress and anxiety, and I would think that could have been the trigger for autoimmune response to my body that shows my pancreas.

Scott Benner 33:11
I'm sorry, yeah, it's all right. That sucks. I say all the time, like, I don't understand, I don't have firsthand knowledge of, like, feeling anxious and But listening to people's descriptions of it over and over again is, I find it humbling to try to imagine what you would do if you're in that situation. Because, like, I mean, everybody's pulled up at work and not wanting to go inside, but if you're not anxious, you just go, can you just drop you going drag your car. I'm gonna do this exactly, yeah, oh gosh, I'm sorry. So, so you listen to podcast. I do, yeah, yeah, enough to say to yourself, oh no, I have an autoimmune disease. My wife has an autoimmune disease, and we have a baby, yeah, yeah. What process there.

Chapman 34:01
It's, it's tough. We've, we've checked the sugar a few times before, just because I'm, you know, hyper aware of the symptoms. I'm like, Oh, two parents with autoimmune, you know, it's, it's kind of, hopefully, I don't know, I don't even want to, like, verbalize it. It's hard to think about. But, you know, like, one time a couple weeks ago, we saw him just absolutely chug in some juice and water. I'm like, Dude, no, we cannot be doing this. Check of sugar. He's like, 72

Scott Benner 34:28
I'm like, Oh, thank you. Thank goodness. He's just thirsty. He's

Chapman 34:31
just thirsty. And then, like, he'll wake up with, like, a real big fat diaper, just pee through his clothes and just, you know, sleep sack. And I'm like, Oh no. Check of sugar, fasting sugar. It's like, you know, 79 I'm like, Oh, this. We're good. So, you

Scott Benner 34:45
know, it's funny. I wanted to ask you throughout the conversation about it, but I didn't want to just jump. I didn't want to just throw it in your face. And then you told me about the the anxiety. I was like, maybe I'll just skip it. Yeah, I didn't want to make you feel like worse. But, I mean, I don't think I can. Like, you're how you. Obviously have to be thinking about it. So, yeah,

Chapman 35:02
no, we were always kind of thinking about it, never really verbalizing it, because if you verbalize it, it kind of makes it real. And so, like, we're like, okay, I know, so scary, Lauren, but let's, let's just check the sugar. Okay, we check it, and we're like, is that good she I'm like, I said, Yeah, that's good. We're good. How does she

Scott Benner 35:20
handle your diabetes. Like, I think this is interesting because, I mean, I'm gonna say, like, it feels like she got two infants on the same day, probably, right, like, an actual infant and an infancy of a diagnosis, yeah, like, I mean, was she even able, or did you even want her to be involved in your understanding of your diabetes? Or how did that work out? Yeah,

Chapman 35:42
she she was willing and able, like I said, she is so gracious and so, you know, strong. I don't know where she gets her charisma from, probably putting up with you. That's probably where she learned, yeah, no. But like my diagnosis day, and she was, you know, eight months pregnant, seven and a half months pregnant, you know, wobbling through the endocrinology offices. I get my diagnosis, and then two days later, we give birth. And then a week after he was born, I had my first diabetes education session just to figure it out for myself. And then we had our seven day old baby at the office with us, and she is just locked and loaded, ready to go, taking notes like she's taking it and stride. Learned everything there's to know. It's a lily where we are, like two people in one mind about it. She is so incredible and so incredibly smart.

Speaker 1 36:25
That's lovely. But I'm now thinking, I want to interview your endocrinologist, because I bet when you guys walked out of that office, you probably bummed them out. So, like, they were, you know what? I mean, they probably sat across me, like, Oh, these poor people. Look what just happened. They got this little baby. This guy's got the diabetes. All of a sudden. You, seriously, you probably ruined their day, right? How did you stay upbeat about it,

Chapman 36:46
knowing that some of my endocrinologist is a pipe one as well, so it was very helpful to have that first meeting and talking to him about, hey, I have this as well. I know what you're going through, and I have kids too. So we're kind of in this together, like I was talking about earlier, having that support system is so helpful, yeah, and so that's kind of what got me through, is knowing that, you know, I have all these people on my side rooting for me, that if there's any any trouble, I can call them up, you know, get some answers, or some solace, or whatever I need at the time. So I'm doing much better now. Like I said, I was, I was really struggling for a while when I was MDI, but now I'm on the pump. It's just made things a lot better for me, mentally and physically.

Scott Benner 37:26
MDI, with a with such a harsh, swinging honeymoon must have been horrendous. It

Chapman 37:32
was brutal. It was brutal because I'd had they. I had my written down. This is my prescription for my Lantus. You take, you know, 12 units at night every day. But what if your need for that day was four units Atlantis? What if the next day was, you know, 21 units Atlantis? I had no way of knowing, because the Lantus, you know, has that extended period, and there's no way you can change it. If it's a low day, you're gonna have you're gonna be low all day, drinking juice, eating gummies all day long, yeah, just trying to stay above, you know, 60. And then there's vice versa, which is a little bit easier to do, because you can just give yourself a little bit extra Bolus, but when you're low, you just constantly drinking juice and eating snacks,

Scott Benner 38:09
everything is always tough. Yeah? It becomes about keeping your blood sugar up all day. Yeah?

Chapman 38:13
So now I'm on the pump and it's from on a low day, it's like, okay, you don't need the insulin. Let's just, let's just pause it and then make sure you're good. So that's what's been helpful for

Scott Benner 38:22
me. Yeah, no, I would imagine you said you're using the tea slim, yeah. Do you have a Dexcom? Or what do you use for CGM? G7 g7 okay, you like the you like the combination?

Chapman 38:31
I do, yeah, it's great, awesome. I see a lot of people talking crap about the g7 for some of the inaccuracies. And yeah, I mean, everything has their faults, but 95% of time. Benner, spot on. I never had really any issues with it.

Scott Benner 38:45
Yeah, I don't have a lot more to say about that than I've said that I've said in the past. I think it's technology, and it works better for some people than it does for other people. And you know, it's, you know, I, you know, I would say this. I would say the same thing to anybody who asked me. I'd say, why don't you get in a time machine, and go back 60 years, and then, yeah, yeah, then live there for three days. Then tell me about how much you don't like your CGM, right? So I mean, but at the same time I do, I genuinely want to be understanding of the idea of how frustrating it is, because it's seriously, I mean, it seriously, is Arden had a, I mean, like a 24 hours just over the weekend where, yeah, first of all, she's sitting down. She's just trying to take notes for a class, right? But she's six seven hours of taking notes, and her Dexcom runs out. Now, I want to say 10 days and 12 hours. So awesome, like it went all the way to the end, but she's sitting there writing. It's fine, it makes that noise. And she, you're like, oh my god, you know. And then she's just ignoring it. She's trying to get to a point where she can stop. And then at some point, I was like, Oh my God. Like, I can't take it anymore. So, like, I got a Dexcom out of the drawer, and I, like, put it on the table, like, next door, not, I'd say, 18 hours. Later, and this just happened overnight. To show like, the other side of the technology, three o'clock in the morning, she has a pot error, so she just it stops delivering insulin. How often does that happen? I don't know, twice a year. You know what I mean like, but yeah. How often does it happen at 3am when you've been up taking notes for 12 hours, and your dad's old and asleep, and you text, and you know this is a problem, and you go, you know I need help. And she thinks like texting me is going to bring me to her. But let me explain to you what happened. I didn't see the text, and she fell back asleep before she could get up and go get herself a pot. So it's seven o'clock this morning. My wife's alarm goes off. I was going to sleep till eight o'clock. That did not happen, Chapman, because my wife goes, Hey, wake up. Arden's blood sugar is 300 and it's rising. Wow. And I was like, Okay, so now I know immediately something's wrong with her delivery system. Because, I mean, we just don't see a 300 Yeah, I pop up, look at my text, see the pod error text, three o'clock. I'm already, like, walking downstairs, doing the math in my head. You know what? I mean, I'm like, All right, it's been four hours. She's gonna need at least four hours worth of basal plus a correction, you know, blah, blah, blah. I grab a pot. I grab some insulin. The dog looks at me, and he goes, with his eyes, he said, This Chapman, he goes, if you don't let me outside, I'm gonna pee on the floor. And I was like, yeah, right on. So like, I let him out. Because I was like, but then you're standing there, and I will tell you that 10 years ago, I would have stood there thinking, like, Martin's gonna be in DKA. I gotta go, like, yeah. But instead, I was like, just go pee real quick, man. And then while he was peeing, I was like, you know, fair is fair. I'm gonna pee too. So I went to the bathroom. I wash my hands, you know, do all the things. And then dog comes back in upstairs, give her a shake, and she goes, Oh, hey, my pot error. And I was like, Yeah, welcome to four hours later, she goes, wait what? And you can see her open her eyes and she realizes it's light out. You know, the first thing she said, if I, if I let you guess, what do you think she said, first I go back to sleep. It's gonna break your heart when I tell you, she said, I'm sorry. Oh, and I was like, oh god. I'm like, I was like, It's okay, don't worry. I was like, you know, next time call me, you know, like, let it ring or something like that. And she stands up, and I'm like, here are the pod, like, you know, do you want me to fill it? She goes, give me a second. I gotta pee. And I'm like, Man, everybody's peeing. And I said, Well, yeah, cuz your blood sugar is so high. And she goes, plus, I just woke up. She just wandered away. So, so I said, You all right? Do you feel nauseous? And she said, I don't feel nauseous. And I'm like, okay, she comes back and then puts a pot on herself, obviously starts it up. You know, she's on, she's in trio. And so the thing makes its first Bolus like as soon as it's on. But do you know how much a Bolus point nine? Oh my gosh, because it's not going to do like. And I said to her, like, I waited because I see she's exhausted, she wants to go back to sleep. And I'm like, Arden, you need to look closer at this insulin. You can't just put this thing back on and let it start working, and you haven't had insulin for four hours, yeah? And she's like, I know. And I'm like, okay, but I walked her through my thinking. I was like, Look, you're four hours without basal. That's four four units. And I was like, and, you know, she did not take her GLP this week, so her correction factor is bigger. And I was like, top my head. I'm like, this correction could be over three units, you know, plus the four. I'm like, I'm at seven. I don't even know if that's 100% right. I'm still, like, half asleep, you know. And she puts it on, and then the then the algorithm is, like, I think we should do nine. And I said, it thinks nine, what do you think? And she goes, let's do that. So she put nine units in. That's now two hours and 50 minutes ago, and her blood sugar is 150 right now, okay, and she's coming down pretty gracefully, but I wonder if I looked, if it wouldn't want a Bolus right now. Let me look, yeah, it's starting to think the algorithm is starting to believe that she's doesn't have enough, but it's recommended Bolus at the moment. It's only point 180 wow. And so I'm gonna let that ride a little longer. She's obviously still asleep now, obviously, because she's in college, and she doesn't have a class for two more hours, so she's gonna sleep a little longer, right? But I think that in the next 10 minutes, when we get to three hours, and I'm not doing it by time, I'm doing it by what I'm looking at here on the Dexcom, I think in about 10 minutes, I'm gonna look again, and I think it's gonna want another Bolus. It's actually Bolus thing a little bit along the. Way, yeah, it gave her only little bits, giving her like point one. So far, it did a point 7.70 it's been Bolus thing, even with the nine. Wow. All right, let me go back and I'll tell you, because I think this is good for people to hear. It did the point nine, like I said, when she put the pot on. Then we did a 9.3 right away. That's 10 units, okay? And then it wasn't much later that it did. Point three, 5.0 5.25 it's jacking her basal up. The 1.6 an hour, takes the basal away, starts getting a drift down, does a point one, hits with the basal again, another drift down hits with the basal again, takes the basal away. It hits 223, at 8:51am, and then it starts to go back up again. It Bolus is point seven, pushes the basal up to two and a half an hour, another point seven, not long after it created the next dip. It's leveling out now. Got a tiny dip. We're finally back under. You know, 200 to 166 or so for the last hour. Did another point one? Just recently a point, oh, five, like two seconds ago. I'm sharing all this. First of all, I'm talking through it because I want five more minutes to go by so the Dexcom reads again. So I can tell you the next number, because the Dexcom says 152 right now. But I'm telling you all this because I think in a million years, most people wouldn't think, Oh, I've just been out of insulin for four hours. I need the amount of insulin that I've just said. Arden's, you know, five seven. She weighs 130 pounds. 135 pounds, right? And I think there are people who go much longer without insulin or without enough insulin. And I think it's helpful to hear like, these numbers aren't your numbers, right? Like, if this happened to you, you wouldn't be making the same exact decision. But I think it's interesting to hear like, bigger picture, what are we really talking about? Like, because Arden is a person who maybe uses 24 units of basal a day, you know. And depending on, depending on if she's supplementing with, like GLP, like micro dosing, or not, like, you know, she might use another 20, 3040, units of insulin a day, depending on where she falls in. That thing, how her hormones are, how she's eating, etc. Still, no matter what you say there, whether it's 40 and 25 or 20 and 25 1015, units, is a big percentage of that, yeah, you know. And I don't know, I just think it's, I think it's helpful to talk about out loud, you know, because, you know, maybe you'll hear something in that, in that story, that that not you, but somebody else, that makes them think like, oh, maybe I don't understand how much insulin I need sometimes, you know. So anyway, I just I had an experience last week with a recording with an adult. There were some things they didn't understand about their diabetes that surprised me, made me feel like some of the stuff needs to get said out loud a little more frequently. Blood sugar is 150 now after the last check. So I'm going to push the point too, because I can do it remotely, and ask you, if you've considered using T Z yield in the last year.

Chapman 48:13
Is that the honeymoon extending type of medicine that they do at the beginning?

Scott Benner 48:18
Yeah, sure enough. Did it at any point in that? Did you think about it, or did you know about it early enough?

Chapman 48:23
Yeah, so I heard about it, think, from the podcast a long time ago, or, like, not long time ago, a long time ago for me, yeah, around diagnosis, and then my endocrinologist mentioned it, and I don't think I want to at all, because of kind of where I'm at in my honeymoon, I think with just this insane variation of insulin use, you know, with a variation of 3040 units different day by day, I'm kind of at this point where it's like, I just kind of want the honeymoon to be over so that I kind of have some sort of understanding of what to do day is going to

Scott Benner 48:59
look like. Your perspective is, I am eventually going to end up with type one diabetes. Full on. Yeah, putting it off for me just means making it too variable longer now Exactly, yeah. Let me add a pretend like layer to this question. What if and again, let me be very clear, this is not the case. What if they said to you, hey, in most cases, it'll extend, you know, the amount of time before you're, you know, really need a ton of insulin by three years, and it's possible forever. Would you try it? Then I'd think about it. Yeah, that would make it a little more attractive. But the idea that it's just going to extend it, but eventually happened, that doesn't tickle your fancy. Really, exactly, awesome. When's the last time anybody said, tickle your fancy? Yesterday? Wait what

Chapman 49:47
I say all the time. Man, do you really I do?

Scott Benner 49:51
Yeah, awesome. Look at you. You might have been maybe you're unknowingly bringing out my deeper understanding of you. So how. One, do you guys think you'll wait before you make another, a little baby?

Chapman 50:03
Yes, that's a great question. It's been a whirlwind year. We know we don't want to wait too long,

Scott Benner 50:09
you know, you

Chapman 50:11
know, maybe the next year or two,

Scott Benner 50:13
really. And you're both on you're on board, both of you. Yeah, definitely awesome. Awesome. What does your wife do for a living? Do I know

Chapman 50:20
now she works in cyber security, and it really, yeah, she's, she's very smart.

Speaker 1 50:26
I just spent a full day at a cyber security Expo. Oh, really, my god, yeah, yeah. I think I told the story, like, somewhere, my brother and I don't live in the same state anymore, and he had to come back home, you know, to go to this, this expo, and he's like, You come with me. And he's like, we hang out all day. And I was like, All right, so, like, I moved my schedule around, and I went and hung out with him while he, you know, gathered information he needed for work and went to, like, talks and stuff. And I was just like, hanging out and everything, you know, I did it so we could chat and be together and have lunch and everything. But it was also at the eagle stadium, so that didn't hurt. I got like a, I got like an on field tour, and I got to, Oh, that's awesome. Tour, the tunnel, where they come out and everything, which was really neat. Yeah, all they talked about was cybersecurity. I know what the hell they were talking they were talking about,

Chapman 51:17
it's a, it's a wild, wild field. But, you know, it's, it's really, you know, booming right now, yeah, just with all the increased technology, they need some protection. So that's what she does. I

Scott Benner 51:28
will say this, and nobody's asking. It's just a CDE W event, if they're listening, or anybody from CDE w is listening, your main speaker was not great,

called out,

Speaker 1 51:41
maybe they, I won't even say, like, I won't even give anybody a hint about who it might have been. I don't doubt that the person knows what they're talking about or has a ton of experience. But I mean, as far as, like, capturing a room, Holy Hannah, not good. A couple of a little more practice would have been very helpful. Oh gosh, she made me want to, maybe want to run my head into a table. I looked at my brother. I was like, Are they all like this? And he's like, what? I'm like, Are you not smelling that? This is not exactly well delivered. And he's like, Nah, it's okay. And I was like, Oh God, you must get the worst speakers, you cyber security dorks. Like, you know, I don't know, practice talking to people if you're gonna do this. Really did make me want to leave the room. I actually looked at my brother. I felt like my mom for a second. He had a big bag of like, stuff that he had to take back to work, and we were gonna go on the tour afterwards, and and I said, Uh, hey, give me your bag. I'll take it out to the car. Get me out here. He goes, You sure? I'm like, Yeah, give it to me. I say we don't want to walk around with this while we're on the triggers. I'd be great. And I was like, plus, you know, like, jeez. Like, maybe give me five minute break from this. Anyway, public speaking is not, not easy. I feel, I feel bad, right? Anyway, she really was terrible. What have we not talked about that we should have.

Chapman 53:01
I think we hit some pretty big points. Yeah,

Scott Benner 53:04
you don't feel like anything's left on set. How did you find the podcast? One of

Chapman 53:08
my diabetes education friends I was talking about, she'll probably listen to she's been texting me once a week. Hey, when are you recording? When you're recording? I can't wait. I can't wait. She told me about it. She's so it was a great resource early on to find why

Scott Benner 53:20
doesn't she come on the podcast? You

Chapman 53:22
definitely could have or she is a wealth of knowledge. She is one of the smartest people ever.

Scott Benner 53:27
Well, we need more smart people, because all I really bring is, like, you know, perspective and dumb stories. So like, yeah, we need more smart people,

Chapman 53:35
yeah. So she, she's a veteran pediatric nurse turned diabetes educator. So she is a great person to talk to, should reach out please, definitely. I'll send her a text.

Scott Benner 53:44
Yeah, I appreciate her telling you about the podcast. Has it been valuable for you personally, like with your with your management, and if so, what parts of it so people know where to go look.

Chapman 53:53
Yeah, absolutely. The Pro Tip series was fantastic. Really helped me kind of wrap my mind around, you know, the basics about everything that kind of hits, like a wide range of things, you know. And then what was the one other series, like the first diagnosis, bold beginnings,

Scott Benner 54:14
yeah, this part always breaks my heart a little bit, by the way. No, you don't need to be sorry. There's no reason for you to remember it like, it's just like, when you live in it, like, I do, oh yeah, you know, you're just like, oh, it's the bold beginning series. Or, you must know, this link and blah, blah. And I'm like, people don't know any of this. They're just like, they're just bumping into it and getting to it when they need it. Yeah, no. But

Chapman 54:33
listening to bold beginnings really helped me when I was just in a panic state, like, sat down, mentally unavailable for anything I'm like, I just need to listen to some, someone who understands, who can help me process this. So that that series was incredible for me. I really thank you for

Scott Benner 54:50
that. No, no, and Jenny, being from the Midwest, didn't bother. Yeah, I'm just kidding. That's awesome. I'm very happy to hear it. Yeah, you. Is it a thing you would tell other people about? It is, and I have

Chapman 55:03
definitely, all right,

Scott Benner 55:04
let me ask you, like, when you got through with the series, did you think, Oh, I was great, except there wasn't enough something, anything missing from it. I think

Chapman 55:13
when I was going through my early, early honeymoon, I know you have the honeymooning episode, but I was wanting more and more and more information about it. I know it's such a not taboo, but it's so misunderstood because there's not enough information about it. They don't really know, like, why it's extended like this for adults, or, you know, X, Y and Z information. I know you can't provide that, but that was what I was searching for at that time. So I need, I need to figure out why this is happening and how I can fix it.

Scott Benner 55:44
The why felt important. Why? Exactly? Yeah, it wasn't comforting to you to know that it was just going to be variable for a while and then it would stop being variable at an indeterminable amount of time.

Chapman 55:54
Exactly it's I'm just like, why? So I need to know why. I need to, that's the nurse part of me. It's like, I need to know why. I need to know why. I need to know how to fix it. I need to see results. And so is

Scott Benner 56:05
it not true though? Like in the end that it's going to be variable, you're not going to see it coming, because it's not going to tell you, and it'll last as long as it lasts. It is, in the end the truth, right? It

Chapman 56:14
is the truth, definitely, but it's the truth that no one to me personally, I don't want to swallow, because you want to know things. You want to know when's the end and what's it gonna look like. So living in that unknown is difficult.

Speaker 1 56:25
I hear you, man, that part sucks. The unknown is, yeah, yeah, I guess, especially if you're an anxious person too. How, by the way, how is your anxiety Great? Is it better now, do you do something for it, or is there something you figured out?

Chapman 56:39
No, not necessarily. I mean, I never really had it until, you know, this started happening. Yeah, I didn't really understand what was going on. Why do I have this feeling in my chest? Why do I can't I breathe? Why can't Why can't I stop crying, you know, but you know, kind of having some help with the pump. I'm not saying a pump is a fix all for everybody, but for my mental health at that time, it really helped me, because of just the constant change and fluctuation and management was really, really difficult for me, you know, trying to raise an infant and, yeah, you know, break it down. So having something taking off my brain, just a little bit of that weight lifted was so helpful.

Scott Benner 57:17
Big deal. So make sure I understand the timeline of this. Then you're not an anxious person, but then you're a nurse, and covid hits, and then you, you gain some of that anxiety, and then the diagnosis and the diabetes and the baby, and then it piles up, yeah, okay. And then, literally, you got a pump, and then that took off, loaded a little burden. And then you kind of, would that do give you enough, enough ceiling space, little headspace to like, get through the rest of

Chapman 57:44
it exactly? It's exactly right? Yeah, I just took off enough load to be able to focus on the other important things that wasn't able to focus on my marriage, my child, and things like that.

Scott Benner 57:54
Can you give me, give us an example of something that happened during covid that that made that time as a nurse fraught and and that it stuck with you enough to start impacting a person who otherwise wasn't anxious to be to feel

Chapman 58:09
that way. Yeah, I mean nothing specific. Thankfully, covid in children back then wasn't as severe. I know I'm not Gosh, I don't want to make anybody upset, but in overall, in children, it didn't affect them as much as it did adults, physically, physiologically. And so we didn't have any kids, you know, passing away or anything on our floor. We did have some pretty insane management of it, with oxygen use and medicines and things like that. But if you just think back to that time looking outside, the streets are empty, stores are empty. You can't go anywhere. And then, but you're a nurse, you got to drive to work through all that. It was terrifying. And then they made my unit. We have 12 different floors at our hospital, and my floor was chosen as the cohort covid unit. So if anybody had covid that came to the hospital, they got sent straight to us. And so we're working through the unknown with all of our n 90 fives and masks and goggles and gowns. 24/7 sweating, getting bruised faces from our masks, everything it was, it was in continuing on doing that for two and a half years during the height of covid every single day, just took a toll on me, and that mental strain, even if nothing crazy was happening, or having some PTSD thoughts of people screaming, dying, stuff like that, even just like the day by day, work of it was scary for me. I know for others it wasn't, but for me, it really impacted me, and so that's kind of where it all started

Scott Benner 59:38
for me. How long had you been a nurse when covid started in three weeks, you had been a nurse for three weeks. Then covid happened,

Chapman 59:46
march 2, 2020. Was my first day on the

Scott Benner 59:49
floor. My goodness, what did you do before? Was you just in school? Prior to that, that was, that was my first job out of college. Geez. Yeah, no, man, that's not right. Yeah, it was.

Chapman 1:00:00
It was quite unfortunate. But, you know, I I pride myself on it now, because how many other people get to say they were a nurse their first, you know, month on the job, covid hit. And if you don't learn anything hitting the ground running, covid will do it too. That crazy time. I

Scott Benner 1:00:15
guess you have a hell of a perspective now, and probably does it make now post covid, post, you getting through your, you know, your initial impact, you know, for you personally, like, do you feel a little more like matrixy? Does everything seem a little easy and a little slow to

Chapman 1:00:31
you? Yeah, definitely. And I think after, like, the craziness, craziness died down, you kind of looked at things a little differently, because you're like, Oh, we got through that. We can do pretty much anything I would imagine. This tough thing comes in. Hey, we got through covid trying to do all the same things with all this craziness going on. We can do this. So it gives you a sense of pride,

Scott Benner 1:00:54
honestly, thinking back now, pressure makes diamonds, my friend, absolutely. There you go. You sound like one hold on. One second for me, we're done. You were terrific. Thank you, awesome.

The conversation you just heard was sponsored by touched by type one. Check them out please at touched by type one.org, on Instagram and Facebook. You're going to love them. I love them. They're helping so many people at touched by type one.org this episode of The Juicebox podcast is sponsored by the Omnipod five. And at my link, omnipod.com/juicebox you can get yourself a free, what'd I just say, a free Omnipod five starter kit, free. Get out of here. Go click on that link. Omnipod.com/juicebox check it out. Terms and Conditions apply. Eligibility may vary. Full terms and conditions can be found at omnipod.com/juicebox links in the show notes, links at Juicebox podcast.com Are you tired of getting a rash from your CGM adhesive? Give the ever since 365 a try, ever since cgm.com/juicebox beautiful silicone that they use. It changes every day, keeps it fresh. Not only that, you only have to change the sensor once a year. So I mean, that's better. Thank you so much for listening. I'll be back very soon with another episode of The Juicebox podcast. If you're not already subscribed or following the podcast in your favorite audio app, like Spotify or Apple podcasts, please do that now. Seriously, just to hit follow or subscribe will really help the show. If you go a little further in Apple podcasts and set it up so that it downloads all new episodes, I'll be your best friend, and if you leave a five star review, ooh, I'll probably send you a Christmas card. Would you like a Christmas card if your loved one is newly diagnosed with type one diabetes and you're seeking a clear, practical perspective, check out the bold beginning series on the Juicebox podcast. It's hosted by myself and Jenny Smith, an experienced diabetes educator with over 35 years of personal insight into type one, our series cuts through the medical jargon and delivers straightforward answers to your most pressing questions. You'll gain insight from real patients and caregivers and find practical advice to help you confidently navigate life with type one. You can start your journey informed and empowered with the Juicebox podcast, the bold beginning series and all of the collections in the Juicebox podcast are available in your audio app and at Juicebox podcast.com in the menu. Hey, what's up, everybody? If you've noticed that the podcast sounds better and you're thinking like, how does that happen? What you're hearing is Rob at wrong way, recording doing his magic to these files. So if you want him to do his magic to you, wrong way. Recording.com, you got a podcast. You want somebody to edit it. You want rob you?

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Scott Benner 10/21/25 Scott Benner 10/21/25

#1658 Dr. Michael Haller Returns

Dr. Michael Haller returns to discuss early T1D screening and how identifying risk markers can open doors to preventive steps that delay or slow diabetes onset.

+ Click for EPISODE TRANSCRIPT

Scott Benner 0:00
Welcome back, friends. You are listening to the Juicebox podcast.

Dr, Mile Haller 0:13
Good morning. Thanks for having me. This is Michael Haller. I'm Chief and professor of pediatric endocrinology at the University of

Scott Benner 0:20
Florida. 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 it can be hard to find these things in a podcast app, so we've collected them all for you at Juicebox podcast.com while you're listening, please remember that nothing you hear on the Juicebox podcast should be considered advice medical or otherwise, always consult a physician before making any changes to your health care plan or becoming bold with insulin. The episode you're listening to is sponsored by us Med, US med.com/juicebox, or call 888-721-1514, you can get your diabetes testing supplies the same way we do from us med. 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 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

Dr, Mile Haller 2:20
Good morning. Thanks for having me. This is Michael Haller. I'm Chief and professor of pediatric endocrinology at the University of Florida.

Scott Benner 2:27
Michael, welcome back. I appreciate you for having me. No, I had such a good time talking to you the first time I thought we would come back and do something else. Let's see, do you remember what we talked about last time?

Dr, Mile Haller 2:38
We talked about lots of things that we started with the intent of talking about inhaled insulin and novel insulin therapeutics. I think we wandered a little bit into immunotherapies for delaying disease and protecting remaining beta cells for patients.

Scott Benner 2:54
And maybe we'll talk a little bit more about what early testing right now and things that maybe can be hopefully done for type one before the on the complete onset. Yeah, that's what I'd hope to talk with you about today. Awesome. I'm trying to look here while you're speaking. I have you trying to see what we called your episode, because it's not up yet, but by the time people hear this, they will have heard it, feel like I have it here somewhere, like it's a grand rounds episode. I think that's what I did. I did. I think, I think I called it grand, grand rounds, inhaled insulin. I think I called it because you were so thoughtful. People can go find if they enjoyed you today, after they heard this, they can go find more of you there. Perfect, excellent. You know, before we started recording, I asked you if you saw this, this news story about something I saw recently about CRISPR genes and somebody having beta cells replaced. And I want to get back to that, but I don't think I want to start there. I want to say at this point I didn't have a podcast, so it was over 11 years ago, maybe more, I had this scientist on that the JDRF set me up with, and he went on and on and waxed poetic about this pouch they were going to make, and the pouch was going to have cells inside of it, and they were going to open your body up, put the cells inside, give you this, you know, immune suppression, and this little wallet full of cells was going to act like your pancreas and on and on and on. And all I really remember beyond that from that conversation is that I asked him, All right, let's pretend for a second. You got it all figured out. It works. How long until I go to Target and get this for my daughter, you know? And he goes, Oh, 15 years. And I was like, wait, what? And he goes, Yeah. Like, if we had it worked out today, there'd have to be manufacturing. We'd have to get the cells. Like he was go on and on, what would have to happen, right? And he's like, so if we knew how to do it today, it would be about 15 years before we could have like, a mass roll out of it. Does that timeline still work? If something was found today? Do you still think it would take that long to get in the hands of an average person?

Dr, Mile Haller 4:54
It's hard to always predict what the regulatory pathway and timeline is going to look like, so I don't think. They were that far off. Sadly, I wish we could compress it a bit. I think it's likely that the timeline will continue to get compressed as more of these options for Cell Therapy come to be and they're potentially even more effective, and it might get a breakthrough status from the FDA, but it's not a trivial thing, to build up the machinery to manufacture these kinds of biomaterials and develop cells that are effective, and then do the studies that are going to result in getting approved. But of course, it's a noble effort, because for the 99% of patients with type one diabetes who are living past stage one or stage two, where they don't need insulin, or past stage three, where the early onset but still have a lot of beta cells left. We're going to need beta cell replacements to provide meaningful, curative therapies for patients. So undoubtedly, people will continue to do the work in that space to try to bring better things to the field as fast as we can. But, but, yeah, it's a slow process. When

Scott Benner 6:06
you hear people you know in your circles talking about all of this, is there ever any you want to get involved in something like, Forget medicine for a second? Like you want to get a car that does this thing? Or you, you know, you want a new television and you think, Well, I'm not going to buy it this year because I heard the one that's coming next year is going, does that happen in medicine too? Because it just occurred to me, like, if they figured it out, like today, and they were like, Hey, we can do it. And, you know, like you said, we're starting to build up infrastructure, and all the other things that have to happen is it not in the back of somebody else's mind, we're probably going to figure out something better than this before we can get this working. And does that feeling slow people down from like, rushing forward, like, Don't you have to be all in on what you're doing and see a pathway, not just to getting it to people, but to, I'm assuming, make money with it, so that somebody will actually get behind it. You know what? I mean? Yeah,

Dr, Mile Haller 6:57
I think that's a good place to compare the difference between scientists and academics and and the commercial aspects of these things. But obviously they have to work in tandem to ultimately get something to patients. You know, scientists are iterative people. They just like to keep doing things to learn and figure out how to do it better, and the notion of we're going to do it better at some point beyond, you know, the thing that I've developed tends not to bother the scientific community, because I know that's the means to progress. It's a bit more challenging on the commercial side. To your point, because, of course, you know, people there have to be able to generate a return on their investment by way of profit of selling a device or a product or a drug, and so they are very much in tunes to, is somebody going to have a, you know, a better widget? The day after I spent 10 years of development to build mine?

Scott Benner 7:52
Yeah, I write you a $3 billion check, and next week I find out I could have had something that was faster, better, cheaper, to production, etc, so on. Like, how do I know when to jump in?

Dr, Mile Haller 8:03
Yeah, so I think that has been a challenge in the type one space, certainly on the immune therapy side, because there hasn't been a large number of therapies that have gotten a label. At this point. We have typlizumab as the only FDA labeled immunotherapy for type one. And there is, you know, Zema cells are the first cell therapy for type one to get a label, mostly around the manufacturing process of that cell approach to islet transplant. But I think the technology space is probably a good example of where that can still be effective and provide patients fast access to new, meaningful therapeutics or machinery to take care of their disease, because there's a number of people in the space, and all of them are trying to innovate to make a better system faster, and there's room for everybody to both make profit and truly develop better better pumps and better CGM so my hope is that we get to a space in the immunotherapeutics or cell therapy world where that can happen too. I think we're just at the fair, you know, we're sort of at the infancy of of that with toplasymab, you know, getting getting across that first finish line, so to speak. But, you know, being nowhere close to the end of the race that we all want to achieve, which is, you know, having a handful or larger number of drugs therapies that we can offer to people who might be at any stage of the disease. You know, that may offer something that you or somebody else's family would call a viable cure. And of course, that may mean different things to different people. You know, there are folks who would be happy with a pump and CGM style cure to their disease if it really meant they didn't have to think or worry about their their diabetes, and they were comfortable and confident that it was going to take care of it. And there are others who, I think very reasonably, say nothing is a cure until I literally have nothing on my body and my body works like it's supposed to, and I don't need. Insulin exogenously there too. I think that the two things are going to continue to be developed in in parallel and hopefully complement each other. And I don't think there's a problem with that.

Scott Benner 10:09
I think you said two really interesting things are the first idea that, you know, using the like a pump or a CGM manufacturer as an example, like they're in the game already, so they need to keep iterating, because I think we've seen how society works with like, a phone, for example. Like, nobody's happy until the new one comes out, and you haven't gotten to I still have to touch all this a number of times. Like, I just, I told you before we got I was two minutes late jumping on because my daughter's rushing around. She's a little late for school, and she's like, can you please bring me a pod? Because I got to change my pod and like, until those, like, those touches go down, you know, right? You're still there. But maybe that's why we should be happy that it's Sanofi, right? They bought Tim as a pop from prevention. So, like, we should be happy that somebody threw their hat in with their wallet, because now they're going to keep pushing. They're pot committed now

Dr, Mile Haller 10:59
100% Yeah, use that exact phrase all the time when I'm talking to patients and families. They are pot committed. Companies don't commit that number of dollars unless they do see a way forward that can generate return on their investment. It all but forces their hands to continue to innovate and develop new therapies. So to their credit. Sanofi has a number of promising immune therapies in the pipeline that are in clinical trials as we speak, that hopefully will complement to plasmab maybe be better than diplomacy map may work better for certain patients. And so again, that may get us to that space where it feels like it feels with with pumps and CGM now, and you have some choice, and you can advocate for yourself and decide which one of those things makes more sense for you or your

Scott Benner 11:46
patients. There's a framework that can be built on, hopefully that somebody's, you know, they're in already, they're not going to stop now. You don't lay out 3 billion and then go, hey, you know what? Forget it exactly. Yeah, you'd push good money after bad before you just gave up. So hopefully that that keeps the process going, and maybe you'll find out that maybe that drug will lead to something for people who don't have diabetes, like, who knows what's I certainly don't understand the the mechanism of the molecule so, but I'm hoping they do, or they wouldn't have bought it. That's my hope there. The reason I bring this up, I'm going to kind of fold together with this next thought, and then we can move forward. I see a lot of conversations online around stuff like this, right? And people either they kind of lean one of two ways that, and the one way they'll Lean is, like, it's coming. They fixed it. I saw there's a lady in China. She doesn't have diabetes anymore. Like, you know, I saw this here. They did it. It's coming. Like, they're either way too enthusiastic or the opposite of it. And I think we've gone over the first part, I want to ask you about the latter, just your personal opinion. What would you say to somebody at a cocktail party, for example, who said, yeah, yeah, no one's ever curing this. There's no money in it. They want to keep me sick. It's more viable for them financially that way. And then they tell you the story about the light bulb that doesn't burn out. And they got the guy in the room and took his patent and his light bulbs and burned all the stuff. And like, you hear all those kind of those stories after that, like, I would tell you that if you asked me to just you gave me money, you said, Scott, you got to bet this one way or the other. I bet that if something comes up, it'll make it'll it'll see the light of day, and people will say it, they'll at least know it exists. I don't know if that means money will get behind it or not, but how do you feel? 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. Full 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 I used to hate ordering my daughter's diabetes supplies. I never had a good experience, and it was frustrating. But it hasn't been that way for a while, actually, for about three years now, because that's how long we've been using us Med, US med.com/juicebox, or call 888-721-1514, US med is the number one distributor for free. FreeStyle Libre systems nationwide. They are the number one specialty distributor for Omnipod dash, the number one fastest growing tandem distributor nationwide, the number one rated distributor in Dexcom customer satisfaction surveys. They have served over 1 million people with diabetes since 1996 and they always provide 90 days worth of supplies and fast and free shipping. US med carries everything from insulin pumps and diabetes testing supplies to the latest CGM like the libre three and Dexcom g7 they accept Medicare nationwide and over 800 private insurers find out why us med has an A plus rating with a better business bureau at us med.com/juicebox, or just call them at 888-721-1514, get started right now, and you'll be getting your supplies the same way we do.

Dr, Mile Haller 15:56
Yeah, no, it's a common question, and parents and families ask it all the time. I'm of the opinion, I think like you, that if you really had a therapy, a biologic approach, that was curative, you as a company could name your price. And the example I'll give that is gene therapies. Right now, there are gene therapies on the market that cure awful diseases. They cost three, four or $5 million a patient. Why? Because the return on that investment is well worth it, and insurance companies are paying it, because if they don't, that patient is going to cost them significantly more. When you look at the lifetime cost of living with diabetes, and I mean all costs, both for buying all the equipment and medical complications down the down the line, and you know, the quality of life, years added, there's no doubt that a therapy that really was a cure could be a profitable therapy for somebody. Now, will that put other people out of business? Yes, but that, you know, that's true of lots of things in the history of innovation and medicine is a reason why people should continue to strive for that, and why I don't buy into the notion that somebody is hiding a cure somewhere. That just isn't the way scientists work, certainly, and even though there might be companies in pharma that would benefit from things being slower to get getting to patients than others. Eventually, things at work are going to find their way forward.

Scott Benner 17:25
I would also be inclined to be a little more cynical but hopeful at the same time by saying that the person looking for the quote, unquote cure is not the person selling you insulin or pumps or whatever else you're buying, where people think like, oh, they want us to keep buying this stuff? That's another person like, there's an ice cream shop on the left side of the street, and I'm going to open up one on the right side of the street. My ice cream is better than your ice cream. I'm going to put you out of business. That's kind of my point is that if someone came up with a cure, they would get financial backing from a group of people who are not involved in diabetes, and those people would look at that as a way to get wealthy off of curing your diabetes, like, I don't know why, yeah, yeah, it seems simple,

Dr, Mile Haller 18:09
yeah. And, I mean, there's the real world examples of that even now. So look at the one you just gave was Sanofi, and they they make in Atlantis, you know, arguably the highest selling in terms of dollars. I think insulin in the world still, and yet they're in the space of trying to prevent or delay the disease. The world's market for type two diabetes and insulin is still huge. And so they can continue selling insulin for a long, long time in that market, even if there are biological therapies for type one. And similarly, Lily, you know, other major producer of insulin, is now in the immunotherapeutic space as well, because they have a therapy, paracetamol that that looked really good in a trial done in Australia called bandit, and they're moving forward to do a stage two and stage three study for potential labeling in the US, internationally. So I think there's places for company to companies, even, even single companies, to be in both spaces and essentially be diversified so that they can have opportunities down the road. Again, I'm not a business guy, so that's not the way I think, but I think that that's that's a reasonable way for for people to see the space and try to avoid the sort of conspiracy theory mindset that somebody is going to keep something that's going to help people and patients locked away.

Scott Benner 19:30
Yeah, okay, I appreciate you going over that room for everybody out there is worried about it. Go find Bigfoot or something. Put turn that, turn that energy on something important as to whether or not there's really UFOs. Need pictures of messy too. Yes, listen, I run a very small business compared to the business that someone's going to run one day if they come up with a cure for diabetes. But if you handed me the cure for diabetes right now, I know how I would market it. You know what I mean? And I not a business mind. I'm assuming that smarter people than me can figure it out. By the way. I want to say I don't think they just see. Dollar signs. I also think that people really motivated people like that. I think they would enjoy having their name attached to something that changed the world that way, right? Great. Michael, like, wouldn't you want your name on that? You know what I mean? Like, if you had that kind of thing, I'd want people to know I did that. I'd want people to I'd want people to know that somebody figured it out that science figured it out, that maybe you guys should get out there and work on something else. Because look what we figured out. You know, we absolutely, yeah, it's only been, what it said, 100 years or so since they came up with insulin. That's the other thing that cracks me up. Like it's been forever, like it's been 100 years. That's not long. 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 a 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.

Dr, Mile Haller 21:43
It really isn't. It is sort of amazing when you step back and think about where we've come in 100 years, from an insulin at all to, you know, all these analog insulins and pumps and CGM that were, you know, purely science fiction are now reality, and they're only gonna get better. So yeah, I think the pace of discovery is accelerating, and I think there's lots of reasons to be hopeful rather than pessimistic, but at the same time, you have to be a realist and know that unfortunately, the cure is not tomorrow or even next year. Yes, it's still a ways away.

Scott Benner 22:19
So then I'll share with you, and I'll ask your what you tell people, but I'll share with you the when someone asks me directly, Scott, what do you think about there being a cure for type one? I will tell them the same thing over and over again. I live hopefully, but we're pragmatic, so day to day, we act like it's never gonna happen like that. Arden's health long term is focused on us doing a great job day to day, hour to hour, sometimes, right? Like it's never going to happen, so we need to keep her as healthy as we can for as long as we can. But I'm also not, not hopeful, and I do think all this stuff is incredibly interesting. Like, am I going to see it in my lifetime, I'd bet against that. I'm in my mid 50s. I'd bet against that, right? If it happened, I'd be thrilled. What I hear is that if somebody came up with it today, I'd be 69 by the time maybe they could get it to market. I'm also listening to stories about how AI is changing every three months. So in my mind, medical research is going to probably get more and more, I don't know, hopefully faster, with the help of, you know, baby like, instead of bench doctors and people sitting down, taking notes and keeping spreadsheets and hoping to find, you know, a connection between this and that maybe AI will get better and better. They'll all dump their data into it, and the thing will go, Hey, I can't believe you haven't noticed this. You know what I mean, like, and maybe that will speed things up.

Dr, Mile Haller 23:49
Yeah, I agree, yeah. And I think that's a appropriate and reasonable way to think about progress. I also am a big believer in having hope. Am optimist. But the thing that drives me nuts is false hope. And there are a lot of people out there who, unfortunately are pedal it contour salesman. They're pedaling in misinformation. And all that does is serve to, you know, upset people further. It's like the whole notion of, you know, the decade of a cure and just just, it's right around the corner. I think that's that's not being fair and transparent, right and realistic for people, that just sets the field back. So I will never give people a timeline either, because I just don't think that's right. I don't think we really know. So why I suggest that you do, but I do think we're every day making progress towards it, and I

Scott Benner 24:37
appreciate that people need to fund their labs, but every time you save a mouse from something, maybe you don't make a press release, because there's every time you do that, it finds somebody whose kid was just diagnosed 10 minutes ago, and they think, Oh, listen, it happened to me 2007 my daughter had diabetes for less than a year, and I woke up one morning, was reading the news, and there it was somebody. Ordered a mouse from type one diabetes, and I actually said to my wife, I can't believe how lucky we are. Arden was diagnosed with type one diabetes right before they cured it, and that was 19 years ago, and I was like, really heartbroken when I realized, when my poor wife had to pull me aside, she's like, listen, dummy, and she explained it to me, but it's how emotional I was at the time, yeah, it's

Dr, Mile Haller 25:21
hard. You can't ignore those things. And fortunately, there are great discoveries made in the lab on a regular basis, but, but I agree with you, I hate that the press and sometimes even the investigators over promise, yeah, and then ultimately, under deliver, when people finally realize, oh, well, that was the 500th experiment, the nod mouse that was curative. Obviously, none of those have translated yet to humans in a very meaningful way.

Scott Benner 25:50
So if you look at those, Michael, the conclusion you come to is that we'd be better off trying to turn people with diabetes into mice, because apparently we know

Dr, Mile Haller 25:58
really good at curing mice. Fantastic at that. You know, I don't care much about about the mice. I care about kids and people in with type one, and so, yeah, that's patients and families all the time. It's just to start a model. It's proof of concept. And to your point about AI like we are now building and have used these in silico models where we we dump in all the data from all the clinical trials of type one in people, and try to model, you know, what might happen with different therapies. So, so you're right. I think we will get faster and better and smarter and hopefully have more personalized approaches as we, you know, understand that that type one diabetes is really 1000 different diseases with different flavors, and some patients are going to need, you know, a certain therapy, and others a different one. And so hopefully, as we continue to get better and better at that, we can, we can really provide meaningful therapy

Scott Benner 26:49
to more people. I genuinely don't remember where I heard this the other day, but some guy running a lab somewhere, I don't even know what they were researching, and he says, Because of AI, he was able to, I guess, fire a lot of his staff because the AI is doing the work that the staff was doing. And I thought, Oh, great, he'll cure the disease, so that people have more time to sit around and not do anything. They won't have a job, you know, at least we'll all be alive. So anyway, all right. So right now, September 2025 what's the best thing we have going? Where should people be focusing? And is there something they could be doing for themselves or for loved ones? What is real and tangible?

Dr, Mile Haller 27:25
Yeah, I think the lowest hanging fruit silver lining kind of stuff is around screening people for risk, for type one, and identifying the ones who are unfortunately going to develop the disease early. Now we know that the community rate for diabetic ketoacidosis at diagnosis is between 30 and almost 50% in some some communities, and unfortunately, we do a far better job of treating DKA. Analysis that the fatality rate is low, but it's not zero, and it's devastating when we lose a kid because of, you know, a previously undiagnosed case, and DKA, on the other hand, if we're screening effectively and identifying people early and getting them enrolled in follow up and early stage clinics, that DKA rate goes down to less than 1% and we convert, you know, a traumatic diagnosis story with an ICU admission and parents not knowing if their kids gonna survive to still a terrible diagnosis, but one that is far more gentle and safe and allows people to transition to the know the idea of now I gotta live this life with type one diabetes, and even there, we're doing a pretty poor job of screening everybody who is at high risk. You know, one in 300 people in the US, at least kids get get type one diabetes. So it's not a particularly rare disease. And that number is one in 20 when you start talking about first degree relatives of people with type one. And last time I checked, you know, everybody had a mother and a father and and most people have siblings in this country, and so there are tons of people living with type one whose first degree relatives are not being screened. And it's really a shame that we're not doing that, because that that's not a research question anymore. You know, it was when we first started doing the diabetes prevention trial and trying to figure out, could we pick up who are the people who are going to eventually be the type one patients of the future? That question of equipoise is a research question is answered, and it's now something that should be standard of care. And every pediatrician and family practice, Doc and internal medicine doc who has patients with type one diabetes, they'd be reminding them, and if they see their siblings or their parents or their young nieces, nephews, cousins, should be reminding them, telling them that they should be getting screened for type one antibodies. And the hope there is if we identify all these folks, so we develop better therapies that will come. Convert type one diabetes from an insulin managed disease to the immune mediated disease that it is, and pick up these folks and treat them to delay their disease, and hopefully one day be able to prevent it

Scott Benner 30:12
entirely. So first of all, like, I think that's awesome, but I have, you know, a kid with diabetes, and there's autoimmune stuff in my family, and I look up at my extended family and I see autoimmune in them that they don't want to hear about you. Try to tell them, and they ignore it. Nobody wants to hear so let's say I actually do get them to go to the doctor. How do I get them to a doctor that doesn't just go, you don't need to scream for that? You're fine, because you're gonna like, it seems like there's so much, I'm gonna use the word ignorance. There's so many, so much ignorance on this path. Like, right? Like, we're counting on me, or somebody like me to say to somebody else, hey, you know, I think you ought to look into this. If you're lucky enough to talk them into it, they're going to go to a doctor who's very likely going to tell them, Nah, you're fine. Don't worry about

Dr, Mile Haller 30:54
it. No, you're absolutely right. I was, I was just at a diabetes camp weekend, Family Weekend, this weekend, a lot of new onset families. And I asked them, like, how many of you had your endocrinologist in this your endocrinologist, not even just the their, you know, their general pediatrician mentioned that your family members should be screened for antibodies, and the response rate was abysmally low. I think it's just a failure of education, of our ability to, frankly, do a marketing job of telling people there's so much out there to know in terms of medical knowledge and practice. So you can't know everything, but this is something that's pretty darn simple, requires just ordering before biochemical antibodies that are in everybody's electronic medical record system to order now and getting folks to do it. So there's a system we call therapeutic inertia that exists until it becomes standard of care meaningfully, even though it's written in the guidelines. Now, it's just not yet something that everybody is practically doing. And changing people's behavior is hard, so we got to start by educating, educating, educating, and get people to be aware, and then they start to do it. And once it becomes habit, then then it will spread. So that's what we really need to be working on.

Scott Benner 32:07
Yeah, the pathway to it seems, I mean, full disclosure, I did ads last year for screen, for type one, and even I was as I was making the ads, and I was like, God, this seems like this isn't going to work. There's a lot there. And then I've seen how they've kind of gone this year with the I'm gonna get, I'm gonna guess the Chrissy Teigen People magazine article has something to do with it, right? Like, and that kind of stuff. But that's not, I don't know. It just feels to me like you just maybe got to go to the doctors and say, like, look, just take a family history and just you need to be the one to say to them, like, hey, why don't we screen for type one diabetes while we're here? Because, I mean, because that's cutting out a number of steps. And, I mean, it would seem to, if you're gonna, like, I don't know, it just seems, it seems like a lot to me, to for me to have to talk a family member into believing and the family member into being lucky enough to find a doctor that's in on this whole thing, and then, even if they are for that doctor to then know what to do. You know, afterwards is the LEAP again. I think the education doesn't lie with the public. I think the education lies with the physician that could order the test that's just

Dr, Mile Haller 33:12
completely agree with you. I think the, you know, the screen for type one program, which is supported by, you know, Sanofi, is really focused on general population screening and guidance, because ultimately, 90% of new onset patients don't have a family member. So you know, just screening family members is going to not give you the biggest overall yield of future type one patients. But my counter to that as always, well, we're not even doing that low hanging fruit of screening all the family members of people who do have type one. So we should kind of, you know, crawl before we walk and run. And you're absolutely right. I think the focus needs to be on educating the providers. They're the ones who have to click the boxes to order the labs, and if they don't even know the names of the labs. They're certainly not going to do that. So we have to, you know, educate them, make it easy for them to do, make sure they get, you know, appropriate reimbursement for when they're spending time talking about counseling and screening for autoimmune disease and Type one. And so those are things that we're actively doing. You know, in Florida, for example, we had some funding from the state this year to expand screening programs for type one, and so we're doing exactly that. We're doing educational sessions, providing continuing medical education for providers going to providers clinics, to literally show them how to order antibodies and what their options are for doing it with either point of care collection kits or sending patients to commercial labs or doing it through a research assay. So I think you know all those modalities have to be used and have to be optimized before we're going to see, you know, the real large number of folks being screened in. For the 60 something 1000 new onsets a year in the US. You know, it's only a tiny, tiny fraction of those that knew that they were going to progress and had antibodies measured before the disease. And that's a shame. I mean, many of those folks we could have picked up if people were screening family members.

Scott Benner 35:17
You know, can I thank you for a second, because I sat in a number of meetings saying this, and people looked at me like, Oh, look. Podcaster boy thinks he knows what he's talking about. Thank you for agreeing. That's all I wanted to say, because I feel, I feel vindicated, because I felt Listen, Michael, and between you me and everybody listening, I took their money and I made the ads, but I first tried to tell them like, I don't think this is where you should be putting the effort. Like, I've been in this space a long time, like I think you want to go this way. I was, I think I did an interview once, and I've said it to them privately, to beta bionics with eyelet. I was like, I don't know what you're doing for marketing, but skip it and just go write the PCPs, because those are the doctors that are helping people with type one who don't go to endos, who very likely do not have good outcomes. Start slapping your eyelid. Pump on those people that's going to help them. Like, you're going to take people with 1011, 12, A, one, CDE, put their a, 1c, and seven. Like, come on. Like, that's a no brainer, but those are the people you're trying to find. You're talking to me, you're on a podcast. I'm talking to people who are on the razor's edge of their diabetes care. These are people who are forward thinking, out in front, putting a tunnel like effort into trying to figure out how to get a six, five AC to a 1c down to five nine. They're trying to get their time and range from like 80% to 85% they're not they're not trying to turn a 12, a 1c into a seven, like you're looking in the wrong places. The

Dr, Mile Haller 36:37
marketing for the one percenters is different than the folks who are,

Scott Benner 36:42
Michael, no one listens. I sit here and get frustrated sometimes with this screening thing again. Like, you know, I guess I'm never gonna get an ad again, but you guys are going about this all wrong. The lady on the peloton that's not going to do it for you, okay? Like, come on, who's watching peloton videos. Michael, you know what I mean.

Dr, Mile Haller 37:05
I can't disagree with you. I know all screening is good in that we identify more people the Yeah, it does seem like they kind of jumped steps one, two and three and went straight to sort of step four, when they when they could have gone with with a lower hanging fruit

Scott Benner 37:22
ESPN, whose wife or daughter or somebody has type one. I'm like, Oh my God. Like, you got to get your head out of New York and the marketing scene there. And, like, see what it is you're trying to really accomplish here. You know, are you trying to put together a marketing campaign that looks awesome? Are you trying to actually reach these people? Anyway, I said that in a meeting, so I'm not afraid to say it here. They never called me back, so I don't think they agreed with me. But you know,

Dr, Mile Haller 37:48
I've done some advisory boards for for companies too, and I'm not shy about sharing my opinion, but sometimes that means

Scott Benner 37:57
they're not calling me again, but they, you know, the funny thing is, is that they should. They really should. I mean, you other people like me, like, I've been around this for so long, like, I know how it goes. You can't just hire a marketing team who no one has diabetes on the team. They don't know anything about it. They spend the first 30 minutes of the phone call asking you to explain the drug to them, like, you know what I mean, and then, and then suddenly I see all this money goes out the window, and there's tag lines and colors and websites. And I was like, this isn't going to get seven people screened. I would actually like to see people get screened, because I've interviewed people who have used that drug and their kids are not developing diabetes. I've interviewed the people who, you know, actually put that pouch into them. You know, for science, maybe this getting screen thing will or won't lead to you having some benefit, but it's definitely going to lead to somebody having a benefit 510, 15 years from now. Like, if we all don't like do a bit, this ain't going anywhere. Like, everybody's got to do their part to make this move forward. You're not just sitting back waiting for the people or the guy or the lady with the thing to do the thing. It's not like that, like everybody's got to get involved. You know, it ain't gonna go anywhere.

Dr, Mile Haller 39:11
Yeah, and I think that's where maybe the pharma folks are hoping that they're seeing, you know, 10 years down the line where we really are doing general population screening and its standard of care, and every single kid who comes through the pediatrician gets antibodies screened and and they're not wrong in that that's what it will ultimately take to identify every single one of those 60,000 kids who's going to progress before they progress. But you know, some of our group's counter argument has always been that's nice, but, but there's all these folks over here that are much higher yield on the per patient ratio that we're not doing a very good job of yet, either or yet, and we should probably focus on those folks first.

Scott Benner 39:51
Yeah. Well, listen again. I want to thank you because, like, sometimes I feel insane in those conversations and and it's not lost on me. Listen for people listening. It's not. Lost to me. I'm a guy that makes a podcast. I have no degree, I have no background, like Michael, you went to more school the first day of college, and I've gone to my entire life. Okay? I mean, this is obvious, and somehow it's not obvious to the people who are making the decisions half the time. And that's that's upsetting to me, because I really do think the screening would be beneficial. But anyway, good luck everybody. All right, so let's pretend they actually get somebody to get screened. They find a doctor who's willing to screen them. What's the process like? What do they expect to have happen next?

Dr, Mile Haller 40:29
Yeah, so I think we're just trying to give people choice providers, namely choice and how they do this, and make it easy for them. You know, there's the point of care, collection kits, enable Biosciences. There's point of care collection kits from the Ask study run out of the Barbara Davis Center, Colorado. There's even home kits that we provide capillary collection through through trial net. And then there's sending people to get a Venus draw at Quest or lab core. And you know, I think proponents of screening in high risk populations, we just need to make it as easy as we can, so that there's no no other inertia, creating barriers for folks to get it done, because there's always a reason, an excuse, to not do something when it's not an emergency in the person's eyes. So that's, that's what we've been trying to do, and certainly awareness campaigns and education campaigns for for the doctors helps and and then the next step, of course, is when they get somebody who's positive, we have to make it as easy as possible for them to do the right next thing, which is first confirm the antibody status. I'm I'm somewhat surprised by the number of folks who get, you know, a single antibody test and then label themselves as having early stage diabetes without a confirmatory antibody, which the you know that that should be done for sure. But then when somebody you know is identified with with multiple antibodies and confirmed with antibodies, they need to be followed up in, you know, an early stage clinic. All the data that I spoke of before that shows reduced eka rates. You know, that wasn't in the vacuum of somebody just being told your antibody positive and walking away your antibody positive. And we're going to follow you, you know, with metabolic testing, and remind you of your risk for type one, you know, every three to six months in a study setting, and that's where we saw the decay rate go so low. So we want to make all those things easy for providers. So we Florida, our team here has set up an early stage clinic where most of what we do is guidance and education, and because of that, we're able to serve people throughout the entire state because we do it through a telemedicine clinic. So if you're a doc in Key West, or your doc out in the Panhandle and anywhere in between, you can call us and we can set up a telemedicine visit with a family to talk through what it means to have antibodies and what their child's risk really is and what we should be doing to monitor them, and then that allows us to talk through all their choices and options. Do you want to be in trial net and have follow up that way and be offered studies? Or do you want to just have clinical follow up and be a candidate for typlizumab? And I think, you know, the most difficult thing is talking to families after the fact, when they're diagnosed, and they say, Oh, I wish I had known about all these opportunities. And they just, you know, they just didn't get that opportunity. Because in their world, their circle there, there weren't people who who knew about the the notion of screening and follow up.

Scott Benner 43:38
Yeah, yeah. Well, Michael, the the amount of I wish I would have in the world, or are great, right? I wish I would have wore my seat belt. I wish I would have stopped smoking. I wish they are endless. Yes, that's usually when it's too late, is when you're flying through the air, thinking maybe I shouldn't have brought a motorcycle. I feel like we're talking to, I don't know if you're aware of this, not Michael, but a lot of physicians and clinicians listen to the podcast. So I I really feel like, like we're making a bigger picture argument to people out there to get screened, but at the same time, I hope who we're really talking to are the people who could actually maybe make a difference on this. So for those of you listening, here's an example. I interviewed a woman not so long ago, and her kid was, you know, misdiagnosed a couple of days at a time, and then there was a person who was supposed to call and tell her to go into an ER, but, you know, went home from the doctor's office without making all their calls that day. And you know, some days later, her daughter's in the hospital throwing up what they described initially as black tar, and eventually, and I forget what it is, it's not common, okay, but it happened to this kid or esophagus and like that. Trust me, the details are lost on me. Go find the podcast episode, but it was like, from the DK, like it was rotting inside, like she was throwing up her flesh. And that is not a thing that's going to reverse for her, and now the rest of her life is impacted by. This. And literally, somebody just had to say, like, why don't we do a finger stick? Why don't you go to the hospital? And so many people drop the ball along the way. And I'm not saying this happens to everybody, but it happens to more people than you think, and some of those,

Dr, Mile Haller 45:15
no, it's a common experience. And just at this family weekend, I asked people to tell their their diagnosis stories. And invariably, you know, there's one out of 15 or 20 that was seen by a handful of providers in the weeks prior to their diagnosis with symptoms and signs that should have been plainly obvious. And like you said, all they needed to do was a finger stick or even a urine dipstick, and the diagnosis would have been made prior to the kid or adult getting particularly

Scott Benner 45:47
sick. And that's it's good that you bring up those numbers, because I do think that, generally speaking, most physicians, clinicians, etc, like, do a great job for people like, I'm certainly not,

Dr, Mile Haller 45:58
you know, it's not the majority of people, but it's still too many. You know, one's too many. So it happens, absolutely, when

Scott Benner 46:03
it happens, it happens that you have no idea how many people come on this podcast, they start talking about their health. And I'm, I want to be 100% clear. Michael, I think the number was 56 days. That's how many days of my senior year I didn't go to school. Of high school, okay, because I was poor and I went to my job at a my uncle's sheet metal shop to make $4.50 an hour. Okay? And so I would go to work instead. I was not a good student, and I still graduated, and I went along the way and blah, blah, blah. And now here I am making this podcast. And I realize you all probably wish it was somebody else whose diabetes podcast got really popular, but you're stuck with me. It was mine. Here I am interviewing somebody, and they're talking about their life 10 minutes. I'm like, Hey, you're anemic. And they go, what? I'm like, you're anemic. You have hypothyroidism. No, I don't. No, you do. You just described it to me. My point is, I know when people describe it to me, how the hell does a doctor not know? Like, this woman's describing her kid who went through this DK, and the whole time she's talking, I'm thinking like the kids got type one diabetes, like no one notices this when it happens to somebody again. I don't think it's a lot. I don't think it's everybody. There's a ton of you out there doing a great job. No one's talking to you. But every once in a while, we're going to hit a clunker, and some people hit a couple clunkers in a row. They go to an urgent care, they don't get a good answer. They go to a doctor, they don't get, Oh, you got the flu. Blah, blah, blah, next thing you know, you're throwing up your esophagus like that kid's got a real lifelong problem now that a week earlier didn't exist in them, if somebody would have just said, Hey, it sounds to me like you might have type one diabetes. And my point is, is if a guy that skipped his senior year of high school to cut sheet metal could figure it out, I guarantee you that a doctor could figure it out too, like it just something's wrong along the way. I don't think we're going to fix that bit, I guess is my other point. You know what I

Dr, Mile Haller 47:47
mean? Well, despite your despite your lack of formal schooling, clearly you are gifted in the art of observation and talking to people. This is why your podcast has been so so successful. And good physicians do exactly that. And unfortunately, the current American healthcare system has disadvantaged providers in practicing the art of medicine, and they don't always take the time to sit back and recognize what is fairly obvious to others, hindsight always being 2020, so it's easy to Monday morning quarterback it but to your point, like those, those kinds of misses are still far too often and easily could have been avoided if we did a better job of educating those providers you know about early signs and symptoms of type one, and at least made sure it was somewhere in the back of their mind, so that when the next kid comes in, you know, vomiting and losing weight in the middle of flu season, they don't just write it off as being as being flu or gastro enteritis and send them

Scott Benner 48:51
home. I'm sure this makes some people upset, and you know, who are scared of AI and me, you could probably mark me as somebody who's scared about what might be able to what might happen too, but I do have this like I am 100% certain I've settled on here so many times. I hope somebody just steals the idea, because I don't certainly have the capital to get it started, but I think that it would be incredibly valuable if people had an app on their phone that they spoke to and just told it how they felt, that would iteratively keep all of their conversations and complaints and continue to look at them, because that's, to me, is the way that you're going to diagnose things in the future. Because even if you get a good doctor, you're counting on, I mean, Michael, you know this, right? You're counting on the person to come in and actually say all the things and not to mislead you with their theories about what's going on. And then you have to You're also arguing with your wife and you got a kid who's like, you know, I mean, like, everybody's got a life. There's a lot going on in people's heads. If you had a simple, personal AI that you said, like, Hey, I woke up this morning and my knee hurt, like, anteriorly, just right here. Like, I don't know it's only happening when I'm driving. And, you know, this happened to me, and my bowel movement was kind of runny today, and, blah, blah. Lot, eventually you'd say enough to it that it would go, Hey, you should look into this, because that's really what you're asking of a doctor, but you're asking them to do it 10 minutes at a time, three times a year. And I really,

Dr, Mile Haller 50:12
I'm bought into the use of AI to take care of patients already. I mean, I have many times put symptom complexes or patient complaints in to see if it broadens my differential or makes reminds me of something I didn't know before. And right? My philosophy in teaching has always been, you know, don't memorize stuff, understand it, and it just makes that so much easier. Now you don't, you don't have to memorize every single pathway or every single name of a drug, but if you at least can give, you know, a large language model like chat, G, P, T, the right information to go find it. It will make it far more efficient for you. So you can get back to that, that art of medicine, of really observing and talking to patients and families and and that's what I think the future is like. I don't think AI will replace doctors, but I don't think there'll be any doctors, successful ones who don't use AI, right? That's just, that's just the way it's going to be. So you can either choose to adopt the technology and let it help you take better care of people, or, you know, you can become a dinosaur,

Scott Benner 51:12
yeah, and it'll stop people from having to send a bunch of people into DKA to learn their lesson as a physician, because that is really what happens, right? Like, it's trial and error, like everything else, like you everything else, like, you keep having experiences, Till one day your brain just goes, Oh, that's this. Like, I've now seen that enough times that it just pops into my head. It's not lost on me. You can't teach somebody everything they need to know to be a doctor in medical school. Like, I get that, yeah, you know, and that there are some people out there who want to be great doctors. There's some people out there. They're like, hey, my mom told me to be a doctor. I'm a doctor. And, you know, yeah, right. Like, so there's a, there's a, you know, a mix of of situations you're going to run into. But going back to the person, the person who's sick, they don't know who they're going to go talk to. They don't know if you're about to walk in with a doctor who's been at this for three days or 30 years. Like, you know what I mean? Are you the one they're going to send into DKA to learn their lesson? Like, that's that doesn't need to be like that anymore. I think at this point, when I go to a physician now, or if I send my kids, I know with reasonable certainty what's going on before I get there, but everyone's been directed. Don't say it out loud. Keep it in your Keep it inside. Let them do their job. And if they don't get to what you're thinking about, that's the time to lay your bread crumbs out and say, Well, I also saw this and this and this. I was wondering if maybe it could be that, and let them think about it. Because I find that if you go in and say your thing, then they don't do their process. And you don't want to take them out of the loop. You'd like to hear what they think and what they what their you know, thought is here. But you also don't want to walk in and walk out when you're 99% sure this is the problem. So I don't know, like I hope everybody I know people say, advocate for yourself. It's I hate that honestly. I hate that word. I hate the idea that you need to do that. I hate the idea that there's possibility that I'm going to run into a physician who you know, if I don't advocate for myself, isn't going to help me. Like you have to arm yourself with as much knowledge as you can, let the physician do their job and then fill in where you don't hear back from them. But you got to do it in a way that doesn't rub people's egos wrong or come off like you're telling people, it's, it's a it's a dance, it really is. You know, it's hard to go to the doctor, is what I'm saying. You know, there's too many people walking around might go with a TSH of four being told they're fine. They've got six different things. They're struggling with it. All point to hypothyroidism. Like that just happens all day long to people. How does that happen? By the way, yeah, well,

Dr, Mile Haller 53:39
that's a that's a good example of one that the data don't really support. There being much that should be treated with the TSH that's in that range, but lots of people come in with the symptoms, and it is hard for physicians to differentiate the ones that may really have symptomatic hypothyroidism that needs to be treated with a high normal reference frames, TSH from, from those who have very valid complaints, but they're coming from other things. So it's not all black and white in medicine for

Scott Benner 54:10
sure. Yeah. So you need people who have been through it enough times to say, like, look, I see the symptoms. I'm going to get you some medication. We'll, we'll see what this does here. And, yeah, I mean, that's just that. One's a is a thorn in my side because it, it, it really, like, derailed a large portion of my wife's younger life, you know, like walking around, fortunately, yeah, it's just, it's, it's upsetting and so, and now, since then, I've had tons of doctors on who talk about it differently. There's a great thyroid series on the podcast, if you really want to understand it like Dr Benito comes on and talks about she'll medicate you 2.1 or higher with symptoms you're you're going to get a thyroid replacement from her. Interesting, yeah, and she helps people at an incredible she's one of those doctors you can't go see anymore because too busy. You know. Do you think that it all. Ends up going that way one day, are the ones that really know what they're doing just going to open their own practice and be cash pay?

Dr, Mile Haller 55:07
Oh, I hope not, just because I think that will result in only a small portion of people having access to to the best of care. I mean, it's tempting for physicians to do that because it's, you know, because it gets rid of all the middlemen and logistics and allows people to spend a lot more time with their patients and provide care that way, we here at our at our institution, at least in our clinic, it's we're about 60% Medicaid, so we would immediately be leaving almost all those patients without access to endocrinologist if we did that. So I think we just need to do better jobs of of improving the system so everybody can have access to good

Scott Benner 55:43
docs. Yeah, is there anything that we didn't talk about that you wanted to that was lovely conversations got I appreciate it. Thank you. I'm gonna keep bugging you to come on like you're great to talk to. Thank you. I appreciate your time. Hold on one second for me. Okay, thanks. You.

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