#1661 The Trolley Problem

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Scott and Erica unpack the trolley problem’s comeback, wrestle with action versus inaction, and connect moral choices to daily diabetes management—pre-bolusing, fear, responsibility, and compassion—aiming for practical mindsets that help.

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Here we are back together again, friends for another episode of The Juicebox podcast. Very recently, in the last few weeks, it became very fashionable in podcasts and stuff for people to talk about the trolley problem, but I got a little captured in it and thinking about it again and seeing it pop back up. It's a thing I've known about for years. I'd like for us to kind of lay out what it is, and both of us take a turn describing how we might answer the question, and then see if there isn't some ways to think about that help you live day to day with chronic illness. If 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. This episode of The Juicebox podcast is sponsored by Medtronic diabetes and their mini med seven ADG system designed to help ease the burden of diabetes management. Imagine fewer worries about Miss Bolus is or miscalculated carbs thanks to meal detection technology and automatic correction doses. Learn more and get started today at Medtronic diabetes.com/juicebox today's episode of The Juicebox podcast is sponsored by the contour next gen blood glucose meter. This is the meter that my daughter has on her person right now. It is incredibly accurate and waiting for you at contour next.com/juicebox Okay, Eric, oh, you and I haven't recorded together in a little bit. Why? It's been a while. Where'd you go? We had summer. That's where we went. Is it okay to let people know that what your daughter did this summer took up a lot of your time? Oh yes, my daughter, who's 10, was on the All Star softball team, which Scott knows a lot about. So it is. It does take up a lot of time, but it's really exciting. That was a fun way to spend most of our summer watching her play softball. Well, listen, did you have fun? Did she have fun? Absolutely, yes. A great team, great families. They got second place. Oh, that's awesome overall in their league. So congratulations. Great first experience. Thank you. I will not tell you that Arden somewhat believes that she thinks that she's more critical of herself as an adult because of her time playing softball. Oh, gosh, so interesting. What I Well, I'd be curious to hear more. Yeah, specifically, because so I guess in a lot of places, right? This is a fun thing. It's, you know, competitive gives you an opportunity to keep the kids together a little longer, make them better at softball, if that's your goal. But my town specifically has gone to the Little League World Series for softball a number of times. Wow. So there's a lot of pressure to be very good at it, and that pressure flows through the men who coach the teams, who think that they are, I would say, think they are defending their themselves against the ones who came before them. So the closer you are to being on the team that is happening now, but the last team went to the World Series, the more pressure there was. And we were very much after that. So there a team had gone to the World Series, done very well. Another team went did not quite as well. And then it was Arden's team's turn. And there was a lot of a lot of pressure I should get on here sometime. And let Arden tell the story of she was undersized when she was playing, which is ironic now, because Arden is five, seven now, and probably one of the tallest girls that is in her friend group, or even that she knows, but she was undersized when she was playing, and she was a rock solid, awesome third baseman, and every year they would try to replace her with a different girl, and every year she had To beat that girl to stay at third base. And it happened seven years old, eight, 910, 1112, every every year, they would do anything they could to try to replace her because they thought she was too small, and then they'd eventually end up with her, and she would do great every time. So anyway, that's got nothing to do with the trolley problem. I. That so very recently, in the last I'm looking at my my calendar here, in the last few weeks, maybe last month, it became very fashionable in podcasts and stuff for people to talk about the trolley problem, which probably just means that somebody that wrote a book was making the rounds, doing their doing their interviews, trying to sell their thing. But I got a little captured in it and thinking about it again and seeing it pop back up. It's a thing I've known about for years, and, you know, views as an example. But I'd like for us to kind of lay out what it is, and both of us take a turn describing how we might answer the question, and then see if there isn't some, some ways to think about that I don't know, help help you live day to day with chronic illness. So let's see if this works. Maybe it won't. We'll find out what an opening. Hey, yeah, keep listening. This might work out. Join us as we figure out what this is. So just reading to you the trolley problem is a moral thought experiment. It's used to explore questions of ethics and decision making, first introduced by a philosopher, Philippa foot and later expanded by Jarvis Thompson, it is not about trains, but it's about the trade offs in decision making. So it's set up like this, and I'll ask it of you first, and you can ask it back to me. Erica, there is a runaway trolley. It is speeding down the track. Ahead of it are five people tied to the main track who are going to be killed if the trolley keeps going, you are standing next to a lever. If you pull the lever, the trolley will switch to a side track where one person is tied up. So your choices are you do nothing and five people die, or you pull the lever and one person dies, but five people are saved. So with giving that serious consideration, what do you think you would do? Well, I would remind myself, there's there's no right answer. You think you would let me help a little bit. Oh, my God, that trolley is going to kill those people. Erica, help us. So I you know, as you've set this up, right? This is a way to think about how we're going to respond in situations, how our our hearts and our brains make decisions and actions. I would like to say, and think that I would instinctively pull the lever okay. But I also know there's a part of me that would probably freeze and panic and try and weigh out all of the decisions, or the two decisions, right, potentially. So yeah, I think I would like to say I would pull the lever there. That would be my answer. You would like to pull the lever. I would like to pull the lever if I don't know if I would be able to in the moment. So you don't know if you'd be able to physically take on an action that would kill somebody because you didn't set the trolley in motion. This isn't your fault when the five people get sliced up. Sorry that it's fake. Makes it so much fun that the five people are going to get run over by the trolley has nothing to do with you. You didn't do this. You've never built a trolley. You didn't build a track, you didn't tie these people up. You have nothing to do with this. If you do nothing, the trolley kills those people, and you take on no responsibility other than inaction. But your inaction would have been you deciding to kill a person who was not going to be killed if you didn't do anything. Right? Have you seen this video recently, going around of staged videos of out on city streets people snatch up kids and run down alleys in front of other people to see what other people will do when it happens in front of them. I have not seen those videos. Oh, my goodness to me, these are very similar ideas. Yeah. So they're also very interesting, because I've seen, like, burly guys grab a kid, the kid starts screaming. They run down an alley, and big men look at it and go, my name is Paul, and this is between y'all. They keep walking, right? And I've seen women pushing their own children in strollers, chase the men down the alley and vice versa. I've seen guys go after them. I've seen women turn a blind eye. It's very interesting, like, and listen, I don't know if some of it is set up or not, but some of them look very real, and it's, again, just a great experiment, because, like, I didn't pick the kid up. I didn't run away with the kid. I'm not gonna hurt the kid. This has got nothing to do with me. If I keep walking, I've got nothing to do with it. But do you not spend the rest of your life wondering, etc. So now, okay, so you like to think you'd pull the lever. What about you? I'm there with you. I think it's a numbers game. Right on its face. I pull the lever, one person dies instead of five people, I would probably be able to later make myself okay with it by saying that those six people were put in that position by another entity that's not me. Just because the one person wasn't with the five doesn't mean that their life was necessarily safe. I don't think I'd carry a ton of in the. Moment, I don't think I would hesitate. I think it would choose the lesser number, but I know it would bother me for the rest of my life. I know I killed that person, right? But then change it a little bit, so now it's five people on the track and one person on the side track, but that one person lives three doors down from you, and you've, you know them, like, you're not friends with them. You're not like tight but like, that's Jane. She lives three streets over. I've seen her a bunch of times. Does that change it for you? Do you think? Yes, I do. If I knew the person that I would kill if I pulled the lever, I would absolutely, you know, if I'm if I'm frozen already in the initial example, that's gonna keep it. That's gonna keep me there. Now, the person on the single track is not somebody you know, but they're 80 years old. Do you say, Oh, they've lived a pretty full life, gosh. Because when you say yes, I'm gonna then put their grandchildren next to them, saying, save my grandma. And like, and so this goes on and on and on. Yes, yeah, the plot of every horrible horror movie. Yeah, you see this played out in a lot of lot of different entertainment, yes, a lot of different things. Okay, one more time, would you do it to an older person? Because, like, you know what, if there were five elderly people and one, we could do this for an hour. We probably could just keep doing this. I mean, what are we really saying? Like taking the trolley problem out of it? Like there are a ton of different variables here that would change how it would feel. But you think for yourself personally, I think for most people listening, having to take the action is the real thing. Like, right? Like, if I pull the lever, it's on me. If I don't do anything, it's on somebody else. You think so? Contour, next.com/juicebox that's the link you'll use to find out more about the contour next gen blood glucose meter. When you get there, there's a little bit at the top. You can click right on blood glucose monitoring. I'll do it with you. Go to meters, click on any of the meters. I'll click on the Next Gen, and you're going to get more information. It's easy to use and highly accurate. Smart light provides a simple understanding of your blood glucose levels. And of course, with Second Chance sampling technology, you can save money with fewer wasted test strips. As if all that wasn't enough, the contour next gen also has a compatible app for an easy way to share and see your blood glucose results. Contour next.com/juicebox and if you scroll down at that link, you're going to see things like a Buy Now button. You could register your meter after you purchase it. Or what is this? Download a coupon. Oh, receive a free contour next gen blood glucose meter. Do tell contour next.com/juicebox head over there. Now get the same accurate and reliable meter that we use Today's episode is sponsored by Medtronic diabetes, who is making life with diabetes easier with the mini med 780 G system. The mini med 780 G automated insulin delivery system anticipates, adjusts and corrects every five minutes. Real world results show people achieving up to an 80% time and range with recommended settings without increasing lows. But of course, Individual results may vary. The 780 G works around the clock, so you can focus on what matters. Have you heard about medtronics, extended infusion set? It's the first and only infusion set labeled for up to a seven day wear. This feature is repeatedly asked for, and Medtronic has delivered. 97% of people using the 780 G reported that they could manage their diabetes without major disruptions of sleep. They felt more free to eat what they wanted, and they felt less stress with fewer alarms and alerts you can't beat that learn more about how you can spend less time and effort managing your diabetes by visiting Medtronic diabetes.com/juicebox Yes, so yeah, it becomes more personal, right? When you're thinking through making the action, taking the action to save, but also saving means killing. So the consequences get shifted onto you because you were it's the difference between the action the inaction, you took the action you did it right? I think that it's really hard. It would be. I know this is not a real life example, but you're you're making decisions in that moment. What is driving you are is either two things. One is the outcome, right? You're thinking about, Okay, I'm going to make this decision because I know that the outcome will be, quote, unquote better, in terms of lives saved, versus I live by these morals, these values, and I and I do not kill, or I do not lie, or I do not steal, or whatever it is. In that moment, regardless of a potential better outcome. Do you make decisions based on the the rules, morals, values that you live by, and that is a driver? But then I think there's the the other issue of like D Are you the fight, flight, freeze or fun response in this moment of making a quick decision. Okay, so now that we've done this, I am fully I have my mind fully back to where I was on the day that I asked you to talk about this with me, because it you guys don't realize, like, I reached out to Erica, like, five weeks ago, and I was like, hey, this trolley problem thing, I see how it applies to blah, blah. Then we get onto the call, and I'm like, I don't know if I remember what I was thinking back then when back then when I said this to you, but I knew if we just started having the conversation, that would kind of flood back to me, and it has. So Eric is like, great, because I didn't know where we I didn't know where we were going to go from here if that didn't happen. So to me, in consideration, I don't know how to say this exactly, but like, pivot that idea of action and inaction, you know something bad is going to happen one way, or I get to make a decision, and then the outcome is on me to me, that's the core of this, right? And then you apply it to living with a chronic illness, or you apply it to having to take your vitamins or your medicine or bolusing or food decisions. And what I found myself wondering back then, when I was wrapped up in listening to people talk about the trolley problem, which, by the way, I don't know nearly enough about to talk about it in depth, there are people who understand it. You could, you could listen to them talk about it for an hour, and you'd be completely interested in it. But taking that idea from I need to Pre-Bolus my meals. But if I don't, I know what happens next. My blood sugar goes up. It's difficult to deal with all day long, blah, blah, blah, but I didn't do anything. I didn't cause this. Diabetes caused this, right? So whatever happens afterwards, whether it's a high blood sugar or or whatever, whatever happens after that decision isn't really on you, it's on the people who tied the people to the railroad tracks. Do you see what I'm saying? It's diabetes. And I think that that can happen to people. I think that they can take the consequence of inaction, and blame it on an unseen figure, and therefore it makes it easier to make decisions that in the end, not to stretch this, this out a little too much, but in the end, you pulling the lever almost points the trolley at you, right? Because now, if it goes wrong, like, if I mess the Bolus up, it's my fault, like I did it wrong. You know, so is ignorance bliss, right? That's really the question of the trolley problem, like, would ignorance be bliss if I just said it's got nothing to do with me? I'm walking away. Could I forget it afterwards? Could I get could I give myself a pass and not think about it anymore? My point here is that if you are doing that with your care, then I just think you'd be better off pulling the lever if you have diabetes. I think you'd be better off pulling the lever if you have thyroid, or if you're celiac or, you know, if you I don't know, whatever you wake up with and fight with every day like, I think it would be better for you to be in the fight, be part of the decision making process, than it would be for you to just say, hey, this, I didn't do this. Does that make sense to you? That what I'm trying to say, yes. So the cut you said the consequences of inaction. It feels like, if you're intentionally choosing to not engage in your in the management, for example, it feels easier when you're when your numbers are higher or lower to blame diabetes. Yeah, I think it makes it easier for you to say that's just diabetes. And in the trolley example, like I, you know, in my mind, I'm imagining like a spindly guy with a long mustache that He's twisting in a big hat, who's tied these people to the railroad, right? And wants to put you in this bad position. I think in that scenario, the diabetes, I mean making quotes around it, the autoimmune, whatever it is that put you in this situation, they're the bad guy. And you didn't choose to have type one. You didn't choose to, you know, feel sick after you eat bread or whatever your situation is, right? And being asked to do something about it, this is not quite one to one, but being asked to do something about it is difficult for people, and not everybody just pops up in the morning and throws their thyroid med in and skips along their way. Not everybody's like, Oh, I'm going to eat in 20 minutes, and I know I'm about to have a fatty meal, so I really want to get a good Pre-Bolus. And that's just not how it occurs to most people. And I think that for the ones who know they should be doing these things. Can't bring themselves to do it, who won't bring themselves to do it, who forget to do it, whatever the reason is, if you take responsibility for it, well then when you don't do it, the shame falls on you, right? I know I should be doing this thing for myself, and I'm not, and therefore I've let myself down. I've let down my loved ones. I've let everybody down. Blah, blah, blah, but if I just don't do anything, then I can say, this wasn't me. It's the dastardly man in the in the mustache. He did this to me. And I think that's what I see when I see people online. Sometimes I think it's easier to ignore it and blame something than it is to grab the lever and say, Hey, I'm in a bad situation here, but I'm going to make a decision anyway. That's my connection. That's this desk, this it's so it's good and complex and deep, and I'm trying to wrap your time my mind around it as I think about, you know, where do we end up when we have a chronic illness? It's so natural to we want to find blame right after, you kind of go through the dismissal this, you know, I'm fine, and there's a shock. And then eventually you get to like, why did this happen? Why me? And then that usually lands on you want to find blame, you have to, we have to write, is it is it me? Is it my body? Is it my family, genetics? Is it God, right? We want to find blame, and usually it lands on my body failed me. So then you're in this kind of battle where we are pitting ourselves against our bodies, and I think that's where we land, if we're thinking about it through this lens of inaction versus action when we want it's hard. It's hard to be in this place of, okay, if my body failed me, if I'm thinking about it in this way, then I'm going to live in a place of blame and shame. And it's hard to make choices out of that, to be, you know, because you're you're stuck. You can be stuck right there, right? And so I'm wondering, yeah, I think the minute you grab the lever, you're taking this nebulous bad guy and saying, I'm part of this now. So the next time something doesn't go the way I want, I can't blame it anymore. Like all those things that you just said, are completely valid. Some people are. You know, it's my body let me down. It's, it is my uncle's fault. He has all these problems. It's in my God, did this to me. Blah, blah, blah, whatever you want to blame, right? But if you stay out of it, then it's that whatever that is for you is to blame. My point is, is that you got to get into the fight to do well for yourself, right? Because there is well that you can do, but it's going to take a while for you to figure out, like, you know what to do. Like, I mean, it's, there's, there's a lot going on here that my example here would be, like, when you go to eat lunch and you have type one diabetes, you're not just picking food. You're not just saying, like, what am I hungry for? What sounds good today? What haven't I had in a while, you are making conscious decisions about your health, your safety, your future, everything, right? Like no one thinks that way. Now, by the way, I want to say something. Everyone who chooses something to eat is making that decision. It's just not obvious to most of us in the in the moment, right? Conscious, really? Yeah, because, I mean your health, your safety and your future, whether you have type one diabetes or not, you know, is at stake when you decide to drink a case of soda, right, right? You've made a decision that's going to impact those things same way. If you decide to, you know, drink water or, you know, have a salad or have a steak or whatever, like, there are going to be impacts of everything but day to day that doesn't hit you. A healthy 25 year old isn't eating a steak thinking, I hope this doesn't clog my arteries and cause me to have to have a, you know, a roto rooter done for 20 years from now. But a person with type one has to say to themselves, my blood sugar is going to do something as soon as I eat this, this is a immediate feedback I'm going to get. Was talking to somebody today who was helping a college student with bolusing, a person who had previously been just awesome at their diabetes, and they got to college, and all the food at the college is garbage, and they just can't they can't figure it out, like they can't seem to win no matter what they do eating on on campus. Now there's a 1819, year old person trying to go to college who is instead, three times a day looking at food and thinking, What do I do here? Like this is coming for me. This is going to give me a high blood sugar. This blood sugar is going to go on for hours. It's going to change how I. And think and how I feel and how I can do, you know, take care of school today and end my long term health and blah, blah, blah, and it would be easier. And I think a lot of people end up choosing the like, this isn't my fault. The school gave me this food, and so my blood sugar is going to be high forever, and there's nothing I can do about it, because this is my situation. I'm saying, grab the lever, pull the lever, take responsibility and find something. I mean, just try. I guess I'm not even saying there's, there's an answer, but I at least like you being in the fight, I think is what I'm what I'm trying to say, and I know that that puts the responsibility for the outcome on to you and takes away your ability. Probably feels like it takes away your ability to blame a faceless thing, but I actually don't even think that's true. If you need to blame somebody, I think he can still blame diabetes like I think he can still blame, you know, the thing that happened to you. You know, I found myself talking a lot lately about and I know I'm using your words when I'm saying it is that what it feels like when your body feels like it fails you? I know that's the thing I've learned from you. Like that phrase, I was able to use it recently in a professional setting where I was asked to pass on what I've heard from other people about living with type one and what I've experienced, you know, as Arden's father. And at the end of what I was saying, I said, I can't imagine what it feels like for the shell that you're walking around in to feel like it's purposefully fighting against you, that you feel like your body is has abandoned you in your trip through the world. You know it's got to be a like a serious mind to have that happening to you constantly, still in all I think you've got a better chance if you're an active part of the decision making process. Yes, that was a very beautiful, empathetic posture that you just shared there. And I think that that's resonates with those of us living with type one or any real you know, chronic condition is this, yeah, my body failed me mindset. And as I've referenced before, Jane Mattingly in her book, this is body grief, toxic coins that has perceived body betrayal. And that's where we when we get stuck in that place of that mindset that my body failed me, my pancreas failed me, my thyroid has failed me. That's a normal response. But we can't get stuck there, because that's when we get we get stuck in a kind of, more of a self pity victim mentality. That's okay to we're all going to get we're all going to experience that at some point, but then where we want to go, and this is where I think the action, you know, getting in the fight, as you say, pulling of a lever, taking the responsibility, is more about taking care of our Body and allowing ourselves to trust. Again, using Jane's term this body trust like we want to trust. In order to trust our bodies, our body has to trust us to take care of it. Yeah, but when we stay in this my body failed me. Mindset, it almost feels impossible to trust our body and our body to trust us to take care of it, vice versa. It's just like a reciprocal thing. I might be getting off tangent, but no, no. So it's a feeling that you can expect to have. It's not a feeling that you can live in forever and do well, yeah, yeah, you find your way through it. At some point. We're gonna We're always as any human being, regardless of whether you're living with a chronic condition or not, you will experience that my body failed me mindset with some point, yeah, and even in this is in the trolley situation, you might be like, I can't, I can't decide. I can't, I can't. What am I going to do? I'm frozen. And then later you might look back and like, wow, why didn't I do something? Or you might look back and say, Gosh, I I pulled the lever, and I wish I didn't, yeah, but at least you mean honestly, the way I think about it, at least you took some action. At the very least learn from it, if it didn't go well afterwards. But to sit there and just say, I don't have anything to do with this. Cover your eyes until you until you drop dead. Like, I don't know, like that. That doesn't seem like the way to go to me. And I think too, that if you put me in that trolley situation, I'd feel the same way, like I really would, like, I would think I'm here now, right? You can try to make the argument that I didn't put those people on the track, but I'm aware of the track. I'm aware of the situation. I know what the lever does. I'm now involved, whether I want to be or not. And truth be told, if you put a four year old on the single track and 580 year olds on the track, I'd let the trolley hit the 580 year olds and I'd save the four year old. I know I would like I know that's where my brain would go to and. I would live the rest of my life knowing I killed those five people. I don't think I'd be able to pretend that somebody else did that to them. And I think that moment like that understanding there is super important. I'm walking along. I've got nothing to do with this. I didn't make the trolley, I didn't make the lever, I didn't make the tracks, I didn't put the people on it. But now I'm involved in it. And, no, I didn't want to be involved in it. Yes, I was forced to be involved in it, but you are involved now. You can't go backwards from that. It doesn't matter if it's fair or not, and that I see as autoimmune illnesses like right there, like, Yes, this is not fair. And I am upset almost every day that this stuff impacts my kids and my wife and and all of you. It's very, very upsetting. There are days that like, you know, Arden is 21 years old. She's in college. I'll look some days and see she hasn't taken her thyroid meds in three days. And I'm upset. I'm not upset at her, because I get it, like I understand what's happening to her. But I started thinking about thinking about what's about to happen to her for not taking the medication, and I got to go to talk to her. She don't want to talk to me about that she believes she can take care of them on her own. The minute I pointed out to her that she hasn't taken it, think she's mad. She's not mad. She's ashamed, right? She feels like she's let herself down. She feels like she's let me down. She feels like she let every about everybody. She feels like, oh, I messed this thing up. That's not how you want her to feel. If you're smart, you know that four years from now, she's not going to feel like that at all when you when, when she's faced with this. So you just kind of got to get her through this point to where she's a, like, a full fledged adult with like a non jell o brain, and then she'll be okay, right? But that doesn't stop me from waking up in the morning, and the first goddamn thing I think, before I can even open my eyes, is, I hope Arden took her thyroid medication, right? Like, so that doesn't go away. That's not fair. I don't deserve to be in this position, but I am, and it's not my fault, but I'm here, and I just think, like, once you're here, it's it, it's you're part of it. Now it now. It doesn't matter how you got there, right? So I kill five old people to save one young person two seconds, no problem. And I think of diabetes and all of this in a similar way. Actually, maybe the worst thing that's ever been said to me is, wow, you wouldn't have this podcast if your daughter didn't have type one. And I'm like, Yeah, I wish I didn't have the podcast. Yeah? Like, really. I mean, this is, I can do another job. It doesn't need to be this one, you know, yes, I don't want this for any of you guys. But I also don't want you to sit around staring at a wall, pretending that what's happening to you is not happening to you, and then writing it off as, you know, I didn't put these people on the track. It's not problem, because it is going to be your problem at some point. And by the way, if I walked away from that lever in that trolley, Eric, if you just said, Hey, listen, you I'm out of here. Okay, I'm not killing that one, and I'm not killing those five. You know, when you walked away, you'd feel just as bad as if you made a decision, right? Yeah, that's all. How would you relate this back to just psychology? Like, do you look at the trolley problem and does it relate back to things that you see people struggling with in some way? It's an unfair question. I haven't asked you to think about it before. You might big, yeah, that's a big question. But I think before we go there, go ahead, going back to what you were just sharing, you know, landing at, you know, the it's not fair mindset, like you do have to work yourself through various stages of grief to get to the place of sometimes things just are right. And that's a hard pill to swallow, and you might get to that place, you might be at the place, and you're standing at the trolley and that okay, sometimes these things are, are I'm going to do, make the best decision possible with the best outcome possible. And I think applying that mindset to, you know, you asked me, Do I see this, this mindset? I think we are constantly whether it's with diabetes or not, making decisions. What is the best outcome I'm going to make a decision now for the best outcome, or am I making a decision now out of fear, grief, anxiety, a feeling, right? Are we acting on our feelings, which aren't always facts, but then later, we look back at those actions that we made based on our feelings, and then in comes blame, shame, just knocking at the door, like, why didn't you know? Why didn't you do that? Why did, why did you say that thing? Why didn't you Pre-Bolus sooner? Gosh, why didn't you give yourself five units instead of 10? Now I'm low, and now I'm high. Or even, you know how we relate to other people, why did you say that thing? They must think you're so stupid. Like, this is you. This is your internal talk, right? Like, or a lot of times I think we. See this concept, the psychological concept, being played out with anxiety, and how we either decide to do something or not, and then later on, when we're looking back at that conversation or action we are we often judge ourselves with either shame or blame. I am also thinking about most often clinically, and we've talked about this, I think we've done an episode or two on this is the fear of low blood sugars. And this is kind of more going into a specific topic, but that is, is still a pretty big driver for people and how they make decisions in their management. Yeah, usually, because of a fear of a low blood sugar later, they have this mindset, it'll be safer. I'll feel safer if I'm a little bit higher later than being low when I'm in a meeting, at a doctor's appointment, when I'm out and about, right? So they're making that decision based on feeling when it comes time to actually Bolus or not, or adjust your settings or not, or change your site or not. Whatever that decision is, if you're thinking about the future saying, Well, I'm going to feel, I'll feel safer later if I'm just a little bit higher, yeah, and then, and then you then, fast forward a couple hours. You're in the two hundreds, three hundreds, and you're saying, well, that I feel safer now because I'm not experiencing that feeling of fearing being low. So that, you know again, it's going back to like causing harm. It feels like you're going to cause harm or prevent harm. How is that driving your decisions? In terms of the Pre-Bolus, I think is an actual application time after time, all day long, yeah, Arden said to me the other day she was leaving for school, and it was just a side thing, and I forget what I honestly don't remember the context other than I said, I think you need a Bolus here. And she said, Yeah, I'm only going to do this much. I don't want to get low in class. And I never think of her as thinking about it that way. But now that she's older and she's on her own with it, obviously that's the thing that she's thinking about. I don't mind being low at home, I don't mind being low in some other places. But, and it wasn't even an aggressive Bolus, it was more of an indication to me that it was in her mind. So I think she had gotten a little lower in a class early on, and then she was like Mount, guarding against that happening to her again, and that's gonna stay in her head forever. And I didn't like, you know, I didn't respond back and say, No, you know, just do what I say. I said, okay, like, I understand how you feel. Like, you know, keep an eye on it. I think. I said, if it hits a certain number, I think you should, Bolus, but I don't know if she did or not, because she went to a class, is a two hour class, and I don't know if she looks at her blood sugar when she's doing that, I wouldn't imagine she does, you know. So I don't know when we make that decision or or you might even see, you know, if you're looking at your arrow go down slightly diagonal, and you know something's coming up. So if we're thinking about the lever, do you I guess it depends on how you see this. But do you pull the lever and either give yourself a glucose tablet because you're fearful of continuing to go low during that thing that's coming up, or do you not give yourself a glucose tablet or correct with a dose because of fear of the outcome, like there's both fearful of either going high or going low, yeah, in this situation, yeah, go ahead. I think it's why I separated the idea away from the trolley problem and brought it more to the idea of just action inaction. Because, yeah, I mean, in the end, the the analogy falls apart a little bit. Because, yeah, you're not, you're not cutting people, you know, with a trolley if you're making decisions about your diabetes, right? Like, there's different versions of outcomes that are coming. I really think it's more about like, it's that part of the conversation about the trolley problem, about, like, would you get involved? Like, would you have the nerve to be a decision maker in this? Or would you because I think what ends up happening is that, if I'm not mistaken, let me see if I can figure it out. I think most people choose not to touch the lever. I'm even looking at your your post about the trolley problem. The studies on this find actually, this is crazy. 80 to 90% of participants say they would pull the lever to save five people so they do get involved. It turns into a moral issue. 2001 in moral psychology study of fMRI, 84% chose to pull the lever. And other replicants of the study find results in the same range. That's very encouraging, actually, but that other version. And we didn't go into this, but there's another version of the trolley problem where they changed the scenario a little bit. I'm gonna have to do this off the top my head, right? Like you're walking over like a bridge. You see the trolley thing happening, but there's a person there, and if you push the person over the bridge, they'll fall in the tracks and derail the trolley only 10 to 20% of people would push the person. So 84% would pull the lever to save the five people, but only 10 to 20% would physically push a person to do the same thing. Interesting, right? What this says is that it shows that people see a connection between indirect and permanent harm and direct harm. That's kind of forbidden. Even when the outcomes are identical, like the harm that they're inflicting, they see differently. It's interesting. Globally, patterns are similar when, when this is talked about, it shows two competing moral systems in our brains, a utilitarian system that's outcome based, I'll save more lives, and a deontological system, which is rule based, that says you don't kill people. That's interesting, yeah, okay. Erica, I enjoyed this. I'll ask you what you thought of it. We both were kind of thinking through and I was maybe even struggling to articulate how I was thinking and feeling and wanting to explain it clearly. I think it actually reflects that this trolley problem is complex, and there isn't really a right answer, right and so I think we I want to get to applying it clearly and have you know these great things to share and encourage you all with, but it's a struggle because it's a struggle to articulate, because it is a complex situation, and there are no right answers, and oftentimes you just land at we just get to be kind and compassionate to ourselves and make the best decision possible, and then be kind to ourselves after the decision, I want to pull the curtain back for people. Like, right before we hit record, Erica was like, Maybe we shouldn't do this today. And I said, that'll be fine. I mean, in the end, it's, I mean, obviously not A, not an apples to apples comparison. It's just a thing that it kind of lit up this conversation in my mind. You know when, when I saw it? Like I said, I don't remember the person who I saw who was describing I don't remember where I saw them describing it, because, like I said, it popped up on so many different places in my feed in in the course of a week. But the person who I saw describing it had a real firm understanding of the trolley problem, and it was really incredibly interesting to listen to them talk about it with other people, who would give their opinions, then they would change the problem slightly by changing people's age or their health or something. It was interesting to see how people would pivot again. I just I got done listening to it, and I thought, This, to me, is like the core of a thing I've been saying on the podcast for a decade. The thing I really do hate most about listening when people talk about diabetes is when they say, oh, that's just diabetes, as if they don't have any say in what happens. And then this made me think, oh, gosh, maybe it's not that they don't think they have a say in what happens. Maybe it's just the way people's minds work, like maybe they just can't bring themselves to grab the lever. Then, you know, here at the end, surprise me. Show me the study that 80 or 90% of the people do have the ability to grab lever, which makes me happy, because that means that I think, I think that means that 80 or 90% of you out there have the ability to, you know, grab the bull by the horns and and make some decisions for yourself and live with the outcomes, learn from your experiences and make better decisions next time. Yeah, I think you should do that. That's what I think you should do. I think you should try. I guess is my point good enough? Yeah, yes, yes. All right, I didn't put you into any professional I didn't put you into any professional quandaries with this one. Everything's okay. Yes, I'm in a practice just being kind and compassionate to myself. Yes. Thank you also for people who are keeping score. This was not an episode where I tricked Erica into giving me free therapy. So I'll see you guys later. Okay, bye. Having an easy to use, an accurate blood glucose meter is just one click away. Contour next.com/juicebox That's right. Today's episode is sponsored by the contour next gen blood glucose meter. Thanks for tuning in today, and thanks to Medtronic diabetes for sponsoring this episode. We've been talking about medtronics, mini med 780 G system today, an automated insulin delivery system that helps make diabetes management easier day and night, whether it's their meal to temp. Technology for the Medtronic extended infusion set. It all comes together to simplify life with diabetes. Go find out more at my link, Medtronic diabetes.com/juicebox, okay, well, here we are at the end of the episode. You're still with me. Thank you. I really do appreciate that. What else could you do for me? Why don't you tell a friend about the show or leave a five star review? Maybe you could make sure you're following or subscribed in your podcast app, go to YouTube and follow me, or Instagram. Tiktok. Oh gosh, here's one. Make sure you're following the podcast in the private Facebook group as well as the public Facebook page you don't want to miss. Please. Do you not know about the private group? You have to join the private group. As of this recording, it has 74,000 members. They're active, talking about diabetes, whatever you need to know. There's a conversation happening in there right now, and I'm there all the time. Tag me. I'll say hi. I am here to tell you about juice cruise 2026 we will be departing from Miami on June 21 2026 for a seven night trip going to the Caribbean. That's right. We're going to leave Miami and then stop at Coke. Okay, in the Bahamas. After that, it's on to St Kitts, St Thomas and a beautiful cruise through the Virgin Islands. The first juice Cruise was awesome. The second one's going to be bigger, better and bolder. This is your opportunity to relax while making lifelong friends who have type one diabetes. Expand your community and your knowledge on juice cruise 2026 learn more right now at Juicebox podcast.com/juice, cruise. At that link, you'll also find photographs from the first cruise. The episode you just heard was professionally edited by wrong way recording, wrong way, recording.com

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#1660 Kind of Type One

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

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
This episode of The Juicebox podcast is sponsored by skin grip, durable, skin safe, adhesive that lasts your diabetes. Devices, they can fall off easily, sometimes, especially when you're bathing or very active. When those devices fall off, your life is disrupted, and it costs you money. But skin grip patches, they keep your devices secure. Skin grip was founded by a family directly impacted by type one and it's trusted by hundreds of 1000s of individuals living with diabetes. Juicebox podcast listeners are going to get 20% off of their first order by visiting skingrip.com/juicebox if you're looking for community around type one diabetes, check out the Juicebox podcast, private Facebook group. Juicebox podcast, type one diabetes. But everybody is welcome. Type one type two gestational loved ones. It doesn't matter to me, if you're impacted by diabetes and you're looking for support, comfort or community, check out Juicebox podcast. Type one diabetes on Facebook. 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 is sponsored by tandem Moby, the impressively small insulin pump. Tandem Moby features tandems newest algorithm control, iq plus technology. It's designed for greater discretion, more freedom and improved time and range. Learn more and get started today at tandem diabetes.com/juicebox us med is sponsoring this episode of The Juicebox podcast, and we've been getting our diabetes supplies from us med for years. You can as well us med.com/juicebox, or call 888-721-1514, use the link or the number. Get your free benefits. Check and get started today with us. Med,

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,

the podcast you just enjoyed was sponsored by tandem diabetes care. Learn more about tandems, newest automated insulin delivery system, tandem Moby, with control iq plus technology at tandem diabetes.com/juicebox there are links in the show notes and links at Juicebox podcast.com the conversation you just enjoyed was brought to you by us. Med, us, med.com/juicebox, or call 888-721-1514, get started today and get your supplies from us. Med. Today's episode was sponsored by skin grip. And skin grip, they understand what life with diabetes is like, and they know How infuriating it can be when a device falls off prematurely, and they don't want that to happen to you. Juicebox podcast listeners save 20% off of their first order when you use the link skingrip.com/juicebox links are also available in the show notes of your podcast player and at Juicebox podcast.com. 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

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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.

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

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

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
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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
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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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