#1799 Bolus 4 - Krispy Kreme
Scott and Jenny talk about bolusing 4 donuts.
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Key Takeaways
- The Meal Bolt Roadmap: A strategic approach to bolusing includes measuring the meal, evaluating yourself, adding base units, layering a correction, building the bolus shape, offsetting timing, looking at the CGM, and tweaking for next time.
- Total Sugars as Pre-Bolus Timing: While not a rigid medical rule, a helpful starting strategy for pre-bolusing high-sugar foods is to use the total grams of added sugar as the pre-bolus time in minutes.
- Algorithm Dynamics: When using an automated pump algorithm, be mindful that the system might pull back basal insulin during a blood sugar climb, which might require a larger upfront bolus or an extended bolus to compensate.
- Don't Underestimate Frosting: Add-ons like icing and fillings carry a massive carbohydrate load. A regular glazed donut has about 22 carbs, but adding icing can increase that by 15 carbs alone.
- Wait for the Downward Tick: Before diving into a high-sugar, fast-hitting food like a donut or cookies, aim to see a diagonal down arrow or a slight drop on your CGM to ensure the insulin has actively started working.
Resources Mentioned
- Juicebox Podcast Meal Bolt: juiceboxpodcast.com/meal-bolt
- US Med: usmed.com/juicebox or call (888) 721-1514
- Omnipod 5: omnipod.com/juicebox
- Diabetes Pro Tip Series: Episodes 1000 to 1025 in your podcast player or at juiceboxpodcast.com
- Krispy Kreme: krispykreme.com
- Oreo: oreo.com
- Wrong Way Recording: wrongwayrecording.com
Introduction & The Meal Bolt Roadmap
Scott Benner Hello, friends, and welcome back to another episode of the Juice Box podcast.
Scott Benner In every episode of bolus four, Jenny Smith and I are gonna take a few minutes to talk through how to bolus for a single item of food.
Scott Benner Jenny and I are gonna follow a little bit of a road map called meal bolt.
Scott Benner Measure the meal. Evaluate yourself.
Scott Benner Add the base units. Layer a correction.
Scott Benner Build the bolus shape. Offset the timing. Look at the CGM.
Scott Benner Tweak for next time.
Scott Benner Having said that, these episodes are gonna be very conversational and not incredibly technical.
Scott Benner We want you to hear how we think about it, but we also would like you to know that this is kind of the pathway we're considering while we're talking about it.
Scott Benner So while you might not hear us say every letter of Miele Bolt in every episode, we will be thinking about it while we're talking.
Scott Benner If you wanna learn more, go to juiceboxpodcast.com/meal-bolt.
Scott Benner But for now, we'll find out how to bowl us for today's subject.
Scott Benner While you're listening, please remember that nothing you hear on the juice box podcast should be considered advice, medical or otherwise.
Scott Benner Always consult a physician before making any changes to your health care plan or becoming bold with insulin.
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Scott Benner Full terms and conditions can be found @omnipod.comslashjuicebox. (2:19) Jenny, we are gonna do some bolus four stuff.
Bolusing for a Krispy Kreme Glazed Donut
Jenny Smith Oh, fun. These are always fun.
Scott Benner I have a list.
Scott Benner These are,
Jenny Smith Are we gonna do McDonald's again?
Scott Benner No. No. We can't do that again.
Scott Benner That was, that was good though. People were very That's
Jenny Smith way fun.
Scott Benner People had a good time with that one. So no.
Scott Benner We're not gonna do that, but we are gonna look at the list, a pretty extensive list that people sent in. Do you wanna do a well, we did McDonald's, so that one's done.
Jenny Smith Okay.
Scott Benner Should we do another restaurant, or do you wanna just wanna do a donut?
Scott Benner Why don't we do a short one here?
Jenny Smith Do a doughnut. Sure.
Jenny Smith We've not done that. Gosh. That's something I guess I would think that we would have already done.
Jenny Smith It's a pretty common
Scott Benner Let's just do a Krispy Kreme doughnut.
Jenny Smith Oh my gosh.
Scott Benner Have you ever had one?
Jenny Smith I have actually had a Krispy Kreme doughnut. Yes.
Scott Benner Alright.
Jenny Smith When I was in college, I worked with Habitat for Humanity.
Scott Benner Okay.
Jenny Smith And our, spring break trips, I was never I never went and laid on a beach.
Jenny Smith My spring break, we took what were called collegiate challenge trips. Mhmm.
Jenny Smith And so we took, like, a big, huge or a couple of, like, 15 passenger vans, and we would pack it all up, all of our supplies.
Jenny Smith We had to get donations, and we would go somewhere out of state And many of the places we went because we still wanted it to be warmer on spring break, we would go or we would pick a location that was somewhere in the South.
Jenny Smith So I'd gone to New Orleans, and I've been to Mississippi and to Georgia and North Carolina and West Virginia.
Jenny Smith Oh my gosh. They were all of my spring break trips were spent with Habitat.
Jenny Smith It was an amazing thing. But my point being that that's where I had Krispy Long story, that's how I got Krispy Kreme.
Scott Benner Travel the country to have a have a doughnut. Well, I'm on their website, krispykreme.com.
Scott Benner Is that what it is called? Let me make sure. Yeah.
Scott Benner Krispykreme.com.
Scott Benner And I'm starting with I think we're gonna do a few of them.
Scott Benner Original just the original glazed donut. When I think of a Krispy Kreme, I just think of, like, a glazed donut.
Scott Benner Okay.
Scott Benner You ready?
Jenny Smith I'm ready.
Scott Benner Alright.
Scott Benner Well, I'll tell you the calories just for fun. It's got a 190 calories in it.
Scott Benner Calories from fat, a 100. Total fat, 10.
Scott Benner Saturated fat, five.
Scott Benner No trans fat, no cholesterol, a 100 milligrams of sodium. Total carbs?
Jenny Smith Maybe 15 or probably oh, a glazed one. Glazed. Sorry.
Jenny Smith I was thinking of a cake doughnut. Probably about 40 to 50?
Scott Benner They say 22. Really?
Scott Benner They say total carbohydrates 22. Dietary fiber less than one, sugar's 10, protein free.
Jenny Smith I wonder how big their glazed donuts are.
Jenny Smith Because that's and it's also then not a terrible amount of glaze.
Scott Benner Okay.
Scott Benner Would you mind all the carbs are coming from,
Jenny Smith you think? From the sugar?
Jenny Smith Would think I mean, the donut itself obviously has the majority of the fat in it. And Mhmm.
Jenny Smith For that many calories, half the calories are coming from fat.
Jenny Smith And there's not really any protein. So that makes sense that it would be approximately 20 some grams of carb Mhmm.
Jenny Smith Based on the calorie value at four calories per gram.
Jenny Smith That's about right for the math of the calories.
Applying Ratios and Algorithm Nuances
Scott Benner Let's do it for you.
Scott Benner What's your insulin to carb ratio?
Jenny Smith It depends what time of day it is.
Scott Benner Alright. Well, let's say you're having a donut in the afternoon.
Jenny Smith So in the afternoon, it's a one to 12.
Scott Benner Twelve. And sensitivity?
Jenny Smith My sensitivity is 85 in the afternoon.
Scott Benner 85 in the afternoon.
Scott Benner We're gonna make it what would you target if you were targeting a blood sugar?
Jenny Smith My target is 85 in my system. 85.
Scott Benner Okay.
Scott Benner 22 carbs and fat 10. No protein in this. Right? No.
Scott Benner Oh, three.
Jenny Smith Oh, there is a little protein.
Scott Benner Little bit of protein.
Scott Benner What's Jenny's blood sugar in the afternoon before she eats this doughnut?
Jenny Smith My blood sugar in the afternoon generally is somewhere between, like, ninety and one twenty.
Scott Benner I was gonna put 96. How we do that? Okay.
Scott Benner I'm gonna assume you have a nice stable arrow because I'm gonna use my strategy simulator online. Okay.
Scott Benner But I wanna hear about you first. So how's Jenny bolusing for this doughnut?
Scott Benner So it's just the doughnut.
Jenny Smith Okay. I have a stable blood sugar.
Scott Benner Stable blood sugar.
Jenny Smith My blood sugar is 85. Yeah. Right? Mhmm.
Jenny Smith Or no.
Jenny Smith What did you say?
Scott Benner I I made your blood sugar 96.
Jenny Smith But the target was 85 96. Okay.
Scott Benner How is Jenny Prebola saying? Ten grams of fat, 22 grams of carb.
Scott Benner Does it tell how many grams of added carb or or added sugar?
Scott Benner Added sugar.
Scott Benner Sugar's 10 protein. It doesn't quantify anything as added sugar.
Jenny Smith So total carbs are 22 and sugars are 10.
Scott Benner Yes.
Jenny Smith So my pre bolus is fifteen minutes in the afternoon.
Scott Benner Okay.
Jenny Smith Sometimes twenty depending on the time of the month.
Scott Benner Mhmm.
Jenny Smith But fifteen.
Jenny Smith Let's say this is a sensitive normal time.
Scott Benner Does this need an extended bolus for you?
Jenny Smith With only 10 grams of fat, this type of thing doesn't need an extended bolus.
Jenny Smith No.
Scott Benner For you.
Jenny Smith Not at all.
Scott Benner You would
Jenny Smith For take me, I would take all the carbs.
Jenny Smith I wouldn't even I wouldn't cover fat or put it into my system, which I could if I wanted to.
Jenny Smith I wouldn't put it in there. I would just put the carbs in.
Scott Benner Okay.
Scott Benner And that's a thing that you think you'd have success with.
Scott Benner So what would your what do you think the bolus would be? Two units?
Scott Benner Are you considering the fat or just not stretching it for the fat?
Jenny Smith I'm just not stretching it for the fat.
Scott Benner Okay.
Scott Benner Well, then it's gonna be more like what? 2.8? Something like that?
Jenny Smith Two point I mean, with my ratio, again, I Yes.
Jenny Smith Can't do the math in my head anymore. Yeah. Is. Was my fault.
Jenny Smith Does it for me?
Scott Benner Well, then just just put me in the world.
Scott Benner You grab the doughnut, How much do you throw in for it?
Scott Benner Somebody goes, that's 22
Jenny Smith cards. I would put I would put if I was just out in the world and I was bolusing on my own, I would take two units for it.
Jenny Smith Okay. So I'd be a little bit heavier than my one to 12 calls for.
Jenny Smith It would be less than two units if it was a one to 12.
Jenny Smith Okay. Right?
Jenny Smith But I would just say two.
Scott Benner The, the the thing on the website says two units up front, point eight five over three hours.
Jenny Smith Oh, okay. For the fat, I'm assuming Yeah. For the website.
Jenny Smith Because it does always consider the fat free.
Scott Benner Not gonna not you know but this is interesting.
Scott Benner So but you know from your own life that that's not gonna need that for you.
Jenny Smith I do. And I can also say that experience for many years on MDI
Scott Benner Mhmm.
Jenny Smith I would never have covered extra for something like this with the system I use now, which is Trio.
Jenny Smith I also would not cover extra mainly because I know that the system is already got my back.
Scott Benner Okay.
Jenny Smith Especially with dialed in settings. Right?
Jenny Smith I mean, all of this bolus thing for anything boils down to are your settings in a pretty good place to begin with.
Jenny Smith Mhmm. And so on other systems, however, I wouldn't have even done it on a basic pump that doesn't have an algorithm in it because, again, nothing is being taken away.
Jenny Smith Right? Mhmm. I might consider other algorithms and the potential response algorithms that are the adaptive algorithms that do more of a hard set, just pull back, suspend based on what the trend looks like, that maybe you need to consider what ends up happening because it's pulled back, and that then adds in to some potential
Scott Benner Yeah.
Scott Benner So you make
Jenny Smith Lingering.
Scott Benner You make this two unit bolus for these 22 carbs, which seems pretty small, but it's got a lot of sugar.
Scott Benner It hits you fast. While you're climbing, the system has pulled back basil.
Scott Benner It's not resisting anything there at all. So maybe you do need that point eight five
Jenny Smith Correct.
Scott Benner Pumped in over the hours afterwards.
Jenny Smith And, again, it may not be just because of the fat.
Jenny Smith It might be because of what your system has actually tried to help you with. Yeah.
Jenny Smith I also think, you know, if pre bolus has been pretty well done, then on some of these systems, may actually see some pretty nice containment of your blood sugar.
Jenny Smith You started my blood sugar at 96, and if I pre bolus right and I eat this, I'm I'm also not one to, like, shove it all down my
Scott Benner might go slowly while you're eating.
Scott Benner Yeah. Yeah. Yeah. Right.
Jenny Smith If I'm gonna eat a donut, I'm gonna, like, enjoy the bites of the donut.
Scott Benner I would imagine if you're bolusing for this, you would wanna see, like, a down like, a diagonal down arrow or a falling blood sugar before you started to eat.
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Pre-Bolus Strategy with Total Sugars
Jenny Smith Yeah.
Jenny Smith I usually say, you know, if you were stable, like, a trend of one or two dots kind of already headed down, each dot on Dexcom at least is a five minute incremental shift.
Scott Benner Mhmm.
Jenny Smith And so you've got some visual of momentum from the insulin already. Right?
Jenny Smith Kind of that tug of war game that you talk about.
Scott Benner Yeah.
Jenny Smith It's the insulin's got a little more tug now. Great.
Jenny Smith I can put the carbs in because the insulin is definitely showing impact, and I know that these carbs, especially with glaze, they're gonna start to hit.
Scott Benner Yeah. The original glazed cake doughnut, Jenny, has 15 grams of fat in it and 40 carbs.
Jenny Smith Oh, see, there's where I probably was think I guessed originally 40 to 50. Yeah.
Jenny Smith So the doughnut you gave that was 22 isn't a isn't a cake doughnut.
Scott Benner No. It's a regular old just glazed doughnut. Yeah.
Scott Benner This is the the cake doughnut, which I prefer I prefer a cake doughnut over a regular doughnut if we
Jenny Smith I was thinking more of a cake doughnut, honestly.
Scott Benner Just to see what that does with Jenny's settings, that turns this into 3.46 up front, and then it wants 1.2 over three hours.
Scott Benner It's like four and a it's over four and a half units even for you.
Scott Benner K. And I say even for you because your your sensitivity is 85 and your your carb ratio is 12. So
Jenny Smith And that's also a lot of insulin at one time Mhmm.
Jenny Smith For me.
Scott Benner For you. Yeah. Yeah. What would that do?
Scott Benner Do you think you'd do you think you'd have success with this or do you think you'd struggle with this?
Scott Benner Think you'd get low?
Jenny Smith I think I'd have to have it as my first experiment.
Jenny Smith And evaluate. Again, a true experiment is always without an algorithm.
Scott Benner Yeah.
Jenny Smith It just is because you get the true action of your decision and timing and the true action of insulin that's just solidly there.
Jenny Smith There's nothing giving and taking. I've grown very much connected to my algorithm.
Jenny Smith I like it a lot, as do most people.
Scott Benner Yeah.
Scott Benner Fills in a lot of holes and takes away a lot of your thoughts later.
Jenny Smith Right.
Jenny Smith So as you ask about, do you think I'd get low?
Jenny Smith Do you you know, what do you think would happen?
Jenny Smith I expect because my system does a a pretty darn good job of preventing lows.
Jenny Smith I think it would try really hard given the load of insulin though being units.
Jenny Smith Mhmm.
Jenny Smith Right? And depending on what my assumed timing would be, I might actually dip a little bit initially that it maybe it couldn't pull back enough.
Jenny Smith That one has 15 grams of fat. Right?
Scott Benner Yes.
Jenny Smith And so I might also expect I mean, I like fat.
Jenny Smith I'm not like low fat by any means. So 15 grams is what I'm saying is 15 grams isn't really a concern to me either.
Jenny Smith Mhmm. But if it did do any pulling back, then the end effect might also be a little bit of a curve up.
Jenny Smith So I would view it as anything that's new. It's an experiment. Mhmm.
Jenny Smith And I see how it works.
Filled Donuts and Fast Hitting Sugars
Scott Benner You know, marketing is a thing because I, for some reason, in my head, thought Krispy Kreme doughnuts were, like, cleaner somehow.
Scott Benner And I know now as I'm looking at the ingredients, I'm like, this is ridiculous.
Scott Benner Why would I even why did I think of them as a better alternative than, like, say, Dunkin' Donuts?
Scott Benner I think it's just the colors. I think it's because they use green around I think it I actually think the marketing works.
Jenny Smith That could be or it looks the the, logo Yeah. Also looks really old school.
Scott Benner Yes. I think Right? Yeah. Krispy Kreme says to me, hey.
Scott Benner We're gonna have a doughnut like a gentleman.
Jenny Smith Or your grandma baked it.
Scott Benner Right.
Scott Benner And Dunkin Donuts says to me, let's go. We're all gonna die together. Yeah.
Jenny Smith Yeah. Actually, Dunkin Donuts is kind of like it's like plastic doughnuts compared to crispy crispy creams.
Jenny Smith And because, you know, Dunkin Donuts, it's a very, like, bold. It's pink.
Jenny Smith It's like it's almost like
Scott Benner It's loud. Yeah.
Jenny Smith Loud. Yeah. Kind of.
Scott Benner It really I think that might be it.
Scott Benner I think Dunkin' Donuts says to me, like, let's get in this pickup truck, set it on fire, and see how long we can drive it before it blows up.
Scott Benner And Krispy Kreme does feel like, oh, my mom my grandma made it for me.
Jenny Smith Right?
Jenny Smith It's just the label and every I mean, I don't even know Krispy Kreme's clearly been around a lot longer, I think, than Dunkin' Donuts.
Jenny Smith I don't
Scott Benner even know. Alright. They have filled doughnuts.
Scott Benner You wanna do chocolate iced custard, or
Jenny Smith do
Scott Benner you wanna do original glazed cream filled?
Scott Benner Oh, there's also a New York cheesecake filled doughnut.
Jenny Smith Oh my gosh.
Scott Benner I can't even this stuff. Almost like
Jenny Smith Imagine what
Scott Benner Right.
Scott Benner Let's do the chocolate iced custard because that's really just Boston cream. Right?
Scott Benner Isn't that what that is, basically? Woo.
Scott Benner Let's go.
Scott Benner Not as much as I thought because you take the cake factor away. Oh, that's interesting.
Jenny Smith He's filling it with something.
Scott Benner Yeah. So it's 37 carbs, 17 sugar, 16 fat.
Scott Benner There's more fat than I thought getting away from the cake aspect, but still that's, you know, okay.
Jenny Smith So it's interesting and that's why I asked about the original doughnut that glazed kind of doughnut that you mentioned before in terms of total carbs versus sugars.
Scott Benner Mhmm.
Jenny Smith Most often, I've seen a lot of people doing it, and I think if you don't really know from a pre bowl strategy where to possibly start with a time is I've seen a lot of people having success
Scott Benner Okay.
Jenny Smith With taking the total sugars or the added sugars if it is on a label and using that as a default starting pre bolus.
Scott Benner Say that again for me.
Jenny Smith Yeah. I've seen so this one has what?
Jenny Smith 30 some grams of total carb?
Scott Benner Total carb, 37. Sugar, 17.
Jenny Smith 17. Yeah.
Jenny Smith So it's about half sugar.
Scott Benner Okay.
Jenny Smith Right?
Jenny Smith But what what I've seen people doing, again, this is not medical recommendation or anything disclosure, blah blah blah.
Jenny Smith I am just saying what I have seen people do and some people have real good success with a starting place.
Jenny Smith They need to tweak it, but as a starting place taking the total sugars, which are the hit point.
Jenny Smith Right?
Scott Benner Okay.
Jenny Smith And they're using that as a marker of how many minutes do I even need to pre bolus.
Jenny Smith Let's start with the total sugars as a pre bolus time. So this seventeen minutes. Right?
Jenny Smith I mean, you might just round it to fifteen to be easy, but
Scott Benner Is there a scientific reasoning behind that?
Jenny Smith I have looked and looked. I don't see a scientific reason.
Scott Benner But you see people have luck with it.
Jenny Smith I have seen people have luck with it, and I have seen commentary on people using that as a strategy.
Scott Benner That's interesting. I'm making a note about that. Okay.
Jenny Smith But I I wanted, you know, more about it just that when you do have a label and you can see, gosh, this is this many grams of carb, but, oh my gosh, 50% of it is added sugars or or the total sugar, you know, kind of added stuff in. I mean, donuts have flour, so that's carbohydrate from natural grain.
Jenny Smith Right?
Scott Benner It's
Jenny Smith processed, but that's another but at least it's not added.
Jenny Smith It's something that came with the flour that they use.
Scott Benner I see.
Jenny Smith Whereas the added is really what you're aiming to see the hit from Mhmm.
Jenny Smith Because it's so fast. And so it's often, like I said, it's often a starting place that I see people using and saying, gosh, I'm just gonna use the added sugars here as a marker.
Jenny Smith Now that also deeper level is where's your blood sugar? Where is it heading?
Jenny Smith Where is it come from? What insulin on board?
Jenny Smith I mean, there are many other factors to consider too, but it's a starting place.
Scott Benner I'm gonna do this just for this one.
Jenny Smith I can't believe you've never seen that, by the way.
Scott Benner I mean, I feel like I have, but, you know, as a good podcast host, I had you repeat it so that people could hear it for yeah.
Scott Benner Yeah. It's a trick of the trade, Jenny.
Jenny Smith Hopefully, I explained it well enough because
Scott Benner I think you did. Okay. Hey.
Scott Benner Here's the ingredients for this chocolate iced custard filled doughnut.
Scott Benner I'll only do this for this one doughnut, then we're gonna go do a couple more doughnuts from Krispy Kreme.
Scott Benner Oh. Enriched flour, wheat flour, niacin, reduced iron, thiamine, mono nitrate, riboflavin, folic acid, water, palm oil, soybean oil, sugar, yeast, hydrogenated soybean oil, soy flour, leavening, you know, baking soda, salt, mono monoglycerides, weak gluten, soy lecithin, skim milk, cellulose gum, ascorbic acid, calcium propionate to maintain freshness, egg yolk enzyme it says egg yolks, comma, enzymes.
Scott Benner In the filling, water, high fructose corn syrup, corn syrup. I like that there's two different corn syrups.
Scott Benner Right?
Scott Benner Hydrogenated coconut oil, modified food starch, sucrose fatty acid esters, salt, natural and artificial flavor, phosphoric acid, sodium benzenate, polysorbate 60, potassium sorbate to maintain freshness, colored with beta carotene.
Scott Benner Icing is sugar, water, cornstarch, cocoa, corn syrup, solids, palm oil, soybean oil, chocolate liquor, soy lecithin, salt enzyme modified soy protein, mono and diglycerides, polysorbate 60, sodium, and something called hexametaphosphate.
Scott Benner Enjoy your doughnut. Damn. That is a lot more in that than I thought there was gonna be.
Scott Benner What the hell?
Jenny Smith Wow. I yeah.
Jenny Smith I I mean, in doughnuts like, you've ever looked up, but doughnuts aren't that difficult to honestly make.
Scott Benner That's what I thought when I was looking at it. Yeah.
Scott Benner Like, it's just a little cake. It's a little piece of cake. Right?
Scott Benner With
Jenny Smith And the funny thing as you're going through them, I'm thinking like and you brought it up.
Jenny Smith Like, they've got not only high fructose corn syrup, which is really corn syrup that they've essentially added some enzymes to, and the fructose in it makes it a little sweeter than regular corn syrup, but they use both high fructose corn syrup and corn syrup.
Jenny Smith Because clearly, there's something fancy in the recipe that makes it taste the right way.
Oreo Cookies Deep Dive
Scott Benner Some of that in too. Alright. So I'm gonna do one more, one of their fancier donuts, and I almost did the I almost did the New York cheesecake one.
Jenny Smith I was gonna ask if, you know, tomorrow is Valentine's Day whether you celebrate it or not.
Jenny Smith Do they have anything special? I know a lot of times
Scott Benner Yes.
Scott Benner There are Valentine's donuts here. After we do this one, I'll look at one of the Valentine's sauce.
Scott Benner I instead of going to the New York, cream cheese or whatever it was, I went to the Oreo cookies and cream filled donut.
Scott Benner And those Oreos really throw on a little punch.
Scott Benner This one has 49 carbs, 28 sugars, 20 fat. That's that's that's a big jump.
Jenny Smith It's a loaded donut, man.
Scott Benner It's a loaded donut.
Jenny Smith I wish I could see what these things look like.
Jenny Smith You have
Scott Benner a you have the Internet know.
Jenny Smith I don't I usually like to let you
Scott Benner I know. I know.
Jenny Smith There's a way we do this. Yeah. Yeah.
Scott Benner The 49 carbs, 20 fat, four protein.
Jenny Smith How much sugar?
Scott Benner Sugar, 28. Now would you tell somebody to pre boast twenty eight minutes for this?
Scott Benner You Jenny's like, I might.
Jenny Smith Look at how much. So 49 grams of total carb?
Scott Benner Yeah.
Jenny Smith Is that what you said? And 28 of that is sugar.
Scott Benner That's a lot of sugar.
Jenny Smith That's added sugar.
Jenny Smith That is more than half of this doughnut is sugar.
Scott Benner Yeah. You know what?
Scott Benner That makes me feel like Do you
Jenny Smith know how many teaspoons of sugar that is?
Jenny Smith I gave you the math for this before.
Scott Benner Oh, you think I remember that? Stop it.
Scott Benner Go ahead. You tell me. Mhmm.
Scott Benner I don't know.
Jenny Smith It's seven teaspoons of sugar. Seven? Seven.
Scott Benner Measuring teaspoons of sugar. Goddamn.
Scott Benner Yeah. Yep. In one of those donuts.
Jenny Smith That's just added sugar. Right?
Jenny Smith That's just the added sugars. So just as a reference, you said I mean, you were very surprised, like, twenty eight minute pre bolus.
Jenny Smith I'm thinking, if there's nothing else in your stomach and you're eating this and
Scott Benner You might need the insulin to be running away to grab this when it hits you.
Jenny Smith Right? Absolutely.
Scott Benner By the way, this pushed me.
Scott Benner Know this was supposed to be about donuts, but this pushed me to oreo.com because those Oreos really shushed up those so chocolate.
Scott Benner Let's see. Chocolate sandwich cookie. I'm trying to just find a regular Oreo.
Scott Benner Wait.
Scott Benner This website is fancy as hell. You ready?
Jenny Smith Even know who makes is it who makes Oreos?
Scott Benner I mean, Nabisco, I Nabisco.
Scott Benner Think. Is that right? Isn't it all like some oil company now or a
Jenny Smith Oh, absolutely.
Scott Benner Or a missile manufacturer or something? A 100%.
Jenny Smith They're all people that you're like, yeah. You should make my food.
Jenny Smith That sounds like a great idea.
Scott Benner Honestly, I think listen.
Scott Benner I don't know a lot about a lot, but I think if you look into it, a lot of the big, like, agri companies are just owned by consortiums of finance of money that, you know, I think that Yes.
Scott Benner The same group that used to own cigarettes or maybe still does.
Scott Benner Like, it's possible RJ Reynolds is making your your bread or something like that. Oh.
Scott Benner But let's say that Jenny gets out of her mind and is gonna eat six Oreo cookies.
Scott Benner Jenny, it's all over. Life's gotten sideways. Alright.
Scott Benner You're
Jenny Smith I go to the store and I'm just gonna sit in my car and Yeah.
Scott Benner You're you're gonna sit and you're gonna eat six Oreo cookies. Now Okay.
Scott Benner Three Oreo cookies is sorry. This website, I think, is meant to is not to it doesn't want you to be able to read it.
Scott Benner So three Oreo cookies has seven grams of fat, so I'm gonna put in 14 grams of fat.
Scott Benner And I really have to pick through this trans wait. Wait.
Scott Benner I'm not put the carbs anywhere near the top.
Scott Benner Carbohydrate oh, it gives you total carbs 25. So six of them is gonna be 50.
Scott Benner Protein?
Scott Benner Is there a protein? Yeah. You're gonna get two grams of protein.
Jenny Smith Woo hoo.
Jenny Smith My muscles are saying, thank goodness.
Scott Benner Things are coming together now.
Scott Benner The my muscles are saying thank you. The added sugar for this is 14, but you're having six, so it's 28. The calculator, which by the way, I you know, the estimator is I don't think even able to take into account the idea of, like, how hard the sugar's gonna hit right away because Right.
Scott Benner It's still like, look, for you, it'd be 4.3 upfront, 1.12 over three hours, like a five and a half unit bolus Mhmm.
Scott Benner With a ten minute pre bolus. But I want you to talk more about it again from your perspective.
Scott Benner You're gonna eat six Oreo cookies. Mhmm. How are you gonna bolus for six Oreo cookies?
Jenny Smith Go for a run after I eat.
Scott Benner And he's like, I'm gonna eat them while I'm running.
Jenny Smith I'm sorry.
Scott Benner Would that work? Can you just eat them while you're running with that, like
Jenny Smith Oh my god.
Jenny Smith I'd probably throw them. Like, there's nothing to drink along. Oh god.
Jenny Smith I can't even imagine doing that.
Scott Benner Have you had an Oreo in the last ten years?
Scott Benner They're not as good as they used to be. I just wanna say that.
Jenny Smith I probably the last time I honestly had an Oreo cookie was in college. Okay.
Jenny Smith Probably.
Scott Benner Yeah.
Jenny Smith Yeah. I mean, I know what an Oreo tastes like.
Jenny Smith Yes.
Scott Benner So these you think about how you're gonna bowl this for the 50 carbs for the regular six Oreo cookies.
Jenny Smith Which again
Scott Benner Well, I look at the double stuff.
Jenny Smith My estimate would be so it's 50 grams of carb because you said three has 25. Right?
Jenny Smith Right. And my expectation is that half of that total carb is coming from sugar would be my guess.
Scott Benner 28. Right. I
Jenny Smith think it was. 28. Okay.
Jenny Smith So I would absolutely let's say my blood sugar is in target, the unicorn number of 100, nice and level.
Jenny Smith Mhmm.
Jenny Smith Let's just say it is. It's not moving.
Jenny Smith I'm going to give this a minimum of a twenty minute knowing my response to a minimum of a twenty minute pre bolus.
Scott Benner Okay.
Jenny Smith And if in twenty minutes, I'm I should be seeing already a downward tick just with my knowledge of how insulin works with me in this situation.
Scott Benner Okay.
Jenny Smith I should be seeing I would give this it's coming down.
Jenny Smith I might even be hitting 80 before I take my first bite.
Jenny Smith So again, here is that time frame is an estimated pre bolus time Mhmm.
Jenny Smith But I'm really paying close attention to my CGM in a scenario like this where I've been eating Oreos since college where I didn't have a CGM and it was my best guess and I I don't have any clue what happened after I ate the Oreos in college.
Scott Benner Do you think it's a mistake that on the mega stuff Oreos, it's harder to find the nutritional information on the website because I don't think it's a mistake.
Jenny Smith Aren't they they're double stuffed. Right?
Scott Benner They're calling this one mega stuff.
Jenny Smith Oh, so they're more than double stuff.
Scott Benner It feels by the way, it feels funny to type in Oreo mega stuff and then nutrition afterwards.
Scott Benner It feels like those are two, two words that don't go together.
Jenny Smith I'm also curious what the portion size would be because the regular Oreos are three is a single portion.
Scott Benner Yeah. I'm finding a bag right now to look at the label
Jenny Smith on I'm curious if because they're mega stuffed, maybe only one is a portion, or are they telling peep or are they suggesting to people that it's two?
Scott Benner I see what you're saying.
Jenny Smith Do you know what I mean?
Jenny Smith Like, are they
Scott Benner Serving size is two cookies
Jenny Smith Okay.
Scott Benner On the mega stuff.
Scott Benner Total carbs for those two cookies are 25, and total sugars are 17. So because you're getting the same cookie amount.
Scott Benner You're just getting more of the cream inside. I mean, I'm calling it cream.
Jenny Smith Sugar actually goes up. You get one less cookie, but you get more stuffing.
Jenny Smith So the carbs remain the same as three regular Oreo cookies. Yeah.
Jenny Smith But the total carbs are actually the total amount of added sugars is slightly more.
Scott Benner Yeah.
Scott Benner And then if you had six of six of these, you'd have 75 carbs.
Scott Benner You'd have seventeen, twenty, 36, 46, 49, 54 sugars. Is that right? Is that 17 times three?
Scott Benner Fifty four? And I think I just let people in real time see my my poor math.
Scott Benner I could have just multiplied, but for some reason, that's not how my brain does it.
Scott Benner That in this three and a half. So three, six, nine, ten and a half.
Scott Benner It'd be 10 and a half if you had six of them. Yeah.
Jenny Smith So there's less fat in the double stuff? Yeah.
Jenny Smith Must just be all sugar then the cookies must have the fat because the other ones have more fat in three cookies.
Scott Benner Mhmm. That puts your balls up to about seven and a half, by the way, in case you're wondering.
Valentine's Day Donuts & Hidden Icing Carbs
Scott Benner Anyway, let's go back to the Krispy Kreme real quick because Jenny asked about the Valentine's.
Jenny Smith If they had anything fancy.
Scott Benner Yeah.
Scott Benner Well, I mean, though, I think the Oreo one, looks it's fancy.
Jenny Smith It looks fancy.
Scott Benner Yeah. They put extra stuff
Jenny Smith on it.
Jenny Smith You know, the funny thing is that when consider this is where my brain goes in consideration of, like, my intake, which you can take it as it is.
Jenny Smith If I'm gonna eat 75 grams worth of carb,
Scott Benner it's gonna be donut. Yeah.
Jenny Smith Yeah. It's not gonna be a donut. It's not gonna be cookies.
Jenny Smith But again, that's me. Yeah.
Jenny Smith This is not a you should do this or whatever.
Jenny Smith It's a if I want that, I'm going for really good sushi someplace.
Jenny Smith And I like want this to be food that I can enjoy, that I'm
Scott Benner sitting on next you.
Scott Benner A year Jenny sends me a picture of her plate from a restaurant. She's like, I'm doing it.
Scott Benner Like like, look at me look at me eating. You know what?
Scott Benner I take your point about the Valentine. It'll be beyond Valentine's Day, obviously, when people get this.
Scott Benner Also, you're reminding me that tomorrow is Valentine's Day.
Jenny Smith There you go.
Jenny Smith Lovely for your wife that you remember now.
Scott Benner She was gonna get flowers.
Scott Benner I love you, chocolat. Oh, I love you chocolat doughnut, teddy bear cookies and cream doughnut, your berry sweet doughnut, and sprinkled with love doughnuts.
Scott Benner So they have four here's why I'm bringing this up because if someone ends up at Krispy Kreme tomorrow or this week, they're gonna go, oh my god.
Scott Benner It's Valentine's Day.
Scott Benner And there's gonna be one in there.
Scott Benner And then it's gonna come home and it's gonna go on your counter. Right?
Scott Benner And then your gonna walk by and there's gonna be a Red Heart donut with a bow on it.
Scott Benner They'll be like, mom, I'm gonna have a donut, the thing.
Scott Benner And you yeah. Yeah.
Scott Benner And then the Red Heart donut has 44 carbs in it and 26 sugars and 18 fat. Okay.
Scott Benner Yeah.
Scott Benner It's not getting crazy beyond what they're No. What they're doing with most actually, will say they do seem to keep their donuts.
Scott Benner They're all pretty similar. Like, the stuffed ones are
Jenny Smith Okay.
Scott Benner Hitting nutritionally about all the same. Like, one doesn't seem oddly different than the other.
Scott Benner The teddy bear is 46 carbs, 28 sugar, nine fat. Yeah.
Scott Benner These these are all sort of, like, you know
Jenny Smith If I was to pick one, honestly, I don't even know I don't know what they look like.
Jenny Smith You said there's like a red heart one. Right?
Scott Benner Mhmm.
Jenny Smith And then the I'd probably pick the teddy bear one, honestly.
Jenny Smith Like, if I was gonna pick one just out of cuteness and but then I'd feel bad eating it if it had a face
Scott Benner or something.
Scott Benner I'm gonna send it to you so you can see it. Hold on a second.
Scott Benner And then they have a a regular it looks like they're glazed donut, but with icing on top and just up with, like, red and sprinkles and stuff.
Scott Benner That's 37
Jenny Smith Okay.
Scott Benner And 15. That's interesting.
Scott Benner Like so so their glazed donut with icing on top is 37 carbs, and it really does look like that's all it is.
Jenny Smith Okay.
Scott Benner Right? And 50. So the glazed donut says 22. You put icing on top of it, it takes it up 15 more carbs just for the icing.
Scott Benner Anyway, I think that's
Jenny Smith partly heavy.
Scott Benner Yeah.
Scott Benner I partly, I feel like that's some of the value in these conversations actually is that yeah.
Scott Benner I just don't know that our brains do the math real quick when we look at things.
Scott Benner Like, oh, donut. It's Valentine's Day.
Scott Benner Like, you know, that kind of stuff.
Jenny Smith Or underscore I know I I think a lot of people unconsciously undercount for things like frosting.
Jenny Smith Like, it I know that there's sugar there, but Mhmm.
Jenny Smith Gosh, it can't have 25 extra grams worth of carb in it. Yeah.
Scott Benner Right? Yeah.
Scott Benner Especially you make a good point because if somebody's eating the the glazed doughnut as part of their life with 22 carbs, then you're like, oh, this glazed doughnut has icing.
Scott Benner There's no way you're gonna add 15 carbs in your mind to
Jenny Smith Right.
Scott Benner To that.
Scott Benner I sent you the the teddy bear so you can see it. Oh.
Scott Benner I know it's a little I don't know if it's cute or odd. You like it?
Scott Benner Jenny likes it.
Jenny Smith It's kinda it is kinda cute. Honestly.
Scott Benner Aw.
Scott Benner Yeah. Well, you'll eat that cute teddy bear and it'll go inside you and try to kill you from the inside out.
Scott Benner That's
Jenny Smith right. There
Scott Benner you go.
Jenny Smith I was so cute.
Jenny Smith You shouldn't have eaten me. Yeah. You
Scott Benner you'll you'll experience your own bear attack.
Scott Benner Not the way you see in the YouTube videos.
Jenny Smith You're right.
Episode Wrap-Up & Closing Remarks
Scott Benner Jenny, thank you for doing Krispy Kreme doughnuts.
Jenny Smith Thank you.
Scott Benner I appreciate it.
Scott Benner I'll talk to you soon. And happy Valentine's Day.
Jenny Smith You too.
Scott Benner Is that why you're wearing red?
Jenny Smith Kinda. Yeah? Yeah. Yeah.
Jenny Smith I mean, we don't really do anything for Valentine's Day, honestly.
Jenny Smith I mean, Nathan will usually bring me flowers or something, but honestly, it's truly is just like a money making.
Jenny Smith No. I I It's like, you know, it's so
Scott Benner I expect my wife to apologize to me tomorrow around 03:00.
Scott Benner And she'll go, I did not get you anything from Like,
Jenny Smith she says I didn't get you anything, and you're like, great.
Jenny Smith Here are your flowers.
Scott Benner I got flowers for you. And then she'll say thank you.
Scott Benner Actually, Jenny, I think this is a good point to place.
Scott Benner I don't think I've ever said this before. I'll just slide this in at the end of the episode.
Scott Benner On all occasions, birthday, Valentine's Day, anniversary, those sorts of things.
Scott Benner I go out on the morning of, I hand select flowers and come home and arrange them myself.
Scott Benner Oh. I think it's a nice little addition. It's like, it's not just here I bought flowers.
Scott Benner It's like I saw these I
Jenny Smith took time.
Scott Benner They look like they were nice together. I put some time into it.
Scott Benner She's never once seemed impressed by that, but I think it's a big deal.
Jenny Smith I think that's lovely. It really is.
Scott Benner Don't don't marry an Irish Catholic girl.
Scott Benner They their their hearts are buried under ice. That's all.
Jenny Smith I'm just saying I married an Irish Catholic boy.
Scott Benner Yeah.
Scott Benner He knows what Jenny knows what I mean. Okay. Alright.
Scott Benner No shade on the rest of you.
Scott Benner I'm sure some of you are very warm and cuddly.
Scott Benner Not as cuddly as that donut. Right. On it though. See you guys.
Scott Benner A huge thanks to US Med for sponsoring this episode of the Juice Box podcast.
Scott Benner Don't forget, usmed.com/juicebox. This is where we get our diabetes supplies from. You can as well.
Scott Benner Use the link or call (888) 721-1514.
Scott Benner Use the link or call the number, get your free benefits check so that you can start getting your diabetes supplies the way we do from US Med.
Scott Benner Today's episode is also sponsored by Omnipod. Check out the Omnipod five now with my link, omnipod.com/juicebox.
Scott Benner You may be eligible for a free starter kit, a free Omnipod five starter kit at my link.
Scott Benner Go check it out.
Scott Benner Omnipod.com/juicebox. Terms and conditions apply.
Scott Benner Full terms and conditions can be found at omnipod.com/juicebox. (38:45) Okay.
Scott Benner Well, here we are at the end of the episode.
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Scott Benner You have to join the private group. As of this recording, it has 74,000 members.
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Scott Benner My diabetes pro tip series is about cutting through the clutter of diabetes management to give you the straightforward practical insights that truly make a difference.
Scott Benner This series is all about mastering the fundamentals, whether it's the basics of insulin, dosing adjustments, or everyday management strategies that will empower you to take control.
Scott Benner I'm joined by Jenny Smith, who is a diabetes educator with over thirty five years of personal experience, and we break down complex concepts into simple, actionable tips.
Scott Benner The diabetes pro tip series runs between episode one thousand and one thousand twenty five in your podcast player, or you can listen to it at juiceboxpodcast.com by going up into the menu.
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#1798 Is Alison Saving Levemir?!
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 Alexaor wherever they get audio.
Alison Smart returns to share vital updates on the ongoing fight to save Levemir insulin. Discover recent FDA progress, bipartisan support, and why this insulin remains crucial for healthy pregnancies. Alison is a returning guest, 1652 Save Levemir.
Key Takeaways
- Alison Smart has spent over two years advocating for the continued production of Levemir (detemir) insulin, securing bipartisan congressional support and engaging in positive, high-level meetings with the FDA.
- Levemir is critical for many individuals because of its unique profile (binding with albumin, lasting 8-14 hours), which avoids the unpredictable hypoglycemia and long-duration issues that can occur with glargine and degludec.
- Levemir is highly proven and widely prescribed during pregnancy for managing both gestational and type 1 diabetes without causing complications linked to poorly controlled blood sugar.
- Novo Nordisk has signaled a willingness to assist a new manufacturer with ingredients, though finding the right non-competing partner capable of navigating the complex biosimilarity process remains the final hurdle.
- Despite excitement surrounding potential future cures like islet cell transplants, ensuring steady, reliable, and accessible insulin production remains a critical necessity for current and future patients.
Resources Mentioned
- Alliance to Protect Insulin Choice
- Juice Box Podcast - Small Sips Series
- Eversense 365 CGM
- Juice Cruise 2026
- Wrong Way Recording
- Juice Box Podcast Type One Diabetes Facebook Group
- Chicago Policy Review article (mentioned in episode)
Introduction and Podcast Updates
Scott BennerWelcome back, friends, to another episode of the Juice Box podcast. Well, everybody, we're gonna jump right in. I'm back with Alison Smart. She was in episode sixteen fifty two called Save Levemir. It actually was out in October 2025, and she's back with us today to give us an update about what's happening and where are you right now.
If you'd like to hear about diabetes management in easy to take in bits, check out the small sips. That's the series on the Juice Box podcast that listeners are talking about like it's a cheat code. These are perfect little bursts of clarity, one person said. I finally understood things I've heard a 100 times. Short, simple, and somehow exactly what I needed.
People say small sips feels like someone pulling up a chair, sliding a cup across the table, and giving you one clean idea at a time. Nothing overwhelming. No fire hose of information. Just steady helpful nudges that actually stick. People listen in their car, on walks, or rather actually bolusing anytime that they need a quick shot of perspective.
And the reviews, they all say the same thing. Small sips makes diabetes make sense. Search for the Juice Box podcast, small sips, wherever you get audio. Nothing you hear on the Juice Box podcast should be considered advice, medical or otherwise. Always consult a physician before making any changes to your health care plan.
Today's episode of the Juice Box podcast is sponsored by the Eversense three sixty five, the one year wear CGM. That's one insertion a year. That's it. And here's a little bonus for you. How about there's no limit on how many friends and family you can share your data with with the Eversense Now app?
No limits. Eversense. Well, everybody, we're gonna jump right in. I'm back with Alison Smart. She was in episode sixteen fifty two called Save Levemir. It actually was out in October 2025, and she's back with us today to give us an update about what's happening. And where are you right now?
The Advocacy Journey in DC
Alison SmartI'm in Washington DC right now working on this.
Scott BennerHow long have you been at this now total?
Alison SmartIt has been two years. Well, just over two years. We started November 8 was the announcement that this insulin, Levemir insulin, would be discontinued in The US, and we started really later that month. So it's been just over two years.
Scott BennerOkay. And what what has you in DC today?
Alison SmartThere are several conferences this week, and I've had some appointments with congressional offices. So conferences with, health and human services members, and, it's it's been a good week.
Scott BennerOkay. What what do you think I I guess, why don't you catch me up on what's happened since you were on the podcast last?
Alison SmartGreat. Yep. So this is just so we're in March, and it was October. So in just the last several months, we've had a lot of progress. We've had, bipartisan congressional support. Congressional members of both parties have sent letters to health and human services asking for a path forward for production of Determa insulin. We've had high level meetings with the FDA that have been a much different reception than we had when we started this two years ago. Two years ago, there was the FDA is used to dealing with large large companies, not not a small patient advocacy group. Mhmm. Well, small. We're we're getting a lot bigger. And the reception with leadership of both the drug shortage staff and the office of biologics and biosimilars was very positive, very understanding, and caring. The response now is we understand you've made it very clear that there's a distinct need for this insulin, and we're hearing about it from more than just your organization, which is excellent. And they said they really want to emphasize there's a clear path forward. If Novo Nordisk will come and assist, there are multiple pathways that could work, not just one. Okay. So congressional letters, FDA meetings, physicians are reaching out. We have maternal fetal medicine specialists and those that specialize in diabetes and pregnancy specifically and other physicians who are reaching out about the need for this insulin and willing to be, part of meetings with congressional staff. We also have multiple manufacturers that we're talking with ready to go that could make this insulin if they get the needed help from Novo Nordisk. And then at this point, we are asking health and human services to engage Novo Nordisk executives in discussions for production of this insulin. So that's that's our progress.
Scott BennerThat's astounding, especially because it started with, what, you in your living room?
Alison SmartWell but yeah. But I was already initially, you know, communicating with others who needed this, and all of us were saying, ah, what do we do?
Scott BennerRight. Right. Yes. You you pulled together some voices who were concerned. And if it takes two years to get them to, okay. We understand this is a thing we should be supporting. I mean, does it take two more years to get the next step? Is it do you think this is gonna go more quickly? Do you think Novo Nordisk is gonna be receptive to this?
Alison SmartSo they're signaling recently that they will help. They've signaled to some congressional offices that we will be willing to assist with drug ingredients with the right partner. I don't know. You know, we're we're I I don't know. I don't know the timeline and but I just boy, we're making great progress, and there's a real need.
Scott BennerThat's so cool. So I don't wanna be, sour, but but let me ask you a question. So when you go to Novo Nordisk and say, hey. Stop don't please don't stop making this or let somebody else make it. They go, we don't care. And then you get some congress people to write some letters to some people and somebody calls somebody on the phone, and now suddenly it's a thing they care about. I mean, is it that simple, or is there more to it than that?
Alison SmartHonestly, I think it might be that simple. I I do. I I just I've I've stopped. Our organization is not reaching out as much on our own. It it needs to come from bigger voices.
Scott BennerMhmm.
Alison SmartBut I it absolutely makes a difference. I mean, manufacturers care. They care what people think, but they really care what influential members of health and human services and the and our administration think for for certain.
Scott BennerSo so is this a situation where it's just kind of like business where, okay, it's not really something we want to do, but people who we count on for pathways, decisions, etcetera, seem to think it's important. If it's important to them, it's important to us. It's like that.
Alison SmartI'm hoping.
Scott BennerWow.
Alison SmartWe'll see. Right?
Scott BennerIs it funny how the world works?
Alison SmartIt is.
Scott BennerSo when you're down there in those meetings, give me give me an example of, like, you're gonna you you have a meeting today, for example?
Alison SmartDon't this afternoon. I have a conference this afternoon I'll be attending.
Scott BennerA meeting you were at previously in days past. You walk in. Are these people that you've met previously? Are you giving them updates? Are these new people you're trying to get on board?
Alison SmartAll of the above. We're we're in contact with quite a few congressional staff at this point that we've been working with for quite some time. Had a meeting yesterday afternoon with a congressional aide that I've been communicating with for over a year. But some of them are new, and sometimes it's just me, but often will include virtually physicians at the last minute or or others, you know, maybe constituents. So it's all different.
Scott BennerExplain to me how you go from a person, you know, a few people focused on something to a slightly bigger group of people to someone who can get a congressional staffer to sit in person with you. How do you build that? Because you're basically a lobbyist now for one very small idea. So, like, how does that work?
Alison SmartIt takes time. It takes connections, and it takes constituents reaching out. So, you know, we've been saying a lot. You know, reach out to your congressional representatives. It works best if we work in conjunction if constituents reach out to their cons congressional aids. And it even just to get to the right aid or the right staffer is difficult. You get to that point, and then if they can talk to our organization, then we can reach out here from Washington DC, and it it works better if it's if it's in conjunction. And and but sometimes the staffers will talk to each other through connections. It's it's been quite the journey.
Scott BennerDoes it need to be it's funny because I'm I'm thinking about the, you know, kind of everything you're hearing people talk about about islet cells right now
Alison SmartMhmm.
Scott BennerRight, as an example. So, you know, there's, you know, couple of people here and there on social media who are like, you should write a letter to somebody and, you know but, I mean, that's not very coordinated. Like, do uncoordinated things do you think somebody like you who understands this needs to kinda grab hold of those ideas and coordinate them? Is that is that really the key to getting it off the ground and and getting it taken seriously?
Alison SmartI do. I it's easy to disregard a form letter or a form email. These congressional staffers get many, many emails. And so if it's just forwarding some form letter, it doesn't get very far. It needs it needs some some personal contact, you know, constituents or just a real you know, maybe some offices are more concerned with certain areas than other, and it it yeah. It's it's interesting.
Scott BennerSo it's it's as easy like, just sending off, a you know, I don't know. Some guy on Instagram told me to send this somewhere, and I found it. That you don't think that's gonna get much traction?
Alison SmartNot necessarily unless there are many, many. Just a few here and there. People people get frustrated when they'll say, well, I sent one message. One message doesn't get very far.
Scott BennerYeah. Hey. How many? Many what is many many?
Alison SmartYou know, I mean, I've asked that myself, and and some have said, you know, if I get 10 or 20 letters, I pay attention. I think it depends.
Scott BennerRight. 10 or 20 letters makes them pick up makes the staffer pick up their head and say, I wonder if I shouldn't mention this to the congressman. That kind of
Alison Smartthing. Or or you can have a few that are really persistent. Just sending one or two messages is really not gonna bend move the needle. Yeah. But persistency and volume makes a difference.
Scott BennerTime. Not and maybe not just months either, but maybe years.
Alison SmartYou know, it depends.
Understanding Insulin Profiles
Scott BennerYeah. Well, you're you're I mean Your thing is I mean, I guess, take two minutes here for people who maybe didn't hear your last episode and tell them how this started, what the impetus was that got it all moving for you, and why you thought it was so important to do.
Alison SmartSure. So my daughter was diagnosed with type one diabetes at age 13, four and a half years ago, and we started on a glargine. So let me just lay out the the different insulins just as a update. Mhmm. You can newly diagnosed are typically placed on a glargine insulin, which is Lantus and biosimilars, and even TUJO is a is glargine, but but it's more concentrated. Those are those are 40% of the market. So they're the largest part of the insulin market. Some don't tolerate glargine well, and the two alternatives are just made by Novo Nordisk. They are Levemir, which is Dedamir, or Tresiba, which is deglidec. And I'll use the the second the generic name even though there aren't generics of those insulins. The basic differences, they they have different pharmacokinetics. Glargine insulins need to form microprecipitates under the skin and have a slow release, and that can be a problem if glargine insulin is injected into a blood vessel. It can produce an unpredictable hypoglycemic event. Also, if if glargine is exposed to heat, it can also produce unpredictable hypoglycemia from a shower or a sauna, and it's also acidic. So some people don't tolerate well the inconsistency of glargine, and some just don't feel well using it. So then some will use and glargine lasts approximately twenty hours. Detamir lasts approximately well, eight to fourteen hours. So it's typically given more than once a day, but there are some people who only need insulin at night for fasting blood glucose. So that's why that insulin is ideal for many. It also acts differently. It binds with albumin. It doesn't form those microprecipicepts, so it doesn't have that same potential for unpredictable hypoglycemia if injected into the bloodstream or if exposed to heat. Mhmm. Degladec lasts forty two hours approximately, which can be a real problem with people who are used to being able to change the amount of insulin to correspond with different times of the day or to correspond with a menstrual cycle, or teenage boys often have multiple more needs in the day versus the night. Pregnancy, we'll we'll talk about pregnancy in a minute. Mhmm. And then we're we haven't included NPH in our argument, but NPH is needed for pregnancy, but it doesn't have a stable profile. Defined peak that can be difficult for type one diabetics but is needed for gestational and type two diabetes. And then there are insulin pumps. Less than half of those who need insulin use insulin pumps, and even insulin pump users need backup insulin, and women with gestational and type two diabetes would not typically use an insulin pump. So those are the insulins that are available. Back to my journey, my daughter initially used Glargine, switched to Levemir, had excellent management for several years. We went back and tried Glargine again. It's just more difficult for her to maneuver with being a she's an athlete and dealing with a menstrual cycle. She also tried an insulin pump, and in her case, it made the activity difficult. I understand some people can make it work, but, we have many in our organization who used an insulin pump for years who appreciate the ability to go back to shots. And then just back to the journey, so two years ago, it was announced that Novo Nordisk would be removing Levemir insulin from The United States. We started working on this, formed a nonprofit. Our goal is continued access to this insulin produced by a new manufacturer. Of course, we'd love it if Novo Nordisk would just continue to make it. They're not going to, but they're signaling that they might help a new manufacturer make it. That's kind of the journey. Can I talk about pregnancy for just a minute?
Scott BennerYeah. I wanna talk about pregnancy. Give me one second, though.
Alison SmartGreat.
Scott BennerIf I take you in a time machine back three years and ask you to explain insulin, do you go, I don't know. There's fast acting and long acting? And now
Alison SmartOh, absolutely.
Scott BennerAnd now you have a a granular understanding of it? Yeah. My question would be, when you talk to somebody at Novo Nordisk, did they always have this understanding? Like, is is there a world where this got this far because four people in a room said, why do we need this old one? We have the new one, and didn't have that understanding. This episode of the Juice Box podcast is sponsored by Eversense three sixty five. And just as the name says, it lasts for a full year. Imagine for a second a CGM with just one sensor placement and one warm up period every year. Imagine a sensor that has exceptional accuracy over that year and is actually the most accurate CGM in the low range that you can get. What if I told you that this sensor had no risk of falling off or being knocked off? That may seem too good to be true, but I'm not even done telling you about it yet. The Eversense three sixty five has essentially no compression lows. It features incredibly gentle adhesive for its transmitter. You can take the transmitter off when you don't wanna wear your CGM and put it right back on without having to waste the sensor or go through another warm up period. The app works with iOS and Android, even Apple Watch. You can manage your diabetes instead of your CGM with the Eversense three sixty five. Learn more and get started today at eversensecgm.com/juicebox. One year, one CGM.
Alison SmartThe variety of understanding is fascinating to me. So Novo Nordisk executives, some understand it, some absolutely don't. The pregnancy piece, some understand, some don't. Here's another fascinating group to talk to. Former, drug reps from who worked for Novo Nordisk, they were extremely well versed in the differences of pharmacokinetics of glargine versus desmir versus deglidec. That was prior to 2015. 2015. So levemir came out in 2005. Tresiba came out in 2015. And at that point, Novo Nordisk reps were switched to promoting Tresiba to physicians. So it's older reps who really, really understand the value of Levemir insulin. But, yeah, the the level of understanding is certainly different.
Scott BennerWell, I was
Alison Smartdepending on
Scott BennerThat's interesting. So I wonder if everybody can, like, understand. I'm sure if you're in a business that's, you know, a a huge company like Novo or other companies like that, you makes sense to you. But for the average person walking around who's running a cash register somewhere or, like, you know, listening to this while they're plumbing, like, it's it seems crazy to think that the company that makes the insulin might not completely understand the value of the insulin. And to understand that the the reps were the ones that were really educated about it, and they were probably the ones keeping the doctors educated, which kept the need up.
Alison SmartExactly.
Scott BennerRight?
Alison SmartExactly.
Scott BennerYeah. Yeah. And then and then you lose that pathway or things become digital. I I also you know, I I'm not lost that you that what you said earlier was you need to look I don't know if you used this phrasing or if it's how it popped in my head, but, like, if you wanna get somebody on your side and get them to understand what you're talking about, you have stand with them in a room and look them in the eye. You can't send them an email or and say, this is really because you seem crazy, like, when you do stuff like that. Like, I'm watching people now, again, with the eyelet thing. I think it's very important. I I don't talk a ton about politics on the podcast, and I probably never will, to be perfectly honest. But, you know, in that eyelet thing right now as an example, you know, they're like, you should have somebody talk about it. I keep saying, I'm waiting for, like, an ad. I shouldn't say this like this, but, you know, I'm waiting for somebody who doesn't look crazy to to be talking about it. Like, right now, I just see people ranting on social media, and I'm like, I'm not interviewing you. I want Alison who can sit down and go, wow. Here it is. You you what know I mean? Like, wanna have an adult conversation about it. Not that I don't think those people are well intended or that, you know, their efforts might, you know, bear fruit or anything like that. Just when I sit and talk about it, I want somebody who can break it down the way you you can. And that person then needs to be in the same physical space as the person they're trying to explain it to because look at all the words you just used. Glargine, the like, you know what mean? Like, deglade like, who under no one understands that. And so, like, you know, you what are you trying to get a congressional staff? What are those people, like, 23? They've been out of college for eight minutes. Right? And you're, and you're, like, degladeck, and they're, lady, listen. Know, like, I I I don't know what you're talking about. Right? It's hard work, but it's really important.
Alison SmartWell, yeah. And I just gotta say it varies. Some of the congressional staff are college interns, you know, majoring in political science, but some congressional and senate representatives will hire a physician, a fellow to be the one conducting these meetings. I had a recent meeting. No.
Alison SmartGo ahead.
Scott BennerNo. That's just awesome. I'm sorry. Like, yeah, tell me. I'm sorry. Recent meeting?
Alison SmartWell, I had a recent meeting with with and the physician who was meeting with me, and there were a few others. She's a nephrologist, which is specializes in kidney conditions. And she says, oh, we don't use Tresiba with our advanced kidney failure patients because of the long duration of action. So it you know, that and so it was interesting because we were able to just sit down and really go the nitty gritties of this this insulin. But you're right. Often, I've had to learn to, I used to when I started this, I think, well, let me give give me ten minutes to really explain the situation, and now I have to be able to concisely present this in two minutes sometimes.
Scott BennerI wanna just tell you, you're better at it now than the last time I spoke to you, actually. Like, I can Thank you. Yeah. Like, you can tell that it really felt I'm glad you brought that up because I didn't wanna say it without you saying it, but it felt like it felt like you sat in a room and you thought, I need an elevator pitch for this.
Alison SmartRight.
Scott BennerYeah. Because because that was, like, super clear. Like, that would that that was really awesome. Like, you're doing that's awes You know what? I I I keep imagining. We're talking about the islet cells and, like, you'll get this you get this insulin back on the market, and they'll find a way to, like, do that, like, the aisle itself that your kid will get that. You'll be like, oh my god. Are you kidding me? How old is your daughter now?
Alison SmartShe's 17.
Scott Benner17. Do you think that she understands the the value of this, like, in the amount of work and effort you're putting into it? Because, I mean, this is most of your time now at this point. Right?
Alison SmartOh, for sure.
Scott BennerYeah.
Alison SmartShe does. She's great. She's she's very supportive, and she'll occasionally talk about it. But she's much happier to just live her life and let me do my thing. Yeah. As you can probably understand.
The Importance of Levemir in Pregnancy
Scott BennerNo. No. Please. My kid doesn't, you know, care about the thing I'm doing either. Okay. I'm sorry. Go back to pregnancy. Why why is this so important for pregnancy?
Alison SmartOkay. So I wanna bring this up in light of the Isla Act because I think people dream of this day when insulin is no longer needed. Right?
Scott BennerMhmm.
Alison SmartPregnancy is a unique situation where there are pregnant women with gestational diabetes. Over a hundred thousand women in The United States a year have a pregnancy with gestational diabetes and need insulin for just the duration of that pregnancy. We're not gonna you're not gonna inject someone with islet cells that's pregnant with gestational diabetes. Right?
Scott BennerYeah.
Alison SmartSo this is a unique situation. For example, let me just give you another example as I talk about the pregnancy situation. Yesterday, I talked to a maternal fetal medicine specialist who's an OBGYN who leads a diabetes and pregnancy program at a major university, and he sees their their division sees over fifteen hundred women, pregnant women each year having pregnancies that require insulin, and Levemir has been their go to for pregnancy. NPH has been a back up if the woman has gestational or type two diabetes, but NPH is difficult for type ones because of its defined peak. But he said you know? And he he even considered glargine and deglidec as off label for pregnancy. He said and and they always wanna emphasize any of these agents is more important than nothing, but we're losing the one that's that works well because a main need when someone has gestational type two diabetes, they often need most insulin for their fasting blood glucose levels at night. So you want this, you know, eight to fourteen hour insulin. So that's just an example, but I'll just lay out the pregnancy argument. Everyone should be aiming for good blood glucose control, but when a woman is pregnant, that nine month period of time, if she has chronically high blood sugar, she has a much higher likelihood of a a large baby that's early, you know, preeclampsia in the mother. A lot of complications come from not well controlled blood sugar in pregnancy, and that's why the need for levemir in pregnancy is so clear. It was well it was shown by the FDA to be proven in pregnancy. It was involved in multiple well done randomized controlled trials, which glargine was not. There's been one randomized controlled trial with Tresiba in pregnancy, but that study was problematic. It didn't it didn't show, outcomes, and the pregnancy argument is huge. And that's why we have physicians, many of them specializing in diabetes and pregnancy, that wanna be part of these discussions and be able to explain why this insulin is needed for pregnancy.
Scott BennerRight. And even you know? I mean, listen. I've I've talked to plenty of people, who have had type one diabetes and used a pump through pregnancy with success. I've also talked to some who offset that pump use with an injected, you know, basal insulin. There's a lot of different ways to to get to the end. You know what I mean? And taking the tool away does seem ridiculous. Also, the idea that, you know, I like the way you started with that. Like, you know, everybody hopes that one day we just won't need it. But the process to get to that, even though they have you know, I just had someone on the podcast, I don't know, a couple weeks ago, right, who's had the islet cell, transplant. They're using the new Tego, autoimmune sup the immune suppressant thing that's not having a lot of side effects or none maybe they're saying so far. And, you know, big success, it it seems like this is a trial. It's not FDA approved. They don't have, you know, a a warehouse full of islet cells to pump into all the people who have type one diabetes. It it hasn't gone through the process of, you know, scaling up or trying to get it through, you know, the insurance process. I always like to say, like, if they figured that out today, if it was perfect, if they had, you know, they had a building full of islet cells to cover for everybody, and they'd still be ten years away from figuring out how to get it to you. And when it got to you, it might not be affordable to you to begin with.
Alison SmartExactly. Totally agree.
Scott BennerYeah. And it's fine to like, I live hopefully constantly. I think it's I think it's actually very important. But I get scared that there are people out there that are like, oh, I heard they cured type one diabetes in this. I I don't really need to take great care of myself anymore because this will probably be over pretty soon. Right. I I do worry about it because it it does happen to people. They get a little laxed in their care because they think, oh, it's common. You know what I mean? Like, they'll figure it out.
Alison SmartAnd Totally agree.
Scott BennerYeah. So it's just important to keep your eye on the real way things work. I mean, Allison just explained that it took her, like, the better part of two years to get people to, like, take her seriously
Alison SmartRight. Exactly.
Scott BennerTo get through that system. So when you reached out, what did you wanna share? I'm I'm I'm asking you a bunch of questions, but I wanna make sure that there's not some like, a message that you wanted to get out or or something you wanted to tell me about.
Alison SmartThat's honestly, that's the main thing. Just that and if we can if anyone wants to reach out, it it really works best as a coordinated effort. So if if people are interested in this, they can reach out to our organization, to me, and then we can work on it from both angles. That would be super helpful. There was and I also just want to let you know if anyone kind of wants a overview of the situation, there was a recent article by the Chicago policy review that maybe I could send you the link for that that just really explains the the problem well. This does require funding. If people are interested, if you could could reach out with that, you can just reach out to our website, alliancetoprotectinsulinchoice.org. I just wanted you to know that there we really have had a lot of momentum, especially in the last few months. So if we can get some more, both physicians, patients, just everyone reaching out about this, it really helps. More hands makes this work a lot better. So and I just kind of wanted to describe the situation again that with all the with all the focus on as you exactly as if you said, you know, this excitement about possible cures, we're not gonna outgrow the need for insulin. We're just not. The newly diagnosed, the pregnant people just and and even the typical type one patient, it's we're years away from that solution. So if we lose sight of maintaining access to insulin I even had I had a physician reach out to me that in her state, NPH was removed from basically the Medicaid formulary, which having an insulin removed from a form from a major state run formulary plan is often the first step to discontinuation. Can you imagine if they removed NPH? I'm I know in our type one community, it's not looked on highly, but, boy, it's used a lot around the world, and it's very important for pregnancy. And new manufacturers are working on glargine. I mean, that's we're gonna be left with glargine. And glargine works well for a large amount of people, but for some, it definitely does not. And so removing choice and not focused on just being able to have sustainable manufacturing of this product that is required to sustain life and pregnancies is problematic. So just wanted to spread the word about that.
Scott BennerAlliancetoprotectinsulinchoice.org.
Alison SmartYes. Uh-huh.
Scott BennerOkay. And you said things have been picking up recently. What do you attribute that to?
Alison SmartInitially, two years ago when we wrote so for example, when we reached out to the FDA, the FDA didn't wanna meet with us. They basically sent a response that, oh, you've got available alternatives. We were getting the response from Novo Nordisk. Oh, you've got seven alternatives to Levemir. You can take glargine. You can take Semglee, Resvaglar, Basaglar, TUJO. They gave us several names for the same drug, and occasionally, that still happens. So here's another example. The Utah Medical Association, I'm from Utah, voted in favor of resolutions that would enable manufacturing of this insulin. And then when when or or that organization went to other states and other organizations, there was a lot of pushback. And they basically said, no. There's all these alternatives, and we know of one physician who's doing fine with pregnant women using glargine. I think so back to your question, why the recent, momentum? I think more physicians are reaching out and more patients are reaching out as they're being forced to switch and saying, I'm my control is worse. I have I have a man who just reached out who said, I've had type one for twenty five years. And the first twenty years, I had horrible control. I just thought I had this horrible condition. I got on Levemir, and I was able to dial it in, and I had great control. And then I've had to switch back again, and it went back to those initial twenty years of that horrible control. I think the increased momentum and the increased interest is people reaching out. Yeah. I think that's what it is.
Scott BennerThat's awesome. Well, has this been a uplifting experience for you, or does it show you a side of life that is depressing? I mean, how do you think of if you can step out of it for a second, are you motivated by what's happening, or is it is it taking the life out of you?
Alison SmartOh, I'm motivated for sure. But, absolute everything you've said. I mean, it's every part of the journey. It's the highs and the lows, the certain I've got this big you know, we've got this big meeting coming up. This is gonna be the golden ticket. And then, you know, it doesn't always happen, but excellent advancements that we didn't think were gonna happen, and then certainly disappointments from others that we we organizations or, you know, entities that we thought would be engaged and involved that aren't. I wouldn't change it for anything other than I would change. I I want this done. I want this to get done, but I wouldn't go back and say, wish I hadn't done this. This this this has to be done. This this needs to happen.
Finding a Manufacturing Partner
Scott BennerWell, you're pod committed now. There's no way out now. You you gotta you gotta fall through to the end. Hey. You said, that Novo said if the right company comes along to make it, do you have an eye on who that is, and are they happy with that choice?
Alison SmartThat is the mystery. So that's why we're compiling multiple because we're hoping for the opportunity to come before them and say, okay. These are the all the ones that we've talked to that are ready to go. But, of course, it could be someone they choose. But that's been a big mystery. We've wanted to be able to present the an optimal idea to them, and I don't know if we've reached that yet. We're hoping. This is definitely it's like it's like working a detective novel, trying to see inside someone's mind. Okay. What what situation will be ideal for you? And we're we're trying.
Scott BennerWhat do you think the time frame is to to finding out if they're agreeable? Because I I I guess for people to understand completely, they've got a kind of I'm gonna use the wrong terminology here, but they've gotta release something or okay something so another company can it's about ingredients. Right? So they probably have Exactly. Well, they probably have what stuff that's their formula that they don't wanna just give away to somebody else unless they get to a situation where they feel comfortable doing it. For whatever reason, they'll feel comfortable doing it. Do you think that's a thing that you'll know about in months, or what's the
Alison SmartAbsolutely. Yeah. I so I used to view this as a puzzle with a lot of missing pieces, And now I picture this puzzle in my head, and all the pieces have clinked into the place into place even just the last month or two, especially the FDA piece was huge. Meeting with several departments with their leadership was a big deal. So all these puzzle pieces are linking into place except for the main one, the Keystone. Yeah. You know? Nova but because all we felt like we had to get all those other pieces in place so we would be ready, and we are. So now is the time. I really think this will happen soon.
Scott BennerWhat do you think their main focus Nova's main focus is on choosing? Do you think it's do you think they're trying to put themselves in a position with a partner that they're helping or giving themselves a financial win out of this? Do you have any idea what their goals are before they say yes?
Alison SmartI think it's, all of the above. I want them to come out looking, you know, the hero in this Mhmm. And and to find the right situation where that's the case. And then just to just to step back, some people wonder why another company can't make this without their help. Even though Dedomere is now off patent, for a new manufacturer to make this would take five to eight years and $200,000,000. I mean, it's just and the uncertainty of proving biosimilarity to the FDA to a product that's not no longer available, a company is just not because I've had people say to me, certainly, companies in India or China are working on this, and they were. But to our knowledge, they're not now. So it will require it will absolutely require assistance from Novo Nordisk. It will require them sharing some drug ingredients for a few years and sharing some of the knowledge, and and the right partner to do that will involve someone that won't be a competitor for them. We'll put them in the best light, and we're doing our best to find that right solution. And we we really feel like we have multiple options that that would be good good options.
Scott BennerYeah. I do wonder if people listening understand that when when a company develops a drug, right, like you said, there's ingredients in it. But it's not like, hey. I use, King Arthur flour, the, the bread flour, and I use, Domino's sugar. And I you know, it's not it's not like there here's a list, and then I can go out and buy that same stuff and whip it together in the same way you describe in your recipe. Like, it's if if if a company says, oh, I wanna make those cookies too, you know, they have to go buy the cookie and then break it down in a lab and figure out what's inside of it and then remake it. And they never remake it exactly the way it was made the first time. They they make a similar of it, which is, you know, where I guess where the word biosimilar comes from. But it's not as easy as like, oh, just tell me. So you're actually asking them like, hey. You've got a you know, you've got the recipe for the flour here, and and you have they you gotta tell us what that is so we can make it. Because we don't want somebody making a similar that doesn't work the way the original works. We want it to be the original. And then Novo has to give away those secrets, and that's scary to them because that's probably something that they've, you know, they've made money on and and developed, and they probably just don't wanna give it away. And I think I understand that too.
Alison SmartSo You explained that super well. Exactly the way you explained. I kind of think of it as, you know, grandma makes amazing cookies, and you can try your best to make them, but you just can't get it just right. But if she shows you how to make those cookies Yeah. It it it goes much better. And and the way you explained it is is exactly right.
Scott BennerBecause it's not just as easy as, like, whip the concoction for sixty seconds. Like, it's it it's happening in a certain mixer, in a certain temperature. The number of variables that go into making a medication and then reproducing it over and over again, it's much more complicated than somebody might imagine.
Alison SmartAbsolutely. And it required so much, research and and studies to bring this to the market. But to be fair, you know, they there was some taxpayer money involved in that, and and I just think there's there's obligations on both sides.
Scott BennerIf you're making me vote for my personal voice, I say, what are you doing, Novo? Just let it be. Like, you you know what I mean? Like, just let somebody do it. Right. If if you ask me to sit here as the host of the podcast, I can see everybody's side in it. Yep. I I know why they don't wanna give it away, and and I understand why we need them to and and all the reasons in between. So yeah. I mean, get off your ass and do it. Like, let's go. Yep. Allison's gotta go home. She what are gonna do after this? Do you think you've made a skill that you'll continue to use, or do you think you'll, like, you know, head back to the farm and stare out the window?
Alison SmartI have no idea. I it will be nice to use some free time to do some take my dogs for a walk. You know? It's been a fascinating educating journey for sure, but we're just feel like we're close. We're not there yet.
Final Thoughts and Resources
Scott BennerIf someone else came to you a year from now, you're done with this. It's all working and we you worked the whole thing out. And somebody else came to you and said, hey. We'd like to hire you to do this again for us. Is it something that you found invigorating, or is it not something you'd wanna be involved in twice?
Alison SmartI can't even go there. I'm just so focused on this end goal and exactly what you said, though. Three years ago, I never ever, a million years, would have thought I'd be doing what I am now.
Scott BennerYeah.
Alison SmartBut I just feel like this need, I have to do it, and I have to do it well. The motivation for me, I really feel like lives are at stake absolutely now and in the future. And the more I get into this, the more people talk to me. I mean, I really feel the literal lives are hanging in the balance, and the pressure is huge to succeed.
Scott BennerI can't wait. I I please keep in touch with me. Like, I I wanna know, like, yeah. I wanna know if you end up working, like, in a Michael's Craft and Floral Warehouse next. And you're just like, I needed something with just just fun, Scott. Or if if this has ignited something in you. Because what did you do before this? I'll let you go after this, but what did you do previously?
Alison SmartI was a part time physical therapist. I don't know. I just
Scott BennerIt sounds
Alison Smartdid my thing.
Scott BennerYou know? Allison, that's awesome. And a part time physical therapist who just spoke about insulin in a way that probably made somebody from Novo think we should probably hire her. She seems to really understand this. That is really awesome. I appreciate you giving me an update. Tell me the website again.
Alison SmartAlliancetoprotectinsulinchoice.org.
Scott BennerAnd you're looking for people's stories, their money, their whatever they can give to to help?
Alison SmartHonestly, biggest thing, their ability to to reach out and say, k. I I wanna I wanna help. I wanna reach out to congressional offices. But, yeah, funding helps with that, but, your time, you're really saying, k. This this this is worth some of my time to reach out to congressional offices to coordinate with this organization and help this happen.
Scott BennerYeah. I don't know if this will actually ever impact my daughter, but I really do appreciate all the effort and, you know, just your of your life that you've put into this so far.
Alison SmartOh, thank you, Scott. I I really appreciate this. You're you're doing great things spreading education, and it's just it's just the world needs people who are willing to engage and share and make good things happen.
Scott BennerWell, I appreciate you putting your foot forward on this one. Thank you so much, and thank you for the kind words. Hold on one second for me. Okay?
Alison SmartOkay. Thanks.
Scott BennerAre you tired of getting a rash from your CGM adhesive? Give the Eversense three sixty five a try. Eversensecgm.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. Hey, kids. Listen up. You've made it to the end of the podcast. You must have enjoyed it. You know what else you might enjoy? The private Facebook group for the juice box podcast. I know you're thinking, oh, Facebook, Scott, please. But no. Beautiful group, wonderful people, a fantastic community. Juice Box podcast type one diabetes on Facebook. Of course, if you have type two, are you touched by diabetes in any way, you're absolutely welcome. It's a private group, you'll have to answer a couple of questions before you come in. We'll make sure you're not a bot or an evil doer, then you're on your way. You'll be part of the family. I can't thank you enough for listening. Please make sure you're subscribed or following in your audio app. I'll be back tomorrow with another episode of the Juice Box podcast. How would you like to share a type one diabetes getaway like no other? Join me on Juice Cruise twenty twenty six. You may be asking, what is Juice Cruise? It's a week long cruise designed specifically for people and families living with type one diabetes. It's not just a vacation. It's a chance to relax, connect, and feel understood in a way that is hard to find elsewhere. We're gonna sail out of Miami, and the cruise includes stops in CocoCay, San Juan, Saint Kitts, And Nevis aboard the stunning Celebrity Beyond. This ship is chosen for its comfort, accessibility, and exceptional amenities. You're gonna enjoy a welcoming environment surrounded by others who get life with type one diabetes. I'm gonna host diabetes focused conversations and meetups on the days at sea. There's thoughtfully designed spaces, incredible dining, and modern amenities all throughout the celebrity beyond. Your kids can be supervised, there's teen programs so everyone gets time to recharge. Not just the the kids going on vacation, but maybe you get the kickback a little bit too. There's gonna be zero judgment, real connections, and a whole lot of sun and fun on Juice Cruise twenty '26. Please come with me. You're going to have a terrific time. You can learn more or set up your deposit at juiceboxpodcast.com/juicecruise. Get ahold of Suzanne at cruise planners. She will take care of everything. Links in the show notes. Links at juiceboxpodcast.com. Have a podcast? Want it to sound fantastic? Wrongwayrecording.com.
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#1797 Pressure
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.
After confusion, missteps, and mixed messages, Britt shares the moment everything changed—finding clarity, better management, and a steadier path forward with type 1 diabetes.
Key Takeaways
- Advocate Relentlessly but Respectfully: Assume positive intentions when working with school staff, but don't hesitate to push for necessary accommodations like a 504 plan to ensure legal protection and consistent care.
- Prioritize Mental Health: Diagnosis is a "marathon, not a sprint." Utilizing therapy and medication (like Zoloft) can help transition from a "fight or flight" crisis mode to a more sustainable management routine.
- Empower the Child: Balancing the burden of management is key; allowing a child to have discreet treatments (like Starbursts in class) helps them feel "normal" and builds their confidence in managing their own condition.
- Education is Evolving: Standard hospital education often focuses on "survival" rather than day-to-day optimization. Seeking out community resources and veteran advice (like pre-bolusing) is crucial for better outcomes.
- Adaptability and Community: Connecting with others in the Type 1 community—whether through podcasts, support groups, or school staff who also have T1D—provides invaluable perspective and support.
Resources Mentioned
- Tandem Mobi System: tandemdiabetes.com/juicebox
- US Med: usmed.com/juicebox (888-721-1514)
- Eversense 365 CGM: eversensecgm.com/juicebox
- Omnipod 5: Mentioned as Courtney's daughter's current pump system.
- Dexcom G7: Mentioned as the CGM used in conjunction with Omnipod 5.
- Juicebox Podcast Website: juiceboxpodcast.com
- Diabetes Network of Arizona: Mentioned for family support and 504 plan assistance.
- Wrong Way Recording: wrongwayrecording.com (Podcast Editing)
Introduction and Diagnosis
Scott Benner Here we are back together again, friends, for another episode of the Juice Box podcast.
Courtney My name is Courtney. My daughter was diagnosed with type one as a five year old two years ago.
Scott Benner If this is your first time listening to the Juice Box podcast and you'd like to hear more, download Apple Podcasts or Spotify, really any audio app at all. Look for the Juice Box podcast and follow or subscribe. We put out new content every day that you'll enjoy. Wanna learn more about your diabetes management? Go to juiceboxpodcast.com up in the menu and look for bold beginnings, the diabetes pro tip series, and much more.
Scott Benner This podcast is full of collections and series of information that will help you to live better with insulin. If you're looking for community around type one diabetes, check out the Juice Box podcast private Facebook group. Juice Box 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 Juice Box podcast, type one diabetes on Facebook.
Scott Benner Nothing you hear on the Juice Box podcast should be considered advice, medical or otherwise. Always consult a physician before making any changes to your health care plan. Today's episode is sponsored by the Tandem Mobi system with Control IQ Plus technology. If you are looking for the only system with auto bolus, multiple wear options, and full control from your personal iPhone, you're looking for Tandem's newest pump and algorithm.
Scott Benner Use my link to support the podcast, tandemdiabetes.com/juicebox. Check it out. Today's episode is also sponsored by US Med. Usmed.com/juicebox or call (888) 721-1514. US Med is where my daughter gets her diabetes supplies from, and you could too. Use the link or number to get your free benefit check and get started today with US Med. The podcast is also sponsored today by the Eversense three sixty five. The Eversense three sixty five has exceptional accuracy over one year and is the most accurate CGM in the low range that you can get. Eversensecgm.com/juicebox.
Courtney My name is Courtney. I am a school administrator and elementary school principal, and I've been in education for twenty years. And my daughter was diagnosed with type one as a five year old two years ago.
Scott Benner She's seven now.
Courtney She's seven now.
Scott Benner Yeah. You have other children besides that one or no?
Courtney I do. I have a younger son who is he's five now.
Scott Benner Seven and five. He was three when she was diagnosed. Were you gonna have more kids and then you stopped? No.
Scott Benner No. Two two is good?
Courtney Two is good. Girl, boy, and you're like, look what you did. We're done.
Courtney Exactly. My husband wanted a third and I said, I'm good with that as long as you carry this third one.
Scott Benner I hope your new wife and you will be very happy. Exactly. Because I'm not doing this again. Thank you. Yeah.
Scott Benner That makes sense.
Courtney Yep. In the family, you, your husband, extended family, other autoimmune issues? No. Nothing. Nothing. Celiac?
Courtney Knock on wood. Not nothing right now.
Scott Benner Somebody has eczema.
Courtney Eczema. Yes. Eczema.
Scott Benner Yes. What about a vitiligo, a changing of the color of the skin? Nope. No. Mm-mm. Thyroid?
Courtney Nope.
Scott Benner Get out of here. Not one not one low energy person in your family?
Courtney No. Really? No.
Scott Benner I believe you. Okay. Who's got the eczema?
Courtney My son.
Scott Benner Your son does. Okay. Yeah. Let's see. You so you don't have any knowledge of diabetes. It's not like you're looking around corners for it. What happens to your daughter that first piques your interest?
Courtney Well, it was interesting because I was at my twenty year college reunion, and one of my closest friends from college, her son had just been diagnosed about a year prior. And she was talking to me about the symptoms and his diagnosis. And I thought to myself, you know, it's funny. Maggie, my daughter, has some of those symptoms. Like, she's going to the bathroom a lot. She's drinking a lot of water. You know, all the classic symptoms. And she's like, it's probably not type one, Courtney. It's probably something else. But, like, if you're worried, like, make an appointment with your pediatrician.
Courtney So I went went back home, waited a few more weeks. And, again, easy to as I'm sure many of us do, like, you know Yeah. Excuse away the symptoms. I was like, I'm just gonna take her in. And sure enough, they she had glucose in her urine, and her blood sugar was three fifty.
Courtney I love my pediatrician, and she said, you have to go to the emergency room right now. I'm like, no. I don't. She's fine. She just had you know, she just was at school. So she wasn't in DKA, which was good. Thank you to my college roommate.
Scott Benner Did you go to the ER?
Courtney Yeah. Mhmm.
Scott Benner Isn't that funny? Your first like, somebody said, you have go to emergency room. You're like, no. No. No. Silly.
Courtney I don't.
Scott Benner No. You don't know what you're talking about. Did you even go to school? I've never checked.
Courtney Exactly. Yep. And then drove to the, children's hospital in our city, and she was admitted for several days, and it all started.
Scott Benner Wow. How how bizarre is that? You're talking to a person you probably hadn't seen in forever. And they're like, oh my god. You. And you're like, you. I remember that time we got drunk at the thing, and you're like, yeah. Yeah. Exactly.
Scott Benner What's going on with you? And she's like, oh, my kid got diabetes. And she's like, oh, bummer. And then said she starts rattling off her life, and you're like, this poor lady looks exhausted. Also, she's describing my daughter to me.
Scott Benner Uh-oh. Oh, wow. Yep. Wow. That's really something. Did you, a year later, look like she looked at the—
Courtney Yes. Absolutely. She just got together with her last weekend. I was meant to go to that reunion and hear that information. And and, you know, the funny thing is working in schools, we have kids with type one at my school, obviously, that I work at. And I still had no flipping idea.
Managing Anxiety and Mental Health
Scott Benner Yeah. That's the You know? Does it stick with you or are you okay with it? That you What's that? That it just didn't pop the front of mind as soon as you saw it.
Courtney No. Because even even working in schools and teaching kids who had type one, I didn't know, obviously, the depths of it and the extent of it and what it all entailed. I just sort of remember thinking, yeah, they have to take insulin. You know, no big deal.
Scott Benner You're not an anxious person?
Courtney I'm a very anxious person. Yes. Oh, it's like it's just the way you said it. That was you were like, oh, no, Scott. You've misread that completely. I'm a disaster. I am a disaster. Yes.
Courtney Well No. But I just you know, you don't until I I I think it's interesting now when I see, you know, kids with, you know, different types of medical conditions, how much you don't really know until you're experiencing it. We have a student that, you know, she has spina bifida. Then, again, that that's a, you know, pretty complex medical condition that she has has to navigate her entire life, and you just never really know until your your kid is the one that is going through it.
Scott Benner No. Of course. Wait. Tell me more about your anxiety. How long has this been around?
Courtney My entire life. Since I was three, Scott. Since yeah. Yep. I remember. But, you know, after Maggie's diagnosis, it was obviously yeah. I shouldn't say obviously, but the worst it ever was. I did the things. Went to therapy, got on medication. I actually found a therapist who her son is type one. So Okay. That was really helpful.
Scott Benner I was gonna say that's probably incredibly helpful. Well, I did the thing. So there's a checklist. I followed it. Do you still do, talk therapy?
Courtney Occasionally. I do. When things feel hard to handle? Yeah. I know the indicators for myself. And, you know, when things when things start to feel really overwhelming, I know, okay. Time for time for a tune up.
Scott Benner What about the medication? Did you keep doing it or did you use it for a while and then stop?
Courtney No. I keep I'm still on it. Yep.
Scott Benner Okay. And what what does it do for you?
Courtney It's funny because I think I can just sort of, like, operate as a normal human being as opposed to somebody who is in this, like, you know, fight or flight crisis mode all the time. So I was just talking with my provider, and she was like, you probably feel like you can go off of it because it sounds like you're doing pretty well. I'm like, I do. And she was like, yeah. You shouldn't.
Scott Benner She's like, no. You should stay healthy. To know you, Courtney, and let me just tell you something. The meds are the only thing holding this together. And those meds are—using bath salts? What are you using exactly?
Courtney No. Not bath salts. Just Zoloft.
Scott Benner Oh, okay. Yeah. And the first one you tried, and it worked out well for you?
Courtney It did. Yeah. Does your husband or other people in your life mention it to you? Meaning, is the shift noticeable to others or just something that's more internal for you?
Courtney I think it's noticeable to others, especially, you know, after diagnosis when our world was rocked. You know, I couldn't sleep. I couldn't eat. I lost 30 pounds. I, you know, just was constantly worried, anxious. So that's—and now I can—I can sleep. I can eat. I can go to work. All those things, you know.
Scott Benner Did someone help you back then? Did you know yourself? Like, how did you know you needed help? Did you overhear your husband telling the kids, don't worry, new mommy will be better than this? Or like, what what happened exactly that kinda made you think like, okay, I have to do something.
Courtney Yeah. The people in my life. My husband, my parents, my siblings, some of my good friends. Courtney's, like, people who I bumped into at the grocery store. Everybody's got Exactly.
Scott Benner I went to get my license renewed, and the lady's yelling at me, you need help. And I'm like, wait. What? Exactly. But the 30 pound weight loss, were you, like, not eating, or what was happening?
Courtney I wasn't eating, and, you know, I just suddenly kinda developed a strange relationship with food. And at the beginning, we were pretty restrictive with my daughter, which I regret now. You know, we just did all low carb. Yeah. I would feel guilty about eating things that were, you know, had carbs and sugar.
Scott Benner Oh, you weren't feeding it to her, so you stopped eating everything too. Were you mad at your husband because he kept eating? Because I know he did.
Courtney Yeah. He was like, listen. That's your journey. I'm over here with my tortilla chips. How did the dominoes fall that make you go low carb with the the child right away?
Courtney I think insulin was scary for a long time, and it was just easier to manage when she was eating low carb. And, you know, I'm a straight a student. I I remember thinking, like, I can I can figure this out? And I couldn't until I listened to Juicebox podcast.
Learning Through the Podcast and Low Carb Phase
Scott Benner Oh, I didn't know that was gonna happen, Courtney.
Courtney Seriously, though. It was—I I remember thinking, okay. Podcast. Someone had sent it to me. I was like, this is good. What it what will it be? Like, ten, fifteen episodes? I'll listen to it. I'll learn everything I need to know, and we'll be golden.
Scott Benner Yeah. Doesn't work like—So when you're like, there's probably, like, three things I have to know. I'll write them down while he's talking. Exactly. So you're saying she's having outcomes, not commiserate with your desires. Things are not going well at all. You try to, like, pull a little bit of information together. It doesn't get any better. And you're like, you know what? Instead, what if we just never had a carb again? Let's try that. Totally. Okay. Yep. And that was, I imagine, probably worked pretty well. Right?
Courtney It wasn't bad. Except that, you know, my poor five year old couldn't have cupcakes when it was someone's birthday or, you know, she wanted something and I said no a lot.
Scott Benner I said no. She's like, mommy, are we married? No. No. So take the, like, kinda like ham fisted cupcake example away. Like, day to day, what was it impacting? Or was it not? Was it just like you got to a birthday party, you're like, god, jeez, we're low carb.
Courtney I don't know. I think it was more about, for me, like, her mental health and her mental well-being and and wanting to be like, you know, "every other kid." Mhmm. Then I tried to relinquish some control and and learn more and say, okay. You're gonna, you know, eat what every kid wants to eat and within limits, of course. She's not having ice cream for breakfast.
Scott Benner But On top of a cinnamon bun? Wash down with a milkshake. That one—that's not—you're just you're just saying, like, common day to day items, like—what happened? She was eating low carb and she—do you think she felt, like, marginalized in that situation or was it your guilt or—diabetes comes with a lot of things to remember. So it's nice when someone takes something off of your plate. US Med has done that for us. When it's time for Arden's supplies to be refreshed, we get an email. Rolls up and in your inbox says, hi, Arden. This is your friendly reorder email from US Med. You open up the email. It's a big button that says click here to reorder, and you're done. Finally, somebody taking away your responsibility instead of adding one. US Med has done that for us. An email arrives, we click on a link, and the next thing you know, your products are at the front door. That simple. Usmed.com/juicebox or call (888) 721-1514. I never have to wonder if Arden has enough supplies. I click on one link. I open up a box. I put the stuff in the drawer, and we're done. US Med carries everything from insulin pumps and diabetes testing supplies to the latest CGMs like the Libre three and the Dexcom g seven. They accept Medicare nationwide, over 800 private insurers, and all you have to do to get started is call (888) 721-1514 or go to my link, usmed.com/juicebox.
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Relinquishing Control and School Management
Courtney I think a little bit of both. Maggie is—I mean, she's a great kid, but she's not "but." And she's very aware of—
Scott Benner Scott, she's a great kid, but she's a little bit of an asshole, I gotta tell you. Like—alright. It's just so funny where you paused. She's a great kid. I'm sorry.
Courtney She is, but what's really important to her is also, like, what other people think and, you know, wanting to be as, quote, normal as possible. She didn't wanna, you know, have to say no to the cupcake.
Scott Benner Did you struggle with that? Like because I I can kinda see myself being of two minds there. Like, if we started off, you know, with the carbs and it wasn't working and we're like, well, let's try lower carb and lower carb worked. And then you start feeling like, well, I you know, I'm not like everybody else. Is there—was there a part of you, like, from a parenting perspective that wanted to say to her, hey, it's not our job to be like everybody else. It's okay? Because that that's a weird position to be in as a parent all of a sudden. Totally.
Courtney Yeah. I I think it was such a contrast and such a, obviously, curveball for all of us, but for Maggie most especially that—and it was it was my own, like, control, you know, issues that I needed to sort of just, like, let go and learn. And, okay, there's gonna be highs and there's gonna be lows, and we can manage those. Maggie gets to be Maggie. What do you call a high blood sugar? Where's the number when you start going, oh, jeez, I didn't do something right.
Courtney I'm not a diabetes ninja. Not yet. And it's one of the things that I would I want parents—I would want parents to know about schools. Like, for me, I'm willing to relinquish a little bit more control when she's at school. I'm not worried about a blood sugar of one fifty or one eighty when she's at school. I'm gonna let that ride out. The pump's gonna take care of it, and she's, you know, just gonna be, you know, high for a little bit. That's okay. She'll come back down.
Scott Benner What system is she on?
Courtney Omnipod and g seven. Omnipod five? Yep. Okay. If she's at school with a one fifty blood sugar, you wouldn't send a text to somebody that said, hey, why are we bolusing here? Nope. No. You'd say, I I think the algorithm's gonna bring this down at some point. Totally.
Scott Benner Is there a number where you call the nurse and go, okay, we're upside down. Let's do something.
Courtney Yes. I think if she's above two fifty, which I know seems high, we're—I still feel like at the beginning of this diagnosis even though it's been two years. But for the most part, she's pretty well controlled when she's at school. And if anything, I'm I'm calling to have her eat a Starburst because she's, you know, in the seventies, which I don't really care for when she's at school because she can drop pretty fast depending on if it's, you know, PE, recess, whatever. Right. So most of my calls are on the low end as opposed to the high.
Scott Benner So you're you're adding context, but she's not walking around $1.80 all day most days. No. I gotcha. I just wanted to understand the the you know, what you're using to calibrate yourself with. And so you were able—to you weren't able to. Zoloft was able to give away that anxiety.
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Courtney I I think some of it was Zoloft. I think some of it was—it's just time. Right? This just becomes part of—you know, I remember listening to one of your podcasts, and somebody was saying something like human beings just adapt. Right? And this is just—we've just adapted. This is just part of our life. And do we wish we didn't have to deal with it? Sure. But I don't—can't—I can't waste time or energy on that anymore. Just gotta keep moving forward.
Evolving Roles and School Advocacy
Scott Benner I think you're going to find because you're—you know, she's diagnosed young and you're a young family still. Right? And how old are you?
Courtney I'm 45. Not that young. Okay. But like—well, you can say it, Scott, but it's not true. Did you start a little late on purpose?
Courtney I did. I got married at 35. And then I had—got pregnant at 36 and 38. Long line of losers behind you? Or—Yeah. That's right.
Scott Benner Oh, jeez. I kept trying to find one, Scott. They're not as plentiful as you think. The one I settled on isn't actually great. It's just—it is great. No, I'm kidding. I'm sure he's fantastic. Well, I I guess what I was—what I wanted to say was that this is gonna morph and change so many times. You won't even recognize this part of it six months from now. Let alone six years from now. If Arden was seven and she was at school, and, of course, this would have been before algorithms and stuff like that, I would have absolutely bolused the one fifty. I probably would have bolused to, like, one thirty, to be perfectly honest. Because I was acting as the decision maker already. Now and then moving forward, you know, after kinda learning how the system she was using, the different systems she's used over the time have worked—there's times when you're like, well, there's no reason to interject here. It's gonna take care of it. There's times when you see and you go, I don't think this is gonna work out ever or or it's gonna take too long. But then, you know, morphing forward, forward, forward, forward till she is, you know, who she is today. The reasons you don't bother somebody to bolus a one fifty when they're 21 are different than the reasons you don't do it when they're seven. You really do have to keep rolling with it and making new decisions. And then at some point, like, the give-it-away part of it—I know how I hope Arden ends up being as an adult taking care of herself, but I also feel like I've talked to countless people and I realized that that's not—it's not reasonable to expect everybody to do something based on, like, directions or a check sheet or something like that. People are just who they are.
Courtney Yep. Well, the other jackpot that we hit was our school nurse is type one. Maggie's school nurse is type one. Oh, wow. Okay. And how do you find that to be valuable?
Courtney First and foremost, just the education and knowledge. I continue to be struck by, you know, how many people don't know the ins and outs. Not that they should, but, or the that it can be critical and scary. And that you have to intervene, you know, immediately. It can turn into a medical emergency. So I think that was helpful. I also think just from my daughter seeing her every day and seeing her sensor and that that it's just part of—you know, she's a great successful adult and school nurse. They have their own little community there of support. Which is—it's just so great. That's excellent. Did you—do you work in the same district your kid goes to school in?
Courtney I don't. No. So you didn't, like, hire the type one nurse on purpose? No. Scott, it was a little bit of abuse of power, but—Exactly. I would've if I could've. But it's very nice. Let's see. How is—I do—Go ahead. Your thoughts?
Courtney I was just gonna say, I I have to be pretty aware of my role at school when it comes to type one kids at my own school because I want to overstep, I think, at times when that's not really my role. I had a student whose blood sugar was low, and we had a substitute who was having him eat Jell-O. And I said, oh, how many carbs are in the Jell-O? And she was like, I don't know. And I said, zero. He needs juice. He's in the fifties. And, again, I was glad I was there to support, but and then I, you know, the community that I serve is a lower socioeconomic than the community that I live. And so there's really a lack of resources sometimes that hurts my heart as a mom and an educator. I just think there's more we could do in terms of advocacy and education.
Scott Benner The Jell-O is interesting. You step in—do you step in and say, oh, I have—or do they know you have a a child with type one, or did you just, like, be like, hey, I have some background on this, and that's not gonna work?
Courtney Yeah. My my staff and students know that I have a child with type one. This was a substitute, so I don't think she knew. Where'd she get the Jell-O?
Courtney I don't know. Funny. I know. I'm low. Would you like my lime Jell-O? Exactly. Why do you have lime? Ugh. Everyone knows orange is better, but that's that's neither here nor there. You know, Jell-O is Jell-O ground up horse hooves? Disgusting. Yeah, it is disgusting, but Jell-O is great.
Scott Benner Why'd you wanna come on the podcast? Also, don't forget to mention that I'm famous like you did before we started recording.
Courtney Scott, seriously. I am still nervous talking to you because you are a celebrity in my house and in my community. And my type one mom friends were so excited for me to be talking to you today.
Scott Benner Seriously? That's lovely. I watched my wife run away from me in the kitchen yesterday. I was like, hey, can I tell you something? She's like, not now. And she just—If that ain't marriage in a nutshell, I swear to you, we were in the car the other day. She brought something up. It was like a social thing. It was a pretty deep point about something she brought up. We're chatting about it, not for long, and I had, like, a—I wanted to add to it. And I—it's—I literally don't remember what it was. It's not important. And I added to it, and there's this long pause, and she didn't say anything. And I turned and I looked at her, I was like, are you gonna respond? And she goes, I'm just listening. I have nothing to say about this. I'm like, you brought this up. You started this conversation, and I'm trying to keep it going. And you just went mute in the middle of it. She's like, yeah, I'm not interested. Okay. So just tell Arden—and Arden goes, I do that sometimes. Sounds like I just get bored in the middle. Anyway—yeah. That's just so lovely. How long have you—I'm sorry, you told me, but you've been married since how long?
Courtney I've been married for ten years. Are you and your husband splitting duties on the on the diabetes stuff, or does he have a thing he does? How do you manage the workload?
Courtney Yeah. It's—I think, you know, been probably one of the biggest challenges in our marriage because when Maggie was first diagnosed, I took it all on. I'm still probably the point of contact. I wouldn't let him do a lot to start, which was, again, just my own issues with control. But then it it got to the point where, you know, I couldn't leave. I mean, literally, I was with my daughter twenty four hours a day, seven days a week. Couldn't go anywhere. Couldn't do anything. Couldn't trust anyone else.
Scott Benner You were spiraling, you would say?
Courtney I was. And my husband is a wonderful, capable, intelligent man. And it was—it became very important for me that we, you know, both were doing things and, you know, and then I just started resenting him for it even though it was me who was preventing him from doing it.
Scott Benner "Don't touch this kid. I cannot believe you are not helping me with this kid." Exactly. That was exactly it. I wanna just say this right now. Kelly told me I was cooking sausage incorrectly last night. Hilarious. It was like—what's happening? And so she said—I wish I would've—I've been married almost thirty years, and I still didn't know to be quiet on this next little bit. She goes, "what's this all over the sausage?" And I went, "are you referring to the pepper?" And she goes, "yes." "Why did you"—what did she say? "Why did you, like, flavor the sausage? The sauce is going to do that." And I said, "well, I'm just doing it the same exact way I've done it for the last thirty years." And I kinda let it go. But I was just—I was standing there with the sausage, and she's doing something else. And we're cooking together. Right? In Cosmopolitan magazine, they tell you that's sexy, but trust me, it's not. They're lying to you about that. And I couldn't let it go and I just I waited, like, three solid minutes through, like, some real silence—because I mean, I was clearly not looking for her input on the sausage making. And I just said, "I gotta tell you, you're a special person." And she says, "how's that?" And already in her voice, she's like, "go ahead. Say the shitty thing you're gonna say." Exactly. "How could you describe pepper as 'what's this all over the sausage?'" Marriage. It was revealed twenty four hours later that she might be having her period. But I don't think that has anything to do with it, Courtney, because her period does not change how she reacts to things. Okay? She is the same person no matter what. And I will use her words, her menstrual flow, and and the hormones that come with it, they only change her inability to deal with me being stupid. Yeah. And so in a normal situation, she would have shut up about how I just spread whatever that is all over the sausage. But on that day, it needed to be described as "what is that all over the sausage?" It has to be said. I swear to God when she said that, I thought, what is she talking about? What is all over the sausage? And then I finally went, "are you talking about the pepper?" "What else is on this?" she said. And I went, "onion, garlic, pepper, the same goddamn thing I put on it my whole life." She goes, "ugh."
Courtney You—she should've done better. Goddamn. I know—was wrong with me. I'm just a horrible person. I was the only man in America cooking during that football game last night, by the way. You're welcome. So, anyway, so you ostracized your husband, and then ostracized him again for allowing himself to be ostracized. Absolutely. Since that's been cleared up, what's the deviation of work? How does it work now?
Courtney It's pretty much fifty fifty. I tend to be the point person for school just because schools are where I feel comfortable. But I just went away last weekend, and I know that he does a great job and is on top of things. And Maggie knows that too now, and I don't think she did at the beginning. She would always only come to me, and some of that was, you know, a mom—Premeditated? Yeah. "Don't go to him. He's horrible." Exactly. but I think she needs to know that there's lots of people and that dad can take care of her just as well as mom can. I agree. We're in—You made your way through it. And you went away, didn't think about it the whole time you were gone, kind of it was kinda free and easy for you?
Courtney It was actually. It was pretty easy. You're selling Zoloft today like water in the desert. There's a lot of ladies right now going, "how do—was that a z? Z o what?" Exactly. Don't think you can ever totally turn it off, but, you know, I glanced at her blood sugar, and I think maybe I texted him once or twice to be like, "did you give her something? She's on the low."
Scott Benner Pretty awesome. Are you from the Midwest originally?
Courtney I'm not. I was born in Boston, and then I grew up in Jersey for most of my life. And now I'm out in Arizona. Your accent's like a really interesting blend. I can't figure out what it is while it's happening. It's nice. It's part of what made me when I incorrectly said a half an hour ago, "so you don't have any anxiety." You sound calm while you're speaking. Is that the school thing?
Courtney I think so. It's just yes. Years of practice. I have a tone, Scott, that stops people from throwing things in my office. Exactly. I learned it in college. That was most of my last year. because you really do make me feel at ease. Your voice makes me feel at ease. Oh, that's such a nice compliment. And you come off so, like, somewhere between Minnesota and Wisconsin/Chicago when you're talking, but you're not at all. Funny, no.
Public School Realities and 504 Plans
Scott Benner Did the whole group of ladies that love me pick straws as to who got to come on the podcast?
Courtney Well, it's funny because one of my good friends is also an educator, and she volunteers for Diabetes Network of Arizona. They do a lot of work with families who are newly diagnosed in terms of helping them get 504 plans set up and support with school. And she was saying as educators, we can kind of see both sides of things—the experience working at a school and then the experience of, "holy crap, now I have to send my five year old to school with this life threatening medical condition and trust that the staff there are gonna take care of her and keep her safe." So she was like, "you go on, Courtney. You're a principal. Go on."
Scott Benner Well, it is hard to know. Because I'm sure for all the good nurses out there who have type one, you probably have worked with people in the past where you're like, "I wouldn't leave my guinea pig with that person." Absolutely. And how are you supposed to know?
Courtney Exactly. And I think—what I do think is that ninety nine percent of school employees want to do the right thing. They're there because they love kids. They wanna make sure kids are cared for, that they're physically safe, emotionally safe. I think what gets in the way sometimes is just a lack of education and a lack of knowledge around type one. And so I feel like gross negligence aside, you can always, and you should, problem solve with the school. I mean, I had to do it for my daughter when she was first diagnosed. I requested a 504 meeting. I went in, and I said, "I want someone to follow her numbers." And they said, "well, we don't have an iPad." And I said, "you can get one." And they were like, "well, we—no. We don't have one." They're for sale. You can get them anywhere. Yeah. And then it was like, "if you don't have the power to get an iPad and follow her, who should I talk to? Is that your technology department? Is it the superintendent?" I think the best advice I could give any parent is, assume positive intentions of the school. They wanna do the right thing. And then you problem solve as a team or you advocate up. You go up the chain of command. No problem. Who should we talk to then? How can we make sure?
Scott Benner Yep. First person says, "iPad. I don't have an iPad." You see that person as the school instead of the person who is in a position that doesn't have an iPad and doesn't have a budget to buy an iPad. And so instead of saying, "look, I don't have one of those, and I don't know how to get it. We could talk to somebody else," they just go, "nope. I don't have an iPad." And it's that simple—those kind of simple answers then spark you on the other side to go, "ah, they don't wanna help me." Meanwhile, who's they? It's just this person in front of you who's limited by their options. Totally.
Courtney And listen—my kids go to public schools. I work in a public school. Public schools are understaffed, under resourced. And oftentimes, your school nurse, your health tech, they are—literally, my daughter's school has 1,100 students. If at any point, I was worried that she wasn't getting the care that she needed because the workload was too much for the health staff, I would advocate. And I know that I could go to the superintendent. Schools are really, for the most part, doing the best that they can. And I'm willing to work with schools all day long as long as we are assuming positive intentions, we're kind to each other, and we problem solve. And if we can't solve it, great. Who else should we talk to then? Who can help us?
Scott Benner What would pre-Zoloft Courtney tell me? Because that sounds like a very measured response when somebody tells you they can't help your kid. Because I'm trying to imagine a person who's more newly diagnosed, who doesn't work at a school, and all they can think is, "I gotta be able to see the numbers." And the people are watching you to see the numbers. So you guys gotta be able to see the numbers, then somebody goes, "we don't have an iPad." You go, "they don't understand." And then it kinda goes like that real quickly. So before—can you contextualize how you would have managed this before you were in your Zen place?
Courtney I mean, I can. And listen, I think it's not just type one diabetes. We as parents are—our kids are the most important thing to us. So it is, I think, natural to get fired up and to immediately wanna come in hot. My brother says, you never wanna go full nuclear right away. So you can, and I do, bitch and moan to my friends, my family, people that get it. And then when I'm interacting with school employees, my professional hat is on. And I try to be kind and respectful and acknowledge the place that they're in while continuing to relentlessly advocate for my child.
Scott Benner I hear you. I wish it was 1978 still. It was so easy. You'd be like, "hey, you gotta get an iPad." And they'd be like, "no, I don't." And you just smack them. And then there'd be an iPad and somebody would get arrested and everybody would be laughing about it for five minutes, then it'd be over. The world—everyone's you're like, "I have to think about where they're at." I agree with you, by the way.
Courtney But I'm saying I think both things can be true. I think you can be a pain in the rear end and relentlessly advocate and still be kind. I think all those things can exist. And in my current role, my professional life, I'll work with parents like that all day long. But the minute someone comes in and is yelling out the seams, it makes it difficult to wanna help them. Not that we don't, but having them on the other side of it, I feel like it makes it easier for me when I'm advocating for my own child or my own children.
Scott Benner When someone's yelling at you, do you ever wonder "maybe they're right? Maybe we are really missing the point here?" Because that's gotta be hard while you're being yelled at to be considerate of.
Courtney It is. We talk about—adults just like how we interact with kids. You can set a boundary and hold that boundary and be kind all at the same time. So I don't think there's ever been a time where I haven't tried to acknowledge, "I hear you, and I hear why you're upset and angry," and all of those things can be true. But again, when you've gone full nuclear and you're yelling at school staff, I think you've lost. I think you lost the battle.
Scott Benner Oh, I agree with you. I tell people all the time, your kid's gonna be at that school for a very long time. You get one chance not to be the crazy guy and once you're the crazy guy, you're the crazy guy forever. Forever. No one's giving that away. Once you pick up that monocle and put it on, they're gonna be like, "alright, here they come." The monocle of crazy. And it can happen easily. You start talking about diabetes to an uninitiated person. Just saying the things that are actually important makes you sound like you're out of your mind. Tough situation to be in. You need answers in the short term, but you can't wait six weeks till you guys figure out what to do. We have to do it now. Let me explain to you why—and then the person on the other side is like, "I think they're making half of this up. It sounds ridiculous. They're out of their minds." Tough situation.
Courtney It is. And if anything, many of my friends worry about being, quote, "that parent." I don't wanna be that parent, so I'm not gonna—Oh, you can call. You can email. You can request a meeting. You can have a conversation and problem solve together. That's actually what we're paid to do in our role as education professionals. So don't worry about being that parent. Be a pain in the neck, but you can do that in a way that's nice.
Scott Benner And I should have a 504 plan. Right?
Courtney You should have a 504 plan. Absa-freaking-lutely. And when the school tells me I don't need one, they are really just trying to get out of being legally bound to something? Not necessarily. I think there are schools that are like, "well, we're doing it already. We're doing all the things that you're asking for. So don't worry about it. It's not necessary." To which I would reply, absolutely, it's necessary. And I'm glad that you're doing all the things and the accommodations are in place for my child, but I need it documented in a 504. Absolutely. I need a leg to stand on if you should stop doing it. 504 is nonnegotiable. And it needs to be specific. Absolutely. And my other guidance for parents would be, decide what's your priority. Obviously physical safety is everybody's priority. But for Maggie, she hates being called out for diabetes.
Scott Benner Okay.
Courtney So we had to kind of figure out—and she's had some amazing teachers. Like what we do right now—I'll call the nurse. I'll say, "can you have Maggie eat a Starburst?" She'll say, "no problem." She calls into the classroom. And when the phone rings, Maggie looks at her teacher, and her teacher puts up a number one. And she knows that means go and eat a Starburst. She doesn't wanna be called out for it. She was like, "mom, we had a substitute the other day. The substitute was like, 'okay, Maggie has to go to the nurse before lunch.' And it was so embarrassing, mom." We're trying to prioritize—and take cues from Maggie what she's comfortable with. My priority as a parent was to keep her out of the nurse's office as much as possible. I don't want her in the nurse's office all day long, which I think schools tend to do because it's easier. But I was like, she can be treated in the classroom. She can eat a Starburst in her classroom when she's low. She doesn't need to go to the nurse if she's in the sixties and having a Starburst. She's fine. She's gonna stay in class, and she's gonna learn.
Empowering Maggie and Looking Forward
Scott Benner How long do you think before you take them out of that decision chain? Like right now, you're calling the nurse who's calling the teacher, who's telling the kid. At what point do you take out the nurse and the teacher?
Courtney I actually think it's probably pretty soon. I was just talking to Maggie this weekend and gonna get her a watch so that we can just start texting because she's there. She's seven. She's really bright, and she wants to take it on. That's the other piece—I wanna take on this burden for her as long as I can. I don't want her to have to worry about her blood sugar during the school day. I want her to worry about being a kid and passing her math test and playing with her friends. On the same hand, this will be her life. And so she should feel empowered that she knows what to do.
Scott Benner Yeah. You don't want her just sitting around like, "I feel low. I'm waiting for somebody to tell me what to do." Seven. She's embarrassed at seven about that? "I don't want people to talk to her."
Courtney She's pretty cool, Scott. She—I turned most of her alarms off because she would get so embarrassed. And then it's also just navigating how you respond when kids ask questions. "Why does Maggie have a phone? Why does Maggie have to go to the nurse?" And we're past that now. What does she tell the kids? I would say, "my parents love me." Well, she's said a lot of different things. Diagnosed in kindergarten, I was like, "you could just say, 'oh, I I need insulin for my body.'" And she was like, "mom, nobody knows what insulin means." She's like, "listen. I'm surrounded by a bunch of these little dumbasses. Trust me. They don't know nothing, mom. Okay?" But I gotta spend my life explaining insulin to these little idiots. Is she, like, kinda older than her age?
Courtney Yes, she is. She's wise. But we talk about it with kids like, "everybody has something." My dad has hearing aids because his ears need help hearing. The little girl who is in a wheelchair because her legs need support. The little boy who has alopecia. Our bodies all need different things. This is a five year old conversation we're having with five year olds, but kids are the best. They just accept it. You just have to tell them once, twice maybe, and then yeah. They're pretty good after that. And I also understand if she doesn't want everybody to be in her business too. So—I guess I'd like to understand a little better on the management side. You started off low carb. What was the a1c during low carb time?
Courtney I don't remember what it was at the beginning. We did it for a few months. Her a1c was 10-something when she was diagnosed. And it's not where—where I want her a1c right now is not where I want it to be. But I love our endocrinologist. She's like, "you're doing great. It'll get better. I'm not worried. You also have to prioritize your own mental health, your daughter's mental health, and this is a marathon, not a sprint." Do you know why she thinks it's going to get better?
Courtney I think the realities of eating and little kids—there's probably things we could be doing differently and better. But, you know, okay, bolus for pancakes, and then she decides she doesn't want pancakes. And then I'm like, "oh god." Just some of those things—the learning curve was so steep for us in understanding how all of the different things impact her blood sugar. You're still catching up, really. Yeah. Totally.
Scott Benner And so I'm assuming where the doctor imagines things are gonna get better is because as your understanding grows, you'll be able to implement those things easier. I think that's completely reasonable. You're educating yourself along the way and learning and you're having experiences that are probably making the next experience even easier. It takes time. It does take time. I remember being pretty upset couple months after diagnosis and calling a close friend. I was like, "I just can't do it. I can't get it right." And she was like, "oh, you haven't mastered diabetes in three months, Courtney? That's weird." I still feel like I should be further along. And—I love you, Scott, but I gotta—I take the Juice Box podcast in doses too. There's times where I'm like, "I need a diabetes break." I need to, like, not—not take a break from care, but from the social media stuff, the reading about it, learning about it. I just need to take a break. And then I feel better and throw myself back in it. But it can be a lot.
Scott Benner Yeah. Courtney's like, "listen. I don't know if you can hear it. I'm gonna cry." I'm in a unique position where all I can do is give it to you the way I see it. And then you're supposed to take from it what you want and what you have space for. And if you wanna come back and get a little more later, that's great. I think it would be wrong of me or anybody to come out and just say, like, "hey, here's some milk toast thing, and it's gonna leave your a1c in the eights, but you're doing great, don't worry about it." And then you might think that for the rest of your life. If you're not ready to do the things that lead to a six or a five—it doesn't even matter. At least you know what it is. And there are plenty of people who understand the concepts, don't have the headspace to implement all of them, but aren't overwhelmed by knowing there's more out there. Totally.
Scott Benner Maybe because you're an educator, you'll understand what I mean here. There's 20 people in a class—two kids are limited, five are average, five are a little above average, two are brilliant, one doesn't pay attention. I don't think we do anybody any good teaching to the lowest common denominator. I think you have to be aspirational when you teach. Agree. Absolutely. And I get—I'm not insulted by what you said at all. I completely understand looking at it and going, "I'm not ready for all this yet." When you're first diagnosed, you're drinking through a fire hose. Right? And you're still sort of mourning and dealing with the grief, but I am forever grateful to this podcast because I think I'd be lost without it. Well, tell me about that. If you're not really ready for all of it, but you're still really grateful for it, explain to me what it's doing at the moment for you, what you expect for it to do later.
Courtney Well, this is a silly example, but we're in the hospital and she's been diagnosed and they are saying, "okay, count up her carbs after she's eaten and give her a shot." And nobody told me that we should pre-bolus. Not a single person at our children's hospital told us that. I think there is so much—and it's not to be critical of the hospital because I think they're teaching you survival. They're not teaching you day to day management. They couldn't. You are so clearly a teacher because you're like, "listen. They're trying their best. I love my nurse." Now let me tell you something bad they do. You love them. Now tell me the bad part. Go ahead.
Courtney But that's my next undertaking—redoing the education that newly diagnosed parents get in the hospital because it was crap. How are you gonna make an impact on that? Well, my type one mom friends and I were like—you're getting diagnosis kids left and right. There's a way that we can provide education to families that also honors that they're in crisis right now. Good education is not handing parents a book and saying, "here's what you do. And here's insulin that your child needs to survive, but don't give them too much because they might die." I actually think the diabetes educators that I've worked with are wanting to improve the education that happens. And I think it would be wise to partner with people in education to say, "how do adults learn? How can we give them more information, but not just 'count up their carbs and give them a shot afterwards'?"
Scott Benner May I break your heart? I was speaking to a health care provider recently. And when I got finished, I thought, "oh my god, I understand this better than they do." And I checked myself—I went to a friend and I said, "is it possible that they maybe are just holding back what they really think, but are saying what is safe to say?" I just felt like I was getting a real vibe—they were saying one thing, and I was adding onto it by saying, "but you have to really consider this too." And then when they said, "oh, no, I agree," but then they went back to the more basic idea, I thought, "I don't feel like they're following me on the rest of this." And the person I spoke to again was like, "yeah, I think sometimes you meet people who really don't get the bigger picture about this at all." They were trained a certain way, and that's all they really know how to talk about, and they haven't dug into it any more than that. And then sometimes those people are in charge of how things get decided. That's scary.
Courtney Well, Maggie had a stomach virus last year, and we ended up in the ER. And the physician asked me when the last time I gave her her long acting insulin was. And I said, "oh, she's on Omnipod five. She's on a pump." And he was like, "yeah, no, I know. When did you give her her Lantus?" They don't know. Yeah. And you're like, "well, a couple years ago, I guess. It's been a while." And the fight of, "oh, take off her pod." No, you're not—over my dead body. You're not taking it off. That's what you're up against. A lot of personalities and understandings and understandings. I just think of it more as—some years you get a good one and sometimes you don't. You just have to bob and weave your way through it. Even when Arden got to high school—I look back now on this lovely thing that the nurse said to me when I was meeting the nurse for the first time: "oh, so Arden will come down and we'll work out her boluses before every meal." I was like, "Arden's never coming down to the nurse's office if we can help it." And she's like, "no, no. She'll come down. We'll be friends." And I'm like, my daughter doesn't need a 45 year old buddy at school. But also I see what she meant, and it was literally from a nice place. It was lovely. But then when I talked to her about diabetes, she really didn't understand it at all. So very quickly, she realized Arden wasn't—that's just where we kept the extra supplies, honestly. We weren't really looking for a lot of input. I wish I could talk to those people, but then you have to count on those people having a self awareness commiserate with the idea that they don't know what they're talking about either. It's a hard conversation to have.
Courtney But again, I think at the end of the day, we can trust that the people who live this experience twenty four hours a day, seven days a week, they're gonna be the experts. I'm never gonna understand spina bifida in the way that the family that's lived it does. I agree. You're doing a great job. Is there anything that we didn't talk about that we should have or anything we missed?
Courtney I don't think so. Again, a shout out to all the public school educators who are doing God's work. And don't be afraid to be, quote, "that parent." That's okay. Get in there and advocate for yourself. You might not come off great, but just try to stay balanced. Don't be the crazy person. That's always my message. Try not to be the crazy person. Not a sprint, a marathon. Absolutely. And if you get a bad one this year, you might get a better one next year. You can still work with the bad ones most of the time. If it's the nurse, if it's the teacher—I'm gonna request something different. I think you can always problem solve.
Scott Benner Can I tell you that I have two children? One has gone through school and then four years of college, and the other one is three and a half years in. I have seen them treated wonderfully by lovely people. I've seen them treated admirably by people who are solid workers—they're just, you know, they get in there and do the work job. And I would tell you that there have been teachers who just flat out do not like your kids. And there's no more high mindedness to it than that. Arden has had experiences where female teachers have said to her, "well, yeah, I'm sure you're used to things going your way because you're pretty." And—I don't know what meeting you're gonna get that all worked out in. So then you realize that's the person you're dealing with, and you try you just melt into the background and just try to get by. You stay out of—this is obviously not the rule, it was an outlier, but it happened. And I probably have about four examples of people being—forget that they're teachers, they're just terrible people. It's sad that kids have to learn that lesson as kids. We wanna protect them, but on the same hand, yeah, there's gonna be people that don't like you. That's a hard lesson. It doesn't always have to make sense either. Meanwhile, most of them are fine. Some of them are like you. You seem lovely. Are you still nervous? We're done.
Courtney I still am nervous. It's just literally a full circle moment in my life. Listen, you're on the short list. When the lady leaves me eventually, I'll throw your name out there—because you seem like you'd be impressed by whatever it is I do for a living. I'm sure that would wear off. I'm gonna need that help in the dating process is what I'm saying. Alright, Courtney, thank you so much.
Scott Benner The podcast episode that you just enjoyed was sponsored by Eversense CGM. They make the Eversense three sixty five. That thing lasts a whole year. One insertion every year? Come on. You probably feel like I'm messing with you, but I'm not. Ever since cgm.com/juicebox. Learn more about Tandem's newest automated insulin delivery system, Tandem Mobi with Control IQ plus technology at tandemdiabetes.com/juicebox. There are links in the show notes and links at juiceboxpodcast.com. Arden has been getting her diabetes supplies from US Med for three years. You can as well. Usmed.com/juicebox or call (888) 721-1514. My thanks to US Med for sponsoring this episode. Thank you so much for listening. I'll be back very soon with another episode. 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 hit follow or subscribe. 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, oh, I'll probably send you a Christmas card.
Scott Benner If you've ever heard a diabetes term and thought, "okay, but what does that actually mean?" You need the defining diabetes series. Defining diabetes takes all those phrases and terms that you don't understand and makes them clear. Find out what bolus means, basal, insulin sensitivity, and all of the rest. Check it out now in your audio player or go to juiceboxpodcast.com. If you have a podcast and you need a fantastic editor, you want Rob from Wrong Way Recording. Truth be told, I'm, like, 20% smarter when Rob edits me. He takes out all the gaps and when I go "um" and stuff like that. I hired Rob at wrongwayrecording.com.
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