#749 Jeremy Gets It

Jeremy Beaulieu, FNP-C, MBA, BC-ADM CDCES.

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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
You are listening to Episode 749 of the Juicebox Podcast.

On today's show I'm going to be speaking with Jeremy, who is a nurse and a few other things got a bunch of letters behind his name he'll tell you about in a second. I love the conversation that Jeremy and I had. Jeremy is the exact kind of clinician you're hoping to get when you have type one diabetes. While you're listening today. Please remember that nothing you hear that Juicebox Podcast should be considered advice, medical or otherwise, always consult a physician before making any changes to your health care plan, or becoming bold with insulin. If you're a US resident who has type one diabetes, or is the caregiver of someone with type one, You'd be doing me a personal favor. You'd be supporting the show, you'd be helping people with type one, you'd be helping yourself if you went to T one D exchange.org Ford slash juicebox joined the registry and completed the survey. T one D exchange.org Ford slash juicebox. Got this little bit of time left here. I don't know what to do with it. You should check out the Pro Tip series it begins at episode 210. It's really good.

This episode of The Juicebox Podcast is brought to you by Omni pod five. Learn more about the Omni pod five and get started today at Omni pod.com forward slash juicebox. And if you already have the Omni pod five, don't miss the Pro Tip series just for the Army pod five is a three part series on episodes 736 737 and 738. Today's podcast is also sponsored by the Dexcom G six continuous glucose monitoring system dexcom.com forward slash juice box head there right now and find out if you're eligible for a free 10 day trial of the Dexcom G six, you just may be dexcom.com forward slash juice box on the pod.com forward slash juice box links in the show notes. Links at juicebox podcast.com to Dexcom on the pod and all the sponsors.

Jeremy 2:26
My name is Jeremy I'm a nurse practitioner. I'm also a certified diabetes care and education specialist and board certified in advanced diabetes management.

Scott Benner 2:34
Wow. That's a quite a quite a list of a bone a few days you have there. I didn't. I didn't know I was gonna be talking to a professional.

Jeremy 2:42
Oh, yeah. Yep. Alma, completely obsessed with diabetes. So do you have it it? I don't I actually don't have anyone in my family that has diabetes. I don't even know where my interest with it developed at my first job out of nursing school was on a pediatric diabetes floor. And I think that's probably where it started to grow. And then throughout my career, it's just gotten to be stronger and stronger of an interest.

Scott Benner 3:10
Wow. Good for you. That's a really wonderful thing to devote yourself to.

Jeremy 3:15
Yeah, I mean, everyone's diabetes is different to me, it's like every day is every patient you see is just so different that it makes things interesting. Like it's never the same thing over and over again. When you

Scott Benner 3:27
when you I don't know how to ask this. Alright, well hold on a second. Let me get through it. I almost got ahead of myself. Jeremy, don't don't. I don't want to put the cart before the horse, you know? Yeah. Let me let me ask you this, then. So went to college, to be a nurse. It's what you wanted to do. You're like, I'm gonna get a nursing degree.

Jeremy 3:46
No. So I went to college and got a bachelor's in sociology, and worked in software development for a little bit and couldn't really do much with a bachelor's in sociology. So I went back to become a nurse. And then after I became a nurse, then I went back to school and got my master's in nursing to become a nurse practitioner.

Scott Benner 4:05
Okay, and good for you. And then what made you move? I mean, how it's not what made you but how do you make the move towards diabetes? Just get a job and it's what it is? Or do you have to find that like, you have to search it out? I guess that's my question.

Jeremy 4:18
It took me 10 years after I after I became a nurse to finally get a full time job and diabetes other than that first job I had and pediatric diabetes. I was in primary care and urgent care but when I was in primary care, I was the diabetes guy in the office. So nobody no provider in primary care. It's our it's rather rare that they actually like working with diabetes because it's very difficult for most of them. So I was the guy that everyone would refer their patients to because I loved doing it. So I just like I I was the guy, some primary care it's rare to manage people with type one or anyone that's on a pump and I had so many patient's on pumps. I was just comfortable with it all so, so I was doing that and then I have a job came available at Joslin diabetes Center. And I applied because I, it's what I wanted to do. And they hired me and I've been doing full time diabetes ever since then that's crazy. Good for you. Wow. And then I got stolen by another hospital as

Scott Benner 5:24
well how does that happen?

Jeremy 5:26
I was doing a research project and our we were doing a quality improvement project at Jocelyn. And we were getting really good good results, I was one of the clinicians like heading it. And the program manager of the place where I am now is the daughter of a woman that was on doing the study with me. And she had raved about me to her daughter. And so her daughter, when someone put in there notice that they were retiring where I am now she reached out and said hey, would you be interested in coming to work for us and where I am now they have a nursing union. So the pay is significantly more than I was making. And that's how they were able to steal me.

Scott Benner 6:10
Well, that makes sense. Hi, would you like to there's more money? I'm on my way?

Jeremy 6:17
Yeah, it's the same exact job. I'm doing the same exact thing. So yeah,

Scott Benner 6:21
my gosh. Alright, so what is your day like at work?

Jeremy 6:28
It depends on if I'm so our days are split between or my week is split between outpatient and inpatient. So outpatient, I'll see people in the office, or virtually. Usually, like every new patient, I have an hour as a follow up patient, I have 30 minutes. So I see anywhere from eight to 16 patients a day. And then when I'm on inpatient service, we just are a console service. So anyone that comes into the hospital with difficult to manage diabetes, they consult us or if they have type one, we're the ones managing it. Like no team here manages type one diabetes, except for us.

Scott Benner 7:02
Okay, how many people on the team?

Jeremy 7:06
There are on the inpatient team, there's three NPS and a PA. And plus we'll have an attending like an MD or do on at the same time. Outpatient, there's godly 28 of us, I believe, or maybe, yeah, something like that.

Scott Benner 7:30
When a patient comes in, how do they mostly see you? Do they see a doctor? How frequently do they see the MD etc.

Jeremy 7:38
So I'm kind of a unique situation. So a lot so when I moved to where I am now from Jocelyn I had about 60 patients follow me, so they only see me every three months. And that's what they want. They have the option of seeing an MD if they want. The same thing with the patients I see. Now, some will see me every six months, and then the MD every six months, we alternate further visits every three months. But I would say about probably 70 or 80% of my patients only see me

Scott Benner 8:08
Okay, okay, and then never, like you're saying, like, once a year, even the MD there's no like, like, I don't mean tech legal, I was gonna say illegal, but like insurance reason why they have to or anything like that.

Jeremy 8:23
No, in Massachusetts, we now have independent practice, but there's really insurance wise, there's no reason for them to see an MD unless they want to. It's really up to the patient. I really don't like care one way or the other. But I I've personally found that a lot of my patients don't want to see anyone else except me. So I just continue seeing them unless there's an issue and I have, like, I run into a roadblock where I can't figure something out, and then I'll consult one of my colleagues, but that has that rarely ever happens unless it's a really weird case of diabetes like, like someone that has had a total pancreatic pancreatectomy. Like they're they don't have any pancreas anymore. Okay, those can be really hard to manage. But other than that, I mean, 99% of the cases I see I, I can manage well, and most of my patients have an agency, less than eight and a lot less than seven. So I do a pretty good job. I think hopefully, I mean, that's why I was stolen.

Scott Benner 9:27
Yeah, well, no, I guess talk about that for a second. What is what's it like? All I want to say I guess give people your perspective of what it's like to see 567 however many people a day, and they all have, like you said diabetes is different for everybody. But I think you mean their lives are different like the yes, yeah, the diabetes is the same, right? The way insulin works like the idea about having your Basal right and Pre-Bolus and your meals like that stuff, the same for everybody but what What are the parts that impact people and change things?

Jeremy 10:03
Is lifestyle things like exercise is a big one or lack of exercise, their diet composition. I mean, with type one, the wind can blow in your blood sugars can go crazy. So, I mean, for type one, it's a lot harder in that regard anyway, because it can, it's, it can be very fickle, like, emotions can do it. So like, especially as people get older and have a lot of people with type one that are in their 50s 60s that are then taking care of their parents. And they can have pre like previously a great control before that, and then all of a sudden, they have desexualized stress and their blood sugar's just go crazy, despite them not really changing much other than adding that stress. So I mean, pretty much anything like you talked with Jenny, like, literally anything can be a variable like it, everything affects diabetes, like, that's one of the reasons I like it is a it's literally everything in a person's life affects their diabetes, okay. It's kind of like a puzzle.

Scott Benner 10:58
Yeah. And so how is it to? How is it to figure that out, when you don't see the people for very long.

Jeremy 11:09
So I'm kind of a micromanager with my patients. So I'm seeing them in the office every three months, but I'm usually touching base with them every couple of weeks to go over things, especially the people that aren't, don't have good control. And I basically micromanage until we get good control. So I'm frequently like calling people on my inpatient days when I'm like, between patients to follow up, adjust their regimen, based on how they're doing. And going from there. So I don't limit my time to the patient to just the office visit, I don't I find that that's kind of funeral. So I actually find that my office visits are fairly quick, because I talk so much to them between visits. But I think that's just my practice style. And not everyone is like that, okay?

Scott Benner 12:03
Do you feel like, do you feel like when they leave, they know what to do, or they kind of have marching orders. And then after they marched to that beat of that drum, so many times it starts to make sense to them.

Jeremy 12:16
Ah, so my guy beat he's educator too. So I also make I do pretty thorough education with them, especially if they don't understand concepts. For newly diagnosed type people with type one, I'm usually seeing them for their initial visit, and then usually touching base with them every like two or three days for four to six months, until we kind of get things where they need to be. Because it's type one is just a different animal. Whereas type two, I can throw someone on something like ozempic or trulicity. And it typically corrects itself. And we don't really have to do anything much other than the ones that we injection, right. So it's really

Scott Benner 12:59
tell me about that variable. Give me that for a second though, the I'm meeting with people every two or three days meeting with them how text messages, video chats, how on the phone,

Jeremy 13:09
I usually by phone, okay. But usually, I'll have like, especially if they're type one, I'll have like, index calm, like, go on clarity, and I'll be able to see what's happening. And we can go over specific things that they ate, they'll keep a log, and we'll adjust based on that. But diabetes is so complex that I also don't want to overwhelm them all at one visit. So even if it's not a new diagnosis that, like you can't talk about diet and exercise and like sick day managed and all the different other variables at the same time, because nobody's going to absorb that. It's just too much information all at once. So the way I do education is kind of piecemeal, like, I'll make sure they get one concept, and then I'll move on to the next one, when they have kind of solidified that. Because, I mean, when I was new like it, I knew I know I overwhelmed patients like throwing everything at them, and it just nothing stuck. And it just wasn't, it wasn't a good use of my time. Or there's

Scott Benner 14:13
how did you learn that it was overwhelming? Like what? Like what, like, I'm imagining like a real life situation happen. And then like, what what, like, you know what I mean? Like, what made you go, Oh, hell, no, no, no, I'm doing this wrong.

Jeremy 14:33
I think it was the, I mean, a lot of it's the look in their face when I'm done. Like, they have that deer in the headlights kind of look. The other thing that I found was that I would do all this education. And then when I'm following up with them a week or two later, to touch base, they don't remember half of what we had talked about and I'm having to read, I was having to redo it. And so when I started doing that enough I was like, Okay, this is clearly not working. And I started to break it up. And that was much more effective.

Scott Benner 15:06
I take your point. Yeah, I'll tell you this. So this is kind of just is random. But I spoke to two people this morning, I don't know. So two people who kind of banged on my door and often was like, Oh, my God, I really need somebody to help me. And I had a little bit of time this morning. And so I talked to to two mothers of have young children. And you Please understand, I don't know them. I've never met them before. I don't think about them, right? And how am I going to try to get them moving in the right direction. So this is how the phone call starts. I say hi, you know, and they're like, Hi. And sometimes people listen to podcasts. And there's a moment where like, it's the guy from the pocket. So I'm like, calm down. Like I'm taking out my recycling now. Like, you don't I mean, nothing's nothing special is happening over here. And then I say, Listen, First, I need you to understand I'm not a doctor, this isn't advice or two people chatting. If I say something, you misunderstand, or, you know, I just flat out get wrong. And I mean, and someone ends up dead. It's not my fault. I need you to audibly tell me you understand, you know, and they're like, yeah, now I kind of say that, so that they understand that, you know, like to be careful. You know what I mean? Like, you need to be careful. But right, but then I initially I immediately, I go like this, I go, Alright, I'm gonna ask you some questions, just answer them real quick. How old? How long? What insulin? Do you think you're honeymooning? How much do they weigh. And then I say what's going on? Then they blurt out all the stuff that has stuck inside of them for the last however many months or years, which ends up being very kind of therapeutic for them, I completely understand. Here's what I think has to happen next. And then I immediately go to basil. Like I want to see the basil right before we talk about anything else. And then make sure that they're, you know, reasonably Pre-Bolus eating their meals, understand the impacts of different food. And then from there, where I'm lucky and you're not as then I get to like hand them episodes of a podcast and say, you know, here just keep, like broadening your understanding of this. And

Jeremy 17:08
I actually recommend the podcast to a lot of my patients, I have the list of like, specific episodes printed out that I want them to listen to, and I actually refer a lot of people to your podcast. So

Scott Benner 17:19
Well, Jeremy, now now you and I like each other much more. Okay. I was already enjoying, you know,

Jeremy 17:25
honestly, I was kind of not scared to do this interview. But my practice style and the things that I tell patients when I'm listening to you, I'm like, holy crap, we sound like the same person. So I'm like, and I was like, Oh, we're not gonna have much to talk about because I do the exact same thing that he does.

Scott Benner 17:45
And you were afraid that we were going to be like, Oh,

Jeremy 17:47
I agree. I agree. He was just gonna be agreeing. I listened

Scott Benner 17:51
the first time I fell in love with Jenny is when she like, I got off. And I thought, wow, she and I think about this very similarly. Yeah, I just love that, you know, because I love Jenny. Oh, my God, there's, there's not enough. There's there's not enough understanding at the level where, where you are at your job? Like, I just, it's just true. You don't I mean, there are too many people who see too many practitioners. You know, it just happened this morning, I said to the second lady I was talking to I said, Hey, how many Basal rates do you have? And she's like, I think it was like he gets four all day, I'm again, but you're on a pump. I'm like, how many different rates use I don't know, like off the top of your head, you don't know how many different Basal rates the kids has. And she opened it up. And every two hours was a different rate. By the way, none of them anywhere near how much insulin the kid needed. And, you know, and I said, How did this happen? She goes, Well, my, my diabetes educator kept changing it. And it's this, it's, you know, it's not always the same. Jeremy, I wouldn't want people listening to think like, this is definitely what's happening to them. But so frequently, I see people use too little basil. Then they over do it with meal incent or corrections, they call it, they cause lows, then they show the graph to a practitioner who says, Oh, you're getting low. Let's turn your basil down. It's fascinating.

Jeremy 19:13
It's, yeah, I see that a lot too. And to me it? I don't know. So yeah, a lot of providers do that. And I've, a lot of times when I see a new patient, I'll start from square one and make them do a Basal rate evaluation where I have them either fast for 24 hours if they can do it, or have them fast for like eight hours at specific times during the day during on different days to actually fine tune their Basal rates and see what they actually are. And every time I do that, they are markedly different from what they should actually be. Yeah, it it's just, to me that's just fundamental like you need to have like I agree with you like you need to have the Basal right to know what their Bolus should be. Otherwise you're just going to be adjusting and working in the dark.

Scott Benner 19:59
It It's all just, you can say it any number of different ways, right? But if you were building a car and you didn't know how much the car weighed, you wouldn't know how to throttle the car. Right? Right. Because the amount of horsepower you would need to drive this vehicle forward would be different if the vehicle weigh 2000 pounds overweight, 6000 pounds. So you the basil is that weight, it's the base, and everybody skips over it like it doesn't exist. I mean, I'm telling you like, throughout the early days of Arden's life. Basil was never spoken about like it was of any importance. It was just like, here's a number that's right. Now let's move on to all the things you're gonna screw up. You know, and I don't know it just it seems like very common to me Well, I'm going to ask you something because on your intake questionnaire, you you really caught my attention. This idea has been in my head for years about a podcast so Jeremy, I think you might genuinely be the perfect person to talk to this talk talk about this topic with me so I'm

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concerned that people don't do a good job of interacting at their doctor's appointments. And I think it's more of a communication thing. And I think it's because I think it's because we get put into maybe a subservient category, when we slide into some people getting the doctor's office and it feels like that person is in charge. They're smarter than me, they know more than me, I'm gonna listen, my ideas aren't important here, I'll kind of keep quiet, where I think it needs to be more of an actual human interaction. You know, and I think you you have to come in ice forward looking each other in the face, and, and making declarative statements and asking for clear answers. But I don't think people do that. And I was wondering what you thought about it?

Jeremy 26:45
So yeah, so I have a lot of thoughts about that. So I personally find not so much younger providers. I don't want to throw like baby boomers under the bus. But it I think when they were going to med school, it was more paternalistic. And so I think when they're, they get conditioned, after seeing their provider for so long that that's how visits should go. Whereas I'm more almost like a coach, like I don't tell patients what to do i elicit information from them. And I'm like, Well, how about how would this work? Like, and we kind of troubleshoot together? But for them, when I'm doing that with them? A lot of people will, it takes them a few visits to actually they clam up, get it? Yeah, they don't. They want me to tell them what to do. And it's like, no, you live your life, you need to tell me what, like how that I can help you. Because I don't know how they live, I don't live their life. And if I don't, if I can't get the information from them, then any suggestion I make is going to be useless because it needs the you need to meet them where they're at. You and I find that a lot of I think it's actually rare to encounter someone with diabetes, whether it's type one or type two, that doesn't have some form of disordered eating. And Jenny's a dietitian, I believe Correct? Not a nurse.

Scott Benner 28:08
So she might she's got a couple of things going on over there. Yeah, um, she,

Jeremy 28:12
she might be able to speak better to that. But I find that like, people come in, and they have aversions to food, different foods, like they don't want to eat fruit, they don't want to eat this or that. Because their provider told them like you're eating too many carbs. And you can't have this and you can't have that. And that's another barrier to overcome to that they just get into this mindset of they can't do things. And to me that, like, life is way too short to live like that. Like I if I if someone told me right now, like if I had type one right now, and someone told me I can't have like mac and cheese ever again. I probably would flip them off. Just like,

Scott Benner 28:51
yeah, Jeremy, you and I are aligned very well. So I think that it's, I don't take a paternalistic view of it. But I do think that, in some cases, with some people, my knowledge might be fuller than theirs. And maybe they don't sometimes know what's important. And you know, I find they're these. These sort of like, these dangling ideas, when you ask people questions, I've talked about it before you ask somebody how how's it going with your diabetes, and people go great. And there's no context to that, like with a number or, you know, variability or whatever, however you're measuring doesn't matter. Because great to them is just better than whatever bad was to them. So whatever the worst they were, if they're a little better than that they're doing great. They have a seven and a half, eight, one C, like I'm doing great. And again, you're not doing great, you're not doing bad, but you're not doing great. And so the the reason that's all important is because the person on the other end of that conversation, when they hear great, they ascribe a number to it. So I've been in conversations where somebody says, I'm doing great, and they're a one C is seven, and when I hear great, I think oh, they're a one c must be five and a half. They're doing great because that's My measuring stick, it's so important to say it out loud. And then that translates the food. How do you eat a week? Right? Yeah, well, you know, if you grew up in a house, where you didn't eat on Tuesdays, because that's how we save money, you might think your McDonald's is great, because it's way better than what was bad in the past. And now you over here, you know, as the practitioner who's eating leafy green vegetables and fish on Tuesdays, you're like, oh, they eat great. They eat fish and leafy green vegetables and take vitamins. And it's, there has to be an honesty. Now, the problem comes is that when sometimes patients are honest, then they run into a time where they get admonished, you know, and then you're like, Well, I'm not saying nothing, because this guy yells at me all the time. So Exactly, yeah. It's a huge problem.

Jeremy 30:50
Oh, yeah. Especially, I think more so in pediatric diabetes. Because I think providers think, Oh, they're kids, and they'll do whatever I say. And then when they become adults, they come with that same baggage, I actually had a patient who her peed her pediatric endocrinologist lost his license for the way he was treating patients. But he has given her so much PTSD, with her diabetes, that it's hard to get her over the anxiety of everything to effectively manage it because of how awful he was to her.

Scott Benner 31:26
So Jeremy is poorly as I feel for this person, I have to ask for a tiny bit more context, how do you lose your license? It like how what do you have to do to for that to happen?

Jeremy 31:36
I'm not aware of the specific she told me about it. And then I asked colleagues at work, and they had heard about him and heard about him losing his license. I don't know what specifically he did. But it was bad enough that he lost his license to practice insane.

Scott Benner 31:49
Now that's really crazy. I would I'm so sorry for her, she went through that. I think that we have to start speaking concretely. But without judgment. And what I mean by that, yeah, if you listen, if you're, you know, I don't care how you eat, honestly, like, if you're a vegetarian, If you're a carnivore, if you you know, if you're at McDonald's every week, all these people, they deserve their blood sugar's to be stable. And so it doesn't matter to me, there's no judgement about how you eat, I just need to know how you eat. So we can know how to talk about this. Because you can't just randomly say to me, my blood sugar goes up after dinner, and it stays at 250 for five hours, but not tell me what you ate. Because that's not enough information. You know. So, I mean, I think that's the first thing is if people are listening, when you go into your doctor's office, you just have to be honest. And if you if you're met, if your honesty is met with, you know, a response that is doesn't make you comfortable, then you need another doctor, because because if you don't get one, you're just going to start lying to the doctor. So now you're going to tell the doctor what they want to hear. The doctor is going to give you advice based on the lies you're telling them and your outcomes are going to be just as bad. That makes Exactly yeah. All right. Okay.

Jeremy 33:04
Yeah, I make them get into specifics. And I have a very non judgmental approach. I'm very honest with my patients to that. I had my own struggles. I think why I identify a lot with people with diabetes is that I had my own struggles with obesity my entire life up until like two years ago, I'm actually on ozempic, which is for people with type two diabetes for weight loss, and was very successful for me, I'm now like 150 pounds, like, I'm at a normal weight now for my height. But it was a struggle. And I I completely empathize empathize with the people that like eat fast food and like, because that's what I was doing. Like, I wasn't eating like, healthy like I should. And I mean, I still don't need like, perfect, like, completely healthy, but I try to, but I don't like when they tell me what they're eating. I don't judge it. I just figure out what we need to do to manage that what they're eating. Yes, once and I focus basically on getting their agency down once they're at once he's at goal, then I start bringing up the subject of like, how can we incorporate, like a healthier diet for you, and then work on that. But for me, it's one thing at a time, I'm not going to make someone make drastic changes to their diet, and then we adjust their insulin because that's just going to it's too much change at once people will freak out with that. Yeah,

Scott Benner 34:15
it's just it's, it's not reasonable. Like if that exactly. If that was reasonable, then we'd all weigh our goal weight, and we'd all we'd all look like we were on getting ready to fight in the UFC, right? I mean, because if that's how it worked, and you would just, we would designate a person in every town to walk around to every person and go, Hey, be healthier. And they'd go exactly, and they'd go, oh, hell, I'm glad someone told me. I'll go turn myself into a UFC fighter right now. But that's not how it works. So you can't, you can't ignore that portion of the human condition. And then just start talking about how insulin works because you're ignoring you're ignoring the bigger picture. The bigger picture is, you're trying to manage them based greatly on what What's going in their mouth? And so you need to know what that is. And you can't be stupid enough to think that you saying to them stop eating. That means they're going to go out the door and go, Oh, well, thank God that guy told me to stop eating that because I'll never do that again. Because that's so I love cheese. Jeremy, look at you. I love you. Tell me how much you would you tell me how much you weighed at your at your, at your greatest number?

Jeremy 35:27
Yeah, I was 220 at my highest. But I'm only for like five, seven and a half. Okay. It was an for my body frame, it was not an appropriate weight. Like I was like, like greater than 50% body fat. I was over fat and under muscled. I got down to 140. And then now I've been working out to like build muscle mass back on because I don't have a lot. And so I'm up to like 150 now because of that.

Scott Benner 35:53
How long was that process for you?

Jeremy 35:55
So I started ozempic.

Scott Benner 35:59
March, by the way, Jeremy, you got to stop saying that word. Because in my head. Now I hear oh, I can't think I can just hear that commercial in my head. But anyway, go ahead.

Jeremy 36:09
Yep. So I started that March 2020, like right before the pandemic started. And by I was walking to and from work, which was three and a half miles each way. So I went on that. And by September, I was down to 140. I lost 80 pounds in that six months, and I've kept it off since

Scott Benner 36:29
then, well, good for you. What does the drug do for you?

Jeremy 36:33
It controls your appetite. So before I was on it, I never got the signal to my brain that I was full. So I could just, I remember being like 2122, like doing my prerequisites for nursing school. And I ate a large Chicago style pizza, I was living in Chicago at the time, I ate a large Chicago style pizza, mozzarella sticks, a large fry, and a bunch of other stuff. Like for dinner one night. And I still felt hungry after I finished. Once I started on the ozempic. i i I actually like feel full like halfway to like three fourths of the way through a meal now, and I never, it was kind of a shock to me, because I never felt full before. I likely have a deficiency like ozempic is a hormone that your body makes, it's just changed a little bit so that it lasts longer. I I'm I'm willing to bet that I had a deficiency in it. And that's why it corrected it so dramatically. And most people with type two diabetes have a deficiency in that hormone as well, which is why it works so effectively for that.

Scott Benner 37:41
Is it written off label for you.

Jeremy 37:44
And it's so I'm on we go V now which is the same exact medication. But it's just we go V's the weight loss version, basically, that's more that is FDA approved for weight loss. But I was on ozempic initially and my I had prediabetes actually, like my agency was 5.8 or 5.9. And that's how my provider was able to get it approved. And that Menomonee ones he's like, I think five. So it definitely helped a lot in that department.

Scott Benner 38:14
Wow, once weekly. Yeah, once a

Jeremy 38:17
week. Crap, hmm. And actually use it a lot. And people with type one as well that struggle with their weight. And it does great, it actually makes their blood sugar's a lot more predictable and easier to manage. So I'm hoping eventually we'll get coverage for for people with type one because it does amazing things for them. It also suppresses glucagon release, so you'd need less basil overall as well. And it slows gastric emptying, so you don't have to Pre-Bolus as much or as long before so it does a lot. It has a lot of good metabolic effects. And I mean, I'm sure you know, like the killer. People don't with diabetes don't die from the diabetes, they die from things like heart disease or kidney failure from the uncontrolled diabetes damaging those organs and medications like ozempic and trulicity reduce dramatically reduce your risk of having a heart attack or stroke. So it's very good for someone with any type of diabetes to be on it

Scott Benner 39:14
does that I by lowering you're able to see your blood sugar.

Jeremy 39:18
Right? Yeah.

Scott Benner 39:19
Okay. Well, that's it. I didn't know we were gonna learn so much from you.

Jeremy 39:23
I try. I actually have an NP student who has type one, she is a normal weight. But she was like, oh, I want to try ozempic and see what it does for me. I want to experiment so I prescribed it for her got it approved through her insurance. And her average blood sugar went down by about 60 points just by starting that and she didn't lose any weight on it. But it made her blood sugar's so much more predictable.

Scott Benner 39:54
No kidding. Any side effects that like did you grow a tail or anything weird?

Jeremy 39:59
Biggest thing artifact with it is nausea. And it typically goes away after you've taken it for a couple of weeks. Like I got nausea for the first two or three weeks, but it was a kind of here or there thing. The nausea though was actually predictive of someone responding really well to it. So if you do get nausea, it usually means that you're going to be a very good responder to the medication. Once your body gets used to the increased level of a hormone that nitric goes away.

Scott Benner 40:22
Wow, that's really wonderful. Look at that science, huh? Yeah, you go. Well, thanks, Novo Nordisk. I mean, yeah, that's who made that right. They make both of them actually.

Jeremy 40:38
They make, I believe they make ozempic and trulicity or not, I was embiggen. We go V trulicity. is made by I think, Sanofi, I don't really follow the manufacturers of the different products because I don't like to be biased. And it's a lot to remember. But I think it's Sanofi.

Scott Benner 40:56
That makes trulicity trulicity.

Jeremy 41:00
Which is the medication it's in the same class. It's just a different medication.

Scott Benner 41:03
Okay. Okay. I understand. Well, I thought you okay, it doesn't matter. I don't know that ozempic song though. Whoever wrote that. Freakin mind control, genius. marketing genius. Because I don't I don't like half know what those Empik is. I don't need it. And I could sing that whole stupid song. Same reason I know about mounds that Almond Joy from the old Charlie Brown TV shows when I was a kid. I've never had a mouse or Nam enjoy my life, but I know exactly how they're built and what's in them. Yep. Yeah. Jane goes to law star Jeremy. Anyway. I'm still like, overwhelmed. As you're talking that you have you don't have diabetes. I think it's terrific. You know, like, like, your amount of enthusiasm for it is exceptional, especially after you've been doing it for a number of years. Is this I don't get bored of it at all. Does it feel like a challenge? Do you feel like you've fixed the like, now I'm gonna pick into your psychology like so. You like we've we've learned a lot about you. Like you said, you don't know why you went into like, why did you go into nursing? Do you think?

Jeremy 42:05
So? When I so when I was young, when I was 10. My father, it was actually national news. And there's like, a true crime show on it. My father murdered my stepmother. And going through that, and I was very close with her. It. It made me kind of want to live my life to not impress her, but to honor her memory. She was a very caring person, and I just didn't want anyone to

die a miserable death like she did. And so that initially, I was actually gonna become a social worker.

And then, when I learned that I, it's really, you don't do much as a social worker in a hospital? That's when I switched to nursing.

Scott Benner 43:01
Okay. All right, hold on a second. I don't know what number episode years will be. But I have like 620 of them out. I think I have about 60 More recorded. I've spoken for 1000s of hours to people with type one diabetes. You stopped me in my tracks in a way that no one has before. That really? Just really shocked me. Just tell me one more time. Your stepmother? Yep. was murdered by your father. Yes. Your your birth father?

Jeremy 43:37
Yes. Correct.

Scott Benner 43:38
I'm so sorry. Okay,

Jeremy 43:40
how old? I was 10.

Scott Benner 43:44
Okay, you all live together?

Jeremy 43:47
So I split my time between that house and with my mom. So I was there on like, Friday, Saturday, Sunday. And then with my mom during the week,

Scott Benner 43:59
okay, but you had a your parents had been split long enough that you're you had a real relationship with your stepmom? Oh, yeah,

Jeremy 44:05
I met her when I was I think three and I was really close with her like she was a mom to me.

Scott Benner 44:12
Wow, your father's in prison?

Jeremy 44:14
Yep. Yeah, he gets out. I think in eight or nine years,

Scott Benner 44:20
I have to ask you a question has nothing to do with diabetes. But does that make you question yourself that somebody who you're that directly related to did something like that?

Jeremy 44:30
It does i It makes me scared to be angry. Because I'm worried that I'll turn out like him. It like I don't have a violent bone in my body. But like, if if something upsets me I don't give my permission to give myself permission to get angry essentially. Because I don't want like I live with that fear that I'm going to hurt someone Looking back

Scott Benner 45:00
as an adult now, do you see prior to it happening? Do you see your father as someone? Like who could have done that? Or do you think it was like a crime of passion? Do you think he snapped or do you think that's so

Jeremy 45:13
it on the true crime? So I think the it was on a TV show, I think on Investigation Discovery called most evil. They called it a crime of passion, except when you read the court documents and know what went on, he planned it, like weeks in advance.

Like, this wasn't just like, he knew what he was doing. So sorry, I forgot like, part of the question you asked.

Scott Benner 45:37
I just meant to do you in hindsight, like looking back as an adult? Did you think he was a person who could have died? Or do you think he just kind of snapped?

Jeremy 45:45
I don't think he snapped. I think he was very controlling, um, his, he had been married, I think, two or three times before he had married my stepmom. The his first wife, he beat her so bad on the lawn that she pretended to be like, knocked out or dead so that he would leave her alone. And then he left went to work one day, and then she escaped that situation. So he already had that history. The morning after it happened. We went to visit my stepbrother and he had witnessed the very beginning of it. And I he told me what what had happened. And I believed him like it. He saw firsthand what was happening. And I didn't really like my dad, he was kind of a jerk to both of us. He was never like a warm and fuzzy dad, it was like You kids are in my way get out. So I was taught like, I was very confused by the adults in my life, wanting me to continue to have a relationship with him and believing him that he was innocent and that he was self defensive. To me it was kind of obvious and at 10 When all these adults are being contrary to you. It's I don't know, it was very mind boggling.

Scott Benner 47:13
So when the adults are like, I can't believe this happen. You're like I can like that kind of feeling. Yep. Yeah. I hear you. Wow, man. That's okay. Well, now we know why you're a nurse. That's good. Yeah, figure that out. Like I you know, I hate to feel like I'm boiling people down to like, but I think people are caregivers for a reason, like something happened to them. They want other people to feel better than they felt at some. I mean, it just kind of seems obvious, but and then you had a weight problem too, which then made me want to dig a little farther into it. Meanwhile, I know nothing about psychology. I just it was enough of a clue for me to ask. I did not think you were gonna say my father murdered my stepmother. But I thought maybe you were gonna be like, you know, there was this girl in eighth grade. She just called me a name or I didn't know we were gonna get here. I'm sorry. I'm you. You're okay with all this talking about it?

Jeremy 48:03
Oh, yeah. Oh, yeah. Like I'm very I got I've went to therapy for years. I'm very, I've always been very open about it. Right. I'm not a very private person at all. Like most people in my life know about it.

Scott Benner 48:14
Okay, no kidding. You went to therapy? Oh, yeah.

Jeremy 48:19
Definitely necessary.

Scott Benner 48:20
God. Well, I'm, I'm glad for you that you weren't there. Your mom must be like, she dodged a bullet. I would imagine. Yeah, she does. Yeah, no kidding. Wish. Was she her his first wife?

Jeremy 48:32
No, they never married. Okay. She was like this third I think relationship in that chain.

Scott Benner 48:41
Wow. No kidding. Is your mom had your Did your mom ever remarried? Did you have a stepfather?

Jeremy 48:46
No, my mom actually ended up coming out as a lesbian when I was in seventh or eighth grade. She had a girlfriend but the girlfriend slash partner didn't really like me so that was interesting growing up with

Scott Benner 49:00
Jeremy at least she didn't kill you. I mean, yeah. Talking about talking about what level of grief there is like you're you're the first person I've ever met that not being murdered is like an upgrade. So my goodness. Well, this is ridiculous. You know, I'm not for people listening. I did not know this was gonna happen. I I love I love talking like this because the way things come out, but I'll tell you no, no lie. Man. You stop me like when you said that. My brain when I think he's talking about a television show, like but it sounded like he said it was his real life. Like, I could literally feel my brain like arguing with my consciousness like that. Well, you probably misunderstood that. Ask it again. You know, wow, man. That's nuts. All right. Well, listen, I understand. You know, I would I would tell you I don't think you're your father. But you know, I would think that that most of that stuff we model unless it's hard why? I heard which are you don't seem hardwired to hurt people. I think a lot of it's modeling and it sounds like you weren't really around him. So,

Jeremy 50:07
right. Yeah, he didn't really want much to do with us as kids. So yeah, although having

Scott Benner 50:11
said that, I don't want you to be in a jail cell one time going to guy on the podcast told me to let go of my anger. My goodness, all right. Anyway, this is fun. Jeremy.

Jeremy 50:24
Having a good time. A lot of come entertaining.

Scott Benner 50:27
Well, listen, not many people come with, you know, something that's been on True Crime television. I appreciate you sharing. Wow. Okay, so watch me do this 180. I'm laughing? Because I feel like it's a transition. That doesn't make sense. But I want your opinion about what people can do, like, Forget you, like forget the kind of provider you are in a generalized situation, what do people do coming in the door to give themselves the best chance at a good outcome?

Jeremy 51:03
I would say taking their diabetes seriously. And I mean, for the best outcomes, the biggest thing I see that prevents people from getting good control is their fear of lows. And it takes a lot, especially if someone has an anxiety disorder, it can be really hard for them to accept that, you know, 75 to 90 is a normal blood sugar. And we really should aim for that at all times, like, at least like between meals, because they're so scared that they're going to drop low. But if you have the Basal is correct, and you know their insulin to carb ratio, and which is something I don't like the concept of and correction factor, right, then they really shouldn't be in any danger, but they get so scared of lows instead of being scared of highs that it it impedes their success. So I think getting over that fear and being willing to experiment is how people are going to be successful. Like you essentially experimented with art and and that's how you're able to find out what worked well for her. Because every person is different. And by experimenting, you find out what works for you. And then you can, you'll know your body better and know how to respond to thanks.

Scott Benner 52:26
I just love just when you said you don't like the idea of insulin to carb ratio, it is kind of bull like it is

Jeremy 52:32
it's meal content, like 45 like 100 grams of carbs, when you're eating pizza is way different than 100 grams of carbs. If you're eating rice, like it's theirs, they're not the same at all. Like it's you need to look at meal content cuz they don't it does food doesn't behave that way.

Scott Benner 52:47
That's why when I talked about an order, when I say Basal Pre-Bolus glycemic load index, like I don't even really go to you would think the next thing I would say was make sure your meal ratio your meal in some ratios, right. But it doesn't mean unless you eat the same types of food constantly, and then your ratio will probably be pretty close. But if you go from one day from a salad, to, you know, to Pizza the next day, and the third day french fries, and then back to you know salmon and a little balsamic vinegar add on in a little bit of maybe a tiny bit of basmati rice and like, you know, something light like that, that that ratio is not going to work on those four days the same way. And exactly and people, people get it into their head. They believe in they believe in things like Right, like, you know, simple example is, you know, our news is a picture now, but it was hard for me to believe because a doctor handed me NovaLogic and said to me, this is insulin, and I went this is insulin, okay? Thank you. I didn't think there were other insulins when somebody gave me Novolog I believe that was insulin, when someone tells you your insulin to carb ratio is one unit for every 15 carbs. You never question that again. Even though what comes next should make you obviously say to yourself, I don't think that ratio worked for this meal. But you don't do that you think there's some diabetes fairy came down, tapped on the shoulder and messed you up and you're not allowed to eat carrots or whatever the hell? You know, like it's, it's interesting to watch people's minds jump over all the common sense to the next thing. And that's why I agree with you. I think that's it, we should call this a We should call this episode meal ratios are both

Jeremy 54:28
they are they really are. I mean, what I do with patients also is remove or I work to remove a lot of the guilt associated with it and kind of put it in their head that you have very little control over when your blood sugar's go crazy if you're using something like an insulin to carb ratio because you're if you're doing it appropriately and you still don't get good control. It's not your fault that it messed up. It means that there's something wrong on I would say my end like we need to figure out what your meal content is. isn't what we need to do to adjust for that. So I try to actually try to take the blame on to myself if things are going wrong, because then I find that people are more willing to experiment that way. And they're not as scared like people blame themselves for everything. Yeah, that's

Scott Benner 55:14
my fault. We should try this. And then, you know, like that. Yeah, they're gonna go, it wasn't me. It was him. This guy, idiot. Yeah. You know, somebody told me recently, I must have said at some point, that you wouldn't take a bucket of water and try to put out a house fire, but you can put out a I don't know, a campfire with it. And why do you think that the same amount of insulin would work on? You know, one impact is that would another impact they said that person said that just like they were like, oh, yeah, that makes sense. It's interesting. It's interesting, what I've seen over the years, like flip switches for people. It's never the things you think it's going to be like the real just, you know, bullet points. Very medical. No one really. It most people don't jive with that. You know, there's some there's some Taipei's, you don't I mean, there are some people who just are like, ooh, marching orders. This is great. You know, but I don't think most people think that way. I was wondering, you don't need to be specific, obviously. But for every 10 people, you see how many people struggle versus how many people are just cruising in there, like give me my scripts, Jeremy, so I can get going again, because I'm great at this, like, what's the what's the delineation?

Jeremy 56:29
Ah, so for patients that have been seeing me for a while, I would say it's probably like eight out of 10 that are fine. Um, new patients that I see. It's usually like, one to two that are out of 10 that are fine. And the rest really need a lot of work. So I'd probably say like, on the grand scheme of things, like four out of 10, that I see what's that are doing?

Scott Benner 56:55
Okay, what's the time from A to yay? How long does it take you to get there?

Jeremy 57:00
Um, it depends on the patient. But I would say, if someone's really out of control, I am following them very closely. I would say within six months, we usually have things in a much better place, if not fully where they need to be.

Scott Benner 57:13
How much of your liability slows you down from moving them as quickly as you want to? liability? Yeah, like, I mean, if like, if this was a game show, and I said, you fix somebody's blood sugar in an hour and a half, you think you could do it?

Jeremy 57:29
I mean, yes, but like, that's what we do with DKA. But you don't want to actually, that actually brings up something about the Facebook group. You don't want to correct someone's blood sugar that quickly because it can cause a lot of problems. So I went on the Facebook group a few months ago and joined and we're like, Hey, guys, I'm a, an NP and certified diabetes educator. And I'd love to be able to help you guys. And I made a comment in the, in my initial post that said, you know, if you're able to, like, I see a lot of people worrying about getting their agency down as quickly as possible. And I was like, it's a marathon, not a sprint, you don't need to get from an agency of 14 to an agency of five within three months, because it's actually dangerous. So you can actually get what's called treatment induced neuropathy of diabetes. Or you can get treatment induced retinopathy of diabetes where you rapidly correct someone's blood sugar's and their body just can't adapt to it. And they start having developing complications from diabetes. And someone who was an internal medicine doctor, I think, in Kansas, like commented, and was like, No, you're completely wrong, because her child has type one diabetes. And I think she thinks that she's a diabetes expert now. And then we got very contentious I was like, posting articles being like, No, I'm completely right. Like, you really shouldn't correct all that fast, more so in like teenagers to adults. But even in kids, you it's better to slowly walk them down versus overcorrect quickly. So that's what I tell patients like it's a marathon, not a sprint, you want to get there, but we don't need to get there tomorrow. Because that also puts a lot of pressure on them that, like, if they don't get it there, then they feel like a failure.

Scott Benner 59:16
Right? Put put some context to it. Like, I think it's obvious you don't want to go from like some outrageous, like, you know, you've been living with a 14 a one C for 10 years, and tomorrow, it's gonna be a five. But if you're an eight, and you can get to a six, that's not a big jump, right? Oh, no, that's not a big jump at all. Right, right. You're talking about from real high to real low. Real quick. Right, right. Right, right. See it? May I make a suggestion? Don't try to talk to people on Facebook. It's not a great idea.

Jeremy 59:47
No, it really wasn't. I deleted my posts and left the group. I was like, this is gonna Yeah, I didn't want to get into fights.

Scott Benner 59:53
Right? You would, but I guarantee you, you should go back in there and just lurk. Don't talk to anybody. resist every one of your urges to say anything. You'll learn how people think, oh yeah, you'll learn their desires, you'll learn their fears, you'll learn what works for them and what doesn't. That's the Masters class and talking to people, I learned more watching people on Facebook and not interacting with them than I do interacting with them. So it's, it's, it kind of goes back to the how you eat thing. Like, it's nice to think that this is how it should be, or whatever this is. But the truth is, it's how whatever it is, you know, however people live whatever their impulses are, their fears, their you know, the things they're willing to listen to, or not willing to listen to. You have no control over that. There is this kind of like, I think I've done this thing by mistake where I've kind of created this almost nebulous ball of information, that does a good job of feeding everybody, not just ascertain somebody. And that's not something you can do one on one, especially when you get ganged up on. Oh, yeah. Then by the way, reposting articles. That's not the way to go.

Jeremy 1:01:08
Yeah, I was like, here's evidence woman, she's a physician. Well, supposedly a physician who knows if she's actually is. But I was like, that's when I would talk to a colleague like here's a bunch of evidence that actually supports what I'm saying and why you're wrong. But yeah, it was just it was just so contentious. And I didn't, she was she was posting a lot of misinformation to other people. And I ended up deleting it, because I'm like, These people don't need to be hearing wrong stuff. I mean, I'm sure she's a great mother. I'm sure she manages your child's diabetes well, but just because you manage your own child diabetes, well, doesn't mean you can extrapolate that to other people, because everyone is different. Yeah, it's

Scott Benner 1:01:40
a very interesting thing. Is everybody thinks that their thing applies to everybody, like when you really if you really listen to me, if somebody you know, did a thesis on this podcast one day, you would really find no matter what episode you were in, that what I'm talking about is Basal Pre-Bolus, glycemic load index, stay flexible, everything is just off of that. There's nothing else I'm not saying anything crazy anywhere else, if you and I'll tell you what, if you're a one C was five last month, and this month, you're in DKA, you know, your, your pancreas just shut off. I don't think there's a ton of concern bringing you from on the 11, a one C down into the sixes and sevens. But if you've been nine, even for years, then you're going to want a slower matriculation. But then you do the math too, right? Like, these people have been suffering for so many years. And now suddenly, they realize it's a hardship like as an adult, like imagine living for however many years with anyone seeing the nines and the 10s. And then learning one day that if your Basal was just point seven higher an hour, and you gave yourself insulin, 10 minutes before you ate or 15 hours before you ate, and that fat causes a rise later, you have this feeling of like last time, last time and lost health. And now it's easy to say, just let's do it a little bit at a time. But if you're the linchpin in that, like you're the thing that you have, and the people you help have, that most other people don't have. Most other people don't have constant contact. That's what they need. So how do you give them enough that they can go away on their own and get to a good place like you're doing? Like, I think people would say you're doing the Lord's work, like, like staying in contact with people like that. Whereas most providers aren't going to do that.

Jeremy 1:03:38
Which I think does a disservice to the patient's like, I think on that those providers parts like they're practicing wrong, like diet. diabetes isn't something that just happens to them every three months, like you really should be in contact with your patients. Yeah. Don't just don't to me, that's just fundamental.

Scott Benner 1:03:53
Don't you feel like the way it's handled is basically you take a it's like you're taking a box of 50 baby birds that are really close to being able to fly, and you go up in an aeroplane and throw them all out and you go, Oh, I think most of them will be okay. But I'm not going to check.

Jeremy 1:04:08
Yeah, essentially. Yeah, same exact thing. Yeah. And hopefully,

Scott Benner 1:04:11
it'll be alright. I mean, I've done all I can do. I put them in the air and they fly. They're close to their age. It's fine. Let's see what happens. And then you come back three months later, and you're like, this didn't work. And they go, Huh, about that. We'll try again, you know, and they don't remember you. You've been living for this for 90 days. It's like being in a war. You don't I mean, like you're, you're, you're, you're steeped in it. You're behind enemy lines. You've got your head down constantly. You always think you're about to get your nuts shot off. And then you show back up this person who hasn't been in this fight with you for 90 days. It goes Oh, I remember war. Yeah. And then they reorient themselves with the last time you spoke to them 90 days ago and try to make another decision. It's a fool's errand. You can't you really can't do that. And then they don't want to hurt you so they see a low somewhere and take away all your baseline and start the whole thing over again.

Jeremy 1:05:00
The Ben just has a self defeating cycle basically.

Scott Benner 1:05:04
And that's how nine years later you end up being an adult who's had an a one to 10 for nine years. Because

Jeremy 1:05:11
yeah, and having kidney failure and everything else that that comes with that a onesie being so high for so long. Yeah.

Scott Benner 1:05:17
So listen, Jeremy, I'm going to tell you something in less they can get you. I think that I've, I think I've put the thing in the world that works the best so far that I've seen for people with diabetes.

Jeremy 1:05:29
Like I Oh, I would agree. Yeah, thank you. That's why I sent so many patients to like I sent people with type one and type two to you, because I think it's applicable doesn't all.

Scott Benner 1:05:37
Did you? Well, if you were in the Facebook groups, though, you would have seen John, last night, a type two, who showed us all his graphs from the months and months before the podcast and the months after, and he is doing spectacularly and he's lost a significant amount of weight. Just from listening to the podcast and having type two diabetes, and I never specifically talked about type two diabetes usually. And yeah, yeah, yeah. I didn't even feel weird saying it when I like as it was starting to come out. And I'm like, Oh, you're gonna say something nice about yourself. And people are gonna think that's weird. But I just genuinely believe it. Like, I think that what we've discovered over this last hours, you need consistent conversation, it can't be getting jammed down your throat, it has to be something that you can hear, believe and take in. It has to be something you can do on your own. And it can't be all at once you need it matriculated over time. And that's what the podcast does it. And then there are other people that tell me that even after they're in a good place, they use it almost like maintenance. Like I it's probably the the equivalent of like an AAA meeting for some people. Like let me just go listen to a person who has type one today. So I keep my head in the game a little bit, you know?

Jeremy 1:06:50
Yeah. And actually, that's what kind of what I like about listening to the podcast, because I get to hear people living with diabetes and their own lived experience, which I don't. I mean, I get that from my patients, but you go much more in depth than and it's more like different perspectives that help inform me of like, what it's like to live with diabetes. There was one guy, I it took me like, four or five days to get through the podcast episode, because he would start you were talking to him about I don't remember his name. You were talking to him about complications from diabetes and how he was living with his complications. Might Yeah, and he would start breaking up and crying and I would lose it. I would just like start bawling. So I was like, Okay, I'm gonna pause it and come back to it when I feel emotionally ready. But like that, that one wrecked me like that, oh,

Scott Benner 1:07:42
it's really important. His conversations incredibly important. It is yeah, you just, you can't live every day, like you think your kidney is going to explode 50 years from now, and you can ignore it, that it could happen. You know what I mean? You have to be somewhere between, you know, a little blissfully ignorant, you know, day to day, when you get a blood sugar, it's 180. You can't sit around like, you know, out of your mind and a puddle on the floor. And you can't forget that that's not okay. either. You have to find a psychological middle ground that you're willing to live in, so that you can live today. Well, and live tomorrow and in the future. Well, at the same time, because it isn't, I mean, listen, I don't really outright say it very often, but you ignore your diabetes, some bad's gonna happen to you. Like, that's just what's gonna happen, you're not going to avoid that you're not going to be the you're not going to be the 110 year old lady smoking cigarettes on the local news go and I'm gonna live forever. Like, you know, like, it's your Listen, I'm not I'm not a I'm not a doctor, okay, but there's a certain amount of sugar molecule that belongs in your blood, it keeps your brain running. You know, if you have too little, you just thought your brain shuts off the sugar in your blood is energy keeps your brain going, you have too little you shut off. That's it, you don't get to turn it back on. Again. Once it's off, its off. Too much sugar is acting as an abrasive agent inside of your blood and your blood flows everywhere down to the tiniest capillaries, like through arteries and veins and everywhere. And it's it's flesh, and it's scraping now that sugar is in there scraping and scraping and scraping and eventually a hole pops and one of them. And that is a stroke. If it happens in your brain, if it happens in your heart, it's a heart attack. If it happens in your toes, you can't feel your toes anymore. Like like that's what you're avoiding. You need a balance of that sugar molecule in your blood needs to be the right amount. Not too little. Not too much. And it sucks, but that's the truth. You know, Seattle. Get in the game. You know what I mean? Like, what what do you think of the pro tips? Have you been through them all?

Jeremy 1:09:51
Yep. I mean, I love them all. Like that's what i Those are the episodes that I like send to patients for them to actually listen to

Scott Benner 1:09:59
them. I'm glad, I'm glad we worked hard on them. Actually, we're going to add to them this year to show awesome yeah, Jenny and I are finishing up a defining thyroid series right now. And then we are going to basically do like director's commentary, ish types of stuff for the protests, we're going to go back and listen to them. And then we're going to come and kind of like add to them a little bit with new episodes, just to kind of, maybe supercharge them a little bit. So

Jeremy 1:10:27
yeah, and one thing that I'm hoping changes in the future, is the whole Pre-Bolus thing, thing. So I use um, so I would say for 90% of patients, it's impossible to Pre-Bolus for every meal, because it takes a lot of planning, especially people with kids, it can flip their day upside down. So I actually have been switching a lot of people to either fiasco or limb Jeff, which are more rapid acting. And the changes are so much better, they can give it right when they start eating. And it gives them the same effect as if they gave it 15 minutes before. But that's one thing I think pharmaceutical companies need to focus on is making insulin function more like actual human insulin so that people can live a normal life.

Scott Benner 1:11:09
Yeah, I also think that I'm right there with the DIS cannula technology. So to cannulas, they should be working on materials that don't look foreign as best they can to your body. Because, you know, bad sites are also an issue you get on me, you go through all the things we just talked about, get all your settings, right, do everything. And then your site starts going bad. You know, like she's got, you know, it's not one thing. It's another, I will tell you that I tried to ask for Arden. It burned and and left her feeling bruised. She could power through it. But it was very, very unpleasant.

Jeremy 1:11:45
I believe it's the niacin that's in it that makes it act faster, which will also cause a burning

Scott Benner 1:11:49
Yeah. So then we transition that boom, Jeff, that was she described as twice as bad as the fee is for her. Oh, interesting.

Jeremy 1:11:56
I've had a lot of people with it, using it through a pump that have had do great control, but also have burning. So they went back to human log and said, Yeah,

Scott Benner 1:12:05
so I'm telling you Arden could wear the Fiats shoe or if he asked pod for weeks, it always hurt her the site was sore it burned going in, but she dealt with it. The loom Jeff, if I'm saying it right, two days, less than 48 hours, she's like, take this pot off. Like she couldn't get through it. So it's no luck for us. So you know, whatever they figured out makes it work better. They got to figure out this piece next.

Jeremy 1:12:31
Yeah. I mean, Peter works really well, too. But I find that it's hard to get insurance coverage for it. Usually insurance will prefer him a logger. Novolog. And if both of those don't work, I can usually get it covered. But a lot of it's an insurance game to like the insurance companies are awful. I hate them so much. Yeah,

Scott Benner 1:12:49
I imagine Arden has been using the pager for ever. At this point, it gets so long. I don't. I couldn't remember when she used to use Novolog it was so long ago. And I find it the way I describe a Petri dish that's incredibly smooth. There's no there's not a ton of like, oh my god, it's working too much now, or it's not working enough now and you can kind of Pre-Bolus and, you know, you can use larger amounts, at least for Arden and it's just there's not a lot. I don't see double arrows ever. Like honestly a straight arrow up or down is fairly uncommon around here. I mean, a straight arrow downs really uncommon around here. A straight hour up. Okay, if we miss a Pre-Bolus, like you just said, but double arrows in either direction. I have not seen in forever. I love a pizza. Actually. I wish they would advertise on the show. Honestly, I would I I'd have no trouble being able to talk about a pizza. That's for sure.

Jeremy 1:13:44
With Arden's What 16 or 17

Scott Benner 1:13:46
She's 17 going to be 18 this summer.

Jeremy 1:13:49
When is she going off to college in the fall? Yes. How do you feel about that?

Scott Benner 1:13:55
home she doesn't talk to any boys.

Jeremy 1:13:59
Like in terms of her diabetes, like do you think she's gonna? I mean, from listening when you had her on the show? I think it was a few months after the episode aired. Yeah, um, I honestly, like love that episode. Because she I have a very similar sense of humor. So I was laughing the entire time. Like she i i loved her attitude. Do you think she's going to do okay, managing on her own?

Scott Benner 1:14:23
Yeah. So I mean, keeping in mind that the podcast episodes a moment in time, like we've been working on this getting ready for Arne to go to college for 10 years. Yeah. And we're still doing it now. Like she and I actually had a really long conversation. About a week or so ago, when I said, Look, you know, I know right now she's applying to colleges. She's just about done. She's been accepted to a number actually, she's been accepted to every college that she's applied to so far. Oh, awesome. She's super excited. She has one that she definitely wants to go to. She's holding out to here about one or two more before she decides. But I said as soon as this whole college application process is over. You and I are going to go back on the podcast and talk again, nuts and bolts, and then we're going to put that stuff in practice in our real life. Now, keep in mind like, I'm not up her butt constantly about her blood sugar. You don't I mean, I helped her, but she I also think the process, I honestly think you're learning through the process. You know, like, you know, she changed a pod about 45 minutes before you and I started recording. And I said to her, I'm like, I don't know what's gonna happen here. Right? So maybe 20 minutes before you and I got on, I saw an arrow like she started going the wrong way. So we took took her old pot off site looked a little angry, is that a good way to put it? And yeah, and I could tell that the site wasn't working as well as I wanted it to for about the last five hours. So much so that I sent her a text while she was at school because she caught some adrenaline from gym. And the algorithm couldn't do anything about it. It was trying and trying and it wasn't having impact. So I said to her, Hey, I think the pods done, we're going to change it when you get home. For now. Let's make a bigger Bolus. So we Bolus a little more we turned this 150 back into like a 120 By the time she got home. But as soon as we popped the pot off and put the new one on, maybe 20 or 30 minutes later, we started seeing up again, she started going 131 40 Diagonal up. And I told her what to do there. Like I said, let's open the loop, which for people who don't know about like pumping like basically turn the algorithm off. Let's run this like a normal pump. For now I want you to get your background Basal insulin, because we're going to make a correction Bolus here. And we don't want the algorithm to take away the Basal. So we opened the loop turned off the algorithm made a Bolus that I knew would correct it. And probably about five minutes ago, actually, while you were talking, I texted her again, I said close the loop her blood sugar's 95. Now. So would she know how to do all that? Huh? Ish. You know what I mean? But we're going to have that conversation more as she just to make sure she understands like the ins and outs of the algorithm. I also think it's incredibly possible that Arden is going to be using on the pod five when she goes to college and not a loop.

Jeremy 1:17:23
Hopefully, the FDA needs to get that approved. Now, like I have so many patients that need to go on.

Scott Benner 1:17:27
Yeah, I think that's I think that's going to happen in any any second now. So that I'm happy about. But also, I don't want to spend a ton of time over explaining the algorithm she's using now only to move her to a different one. So I'm waiting for that little gap in time. And then we'll keep going. I honestly think she's going to be okay, I think the bigger issue with her being away, is going to be the impact it has on her at nighttime. Because there is still now you know, a time or two a month, where you change a pot at the wrong time of day. And then you end up with a high blood sugar as you're going to bed, you make a Bolus for you over do it. And then somebody has to help you to in the morning. Like that's the time I'm more concerned about for her. Yeah, you know. And even at that, you know, the other day, I did say to her just kind of in passing, I was like, Hey, listen, we should start paying more attention to when we change your gear. As like, we don't do it now, because it's not really problematic. But there are times of day where you should start thinking about changing your palm so that you don't have overnight issues. I'd rather you have an a daytime problem than a nighttime problem when you're at school. And she was just like, alright, you know, and so that's the stuff we'll do, but I don't see. I don't see her leaving as some finite ending to our story. Like, you know, I can write, I can do diabetes blindfolded. And I can do it just at a distance to I won't have any trouble helping her get settled at school, I don't think

Jeremy 1:18:55
I think I was actually more interested in like the alcohol conversation if you've talked about her with that, with how that's going to affect her. Because I mean, hopefully she doesn't drink until she's 21. But it's college. And that's a big sticking point for a lot of my pain, my young adult patients, managing how to consume alcohol and also manage their pump.

Scott Benner 1:19:15
Yeah, I imagine my kids don't aren't drinkers, either. My wife and I like it would be incredibly shocking to me if my children drank to access.

Jeremy 1:19:25
Oh, good. Yeah, I mean, even one drink like one glass of wine can affect can be pretty dramatic for some people.

Scott Benner 1:19:32
My kids have grown up with we talked about modeling earlier. Like, in our extended family. There's modeling that is made my children they don't want to drink.

Jeremy 1:19:43
Oh, good. Yeah. So avoiding alcohol in general is good, but with diabetes, it's always a good idea anyway, but yeah,

Scott Benner 1:19:50
yeah, kidding. I mean, can I tell you she's never going to do it? No. Can I tell you she's not going to change into a completely different person. I mean, I don't think so. She's pretty headstrong, but I think she knows who she is. To enough, I don't think I don't think you could push Arden off of who she is, if that makes sense, to if that ends up being who she is, then we'll have to figure out how to handle that. But I'd be surprised, I guess we'll say, you know,

Jeremy 1:20:15
she seemed like she had a good head on her shoulders. She was very bright. She's

Scott Benner 1:20:19
basically me with like, in a girl's body. She's very just kind of like, she has a dry sense of humor. She's confident that she's smart. She knows. She knows what she knows. She knows what she doesn't know. She doesn't try to play and you know, she doesn't try to play in Sandbox, if she doesn't understand she's, you know, she's consistent. So and she's tough. Like, she really is a tough kid. So we'll see what happens. But yeah, I do. I know. It's in the back of my head. You know, I'm like, it's gonna happen. One of them's gonna turn into a heroin addict or something, you know, oh,

Jeremy 1:20:55
well, you have clarity on her anyways, if she dropped below in the middle of night, you get an alert on her, correct? Yes,

Scott Benner 1:20:59
yeah. But she's gonna be too far away from me to do anything about it. So

Jeremy 1:21:04
that's what I usually recommend parents do is actually get to know the roommate of them. Oh, and have their number. I actually had a patient who was on an omni pod. This was like six or seven years ago, who was on Dexcom. She was something happened to her partly because of malfunctioning pod where it did something to her Basal rate. And she was like, basically, she was like, 30s overnight, and she didn't wake up to it. And her mom got the alert at like three or four in the morning, or actually woke up to it, and called the roommate and the roommate actually was able to go in there and give her her glucagon and, and bring her back up. And without that, I she probably would have died.

Scott Benner 1:21:45
Yeah, that's crazy, though. I'm gonna make sure I have 19 different ways to get to her. Don't worry about that. I probably put an air raid siren in her dorm room, and I'll I'll just control it remotely. I don't know.

Jeremy 1:21:57
Yeah. I mean, I tell that to like husbands and wives. I tell that like to anyone that has any sort of partner or like in their life, to get clarity and share it and make sure that you are always connected. I had one person, another person who went low in the middle of the night, she was on a business trip in Japan. Her husband got the alert, called the hotel. They had to break into the room to wake her up because she didn't wasn't responding to it. And then she was able to treat it and be fine. But if she didn't have that, who knows what would have happened? Yeah,

Scott Benner 1:22:28
terrible. Who really is. This diabetes sucks. It's not it's not great news. Alright, listen, Jeremy. We've been we went over time. Is there anything? I didn't ask you that you want me to?

Jeremy 1:22:40
Um, I don't think so. But I'd love to do this again. I love talking about diabetes.

Scott Benner 1:22:45
To me, I don't see how you're not gonna be back on the show. What do you think of that? Oh, that's great. Dude, you came with stories. You have a clearer view of how to handle type one. Let's stay in touch. I really appreciate you doing this. I really do. Yeah, thank you for having me knows it was a it was a real pleasure.

A huge thanks to Jeremy for coming on the show and talking with me about what he does for a living and some of my ideas as well. Thank you, Jeremy. How also want to thank Dexcom and remind you to go to dexcom.com forward slash juice box to see if you're eligible for a free 10 day trial of the Dexcom GS six. And of course, Omni pod.com forward slash juice box find out about the Omni pod dash and the Omni pod five and get yourself going with a tubeless insulin pump that Arden has been wearing since she was four years old. On the pod.com forward slash juice box links in the show notes, links at juicebox podcast.com. To these and all the sponsors, where you click the links, you're supporting the show. If you're into helping people, especially people with type one diabetes, I'd like to ask you to go to T one D exchange.org. Forward slash juicebox. When you get there, fill out the survey completely. And you've helped somebody all you need to be is a US resident who has type one diabetes, or is the caregiver of someone with type one, t one D exchange.org Ford slash juicebox. Join the registry, complete the survey. Help someone with type one diabetes, help yourself perhaps and support the Juicebox Podcast. You will do all of this in the fewer than 10 minutes that it will take to go to that link and complete the survey. The survey is very simple. You'll know all the answers to all the questions. It is also HIPAA compliant and completely anonymous. T one D exchange.org Ford slash juicebox. There are links in the show notes of your podcast player and links at juicebox podcast.com to All of the sponsors, and two T one D exchange, when you take the time to click on my links or to type them in a browser, you're telling the sponsors that you came from the Juicebox Podcast. And that is a wonderful way to support the show. Are you looking for a vibrant and intelligent community around diabetes? look no farther than the Facebook page, the private Facebook page for the Juicebox Podcast. It's called Juicebox Podcast, type one diabetes. The group has over 28,000 members. And those members are responsible for between 70 and 110 new posts every day, on the Facebook page. Every conceivable conversation around diabetes is happening at Juicebox Podcast, type one diabetes on Facebook, you're gonna see great questions, thoughtful answers, and supportive people. No matter if you're an adult living with type one diabetes, or the caregiver of someone with type one, this group is for you. Doesn't matter if you eat low carb, or high carb or somewhere in between your questions and thoughts are welcome on our Facebook page. I hope you check it out. Last little bit. If you're looking for the diabetes Pro Tip series, or the defining diabetes series or any of the other multitude of series that exists within the podcast, you can find them in a number of ways. They are at juicebox podcast.com. They are at diabetes pro tip.com. And if you belong to the private Facebook group, you can find them listed in the featured tab. Now if you're enjoying the podcast, please consider sharing it with someone else that helps the podcast grow more than anything word of mouth is definitely how the show has become what it is. If you have already shared it with everybody you can think of and you've bought it on the pod or index comm or supported one of the other sponsors. You've done the T one D exchange survey. And now you're looking for another way to give back to the podcast. Super simple. A five star rating and a thoughtful review in whichever audio app you listen in would be amazing. Thank you so much for listening. I'll be back very soon with another episode of The Juicebox Podcast.

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#748 Asher

Rebecca's son has type 1 diabetes and autism.

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

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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
You are listening to Episode 748 of the Juicebox Podcast.

On today's show, we're going to be speaking with Rebecca who is the parent of a child with type one diabetes, who also has autism. While you're listening, please remember that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, always consult a physician before making any changes to your health care plan. We're becoming bold with insulin. Are you a US resident who has type one diabetes, or is the caregiver of someone with type one? If you are, please take a few moments to completely fill out the survey AT T one D exchange.org. Forward slash juicebox. I'd like to take a moment to thank you because last month in August of 2022, the Juicebox Podcast hit a momentous milestone, a half a million downloads in one calendar month. Thank you so much for listening for sharing and supporting the show really means the world to me, thank you.

This episode of The Juicebox Podcast is sponsored by us med. Get your diabetes supplies from us med. That's how we do it. To get started, all you have to do is call 888-721-1514. Or go to us med.com Ford slash juice box. When you call that number, or click on that link, you'll be able to get a free benefits check and get started with us med. This episode of the podcast is also sponsored by Ian pen from Medtronic diabetes. If you're looking for an insulin pen that gives you much of the functionality of an insulin pump. You want the in pen in pen today.com Head over learn more and get started today. Hey, Rebecca. Hi. How are you? I'm good. I'm I don't know. It seems really to me.

Rebecca 2:31
Okay, at this point in my life, it's always too early.

Scott Benner 2:35
Yeah, I just don't know. I don't ever. I don't know. I I feel like I'm three years into COVID. Like, nothing's this like, right? Like my, my wife's like, I'm gonna go to work and it's like, okay, so she went, and she comes home she was nobody was there. Magari it's the companies can't even get people to go back to work. They're like, go back to work. And people like, all right, they just don't go from home or they're just not showing up. Let's work from home stuff like these working for home for so long. That they you know, they're just like, like it now. So everyone calls their boss with a reason. We can't come in. I got this, you know, and then the 60 people are supposed to show up at an office building. There's four people there those four people are like, Oh, no coming back if nobody else is coming back, you know. And, and so my wife's like, now she's in the dining room again. And now it's not even the dining room anymore. We got rid of the dining room table like she's using it as a desk she put a sofa in there you know like I'm like I'm like she's never gonna go back. We need time apart.

Rebecca 3:44
I missed I miss working i People are crazy. Ya know?

Scott Benner 3:51
I think the worst thing is my wife is a real like Type A like hardworking person. So all this does, like you would think like oh, it eliminates her commute. And you know, probably saves her all kinds of time. It just gives her three more hours a day to work.

Rebecca 4:05
Hey Scott, I'm sorry Give me one second the nurse is calling me from school ready Hello. You understand but are you there?

Scott Benner 4:16
You know I was

Rebecca 4:19
to be sorry, the data sabot nurse today and she she saw the Dexcom and the phone and the new pod and she's like, which ones which?

Scott Benner 4:31
Well, we'll just tell you what, introduce yourself and we'll then we'll jump right in.

Rebecca 4:35
Um, I am Rebecca burn Werth. I'm a stay at home mama to Asher and archer. And Asher's my little my little diabetic. He's four years old in he's also got autism on top of it. That's why That's why I was message you and like, Hey, I don't know if you'd like to talk to anyone who has autism on top of diabetes, but like I'm willing

Scott Benner 5:01
So ash, first of all, did you name your children so that one day they'd be on a CW show what's going on?

Rebecca 5:08
It was just laziness because we had such a hard time picking out Asher's name. When it came to a little Archer, we're like, we'll just stick with a

Scott Benner 5:15
honestly, did you really just replaced the s with an orange SC, right? Oh, pretty

Rebecca 5:21
much. Yeah, Archer is one more letter, but they're pretty common. They're, I mean, they're pretty close. Yeah, guys, I also like people getting confused. So

Scott Benner 5:31
let's keep most of these letters. And so is Archer younger or older than Ashraf, He's younger. He's too. He's too. Okay. So, I, we're going to start off by saying that what I know about autism fits in a thimble. So I'm going to be asking a lot of questions. Okay.

Rebecca 5:48
Okay. I feel like I'm still learning too. I'm sure I know more than you.

Scott Benner 5:53
Did you imagine? Honestly, Rebecca, at the end of this time, can you imagine if the takeaway was that I knew more about autism than you did?

Rebecca 6:02
I mean, I would actually be happy about that, because I feel like I'm plugged into the type one diabetes community. And I've learned a lot from them. But autism not plugged in with anyone yet. I gotcha. interest. And, and so it's been a lot easier to learn about diabetes than autism. I've also had a harder time with the autism diagnosis than the diabetes one.

Scott Benner 6:24
All right, let's find out about all that. She have a baby? And how quickly did it become evident that Asher had autism.

Rebecca 6:38
I feel like I caught it late. And it's because we've moved six times since Asher was born. And I'm now going to be seven times. So we weren't plugged into a community, we didn't have a lot of people we could hang out with, he didn't hang out with other kids. And my little one just came home, you're probably going to hear him. And so we thought that he was just having a hard time learning to talk because he didn't have a lot of people to talk to. Okay, other than mom and dad. Looking back, I'm I feel like I could have caught it around two years old, instead of when I did, which was this past year, so more around three years old. And plus, it was during COVID. So you top that all off. We moved during COVID and literally met no one at that time. So it's just a lot of no community for him to talk to. Why

Scott Benner 7:39
are you a military family? Are you running from the law, like what's going

Rebecca 7:43
on? I was the National Guard. So I didn't move a lot for that. It's just my husband and we got married. I felt like decently young. We both just gotten out of college and it's just trying to find a stable job since then. And he's a contractor. Okay, so I know, I know, a lot of people will hear contractor know what that means. But it just basically he works for himself and usually is on one to two year contracts with people. So it's been a lot of moving around.

Scott Benner 8:10
Following work. Yeah, yeah. Okay, much. Alright. So what do you say? Well, hold on a second. How old is Asher? When he gets type one.

Rebecca 8:20
He was two and a half years old.

Scott Benner 8:23
Okay, so you, let's figure out how you learned about that. What What were the signs that got you to a type one diagnosis.

Rebecca 8:30
Um, I actually had I had gestational diabetes with little Asher. And Daniel is actually the one that caught it. My husband, I feel like he has had watched me with my pregnancy and connected the dots with Asher he had gotten really thirsty. And he would get tired and just lay down on the ground while trying to play with his toys. And Daniel came to me is like back, I think he might have diabetes. So like, Why No, he's like, yeah, he's does one of the sciences. They drink a lot. And he's just drinking so much and paying so much for my that No, but I of course went and looked, I just didn't want it to do diabetes. I went and started researching. I'm like, okay, so I called the doctor and took him in. And it was one of those instances where the doctor just wouldn't listen to mom. And I told him, I'm like, Hey, I'm worried my son has diabetes. So I brought him in to get tested. And the doctor was like, No, I think he just has a UTI. So bring them in tomorrow, and we'll test them for UTI. I'm like, No, I would like you to test him for diabetes because I really think that's it. These are all the things we've been seeing with him. And we're worried so we'd like to get him tested just to check is like okay, well bring them in in morning. And I brought him in in the morning after he had fasted. He's a hungry baby who is miserable because I'm not letting him to drink anything. It And it was a nurse practitioner who was very sweet instead of the doctor this time and she was like, okay, she sat down. She's like, so you think Asher has a UTI? I'm like, No, I think he has diabetes. And she's like, what? I'm like, Yeah, I brought him in because I want to test them for diabetes. She's like, Oh, I'm so sorry. That's not in my chart at all up? Of course, not. Like, I want him tested for diabetes. I've had him tested for UTIs here recently, and like, I don't think that's it. And she's like, Okay, well, we'll test them for diabetes, and just to, as a backup will test him for UTI. And I'm like, okay, so um, she tested is a one C there, as well as his blood sugar, and his blood sugar was really high. And so she's like, Well, based on the blood sugar, I am worried, but we'll get back to you. And then, of course, had the appointment later. And the same doctor who wouldn't listen to me was at the appointment. I was just so further, he did apologize or anything when he had been such a speaker. And he didn't remember me either.

Scott Benner 11:10
He didn't from how from when it was

Rebecca 11:12
like a week? Late, remember me? That's been that's been most of our experience with with medical stuff since since I felt like I got pregnant.

Scott Benner 11:25
Well, you're probably are you diabetes? I'm sorry. Just let me ask you. Are you always new in the because you're moving so much to meet the doctors not have a chance to get to know you?

Rebecca 11:35
Maybe? Maybe that's it. But even like, I know a lot of people have issues with emergency rooms. But like, I've had issues with the emergency rooms where it almost killed me because I was bleeding internally, and they just don't listen to me. I don't know. Like face that's like, I'm dramatic or something. But they don't listen to me. I don't know.

Scott Benner 11:56
Can we for a second? That's interesting. Do you find that? Do you find that in the rest of your life as well? To people? Is it your voice or your because I've said this on here before but I do more of my business over the phone? Because I have a deep voice.

Rebecca 12:12
But I think maybe I'm too nice. Okay. But I genuinely think a lot of times, I'm just too nice and don't put my foot forward as strong as I should, I guess. But I don't know. When it came to my baby. I was pretty pretty forward. But with myself, I don't. I'm very quick to like jump in to battle for people I care about, but not for me. So they'll walk all over me. But with Asher, I was pretty forceful about the diabetes. They were like No, and have been ever since. Gosh, it's been a lot of fighting even to get the autism diagnosis. But we got it.

Scott Benner 12:48
So you don't have type one in your life from maybe six months or so before? You've you figured out the autism. Is that right?

Rebecca 12:58
Yeah. Let me just work out the time. Yeah, because he got he got diagnosed too. So it was probably about six months till we started really noticing. Okay. And it was because it was because I was looking for a preschool for him. And no one would take him because of diabetes. I was really struggling. And I called the one preschool that was like a peer program where they have a bunch of kids come in that have special needs as well as kids without special needs. And I was trying to get him as one of the kids without special needs of mine was filling out the form. It really sounded to me like Asher was special needs. I was like, oh, no, I don't think they're gonna accept them. And the lady, Becky, she's wonderful. She works at the school. She called me she's like, so I feel like you were very honest on this application. And she's like, I feel like, maybe we can bring after it and get him screened. So he can become one of our students on the other side if you're open to that. And so,

Scott Benner 14:10
Becca, let me ask a couple of questions here because I think I'm following you, but you're not 100% saying it. So you're as you're filling out a form, in your mind trying to be like type one diabetes, that's not special needs. And that forms asking you questions, and you're like, yes, yes. Yeah. Oh, geez. Yes. And then you hand the form to someone else. That person looks at it and says this kid has autism.

Rebecca 14:37
She didn't say he had autism. She said she wanted to get him screen and that she thought she thought speech delays based on what I wrote speech. Have speech delays. Yeah, he has speech delays along with autism because I was like, I understand the difference, but

Scott Benner 14:52
because as I heard that I'm like, but that form is really well designed. If it can just oh yeah, if he could just pluck that out. But so she saw speech to lays okay, then he goes into testing, I'm assuming this is where we get to it.

Rebecca 15:05
Yeah, it was about three months of testing. And at that point I had already started, I took him into the doctor and already started the process of getting them into behavioral psychologists. But there was a year long waiting time to get him like medically diagnosed for autism. So the school diagnose him for me. And he started school there, which has been a huge blessing this past year, he loves it so much in and no one else would take us so he wouldn't have been in school, if not for that. And then he the process of getting him diagnosed medically, I ended up having to travel about four hours away to a psychologist that would allow me to pay out of pocket. And she diagnosed him we paid out of pocket rather than using our insurance to give them an early diagnosis. So I could start getting some more help like speech therapy and occupational therapy, and ABA therapy. So I really had to rush it because I don't know if COVID is affecting the system or if it's always like this, but they say the earlier you intercepted the better and I was already late so I was like I gotta do some digging for, for him.

Scott Benner 16:20
So how do they describe? Again, I'm not I'm a little bit of a neophyte on this here. But is autism designated in severity or levels? Or how to how was it thought of by the, by the medical community?

Rebecca 16:35
From what I understand, it's different everywhere. The psychologist I went to gave him a level two autism out of three. But some parents just based on Facebook, like autism pages that I've followed, say that their their doctors didn't even give them a level, they just say, hey, they have diabetes on the forum, and are not diabetes, I'm sorry, autism, on the form. But we got a level two diagnosis, but not everyone gets a level on the autism spectrum.

Scott Benner 17:06
So if you describe Asher to me, like what are the things that you see that? That now that you know, he's autistic, what do you attribute to autism, in his, in his life,

Rebecca 17:21
his ability to communicate, he communicates different than everyone else. And I think one of the best examples that really helped me understand my son a little more, I was reading a book on autism. I don't remember it, I could send it to you after this. But the guy said he's like, this kid kept, kept saying, whenever he met people, he would quote, the scene from The Wizard of Oz, where the witch comes in the Good Witch. And she says something to Dorothy to like, say hello, but it's like grand and exuberant, and it's a quote, so it's a little longer than hell up. And every time the kid saw someone new, or, or, or saw like his mom after school or something, he would say that, and the doctor helped her understand the doctor wrote the book helped his mother understand. He's telling you Hello, from what he understands to him, Wizard of Oz was just this very memorable moment, where she comes over and says, Hello, in this grand way. And that's how he's learned to say hello. So he's saying hello to you in that moment. And Asher, when he gets really upset, he'll start quoting things that he loves, like he loves Winnie the Pooh for the longest time growing up. And he would quote this part where we got upset when he was upset with me, because I'm like doing diabetes things or I'm not understanding what he's trying to say. He would start quoting this little scene from from Winnie the Pooh. And I didn't understand why for the longest time until I read that book. I'm like, Oh, he's trying to tell me Mommy, I'm upset with you. I'm upset you aren't understanding me. So it's just his his speech has been the biggest thing. I feel like

Scott Benner 19:13
Does that happen with everything? Or is it just big things? I mean, he like does he go into King Lear if he wants to drink of water or

Rebecca 19:23
he speaks of like, one word two words. I'm lucky to get a sentence out of him because he doesn't understand how to form sentences. So if he wants I give him like the sugar free lemonade if he wants lemonade, he's like juice or if if he's gone to the bathroom in his diaper and wants changed, he says body I'm trying to make food. I've got this little board upstairs with all these pictures that he can like run and point to to communicate to me if you want something,

Scott Benner 19:58
and that all works well for him.

Rebecca 20:01
I mean, it could be better, but we started speech therapy. So I think he's one of the autism spectrum children that's actually going to talk to me one day, it's just gonna take a little time. Because he's super smart. It's just his speech is what gets in the way.

Scott Benner 20:21
Is there anything besides the speech that's indicative of autism?

Rebecca 20:25
Um, he does seem to have some issues with fine motor skills, but overall, he's pretty good with it. He just struggles with like a fork, or a spoon. He he's awkward at holding them. But he's, he's not as severe as some autistic children I've seen. And most I feel like I don't, I don't want to, like lump it all because they're all so different. All autistic children, but I know a lot of them aren't very social. They avoid eye contact. They're very scared of the world around them and very sensitive to touch. But I'm blessed in that Ash are loves. He loves cuddling. He loves being held, he loves being hugged. He loves adventure. He loves going new places and seeing new people. So there's a lot to him that that he a lot of the symptoms to autism that he didn't get. Seven the cats. I'm sorry, my cats being really hyper.

Scott Benner 21:28
Okay, we can't see we can't see your cat.

Rebecca 21:33
She's, she's usually pretty scared. If she doesn't speak it out in here to have fun, which is rare. It's

Scott Benner 21:39
just sort of stopped talking. You're like, hey, cats. And I was like, Oh, I'm sorry. For 20 minutes into this. I'm starting to get Bolus apart, Rebecca is gonna lose her mind. Anyway, so. Okay. How is the I'm trying to figure out how to ask this question. I guess so. No, no, no, not not like, I'm going to insult you. I just I'm trying to Rebecca, I don't know, if you realize this, I'm trying to layer a story together. So at the end, you feel like you've been taken on an adventure, but I have not at all, given any thought to this prior to getting this. So

Rebecca 22:17
Toki I enjoy your podcast, thank

Scott Benner 22:19
you. I want to know your husband sees the lethargy and the urination and the drinking. He connects that to your gestational diabetes, something he saw there, you get diagnosed. I mean, at that point, you just have a, you know, you have a young child with diabetes. And are you starting that journey with what like, what do they send you home with this? My first question?

Rebecca 22:48
Um, well, I have just gotten out of the military. And he's a contractor. So we had no health insurance. When Asher got diagnosed, we were in between getting health insurance from the military and then trying to find some for him. So we they sent us home with the bare minimum, while we try to figure out so we came home with a little vial of insulin and, and a bunch of syringes, and reader, which I actually had a ton of, like glucometers at home, as well as ketone test strips. But that was all new to me, because my gestational diabetes wasn't so bad that I needed insulin, I I just had to have a pretty strict diet. I was pregnant. So all of that was pretty new to us. It was a neck and I pretty difficult. No kidding,

Scott Benner 23:51
right. So you dig into that first? And did you find it? I mean, how overwhelming was it for you? New Baby, were you pregnant?

Rebecca 24:06
No, but I had a little I think Archer did math. And he was only three months old at the time, maybe? I don't know. No. Three months old. He would have been it would have been a year and three months.

Scott Benner 24:21
Okay. But that's still that's a very new baby on top of a young a young child who now has diabetes. So you're a little overwhelmed by the way every time you say I was in the National Guard and my husband's a contractor I just assumed he's a hired killer for the government you understand right? No, he's sounds like you're jumping around the country often people but

Rebecca 24:45
he would love me told that he were a total nerd some play like Dungeons and Dragons and he's always a rogue

Scott Benner 24:54
don't even please never tell me what he does. Okay, because I just like it It's like assuming like an under the cover of night you guys like swoop into like Minneapolis and take out a congressman and then just leave. You know what I mean?

Rebecca 25:07
I think when he does, it's pretty cool. But no, he's not like Tom Cruise.

Scott Benner 25:11
Gotcha. So she but he moves around a lot. It sounds like his job is active. Are you kind of on your own with the diabetes? Are you guys doing it together?

Rebecca 25:21
No, he actually works from home. Okay, yeah,

Scott Benner 25:24
he brings the bodies there. That's nice. No, but no. Okay, so So are you guys are sort of in it together? Yeah,

Rebecca 25:35
yeah. He's very involved. Really good, daddy.

Scott Benner 25:40
Excellent. Do you have like CGM now or how are you managing?

Rebecca 25:45
Yeah, we got the Dexcom was one of the first things we got. I feel like, I felt like I got it pretty quick, too. I think it was four months in. Yeah, we've been on the Dexcom for a while now. And I feel like if I had to choose anything, that would be the one thing that I could not do without for him.

Scott Benner 26:05
Does Asher have trouble telling you if he's low or high? Or how he feels?

Rebecca 26:10
I feel like he doesn't really have to. But I don't think he understands it. No. He doesn't understand when he's lower high, he'll just come up to me and ask for juice. There have been a few times very surprised me, like, in the middle of the night before his Dexcom went out off one time he came into the room, which he never does. And asked for juice. So yeah, I think he understands it. But he doesn't know how to tell me.

Scott Benner 26:40
What's that mean? It's obviously it's a major sticking point for for his day to day life, not just not just with diabetes. I'm trying to imagine as he gets older, how he's going to interact with that, like, can he test his blood sugar? Or

Rebecca 26:55
I think he will be able to Yeah, yeah.

Scott Benner 26:58
He understands what's happening in any, like way, often at his age.

Rebecca 27:02
No, I think it maybe 12 or 14, he'll be able to start doing that. That's me hoping he'll be able to start doing it by himself. But like, we can't even get him to get potty trained right now. My two year olds almost potty trained, but we're struggling with Asher. So

Scott Benner 27:21
how does that manifest real life does he have? He's wearing diapers?

Rebecca 27:25
Yeah, he's still wearing pull ups. Okay.

Scott Benner 27:29
And so it's so interesting that he can connect his like anger as an example with cartoon anger on television. And, and it's enough to make him recite something even though he doesn't speak in sentences, usually. But he's not, but he doesn't connect, like the urge to go to the bathroom or going to the bathroom. Yeah, that must be

Rebecca 27:54
going to the bathroom. It's more. He is used to a routine and he doesn't like that getting changed. That's one of the things with autistic children, you tend to get them on a strict routine because they have a hard time understanding the world changing around them. I see so that it's predictable, and they know what's coming next. And so trying to switch him out of pull ups when he's always warm pull ups has been very difficult because he's like, I don't do it that way. I do it this way. Mommy. We don't we don't we don't change things. So I think He's smart. He's just a little stubborn.

Scott Benner 28:34
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I mean, it's interesting. Like it makes you think about how many things you teach a child that they just do because you tell them the beginning until it becomes a habit for them. Except if you can't. If you can't get Asher over that leap that like no go do it here. He's like, Yeah, no, thanks. Yeah, that's interesting. It's insane

Rebecca 33:45
to me because they'd be like, if orchard come first in Azure second, I would have been able to catch Asher's autism so much quicker because Archer, I just watch him and he's like jumping and leaps and bounds as far as communication he, he he's able to put his shoes on and already when Nasser is just now starting to, like, try to get dressed and put his shoes on. He's he, he talks in sentences. Sometimes the nightmare like picks up new words every single day. And he's just so on top of things. And Asher, I look now and Archer is catching up to Asher. And I'm like, wow, I wish I had no more. But well, I wonder your new parent?

Scott Benner 34:29
Yeah, no, I mean, listen, you don't you don't know what you don't know right now.

Rebecca 34:33
I mean, we caught us. I'm proud that we caught his diabetes so early. We caught it really early. But as far as autism, I really wish I could have caught it early, but I feel like we're still fighting to get him through it so

Scott Benner 34:48
well. It makes me wonder if one day as Archer kind of like matures and starts doing some of the things you need to ask her to do. I wonder if Asher won't be able to model it because he's seeing Archer doing it. It

Rebecca 35:01
was already learning language from his brother. Okay, no that much he I see him copying his brother a good amount. So hoping when I potty trained Archer Asher would be like, Oh, what are you doing but so far now not interested? Like doing it even with our jaggedy little I have these little keto cookies and they give him a cookie every time he goes potty and Asher loves those things. I'm like, let your brother's getting cookie. Like whatever. I'm still going in my

Scott Benner 35:30
bathroom and that toilet. I'll give you anything you want. Well, I think maybe although I imagine Archer is probably like in the bathroom. Like why always in the audience when I'm in here? Like, you're like, Look, buddy, look at what's going on in the body. Isn't that great? Now, well, gosh, is that? Is it incredibly taxing for you personally?

Rebecca 35:55
What what part like one partner?

Scott Benner 35:59
Rebecca, your wife?

Rebecca 36:02
I think my husband would say yes, it is.

Scott Benner 36:06
But how do you see your support? Pretty young, right?

Rebecca 36:11
I am 29. So I don't feel that young anymore.

Scott Benner 36:15
You're pretty young. Yeah, it's 29. You've got a four year old.

Rebecca 36:19
So I'm about to turn 30. And Jenny.

Scott Benner 36:23
That's what you're dreading.

Rebecca 36:25
Because everyone's making baby, my husband and his friends joke about it all year long. It feels like a 30 this year. Oh my great.

Scott Benner 36:33
Try to tell my wife she was 50 the other day and she corrected me because she's not she's a couple years younger than that. What's the difference? She goes, there's, there's a lot of difference.

Rebecca 36:43
It's zero,

Scott Benner 36:45
I guess. Trust me, don't matter. But, um, but But I mean, seriously, like day to day? Are you overwhelmed? Are you? I mean, do you lie to yourself? Are you just okay, you know,

Rebecca 37:01
I feel like I will be very honest. I actually I started taking some depression pills, after all of these diagnosis. So I would say that I think it's affected me quite a bit. I think I handled the diabetes, okay. Because I kind of felt in control. Like, I had all of this technology. And like, if I, if I am on top of things, if I, if I wait, can I say what you say, like me aggressive with insulin and whatnot Am I can I think keep his numbers down. And this is something I can control because I'm blessed that he's born now, with all of this technology that makes it so much easier. But then he got his autism diagnosis, and it just kind of felt very much out of my control. I remember that was kind of like the breaking point for me. They, they they told me he had autism. And I took him to the park and just let him play because he just so adventurous, loves playing all day. And they just sat on the there was a rock climbing wall thing that's kind of like a cave. And I just sat on top of that and cried in answer actually came over and actually recognize that I was sad, which he's not good at recognizing emotions one of the time I think that's one of the only times they can think he actually understood I was sad, and came over and just hugged me, he stopped playing and just hugged me for a little bit. But it it made sense because I, I would watch I have a friend named Anna, whose son got diagnosed with diabetes a month before me. And she's, she's the one who showed me your podcast. She's guided me a lot on on his diabetes and helped me a lot on his diabetes. And I would watch her with her son who's very close to Asher's age. And just compare and be like he understands so much she can explain to him he understands what is going on while with Asher he would get so upset while I'm trying to with all but syringes and trying to put the Dexcom on him and the pump on him and and I hated how miserable it was making him and the fact that I couldn't explain to him I was doing it out of love for him. And the desire for him to stay here with me as long as he can and be healthy because of my efforts while he's on stage. So that was the hardest part for me with his autism was just not being able to tell him baby I'm hurting you because they love you. In so the communication with autism has been the hardest part. That's that was the breaking point when I realized oh, this is it. He's not gonna learn to Tucked in a few months, it's gonna be a while. Do you?

Scott Benner 40:05
Do you? Do you believe that he understands you? He just can't tell you he understands? Where do you think

Rebecca 40:12
he understands more than I think he does? I don't think he understands his diabetes and what it is and that he's different, which I think is okay. I think it's okay, I think he's gonna be oblivious a lot of the times to how different he is. And that in that way, autism might be a bit of a blessing, because he's like, Oh, I'm just gonna go play now. And he's not going to notice, oh, I'm wearing these robot parts, and they aren't. He's just gonna be like, Oh, why aren't you doing this? Okay, and go on with his life. But it's just the early years that are gonna be really hard on me, because I can't talk to him. But I think I will get to talk to him at some point.

Scott Benner 40:54
Well, can you? Are you able to communicate with them in other ways? Is the I mean, you said he's not great with seeing other people's emotions. But can you hug him? Or?

Rebecca 41:05
Yeah, he loves cuddling. He understands like, I can give him directions be like, go get your shoes, or did he come here and work on night night? And a lot of that he's come to understand just the basic every day because we've had him on a strict schedule. And so he understands what's coming next. He knows what I'm saying. But then there are times where the says something from a cartoon or something good in he says it in a correct circumstance, but like it actually makes sense. I'm like, Whoa, okay. You learn something my boss and baby Good job. So it's just it's hit or miss all day. It's full of more surprises than I think most most parents I know. Most parents get a lot of surprises on the daily but Asher it's it's big leaps and bounds. With the smallest things. I get to celebrate small things with him all the time. Like oh my gosh, you just said three words together. That's awesome, baby. Good job. So

Scott Benner 42:01
cool. Okay, well, I'm finding this overwhelming I'm sorry, but that's pretty unfair, isn't it? an hour, I'm just gonna, like, you know, I'm taking my dog to a candle and you're still gonna be there with Asher. And I'm like, oh, gosh, this is a lot. Is there any autism in either of your extended families?

Rebecca 42:27
No, not diagnosed. Um, my husband and I think that maybe there could be like some very, what's I'm trying to think of a way to word this, but not severe, not severe autism. Um, but it's not diagnosed. It's just that generation right before autism really became more pronounced in in the world.

Scott Benner 42:56
How about diabetes or other autoimmune diseases?

Rebecca 42:59
Um, my grandpa, I don't remember. I feel like he was like 29 when he got type one diabetes, so my grandpa did get diabetes. Other than him? I don't know of any other diabetes. I know that according to everyone, I'm pre diabetic, but I don't have type one. Mine would be type two because of the gestational diabetes.

Scott Benner 43:21
Right. Okay. Well,

Rebecca 43:23
hey. What's okay, yeah, my my husband's great grandfather was diabetic, I guess. So it's on both sides. Type one. There's a lot of type one. There's a lot of autoimmune diseases on my husband's side to not diabetes with a lot of autoimmune diseases that are really weird ones that don't ask me to name

Scott Benner 43:43
you don't even you don't have examples. Yeah.

Rebecca 43:46
I'm sure my husband could do another one. Your uncle has honey. includes this.

Scott Benner 43:56
You trying to make me look foolish while I'm googling kleos

Rebecca 43:58
this month? I can't say it. Yeah, I can't say it. I got it. There chat. There's a chat. Let me see.

Scott Benner 44:06
It's a it's a spine disorder.

Rebecca 44:09
Yeah, it's like I know that it kind of like all of his spine molds together over time. Um, it's very painful. And he has to like constantly stay on top of working out and stuff to keep it from getting like,

Scott Benner 44:25
trying to see us together to see if they're calling it autoimmune. And I'll say it I'll do my best to say it in a second. Ankylosing Spondylitis

Rebecca 44:40
Ankylosing Spondylitis that sounds that's how my husband said at least initially pretty good but

Scott Benner 44:45
I'm not great with words is both an autoimmune type of arthritis and a chronic inflammation inflammatory disease and autoimmune disease develops in your body. Yeah, I don't need to be told about it. I mean, diseases thanks. It's more common among men usually begins in early The adulthood symptoms typically appear include reduced flexibility in the spine, reduces flexibility eventually results in hunched forward posture pain, the back and joints is also common. Interesting.

Rebecca 45:14
Daniel actually has an autoimmune disease I always forget because I know I know he's he doesn't like it but I don't notice it is what is it honey vitiligo vitiligo what? Yeah, it's what Michael Jackson had. Yeah, no, no. All over the place and I don't really care. I think he's still handsome.

Scott Benner 45:39
So his his skin is like he has less pigment in some places. Yeah. Okay.

Rebecca 45:44
I feel like he's still white though. It's not noticeable to me. So

Scott Benner 45:48
Daniel is so white. You can see this middle Lago

Rebecca 45:53
we my friends joke, you know, um, but it's goodness. The vampire movie that came out when I was younger Twilight. Okay. And word from Twilight. A lot of my friends say that he looks like that pale white like he's not quite that failed. But he is pretty pale. He could definitely be Edward on Halloween.

Scott Benner 46:13
Either think a t shirt. I'm so white. You can see my vitiligo was hilarious.

Rebecca 46:19
And that is pretty great.

Scott Benner 46:20
I purposefully stopped myself because you were like, you know, the vampire movie that came out when you were when I was young. And my brain jumped to Interview with a Vampire. And then you said Twilight, I was like, Oh, God, I'm so much older than Rebecca.

Rebecca 46:37
I love Twilight. Oh, goodness.

Scott Benner 46:42
Did you know I did. I'm gonna try to find out what your Interview with a Vampire came out because I'm feeling 19 9402 years before that. And by the way, I wasn't all that young in 1994. I was Oh, good. I was like 25 Maybe?

Rebecca 46:59
Oh, yeah. You're a bit older. I think maybe my parents age.

Scott Benner 47:06
Really? Um, how old are your parents? They're about 50 years old. Yep. I could be your father Rebecca. That can't be true. Hold on. Just that you're 29 Let me get a pen real quick. Homozygous 50. A put those 29 under it. Now the nines. You carry the one I get one. And then this becomes a four. Oh, yeah, I guess maybe I could be. Well, that's upsetting. Jesus? What do you try to bum me out?

Rebecca 47:39
No, does the I'm bummed about being 33

Scott Benner 47:43
I can't believe that I can be your father. That's so terrible. I gotta give up soon, I guess right? It's over? No, no,

Rebecca 47:56
no. You got a lot left.

Scott Benner 47:59
How old is the oldest person? You could be the mother of?

Rebecca 48:03
Oh, goodness. Let me think. I mean, if I could have had a kid pretty young,

Scott Benner 48:10
right? Let's say you have a team practice. I'd say you're right. You have a baby team. You can have a 14 year old right now. I could, how would that make you feel?

Rebecca 48:20
I find it terrifying. Well, that's

Scott Benner 48:21
how I feel thinking. I

Rebecca 48:25
mean, it's not because like, it's not because if it just it's the idea of owning it, or having a team that that's the part that terrifies people.

Scott Benner 48:35
You know, I do? No idea what it's like,

Rebecca 48:38
I didn't want low girls for a reason. Oh, guess what?

Scott Benner 48:41
It's not a pleasure, that all hope is kind of terrible. You say something to her. And she's like, I'm not doing that. Like wait. And then I don't know what to do. Because that's the part where my dad would have like, thrown me through a wall. So I don't even know what to say, you know, like, Wait a minute. You're just not gonna do it. Please do it. Now. That guy. I don't know what to say. What's next? I mean, when reasoning when I mean look at the world when reasoning doesn't work. We pretty much jump right to war. And so I don't know what the

Rebecca 49:20
ground is pretty quick on that. But how does that even happen?

Scott Benner 49:22
Like I'm not gonna let her go to school or do her homework or I don't know the whole things. I'm

Rebecca 49:27
not gonna go to school when she's been out of school for it like

Scott Benner 49:31
Yeah, I know. Right? Basically been in school for high school. I can't wait till she gets to college. And she's like, Oh my God every day. It's it's crazy. Okay, so All right. Let's go back to your for a second. Did the you felt depressed? And then you tried. What did they give you?

Rebecca 49:52
Oh, goodness.

Scott Benner 49:53
I like like, you don't quite know the name of anything, Rebecca. I don't. You're like my husband.

Rebecca 49:58
My brain I Oh, I some things. I'm just like, yeah, that can go.

Scott Benner 50:03
Oh no, I find it kind of delightful. You're like my husband has an autoimmune disease. I don't know what it's called. Hey, baby. What's that thing called? The why? Oh, he's handsome. Don't worry about it. So anyway, so you're on something? Did it help?

Rebecca 50:20
Yeah, it's Zoloft. That's what it is. Yeah, it's when I was very weary about going on, on pills, because they scare me if I like I saw a lot of friends like turn pretty. turn bad on pills. So it scared me. But she said that this was the least had the least amount of side effects and was the safest one that's working for you. She can? Yeah, she said she can give it to pregnant moms. So she's like, I feel like this is good. And I've been a lot better on it. I'm much better. My husband whenever I snap on him, or, like crying over dumb things. He's like, did you take your pill?

Scott Benner 51:01
First, I would like to ask, Is it funny? It's just like with diabetes? Like, are you low? I don't want to yell if you're low. If you've took the pill, I don't know what to say all the sudden, you take the pill that I know that I'm you're actually mad and I'm scared. Oh, my gosh. This seems like a no brainer question. But let me just ask it anyway. Any plans on having more children?

Rebecca 51:26
No. I might adopt, I really want to adopt. It's just I feel like I need to get Asher in a place where it's a little easier on me and him before we look into adopting,

Scott Benner 51:38
and then some more difficult questions, do you? I mean, diabetes is one of those things where I think parents minds race ahead, like what happens when they go to college or get married? Right. But autism, I would imagine is that times a million.

Rebecca 51:55
Yeah. I felt like I struggled a lot with the fact that I was worried. I might have a kid in the house forever. I feel like I've reached a point where I think he's going to be very independent and go off on his own at some time. I think he'll need a guiding hand sometimes. But I'm Mom, I'm always here. I'm always a call away. I don't. I think he'll be okay. As far as that goes.

Scott Benner 52:25
Tell me more about that concern. Is that a concern that I'll be 133 years old, and my 60 year old will be living with me kind of feeling or is it? Is it a feeling like your life won't get to move on? Or his life won't get to move on? Or like, what's the real? What's the fear? Like it

Rebecca 52:43
makes me sound so selfish but my life? No, I was I was very independent, very adventurous. And I'm and I'm a go getter. I loved I was valedictorian, and join the military and work three jobs to get through school. Like I was always very active. And I've had to be a stay at home mom for my kids. And I'm learning the blessings in that but i It's not easy for me at all.

Scott Benner 53:14
I can give it a lot of way.

Rebecca 53:16
Yeah. Yeah. I am adventurous. And I'm I know, I tell myself that like when they're like 12 and above, we could go on adventures together. But I'm having a very hard time at this age.

Scott Benner 53:33
Would you like some some stark truths from my life that Oh, no, no, I know. Everything you hope for the future doesn't happen. I believe I've learned that already. But here's the good news. If you just accept that it really does get easier. It turns out that the problem is with ready. It's hope that kills you

Rebecca 53:57
know, there's okay. There's a what is it? Pandora's box. You know that story? Hope was the only thing left in the box. And I remember I majored in English and I remember having to write a paper on whether I thought that was because home was good and didn't need to be released. Or else or hope was so bad that one thing got left from the box of all these terrible things because it was like it was too bad to let loose. Man

Scott Benner 54:30
so the taking the I was gonna say Joking aside, I'm not joking, but let me give it better context, I guess. So I became a stay at home father in 2000. Okay, now we all know that was 22 years ago. My God when you were seven years old, but okay. And it happened for us, like not a plan. So we were married, and then we noticed we were pregnant and And then we noticed there was going to be a baby. And you know, during the pregnancy, it became one of our jobs. It felt to me to go look into daycares. And so after because I worked more locally, I would come home in the afternoon and go check out daycare centers. And one day, I just came home to Kelly and I was like, I really don't want to put the baby in daycare, it made me feel like we were kenneling it, you know what I mean, hadn't even met the baby yet. I was already like, looking for a place to like, put it. And that seemed kind of wrong. To me. It made me make this outlandish statement to my wife, I was like, You should stay home with the baby when the baby comes. Now. If you could have gone back 22 years and met us, you would know that Kelly was our only hope for decent income. You know, saying that she should not work was sort of, I mean, she laughed directly at me when I told her. She's like how she's like, I think she said, If I quit my job, we're gonna live in a trailer, like somewhere like in a swamp or something like that. I forget how she put it exactly, because that's what you're gonna be able to afford, which I found emasculating. But point taken. She was right. And then she said, I think you'd be a great stay at home dad, why don't you stop working and stay home with the baby? And I was like, okay, so you know, you're young, and just like, whatever I got. Alright, that makes sense. I think in the end, the swing was like, $900, back then, like, you know what I mean, we lost 900 bucks for me quitting my job every month, which was just not very much back then. You know, like, it was just like, we're like, whatever. And so, and you start doing the other bills, you know, like, Well, geez, by the time you take out gas, and me going to lunch, and like, you know, this might be a breakeven, we might be able to do this. So baby comes, here comes coal. And now I handle it in a very kind of functional way. Like, I'm like, treating him like a project or a job or something that has to happen, right, and I'm just doing the things. And I was pretty miserable for a while, because I kept thinking about all the stuff that I wanted to do with my life that seemed like there was no possible way I was ever going to do now. And it wasn't until I made kind of the conscious decision to find joy in being his dad, that that stuff stopped mattering. And it turned out that I had had all these, I mean, call them dreams, but that's the wrong word. I had all these ideas of things that I thought would be great to do. And they seemed like possibilities to me, which was great. So because they seem tangible. It felt like I lost them. But in truth, I wasn't any of those things that I thought I wanted to be or try or do. They were just, they were just out in front of me kind of like a carrot on a stick, like, oh, maybe you could write a book where maybe you could do this. And suddenly you're raising a baby, and you can't do any of that, like, you know, none of that's happening. And then when I made his happiness, or his accomplishments, or our accomplishments together my goal, then suddenly I was I was actually reaching my goals, it was actually better than hoping to be a thing that I probably was never going to be anyway. Because I could actually do those things. And it was helping him. And so when I found joy in being a stay at home dad, I was able to let go of that feeling that I had lost something that makes sense. No, it

Rebecca 58:38
does. I felt like someone here recently said something that gave me a lot of peace. We're in we're in the process of selling our home, and I had to travel to Pennsylvania to look for our next home. While Daniel stayed here with the kiddos. And, um, when I went up there a realtor, my mother in law, she loves talking and she was telling her realtor or story over the past few years, which has been kind of crazy. And we're believers and she's like, it was crazy the way things lined up, like God had everything in order. And she told her testimony and then the lady looked at me she's like, I hope you know, it's very clear that you're doing something right. You're living right. And it just kind of like put me at peace and like you know, I'm I don't like being a stay at home mom, but I'm doing the right thing for my kids and the right thing for my husband. And well and I'm seeing the blessings as a result of that. No,

Scott Benner 59:47
no, that's lovely. Does Asher travel well like Does he like date outings and things like that? Are they difficult Are they pretty easy?

Rebecca 59:56
Um, he loves going places for you. I mean, In for me, not really, because that's something you can learn from autism. He a lot of the questions on like, surveys and stuff I had to fill out was like, Does it seem like your kid is deaf sometimes do you say his or her name and they just don't seem to hear you. And you think they might be deaf? And I knew Asher was a deaf, but I'm like, yeah, definitely. Because I'll say his name over and over. And he's just in a whole other dimension or something. Yeah, and, and it's because they just are. So when Chuck rain didn't just so zoned in on one thing, I feel like that's why a lot of autistic, a lot of geniuses have had autism, because they're so good at focusing on one thing, but when we go out places that zoning out is so stressful, because he can just zone out on something and he's done it and I've got a handle. I literally had a nightmare like two nights ago about having to go save one son, who was about to get hit by a car, but leave Asher who doesn't listen, and does it like, can't hear me and I'm probably gonna lose him the moment I let go of him. And it just really, it just shows what an anxious person I am. That stupid nightmare drives me nuts. But it's really hard just because he doesn't hear me and it's not like he's ignoring me. He's just in another world. It's full of wonder,

Scott Benner 1:01:35
I have to tell you, I regretted saying does Asher travel well, because I felt like I was categorizing him like a, I don't know, like egg salad sandwich. Like, does he hold up throughout the day? But I didn't mean it that way. I just meant, like, can you go out and be adventurous just on a different level. But at the moment, it's not easy for you?

Rebecca 1:01:56
Yeah, it's not easy. I try. I got like a Skype zone membership for them for a little while we'd go there and play. It just needs to be like a controlled, a controlled area that I can keep tabs on him like an indoor playground or a gate. I always go to the gated parks and stuff for them to play. Like, give me a second Archer, honey. Put that back, please. Thank you. Thank you.

Scott Benner 1:02:25
Hi. That's alright, to get your weed. I'm just kidding.

Rebecca 1:02:30
We're in the process are appraisers coming in today. So I have decorations out that I don't always put out and he of course was touching on them. That's why I don't always put them out.

Scott Benner 1:02:39
I can't believe you're like moving again and buy homes. So you're well.

Rebecca 1:02:46
Okay. This one we're hoping is a permanent move for a little while. Lease this this home we thought was going to be for a little while. But this home we bought before Asher got diabetes and autism and all these things, okay. And we don't know anyone here. And we just want a support group. So we're moving back to where my husband and I met where his parents live and where his best friend live. And we have our church and just people so maybe I can actually go on a date with my husband sometimes. And actually be able to have him I went to urgent care here recently. And in he couldn't go with me. He had to stay with the kids. I'm like, so we're like be what people nearby that can learn about Ashers disease, his grandparents can learn about it, his best friend can learn about it that way if anything ever happens to us. He has someone to go to

Scott Benner 1:03:45
right. Oh, that makes sense. I know that feeling of like, you know, I think it's called divide and conquer. But in the moment, it doesn't feel like that. It's like you do this? I'll do that. You stop this from burning down. I'll stop this from flooding. And I'll see you later tonight. And you kind of move in different directions. I mean, listen, it's it's what the right way. I feel like I feel like people would expect me to be like trying to be uplifting to you, but I don't think there's any reason to both

Rebecca 1:04:14
be honest. Yeah. Terry.

Scott Benner 1:04:19
Things aren't exactly rosy. But I think there's a way to think there's a way to live that life. Because you're obviously going to I mean, what is the alternative? And you're gonna go to the mall and not come home, right? Like there's no other like, Have you considered that by the way?

Rebecca 1:04:39
I joke to my husband about it. Like I could have gone to the grocery store. I

Scott Benner 1:04:43
gotta go get Scratchers and cigarettes. I'll be back. I do think there's a way to live like really well. Yeah, outside of these things. It's just it's just a mindset, really, and it's not similar to the one you had when you were 23, and you were like, I'll probably get married and we'll just like, do cool stuff. And me and the kid and the husband will jump off a mountain together. And it's gonna,

Rebecca 1:05:10
like show you the type of person I was and still am somewhere in there. My like 10 year goal was to major in English, and then go teach for a few years because I got a grant for teaching and in Alaska for two years, because I needed two years of experience in teaching to go teach at an international school overseas in Thailand. And I intended to move every few years from one country to the next teaching English. Because I love traveling.

Scott Benner 1:05:44
So were you going to take your husband with you? Or what was the plan there?

Rebecca 1:05:48
I did it. I did it play another husband. I fell in love. I completely changed that plan, which is okay. It's fine. Don't

Scott Benner 1:06:00
worry everything.

Rebecca 1:06:01
I mean, I'm looking back at him. Because I feel like at the beginning of our marriage, it caused some issues. But no, I did love my husband.

Scott Benner 1:06:10
I definitely know my wife didn't want to get married. And I'm not certain she loves me. So it's not like we've been together a really long time. But my wife said, she used to think about her life as she wanted to live in an apartment in New York City with white furniture. That's how she would put it white furniture. I think that was her way of saying like, by herself,

Rebecca 1:06:33
he literally stood the annual white couch the other day, and I was like, I wish I could have this

Scott Benner 1:06:40
you can't Rebecca gonna be white anymore. So the new house have a little ground outside it done.

Rebecca 1:06:49
I almost didn't look at the new house because the pictures showed just like this miniature space out back and like, it looks like it has no yard. And I'm happy I went because there was like a whole lot to the left of the house. That was a very big space. That was perfect place for the kids gonna be the first thing we're gonna do, we're gonna fence it in. And I keep saying I want to get the boys to playground so that we can all just hang out outside, right?

Scott Benner 1:07:17
Or you can release them outside and their release. Drink and see how that goes with your depression medication. I'm just kidding.

Rebecca 1:07:25
We're gonna get a dog. Oh,

Scott Benner 1:07:28
Rebecca, you need more things to take care of. You should definitely get

Rebecca 1:07:31
love and talk. Oh my goodness, my parents bought me mom when I was 16 after a really bad breakup, because I'm an emotional wreck all the time, apparently in life. And that dog was like a therapy therapy dog for me.

Scott Benner 1:07:45
My baby, make sure it has no health issues. Please. Don't even get one that like itches.

Rebecca 1:07:50
I'm gonna get diabetes.

Scott Benner 1:07:53
Your dog will definitely get diabetes, its legs will fall off. It'll need you to carry it somewhere. Oh, no, like, yeah, you'll be like, Oh, this is fine. I know how to do all this work. Wow, this is? It's interesting, because you're so new to all of this, that you almost don't know what you're doing yet. Anyway. But yeah, it's interesting to hear you're feeling your way through it, you know,

Rebecca 1:08:19
learning. Maybe I maybe I help a parent by that's working through the whole autism diagnosis thing, because there. I will say something I didn't know. There are schools in every single state that are early intervention schools that are free from the state for autistic children, or just special needs children.

Scott Benner 1:08:40
How do you find that?

Rebecca 1:08:41
I stumbled upon it. But I looked it up in Pennsylvania. I looked up early intervention schools. And what was another search that I did for that? Special Needs schools for young children? Yeah, there were a ton of resources online when I googled that for Pennsylvania since we're moving up there. And now

Scott Benner 1:09:04
I see it early intervention programs. I just Googled early intervention services. And yeah, it comes up for like every state. Yeah. All right. Well, there you go. Well, we did something good than if we got that.

Rebecca 1:09:18
Yeah. Something I stumbled upon it by pure luck, but maybe someone else can hear this and be like, Oh, yay. so helpful.

Scott Benner 1:09:26
You said, online. There's there are there communities. I mean, are you in my Facebook group is an example.

Rebecca 1:09:33
I am in your Facebook group. And there are autism like Facebook groups. I actually deleted all of my social media though, for my mental health. It's helped a lot so I can't direct people to good Facebook group for autism anymore.

Scott Benner 1:09:52
Tell me about that a little bit. So you were finding community online but something about being online wasn't good for you? I just

Rebecca 1:09:58
feel like since co All of it and like the election and everything, everything has gotten so toxic on social media, that it just ended up stressing me out every every day that I got on social media and looked. It's like someone's lashing out at someone who has an opinion on something and just seeing all the hate was really discouraging to me and just seeing all the crap that's going on in the world, but I feel like I'm dealing with all this crap in my own life as like, you know, I'm gonna, I'm gonna go ahead and delete this might have been a lot better since I deleted it. My husband likes it too. So he's like, Oh, my wife is actually paying attention to me and not scrolling through Facebook. So

Scott Benner 1:10:41
Honey, honey, honey, well, have you not found Have you not

Rebecca 1:10:45
found wordly wordly What's that?

Scott Benner 1:10:49
I don't know. It's this thing that I see my wife doing? You fill in like, you get like, Oh, is

Rebecca 1:10:54
it a game?

Scott Benner 1:10:55
Thank you. I think it's like it on the New York Times website if I'm not mistaken, but I guess you get. Alright. Let me see if I can understand. I think you get six opportunities to spell a five letter word. And within that, you have to say, God, how bad I am. Wordle if it works, looks like Wordle Yeah, like Wordle le so

Rebecca 1:11:20
it's one of those like games again, I forget what was the one that came out? It was like a bunch of numbers that look just like this. And I was obsessed with it and played it non stop.

Scott Benner 1:11:30
I don't know. I just have not played this

Rebecca 1:11:33
and I'm not gonna learn it because I can tell will be a problem.

Scott Benner 1:11:37
Oh, look at it. You're like Kelly, Kelly. Kelly. She's my I'm trying to find a five letter word like, why? Like I married you. Oh my god. Hold on a second. Can we speak for five letter words? Do we come back to me please? Yeah, we're that or she just likes like there's like this Tetra. See kind of game. She's like, this is very relaxing. We just putting shapes together. And now it's like, what are you doing? Anyway, I understand like, it is, I mean, there's so much good online. And but there's so much of what you described. And sometimes it's hard that you're walking a path trying to get to the good stuff. And you've got to dodge in and out of everything else. And it isn't I'm

Rebecca 1:12:17
also I'm also a people pleaser, if I was in direct sales, and I felt like it made me very popular. Got me a lot of ladies who love just messaging me and love my life. And that was good. That was beautiful. I loved I loved spending time and meeting new people that way. But it got really overwhelming because I felt like I had to respond to literally everyone.

Scott Benner 1:12:39
Oh, you have that pressure? Yeah. So I used to feel like my, my Facebook group is huge. And I used to feel like, like, I used to feel like oh my god, like what am I? Like, am I supposed to answer all these? Like, how would I do that? And then and then I was able to let go of that. But I got lucky because the group can kind of like help itself. And you know, but I know. There's a pressure you're like, well, somebody asked, like I'm tagged in something. It's almost like it's almost like somebody's texting you you're not answering them. You're like they're expecting an answer. Like, you know, if I'm open to being tagged in something, then I should follow through. And it does get overwhelming. I found though that keeping online simple. My first rule on the Facebook page is I'm going to read it to you it says Be nice, be helpful, be human, treat people the way you would hope to be treated if you break the rules that I'm going to have to kick you and I don't want to be involved in both. I really just like, you know, oh God, just please don't make me. I don't want to be involved make me need to stop. Like there are people who know me. Well. We're like, sometimes you post something. And the way I read it is it says, Well, you all just leave me alone. And it's just it's a strange thing, but it's tough because it gives and takes you know and yeah, but if it's if it's bad for you, then it's bad for you.

Rebecca 1:14:04
Yeah. I felt like it was okay until Asher got sick did bluey stop honey. What's up? Hi. He finally reached his limit. He's

Scott Benner 1:14:16
just like, you're done. Lady. It's over now. Tell the guy to buy Well, that's fine. Rebecca, tell me Is there anything that we didn't talk about that you wanted to? Um, I don't think so. Know that you're okay with this guy headed

Rebecca 1:14:30
off? Yeah, I think I hit all the key points.

Scott Benner 1:14:34
I will let you go find out what's up with Blue's Clues. Is that what I'm talking?

Rebecca 1:14:38
Louie Louie? Yeah, it's really cute. Honestly, just sit and watch the episodes are super short a Disney plus and I think you'll get a kick out of it because you're a stay at home dad.

Scott Benner 1:14:49
I like that you say you don't like it but you're like this blue is good. It's good watch and

Rebecca 1:14:53
so it literally I will happily sit and watch this with my kids. How

Scott Benner 1:14:58
do I spell bluee Me What's wrong?

Rebecca 1:15:01
Oh, he paused. Oh no, it's very cute. Like, there are episodes of him, like the dad taking his kids to like take out or something. And, and he's tell them don't play with that. Don't pee in the bush. Don't do this. Don't do this, like totally stressed out. And the lady comes out with his takeout and she's like, just give it a few minutes. I'll bring the rest of it out in a minute. And the kids are like, what does that mean? Daddy's like, go play in the water. It's really cute.

Scott Benner 1:15:36
I'm glad you like it. I think you're gonna like more of this as time passes. You're like, Listen, I'm gonna tell you something. I could probably sing the theme songs to every TV show that was popular for kids when my kids were little. And you wouldn't have no idea what I was talking about. Like, like Rolie polie. Olie

Rebecca 1:15:57
oh my gosh, no, I know. Rolie polie.

Scott Benner 1:16:00
I know. I know OG Blue's Clues, right with Steve, like not this other person who you think is then it's not really

Rebecca 1:16:07
realized that because I could be your daughter. I probably know all of those. I don't speak as I will. But ages that I do them.

Scott Benner 1:16:16
I once went to a live staging of bear in the big blue house. What do you think of that?

Rebecca 1:16:22
That is awesome. No, it's not very jealous.

Scott Benner 1:16:27
It's definitely not awesome. Are you really I love

Rebecca 1:16:31
to bear the big blue house. We didn't have TV. So we only got to watch it would be with our grandparents house. And that was what I always wanted to

Scott Benner 1:16:38
watch. Wait a minute, they didn't let you have TV?

Rebecca 1:16:41
No, we grew up in Idaho. And we played outside all day. Bare feet. So

Scott Benner 1:16:46
oh my gosh, I can't believe you didn't have TV. I don't even know how to like process that. I felt like you just said I was abused as a child.

Rebecca 1:16:57
We have VHS tapes, but like you don't you only watch them like a few times. And you're done. So we spent most of our time playing

Scott Benner 1:17:04
how many states have you lived in? Do you know?

Rebecca 1:17:07
Um, I Okay, goodness, born in Hawaii, to Texas, grew up in Idaho, moved to Pennsylvania, lived in Oregon for a little while. Went back to Pennsylvania, went to Virginia for a few years, ended up in Maryland, then went to Georgia. Then went to Pennsylvania again, then Maryland again now Virginia, and I'm going back to Pennsylvania.

Scott Benner 1:17:35
She that was 13 different homes. Three times in Pennsylvania twice in Maryland. Is that right? You lived in? Is that 10 Different states then?

Rebecca 1:17:45
I don't know. I lost my fingers.

Scott Benner 1:17:49
Um, so if you all saw me with my fingers just now you'd be you'd probably be sad for yourself that you're listening to the podcast.

Rebecca 1:17:56
I was enjoying listening to you do math on your age. I wasn't gonna interrupt you. Because I found it quite humorous.

Scott Benner 1:18:03
Believe how old I am. All right. Rebecca, get the hell out of you bumming me out. And and you're making me feel good. Because you're, you're um,

Rebecca 1:18:12
I'm a hot mess Express. Yeah,

Scott Benner 1:18:13
but you seem okay. Yeah. Yeah. I mean, I think that's really is the takeaway from it. It's been better. Well, yeah, hell.

Rebecca 1:18:22
No. I mean, like, I've been better than I was.

Scott Benner 1:18:25
You're like, you're getting better. But yes, I

Rebecca 1:18:27
have been better.

Scott Benner 1:18:28
Imagine. I mean, at least in Hawaii, Hawaii. Were born Hawaii.

Rebecca 1:18:33
Yeah, that sounds like all I remember is the cockroach. So that's the only memory I have a boy.

Scott Benner 1:18:39
So it's not as nice as I wish more.

Rebecca 1:18:41
No, I'm my first memory was mom cuz they were military. And we were in military housing. And I remember going up the stairs with mom and mom saw this huge cockroach and like turned into Spider Woman, and ended up in a corner holding onto the railing like standing up on it somehow yelling for my dad. That's my first memory.

Scott Benner 1:19:03
He told me that the people that I was counting on to, to protect the country are afraid of cockroaches because apparently breaking down my entire spiders that I was in the military. So yeah, you're breaking down my whole construct of my safety. So you're saying that like a foreign country would just have to show up with a bunch of cockroaches and spiders and we'd lose a war immediately. No, I think we might. Great. Everything's fine, Rebecca. Alright, listen. Keep your head down.

Normally, I'd be like, what's our takeaway here, but our takeaway is just that you're laughing? And I think that's good. Yeah, you know, all right. Well, I really appreciate you doing this with me. Thank

Rebecca 1:19:49
you. Yeah. Thanks for having me.

Scott Benner 1:19:51
Have a good time.

Rebecca 1:19:52
I did. I enjoyed myself. I like talking. So that's perfect that you're talking to someone that As an adult, so

Scott Benner 1:20:02
Alright, hold on one second

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#747 Bold Beginnings: Flexibility

Bold Beginnings will answer the questions that most people have after a type 1 diabetes diagnosis.

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

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+ Click for EPISODE TRANSCRIPT

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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 747 of the Juicebox Podcast.

On this episode of bold beginnings, Jenny Smith and I are going to talk about flexibility. Don't forget the bold beginnings series is all about things that listeners of the Juicebox Podcast wish they would have known in the beginning. While you're listening today, don't forget 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 enjoy Jenny Smith and you'd like to hire her, she works at integrated diabetes.com. If you're liking what you're hearing in the bulb beginning series and want to expound learn more, you're looking for the defining diabetes episodes, and the diabetes pro tip episodes. There are lists of them at the Facebook page Juicebox Podcast type one diabetes. In the featured tab that's a private group with over 27,000 members. If you're not on Facebook, check out juicebox podcast.com or just search in your favorite audio app.

This episode of The Juicebox Podcast is sponsored by in pen from Medtronic diabetes, take the right insulin dose at the right time. The right pen is a reusable smart insulin pen that uses Bluetooth technology to send dose information to your mobile app. Offering dose calculations and tracking in pen helps take some of the mental math out of your diabetes management. You can get started right now within pen at in pen today.com. Or perhaps you're ready to talk to a healthcare provider about m pen. Again, in pen today.com. Head over there now to hear about the app that has current glucose on it meal history, dosing history and much more like dosing reminders, carb counting support and that digital logbook, lighten your diabetes management load with in pen from Medtronic diabetes seriously, in pen today.com. Just head over now and check it out. impendent is an insulin pen that you may pay as little as $35 for offers available to people with commercial insurance terms and conditions apply. But $35 for an insulin pen that talks to an app on your phone and keeps track of things. Not unlike an insulin pump. This sounds like something you want to learn more about in Penn requires your prescription and settings from your healthcare provider, you must use proper settings and follow the instructions as directed. Or you could experience higher low glucose levels. For more safety information visit in Penn today.com. I don't have the energy to pretend that we haven't been recording for the last hour, Jenny. So we're back. We're back with the bold beginning series talking about flexibility. Maybe an unsung tool along with texting as far as I'm concerned about diabetes. So yes, this first person says that in the beginning, we were not educated on the needs of insulin, and how they would change over time or with exercise or with growth. It was just about finding the settings that fit at diagnosis at diagnosis. I wish I was told that these things would change and the diabetes was a marathon and not a sprint. And that I would need to be flexible. So do you see that a lot with people they're stuck in like this number used to work, I don't know what happened.

Jennifer Smith, CDE 3:54
I do especially for people who have a level of an endo I would say or a level of somebody that they are only really only checking in with, you know, every six months, they're kind of left to their own ability to manage. And even though what was working isn't working anymore. They don't have the tools to evaluate how to make a change, or they don't necessarily maybe feel safe making a change because they've had enough. I call it hand slapping when they go into their physician's office. Well, why did you change this? You know, this number is different in your download. Why did you not do what I recommended six months ago? Well, I mean, there's some explanation something changed. Yeah, I tried to navigate it. Right. So I think that's a reason that some people end up sticking with where they are even though they know it's not working or they realize that something's changed. Because they may not have the know how or the care team to really help them.

Scott Benner 4:57
I think to add to that one of the sadder things I say is when people know that they should be doing something and they let their fear of what's going to happen when they get to the doctor's office stop them. That takes me into this person's statement. I thought that insulin, the initial insulin dose was it and it was set in stone. And then we know we learned very quickly, that the more flexible you are, the more successful you could be that you could change a dose if it's not working. Or, you know, if you're worried about changing themselves, or call the doctor, the nurse, she said she called her CD every day for two weeks. But her takeaway here is don't suffer, try something else. And you will find something that works. I mean, that's just that's a great statement, you have to just keep experimenting and trying things. And if something doesn't work, try something else. And I think the way I put it in the Pro Tip series is that when you're learning to Pre-Bolus a meal, you can if you have a CGM, see what happened. And then the next time say, Well, look, I'll do a little more, a little less, a little sooner or a little later, you adjust your timing and your amount until it starts working for you the way you expect it to or the way you want it to forget. Expect it like the way it the way it can work.

Jennifer Smith, CDE 6:08
Right. And I think the comfort level, from another piece of understanding can you can get comfortable faster, if you understand that. You're going to try something. And if it goes the wrong way, meaning you're not higher, but you're actually lower than you ended up being. You are not in the middle of a desert without tools to help write that drop or that low. Right. I mean, maybe you are in the desert. And if at that point, you clearly need to have supplies.

Scott Benner 6:41
Someone stuck in the desert, they're listening to this podcast they have they're misusing their, their their resources, are resources at their disposal. Use the phone to call someone.

Jennifer Smith, CDE 6:51
Yes, exactly. But you know most of us have, thankfully have something to treat that drop with. And if you are experimenting, have those things on the ready, right? Have them in your pocket, have them in your purse, have them in your glove compartment, whatever. Because you may with experimentation, find that things don't necessarily the first time go the way that you want them to go.

Scott Benner 7:14
Yeah, yeah, be ready for it not to go. Ready. Ready, that's for sure. Be ready. That's right. Yes. Well, here's this next statement says that what I didn't understand was that the carb ratio was a guide even. And the Basal insulin which needs would change, she said, I had a magical idea that if I measured everything, I would nail down the doses. And that would be it, they'd be done. Right. Like she just wasn't measuring the food correctly, she wasn't assessing the amount of carbs. But go to the pro tip about glycemic load and glycemic index to understand that all carbs aren't created equal. She said that we would glide through diabetes with no problem was her expectation, if she just measured the food correctly, the endo made it seem like that as well. And I wish someone would have told me that you have to be flexible, and that dosing changes would have saved me quite a bit of time and stress.

Jennifer Smith, CDE 8:06
And in terms of like clearing that up dosing changes, there are a couple of thoughts around that right dosing changes, meaning as you grow, or as your child or your team grows, their doses will change. Yes. But another like way to think about dosing might be the strategy of the dose might not be the amount that changes meaning your insulin to carb ratio. But this type of a meal may use this type of dosing strategy for insulin. So doses will change. Many people have different insulin to carb ratios through the through the day, depending on the time of day. And as precise as you can be, with a label or with estimation. Absolutely. That goes a long way. But

Scott Benner 8:53
Arden doesn't eat a lot of like sugary candy, but when she does, it requires a longer Pre-Bolus with less insulin than the carbs would indicate. So if she's gonna eat 15 carbs of gummy bears for fun and not for you know, as as low, then, you know, it might not be the exact like in Arden's case, 15 cars would be like three units and 3.2 units or something like that. So she probably doesn't need the whole 3.2 She might need more like two, but she's gonna need it with a longer pre loss because the sugar is gonna hit her so quickly. And but it also doesn't punch with the same weight as a baked potato does. So you don't need as much insulin that might sound in the beginning you that might I might have just somebody who's newly diagnosed could have heard that and thought, why don't you just tell me I have to build my own rocket and fly to Jupiter. Because I don't know how to do any of those things. But this stuff is not difficult once you get it's

Jennifer Smith, CDE 9:53
not and I think one thing to kind of clean that up in terms of the insulin to carb ratio is B Because most people eat a complex type of like meal, there are a little bit of all the different macronutrients carbs, proteins, fats within a meal time. ratios. For most people are really adjusted with that idea in mind of a lingering effect of a meal. So ratios are often more aggressive than they would need to be if we just lived on simple carbs. Simple carbs have a very quick process, they go in fuel the body, they come out. And that's why if you really eat only carbs, you're constantly driving this hunger road, right? So that might explain the difference between ratios for a meal versus ratios for a handful of gummy bears that I just want to eat.

Scott Benner 10:51
By the way, there are some brands, gummy bears are better than others. But I'm not here to push up gummy bears. This person just wants me to make the point that because things are dynamic, and flexibility is important. It's another reason to say that a person who you only see every three or six months might not be the best judge of how to make adjustments was a nice way of saying that. I think the most important thing that someone could have told me is that insulin to carb ratios, Basal rates, correction factors will change forever. I don't know if they change forever. But it changed a lot when you're young. And you're growing. Because I had this notion again, that they wouldn't change little things like Right, like, why would? Why would these things change, you could have been a more sedentary person and suddenly become more active, those things would change. You could gain weight or lose weight, those things would change, you could change the way you eat from more complex meals, like Jenny just described, to plant based or, you know, correct, whatever these things would all change how much insulin you're using. These are not. These are not like set in stone numbers that no matter what happens forever and ever are going to work. This person says My biggest help was just hearing on the podcast that I needed to be fluid that nothing was going to be absolute. A lot after I was diagnosed, I spent five and six hours a day researching how why? What can we do like just everything I didn't know what to do. And after my daughter got her Dexcom we would watch the numbers all day just and it burned them out. Yeah, this is flexibility coming from a different like we've been talking about flexibility about using insulin, but this person is talking about flexibility. Yeah, for life and to pace yourself. It was you know, I would say that took me some time as well. Because I was at one point not good at diabetes, then got much better at it. And then as my daughter started having impacts from hormones, it got hard again. And I had this expectation set in my head that I could keep her blood sugar under 140. No problem. And then all of a sudden, it started to go up more. And those higher numbers gave me made me stressed. Yeah, you know, and I had to say to myself, I'll figure it out. But while it while we're figuring it out, I can't torture myself the whole time. And so that is sort of flexibility with how I was thinking about the numbers, you know,

Jennifer Smith, CDE 13:32
right hand because people get a CGM. Many people not everybody, but many people get a CGM very quickly after diagnosis. Now. So you have you have this scale of information to be able to watch. And I think, you know, in this person's case, obviously, it was the watch from a well, I don't know what any of the variables are going to do. So I just have to watch. All day long. I just I and maybe they were doing it initially from a standpoint of learning. But then you can get into this almost OCD habit of if I don't watch it, what if something happens when I don't see what's going on? Right?

Scott Benner 14:16
Right? Yeah, for me, if you have a CGM, the the key to losing that feeling is to set reasonable alarms high and low. And do not think about that thing. If it's not beeping, just correct. Let's go Yeah,

Jennifer Smith, CDE 14:31
absolutely. And that they meet those targets might get, you know, a little bit more narrow or narrower as you feel more confidence and more comfort and understand insulin a little bit better. Understand. I treated the low. It's good. I know that this amount works. I don't have to worry about it. You know, again, I can say that. I mean, I did so many finger sticks before I got my first CGM so many finger sticks today. Mine might have back They looked like a line of CGM over the course of the day. But I, you know, I was constantly setting an alarm. Oftentimes, I didn't even have to wait for the alarm to go off for an overnight like fingerstick. Because I, I did worry about overnight lows. Yeah. And without a CGM, I had no way to know other than what my blood sugar was at bedtime. And then what it was at like two o'clock in the morning, which when I was on injections with a Basal insulin was my time to go low. And once I was on a pump, and then I started on a CGM, not too long after I had my pump, it became very, like, visible to me that I didn't have to have that alarm anymore. Okay, again, with the alerts and everything that I set well in my CGM, I stopped setting an alarm. I was like, if my blood sugar goes above or below, like you said, I will get alerted. And if I don't get alerted, I can just sleep. It's great.

Scott Benner 15:58
I think it's a great way to just alleviate that stress. It's just I mean, our hours are very tight, I think 70 and 120. But when it's not beeping, we're staying between 70 and 120. And there's no reason to think about it. And they're so tight that if she gets the 120 and she's rising, it's not difficult to come back around and fix it. It's not like you can't, you can set it like, you know, 70 and 300. And go I don't know, I don't have to worry about this thing's not making noise. But yeah, flexibility around diabetes. I mean, listen, flexibility around everything is really important. But around diabetes, it's going to, it's going to help you. I mean, you just heard it a number of different ways, not just dosing, but I think psychologically, too. Absolutely. Cool. All right. Well, Jenny, thanks so much for doing

Jennifer Smith, CDE 16:49
absolutely always fun.

Scott Benner 16:59
Thanks so much to Ian pen from Medtronic diabetes for sponsoring this episode of The Juicebox Podcast. Check it out at in pen today.com. If you can't remember that there are also links at juicebox podcast.com. And links in the show notes of the podcast player you're probably listening in right now. And if you're not listening in a podcast player, I mean, can you please subscribe and follow on a podcast app it helps the show and honestly it's easier for you. The episodes come right to your phone, and the phone is right with you constantly. Mine's right here. See, I just picked it up. Everyone always has their phone.

So let me just tell you again, because I know there are a lot of episodes of the podcast if you're looking for the defining diabetes episodes, or for the diabetes pro tip episodes there of course, right in your podcast player, just go to all episodes and you scroll around and you can find them or search and find them by searching for something like diabetes, pro tip or defining diabetes. There are also lists available in the private Facebook group, which by the way, is completely free Juicebox Podcast type one diabetes, so not only you're going to find a Facebook group, with 27,000 members in it, people just like you were sharing experiences and ideas. But at the featured tab at the top, you'll find all the lists of not just these series, but all of the series that exists within the podcast and there are many. There's even a special website diabetes pro tip.com, where the defining diabetes and diabetes pro tip episodes are even if you just needed to see the episode numbers that correlate with each episode so you can go back to your podcast app and and look for that episode. I may have just made that sound more difficult than it is juicebox podcast.com diabetes protip.com Juicebox Podcast, type one diabetes on Facebook, or just scroll through your podcast app or use the search feature. The defining diabetes series is amazing, as is the diabetes Pro Tip series. You don't want to miss it. If you've been enjoying these bold beginnings episodes and you want to dig down deeper, those two other series. Those are the place to go. Thank you so much for listening. I'll be back very soon with another episode of The Juicebox Podcast.

Test your knowledge of episode 747

1. Why is it important to understand the different types of insulin?

• They have the same function
• To use them interchangeably
• They have different functions and purposes
• To avoid using them

2. What is the importance of regular blood sugar monitoring?

• It helps in managing blood sugar levels effectively
• It eliminates the need for insulin
• It has no impact
• It is only relevant for type 2 diabetes

3. How should insulin doses be adjusted?

• Based on fixed schedules
• According to blood sugar readings
• By avoiding all physical activities
• Without any changes

4. What role does diet and nutrition play in diabetes management?

• They play a critical role in managing blood sugar levels
• They should be avoided
• They have no impact
• They are only relevant for type 2 diabetes

5. How does physical activity impact blood sugar levels?

• It has no impact
• It can help in managing blood sugar levels
• It should be avoided
• It only affects type 2 diabetes

6. How should diabetes be managed during illness and stress?

• By ignoring blood sugar levels
• By closely monitoring blood sugar and adjusting insulin as needed
• By avoiding physical activities
• By reducing insulin dosage

7. What are the benefits of using diabetes technology, such as insulin pumps and CGMs?

• They simplify and improve diabetes management
• They make diabetes management more complex
• They have no impact
• They are only for healthcare providers

8. Why is building a support network important for diabetes management?

• To avoid physical activities
• To manage the emotional and practical aspects of diabetes
• To ensure proper carb counting
• To reduce the need for insulin

Submit

Change Answers

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The Juicebox Podcast is a free show, but if you'd like to support the podcast directly, you can make a gift here. Recent donations were used to pay for podcast hosting fees. Thank you to all who have sent 5, 10 and 20 dollars!

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