Scott Benner 12/7/21 Scott Benner 12/7/21

#590 Empty Nest

Susan is an adult type 1 and a mother.

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

Scott Benner 0:00
Hello friends, and welcome to episode 590 of the Juicebox Podcast.

On today's show, I'll be speaking with Susan. She is a person who emails me a lot. Not a ton, but a fair amount. And I liked her emails and thought, well, I bet I'd like Susan. And I did. And I think you might too. Please remember, while you're listening that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, always consult a physician before making any changes to your health care plan, or becoming bold with insulin. I don't want to give this all away. So I'll just tell you that Susan was diagnosed at age 14, and she's just recently turned 60 years old. She's had type one diabetes for quite some time. Her experiences are interesting. Her perspective, unique, and her style is delightful. Hello. Hello. Hi.

Susan 1:08
Hi, Scott. Are you like I know you but you don't know me? It's very weird.

Scott Benner 1:14
I feel like you'd think you know me and I definitely don't know you. That's that's the that's the whole point of this right

Susan 1:22
now. So we don't see each other. Is that correct? It's just Yes, yes. Okay,

Scott Benner 1:27
that's fine. This episode of The Juicebox Podcast is sponsored by the Contour Next One blood glucose meter. Find out more at contour next one.com forward slash juicebox. Get the meter that my daughter uses. This episode is also sponsored by Omni pod makers of the Omni pod dash and the Omni pod promise. You'll find out more about the promise later. But right now, let me tell you that if you're interested in finding out if you're eligible for a free 30 day supply of the Omni pod dash, it's just a click away at Omni pod.com forward slash juicebox.

Susan 2:04
Hi, I'm Susan. I live in Jacksonville, Florida, which I never thought I would live in. And I have had type one diabetes. Well, next month will be my 45th diversity. And so that you know, and I got it when I was 14, and had a bad start. Rough many, many years.

Scott Benner 2:27
Before I asked you about that. Do you broadcast your voice for a living? Or have you in the past? You have a very lovely voice?

Susan 2:33
Oh, you're so sweet. No, I was actually thinking about how I probably would hate my voice if I was hearing it today. And you know, but I just have to speak and not think about that. Because otherwise I would hate it. I probably mess something up.

Scott Benner 2:50
Of all the things that I know you're very welcome. But of all the things that I don't expect from people, that's one of them that they're very concerned with what their voice sounds like. And I always say the same thing. Like no one knows what you sound like either even you by the way, you don't know what you sound like,

Susan 3:04
well, we hear our voices through the bones in our heads. So we don't hear our voices the way other people hear though.

Scott Benner 3:11
No, but your your voice is smooth. It's a little creamy, a little smoky. And then you modulate once in a while. It's like you're doing it on purpose. But you're not are you?

Susan 3:21
No, not at all. That's really great, though, I do love the idea of like, reading out loud. I used to do that with you know, when my kids were little I read to them out loud and you know, good. And I listened to podcasts and books on, you know, on audio, so I know that it matter. You know what I was doing it very unconsciously.

Scott Benner 3:44
Well, no, it's so funny that that's what you thought of because the juxtaposition is, I was thinking, you know, back in the 80s when those adult phone lines were open, you probably could have made a lot of money.

Susan 3:57
So you can really still use a you know, like, a little from home occupation. So

Scott Benner 4:02
I don't think that business anymore, though. I mean, I think technology has gone past a lady on the phone being nice, too. So yeah, that's true. It's got to do you remember in back in the day like at midnight on you're watching television, all of a sudden like a stark phone number would pop up in front of you and some girl in what appeared to be a lingerie would start telling you to call her and you're like, why is this happening? And I really hope my parents don't see this.

Susan 4:31
She had real smoky creamy voice. I mean, that was over the top. Yeah, I think we I mean I know the type. I'm not that type but like yes, I remember.

Scott Benner 4:42
Alright, now you're like listen, this is not what I expected from this. Tell me

Susan 4:47
listen to enough of your own

Scott Benner 4:48
you thought this was my

Susan 4:50
baby you you know and and their conversations and that's that's really

Scott Benner 4:53
good. For you said 14 When you're diagnosed. I was How old are you now? Can I ask

Susan 5:00
Well 45th Diversity next month and my birthday is in October. So let's see calculator. So

Scott Benner 5:06
hold on 45 is easy. And then you add 10 to it. That's what I would do. 55 And then you got to get the four that you left behind. That makes you 59

Susan 5:15
That is correct. And I've tried ever since I turned 50 I've trained myself to not be embarrassed to say that because it is a little bit of a mind bender. When inside you feel young, and I do feel young inside in so many ways. I don't feel like what my impression when I was young of what a six year old would be. So, and I have friends of all different ages, which I really love, and I really proud of that. So, um, yeah, I'm gonna be 60 in October. Anyway, so yeah, 14 years old, we change things I would

Scott Benner 5:52
imagine. So do you remember anything about it?

Susan 5:56
About my diagnosis? I remember. So it happened in June when I actually finally got a diagnosis. I do remember. I was in eighth grade. And I remember spending, like probably two semesters of running to the water fountain as soon as class would let out. You know, impeding lot all the classic symptoms. But my mother who was usually a, you know, run them to the doctor at the first sniffle. I think subconsciously, she knew something was really going down. And I think she was I'm surmising here. But I do think she just, she knew that I had a regularly scheduled doctor's appointment in June. So we waited it out. And I do also remember that the last week or two before that doctor's appointment, I was too sick to go to school, like I was home, and I remember orange juice, I remember going to a fair, we would have a memorial day fair in our town, and there would be you know, Slurpees and can be cotton and stuff like that. And I was not like a big sweets person. But I remember like really screwy dietary choices. Because I didn't know what was going on in my body. Anyway, then I got my diagnosis. Um, you know, I was in the hospital, my parents came in, and they were like deer in the headlights. And I kind of sort of said a 14 year old, who didn't know what she was doing loose, you know, to her own devices. And my doctor was not I, you know, if they, if it were my kid now, I would switch them to an endo right away. But they let my primary care physician be you know, do everything. And I remember leaving the hospital after about a week saying, shouldn't I get a special diet or something? And I was told, you can eat what you always eat. Just don't eat too much sugar. I mean, oh my God. Is that bad advice? Or what? So honestly, I don't even know how I stumbled through the last 40 years. I really don't. And I consider myself very, very lucky that I do not have any severe complications.

Scott Benner 8:33
That's I mean, I, I'm a little frozen by it not because not because my experience was so much different, or that things are so much different now. But because of what you just said that you came out the other side. So like, not effortlessly, but well? And how? Like, do you ever think about that, like the randomness of Lacan? Oh, yeah.

Susan 8:58
Because I think some of it was genetics, you know, because I can't account for it any other way. And I just like, I didn't know what I was doing. And it wasn't till. Honestly, there was it was, it's been a life journey that I kind of only embraced in stages. So I met my future husband when we I was in my late 20s. And that was the beginning of kind of wanting to take care of myself better. I mean, no one ever said, Hey, listen, you're really going to have to do this on your own. And because you see your endo like once every three months, like they can't live with you every day. So you're gonna have to do this and you're good. You better study about it too. And I really just ignored all of that. And then I you know, and then I we decided we wanted to get pregnant and you know, I know knew I had to take care of myself on a different level to do that, in preparation for it. And during the pregnancy,

Scott Benner 10:06
did you know that the doctor told you? Or was it a feeling?

Susan 10:10
Um, I don't, I'm trying to remember if it was like me reading or the doctor taught parallely both, but there was that image of you want to make your body your incubation incubator, like as, as close to normal as possible. And so as a pregnant mother, you're, you're, you're thinking, Oh, my goodness, like, oh, day 72 My blood sugar's high. What part of the baby is developing today that I could be affecting for its life? So you know that yeah, I was really aware that I had to be really, really careful. And my blood sugar's were great. I was still on multiple daily injections. I had an endo at the time, I was living in New York City at the time, and my endo had said, I had asked him about these newfangled things called pumps, like, and he said to me, I know you, Susan, you it will remind you all the time that you're diabetic, you will not like having one. And that was really bad advice. And I don't know whether he some people have suggested that maybe he just didn't know how to help you, you know, have a patient with a pump? And I don't know, I'm not going to pin that on him. Maybe he really did think he knew me.

Scott Benner 11:33
Um, maybe maybe people should keep the first thought they have inside of their head till they're sure about it. That's a problem that people had like, oh, occurred to me what's

Susan 11:42
happening is when my son became a toddler, I found that I could not you know, I my blood sugar's were all over the map, because I was dealing with him first and dealing with me after. And I just thought, and by then we were living in New Jersey, and I had a different Endo, who had handed me a VCR. Remember, VCRs, she'd handed me a VCR, about about pumps from one of the pump companies. And she said, Just keep it. You know, one of these days, maybe you'll watch it, maybe you'll be interested. And I remember seeing it in my VCR player, when my kid was about two, two and a half. And because I thought I'll never have any more children. If these are my blood sugar's I can't do it right now. And I looked at that video, and I said, Oh, my goodness, I need one yesterday. And we got a pump really fast. I believe it wasn't an sunshine, remember, because we I did stay anonymous for a good long time. Until they

Scott Benner 12:52
I'm amazed that your endo gave you a VCR tape and gave you the instruction like you hear from people when they want you to think about life insurance. Take the packet home, look at it when you have time. Yeah, that's interesting.

Susan 13:06
I guess the older the other end, is, his voice was in my head, maybe? Like this isn't? Yeah, she didn't give me a hard sell, which was probably fine. Because then when it was meant to be then I moved on head. So then oh, and the other thing that first endo had said to me was, I challenge you to show me a person on a pump that has as good blood sugars as you do now, I did get through a twin pregnancy on MDI, and they were good blood sugars. But, you know, of course, I don't know if he was looking at the hemoglobin a one C at the time, because we know that that is not like I knew I was getting highs and lows. Not not necessarily during the pregnancy, that I mean about that all the other times,

Scott Benner 13:55
what's that, like? Cuz you're, you're, you're an adult, right? Like, I don't mean that other people on here on adults. I mean, you've got experience on top of decades. So what is that really like when you know the truth, and yet the person across from you is gone. You're doing great. And when when he says or she says you're doing great, and you're thinking I'm not I almost fell over on the kitchen floor the other day, and then my budget was 400 After I corrected it, like, why not speak up? It feels like going to a mechanic and you know, the car won't stop and the mechanic goes, I This thing's great. You just go okay, and you drive away like why not go no, no, no, the brakes don't work. Help me.

Susan 14:33
Well, I'll tell you exactly why. You know, it took a long time to change a mindset because I you know, I had been in that particular group for a very long time. That's one thing. I didn't have a I didn't have a concept of really, where my blood sugar's should be like what was truly healthy and I will tell you one other thing about my lows. I think I've been enormously fortunate. I've never had a seizure. I know that you had that experience with Arden. I've never had a seizure. I have never passed out. I passed out once in my adult life and had nothing to do with diabetes, believe it or not.

Scott Benner 15:19
Is it when you found out you had to move to Florida? Pardon me? Did I find that I had to move to Florida?

Susan 15:26
Honestly, where Jacksonville isn't like the rest of Florida, and we really love it here isn't

Scott Benner 15:30
people from all over Florida, listen to the podcast be nice.

Susan 15:34
Like we'd like our community very much. Um, but no, I just, um, I think I that was never I haven't been afraid of Lowe's. Or maybe some of that was ignorance. I mean, when after hearing some stories on your podcast, I think, oh, you know, maybe you should be a little bit more concerned. I could feel them even before I had the technology to show me where my blood sugars were heading. I could feel them I never was insulin on or, you know, low unaware. And I would treat them and I never walk out of the house without juice boxes. So you know, I love the name of your podcast is very close to that. Is it like small ones, I found the small with

Scott Benner 16:18
the tiniest ones to fit in your purse, I'm always worried when I give them the art. I'm like they're gonna break open in there and ruin the purse. Like that's what I always think about and never happens. And I'm always by the way, whoever makes juice boxes is an engineering genius, because you can basically throw them around and squeeze them and they won't break anyway, props to that person.

Susan 16:35
I've had like, some be carried around long enough so that they start to lose their shape. And then they will start to leave.

Scott Benner 16:47
You think yourself, I'm going to throw this one out. This one's done its job even though I haven't drank it? Or do you? Or do you follow through and trick?

Susan 16:56
Oh, um, it depends on if it's an emergency. Yeah. I mean, honestly, if it's starting to leak, I'm throwing it. But if you you know, if I've discovered it, say I'm in my bedroom, minutes the morning and I'm refilling my handbag or something, right? You know, if I'm somewhere, you know, it's Yeah, try doing a try doing a juice box with a mask on on an airplane. I didn't do that. I decided that was not going to work because I recently flew to California, like, can't do it. It's a two handed proposition in order to remove the bottom part of your mask. If you're really trying to keep masked, you just can't

Scott Benner 17:36
you imagine a person sitting next to you doesn't know you're that's like this lady's breaking the mask rules to have a juicy juice. Let's

Susan 17:45
see, when my kids were little. I mean, my kids kind of understood that this was mommy's medicine. But I remember a friend of theirs. One day, looking at me we were sitting in, in our synagogue, and he looked at me and it was really young. And he wanted one too. And I'm so sorry, this is like,

Scott Benner 18:08
get away kid. I saw a gentleman at an event one time, who had type one who was a massive person, you know, he was six, four and probably weighed 240 pounds, and he was this huge guy. And he was walking around drinking this juice. And it was it just looked so much tinier in his hand than it does anywhere else. And it, it felt both kind of initially ridiculous. And then the more I looked at him, I thought looking help kind of like effortlessly and without consideration. This grown GIANT PERSON is wandering around and just drinking it felt nice afterwards that he didn't feel automatic, you know what I mean? But yeah, but back to my question, though, like so all that time prior. And the doctor just tells you like hay, whatever you say you have to change your your perspective. And your idea of what good is and you're telling a common story that most people tell I met a person I wanted to be healthier, I want to have children I want to be healthier, like that kind of stuff that seems to be very human that idea of I don't need to better myself until it benefits someone else I've given up on understanding it just seems like that's how it is.

Susan 19:18
I think I connected that actually embrace like I do now, but I know now that the bad, right? Take care of myself that, you know, then then, like I have to pay a lot of attention to diabetes in order to have a better quality of life. And in the past I thought that ignoring the diabetes, which is like good, it was rare, and I had to deal with it when it was too high or too low. But I really like oh my goodness when you're on it. Well, when I first started taking injections, it was Lintian regular and it sets your course for the day. Yeah, you You know, and I balked against that. And honestly, I don't think it was ever Well, I was ever well schooled in it. But I just like, pumps were made for me I needed to be able to live my life in a, you know, where life was coming first, not whatever schedule was set for me and I and as I said, my parents were deer deer in the headlights, so I didn't really, they didn't know what was going on. They didn't really try to educate themselves. You know, I wasn't sent to diabetes camp. I didn't know any other type one diabetics for decades.

Scott Benner 20:42
Right. And you were was an island. My math is right. You were diagnosed in the mid 70s. Ish. Yeah,

Susan 20:48

Everyone was else was celebrating the, you know,

Scott Benner 20:53
the centennial? Well, but my where I was going with that is, do you remember how old your parents were around that time? Ish?

Susan 21:02
I could figure it. Let's see. Yeah, mom would have been about 44 Because she had me when she was 30. So

Scott Benner 21:09
your mom was born in the mid 30s? Then? Pardon me? Your mom was born in the mid 30s. Meaning that she grew up in a world where like, people got sick and died. Like it wasn't she hurt her space wasn't, you know, like, oh, you get sick and then someone figures it out. Or they give you this neat medicine that does something or it was like she was only mean, she grew up in a time where friends died, where people went to the hospital didn't come back for things that today you don't even think of as being dangerous. That's so interesting. I'm sure she's passed now. But that'd be very interesting to hear from somebody. Like I wonder if you were diagnosed and she just thought, Oh, we lost one.

Susan 21:48
Well, here's the irony of irony. Well, first of all, she I was her firstborn. And she had already lost a brother in infancy. Not infancy. But like toddler, a young adulthood like maybe four to leukemia, and then another brother in the Korean War, so No, she wasn't gonna let me go easily, I don't think. But um, where was I going with that? I don't know. I don't remember

Scott Benner 22:22
when you said Korean War. It made me think of mash. So my head just awful. Oh, yeah.

Susan 22:26
I remember the first episode. Like literally, I remember watching it.

Scott Benner 22:30
Yeah, I know. People don't understand that idea anymore. It's like being somewhere on a day to time to watch TV show. But yeah, but But my point just was, I wonder how much control she felt like she had probably none. And maybe she thought you were a better option than she was. Which is ridiculous. I mean, you are a parent of a parent that you know, 14 year olds are not really good at things.

Susan 22:56
Well, I was terrible. I will also say, In her defense. I was a very headstrong kid. And if someone tried I mean, she probably, you know, first of all, she she did trust my intelligence. But, you know, I don't think she had an any clue as to what she was really, you know, leaving me up to here. But I really was very headstrong. So, um, was she

Scott Benner 23:24
aware that you would get dizzy that you would like that the things that would happen to you because, you know, it just occurs to me while we're talking that you've had so much experience with this. I'm not calling you old. I'm just saying it's it's it's a nice thing like you have a depth and length of experience to be able to tell me if living prior to faster acting insulin pumps, the CGM that I did. Did you just feel like you're? I don't know, driving with your eyes closed and just waiting to hit something to turn the other direction?

Susan 23:58
In retrospect, absolutely. And Apple spec completely,

Scott Benner 24:01
how much do you think that impacted your life? I'm gonna start today by speaking about the Omni pod tubeless insulin pump. My daughter who is 17 years old has been wearing it on the pod every day since she was four every day beyond the pod, and it has been nothing but a friend through this entire time on the pod is tubeless. It is wireless. And it is lovely. Just this little pod that you where it holds the insulin right inside of it. And so it doesn't have to be connected back to some controller that's holding your insulin. It's all with you constantly. When you need to make an adjustment or give yourself insulin. You pull out a little handheld device. And you push a couple of buttons. Bada bing, bada boom, it's all done. Back in your bag back in your pocket with the device. And that's that this tubeless thing it's important because you can Shower bave swim with the Omni pod on you don't have to take it off all of the other insulin pumps that are wired like that you have to take them off to enter the water not with Omnipod isn't that convenient? It is. How about when you're playing sports or doing activities where you're worried that your tubing might get caught? You don't have that concern with an omni pod. Now you can go to Omni pod.com forward slash juicebox to find out more about this. But before you go, let me tell you this one brief story. It's crazy. And it's true. A friend of mine recently broke their finger in an insulin pump tubing accident, how I realized that is a something that's not going to happen every day. But as soon as I heard that, I thought, well, that wouldn't happen with Omni pod. No tube. Don't worry, she's okay. Omni pod.com Ford slash juice box head over and find out. If you're eligible for the free 30 day supply of the Omni pod dash insulin pump. You can also ask them to send you a free demo pod. We're just poke around the website. And if you're thinking Well, Scott, I will but maybe not today because I'm waiting for that next big thing from Omni pod. If you're thinking that you don't have to because there's no need to wait for the next big thing because with the Omni pod promise you can upgrade to Omni pods latest technologies for no additional cost as soon as they're available to you and covered by insurance terms and conditions apply. But like I said, they promise you can upgrade. So get started with Dash today. And if something different comes out later that you want Omnipod promises you can upgrade. Alright, now let me tell you about the Contour Next One blood glucose meter. It is small, easy to hold easy to use has a super bright light is incredibly accurate and offers Second Chance test strips. Honestly, that's all I should have to tell you. I should stop right there and go contour next one.com Ford slash juicebox. But I'm going to tell you more, I'm going to give you my opinion, it's super simple when it comes to blood glucose meters. In my opinion, we don't pay enough attention to the quality of the meter, the quality of the number that comes back from the test, is it accurate? It's important, and for some reason, we don't think about it, we just take whatever meter the doctor gives us. You don't have to do that. The Contour Next One blood glucose meter may be cheaper in cash than you're paying right now through your insurance for your meter. It is definitely incredibly accurate. And it offers Second Chance testing means if you touch that strip to blood, but don't get quite enough, you can go back and get more without ruining the test strip or the quality of the results. It's important so just look into it. Contour Next One comm forward slash juicebox take a couple of minutes to upgrade your gear. Do you really want to be making decisions with bad numbers? Of course not.

Susan 28:09
Tell me how much

Scott Benner 28:10
do you think that reality impacted your life?

Susan 28:13
Of not of kind of driving blind?

Scott Benner 28:17
Yeah, of the feeling that you're walking around? Knowing that at any moment, without without any kind of warning, someone might run up behind you and smack in the back of the head like do you mean like your? Is that not how it felt like it feels to me that's what it would be like but I don't

Susan 28:34
I think because you're so schooled in it your daughter was diagnosed and you made it your business because um, because we're able to write we have the internet we've got all this these tools. I you know, I? I've I think I got by by ignoring the reality you're talking about. I really do. I don't think I am. Okay. I think as much as I could, you know, and there were times when I couldn't ignore it like when I was okay, so I've heard of parents who worried that their their diabetic child shouldn't live alone. I was fearless. I moved you know, we I grew up in the suburbs of New York northern suburbs. And, you know, when it was time for me to go to school, I left high school early and you know, graduated early and went straight to New York City. And never for a moment do I remember my parents ever saying they were worried, you know, worried I wouldn't wake up one morning or worried. You know, I'm fearless. I was fearless about it. You know, not only in retrospect does it occur to me that maybe maybe they shouldn't worried or maybe I should worried. Um, so when I was your age mean, I ended up I did end up in DKA. And I ended up in the hospital. I remember the Shah of Iran was in the same hospital at the Time that dates me a bit. Um, and, you know, and then I think after that I kind of went back to how I

Scott Benner 30:08
muddled through where did the K come from? Did you stop giving yourself insulin?

Susan 30:13
No, I just must have really been out of whack. No, no, I never, you know, I never did any of those like, Oh, don't give your you know, manipulate your insulin, so you'll lose weight? I, I don't think I understood that one could even do

Scott Benner 30:29
I feel like that back then. There are some people who would just stop taking their insulin in silent protest. I never did that. Yeah. And I think it's interesting, because it is a personal protest it and if anybody, anyone listening has ever done that, who wants to come on and talk about specifically, I'd be thrilled about that. But just the idea of like, I don't want to have diabetes anymore. Let me see how long I can go without paying attention to it. That wouldn't work very well, no, no. It doesn't work well. But I don't think that it was uncommon. Or maybe it's still common for people.

Susan 31:01
I will tell you a couple of things that I think are, in retrospect, surprising. One is that I never felt sorry for myself. And I still don't, I think between my parents like I couldn't, I knew the minute I was diagnosed, I knew intrinsically that I was stuck with this for life. And so that and somehow feeling sorry for myself, didn't seem like it was gonna get me anywhere. I'm not that I didn't have depressions about other things at different parts of my life. But I've never said I it's interesting, isn't it that I've never sat around feeling sorry for myself about the diabetes. And in fact, now with some of that wisdom, and everything, I look at some of the things that diabetes has brought me in terms of my relationship with my body as blessings, like I talked about the blood, oh, that's one of the blessings of like, the fact that I'm so I did become Oh, and here's another Okay, I did become very aware of my body. As much as I wasn't like maybe in terms of diabetes, in terms of other things. What was going into my body diet wise, I became, you know, pretty, I have a baseline knowledge of nutrition. So I think one of the other things, not just the luck, and the genetics, but also the fact that I have mostly been vegetarian, or a fish eating that, you know, a pescatarian.

Scott Benner 32:32
Specifically, one of my questions, yes. What, like

Susan 32:35

So I do think that's helped a lot. And in fact, I used to, it used to annoy me when I used to get diabetes forecast years ago in the mail, which I did only sporadically and probably hardly ever really looked at one of the things that annoyed me about it was that I felt like they should be shouting from the rooftops that everyone should be vegetarian, like, it seemed to make so much sense to me. But you know, they didn't do that.

Scott Benner 33:01
I was in that magazine. Once. That's all I wanted to say about that.

Susan 33:05
You were in it. Oh, now I have to go look, I don't

Scott Benner 33:07
know where I just remember having somebody send me a copy and say, Look, they're talking about you in this thing. And I was like, Oh, I didn't know how to feel about that. It was, it was fun. At the time. I don't know where the magazine is now. But so you got to something on your own that I've been wondering the whole time you were talking. Because it wasn't just luck. It was you were kind of for many years, just putting in insulin eating on a schedule, but not eating really high carb or high sugar items. So the insulin was probably having a good go of it against the food, even though you're pretty blind to it, because you're just really testing that a one C every once in a while. And so your health was able to stay there. Like isn't that strange that if you would have been like a different eater, you'd have a different outcome right now.

Susan 33:59
I think that's true, but I will I can remember vividly in high school. thinking, Oh, could my blood sugar slow I can have some Haagen Dazs No, I mean, I wouldn't do that. No, in fact, it really has taken me a so long it's been such a journey. But i i In fact, I'm my mantra these days is treat your Lowe's with with you know with some juice that you can titrate because food even if you know what's on the package with then we love nutrition labels right? It doesn't it doesn't treat it the same way and it you know it can throw me off so like don't forget just have the juice don't look at it as an opportunity to have this blueberries or that you know, whatever. Whatever the name, you know, filling your own food. I'm still learning still learning so much.

Scott Benner 34:55
It's hard. It's hard. Must be hard. I should say not to have that feeling because I've seen that happen to all and where she's like, wait, I'm getting low, and she lights up. She's like, this is my shot, you know, and then she'll roll into the kitchen and just grab something that she normally wouldn't eat. I think

Susan 35:11
she's so lucky to have you to catch it on the other end. I mean, because you you're, when I first started listening to this podcast and listen to the way you in fact, when I first started listening, it confused me a little about whether it was you you had diabetes, or your daughter because you would speak about it like it was yours. But which is kind of beautiful. I never had a parent that did or anyone who did that, right. Well, I mean,

Scott Benner 35:41
it's very nice of you to say it that way. Because that's not usually how I hear back from adults with type one about it. They're like, you talk about like, you have it, you don't have it, they're mad. And I'm like, I don't think I have diabetes. And I certainly am not trying to sound like I do. Oh, you know,

Susan 35:55
people are too critical Yeah, I went I went cold turkey from Facebook a while a couple of years ago, and yeah, I don't miss it. And and I just like it's it's just a wash with people who take, you know, feel safe being critical of each other.

Scott Benner 36:13
I think all those people should try recording their conversations for five hours every week and see if they don't once or twice, speak it in a way that they don't mean. You know what I mean? Like if I yeah,

Susan 36:25
like, I try not to be too judgy

Scott Benner 36:26
you're very nice. Well, okay, so, a lots happened so far. Let's figure out what to do next you so you've kept up this eating style your whole life. Alright, and

Susan 36:40
how much except when I went to Europe at one point where I didn't want any dietary restrictions, so I ate you know, everything that everything and anything that was put in front of me not I don't remember desserts so much what I remember is eating like sausages, which I you know, I am Jewish, I did not grow up in a kosher home. I'm quite kosher now. But I had a squid, I mean, I like everything. And I do remember going to bed with bottles of Perrier, like just taking him up to bed with me. And I knew how to say I am diabetic in like three languages at the time, just so I could get, you know, get through what

Scott Benner 37:26
you needed. So your idea was just you're going to culturally experience what exists where you are?

Susan 37:32
Yeah, I just wanted to I dropped the vegetarianism for a period of time and then and then picked it up again. Later, a few years later, it really kind of it took a few years to get back to

Scott Benner 37:45
it. I'm the only one in the house that really likes fish. And then, which means I don't get fish. Do you don't mean? So I wish I lived with more people who enjoyed the same food I did.

Susan 37:56
But yeah, you should come to my house, I met Craig fish.

Scott Benner 38:00
Thank you, I would like

Susan 38:04
Jacksonville, I just

Scott Benner 38:05
you know, you find yourself in a situation where you're cooking for other people. And you're think, Oh, this isn't what I would make if I was cooking for myself. But okay, here we go.

Susan 38:14
Yeah, I I've been two of my three just moved out of the house across the country. And already the load is so much lighter. And I don't have to, you know, I've only got three different taste buds to cater to instead of five.

Scott Benner 38:30
So it's kind of nice. What's that like to have adult children move far away? That's one of my big fears.

Susan 38:38
Well, I'm, I'm very excited for them. And they've been wanting to go to LA for quite a while the only thing that stopped them was when LH locked down. And we were finally able to talk sense into them. And then of course, I made sure that they were both vaccinated before I would let them go. Other than that, you know, I raised my kids to be independent, and they neither, neither of them wanted to go to college. There's still money sitting there waiting for them. If they ever decide the booth, I have a house full of creatives. And they are both musicians. And you know, so I finally said, okay, then since I don't understand how you think you're going to land there, you know, by just looking up apartments online. Maybe one of you should come out with me and we'll try to find you an apartment so at least then I'll know where you're going to be right, right. And that's what we did. And now Now they and then they rented a Penske Truck and they drove across country.

Scott Benner 39:44
Wow. See, all of that sounds amazing. But what about the part where you don't get to talk to them or see them as frequently?

Susan 39:51
Well, I'm not to say not not gonna say I'm not going to miss them because I will. And I have my own agenda. because I've put my life on hold for many, many years to raise them. So I'm looking forward to I'm an artist that doesn't get to really do much art. And I'm really looking forward to getting back to my studio. And we are planning a trip to LA in July, so we will get to see them. And you know, and there's technology and FaceTime. And I think I think they will be calling quite a bit because they're really it's the first time on their own. Even my 22 year old he was home all this time. Yeah, since high school graduation. And so it's really the first time navigating life right, you know, in a big city in Los Angeles, and I think they'll be calling, I

Scott Benner 40:48
have to tell you the whole thing sounds right. And that's what I hope to I done the same thing I want my kids to be, you know, artists already talking about where to go, and she's still in high school. And my son makes you know, a lot of comments like, Well, when I moved to wherever I move to, but I feel like means, you know, I think sometimes you bring your kids up in a nice suburb, because you want it to be like cozy and safe and nice. And what it ends up feeling to them is boring. You know, and then they're like, Oh, let me roll out of here. And I'm excited for all that, that they would consider it that they would do it that they're not scared at all that makes me happy. I just don't want to not see them. But I'm wondering if I would get to a point like you were I'm just like, Yeah, I did my time. Like, I'm good. You know, like, I'll see him when I say him, that that kind of seems beautiful to me.

Susan 41:34
So, my lovely mother that we've talked about a couple of times already, um, she really, there was a I mean, she was she was a really good mother. And I as I get older, I feel how much of her is in me and she was a very kind person. The the part where there was a mismatch is that she just wanted you to kind of she wanted me to be demonstrative demonstratively close and loving to her. And because she didn't give me the space to come to her, she always made the all the first moves. That the headstrong kid that I was I kind of backed away. And I have never done that to my own kids because of my own experience. I've always and because also their boys, you know, there comes a time where, oh, gosh, we can't have public displays of affection. Right? So I you know, I would ask them, you know, can I have a hug? i My boys are extremely affectionate. And I think I'm so lucky. I'm so I, you know, I think it even in this moving out part, I think letting them call when they have the time and when they need to. For me, that's the way to go. Now my husband's a little different. He's the one who's who's going to have his, you know, way harder empty nest syndrome, because he's also the one who went to work every day in his not nine to five job and miss, you know, a lot of day to day interaction with them.

Scott Benner 43:19
Oh, so when they were older and decided not to go to college, that's probably the most time he got to spend with them.

Susan 43:25
Yeah, and all three of them have made that same decision. And we're talking about, you know, coming from a mother who, you know, I only got my Bachelor's, but I went to college, my husband, you know, he's, he went on and got ordination. I mean, he's, he, he's, my kids are lifelong learners, though. They're very, very, they're very, they're like, one of them's actually an autodidact. I would call him he's such a, you know, an independent learner. So, I mean, I don't worry about them, but they know that it's there as an option. The thing about college, and I think it'll help you to think about this is that it is like a halfway house to life. It's like the safe halfway house, they can be independent, they're in a safer environment than if you just let them out loose in LA, but that's what my kids want to do, and I can't live my life for them. So I hope you know your listeners don't last you for this guest but I really you know, I think they're gonna be fine.

Scott Benner 44:37
No, no, I appreciate your message. I also think that you know, everyone listening to as little kids you know, you guys can't wrap your head around it, you know that you're just one day gonna be like, Alright, go ahead, leave goodbye. But it's gonna happen. So, you know, it's not going to not happen. And

Susan 44:54
this is what we raised them for me. We raised them to be independent stand on their own two feet. Think your life out, you know, this is how I raised them anyway,

Scott Benner 45:03
oh, I've thought of my life very, you know, very simply, I just, I want to do a really good job with my kids. And then I want to hopefully have enough time to do something fun at the end. Like it just seemed to me, like, pretty basic.

Susan 45:21
I know. And I had my kids later. And I mean, I had my, I had the last two who were 18 Now, you know, I was 40 When I gave birth to them. So, I've been waiting a long time to, you know, take this maturity that I've gained, and this time on, they'll have and, like now live my life again. And I just always prayed that I will live long enough to you know, to create things that I'm proud of and feel like I'm leaving, you know, something behind and you know, all the all the art that's in my head that I'm hoping to create that it that I may I have enough time to get it out.

Scott Benner 46:02
I know how you feel. I always think that whenever whoever leaves last will leave I'll close the door backup trip, quick. bang my head on the table and Trump dead? Don't be like No, as I'm falling over, I think no, no, just no need to get a little more lucky at the end. Hey, do you have any other autoimmune issues?

Susan 46:23
Yes, I have a thyroid deficiency. I actually did recently get tested to see if it was Hashimotos or not, and it is not. And I've had that since I was 15. So it was about a year after I was diagnosed and yes, there are in my family to my both my grandmother and my mother ended up with type two diabetes after I you know, I kind of I always joked that I was ahead of the trend like everyone everyone's getting diabetes. Now I you know, I was ahead of the curve even in my own family. Um, and yeah, I think it all comes on my mom's side my my grandmother had rheumatoid arthritis. My mother ended up with something called myelofibrosis which, you know, ended up killing her but she she definitely lasted beyond what the doctors predicted. I think that's pretty much it for me

Scott Benner 47:28
and the kids are, don't have anything going on.

Susan 47:31
Um, one of my kids has GERD you know, he has reflux, but I don't think that is I don't know if that's considered autoimmune. No, they're pretty there's some allergies and we Yeah, no, they're they're pretty. Pretty good. Thank God. Yeah.

Scott Benner 47:53
Huh. esophagus itis is often caused by stomach fluid that flows back into the food pipe. The fluid contains acid which irritates the tissue. The problem is called. Wow, I'm not going to try to say that but it's GERD. An autoimmune disorder called ISO philic. Asafa giantess is also causes this condition. So guards not. But there is a condition. That's all I mean, they can cause it apparently.

Susan 48:20
Interesting. I'll have to look that up. No, I mean, there definitely runs in my family on my dad's side. My dad died of esophageal cancer and his older brother did and that doesn't run in families, but GERD can. And that's a precursor. It can cause esophageal cancer. How

Scott Benner 48:42
old was your father?

Susan 48:44
My dad was around 70. A

Scott Benner 48:48
little older I am. They found that I had a little bit of that too. So when I, when they couldn't figure out my iron thing at first, and I got you know, I don't know what they call it. But I got scoped from both sides. Right. They find lots of fun, right? Yeah, there's like, I know, it's not really it's not precancerous, but there's some sort of cells that they find on the wrong side of like your stomach in your esophagus, like so there's like some stomachs. I guess, if I'm wrong about this, I apologize. But I guess something that belongs to my stomach is in my esophagus. And then they just go back every couple years and check and the guy's like, Oh, if we find it, we'll just like, clean it out. And he's like, you know, if you pay attention to it should never cause you a problem. But it is one of those things that could lead to what what not your father apparently.

Susan 49:36
Right, right. No, you definitely have to take care of it. And scoping as fun as that is. That's I guess that's the best way and you've got a doctor who's on it. So, you know, that's, that's it. I mean, EMRs gotten scoped. And my sister's got Barrett's esophagus. My uncle, my dad's younger brother has Barrett's so I, to the best I've been scoped to, to the best of my knowledge. I Do not have the issue. But God knows. I've got enough others. So, yeah, our meeting I have, like I've taken up a lot of time here

Scott Benner 50:10
Barrett's is what? Like, I heard in the conversation, but it's like precursor to I don't remember, I maybe I should have paid closer attention. You can look it up. So it turns out in the moment, when, uh, when it was when I was going through it, my iron was so low, I couldn't pay attention. So it's much better. Yeah, well, this is, um, you know, I have to tell you that I get a lot of notes from people thanking me for having on you know, they say older people who have type one. But I just, I guess it's just sort of a, because of the way social media works, and where the sweet spot is, for the ages of people who are most commonly on social media people over 50 Get a little ignored. You know, just because they're not as common online, but I think they are common, I just don't think you hear from them as much.

Susan 51:01
I used to be, but I'm just not anymore. Um, because I want to live my life and not, you know, not through a screen so much. But I will tell you, it was social media that first made me feel less of an island. I was I was feeling so alone, one night, many years ago. And I thought to myself, someone out there's got to be, you know, writing about type one diabetes or something. And I found six until me carry sparlings. Blog. And that was like, I read it regularly for a while, because it made me feel less alone when someone else is getting their tubing stuck on, you know, on handles in the bathroom. And it was just, like, just the little things about having to live with this. I just loved it. And I felt less alone.

Scott Benner 51:55
I think her I think her blog is closed up now. I don't think she

Susan 51:59
Yeah, I know. I went back to it recently and saw that it was closed. And other things.

Scott Benner 52:05
I guess you can only write about your tubing getting caught not and she I'm joking. She heard a lot that a lot more than that. But I guess at some point, you just run your course with things. You know, I don't know her.

Susan 52:18
She also I mean, sounds like she also turned to other things. Like she's wrote poetry and wrote a book. And that's really, our blog was enormously useful. It was, you know, I didn't immerse myself in every single person writing about diabetes, like I, you know, I don't have that kind of time anyway. So I found hers. I liked it. You know, in terms of podcasts, I've done yours. And I liked it. Like, I don't listen to other ones. So there's no reason you should know Exactly exactly. Because yours is the best we know. Well, that I

Scott Benner 52:51
mean, not just that, but because how much are you gonna listen to before you're just like, Okay, there's not a lot of extra things to say, You know what? I mean? It's somebody in the end, you have to like the person who's saying it and the perspective they have and stuff like that.

Susan 53:07
Well, the pro tips are amazing, too, that just, you know, I've my primary care physicians son got diagnosed. Recently, we think they think it's type two right now, but I was like, listen to these this is what can you, like, make sure he listens to them? So

Scott Benner 53:25
yeah, I have to be honest, like that was, um, you know, making the Pro Tip series was good for me. Like, it was a growth thing. I just knew a second. The spring here and I'm hours are not pleasant. For me. It was a it was a it was a human growth thing for me. Because I, I thought, okay, the podcast is doing well. And it has these ideas. And I do think that even though I've been having conversations and things come up inside of conversations, you know, I'm seeing people have enough success with these ideas, I should put them all in one place. And, and segment them a little better, you know, be an adult, you know, and so, I was getting ready to do it. And I could have done it. And then I just thought, no, I should add Jenny to this, like, Jenny will bring a different perspective. She'll keep me, like, focused, you know, she'll be able to talk about things that I can't speak about it. So it'll be more it'll be medical and personal, like together, you know, and, you know, it's funny, like, there are people who can listen to this podcast and think that Jenny, you know, like, is Jenny's involved in the in the episode She's involved at all I mean, to say is that like, if you think of the podcast as a candy store, I own the candy store. You know, but Jenny, we're

Susan 54:55
going for your CDE cuz I just saw I always have been You know, it would be such a great fit one would think, although I know you love podcasting, but

Scott Benner 55:04
you know, so a lot of people say it to me, just like there's something in one of your emails that you said that a lot of people said to me, but I'm gonna get to that before we end. I thought of it. I'm not a book learning person. I'd be terrible at it. I don't even know if I'd pass it to be perfectly honest.

Susan 55:22
But it's so interesting that what all that you've come to is completely then been seat of your pants life. You know, it's it's been that's, that's interesting. But that's self knowledge to

Scott Benner 55:32
it all comes from what I said earlier, which I have a very deep desire to be a good parent. And this is what happened to my daughter. So yeah, this is what it needed. Like, if she would have not gotten diabetes, but decided she wanted to ride a horse. I'd know a lot about horseback riding now. Right? You know, it really is just what happened. I just if I tell you, I'm going to do something, I'm going to do it. So when I said to my wife, I want to have kids. I didn't mean like, I'd be super interested in it for a while. So this is just what happened. And then you mentioned earlier, like people have the internet, but I didn't have the internet. And it's so funny. You brought Carrie Sparling up, because back when I started a blog, I believe that it was her. Another guy named Scott and a guy named George, those were the only three diabetes bugs that I was aware of at that time. And I wasn't really aware of them. I didn't become aware of them until later, when someone said to me, because I really had like, when I was doing it, I thought Oh, my God, this is genius. Why is no one else ever done this before. But the internet was very new. And then somebody said, oh, there are other people doing it. But it wasn't 1000 people, it wasn't what it turned into eventually, which was over 4000 blogs, it was like three other people. And then mine came on and some others came on. But I was so bad at Search Engine Optimization, meaning I didn't know that it existed when I was writing. But no, you couldn't google me. So my blog grew completely word of mouth. And that ended up being why it grew slower than the other ones did. So mine was never big. Nobody ever thought anything until suddenly, one day it was. And then I learned about SEO and how to, you know, come up in a Google search. And that that broadened it. But at the same time, it only lasted a couple of years. I think of them as seasons. Isn't that funny now, a couple of years, and then people stop reading. But people were just like, I'm not gonna read your 600 word blog posts. Like, I'm not doing that, you know. And then the podcast came from that. But everything that I learned about diabetes in there, I figured out like living in it, because I didn't have anybody else to ask. And I wasn't opening up that stupid book with the Panther on the front of it. So I just, and by the way, it might be a great book, I have no idea. There's a pink panther book they used to give you and you were diagnosed. And maybe it's a terrific book. But my brain doesn't work that way. I didn't ask questions at the doctor's office, I didn't read anything, the Internet didn't really exist. So I just kept intently watching what was happening, and tried to figure out how to make it happen better or worse, or sooner or later by manipulating the insulin, and then wrote about it and brought some ideas together. And

Susan 58:38
well, you've been part of my sea change, I would say, you and the getting a, you know, because animals went out of business, I had to get a new pump. And I really looked at what was on the market. And I looked at the Omnipod. But I really felt like it was big, it felt big.

Scott Benner 58:57
First one. Yeah. But,

Susan 59:00
um, and I chose the tandem and, and getting the G six Dexcom at the same time, which I had tried in earlier iteration, but and I just felt like at the time, it was so expensive for me to do and I was still pricking my fingers all the time. So I decided I would just wait until they came out with one where I didn't have to prick my fingers. And boy howdy they did it was and it's been well, actually, I'm one of those people that it will very often quit before it's 10 days, which I wish it didn't do that but I call Dexcom all the time, but they're they're a wonderful company with really good customer service. And you know, they always replace them

Scott Benner 59:46
on enough times and describe to me that like look, this is a thing that goes on to a human being like we make the thing then your body chemistry comes in. So if it was less days or fewer days for you, my wife would be so proud of me that I didn't say less days and I caught myself fewer days for you than it does for Arden. Who by the way, where's her Dexcom? I would say 99.5% of the time, right out to the last minute stays on. Yeah. And it works great. But

Susan 1:00:12
I know I've asked them. I mean, I went one day, they actually even got me on with a nurse that's on their staff. And I said to you, it Okay. Could it be that I'm hitting scar tissue? Because I've been diabetic for so long. And so many things have gone in my abdomen? Could it be, you know, all these like we, I said, Look, if you ever decide you're going to do research on the people, you know, the chemistry of the people who it doesn't work the full 10 days for like, oh, Sign me up? I would love to do that. But yeah, they didn't have a good answer. And so I just live with it. Because it is really good technology while it's working. And it's you know, I always just hope that it doesn't poop out at a point where I really need it. Like, there have been some really bad times where I'm like, this is like, I'm walking for, you know, for the next hour, and I don't have my next call

Scott Benner 1:01:06
just goes away. Yeah. And also the,

Susan 1:01:10
I have two other pieces that have made a big difference. One is I my insurance company said I could have a, a coach through something called Vita health. And that's been really wonderful. I really campaigned to make sure that coach was a CDE. And the person I have right now knows a lot about tandem and she's she's been trained specifically in tandem. So we are working to tighten up my settings. And you know, because I know that it can be better. And then the last piece and she's just been amazing. The last piece is that I finally decided to get an Apple Watch. And having my blood sugar's on my wrist has been instead of you know, having to pull out a palm or find my phone has been really great.

Scott Benner 1:02:04
I'm really hopeful that the Dexcom g7 will go directly to Apple Watch. If that happens. Don't

Susan 1:02:10
wait. Because yeah, that was what was holding me back in one day, I just said, you know, it's not even worth it. I'll just let me just get one and they had a really good deal. So I did it.

Scott Benner 1:02:21
That's excellent. So the last thing I wanted to talk to you about was in one of your emails, Susan emails me, not frequently, but reasonably frequently more than other people. Use you asked a question that a lot of adults with type one asked me? Do you remember the one it's it's about Arden? How are you going to give this to this knowledge? Yeah.

Susan 1:02:42
How are you going to hand it off? Because you're you're very hands on? And I think you've actually answered in in a couple of your interviews.

Scott Benner 1:02:51
Yeah, I but I wondered what the if you could help me more with what the question is? Was it a physical? How are you going to put thoughts into somebody else's person? Or how are you going to let go of something you're so involved in? Which part of it? Did you mean more?

Susan 1:03:06
I don't think it was. I guess it was more about somewhere in between all of that. Like, if I know, I've heard I've since heard you speak about the two of you making decisions together? Or you'd say how many carbs do you think this is? So you actually have been trainer all along. But I think when I wrote that I thought you were maybe doing all of it, or most of it. And she was probably younger at that point, at least when I you know of the interviews I had listened to at that point. So I guess, and also knowing that I had well, I had bad training, but I had had to handle mine from a young age. I also believe I kind of think it is important for young people like I don't like when schools say you have to do it this way you have you know, and I know you don't like that either. So I think it had to do with how are you? How are you? How were you going to transition between you know, you have a holding most of the knowledge and most of the most of the control but I'm not saying control like because you're controlling. But you know, being the parent, and her starting to do that herself. And it sounds like you're already doing that.

Scott Benner 1:04:35
I'm just interested because because you have the time and the experience. And so do most people who asked the question, and so I'm always I'm interested in what it is they're concerned about or what happened to you, that makes that be your concern when you hear our dynamic? Well, I

Susan 1:04:54
did feel as I thought you know, also thinking about that later Leaving home aspect, there will come a time in the not too distant future because she's What 16 or 17 right now? Yeah. Where she, you know, she'll go off to college, presumably, but maybe not necessarily my kids sure didn't. And, but when she does, she, you know, I mean, you can still follow her, of course, but, you know, you could do a lot still, but you know, and has she ever wanted to say, you know, Dad, I got this now. I don't know. Well,

Scott Benner 1:05:32
the other night, she went out to dinner with my son and their cousins. And they all just went by themselves. And as she left, I was like, Do you need anything? And she's like, I'm good. And I say, okay, and she went out had a, you know, bar food type meal. That was I, you know, pretty high in fat. She did a good job with it. She came home, she mentioned, she's like, just see how good my Bolus was. And I was like, I did, I was great. And I said, good. I said, you know, you know that we're going to be getting hit with the fat soon. And she's like, I know, but I don't know how much to Bolus for that. I was like, Okay, well, I would do this much. And then she did. And, and, you know, it went the way it went. But I think that, in my mind, like the idea of her getting older or not being here, whichever it ends up being, it's kind of the same problem, that this is what's gonna have to happen next, like, she's gonna have to have the experiences so she can see it happen. And then I have the tools to give her. So I don't think that I expect to just download my thoughts into her. Right, I expect that she's going to learn to have diabetes the same way everybody listening learns. And except, you know, she can text the guy from the podcast, given her pretty much indifference rates

Susan 1:06:59
start and kept her so healthy for so many years. What What's it gonna feel like for you? It presuming your share your that you're still sharing, and you see what she's doing when she leaves? Like, if you see her one day, you know, not doing so well? What's that going to be like for you,

Scott Benner 1:07:22
I hope that what it'll be like is that I look at it and go, This is what I've been telling people, like, I hope I have the courage of my convictions and that point, like, then I can say, this is an experience that people need to see. And then the hope is that she'll be one of the people who doesn't want it to happen. And not one of the people just because I have this is fine, I'll let this go.

Susan 1:07:42
Well, she also knows how good it feels to, you know, to feel good to feel kind of normal, because your blood sugars are in a good range. Right? So she's not gonna like the feeling, and she'll feel it at a much lower blood sugar than some of us. Yeah,

Scott Benner 1:07:58
I mean, and then in the end, right, like, like you mentioned with your son's at the very end, if she doesn't do the right thing, I will sit her down and explain it to her until she agrees. That's my job, right? I'm not, I'm not here to be friendly. I got to make sure everybody's okay.

Susan 1:08:17
I know, that is the hardest part about parenting, right? That like, you're not the friend, you're the parent that there are times when it's rough.

Scott Benner 1:08:25
I am not going to do well, living the end of my life, see my children in any kind of like, massive failure, like, like personal like, I'm gonna think like that will make me feel like I did something wrong. And so they can, their lives can fall apart just as long as it happens after I'm dead. That's all I just

Susan 1:08:45
think you know that they Well, hopefully, it'll be small failures and the ones that they because you really do learn from the failures, of course, more than the successes. Oh, no, no, yeah, true. Isn't that it's true.

Scott Benner 1:08:56
It's 100% True. And I'm not saying they don't have things go wrong. I'm not I'm not saying that at all. I'm saying that, you know, if Arden's held up in a, in an apartment somewhere, and or a one sees 15 And she's like, I don't care. I'm going down and hard and fast. Like, I don't want to know about that.

Susan 1:09:13
No, of course. No one wants to see that. Right. Um, have you ever heard of the book The blessings of a skinny?

Scott Benner 1:09:21
No, but I believe in it. It's, uh, yeah, it's

Susan 1:09:24
really, uh, I guess I want to say, predated the whole free range parenting thing, but it really is about like life's consequences. Let it you know, parents need to, you know, need to not be helicopter parents and let life's consequences teach

Scott Benner 1:09:41
you. You can't take away the learning experiences that that you're being given every day, naturally. Because then when something goes wrong, nobody's prepared for it at all. And that and that can happen. Yeah, and that can go that can happen in ways that you can't help you know, I mean, somebody gets have, I mean if something went wrong with your life in the middle of the pandemic, for example, that'd be a difficult thing. Like even with some good calluses on your on your soul, like that still might be something harder to get through. But you gotta have a little callus. You know what I mean? You got to be a little tough, and you can't be tough when your mom's picking you up off. She's running out of the stands and picking you up off a basketball court when you're eight years old, like you got to be like, just get up. You know, I remember saying to my wife, Oh, interesting

Susan 1:10:28
about having my children move across the country, because I will not be there to pick them up. You know, short of a phone call, but I won't be there. And as they drove up, drove off in this Penske Truck as an 18 year old and a 22 year old, and I'm thinking Penske will rent to it. And he's the better draw, he's the driver with more experience than my 22 year old. And, and he, you know, and I thought to myself, here's where I just have to trust me, I just have to trust it.

Scott Benner 1:11:08
But then I am gonna bang out an email dealer, dear hurts, your business practices are horrible. And let me tell you why I just watched my son driveway with one of your products. And that kid shouldn't be given a truck.

Susan 1:11:21
Well, it's funny, and they got all the way across the country. And he really, really was enjoying the driving experience. And then we got a call yesterday, they reached LA. So that's great. And they're near the place they'll be renting. He said that we had an accident i that the map had steered me through a construction site and I needed to get out of it. And I backed up and I kind of deemed another car. They got so far, so

Scott Benner 1:11:51
close, so close. Hey, that, listen to that one, one step at a time until the young kids listening. Those math programs are ruining you. You don't even know where you're at. Okay, maybe look up, drive in a direction. See what happens if it goes wrong driving a different direction, you'll be fine. My son never knows where he's at. He's like, I don't follow the thing

Susan 1:12:12
between being like taking a drive. Like if you're easy. Do you like going out for a drive with your family or your wife just just to go for a pretty drive? Have you ever done that?

Scott Benner 1:12:23
Yeah, no, of course. Okay,

Susan 1:12:25
so you, if you're in a nice area, and it's pretty, then you're going for a drive if suddenly, the area starts looking sketchy, then your loss that's

Scott Benner 1:12:35
when you're scared, you're lost. When you're not scared, you're going for a lesson one of the things I hope to do towards the end here, I know I'm saying the end I'm about to be 50. I'm hoping to make it longer. But I'd like to get like an electric car. And Evie. And I would like to drive around and go on some road trips and see some things that I want to see and and to wait

Susan 1:12:53
for Biden to install lots of chargers. Because the problem with the Evie is that and they're wonderful. And I want one too, I've decided no more gas vehicles at all in our household. But the problem is that their range is only what the range is. So you know, I have a friend who drives one. And she said and the reason we decided to get it is that when we do go on long drives, we'll just rent the car.

Scott Benner 1:13:23
I'm counting on the Tesla network. That's what I have my fingers crossed for. That's a pretty like, like country wide network. I think you can make it almost anywhere.

Susan 1:13:32
Actually, I do know you can make it across the country on a Tesla. We have friends who did do that they moved from Jacksonville to LA and they made it across in their Tesla. I just mapped it all out. Right?

Scott Benner 1:13:45
See, and I just want to get in the car and see if we can get somewhere without killing are strangling each other. That's my goal.

Susan 1:13:53
I can't afford a Tesla. But good luck, Scott. Oh, great.

Scott Benner 1:13:56
I didn't say I don't know that. I can't either. I'm just saying like, that's what I'm what I'm leaning on here is the idea that maybe that's the way to do it. Or that maybe that they did it. Other companies will do it as well. You know what I mean? Like, like, maybe, like, I see that one of the selling points of Tesla's seems to be that they have that network. So maybe maybe other like car manufacturers or I don't know, companies will say yeah, we should build a network like that as well. Like, that's my hope is that that that that idea? Will will bear out and more people will try it and create networks like that. I would like to try an electric car. It just from a technology standpoint before I die, like it seems like the future you know,

Susan 1:14:36
oh, it's amazing technology. I'm my friend drives a Chevy Bolt. And it you know, it's she's two years in she's never had a repair and my I guess my mechanic was saying, Well, you know, there's nothing there's no belts. There's like all the things we have to repair on traditional engines. I It's just not even the it's a

Scott Benner 1:15:01
giant slot car. It's two turning wheels on an axle and these little, these electric motors, and other than that nothing and some companies are starting to talk about, and I have to go, I'm sorry, I have to jump on to something else. But some companies are starting to talk to and I talked about an idea of, I think what they call like, steer by wire, meaning that at some point in the future, your steering wheel won't even have to be connected to the front axle. It'll be like a joystick, like, you turn it, and then the computer will turn the wheels commiserate to how you're turning the wheel.

Susan 1:15:34
So interesting. I had a I have a friend who we went to the movies, this was pre pandemic, with, I don't know, one or two of my kids. And at the we walked out the movie theater, and he said and watch this a hugh is already enjoying, like showing us his new Tesla. And he said, watch this. And he had the Tesla come pick us up no driver. And that was terrifying. I mean, I just feel like if I'm standing on a street and I see a car walk go by with no driver that does that's like,

Scott Benner 1:16:05
that's the future. I just want to see the future was I was I had a computer when I was 13, which is a long time ago was one of the first computers you could buy in your home. And I want to drive an electric car before I go. And by the way, before I get so old that it feels so fast. And I'm like, I can't do this. I'm old. Like I just you know, I want to get in one time and try it before that.

Susan 1:16:23
So you'll be able to I mean, they're gonna they're gonna come way down in price and Oh, absolutely. Yeah.

Scott Benner 1:16:29
Fingers crossed. All right. This was delightful. I'm sorry, I have to rush away. But I really appreciate you doing this.

Susan 1:16:35
It was really delightful. And listen to I'm so glad. Sometimes you take care. Have a great

Scott Benner 1:16:41
day. You must be thinking right now. It's Scott ever going to run out of amazing guests to have on the Juicebox Podcast? No, I'm not. I'm not going to. This was another one. Susan Ching, paying us back with good talking. I want to thank the Contour Next One blood glucose meter. For being a sponsor on today's episode, go to contour next one.com forward slash juice box. Get yourself a good meter, not just any meter. And I'd also like to thank the pod makers of the Omni pod dash and the Omni pod promise go to Omni pod.com forward slash juice box. Find out if you're eligible for a free 30 day supply of the Omni pod dash tubeless insulin pump

thank you so much for listening. I'll be back very soon with another episode of The Juicebox Podcast.

#589 Be the Change

Dr. Arwa Al Hamed is creating the change in Saudi Arabia that people need.

+ Click for EPISODE TRANSCRIPT

Scott Benner 0:00
Hello friends, and welcome to episode 589 of the Juicebox Podcast.

I had a terrific conversation with r1. Let me tell you a little bit about her. She came to the United States from Saudi Arabia. When she got to the United States, she got herself a PhD, and then moved back home, where she is now a nurse scientist, and the first pediatric nurse practitioner in the country of Saudi Arabia. I think you're gonna find that our conversation is about more than diabetes. It's about how difficult change happens. And it shines a spotlight on one person's effort to make that change. Please remember, while you're listening that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, always consult a physician before making any changes to your health care plan, or becoming bold with insulin. If you're from the United States and have type one diabetes, or from the United States, and care for someone with type one, please take just a few moments to go to T one D exchange.org. Forward slash juicebox and fill out the survey. It'll only take you less than 10 minutes. It helps people living with type one it helps research and it supports the show

this show is sponsored today by the glucagon that my daughter carries. G voc hypo Penn Find out more at G voc glucagon.com. Forward slash juicebox. Today's episode is also sponsored by touched by type one, please head over to touched by type one.org. Or, and and or find them on Facebook. And Instagram touched by type one helps people living with type one diabetes. And you may be very interested in how they do that. There are links in the show notes of your podcast player and links at juicebox podcast.com. To these and all of the sponsors.

Dr. Arwa Al Hamed 2:10
My name is Arwa Al Hamed. I am from Saudi Arabia, identify myself as a pediatric nurse practitioner. Right now I'm not practicing per se but I'm an assistant professor at the University. In the School of Nursing, where I am teaching pediatric nursing to undergrad I'm also doing clinical instructing for the pediatric nursing care course. I'm also involved in research with pediatric were affected by chronic illnesses focusing on their cognitive functions, psychosocial health, as well as transitioning and quality of life.

Scott Benner 3:00
Wow. Okay, well, how does that all happen? Let's um, how old are you?

Dr. Arwa Al Hamed 3:05
3033 Are you reaching? 34?

Scott Benner 3:08
Have you been in college since you were seven?

Dr. Arwa Al Hamed 3:13
Yeah, I think I've been in school most of my life. I practiced nursing. I own the bedside for three years. But then I immediately joined the post grad where I just came back from the US actually, two years ago. So yeah, for more information I did my master and PhD in the US. Part of it in New York and and other parts in Ohio, Cleveland. This is where I met Julia Blanchette. That's right, three,

Scott Benner 3:45
Angela has been on the show a number of times. And she introduced us. Yeah, that was really sweet. So how do you when you decide I don't want to be a bedside nurse anymore? I'm going to get a PhD. What's the what's the search, like for where to go look for it.

Dr. Arwa Al Hamed 4:02
Right? So it's actually it was not a time where I didn't want to do bedside, I would never stop doing bedside. But at that moment, in the place where I was working, it sounded to me like a dead end. And I was I found myself into studying more specializing more in academic areas, because at that time, my only option was either to continue to be only to on the bedside or do admin work, though the career path for nurses at that time was not not promising from my perspective, in terms of higher education. And I was, yeah, I was always hoping that I finished my undergrad and then proceed to Masters and PhD immediately. I was worried that continuing to be on the bedside area will prevent me from doing my master's in PhD. At that time, there was no option to go to do my masters and PhD through through the hospital. So the only option was to me is moved to academia. And there was opening and they wanted people to come and work there as teaching assistants, and then they would sponsor them to go and do their masters and PhD. So they come back and teach at that time, and we still have a big shortage in faculty in the nursing, undergraduate studies,

Scott Benner 5:38
what's the length of time you spent in the US?

Dr. Arwa Al Hamed 5:41
About seven years?

Scott Benner 5:43
Wow, by yourself? Or did you go with family?

Dr. Arwa Al Hamed 5:46
No, by myself? Of course, family we'd visit every now and then.

Scott Benner 5:50
No, but still, you moved from where you are now to? Yes. The Midwest of the United States or Vegas? Not really, wherever you are not in Ohio.

Dr. Arwa Al Hamed 5:58
I started in New York, I started New York, actually, I was very shocked with the snow. So many times I wanted to go back just because of the snow. So I'm very glad that my brother was with me. Initially, he came with me for first three weeks to just help me settle, etc. If he wasn't there at that time, I would have been in Saudi because I couldn't stand the snow. Like you didn't make sense to me. People. Oh, it's that. Yeah.

Scott Benner 6:27
The people listening? Well, no, because we started recording after we talked about it. But you started in a room that was a little noisy. And I said you know it, but is that you said it's air conditioning? And I said can you turn it off? And you were like, No, I'll die. Yo, I just know must have been? I mean, how what's the temperature outside where you are now?

Dr. Arwa Al Hamed 6:45
About 100 to 200? Yeah. And that's only the beginning.

Scott Benner 6:50
Your summer runs concurrent with ours. So you're in spring right now moving into summer?

Dr. Arwa Al Hamed 6:56
Yes, yeah. But you know, our spring is basically your summer. And then it gets different summer that you will never have, hopefully, you'll never experience. Unless you happen to visit in the summertime, which I don't recommend.

Scott Benner 7:10
You think I'll just burn up like a piece of paper, probably.

Dr. Arwa Al Hamed 7:14
Especially in the central parts of Saudi. If you go south to be nicer, it's mountainy. heli. But in in the central area. It's really, really hot and dry, and dusty. We get lots of sand storms. So you know how you guys spend most of your winter indoors. We have the same thing. But in the summertime, most of the monthly spend in the summer are indoors just because we cannot do anything without Daisy. So it's you're either in a mall, in the restaurant or in the house. Yeah, mostly indoors

Scott Benner 7:50
and the trunk of your car has seven cases of water and it just in case you stopped.

Dr. Arwa Al Hamed 7:56
Actually, you wouldn't do this because it will be very hot. It's not drinking anymore.

Scott Benner 8:02
What about in the evenings? How? How much does it cool down?

Dr. Arwa Al Hamed 8:07
Um, it's still very hard. Sometimes some nights are nicer than the others. But generally, it's not really nice. Gotcha.

Scott Benner 8:18
Wow, that sounds terrible. But I understand being scared by the snow because I hate the snow. And I was born here. So you see it and and that wind, right? Especially in New York City, people who've never been there don't know that the wind whips one way through the city. So you can be walking down one block where you're where you're shielded from it, and you're just like, Oh, this isn't so bad. Then you get to the intersection and a wall of frozen air just hits you.

Dr. Arwa Al Hamed 8:46
Right, will make you be tearful. I didn't know that kind of a phenomena. You were crying in the wind just because of how strong is the wind?

Scott Benner 8:57
Yeah, I must have been hacking a shop. Okay, so you're in? You're in New York for a while, and then you went to Ohio after that? Correct. Okay. So you get a master's and what was your PhD in?

Dr. Arwa Al Hamed 9:11
Um, so I did my masters as a pediatric nurse practitioner, and I finished and immediately got accepted in Case Western, in the in their PhD of nursing program. And my focus was basically the cognitive functions, together with some specific cognitive measures and quality of life in children who are living with chronic renal disease, or early stages of renal failure.

Scott Benner 9:44
It's interesting. Let me ask you another question. Before I get to that, though, the US health system versus what you were coming from in Saudi Arabia were their vast differences or was it fairly similar? What did you find?

Dr. Arwa Al Hamed 10:00
Okay, so right now we kind of have both systems if if I would say, yes, the Saudi has the government funded health care system, meaning that every Saudi citizen is entitled for free health care, and we have certain amount of government hospital in addition, we also have private sector like health. Health services being offered through private sector, meaning we have hospitals, private hospitals, that if you want to go pay out of your pocket, you can, you can still do that. Now, it's increasing, it seems like the country is even now giving more support to private, private companies to open and establish more hospitals, clinics, etc. So both of them are flourishing at the same time. Generally, everyone is entitled for this special also those who go to the military, or work in the military, or in the National Guard, for example, in my case, they also can have their access to their military hospitals. What happens is, because of that, still, we you're not, you're not going to get quick access to health care, unless, of course, if it's emergency emergency rooms are open, but thinking about dental health, dermatology, or like those primary health care services, we will have to wait sometimes months to get appointments. And this is where you might choose to go to private. It's not completely for specific services, if you if you need there are also the

Scott Benner 11:47
I'm sorry, for the speed of being seen, where are their quality differences as well?

Dr. Arwa Al Hamed 11:53
No, for that, mostly for the speed of being seen. I'm pretty lucky living in the US because we're still a little bit centralized, where all the good services are located in Riyadh. So you would really or in this case, the government hospitals, as well as the private hospitals offer pretty good quality. I personally would choose to go into government, because most of the government, hospitals are educational, or university hospitals. So you're being treated with very, you know, long standing. medicine, medical colleges and nursing schools, etc. With that being said, I'll also need to make clear is a few work in companies, some, some big companies, they offer also your they can offer you what you call medical insurance. And it depends on of course, in the coverage level, etc. They have levels, depending on your position, etc. And now the country is moving toward pushing all those who work in private sector to to offer all their employees

Scott Benner 13:12
will be can insurance. That's interesting.

Dr. Arwa Al Hamed 13:14
So that's why it's now it's confusing. We have both systems. Right? Well,

Scott Benner 13:18
it's also interesting that here, people are complaining about health insurance and pushing for a private, you know, a lot of people want a private answer, or excuse me a government answer where everybody's sort of covered, you know, at the same rate, and there you have that, and you're moving towards medical insurance.

Dr. Arwa Al Hamed 13:40
I don't think we're moving but I think

Scott Benner 13:43
it's becoming more prevalent.

Dr. Arwa Al Hamed 13:46
Right, it's, it's, I think it's because of the high load that the government hospitals are facing, especially from those who are not covered under military hospitals, we have many military hospital, big hospitals. So the load will for the other like, citizens will will fall on to some big government hospitals, where you will have to wait, sometimes months, sometimes years to do procedures. And I think one strategy is that the government is trying to support more entrepreneurs to open private hospitals and then we will help you paying for for for insurance, just make sure that everyone has at least an option. So they don't have to wait months and months for the government. Right? You know what I mean? So you will still be entitled for the government service, but instead of waiting, you can still have other options.

Scott Benner 14:47
Okay. Now, what about the standards of care? Did they vary between there and here or were they pretty similar?

Dr. Arwa Al Hamed 14:54
Right, many hospitals in Riyadh and in Jeddah, the two Me in large cities in Saudi and the East in the East Coast, we have an another two big cities. Most of the hospitals there are JCI accredited, I think joint commission accredited most of them. So I'm assuming most of the hospitals follow the US standards, specifically the military hospitals. Surprisingly, a lot of them worked or collaborated with, develop what United State developers like, for example, in my case, in my hospital, they they collaborated with some companies from the US early on to establish those standards, even in terms of equipment, etc.

Scott Benner 15:53
What have been in diabetes, specifically, if you're if you're diagnosed there today, what happens do you get, you don't get regular and NPH insulin you get? You get modern insulins, right, like some version of Novolog, Humalog, that kind of stuff. Correct? Right? And do people start off with injections? Because I get a lot of letters from people living in your area? Asking me if I know how to get CGM and insulin pumps there, that actually happens frequently. Are they not readily available?

Dr. Arwa Al Hamed 16:28
Um, they are. But again, I would still consider, well, it's very important to mention that still services are mostly, like heavily provided in central areas or big cities. So maybe you will hear that from residents have rural areas or areas far away from the central areas or from the large cities in the kingdom. The other thing? I think, yes, it depends on where they are from, or that they're, depending on the supply, or if they got those new equipments. I also noticed some people are a little bit afraid of the pumps. In my family, a few of my cousins actually have type one diabetes. And two of them, actually, their parents are not very comfortable having the pumps, so they still prefer the injections. But they are still they're here. They're offered. And I think it's based on preference.

Scott Benner 17:39
Yeah, I actually know a few families that fly to America buy products and cash and flight back. And maybe, maybe things are changed since even I've heard those stories. That's a it's, I mean, it makes sense to that, as you get further away from population centers. Can't care. I don't know if it slips or if maybe just the ideas haven't gotten out. Because there's fewer people. And you know, they don't get a chance to see each other using them. I would also wonder how you keep insulin cool. They're like, yeah, they

Dr. Arwa Al Hamed 18:15
will it same, same thing. Same thing applies to the US in the summertime, they will always move with their small refrigerators with them. Okay. All right. But we don't do lots of summer activity in the summer time. So unlike in the US, for example, in the US, you would be worried right about kids going camping or going for the beach or going for sports. I'm very, very limited. Things we do out during the summertime, so they're always in the refrigerator.

Scott Benner 18:45
has these.

Dr. Arwa Al Hamed 18:47
Yeah, referring back to the to the pump, over the one I give wrong information. There might be other factors that I'm not only pretty aware of. So yeah, I'm just not one to be honest enough. I might not be very familiar with all the other factors.

Scott Benner 19:06
Okay. No, I appreciate that. I just, I'm just interested in your perspective. So when when you get your PhD, I guess that kind of drives your, your your focus moving forward. So you come home, was it always the plan to come home and practice? Yes, it was. So you come home with an eye on helping with the cognitive issues. And you're you're in this one focus right now. Is that right? Or do you move outside of it as well?

Dr. Arwa Al Hamed 19:33
I know a little bit outside like for example, lately. Actually, Julius specifically inspired me to look at that variable, where transition specifically that we don't have transition clinic that transition clinic by itself is a new idea. In some specialties they started applying them, for example in rheumatology They already have transition clinics to treat kids who are moving from childhood into adulthood. But for type one diabetes, despite the high the high prevalence here, they don't. And what's also concerning to me compared to the US is that we consider children as as to be treated in the pediatric clinic. If they are from one day old until 14 years old, only. Unlike in the US, where they can continue with the pediatrician until they are 21. I'm not wrong. We're 24

Scott Benner 20:44
You can stay with your knowledge here. I'm sorry. If you're in college, you can stay with your nutrition till you've graduated. I'm sorry, you broke up,

Dr. Arwa Al Hamed 20:55
right? No, I'm here. He only until 14 Once they get into it.

Scott Benner 21:07
Or why you just disappeared? We lost our Yes, I'm back to the dog get you? Yes. Yeah. I'm okay. No, no, it's fine. Yeah.

Dr. Arwa Al Hamed 21:22
So that was concerning to me. Because I was wondering what happened to those kids? Do we just send them to the adults? area? Starting from 50 years old? How about if they're, like, even if you're considering them physically at puberty? In terms of mental or cognitive? or you're not? You don't know yet, you know, even deciding who's mature and who's not takes a psychologist to review that it's right. So they just at 14 years old, they just discharged from the pediatric area, and they send it to adults, where everything is different, their approach is different providers different and the family should not be involved that much, and all that has an influence on their compliance.

Scott Benner 22:10
Can I? So is that cultural that age cut off? Or is that? Yeah, it is?

Dr. Arwa Al Hamed 22:17
It's, it's a Yeah, because I'm not sure if you're familiar we consider for a boy who was at puberty, or a girl who was at puberty, they're considered already mature. Oh, so you have to, for a female she has to cover up from other male who are not from her family? And for the for the male, he cannot be cannot be with other females who are not among his family, or they're not? They shouldn't they should cover up. I see. So in that case, we regularly admit, admit them in pediatric units. Of course, that was mostly before we had shared rooms, etc. So usually the sitters or the those who are admitted with the patient are usually mothers. So for this patient to be boy at puberty was very inconvenient. So usually they they put that cutoff limit. So they it's for segregation purpose is to help segregation.

Scott Benner 23:20
Make sure I understand continued, yeah, make sure I understand if my son was diagnosed, right as he hit puberty in that age, then my wife could not go with him to the hospital. Because there'd be a commingling of genders is

Dr. Arwa Al Hamed 23:39
no no, no. admission for admission, your jewelry for convenience, but no role to prevent anything. No, they can still go and do everything together. But I mean, for convenience purposes, they organize it that way.

Scott Benner 23:51
So this one cultural idea, leads leads to separating, like putting children into adult care was something that's really confusing that they're probably not ready for it. Because at that age, I mean, I have to be honest, at that age, I was like, stupid. I didn't you know, I didn't understand anything and I had no context for anything still. I guess I didn't grow up where where these kids did so maybe I would have been more mature at that age. I'm not sure. But that's incredibly interesting. So you said that the care differs between the segment of children in the segment of adults how does how does the idea of carrot change

Dr. Arwa Al Hamed 24:30
like for example consider how the care in in pediatric clinics for example is always family centered right? You're not gonna be able to access the child without his parents in and most of the cases are usually mothers. But now with with moving to adulthood, your family or or not really The focus you are the focus now your should be all of a sudden, the one who is taking care of all the details, including scheduling and compliance and not only prescribe administering your medication, but following up all these different appointments and supplies, etc. So the approach is different. Now you're not only communicating, you used to communicate with the whole family, but with adult you mostly communicate with the patient. How does that work? And the other thing

Scott Benner 25:35
I like? How does that end up working out? Like, is that a, like a? Okay, rock solid? Everybody's doing really well and super healthy? Or is it problematic? Somewhere in between?

Dr. Arwa Al Hamed 25:47
It's a it's actually a very good question. Because when I came back, and I noticed that I, I communicate with some of the endocrinologist, we work with the pediatric endocrine, and they, they told me that they they tweaked a little bit within this system just to keep their patients with them until the physician feels very comfortable. discharging the child from pediatric to adult. Which is to me it's nice, but at the same time, it takes a lot of effort from the physician side to our would it go assess the

Scott Benner 26:27
kids, right? Yeah.

Dr. Arwa Al Hamed 26:29
And yeah, they still have to what to call it compromise that it's a bit and talk with with sometimes admin people or you know, hospital admin people, because they they keep pushing for that, like, you have to move this child to adulthood he's he's already in the system, he's 14 You need to move into other then they will go and a little bit Jani advocate for their patient to just keep them under their care until they feel comfortable. Making sure that the child started to be independent, start administering his medication or following up his coming at least to the clinic, sometimes alone, etc. And once they feel ready, they, they they transferred them, but it's not always possible. Sometimes you will have to do that.

Scott Benner 27:21
What are a one seagulls there?

Dr. Arwa Al Hamed 27:25
Huh, I don't have an accurate number. But I'm assuming

Scott Benner 27:31
Well, what would you ask some what would you hope someone wish was aiming for? If you were if you were I would

Dr. Arwa Al Hamed 27:41
say six 6.5? I would say okay, that's fine. Five

Scott Benner 27:46
is diet there. There any cultural differences in foods that make type one management easier or more difficult?

Dr. Arwa Al Hamed 27:55
Um, I would say yes, it would make it more difficult just because the, the culture or the lifestyle here is is sedentary a little bit because especially that the weather people are very reluctant to go out with that. Weather, especially in the summertime. And summertime, or summer weather specifically coincides with summer vacation, which is quite long. And not every not all kids get to travel or do activities. Most of them are indoors. gyms and look or to to to participate in a gym or something indoor usually costs money. It's not possible for all families to offer that for all their kids. So I would assume the the diets with all the options, we have people like dessert here, people like variety of food, we have vary. Now the fast food thing is, is becoming an expert here. Like making all sorts of us fast food, but now we no longer have changed restaurant or we do but we're very becoming very, like good at making our own local restaurant or fast food and especially kids that they're like adolescents or, you know, they cannot resist all these options, especially in the summertime. So I'm assuming it would be a little bit difficult. I personally noticed that when I came back, people eat lots of snacks, unhealthy snacks here compared to in other countries where snacks are limited here. They have a lot of options. It's very tempting. We're very very good at making dessert here. Very, very good, like insanely good. You're welcome by the way.

Scott Benner 29:50
We We've exported all of our best goods to you to learn from McDonald's. Congratulations. That's terrible. Can I ask just from a personal like standpoint? What? Is there anything you miss about the US? Either professionally or personally a lot.

Dr. Arwa Al Hamed 30:15
Um, I miss a lot. I miss the weather, I miss the green life, I get very attached to the lifestyle where I do go out during the summer all the time to parks, mountains, lakes, rivers, I miss all this, to be honest with you. I missed the diversity very much. I kind of got addicted to it. So now every time I go out or socialize, I get bored very quickly, because people are mostly the same here. There's from the same culture from the same place. We you know, we don't have a lot of we don't have a strong immigration history. We do have expats coming to work here, but not immigration, per se. So people don't end up mixing and being just one. One country. No, we still have a lot of people coming to work, but not so much mixing. And unless you make active efforts to do that, which I ended up doing, I ended up joining meetup groups as if I'm still in a new country, just to just to fill that need of meeting new people or diverse people every time. That's interesting.

Scott Benner 31:26
Yeah, I guess you ask a question. And once it gets answered the same way, four or five times in a row? Not a lot of excitement about asking it again.

Dr. Arwa Al Hamed 31:33
Exactly. Yeah, exactly. It was always interesting here to conversate with people and you'll always hear different religion, different culture, different ethnic background, there are different interests to like people who usually do the same thing that a majority of people are kind of similar. And even there, and you know, we're very social oriented. Society here, we still like to fit in. And it's, it's now it's changing at least. But still like the overall picture is that everyone looks the same talks, the same, does the same thing. So on

Scott Benner 32:23
you made me think of earlier, I kind of had a light bulb go off in my head when you said people are either at home or in the mall. And it reminded me of a time I visited the Dominican Republic, and there was this mall. And it just felt like everyone was in it. It was it was the busiest place I've ever seen in my life. And it never occurred to me that it was about getting out of the hot weather. Until Ryan just said that. And the the idea of diversity, that's not going to change there anytime soon, I would imagine.

Dr. Arwa Al Hamed 32:56
It's actually changing in Riyadh, specifically in VR, but now is becoming like a very big hub for all new companies and new investments and with with most of them the vision of 2030. All this is they're attracting more businesses to open and beyond. So a lot of people coming to work in Riyadh every year, right? It's interesting. Yes, it's very interesting. Compared to before, now, I see more and more opening up. If you go out now you see a lot of people from different places, going out more before with with COVID. And all the travelers restriction, people would come work and then they travel, you would rarely see them coming out in the weekend or coming to entertain in Riyadh. But now with the COVID restriction, I came to realize how much diversity we have in Riyadh. Because now with all the travel restriction, people ended up spending their weekends you're spending their vacations and be out. So you start seeing people from different countries and places in Riyadh, some of them are and I think you and I think it's going to get even more diverse because the plan is to have like, more foreign companies opening their headquarters and beyond. So I'm expecting to see more and more that's

Scott Benner 34:29
like that. That's probably particularly exciting for someone like you who's lived somewhere that's more diverse.

Dr. Arwa Al Hamed 34:36
It is I'm enjoying it very much. i It's true. You don't see any changes at the level of the society like comparing it to people who would be living here for years and years changing even though like building block of the country itself, but you will still see six to see changes people opening up more now and and being more accepting of differences where now you don't have to do active effort to look like everyone else because you start being more than welcome then accepted the way you are. So I'm enjoying it for now.

Scott Benner 35:19
Yeah, I would be excited. Are you married? I didn't ask. No, I'm not. I have no idea what's happening right now. Siri just started talking for some reason that really messed with my head hasn't happened.

Dr. Arwa Al Hamed 35:35
Maybe she wasn't happy with the question.

Scott Benner 35:37
Yeah, I gotta try harder. I marriage question I couldn't hear with my headphones on. Do you think it was? Do you think my speaker just started going? Like, come on, buddy? Try harder? No, I just was. I was just interested. So your your are you? Is that something you're interested in? Marriage? Yeah. Is it uncommon for you to feel that way at your age living there it is.

Dr. Arwa Al Hamed 36:02
Mostly, most of people in my age are married and have kids, including, like me, whether despite of the gender, but I think especially living in Riyadh, again, I will keep pointing back to Riyadh is because even in the other, not only the becoming the hub for all the new jobs and for all career, nice career pathways, people would move to Riyadh, from different cities, even in in the kingdom. So you start meeting people at their 30s, who marriage is not in their priority, because career is their priority, mostly. So now it's becoming common that you see people in my age, or not married and they're okay. They're, they're not desperately looking forward, or they're not facing pressure from the family to get married. It's becoming normal, just another normal. I think it's mainly because of carrier. Most of the people I meet who are in my age and are not married, they're always very passionate about their carrier what they're doing.

Scott Benner 37:28
So it basically breaks down some lines, like you're gonna build a family or you're going to or build a career but it doesn't those two don't mesh well together. Like the idea of two really career motivated people living together doesn't happen quite as much. No, it is not for you.

Dr. Arwa Al Hamed 37:49
But I think it's very interesting. If we start talking about this, I will be talking for like, two more hours. I think, I think what happened is with this transition, that the the to the sudden and quick changes that happened in Saudi in terms of society, and economy, of course, economy has been okay all the time. But now is there a major society changes for example, now, we were driving before we didn't, and all the breaking of the segregation that's happening now in many places, et cetera. So there's major dramatic societal changes. What happened is up in Wilson, their 30s. There, they're still there in between. They're not from those who are before the generation who are older or they're not even the current generation who are already experiencing these changes, that they don't feel anything different for us or people in my age. We're facing lots of conflicting ideas. We continue to compare what we see now compared to what we've been taught to what venues to do or what they've been prevented from doing etc. Compared to now where everything is different. So I think what happens is those who cope very well and adjust quickly and and fit in they they might they need to find someone who's that similar to them. Who who's adjusting well and adopting all those new changes without feeling any conflict, any internal conflict. And and here comes a problem. I think girls are doing much much better in this compared to guys in our age. Where they still not sure if they like what they see now and if they're okay to completely adjust to what they see and they're still stuck to some old Ideas are old about, you know about gender about what to expect from a wife what to expect from marriage, all this? Right? Well, I think I'm in that space and that gap in that space. Yeah.

Scott Benner 40:13
Yeah. I mean, listen, it makes sense, right? Because when, when human rights and civil rights and things like that get more and more available for people, it really does end up benefiting women. exponentially, right? Where, right? Whereas men are like, Wait, so then yes, there's no lady that's gonna clean this stuff and make me food. But you don't like me? You don't get quite the same deal if you're on the other side of it. So that makes 100% sense. And so people are holding out, they're like, I wonder what life could be. I'm gonna wait and make something cool, right?

Dr. Arwa Al Hamed 40:50
Yes, yeah, some of them are actually waiting to be stuck

Scott Benner 40:53
inside the air conditioning. Because

Dr. Arwa Al Hamed 40:57
a lot of girls in Saudi know, they don't want to wait, they feel that they spent so many years in that old mentality. And they don't want that anymore. So they're very eager to live their life to their maximum capabilities and maximum potentials, either at work, or even in social life. So they always have plans when I meet girls in my age, it's, it's, it's very surprising. And interesting, because most of them are in the same page. Most of them, they just want to enjoy all those privileges that we have right now. can travel anytime, anywhere. We can do any hobby that you wanted before, and was not an option. For example, music, playing instruments, you can only do that at your home or practice it with your family, but never something that you can work on or be have a carrier or something that you can make a business out of it. Well, everything is just all of a sudden open. It's kind of distracting even from looking for marriage, believe it or not, you

Scott Benner 41:58
know what it sounds like? It sounds like Netflix for life. Like there's so many. You just scroll and scroll and scroll and never watch anything. You're just like, there's too much to do. I can't pick. But that makes sense, though. And it kind of sounds exciting. What what do you think, started that kind of boom? Was there one cultural shift that moved everything in a different direction?

Dr. Arwa Al Hamed 42:23
I think there are so many. But for example, I give you a very, very simple example. Some of the, I think king king, King Abdullah, previously he was Prince Abdullah Ahmed. And then I think probably I'm not sure if you're familiar with all the royal family members. But King Abdullah, for example, he started a move that was I think, about 15 years ago, where they started the studying abroad program. They have, they created a program where they sponsors students with high GPAs starting from like fifth when they finish high school. And they can sparse they sponsor them for studying abroad. Programs in different countries started with the US, Canada, UK, and many others. But the three main big countries that we used to go is the US, Canada and the UK. It started a long time ago about 15 or 20 years ago, I think the plan would from what you see is that they want to prepare a generation of people who are let's say, Western, educated, they're, they're, they're used to seeing different cultures because think about we've been a little bit Yani introvert for some time, in terms of like exposing to different cultures, different races of religion. So I think the plan was is to not only make them get Western education, but make them mix with other cultures or other religions and and then when they come back, they're more ready to absorb the new changes or that are already happening. So I think that worked for big part of what's happening because those students when they came back, most of them now are the leaders and most of them that say ministries, all the government services or the big, big companies in Saudi Arabia. So I'm assuming that in part worked. And then, of course, the new Prince Mohammed bin Salman, with that knew, of course, that's the first and the only time we ever had a young leader, that young leader and that kind of changed everything because he is I think he has chords to change things that others were very reluctant to change us. They were very afraid to change those social things that were fully yeah thought about it as religion when in fact it wasn't. I think he was just courageous enough to start pushing for those changes that has been already there. But it would, no one has the like, really the chords to apply them or implement them.

Scott Benner 45:35
Right? I have to admit, the first time that I saw in the news that it was a big deal that a woman was driving a car. I was I stopped me for a second I thought, Wait, women couldn't drive cars. Like I didn't. That was not something it even occurred to me. But this is it's kind of fascinating because you're, you're transitioning, but that transition still has to happen culturally and slowly to some degree like you can't I imagine you can't just like if you could just magically flip a switch and move everybody into a different space. It would probably short circuit most people's minds, right. Like it's it's that different from what they're accustomed to and what they were expecting growing up. Mm hmm. Wow, that's fascinating. Yeah,

Dr. Arwa Al Hamed 46:17
but because lots of people don't realize that just give me a minute.

Scott Benner 46:27
No, you're fine. Do we have to shoot somebody away?

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Dr. Arwa Al Hamed 47:32
Yeah, my brother is just looking for my car keys. So yeah, it's people don't realize that we didn't wait for driving to to start developing very quick. Well,

Scott Benner 47:55
are you broke? Are you back? You're not back. Tell me when you can hear me again. Hello, hello. Oops.

Dr. Arwa Al Hamed 48:11
Sorry, mixed environment.

Scott Benner 48:13
I'm so sorry. Hey, I gotta cut you off. You. You were gone for about 20 seconds. So I apologize. But you the last thing I heard you say was it didn't just happen with driving? Yes. Yeah. Okay. I'm sorry.

Dr. Arwa Al Hamed 48:27
Yeah. So I'm saying it didn't just happen when we started driving, but it would it started. Very long time ago. We had women working in, in businesses in medicine, and academia, their Dean's, they're working everywhere. From very long time ago, my mom was one of them. And then driving was a very, very minor compared to what we were empowered to do. Long time ago. What was going on is that for some reason, they associated driving with some religious restrictions, which wasn't a right. Connection. It was never a true connection that was made, right? It was very easy for it to like, stay there. Don't touch it. Okay, that's fine. Just keep it it's not really preventing us from doing anything. We can still study, we can still travel, we can still go to the US and do PhD, we can come back and be prime ministers, etc. So it was never a barrier. But

Scott Benner 49:47
if I had to go Yeah. All right. If I had to guess it sounds like one of those things that men who wanted you to wash their clothes and make them food thought, whoo. If we start letting women drive, they're going to get out in the world and figure out it's not as much fun to do my laundry as I told them it was, doesn't that have like sort of like that just like the idea of you restrict somebody travel or their ability to see other people or interact with other people who have different ideas, then you restrict their ability to dream those things. And then you can kind of it's easier to control them than I would imagine.

Dr. Arwa Al Hamed 50:19
Yeah, yeah, of course. Yeah. Although we we wasn't just about like watching the laundry. It's more like, it's more deeper than that. But yeah, it's 100%. True. I, I get I still meet people are compensated with people who would still feel threatened by by having their wife striving for the same exact reason, although they weren't admitted. He would tell you Oh, no, I'm afraid it's too crazy out there. People don't drive nicely, oh, I don't have money to buy another car. They will, they will use all these other excuses. But if you start pushing and pushing and pushing here come to the, to this true, true idea behind it is that it's such Right,

Scott Benner 51:05
yeah, you get you get frightened that people will see a world and think, Wow, this is better than the world I live in. And not come back. Yeah, I mean, and when you're, when you're so accustomed to that being the truth. I mean, giving it away, if you look at it from the male perspective, like just giving it away, must be it must be difficult. You know, I mean, I'm, I'm 50. And in America, you know, I was I was I became a stay at home father in my 20s. It was incredibly uncommon at that time, when I when I did it. And it was looked at unfavorably by most of the older people in my life, they mostly looked at me like, Oh, he's taking advantage of her. And he should be working. And they didn't understand that we thought that this was a the best balance for us, you know, and the way we can make things work. And I will tell you that there have been times when I'm growing up, where I think I love the way my life worked out. But you do wonder sometime like what was it like to, you know, 1950s America, come home and have a bunch of people just treating you like a king walking through the door? You know what I mean? Like, that's never happened to me in my entire life. I don't think I would want that. But might have been cool. Cool to see it one time just to see what it was like, you know, my example about the laundry is because I'm the one that does the laundry at the house. And I want to get away from it. Yeah, I hate doing the laundry. But that's that's not the point. The point is that you guys are making these amazing leaps. And are they? Are they transitioning? I would think not just in the medicine, but everywhere because you're getting new ideas. People have been exposed to more, I mean, you you might well see a real, a real Renaissance.

Dr. Arwa Al Hamed 52:55
Right, actually, with medicine, the medicine started to advance in the country, way, way, way, way back. It was actually one of the few specialties that the country didn't really, or the country sponsored all endeavors related to medicine, from the early ages of this country. So that's why if you compare hospitals in Saudi Arabia, specifically as compared to the other Middle Eastern countries, even other Gulf countries, we have some of the best physicians and hospitals I'm not saying this because I'm Saudi, but this because really, really it's it's it's true. They spend a lot of money in this in the country invested a lot in most of them are prepared either in Canada, Germany, UK, US, and most of them, they've spent their fellowship there. We still collaborating with big hospitals, and big. I'm not sure how you call those kind of companies, but those who develop hospitals. Yeah. So yeah, we a lot of ongoing businesses that started decades ago.

Scott Benner 54:16
Yeah, they're like private for profit hospitals. Hmm. Right. Exactly. Yeah. Well, I just had a question on the tip my tongue and just fell right out of my head. Damn. Shoot, shoot, shoot, shoot, shoot, where did it go?

Dr. Arwa Al Hamed 54:32
Say you're asking about the transition? Yeah,

Scott Benner 54:35
I'm sorry. I blanked out for a second. But yeah, um, the, the idea I'm wondering about is, will like, at what point do we see the information that was brought back to other places, refined by other places, and built on top of like, that's because I don't think that diabetes care. In the US is particularly finished, right? It's better than it was. But you can still go to plenty of places who are operating like it's 10 or 15 years ago. And so my expectation, well, I guess it's my hope is that the diabetes care will become more, two way, meaning people won't go into doctors offices and just be told, Do this, do this, do this. And then you come back, and we'll measure it again later. And we'll change some things. Like I want to see people in a position of power in a position to say, I'm going to make a change to my Basal insulin, or I'm going to, you know, I'm going to come to realize that this meal needs more insulin than this other meal, and not just use some carb ratio, and just, you know, let my blood sugar be high for four or five hours afterwards. And I'm wondering if this spreading of information won't in time lead to people understanding that better? But I mean, do you think people understand that they need to be more proactive with diabetes care? Or do you think that that understanding exists some places and not others?

Dr. Arwa Al Hamed 56:13
What what's good about type one diabetes, specifically, that it's affecting the, unfortunately, at least considering that the prevalence is increasing with recently compared to before, I think it's being affecting the gender, the new generation, who are very, let's say, first of all, they're tech savvy, most of them, they are, they are being raised differently than kids before. So most of them, they, they do things because they want to do what they need to be convinced the you cannot tell them what to do anymore. You need to convince them why they need to do things. So this type of mentality or mindset, is, will make me think that it's possible. Because you see them now I, I interact with a lot of like, let's say, school, school aged school age, kids to dollar since they they're very mature compared to we when we were at their age, and they're very independent, more getting there, they're given more opportunities to practice their independence compared to us back in the days, specifically girls, for example, I was not, I was never allowed to go to pointment alone or everything, my mom would be very worried. So she prepared to go with me. Now, they do everything alone. So I don't I think that this was tacitly tait the implementation of like self care of all the principles of self care or individualized care. However, what I think still might be a barrier is the approach from medicine itself. The like, I think health care providers are not confident enough that those kids are able to do that. And that's why they maybe insist on depending on the parents, so you know, that's this age generation difference where you as an as an adult don't think that they know enough, or they don't trust them enough. But unless if we start adopting this new mentality that no, this new generation is able to do it, just simply because they are raised differently. They've been allowed to experience everything they've been allowed to do do things alone, so they are stronger than when we were at their age. So I think the change needs to start from that provider itself.

Scott Benner 59:05
It's exciting, isn't it to see a generation of people who are less restricted than the one before them, and to see what they kind of do with it. And, you know, obviously, everyone doesn't take it in a great direction, but some people really do. And that idea of self care for medicine really translates to self care for a person in total, just their ideas and their goals and their focuses. Everything is within their control, I guess, and no one's telling you what to do with it. So they're able to explore directions and your people are going to find people are going to find lives that they just never would have been able to find in the past, because they felt so I mean, it's not even that you just felt so much but your parents were scared, like you said, and they would insist Still that fear on you whether that fear was safety, or religion or government or whatever it ends up being, you know, you can't do that. Or we don't do this. We can't say this. We can't go here. I mean, you can't play a flute outside of your house. And now that just, I'm super excited about where, where it's heading. I think this is the a very exciting generation of people to pay attention to. I've always thought that I was interested that you said it to. So yeah, they're

Dr. Arwa Al Hamed 1:00:25
very, very, very self determined for their age, honestly.

Scott Benner 1:00:29
Yeah. It's crazy. My daughter made 35 If you talk to her, and she's exactly she's 16.

Dr. Arwa Al Hamed 1:00:34
Yeah. Yeah, like, if you notice, especially now, these days, for example, I have three brothers. One of them is 40. Of course, they're all adults, but they all can spend time with the friends from all different age groups, like they all together that they have 10 years different from each other. But when they gather with their friends, they have friends from all age groups, and they enjoy their time they travel together, they do things and look, wow, before we didn't do that, we would stick to people at our age. Yeah, even for me, when I when I gather with with my family, we can spend hours and hours conversating with 16 years old, and you would never feel like she's only 16

Scott Benner 1:01:22
I interviewed three girls who were like 1315 and 17. I interviewed them together. They're these three friends who live on this island together. And they all have diabetes. So I was like, I'll just, you know, I never done an interview with that many people before. And it was a little it felt like hectic to me sometimes. But when I got to the end, I thought, huh, that's crazy. I'm, I could be their parents. And we just had a very normal conversation. It was, it was fascinating. Three girls taking care of their diabetes that you know, 15 I think 1617 Like, whatever they were there, they're young, you know, and they just didn't come off as young. Like, don't get me wrong, they're still, you know, they're a little giggly sometimes. And you know, they maybe don't follow sarcasm as well as an older person would or stuff like that. But they're just they have thoughtful, they know who they are. I guess that's really what it ends up being is you ask them a question. And they know the answer. Because they're connected to themselves. They're not just these robots that their parents are controlling through life. They're their autonomous people, and is absolutely lovely, you know, really great, right? I don't.

Dr. Arwa Al Hamed 1:02:34
So, again, good. Going back to the transition. Yeah, I think maybe they are better off compared to other generation. But I think still, right, that the purpose of transition clinics, sometimes it's really not only for the patient themselves, but really, it's for the provider to, to prepare for this transition. Because we we don't have some somewhere in the middle, we either have a pediatric who's very nice, and who will involve the whole family. And then all of a sudden, we will have an adult endocrinologist who is used to older people, and he was just asked specific questions, and he's not going to dig deeper with the patient and just tell them a list of things that they need to do. And then they just go home.

Scott Benner 1:03:25
Yeah, that's a shame.

Dr. Arwa Al Hamed 1:03:28
Hey, but for this specific generation that we just said, I think, physician physicians or, let's say, providers in general, whether professional nurse practitioners, they need to be prepared to trust them. Or at least to be able to assess those kids from different standards or standpoint, not just use our our own ideas that oh, they're they're young, by default. We shouldn't trust them. Or by default, they shouldn't be controlling their condition 100%, etc.

Scott Benner 1:04:07
Yeah, I mean, there are people who are able to do things that their age wouldn't indicate sometimes, and those people shouldn't be left behind. Because you're like, Oh, well, they're, they're 13 they don't understand that I've had kids come on the show, that are astonishingly good at taking care of their diabetes. And they're, they're young, I have one coming up soon, a girl living in Russia, and she's young and found the podcast on her own and figured everything out by herself. It's fascinating, you know, but it's really, really cool. And I think that that shouldn't be taken from people like everyone's not going to get it on a deeper level, but everybody should have the opportunity to try. You know, that's, um, it seems like the old way of thinking about it was most of you aren't gonna understand this. So I'm not going to bother explaining it to anybody. You know, answer my questions. The dials us a little more here. That's it. That's, um, and now there's glucose sensing technology, which just opens your eyes to what's really happening with your blood sugar. Fascinating, you know? Yeah. So what is your goal? Like, what do you, you got all this education, you came home, you're living a, you know, a different lifestyle in Saudi than probably, you know, two generations ago if your family did? What what are you going to do with everything you've amassed? What is your? What is your hope?

Dr. Arwa Al Hamed 1:05:31
Okay. Two big questions of carrier? Yeah, it's a big question. It's a very big question. And then it also keeps changing, I think, because sometimes what you come back, hoping that you want to do is really not feasible for probably not, not going to say not possible, but it will might take you years and years to even do 10% of it. But so you show you I think, what what parts of resilience mean is even your goals, we need to keep modifying them, not necessarily lowering your expectation of yourself. But know, maybe you now have a better perspective of how is it really going on here? Because I may, I may had ideas about what I want to do. But when you come here and experience, life, here are the flow of things and what exactly needed, you might start realizing that there are other other areas that needs to be worked on as compared to what you had in your mind. Or instead of this one, this is more important for the country at this time, specifically. So this is what's been happening with me is that I've been trying to find the right way to reach or not reach, because I don't think there should be one goal that you reach it, and then you're done. No, it's always changing random underneath. So the plan is, when I did my PhD, I focused on cognitive functioning, and how it affects their school performance. And then eventually, their chances of getting accepted in colleges and then getting good jobs for patients with renal failure. But now I'm trying to expand it more on other kids with chronic illnesses. Because what happened, especially with renal, or children with renal failure, although it's considerably a rare condition, especially in developed countries, it's still the focus in their care is mainly stabilizing them. Physiologically, at least, or maintaining Yoni is at least, to stay alive and decrease mortality, decrease morbidity, etc. But the advancement in career or schooling is not a priority at all. Which is I understand why it started like that. But I also don't understand why it continued. Of course, initially, we will just want to make sure they survive, right? But then eventually, what is it just make them survive, but how about their quality of life? How about their opportunities to pursue their life goals without affecting their economy, IQ, status, etc. So that was my plan is to go back and dig deep in the system, and find out those gaps where those kids sometimes just don't go to school because they get admitted quite often to the hospital. So the family feels a burden, and then they stop sending the kid to school. So those kids will, will will not be able to catch up with the schooling system. And some of them don't end up never going.

Scott Benner 1:09:16
They just stop advancing right you so you just end up being as mature and as your age of when you're diagnosed with something like it's almost like getting sick ends your life instead of exactly right instead of figuring out a way to incorporate it into your life.

Dr. Arwa Al Hamed 1:09:36
Exactly. Even sometimes when they get the kidney transplanted the new kidney transplant and they still because of fear from getting infection, it's some families don't send them to school. Of course, we don't have such a role where they can be where they need where they can be referred to protection services due to that, it's still not technically considered neglect. We do have child protection service but like not send them to school per se for a chronic condition is not really something clear cut, you know? So, so yeah, sometimes out of fear, they just don't send them to school and continues being a problem. So I, this is this is where I started developing the research ideas, why and what can we do to prevent that? I heard when I was in the city, I heard that their start, they have some tutoring programs where they can come to the child during his data session, and offer him some schooling, etc. We didn't have that. We don't have that yet. So my hope is was to create this program where it can be a collaboration between Ministry of Health Ministry of Education, where we can have a whole program established for children with chronic illnesses in which they have regular follow up regular cognitive assessments, psychosocial assessment, and it's, you know, embedded in the education system for these kids. So they can sign up on this program once they are diagnosed. So we track them early on, we identify any limitations if they have, if they have specific problems with math, per se, just due to for example, anemia, maybe with with renal patients, for example. Maybe they will have specific problems with memorizing due to anemia and poor memory, etc. Do you recognize that? Do we have that into consideration? If yes, how and what we're going to do about it? It's unfair that those kids are being treated as normal kids, or they should they have all the right to be treated as normal kid, but I'm, I'm afraid that sometimes we will miss some limitations that are specifically to their condition. But we don't know. Yeah, so that they don't do anything.

Scott Benner 1:12:12
So they don't become disposable. And you don't just see them as a they've got an issue. And now that means they shouldn't enjoy the same ideas that everybody else gets the hope for. It's just exactly. It's amazing. That's beautiful. So you keep bringing them, the idea is to keep bringing them services, that keep them up to speed while they're taking care of their health. Right. Yeah, that's it. I mean, it's so simple, right? Doesn't it just make sense? You know, yeah, people should not because,

Dr. Arwa Al Hamed 1:12:41
as I, as I mentioned to you, when I came back, carry alized, we have other gaps that should start before that, that needs to be fixed. Before we start implementing such programs, for example, we we had, we don't have school nurses yet. Okay. So when you first think about such a program, right, you would think immediately of the school nurse who will be doing the evaluation, or the follow up for this kid, at least in the school, right? Who will be going to do this, for example, cognitive assessment or these regular assessments, I was hoping that this can be implemented in the school system. But if we don't have a school nurse for a specific school or for this specific district, then who's going to do that? Right. So this is where I started realizing, okay, let me modify my goal and start looking for, like, other things related to that to see where the gap is where you can start fixing the the issue is,

Scott Benner 1:13:41
Is it crazy to think that school nursing could become a thing? Like the gift somebody got behind it? Would there be a way to get it funded? And and

Dr. Arwa Al Hamed 1:13:50
I think the funding is just what's what's what's preventing it's, it's, it's a as a law, it has been issued four years ago. But now each hospital needs to have school nurse implementation. Not yet. And I think mainly because of funding issues.

Scott Benner 1:14:11
So you have to you really do have to jumpstart things, they don't just either things start out of necessity, or they start because someone who has the the ability financially gets behind an idea and moves it forward quickly. There's no, there's no other way that things begin really.

Dr. Arwa Al Hamed 1:14:30
Exactly. And you know, what's the major major problem here is the lack of data, unlike in the US were already well established. The search data are there to be to support your ideas, let's say yeah, to support your ideas or to support your proposals for policy health policy changes cetera, we still don't have that. So that's why you come to realize that okay, I need data. In order for me to come and approach decision makers or leaders in the healthcare sector, where they have a lot of huge priorities to come and tell them, you know, what, stop and fund school nursing system? First question that will come to mind. Why, why why now? Why is it urgent, but if you have the data, and if you can show that this is exactly what's going on, those there might be facing additional difficulties making families additional additional difficulties finding jobs. They don't, they just can't, they are not allowed to make good GPAs, basically, just because of how their condition is. So yeah, this is my help starting from the basics and trying to establish some database.

Scott Benner 1:15:42
Well, I hope you are able to figure out a way to make it happen, because it's obvious while you're talking to me, like it makes me feel this way. It's it's, it's obvious why things take so long to come together. Right? Like, it's just it's clear, there's so many moving parts and so many people that you have to talk into it, there's money that has to be raised, and you have to actually do the physical thing, it's not enough to just have a great idea, you actually have to accomplish it afterwards. And then it takes time, then you imagine that you bring in the school nurses, and some of them you hire suck, and then you have to be replaced with other schools, you know, it takes time to get it working smoothly. And thanks. And we all don't have that much time. Like, we're all just like, hey, like my kids in school for this long, or my life is only this long. And then people get frustrated that things like that don't exist. And that frustration can sometimes end up killing your motivation. Yeah, it just takes away your drive. You just think, Oh, I'll never get this done. I might as well go do something different. And you need people to do those difficult things and have those fights. Right? Yeah. So you might as well be one of those people go get them? You know, it's got somebody's got to do it. Somebody has to decide. This isn't I mean, listen, it's a much different scale. But when I began this podcast, I thought, I'm going to talk to people about diabetes the way they need to be spoken to, and not the way that the establishment says, okay, like that, that just needs to start there. Like, we can't just keep telling people, Oh, it's okay, you're fine, you're doing great. Don't worry about it. You know, meanwhile, they're having all the problems that come with out of control blood sugars, and then they're being told by somebody don't worry about it, when they could have gotten actionable information that would have helped them, maybe pull things together a little better. And and instead, we were, you know, oh, we don't talk to people like that. That's dangerous. You can't tell them like you can't tell them how insulin works. Like, shouldn't we at least understand how insulin works? I mean, how many people don't understand how to Pre-Bolus a meal don't have never even been it's never been mentioned to them ever. And they have diabetes. It's, it's crazy. You know, so I just thought, well, I'm going to do it, and we'll see what happens. So sometimes you just got to leap. Because trust me, there were people telling me not to do it. established ideas were very much against it. And I had to fight through many times of people, you know, speaking poorly about me behind my back, or sometimes to my face and telling me that I'm doing it wrong, I'm doing it wrong. And I was like, well, you can do what you're gonna do. And I'm gonna, I'm gonna do what I'm gonna do. And it worked out very nicely. And I hope you have the same kind of success.

Dr. Arwa Al Hamed 1:18:20
What's your background? If I may? I have

Scott Benner 1:18:23
no background with the speaker.

Dr. Arwa Al Hamed 1:18:25
I know, I mean, education. No, I

Scott Benner 1:18:28
know. I know you do. And I don't have any background. I graduated from high school. I went to, I went to work in very blue collar jobs. Okay, I met a woman who was nice enough to recognize that I might be more than my station, if that makes sense. We made a family. And my second child, our daughter, Arden was diagnosed with type one, when she was two, I began using the skills I had writing to write about it online when she was three. And about seven years ago, after developing, I don't want to call it a system, but developing a way of managing blood sugars no matter what you're eating, and keeping a one sees my daughter's a once he's been in the fives for like seven years. And she has just no diet restrictions. And it's because I fundamentally understand how to use insulin. So about seven years ago, I started this podcast, and

Dr. Arwa Al Hamed 1:19:26
I beat this podcast is seven years old, seven years

Scott Benner 1:19:29
old. Yeah. And it's been heard, you know, it's been downloaded. I think we're up to about 4 million now. And it's all over the world. And if you go to just as an example, the Facebook page for the podcast, you will see people constantly all day long, either sharing their struggles and helping each other or sharing their successes and motivating other people. It's really, like astonishing, you know, and it just was, and I will honestly tell you that on day one This somebody established in this community told me you can't do this. Do not talk to people like this, that you can't tell people this stuff. And I was like, Well, I think I think I can. And I'm going it's not a secret. Yeah, well, it is a secret because people are scared to. They're scared to say anything that isn't concrete about diabetes. And I believe that people are smart enough to hear nuance, and apply it to their life. Crazy me. Right. Right.

Dr. Arwa Al Hamed 1:20:27
So yeah, what's the problem telling people that is, is not concrete? Now after COVID? Everybody knows that? Nothing is concrete. Yeah, right. I think people are, I think, again, you know, what, Scott, I really think it's the old mentality that the younger generation are fragile, don't tell them this, they don't need to know this. They don't need to know all the details behind this, and, and so on. So I think you, you came to realize from your experience with your daughter that they are not, they're actually sometimes stronger than us, because they are just born in a different generation. So even I think it came in the right time. Despite all the the recommendation not to it came at the right time, where were kids at this age, are prepared for this level of knowledge for this, that's for these specifications that they're able to do with it, especially that this came with technology, advancing technology, and having this smartphone in my hands with all those potentials that it has, it became very easy for this generation to absorb all those details and apply it in their daily life. Unlike us before, I mean, our generation, we only had TV, and we only watched whatever they tell us to watch whatever they have on the TV. But now they have this, they can choose every moment they have the ability to choose what to read what to listen to, and what to write. So all this gives him this capacity to deal with all the details. Maybe you we are more fragile than them now. Oh, no.

Scott Benner 1:22:15
Yeah, I mean, and you just keep getting to enrich yourself any way that you see fit. And I'll tell you to, here's an aspect of forward thinking that impacts the podcast success that you would never consider. But it's it's this is that 1015 years ago, if I would have done this, let's say the technology existed, and I could have done this. It's a full time job. So I can't I have to sell ads on this podcast, if I don't, I can't do this, right. So 10 or 15 years ago, if I had a podcast, this same podcast, and it had ads on it, people would have yelled at me for making money from diabetes, they'd say, Well, you can't make money off of someone else's illness. And ads are insulting to me. And trust me, I've seen it happen to people. But somewhere in the last handful of years, people became savvy enough about the internet, to understand that if you want somebody to give you something that is consistent, and quality, that they're going to need to put time and effort into it, and that they have lives as well, and bills and families. And so suddenly, no one. It's it's an idea that's gone in the world. Like no one watches a YouTube video. And when the ad comes up, yells and screams at the ad you go alright, I understand I'm not paying for this, the ads paying for this, I get it. And now that that's acceptable. That actually supports me because honestly, this is I record with you today, someone tomorrow, another person on Thursday, in the last 48 hours, I've edited together five episodes, and prepared them to be online, I've probably put, I've probably put 45 hours into the podcast in the last four or five days. And wow. And that's a that's a job, right? So now I'm suddenly able to do that because of people's acceptance and growth and understanding of how the world works. Everybody needs to understand reality so that they can have reactions and experiences that are real, and not just, you know, I'm going to be mad at you because you have a podcast and it makes money and I wish I had a podcast you don't I mean or something like that. It's just it's right. It's a growth of people that's allowing us to help people grow. It's really cyclical.

Dr. Arwa Al Hamed 1:24:28
Right? I bet you also have some of your fans are probably YouTubers too, right? Because now all kids are YouTubers. They all talk in the YouTube language. I have my nephews they they know all the details behind how to become a YouTuber. They know how much money they will give you. You they know what what is the guidelines, and how long is your YouTube should be and how many likes you get in order for you to sustain them. I'm talking about kids who are 11 years old. Old are nine years old, you know, the language I'm talking right now is something very advanced. I mean, so that's why I, the the, the it's easy for this generation to understand why you need to maintain ads in your right. Well, you need to have ads in your show, etc. It's very easy, unlike before. So I think it all happened just in the right time.

Scott Benner 1:25:23
It really did. And there also seems to be this idea now that people seem to want good for other people. Like it's not as competitive anymore, I guess, you know. So, you know, so they look at you and they go, Oh, you have an ad in your pocket. That's cool. I hope to have a blah, blah, blah, you know, and they're, they're excited by the, by the possibility. And I talk this way about diabetes as well. Because there used to be a fervor an idea that you did not share your success with insulin online, like don't show people flat graphs, don't show them that you could Bolus for pancakes, because you're showing off and you're making other people feel badly. Well, I didn't believe that what I thought was that if I could do it, then maybe you could believe that you could do it. Right. Like to have an example in front of me. That's like, wow, that's that's possible. Oh, okay. Well, I'll try that. And and I think that people feel the same way about the podcast, older people will look at me and say, Well, you make money from A what now. And they're almost mad about it. Because they because they work the last 30 years in a car, plant manufacturing cars, and I get it like in their mind, I'm sitting in a room and I'm just chatting. And but younger people are like, Oh, that's cool. Because they see it as a way to live. Whereas older people see it as a as a like, somehow, like you cheated. It's an otologist perspective. It's really terrific. I'm excited about what's to come. And I'm excited. There are people like you out there having thoughts like this.

Dr. Arwa Al Hamed 1:26:53
One more last. One more last idea before. Before, it's just a toy for me. I think what's what was although I, I was a bedside nurse, and specifically the unit I worked at was sub specialize in endocrine and natural. So I dealt with lots of newly diagnosed diabetes kids with a lot of decay after they're stabilized, of course, not in critical care, but in the unit. How, however, my experience with one of my cousins who had type one diabetes, since he was I think, 11. And then with Julia, specifically, being the first close friend of mine who, who had diabetes. So it What was nice about this experience is that it simply normalized. living with diabetes, even for me, for someone who was from the health care area, but I never lived with diabetes daily, I never had diabetes as part of my daily conversation or routine or where I have to, like, think about it all the time. Whenever we talk about oh, she will check her blood sugar, she will mention her blood sugar then often mentioned something about the diet or today I had my blood sugar, blah, blah, blah. That's why I'm feeling this now. And it was part of the daily conversation. So it was to me like something normal. I'm not saying normal in terms of like, of course, they're not normal in terms of their physiological needs are different, but at least the they're not isolated anymore. Or just they have to be isolated. Just because you have this condition. It helps having this normalization making even the conversation the terminology. Very, you know, very witty call it it's reacquainted. So everyone knows, and it's not something, oh, you have diabetes. And I don't I don't need to feel sorry about you anymore. I just feel that this is part of life. Someone has a B to someone doesn't and that's it. This is how life but before you don't know that, that there are a lot of people are experiencing this on a daily basis and you have to deal with it. So what I like about approach of Julia, where she used to share this with us all the time is was it was normalizing it to me I was not stressed out or I mean worried when I'm whenever this topic is mentioned in front of me. I'm more prepared to deal with it, even psychologically, that's just because it happens in front of me all the time. Yeah. So I think even podcasts like yours serves this purpose unintentionally, where you're meeting with people, different countries, and you're normalizing that the experience of type one diabetes and making it Very special. Honestly, it's

Scott Benner 1:30:01
an out and proud mentality. It really is. It's just like, I'm not gonna hide anything, you get to see it. And then like you said, after I see it a number of times, it becomes normal to me something that I hadn't seen before. And then it that's it, the issue is gone, it just disappears into the ether. You just, that's all you have to do is, you know, what is it? What do they say? Sunshines the best antiseptic? Is that the saying? I'm probably not, right, right. Now I've said it, and I don't wanna hold on a second, the sunshine I'm gonna find it is the Sunshine is the best disinfectant, which just means, you know, bring things out in the light of day and it it takes care of the rest, you know, and that's amazing, right? Yeah. It's very exciting. So would you say in general, then, based on your studies, and what you're saying is that is to take someone with an illness, who and understand hopefully, that that illness isn't such that it's going to, you know, end their life, if it's something you're going to live with, that you need to get up and get back to normal? As fast as you can. And that you might need to understand that you're gonna need some support in different places. Yes, but that the most important thing you can do is to not stop, keep going. And don't give away the idea that the life you thought you could have is still available to you.

Unknown Speaker 1:31:25
Right? Yeah, absolutely.

Scott Benner 1:31:26
I love it. All right, we did it. Thank you.

Dr. Arwa Al Hamed 1:31:30
Oh, thank you. Thank you for giving me that chance to share my perspective from 1000 miles away. I hope things went very well with the recording. And thank you very much for this opportunity.

Scott Benner 1:31:45
You're very welcome. No, everything's great. You sound terrific. I've got I've got your recording captured here. And I am I'm super excited to share with you. A huge thank you to one of today's sponsors, G voc glucagon, find out more about Chivo Kaipa pen at G voc glucagon.com Ford slash juicebox you spell that GVOKEGL You see ag o n.com. Forward slash Juicebox. Podcast like to thank touched by type one for their continued in long time support of the Juicebox Podcast check them out at touched by type one.org and find them on Facebook and Instagram. Don't forget the T one D exchange T one D exchange.org forward slash juicebox. Take a few minutes and fill out the survey.

#588 Diabetes Variables: Final Episode (Sorta)

Scott and Jenny Smith, CDE share insights on type 1 diabetes care

+ Click for EPISODE TRANSCRIPT

Scott Benner 0:00
Hello friends, and welcome to episode 588 of the Juicebox Podcast. I thought this was going to be the last variables episode. I had a lot of examples sent in by listeners left, but some of them weren't feeling like, like they needed their own episode or were really variables. So Jenny and I were going through them. And then it occurred to me how to finish up the list. is gluten one or no?

Jennifer Smith, CDE 0:30
No, I would not consider that a variable because quite honestly, gluten if you did group it with anything, it would be grouped with inflammation and it would be then grouped with like digestive stuff in terms of inflammation, and once it's gone, it's not a variable anymore.

Scott Benner 0:46
Yeah. Now I'm looking like we did a really good job of getting through these headaches, wet weather and esteem. Some people are just like, it rains in my blood sugar gets funny. Oh, I get low. It says wet weather causes highs and sunny weather causes lows. Wet weather makes you sit around. Right? And sunny weather makes you get up and move around. Is that right? Gotta be yet right.

Jennifer Smith, CDE 1:15
I would expect that that's what it is. Honestly, yes, we'll

Scott Benner 1:19
drop that into something at some point. Ooh, constipation. That doesn't strike you that way.

Jennifer Smith, CDE 1:27
I you know, I mean, the question really becomes with constipation, how much is that leading into pain or stress because you haven't gone to the bathroom? Or is it really in terms of things aren't digesting as well? So we have slow digestion I mean, that's like a bunch of things that constipation could be causing that are then the impact on blood sugar a constant Yeah. It's in and of itself is not a very

Scott Benner 2:07
Arden was little before we knew she was on the she a thyroid medication. Her blood sugar's would be more and more difficult. And then she'd go to the bathroom all at once, and it was level right out again. But it was just, you know, I don't you can't I can see how people might see it and then think it but

Jennifer Smith, CDE 2:25
right. I mean, I can see it in terms of pregnancy. Women's digestion slows in pregnancy. And if they are having significant issues with constipation, again, the question is, is there enough backed up slow digestion that is continuing to impact things enough, from an absorption standpoint that you're missing? Covering stuff that should have been eliminated a while ago? You know, or is it that there's pain because of it or, you know,

Scott Benner 2:57
I have to tell you, we have a half an hour here and our little chatting just now made me realize how to handle the rest of this list, okay.

On today's episode, Jenny Smith and I will go over the rest of your diabetes variables list. We first talked about variables in Episode 231 In a protip called diabetes proto variables. And then wow, two years later, I started the variables series. It began with trampolines went to temperature travel, exercise, hydration, food quality, leaky sites, video games, stress masturbation school, bad sites, growth hormone, sleep pump, site placement, full moon diabetes, tack weight change Walmart today is and the rest I'm not sure what the call it yet. And then by the way, there's going to be two more after this, but you'll hear about that later. While I'm talking to Jenny Smith, who by the way, has had type one diabetes for over 30 years. My friend Jenny holds a bachelor's degree in Human Nutrition and biology from the University of Wisconsin. She's a registered and licensed dietitian and certified diabetes educator and a certified trainer and most make some models of insulin pumps and continuous glucose monitors. She is also simply the best, the bestest. You want to hire Jenny. She works at Integrated diabetes. This show is sponsored today by the glucagon that my daughter carries, G voc hypo pen. Find out more at G voc glucagon.com forward slash juicebox. And as season seven winds down and the end of the year approaches. I'd like to mention all of the sponsors this year we were sponsored by Dexcom they make the Dexcom G six continuous glucose monitor by Omni pod makers of the Omni pod dash tubeless insulin pump touched by type one my favorite diabetes organization, the Contour Next One blood glucose meter, G voc hypo pen that's glucagon. And towards the end of the year TrialNet did a little sample ad with us for about seven weeks. Hopefully they're happy and maybe they'll come back in 2022. I did just add another advertiser for 2022. I'm not allowed to say who it is yet, I don't think. But it's somebody who's been around before. And I'm glad they're back, we'll say that. On top of the advertisers, there's the T one D exchange, who, while they are not an advertiser, every time you hear me talk about them, they don't pay me to talk about them. But they do give me a couple of dollars. Every time you take their survey AT T one D exchange.org. Forward slash juicebox. I've thanked everybody this year, over and over again. Who has bought me a cup of coffee at buy me a coffee.com Ford slash Juicebox Podcast. What else? Have you heard me talking about these bumpers and ads? No, I tell you to go to the private Facebook group for the podcast right Juicebox Podcast type one diabetes that now has like 17,000 or more members in it. So bustling type one diabetes page full of really good people. It's very unlike Facebook, but happens to be on Facebook. I tell you about Juicebox Podcast calm, the diabetes pro tips, the defining diabetes series, the variable series how we eat algorithm pumping, after dark, you guys are just over and over again. Terrific. So much so that November, I'll tell you that today's the 29th when I'm recording this November just became the most popular month in the history of the podcast. As a matter of fact, every month since May of 2021, has been the most popular month of the podcast, this podcast will do over 2 million downloads just in 2021. And it's all because of you guys. It's how you share the show and talk about it. It's when you put great ratings for it wherever you listen,

it's word of mouth, there's nothing else to it, if you enjoy the show, tell somebody else it helps the show to grow. When the show grows, more people hear it. When more people hear it, we have a greater chance of somebody needing one of the advertisers. When that happens, and you click on one of my links, the advertisers come back. And I get to keep making the podcast. And then you get to keep listening to it. It's a circle of life kind of thing. So thank you very much to everybody listening to everybody who's ever shared or told their doctor or a friend or to the lady this year who told me she bumped into somebody at a Costco wearing a Juicebox Podcast t shirt. Like my favorite story of 2021. Two people who listened to this podcast met strangers, right out in public. That's pretty cool. Anyway, I appreciate you guys so much. And I appreciate the sponsors. It's a terrific lineup of quality products, organizations and services for people with diabetes. I'm super proud of it. I really am. I've never once ever thought, Oh, I can't say this ad. You know, I'm lucky to have advertisers like this. And I'm lucky to have you guys listening to the show. So that's it. Here's Jenny and my conversation about the end of the variables list where we basically just go over a bunch of variables. We've gotten to the point on the list of variables that were sent in by listeners where there are multiple ideas that sort of they fit together. You know, they're the, you know, somebody says emotions, but then somebody says getting angry and stewing and being angry, Jenny and I can't do a variable for each and every one of them. So what were tantrums? Yes, right. That's right. So instead, what we're gonna do is run through what's left on the list, and just hit each thing very quickly will tell you if we think it's a variable or not, but probably doesn't deserve its own episode or need need its own episode. And then that'll be it. We'll move on, we're gonna start adding more stuff back to the Pro Tip series after that. So, alright, Jamie, here's what we haven't done yet on the list. And to be clear, the list is 150 things long. We've already done the things that are clear variables that, you know, translate to a lot of people, right. We can't do the, you know, the one thing that somebody is like, you know, pointing to for themselves specifically, we're not going to start doing personal variables. But here's some stuff that we didn't get to, but probably mentioned in other episodes, so showers and baths we talked about in the temperature episode for sure. Right? Yeah. So if you want that head back to their illness we did talk about and obviously being sick blood sugars, was one week could have probably made its own episode, but then you would have seen how it leaned into other ones is somebody just said Life, they're trying to be funny, I get it, right. Life is all variables, high blood sugar moves around because things happen. But that's what the whole variables episodes are about is that there are these little things that happen in your life that you don't, you don't think of as being impactful. And I think what happens sometimes, and Jenny and I were just talking about it kind of privately a second ago, is that we don't see the forest for the trees, sometimes, you know, Walmart makes me low, not usually I sit around and my, my blood sugars are at one level, and I have an insulin use at one level, and then suddenly I get up and running around, I'm grabbing things in the store. And then my blood sugar goes down, Walmart doesn't make yellow activity. When you have a bunch of active insulin, make sure though, but that's the life thing. Right? Like, there are things that happen. I think, I think that the thing to remember here is that you have your settings put together in a way that works best, during the largest swath of your 24 hour period, as you have, you've been able to figure out during your

Jennifer Smith, CDE 11:13
typical, yeah, honestly, your typical day, you have, which is the reason that we do testing on more typical days are not going to tell you do testing of settings and stuff when you're sitting at Disney World. That wouldn't be purposeful, right? So the purpose of discussing variables is to understand that in a day, variables could become part of your day. And this is how to expect your blood sugar to maybe react with this variable in the picture. But it doesn't know it's not always going to be there, you know, maybe 80% of your days of the week, you cost along just fine. Until you know, Aunt Mary comes to visit on Friday, and you didn't expect

Scott Benner 11:58
you decide to cook a big meal and it gets hot in the house. And right like there, I get it. Like you don't want to be thinking about diabetes constantly. But those things are impactful. And if you're, you know, if you're a person, for example, who's fairly sedentary and you're using a heavier Basal profile to combat that, you might not even know that's what you're doing. Right? You know, and then all of a sudden, you're running around putting a lasagna together, it's 80 degrees, you're sweating, you know? Sorry, yeah, it's impactful. You know, it just going down the list. Somebody sent in insulin efficacy, like expired insulin or insulin, let's hit like, extreme temperatures. And yeah, I mean, okay, that's a variable. But I mean, how often is that going to happen? You don't I mean, like,

Jennifer Smith, CDE 12:47
right, on a day to day basis? No, right. But on a, again, a setting where you are out of your normal environment. Let's say you're carrying your insulin around, or you're hiking through the desert with insulin in your pump, or in your backpack and a pen, or whatever it is, that is a variable that now becomes something to consider. If, in fact, you start to see blood sugars that are not the typical for you,

Scott Benner 13:14
right? But if you opened up your vial of insulin seven days ago, it's been working great. And suddenly, it's not working anymore, but it's been in the refrigerator the whole time. That's a weird place for your brain to go. But it happens, correct? Because it does, why does it happen to them? Because they can't imagine bigger picture what could be going on? So they start going through the real obvious of oh, maybe this since it's not working? It's the same thing as when we just did a diabetes technology episode where people are like, this pump doesn't work. But sometimes it's you don't know how to use it. Right? Yeah, you know what I mean? And yes, you don't see the forest for the trees again. And I think that right, not that your insulin can't go bad, like Jenny's saying if it's out in the heat, or if it's if it's way past, you know, a date, but it didn't just magically stop working. So write fairly

Jennifer Smith, CDE 14:01
well, one I would definitely add to that, though, is consider the mode of transit that the insulin got to your house as well. Okay, especially in different temperatures or different areas of the world, right? Because if you like I go to my pharmacy to pick up my insulin, I pick it up, I bring it home, it goes right in the refrigerator, there's no delay, right. Many people get their insulin supplies shipped we do. Right. So depending on time of the year, I always recommend people check you know, was the ice pack or the dry ice or whatever it typically arrives with? Was that in there Was it cold when it arrived? Did you put it right in the refrigerator? All of those things would be considerations in terms of Yeah,

Scott Benner 14:46
perfect. We there's somebody put on here gluten, if sensitive or celiac or other food intolerances. And you said when we went over it privately, you didn't really think it was its own variable, but If it was, it might be bundled together more with another one that's on here, which is inflammation. So, yes, yeah. So people who are gluten sensitive who are not eating a gluten free diet do have inflammation in their stomach lining, and I'm not a doctor, but down there towards the middle of your Yes, yeah. And that inflammation can make you seem what insulin resistant,

Jennifer Smith, CDE 15:25
more resistant, typically, because inflammation is like a stress in the body again, you know, we're talking and I said, kind of goes along with a lot of the inflammatory not only the digestive, but also things like lupus, and rheumatoid arthritis, and fibromyalgia. And all of those types of things are an inflammatory type of condition. And so uncontrolled or mismanaged, they will usually create a sort of a system of stress in the body, which will usually keep your blood sugar's running higher until they are better managed, which kind of goes along with the the gluten component, right? If you're on a gluten free diet already, you shouldn't have that inflammatory nature in your digestive system, you it should be calm, you should be digesting food the right way. If in the case that you went to a restaurant, you've been following a gluten free diet, and you do get gluten containing bread, let's say even though you ordered the gluten free bond, for example, could you have potential change in blood sugar because your body is so sensitive that you notice a difference? Digestive Lee right away and you don't feel good? Right? All of those would come along with kind of some of the things around like a stomach bug, possibly in terms of adjustment and what to plan for and how to adjust.

Scott Benner 16:50
If I say if I say one of these that you think is its own episode, just stop me and go. That's actually okay. Okay, so the next one, I don't think so. Specifically, somebody said, and this is very timely vaccines. So does a vaccine impact your blood sugar? Or does the fact that the vaccine makes your body, you know, introduces something into your body that your body has to fight off and create a resistance to is that process?

Jennifer Smith, CDE 17:16
It's that process, it's really not, I mean, overall, it's not the I got a shot, my blood sugar went up, that the case at all, it's actually the content of it, that creates a system of your body reacting to it, and some people's bodies react fine. With no issues, no symptoms, they go along fine. Some people have the typical like sore arm kind of thing, you know, those kinds of injections like intramuscular, whatnot. And sometimes just that sore arm kind of feeling could be enough, again, inflammation in that site to create a little bit of a bump in blood sugar. I would say that the only thing that would coincide with actually getting a shot in terms of like a vaccination, but they're they're pretty big needles for the most part. So if you could have a quick rise in blood sugar in that like setting, because you're scared here.

Scott Benner 18:11
Yeah, that stuff. But But again, to use the Walmart reference, again, the vaccine, just the sheer, I touched the vaccine to my body, my blood sugar went up. There's a mechanism in there. It's not just that you got a vaccine, it's the rest that happens afterwards. Yes. Is alcohol its own Do you think?

Jennifer Smith, CDE 18:32
I would think so. Yeah, I think that's a good discussion.

Scott Benner 18:35
All right. So I'm gonna mark that as its own episode. Medications in general, people just put medications. So I mean, there are some sugar fillers in some medications, right. Like, there are

Jennifer Smith, CDE 18:53
kids, especially kids, like, you know, antibiotics are often a liquid of some kind that is flavored sweetened to some degree to get the child to take it. So those could certainly and usually do have some type of carbohydrate in them or sugar in them. Other people, though, in terms of medications, could have reaction. And that's where it's really important. Anytime you start on a new medication, ask your doctor if they've checked. So they can tell you whether or not you start paying attention to your blood sugar. Because some medications that you will take long term could definitely have an impact on blood sugar, either making you more sensitive or making you you know, more resistant or whatever it is, while the med is doing what it needs to do for what it was taken for. It may have an indirect you know, sort of impact on your blood sugar.

Scott Benner 19:46
Alright, I have a thought but I'm going to add it to something else. So pain we're in the same situation. We talked about that already adrenaline, like you know, reactions to, to pain. I don't. I don't think that needs its own. I mean I don't think so. For second episode was a pain Yeah, if you're on paying your budget or Miko up we'll see you later. Right? Is menopause its own

Jennifer Smith, CDE 20:12
I would say menopause could be its own definitely.

Scott Benner 20:15
I thought so too interesting. Waking up in the morning Okay, guys, we have great episodes on that. So we have what did we do? We did feet on the floor defining diabetes we did defining diabetes, Dawn phenomenon and now we're gonna we did. How do you say it Jenny's? Oh, this smoky? Yeah, we did that. So go find those defining diabetes. If you're are you thinking waking up in the morning is its own thing? It definitely is. But we've got that covered in space covered. Yeah, yes. Lots of involve our allergies, like illness.

Jennifer Smith, CDE 20:56
Allergies, or like illness or kind of like inflammation, quite honestly, I mean, allergies create right, a reaction in the body that inflames kind of somewhere in your lungs sometime most often like nose sinus cavities. And so that could create enough of a stress on the body to cause a rise in blood sugar until you get it controlled. Now, the other variable with allergies is what type of medication again goes along with meds? What kind of medication are you taking to control the allergies? Some meds for allergies have done definite impact on blood sugar and will cause them to go up? Okay? If especially if they're steroid

Scott Benner 21:38
based. Yeah. And steroids in general, just Yes. Are gonna make your blood sugar go up and yes, and be incredibly resistant. Meaning Yes, you might. I've seen people with like two or three times their Basal rate trying to fight steroids for days and days. Yes, yeah. I actually just interviewed a boy from gosh, where was he from Ecuador, who has an illness that requires them to be on steroids all the time, and the amount of insulin he uses is spec exorbitant,

Unknown Speaker 22:09
I'm sure. Alright.

Scott Benner 22:12
So then it right. dreams, dreams or adrenaline. Like you just get really scared because your blood sugar grew up in the middle like that ever happened to you?

Jennifer Smith, CDE 22:21
I would guess I mean, I, I guess I if I've ever had bad dream, and thankfully, gosh, I don't remember really that many, like nasty, bad dreams where I wake up. I'm like, Oh, my gosh, you know. And at that point, I was probably just happy that I woke up like in my bed and like not in the weird scenario of my dream. Right. So whether I checked my blood sugar or not, I mean, it's typically just a it's it's sort of a an unconscious sort of reflex for me to be like, what's my blood sugar when I get up? Even if it's just to go to the bathroom? overnight? I always check. I would expect though, it would have adrenaline type of impact on blood sugar, if it was a scary enough or a worrisome enough situation in the dream? Yes.

Scott Benner 23:07
Okay. They're out. Cortisol is I mean, hormone hormone. So we've done that already. Singing makes my blood sugar drop.

Jennifer Smith, CDE 23:21
Oh, well, if singing is something that brings you a lot of like happiness and pleasure, then it could very well be that relax, you're relaxing, and you're really you're got those like feel good hormones kind of kicking. It could be that or if you are singing, again, context to the setting of singing, right? Because if you're singing and you're singing on stage, and you're in a theatre production, and you're moving around and changing, that could be a bit of activity as well as just the happiness of singing.

Scott Benner 23:55
Interesting. And then ironically, on the list the next one's emotions. So

Jennifer Smith, CDE 24:00
Oh, yes, I mean, emotions, definitely. I mean, emotions could be adrenaline based emotions, they could be happy based emotions, they these definitely kind of all go together. I would say that happy is often associated with like a drop in blood sugar, or more stability or more sensitivity, right? But I've also seen kids who are super, super excited about their birthday party, and their blood sugar rises, despite them being so happy. That adrenaline rush that they get because it's like they just were dropped off at like Disneyworld. Right?

Scott Benner 24:40
So the adrenaline overwhelms the emotion. Right? Yeah. Is caffeine its own or no,

Jennifer Smith, CDE 24:47
no, I think caffeine is an easy one caffeine. In the majority of people that I work with, and myself included Haftar years ago doing enough testing around x I was like, What is this weird strange thing after I start Drinking coffee. Most people need to Bolus for caffeine. It's it's not an unless you're not already covering like creamers or sweetened creamers or something like that. Well obviously, consider that as a first step Bolus for something that you're adding. But if you're just drinking a black cup of coffee, and you have this rise in blood sugar, nine times out of 10, more than that even is going to be the caffeine and you have to figure out usually I say, figure out how much of a rise you're getting. And then cover it with what would correct that rise.

Scott Benner 25:33
Okay. The next two we've literally talked about in the last couple of moments in a different way infections and excitement so we're good there. I will say this. If this one's an episode, I don't know because I've never understood when people talk about this daylight savings. How the heck does that change things that much it's an hour right.

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How the heck does that change things that much? It's an hour right? It is.

Jennifer Smith, CDE 26:56
And I think it's a it's a pretty quick in what I would expect in terms of explanation. Depending on what you're doing with your insulin doses, it may have some impact. Like, let's say you are the person who has different settings overnight for your Basal, right. And you don't adjust your pump accordingly. So now you could be running settings that are not jiving with the actual timeframe that they're now needed it. Okay. So in a way, could it? Yes. If you're not adjusting, so that your system can give you your right doses. Right.

Scott Benner 27:47
So then that goes right along with this one here. schedule change, same thing. Yes.

Jennifer Smith, CDE 27:52
schedule change, same thing. And in fact schedule change, especially for someone who has a very drastic schedule change from what they had been doing a nurse who had been doing day shifts, who is now working the like 11 to seven shift, right. That's a big change and a definite difference. And most likely we'd have to do some new testing around that to figure it out.

Scott Benner 28:16
Let me see if you agree with me here teething. Oh, hold on. I was almost dead right there. Just almost went down. Oh, no. Can you imagine you'd be like,

Jennifer Smith, CDE 28:29
it'd be like, 911 Yeah, I'm calling for this location, not where I live.

Scott Benner 28:34
Making a podcast with a man in New Jersey just fell right out of his chair. Please help. Teething and getting a tooth is going to be pain, inflammation, and maybe

Jennifer Smith, CDE 28:47
an irritability, more temper tantrums, probably less sleep. I mean, all a collection of variables in one.

Scott Benner 28:55
And we be looking for higher blood sugars from that correct. Okay. Moving. I mean, is Walmart, right? Like you're moving? Yes. Either excited or nervous? And probably more active than you think. So emotions, adrenaline. Yeah, hopefully this is you know, I'm actually enjoying this.

Jennifer Smith, CDE 29:15
But yeah, it's kind of fun going through them because I think people think about it in terms of words, right? People have a lot of different explanatory words for the same thing,

Scott Benner 29:26
the same thing over and over again. Yeah. And they give you an insight into their lives, injuries, breaks and concussions. I feel bad for this person. Oh, that's not good. Yeah, but but that's, uh,

Jennifer Smith, CDE 29:37
maybe they're a hockey player.

Scott Benner 29:38
I hope so. Alright, but we definitely covered that. Okay, so here's one where people I mean, we've talked about illness over and over again, it's in an illness episode. I'm going to skip that. Hormones we've done I mean, carbs and protein. You know, guys, there's tons of episodes on that we you know, if you

Unknown Speaker 30:00
go back and listen.

Scott Benner 30:03
If carbs is like the OG variable, right in diabetes, I don't think that its own episode, but I appreciate you putting it on here. This person, you know, talks about work about how they need different Basal rates on different rotations of their job, which is really just spoke about cyclical hormones in a tween who hasn't had their first period yet. So, I mean, in the lead up to your first period, you can start seeing hormonal impacts. If I was you, I would take that as a nice thing. It's like, they're like training wheels. Yes, yeah. For for learning how to do that. Yep.

Jennifer Smith, CDE 30:43
And I think we talked a lot about that in hormone based episode. Yes.

Scott Benner 30:49
Definitely did absorption injection sites we did site. We talked about sites, scheduled transitions, shared custody of families. I'll tell you what, I don't I get that that's a variable. But I still haven't found a good way to talk about that. And when we do, it won't be in a variable episode, it will be in a longer one. Because agreed there is a huge there's a huge problem. If you're managing one way and someone else is managing a drastically different way. And you're passing this person back and forth. Correct? Yeah.

Jennifer Smith, CDE 31:21
And I've worked with plenty families where it can work really well, as long as everybody's on the same page in terms of the best interest of the child. And it can work really, really poorly.

Scott Benner 31:35
Yeah. If if they were just hey, do you have enough information in your head to do a pro tip about how to do it? Well, you think? Yeah, yeah. All right. I'm gonna mark out for that one. inactivity is, you know, I think obviously, if it's not your if it's not your normal situation, right? If it's not your typical, like you said, then inactivity could make your blood sugar rise, if you're usually more active and suddenly inactive, you would probably get a rise from that. Mm hmm. This one's really interesting. But we already talked about being around different people. This person says that their steps on their blood sugar goes down when they're around their daughter, which is probably just the happiness and comfort thing, I don't believe I would think, yeah, unless their daughter is magically giving off. Insulin in the air.

Jennifer Smith, CDE 32:26
Right? Or again, I mean, it kind of does go back to like us a separate household type of management, you know, maybe the child whose blood sugars now even out when they're with you. It could be because they feel more secure, they feel more supported. They feel like somebody is actually helping them to pay attention versus the other scenario.

Scott Benner 32:47
And here's another one. The next one, my daughter is blood sugar rises, the minute we walk into the my parents house, so either your daughter's really excited to be at your parents house or doesn't like being there would be my guess, right? Correct. Okay, yes. No. Isn't that interesting that you kind of have like a little meter on you, that tells you? Oh, yeah, it's interesting. Time Zones, I think, are the same thing, as you just talked about with daylight savings time, except it happens quicker, right? Instead of happening

Jennifer Smith, CDE 33:17
in time zones are it is it's kind of the same thing as just paying attention to remembering especially if you're on some type of technology that delivers your insulin, right, some type of pump, making sure that you change the time, once you arrive at your final like, stay their destination. So that you have all of your settings that are now coinciding with the time that you're in.

Scott Benner 33:43
What do you think about times of day eating? Do you think do you think that chicken parm with little pasta takes a different amount of insulin at 3pm that it takes at 8pm than it would take at 9am? Or do you think that people's just have such varied Basal rates? Maybe. I mean, can food really hit because I don't think of food that way. I Bolus for something the way Bolus for it. I've never considered the time of day but Arden's settings are really rock solid, so I don't know.

Jennifer Smith, CDE 34:13
Right? Which means that you've tested and if she and I don't know what her settings are like, but if you have more than one insulin to carb ratio through the course of the day, her dose may be different for something like she decides at nine o'clock in the morning she's going to eat chicken parm versus at eight o'clock at night. The doses may be different but your strategy for managing that meal should remain the same in terms of that she needed a Temp Basal increase does she need an override does she need some kind of you know assisted in in something like that. But most often, people's insulin to carb ratios are what are going to drive the control around the same meal despite it being a different I just got that question the other day from a family so well you know, he's getting two and a half units of insulin for dinner for this. He eats it for breakfast Shouldn't he also always get two and a half units? Depends on what the ratio of the time of the day

Scott Benner 35:11
yeah and it's important that I'm glad you pointed that out because the reason I don't notice it is because Arden's carb ratio is the same 24 hours today it's super aggressive and it's the same

Jennifer Smith, CDE 35:23
are her ISF is different based on the system that she's on or her ISF different through the day then that may make a difference?

Scott Benner 35:29
Yeah overnight but not when well d times the same yeah day times always the same. Yeah. Lobby insulin go Yes. We'll work it out later. Let's stay ahead of this blood sugar. Eating girl lots of insulin. She and she eats a fair amount it's um she's a definitely a she's got a good appetite when she has a good appetite. We talked about this one because we found it interesting. Off off off microphone but this person says during wet weather that causes high blood sugars and sunny weather causes low lows. And the best agenda and I can come up with is

Jennifer Smith, CDE 36:13
that you're less active if it's wet and rainy and whatever outside and you're more active when it's sunny, and you're probably outside more or you know just enjoying even being out in your yard and gardening versus sitting inside.

Scott Benner 36:26
It's got to be like barometric pressure doesn't move your blood sugar, right?

Jennifer Smith, CDE 36:32
I've never looked that one up. That'd be an interesting thing to look up. I've never, I've never checked.

Scott Benner 36:37
All right. Well, if it turns out that it does, we will come back and apologize. Yeah, Anastasia, does that make your blood sugar go up or down?

Jennifer Smith, CDE 36:46
I think it's probably what I would expect is that it's more relative to how your body reacts to anesthesia. Honestly, I mean, my personal and one is that I react horribly to anesthesia. In fact, I always tell the anesthesiologist I'm like You Give me whatever cocktail has the most to stop the nausea and whatever after because after everything that I've ever had anesthesia for. I am knocked for a loop and I feel horrible and that actually drives my blood sugar up because I feel horrible.

Scott Benner 37:21
Okay, so alcohol is does that need its own?

Jennifer Smith, CDE 37:26
I think we set Yeah, I think calls definitely. We're gonna make

Scott Benner 37:29
that its own episode. One that we talked about, about people said constipation and stomach motility and Jenny's like I'm not sure about that. But I have seen that a little bit with Arden. If she hasn't gone to the bathroom in a while her blood sugar can get sticky. And then the minute the event happens, it starts to come down. Come down. Yeah, but I mean, it's got to be a pretty drastic scenario. Constipation scenario, like I just haven't gone since yesterday. You know what I mean? Like?

Jennifer Smith, CDE 37:57
Everybody should go to the bathroom every day.

Scott Benner 37:59
I was gonna say that to everybody poops and everybody should poop every day. And if you're not, yes, fine Metamucil or eat a vegetable.

Jennifer Smith, CDE 38:07
My boys love that book. It's I think, actually, it's called everybody poops. They love that. They think it's hilarious.

Scott Benner 38:12
I'll tell you what, at a certain age. I thought it was hilarious too. And that age for me was 37

Jennifer Smith, CDE 38:19
is another fun you want to say? I need a new but oh my god. We laugh and laugh when we read it. It's so funny.

Scott Benner 38:27
Glycemic Index of food is definitely a variable and we have multiple episodes on them. Please go find Yes. Hot tubbing shopping Pre-Bolus thing versus non Pre-Bolus. And these things are all self explanatory playing hockey is act in track and field violin lessons, which is probably stress or anxiety I would imagine.

Jennifer Smith, CDE 38:46
Could be I don't know I was a violin player. But I also didn't have a CGM at the point at which I was playing violin so who knows what was happening?

Scott Benner 38:55
So I'm gonna draw a line here because you're out of time but let's just end with this. Were you any good at the violin?

Jennifer Smith, CDE 39:00
I was really good at the violin I haven't played in years I just I don't really have the time or you know keep up with it. But I yeah, I played from kindergarten all the way through college.

Scott Benner 39:11
Oh, wow. Do you think you could pick it up and like knock something out with it?

Jennifer Smith, CDE 39:15
I could I actually I really right now I need a new bowl for my violin because the strings on my on my bowl are done. So but other than that I could

Scott Benner 39:25
your violin is good. You just need a bow.

Jennifer Smith, CDE 39:27
I just need a bowl. And I've looked into getting it repaired and getting a new one and I just I look at it and I'm like, Ah, I could spend that money.

Scott Benner 39:38
Just don't do it. If I leave this in someone's gonna send you a bow so the other night somebody went on my buy me a coffee link and left me so much money. I was like, stunned Oh, and with this really wonderful note and I wish this was more and it made me I was very happy that they felt that way. And I took the money and I bought hard drives to backup episodes. This sounds awesome. Yeah, but I was also it's weird. It makes me uncomfortable. So that is I know if a bow like if somebody said to me, how do I send a bow to Jenny? Okay? No, you'd be like, Oh my god, don't do that, please.

Jennifer Smith, CDE 40:16
No. I mean, I've gotten really nice thank you is, which are, I think they're, they're the most appreciated. I just, I love hearing how much this helps people, honestly. And those are, those are the best, like feedbacks kind of thing. You know,

Scott Benner 40:33
sorry. I really do. Okay, so the next time we get together, we'll do a couple of them that we've that we've set on and then we might do another run through the rest. And I thought this was good. So awesome. Cool. All right. Yay, one second. Yeah, I like it when things work.

A huge thank you to one of today's sponsors, G voc glucagon, find out more about Chivo Kaipa pen at G folk glucagon.com Ford slash juicebox. you spell that GVOKEGL. You see ag o n.com. Forward slash juicebox. That's it for this one. Thanks so much for listening. And for sharing the show. I'll be back soon with another episode of The Juicebox Podcast. If you want to wait till after the music, I'll run through the links for every one of the advertisers just in case you need them.

So on the pod is a tubeless insulin pump, my daughter's been wearing it forever. And you can find out more get started and see if you're eligible for a free 30 day supply of yummy pod dash at Omni pod.com forward slash juice box. The Dexcom G six continuous glucose monitor is a mainstay at this house dexcom.com forward slash juice box. The Contour Next One blood glucose meter is in fact the meter that my daughter uses. It is literally the favorite one that I've ever held or used. I am not kidding. Contour next one.com forward slash juice box. If you want to see people doing wonderful things for people with type one diabetes, go to touched by type one.org Or visit them on Facebook, or Instagram. And of course the GMO hypo Pan was today's sponsor, so we don't need to do that one. You can find out if you have auto antibodies that lead to type one diabetes at trial net.org forward slash juicebox. Tell them I sent you touched by type one mentioned oh and the T one D exchange. Take the survey. If you're from the United States and you have type one, or you're from the United States, or you're from me, I came to say the words. I'll try again. Or you're from the United States and you're the caregiver of someone with type one. You can take the survey probably in less time than it told me to. Then it took me to tell you all this because I see him a little gobbly goo in my mouth. He won the exchange.org forward slash juice box check out the Facebook page. There's a public page called bold with insulin, a private page Juicebox Podcast type one diabetes, I'm on Twitter and Instagram and tick tock just look for Juicebox Podcast. diabetes pro tip comm is where the diabetes pro tips and the defining diabetes stuff is. It's also at juicebox podcast.com. It's also in your podcast player. There's great lists of them in the Facebook page. I think that's pretty much it. I really appreciate you listening. I'll be back really soon. Take care