#797 Island Adventure

Paola's daughter has type 1 diabetes and was a guest on episode 467 'Come Together'.

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

Scott Benner 0:00
Hello friends, and welcome to episode 797 of the Juicebox Podcast.

On today's show, I'm gonna be speaking with payola. She is the mother of a girl who's been on the podcast before. As a matter of fact, her daughter and her friends who all have type one diabetes were on together. If you remember that episode, this is going to be the mom of one of those girls. 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're a US resident who has type one diabetes, or is the caregiver of someone with type one, please go to T one D exchange.org. Forward slash juicebox. Join the registry, fill out the survey help people living with type one diabetes, help yourself move diabetes research forward without getting off your sofa. There's so much you can do in just the 10 minutes that will take you to complete that survey, T one D exchange.org. Forward slash juice box. If you're looking for the diabetes Pro Tip series that defining diabetes series bold beginnings or any of the series within the podcast, they are now listed at the top of juicebox podcast.com. Just go to your browser, and they're all right up there. If you're on a phone, hit the little menu icon, and then you'll see the list this episode of The Juicebox Podcast is sponsored by Ian pen from Medtronic diabetes. You don't want an insulin pump, but you want some of that good functionality that an insulin pump has. You're looking for the in pen in pen today.com today's podcast is also sponsored by Dexcom, makers of the Dexcom G six continuous glucose monitoring system. You want to see your blood sugars in real time. Watch this. I'm going to turn my head. I now know Arden's blood sugar. I just looked at my phone. That was how quick I did 103 and stable. What do you think of that? You can do that to artists not even here actually are in the state right now. dexcom.com forward slash juicebox.

Paola 2:15
Okay, my name is Paola and I live in the Cayman Islands. My daughter is a Mayan. She's 18 years old and she's our type one diabetic daughter.

Scott Benner 2:26
Okay, was was my on the show before?

Paola 2:31
Yes, as a matter of fact, she was she spoke to you maybe a year ago, she was with her other type one diabetic friends on the island. And they interviewed with you. Yeah,

Scott Benner 2:44
okay. Oh, that's I still have such a fond memory of talking to those girls. It was, That episode was so much fun. I had a lot of fun. So, and you guys are the reason I am the number one podcast on the Cayman Islands. So thank you very much. It's our pleasure. Also, with five other people would start listening to one podcast, I think it would knock me off, but it's not a huge population.

Paola 3:09
Um, no, it's a very small population. As a matter of fact, I have shared it with a few other diabetic kids as well as adults. I'm not 100% sure whether they've been listening as well. So I wouldn't be able to tell you know, that's

Scott Benner 3:25
okay. I just know that when I look at my stats, I am always crushing the game in Ireland. So I'm excited. That's awesome. Yeah, you guys are you guys are moving the needle over there for sure. Well, what made you want to be on today?

Paola 3:40
Well, for one, I wanted to share my diagnosis, her story and also as a teacher, I wanted to share a few tips that teachers can do if they do have a type one diabetic student in their classroom.

Scott Benner 3:55
Okay, cool. Well, first, let me see if I can figure out what episode The girls were on. So that sure, do you remember what it was called?

Paola 4:04
Ah best? No, I wouldn't. I can text them. Yeah, and asker I'm sure

Scott Benner 4:15
it'll be more fun to see if we can figure

Paola 4:19
I think it was around the 404 20s. Maybe if I'm not if I'm recalling correctly.

Scott Benner 4:25
Okay. You know, the number.

Paola 4:28
I I could be round though. Well, that's more in

Scott Benner 4:31
the let's find out if you're right. Nice try. No. All right. Well, we'll figure it out as we go. Okay. So my is how old when she's diagnosed.

Paola 4:46
Maya was seven years old. She was diagnosed on May 8 2011. And first grade,

Scott Benner 4:56
first grade. Were you guys living where you are now at the time?

Paola 5:00
No, we were actually living in Ecuador. So prior to her diagnosis, um, I did, in fact, lose quite a bit of weight. But I didn't see any of the signs. I mean, all I knew was a she's always been a very active child, and she was running around and doing all sorts of sports. And I didn't pay attention to the weight, I feel horrible about it, because I didn't really pay attention to it until it got really, really bad. And then because we had a long weekend, the pediatric, our physician told us that we could run a blood test, we got the results, but there was nothing, nothing out of the ordinary, I guess and what he saw. So call them again and ask them there's something really definitely wrong because the Maya was super lethargic, she was laying on the couch, and it was very hard for, for her to stay up to stay awake. And, and that was normally not our child's I mean, she was always active playing with our dogs and things. And so we thought this was really weird. So we quickly ran another set of bloodwork. And as soon as we found out that our physician called us and told us, You have to come right away to the, to the hospital because of my is about to go into into a coma. Oh my gosh, yes. While she was extremely high, very lethargic, her head was falling down completely, she could not hold her head correctly, her arms just went down. It was it was really scary. So when we got to the hospital, we had lots of physicians, nurses poking her testing this and that, and it was, nobody was giving us any answers. All we knew was what they were doing. And it was very hard for us, as parents. And finally, a few minutes later, the pediatrician came out and told us well, I Maya has type one. And we were just shocked.

Scott Benner 7:12
Wow, it's crazy. You said that you felt like you ignored things. But what specifically did you see that now, you know, in retrospect, was a sign? Well,

Paola 7:21
yes, I'm glad you asked me that. So now I know, for example, the constant weight loss, the thirst. Going to the restroom at odd hours. But we have always been a family that drinks a lot of water. So to us, it didn't really become strange that she was more thirsty than before. You know, it just wasn't strange to us. And so when I learned about all the symptoms prior to that lead to the diagnosis, then I was just Oh, my goodness, I should have paid attention to this. Yeah. Well, obviously you. You don't know that. Because you're just not informed on a

Scott Benner 8:02
very little way to know how many how much weight do you think she lost?

Paola 8:07
Um, she was, she must have lost about 20 pounds or so. Wow, she was so thin Scott, you could see her ribs. And of course, I didn't notice this, particularly because she was seven years old and she got dressed by herself. She showered by herself. She ate all her her meals. So there was no way for us to really notice anything other than the 24 hours prior to her diagnosis, maybe even 36 hours prior.

Scott Benner 8:38
That's why that's how it happened to us to. I mean, Arden was clearly in hindsight, had lost weight, and, you know, all the other stuff, everything but until it became emergent, like to the point where you're like something's really really wrong. I couldn't I mean, I didn't put any of the pieces together. I also think that looking back on it as the person I am now is not helpful, because back then nobody in my family had ever been sick. I didn't like you know what I mean? Like we were living that life you get up you do your thing, you come home, you go to bed, you do it again, like get it no one was ever there was no illnesses to think about in that moment. Now, of course, like now I'm like, I'm like a radar detector, you know, something changes on like, what's gone? What would was less time moved to the bathroom.

Paola 9:34
Exactly. What happened here and I paid? Yes. And I also pay attention to those types of symptoms or signals and my students, so I'm super aware.

Scott Benner 9:47
No, I'm sure the kids are completely annoyed by it. Right. But I do ask questions like How long was your period? Oh, yeah. How'd this go? When's the last time you went to the bathroom? When's the last time you did this? Have you been eating Okay, how do you feel like the last thing I said to my son this weekend was, how do you feel? And he was like, why don't you need anything before we go? Like, all I was really saying was like, I was trying to signal him, like, think about yourself for a second. You know, because you're busy, and you're a college and you're playing sports, and you're doing a lot, like, stop for five seconds and think about your health. Has it been okay? And he's like, no, no, I'm good. And I was like, okay, but that's all I was really doing. At that point. I was just trying to get him to think about back then I didn't know what the hell was going on. So back then I just thought I was going to work and make some money and buy a house one day, and the kids would get married, and I'd retire. Like, that's how I felt my whole life was gonna go instead. This hell happened. So anyway, so. So there she is in the hospital? How is the health care in Ecuador? Was it okay? Were they able to help her?

Paola 10:48
Well, that's a good question. So we were provided and connected with an endocrinologist, not necessarily a children's endocrinologist or a pediatric. But he was the number one in in Ecuador in the country. And so everyone spoke very highly about him. So he came over Amaya was, was given her insulin through an IV, her meals came in. And she started to gain a little bit more for color and our skin a little bit more attentive, and so forth. And then came all of our training. So this physician would sit with me and would draw these, I'm not kidding you. He would draw these mountains and hills and in it, put formulas, and he would tell me, this is what you're going to do at this time, you're going to divide it and multiply it by this at this time, remember that this formula only works from this time to this time and so forth, then so am I was actually at the hospital for 10 days, because her her body wasn't reacting positively to the to the insulin and so they kept us there for a little longer. And then by the time we were ready to go, I I had more than 20 pieces of paper with different formulas and hills and mountains that I needed to be able to multiply and add and divide. And and all of this was so confusing at first. So confusing. That's it. And

Scott Benner 12:24
yeah, the math is the first thing that made me cry. Well, after the realization, the next thing that made me cry was the math actually. So

Paola 12:32
yes, and I'm not a very good mathematician either. So I thought, How am I going to figure this out? I mean, this is so complex. But so we were with this physician for about a year and a half or so. And then we had an accident took place in our family. And so we I tried to get a hold of them because the Maya was her numbers were really high. And I could not bring them down regardless of how much insulin I was. I was giving her we were using lentils and a Piedra back then we did not have the Dexcom because that technology didn't exist in Ecuador, and when when she was diagnosed, and so we went home with lentils and a Piedra and had to be administered at set times. So we had to go and train, not necessarily trained, but informed the school, the nurse that the school wasn't very comfortable and giving Amaya her shots, even though she's a nurse. So

Scott Benner 13:43
you said something a second ago, I'm confused by or I'm not following the thread on. You said there was an accident in the family.

Paola 13:50
Yes. So my sister passed away. And terrible accident.

Scott Benner 13:56
Okay. And did that have an impact on my care? Is that what you're getting at?

Paola 14:01
Or? Yes, yes. I'm sorry. So yeah. So we had this accident, and my sister passed away. And we were trying to get a hold of the physician and the endocrinologist, but we couldn't. And so when I finally got a hold of them, I asked them, look, these have been her numbers these days. And I have done everything that you've told me and I have not been able to bring her blood sugar's down. And so what do I do now? And he just told me, he just brushed me off saying things like, don't worry about it. Let her numbers run high. This is a hard time and your family don't worry about it. Just keep on giving her insulin Make, make. Make your meals weigh up told you and nothing more. or, and when I got home, I thought this can't be right, there must be something that we're doing wrong, right? Because her numbers were so high, she was constantly above 250, rarely below 180. And the more that I read online about the different things that I could be doing as a mother, when you have a type one, I would share that information with a physician. And he would just brush me off saying, Oh, no, that's the way they do it in the US, we do it here differently. Don't worry about that. Just keep on doing what you're doing here. What's interesting

Scott Benner 15:36
is so that he had one idea of how to do this, and no other interest in looking into it. Beyond that,

Paola 15:44
nothing, nothing, no other interest. And so after that position, I thought we can't continue with it. So immediately, I started looking for another another endocrinologist, we found another person who works closely with a nutritionist, and we thought, oh, this would be great. Because finally somebody else will be able to guide us with carb count and a proper balanced meals and so forth. And so we thought, okay, let's go with it. We lasted with this doctor for about eight months, because every time that I went with Amaya to have her checkups, he was so rude. So, so rude and his way of treating me Why Why don't you understand this? Can't you just figure out you're multiplying, you must be dividing and doing something wrong? How come her numbers continue being so high? And so I felt very threatened by his way of talking to me that I thought I can't continue like this, because it's not healthy for me. Therefore, I cannot help my daughter

Scott Benner 16:54
when you there. When you look back on that? Do you see a situation where he was covering for his lack of knowledge? or D?

Paola 17:04
Absolutely. Absolutely. He knew nothing. He he was basically giving us the same guidance that the first endocrinologist gave us, but then adding a twist, which was the nutrition factor. So he would say, make sure that she's got these items, certain meals, so that you have a better balance of of your food. And we thought we were doing okay, but every time we went to him, it was my stomach would be in the knots. I would get so nervous. And it wasn't healthy. Yeah.

Scott Benner 17:44
Oh, and you weren't gonna get anywhere either. Plus, it makes you crazy because you see a problem. And you know, there has to be a fix to it. And then the person who's in charge is telling you, you know, this is fine. You know, this is okay. Or you're doing it wrong. One or the other? And

Paola 17:58
yes, yeah. And constantly, the blame was on me. So I was doing something wrong. It wasn't a my, yeah, he never checked on a maya never. So it was always me. I was the one that was doing something wrong. I was making mistakes here and there. And so I felt I could not continue with him either. And so we were lucky enough to find another endocrinologist. And she was very interested in the background knowledge that we had with numbers and the nutrition and she so she made a few twists to a Maya's doses of both lenses and a Piedra and number started to get a little bit better. And we thought, okay, this is great. You know, so we're on a better track right now. We thought, This is fabulous. In those days. And as the years went by, Maya went through all her elementary years. So she finished school, she had great teachers. Her second grade teacher was fantastic. And so she was she had our phone numbers on the classroom phone right above it on a post said, she tried to help my as much as she could with, we're making sure that she was asking that she drank water that she was eating what she was supposed to be eating. And so she had a lot of she gave me a sense of security, which was very important as she was coming new with with diabetes into a school and to a school that had never had a type one diabetic students.

Scott Benner 19:44
Wow, that's lucky right to find somebody that that's willing to get involved and, and to understand what was your level of understanding of that point as you're as you're sending her into school, and you're having these problems with the doctors and not sure like, what's her or health, like at that moment? Are you still looking at 250 blood sugars? And you wondering what's going wrong? Or had you had you made a leap yet to figure this out on my own?

Paola 20:09
Well, I'm glad you asked me this, because prior to, while we were with our first two doctors, everything I heard from them was, oh, you can't continue doing it, you have to follow these rules. And make sure that Amaya takes in her insulin at the set times. And she's got to eat this amount at this time with this amount of insulin. So it was very rigid. And so that didn't allow us a lot of flexibility. And when we went to our third physician, she twists I allow my head to have more flexibility. She doesn't need to take her insulin at this time. If she's not hungry, she does not need to eat, you know, so it gave us a little bit. It broke away from the from the constraint that we had before. And besides that, I was reading, I was researching about the technology that existed in the US. And I thought, how can we don't have this here? I mean, I would question them.

Scott Benner 21:14
Yeah. Let me ask you a question. Did anyone in the beginning tell you you were doing sliding scale? They were used, that I was doing what? Using a sliding scale? Sometimes when I stepped on a scale, I wish it would slide away from me. But that's a different story. How would you like to use the in pen from Medtronic diabetes? You might be saying to me, Scott, what the heck is that? Just an insulin pen? Oh, no, no, it's not just an insulin pen. I think you and I need to visit in pen today.com together to learn more. I've clicked on it already. Have you know you haven't, you're on your phone, probably. But I'm here. So don't worry. In Penn today.com. This is where you're going to learn about what is this thing asking me to do? Do I want to take a survey now right now I'm making a podcast. Hold on, we'll do that later. Here's what you get with the pen, you get the pen, which is terrific. It's a pen. And then you get an app that connects to the pen. Now you see what's happening because that app is going to show you your current glucose. You can see your current level After pairing your continuous glucose monitor Oh, oh, okay. What else meal history, dosing history. Activity Log. That's right, you can see a list of the recent actions including doses meals and glucose readings in the activity log. How about if you push that Reports button reports can be generated for up to 90 days of data. It will and the impact is going to show your glucose history your active insulin remaining. That dosing calculator, I don't think you need to know anything else. If you don't want to pump. I mean, you have to look at the impact. And that's just my opinion. But I think you might agree once you go to in Penn today.com. When you're ready to try it fill out the form and you get going. There's videos there to learn about the in pen. testimonials from users, you can find out about their 24 hour technical support their hands on product training, online educational resources and learn about this offer that says you may pay as little as $35 for the event offers available to people with commercial insurance terms and conditions apply. But it's definitely worth you head over to Impend today.com. To find out more in pen requires a prescription and settings from your healthcare provider, you must use proper settings and follow the instructions as directed, or you could experience high or low glucose levels. For more safety information, once again, in Penn today.com. Dexcom is going to give you the power to manage your diabetes with confidence, make better diabetes decisions in the moment with the Dexcom G six. At the beginning of the episode, I told you that my daughter's blood sugar was 123. I think I'm looking now it's 109. It's drifting up slightly. I'm able to watch that with my phone, you can to Android or iPhone. Arden has her phone with her. It's feeding the information into the cloud. And then it drifts back down into my iPhone. I don't think that's technically how it happens. But the cloud is how it works. And you can see, speed, direction and number. That's amazing. Actually up to 10 people can follow a Dexcom user, anyone you want. That could be a teacher, it could be I guess you could be your priest. It can be really anybody. I don't know who you're wanting to do it but I mean probably use your visual mom or your dad or your husband, your wife or something but you know I'm saying dexcom.com forward slash juicebox. See the speed, direction and number of your blood sugar in real time on your phone or on a Dexcom receiver. You have no idea how valuable it is. It's everything. Every decision we make. Every card we cover, or don't. Every time we use insulin we first Look at what the Dexcom is telling us about what's happening with Ardens blood sugar. You will love it dexcom.com forward slash juice box Do not delay, you may be eligible for a free 10 day supply of the Dexcom G six. Go to my link to find out more

they ever used those words like you shoot this amount of insulin and she has to eat this many carbs?

Paola 25:36
They then say it and but I'm assuming Yes, they did. In Spanish. It's it's it's called something else. But yes, it is the same ideas there.

Scott Benner 25:45
Okay, so. So did you see? So interesting because you're being told one thing, and then you're online, you're like, seems like people do it a different way. And so you get to this new doctor. And they're basically you're telling you now count carbs use insulin for carbs? Correct? Okay, great. How long was that since her diagnosis?

Paola 26:07
Um, it was probably in my first four or five years.

Scott Benner 26:12
Wow. So for first four or five years, you're doing sliding scale, and then maybe 2016, you start counting carbs?

Paola 26:21
Correct. And so just to give you another idea of how bad our situation was with her man with our management was a minus a one C was always above nine. I could not bring it down. Was that because I didn't have the tools?

Scott Benner 26:39
Can you talk a little bit about how that made you feel? Personally,

Paola 26:45
I was heartbroken because the more I read about the care that you should have, the more that I wanted to make amends to what we were doing with with our daughter, and I had no support by the doctors. And so whatever, whenever I went to them, and I said, Hey, I read this article, I wouldn't even print it out for them. Look at this. Can I do this? And they would be like, no, no, no fallout, this is the way we do things. Ignore that. That's the way they do it in the US don't pay attention to those things.

Scott Benner 27:21
That sucks. I really does. Well, okay, but you got away from it. How did you so the new doctor helped you move away from it?

Paola 27:28
A little bit? Yes. So she made a few changes. But this is the best part. Am I yeah, we're in fifth grade. And because we, we? Well, my husband and I both work at American international schools. And am I as is a student in in those schools. We had a family who came from Canada. And they their youngest child was a type one. And their middle child became is best friend's in grade five. So their friendship led to us becoming very close to this family and learning from them. So it was my first time seeing a Dexcom it was my first time seeing the different types of snacks that you could have for in case you're low. It was our first exposure to to making corrections when you saw certain numbers. It was the first time that we heard about Pre-Bolus ng we had not heard about it before. Okay. So it was there was a lot of new things. And so we this family was amazing to us. And they shared even the friends for life conference in Orlando. And so we we thought, okay, we're gonna go. And so the two families, we left together from Quito, and we arrived to Florida, and we were in the conference together. And, gosh, it was just like, I cannot believe I am listening to all of these things that I have been wanting to do, but I have been unable to do it. Because the physicians wouldn't allow us to make those changes, would you? Would you ever

Scott Benner 29:23
would you have ever considered just going against the physician? Or do you do you think that's not something you would have been capable of doing?

Paola 29:32
I don't think my first years I would have been capable to do it. I would have been very hesitant just because I feared that I was playing with the insulin. I wasn't 100% sure that I could make those changes on my own. Sure. And so I was very hesitant. No, I

Scott Benner 29:51
understand. I just I want people to hear that. That it's that even in the face of I mean your own common sense, or your own ability to look added more information and say, I don't think this is right. Or at least I think we could be doing this differently, and maybe be having some better outcomes. And I mean, my goodness, like there certainly was room for better outcomes. Let's just say what he wants. He was that whole time. eights, it wasn't

Paola 30:14
the nine nines, late eights, nines, 10s. I believe we even got to 111 at some point.

Scott Benner 30:24
So this is how we do it in Ecuador, is is nines. And we're okay with it. And, and that person would have, I'm a little angry that person would have just let your daughter live like that her whole life until she was probably in her late 20s When she started having some sort of side effects from high blood sugars. And then they would assess like, this is what it this is just diabetes. It says, you know, that's it. Wow. That's it terrible. Absolutely. So meeting so meeting this other family really was by the watershed moment for you and hearing them say, yeah, right.

Paola 31:04
Absolutely. Absolutely. We're still in connection with them. Both Amaya and their daughter have gotten together. They're constantly chatting with each other. And so our connection with them is very, very strong as they've been wonderful to us. And because we were able to go to the friends for life conference, both my husband and I attended two different workshops. And in one of those workshops, we learned about Dexcom. And we were dumbfounded by this, oh, my gosh, what is this thing? And so we attended the whole workshop, and we asked them, a few families, what would be the most important tool if you were able to get one of these tools? Whether it's the pump? Or the Dexcom? Which would be your first Yeah, and everyone said, The Dexcom? Everyone said the Vex, I

Scott Benner 31:56
understand. Yeah, I mean, being able to see it is it's just the best part, right? Like, I mean, honestly, after you see it, then you then you want a pump immediately, then you're like, oh, okay, well, now I know what to do. You know, but first step, seeing things go on understanding them better. Seeing what you can do with the insulin makes such a big difference. It's just, it is I hate to say a game changer, but it really is.

Paola 32:22
Oh, absolutely, absolutely. So we looked into it, we called our insurance, we found out we were not going to get coverage for the Dexcom. But we thought you know what, her health is far more important right now. And as teachers, we made the huge sacrifice. So we bought six months supplies of Dexcom when we were in Orlando, and took them with us to Quito. And we also bought I had not heard of these, the glucose tablets.

Scott Benner 32:55
Okay, what were you doing? We have, how did you manage low blood sugars?

Paola 33:00
Um, well, this is this is the other crazy stuff. In Ecuador, the physicians, both physicians told us just give him a little bit of soda, if she's low, and we are a family that we do not drink soda at all. Just give her some oranges. And so what we did was, I would give her a little bit of fruit juice, any kind of fruit juice, and that would bring her up again. Okay, but it wasn't glucose tablets or anything like that. Yeah. So

Scott Benner 33:26
everything that was handy that she could carry with her and, and things like that. Exactly.

Paola 33:30
Gotcha. Exactly. Yeah. So we we arrived with the Dexcom. With, with glucose tablets, and right after we went to see the endocrinologist and we were so excited to show her the tools and provide her with some of the information that way she may also guide other other patients with it as well. And we showed her the glucose tablets and all of this. And she just sat there. Oh, Scott, it was so horrible. She just sat there. Let me talk about all of these things and said, Oh, Allah. We don't manage diabetes that way in Aquitar.

Scott Benner 34:13
Still, still that's the answer. Okay. That was

Paola 34:17
her answer. Was her answer.

Scott Benner 34:20
Is that about when you were done? Were you just like, yeah,

Paola 34:23
we waited we waited until she until we had another bloodwork. I believe we waited about six more months. We saw her twice after that last time. And that was it. Yeah. Because in the US in order for you to get Dexcom you need a pediatricians. What do you call it? The prescription from a pediatrician and endocrinologist, pediatrician that can give you the prescription for it. So we were able at the friends for life conference, meet several people electricians and we found this amazing doctor. And she made immediately examined Amaya. She did some blood work for her. And immediately right after she gave us the prescription and we were order we were able to purchase Dexcom.

Scott Benner 35:16
Wow. That's great.

Paola 35:17
She did it for us.

Scott Benner 35:19
Maybe because somebody else you?

Paola 35:21
Absolutely. And with with this doctor, we stayed until we came. Well, we we've been with her ever since. Yeah. So that means that we have had to travel to the US and get a Maya to see her endocrinologist and in Orlando, get blood work. We take us we do as much as we can with bloodwork and Ecuador. But then we would take the results and whatever other checkups that she needed to have done, we would do those in the US.

Scott Benner 35:56
So just to kind of back up for a second. You and your husband are both teachers. Is that correct? That's correct. Yeah. And so you just Where are you from originally? I'm from Ecuador. You are originally from Ecuador. Okay. And your husband as well?

Paola 36:11
No, my husband's from Venezuela.

Scott Benner 36:13
Okay. Did you meet him? Because he came to Ecuador to teach.

Paola 36:16
No, I actually met him in St. Michael's College in Vermont.

Scott Benner 36:22
Of course in Vermont. And

Paola 36:25
I know I know how you feel about Vermont?

Scott Benner 36:28
I'm just saying we're all the Ortiz's meet in Vermont. Yeah. So common. So okay, so you were in school in Vermont? He was from Venezuela. You were from Ecuador. You met there. You guys obviously got together. He came with you. And did you ever consider going to Van as well? No. Girls always win those conversations. Okay, so maybe your house basically. But you don't? Where have you lived since Ecuador?

Paola 37:00
Well, I was born in Ecuador. But I grew up in in Boston. And then I finished my elementary and middle school in Vienna, Austria, right. And then I graduated, I finished high school and Pennsylvania, and did College in Pennsylvania and then went to Vermont, and then Ecuador. And now Cayman Islands. Well, in between we've done Costa Rica, Colombia, Ecuador, Cayman Islands now

Scott Benner 37:30
do you just go where the jobs are where the teaching jobs already you pick places you'd like to work in, or like to live and then find work?

Paola 37:37
Um, it's where the jobs are and the experiences. It also has to do with how much we're gonna get paid. And so

Scott Benner 37:49
then, how did this happen to you when you were a child? Were your parents doing something similar?

Paola 37:55
No, my dad was secretary general of OPEC.

Scott Benner 38:00
Oh, that'll move you around. Yes.

Paola 38:04
So my dad was a diplomat for a good number of years. And so that allowed my sister and I to go through several international schools. And that's why I love that type of life. I have friends from different parts of the world. And so when the time came for us to choose a school for our Maya, I thought she has to enroll, we have to enroll her in an international school because they're so great.

Scott Benner 38:31
Wow, that's really cool. So I now remember teasing my about what her dad did for a living, because she was talking about how she wasn't Ecuador. But now she was here. And he was from like a perspective of a younger person. And I said to her, if I'm remembering, right, I said, my Are you sure your parents are teachers, but if they're like, international gunrunners, or something like that? And she said, she goes, they're not. I said, How do you know? And I just so enjoyed the pause after I said, How do you know where I know her brain was like, maybe they are lying to me. So it's just it's such an interesting life to be able to move around like that. And very, yeah, it's excellent. Actually.

Paola 39:10
It is it is. We're hoping to move in about two more years after we've been here for five years and Cayman Islands then travel elsewhere, just because it's your best way to get a real feel of living in a country taking in their culture, their traditions, the music, the food, and learning as you're working. So we love it.

Scott Benner 39:33
So you think I'm sort of after the girls after my is done, ready for college, then you guys might move somewhere else?

Paola 39:40
Yes. Well, am I coincidentally Scott, Maya is in the US right now. Because she's visiting the college that she has accepted. Oh, yeah. That's about I'm sorry.

Scott Benner 39:53
That's exciting. I just did this with Arden. Kelly and I just took art into a number of schools, and she chose one then we spent a few days and, and and got the feel for the place. And it was a it was such a good time. It's very good for her. What is she going to study?

Paola 40:08
Um, she wants to do something in the sciences and biology, but she's still unsure. 100%

Scott Benner 40:15
sure my son is about to graduate, he's still unsure. So it's off. He's, wow. He's like, he's like, I don't know, do you want to get a master's degree? And he's like, Oh, no. What do you want to do? He goes, I'm gonna take a break. He's like, I'm tired of school. Oh, well, there you go. Yeah, that makes sense. But that's very excited. Good for her. That's, that's yeah. Tell people nowadays, what's my agency?

Paola 40:41
Oh, so before we spoke to you, three months ago, her agency was 5.5. And about two weeks ago, she went, we went to the doctor and her agency went up a little bit. She's at 6.0. And we blame schoolwork. Because it's been very hard for her to, to manage the stress that she's dealing with. As a high school student, as a senior. There's lots of work and exams, and she's doing the IB. And it's very draining. There's lots to study. And so it's been harder for her to manage as tightly as she was doing before.

Scott Benner 41:27
Okay, that that I think is, I think, pretty common. Is she? Is she managing it more by herself than she was in the past?

Paola 41:38
Yes, yes. So I've tried to let go of the reins a little bit just because I need to get her ready for college. And so so that she becomes more independent. She's really good about bolusing prior to her meal, so that is that is a huge plus, she's really good about that, um, counting carbs, or predicting or estimating how much is her meal is a little harder, just because sometimes she'll forget, oh, the fats. Oh, I need to add this for the protein. Yeah. And so that's where she makes her mistakes. And then that raises her numbers a bit. It's interesting.

Scott Benner 42:16
This is right where Arden is right now to like she's taking more and more of her, her care over. And she's having these like experiences like I did before, where she's trying to figure out, you know, what is this meal going to do ahead of time and get getting it right sometimes and getting it wrong sometimes and missing things like fat and protein. And you know what day of the pump, it is that kind of stuff. I still I'm doing my best to just slip in once in a while, you know, like I'll say like, I think maybe you should change your pod before you go out to dinner. She's like, Oh, no, there's still 30 units. And I'm like, I know. But if you look at your blood sugar, your blood sugar over the last four or five hours, it's been drifting up and you've been bolusing more, it's a good indication that the site might be done. And, you know, a couple of times chickened out, and it'd be fine that she comes home and she's like, I have to change my pot. And I was like, I know. So it's watching her figure it out now, but it's going pretty, pretty well actually. And it sounds like I mean, listen to six a one save for as a 17 year old girl, as it's really good, you know, so she's getting it and so will so am I right?

Paola 43:27
Yes, yes. I'm thrilled that she's so independent with it. So at school, she'll just change it. She's got her supplies at school. And prior to this trip to visit the school that she's going to go to in the fall she took all her supplies with her she was ready we had the the doctor's letter indicating what she was taking with her because when you travel with all of these items, they set alarms they they stand out because it's not your common Mm

Scott Benner 44:03
hmm yeah, so she's got the letter that's like I have diabetes and the stuff is my equipment all that stuff. She buyers Yeah, yeah by yourself right now she fly to the states on her own?

Paola 44:13
No, no, she actually went with her dad my husband took her I couldn't go just because I have a friend visiting so we had to divide and conquer. Gotcha different place. How many kids um, is our only daughter.

Scott Benner 44:27
Is there any other type one in your family?

Paola 44:30
No, so am I is our only type one but my mom has Hashimotos and rheumatoid arthritis. Yeah. And her for oh, this is something I forgot to tell you about. A Maya was misdiagnosed with fibroid and therefore for her first five years she took levothyroxine

Scott Benner 45:00
How do you miss diagnose her with it?

Paola 45:03
Well, the doctors just run these tests. And immediately they must have seen that the numbers were a little off with her thyroid. And so therefore, they gave her this medication. And she had to take it daily until we went to the US. And we met this other endocrinologist, she did the blood work and immediately said, Wait a minute, this is just wrong. Take this out, you are not going to take levothyroxine anymore. And and let's see what that's going to do to your system and about six months. And so we ran tests after that. And she confirmed Amaya, in fact, does not have a thyroid issue.

Scott Benner 45:44
Hold on a second. Let's pick through this. This is interesting. So do you remember the numbers back in Ecuador? Like what was the TSH that made them made them think she needed the thyroid replacement hormone?

Paola 45:56
I believe? Probably, if I'm correct, could it be three, four? I could be wrong, though. Three

Scott Benner 46:05
or four number? And then what is it now without the without it? anymore?

Paola 46:14
Yes, they do. But I don't have her latest results.

Scott Benner 46:18
So I would say to you this that they'll call any number. There's a big wide range where they say it's in range. I think that thoughtful endos will keep your TSH under about 2.1. Right? They want it to be under there, but it's a lot about symptoms. So does she have the symptoms? Does she have tiredness or weight gain hair loss problems with her nails? Constipation, moodiness, does she get cold or hot? Like that kind of stuff?

Paola 46:55
Well, now that you mentioned that, that is exactly what's happening right now, in the last two years, she's been feeling a lot of those symptoms that you described, and her endocrinology was on island hasn't given her any medication because her number her range is 182 to one I believe.

Scott Benner 47:14
So it's very close. So I would say this. Very similarly. It's interesting, very similarly to a lot of things about diabetes. The, you know, the the range that they quote unquote, say is is normal is not what's important. So with thyroid, it's symptoms, like you should treat the symptoms. And don't worry about what the blood test says so much. I think it's very possible that unlike diabetes, the way they do it on Ecuador, about thyroid might be right. The doctor might have got the thyroid piece, right and the diabetes piece kind of wrong. So if she's having if she's having those symptoms, that thyroid replacement hormone could take care of it in just a couple of weeks. She could feel better. Oh, okay, isn't that interesting?

Paola 48:07
Oh, I should run those tests. Again, I would replay there's a couple

Scott Benner 48:11
things you can do here. Hold on, I'm gonna look over at another heater monitor for a second. So there's a whole series on thyroid that I just did. Called the finding thyroid, I would listen to those. And I would listen to episode Hall a second. You would think I'd be better at knowing my podcast than other people. But that's not the truth. Episode 413 thyroid disease explained, is a long thoughtful conversation with the woman who manages my family's thyroid problems. My wife, my son, my daughter, so she's not an outside of the box thinker because I don't like that term, but she's just more in tune with with managing a thyroid problem. So where as a some doctors will say oh, your TSH is three or four that's in range, you're fine. A doctor like Dr. BENITO who you'll find it episode 413 will tell you I think her numbers like 2.1 or something like that showed Matt she'll medicate over like 2.1 If there's symptoms, and my both of my kids thyroids are managed like right out to the end of the earth and they and they don't have trouble with them. And she even supplements their T three a little bit, which is definitely more outside of the box thinking but like for instance, Arden's thyroid if she just managed that with a T for replacement, which could be lever thyroxin or Arden uses terrorists and there's a couple of different drugs. Her thyroid numbers are great, but she's still very tired. But if you add a tiny bit of cider mill to Ardens regiment which is T three, then the tiredness goes away. So it's, it's really it's you got to find somebody who understands it. But I think I think that you got good information the first time. And then you got to the states where they just said, Oh, this isn't rain. She doesn't need this. But I think I think, yeah, I think it's possible. Well, I mean, from what you're saying, but I definitely think it's worth looking into it if she's having the symptoms right now.

Paola 50:24
Yes, now that you mentioned those symptoms, I will definitely call on our physician and see if we can get some blood work done. Just that, you know, and Aquitar. Thyroid is the most common ailment, really? Everybody has it? Yes. One we live in altitude. So the altitude has a huge factor in it. And in addition to that, there's our salt has less sodium than your regular salt, and therefore those may be causes. Yeah.

Scott Benner 50:56
You guys use a lot. You guys use a lot of sea salt on your foods? Not? Not regular table salt. Oh, isn't that interesting? You'll hear about that. And the episodes to be talking about that a lot. Yeah, so people, you saw that you see more goiters jump started, you see more goiters? In Ecuador.

Paola 51:14
Yeah, you probably do. Yeah. Interesting. For sure.

Scott Benner 51:18
Not crazy. Sure. You know, as you and I have been talking this whole time. You You really helped me and you don't know why I'm gonna tell you in a second. I recorded this episode back in October. It's April now. So it's a while ago, with a with a boy, young boy as type one who lives in Ecuador. And oh, wow. Yeah. And I kept thinking, My goodness, that episode should have been in my editing queue by now. Like, why have I not edited that show yet. And it was, I looked while you were talking. And it's a simple, just a file management problem. It got moved into a completed folder, and it's not completed. So I just slid it back over. I may have never noticed that I didn't post it. Had you not said I grew up in Ecuador. So thank you so much. I really appreciate it. My pleasure. Yeah, it's um, it's a great story that kids got crazy and sundry. I don't want to ruin it for people because it'll be out before they hear yours. But it's, it's a really great story. And you saved me from never putting it up. So thank you very much.

Paola 52:24
Oh, my pleasure. My pleasure. Well, I know now, for example, that you can get T slim and Ecuador. So that is that is that's a major plus to any type one diabetic that is diagnosed. Yeah. Maya was like,

Scott Benner 52:43
Oh, my gosh, the availability of all this technology is just very important, you know, and the companies they think move it around the world, I guess, as fast as they can. But there's so many different health systems and insurances. And but, you know, the way things get paid for it's just, it's incredibly difficult. There's plenty of people in all kinds of different countries that come on the show and, and do what you do, like have to leave the country to pick up supplies. It's, it's, it's pretty common, actually, if people can afford it. They're doing it all the time.

Paola 53:12
Yes, yes. And so that's why am I was able to get the ducks calm. That's why we use the Dexcom before we even went to the pump. Because we know for sure, we were battling issues to get coverage for our Dexcom. And so we knew that if we tried the pump that that was going to even be a steeper hill to climb, and we knew that was impossible. And so the insurance company said to us, okay, what we'll do is we'll cover 50% of the Dexcom because it is a medical need. And then you guys can cover the rest, but we cannot cover your pump.

Scott Benner 53:50
That's something Well, yeah. What now? She's gonna be on your insurance for a while, obviously. Yeah. Everything else. Okay, but at least she'll have better access when she's in the States, right?

Paola 54:04
Yes. Well, as soon as we moved, and we took this post this job and Cayman Islands, we were assured that the insurance company would cover a mic as am I as needs and so we got the pump. Four months after we arrived.

Scott Benner 54:23
Okay, pretty quickly. That's it hasn't been has been Omnipod. Yeah, it hasn't been the same issue there as it was prior.

Paola 54:30
Gotcha. No, no. Yeah, actually. It's been wonderful.

Scott Benner 54:33
Yeah. The three girls that were on together, including your daughter, were they all using the same pumps? Or no,

Paola 54:39
they are yes, they all use the Omnipod. They all use Dexcom. The only difference is that one of them is looping. The other one was looping but something happened to the Reilly link and therefore she stopped looping and now she's back to regular pumping. Regular pumping gas

Scott Benner 55:00
Chess played something. I just it's for people who don't know is these three girls that are friends. They're not even particular. They're not even Exactly. Similarly, age, they all met through, you know, through having diabetes and living on cayman islands like that. And, you know, Maya was one of the three girls. They were just really delightful. That's excellent. Cool. Yeah. Well, yeah. What else have we? What have we not covered that you want to talk about? I want to make sure we're getting it everything.

Paola 55:28
Oh, thank you. So may I talk about teaching a type one student? Yeah, please. Okay, so, in when I was first diagnosed, I had never had the experience of having a type one students. Um, I was diagnosed in May. And then in September was, as we started school, I got my first type one diabetic student. She was from Brazil. And she came with no technology tools. Mom was a complete wreck. If I thought I was a mess. Because I thought I was a mess. This mother was by far, messier than I was completely. She came to school every day with her daughter's lunch, she, she waited at the school, she was she was making sure that she had her insulin thing, this poor woman lived the entire school year on campus. And so this, the students that I had, she was very shy, very quiet. She didn't want to engage much with with her peers. And on top of it, she had had such a horrible diagnosis in Brazil, that it made her not want to share her diabetes with anybody other than just let me know how she was feeling. So it was very hard. Okay. And as I tried to train the next year's teacher that she would have, because she was going up another grade, the family heard that they were getting transferred. So she left. And so the summer comes, we start back up in September again. And I hear that I'm going to have another type two student. And so I get my students, she had a little bit more knowledge about type one mother was very supportive was diagnosed at the same age as Amaya. But she didn't have any technology either. And she managed with the same more or less the same formulas that I was seeing and that I had been using with Amaya. The same story, we finish the school year, and this child leaves the school and the summer comes. And then again in September, I get my third type one students. This was three, three years in a row, right, three years in a row. So I was I was looking at this and saying, thinking to myself, what what's happening here. I'm not an experienced mother as a type of a type one. But yet, I'm getting all of these students and I'm trying to learn from them and get the best experience that I could from them. Now my third student came from the US was a mom from from Boston, she was doing some anthropological studies in an Exeter and he came with a pump with the Dexcom. It was the first time that I had seen the Little Red Book of the American Association of diabetes, the one that has the carb count on it. It was the first time I had seen that little book, I had never seen it before. And his pump was wired. So I'm assuming it must have not been the Omnipod. So we had it was with this particular student was my first time that I had that I had used the glucagon. I had never used the glucagon before nor the will nor did I know how to use it. But mom when she came in at the beginning of the school year to let me know about her son. She taught me how to use it. And that was my first time with it. And I had never seen it before. You didn't need

Scott Benner 59:22
a student though. I beg your pardon. Did you have to use it for the student or you? You were just trained on it?

Paola 59:28
I was trained on it. And a few months later, I believe it was after Christmas. My students had an episode and so I had to give them glucagon. Wow. Okay. Yes. And that to me was a shock.

Scott Benner 59:45
Yeah. Was that a common thing for that boy or do you not know?

Paola 59:49
Um, I believe that wasn't common because he had we had had a sports morning and so he had done a lot of sports, I believe. And so Oh, probably he hadn't eaten what he was supposed to and his blood sugar just went,

Scott Benner 1:00:04
wow. Wow, Was that scary?

Paola 1:00:07
Super scary. I had never experienced that before. In the meantime, I had my students wait outside for me while I was taking care of this particular student. I had some of the some of my colleagues also there with me, they were all giving me all sorts of positive energy. Paula, you can do it. If you can do it. You can do it. You know, it was just like, oh my god, that but I wasn't 100% Sure, because I've never administered glucagon before.

Scott Benner 1:00:32
Sure. And at this point, at this point, Maya has type one.

Paola 1:00:36
Yes, I am I already had. Right. So

Scott Benner 1:00:39
you're probably like, great. Is this gonna happen to her? Yeah, exactly. Right. So exactly. So these three kids in a row? Did you learn something new from each one of them?

Paola 1:00:51
Yes, I did. So I took on about little bits and pieces from their management. And I tried to tweak that with with Amaya. But then I would share that information with the physicians and they would bring it down again. So it got to a point where I stopped sharing, but I was I was doing a little bit of the things that I would learn from these three students. Although the two first ones were managing exactly the same way as I was. Okay. Okay. It was just my American students that managed it completely different because he had the pump.

Scott Benner 1:01:27
Yeah. Hadn't had more knowledge and more technology. Yeah. And then okay, yeah. Did you ever figure out why they kept leaving? were you driving them away? Or was that just happenstance?

Paola 1:01:37
I know, you may think it's that way. But no, I'm all of these families, because it's an American International School, they get transferred quite often come and go. And so they all left. And this the my last students, they, they were actually supposed to be in Ecuador for two years, but the mom was able to get all the data that she needed for her research. So they left

Scott Benner 1:01:58
Okay, now, the fourth year, was there another kid? Or is that there?

Paola 1:02:01
No, no, no, that was it. That was it. And so currently, I have a type one students. She is She was diagnosed in first grade like Amaya in May. And she's on the Dexcom and the Omni pod lived in the US was diagnosed in the US. And then they moved to Cayman Islands, for her to start grade one. And when she came, no, I'm sorry, grade two. And the second grade teacher did not get involved at all with her management. She did not follow her in the Dexcom nothing. And so mom was a little worried about her schooling, primarily because she had had a very negative real conversation with the school's nurse. And so that didn't go very well for her. So she was hesitant to allow the nurse to manage her daughter. And so that was that was very difficult. So she would come to the school to change her pods to administer any other insulin or any other food that she needed. The teacher wasn't engaged at all with her management. And so when, when, when it came to her being in my classroom, mom asked specifically that she'd be placed in my class. And so before school started, I had been following her on the Dexcom. So I follow Amaya, and my students and all of a sudden I've got alarms, beeping, her alarms, my alarms, I've got cases for low blood sugars. In the classroom, I make sure that my students has a possibility to engage in every single activity that I do in the classroom. She if we're gonna have snacks, I make sure that she Bolus us for the snack prior to having her snack if we're gonna have a celebration. It's exactly the same way. I've never put her on the side. She's made short videos about her diabetes and tried to teach peers about it. It is lovely to see how the students are so aware of her needs. When they hear an alarm. They immediately come and ask me Miss Paula was that Amaya or is that Emily? And so they are aware of her alarms they they know how she feels if they see her laying down a little too much or or babbling or sometimes she'll start sweating. Then they'll let me know this Bala. I don't think Molly feels okay. And so immediately I'll go over, I'll check on her. We've done meter checks in the classroom, we've done pod changes in the classroom, anything that she needs and to help her feel as comfortable as she possibly can as another student, right, not as a type one student, but just as another student.

Scott Benner 1:05:25
Yeah. Is it? Is it common that if everything's sort of out the open and comfortable for all that all the kids are comfortable with it?

Paola 1:05:36
Yes, well, so. So like, I as a mom, who is going to monitor Amaya, I've always told my students you're going to hear these alarms, this is what this means. I teach the students I give them many workshops on what the type one is. And so they're aware they're more informed. And so when I had Emily, I did the same thing with the with her peers. And so she's, she's feeling super at ease in the classroom, she feels comfortable, if she's hungry, she'll just get her snacks we Bolus sometimes it's wonderful I can, I could see her numbers really going on, on a relatively straight line. And I'll tell her before lunch, don't Bolus until we're in the cafeteria, and then you Bolus. So the kids are hearing all of this vocabulary. And so they're wondering, what is that? You know, they ask questions,

Scott Benner 1:06:35
how old right down to your current student? How old? Are those kids?

Paola 1:06:39
They're in grade three,

Scott Benner 1:06:40
three. Okay, that's excellent. I'm super excited that you're doing that. You're spreading your awareness around and helping and, and learning at the same time and just, you know, absolute treating people like people and, and not like problems or illnesses. It's just, it's a wonderful way to think about it. And and you can see that if you didn't have the experience you had you very well may not know how to do any of that. Just like, you know, you spoke about with a student where the teacher they had last time they're like, look not you know, this one's not really engaging. This teacher doesn't engage with her on about diabetes at all. That's really what

Paola 1:07:15
exactly, exactly, so her mom is super i We chat all the time I let her know, you know what we had a birthday, I'm going to we're going to have this snack, I'm going to Bolus this much so that she knows so well, mom is Mom is constantly informed of whatever changes I've made, whatever boluses I've done corrections have made and even when I've given her a juice, if there's a need. Now, I do that all the time with her now that we're getting to the end of the school year, and mom is a little concerned about what's going to happen in grade four. You know, I don't know if she wants me to continue, continue following her on Dexcom, I would be more than happy to do it. But I don't want to interfere with whatever's happening in that classroom as well. So I want to make sure that the teacher is well informed not that she would be able to Bolus because just I was talking to two of the grade four teachers. And they both said, You know what I would prefer if it stayed in your hands, I don't want to have anything to do with it. You know, because they don't feel comfortable managing the PDM and inputting all of this data and if necessary, so some of them feel comfortable. Others don't feel as comfortable,

Scott Benner 1:08:31
right? And then that's just what happens, right? It's the luck of the draw, you get a teacher who's like, I'll give it a try. Or you might get a teacher, it's like please, I don't want to be involved in this. And however that is does the school not know who's who, with who the teachers are? Like, couldn't you put the student with somebody who might be more amenable to learning?

Paola 1:08:50
Yes, yes, I believe so. So that that meeting should come in early June, where we gather as teachers and we put specific students in specific classrooms, just one out of a request of a parent for a health need. And in this case, my students will have a health need, therefore she needs to be placed in a good classroom. Nice. Well, that teacher that is going to be willing to make the changes that that she would need, you know, make adjustments,

Scott Benner 1:09:18
right. That's excellent. Yeah, well, pal, I thank you. I have a couple of recordings today. So I have to bug out. I can get to my next one on time. But I want to make sure that we're that were you feel comfortable about what we did today.

Paola 1:09:33
Yes, thank you so much, Scott. I really appreciate it. I wanted to, to talk to you to share my experience as well as what teachers can do in the future for when you get a type one students you know, it's so common, so common nowadays. That if you get one or two that that know how to how to manage it. Gosh, what an what a Comfort it is for a family to know that there's, there's somebody that can help.

Scott Benner 1:10:04
Well, I think overarching ly, your through your conversation, what I took from it was to be open minded, because you ran into a number of people who weren't. And it stifled your daughter's care for years really. And then then you, you know, you were open minded but they weren't and that blocked you. And then you get, you know, you get later on in your story. And you find out that there are teachers who are some of them are, again, more open minded to being involved in something that they're not comfortable with. And, and some aren't, some are, some aren't. And even how thoughtfully you were taking from other people like sort of paying attention to like, well, this students doing this thing, we don't do that. Let me examine that. Is that something that we could maybe integrate into our lives and make our situation better, and then giving back to them? It's just it's communication, open, mindless call, whatever you want? That's what I took from your conversation. So thank you very much. Yeah. Yeah, sir. Oh,

Paola 1:11:04
thank you, Scott, I really appreciate it. I hope that more families in Ecuador hear the podcast, I have been suggesting it to a few that I know that are families with type one, so that they also listen to you and learn from you.

Scott Benner 1:11:21
I hope everyone learns how to balance the insulin that they need against the carbs that they're taking in, and, and learns how to, to, I was gonna say, fight back, but advocate for yourself, when you notice something happening in your life or your health. That just doesn't make sense to you. But somebody in a position of power is telling you, it's okay. It's very important to continue to question that, and to try to get your own answers. So

Paola 1:11:49
yeah, I believe so I believe that I am an advocate for that. Because otherwise, then we can all learn, we can all make changes to better our health, and it's the health of our kids that is at stake. If we don't learn and don't question,

Scott Benner 1:12:05
you don't want your life to be stuck in the spot where somebody else randomly puts it because of their lack of understanding. So Correct. Yeah, go get it. Absolutely. Excellent. All right, hold on one second. Of course, I could turn the recording back on you. Go ahead. We were saying goodbye. And you said you wish we were recording. So what did you want to say?

Paola 1:12:24
I just wanted to say that your podcast has been our lifesaver, I have learned so much from the stories of different moms and dads dealing with this condition and making the changes and questioning physicians and at the same time learning about all of those pro tips, the the ideas that are behind the a better care are so important for every single family to, to take into that to make those changes to to make sure that we provide the better health for ourselves. And you do it so naturally. And so Well, Scott, so thank you from the bottom of my heart,

Scott Benner 1:13:04
thank you for telling me that to turn the recording back on because I did not want to miss that. And you're very welcome. I genuinely appreciate the kind words and I hope that other people find similar outcomes, listening to the podcast. So I mean, you guys are doing terrific. It's really It's inspiring, so well done for you seriously. I mean, thank you so much. Of course, I can say it as much as I want, it doesn't mean everybody hears it and puts it into practice. So it's very, very exciting. Okay, now we'll stop again. I mean, if you unless you're gonna say something else nice about me, then I'll let this go a little longer. But

I want to thank my guests for coming on today and sharing her story. And of course, I'd like to thank Ian pen from Medtronic diabetes and remind you to go to Impend today.com to get the insulin pen that does more. And of course, Dexcom, makers of the Dexcom G six, they'd like you to come over and see if you're eligible for a free 10 day trial, the Dexcom g six@dexcom.com. Forward slash juice box. And if you don't need the trial, just want to get going. You can do that on my link as well. links in the show notes of your podcast player, and links at juicebox podcast.com to Dexcom in pen and all the sponsors. When you support the sponsors, you're supporting the production of the show. And for that I think you among other things there are a lot of series within the podcast that people listen to that kind of standalone items and I've put them all in one place. You can find them at juicebox podcast.com. At the top of the page you'll see home episodes other stuff right but then you'll see after dark asks gotten Jenny algorithm pumping bulb Beginnings The finding diabetes to finding thyroid diabetes, pro tip diabetes variables meant For Wellness, they're all there. If I see you guys using the links and enjoying them, I actually have a couple more things I'll put up there for you. So if you're in a browser there at the top of the page, if you're on your phone, you have to hit the three lines, that means menu and then it'll drop down and show it to you. So I'm just going to click on one to give you an idea I'm gonna click on bold beginnings, takes you to a page says if you were just diagnosed with type one diabetes, the ball beginning series, did you bah bah bah. And it lists all the episodes honeymooning adult diagnosis long acting insulin. So there's a ton of them there. I'm not going to read them all to you. Right there. There's an online player you can list the all the episodes there are you can launch links to Apple podcasts, Spotify, I heart podcast, Amazon music, you can of course, go to your own podcast app and search for bold beginnings Juicebox Podcast there, you scroll down a little more, and you'll see links to defining diabetes, the thyroid series, algorithm pumping diabetes variables, s on and on. They're all right there. Just watch it. Here's the afterdark I click on that. Now I'm on a different page for afterdark it's amazing how the internet works. You know, the internet. It's magical. Anyway, you can find all these in the podcast player you're listening in right now. But I wanted to make them accessible and shareable on the website. And that I've done and now I've told you about it. And because of all this and that and the other thing, I'm not finished. I'm dizzy. I've done five of these tonight. I hope you guys have a good weekend. I'm gonna go to sleep

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#796 REPLAY: Turkey Tutorial

Prepare for Thanksgiving—or any day—with Scott as he applies all the core principles of the podcast to this potentially anxiety-producing holiday. He discusses tried-and-true concepts like being bold with insulin, bumping and nudging, using increased temp basals and extended boluses to provide a “blanket” of insulin to help make the grazing and unusual mix of food associated with the day easier. Episode first aired on November 25, 2020 as episode 412.

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.

+ Click for EPISODE TRANSCRIPT

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

Scott Benner 0:00
Hello friends, and welcome to episode 796 of the Juicebox Podcast.

On Thanksgiving morning in 2020, I woke up with this idea of how to talk people through Thanksgiving. And I recorded it and put it up for people to listen to. It got a great response. I see this episode shared online quite often actually around days like Thanksgiving where there's going to be consistent food throughout the day, you know, grazing, not some kind of set meal times. People seem to love it. They share it with each other. But there are so many new people listening to the podcast and I thought anyone not on Facebook are lucky enough to see it on Facebook isn't going to know it exists. So today, I'm going to replay it for you. If you've already heard it as Episode 412, you're done. There's nothing for you to do, you can leave. But if you'd like to hear me talk it through sadolin while you're making the gravy, I will talk about how to Bolus on a hectic day like Thanksgiving. There aren't going to be any ads but I will list the advertisers before the program starts. Please feel free to use my links if you ever have the need, as it supports the show great like I'm going to say this here just quick even though I think it gets set again on the recording but 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. The Juicebox Podcast has been sponsored for a long time by some great companies on the pod makers of the Omni pod five and on the pod dash Omni pod.com forward slash juice box by Dexcom. Makers of the Dexcom G six continuous glucose monitor. See if you're eligible for a free 10 day trial to Dexcom g six@dexcom.com. Forward slash juice box use the most accurate and easy to use meter that I've ever held. The Contour Next One at contour next one.com forward slash juice box. My daughter carries G vo glucagon and you can find out more about it at G vo glucagon.com forward slash juice box. One an insulin pen that does more. You're looking for the in pen from Medtronic diabetes in pen today.com We get our diabetes supplies from us Med and you could as well. Us med.com forward slash juicebox would you like to see an organization helping people with type one, all you have to do is go to touch by type one.org and ag one by athletic greens is the drink I drink every morning. You could go to athletic greens.com forward slash juicebox get yourself some ag one. All right, let's find out what I sounded like two years ago. Hello, everyone, and welcome to episode 412 of the Juicebox Podcast. Think of today as a pep talk for Thanksgiving. Today we're just going to talk about how Arden is going to manage on Thanksgiving Day. Which if I'm being honest, really is about how we manage every other day. Just that people seem to get very nervous around these holiday situations. Can I understand why there's probably more grazing and snacking. There's also a lot of variables in what you're eating. We'll break it all down. Talk about how I'm going to attack it. See if you can find some good ideas in here for yourself. Please remember while you're listening that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, always consult a physician before making changes to your health care plan. Becoming bold with insulin or stuffing your turkey and that's not some weird euphemism actually think when you stuffed the turkey. You can like mess it up and cause a problem is it trick and Gnosis botulism? Botulism that sounds like something to do with a can. Alright, so before we get everything else, let's just figure out what undercooked poultry does to prolong cooking you're stuffing in the turkey they're calling that a mistake to avoid I can tell you personally, I used to put my stuffing in the turkey but it slows the cooking time way down and doesn't allow an even heat to go through the bird and I don't do it anymore. I prepare my stuffing and actually make it by hand I bake the bread tear it up days in advance let it become stale almost and then combine it with a whole bunch of different that's not the point I make my own stuff. Make the stuffing and I put it in a pan and bake it in the oven. Because I found when I put it the stuffing in the bird took too long to cook and I wasn't getting a cook through the way I wanted. So now I'm drying the outside of the turkey took took the internal portion what Hold on a second uncooked. I know we'll get through the rest of it. Just give me a second Turkey causes Wow. Raw and undercooked meat and poultry can make you sick. Most raw poultry contains Wow can't be low Baxter can't be low back there needs a better name. It also may contain salmonella, Clostridium perfringens and other bacteria. Raw meat may contain salmonella, E. E stands for EU in this situation. How long does it take to get? I'm falling down a rabbit hole here. How long does it take to get food poisoning from Turkey? 12 to 72 hours the symptoms usually lasts around four to seven days. Wow. Cook your turkey. You know poultry it has to be cooked to 165 degrees, right? Hold on Turkey. Done. 100%. Right. Yes, 165 degrees. A whole turkey is safe when cooked to a minimum internal temperature of 165 degrees Fahrenheit, as measured with a food thermometer. Check the internal temperature in the innermost part of the thigh and wing and the thickest part of the breast. All right. There's our little turkey tutorial. Whoo, I just found the name of the episode by mistake Turkey tutorial. That'll be fun. Alright, I'll do that. Let's talk about some other stuff. Everyone freaks out around holidays. Oh my god, we're gonna be snacking all day. There's food in the house. There's bowls of food on the cabinet. There's grazing, I hear you. Maybe this COVID Thanksgiving might not be exactly the same as most but still, it's here, right? You're gonna get up have a breakfast, there's going to be a big launch or a big dinner. grazing in between pie. I'm assuming cookies. gluttonous extravaganza. Here's how I think about a meal with insulin. First, I wonder how long does it take for the insulin to start working? How long till it effects the blood sugar? And how long will it last in the body? That's my first thing. How does the insulin work? And Arden first thing to consider? Second thing? What is art and eating carbs? How many? Yeah, that's easy, right? You count the carbs. Everybody's like, no, no, it's not easy, Scott. Because stuffing. And it's pretty easy. You don't I'm saying handful of stuffing ish is probably a piece of bread and a half something you got to you got to wing it a little bit. Just didn't mean weighing it because of the turkey. You got to just kind of like roll with it, you got to look and guess be kind of aggressive. But still, the most important thing here is Pre-Bolus thing, getting your insulin in and working so that it can time itself up with the impact of the food. So what we're talking about here is timing. So that the insulin kind of comes online, at the same time that the food comes online, meaning while the food is pulling up on your blood sugar, you want the insulin to be pulling down, you want them to get involved in a tug of war that no one wins. That's how you keep a stable line. You know, when you see people's lines are super stable on their graphs. But they have food in there. And they're like, Yeah, but you can't find the bagel, you won't be able to hold on work. I'm sorry, I've been sick. How do you not see the bagel on the line is because that as the food impact is trying to push the blood sugar up, the action of the insulin is trying to pull it down. And so it just creates this stability. No side is winning the fight. So you have to Pre-Bolus your food, you can't let the carbs get ahead of the insulin. And to understand Pre-Bolus thing better, you can check out episode 217 diabetes pro tip Pre-Bolus. Now the next thing to consider is the impact that the food or the drink you're having is going to have on the system.

And it's not as easy as saying this is 10 carbs, because 10 carbs of Hawaiian Punch will impact your blood sugar differently than 10 carbs of macadamia nuts. I don't know how many carbs are in macadamia nuts. But imagine you've eaten 10 carbs of them. The punch will hit you quickly and harsh right your blood sugar will shoot straight up while the macadamia nuts which by the way, I've checked on and one cup of whole or halved macadamia nuts have 19 carbs. So if you have a half a cup of macadamia nuts, which is probably what like a handful, you've got 10 carbs, but they're not going to hit with the same exuberance that a simple sugar like a juice would. So keep that in mind for a second you have 10 carbs worth of impact on your system. If it's something liquid, like the juice or something sugary, it's gonna happen very quickly. So you need the insulin to be working when the Hawaiian Punch goes on. I have no idea why I picked one punch. I've never drank wine punch in my life, nor do I know anybody that drinks it, but that's not the point. The point is, you may need a longer Pre-Bolus so that you can match the action of the insulin up to the impact of the Hawaiian pot. And now for something like the nuts, you might be able to Bolus with the carbs, wait a couple of minutes and start eating. Because as the insulin slowly comes online and begins to work, the nuts are slowly coming online and trying to push your blood sugar up. Now the key around these bigger days, I think, is understanding there's going to be a mix of foods, a mix of impacts. Pumpkin pie is sugar, and milk, right, there's like, like milk in it, I think. So there's some fat, but then you have the flour from the pie. So you have two different impacts, you have the sugary filling impact, and the karbi flour impact. Same with a cherry pie, apple pie, sugary and carby. At the same time, it's not dissimilar to Chinese food, where you'll get the slower carbon pack of rice, but the quicker sugary impact of some of the sauces. So imagine that for pumpkin pies and example, you'll need enough of a Pre-Bolus that you'll head off the sugary spike. But you still need enough insulin over the timeline that the pie is going to impact your system to keep down any slow risers. So there's two things in there, a more fast acting carb and a more slow acting carb. If you're pumping, you may use an extended Bolus, a Bolus that we put in a portion upfront and drag the rest of it out over time. I'm also a big fan of manipulating Basal insulin. top line idea being that if your Basal is set to keep your basic body function stable, and now all of a sudden, you're adding a whole lot of carbs over many, many hours. It's reasonable to think that the Basal insulin you're using on a normal day might not work as well, on a carb heavier day. To learn more about Temp Basal increases and decreases go to Episode 218, also part of the diabetes Pro Tip series for Temp Basal. While we're at it, you're going to want to look at episode 263. It's about how fat and protein impacts your blood sugar to things that you don't think of as being impactful on your blood sugar, but they are fat slows down digestion, slower digestion lengthens the time that the carbohydrates impact your system and protein. As your body breaks it down. Your body turns protein into anybody. Glucose and glucose is anybody. sugar and sugar makes your blood sugar go up. So all those proteins people like those are free carbs, those are free carbs. Are they diabetes, pro tip, Episode 263, fat and protein. Some people who aren't MDI multiple daily injections who are injecting their Basal insulin and not manipulating it with their pump. Find on days like Thanksgiving, a little little extra basil might be the way to go. The idea being your Basal insulin, again is only supposed to keep you stable at a number and stable. So if you're super stable all day without food and your blood sugar's 200. My opinion your Basal is not strong enough. But if you're super stable all day at 95. Without food, Basil is probably right on. But what if you put in a tiny bit extra, it would be holding your blood sugar down a little farther. But if you're planning on grazing all day, and eating that may again be necessary. All we're talking about is manipulating the insulin to put it where you need it. My goals during the day are really simple. Yours should be to I'm trying to maintain the steadiest blood sugars as I possibly can. And I want to avoid spikes and significant lows. After food. I don't want Arden's blood sugar to go over 140 and in a perfect situation, I'd like Arden's blood sugar not to go below 70. But you know, if it hits 65 for a second, it's not the worst thing in the world my opinion. I follow a few rules around this. First one is, it is far easier to stop a low or falling blood sugar than it is to return a high blood sugar to a safe range. Right? So stop a fall with a little juice, get it leveled out, start over again, or have a 300 blood sugar that you're fighting with all day. Which scenario would you rather Bing for me? I'd always rather be on the other side. But don't get me wrong. I'm not trying to make a low blood sugar. I'm saying that they're easier to fix without a rebound. How do you stop a high blood sugar from happening if you've messed up the Bolus? Well, I'd look into bumping and nudging a little bit. That's going to be in Episode 225 diabetes pro tip, bump and nudge. Basically the idea is this. I think of type one management as driving. There's lines on either side of the lane and I I'm trying not to leave the lines. That's why I have my daughter's Dexcom CGM set at a high alarm of 120. A low alarm of 70. If she should drift under 70, we bump it back up with a little bit of juice. The idea being, the less you use in carbs, the less likely you are to overcorrect up. So I'd like to know sooner, so that I can kind of bump it back up. Same thing with the high blood sugar getting over 120 legit back down again. Again, the idea being the amount of insulin that it takes to turn on 120, that's rising into a 90 that stable is far less insulin than it would take to turn a 200 into a 90. And you know, once you start getting up 151 8200, you start using more and more insulin, which eventually causes a low later. And then should you miss address the low now you're on the roller coaster and you're up and down. So I like keeping what feels like tighter tolerances, so that you can just make small adjustments to stay in your lane. Over time, that turns into better bolusing. Better correcting, you just get better at it. In general, before you know it, you don't really leave the 70 or 120 or whatever range you said, that's been my finding. If you're interested in learning more about the Dexcom G six continuous glucose monitor, go to dexcom.com forward slash juice box. There are links right there in the show notes of your podcast player, and at juicebox podcast.com. Now I think it's important to remember to Bolus for what you're eating. But all of that infers that your settings are good to begin with. And for many of you, this might end up being your Achilles heel. What do I mean? Well, many people I find have Basal insulin that is not well dialed in. So either your blood sugar's are always on the higher side. And you're making these very aggressive bonuses at meals because you don't realize that but when your Basal is off, well then your meal Bolus is off to here's what I mean real quickly. Let's say that your Basal insulin should be one unit per hour, but you have it at a half unit per hour. That means that every two hours of the day, you're missing out on a unit of insulin. So if you're at a half, and you're really a one, you're 12 units deficient over a 24 hour period. So you're trying to make that insulin up somewhere, you're very likely making it up with your meal insulin. So if you're not using enough basil, you probably think you need more for your meals than you actually do. Meaning if you had more basil, which would hold your blood sugar lower and more stable, you would need less insulin, mealtime. And vice versa. If your basil is too heavy, you're probably one of those people who's like, oh, I

barely use any insulin at meals. Because you have so much Basal insulin going throughout the day, you're basically feeding the Basal to stop you from getting low. Does that make sense? And if that does make sense to you, but you'd like to learn more, check out episode 237 diabetes, pro tip setting Basal insulin. So back to my original thought here, you need to put insulin in for the food you're eating. If you eat something at 9am, and then at 10am, and 11:30am. And then again at 11:45am. These things all need to be covered by insulin. Now if your settings are right, then put what you put in at 9am is for that food, what you put in a 10 is for the next food, etc, and so on. But if you're too aggressive with your meal, insulin, meaning your settings are way off, maybe what you put in at 9am and 10am was too much for that. So you're thinking oh, the thing is, you know, 1130 that's free? Yeah, it may be but it'd be better to just get your Bolus is down better. So that you can continue to Bolus for the things that you eat. That becomes very important on days like today while grazings in line. Because what happens is you start thinking, Oh, I have enough insulin for that, then you don't then you're 100 blood sugar turns into 150 You know, like it'll come back down. And then it doesn't, you have to Bolus for what you're eating. My opinion is to stay aggressive with the foods that you're eating. Keep after them with insulin, and if you do cause a low later, well, lucky you. It's the most food horrific day of the year, there's something to eat. Again, I'd rather be on the lower side than the higher side. And you might be thinking, Scott, that stacking my doctor told me never to stack insulin. to that. I would say it's only stacking if you don't need it. If you do need it. That's called bolusing if things do go wrong, please do not throw yourself into a tizzy. Don't start yelling about diabetes being unfair and you always knew this was gonna happen and falling into the drama because the drama stops you from learning the lessons because everything that happened is right there in front of you. You can see I Bolus here then this happened. I wanted that to happen next time I should Bolus a little more or a little less or a little sooner or a little later. You don't want to give up the lessons. They're hard fought Right. And you don't want to keep having to have them over and over again just to learn them. So get rid of the drama. Try to figure it out, you can do it, you can absolutely do it. Make your best guesses about carbs. Keep in mind that potatoes are going to hit a little more substantially, then I don't know green beans, right green beans, thought Garza. Um, I think green beans, carbs, I don't really eat green beans. Hold on a second. Yeah, green beans have carbs. A couple of green beans has seven carbs. I don't really count carbs. Actually, I just sort of guesstimate the plate. And you probably can too, if you have enough. If you have enough time in the simulator, and you've really been able to figure it out. You just sort of looked down you go, I'll tell you right. Now, here's how I do a plate I go potatoes 30 piece of bread 20. Turkey 10. Beans, 10. We got here cranberry sauce, I don't know. Little bit of it five. I just roll like that was bang, bang, bang, bang, bang, insulin goes in good Pre-Bolus Get a good fight set up between the food and the carbs. And then correct on the backside. If you have to, you may have to correct with insulin, then you may have to correct with food. I'm not sure. But sitting around and waiting and crossing your fingers. It's not a good planet, I would much rather punch first. That's sort of how I think about bolusing. Because when it this is a sports metaphor. So I'm sorry if you don't get it right off the bat. But you need to dictate the pace. Right? You come out swinging any way you want to think about it. You act first. So that the next thing that happens is because of you because at least that you can measure. Right when you cover your face. And you're kind of hiding and you're just hoping not to get knocked out. You don't know what's happening to you. You don't know why your blood sugar is doing what it's doing. But at least you can say, You know what, I had an eclair. I thought it was 35 carbs, my blood sugar went to 200. And later I had to correct with another unit. So next time I'm going to get that unit into the original Bolus, I'm going to say it gets that ICLEI or maybe it is 35 carbs, but it punches like it's 45 carbs, or whatever. You know, your numbers may vary. But the idea is there. I learned from that and move on. And the next time I have an eclair they do a better Bolus job. That's it. Get out be aggressive. Don't be scared. Do your best test if especially if you don't have a Dexcom CGM test, use your meter My daughter loves the Contour Next One meter. And you can learn more about it at contour next one.com forward slash juicebox. But that's how we roll Arden pumps, I should have said that up front, Arden has an Omnipod she's had an iPod since she was four. And she is 16. Now, as a matter of fact, if you'd like to learn more about Omni pod, you go to my omnipod.com Ford slash juicebox. And Omnipod would be delighted to send you a free, no obligation demo pump, you can actually try it in your home, see if you like it. But that's beside the point, I digress. You have to do what you have to do. Whether you're on MDI and you're going to be a little more aggressive with basil for Thanksgiving, where you're on a pump. And you think yourself yeah, this is the second day of my arm, the pod but my site starting to get a little funky. So I'm going to change my insulin pump the night before Thanksgiving. So I have a nice fresh infusion going on Thanksgiving Day. Those are the kinds of little things you can do to prepare. From there. Don't get behind because when you start chasing blood sugars, it takes a special kind of ninja level to crush a high, bring it down and get it stable again. So as corny as it sounds, you'll never get high if you don't get high. Make sure your base was right. Learn your Pre-Bolus times understand the differences in different glycemic loads and glycemic indexes of foods. Ie how hard and how fast they hit you and go for it. Test when you need to test. Be ready. But don't let it ruin your day. And I'm saying you can have a good day too. And if you're catching this one the day before Thanksgiving, you're like well this would have been helpful last month. The podcast is always here for you will get the guts Get it together for Christmas dinner. Right? doable. It's very, very, very, very doable. For perspective. My daughter has a once he has been between five two and six two for almost seven years. She has no diet restrictions. Her blood sugar's are very stable. Her time and range is excellent. She has the consistency that you want. And the only thing I know how to do is use insulin. Everything else is extra. There's a ton of variables don't get me wrong. A lot more than what we spoke about here today. As a matter of fact, in Episode 231 diabetes proto variables we talked about a lot of them. We talked about it ton of stuff, how exercise impacts things. And there's no doubt that it'll take time for you to understand all the variables in a way that's actionable in the moment. But it is incredibly doable. So if this is your first time hearing the podcast, I hope you jump into those pro tip episodes, and see what you can figure out. They're all available at diabetes pro tip.com are right here in your podcast player. And if you're a longtime listener, you're just looking for that pep talk for Thanksgiving. Go get at it, you can do it. Oh, you know what I should say, if you're gonna have time around family and friends who don't understand diabetes, and you wish they understood it better. Episode 371 explains type one diabetes to an outsider. Maybe then Mom will understand why you're a little agitated. Because all the different pies are coming and nobody told you how many carbs are in them and etc, etc. All right. I really enjoyed this. I hope you have the happiest of Thanksgivings. I know you can do this. And if you need help, check out the private Facebook page for listeners of the podcast Juicebox Podcast type one diabetes. There are over 7000 people in there talking about management. And if you have a quick question, I can't think of a better place to ask. I want to thank the sponsors even though there were really sponsors on this episode, but I slipped them in you know I'm saying the Omni pod tubeless insulin pump, you can get a free no obligation demo of the AMI pod sent directly to your home by going to my Omni pod.com Ford slash juice box. You can learn more about the Dexcom G six continuous glucose monitor@dexcom.com forward slash juicebox. You can also get yourself a Contour Next One blood glucose meter which is the easiest to use and most accurate blood glucose meter that I've ever used for my daughter. Contour next one.com forward slash juice box. Add your voice the type one diabetes research with the T one D exchange T one D exchange.org forward slash juicebox. That's for US residents only.

You know, I cook every year Thanksgiving and the one thing I can't figure out is how to make gravy myself. I am bad at it. And it had something to do with the drippings. And flour. There's whisking involved, but I just can't do it. I don't know what your plan is. This year, I'm going to actually smoke a turkey a smaller one and a pellet grill and make a smaller one in the oven bacon tubers. I'm trying to cook two birds with two ovens at the North. Trying something new but didn't want to mess up and have forever to be like oh great. This sucks. So I'm gonna double up on the birds this year and see which one flies. That was a terrible joke. Mashed potatoes I'm great at going to be some yams, beans, vegetables, cauliflower, making some fresh bread. Like I said earlier, I make the stuffing myself learned from my grandma. I hope you have a great day too. No matter what your tradition is. I think you can do this. I swear you can. Let me just leave you with this. If you told me I could, in two sentences explain diabetes on Thanksgiving to you. I'd say get ahead and stay ahead. And then if you didn't cut me off right away, I'd say you have to get your Basal rates, right. You need to learn how to Pre-Bolus and please understand the different impacts of different foods. That's really the basis of this. That's enough to get you through tomorrow. And those pro tip episodes, they'll teach you the rest. Thank you so much for listening, have a happy Thanksgiving. There's a lot more coming on the show between now and the end of the year. I actually have a doctor coming on next week who is so well versed in treating thyroid issues I just recorded with her today. It's a it's an absolute joy to treat you're gonna love and you know what I'm asked will say here, all the sponsors are back in 2021. And I'd like to thank them Dexcom on the pod Contour Next One touched by type one, G vo Capo pen, T one D exchange. Their support allows the podcast to get produced the way it does. I'm sitting in front of a microphone the day before Thanksgiving recording this for you. Because this is my job. And I get to have this amazing job because you guys support the show and your support leads to add support and add support pays my bills and then I get to sit here and do this. So it's a circle of life kind of a situation for everyone except the turkey.

Well, thank you so much for listening. I hope you enjoyed it. I'm sure you're going to do terrific today or whatever day we're talking about. Maybe it's Christmas or a baby shower or something like that. I hope This helped you get through it. Thank you so much for listening. I'll be back very soon with another episode of The Juicebox Podcast. Don't forget to support the sponsors. There are links in the show notes of your podcast player, and links at juicebox podcast.com. To all of the sponsors. When you use them, you're supporting the show. Don't forget to take the T one D exchange survey and T one D exchange.org. Forward slash juicebox. And of course, share this episode and the podcast itself with someone else who you think might enjoy it. No matter what day you're celebrating, I hope it's a good one. If things aren't going well or you're looking for a little more help, you should head over to the private Facebook page for the podcast Juicebox Podcast type one diabetes, and there will be someone there to answer your questions. The Facebook page is always free. And and this is amazing. And it's inhabited by over 30,000 people just like you have a question ask it I bet you someone answers it might even be me. And now for the next 35 minutes I'm going to do my turkey calls which I've been working on all year

Wait, I gotta get closer to the microphone. Sorry

let me get clear. I got it ready Yeah, I'm just getting alright. Happy Thanksgiving.

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#795 Defining Diabetes: Kussmaul Respirations

Scott and Jenny Smith define diabetes terms In this Defining Diabetes episode, Scott and Jenny define Kussmaul Respirations.

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
Hello friends, and welcome to episode 795 of the Juicebox Podcast.

I'm excited to have Jenny back today for another installment of defining diabetes. And today, Jenny and I are going to define qu small respirations. This will be the 45th installment of the defining diabetes series. It's a series that takes the time to define the terms that you use every day with diabetes, from fat and protein rise to brittle diabetes, bolusing and everything in between. Check out the finding diabetes short episodes that let you feel like you know what you're talking about. And bonus, after you listen, you will actually know what you're talking about. There are a number of different series within the podcast. So if you go to juicebox podcast.com, to see a list of them. If you do it on a browser, you'll just see it at the top. And you notice the finding diabetes click on it. If you're on your phone, there's a little menu like the three lines, it's a menu click on that, then it shows you to find diabetes. There you will get a complete list of the episodes, as well as an online player and links to a number of different popular podcast apps and links to the other series like bold beginnings thyroid disease algorithm pumping diabetes variables, ask Scott and Jenny mental health afterdark and the diabetes pro tip episodes. 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.

Jennifer Smith, CDE 1:46
I like when are my kids going to be home making noise? Okay, so

Scott Benner 1:49
I'm recording. Okay. Jenny, we have finished up with our bowl beginning series. So let us move on or back to maybe I should say, a couple of defining diabetes terms which I've had on the list here for a while. And we have not gotten around to

Jennifer Smith, CDE 2:06
are these easy ones or hard one? No, I

Scott Benner 2:09
think they're, I mean, they're easy enough. They're just sort of terms that I don't know what happened. Like they, they didn't pop up the first couple of times and what I said to people like what should we define or even when I at the beginning said, what should be defined. There's also stuff on the list that's come up because you and I have been talking along the way and I've realized, wow, I don't know what that means. So I think if I don't know maybe other people don't know why they're. So let's, let's do some there'll be some short ones today. Awesome. Okay, I'll mispronounce some things. And you've you've you've sent me straight and then we'll start talking. What is a coup small respiration?

Jennifer Smith, CDE 2:51
Ah, that's a very good one. And we've certainly talked about something that would be where you would see this right. And we've talked about DKA. And we've talked about ketones before. Correct. So essentially, it's a really deep, a deep, like, heavy, almost like labored breathing that comes most often with DKA or diabetic ketoacidosis. Right? Because of metabolic acidosis. Essentially,

Scott Benner 3:31
it's interesting. I like watching you pull it out of your head because I'm looking at it written in front of me. And I'm like, okay, so cool that she's just getting this so. Yay. So my experience with it. Is that on the evening, wow. On the evening in 2006 when we realized Arden had diabetes, where we realized we thought she did. It was the end of a number of days where she was just listless. I don't even know how to say it like she was beyond like a zombie. You'd move her from one place to another and she just plopped down you know, she was so young, like two years old just just turned two years old. And that day, we were on a beach vacation. So Kelly took hold of the beach. And I stayed home but in the in the beach house with Arden. And I thought no, no, I'm going to try to get her. I'm going to try to take her to the beach. She'll see the beach in the ocean. She'll get really excited. I got her already. I took her the ocean and we kind of stepped I sat her down and she just I put her in the sand. And she just didn't move out there. Yeah. So we I took her back to the house thinking okay, well, she's still sick obviously. And late late that night, the whole family sitting up playing board games or card game or something was like a big family thing. It wasn't just the four of us. My wife's extended family was there. And I remember like looking across the room, trying to figure out what was wrong with the Arden And she was panting Yeah, even in our sleep like she was sleeping and she was just, like really quickly in out in out panting, panting, panting and I realized now that's what this is, right? This is. And so I have here a small respirations are fast, deep breath that occur in response to metabolic acidosis. Small respirations happen when the body tries to remove carbon dioxide and acid from the body by quickly breathing it out. Diabetic Ketoacidosis is the most common cause of small respirations.

Jennifer Smith, CDE 5:33
Correct. So it's also a reason that a lot of times when you bring when you would go to the emergency department, they'll usually do like an electrolyte panel, they'll look at something called bicarbonate levels and those types of things because this acid kind of component of the body that comes and causes that labored breathing is really because of the increase in acid production, and the ketones and everything that your body's like, must get rid of this thumb away. You know,

Scott Benner 6:09
it's so interesting that your body tries, I wonder if it works at all? Like, is it? Is it dissipating it a little bit? Or is it like a panic? You don't you mean?

Jennifer Smith, CDE 6:19
Like? Yeah, that's a good question. I mean, you know, the, the breadth of people who have really elevated blood sugars and are in DKA. Oftentimes smells like acetone, right? Or a real sweet fruity kind of smell. So I would expect some of its being expelled. Much like, you know, the body is also the reason people often come in severely dehydrated in DKA, is because the body is also trying to rid those ketone bodies and everything by pulling, pulling pulling fluid from the other parts of the body, dehydrating the body but creating a loss through urine.

Scott Benner 7:01
Okay, yeah, well, I've seen, like these kinds of historical writings, where they said that the Egyptians used to refer to a disease called the Great drain, is that right? And they thought people urinated themselves to death. But historians believe that might be type one diabetes.

Jennifer Smith, CDE 7:20
In fact, it ages ago, one of the very easy tests was physicians would just taste the urine. Because it was very sweet,

Scott Benner 7:31
right? And then that meant diabetes. It's interesting. When someone asked us to describe the smell from Arden's breath. I described it as metallic, and calm, and Kelly described it as fruity. So it's interesting, good, because it just a little side note here. DKA symptoms may include fruity, scented breath, weakness, vomiting. So Arden was obviously I mean, just based on this conversation, she was in DK at that point. Oh, I would. Absolutely. Yeah. Even though it's funny, because I asked that question of people when I interview them. And oftentimes, they don't know the answer. And now I realized, as I look back, I don't know if anybody ever said that to us or not. And if they did, if I would have even known what that meant. In that moment. You don't I mean, like, or like, now I know to be like, Oh, no. But back then if somebody would have said, Hey, your kids and tk I would have been like, yeah, it's three o'clock in the morning. I don't know what that is. Right. You know,

Jennifer Smith, CDE 8:32
the interesting thing I was curious about your question about whether anything is actually expelled with all of that. So I did a quick look. And it says that the rapid breathing increases the amount of carbon dioxide exhaled, thus lowering the serum carbon dioxide levels and helps to result in some degree of compensation. So there is definitely something coming out that the body is, you know, having this increase in respiration, so so it's helping you not that it's going to definitely help 100% trying to do something

Scott Benner 9:12
else and cracks in the dam and you've got 10 fingers, like, yes, it may be to that level. Well, yes. Hey, listen, if it buys you any kind of time, then thank you, but it really is another it's just really another example because we talked about this sometimes with low blood sugar, right? Like talking about how your body seems to shut down systems in order of importance as your blood sugar gets lower and lower. This is another example that this is your body just like trying to take one more breath. You know what I mean? To stay alive a little longer. super interesting. Okay, so I mean, I don't think anybody who's going to hear this episode is going to hear up before they they know they have diabetes, but if you see this happening, it's it's Dr. Time also there's one other example of why I want to just insert this here since we'll have people's attention. Of course. There's apparently another let's see what two conditions is small breathing associated with disruptions to these compounds can cause small breathing, which is typically associated with conditions that cause metabolic disturbances such as kidney failure, and diabetes. So you could see this in a person and it be kidney failure over diabetes. It's interesting.

Jennifer Smith, CDE 10:27
Again, because the kidneys are very, very much an expeller of many things, right? I mean, there's a filtration system that kind of ends up going on with the kidneys and when your kidneys are not functioning the way that they that they're supposed to. It leaves more of that to sort of float back into your body rather than be removed.

Scott Benner 10:46
Okay, so All right. Well, all right. Well, thank you for doing this with me, I appreciate it. When you have diabetes and use insulin, low blood sugar can happen when you don't expect it. G voc hypo pen is a ready to use glucagon option that can treat very low blood sugar in adults and kids with diabetes. ages two and above. Find out more go to G voc glucagon.com. Forward slash juicebox. G voc shouldn't be used in patients with pheochromocytoma or insulinoma. Visit G voc glucagon.com/risk. Good. Let's see. That's just one I always think. How do we get past? That's

Jennifer Smith, CDE 11:28
one I don't think I have. Honestly, I don't think I have ever used that term in any education I've ever done with anybody. Well, mainly because they come to me and they already have diabetes. Like, pay attention to this. That's not going to happen unless you are really in DK again.

Scott Benner 11:48
Get used online so frequently that I thought, well now people are saying it out loud. If they don't know what it is it's going to be another it's another tripping point if you don't know what it is right? Yeah, okay. A huge thank you to one of today's sponsors, G voc glucagon, find out more about Chivo Capo pen at G Vogue glucagon.com forward slash juicebox. you spell that GVOKEGLUC AG o n.com. Forward slash juice box. And don't forget, there are 44 Other defining diabetes episodes that you can find at juicebox podcast.com. Or by just searching your podcast player. For the words juice box, defining diabetes, they'll all just pop up in front of you.

Thank you so much for listening. I'll be back very soon with another episode of The Juicebox Podcast. I want you to know that I got that pop that that cheek pop first trot right in the microphone. If you're lucky, I'll do it for you one more time before I'm done. Thank you again for listening. Please share the show with someone else who you think might also appreciate it. And if you hear teaching yourself definitions because you're newly diagnosed, please don't miss the boat beginning series. It's terrific and great for people who have just learned that they have diabetes. So here sorry. That was pork. That was that was good, right? muttrah too fast. Here we go. Nope. Okay, I'm done. That was terrible. Should I leave that in? Yeah, okay. Oh, shoot. Jenny works at integrated diabetes.com If you want to hire her, she's terrific. Check it out.

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

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