#751 Bold Beginnings: School
Bold Beginnings will answer the questions that most people have after a type 1 diabetes diagnosis.
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Scott Benner 0:00
Hello friends, and welcome to episode 751 of the Juicebox Podcast.
Jenny Smith and I are back today with another episode of the bull beginning series and today Jenny and I are gonna talk about sending your type ones to school. While you're listening today, don't forget two things. One, Jenny works at integrated diabetes.com You can check her out and higher if you like, and to 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. If you're a US resident who has type one diabetes, or is the caregiver of someone with type one, in fewer than 10 minutes, you could go to T one D exchange.org. Forward slash juice box and fill out their survey. When you complete the survey. You've helped the podcast, you've helped people living with type one diabetes, and you may just have helped yourself T one D exchange.org. Forward slash juicebox. Hope you're enjoying the bowl beginning series. It's not done yet, there's more coming. If you've missed the earlier episodes, you don't even have to listen to them in order if you don't want to just go find them
this episode of The Juicebox Podcast is sponsored by touched by type one, please go learn about my favorite diabetes organization at touched by type one.org and find them on Facebook and Instagram while you're at it. This episode of the podcast is also sponsored by in pen from Medtronic diabetes, get yourself the insulin pen that gives you much of the functionality of an insulin pump in pen today.com. Jennifer, we're back. Yay. We're gonna do for the bowl beginning series today. Just the very simple headline here school. Now I was surprised. And then I thought about a little bit. There weren't a ton of questions about school. And then I thought oh, maybe that's because they didn't know the questions they ask. So I started adding more stuff to the list because it hit me pretty quickly. Okay, all right. So what ends up happening, if you hear most people's stories, they're diagnosed and school starts a week from now, it's always it's always that story, right? Like you don't get the whole summer to figure it out or something. It's like,
Jennifer Smith, CDE 2:43
it's over a break. Often, right? It's like somebody comes home for like Thanksgiving break or like the the winter holiday or something. And parents, especially for kids who have just gone to college, their parents are like, you don't look, do you feel okay? You know, and, and there's a new diagnosis. And now you get to go back to school two weeks later, let's figure it all.
Scott Benner 3:06
Anecdotally, I've always believed for like, a long time before I'm started making this podcast, just hearing people's stories and writing about diabetes, that people's lives are very like frenetic. And then when you hit a holiday or a vacation, or a long weekend, even you slow down enough to look up and go, there's something wrong with that kid. You know what I mean? Right? So
Jennifer Smith, CDE 3:30
right, well, and I think when kids go away, you also you miss the everyday visual that you usually have of them. So then when they do come back, and they look very different. I mean, not just like hair color, or how they're dressing now, there's a very visual, physical difference. And you can say, you didn't look like this. When I sent you to school in September.
Scott Benner 3:54
It's the same problem I have is when I'm walking through the house, I'm like, no one's gonna notice I've lost five pounds. So you just go up somebody's like, do you see it? Do you see the five and they're like, You look exactly the same. Thanks a lot.
Jennifer Smith, CDE 4:07
So take a beach vacation and then come back. And they'd be like, See, I do look different.
Scott Benner 4:13
So you know, just people say, Well, how do we transition? Back to school? Two big question. People want to understand about 504 plans, which I think are I always thought were widely understood. But then I I just realized I only know about them because of Hardin. And so we'll start but we'll start here. This person said it was crazy to me that after diagnosis, I was teaching my daughter's teacher about her care when it was so new to myself, and I didn't really know what I was doing. So I felt like I needed support and resources about transitioning. And she just said she said the schools can't really do much and they don't know anything. I either. And I will say from my own personal experience, the schools would try to how do i mean this? Sometimes principals are politicians, and it's their job to go, everything's fine, you're going to be fine. Your kid is going to be fine. Leave your kid with us. But they're not used to dealing with diabetes. It's always like, like, my, my daughter had a principal one time I swear to you, if you showed up at the front door, and the building was on fire, and people were jumping out the windows, she would have said, Go home, everything's fine. We've done this before. Oh, okay. She's just glad handing you right into, right into hell, you know, so, but when it's diabetes, specifically, what I find they like to say is, uh, we had a kid here last year with diabetes, or there's cars where there's two kids here. And it, it struck me finally, I don't know, the management style of these two kids at the level of their health, like, you know,
Jennifer Smith, CDE 5:58
absolutely. That's what I was gonna say. And it's a big one that a lot of when parents asked me, How do we approach this? What do we do about it, and that's one of the first things is to make sure that you have structured the needs to your child, like you said, Many schools have had experience or the nurse has been there long enough that they've had at least one student probably with, with type one diabetes. Again, the school might have a couple, but your child's plan is your child's plan, just because this other child doesn't seem to need accommodation or assistance with things. Their management style is very likely different than what you're doing with your child. And so they're very well we'll need to be some instruction and schools differ school to school system to system private versus public what they have in terms of resources, and allowances, some nurses travel between schools, and they're not always there. So it means establishing somebody that is always at the child's school, for the really young kids who may need somebody to check in with, versus the nurse that's always there. There are so many things that I've heard and seen that I mean, there are 1000s of ways that people address the needs. Yeah.
Scott Benner 7:19
And it does really begin with the scenario you're in. I mean, you just said it. But it's, you could be in a school where there's literally no nurse, and right, they're telling you like I don't know if you've ever met Mrs. You know, Smith, she works at the front desk, she's lovely. She'd be happy to give your kids a shot before from you're like, Okay, who she was, she answers the phone. And, you know, and she might end up being a godsend to you like, I have no idea. And but you have to you can't run in there and have all these expectations, and they don't have the infrastructure to handle it. Correct. Right. And you can't just force them. What I've learned dealing with schools, is that they're just people at work. Like you want to think of them as special somehow, because they're a teacher and etc. But they're people, they're at their job. They're not look, I mean, imagine if someone came to your job, Jenny, and they were like, Hey, we saw the things you do every day. That's great. Here's what else I'd like you to do. Right? This is Billy, don't let him die. You're like, Wait, hold on. I don't want that to be my responsibility. And that's what I would run into all the time. I had trouble finding people to be glucagon delegates, because they were like, wait, I'm like, Listen, if this should happen, if Arden has a seizure, you stick this thing in her butt and push the plunger, and you're going to say that's it. Yeah. And you're gonna save, you're gonna wait for 911 and hope and try to keep it from hitting your head on something like, You know what I mean? Like, nothing different than you would do if a kid needed an epi pen? Or? Oh, no, no, I don't want to be involved. The our school nurse had to search the school to find a handful of people who were willing to do what do it. Yeah. And I think,
Jennifer Smith, CDE 8:57
oh, sorry, go ahead.
Scott Benner 8:59
I didn't blame them.
Jennifer Smith, CDE 9:01
Right? Not at all. And, and you do. I think there are two definite, like mindsets that you have to have when you're coming up with a plan for your child one, a teacher is first a teacher, that is what they are, therefore, they have all of the other students as well. That doesn't mean that the needs of your child are not important. But you do have to understand that there's there's teaching that needs to happen. There's a purpose for going to school. So then establishing people that can be the check in person. Many times I've found that it's it's a little bit easier when schools have or your child's classroom has a designated like Teacher's Assistant. That's always there. The teacher has the instruction but has the chance to keep teaching where the TA is kind of there to help and assist behind and maybe more the one that you end up teaching more to because they've got a little bit more ability To help, right. But again, each school I think the biggest thing to go to first is whoever the head of the administration is, whether it's the principal or whatnot, what are your accommodations? Have you experienced this before? What What have you seen as protocols, this is what we like for our child. This is what we do. This is how we navigate and manage and have a plan or an idea already. And again, newly diagnosed, you may not know where to start. And that's where the community is very beneficial. And I've seen many, many plans posted, we've done this for our child, or we have these instructional like, you know, decision matrix that if this, then this, and it's very cut and dry and very easy to follow. Some teachers and people in the school are very willing to follow the CGM data, others don't want to do anything other than just respond to an alert message. So again, everything is very different. You kind of have to see what the school can accommodate. Yeah,
Scott Benner 10:59
we had a wonderful woman who was like, I have diabetes, I can help. And then we're talking to her and she had type two. And you know, she had never taken insulin before. And she was on Metformin, or something like that. And I was like, Oh, sure. Your skills are not going to translate here. But thank you very much. But we still, you know, she was willing to listen, and so there and learn people, and those are the people we taught, and I think that expectations are important. But it's always the seasol to me, you know, it's like, Well, I think my kids should have stable blood sugars at school. And then your school might say, Look, we're not comfortable bumping 150 blood sugar for your kid, like we're not going to do well, we'll treat over whatever the the orders from the doctor say. And that's, that's where I'll tell you, there's a simple sentence that you can put in your order from your doctors, if you can get your doctors to write this. Like, I don't you'll learn it any way you will. But basically, what it says is, these are the rules, unless the parents say otherwise. And then we and then we defer to the parents, and that way you can make to help make decisions. Yes, but you still might run into a nurse or somebody at the school is like, look, there's five kids that have diabetes, the school, we don't do this for any of them. And somehow they think that's a rule, then, you know, and so the way I always think about it is this. School is a long process, you're going to be in the same building. For a number of years, you might move to another building for a number of years, it's still the same system. These people work with each other, they know each other. You have to find a way to get what you want. Without being a pariah. You can't be the person that when you walk in the front door, they look up and they go oh, God, it's Jenny, you.
Jennifer Smith, CDE 12:48
Oh, right. Oh, yeah. Absolutely.
Unknown Speaker 12:52
With this Johnny, with a
Jennifer Smith, CDE 12:54
fake smile on your face, and like, Hi, how are you today? In the back of your mind, you're like, oh, no, hate
Scott Benner 13:01
me. Because I because I'm in here going, like, you know, I need you to correct a 120 blood sugar because I don't want my kids blood sugar to be that high. Right? I think that in the end. To break it down. You need, you need to have a plan that you can teach to someone else. Correct. If you're newly diagnosed, I think you need to explain to them, listen, we're just figuring this out. This whole thing is going to be kind of malleable for a little while. I'd appreciate it. If you could roll with this a little bit. I'm also figuring it out. I think you have to understand I don't want to say this. I don't mean this poorly. But I don't imagine that there are many nurses who are one minute at the premier children's hospital in the country working in the PICU that wake up one morning and go you know, I think I want to be a nurse at a middle school in my town. Like, these might be people towards the end of their career. Their training might be older, who knows what what the situation is right? But they're probably not Doctor House is what I'm getting at? Probably not Yeah, it's so they might have ideas in their head that are from a kid they helped three years ago, years ago, five years ago, 20 years ago, you have no idea. So you're, you're educating yourself. You're educating them along with them. But what I ended up figuring out, and then we'll go to some people's questions. I know I've said this in different places on the podcast, but it belongs here in this episode. For kindergarten, first second grade, Arden went to the nurse on a schedule. There was no there's no CGM at that point. So she was she was just going to nursing finger sticks shooting we had her like broke. I basically broke up the day in a way that I thought it seems unreasonable that she'll be she'll get low in my gaps of time, and I look back she never did get low. Oh, of course Ray once he was like eight, so her blood sugar's were pretty elevated to begin with
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Jennifer Smith, CDE 17:27
But you started I think what you're saying here is that even a couple years in, you were really going off of not only technology that you had, but also a baseline that you could teach. That worked easily because it was a structured schedule. And for the newly diagnosed going into a school type setting, I think that's the best that you can really start with is these are the basics that need to be done to keep my child safe. And to allow learning because that's obviously the reason you're sending your kid there to is is to learn. Yeah, and if they're getting interrupted all the time, because of of alerts and alarms and things that are too aggressive for this point in diagnosis. It's not helping anybody
Scott Benner 18:16
well, and and what ended up happening was I basically spent the time from an origin was to till she was five, figuring out an ebb and flow to the day where she wouldn't get low. And then I sent her to kindergarten with that. The school was resistant about some of the things I wanted. And they didn't help her with a couple of things I'll bring up in a second. It happened, we had it set up where she tested, tested, tested, then at lunchtime or snack time even she'd go to the nurse's office, they would test her call me Tell me the number. And I would tell them how much insulin to use. And then they would send her back on her way. And she'd come back and test again. And this would happen before it would happen before snack recess at lunch where she'd get tested. And one day, my timer went off for for recess, and no one called me. So we did a couple of minutes. And I waited a couple more. And I have to tell you, I mean looking back on it. It was I was in like abject horror at that point. It just like we haven't total panic mode is going on, you know, is she is she having a problem? And they're helping her is like, I don't know. So finally I just call the school and I was like, Hey, Scott, you didn't call me about Arden. And the woman. The nurse said, Oh my god, Arden and she slammed down the phone and she was gone. And I was like, and you're like okay, what uh, what is that mean? So I sat there for a second and I thought, well, now she knows I know. And she knows she seems to know something to our way. Right? And she calls back and she goes Hi Arden's with me. She's fine. And I'm like, okay, And then they test her. So a little boy came in with a heart issue and had to be put on a monitor. And they just forgot Arden. And Arden went right from school. And because the nurse didn't come together, she was in kindergarten, she went right out on the playground. So they chant, they plucked Arden with a 50 blood sugar off the top of the monkey bars, and brought her inside. And I then went to the school and said, Look, this is what I was telling you about. Like, we can't just hope that the nice person in the nurse's office remembers to save our son's life every day at 1015. Like, you know, like, we need to and then they were more willing to listen to the ideas that I had. Right. When Arden left second grade, maybe one of the luckiest things that ever happened to her was that her teacher and teachers will know this phrase, I don't know what it is, but her teacher wanted to move from second grade to third grade with the kids. Okay, so she did that. She taught the kids in second grade, went to third grade and taught the same group of kids.
Jennifer Smith, CDE 20:59
That's a nice school that does that was very cool. And a frequent thing. By
Scott Benner 21:03
the way, that person that teacher was that Arden's graduation, like she showed up at her high school graduation and went around and found every one of those kids and took a picture with them. It was very, very nice. But what ended up happening for Arden was, we had we had fresh eyes that also knew the past. And Arden was struggling in math. So the woman calls me one day. And she says, I know why are you struggling with math.
Jennifer Smith, CDE 21:30
And I said, why she where she is with her blood sugar at that time of day
Scott Benner 21:34
when we sent her to the nurse. So the math instructor would start five minutes into it every day, Arden would get up and quietly leave the room and go to the nurse's office, come back five, seven minutes later missed the instruction, and then put her head down and try to do the work. Yeah, no one ever noticed. It just it just because it was such a part of the day. And it took her a couple of years to rebound and catch up from that because they were still moving forward. She had to learn the back stuff. And it was that moment. I was like, Okay, we're done. And that's if you go to episode for the podcast, I talked about how I figured out how to text diabetes. And Martin has never been to the nurse's office since that that moment. So the last day of like the last day of second grade. Because she contacted us over the summer and told me that.
Jennifer Smith, CDE 22:21
And that's something to navigate to, you know, because some school systems again, with these plans, you really have to think about how they're written. Because if they're not written specific to what you have worked out and is safe with your child to do texting, diabetes, not having to go to the nurse, the nurse is there in case of need or somebody else. But otherwise, it's just navigated between you and your child. I would say that that's, that's less common. And it's it's kind of a special school or a special written plan that really worked out that way. I've seen much more the, the child has to check in with somebody. And even if your child is very able to do majority of what they're doing on their own, because they do it in the summer, on their own or on weekends or whatever. You have to kind of almost prove that they can do that. Before they'll let you not check in with someone. Yeah,
Scott Benner 23:21
no, I mean, I very specifically on my end, I don't I didn't you know, I was a stay at home parent. So I wasn't at a job. But I could make that part of my day. I mean, if right. I don't know how it would work for other people. But it it definitely. It definitely freed her up to move around the building better. It actually helped us fix problems more quickly, right? Like she didn't have to go to the nurse to find out that she was low and get something like we would do it in the rain. It's how she started bolusing like she would Bolus in class before going to lunch stuff like that. It's not going to work for everybody, for sure. But it was the way I found to get around this stuff that just kept coming up, you know? Yep.
Jennifer Smith, CDE 24:05
And that's it. I mean, that's important. Absolutely. I've even seen many comments from parents who have problems with any accommodation at all. My my teachers won't do that. They don't have time to do that. Your child isn't special. They don't need this kind of accommodation. I mean, I've seen the total opposite in terms of assistance, which obviously is not what you want to walk into.
Scott Benner 24:31
Why what I would do is every year in the summertime, I'd go and meet with Ardens teacher, and I would explain diabetes to them. Because they're not going to know right? And so you say things like you don't want their blood sugar to get low. They don't know what that means. Yeah, like a great like, why? Because when I'm 60 I don't feel well and when I'm 50 I'm dizzy but do they know like your brain will shut off when you're 20 like I don't know what they know and you will also want to be able to tell them listen And this is a real concern. And we need to guard against this. Having said that, I don't imagine it's going to happen. But then again, correct, yeah, a light doesn't go off on your forehead before you're going to your blood sugar goes to 35. Like, it's just no, nobody tells you ahead of time, you know,
Jennifer Smith, CDE 25:17
well, and one thing that does hit from a teacher level, obviously, that's their job is to instruct, right? One thing that really sort of comes across in terms of the importance of glucose. And what their job is supposed to be is giving some baseline information about blood sugar level, and learning ability. blood sugars here and here outside of this range, are going to mean that my child may be fidgety may not be paying attention may be causing problems, when it's not, it's not what they want to be doing. It's because their blood sugar isn't right. Thus, my kid isn't going to be learning what you're trying to teach them, it's going to be disruptive. So if you help us to keep their blood sugar in this range, you can continue instructing better, my child will keep learning better. And it's a win win. Right? That's a point that often makes sense from the teacher angle is the association between learning ability, attention ability, and glucose levels.
Scott Benner 26:24
And I, I shone a light on security and, and health and I told them about long term health too. I said, Yes, we because they're like, Well, why don't we just leave our blood sugar higher? And I said, because, you know, there's, there's damage that comes from that, to that it's more long term. I think the way I put it in one meeting one time is I said, Listen, if you want to keep Arden's blood sugar at 200, all day, why don't I just pull her out of school, send her to an island and let her live her life? You know, it's like, because at least she'll be healthy. Like, maybe she won't have an education, she won't know how to, like,
Jennifer Smith, CDE 27:00
work or help herself or know how to pick coconuts. But she'll be
Scott Benner 27:03
alive. And you know, like that. I'm like, That's not okay, either. And they're like, Well, I don't understand why this kid. We don't we don't help this kid until their blood sugar gets to 200. I was like, well, that's their decision, like, No, it's not okay. And you're right, you have to, you kind of have to be both sides of the conversation, you need to get what you need, without upsetting anyone. And you have to be helping them. It's in negotiation, that you're the only one who cares how it goes. I don't know if that makes sense or not. Right. So you almost have to defend the person who you're negotiating with the same time I used to put, every year I would find something in Arden's 504 plan that we didn't need any more. And I would give it away at the 504 meeting to make them feel better. I'd be like, no need to do this anymore. Like you know, you're doing this, you don't need to let's make this easier for you and get rid of this. And then that we'd leave the room and they'd be like, Oh, good. I got. And, and, and meanwhile, you were never really adding things to 504 plans, you were kind of just manipulating them to make them work for the age range, like all the sudden, like standardized tests, or the technology
Jennifer Smith, CDE 28:14
that you now have. Right, right, right, God, yeah. I mean, as that changes there, and especially with the technology that's changing the way that it is right now, with all of the FDA approved products, there is less attention that a teacher or a nurse may need to give, it doesn't mean that they don't need to know how to help in the case that it comes up. But this technology can certainly be something to educate them. While their system is going to do this, it should be catching these kinds of things, they still need to touch base, or they still need to check in with you about this. So again, those might be the touch points, kind of like you're saying that you don't have to really do as much. They got something here helping but we still need this in this in this.
Scott Benner 29:01
In the end, you can set up a 504 plan, which is going to give you some legal backing, like once it's in the 504 plan, they have to do it. But there are you do need to understand private schools don't need to accept kids no matter what. Right.
Jennifer Smith, CDE 29:20
That? That's an interesting question. I mean, private schools typically have different rules than public schools. And if they don't have accommodations, it often falls to the parent to find the accommodation so that their child can stay in that private environment.
Scott Benner 29:41
And preschools fall into that heading to Yes, it's might be hard difficult to find a preschool who's willing to do this for you. Right? Yeah. Yeah, it is very interesting. Okay. So some of the things that I've run into no matter what you're gonna Get your kids schedule, and they're gonna have gym right before or after lunch or lunch and you're gonna be like,
Jennifer Smith, CDE 30:08
a lot of fun, I've got a couple little kids who got, they've got recess, then they've got snack time. And then they go to gym class. That's fine, yay,
Scott Benner 30:20
write it off, and then pour it in, then put insolate in, and then have him run some more. Yes,
Jennifer Smith, CDE 30:26
that's fun. And it's not every day. So you can't even accommodate like an everyday like, pattern or something. It's like Tuesdays and Friday. And this is what
Scott Benner 30:36
I know, I actually did have in one of Ardennes accommodations that they couldn't put activity right next to lunch. But it took me a couple of years to get them to agree to that. And so and it was hard. I mean, it was hard to get them to do that, to be perfectly honest, that was every year,
Jennifer Smith, CDE 30:54
because it's a manipulation of what the schedule is going to look like for everybody, then it doesn't just affect her, every kid in her class is going to also not be able to have
Scott Benner 31:04
or you have to put a class where she doesn't belong to make it work, etc. And in the end, I never made them do anything. We always did come to an agreement along the way, because I was never looking to be like I I mean, I don't know if I was or not. But I was trying very hard not to be like, Oh God, here he comes, you know, like, I don't want to talk to that guy hide. When Arden went into high school, and the nurse said, I actually brought along the nursing staff. So I learned this in elementary, from elementary school to middle school, I brought the nursing staff from the elementary school to my first meeting with the nursing staff from the middle school, that's a great idea. Because I was like, I'm gonna say I do a bunch of stuff, it's gonna sound crazy to you. And this person right here knows how it works. And so that made the next person. So when I got to the high school, I did it. But the nurse was just like, well, that's not how I do it here. And she pushed back and she had like a big personality. And she goes, I like having a relationship with all my type one students. And I said, Well, that sounds lovely. But in my world, I would love it if my daughter didn't know you. Right? That's what we're shooting for. Okay? Just like every other kid in the school does not want to end up in the nurse's office. I don't, I'm sure you're wonderful. I bet you make it fun for the type ones. But that's not our goal here. So she pushed, she pushed back and pushed back and I was like, listen, it's not what we're doing. Like, it's not gonna happen, like, we're gonna bring some supplies. And if something gets completely upside down, or Arden has to swap a pump or something like that, you'll see her, right. And that's how it ended up going. And she was okay with that after a while, you know, but it took way to talk about it. They had to they had to wait and take time. Nobody ever yelled at each other. That's the other thing. If you're yelling, it's over. Like don't don't lose your don't lose yourself there. I think. You know, as we're talking about this, I wonder if I couldn't create a place online where people can upload their 504
Jennifer Smith, CDE 33:03
plans. That would be I think, a really great resource. I mean, kind of like, kind of like you have a place online for people to look for good endos, or good doctors or good educators? That would be a really great resource.
Scott Benner 33:18
Yeah, I wonder if we couldn't just turn them into PDFs and put them so people could look at them can look at them. Because
Jennifer Smith, CDE 33:23
you I would even say maybe categorize them, like, toddler age, like almost preschool, you know, grade school, middle school, high school, so that as you filter through them, you can go age appropriate. Yeah. For what your accommodation might look like, or how it might change. Like you said, you took your nurse along to prove to the next entry level of kind of school age, this is what work this is what we did, it is just fine. You know, please accommodate.
Scott Benner 33:51
I'm thinking that because like I'm looking at a question here, like, what do I do if my kid wants to skip lunch at school? Like, I don't know how to answer that question. Like, yeah, I mean, I do. But it's, it's not something you're going to put in a 504 plan or something like that in so there's going to be more, there's going to be more scenarios that are really going to be on you to kind of like dance with then just hoping that there'll be in this document and that fixes everything.
Jennifer Smith, CDE 34:16
Right? The document really should be very specific needs, right? Not what ifs. In right in what if my kid doesn't want his snack in the morning or doesn't want the snack that was packed and prefers the cupcake that came in as the birthday treat? Yeah, what if what?
Scott Benner 34:33
Yeah, no, the 504 plan can't incorporate everything that your anxiety might put into your head on from day to day like it's like Ardens was stuff like Arden has a bag with her. It'll have these things in it. If there is an emergency in the school, you need to make sure that bag goes with Arden and that was when she was younger. Right? And then as she got older, the language changed slightly to like you can't restrict Arden from taking the bag, you know, once it was on her to remember the bag, right? You know if Arden's load, do this, then do this then call 911, after you've done that call the parents or we had stuff like you have to get the school bus driver trained to understand basic, like stuff like that. Yeah, it wasn't like if Arden decides at 3pm that she wants to x, then you have to, like you can't. I know, that's what people want. But this documents not going to be. It's not everything, you know, it's just it's, it's the stuff.
Jennifer Smith, CDE 35:35
And if anything, that kind of detail may make it very confusing as to the very, very real and important things that really should be being done every single day. The same way.
Scott Benner 35:47
Yeah, right. But little things like as Arden got older, she would write her blood sugar on the top of a test before she started taking it. So she'd look at her CGM and write her blood sugar on the top. And that way, if the test came back, crazy, wonky, different than you expect her skills to be, we could say, hey, look, her blood sugar was high, maybe you could let her take it again. Right we've ever
Jennifer Smith, CDE 36:09
done with a CGM, you could have followed what happened to the blood sugar, you know, maybe blood sugar started out fine at 101. But then in test taking, she's not really paying attention. And it really starts to dip there too. You can follow that information to be able to go back and say, you know, could we potentially do you do this?
Scott Benner 36:25
It's funny. So if I, if I started this episode over and decided to make it two minutes long, I would say you're in a relationship with these people. Now. It needs to be harmonious. There might be times where you have to bite your tongue. You don't want to get into a fight with anybody. It's a long process. You might be with them for 12 years. And there are going to be times they're gonna say things that you're like, that's not right. But you got to understand their perspective, too. And make it work. Yeah, it's like being married. Except I'm just gonna say without the sex. But you know, if you've been married, I've been married.
Jennifer Smith, CDE 37:05
Yeah, there's give and take. Yes, exactly.
Scott Benner 37:07
You give a lot and somebody takes a lot. If you're lucky, your kid gets his lunch on time. Okay, all right, Jenny. Well, thank you very much, of course.
A huge thank you to Jenny Smith for being here with me again today. And I'd like to remind you that you can hire Jenny integrated diabetes.com. I'd also like to thank Ian pen from Medtronic diabetes. If you're looking for an insulin pen that does more, you're looking for the in pen in pen today.com. In a few moments, I'll tell you a lot about the show. But one of the things I'll tell you is how to find the series. So if you've just stumbled upon this one, and you'd like to find the rest, there's a way to do that. I'll be telling you about it in just a second.
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Test your knowledge of episode 751
1. Why is early diagnosis and treatment of type 1 diabetes important?
2. What are the common symptoms of type 1 diabetes?
3. What is the role of insulin therapy in managing diabetes?
4. Why is carbohydrate counting important in diabetes management?
5. How should blood sugar levels be managed during exercise?
6. How can stress and emotional health affect diabetes management?
7. What are the benefits of having a diabetes care team?
8. Why is it important to stay informed about new research and advancements in diabetes care?
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#750 Tour De Force
Pam has had type 1 diabetes for 50 years.
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 750 of the Juicebox Podcast
we are all in for a real treat today because Pam has had type one diabetes for a very long time, and she's going to share a lot of it with us today, you're gonna learn about diabetes, you're going to learn about being married about love and loss and life. It's a tour de force this episode. 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. If you have type one diabetes, and are a US resident or our US resident, and are the caregiver of someone with type one diabetes, go to T one D exchange.org. Ford slash juicebox. complete the survey. And you've helped someone with type one diabetes, you may have helped yourself and you've definitely helped the show. T one D exchange.org Ford slash juicebox completely HIPAA compliant, absolutely anonymous. It only takes 10 minutes or less.
This show is sponsored today by the glucagon that my daughter carries. G voc hypo Penn. Find out more at G voc glucagon.com. Forward slash juicebox. Today's episode is also sponsored by the Contour Next One blood glucose meter. Arden uses it. We love it. And you can have one to contour next one.com forward slash juice box.
Pam 1:57
Hi, I'm Pamela. And I've had type one diabetes for 50 years.
Scott Benner 2:02
And Pamela you're 51 years old. Is that right?
Pam 2:06
No, I was diagnosed at 22.
Scott Benner 2:09
Okay, you're 72 years old.
Pam 2:13
72 years young.
Scott Benner 2:15
You know, the other day, someone made a big deal to me that I didn't look my age. And as I was having the conversation with him, I kept saying I'm 50 years old. And we turned around and took three steps away. And Arden says you know you're 51 Right. And good. And I said no, I am not. Is that what happened my last birthday? And she's like, Yeah, your last birthday? You were 51? I said, Oh, I have to stop saying I'm 50 then. Anyway, 70 TuesdayA feels like quite an accomplishment, I imagine.
Pam 2:46
Yeah, I guess 72 is the new 50 though, isn't it?
Scott Benner 2:49
Is that what they're gonna say? That's what I've heard or read. Is that Did you read that in a place where you're, you're back didn't hurt or
Pam 2:59
nothing hurts on me. Thank God.
Scott Benner 3:03
Oh, yeah, let's let's find out a little bit about all that. That's probably something else. So 20 G's 22 years old. 50 years ago? What year was that?
Pam 3:13
Around 1972. Wow. Because I was 17 in 1967 when I graduated high school and so.
Scott Benner 3:25
So I'm going to tell you I was born in 71. So that's probably about right on.
Pam 3:31
Perfect. Yeah, I think that is right. Uh huh. Yeah.
Scott Benner 3:34
Do you remember anything about that at all?
Pam 3:37
Oh, yeah. I was living in Los Angeles. I was a professional singer, musician. And I was losing weight. But I didn't notice it because I'm pretty thin anyway. And so if you lose, if you're losing two pounds, you know, a month. I kept thinking, well, I exercise a lot. I'm just toning up, you know. And I went home to visit my folks in Kansas City. And they took one look at me, and they said, get on the scale. You know, I didn't even own a scale. So my dad says, Your 90 pounds, you know, I thought Oh, God. And I remember when I was in LA that I was in the movie theater with a girlfriend I was holding up. I don't even know how big they are those huge family size Cokes. I mean, I never drink that stuff anymore. But she said, Pam, I'm embarrassed. We're in a movie theater and you're holding up this whatever. 64 ounce bottle. So I guess I was really starving for sugar. Right? Right. And I was so my parents said Tomorrow morning, we're going to go to your cousin who's a urologist and he's going to check you out. up. I was in his office for a few seconds. And he said, You're going to the hospital? So my blood sugar was 1200.
Scott Benner 5:10
Wow. How long do you think that had been going on before you made it to the doc problems?
Pam 5:16
Probably at least a year or two, maybe it was lower. And it just kept getting more and more, I really don't know. You know, I had no way to know. But I went into the hospital and a woman who was very nice, came in and showed me how to inject myself with insulin. She showed me on an orange and then every time I chewed it into myself, I think that the orange, so I'm just gonna sip a little water here, you're fine. So and then another woman came. And she said, I've been diabetic for, I don't know, 40 years, she was probably in her 50s. And she told me that she had no complications. She told me what she did everything she did was, you know, good. And I thought that's going to be me. And I felt so good after having insulin. Oh, my God. I was like the old knee again. Right. So it wasn't depressing for me. It was a rescue. Thank you. Yeah, no, no, of course. So that's, that's that was my beginning.
Scott Benner 6:27
Wow. How did you make it out to LA to be a singer? Because that's not what you ended up doing through your life. Is that right?
Pam 6:34
Well, I did that for 20 years. I was I played Funny Girl in Fanny. I played Fanny Brice and Funny Girl musical in high school. And I decided that I was going to devote my life to music. And I, my parents, I knew if I said I want to move to LA, they would have said, No, you have to go to college. So I was in my sophomore year I, I went to USC, and they had a musical comedy workshop with the Civic light opera that I got into. And so they would work with me every night while I went to college. And then I dropped out because I got on a TV show. And I dropped out of school. And then my you know, my parents were thrilled. And they watched me and you know, it was all good. All right,
Scott Benner 7:18
Pamela, what TV show? Are you on? Pam?
Pam 7:21
Oh, God. I mean, this is the Flintstone era. Right. Let's see. That was Jim Nabors musical variety show. Really? Yeah. You know, go. He used to play Gomer Pile.
Scott Benner 7:35
I know, I know who you're talking about. I'm, I'm worried that I know what you're talking about. Even more worse? Scary. You said that like, oh, well, you're not gonna know what I'm saying. But I know, that's what you like a background singer or a player? Well,
Pam 7:53
they, they, I was the ethnic girl. They had an African American woman, you know, a blonde and I was the brunette and there were four guys and four women. And we would sing, you know, with Jim and do skits. And I mean, just everything really, it was really fun. But after a year, I thought, I'm going to end up like these other women being BACKUP SINGERS for the rest of my life. So I quit. And I started traveling, you know, to Japan and the Playboy Club circuit and all you know, that's what I did for 20 years. Yeah, I
Scott Benner 8:31
have to tell you, the funniest thing is that at that time, what passed for an ethnic girl was a was a white girl from Kansas with dark hair.
Pam 8:40
A Jewish girl. Oh,
Scott Benner 8:42
I see. I see. That's how I got. That's what passed for ethnicity at that point.
Pam 8:48
Right. Right. Right, by
Scott Benner 8:51
the way, and not for nothing. How did the Jewish person ended up in Kansas?
Pam 8:55
You know, there are millions of people in Kansas. I mean, they're just an incredibly large amount.
Scott Benner 9:02
There's, I didn't realize there was a big community there. That's interesting. Yeah. Huge. That's something so All right. Well, I now think you're famous from this story. And anybody my age or older believes that but everyone younger is like she said, Jim Nabors, I don't know what that means. I know. I know. It's very interesting. Okay, so so when you went home and you were diagnosed, did you ever go back to LA or did they did that? Is that what brought you home?
Pam 9:33
No, I had just gone to you know, I was diagnosed and and I went to the hospital and once I felt good, I went back to LA did
Scott Benner 9:39
go back. Okay. Yeah. How much longer did you stay?
Pam 9:44
20 years. Oh, wow. No, I left when I was 40 years old, and I moved back to Kansas City. And when I was 43, I met my late husband, who was incredible and we were married 30 years. He I got a year and a half ago. And so that's why I'm back in Kansas City. But I love Kansas City. I mean, I, you know, I grew up here so
Scott Benner 10:08
yeah, I'm sorry Kansas City, Kansas, Kansas City, Missouri,
Pam 10:13
Overland Park, Kansas. Okay. Okay. And I, well, when I up till nine, I was in Missouri, and then we moved across the state line a few blocks, and I was in Kansas. So
Scott Benner 10:25
first, a change of pace. Okay, so there's a lot of richness going on here. Hold on a second. So after you decided, I don't want to be a backup singer anymore. You were still in LA for quite some time. So what did you do between those years?
Pam 10:38
Right. I was so lucky. I got my agent booked me in Japan. And I got to go to Tokyo, Osaka and Kyoto. And I would be like a tourist in the day and I would explore and then at night, I'd sing with a great big 17 piece band, I had big band charts that my arranger made for me, and the stage would be spinning around and there were all these Japanese or Asian men, there were no women. And then I would sing, you know, and then, you know, maybe Osaka and Kyoto there might have just been a trio. And then I did the Playboy circuit, which was really an archaic. I'm sure no one that's 30 years old, even has ever heard of it or even 40 but they'd have a comedian open, and then I would sing after that.
Scott Benner 11:35
Okay. Pam, you for clarity. You had your clothes on while you were saying,
Pam 11:39
oh, oh, yeah, I was really I was already a feminist at that age. I was I was kind of like, not happy these women had to wear those bunny suits. It was I thought it was really weird. But you know,
Scott Benner 11:52
so interesting. Wow. So you made a living like that that whole time? You never married in that time?
Pam 11:58
No, I you know, I had this I made this vow you know that I was going to sing until I was famous and and you know, I recorded with Richard carpenter after his sister died, but a&m Records was afraid to put me on with with him. So they got Dionne Warwick instead. And Dusty Springfield, they thought because it was his solo album, and they thought that would sell better. But, you know, after that, I was pretty disappointed. And I, I decided that I was kind of burnout that I wanted to go home and be near my family.
Scott Benner 12:33
So So through all this time, the 70s the 80s. I mean, when did you move home? What year? Do you remember?
Pam 12:40
Yes. 1990. Okay,
Scott Benner 12:43
so 70s 80s Up until 1990. You're living this life in a world where diabetes management is pretty shaky. So how did you think about your diabetes during that time? Or did you not or how did it?
Pam 12:57
Oh, I did. I had my cousin out there knew the best endocrinologist I think, honestly, in the face of the earth at that time, Dr. Sherman Hovey, and he was president of the ADEA. He had a support group, he had a diabetic educator, he had you could call anytime, day or night, and somebody would be there to help you. It was unbelievable. And he told me, Pam, you know, you have a couple choices here. Your you can either take care of yourself, exercise, measure your food, with your insulin, and you know, I've always eaten a lot of carbs. And, or, you know, don't do those things. And you can you might suffer the complication. So I thought he was my inspiration really, he? He inspired me to. He said he ran on the beach every morning, five miles, you know, and I thought, okay, I can do that. Yeah. So. So anyway, I kind of had good role models,
Scott Benner 14:05
okay. And what was management? Like? I mean, you were animal insulin at first, right?
Pam 14:10
Oh, my God. We had urine sticks. That's how we checked our blood sugar. If it was dark green, you were super high. If it was really light green, you were wonderful.
Unknown Speaker 14:23
So that was the whole thing. Yeah, that was it.
Pam 14:27
And then your years later, they came out with glucose glucose meters with foot kilometer.
Scott Benner 14:34
They were bigger back then though, right?
Pam 14:38
Yeah. And I thought, you know, I was living alone. And I thought, I'll just check my blood sugar 10 times a day because that way, I won't blackout and you know, that that'll be that'll be the best way to go. And I was singing, you know, and so on the 45 Minute shows and you go into the bathroom. On the break, check your blood sugar, come back out. And, you know, so that's just what I did. Because singing burns up a lot of glucose, you know, you're jumping around and all that. Yeah. Pam, did
Scott Benner 15:11
you blackout frequently?
Pam 15:14
No. The only time I had one blackout. Well, two and 50 years I've had to. I was driving on the freeway from Santa St. I can't remember where I was San Diego or somewhere. I would did a recording session. And the person that was recording me took me to dinner. Just a nice guy, you know, friends, and I don't drink. I still don't drink. But that night, I probably had a fourth have a glass of wine. And I probably was so focused on talking that I didn't think about my carbs. So. So my car. Yeah, so I blacked out. Wow. Yeah, and I'm alive. I mean, is a miracle. Really?
Scott Benner 16:05
Was that? Did you ever seizure? Yeah, that's how you would put it right. And how did you I would call it how did you come back from it? Like did someone help you? Or
Pam 16:13
well, I was, you know, 65 miles an hour on the freeway I pulled into I didn't know who I was or where I was I it was like a surreal nightmare.
Scott Benner 16:32
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Pam 19:33
And I pulled in to the side of the freeway, the left side and the police were knocking on my window. And I thought I guess eventually I opened the door and they took me to the hospital. I probably had a diabetic bracelet on and that was sat and the other time when I was married my husband You know, he knew when I was acting strange that my blood sugar was low. And so he wanted to call paramedics. I said, No, do not call them I was like banging on his arm, which I've never would do normally. And then the next thing you know, he said, I was out laying on the floor, you know, so that was my two escapades never had anything since. And I've never I don't think I ever will, because I'm so well controlled. And I, you know, I've Dexcom and all that. So,
Scott Benner 20:28
yes, back. So back in those days, though, in the beginning, did they measure a one C or how did you measure? Yeah.
Pam 20:35
Oh, yeah. I was about in the high fives.
Scott Benner 20:38
Okay. Did you eat a particular diet? Or?
Pam 20:42
Yeah, okay, I did the the woman that taught me at Dr. holdings office told me, you know, I would eat four carbs a meal 20 grams of fat because the fat slows down the rise of glucose. Fruit. And they gave me a booklet, you know, that diabetic booklet with all the little foods and how much they Yeah, the equation. And so what else do I have? All of that every day? Every day? Yeah, tons and tons of carbs. But now, you know, as I got older, I started doing research when I could on the phone and saw that high fiber doesn't escalate your blood sugar very much. And so, I mean, now I've been eating high fiber for almost all a great part of those 50 years. And, you know, people talk about how diabetic people say they want to eat chocolate cake, or, you know, I haven't wanted that because I'll eat a mango. 90 grams of a mango is 15 carbs. So I put it on my little scale. And it's to me the best, you know, my taste buds have changed.
Scott Benner 21:55
You probably you prefer the sweetness come from? From some natural from fruit. Yeah. Yeah. Go ahead. I'm sorry.
Pam 22:04
No, I just said I don't like to take chances. And so I don't, it's not worth it to me to go out and you know, have a hot fudge sundae when I don't even want it anyway. I mean, the thought of it almost gags I know what it would do to me, you know, and then I'd have to chase the blood sugar with it. The pump the Dexcom in the My Omni pod, and I'm looping with the Reilly link which is changed my life. Right? That, you know, I? I mean, I guess I know that type one. People with type one do do that. They can't they eat something real sweet. And they work it out. And there's things you can do with your Reilly link or whatever looping device you're on. But for me, I just don't want to take the chance because I like I said, it's not a big deal. So I don't crave that stuff.
Scott Benner 23:00
Yeah. Would you consider yourself a lower carb eater like your overall daily carbs?
Pam 23:06
Well, I have four for breakfast for for lunch and five for dinner.
Scott Benner 23:09
And that includes the fruit. Yeah. Wow.
Pam 23:14
And then the 20 grams of fat, which does not it's not the lean meat included in the lean meat. It's outside of that. And then what else? I don't know.
Scott Benner 23:23
Damn, I gotta tell you, you're 72 and I'm gonna ask I'm gonna start eating your diet.
Pam 23:30
Well, you know, it's really good. I mean, my cholesterol is so low. My a one C is a five. Now I don't recommend that for anyone listening to this program. But for me, it works because I'm very careful. And I exercise the first thing after breakfast, I'm on the treadmill. 30 minutes and then I do yoga. I'm a yoga teacher now, last 30 to 4050 20 years. So you know I do I stand on my head. I do all kinds of crazy stuff. But all works and then I go about my day. So that's my life. Basically.
Scott Benner 24:08
I want to pick through it a little more with you got up this morning. You ate breakfast. What do you have?
Pam 24:14
I the same thing for breakfast every day. High fiber waffle. It's got 21 carbs and then fruit, apple sauce on my oatmeal with and I became lactose intolerant this year, which is really fun. So I take these lactose pills and then I have lactose, you know no lactose yogurt, but I still have to take them because I react anyway. So that's what I eat. And then what else? I guess that's it. Peanut butter. Peanut butter on the waffle. Oh, not almond butter. I used to do peanut butter. I'm almond butters real super healthy. My endocrinologist in California told me so.
Scott Benner 24:57
I'm confused about one thing so a second ago. I thought you said the waffle had like 21 carbs in it. Is that right does oatmeal, but earlier you said like like three and four and five at a meal but what I'm misunderstanding, okay, you're saying okay,
Pam 25:13
okay, so the oatmeal has 20 carbs that brings it up to 41 The fruit has 1541 and 15 is 56. And then I'll eat one Triscuit
Scott Benner 25:30
Oh, so you have a meal with like over 50 carbs in it for breakfast.
Pam 25:35
It's got 60 yet 60 Really? Okay. And then
Scott Benner 25:38
how much insulin is that for you in the morning?
Pam 25:41
Well, I can tell you that my overall Basal rate all day is to 2.1 It used to be for
Scott Benner 25:50
weight tell me 2.1 An hour or 2.1?
Pam 25:53
No all day. My Basal right now that's without the food. You know, that's just my you know, Basal
Scott Benner 26:00
way I'm fine. Hold on one second. I'm getting I'm pulling up a calculator. I know we were gonna have so much fun. Hold on a second. All right. So if you're doing I'm just going to round it and say two divided by 24. You're getting less than point one an hour and Basal. How much less than point one
Pam 26:22
or around No, point. It's it's point 05 points all day. And all night except for o 10. You know, for two hours in the afternoon and at night. It's 25 and 35. What do you know, one hour of 25 and one hour of 35? How much do you know? Oh point 35.
Scott Benner 26:46
Yeah, yeah. How much do you weigh?
Pam 26:49
118 117.
Scott Benner 26:51
Is this a chair? Okay, so did you. I'm assuming you. Pam I am assuming you went through menopause like 20 years ago. But oh, yeah. But But But prior to that, were you on a pump prior to menopause? Know what your basil your total daily basil was before?
Pam 27:13
Oh, yeah, it was so much higher. It was like all day long was a whole bunch of insulin like you know, 20 Oh, oh, point 30. That hour. And then oh point 50. Another hour? You know, it was It was
Scott Benner 27:27
wild. So if you're if you were prior to this, like a half a unit an hour, and now you're not even you're not even a unit? Yeah, you're so low, so much lower. So but do you think that's is that the change is the loss of the hormone fluctuations? That changed?
Pam 27:44
Oh, no, it's the it's the the Riley Link has changed my life.
Scott Benner 27:52
I'm sorry. So you're using loop right with?
Pam 27:54
I'm looping Yeah, changed my life. So I have
Scott Benner 27:58
and so the loop is, is keeping you super steady with a lower Basal rate. But you're making up for the insulin you need at meal. So your your what's your insulin to carb ratio? Do you know?
Pam 28:11
Yeah. 115 grams of carb to one unit of insulin one to
Scott Benner 28:16
- Okay, so you're one to 15 You have a very low Basal rate. Do you notice the loop giving you extra Basal during the day? Or is it fairly stable?
Pam 28:26
You know, when if I'm under stress, I'll hear it going beep beep you know, I'm going Oh, thank you, you know. And then I found this override, just lately. Boy did that change? Well, that let's see, the override is good. Because I took an improv class lately, just for fun. First time I went there was kind of stressful. And so I put the override on, you know, for a temporary Basal. And it asks you what, what amount of how high you want your blood sugar to go, how low and how high and you fill it in. And then it just during that time that I was at the the first improv class I wasn't I was my blood sugar's were perfect. Instead of me bolusing for stress and giving myself two units of insulin and then have have to, you know, it's like a roller coaster.
Scott Benner 29:24
So you turrible you go to that little, you go to that little icon at the bottom of the app, the heart, you touch that right? And then you roll up to what G like, would you use 130%? Or where did you go to? Do you remember? Well, it's
Pam 29:37
not a percent they they asked you what range you want your blood sugar, right, like, you know, so I put it low. I don't want to tell people because I don't want anyone to get into trouble.
Scott Benner 29:48
You okay, so you just changed your target so that it would be a little more aggressive. Oh, look at you. So you didn't change the strength of the algorithm by rolling up the percentage you just changed your turn. Get to be louder.
Pam 30:01
Yeah, just for that hour or two or Yeah. You know, I was I was on stage doing this improv and I could hear my little thing going. And I was like, Oh, thank you. It's like a human pancreas, you
Scott Benner 30:13
know, feels good when something's looking out for you, that's for sure. Yeah, you're like,
Pam 30:17
Oh, thank you without putting my Dexcom on the attentive, I always have on the 10 of sound. And you know, God, how embarrassing that would be during an improv.
Scott Benner 30:28
You could just, you could just improv right around the noise I would have. Yeah,
Pam 30:31
yeah. It's Aliens. Aliens have landed.
Scott Benner 30:35
How long have you been using loop?
Pam 30:43
Let's see about three years, three or four years. You said yourself? No, no, no. So I was teaching yoga outdoors at this hot springs, and 10 women or 15 women walk in wearing Omni pods they have bikinis on because it's people go swimming. And I ran up to them after the class. And I said, I wear an omni pod to and some had pumps with the tubing, you know, and everybody was proud. It was like they were being Bold. Bold was insulin. Right, right. So they said, Don't you know about the Reilly link? I said, No. And they told me and I went ahead and ordered it in my, my husband, my late husband's brother, was a genius, launched a lot of spaceships and T peep, set it up. And then my husband watched. And then every time I had to replace it, my husband would know what to do. When I moved to Kansas City, he was passed on and so I had to hire somebody because I I'm just not a tech person. No, I
Scott Benner 31:47
remember a half an hour ago, when we got on this call, I didn't think you were a tech person.
Pam 31:55
I mean, I think to myself, I can't imagine what anyone listening to this show that's 20 or 30 is thinking because they're just eating whatever they want most people and they don't want to live this crazy life. But to me, it isn't crazy. But it looks crazy. I guess, you know,
Scott Benner 32:12
I don't know about that. Pam. I also think that as you get older, I don't, maybe everybody doesn't feel this way. But some things lose their luster. And for me eating was one of them. Like, I don't know if that makes sense. Like I realized how much eating was around. I guess community, right, and social socialization and then, you know, I, my my mom's birthday was recently my mom turned 80. We had her over, she wanted steak and shrimp and we made all this stuff. And I had I had steak leftover. And for days afterwards, my kids would like, they're like, hey, it's lunchtime. What are we going to have? Well, Dad's gonna eat that steak. And I just be like, yeah, it's good. Like, I don't need it to be. I don't know. Like, I don't need it to be a whole big different thing constantly. Yeah, I don't know if that's a thing that comes with age or not.
Pam 33:04
Maybe Yeah, cuz i i really like my, I mean, I different things sometimes at night, but in the day, it's very similar.
Scott Benner 33:14
You know, I'm taking any supplements or have you over the years.
Pam 33:16
Oh, yeah, I take I take like, you know, everything. Vitamin C, multi. E, flax oil. You know, all that vitamin beta carotene. All that stuff? No
Scott Benner 33:31
kidding. Did you and your husband have kids? No, no. Was that like, because of your age? or diabetes? Or what?
Pam 33:40
No, he had a daughter. And so he felt like it would make her feel bad, you know, that? We would because we're living in Kansas City and she was out in California. So that's what we you know, that's that was a decision. And you know, as a result of that, I've been in a lot of programs with like Big Brothers Big Sisters. Now I am and then a diabetic program with Children's Hospital where you mentored a type one child, so I always have a child in my life. It's I love children. Yeah. It's very important to me.
Scott Benner 34:14
Was it disappointing to you not to have kids or,
Pam 34:16
you know, I don't think at the time I kept thinking, Well, my husband has a daughter, it'd be like our daughter, you know, even though she's out of town. And so that's kind of how I, you know,
Scott Benner 34:28
kind of, Pam, you probably dodged a bullet. If I'm being honest with you. Every day these kids seem to want something you're needed or I don't know. Good. Or they have emotions. You have to tend to or there's a lot Sure yeah, no, that's that's interesting. And I looked at your LinkedIn I've seen you've done a lot of nice things over your life.
Pam 34:50
Thanks. Yeah, good. It's so a few I looked at your your you've done a lot of good writing and
Scott Benner 34:57
you're very tight. You don't be nice to me, Pam. It's okay. We're Talking to true. Oh, it's true. I, I, that's very interesting. I try to come off like just like a big dummy that makes this podcast. Is that working Pam? Or do you think I'm not getting away with it?
Pam 35:11
No, I think you're, I think you're very understanding. I've listened to a lot of them. And I learned I've learned a lot. I kept thinking, what can I learn, right? But, of course, there's always so much to learn. And, you know, for instance, I learned setting your warning sign that you're going to get low, higher than, like, I had it on like, 65. Well, by that time, that's crazy, isn't it? So even though I do have a signal that says you're starting to go low, so anyway, I've changed that. I've learned I've just learned a lot.
Scott Benner 35:47
Yeah, I appreciate that very much. Okay, so did you know many type ones throughout your life?
Pam 35:57
Yeah, they, they didn't take care of themselves and make this some of them are gone. Now. Let's just say it, you know,
Scott Benner 36:05
how did you end up meeting them originally?
Pam 36:08
Well, I went into one at a diabetic store. My little, the little girl I mentored in the program, she was 12. When I met her, she's 40 Now, but she lives in California. But um, you know, I'm, I know, I know what, you know, I know what's going on with her. And so I guess I don't know.
Scott Benner 36:32
Too many. Yeah, but he's, I was wondering without, like, the digital age, because you're, you're in a really interesting situation. I mean, you lived, like, right over top of the, of the line where the Internet came. And, and you're somehow involved in it now, like, you're, I mean, you're using a do it yourself algorithm to manage your diabetes, you're in my Facebook group, you know, you're you you meet with people, socially, you meet with people, like through your businesses and doing yoga and things like that you have a lot of interaction with people. And I just wondered how many of them would have diabetes? And I didn't, I didn't imagine many. But But are you saying that's the of the people you know, you've seen poor health outcomes for them? Well,
Pam 37:21
I have a cousin who started out on pills, you know, as a type two. And then And then his, his wasn't getting regulated. And so they put him on insulin. And he's doing better. I think the little girl that I sponsored, I was hoping that she would have no complications, like me, but she's had some heart stuff, you know, it's just, you can't make anyone do anything. And I never tried to push my eye, you know, push, make her feel like you talk about on your show shaming someone, you know, and I would, I would never do that to her. And but, you know, when children grow up with a parent that maybe doesn't feed them healthy food. They really don't want any healthy food, you know? So it's, I mean, that's not for everyone. But I mean, I noticed that sometimes that how you grow up and I was just lucky my mom lived to 101 and a half. She walked a lot. She ate healthy and you know, so I had a good role model. I was lucky.
Scott Benner 38:31
101
Pam 38:33
and a half.
Scott Benner 38:34
How did she pass? Did she?
Pam 38:36
She choked on something.
Scott Benner 38:38
I must curse Pam. Okay, but really, that's what got her. Hmm, that's crazy. Yeah. She was she was still going.
Pam 38:49
Yeah, it was so funny, though. Last year, so my husband would come over and visit we moved her out to California with with us. And I put her in a little residential home with like four other people. And my mother would look at me and she'd say, who said old man with you?
Scott Benner 39:08
Talking about your husband? Yeah. Well,
Pam 39:11
you know, she started not knowing anybody but me. Right? Because I spend a lot of time with her. So you know, her quality of life wasn't so great the last year or two so that's, you know, it was okay. But
Scott Benner 39:24
that's what good did your father how long did your father live?
Pam 39:29
At six and he had Alzheimer's, so I'm sorry. Yeah. Yeah. And he didn't have exactly you know, he didn't my parents never drank really didn't drink but for smoke, but although my mom did maybe for a few years when I was young, but you know, I think genetics has something to do with
Scott Benner 39:52
I mean, obviously, yeah. What about other autoimmune issues? Do you have any others
Pam 39:58
well, From age 20, well, when I got diagnosed round 24 to age 40, I could not get rid of female fungal infections. I just couldn't they, you know, all the medicine didn't work, right. So when I went back to visit my parents now, you know, I'd had it for all those millions of years. And, you know, it's not fun to die of a chronic infection when you but affects your blood sugar. And I saw a really, I call him brilliant immunologist from India at one of the, you know, hospitals here. And he fixed it for a year with some medicine, but he said, You can't be on this forever. And he said, he was really a holistic person. He was looking at the whole person. He said, Pam, I think you're depressed. I said, Oh, no, no, no, not me. He said, here, I'm gonna give you an antidepressant. I said, No, that's okay. So I took it home. I swallowed it, I felt I felt I just fell asleep. And I just I flushed down the toilet. I thought, this is like crazy medicine for, and I'm not crazy. And anyway, to make a long story short, I did get depressed around the time I moved back to Kansas City, seriously depressed. And I was I got treatment. And in one month, my phagocytes that the immunologist found that were a 2%. They should be 100%. In one month on an antidepressant they were 100%. One month. He was right.
Scott Benner 41:41
What is that measure?
Pam 41:45
Well, phagocytes eat bacteria have something to do with eating bacteria? Your body?
Scott Benner 41:50
Yeah, I'm looking right now. The type of cell within the body. It's called.
Pam 41:53
It's called? pH. A. Yeah.
Scott Benner 41:57
Absorbing bacteria and other small cells and particles.
Pam 42:01
Yeah, I mean, I really felt hesitant to even share that I'm on an antidepressant because I don't, I don't tell very many people, you know, except my close friends. I know all the people. You know, people think that you're, you're weak and fragile. And
Scott Benner 42:16
you don't realize generational concept, though, don't you think? Like maybe, maybe because of your age, you think of it that way. But I don't imagine that, that people would think of it that way any longer.
Pam 42:28
I hope not. Because chemical imbalance happens and you know, in our family that was prevalent, and so that's just but you know, it fix my immune system. And all those years, being a mess. And all of a sudden, I wanted to get married. You know, the counselor said to me, have you ever thought of getting married? And I said, Oh, that's a good idea. You think somebody would want to be with me? And he said, Sure. So that's when I met my husband. Yeah. Then we got married. And it is incredible. My My life was so much richer than being a singer. And a musician. I mean, you know, if I had to do it over, I would have had four or five kids. But, you know, kind of late for that.
Scott Benner 43:13
Right? You were later when you met him. I see. I understand now. Hey, yeah, we met. Yeah. You know, who wasn't interested. Jim Nabors?
Pam 43:21
Oh, I don't want to laugh. I'm sorry.
Scott Benner 43:24
I think you and I the only one that understand that statement. So yeah,
Pam 43:27
I know. Well, and I respect everybody. Oh, sure.
Scott Benner 43:31
No, of course. No, no, no, I'm just teasing. But I know. Yeah. But that's really interesting. So because I'm glad you shared that part. Because the story felt a little disjointed, because it didn't make sense to me that you got married at 43. And now it does.
Pam 43:48
Yeah, yeah. Okay. Yeah. I mean, I wasn't afraid of getting close to someone, you know, all those years, I would pick unavailable men, and all of a sudden, I had an available man and, you know, really scared, but I could, I was able to handle it and embrace it and feel grateful. And it was just wonderful.
Scott Benner 44:07
That's excellent. So no, thyroid stuff for celiac or anything like that.
Pam 44:12
No, nothing. I have no no complications of you know, from diabeetus. And I'm good. I just nothing else.
Scott Benner 44:20
Wonderful. Any siblings? Yeah,
Pam 44:22
I do. I have a brother. He's eight years older.
Scott Benner 44:27
Does he have any issues?
Pam 44:30
Not No, no, no. diabeetus I think my father had some family members like a little boy that had diabeetus like a one of his nephews had diabetes. So that's what we think. It's that in the family in that way when
Scott Benner 44:47
your father Yeah, your brother has children. Uh huh. They're fine. Nothing there. Yeah. Interesting. Okay. Yeah. Wow. All right. Well, what made you want to come on and do this for 45 Min. Listen to this, I wanted to ask you why you want to come on the podcast?
Pam 45:02
Because I think it's important that people understand that taking good care of yourself is it's it makes life less complicated. You know, it's enough complications just being diagnosed. And then I wanted to make things a little easier for myself. And for me, that made it easier. I respect that not everybody wants to do that. But and I also think being a mentor for a young child is a good thing. And I wish more hospitals have that program. I don't think, you know, I mean, there's one, my endocrinologist has one patient that has is looping. Can you imagine that in Kansas City? One patient?
Scott Benner 45:50
Yeah. I don't want to out somebody, but I think there's a person on the show. I think they're pretty open about that person that's been on the show before? Who, who lives probably very close to you, who's who's who's been very involved with looping in the past. So okay, yeah, no, I know what you're saying, though. It's all these people. You know, the way I always think about it is through the podcasts or the context of the podcast, because, you know, I get enough feedback from listeners, that I am comfortable saying the podcast helps people. And yeah, and yet, I know what my reach is. And while it's, it's, it's really great, it's nowhere near the number of people who could benefit from the information. And so you, you only are ever reaching a small number. So to hear that there's only one other person in your, you know, hospital setting that's even aware of this. I mean, I'm hoping that changes, I'm hoping the the algorithms that are available now from tandem and on the pods and things like that I'm hoping they become more prevalent with people because even without a firm understanding of diabetes, they might achieve much better stability and a one.
Pam 47:04
Oh, yes. Yeah. I mean, it really does help tremendously.
Scott Benner 47:09
Do you ever think about, I don't want to be a bummer. But do you ever think about what might happen if you become incapable of thinking about your diabetes the way you are now?
Pam 47:20
Yeah, scares me to death. I mean, I've thought of that. And I thought, oh, my god, how am I going to just you know, my settings? You know, nobody's going to know how to do that. So yeah, unless I remarry, and somebody's smart as my husband was.
Scott Benner 47:37
But are you trolling for 75 year old guys that understand how to use their computer that was going on?
Pam 47:43
60? About six years? Oh, yeah.
Scott Benner 47:46
You want to get more of a boy situation?
Pam 47:49
Well, no, you know, I just feel that I don't, the people that I meet that are my age, I don't think I think I need somebody with a little more. You know, I don't know.
Scott Benner 47:59
Yeah, I Yeah, you don't you don't in any way, come off your age. That's for certain, you know, like talking to you, or even like, you know, I can see you online or like looking at photos of you or anything like that. Like, it's you don't feel I mean, that you're 72 was surprising to me.
Pam 48:18
Thanks. Yeah,
Scott Benner 48:20
that's no, I mean, it's a big deal like it is because it's not just about dumb luck, right? I mean, sure, genetics are helpful. But you've also put a, you know, you've put a plan in place for eating, and it's working well, for you. You're on top of your diabetes and in a major way. You know, these things are, you know, you're not, I wouldn't imagine you're having these successes by mistake. It seems like you're you're meaningfully trying to accomplish them. And while that doesn't always work for everybody, you're seeing the fruits of your labor here, I think.
Pam 48:53
Yeah, I think exercising every morning for 30 minutes on the treadmill helps tremendously. My Basal rate was so much, so much higher. Before I did that every morning. In order I'll listen to the news or watch TV or something, just some stupid show that, you know, so I don't realize I'm really on the treadmill, but I think that's a made my Basal rates really low.
Scott Benner 49:18
I would imagine I agree to and you do you do it every day, seven days a week? Yep. Yeah, it's the consistency too. Because the truth is, is that the exercise is creating a variable for you. That variable is allowing you to probably use less insulin.
Pam 49:34
That's right. Yeah, that's right. I see. I seen that
Scott Benner 49:38
percent. It's 100%. Right. Did you figure that out on your own? Or did you kind of fall in your mom's footsteps to the walking?
Pam 49:45
Well, I figured it out because I was you know, I used to treadmill maybe several times a week but then I started noticing, especially with the loop in the the Dexcom that I My blood sugar's were really, really good when I started doing it every day, and I thought, boy, that's good. I mean, with a loop, you know, if there's a day where I just think I don't really want to get on, I'll create that temporary override for a few hours, you know, and then maybe I'll ride later in the day, you know, and then I walked my dogs every night for about a half hour to so I mean, and teaching yoga and sure, standing on my head for five minutes in the morning, you know,
Scott Benner 50:29
you're very active. Like, yeah, I'm here. Not for your age, by the way. You're just you're very active.
Pam 50:36
And yeah, nothing, nothing hurts. Luckily, you know, right. So
Scott Benner 50:40
no, I take your point there, because there are plenty of people who might like to be active and are having trouble. They can't Yeah, reasons that are, are not their fault. Wow, that's something so would you I mean, you talked about a five a one C now, was it always that low? Like
Pam 50:56
three? No, no, no, it got better. When I started looping. It was, you know, middle, I think years ago, upper fives, and then they got to the middle fives, and then maybe 5.2 or 5.3. And then after this loop, you know, it just kept getting better and better.
Scott Benner 51:18
Does anyone follow your Dexcom? Like you live alone, right?
Pam 51:23
Yeah. No, somebody should though, because that'd be nice. You know?
Scott Benner 51:28
Yeah. Do you I don't want anything could
Pam 51:32
I don't know who would do that. I mean, my my brother's really busy with flying in and out of town visiting his kids and my sister in law, they are busy. They go overseas, they go on trips, or they're not here that much. So I don't know who and I have some girlfriends, but I would not ask to put them under that kind of stress.
Scott Benner 51:56
I just I mean, I'm I'm just thinking about like, you go to bed every night by yourself. So yeah, you know, it's
Pam 52:04
but my Dexcom setting is on attentive. Have you ever heard that noise? The attentive one,
Scott Benner 52:10
does it go in like that?
Pam 52:12
No, it does. Doo doo doo doo doo doo. Oh, god, it's a killer.
Scott Benner 52:18
So that wakes you up?
Pam 52:20
Oh, yeah. Oh, yeah. But you know, usually is by pretty much no, when I go to bed, I can look on the forecast of my loop. And it's showing that you probably aren't going to have any Lows tonight. You know? Or if it says you are because maybe I took a virtual yoga class on top everything else. It sucks. See 545 Just like an hour and a half. So I will eat something more before I go to bed. You know. So the loop has that advantage where you can actually see your forecast.
Scott Benner 52:58
Yeah, no, I know. It's a it's a big help.
Pam 53:01
It's huge. Yeah, it really is.
Scott Benner 53:07
I don't know what else to ask you. There's so much like you, it feels like you've done a lot and the time has been kind to you. And and I don't know, it's a is there something you'd want people to know that? That I'm not getting from you. I'm so worried. I'm not asking you the right questions, I guess is my is my concern.
Pam 53:32
I don't know. And see. I was just looking at some notes that I made. But I think I've already talked about all the things that I put notes for?
Scott Benner 53:50
Well, well then let me ask you this at your, you know, at your age, how do you find a podcast?
Pam 53:58
There was a Dexcom group on Facebook, I think I'm pretty sure that's where I was. And I said I had diabetes for 50 years, I have no complications. Well, I don't remember if it was like 1000 people or 700 people, but I mean, so many people wrote, how in the world have you done this? And I said I said I told them kind of in a brief few sentences. And one of them said you should you should be on the juicebox show. Really? And that's that's that's, that's that's how I found you. Yeah.
Scott Benner 54:31
Do you listen to it?
Pam 54:34
To the juicebox Yeah, well, now I do. Yeah. Okay. I love it.
Scott Benner 54:40
I'm glad. That's excellent. And do you think that do you believe that because you're very you've been very careful through this entire like time we've been talking so far right? You're not giving anybody advice and you're very careful to say this might work for me and not for other people. Like you know, I don't I don't want to say what I do because it might not be right for some What else? But I mean, if you had to encapsulate where your success is coming from, you think it's, it's a mixture genetics, your diet activity like, Well, how do you think of it?
Pam 55:13
No, it isn't. Because when I was in California, I was in my 20s. My doctor wanted to put me on cholesterol medicine because my cholesterol was like, you know, 200 and something. And I said, No, I'm going to just eat more carefully, you know, and that's when I changed. And then right now my cholesterol is 150. And the good and bad are excellent. So maybe genetically if I ate bad I get maybe you know it, wouldn't I plus? Yeah, but I think I think it's exercise. I really do. I think it's the diet. Eating lean protein. You know, I don't eat hamburgers. Meat doesn't read meat doesn't appeal to me. I like chicken and fish and tofu, believe it or not, and
Scott Benner 56:05
and being attentive to your mental well being to say that being attentive to your mental well being was a big boost for you as well.
Pam 56:14
Yeah. Oh, boy. Was it? Yeah. Because you make better decisions when your mind is, you know, in a healthy place.
Scott Benner 56:24
Well, that's really, it's really interesting. Can I ask? Do you date?
Pam 56:30
I'm just starting to Yeah.
Scott Benner 56:32
How long has your husband been gone? I'm sorry,
Pam 56:34
I a year and a half year and a half.
Scott Benner 56:37
Are you getting lonely?
Pam 56:39
Oh, God. I mean, with COVID. You know, all this hit with I thought we thought he had 30 or 40 years he was healthy. And it was genetics. He inherited his father's pancreatic cancer. He did my husband didn't even drink hardly ever. And ate like I did exercise so that we thought his neuro endocrine cancer, they grow slow, and people live with it. 30 or 40 years. But anyway, they told us that the doctor said you've got two weeks to two months. He fell over in the room. They took him to the hospital and he died five days later. I'm sorry. So yeah, so I mean, I loved him so much. He was communicative. He was sensitive. He was he was i He was brilliant. He graduated from CU with two degrees and the top of this, you know, 1% of his class. Somethings. Whom latte you know. So anyway, but I've been in some meetup groups. And because online dating was horrible, scary, and a lot of scammers and, but I, you know, starting to meet some interesting people. So I think I just I've pushed myself out the door to when I don't feel like it to do something. You know, I'm in an improv class. I take art classes. I just tried to do things to meet to meet people. Yeah, make because I moved back and most of my friends moved away. So I met a when I'm in a widow's group, and it's fabulous. I met. I have friends I've making there. So yeah, I mean, I'm really doing better now. I'm glad we didn't talk six months ago, or, you know, a year ago.
Scott Benner 58:32
Questions if that's okay, around this. Sure. First of all, lighthearted. Our boys still boys no matter their age.
Pam 58:41
I don't know. I just I've never I've never been romantically involved since my husband died. So I don't really know.
Scott Benner 58:47
I'm saying, like, as you're meeting people? Do we? I'm trying to figure out if I'm ever going to completely mature. Are they still knuckleheads, even when they're 60 and 65? Or are they still get to your boobs? Like, where does that go?
Pam 59:02
No, I don't think so. You know, I mean, I've tried to find an evolved person, kind of like my husband, you know, that has that creativity and analytic. Someone who's analytical and creative is good because I, I played piano, but I need more analytical. So you know, that balance is good. And, you know, if you meet a man who believes in feminism and respects women, then, you know, I don't think they would do anything inappropriate, really, because they know that you have to start Yeah, you have to start out as friends. And
Scott Benner 59:42
I just yeah, I'm excited to hear that it's possible I'll be completely mature one day. So that's exciting for me, seriously. And so so when your husband passes is is it? Is it difficult to take care of yourself after that, like where do you I like yeah, you know, I'm saying like, what's the process of finding life again?
Pam 1:00:04
No brother with COVID You know, I couldn't even get out because no way that I knew was really getting out and I lost my appetite. I had to eat. It was like, it was like eating force feeding yourself every meal. Nothing tasted good. I ate cauliflower pizza, probably 80% of the time, because that's the only thing that tasted good to me. And of course, it's, you know, I know I know what the saturated I don't eat much saturated fat. So. But yeah, it's just been it was, honestly, it's been it was a nightmare. And I'm glad to be feeling better. But you know, I still, I still cry. And we I have two dogs. One dog when he died wouldn't come to bed for three months. Oh, yeah, they always sleep in bed with us. He would sit by the front door, wait for my husband. So but the other dog didn't even know. I mean, she was oblivious. So you know, they're great. I mean, they they have supported me. They are i i love them. I kiss them 100 times a day. And I read the other day that pumps up your endorphins. So I don't do it for that reason I do it because I love them so much.
Scott Benner 1:01:28
But that's it's, it's, it's nice to have something somebody you know, to.
Pam 1:01:33
I can't. Yeah, I can't imagine coming home to nothing, you know, but it's been really lonely. And I missed the friendship. The most, you know, the my husband, I could talk every night forever. And you know about anything, everything. And we never got, we never get sick of each other. It was like, we knew what we knew what it was like to be with other people. And we knew the difference, and we were grateful. So you know, but I do believe that I I know. It's not easy. But I think eventually I'll find somebody like that.
Scott Benner 1:02:11
It's it's I'm always fascinated when I talk to people who have lived a longer life. And how when you you examine it and look backwards at it, that you've had not just a long life, but sometimes it feels like almost multiple existences within the timeframe that you've been alive. Like, you know, there's the talk, you know, I mean, there's a time where you're a student and a child, then you're in LA, and then you're, you're married. And it's just, it's almost like you've lived three distinct scenario. That's
Pam 1:02:44
true. No, that's true. Yeah. And you don't realize it, because I've always been very independent. But it's almost feels like a half of you, you know, is gone. And you have to claim yourself. And, you know, not that I ever, you know, was a needy person with my husband or any event, I was still independent, but just you know, it's like finding your identity again, with without having your best friend with you.
Scott Benner 1:03:14
Sure. No, that makes complete sense. But I'm very sorry for your loss. That's for certain. And it sounds like he was terrific. And yeah, you know what you're looking for. So hopefully, somebody in that areas is going to pop up at a at an art class or a yoga class.
Pam 1:03:32
Well, I have to tell anyone that's listening. I know, when I told my husband when we were dating that I had diabeetus. He said it took him like a little bit back about I don't know what the word is, you know, it kind of like woof, yeah. And then he said, he realized I was 43 I'd had it since I was 22. I didn't have any complications. And he saw how I ate and how I took care and how I exercise. So he was okay with it. He wasn't scared anymore. And he was so supportive of the way that I you know, he apes very similar to the way I ate not, you know, not exactly but healthy. And so, there are men out there that won't, you won't blow them away. Yeah, if they really are evolved kind of guy. I
Scott Benner 1:04:25
try to tell people that all the time when we're talking about the subject that the right person won't be scared. Right, you know, and you don't want to you don't want to force a situation where somebody really is looking at you as if you have an expiration date on you or something like that.
Pam 1:04:43
Well, yeah, that's I mean, that's exactly it. I mean, I went out from, you know, online dating a few times and it was kind of like, most of the men wanted women way younger that you know, they're they're my age so that they kind of be around to take care of them. That's what's one of them told with me, and, and then you know, any flaw, like having diabetes, some men is a flaw, and they want a perfect woman, and I'm not perfect, and you know, so. But I'm okay with myself. And so you know, you just have to find the right person that looks at you as a whole person, instead of that your diabeetus is going to ruin their, you know, their lives, or you're going to drop dead. You know, a lot of men, I understand them being worried if somebody doesn't take care of themselves. But
Scott Benner 1:05:34
yeah, but yeah, it's funny too, because I can I take the perspective of, you know, if we're going to meet and be together, I'm worried about you needing something and I'm worried about me needing something, I actually had a conversation with a person, I'm gonna see if I can find a way to talk about this. Pretty recently, and they're, you know, my age. And one of the spouses in this very long time marriage was people have been married forever, you know, one of the spouses is starting to have different medical issues, and they're not really like huge things, but they're time consuming things. And the other spouse said to me, I'm getting, I'm getting tired of them being sick. And I, it shocked me because I, gosh, if they've been married 30 years, probably, and, you know, together since they were kids almost. And, and that idea of like, it's not, it's not the person, it's not the spouse that's bothering them. It's almost not even the medical situations that are bothering them. It was that it's taking up so much time and time started feeling finite to the person I was talking to. And you know, if you have an injury or something happens, and by the time you get it fixed, you're taking care of it six months later, and every day you're worried. And the person was like, I want to do things, I want to go somewhere I want to, like, you know, blah, blah, blah, like I have things I want to do. I I was I think I was equally shocked that they set it as I was understanding of what they meant. Yeah, you know,
Pam 1:07:15
well, that's pretty heavy. I mean, I mean, I felt with my husband, it was an honor to take care of him. I mean, I was really wasn't taking care of him. Because, you know, he wasn't. Yeah, I mean, but me, you know, towards the end. Yeah, but a little more, but I, you know, I understand that I just, I'm just, I just like being with with him. And that was more important to me than going to, you know, Tahiti, or you know, Caribbean or, you know, so
Scott Benner 1:07:49
I don't know, I wouldn't be I think I fall on your side of this too. But I have to be honest, it made me think, Oh, my wife's gonna bail on me if I guess.
Pam 1:07:58
Well, yeah, I hope no, I hope not. I think you know, yeah, I mean, I hope not. I mean, look, you've gone through all this with your daughter. And, you know, that's been a lot of work, right?
Scott Benner 1:08:10
Yeah. No, I know. You saying I deserve a little compassion if something goes wrong with me. Yeah,
Pam 1:08:15
I think so. Well, we all need to give ourselves compassion. This is what I'm learning from his deaf that I need to be compassionate. If I just didn't do something that today it's like, it's okay. Pam, you took care of your diabeetus you took care of the dogs, you gave one of them their meds? And that's all you have to do. You know,
Scott Benner 1:08:35
I am I'm of the camp to him that everyday doesn't need to be a Lollapalooza situation. You know,
Pam 1:08:42
it can't be It can't be perfect, you know. So, I think I felt like it was more like that. It's so interesting. I mean, I think before he died, I felt like, you know, every day was so exciting. But, you know, once I lived alone had been living alone. It's been a whole different story. But pushing yourself to be out with people has helped tremendously. Yeah.
Scott Benner 1:09:08
That's what I'm taking away from what you're saying is that is that being around other people is a saving grace for you?
Pam 1:09:15
It is just isolating, even though that's what I want to do, I have to not do that. It's horrible. Yeah.
Scott Benner 1:09:24
Do you? Do you sometimes just, do you ever think well, it's over? I did all the things I'm going to do. Does it ever get to you that way?
Pam 1:09:32
Yeah. I mean, for a long time, I've thought I'm, I'm never going to, you know, be be with anyone again. And you know, I think I know a lot of people who've had bad marriages and when their spouse has died, they don't want to get married again. But people I've in my widows group have told me you know, if you had a good marriage usually do want to meet someone.
Scott Benner 1:09:56
That's your expectation. Hey, yeah,
Pam 1:09:58
but I don't Yeah, yeah.
Scott Benner 1:10:00
Oh, how? How valuable do you find your memories at this point?
Pam 1:10:07
I that's pretty good. You know, sometimes it's not good. I'll think I want to do this, this and this. And I'll forget, like, I saw something on Facebook where this woman said, I won't write it down because I'll remember and then she goes, haha or something. So once when I write things down, you know, because so it really helps. And
Scott Benner 1:10:27
so as your memory tails away as you get older, do ya? Do you have trouble recount like recalling your life? Like, especially since your husband's gone? I'm wondering like, is it helpful to you to think about things that you enjoyed or moments? And are those are those easy to come by? Or harder to come by?
Pam 1:10:48
Yeah, I'm not there yet. I can't. I don't honestly don't even enjoy looking at photos. I can't listen to some voicemails that are still on my phone from him. But I know that one day, I will be able to look at all the beautiful things live that we spent and you know, not be sad. Afraid. Yeah.
Scott Benner 1:11:11
So at the moment, it's painful to experience.
Pam 1:11:15
Yeah, it's hard. You know, everybody says that the first thing they say is, oh, think of the good memories. You know, when you tell them you died? Well just think of all the great times. It's like, well, you, you think of all the great times because that's making me feel like I'm going to throw up right?
Scott Benner 1:11:31
Yeah, yeah. That is what I wanted to understand. So the the memories are, are not as for you, they're not as valuable obviously as as a real situation would be. And at the moment, you're not finding them comforting.
Pam 1:11:45
No, I'm getting much better. You know, it's gotten Yeah, it's gotten much better lately. So you know, it'll, it'll just keep getting better. I think it just time.
Scott Benner 1:11:58
No, I appreciate you sharing all this with me. I really do. Thanks. Yeah, no, it's uh, it's been very, it's been enlightening. You know, it's, it's, this is a week where I talked with you. And earlier in the week, I spoke with a 22 year old girl who was diagnosed while she was in college. And to hear her talk about her life, she only has the perspective not that this is a bad thing. But because of her age. And her situation, her her almost her entire perspective. As of now. It's of what she's doing right now, what happened in the recent past, what she hopes to happen in the very near future, she doesn't have the ability, as, as most people her age wouldn't, to wander ahead by decades. And she has no perspective because she was a child, you know, just prior to this happening. And then to hear you be able to reach back to a time when you were 20 or 30, or 40 or 50 or 60 When you were with this person or lived here live their experience something even to hear that you had an infection that lasted I mean, I'm spitballing here the numbers but some some 15 years, like I tried to put myself in that perspective of living with it for 15 years. And at the same time, it's something that you have not lived with for 32 years. It's right. Yeah, it's really so good. Pal, I'm sorry, I think I cut you off.
Pam 1:13:31
Yeah. Oh,
Scott Benner 1:13:32
I'm sorry. You were gone for a second. I lost the signal.
Pam 1:13:36
Yeah, well, my little sister, you know, I just joined Big Brother, Big sister and I have a little sister and boy has that helped who? Oh, I just love this little girl. She's nine years old. And when I met her she was a and so yeah.
Scott Benner 1:13:53
Ya know, I can imagine that would be valuable. Just to be able to, it's not as much right about directing people as it is. I mean, just kind of leading them more than telling them I imagine like just being there for an example is probably such a big deal. Yeah. Okay. All right. Well, Pam, if you don't have anything else, I'm I feel good about this. But I want to make sure that we've covered everything. I think so. Yeah, you're probably like how the hell I didn't think we're gonna talk this long.
Pam 1:14:23
Well, I hope I didn't share too much. You know, I mean, so
Scott Benner 1:14:26
for me or for you. I thought you well.
Pam 1:14:29
Yeah, I just hope your listeners are okay with hearing all the gory details and all the I did good stuff. So
Scott Benner 1:14:37
Pam as as hard as this might be to believe because this is your now and you're living through it right now. I thought you told a beautiful story.
Pam 1:14:45
No, thank you.
Scott Benner 1:14:57
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#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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