Scott Benner 5/9/22 Scott Benner 5/9/22

#678 After Dark: Nolan's Story

Jen has type 1 diabetes and is here to tell Nolan's Story of addiction, mental illness and overdosing.

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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 678 of the Juicebox Podcast.

On today's episode of The Juicebox Podcast we have another in the after dark series. I'll be speaking today with Jen who has type one diabetes, and is the mother of three children. Her son Nolan had type one diabetes, and he also struggled with addiction. Jen does a very brave thing today sharing Nolan's story with all of us. And I'd like to thank her right now, for what must have been a very difficult hour. She was honest and open, as she discussed Nolan's life and his struggles. Please remember that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, always consult a physician before making any changes to your health care plan, or becoming bold with insulin. If you are a US resident who has type one diabetes, or is the caregiver of someone with type one, spending a few minutes today at T one D exchange.org. Forward slash juicebox. Taking their survey will help people with type one diabetes, T one D exchange.org. Forward slash juicebox. Take the survey

this episode of The Juicebox Podcast is sponsored by touched by type one, a wonderful organization doing amazing things for people with type one diabetes, learn more about them on their Instagram page, their Facebook page, or at touched by type one.org. The podcast is also sponsored by the Contour Next One blood glucose meter. Learn more Get started today. Or just buy the thing at contour next one.com forward slash juice box. My daughter's meter is a great meter. And I think you're gonna like it to contour next one.com forward slash juice box.

Jen 2:11
Hello, my name is Jen. I am a type one diabetic and the mother of a recently deceased type one diabetic.

Scott Benner 2:18
Okay, Jen, I know you from the private Facebook group. Yes. How long have you been in that space?

Jen 2:28
In the private Facebook group? Gosh, probably less probably about a year. Okay. We not that. Yeah.

Scott Benner 2:35
Yeah, not not all that long. The group might not even be like two and a half years old. So you could have been there for a very long time. And it not been that long. On the calendar. I guess that my I'd like to ask you a little bit about yourself first, I guess. How old are you now? And how old are you? Where are you when you were diagnosed?

Jen 2:57
So I was I'm 48 years old now. And I was diagnosed around age 40. I have what they call led a diabetes. I had a very slow onset, they thought that I was a type two until I almost died. Well, one doctor knew that I was the type one. He tested me for the autoimmune antibody. And I had that. And so he diagnosed me as type one. And I was proud 4041 When that happened

Scott Benner 3:34
prior to that, were you struggling with diabetes and nobody had tested you.

Jen 3:39
You know, I had I had gestational diabetes. And no, I hadn't had it really tested other than the gestational. My sugar stayed high. After I had my baby. We don't really know how long I had I sugars. But I was having trouble with getting infections. I got pinkeye maybe 20 times. And I wouldn't I just kept getting pinkeye. And so they checked me and started me on Metformin, which did not do anything and I just continued to get sicker and sicker. Put me on a couple of other type two medications. And then I went into the UK and had to have I got cholecystitis, which means my gallbladder had gall stones. And I had to have my gallbladder out. And they found out that I was a type one. So they did they finally did a fasting C peptide and checking in those type one

Scott Benner 4:41
from this. Oh, I'm sorry. I didn't mean to cut you off. Nope, that's okay. Go ahead. I was gonna say from the time that you began to not feel well. From I guess the question is, from the time you were gestational till the time you realize something was wrong was how long? About five years? You're okay. And then from that time until somebody told you you had Lada How long was that?

Jen 5:08
I'm sorry. So it was about it was not feeling well continued after I had my child, my youngest. And it was about five years until they said that I have IDs.

Scott Benner 5:19
I see. Okay. All right, Jen. I hate to say this because we went through so much trouble before we started, but I don't know if I like the headphones. I might. I might try without I might just ask you to go through the phone. Yeah.

Jen 5:34
Okay, one moment, okay. Is not a problem now. Thank you. I gotta turn them off. Hold on a second. Okay, how's that?

Scott Benner 5:49
Yeah, it's probably going to be better than the headphones straight in your longer sentences. They strain. I don't know how to put that other than when you speak more than a few words. Your, your, your ladder words in those sentences start to kind of drift away. So okay, yeah,

Jen 6:05
just just a moment. Now, is it better now like this? Yeah, you're

Scott Benner 6:09
fine like that. Okay. So I'll keep it off speaker

Jen 6:12
and on the phone. Okay, thanks. Yeah,

Scott Benner 6:16
it just sucks because you've got to be cognizant of your hair, not touching the phone and like all kinds of little things that make noises, like whatever that is, and like, you know, that kind of stuff. So just do your best to find a spot where you're comfortable. Okay, okay. So you this all happen after your youngest. So how many children have you had?

Jen 6:35
I have three children? Three. I had Nolan, Patrick and lemon is my youngest. What are their ages? So lemon is 13. Patrick is 21. And Nolan passed at age 24. Just a couple of weeks after his 24th birthday.

Scott Benner 6:52
Oh, one right after his 24th Okay. And you were about 24 When you had Nolan.

Jen 6:58
Yep. I was 23. Okay.

Scott Benner 7:02
So you have type one diabetes. Am had no one been diagnosed at this point yet?

Jen 7:10
Yeah, he was he was diagnosed before I was he was diagnosed at age seven. Okay. And yeah, I think if he hadn't been diagnosed, I likely would not have even gone to the doctor for what was going on with me. I would have just chalked it up to being old.

Scott Benner 7:26
being old. I don't know. I don't know how old you are. 3030 some years old. But I hear what you're saying. Well,

Jen 7:31
but with the first time you're 30, you don't know what it's like to be 30.

Scott Benner 7:35
Yeah. So no, I understand. I just would have seen like, oh, I guess this is the path of my health. And right, that's right. I understand. So let's talk a little bit about when Owen was diagnosed, how did you figure that out?

Jen 7:51
Well, that was interesting. He was he was getting infections that wouldn't go away. And I'd taken them to the pediatrician. Oh, gosh, it seems like every other week, I was in nursing school. And I remember, I just took him to the pediatrician so much because he had sinus infections. And then he had this big, swollen parotid gland. So that's right on your jawbone. And he just had his face was uneven. And so I took him in. And they said, well, hmm, I don't know. I don't know what this is. And we did some blood work. He did like a complete blood count. He didn't do a sugar. He didn't do a metabolic panel, otherwise, we would have known. And then I took him and he sent me over to an en te to look at the parotid while the en eyes went to two different un and T's because one was just kind of a mean guy, and I didn't like him. And the other wanted to operate on him right away. And by that time, I was in nursing school, and we were learning a little bit about diabetes. And by that time, Nolan had started to wet the bed. So that was a big flash for me, though. Well, he's wetting the bed. So I took him. They wanted to schedule surgery, and I said, Well, shouldn't we just find out there? He's not diabetic first, because he's wetting the bed. And he said, No, he's wetting the bed because of his adenoids. And I said, That's it. And I said, Give me his medical records. So I took him over to my doctor, who on December 20 2000 tour said, Sure, we can do a blood sugar check. And we did a blood sugar check. And he was up in the seven hundreds hadn't eaten, because he had been vomiting that day. I mean, he was diabetic. And so he referred us

Scott Benner 9:45
to imagine right? He was he was in decay as well.

Jen 9:49
You Oh, yeah. Oh, yeah. He had fruity breath, all the things that you look for. And they actually he referred us to a pediatrician who was an internist. Just at their office. So he came in and scroll down. One U, H for our Q 15. One for you l QD, meaning one unit for every 15 carbs of human login meal time, and then four units of Lantis daily and send us home. You didn't go to the hospital? Yeah, my dad came in and said, you know, arguably a lot of people would say you should go to the hospital. Do you want to do that? And at the time, I was an idiot. And I was like, Well, no, the hospital means he's sicker. Okay, so we went home with no blood sugar meter with a script for insulin, and a kid that we could very easily kill that day. Yeah. So yeah, that's what it was. That's how that happened.

Scott Benner 10:49
What was at that time, if I'm, if I'm doing the math right here, Patrick's around four years old. Maybe you have two small kids. Yeah, yeah. And are you a nurse now? Did you finish nursing school?

Jen 11:02
I did finish nursing school. Yes. And yes, I'm an RN, now, okay.

Scott Benner 11:06
Yeah. What was life, like, growing up with a kid who had type one, you know, what was? What was the pathway for you and for him,

Jen 11:18
you know, I, I submerged myself into the diabetes world, spent every moment on on websites and research and looking for why this happened. I was still in school. And in school, it was funny, because I was learning the opposite of what I was learning in real life about diabetes. So I had to really kind of temper myself for school and make sure I passed the tests by giving the wrong answers. Just because nursing care for diabetes is not very succinct. It's not very, it's not what people with diabetes do. I started to volunteer at diabetes camp, we started sending Nolan to camp and I just really immersed myself in the world of diabetes to the point that, you know, I think my family missed me. I think I missed him a little bit, I think that I, I put so much into this tragedy that happened to my son and trying to make it better and trying to find the best care for him and do the best that I could for him that I think in some ways, I kind of lost him. I forgot that he was a whole person.

Scott Benner 12:31
You just, you just saw the diabetes.

Jen 12:35
I saw him too, but I felt so I've just really wanted to make it as good as possible. You know, and just really make sure that he was getting the best care possible. And that and that, you know, we we fought it.

Scott Benner 12:50
Was it were things not good? Or was that just your perception that they you're trying to get them back to perfect?

Jen 12:59
I think it's my perception. I think he was doing well. I mean, his his a onesies were all great. He was doing well. He he took it in stride. like you wouldn't believe there were some battles when he got older, but he just really took it well. I think that just the regular things about a child kind of fell by the wayside. And I don't think anyone minded or thought any different of it, but in retrospect, I see that now that you know, he was a musician. We did We did music stuff with him. We took him to the conservatory and he did his drumming there and stuff and, and you know, but I feel like it was always me falling behind going, Oh, your sugar, sugar, you know, and you do you have to you have to make sure they're okay and not landing in the hospital. So really, it's a fine line, taking care of a kid with diabetes.

Scott Benner 13:58
So, okay, I guess knowing the rest of the story is tainting how I'm asking my questions, but Sure, but I guess there's no way around that honestly. Sure. Is there any chance that Hindsight is making you think this like when did you start coming to this conclusion I guess

Jen 14:19
I think I started coming to the conclusion I think I came to it right away. I think I came to it right away realizing this is this is I'm making a choice and this is the most important thing making sure that he stays alive and and that he is in good control and that he doesn't have complications later. So I think hindsight does taint it. I don't regret anything I did and I wouldn't do it differently because you can't you do what you do when when it's going on and and I would do so much of it just like I did. Because you do have to you have to advocate for your child. And I did A lot of that. You know, you have to go to bat for them, you have to argue with the school you have to you have to the school nurse is either your ally or your enemy. And that can get that can get really touchy, too. I don't think I would do a whole lot different though. I think there's days when I think that I would. But what I would have done differently would have led to him leaving us sooner. So like if I just allowed him to do everything the way he wanted to do it, he would have been gone sooner.

Scott Benner 15:35
Okay. The technology back then. So Nolan's diagnosed in 2004. Is that right? Yes, that's two years before Arden was diagnosed. So our technology path is going to be very similar because there was no, there was no great leap from 2004 to 2000. No, it wasn't so you were get you probably had. I mean, maybe a pen if you were lucky. But needles and a small meter. That was all you're here.

Jen 15:59
Yeah. Right. Yeah. And started pumping though. Yeah, pretty soon.

Scott Benner 16:04
Okay. So your your, your focus is on trying to keep his blood sugar's stable, trying for him not to be too high or too low. Aiming for that a once every three months, it's pretty much feels like your only ability to understand how well you're doing. And that was right. The extent of it. Is that right?

Jen 16:24
Yeah, yeah, pretty much. Yeah.

Scott Benner 16:28
Was he having a lot of lows or highs? Do you recall?

Jen 16:32
He had a few lows. He didn't have a whole heck of a lot of lows. And his highs were like under 200. So he wasn't really he was really in good control. I think his first A once he was five something. And then he just slowly made a climb. Like I think the highest he had before he was 18 was in the sevens. Yeah. Okay. Um, you know, he was usually around six, okay, you know, six and a half, seven. And so he did really well, until he got older.

Scott Benner 17:04
And so through regular elementary school, middle school, he was doing fine. Did he start to ignore his diabetes at any point, as he got older,

Jen 17:17
middle school, he started he wanted to take it, take it into his own hands more. And I was told at the very beginning. As soon as he was diagnosed as you need to let him as his diabetes, you need to let him do his stuff. Okay, so I tried my hardest and that was excruciating. Because he would, you know, middle school, he, he just kind of got tired of it. I would say, Do you have your kit? Yes, I have my kit. Can I see it? No, I have my kids in my bag, or you put my bag mom. Okay, so I take him to school. And I get to work on the other side of town. And I get a phone call from the nurse that said no one forgot his kit. And there wasn't my card had fallen out of the bag. But this happens so often, like almost daily. And he would start to lie about his blood sugar's and, you know, 107 it's 109, you know, and finally realized that if he was gonna lie, he should give me a believable number. It's 210. You know, I mean, he, he just became really resistant to having diabetes. And he was tired of it. He didn't like it. But he also that's when mental illness starts showing up as well. And that's when he started showing a lot more signs of mental illness as well as middle school. And so he had we just behaviors and stuff like that, and he would get in trouble at school. And I mean, it just became a whole lot to deal with.

Scott Benner 18:46
Right? Were those mental illnesses ever diagnosed?

Jen 18:49
Yes, he was diagnosed with bipolar disorder when he was oh, I want to say 18 He was diagnosed with ADHD at a young age, which we know now that a lot of ADHD in children shows up later as bipolar disorder. They're on the same spectrum. I didn't know that until recently, but so a lot of kids are misdiagnosed and medicated. And that's what happened to Nolan. I don't want to say he was misdiagnosed you can have a DD and bipolar disorder.

Scott Benner 19:21
Right. So he was being medicated for ADHD when he was younger. Yes. Yes. How does what can you remember the first time you thought something's really wrong? Like how does bipolar show itself the first time in your situation?

Jen 19:37
I think the first time I realized something was really wrong

Scott Benner 19:50
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Jen 23:05
you know, I guess when he got kicked out of middle school, he got kicked out of middle school because he bought a marijuana joint from a kid in the bathroom. Now the kid has sold it to him get to stay in school. I'm not sure how that worked out. But being diabetic and being one of the only diabetic kids that is Middle School. And on top of that the only diabetic kid with with a 504. Is it a 504? I can't even remember now with a care plan. Yeah. And a mom that was involved. They were really happy to get rid of them. And I thought that but I thought no, Jen, you're just being paranoid. That's not why. But yeah, they're happy to get rid of the diabetic kid who they have to answer to the parents of. And that was a theme that kind of went went around like him and another kid would get in trouble and he was always the one that got in more trouble. What so he bought what he bought was a fake marijuana joint in the bathroom, oh, and middle school, but that's what happened and he got kicked out. So he went to alternative school and now alternative school they had, you know, trouble getting him to listen and the teachers really sat and talked to me and said, Look, you know, I'll ask him to do this sweep the floor. And I come back in an hour and he still hasn't done it like he's this is a problem. And that's when I really started realizing that there was some some issues with him. He seemed absolutely normal. But his functioning level was not he just compensated so well.

Scott Benner 24:36
So there was you didn't see the big swings it wasn't manic and then depressed. It didn't go back and forth like that.

Jen 24:43
Unfortunately you know, with high blood sugars, we get moody. And so I did see mood swings, but we didn't know Is it is it at first we thought it's diabetes stuff. It's diabetes stuff. and it is. And then we thought, well, it's bipolar stuff. And it also is. And there's just no way of knowing which one it's related to. Keeping him on the bipolar medications was, was hell, he didn't want to take them, they make you feel crappy. I would find them hidden. You know, they, they'd been in his mouth, they were hidden. I check his mouth, say, show me that you swallow. Like it was like jail. Right? And he just didn't like them and wasn't going to take then most people with bipolar disorder don't like the medications, because there aren't really very good medications for

Scott Benner 25:35
Yeah. And so this just persists on I mean, he wasn't really going to middle school anymore. Like alternative school doesn't sound like it's not it's not a public situation, right?

Jen 25:45
No, it's for kids that are kicked out of middle school for behavior stuff. So, you know, he got put in behavior classes when he was in high school, he went to regular high school. And the behavior classes were such that they were in the basement. When the regular kids walked by for lunch, the behavior kids were made to turn around and face the wall. It was it was not good. I'm not sure. He really didn't, he never thought he never had sold drugs in school. He, he just was a he was kind of a jerk. You know, he would giggle and not do what he was supposed to do. And he had fun when he was in school with other kids. So I think that he is, I always said he glowed in the dark, because of the diabetes, because of the involved parent. I remember going into the school and it was the first day of school, I had to go have my meeting with the nurse. And three or four different types of kids type one kids at the high school walked in and the nurse said, Okay, what is this your insulin? What do you How much do you take? And they're like, I don't know, how often do you check your blood sugar, like in the morning and at lunch? And she's like, okay, and you take how much she's like, they're like five units. And she's like, okay, and that was their plan. And I thought, that's crazy. You know, these parents aren't involved at all.

Scott Benner 27:14
Well, you have, obviously, intersecting issues that we're all coming together to share, I give you up. And then the bipolar comes, and even was ADHD early on. And then I imagine at some point, drug use ramps up.

Jen 27:29
Yeah. Then he started with drug use. And he started smoking marijuana, and taking pills from kids. And he did that for a few months and was just ridiculously tired of it. And I remember getting a text message him from him at my job. And it said, Mom, we need to get me help. real help. I can't keep doing this. I don't want to keep doing this. And I just cried. So I started trying to find him help. How old was he would have been about 16. I want to say 15. I'm sorry, he was about 15. And I was working at the hospital in a clinic. And I would spend every break time calling and calling P MCs which they're called P MCs. They're for kids with medical and substance abuse issues or behavior issues. And they they're all medical, the m&p MC is for MediCal. None of them would take him he had Iowa Medicaid. And I could not find a single place in Iowa to take him because of the diabetes. They said they were not equipped to deal with somebody with type. They weren't comfortable. They weren't equipped. They didn't have a nurse. Yeah,

Scott Benner 28:50
I've heard this a lot on the podcast when people are trying to get extra help for their kids that have you know, extenuating issues. And yeah, and then places are always like, well, we don't take kids with type one happens a lot.

Jen 29:03
And it's ridiculous. So I called the American diabetes Association. And I got an advocate who sent a letter and they got in touch with a social worker who was wanted to advocate for him. And we forced a couple of places to take him. And they would kick them out. They would find a reason to kick them out. One of them said, there was a bunch of kids that ran away. And no one opened the door to let them back in when they came back. And he mumbled something about why I want to run away or something and they sit up that's it. You're done. You're type one, if you run away, you'll die. It's a liability. And that's and they kicked him out. They made me come pick him up on Easter. And it was over in Fort Dodge. They I asked for his medical records because I was going to deal with the advocate on it. And they you know, told me my kid was not an angel and I said well, I didn't think you're safe. But thank you But I do think you should keep them in treatment facilities. You know, just it seems wrong and people have really a lot of trouble believing Oh, they won't say no. Because the diabetes? Yes, they absolutely 100%. Well, and that is a tragedy.

Scott Benner 30:19
Yeah. Well, where does that where does this all lead to? I mean, that that's a rehab. It's not. I mean, he's not getting you know what he needs from there. Obviously, they're, they're kicking him out of there. And now he's back on you. Are you married during this?

Jen 30:33
I, he's his dad and I divorced in 2009. So his dad is an alcoholic. And as that plays into a lot of his problems, his dad's an alcoholic with major mental illness. In fact, his father right now is missing. We don't know where he is. He was eluding the police about three days before Nolan passed away, and is jumped in and faked his own death. figures on suicide and now is hiding from the police. Wow, that's so that's that's it? Yeah. It's really an interesting twist. Drama,

Scott Benner 31:07
I'm not looking to go down his path. What kind of what kind of mental illness for him?

Jen 31:12
Well, I would say schizophrenia, but he's not diagnosed, but definitely bipolar. But he has a lot of paranoia. You know, he's just a really smart guy, very talented musician. Just really clocked out of his kids lives and was an abusive person. So Gotcha. Yeah. mentally abusive,

Scott Benner 31:35
right? Like that. So does Nolan's drug use like it? Because I'm thinking back to when he says to you, I can't do this. I don't want to do this. But but he was, I'm assuming self medicating, at that point. Trying to get around, eventually go back to it.

Jen 31:52
Yeah. Oh, yeah. He didn't ever stay sober for too long. You know, self esteem and all that kind of plays into into your choices. He really had trouble staying sober. And he got into, you know, he drinks sometimes it was never his drug of choice. But he did start using methamphetamines. Probably when he was about 17. We would take him to the hospital, I would find him. You know, I find him downstairs in DKA. We take him to the hospital. And after we'd have him in the hospital, in the ER, ICU, then we'd go to psych. And psych would be able to send him somewhere. Because what we wanted to do was find a place that would get long term treatment and maybe get him out of Sioux City. halfway house, that kind of stuff. But did so he would go to Cherokee, which was the mental institution and that's the one place that would always accept him. But it would happen the same way every time er, we'd start making the calls. We'd go to the ICU, we'd spend another couple of days making the calls. And eventually, Cherokee would always be the place that would take him. And so they take him up in the ambulance up there. Sometimes he would pull out his own IVs and try to walk out of the hospital and have to be stopped by the by the security there. But they always would take him and he turned 18 up there and Cherokee. We went all the family went up for his birthday party. We always kept in really good contact with him. His grandparents on both sides were very supportive. His brother and sister and I would always go up and visit and his dad tried to visit a few times. It's sometimes he wouldn't see his dad. So it just back and forth with Cherokee and finding different placements and and just in and out of treatments for the last seven years.

Scott Benner 34:04
Yeah, Jim, I try my hardest to just sort of stay dispassionate while I'm having these conversations. But Nolan had his 18th birthday party in a facility that almost made me cry for some reason. I mean, we've been talking for half an hour, nothing you've said has been like, you know, right. Not happy. Yeah. Yeah. And yet that got me. Yeah, really. He

Jen 34:27
went, he went from the pediatric unit to the adult unit on his 18th birthday. And we took pictures we they let us use a party room there. So we all drove up to Cherokee me grandma, grandpa, Indian grandma, grandpa for cello and and just all the family went up and his brother and sister and we were able to have this birthday party and it was just very bittersweet.

Scott Benner 34:54
Let me ask you a few questions about this from your perspective. So now, at this time, it's been a few years When he's 18, are you hopeful that this is going to get turned around? Or is this the thing you live in every day? That you're just like waiting for the other shoe to drop? Like, what's the what's the feeling in the back of your head? Oh, okay.

Jen 35:15
Yeah. Oh, like I think at that point, I had hope. But every time something else would happen, it was a shoe dropping, and there was always a shoe dropping so many shoes. And I think we, I always held out hope. But I always knew in my heart somehow, that no one was like, a gift that was on loan, if that makes sense. Ever since he was a little baby, I kind of knew that. And, you know, he started overdosing, he would be fine for a little while, and then there'd be an overdose. Or there'd be, you know, finding him comatose, calling the paramedics to come get him, he's having behaviors, big time, just breaking everything in the house. He just, and I had hope. But I saw him suffering so much. And that was the hardest part. It was to see somebody you love so much that you brought here, you know, that didn't ask for an invitation. And to see them suffer like that, to see him suffer with the diabetes ruined me. When he was diagnosed, I just, it was the worst thing that could have happened. And and I don't know why. Because it is not the worst thing that can happen. But it's pretty bad news. It's really hard for parents to go through that. Yeah, I took it really hard.

Scott Benner 36:45
Yeah. I can tell you that. I can tell no. Yeah. Talking about throwing yourself into it. How Oh, anything? It was.

Jen 36:54
It was it was everything. I just wanted it to go away. Because I think I think because, you know, we saw a little problems with him before when he was a kid. I think I thought just why him? Why not someone who can handle it better? Why not me? And I said, God, give it to me instead. And then God misheard me, he's had I said, as well. Why any hearing aid? I know. Anybody know,

Scott Benner 37:21
I just need to ask you just for context here. Do you have any mental health issues?

Jen 37:25
Um, I have ADD, and I have some depression. Um, so yeah, I those are mental health issues. Yeah. I think my doctor asked me if I was bipolar. A problem, I guess, mildly. I've always been really functional. But when I was a little kid in school that add was that wasn't a thing then. I mean, I'm 48 years old. We didn't have medicine for that. Really?

Scott Benner 37:52
There were just kids that didn't listen. Yeah,

Jen 37:55
there are lazy they like calling me lazy. I hate that word. Hate it.

Scott Benner 37:59
How about your other, you know, your other two kids? How are they?

Jen 38:03
So Patrick is I would say the perfect child or what they call the family hero. He has very few problems. He does struggle with depression. But he does seek help for it when he needs to. He's really ideal in the sense that he's been very self sufficient. He's very caring and kind, very funny. Just very healthy and forward moving now. He no one was his best friend. He lost his best friend. But he's really pushing to do some things now in life that he might have had on hold. So he's I you know, I don't think anyone in my family is 100% healthy, but Patrick's pretty good. Lemon. My 13 year old. She's wonderful. I think she's just an amazing kid. Two, she's learning to play guitar. She working on a feminist fanzine that she's doing. She's just really a cool kid. She does struggle with all the trauma that she's seen in her life with her brother. And the dynamic between her brother and I, I think it's got to be so hard for both of them to go through because with the drug addiction, there was just a lot of anger and and unhappiness and so many tears and so much trauma. And with the diabetes, and both of us being diabetic and moody, just you know, Nolan and I were a lot of like, in some ways. I always say he got the worst of me and his dad and then it was amplified. But he's really, you know, I think they I think both of my other kids are are very fortunate to be very bright and very aware of their own situations

Scott Benner 39:57
or their other autoimmune 's with any buddies, celiac thyroid anything.

Jen 40:03
So I would say that Patrick, who will not go to a doctor about it has possibly got like, IBS, celiac or something. He does have some stomach problems. But no, nobody's been diagnosed yet.

Scott Benner 40:17
Okay. How about your exes side of the family? Do you have any knowledge of them?

Jen 40:22
They don't have any and I'm close with the family. They don't really have any autoimmune. You know, they've got cancer in their family, but no and heart problems, but no autoimmune.

Scott Benner 40:31
Okay. So I'm gonna kind of fast forward a little bit now, because I'm assuming that from 1819 2021, it's just probably story after story of hard times, and craziness and stuff like that. Yeah. Are you? Absolutely. How did you take care of yourself during that time?

Jen 40:51
Well, that's a really good question. In all honesty, I don't think I did. I stressed a lot, I worried constantly, I wasn't sleeping. One night, I had thought, well, I can't sleep. This is so stressful when we have a glass of wine. And so I started drinking wine to go to sleep. And it didn't take very long until I was a full blown alcoholic, I could not stop. I checked myself into the hospital, in a what I like to call a bold career move, because I live in a very small town. And I went to treatment, so that I could stop drinking, and I haven't drank since that was three, almost three years. Good for you that I'll go. Yeah. But I if I didn't believe that addiction is an illness, I would be ashamed. But I wish I hadn't taken that first drink. You know, I didn't drink at all before that for many years. But it just it got me. Yeah.

Scott Benner 41:58
You were. I mean, was there a moment when you like, Did you see the juxtaposition? Did you say, Well, I'm medicating myself, the way that no one is?

Jen 42:08
Yeah, yeah. I said, I saw it right away. I saw it right away. But I couldn't stop. I went to meetings, AAA meetings and got my 24 hour chip, probably 24 times. You know, I wasn't able to physically stop I was having withdrawals and all of that and it was, life had become so stressful. that I had, just I guess I kind of threw myself into drinking. And I kind of had given up.

Scott Benner 42:45
Okay, yeah, I was gonna say at what point during all this to just go Alright, Everybody get in the garage. Let's start the car and go to sleep. Like gig. Yeah, seriously? Yeah.

Jen 42:55
Yeah, I felt like it not with the other two kids. But honestly, I had ideas of, you know, I felt so no one. He doesn't fit anywhere in this world. There's no help for him. I can't help him. Nobody seems to care. He doesn't, you know, he just can't get the help that he needs. He doesn't belong on this planet. And I'm just gonna take him with me. I had thoughts like that. And that's terrible. It's terrible. But I didn't want him to go alone.

Scott Benner 43:21
I can understand. I mean, what your Yeah, it's not what Listen, my kids got type one diabetes, and you know, thyroid. And you know, last night, for example, her toes got numb, which seems to be happening out of nowhere. And you know, like, there are things like that, that you think, well, these things suck. But we're gonna get through life, like, reasonably well, pretty great. But at what point what point does someone just pile one too many pebbles on the pile? It's on your head. And you just think I can't I just can't like it. Yeah. Not only that, you can't shoulder it. But that, that none of the things about life that make life pleasurable, exist anymore, because you have diabetes, you're depressed, you're drinking, he's doing drugs. He's got diabetes, he's bipolar. There's no second in the day that I can imagine for you where you were just like, you know, Leave It to Beaver. Like none of that existed. Oh, no. Yeah. Right.

Jen 44:15
I mean, I still make dinners for him. I still did like a lot of mom's stuff. But I clocked out, and for about about 18 months, I clocked out and then, you know, a clock back in and I knew that things wouldn't be perfect when I clock back in. You know, there were times when, when I would be so drunk that Nolan would pick me up and carry me to bed up the stairs. And I just thought that was so funny at the time. All isn't it funny? And it wasn't funny. I mean, it's really sad. But we also had that mutual love for each other that we cared for each other so much that, you know, he wanted to take care of me too. And when I wasn't drinking, he couldn't take care of me. And that caused some sadness for him. But it got to a point. I said spent so much of no one's life, so afraid of him dying, just petrified that he's dying. And then one day, I realized that now more than being afraid of him dying, I was afraid of doing this when I'm 80

Scott Benner 45:18
I see this, and that was a big deal. It's never gonna stop.

Jen 45:22
And I became more afraid of of that than him dying. Because I knew he was unhappy. I knew that I was unhappy, I knew that my other two kids were suffering. And it was becoming a burden on everybody around us. Because with drug addiction comes so much manipulation, and so much pain for the people. Like my mother could never say no to him for anything. You know, and, and because she loved him. And he would manipulate and cause harm. You know, he would take things from people sell them for drug money. What drug addicts do?

Scott Benner 46:02
Yeah. Are you saying I'm gonna, this might be ham fisted for a second, I gotta get through this thought. But are you saying that at some point? It it mimics I don't know, like someone being born with so many birth defects or so many medical issues that you think to yourself like, this is not this person's not equipped to live life even. And if you start thinking about that idea of like, maybe this is just a failed experiment, and it's not fair to them to be in this situation.

Jen 46:35
I think after I picked him up out of comas, so many times and Ted go to the hospital and psych Yeah, absolutely. And he had said to me himself, you know, I, I had complained a lot about it, like no one, this is hurting me so much to see you in the state that I see you in almost dead, like the time before he died that he went to the hospital, his body temperature was 87. That's dead, but he lived through it. And the doctor told me he's gonna have really bad brain damage and damage if it wasn't fine. Like he was fine, except for. He wasn't fine. But he probably lost some impulse control. But he didn't, you know, they said he was going to be a vegetable. And I'd said, Well, we're not going to keep him around as a vegetable. That's not what he wants or what anyone wants. But yeah, you're you're right. It was like it felt like that. Yeah. You know, now that you say that it felt it felt a lot like that. This is that I was doing more harm by keeping him around. And he even told me, Mom, stop saving me. Maybe it's my time to be an angel. And I thought

Scott Benner 47:41
he could that he could think that is one thing, but for you to hear it and to think, well, he might be right. That's another that's another thing like, like his, his existence felt cruel to him.

Jen 47:54
It did. Yeah, it did. Okay. I mean, the the existence with diabetes is cruel. The existence with diabetes and bipolar disorder with schizoid, fast, effective traits. That's mean. No, that's not. That's terrible.

Scott Benner 48:11
And then in that situation, the drugs are inevitable, actually, I mean, I've spoken Absolutely. I've spoken to enough people have have Bipolar to know that the drugs are are inevitable after that. So yeah. And you describe something that I don't want to skip over. And I also don't want to make you dig through it too deeply. Because it sounds painful. But the one thing I think maybe we're not talking about is that being lost on drugs doesn't exactly set you up for taking care of your blood sugar as well. So no, right. So not only is he kind of obliterated on what was the drug of choice by the end, methamphetamines. Okay. Not only is that happening, but on top of that wildly out of control blood sugars.

Jen 48:53
Oh, yeah. He became septic, probably five times and had to go to the hospital in the last year of his life. He tested positive, you know, he tested his blood sugar was in the 1500s. When they had him in the ICU, one of the times it took him three days to get it down. Below 700 I feel like it was ridiculous. He had sepsis, which is deadly. He had tested positive for tuberculosis. Like the kid made it through so much. It was done his body just the havoc that that wreaked on his body. You know, it was poor body and he I just looked at him and I think what a beautiful kid he was, and all the things that were going on inside of it the brain and and his body.

Scott Benner 49:50
If I give you a magic wand, you can lift away one of his troubles. I'm guessing it's the mental illness stuff, right?

Jen 49:58
And it's funny you say that because when he was cared, it was always the diabetes I'd take care of, it's always the diabetes, that I would take away. But once the drug addiction started, it was definitely the mental illness I would take away because that would help that would have that would have made it easy to recover from drugs easier to recover from drug addiction.

Scott Benner 50:18
This is uh, maybe, uh, maybe this questions, not clear, but or maybe it is, but if you take the bipolar away, do you think he was still an addict? Or do you think the drugs were a function of the bipolar?

Jen 50:31
I think the drugs were a function of the bipolar, okay, for sure. I don't think you would have tried the drugs at all, he was so impulsive as a kid. You know, if someone said This feels good, he would have tried it. And he was always that way. very impulsive.

Scott Benner 50:47
Gotcha. Okay, so anyway, geez, Jeff, give me a second. I don't know how you're living through it. Because it's, it's on top of me now. Oh, no, no, I'm okay. I don't want you to worry about me. It's just, I'm just listening very intently to what you're saying. And I'm thinking ahead and trying to imagine things. And it's a lot all at once. Yeah. So when do I know? When do I see you? Like, pop up in the Facebook page? Like, what? What got you there? Like, what made you find? Did you find the podcast first or the Facebook page? First,

Jen 51:26
I saw on the Facebook page first. And I think out of all the Facebook pages that I belong to for the for diabetes, this was the one that was that was good that had that was more real to me. And I posted something about Has anyone else ever struggled with Max meth addiction? I was reaching out this was the last time that he was in the hospital, Biddle. Um, was it maybe it was when he was in treatment, and he went to the hospital in Champaign, when he lived in Champaign, Illinois, and he was in treatment there. I had just said, you know, my son's in the hospital, he's has anybody else ever struggled with the meth addiction? What do you do? You know, what is this, you know, just reaching out. And the response that I got from people was one, so supportive, and to so much response, and I was just, I was shocked. Because most people kind of ignore that kind of thing. Most, especially parents with diabetes, they don't want to, they don't want to hear it. And they don't want to see that that could happen. They just, it's, it's too much to think about for sure. And that's something I thought about, I don't want to worry, parents of new diabetics by any means.

Scott Benner 52:40
That's my for you, I listen, I often have this thought, while I'm making the podcast and seeing all these people's lives virtually, that, you know, people, you know, babies are born every second, there's just countless numbers of them. And they're all going to go in slightly similar in slightly different directions. And some kids are gonna end up being alcoholics, and some kids are going to end up not and some kids are going to end up on drugs. And some kids aren't some kids are going to be incredibly kind. And some people are going to be mean and like blah, blah, blah, blah, right? And right. And we knew you have this idea when you're when your kids are younger, and they get diabetes, like oh, this is the thing they're going to be except those people still end up being alcoholics, drug addicts, nice people, etc. You don't you don't think of that when they're eight. And I'm, you know, I can hear when you're talking about Nolan even. I feel like you picture him sometimes. Like he's six, seven years old, when he's just nothing but possibilities.

Jen 53:38
Yeah, yeah. And I saw that throughout his life, I still till the till the day he died. Well, maybe a couple of weeks before I stopped, kind of, but he was doing so poorly. But I still had fleeting moments till the day he died of feeling. Hope for him. Yeah. And you know what a smart guy he is and what he could do, you know, he, he was very smart. And he was such a talented drummer and an artist, and just all of these things. And I thought, you know, he had just gotten a tattoo gun for his birthday. His grandma said, that's what he wants. Should I get it for him? And I said, Who cares? At this point in his life, getting whatever makes him happy.

Scott Benner 54:24
All right, in this rocket right into the ground. Great. Yeah, let's go for it. Right.

Jen 54:27
Yeah, basically, yeah. And he wanted to tattoo me and I was actually going to let him after he, you know, showed that he could do a tattoo on himself. And so he did a tattoo on himself, which he had done when he was younger anyway, with the kid made a tattoo gun out of a remote control car motor, like he was 10 or 11. When he did that he just was smart, but the deviant and because who wants to kid detect?

Scott Benner 54:54
What a weird, weird parenting moment my child has fashioned another device out of a device except pig likes to draw a picture of Scooby Doo on himself. So now I'm not sure, exactly.

Jen 55:04
Well, you know, he tried to he tried to tattoo the word love on his arm. But I confiscated his gun. So he only had the first two letters. So it said l o. So I called it his British tattoo, I'd say hello. He got so mad.

Scott Benner 55:20
So, so back to where you're at in that Facebook group, like you come in, you asked that question, what I saw, and I can't see the whole group, like, it's too big for me to, like, stay on top of but what I saw was a lot of just support for you. I don't think people had a lot of practical advice, but they were there was a ton of kindness

Jen 55:41
to absolute so much kindness. Yeah. Was how much time was

Scott Benner 55:45
that actually helpful for you are?

Jen 55:47
Absolutely, absolutely. And a lot of people saying yes, my sister's a drug addict, or this and that and just talking about people who had addiction in their family, it just opens up the conversation for people. And it's so liberating. Because you don't go around, you know, everyone's got that bumper sticker that says, you know, my son's an honor roll student, you don't say, hey, my son got into a really good treatment facility. I would, I would, but but they don't make that bumper sticker. But shouldn't they? Yeah,

Scott Benner 56:18
my son handles math fine. Just yeah, no way to do that. So so he gets put into treatment around the time you're on the Facebook group, and then gets out. And then it happens again, am I remembering that right?

Jen 56:32
Yeah, he came back to Sioux City. And he relapsed pretty quickly. And then he had, I want to say two or three more stents in the hospital.

Scott Benner 56:44
And he made these related stuff.

Jen 56:46
It was always for diabetes. But it was always because so what would happen when he would do the math and he would be up on meth for several days, and then he would go to sleep and people on meth sleep for several days at a time? Well, unfortunately, Nolan doesn't have several days to sleep because he needs to take insulin. So many times, I would kind of try to follow his pattern, I would go to where he was, I would give him insulin, I would find his insulin and give it to him. And, and that was another thing is insulin was never kept in a good way. You never knew if it was expired or what you know what you were, you'd give him whatever, right. And sometimes he would fight you and if he was going to punch me, I wouldn't do it. You know, I would say okay, we're gonna go I, I love you goodbye. But I would try pretty hard to get his insulin. And it's a miracle that he lived through that as many times as he did. So he would wake up and take insulin and you know, his sugar would come down and he'd be fine for a week or two. And then you'd start up again. So this pattern is hard to follow the pattern because it changed.

Scott Benner 57:57
Testing. Give me a testing.

Jen 57:59
Yep. Testing.

Scott Benner 58:00
Okay, sorry. So you were trying to chart you were trying to find a pattern you and you couldn't. So when you went and visited? Yeah. You were visiting him like in like, where he was held up using it, wasn't it? Was he even living on his own? Or was he bouncing around or

Jen 58:14
he was homeless for a while. And then he on his birthday? September 16, my mom let him move back in. He was already kind of staying. He would go there to shower during the day and stay for a really long time. And she would make him leave at night. There was our you know, we were trying to do the tough love, like you can't do drugs and stay here. But she just couldn't. And I'm glad because he died at home and not on a street corner at my mom's house. And yeah, so and I had been I was in Des Moines, so I was two and a half hours away. And then on the way home. I got a call from Patrick. And Patrick said, Nolan is cold. And he's not I don't think he's breathing. And I said, Okay, call 911. And I had just left the morning and had two and a half hours to travel. And I called Dennis who was driving in front of me my fiancee and told him what happened. I said, I think no one's gone. And this is something we just were, it was a matter of time, because he had just been in the hospital weeks before that we just knew. And you know, I hung up the phone and then I panicked and lost it and started crying. My youngest was with me and she started crying. And we were just kind of panicking all the way home. And then we got home and he was gone. The paramedics come and pronounced him dead. My mom lost her mind and you know, it just it was it was a big family and then we just kind of sat around and told stories about him and It felt peaceful.

Scott Benner 1:00:02
Can I? You You said you knew this was gonna happen. I remember you being on line once and saying that he was in a rehab, but they kicked him out or something and you were like he's going to die like you were you were positive like a week before this happened that it was going to

Jen 1:00:18
yes, this was this. This was not in rehab this that was in the coffee psych facility in the hospital, and he was supposed to go to inpatient treatment. And they had had him signed up to go to inpatient treatment, all the doctors, and I'm looking through the doctor's notes and everything, everything says inpatient treatment. Well, the very last day, the nurse practitioner who has done this before, several times, let him go. And I called, I heard that they were gonna let him go. Because he called and said, Can you pick me up? And I'm like, hang on, let me make some calls. So I called and I talked to Sarah, the social worker, and I say, Tara, she can't let him go. He's gonna die. He almost died. The last time he did she know, he almost died. And she said, Yeah. And I said, Does she know that he's going to die if she lets him go? And she was quiet for a second? And then she said, Yes. And I just lost it. I couldn't, you know, and then we picked him up. And I picked him up and took him to my mom's we talked to her, they decided he couldn't stay there if he was going to use and he said, he's, you know, he wouldn't stay there. And he was homeless for a couple of weeks. And that's, and then he came back to my mom's he was at my mom's for another. He was I suppose he was homeless for a week. And he came back to my mom for two weeks, and then that's when he died.

Scott Benner 1:01:49
Well, I'm very sorry that any of this happened.

Jen 1:01:52
Thank you. Me too. Of course.

Scott Benner 1:01:54
Can I ask you? Was there any sense of like, relief? That's might be the wrong piece?

Jen 1:02:01
Or no, yeah. It's not a wrong word. Yeah, there was lots of sense of relief with it. I mean, because he wasn't suffering anymore. You know, we had our first holidays. And not only, I mean, I missed him so much. And it was hard, and it was sad. But when you have a drug addict, the holidays are not good times. Because you're constantly worrying about what is what are they going to do? What are they going to show up and have a problem with? How are they going to, you know, he would become very, his sugar would get really high, and he would be extremely moody and mean, and yell and verbally abusive, and just these things that would just very upset me so much, even though I knew that it wasn't coming from his heart. It's just upsetting. And so there's been relief. But then there's been the extreme sadness, and then the the sadness for what his life should have been. Yeah. Came right. You know, I hate to say should because that's presumptuous. But I what, what it could have been or what, you know, why did he have such a hard time? Yeah. You know, and all these other kids get to have nothing physically wrong with them. You know, all kids with diabetes have such a hard time.

Scott Benner 1:03:19
Yeah. But then once it starts to, when all this other stuff on top of it, though. Oh, yeah,

Jen 1:03:25
absolutely. Absolutely. Is that fair? And I don't think life is supposed to be fair. I'm not. I'm not one of those people. But I mean, nice was a little more fair.

Scott Benner 1:03:38
A little more fair would be okay. Yeah. How long has he been gone now?

Jen 1:03:43
So he died on October 3 2021. So it'll be six months coming up soon here. It seems like longer. And so also, it seems like yesterday, too, sometimes.

Scott Benner 1:03:54
So has this. I've so I still barely don't want to ask you these questions. But you can. It's pretty open, has his passing made your other kids lives easier in some ways, and harder in some ways.

Jen 1:04:09
It's hard for them because they lost their brother and their friend. But it opened doors for sure. One, I've gotten to know them a little more now. So they kind of get their mom back, which is nice. We're learning to know each other a little bit now. Patrick is going to go to college now. He's never gone left town or anything like that, because he's wanted to stay home in case something happened with his brother. That was never asked of him. But it's just what you do for family. So yeah, some doors are opened and I think that Nolan would have been very, very happy to open those doors.

Scott Benner 1:04:52
Was he aware of the impediment that he was on other people's lives?

Jen 1:04:58
I think so. And he was definitely aware of how much he impacted my life. And he would say, don't do those things for me. He wanted independence, he wanted that. But we knew what would happen if he had it. And it did, you know, the more I pulled back, the more sick he got, and I but, but pushing more and taking more control would have made his quality of life so poor. Because what 24 year old wants to be taken care of by their mother,

Scott Benner 1:05:37
I think you're in a completely Listen, my understanding of all this is is, you know, obviously not yours. But I've now interviewed two people who have who are bipolar. And now have this conversation with you about your son. There's an after dark episode, I think it's back in the three hundreds, it's just called after dark bipolar. And it's okay. It's with a young man who has type one and bipolar. And I'm telling you that if his experience was even anything like your sons, I don't understand how you're supposed to. I don't understand how you're supposed to win. You know, so I couldn't see a path through it. When I spoke to him. I don't see a path to it. While I'm speaking to you. I think that you're either. I mean, I'm trying to figure out why you seem so okay. Right now. Or, I mean, how is

Jen 1:06:29
it? I think, I think that I'm okay. I guess, I guess it's who I am deep down. Like I said to the lady doing my eye exam, she had known me and known about my son and said she was sorry. And I said, you know, I got it late. Think of it this way, I have two amazing children living and I got 24 years was an amazing, brilliant human who taught me a lot. And I have to think of it that way. Because there's no any other way is very negative. And really, and don't get me wrong, there are times when all I am is a bundle of tears, and I just hate everybody around me. And I have to curl up in a ball and go cry by myself and write sad stories and just feel incredibly sorry for myself and miss my son. I have to do that sometimes. But then there's other days where I wake up, and I feel that way. And I I let myself do it for half an hour. And then I have to move on with the day. I do some yoga, I'll do some, you know, make some coffee and just read or meditate and then just go to work. Whatever. I I guess I speak about it, frankly, because it is Frank. It's It's It's facts. And missing tremendously most of the time, but I still feel him here. If that makes sense. It does.

Scott Benner 1:07:58
When you close your eyes and you think of him. Is he at a certain age?

Jen 1:08:03
Yeah, I think them at about 2021. Okay. Yeah, I think of him about 21. I mean, I miss him as a little boy, but I think of him is perpetually about 21 With just a little bit of scruffy facial hair, messy hair, making some dumb joke driving around with the dog in his car. You know, his best friend was that dog Tommy and he I'd be driving home from work and I'd see him pass me on the road, the dog sitting in the passenger seat like a girlfriend. It was just the cutest thing in the world. So

Scott Benner 1:08:40
was he able to have any personal relationships.

Jen 1:08:44
He had girlfriends. And he had a lot of long term friends a lot more friends than I knew about because his funeral is packed full of kids. He did have friendships and he had some girlfriends, but towards the end, I think the addiction and he even said Who wants to go out with a drug addict? You know? And I said, Well, yeah, I always hoped you'd find a girlfriend that would be like a nurse and want to take care of him. But I didn't I wouldn't want to do that to her either. Right? Because it's too hard.

Scott Benner 1:09:17
Do you think? How, how prevalent Do you think that the drug problem is in your area? In general? Oh, it's

Jen 1:09:26
huge. It's huge. There's a lot of it here. So cities, especially with methamphetamines, it's really big. And alcoholism is huge here too. It's kind of you know, it's a conservative conservative area of Iowa where there's a lot of very poor people. And then there's your middle class and then there's a lot of very wealthy people. The poor and the wealthy are make up a huge portion of the population. And it's anytime you have those economic issues you have people that are doing? I mean, some people use methamphetamine so they can work three jobs. And they do it for years.

Scott Benner 1:10:07
Wow. Yeah. And not to make a ton of money just to keep going.

Jen 1:10:11
Oh, yeah, just pay the bills. Right.

Scott Benner 1:10:12
It's sad. No kidding. It's sad. Jen, is there anything that I haven't asked you about that you wish we would have talked about?

Jen 1:10:21
I don't think so. I think you did a really good job asking good questions.

Scott Benner 1:10:25
Thank you. I've been looking forward in an odd way to talking to you for a while. Me too. Yeah, I just know that. As the as the day gets closer and closer, and I see your name coming closer to me on the on the calendar. I just I don't want to do a bad job is how I started thinking as it gets closer. Oh,

Jen 1:10:45
you do? Wonderful. You did great. I made me feel good. And no judgment. And I really liked that. And the stuff you said to me before, too, about this is real. This is real stuff. And you don't want to sugarcoat things like that. No pun intended.

Scott Benner 1:10:59
Yeah, I just think that, um, I mean, listen, I whoever would hear Nolan's story, and judge him. I mean, has no, no, no idea about health or, you know, like, it's just, there's only so many things that can get attached to you in the course of a lifetime, then they're gonna drag you down. Point. Like, I mean, yeah, they're not like, you know what I mean? Like, it's, yeah, mental illness is still completely misunderstood by some people. This this poor kid was, he was just taking the past that were available to him. And yeah, none of them are good. No, you know, it's not that there was a good path available, and he just decided not to take it. I just don't think his options were in any way going to lead them to where anybody would hope for him to go. Yeah,

Jen 1:11:47
I agree. Yeah.

Scott Benner 1:11:48
I'm glad you said that. No, it's sucks. But I mean, it does.

Jen 1:11:53
Get 24 good years,

Scott Benner 1:11:55
ya know, and I'm really impressed with your excuse me. I'm really impressed with your ability to, to focus on the good stuff. Thank you. Yeah, no, it's really wonderful. I want to wish you a ton of success. And are you taking care of yourself now? How's your time? I am. Yeah,

Jen 1:12:14
I am. Yes. I just passed my written out but the tests with no retinopathy so I'm, I'm happy with that. Because I'm old. And yeah, yeah, I'm doing I'm doing good. I finally got myself to You know, I'm on the league right now. And and I'm taking a lot better care of myself now, too. So, in honor Nolan, we always say that everything goofy that we do. We say it's an honor and all and and everything, you know, but there's a lot of things I do in honor of him too. So

Scott Benner 1:12:41
listen, I we didn't talk about him at all. But the bravest person that story is the guy that's dating you.

Jen 1:12:47
Yeah, I know. Tell me about it. He's He's a lucky guy. Dennis is a really good person. You know, he has a good you know, his dad was a type one. So he has a lot of understanding of that to

Scott Benner 1:12:59
really well, I'm glad you found. I'm really happy. Like it made me happy to think that you that you have somebody. Yeah,

Jen 1:13:05
you're the second person to say that today. So yeah, you're right. It makes me happy too.

Scott Benner 1:13:10
Yeah. I mean, you've been through a lot too. You deserve it. And sort of your children, I hope I hope Patrick goes off and, and builds a big life for himself. And I think lemon sounds like she has enough time to kind of process all this and, and find her own way. So

Jen 1:13:27
he's doing good.

Scott Benner 1:13:28
I'm glad for you.

Unknown Speaker 1:13:29
I thank you so much, of course.

Scott Benner 1:13:40
Once again, a big thanks to Jen for coming on the show and sharing Nolan's story. I also like to thank touched by type one.org. And remind you to head over there and check them out. And the Contour Next One blood glucose meter, which you can learn more about it contour next one.com forward slash juicebox. There's also links in the show notes of your podcast player, and links at juicebox podcast.com. To these and all the sponsors, head over to t one D exchange.org. Forward slash juice box and take that survey. And if you're interested in more after dark episodes, I can tell you about them. Let me wait The music's just wait one second.

There are so many more episodes in the afterdark series. Couple of ways. You can find them either at juicebox podcast.com, scroll down, you'll see them there. Or you can go to the private Facebook group Juicebox Podcast, type one diabetes, go to the top of the page, the page or the top of the page, click on the featured tab. There's some featured posts there. One of them says Juicebox Podcast series. And there's a whole bunch of lists a whole bunch of lists. There's lists of lists. No seriously, there's these really great little graphics that break down different series. For example, there's some special episodes. There's the Pro Tip series, the quickstart guide how we eat diabetes variables. Scott and Jenny episodes, how to Bolus for fat and protein. And right now, there's so many great lists here. Oh, there's a whole series about pregnancy, thyroid, and then after dark, this is a episode. What do we say at the beginning? 677? No 678 of the podcast, but it might be like, oh, gosh, let me I can read them to you. First afterdark was it episode 274 is about drinking to 83 was about weed 305 trauma and addiction. 319 was sex with type one from a female perspective. 336 was depression and self harm. 365 was sex with type one from a male's perspective 372 divorced and co parenting 380 For bipolar 393 bulimia and depression 399 heroin addiction for 22 is called afterdark Ami. 450 psychedelics for 62 Sexual Assault PTSD for 72 living with bipolar five await adult child of divorce 531 diabetes Complications 545 Eating Disorder 558 life struggles 577 50 years 585 ADHD cocaine and abandonment. These are the titles 606 childhood trauma 618 sex worker 627 Male disordered eating 651 recovery and today of course 678 Nolan story. Check them out. I think they're some of the more brave episodes of the podcast. Thank you so much for listening. I'll be back very soon with another episode of The Juicebox Podcast.

#677 Defining Diabetes: Hypo and Hyper

Scott and Jenny Smith define diabetes terms

Scott and Jenny Smith define diabetes terms In this Defining Diabetes episode, Scott and Jenny explain Hyper and Hypo.

You can always listen to the Juicebox Podcast here but the cool kids use: Apple Podcasts/iOS - Spotify - Amazon Alexa - Google Play/Android - iHeart Radio - Radio Public or their favorite podcast app.

+ Click for EPISODE TRANSCRIPT

Scott Benner 0:00
Hello friends and welcome to episode 677. It's a short one, but it's good

Hello, everybody on this episode of The Juicebox Podcast, Jenny Smith and I will be defining hyper and hypo as it relates to all things, not just diabetes. Please remember, while you're listening that nothing you'll 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'm going to just ask you the briefest of favors. If you are a US citizen who has type one diabetes, or is the caregiver of someone with type one diabetes, please go to T one D exchange.org. Forward slash juicebox. When you get there, join the registry take the survey takes fewer than 10 minutes, I would consider it a personal favor T one D exchange.org. Forward slash juicebox. If you're enjoying the Juicebox Podcast, please share it with someone who you think might also enjoy it. If you're loving the defining diabetes series. There are so many of them to choose from right there in your podcast player, where diabetes pro tip.com. This episode of The Juicebox Podcast is sponsored by us med. US med is a place where you get diabetes supplies, and they do it. Well they do it better. They offer you better service and better care than you're accustomed to getting. All you need to do to get a free benefits check is to go to us med.com forward slash juice box or call 888-721-1514 Hi, Jenny. Hi, Scott. How are you?

Jennifer Smith, CDE 2:05
I'm fine. How are you today?

Scott Benner 2:07
Good. Have you seen the little animations of you and I talking on Instagram and and Tiktok yet?

Jennifer Smith, CDE 2:14
I have I saw when you originally showed me what was going to be there but I have not seen recently. Because I have to admit I'm not a tic tac, or Instagrammer.

Scott Benner 2:26
So the person making the videos Maggie, who is a great young artist whose sister has type one diabetes. She has now added what I'm gonna call googly eyes to us. So while we're talking now the eyeballs move around inside of the eyes. Oh no, I'm absolutely like enamored by it. So

Jennifer Smith, CDE 2:43
I'm sure that if I showed it to my boys, they would probably think it was the coolest thing in the world to see

Scott Benner 2:47
your voice coming out of a cartoon. Yeah. Oh, yeah. All right. Well, you should check it out. I don't think you should get on Tik Tok because I have to tell you, it really is a time suck. Like it is it is the scrolling. Like I got it just to put this stuff, you know, for the for the podcast app. And then I'm like scrolling and I'm like, oh my god, I can see how people get lost in this. It's fascinating. So

Jennifer Smith, CDE 3:06
yes, I have stay away. I have more things that I need to do then.

Scott Benner 3:11
Yeah. If you're not on Tik Tok, you're doing okay. I think I was hoping today that we could define something that I mean, in all honesty, I had skipped over we I'd made a list and thought this isn't necessary. But it is. So we're going to do it. I want to define hypo and hyper just those words, and then we'll attach them to diabetes, and a couple of other things. So you know, everybody understands, again, Isabel helping me with the Facebook page, she said, I know this seems basic, but you really could use an episode on what hyper and hypothyroidism is people ask especially new newly diagnosed people, we don't have anywhere to send them. So here we are. Great. Awesome. Okay, so let's start like super simple, right? We're just going to use the dictionary. Hypo is a noun, and it means

Jennifer Smith, CDE 4:11
under or beneath a level of where you want to be. Right? And, yes, I mean, hypo hypoglycemia, hypo thyroid, hypo, many other medical terms that come along with hypo, it is like, it's low, right? It's under where a level of comfort would be.

Scott Benner 4:35
I also should have said and this is going to be a good indication to all of you that I stopped paying attention to my English teacher in about seventh grade, but it actually can be used as a verb as well, but we mostly think of it as a prefix, under beneath down less than normal, in a lower state of oxidation, for example, in a low and usually the lowest position in a series of compounds. So glycemia You know, I didn't think of this but darn it. Let's define. Let's define glycemia for a minute. Why not? I don't even think glycemia is a word, right? It is the presence of glucose in the blood. Now I'm learning. Yes. All right, like this podcast, okay? Jenny, then you

Jennifer Smith, CDE 5:21
can then you can put them together low presence of glucose in the blood. Yeah. Jenny, I hypoglycemia.

Scott Benner 5:29
I was gonna say I would listen to this podcast. Okay, so glycaemia the presence of glucose in the blood. So hypo, beneath normal, less than normal, presence of glycine, of glucose in the blood, and then hyper, which, if you've anyone's ever had a hyper kid, you know, this won't sound crazy, highly excited, extremely active, excessively excessive. That is or exists in a space of more than three dimensions that one doesn't really like It's like hyperspace. Oh, yeah, I really should have paid attention in school. This is all very interesting. I feel like an idiot. Okay, so but excessive, is where we're going to ride on this. So hyperglycemia excessive presence of glucose in the blood. That's it. Now, why somebody couldn't just call it high blood sugar and low blood sugar. You know, smart people, doctors, they fancy.

Jennifer Smith, CDE 6:25
Right? Well, and they're just medical terms, right? I mean, hyper and hypo, even in the sense of other medical conditions that carry that same prefix, if you will. They're just a medical term, rather than saying high and low blood sugar or high and low blood glucose even I also think, just glucose and sugar, right? I mean, when you say, my blood sugar is this, some people say my blood glucose is this, it's just another word for the same thing.

Scott Benner 6:54
Do you have a preference? Personally, when you write it out? And you know, someone else is gonna say it? Do you think blood glucose or blood sugar? How do you write it out?

Jennifer Smith, CDE 7:02
I abbreviate the G, because that's my quick way to type up something.

Scott Benner 7:08
After writing blogs, for so long, I did the same thing. But in the beginning, I had this like this blood sugar sound. I don't know. Like, I like this is not sound, I don't know, appropriate or something like that. But I don't think of it now. It's however it comes off my fingers when I'm typing. Like when I'm talking to somebody, I don't think of it one way I don't care. I

Jennifer Smith, CDE 7:28
guess if you, if I think about when I write about it, when I'm writing more professionally, I use the term blood glucose. And when I'm writing more from just a general kind of public, I typically use blood sugar. Okay, not that people don't know what glucose is, especially within the diabetes realm. I just think that blood sugar is often more what we say. Yeah. And so it's more readable. I don't know if that makes sense.

Scott Benner 8:02
Yeah, I think it just makes it feel more affable, honestly, just sure available to people. As an example, and we're not going to turn this into a third grade English lesson, but hypothyroidism is a condition in which the thyroid gland doesn't produce enough thyroid hormone. So back to hypo, low last, etc. Hyperthyroidism, the overproduction of a hormone by the butterfly shaped gland and the neck called the thyroid. Excessive too much. I just pulled up a couple of other words to make the point that it's not always about. It's not always about medicine. Hyperbole, as an example, is an exaggerated statement. We're claimed not meant to be taken literally hyper hyper. Right? Is the prefix. My, my last thought is just to get away away and Jenny used to be a nurse. Right, Jenny? What is hypo perfusion?

Jennifer Smith, CDE 8:56
Good to correct you I wasn't a nurse, or I'm not a dietician.

Scott Benner 9:01
Sorry. It's the same thing.

Jennifer Smith, CDE 9:05
Oh, well, you know, if I had thought that when I was going to school, then I probably would have ended up being a nurse. But yeah, so that different,

Scott Benner 9:15
I make a suggestion. Sure. We'll have to add CDE to the defining diabetes series.

Jennifer Smith, CDE 9:23
That would be great because you can have many credentials that precede CDE, which is actually not CDE even anymore. It's now c d c e s certified diabetes care and education specialists to make it even more complicated than it ever was.

Scott Benner 9:40
Have you given over to that yet? Because you you said you were gonna fight it in the big guy

Jennifer Smith, CDE 9:44
in credentialing just in terms of my signature and the way that I you know, put, again, sort of publications and that kind of stuff out I do. But I still call myself a CDE because I that's just like, what I've been long term.

Scott Benner 9:59
I have to Say I like these. Oh my gosh, I've gotten too hot tea and it doesn't matter. Oh no. I'm just gonna start drinking scalding water. When I'm recording from Elon just, I'll drip a little lemon in it and pour down my throat. I was gonna say I like the free flowing pneus of our conversations, because my just miss speaking for a second, immediately made my brain go, Hey, why are we not defining this stuff for people? Because people all the time, say, who just see today? I don't know, I saw the lady. You don't I mean, like, the doctor is the doctor, an endocrinologist? I don't know, what's the woman I don't know. Like, like, you know, she writes the prescriptions. It seems like she's got a medical degree.

Jennifer Smith, CDE 10:37
That's I saw these people. And they told me to do this. And I don't necessarily know what they are, you know, in fact, in terms of like that defining of even clinicians, many endo offices now sort of transition often on between, you see the Endo, you see the nurse practitioner or you see the Endo, or you see the PA, a physician's assistant, right, and you go back and forth. So it's not every three or four months, you're seeing the same Endo, you may see them only twice a year and in between, you actually follow up with the nurse practitioner, the physician's assistant, because that's the time that they have.

Scott Benner 11:13
So my brain like, I know, you have a firm background in nutrition. Like I understand all that. And I guess my brain just was like, well, she's the CDE she must have had to have been a nurse in the middle of it. And now so Okay, so we have more stuff anyway. Just

Jennifer Smith, CDE 11:27
remember things in nursing school that I was like, Yeah, I don't want to do that. I don't want to ever ever do that to a person. So no, I'm not going to be a nurse.

Scott Benner 11:37
Well, then just for fun.

Jennifer Smith, CDE 11:38
I I very much appreciate the nurses who do and can do those types of things. But I That's not me. I can do blood. You could bleed all over me. I could do wounds, weird looking gashes.

Scott Benner 11:51
Where's the line pee?

Jennifer Smith, CDE 11:53
Oh, the line is mucus. Oh,

Scott Benner 11:57
I wish you could have saw the face Jenny just made we should make it a poster. I just sideways or tongue came out or one of her eyes went one way she's like,

Jennifer Smith, CDE 12:05
yes. No, I was I was an ICU dietitian. So I did like tube feedings and IV nutrition and all that kind of stuff. And I would have to move away when they were doing like suctioning of patients and stuff. I like the noises and not for you. Not for me. Nope. My Oh, come back. Thank you. My wife

Scott Benner 12:27
is like three clinicals away from being an RN. And I mistakenly got her pregnant before she could finish off. So I do remember that she never got back to it. But she even said that. She thought by the time if she would have finished she's like, I don't think I could have like actually helped people. Like it just was Yeah, her vibe. And it wasn't about the people. It was more about the that stuff. Okay, but anyway, just for shits and giggles Do you know what hyper perfusion is? Now that I brought it up? Because if not, I gotta tell people.

Jennifer Smith, CDE 12:57
What and why? I'm curious actually. Why?

Scott Benner 13:00
Because it had the word hypo in it. And I thought I wonder if anyone just randomly know what this is? Oh,

Jennifer Smith, CDE 13:05
well, it has to do with like blood flow. It's hyper. Hyper is more and hypo is a reduction in the amount of blood flow.

Scott Benner 13:15
This is why you're listening to the podcast because Jenny knows stuff about stuff she doesn't know about. Hypo fusion has nothing to do with diabetes, but it describes a reduced amount of blood flow. There you go. You can't trust somebody who knows stuff. They're not supposed to know who you're supposed to trust.

Jennifer Smith, CDE 13:29
Correct. There you go. Well, thank

Scott Benner 13:31
you so much for doing this. I

Jennifer Smith, CDE 13:32
really You're welcome. Absolutely.

Scott Benner 13:36
That was good. That was hilarious. Actually. It's always fun. Good time. All right. hyperperfusion. I'm getting rid of tabs on my

Jennifer Smith, CDE 13:43
Yeah. Are we stalled for a second? I need to I think I forgot my orange link in my kitchen. And I need to go grab it because my loop is red right now. We'll be right back.

Scott Benner 13:54
No problem. While Jenny's off getting her orange link. I'm going to tell you about today's sponsor, US med

just the other day, I had Omni pod send Arden's prescription for Omni pod five over to us med. All of this happened without problems. That's what we want. Right? Nice and easy access to our supplies. US med offers that with their white glove treatment. US med accepts Medicare nationwide and over 800 private insurers. They carry everything from insulin pumps and diabetes testing supplies to the latest CGM, like FreeStyle Libre two and the Dexcom G six. US met always provides 90 days worth of supplies with that fast free shipping that I've been telling you about. If you want better service and better care than you've been accustomed to getting with your other suppliers, check out us med. They've helped over 1 million diabetes customers since 1996 are the number one rated distributor index com customer satisfaction surveys, the number one specialty distributor for Omnipod dash, the number one distributor for FreeStyle Libre, and the number one fastest growing tandem distributor nationwide. US med get your free benefits check right now. Us med.com Ford slash juice box or call 888-721-1514. There are links to us Med and all of the sponsors in the podcast player shownotes that you're listening in right now. Or at juicebox podcast.com. And don't forget to take that T one D exchange survey AT T one D exchange.org. Forward slash Juicebox. Podcast support T one D exchange, you're helping people with type one diabetes, and you're supporting the Juicebox Podcast, keep the show free and plentiful by supporting the sponsors.

on next week's defining diabetes, Jenny and I will be defining all of the different types of diabetes. And there are more than you think. To find a list of all of the defining diabetes episodes, go to Juicebox Podcast type one diabetes on Facebook, it's a private group for people who listen to this podcast. And right there at the top of the page. You click on a little tab called where the is it God, I can never remember the name of this. I'm going to curse. I'm going to curse. I don't want to curse just trying to finish this ad and I'm done for the week when I get this done. Like I actually get a day off tomorrow. I mean, I still have to record but I don't have to edit and I just want to tell you the name of this. Featured, you go to the Juicebox Podcast type one diabetes, it's a private Facebook group. Almost 25,000 people in it. They use insulin, they chat with each other, they help each other. And under the featured tab at the top. There's lists of episodes in different series, including the defining diabetes episodes. So if I didn't sound too crazy, just then maybe you'll go check them out. I just didn't want to curse. That's the end of my week and I had knee surgery. I'm feeling okay, but I'm not supposed to be sitting here right now. I'm supposed to have my flights. This is not your problem. Just go find that. Just go find it. It's Juicebox Podcast type one diabetes. It's a private group answer a couple questions you get right in. It really is a magical place. I'm not kidding

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

#676 Dexcom G7 is Getting Close

Jake Leach Executive Vice President and Chief Technology Officer at Dexcom is back to talk G7.

+ Click for EPISODE TRANSCRIPT

Scott Benner 0:00
Hello friends, and welcome to episode 676 of the Juicebox Podcast.

Today on the Juicebox Podcast, I don't know why I'm talking like this. Let me start over again. On this episode of The Juicebox Podcast, I'll be speaking with Jake leech. Jake is, you know from Dexcom. He's been on the show a bunch of times. And he's here today to talk about g7. It's a short episode, but it's full of good information. If you're looking forward to the Dexcom g7, you're going to like what comes next. While you're listening today, please remember that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, always consult a physician before making any changes to your healthcare plan, or becoming bold with insulin. If you are a US resident who has type one diabetes, or is the caregiver of someone with type one, your answers to simple questions are valuable. Go take the survey AT T one D exchange.org. Forward slash juice box in fewer than 10 minutes, you will help people living with type one diabetes while you're supporting the Juicebox Podcast.

This episode of The Juicebox Podcast is sponsored by us Med, get your diabetes supplies from us med find out more and get your free benefits check by going to us med.com forward slash juicebox. Or you can call I love reading the phone number. It brings me back to my childhood when I watched television, I was who my parents were the television. And then the ad was nevertheless ready. 888-721-1514 That's 88721514 Call now. That is how every ad when I was a kid ended? Was that the phone number that they said call now. Anyway, if you call that number, or you go to the link, you can get a free benefits check and get started with us, man. I'll tell you more about them later. I actually just switched over Arden's on the pods to us med.

Jake Leach 2:25
We're working on getting g7 approved, sorry about being late. It's not a stupid excuse. That's literally what I was on the phone talking about. That it's approved, don't take that as long as the record is more of like three questions. All

Scott Benner 2:42
right, hold on a second, I can't get my light to come on. So I'm going to be in the dark. But I'll still be see if I can throw a secondary light on. No worries. Let's see. Hey, how are you? Good, man. How you doing? I'm on okay. So is that really what you were doing? You weren't just like in the bathroom? And you couldn't get here on time? What was that? No,

Jake Leach 3:08
no, literally, I was I was on the phone with our team, we're, you know, back and forth with the FDA, they ask a question and you answer it, then they want some more clarification you answered. And I mean, it really comes down to there's just so much in these filings that they you know, they can't possibly read all 38,000 pages. So they just kind of pick areas that they want to spend some time with. So we ended up helping point them to the right places. And so it's very, it's really interactive. It's great. And very thorough, but it takes a little time.

Scott Benner 3:36
Yeah. Does the integration with algorithms change your submission? Or is that on the pump person side?

Jake Leach 3:42
That's on the pump side. Yes, the pump side, they basically once we get G seven approved as an IC GM, then they quickly do their submission. They've a little bit of validation work they have to do on their side to show that they have compatibility with the new G seven system. But it's all of this is based on the work that FDA has done to do the I CGM and the AI Controller it really facilitates quicker approvals. If if they wouldn't have done that, it almost likely wouldn't, you'd have to run a new study with every generation of technology instead of trying to make them more compatible. So it's pretty it was good forward thinking on the FDA has purposely set it up. So yeah, each of those pump companies will have a submission right after we achieve seven approved that they'll have to go through to get the g7 approved for use with their automated insulin delivery systems.

Scott Benner 4:31
Do you think that I'm going to ask you to speculate Do you think that's something they have ready to go and they're just waiting for you to get your Okay, so they can submit theirs? Or is it a process that like starts at day one when you

Jake Leach 4:40
know No, there are both both of them in tandem and insulet are already working on g7 integration. I've already seen prototypes working of their systems so they you know, they're not ready to like file it right away. They might be by the time we get to seven approval we'll see you know, because you know, probably a little More review time on D seven. So we'll see. Hopefully, I mean, they're moving as fast as they can. We're supporting them in every way to help them move as fast as possible. But there will be some time where people will stay on G six, if they're on those systems before they can move to G seven. What was I'm going to jump around a little bit here. Do you mind? No, I'm no problem, man.

Scott Benner 5:19
Good to see you got approval overseas already? Yeah,

Jake Leach 5:24
we got to see Mark last last month. And you know, we'd like to move fast. So we already moved into a limited launch. So g7 is in the hands of customers in the UK right now. That the recent attd show that just is wrapping up in Europe, they, we had a number of clinicians that have used the product as well as some of their customers. And they shared a little bit feedback, feedbacks been great. No surprises. Everyone loves the smaller size, easy use new app, the grace period, the 30 minutes start up, the more configurable alerts. For convenience, there's just there's a whole lot in g7. So pretty, everyone's pretty happy with it. We're happy with how it's going. We do these limited launches just to test, you know about the product, but also just our systems technical support, make sure we know how to support this, the last thing you'd want to do is go big and then have an issue that while it's fit, correctable it's kind of hard to correct when you're hurt. Yeah. At the scale we're at. So you want to get it going a little bit slower at first,

Scott Benner 6:23
was that the first time that that's happened that you've gotten something moving overseas before in the US on a new products?

Jake Leach 6:30
No, it's you know, there's been lots of different reasons over time where this has happened. I'll give you one example is g4 actually was approved first in Europe, with the Animus pump of all things right. So that was actually a previously approved version. So that was, you know, then we ended up redesigning some of the GE for for a product, he made it g4 Platinum, and then launched it. This one was just the case here is that the clinical trial that we had to run for the FDA is a little bit larger and takes longer than we the one that is required for the regulatory agencies in Europe. So we purposefully ran two separate trials, we wanted to get the product out as fast as we could. So we ran a trial for Europe. And we ran a separate trial for the US. And we submitted the European submission while we were still running the US trial.

Scott Benner 7:21
Okay. Can I flow through some questions real quick? I think they're going to be kind of kind of quick ones? No, of course. Excellent. I have these are from people who listened to the podcast who want to know what they want to know. I'll, I'll start with, they're wondering if the new form factor of G seven cuts down on compression lows. I've asked you guys this question in the past? And the answer has been We hope so. But I was wondering if you have any more data? Yeah, we don't, I don't have anything valid validated to say, you know, if

Jake Leach 7:51
you place the sensors in the exact same spot, and you lay on it in a, you know, statistical format, does it reduce compression, those, I don't have that, but what we have seen is that with the size of g7, it can be worn, you know, in slightly different locations on the particular the arm, where you can kind of move it around that because the sensor probes shorter, it's also more comfortable in the arm. So people have found like they can wear a little bit lower and there are a little bit higher. So we have seen people that they experienced professional have figured out how to move it around a bit so that they don't don't have it, but they still can happen on g7. But from a statistically significant perspective, I don't have an exact answer. Is it less, but it's certainly more comfortable to wear? Because it's so much thinner.

Scott Benner 8:36
Yeah. Hey, you just mentioned the sensor probe, does it go on in on a different angle than the G six?

Jake Leach 8:42
It does? Yeah, it goes straight in. It's a 90 degree angle versus the 45 degree angle. And what we were able to develop sensor technology within our electrodes that allow us to have a shorter sensor probe. So the depth is actually slightly shallower than G seven or G six. So G seven shallower than G six. And it's also less sensor probe under the skin because it's straight in versus that 45 degree angle.

Scott Benner 9:04
Oh, no kidding. So the G six is it? Am I ready? Test my memories at 13 millimeters? Yes, yes, exactly. I can't believe this is how long I've been doing this chicken. Bird right off the top of my head. What about the g7? Is it? Do you know the measurements? six millimeters? six millimeters? Oh, that's amazing. Oh, cool. Is the change in size going to impact the cost at all? I think what people are asking. Moreover, as do you see yourself as a competitor with libre or a different? Are you in a different space than they are?

Jake Leach 9:38
Well, actually, Scott, that is a very good question. So we're definitely looking at a portfolio of products. So in Europe, we've launched a new product called Dexcom one which is going to be in same the same markets as our G seven product as well. Usually six but we'll be replacing G six with G seven. The ideas There's certain in certain countries, people have access to GS six, but they may not. There's some people that don't have access to G six. So for example, right now, it's some countries categorize if you're at higher risk, meaning maybe a pediatric whose parents are taking care of their diabetes management or someone who's hypoglycemic and aware, they absolutely have to have alerts and alarms. Those folks have access to G six, there's a large population of people that don't have access to G six, they have access to other technologies. And so what we did was with Dexcom, one, we brought in the product, it's doesn't have all the same functionality as G six. It's a simpler product, but it still has alerts and alarms, it's still all based on the same accuracy, same hardware platform with a new mobile application, the whole purpose of that product is to help grow our business internationally and give more people access to Dexcom CGM. And so that product, you know, just over the past year, we've we've opened up over a million new people who have access to Dexcom that have never had it before around the globe. So that and then we're kind of just starting with that we've launched in a few countries with Dexcom. One, and we plan to launch in quite a few more. But, you know, getting back to that question around cost, you know, g7 is not intended to be more expensive, or at a higher out of pocket for people, it's, you know, part of people's cost of the product is have their insurance coverage. But you know, there's 30% of our customers don't pay anything. And you know, the other 30% pay quite a low copay, I think it's less than 30 $60 per month. So it's, you know, g7, one of the things about launching it is there's some coverage that we have to get for the product to ensure people can transition from G six to G seven, or get coverage for D seven. So there's some steps we take once we get FDA approval.

Scott Benner 11:51
So for people who are out of pocket, though, will there be an increase from cheese?

Jake Leach 11:55
I don't believe so. Yeah, I'm not. I mean, I'm not deep into the pricing discussions, but I don't expect it we don't have any expectation that we're increasing price for QBO. Customers,

Scott Benner 12:06
okay, great. When, eventually, one day when on the pod five and control, like you are compatible with G seven, and they're through FDA and everything, this is a big, I know this isn't really a question for you. But I got asked so many times, today, I'm going to bring it up anyway. If someone set up with GE six on one of those systems, and they move to G seven is it going to just be as simple as going into a setting and telling it I'm using the G seven now not the G six

Jake Leach 12:33
there, you know, each each, the architecture, these systems are a little bit unique, right? Each one is, you know, the Omni pod has the algorithm on on top of the disposable, you can look at control IQ, it's built in to the pump. And so you take control IQ for an example, when you want to upgrade to G seven, there'll be a firmware update that's required on the pump. Similar to my expectations be similar going from Basal IQ to control IQ, and they did the you could do the update is going to be something similar to that is what I would expect. And, you know, with Omnipod, it's likely a new firmware version on the pod, right that can communicate with G seven. So I think it's gonna be you know, the whole point is it's very easy for customers to do it. It's not like you have to get a whole new system. It just you know, it's about making these systems upgradeable. That's the whole point of trying to be able to keep up with the innovation that's going on in you know, sensors AI D they're all on slightly different timelines, but you want them to come together. So Right. That's why the FDA is approach with a CGM was such a good approach

Scott Benner 13:37
of let's see, oh, people want to know about overlaying session time. So we'll with g7, will there be a possibility of putting on a new one while you're still wearing an old one?

Jake Leach 13:47
There? There is completely you can do that if you want. With the 30 Minute startup time, though, it's it's not quite the same challenge that you're trying to solve for. Because right now, you know, I get feedback from customers that the two hours that they don't have the CGM data while it's doing its warm up at the initial beginning session is a terrible time because you know that the ID systems are not working or they're not getting that data, they're flying blind. So you do have a 30 minute startup with G seven, G seven starts the sensor session immediately upon insertion automatically you don't have to do anything so it just starts Okay. And you get into 30 minutes later I get data. Literally you get data Yeah, accurate, reliable data.

Scott Benner 14:35
US med is a place where you can get your diabetes supplies, they offer you white glove treatment. US med is a number of things. I'm gonna rattle them off for you right now ready, the number one distributor for FreeStyle Libre systems nationwide. They are the number one specialty distributor for Omnipod dash, the number one fastest growing tandem distributor nationwide, the number one rated distributor index com customer status faction surveys. How about that? They have served over 1 million people with diabetes since 1996. They always provide 90 days worth of supplies and they have fast and free shipping. That's right us med carries everything from insulin pumps and diabetes testing supplies to the latest and CGM, like FreeStyle Libre two, and the Dexcom G six. Here's a little personal information for you that you really have no business knowing, but I will tell you anyway, I just had Arden's prescription for Omni pod five, sent to us Med, they accept Medicare nationwide, and over 800 private insurers, you should check out us Med and find out why they have an A plus rating with the Better Business Bureau. How do you do this? Well, you can do it with a link us med.com forward slash juice box or by calling this special number just for Juicebox Podcast listeners. That number is 888721151 for us med wants you to get your diabetes supplies, they want you to have a better experience than the one you might be having now with whatever company is sending you your supplies, switch to us Smith. But also remind you to go to T one D exchange.org. Forward slash juice box and fill out the survey. And lastly, that the links to us med T one D exchange and all the sponsors are available in the podcast player that you're listening in right now. Like go in there. There's like shownotes, they're right in there, or they're available at juicebox podcast.com. Super important. When you click on the links, you're supporting the podcast if you love the podcast, if you love how much content there is, and that it's free for you. Supporting the sponsors and sharing the show with others are the two quickest way is to keeping it going.

Is there is there any kind of wonkiness in the first 24 hours like some people see what G six

Jake Leach 17:03
the all, you know, my experience with CGM technology over you know, last 20 years is that always the first day, and there's more a little more variability in that day at times some people experience it more than others, some people, you know, experience once in a while. And it really just comes from the form of kind of wound response from inserting a sensory of a brand new sensory insertion site. There's a whole lot that's actually going on from a physiology perspective. And so that does create variability in the first day. And so the performance is still really good. But yeah, you can have some of that, you know, signals that generally they run a little lower sometimes, you know, that give you a bit of a dip in the sensor signal. But still still accurate and reliable, but not, you know, not perfect. It's clearly the meds on the later days are better than the initial days.

Scott Benner 17:58
Things I think we know already were times 10 days.

Jake Leach 18:00
It's actually 10 and a half days. Okay, there's a there's a new feature called grace period. And

Scott Benner 18:07
we talked about that before. I have not spoken anything about it yet. No. So yes,

Jake Leach 18:11
we have this new new feature on G seven that was basically designed based on feedback from customers saying, you know, when the sensor stops showing data exactly 10 days after I insert it, it's not always the most convenient time to change my sensor. So sometimes I have to stop my sensor session earlier to replace the sensor, because you want to do what's convenient. So the the 10 and a half day we're on g7. The grace period, which is 12 hours is basically once you get to your 10 days from sensor insertion time, so let's say you did at four o'clock in the afternoon 10 days later at four o'clock in the afternoon and it's saying hey, we're going to time your sensor off we actually want you seven extend it we notify you saying hey, your sensors expired, but you have another 12 hours to find a time that's convenient for you to replace your sensor.

Scott Benner 18:56
Wow. Do you have anything that will make my daughter actually pay attention to that message when it pops up and says a little arm that'll come out of it and like knock around their house or something like that? I say change your sensor art and what happened? I don't know. It told me something earlier but I didn't read it. That was great. Thank you

Jake Leach 19:17
every time you go every Yeah, we're trying.

Scott Benner 19:21
I know you guys have been doing I know that you've been doing testing on adhesives because listeners of the podcast through T one D exchange have gotten opportunities to be in trials for but have you got any? Any results from that yet? Or people are asking a lot about adhesives. We have

Jake Leach 19:38
Yes. So a couple couple things on adhesive. So G seven has a new adhesive. It's different than G six. It looks similar, but it doesn't have some of the compounds that we've identified that can be irritants for some people. So the within the adhesive of G six we've through those tests that we were really happy that people were supporting those trials and participating in them, and wearing all the different types of patches, because it really did help us learn about some of the compounds that can cause irritation. They're not identified as irritants, but they ultimately can become them for certain people. So g7 doesn't have those in it. And actually, with G six, we've been working on a version of the patch that doesn't have those same compounds in it, a little bit of its proprietary between us and our patch supplier. But we basically are very focused on ensuring that we have as little irritation as possible, while still sensitive, having sensors last you know, that he here to the body, it's kind of like this little bit of a balancing act at work. But we've learned quite a bit over the last year and a half with those studies. So appreciate everyone participating in those that can and people will see it in the products, which is seven in particular, did it become more easy? Because the product is smaller? Does the adhesive not need to be as strong because it's not holding on as much weight? Or did that not? No, it was just it's just basically using some different types of adhesives and not including the same ingredients. And also some of the manufacturing processes we use are different with G seven that also helped enable using some different adhesives, they literally if you look at it, you can't tell the difference. But the g7 adhesive is, is strong. It's not less strong than G six. You're right, though it's quite a bit smaller, which is nice. Yeah. And then also with every g7, we supply the over patch for use if folks want to it's automatically placed in the box. And so you'd have to call for that separate

Scott Benner 21:39
burners, DME, durable medical, pharmacy, Medicare, how is that all going to be covered?

Jake Leach 21:48
So generally, for GCC, so you're basically asking me when we transition to g7? Yeah, well, there's a basic Yeah, the it's a bit of a, it's a bit of a process, the DME and Medicare usually moves a little faster than all of the pharmacy contracting. So you would expect that DME coverage would come quite quickly upon FDA approval, and then the pharmacy contracts will work their way over time. But we are working on programs to ensure that customers can get G seven as fast as they can. So more to come there. But it does, it does take a little bit of time to get the G seven into everybody's systems in the pharmacy and available for every all the patients that have G six today.

Scott Benner 22:29
Okay, well, G seven, show any improvement over sensor errors and not lasting 10 days for people.

Jake Leach 22:36
Yeah, it's, it's similar. It's similar in terms of g six. But what we have seen is that, and I know a lot of customers do wear G six in their arms. But we are seeing with G seven quite good sensor longevity when worn in the arm. And so if you look at the clinical trial results that we've published, we get better performance in the arm that we do the abdomen, the abdomen, still very good performance, but the arm is better. And so we we've we've kind of known that, or we thought that that was the case for quite a while, but we'd never run enough large clinical validation study work to really prove it. But with the g7 studies that we ran for approvals, they were quite large, you know, hundreds and hundreds of customers or patients subjects in the study, and both pediatrics and adults. And that we saw in both cases the arm performance was it was more accurate and lasted longer in the arm.

Scott Benner 23:30
Interesting. Are you expanding the approved places? Or is it still the same as before?

Jake Leach 23:34
No are no g7 Our intent is to get an arm indication to get definitely it'll be indicated for use in the arm.

Scott Benner 23:40
I often only wear scars on her hips. So I'll be interested, I wonder if the size change would maybe get her to move it to her arm. That'd be great.

Jake Leach 23:50
It's it's it is quite convenient. With the size and it's one of the things like it's kind of obvious, but when you actually experience a product, you You do understand how much smaller it is and basically forget you're wearing it is really quite different than my LG six experience. Okay, excellent.

Scott Benner 24:07
Smartphones at launch, are you adding any, are there going to be the same ones that people get for G six.

Jake Leach 24:12
So we so we're basically the way we approach smartphones is we're always working on whatever the latest available phones are. And so with Apple, you know, always takes us a little bit a little bit of time to get all of the validations and testing approved and you know, through the system. So you often get a little warning that says we're still in the middle of testing this GPU kit. Okay, and you can continue to use it. But we are still in the formal validation phase. So won't be any different with G seven Apple will we're working on the latest phones and iOS is there. Same with Android, right? The Samsung models are are the ones that we support the most number of phones, but we you know we are internally working on programs where we do want to support more handsets. We think about it as we go global right? We're During this global business in the US and outside the US and you know, there's a lot of different handsets out there. And so we're working on ways to be able to support more. And for us, it's really just about can we enhance our efficiency in the testing that we do to validate, we have to validate every single phone to ensure that the Bluetooth performance meets the requirements, because the alerts and alarms of our products are so important. And if the Bluetooth isn't reliable on that particular handset, which is not uncommon, then we really don't want customers using them. So that's why they end up not being supported. Yeah. A lot. A lot of people say, Well, we get support, tubular support anything, but it's actually interesting. And within each cell phone, there's some different hard functionality, in particular on the Bluetooth chips. And they're not all as reliable as we would want.

Scott Benner 25:46
Yeah, I guess Speaking of things that integrates with Apple Watch g7 to Apple Watch.

Jake Leach 25:53
So geez, yeah, so at launch, you'll have the same functionality as G six in the US launch with, with a secondary display of your information on on your watch, you can clear your alerts. So you basically you get the alert, you can acknowledge it on the watch. But the director, watch, we did build it into the hardware of G seven. So the wearable has the capability to do that functionality. And we're looking forward to some an upcoming release of a new watch OS that has a bunch of support in it that we need to help us make that feature actually happened.

Scott Benner 26:31
How about Garmin,

Jake Leach 26:32
Garmin will be the same as it is today, which is the functionality where if you have the Garmin Connect app, then you can, you know, basically put G seven data on your garmin watch, you just it's it'll be the exact same process. The beautiful thing about those cloud API's that we've launched with partners like Garmin is that which is G 60, G seven, it's a very simple update on our side. And then you may have to log back in, log out and log back into your account with that g7 credential. But really simple

Scott Benner 27:03
check, you have to go where do I have more time? Now you have a few more time? Yeah, I

Jake Leach 27:07
was late. You have more time.

Scott Benner 27:08
Excellent. Thank you. I was like, I'm not sure if I'm getting if we have to go or not. So I didn't want to I don't want to drag you along. So let's talk about that for half a second. Somebody asked me a question that I wasn't going to ask you. But based on what you were just talking about with Apple Watch, I'd like to understand this piece a little better. The question was, could you get me functionality with the apps where it calls me for a low at like sugar made has was which was the statement? And what made? What made me think I wouldn't ask the question is, in my mind, if you can't say that it's going to do it? Definitely, then you can't get it through the FDA. And so that's where functionality like that becomes less easy to try to put into place. Am I right about that?

Jake Leach 27:51
You are you are Scott, you know, the one of the most critical things our product does is the alerting in the FDA and our Dexcom as well view that is it's a really important aspect of the product. And so when it comes to safety, it is the thing that saves lives, when you get those low alerts. And so it, it is something that validation of those things takes, you really have to go through a lot of different use cases, edge cases, all kinds of stuff to make sure you have absolutely everything covered. And that's really been what you know, as we've worked on the director watch with on the Apple Watch platform, ensuring that every user gets reliable alerts, when that thing becomes your main receiver, your phone's not around, your receivers are on your pumps not around. So you're not getting an alert, unless it comes from that watch. And so being able to do that reliably has been something that Apple and Dexcom have worked together on to ensure that that can happen. And from my perspective, on the technology side, we're really close to being being able to introduce that functionality. But as you mentioned, the call feature, it's very similar in that it just has to happen. We do know our partner, sugar mate has that functionality. And trigger mate quickly connected up to our real time API once it's been available now and so there, they do have that. So it's not on our roadmap to add that. But you're right though about it gets pretty difficult to do some of those things what

Scott Benner 29:21
it scared you if I if you say hey, if this thing reaches a certain number, we're gonna send you a phone call. And I don't know it has to do with a cell network and the cell network was down. Then suddenly the alert you told me I was gonna get didn't come and there's nothing you can do about it. So you can't put yourself in that position to begin with.

Jake Leach 29:38
Yeah, yeah. And you probably will call us and it'll be a complaint that hey, it didn't work and we're gonna have to investigate it. And so yeah, it definitely is one of the things that when we when we're doing you know, we listen to customer feedback. A lot of the features in G seven are based on the great feedback that we've gotten from customers around g six, right. And so we we We're very thoughtful about which features we introduced and how we prioritize them. And you're bringing up one of the things that's can actually can add some complexity for sure. G seven is going to be approved for what ages? It's same as G. 602. And up to that's the intent.

Scott Benner 30:17
And let me just ask you about the apps little bit because I feel like we've been talking about these revamped apps for I'm gonna say forever. Maybe, so little things, you wouldn't you wouldn't tell me last time we talked, but are we gonna see rate of change on the new apps?

Jake Leach 30:33
So not not immediately. But it is definitely in the roadmap, because we've gotten a lot of feedback on that. And actually, after our last call, I dug in to see where in the feature priority list it was. So it's not in the initial release. But one of the things that we're doing different with G seven is we have a cadence, we call it our release trains. But we have a whole cadence of things planned for the next couple of years to bring significant value to customers through new versions of the app we've been in the past, you know, which is six, we didn't bring, you know, we did a number of enhancements to it. But they weren't as frequent as I want, as we want. And so what we're working on is, how do we bring more value faster, and it's really doing a lot of what, you know, the tech industry does, in our software team looks much, much different today than it did even a couple of years ago in terms of size, capability and breadth. So what I'm really excited about what we're going to be doing with our apps, as we continue to go forward,

Scott Benner 31:32
do you anticipate more frequent app updates than have been normal in the past?

Jake Leach 31:37
That's, that's the intent. That's what that's the expectation we've set for ourselves is that we're going to be developing features at a much faster cadence than we had in the past.

Scott Benner 31:47
Okay, so I'll hit you with these little things that seem like messages more than questions since the last one, like it might have helped in the past. One of them was overwhelmingly more Android phones, please, which we already talked about. People feel very passionate about the packaging being lesser every time and the ability to recycle things. A lot of people give feedback about that. And then there's a message for you here, which I'll save to the end. But this is the last question, which I think is hilarious as you're trying to get g7 through the FDA. What is GA going to be like?

Jake Leach 32:23
Well, we wouldn't be we wouldn't be Dexcom if we weren't already working on that. So yeah, absolutely, we are working on GA, it's a another kind of step in the wearable technology, making it you know, less than even, you know, more discrete. Manufacturing scale, right, that's become a very important part of how we design our sensors is we need to be able to manufacture you know, hundreds of millions of them. And so there's a bunch of that kind of technology that's going into g8 g7 is going to be a big focus for us, though, our plan is to roll it out as fast as we can across the globe and reach millions of customers with it. And so, yeah, GA is a program, we are running it, and we're excited about what's going on there. But you're not gonna get any secrets at me today.

Scott Benner 33:11
Well, then I'm still gonna ask my last question. Do you have any idea when this might happen?

Jake Leach 33:17
You say an FDA approval and g7 lunch? Yeah, my expectation is it happens this year. We've got you know, we're in that back and forth period with the FDA. Things are going great. We're really happy with how the good the interaction. And so you know, we're thinking sometime after Ada, likely So Ada is coming up here in June. And so, you know, our last earnings call we talked a little bit about, you know, our expectation is sometime after AD will get approval, and then we'll be launching but in a meaningful way this within this this year. It's not like we're launching on December 31. That's not our intent, right? Of course, regulatory timelines are always I've always Kevin CRC, you know, everybody asks us to predict when the FDA approves the product. And so it's, you know, we basically are saying our best estimate at this point, given what we know today is that it'll be some time after ADA but will allow a full launch at but this year, Jake,

Scott Benner 34:14
Kevin's more fun around these questions. And you are, I just want you

Jake Leach 34:17
to know he can be

Scott Benner 34:20
and there's a number of messages from here from people who just wanted me to say thank you for the technology. So I won't I can't read them all to you. But a lot of heartfelt thanks came through as well.

Jake Leach 34:31
Very, very much appreciate all the folks that that use our technology every day to you know, help them manage diabetes.

Scott Benner 34:38
Yeah, no, thank you for taking the time to do this. I appreciate it. Cool. Thanks, guys. Take care Jake. Jake, you think we'll be doing this

I bet you want to know what I asked Jake when I shut off the recording and what he answered, but I guess I'm telling you thank you so much to Jake leech for coming on the show and talking today about Dexcom g7. And thank you to us med for sponsoring this episode of The Juicebox Podcast head over now to us med.com forward slash juice box or call 888-721-1514 Get your free benefits check and get started today with us med. Getting your diabetes supplies should not be difficult, and with us med it won't be

if you're new to the Juicebox Podcast, hit subscribe in your podcast app or any audio app that you're listening in, for instance, audible Spotify, Apple podcasts, etc. etc, etc. Hit subscribe or follow follow and subscribe. Get the next episode right there on your phone. If you're looking for support online, the Juicebox Podcast has a Facebook page it is a private page with nearly 25,000 people in it. They all use insulin or love someone who uses insulin. And they're having vibrant and valuable conversations all day long that you may enjoy. You could get involved in them or just kind of look around and see how people handle things. It's actually very helpful. And a great way to learn about type one diabetes management and the use of insulin in general. So I'm saying type two as well. You hear me? Thank you so much for listening. I'll be back very soon with another episode of The Juicebox Podcast.