#807 After Dark: One Thing After Another

Kelly has a child with type 1 diabetes and a lot more going on.

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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 807 of the Juicebox Podcast.

I didn't understand when I began recording this episode that it would be an after dark. But I've, I've given it that distinction because the person we're going to be speaking with today suffered a number of different abuses throughout their life in the past and they get spoken about. And I like to put stories like that in the after dark category so people know what to expect. So in a few minutes, we're going to speak with Kelly, she's the mother of a few children, one of them has type one diabetes, a bunch of autoimmune stuff in her family, and some different issues with her son, and herself. You're going to hear about it all as the conversation unfolds. 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 healthcare plan, or becoming bold with insulin. If you have type one diabetes, or are the caregiver of someone with type one and are a US resident, please head over to t one D exchange.org. Forward slash juicebox. Join the registry complete the survey it will not take long and once you've done that you're helping to move type one diabetes research forward right from the comfort of your home. This show is sponsored today by the glucagon that my daughter carries G voc hypo penne Find out more at G voc glucagon.com. Forward slash juicebox. today's podcast is also sponsored by touched by type one. They're a great organization helping people with type one diabetes, check them out touched by type one.org or find them on Facebook and Instagram. And lastly today but certainly not least, this episode of The Juicebox Podcast is sponsored by Ian pen from Medtronic diabetes. If you're looking for a way to give yourself insulin that's not through a pump, but you'd like some of the features that pumps offer. You want to find the in pen from Medtronic diabetes at in pen today.com

Kelly 2:21
My name is Kelly. I am a neurodivergent mom of a neuro divergent child who is also a type one. And I also have two other kids like Kelly

Scott Benner 2:37
and you've got me googling immediately. That's fine. I feel like neuro divergent is a new fancy word for something I already know. Yes, it is right? Yes, neuro diversity. Neuro divergence. Neural variants refers to variations in human brain and cognition for instance in sociability learning attention, mood and other mental fluctuation or functions fluctuations, function sorry. In the case of you, how does that how does that

Kelly 3:13
so I have diagnosed ADHD and dyslexia and I'm currently looking into the process to see if I may be slightly autistic.

Scott Benner 3:25
Okay, but what what about you made you want to look into that?

Kelly 3:33
My social awkwardness and my inability to take social cues from people like I just am horrible at reading facial and body cues. Okay. And I tend to be I am overly friendly. And I I am awkward, extremely awkward. Is that,

Scott Benner 3:57
oh, Kelly, by the way, when we were talking before we recorded you were so boisterous and now you're like demure which is fine, but I might ask you to put the mic back a little bit to your mouth.

Kelly 4:08
Okay, well, I think I was running around a little bit. Because with with my neuro divergence, I had written you down for the 30th and then all of a sudden, I got like, a little thing on my phone. And I was like, oh, it's today.

Scott Benner 4:27
Oops. So how old are you?

Kelly 4:30
I am 48 Okay, this October.

Scott Benner 4:32
It is anything about your social awkwardness, been an impediment? Airlife.

Kelly 4:41
Um, relationship wise, extremely. I don't have I don't really manage to maintain relationships at all. And that can be ADHD. But I also tend to just, I just can't deal with people's stuff. It's draining and too hard. Okay? It's too hard for me.

Scott Benner 5:08
So one thing at a time, you can't deal you can't seem to hold relationships together. But you're married. Do you mean like, like friendly relationships? Yeah. Okay, friends, is that because people back away from you eventually, or you get overwhelmed by them and back away from them?

Kelly 5:25
I believe there's something called a I don't know, if I say it, right. I lose my words a lot. That's the ADHD. Well, there's, there's this issue where you're, you do a lot of masking. And so you're, you read people, and then you try to pretend to be what they want, or you take take up. You take a behaviors that you think somebody else likes, you know, and over time, when you get really comfortable, it kind of falls away. And people aren't cool with that.

Scott Benner 6:03
And then you're come off as harsh or what how do you think you come off the people when you stop masking?

Kelly 6:10
I had somebody tell me, I was frigid. Okay. And the dating? No, I was a business relationship. Okay. I used to work with people. So so it was like, they liked me, like me, like me, and then like, four to six months later, I'm too analytical. I'm to book books and numbers, and I have no interpersonal relationships. I have just no ability to relate to people. That's an it's very lonely.

Scott Benner 6:47
Okay. What Why is it worked with your husband? How long have you been married?

Kelly 6:51
I've been married 15 years. Um, because I never ever messed with him. I don't think I've just never been anybody who other than who I am.

Scott Benner 7:05
Why do you think you didn't do that? Oh, I can tell you that story. Well, if it's a story, then perfect.

Kelly 7:12
It's a good story. I, I do have friends that I managed to keep who understand me. But I went on. I had an employee told me that she thought I needed to get out. And she was my friend. And so she said, Hey, meet me out here for dinner. You look terrible. You haven't been taking care of yourself. And I had been sick. And so I went to meet her. And then she tells me halfway on my way that by the way, I'm on a blind date with this guy. And you're just my, forgive me. My safety net? Because who knows he might be a murderer.

Scott Benner 7:55
Well, then, if listen, if he isn't a murderer, then you who have not been taking care of yourself and have been sick will be a perfect sidekick. For this scenario. You'll just I

Kelly 8:04
know, right? Well, here's the thing. I'm a six foot tall redhead, so I tend to intimidate a lot of people.

Scott Benner 8:15
I might look sickly sir, but I can fight.

Kelly 8:18
Exactly. So it was that kind of thing. And in the process of sitting there at a bar, getting drinks and stuff. My friend told her date that she was sitting with her six foot tall redheaded friend. And then the date and I got along really well. Okay, I see. And seven days later, he asked me to marry him. And two months later, we were married.

Scott Benner 8:47
That was 15 years ago. Yeah, for 28 around there.

Kelly 8:55
When I met him yet, Was she upset?

Scott Benner 9:00
Because it's possible. Kelly, you're confusing neuro divergence for stealing people's men.

Kelly 9:08
That can be a little bit of a problem too. But I don't want to, you know, yank my own train on that one.

Scott Benner 9:15
I think it's blow my own horn. But I got Well, you're

Kelly 9:18
right. Anyway, you're right. See, ADHD is fun. She, it commenced like this. I told him, he was a player and he took my phone and called his phone from it at the dinner while she went away to do something. And I said, you're on a date with my friend. I'm sorry, this is a bad idea. And then the next day he called me at my job because he knew where we both worked. And he's like, it's okay with her. I talked to her. And I was like, really? That's really bold. And then she called me and said, Go out with it. I'm okay. still weird.

Scott Benner 10:06
How do you? How do you get proposed to in seven days?

Kelly 10:12
I don't know. I don't know. I wouldn't even kiss him for four.

Scott Benner 10:17
I think you know, and you don't want to say on a podcast. What do you think of that? It's okay. No, I

Kelly 10:22
swear to you. I think it has everything to do with us just spending a lot of time talking. And I wouldn't kiss him. I wouldn't you know, do anything with him because I just have to add this to add this huge, like cold sore up

Scott Benner 10:38
my mouth. During

Kelly 10:42
cold sore. Oh, my mouth. I looked like I was dying. I had pneumonia. I wasn't just sick. I was sick.

Scott Benner 10:50
All right, Kelly. I gotta figure this out here. And forgive me for being blunt. Do you have great cans? What's going on? Exactly. Something do Oh, do you? Okay.

Kelly 10:58
I do. I am. I'm not just a six foot tall Red House. I was a really hot six foot tall. I modeled in the 80s and 90s. So, okay, I I'm not I'm very pretty.

Scott Benner 11:12
I see what happened. Okay, now. I mean, I'm trying to figure out you're not touching. You're not kissing him. You're, you're just talking and then you're getting married. And I'm like, I don't understand what's happening here. But I've seen

Kelly 11:21
with a lot of cuddling. Alright, that's about it.

Scott Benner 11:25
What kind of a player cuddles

Kelly 11:29
the one who realizes the girl he's out with has a fever and she can't keep standing.

Scott Benner 11:35
That's very kind. Oh, okay. All right. So yes, very kind. So you, but you didn't, you know, there were no errors about anything. You didn't pretend to be somebody different or do what he likes or something like that. Which by the way, it's I don't I know nothing about this world. But there's a there's half of my brain here that saying if masking who you are on a date is autism than every girl I've ever met as autistic.

Kelly 12:05
Masking is ADHD and autism, excuse

Scott Benner 12:08
me, if it's anything is what, you know what I mean? Like if it's like, I just thought people put their best foot forward generally, like you're telling a story that I've heard before told like this. I met a guy. I pretended a lot. You know, like what he liked. Eventually it came out that I didn't care about basketball. And we broke up and then one day I was out my friend not looking to date acting like myself, and he liked me. Pretty much right, but that's ADHD.

Kelly 12:36
I have ADHD. Yeah.

Scott Benner 12:37
Okay. But I'm not saying you don't have ADHD. I'm saying that's a function of it.

Kelly 12:43
Well, ADHD, a lot of times you're well, for me, you have spatial issues. So my clumsiness has a lot to do with my spatial issues. I could just walk into a wall and I, it's like, I don't know how that wall got there.

Scott Benner 12:58
So I did it. I used to walk into corners. Like when I turned corners, going from room to room, I would always brush into the edge of the wall. Yeah, that's a special issue. Yeah. And then one day, I said to myself, hey, stop doing that. And I've never done it since. Like, literally, it was the thing, like I would close cut the walls, my turns, and I would always like be bumping my shoulder on walls. And one day, I remember stopping myself and saying, This is ridiculous. Don't do this anymore. And I don't think it's happened to me in 15. So I don't know, like, I'm fascinated by this because you're you and anyone else who has ADHD or whatever. Partly describes. I mean, I don't know, like, like losing a word. Give me more examples of what ADHD is, that's what I need.

Kelly 13:47
Well, there's all different people for you from people.

Scott Benner 13:50
Have you ever heard me you? Yeah, I will

Kelly 13:53
get into a conversation with somebody and I will veer off into another direction and tell a whole other story with a severe like when I'm telling the story. My emotions build up. Yeah, real easy. And then I get emotional and like React. And I'm, I tend to be and then I'll lose my words when I'm trying to when I get flustered. Yeah, with names. I'm horrible with names, but I know that people's faces, and I can't, I have trouble. I'll reread the same sentence over and over and over and over again, on something and if I'm not interested in it, I just can't even it won't come in my head. I can't. It's like, it's like, I'm speaking. I'm reading Latin. You know, and I just, I can't understand it. It's like a foreign language all of a sudden, are you done?

Scott Benner 14:45
I'm sorry. I just want to check to make sure you're okay. If we keep talking about this, because I don't. I'm not I'm going to come off. Like I'm minimizing what you're saying, but I'm not I'm just trying to have a conversation around it. You're describing me. I don't have ADHD How do you know? Why would it matter? It's my question, I guess I'm 50 out of the house, I have kids, everybody's happy, they're safe, we pay the bills. And once in a while I look somebody in the face and don't remember their name. And I tell stories, and I can get emotional while I'm talking. Is that a problem?

Kelly 15:18
It's not a problem. But it's a problem when you're in an environment with a lot of people and they don't accept you.

Scott Benner 15:26
Yeah, I mean, I understand that. I really do. But what's the difference between that? I'm going to, you're going to help me if you can, you're going to explain things to me. I don't understand. What's the difference between that? And me being? I don't know. I'm just going to try to make something random up. Like, what if I was just a person who just talks about basketball, I have no other real interests. I love basketball. So much basketball is what I talk about, I go to my job. And every time I'm in a social setting, I bring up basketball. Turns out, nobody in the office likes basketball. And because of that, they don't talk to me as much. What's the difference?

Kelly 16:04
For you? You don't realize they don't like it? Who? Like,

Scott Benner 16:07
here's the question, Who cares? If they don't like basketball? I love basketball.

Kelly 16:12
See, that? Who cares thing, right? That happens over time, doesn't it?

Scott Benner 16:18
No, I don't I've been like this my whole life. I am very fairly comfortable with who I am. And I have met people who really liked me kind of like me and don't like me. And I tend not to talk to the people who don't like me. But that's never once made me think that I have a social disorder. Well, so I'm trying to figure out what makes what made it a problem for you enough that you had to say to yourself, I need to go speak to somebody to find out what's happening, because I'm having that much trouble.

Kelly 16:46
Like that's diagnosed as a six year old. Okay, in the what,

Scott Benner 16:51
I'm sorry, I couldn't communicate,

Kelly 16:53
I wasn't taking up speech. I wasn't. I didn't have the same skills other children did. And I was different. And I needed somebody to help me do the things that other people did. Thank you. Stop me.

Scott Benner 17:09
I'm sorry, I had to be off, I want to understand, thank you, I'm sorry, good.

Kelly 17:12
For me, I had to take Ritalin from the age of I think I six to I took it till I was 14, to be able to even focus on anything because somebody would come talk to me, and they'd be talking about one thing, and then all of a sudden, my mind would go somewhere else, and I'd bring up something else. And they'd be like, are you listening to me? Or if they tell me, you know, I had a really rough day, and my boss really sucked. And then I would tell them? Well, I've been through that. And I would give them a story. And they thought that I was narcissistic, and trying to hijack the conversation, when I was just trying to empathize with them. Because one of the ways people with AD HD and autism tend to tell their own personal story to say, Hey, I'm with you. I understand what you're saying. Right? It's not, it's the only way we know how to interact. And for other people, they either think you're a narcissist, or that you were not right in the head.

Scott Benner 18:24
What if they're the narcissist? What if they're terrible? I know some? No, first of all, but listen, if someone comes up to you, this whole podcast, by the way, is people telling me stories, me relating things that I've gone through back to them, right. And so in this setting, that's expected. It's a conversation. I think, in life, it's expected. It's also like, if someone comes up to you and says, Oh, my gosh, this thing happened to me. And I'm terribly upset by it. And I can't dig myself out of this hole. And you're listening to them? And think, Well, I would like to help them. I've been through something similar. Let me explain it to them, like how it happened to me. And then maybe they'll grab some commonality from it. Or maybe I've made a decision they haven't made that they'll find valuable, and you tell them your story back if that person was then to say, I can't believe you're trying to make this about you. I think it's possible they have the problem not you.

Kelly 19:25
It's just how it's every conversation you have. So

Scott Benner 19:29
so so no matter what happens if if so if I came up to you, and I was like, I love this Yellowstone, it's on the Paramount plus Have you seen it? And you instead of going I have not seen Yellowstone or I have seen Yellowstone and I enjoyed it. You will say I watch a TV show to that I really like and then tell them about it. Is that the vibe? Pretty much okay. All right. You're really helping me understand this because because I think people say vague things when they're describing complex issues, and we never get down to the real root isn't like, like the stuff that you told me in the beginning? I was like, Okay, these are the things I've heard people say before. But were like, how does it really, really impact you? Like, that's, that's what I'm, I'm very pleased that you're able to explain to me. So thank you very much. So six years old, although may I say you grew up right during the Ritalin revolution, the Ritalin revolution. So you could have grown up at a different time and somebody wouldn't have given you Ritalin? Correct. Did it slow you down?

Kelly 20:30
Oh, my God. So taking Ritalin for me was like, taking a pill that gave me constant tiredness and depression.

Scott Benner 20:39
But you could have but you didn't change the subject in a in a conversation anymore as a six year old?

Kelly 20:44
No, I would still change the subject in the conversation. But I wouldn't sit there and have a million different topics going on in my head. Like right now I'm staring at my microwave wondering why is that metal over there? This silver and the other one is that silver and it's just popping in my head right now while I'm talking to you and I can't get it to leave me alone.

Scott Benner 21:05
Okay, that's interesting. Why do you think there are two different colors of silver what's occurring to you right now.

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Kelly 24:01
It's, it's like more bent, it's bent as the the light hits it. And and the the silver on the stove is more flat. And they both were put in at the same time. And they're the same company and I don't understand.

Scott Benner 24:13
Right. So one of them's reflecting the light differently. You think?

Kelly 24:18
Yeah, there's that? Yeah. But it's the same company. And it just looks completely different. And it makes me think that one has a different level. I don't know maybe a plastic polymer in it.

Scott Benner 24:30
Yeah, right. Maybe they were just saving money somewhere.

Kelly 24:34
But I'll go off and I'll go look that up and try to figure it out. Well, okay, and that's that's ADHD, all of a sudden, a whole other topic comes into your head, you lose everything you were discussing, and you can't get away from it. So then you'll do something called hyper focusing. And you'll take an interest in something which is extremely helpful when you're learning about your child.

Scott Benner 24:59
You Interesting. And then but and you find this a problem like, I don't know what your day is like or

Kelly 25:04
hyper focusing is not a problem for me, okay? Because then it's all all all that. But when I'm all all that my husband has said you have to stop. You have to stop. There's other things to do. We have three kids, please. You know, you need to focus on other things.

Scott Benner 25:23
And are you able to do that when he brings it up to you?

Kelly 25:27
Yes. Okay, I am able to do that. It's just

Scott Benner 25:32
is it upsetting when somebody tries to break you away from your hyper focused activity?

Kelly 25:39
can be frustrating,

Scott Benner 25:41
frustrating. Okay. All right. I understand. Thank you, Kelly. That was really well done. I appreciate I know, that probably wasn't easy to do. And I appreciate you digging through it with me. So you have three kids. They are how old?

Kelly 26:02
1311 and

Scott Benner 26:04
813 11 and eight and which one of them has type one?

Kelly 26:08
My 11 year old son love your old son. Okay,

Scott Benner 26:12
how long ago was he diagnosed?

Kelly 26:16
So I go back and forth. I can't remember the exact year but my father in law told me it was five years ago, January 17.

Scott Benner 26:26
So he was six.

Kelly 26:30
And that's what I can't remember. I for some reason, can't remember that. That much.

Scott Benner 26:37
You know how I do Arden's diagnosis they she was diagnosed when she was two she'd only been to for a month. And she was born in 2004. So Arden was diagnosed in 2006. That's how I ended up doing it. Because if you just had what years are undiagnosed, I'd be like, 2006, like I ate come slower.

Kelly 26:56
So I'm basing my little one she was two and a couple months. So yeah, it was two. I think it was

Scott Benner 27:04
cool. Okay, so about six years old. Were there any other autoimmune issues in your family line?

Kelly 27:12
Yes. Okay. Goodness. Yes. Who and What? My mom has severe rheumatoid arthritis. My sister has Hashimotos my other sister has ankylosing spondylitis. My brother has rheumatoid arthritis. I don't know about my little brother. But yeah, and then. Who else? Oh, my mom is bipolar. I don't know. We go back. I listened to a lot about that.

Scott Benner 27:48
Yeah, I mean, that's all actually all very interesting. So this is it. So there's you said your younger brother. I don't know. Because you don't know your younger brother just because you don't talk about it.

Kelly 27:58
We he stayed home when I left. And so I don't really have the best relationship. Gotcha home.

Scott Benner 28:07
Should we dig? Should we dig through that a little bit before we get to your son? Or what do you think?

Kelly 28:13
You can absolutely go ahead because I was gonna, it kinda like everything comes back to trauma. So

Scott Benner 28:24
well, how old were you when you started experiencing that at home?

Kelly 28:29
trauma. I don't know. I remember being three years old. And my mom was locked out of the house and trying to open the door. And I couldn't get the door open. And her screaming really nasty things at me. And I I realized she left me home when she went to the store.

Scott Benner 28:55
Okay, so sleep. So you were a three year old asleep. Your mom went to the store came home and then couldn't talk you through unlocking the door so she yelled at you. Okay, Mom was bipolar. You're saying

Kelly 29:08
she's she was bipolar and borderline personality disorder. Okay. That's a lot, which I only realize I learned recently from a social worker

Scott Benner 29:20
by describing her to somebody who was able to say no,

Kelly 29:23
no, somebody who interacted with her later in her life. After she was I don't know, that's very complicated story. It doesn't

Scott Benner 29:33
matter. But you figured it out somehow. Okay. Your father, what was he in the situation?

Kelly 29:43
He was a nice man who went to work at like 4am and came home at 10pm. And he just couldn't put up with his wife and wouldn't give her the finances she needed because she was irresponsible with money. And so he just avoided her like

Scott Benner 30:03
she was the plague. Okay, but didn't leave her.

Kelly 30:07
He didn't leave her until she forced the issue.

Scott Benner 30:11
Gotcha. How many kids now? Did they have? Five? Where are you in that line? For? You're the fourth. Yep. Okay. What so was the the wrath of her mostly yelling? Or was it other stuff?

Kelly 30:30
It depended on which child it was. My mom used to like to humiliate my, just above me sister. She would just humiliate her and hit her in the most egregious ways, like, and she she was unhappy with how my sister cleaned the bathroom. So at two o'clock in the morning, she pulled her out of her bed to clean it again.

Scott Benner 30:53
Yeah, that's, that sounds pretty classic, actually, for what was going on with your mom. Your mom was not getting any treatment. I imagine what she treated with alcohol or drugs. Do you think

Kelly 31:02
so? Because my mom had severe. Oh, god bless the word. What does that rheumatoid arthritis. She was doing a lot of experimental things that other doctors had given her. And she was doing like, I mean, I remember she did a study on the MRI, like she volunteered to be one of the first people to lay in there and get tested on how to use an MRI on a person. And so she was always like a guinea pig trying to find a way to get I mean, like when I say my mom was severely disabled, her hands were just so bent and swollen and, and her face and she was on prednisone all the time. 24/7 which makes you aggressive, and irritable. She was on so many drugs, methotrexate. She like seven different drugs. But I don't believe any of them dealt with her bipolar. Or I didn't at that time. I don't. I don't even think she completely knew she was bipolar. And if so she used to, like I remember when I was like three or four. She just went away for three months. And didn't come back. Yeah. And we'd go visit her in a hospital. Okay. And then it happened again, when I was like six. And after she had my brother, I was six. Yeah. And it was just a lot of my father saying that one's not she doesn't have ADHD. That's not real. And my mom, you, you need to get better. And what's wrong with you? It's not real.

Scott Benner 32:44
So your your dad would say that your mom's problems weren't real or that the kids problems weren't real, or everybody, all of us anything. All of us? He probably didn't have the bandwidth to talk about. One more problem, I would imagine. Yeah.

Kelly 32:57
No, he did not. And he didn't only till the more recent years, even acknowledged stuff like that.

Scott Benner 33:04
Yeah. Do you still speak with him? My father passed away last year. Oh, I'm sorry. Prior to that, were you in touch? Yes. Yeah. But with your mom? No, no. Okay. My mom

Kelly 33:18
passed away in 2015. And I really hadn't talked to her since my grandmother had passed away. I think I was 26 at the time when my grandmother passed away. And the time before that, I was 16.

Scott Benner 33:33
Oh, my gosh. So you left at 16.

Kelly 33:37
I was I tried to leave on my own. Because my mom was just being erratic. She broke up with my boyfriend for me. She quit my job for me, which I had a job and I was buying groceries for our house. And that meant there was no food. And so that was a problem. Plus, that meant I couldn't go do anything. And she was always screaming your father doesn't give me enough money. I don't have any money, do anything. I have nothing. He's just trying to make me die here. It was. It was delusional, delusional, delusional, all the time. It was and so I took all my stuff. One day, after I walked home from the job, I thought I was going to I had worked in a video store. And I walked home. And that day, I took all my stuff. I got garbage bags, filled it up and I live. I was on the third floor of the house. I dropped them out the window and then I went to take the garbage out and I asked my neighbor to let me put them in his driveway, which he did, because he was kind and he realized my mother was unwell. And then I told her I would like to call my father And then I wanted to leave, because I couldn't take it anymore. Yeah. And she cried and yelled at me and said it. This is not working. You're You're kidding me. This is silly. And I was like, you're taking everything away from me that we need. And so she's like, Well, why don't you just go to your friend's house. So she drives me to my my friend's house. Which was really her friends, her, a girl who I was allowed to spend time with. I wasn't allowed to have any relationships with anybody, by the way. But then, it was all about control for my mom, let me tell you, and I went there, and she wouldn't let me take the bags out of a car. And she then said, I they had me go to school. The next day, I went, I went to a Catholic school, just so you know, a private school. And that afternoon, the police came and told me I had to go on a different bus. And I had to go to my father's house. Except I have nothing but my uniform on. That's all I own. Yeah. So everything was to take everything away from me. Well, if she's gonna do this, I'm gonna go through everything. She hasn't made sure she gets nothing.

Scott Benner 36:20
of value. Yeah, no, I've heard this story before from other people. I know exactly what you're talking about. Yeah, yeah. So did you eventually make it to your father or no?

Kelly 36:32
Well, so my dad was dating some lady and living with her at that point, and they were gonna get married. And so I went to my grandmother's, and I got the top bunk, and a small bedroom. And my big brother had just come home from college, and he had graduated. And so he had the bottom bunk, although he'll say he never shared a room with me. But we did. And he, I essentially got like a pile behind the bed. And I had to kind of start new except a week later, and my mom said that my trial was over. If I liked what I was dealing with, then I can come get my stuff. And so I had a friend from work, take me to my house, and my mother then wouldn't let me in the house called me nasty whore, and said that, I don't deserve any chances. And so she gave me bags of things that weren't mine.

Scott Benner 37:33
Ah. Let's Catholicism is really working for everybody.

Kelly 37:38
I know, right?

Scott Benner 37:41
You guys Irish.

Kelly 37:44
We are a whole bunch of things. But she's Irish and I, Irish and English. I don't know. I've never completely understood my grandmother's background. Her mother. She, she I as far as she never told us about it really completely. And it's taken a couple of years of digging, but I believe she was English.

Scott Benner 38:04
Was her mother like this? No, no,

Kelly 38:08
her mother was like the life of the party. She was a woman who married divorced a man when her daughter was two in the 40s and 50s. She was a real head turner, by the way, I think I think I looked like her. Okay. And she had another husband, who was like 30 years older than her. And he was like a popular restaurant tour in New Jersey.

Scott Benner 38:39
Interesting. That's really

Kelly 38:41
New Brunswick area.

Scott Benner 38:43
Any of your brothers or sisters have any signs of bipolar?

Kelly 38:49
No. Well, maybe my little brother. I don't know. You know?

Scott Benner 38:54
Sure. Right. Right. Yeah. Okay. She's so Kelly. You expect and probably through therapy and talking to people who know better about stuff like this than you and I, that some of your issues come from growing up in a scenario like the one you just described? Correct. Okay. And even though you were there for just the first 16 years, once you left, I mean, what happened between 16 and 18? Just lived your grandmother's while you finished up school?

Kelly 39:28
No. So it really I had tried to keep that job where the person had helped me and I really loved working there. But it meant like riding my bike 13 miles. And so I started living at my boyfriend's house a little bit and sleep like I would, I would go home to my grandmother's house like Monday night and then on. If I had to work I would maybe go Back to my boyfriend's house on Thursdays and then I would sleep at his house and then, you know, it was a bunch of stuff that went on with me kind of hanging out with friends and staying at friends houses rather than at my grandmother's house because my grandmother was old. And it was, I felt guilty, because I felt like I was taking advantage of an old lady.

Scott Benner 40:25
Okay. I understand. So did you go to college then?

Kelly 40:31
I did, but I took a year off. So

Scott Benner 40:34
between 18 and 19, you took a year off? And then but you did go and complete a column well,

Kelly 40:39
okay, I did not complete college. I went to school. I was 19 When I graduated from high school, because I was older because I stayed back in like second grade or something. And I was I was still in the private school because it was in the divorce decree. My father had prepaid for everything. So I still going to the private school I was going to, and then senior year, I got pregnant. And you know, we did not continue that. I understand them. Okay.

Scott Benner 41:26
Yeah, no, I understand. I started doing the math when you said it. So okay. And then

Kelly 41:31
I couldn't bear to go to school or do anything. All I did was, I kept my job. My boyfriend went off to a university that was far away. And his mom was like, Oh, you can live with me. It's okay. I love you so much. And I was just like, I can't live with you. I can't even stand to be here.

Scott Benner 41:50
Right? What part of the General General part of the country did you grow up in?

Kelly 41:55
I'm from New Jersey. You're from Jersey.

Scott Benner 41:57
Okay. This is a hell of a story, Kelly. It really is something else? And is there a moment ever in your 20s? Where you feel like, I've, I've gotten away from this. And then No, you've never felt clear of it. So

Kelly 42:17
I just, I, like a lot of people who have learning disabilities or disabilities in general, they tend to gravitate to trying to understand people. And sometimes that means making bad decisions, especially when you don't understand how to interact with people so well. And then I ended up with a man who was horrible who abused me. I'm sorry. It was like, so before I left my mom, she did start using drugs and alcohol. And she was doctor shopping, is what I think she was doing. But because she couldn't afford the drug she needed for her. Rheumatoid arthritis. So she was I mean, literally, and this is when I could do it. She she'd pull up in front of the local liquor store, and she'd say, here, bring this note in and get a 24 pack. And that 24 pack was every day.

Scott Benner 43:11
Okay. She was drinking while she was drinking that much to get through. Yeah, yep. And then, do you think people, younger people even understand the concept of your parents sending you somewhere with a note? Like my, my wife, my wife used to get sent to buy cigarettes with a note?

Kelly 43:30
Oh, but she would she would smoke a pack a day, too. Yeah. So it was a lot of smoking, a lot of drinking. And then

after I'd moved out, and I actually had cried to my dad to go to the court to try to save my little brother. And he's just said, I just don't have the money to deal with your mom. And I was like, Oh, okay. Because we're all disposable dad. That's great. So my dad had lived it. So in between there, I had moved in with my dad and his new wife. And she was worse than my mom.

Scott Benner 44:11
Dad could pick up I know,

Kelly 44:13
I know. But then you think about this. That was how I picked relationships. And I never really had a really good healthy relationship because that that relationship with the boyfriend she made me break up. That was actually a really nice relationship.

Scott Benner 44:30
That's probably why she made you stop doing it.

Kelly 44:34
Well, yeah, and she didn't know a lot of stuff. And she, she made this story up. She told me, I heard him talking to his friend in the backyard. He's gonna try to have sex with you. You're not gonna have sex. Let me tell you. I'm going to stop it. And I was like, Oh, okay.

Scott Benner 44:54
How old were you at that point?

Kelly 44:56
Um, I was 16

Scott Benner 44:59
Did you already have so So the kid, no, no. Okay. Well, he was probably going to try to have sex with you. But that

Kelly 45:06
wasn't. I was trying to do that with him. And he told me no.

Scott Benner 45:14
Okay. She did. She didn't

Kelly 45:17
know that.

Scott Benner 45:19
She No, yeah, no, I'm saying she obviously made up the story, but it was, it was a reasonable guess is what I'm saying. First, for a 16 year old boy to be thinking about that. Correct? What behind? Just generally, I don't need you to go very deeply. But relationship in your 20s where you said it was abusive? Was that physical or mental or? Both? Both? How long were you?

Kelly 45:48
In and out for 10 years. Every time I'd get out, he'd like, come back to my door. I mean, I had, and he was always like, Oh, he was, I mean, the first time he hit me. So I actually went off to, I went to the community college, and then I had gone down to New Orleans to live. And then I was going to go into two lane. And then I had been assaulted by a roommate. So I left

Scott Benner 46:28
at Tulane.

Kelly 46:31
We were in a house. We weren't, like, Okay, I

Scott Benner 46:33
say, I hadn't

Kelly 46:35
even really started school yet.

Scott Benner 46:38
And this was a sexual assault.

Kelly 46:41
No, no, it was a girl. And she was my friend.

Scott Benner 46:47
And she just hate like, hate you that kind of thing. You don't have to tell me. Yeah.

Kelly 46:54
Okay. Um, it started months earlier over a guy. And I had, I was in college, and I had a friend. And this friend one day goes, Hey, you want to go to a Matthew sweet concert? And I'm like, Yeah, I want to go to a Matthew sweet concert. And so I'm like, okay, oh, my God. He asked me out, like, this is awesome. And I get in the car. And there's this other guy in the backseat. And I get in the front seat. And he's like, Hey, do you mind getting in the backseat? And I'm like, oh, yeah, no problem. And then we stop at somebody else's house. And we pick up this other girl who then proceeds to stick her tongue down his throat. And I'm like, Oh, I guess this isn't a date. Oh, I'm seeing that I'm supposed to be with the other guy. Oh, okay. I wasn't used to that. And then we were very good friends for like two years, and we were just only ever friends. And then one day I said to him, I said, I don't understand why you never, ever wanted to go out with me. And he said, I did. I asked you out. But you said that you wanted to stay single. And I said, Yeah, like not get married. And he's like, Well, I perceived you wanted to be single, single. And I was just like, great. And then he kissed me. And then my friend got upset because she apparently had started to become attracted to him, which she always knew that I was attracted to him. And it was like, why? So she said, you either stop it, or I'm not your friend anymore. And so I stopped it. Kellyanne, I told my guy friend, sorry.

Scott Benner 48:57
Everything about your story is making me not about you, by the way, just in general, because I live in the world too. All I can think is like, is everyone out of their mind? Like everyone? You do not I mean, just in different and spectacle spectacularly odd ways. Like between, you know, interpersonal relationships and dating and, you know, parenting and nobody can like, like, no one in your life can come close to making a good decision. It's, it's fantastic. Like you've actually moved so far away from how you grew up. It's, it's, it's laudable, honestly, do you know what I mean? Like it's it's fascinating that you were able to get to where you are right now. Yes, if you ever stopped to just kind of celebrate that.

Kelly 49:51
I do. I do. celebrate that. Good.

Scott Benner 49:54
Good. I mean, it's like you climbed out of six different pits. It feels like

Kelly 50:01
I've, it feels like that to me too. But sometimes people say that your stories are so outrageous that nobody will believe them.

Scott Benner 50:09
No, listen, I have no reason not to believe you. And it makes sense if you kind of reverse engineer it. If though if you at six years old, which by the way, Listen, I'm not a doctor, I wasn't a doctor in the 70s. I don't know what I'm talking about. But I've seen people put on Ritalin and it wasn't good for them. And no, I could stand here and make a pretty solid argument that a six year old shouldn't be able to keep a single train of thought while talking to a bipolar a woman and her husband who made six babies with her five babies or whatever. Like, like, you know, it's, it's not like you were, it's not like you were being raised by the Queen Mother. And and you you don't I'm saying like there was a lot of craziness from your mom. Like, why are we? I mean, if I could put myself back in that moment, I don't think I would put your mother in charge of making a decision about whether or not to medicate you at six years old. Do you see what I'm saying? And and so, now you're in it, right? Well, listen, you were in it the minute they had you like, right, so you're in their hell. And now you're being brought up with their ideas, you're being brought up with their, you know, limited ability to parent. And then they do it to more people by you know, they have kids, and then you guys live in a bubble where this is happening, your father gets more and more this illusion to move away your mom's slides further and further into her mental illnesses, which makes your interactions worse and worse and worse. And then it's no doubt that it's just not a surprise, that you would continue to end up with people like this. It's probably what you gravitate towards, even though you don't realize you're gravitating towards it. Like there were probably kids at Tulane that weren't going to hit you. But how the hell would you find them? Because that's not what you think of as the world. Does that make sense? Yeah, yeah. It just feels like, you know, this thing breeds more of this thing. And then when you try to leave it, you find more people like that. And then when you actually find people who aren't like that, that's probably when you don't deal well with other people.

Kelly 52:24
Well, the girlfriend, the girlfriend that assaulted me, she was like, my best friend of like, three years. And, and she, she wasn't I ride or die. Yeah. And I was living in her house with her a lot. Like, I would come sleep with her at her house, not like sleep with her. Not like that. But like, roll out a bed, that bed thing. And I'd sleep next to her bed. And it was. And so like, when it came to her the guy I was gonna choose her because she's my ride or die. And she was like, the only girl ride or die that I had ever had that kind of liked me.

Scott Benner 53:10
And maybe that's all I'm wondering is if you didn't grow up like this, in this scenario, if when you got to college, your ride or die would have been a different person. Probably yeah. And like, what is it about? Like, when you stop and think about it, it doesn't. It doesn't shock me that you were very good friends with a person who eventually could come to strike another person. Because I'm guessing that subconsciously, we're all drawn to people that we recognize. Somehow, hey, you know what I mean? Even if it's not like, even if in your in your like, functioning like conscious mind, you're like, look, that's how my mom is. I don't want to be around people like my mom. Like, even if you know that. When you start making small, subconscious decisions about people and things. I'm assuming you choose stuff that you're more comfortable with, even though that comfort isn't good for you.

Kelly 54:11
When I look back, now, I can see that but in the moment, I didn't see it. Sure. I couldn't see it. And when when I left her she, she they the roommates all voted me out. I mean, I'm the one that got strangled, and black guide, and I got voted out of the house because they said I cause too much drama. When I didn't think I caused any drama. Actually, I just kind of went to work and came home and was saving to try to pay for my first semester. Yeah. And so yeah, that wasn't working. And so I never got to do that. And then I came home and she called me lots of names and said that I would never, ever do anything successful and a bunch of other things that she said to me so that when I came home there's this guy I was just looking for somebody to pick on, I guess.

Scott Benner 55:05
And you probably look apart at this point after having gone through these things so many times, like, Oh, I was

Kelly 55:11
so skinny. So I was I, you know, I can look back at old pictures and be like, God, I was really pretty. What was I thinking I was so low on myself. I never. My mom used to call me. Uh, she called me a fat whore.

Scott Benner 55:26
Oh, all the time. That's sweet. And what I was thinking was is that predators can recognize prey. And you've been preyed on by so many people, that it probably, it probably exudes from you, and you don't even realize it. And so they're like, Okay, well, this one will be easy for me to manipulate or whatever it is. They're thinking of doing? Probably, yeah. Oh, that's terrible. It really is.

Kelly 55:54
I should have just stopped it. I don't. I didn't stop it. The first so I had moved back in with my grandmother. And she was she I mean, she's in her 90s. Okay. Wow. And we had it was just a couple of weeks after I moved back. So it was probably like, February. And he was doing stuff with somebody else. And I was just like, oh, well, this is not like, well, I didn't know that. Well. Oh, dang. And I dropped. I was drinking a wineglass on my front porch. And I was 21 at this point. And I dropped it. And he said, You, you threw that at me. You. You purposely tried to hurt me. And I'm standing I was like, No, I didn't I just I'm just so I'm a klutz, I'm just a big klutz, and I didn't, you know, you're just angry at me. And then he, he's, he, like, back slapped me. And then I ran in my front door. And he knocked me down and, and he choked me to like, I was unconscious. And I woke up in my own bed with him behind me, making sure I was okay. telling me how much he loved me and all that stuff. And I would never do that. And, you know, thank God, your grandmother didn't come out of her room. Oh, my God. He was like two in the morning. And it was just always from there on end. Because my sister lived with me at this time, too. And she was at one of the universities locally. And he would just say he could take them both both out, if I ever told anybody.

Scott Benner 57:46
So he was willing to threaten to kill people around you if you talked about what happened. But he had to wait for something like the wineglass to fall to hit you, which hitting you is what he wanted to do. Like for. It's got nothing to do with you, Kelly. I don't imagine you don't know that now, years later. But like, he's got his own significant issue. He's just waiting for anything. That's an excuse for him to lash out the way he wants to lash out.

Kelly 58:17
Oh, it's just, it was constant after that. And that was like, he used to get upset that I wouldn't pick him up. And I was like, I work too, you know, and that's my car. He didn't have a car at the time. And he's like, you're supposed to pick me up at this time and do this. And I was like, Okay. It just, it was just easier to go along, than have to put up a fight and have him threaten people in my life. And so you know, I did it. And then one day, I thought, hey, let me do something because I'm having this relationship and it's sick, I guess. And I'm trying to, you know, love this person, I guess, because this is what I'm stuck with you. Everybody in the world just like this. Apparently, my view

Scott Benner 58:58
is now starting to feel for sure.

Kelly 59:01
Pretty much how it feels. And so I ran to a Starbucks in like two towns over and then came back and brought him coffee. And then the people in office are like, yeah, he's like, left. You were supposed to be here earlier. He was looking for you. And I was like, Okay, this is before cell phones. Okay. I had a pager. But I then find him walking home, which was way too far for him to walk, but he was going to do it apparently. And rather than call his parents he, you know, called me and I didn't answer the phone, and I didn't you know, so, yeah, I picked him up, and there's some construction and he's yelling at me and I'm like, Hey, I got you this coffee. I thought it would be a great surprise. I thought, you know, it'd be really nice. I even brought the people in your office. Some coffees, and I thought it was I was just trying to surprise you with something sweet and kind. And he took my wallet and threw it at my head while I'm driving and went out the window in a construction zone, so then I stopped and crawled on the ground wall, all my stuff is on the road. Nobody ever did anything. You know,

Scott Benner 1:00:11
it's demoralizing. It's terrible. I don't even I mean, there's obviously nothing to say it's just, it's, it's a mess. I don't know how you don't know how you got this far through it to be perfectly honest. It's, you know, it's just one thing after another. And it was,

Kelly 1:00:30
yeah. But one day, I, all by myself broke my leg. And I was standing on my front stoop, reading my mail, I had moved to my own apartment at that time, because every apartment I lived with roommates with always told me he wasn't, he was not allowed to come to it anymore. They didn't like him. And I guess, their way of trying to push somebody out of my life was to say, Hey, you can't live here anymore. If that person's here. So I finally found my own place. I'm reading my mail, I fell, because I have facial issues. And I broke my leg. But it was a hairline fracture, I could still walk, but it was so excruciating, excruciating ly painful that he got to my house that night. And I said, Do you think you can keep taking me to the ER, he's like, you're fine. There's nothing wrong with you. And I go, do you? Do you see the bruise on the leg? Can you take me to the ER? And he's like, No, you're fine. And it was just, it was always like that, you're fine. And then within like, two weeks, I went to my doctor's and I just cried so hard to her. And I mean, she knew what was going on. Right? She knew she, she cuz I was like, I'm so depressed, I'm this or I had other things that would happen.

So she took me down to the ER and tried to admit me

Scott Benner 1:02:04
to try to get you away from him in general. That and the other things, yeah,

Kelly 1:02:10
okay, get help. And I didn't understand what was happening. So I had to call my sister because I if I was admitted, that would affect my job, and how is that going to pay my bills, I don't live with anybody. And I don't have any support system. That guy is my support system at this point where I'm so isolated. And my my sister's husband's a psychologist in a hospital system. And he talked them out of it. And I went home. But in the process, I was required to join the crisis Women's Center, at the hospital. So every week, I had to show up at overlook Hospital in Summit, New York Summit, New Jersey. And, and, yeah, I had somebody named Christine. And whether she knows it or not, she saved my life, because she taught me how to talk to him and not get hit, and to mirror behaviors to him. So I did what he needed me to do at the time. But then when it came down to breaking up, she always says, you're always trying to break up with him, and you're trying to get out of the situation. And I said, Yes. Well, he has to think he's breaking up with you. He's got to break it off. And so they taught me over four or five months of going every Tuesday that I, I would tell him, yep, I'm going to talk about you and how you treat me. And they said, it holds him accountable for his behaviors. And, and the process of it, he broke up with me. And I was 30 at this point. And he never stopped coming to my house or ringing my phone or checking on me at work. Just so you know. That went on.

Scott Benner 1:04:11
Yeah, until you meet your husband. I don't even Yeah, you Kelly. I don't even know what to say that it's a that it's necessary. That a crisis center teaches you how to slowly break up with a lunatic. Like that's just it's that that is necessary, I think says a lot. Really. That's my God.

Kelly 1:04:37
And that's what a lot of people don't understand about women and abuse. They want to get out. Why don't they get out? Because if they walk away from this person, this person is still behind them. Because they think they own you. He he got married in those two years to somebody else. wouldn't leave me alone.

Scott Benner 1:04:59
Wow, it's Yeah, I mean, listen, if you want the the high level takeaway from this ladies, and I'm being serious here, don't take guys that can't afford their own car. I swear to you, it's an indicator. It just really is. I don't know why in a driving society. If a guy's asking you for a ride, I'm telling you, there's something wrong. That's all. I don't mean to to make light because I'm not I really feel like that's something that you should pay attention to as a red flag. I

Kelly 1:05:30
helped him get a high powered job don't really don't think he he didn't. He ended up driving a Porsche.

Scott Benner 1:05:37
Jesus. I know. That's, that's just upsetting. Alright, so Well, okay, so Kelly, you know, that's a long that stuff, I guess pretty, pretty far from your past not probably doesn't feel like it when you start talking about it. But you know, 15 years ago or more. So when you meet your husband, and things are just normal? How do you, you're able to accept that and just move on and be normal?

Kelly 1:06:05
No, no. I'm just not a normal person. So I can't accept that. And I guess I guess, I guess my, I don't know, I just, you know, I sing that song to myself from like, Sound of Music. Somewhere in my youth or childhood, I must have done something good.

Scott Benner 1:06:24
That's what helps.

Kelly 1:06:25
It does. I sing it to myself every time I'm like, How did I get here? I wouldn't change a thing. I'm so glad I'm here. Because where I am, I'm having a very happy I've. And I didn't know what normal was until I met my husband. And then he's just just really nice, intelligent guy. And so I when he, by the way, just so you know, when he asked me to marry him. I said, you don't even know me. I'm crazy. I have ADHD. Do you know I have ADHD? And I'm dyslexic? I mean, I walk into things all the time. I'm a huge clucks. Are you sure you're ready for that?

Scott Benner 1:07:06
Yeah, you should not have done that. You should have just said to all this guy seems normal. I'm definitely going to start trying to hang around with normal people.

Kelly 1:07:14
Well, at that point in time, I didn't I wasn't sure he was normal, though. Because I actually did. I did date, like numerous people. And the first minute they did like, anything controlling or anything weird or anything, just anything. I was like by sorry. Nope. Yeah. So it was it was like two years of me dating while that other guy is still following me around calling me and showing up my house on random moments. Yeah. And

Scott Benner 1:07:45
so we're split. Let's interest that. Well, it's interesting, because your life is beginning to split in two different directions. But it took a very long, long time for that Velcro to pull apart. And because the bad boyfriend person was still trying to stick to you, and you were trying to go in a different direction. And let's, I mean, it's amazing that you were able to and it sounds like you know, with a lot of help from people.

Kelly 1:08:11
I did. I've always had angels out there. Yeah, helping me. That's and that was one of those weird things. It's so weird. I'm not I know I'm Catholic, but I'm not religious. But you remember that boyfriend I was telling you about the the one my mom made me break up with Yes. When I broke up with when that guy broke up with me, but really I broke up with him in a very long, elated way of doing things. It was no a lady elaborate way of doing things. I started having dreams about my ex boyfriend of that time. And what I hadn't known is the day that he broke up with me was the day that that he died.

Scott Benner 1:08:52
Wait, wait, hold on, stop. Start over which boyfriend, the boyfriend my mom broke up with when you were like 1616 The boy wanted to have sex with you.

Kelly 1:09:06
But no. She said I wanted to have Yeah, that she said yeah, he died. He died with cancer. When he was 29 Oh my god. I didn't know. But the day that my relationship ended with the bad guy. I had been dreaming about him for a little bit. The first day of the first boyfriend. I mean really honestly, he was my first boyfriend. And I had been dreaming and he always had told me you know, I he had always said he did love me. Stuff like that. And I even add had kept up with him over the years, even though I was dating other people he had you know, he had still been my friend. And then when he met his wife, I guess he had come to my house and he had said something to me. Um, you know, I met somebody, and I wanted to just make sure it was okay, that this is the way I'm going because this may be something and I didn't know what he was asking me. I think I was like 1920, right. And I was like, I don't know what you're asking me. Because we're not together. And he's like, Well, I'm just checking if we couldn't be together. And I was just like, I'm like, you live so far away from me. I don't think this would work. I'm in college. I'm just trying to be free. I mean, I'm just trying to be free at this point, because I had such a tumultuous relationship with the previous guy.

Scott Benner 1:10:36
Oh, yeah, I have to tell you, if you would have gotten back together with him, and he passed away 29 from cancer, I would have thought that's on brand for Kelly. You know, like, I'm actually the whole time you're talking, I'm thinking the diabetes for your son is on brand, like because you must have just, like been like, oh my god, is this like, this stuff never going to stop. You know what I mean? Like, just, I mean, cuz you're, you're, you're build a life. You're doing it now. And then your son gets diagnosed? I would have been. I mean, I'm asking, how did that strike you at that time?

Kelly 1:11:12
So I'm part of that relationship where I was abused was a lot of abuse in the car. And so when this happened, so you have to understand what my husband's job is first. Okay. My husband works at sea. He's a merchant mariner. He's a chief engineer on a ship. Okay. Okay, and so he leaves for like, 10 to 12 weeks at a time, sometimes the longest he's left it's 141 days. Well, I'm by myself. And so we had gone his dad likes to sometimes sometimes he flies out of where we live or Hill, we have to drive down if he depending on which port he has to go to. We drive to look like Elizabeth or something. New Jersey? Yeah. That port. And so I was meeting my father and my father in law in Newburgh, New York, because that was kind of midway for us. And he would take him the rest of the way to New Jersey. And we would we sometimes go to like a local popular, inexpensive, breakfasty kind of place, like not a diner, but a popular. You know, I'm trying not to say the name. Sure. And so we had gone there that morning. And I was leaving my husband with my father in law, and my son is sitting across me. And he orders a plate of pancakes. When he's six. Granted, he's a big kid, by the way. Because I'm six foot my husband's six, two, so yeah, we're not small people. And he ate three huge pancakes. And then he asked for my father in law's parents cakes, and he ate those two, those four pancakes. And then he took my soda. And he took the toast that was on the table, and anybody sausage or bacon or anything, they had anything that was leftover, he asked to eat. And I, I was like, what is what is up? And so he had, we thought I had had him at a doctor's office twice in the last couple days, but we have to move to bring daddy to work, you know. So this is what we do. And we drove down, we dropped. My husband was my father in law, and I said, you know, I'm gonna go to Target afterwards. Because we don't live anywhere near where there's a target. Just so you know, there are places there's no targets. And every time I tried to go shopping, we had to go back to the bathroom. I was like, literally every five minutes. I don't even know what his blood sugar was, but he was graying. He was had to go the bathroom so much that I was like crying I pulled over on the way home like six times so he could I had a minivan so he could pee out the door

Scott Benner 1:14:13
right there's no way he didn't love that right? He probably did. Oh my gosh, you're saying it now and I'm like I want to do that.

Kelly 1:14:24
I wish I could but I hear you can if you get this certain little cup thing.

Scott Benner 1:14:29
Female I would find that freeing I believe to pull over on the highway and just pee out the door.

Kelly 1:14:35
Pretty much but I you know yeah, things are best years old and I'm a spastic. I have a two year old in the back. And then I have at that time my other my other child is eight. And we had had a rough time with her the previous year because she had a burst appendix. So I'm like super on guard mommy. Well, let me tell you. I'm feeling my son's belly. Is this tight? Does this hurt? Does this every day I at this point, every time he gets sick, that's what I would do. And he's like, No, I'm fine. I was like, then why do you have to pee so much. So, I actually had had gestational diabetes during my third pregnancy, okay, for my two year olds. And I had. So here's one of my ADHD moments when I went into the hospital to be trained by the nutritionist who also apparently is a type one diabetic. I was giggling because at that time, my son was three, three to four, somewhere between there. And he had just gotten diagnosed with global dyspraxia. But they had suggested I modify his diet to make sure he wasn't allergic to anything read to make sure he wasn't allergic to this, because he had always had stomach problems, like eternally crying, stomach problems that his stomach hurt. And this is years before he got diagnosed, you know, and it was just even as a baby, always crying, always giving something for his stomach. Always, I never slept anyway. Because and then I had another child. So it was just take this food away, take that food away, we went gluten free for a year, it did nothing. Like took all any kind of things with dyes. We did all this stuff. And in the process of going to learning about nutrition, I sat there with this nutritionist who's telling me that I have to do all this stuff. And he's looking at me, he's like, why are you laughing? And I'm like, so many months pregnant. And I'm just laughing because I don't know how to react to all the different diet things. Now I had to do that I was already doing for my kid. And I was like this. I'm laughing because life is funny.

Scott Benner 1:17:01
But as bad as I've been through worse, what do you think of that? Yeah, but

Kelly 1:17:07
I didn't say anything. I just I was uncomfortable. I was very uncomfortable. A this guy was pretty hot. Be I'm embarrassed and see I'm inappropriate at this point. So I say nothing. I just sat there, like, smiled and laughed a little. And I was just like, so he had told me some things, some signs that I had to look for. And these were all the signs that my son was having. Yeah. And he didn't know that he saved my son's life by telling this stuff. So several years later, guess who's our pump trainer? The hot guy.

Scott Benner 1:17:49
By the way, if girls were uncomfortable around hot guys, I think this explains why people are so comfortable around me. I just realized that now when you were saying I was like, Oh, that no one's ever been uncomfortable. Oh, then I was like, I got it. Alright, I say. So, okay, are you? I'm dying to know, Are you incredibly good at diabetes? Or do you struggle with it?

Kelly 1:18:15
Well, I hyperfocus That's it. I'm sorry. I spent the first couple months figuring everything out. And while my kid is MDI, I kept him so he's never been number one, his diagnosis before 10. Number two, his a one C was 7.8 a diagnosis. So I caught this early pretty early. Yeah. Because of the guy in my nutrition meeting, right? And then it just it saved his life. And I then went down the rabbit hole of diabetes. I didn't even I knew of you because at diagnosis, my doctors the nurse practitioner gave me your name the city city. She gave me your juice box and listened to Juicebox Podcast but at that time, we didn't have cable. We didn't have any of that stuff. We had HughesNet which is a satellite, okay. And I didn't have enough data to listen to you.

Scott Benner 1:19:17
That's nothing I can do about that. Kelly. That can't be my problem. But I understand the idea. Wait, what hospital by the way. Albany Med, Albany med. Okay.

Kelly 1:19:28
And Albany, med pediatrics. endocrinology is our doctor and they are amazing. We see a nurse practitioner Christine Wohlfahrt. And she is an amazing endocrine. NP. And she's awesome. And so is nurse Nancy and Kristin all of them. They are awesome. Let me just shoot them. Yeah. And so we also you know, Alex, I shouldn't have said it. Well, Alex is my son. Okay. Uh, Alex has I don't know, I've always been able to handle this. I've always managed, there was a lot of sleepless nights. Let me let me tell you, those sleepless nights were spent. I like literally stayed up for like five days straight when he was diagnosed and just read, read, read, read read. And here's the hyperfocus I can read that stuff if I have a desire, and it was constant and with in. So, two days after we came back from the hospital my son started vomiting. And I called up nurse Nancy. And she, she was like, Well, you know, just just do straight basil. And just give him sips of soda or sips of drinks and just stay there with him. But you have to make sure he gets insulin. So drink insulin, check blood sugar, and I was like, okay, okay, I got this. And I'm on like, freaking out. I sat next to him, his bed on the floor, the entire two days that he was sick. I kept him out of DKA. I kept him below 200. And he just had a stomach virus. There's just a fluke. But when he was diagnosed, one of the the, of course, you know, he had to be diagnosed on a day that was like an eight inch snowstorm. And I had no coverage for my kids at home because my husband had left to go to work. Yeah, and was already in the middle of the Atlantic Ocean.

Scott Benner 1:21:38
At this point. He has the global dyspraxia diagnosis already or Yep, yeah, that's already there. And am I understanding that correctly? I'm looking online here. It's also referred to as clumsy child syndrome. Yep. Confused matters more developmental dyspraxia. Basically, DCD refers to an overall motor incoordination. Yeah, like bumps into things.

Kelly 1:22:05
But so when he was 10 months old, he broke his arm. Okay, and we couldn't even figure out how he broke his arm. Because we had our mattress on the floor, and he had kind of crawled off the bed at me. i It was like, 11 o'clock at night, and I just went to the bathroom. And yes, my kids slept with me in the bed. And that's just what we did. Because he never slept anyway. So yeah, he broke his arm had a buckle fracture in his I think it was his right arm. Yeah, it is rest, right. That's where you get those? Yeah, yeah. And he had a lot of accidents that were just really fluke. Like when he was like to, I don't even know how he cut himself. He found a way to cut his hand so bad that he had to get stitches. And I was like, I was all I did was walk around the house, and we were playing hide and go seek it with my daughter. And I was like, I don't even know what you touched. Yeah, like, I couldn't find it. But I found bloody hand marks on the back door. And I was like, what happened? Where's my kid? You know? And, yeah, it was just always awkward things. And at this time, my daughter was getting speech therapy. And she was three years, two to three, she got speech therapy, and he was like 1011 months old. And the therapist looked at me, and Katie was her name. And she goes, Hey, Kelly, there's there's just something not right about Alex can just, he's not meeting. He's not meeting the milestones the way he should be. And I was like, Well, the doctor says, you know, everybody's different. So I was like, Yeah, everybody's different. And she, we then got him some help. After he was age. One day, the health department came in and assessed him. And he got speech therapy from Katie and both my kids at the same time. And they were both helped. But then all of a sudden, he qualified for occupational therapy. And so they come to your house where I live, and they do that, and it's all covered through the health department, because they're trying to help kids get to where they got to. And we're always going to developmental pediatrician at this point in Albany. And so, yeah, I'm slowly we got a diagnosis over two years, after a lot of assessments and then my son has, for most of his life, had yoga therapy, occupational therapy, physical therapy, because he also seems to have hyper joint mobility issues too. Okay. And he's, he grows so exceedingly fast also, which is a little bit unusual, but it's, it's good but he if he was to do like, say he was to run down the road, he fatigue so much his knees and joints hurt so bad. He stops and he his blood sugar drops like really fast. So more abnormally than a normal person or a normal type on there but

Scott Benner 1:25:12
the key I'm sorry, good.

Kelly 1:25:16
I was gonna say he just everything is quicker and faster he fatigues he gets shaky. Even before diabetics because of the global dyspraxia hands shaking. They once told me he'll never be able to ride a bike, he rides a bike. He'll never ever play with Legos. He plays with Legos, he'll never be able to write his name, right? Well, given time, he's still, in my experience, men don't have the prettiest handwriting. So

Scott Benner 1:25:47
what I'm seeing here symptoms of this can include poor balance, poor posture, fatigue, clumsiness, difference in speech, perception problems, poor hand eye coordination.

Kelly 1:25:57
Yeah, his speech was really delayed. I mean, when he would say I have videos of when I look back at videos, back when, when he was Wow. Like, he would talk like that. Right? It was it was different. So here's the thing, global dyspraxia, just like everything else, there are. Everybody has. There's a severity level and less of a severity level. Every time they've said we can't do something he does it. So

Scott Benner 1:26:28
Harry Potter has this. The actor the actor? Yeah. Interesting. Yes. A lot of people do. Right? No, it's actually the thing I was reading says that five to 18% of the population may have it. Yep. That's interesting. All right.

Kelly 1:26:43
I believe it comes under the bracket of dyslexic diseases are developmental delays, not disease.

Scott Benner 1:26:52
And so it's not that I haven't enjoyed this. But back to my original question from 10 minutes ago. How are you? It's funny. I was having a good time. How do you end up managing like do you hit your goals for his blood sugar's what are your goals?

Kelly 1:27:09
So here's the deal. I keep his goals 85 to 180, because we, the doctor and I have talked about it a lot of times, like when I will check him, his blood sugar's always significantly lower than the Dexcom says, and we think that there's, so here's the thing that goes with this. He also has, like, it's not gastroparesis, but it's a slowing of the intestines. But we've started to think that it has actually everything to do with global dyspraxia, not diabetes, the all the motor skills, motor movement throughout the body is less. So we think that he has his blood flow and everything might just be slightly slower, slightly less.

Scott Benner 1:27:58
So the process of his waist coming out is slowed.

Kelly 1:28:04
Yeah, okay. Like I said, he always had stomach issues. He's always had so many issues with the stomach before we even got diagnosed. So it was always trying to figure out what he was allergic to. They did allergy testing, they said, pretty much nothing might be sensitive with milk. Have you

Scott Benner 1:28:24
tried, I'm gonna end up saying this a lot, because it's been helping Arden but have you tried something simple, like digestive enzyme along with his meals to see if it moves things through better?

Kelly 1:28:35
You mean a probiotic?

Scott Benner 1:28:37
No. More specifically, there's, there's like digestive enzymes there's, you take them right along with the meal.

Kelly 1:28:46
And no, I haven't tried this. Yeah. I'll take the suggestion though. Worth a

Scott Benner 1:28:50
shot. I mean, you just kind of pop them with your with your food. Okay. And then if he's not eliminating on a good schedule, adding maybe like magnesium oxide might be valuable. We have

Kelly 1:29:05
added magnesium, magnesium oxide did add magnesium. I don't know if it's oxide, though. Check. That's just magnesium. Man. And so he gets a leg pains, a lot of leg pains throughout his life. He's always had severe leg pains. But he's also he's 11. And he's 511.

Scott Benner 1:29:25
Yeah, that's hard to know. Well double check the magnesium because there's a couple of different versions and magnesium oxide is what you're looking for to go to the bathroom more frequently.

Kelly 1:29:38
They have him on MiraLAX eternally, like he just takes me relax every day because if he doesn't, he has that whole slowing. And so he'll go super high. And then when he actually eliminates he'll go super low. But for him it's like I've found him at like 29 So

Scott Benner 1:29:56
like quickly happens fast. It does Yeah, cuz his body When he empties out, then his blood sugar drops, right? Yeah. So they have him on a laxative. Does the laxative work or not really?

Kelly 1:30:09
It does. It does so, and everybody swears it's not bad for him. I've read a lot of reports, I've gone back and forth, but this is what helps. And I don't really enjoy the low blood sugar like that. No, of course. So like, I will go in there and it will say he's 85. And he might be 40. So it's harder, and has a one C has always a sense diagnosis, his first visit after being diagnosed, he was 6.2. And then he was five point, I believe it's 5.6. But last, last, a one C was 5.6. The one before that was 5.2. We've always stayed between 5.2 and 5.6. Am I am maniacal controlling person I might be. But I also we loop also, at this point.

Scott Benner 1:31:09
Sounds like you're doing well. You really does. Yeah.

Kelly 1:31:13
We don't have a lot of side effects with things. But I take things a little bit more serious than other people do. And my husband just backs me up. He's the tech guy. He he codes on his own anyway, building systems and stuff. And I am I'm just more medically capable. That was what I was gonna go to school for. So

Scott Benner 1:31:34
Gotcha. Well, here's something very quick about magnesium. I'm reading from a health line article. Because of its low absorption rate in your intestines. Magnesium Oxide may lead to digestive effects like diarrhea, so if you're not going, it gets you're moving it strong laxative effects are why it's commonly used to treat constipation. Jumping ahead a little in the article. In contrast, magnesium citrate, magnesium acetate, I'll tolerate magnesium malate, and magnesium glycinate all have high absorption rates, and are more effective at increasing magnesium levels. So if you're trying to actually bring your magnesium level up, you don't use oxide. But if you're trying to make yourself go to the Poopoo oxide is the way to go. And sometimes doctors get that messed up. So check the magnesium to make sure you have the right one.

Kelly 1:32:23
So we're not using magnesium to help them go. Number two, we're using the magnesium to stop the leg pain.

Scott Benner 1:32:31
Is it but is that working for that? Yes. Okay, good. Well, then maybe that's maybe you could do some magnesium oxide. In addition, yeah, it would be my was what I would wonder and digestive enzymes are I'm just gonna pick one that I'm aware of a second the company called Pure that makes it I mean, a lot of people make them but I'm choosing that one to try to find the find what's actually in it for you

why not? Tell me Give me a second

you must be thrilled that like something about your personality is actually helping with something like with diabetes, right? That's pretty cool.

Kelly 1:33:38
It's it's very encouraging. And because of my searching because of my hyper focusing, which actually I'm trying to kind of get away from sorry, that's my text messages. That's

Scott Benner 1:33:52
okay. That's what happens. You get a text.

Kelly 1:33:55
Yeah, that's my I love that. I love that. That movie.

Scott Benner 1:34:00
What's it from? I couldn't hear it. It just sounds like kids.

Kelly 1:34:03
What is it? What is that guy? Steve Carell movie. This is how I do things with a

Scott Benner 1:34:12
ripoff. cartoon. Oh, a cartoon.

Kelly 1:34:15
The cartoon is the Steve Carell movie where he's, he's the bad guy, but he's really the good guy and he adopts his little girls.

Scott Benner 1:34:21
Oh, he's grew like crazy. Yeah. Stuff like that.

Kelly 1:34:27
That's the little girl screaming. I'm so happy about my unicorn.

Scott Benner 1:34:33
Alright, so I'm looking specifically at the pure encapsulations version of the digestive enzymes they list 391 milligrams of proprietary. Enzyme blend, amylase protease protease six lysosome lays lactase Lepus beta glycinate I'm not I'm butchering these words in Virtus cellulous Alpha Gala, Tosa. Oh my goodness. protease three phytase, and people who know how to pronounce these are probably like Way to go, Scott. He must cellulous. So I don't know, honestly, what any of that is, what I can tell you is that Arden was digesting your food slowly. And we went to a regular doctor who, like, immediately turned us off by like acting like she was gonna need pain medications and all this stuff. And we were like, Wait, what the hell like this all seems very like, like a big leap, you know, not something she'd want to do. So we added these, these enzymes to her meals, and the magnesium oxide to her diet to help her go better. And she had a real great like, change. We bumped into a little bit now when she's at school, there's so much fried food in the cafeteria, that she's starting to kind of like even though she's taking this stuff, she's having some troubles. So we actually talked to her last night and said, you know, let's cut things out with oil and fried stuff, like and she's like, that's gonna be hard here, but do that. And I think she's got some stress to be in a college, you know, for the first time. So but I'm telling you that for months, this was when she was on a reasonable diet at the house. This stuff was helping just 1,000,000% So it's not expensive, and it's worth giving a shot to you. So good luck. Yeah.

Kelly 1:36:29
I don't we don't even do any fried foods here. Really? Yeah, ever.

Scott Benner 1:36:33
Yeah, we don't normally either. And then, you know, she's, I think she's realizing like, she's picking stuff up in the cafeteria, and she's not paying attention to how it's cooked. And so we had that conversation last night to pay attention to that.

Kelly 1:36:44
But that's how you get the freshmen 10.

Scott Benner 1:36:47
Well, it's how you, it's definitely how you eat a bunch of oil that you don't realize you're eating and it's not good for you and hard for your body to process. So Kelly, let me ask you if there's anything we haven't talked about, that you meant to because we're up on time.

Kelly 1:37:01
Oh, um, oh, I was gonna tell you about the diagnosis when he was diagnosed. That affected my, yeah, complex, complex. PTSD, tell me because when he was diagnosed, I had to leave him at the hospital without me to go home because I had had to ask my brother in law to come get my daughter from school. And I had my two year old with me. And I don't do hospitals very well, at all. Since since forever. But because I was so highly abused in a car. I couldn't get in the car to go home. I had to like work myself into the car to get home to leave him. I see. And it was a struggle. And it really affected me. And it was like the first time that I had to deal with the abuse in yours.

Scott Benner 1:38:06
Oh, I see. Okay, so the PTSD kind of just triggered you. And then it brought back your desire to not be in a vehicle because this is where the guy would yell at you and hit you. And so when your son's diagnosed, the eight you get better whatever happens happens, and then all that stuff comes back. Well, it's interesting.

Kelly 1:38:27
And that's like the first time I actually had to kind of confront a little bit of it with my husband.

Scott Benner 1:38:33
Oh, because all of a sudden you can't get in a car. And that doesn't make any sense to your husband.

Kelly 1:38:38
No. For years, I've told them please don't speed around corners and stuff it I get like I get like, I guess I get nauseous. Okay, yeah, nauseous in the car. But if I'm driving car, I have no problem. There's some control things. But when I was leaving that day, I just broke down and fell on the ground. And I just couldn't deal with getting in the car. And I'm putting a two year old in the backseat going I can't believe this is happening and I can't believe leave my kid. And I can't believe I have to trust these strangers, which I don't trust anybody because of all my experiences. Sure. And I just struggled so much just to get in my car and drive. And then of course it's snowing. Eight inches. It took me it's usually only an hour drive to Albany, but it took me like three hours to get home. And then three hours to go back. Yeah to be with my kid. Oh, that makes sense.

Scott Benner 1:39:39
Yeah, but so it makes sense that it takes longer and at the same time. You're you're staying away from him longer because it's taking you longer which is also making you upset. Yeah, well that's a vicious circle.

Kelly 1:39:53
It is. But yeah, I I just focus on everything and That's what it is. And he's got a lot of support at school. He has a one on one aid with him. 24/7. Yeah, he's a smart, smart kid, by the way. No, I imagine. He's a smart kid. He doesn't believe that he's smart, because he's always been stuck in those special classes with other kids. Yeah, I understand that that's a little frustrating. And this is probably the first year that he's actually moved into the normal population completely. No Good for him. That's excellent. So yeah, and but he has an aide because with the global dyspraxia in his hands, he sometimes shakes and he can't, the fine motor skills just when he's in a situation, you can't tell if it's the diabetes, or if it's global dyspraxia? Oh, I see. He may need somebody to dial into his phone for him.

Scott Benner 1:40:48
Okay. Oh, I do understand that. Okay. And so somebody, he has an aid for that?

Kelly 1:40:54
Yes, he does. He has an aide 24/7. And, you know, the nurses are always just because he's also coming into his own where he wants to do everything himself. And it's been a bit of a struggle. And recently, we've been dealing with some like, hey, you know, we are not with you. And this, the sitter didn't know that you gave yourself six units of insulin. Why did you give yourself six units of insulin? And then take another 14? No juice, yeah. Oh, within a half an hour. And he was like, what? And then he's like, I'm like, Yeah, tell me that you deleted something in there. Because I'm thinking you did. He's like, Well, and I'm like, we don't really like using basketball me. But it's just little things like that, that he wants to take on himself. And I'm bold with insulin,

Scott Benner 1:41:48
like, you know, he's struggling. He's struggling to do stuff. He's,

Kelly 1:41:51
he's struggling to do stuff on his own. Because, you know, he's, he's 511. And all this responsibility is put on him. And people think he's way older than he truly is. He's 11. Yeah. And it's, it's a power struggle recently. And

Scott Benner 1:42:06
he's got his body, but not the mind for it yet. Correct. Yeah. What happened to my niece? By the way, I hope this doesn't seem like I'm turning this into a story about me. But that's a reference at the beginning of our conversation. But my niece got really tall very quickly. And it was hard not to treat her like she was older. Because standing in front of you, it felt like she was interesting. Yeah, I see that. And then he got this other, plus the hand eye coordination thing and everything else that's happening.

Kelly 1:42:36
And I mean, developmentally, he's, he's, he's more where he should be developmentally. But he's all masculine. And he wants to be a tough guy kind of thing right now. Yeah. The only boy here when dad's away. And it can be a little overwhelming on me. And more recently, I mean, literally, in the last two months, he went from five, nine to five 511. And it's like, when I say, Hey, you actually have to take care of your room. And if that means filling your diabetes shelf up with your stock, that means you're doing it, right. And it's just, you know, you got stuff like that.

Scott Benner 1:43:17
I hear. Okay. All right, Kelly. Well, I can't thank you enough for sharing this with me. I'm sorry to push you away real quick. But I have to jump on a different phone call. So I'm good. I'm up on my time. But I I don't know why I didn't realize this was going to be an after dark episode. But here we are. It definitely is. And I'm, I mean, I'm, I don't obviously I telling you, I'm sorry, for what happened in your life is meaningless. But it was it was nice of you to to share it with everybody. So that they can, they can can listen along and maybe, you know, recognize some things that have happened to them or to other people in their life. So I appreciate it very much.

Kelly 1:43:56
Thank you for having me. No, I was and I'm happy and I'm safe. And I'm sound

Scott Benner 1:44:01
No, I know, it's the hardest thing about these conversations. When people go back into their past to relive things you can kind of get like, you can think like, oh, that's happening right now. But you were describing stuff that had happened to you in the past, which is obviously incredibly impactful, and it's impacted the rest of your life. But at the same time, you're not in that crisis at this exact moment. But no, I'm in a great place. Yeah, absolutely.

Kelly 1:44:26
There's hope for everybody out there there's hope get help and and Domestic Violence Crisis Center. They are there to help you. They will get you through it. And they give you a lot of work for you to get through life. And then I've just I've just isolated myself more and how could you not during the pandemic, but I live on a homestead I homestead and I have chickens and there's goats down the road and horses and cows and I farm.

Scott Benner 1:44:53
Nice. That's excellent. And I kept thinking while you were talking how 20 more years from now, how much farther away that'll feel Oh, it will. 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 juicebox. I'd also like to thank Ian pen from Medtronic diabetes and remind you to go to N pen today.com And of course, touched by type one.org. A really sincerely wonderful organization that you should learn more about touched by type one.org. Thank you so much for listening. I'll be back very soon with another episode of The Juicebox Podcast.

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#806 Dexcom G7 Approved By FDA (with Dexcom COO Jake Leach)

Dexcom COO Jake Leach is here to talk about the FDA approval of the Dexcom G7.

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 806 of the Juicebox Podcast.

What we have here is a bit of a Christmas miracle it seems. On December 8 2022, just yesterday, the FDA announced approval for the Dexcom G seven. And so of course, I have Jake leach here today to tell you all about it. Jake is the Chief Operating Officer at Dexcom. But more importantly, he's worked there for nearly 20 years, and his understanding of all things Dexcom is fascinating. I mentioned at the end of the episode when Jake and I finished talking, but I'm throwing questions at him from like, accuracy. You know, when's it gonna be available? How did you make this? What do you plan on doing about that? And Jake, just man, he just has the answers. Absolutely fantastic. It's a great conversation is only 30 minutes long. But it's a ton of questions that came right from you, the listeners a few of my own, and all of Jake's answers. So settle in, and enjoy. 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.

If you're new to the podcast and you don't know anything about it, you should hit subscribe in your favorite audio app, Spotify, Apple podcasts, Amazon music, wherever you get your shows, follow or subscribe. The Juicebox Podcast puts up new content four times a week, Monday through Thursday, you'll hear interviews with an adult living with type one, or a parent of a child who has type one. And we talked about all kinds of stuff. For instance, there's an entire series of after dark episodes where we talk about topics that most people don't talk about. There's ask Scott and Jenny where I and Jenny Smith CDE, who has had type one diabetes for 34 years answer your questions. We have entire episodes about algorithm pumping on the pod five control, IQ and looping. There's the bold beginning series for people who are just starting out with type one diabetes. And all of the questions and topics were suggested by listeners of the show when they were asked, What do you wish you would have known in the beginning, there's the defining diabetes series, which is just every conceivable phrase and term that you'll use with type one explained in short, fun, understandable episodes, we define thyroid issues in the defining thyroid series. Talk about the different variables that impact your blood sugar's than life. In the diabetes variable series. There's an entire mental wellness series and heard about it. I wouldn't be surprised that diabetes Pro Tip series from the Juicebox Podcast, I could explain to you what it is. But instead, I'll read you this. And then we'll get to Jake, and the Dexcom g7 excitement. This is from a listener. My son was diagnosed type one about five months ago, I have learned so much from just the pro tip shows, and I will be listening to all of the episodes. This podcast is amazing, both for the information and for the shared experiences from Scott and his guests. They make you feel less like you just got hit in the face with the shovel. And more like you can find a way to keep your loved ones happy and healthy. Check out the diabetes Pro Tip series at juicebox podcast.com. Go to the top in the menu where all the series I mentioned and much more are listed. Or you can go right into your audio app and search Juicebox Podcast pro tip. And they should all pop up right in front of you the first Pro Tip series. Is it episode 210. It's called newly diagnosed or starting over. Yesterday, I woke up to an email about g7 being approved by the FDA. It's a number of months. If I'm being fair. It's a lot of months since it was approved in Europe. That surprised me. Did it surprise you?

Jake Leach 4:21
Yeah, it did. Yeah, we anticipated those two review cycles to be similar in time. And so our goal was to launch the product globally around the same time but the approval in Europe came as expected and the FDA approval took a little longer than we anticipated. So it did yeah, it very happy to have it now very excited to get the product in users hands now but it it did take a little longer than expected.

Scott Benner 4:49
Okay. Can you tell me why? Like what the

Jake Leach 4:53
primary reason was we had to, we had a feature in there called silence All that we had to remove it's it's in the product, it's outside the US, but remove it from the US product. It's basically a feature that allows users to silence the alerts for up to six hours. You know, so that if they're in a situation where they understand this, basically, I got it, I don't need to be alerted by my CGM. At this point in time, I'm gonna, my glue is gonna be high for a while I know that it's low. Really just silence those audio alerts, the FDA wants to see a little bit more information before they get comfortable with that. So we basically had to take that out of the product. For the US for now, we intend to put it back in very quickly here, working with the FDA. But that was the reason why the review took a little longer, because we had to actually make that change and then respond to the FDA with the changes.

Scott Benner 5:47
Well, it's interesting that it's making a change responding with all that all the backroom stuff takes that many months to get accomplished. It's, it's really crazy. Alright, so why do you like that feature? Why did you want to add it.

Jake Leach 6:02
So it's a highly requested feature by users, because they while they love their alerts and alarms for glucose, and the other aspects of the product, they, they, when they understand their glucose is out of range, they don't always need to be reminded every 30 minutes. And so with some of the particularly the low alerts, it'll continually remind you even if you acknowledge it, pick, you can only acknowledge, acknowledge it, and it'll come back in 30 minutes. So that is the primary reason it's really strong user request. And so we are getting very good feedback about the feature outside the US. And like I said, we intend to bring it in as soon as we can.

Scott Benner 6:39
Okay. I'm gonna ask you to be paired to you. If there's anything you want to say before I hit you with a delusion of questions that people gave me to ask you. Do you have any app happy

Jake Leach 6:49
to answer all the questions, but just wanted to share in the excitement of the community, and you know, everyone who we now have, you know, g7 approved, we're working very quickly to get it out. Early 2023. And my say early means quite early. And we be on the heels of Medicare, the CMS recommendation for coverage for folks, Basal insulin, so not just intensive insulin anymore. So really a lot of expanded coverage for use of CGM. On top of that you see the g7 approval. So could be more exciting time. For Dexcom. And for the community in general,

Scott Benner 7:30
is the Medicare distinction, a first step to private insurance accepting those ideas?

Jake Leach 7:36
Yeah, absolutely. Usually Medicare leads. And then private insurance generally follows quite quickly after that. And so its expansion of CGM to many people who could benefit from it who weren't previously covered.

Scott Benner 7:49
It. Is that an early step towards getting type twos covered?

Jake Leach 7:53
Yeah, so that that Basal coverage is type two. You know, most folks on Basal insulin are type two as well as anybody would take to it there has hyperglycemia challenges. That's also part of the recommended recommendation from CMS to Medicare. So yeah, and then there's, there's still, as you mentioned, there's still a group of type two individuals who would not be covered by Medicare. But that's our next focus, we want to focus on how do we get coverage because we know CGM has clinical benefit in that population. And so do it basically generating the evidence that's required to show that to payers,

Scott Benner 8:30
in my mind, getting it on to type twos without forcing them to get into a situation where they have to use insulin makes a lot of like, health sense to me.

Jake Leach 8:39
Absolutely. And I think we're a years from that. Um, you know, nothing ever goes as fast as I want it to go. So, you know, I think there there's, you know, a lot of folks are you know, CGM, it's continuing to expand and there's a lot of folks are working through, you know, glucose programs, the level two program at United is an example of, you know, an insurer, basically taking CGM and using it strategically in their type two population, to generate better outcomes. And so there's, there's gonna be a lot more to come over the coming years here.

Scott Benner 9:12
It's exciting. I've been interviewing a lot of type twos lately, and all of their successes seem to come from when they start to think about their type two diabetes, like type one diabetes, and they start using insulin in targeted ways, and they have all these great improvements afterwards. So anyway, that's way off the track for for a conversation where I only have here for 30 minutes, but well ask the big questions that I imagine you know, everybody wants to know, right? When early 2023 That's great. Will you have will it be like a wide rollout or is it going to be one of those things where you know, like, three guys at Tesla drive in the car and nobody else has one?

Jake Leach 9:51
It is a great question because, you know, we, we often do limited launches to make sure we got every word comfortable with everything the support of the product, the product itself. But we had the opportunity to do that overseas in Europe. So we did a limited launch there. And then we moved into full launch. And so our US launch will be full launch. We don't intend to constrain it. We feel comfortable with the amount of product we have as as well as the timing. So it's basically going to or early 2023, it's going to be generally available.

Scott Benner 10:25
Do you think it will create more initial customer service needs? Or do you think that the ease of use might actually take back your your need for CSR coverage?

Jake Leach 10:36
What we're seeing with a g7 o u s, is that it definitely has resolved a number of the things that we experienced with the G six launch that needed support. Any new product generally requires some level of new education. And so we were ready for you know, we have the support, we've done this is the seventh time we've done a product launch each one's bigger, but we learn every time we do it. And so we learned quite a bit from our G six launch about the expectation and customers and the support needed. And so we'll be ready for for it. We've been handling the European launch quite well. And so we're we'll be ready for us.

Scott Benner 11:17
Alright, well G six transmitters can continue to be made. And do you have Is there a timeline for that not to happen are

Jake Leach 11:25
we basically will continue to supply we are planning capacity for G six will continue to supply that product until everyone has transitioned over to G seven, the the folks that are kind of some of the end customers that were waiting for compatibility with G seven, those folks will definitely we've always loved sensors and G six transmitters as needed for that tire group until everybody shifts over we do intend to roll out G seven faster than we did G six globally in terms of, you know, kind of upgrading everyone up to the g7 product and so, but we'll we'll continue to make GSX as long as we need.

Scott Benner 12:09
Sometimes I noticed when I asked people hey, if you have questions for Jake put them here, sometimes I noticed you see their fears in the questions. And some of the questions. I think, if they weren't afraid they wouldn't ask, but this is one that I think I'd like to cover anyway, I know the answer. And I have no idea what the answer is. But a person asks, every time I changed my my G six transmitter right now, I kind of have to go into my pump and tell it I've put on a new transmitter. And now they're hearing that the g7 every device they put on, it basically does its own transmission, and they're worried they're gonna have to go into the pump, but that's going to be automated, I imagine.

Jake Leach 12:45
So there's a couple of things there. So we'll start with the, with the pump. So one of the things, advancements with G seven is there's a four digit pairing code. And it's just numeric. It's not alphanumeric, so there's only four numbers that identify the transmitter you're trying to pair with. And so there's some sophisticated analytics under the hood there that make allow us to do that. Because clearly the identification number for the transmitter is quite a bit more than just four digits. But the pairing code is four digits. So with a pump, you have to you do have to enter in the four digits. But because that's a more frequent process, it'll be more easily accessible on the mobile phones, the actual applicator has a QR on it, that you can just quickly take a picture and it loads all that information into the into the display device

Scott Benner 13:39
processes is sort of it happens quickly during it. But it's not some great thing where I'm scrolling through screens and that kind of No,

Jake Leach 13:46
it's designed, it's something that you have to do it. But it's very simple. And that's why we put made the pairing code we reduced it so that it would be even simpler for users. Cool.

Scott Benner 13:58
Well, people still be able to calibrate a g7 if they want to.

Jake Leach 14:01
Of course, yeah, absolutely. Yeah. Is it that feature is still there, if you want to use it

Scott Benner 14:06
is the adhesive on g7 the same as the adhesive on G six.

Jake Leach 14:09
Now it's different. If you look at the patch, it may look very similar from the surface, but it's actually a new, new adhesive. That is we've seen in our early clinical studies as well as early performance outside the US that there's less irritation with with the sensor patch. For those, you know, the very, you know, it's a small group of folks that there are folks that do have, you know, patch rotation issues. And so we've seen a reduction in the number of that. And the occurrence rate.

Scott Benner 14:39
Is there any chance that this is the time you're going to tell me that it's going to work directly to an Apple Watch.

Jake Leach 14:47
Not not right out the gate, Scott, but it's not far off. We built it into the hardware, we finally have the capability to have that directly in the g7 hardware. And so it's going to be an app release that unlocks that feature

Scott Benner 15:01
makes me remember, you know, you might have context for this when I was young, Kevin Smith, the film director was like blowing up. And he used to have these little private film festivals. And every year, I'd go to one that he would hold. And there was a, you know, you'd say, Hello. When you get there, you start to know them after year after year, people recognize each other. And the last time I ever went to one, I shook his hand, and I said, Will you tell me when I'm too old to come to these? And he said, if you tell me when I'm too old to make these movies, and I just had that feeling in my head, like, you and I are like, you're on the edge of retirement. I've been making a podcast for 20 years. And I'm like, is it gonna work with the Apple Watch? I don't know why that popped into my head, or why wasted time with it. But it just delighted me just now what I was thinking about. Alright, so it's built into the architecture at this point? Yes, absolutely. Yeah. Bluetooth architecture has been updated to include it. Do you expect that to happen with the g7? Yeah, absolutely. Okay. Yeah. All right. What's happening to the apps? Right, now we're gonna get a new, like, will a g7 users gonna get a new app? But will the followers like what all is going to happen there?

Jake Leach 16:08
Yeah, so the g7 plugs seamlessly into the end of the architecture. So when a new when, for example, when the user basically upgrades from G six to G seven, they actually use their same G six username and password. They enter that into the g7. And all their data is still in there clarity, still links in so now G seven is just updating their data, it also moves over their settings. So similar to when you enter your past user name and password into a new G six app, it remembers your previous settings, G seven, does the same thing. So it makes it easier, easy for customers to transition over. And then the followers, clarity app, all of that just they work. You don't have to get a new one. It works with g7, will you be updating the follow up? We will we've So over the past couple of years, we've been kind of laser focused on rolling out G seven, basically getting it ready for global launch as well as our Dexcom. One product. So both of those are on this completely new software platform. So we've been spending a lot of time our teams have been focused on that. But as we were rolling, we've been rolling out Dexcom one g7 has now got our US launch coming in a few more rollouts globally, through the 2023. In early 2024. The team is going to be we're going to be able to focus a bunch of the resources on continued innovation in the both the follow space clarity, as well as the g7 and Dexcom. One app, so bringing more features to those. So you'll be seeing a more rapid cadence, we've built a lot of software capacities, you know, basically the capacity to develop software to be able to do both Dexcom one ng seven at the same time. And across the globe. So we get a lot of capacity we can unleash on new features.

Scott Benner 17:56
Give those people something new to do. So at launch, no delta, no rate of change.

Jake Leach 18:02
No rate of change at launch. Not yet. Not yet. But it's on the list

Scott Benner 18:06
on the list for the new app. Okay. Android as well, right? Android? Oh, yeah. Yeah, okay. Yeah. How? Where do you, it's just kind of gets away from G. Seven for a second. But it doesn't really open access for things like looping sugar, pixel glucose, stuff like that, is that you guys? Stay in the course on how you think about that?

Jake Leach 18:33
Yeah, I mean, we've always thought about it in terms of, we want to have as much accessibility as we can. And so that's the reason why we have our API's. It's the way we do our partnerships. So I think it's, you know, we, we've always kind of embraced the community, the innovation in the community, and all of the great stuff that's being done there. And so, you know, we walk a fine line between, you know, regulated devices, and in making sure that users get access to their data. So our philosophy there hasn't changed. So while new systems do, you know, things change with new systems, for in all kinds of different aspects, and so there'll be no work to do for compatibility for anything, but we definitely understand how important some of those systems are to people.

Scott Benner 19:22
I think every time you make some sort of an announcement about something, excuse me, it brings up anxiety for people who loop or, or something like that, like they think like, is this going to be the time I wake up and it just doesn't work anymore? So it's nice to hear. Accuracy stuff first. 24 hours? Same better different than G six.

Jake Leach 19:42
Yeah, it's, it's, it's a little better. You know, it's still the lat the first day is, while good, the days after that are even better, in particular with the seven with the 8.2% Ameri D in the ice CGM. US study that's, you know, most most accurate I CGM data ever produced so we are very excited about that and so G seven is you know it's it's based it's based in the technology that we've been working with with G six and other generations but we've made quite a few enhancements both to the sensor probe and as well as the glucose algorithm

Scott Benner 20:22
that mark number is that just for arm where is that anywhere that it's okay to where

Jake Leach 20:27
it's arm, its arm where so it's 8.2% and adults 8.1% arm were in in peds. And then with peds, we also have the upper buttock location indicated.

Scott Benner 20:41
Okay, how about somebody is asking me about accuracy at higher numbers when people are fighting with high blood sugars. Do you see any improvement there? I guess I should just ask you how you see this as an improvement over GSX? Really?

Jake Leach 20:55
Yeah, it's what it really is, is it's all about even more consistent sensors, right? When you look at a population of sensors, in a clinical study, you know, it's not like every single one has an MA or d of eight, you get some with, you know, Emiratis have four and some of the you know, in a particular individual or particular sensor, you want to get to be, you know, a little bit higher than that. So, what we're seeing with G seven is there's less outliers, it's more it's a tighter distribution of performance. And so that's one of the things that really helps drive down overall system performance. Because the M or D number you see is it's a average across a an entire clinical study.

Scott Benner 21:33
So if I said to you just do a clinical study of day three today, eight, you'd see a better number than me making you put in my entire 10 day where yeah, of course, yeah, that's how

Jake Leach 21:45
people game CGM systems, right you do. You do a clinical study and don't do any data on day one, or you don't do any hypoglycemia data. I mean, there's there's all kinds of ways to game clinical studies, the ice CGM criteria that the FDA said basically specifies exactly how you're supposed to run your clinical study, which is why it's a rigorous standard.

Scott Benner 22:05
My buddy's a good guy, if you don't think about the fact that he takes our wallets when we're together. Have a look at the whole picture. All right. Out of pocket costs, is it going to be similar to G six. So this episode doesn't have any ads on it, because it came up rather quickly. You know, the Dexcom G seven announcement was yesterday came out of nowhere. I wanted to get this episode with Jacob for you right now. And I've already I've already done all the ads I need to do this week. So I don't have any left. But I do want to just take a second to acknowledge that I'm able to make this podcast and on a Friday afternoon, surprise recorded episode with Jake leach from Dex calm and get it right online for you. Because this podcast is my job. And it can be my job because of the sponsors. They keep they keep the whole thing going, they keep the lights on they helped me pay my bills. And I want to give them a second because it's the end of the year. And we've had we have a lot of great sponsors. And I want to take a moment to thank them for their sponsorship in 2022. And to thank the ones who were staying with me for 2023 and they are on the pod makers of the Omni pod tubeless insulin pump and that Omni pod five automated system, you can learn more about it at Omni pod.com forward slash juice box. Of course Dexcom is a sponsor dexcom.com forward slash juice box. Another sponsor of the show is the Contour Next One blood glucose meter. My daughter has been carrying this meter forever. It's absolutely terrific, incredibly accurate, and you can learn more about it at contour next one.com forward slash juice box. If you want to use the glucagon that my daughter carries, you can get ge vogue at GE Vogue glucagon.com forward slash juice box check out that GE Vogue hypo pen. US med is where we get our diabetes supplies us med.com forward slash juice box or call 888-721-1514 They carry all the latest supplies, but check them out. And last but not least touched by type one is a beautiful organization supporting the dreams of people with type one diabetes at touched by type one.org. I'd also like to take a moment to thank in pen from Medtronic diabetes for their support in 2022. They won't be back in 2023. But that's okay. They were a great great supporter of the show in 2022. And one of the reasons why you were able to get the show so plentifully and for free, and while I'm thanking people, I have a new sponsor in 2023 athletic greens. If you're looking for that AG one from athletic greens, a green drink that actually tastes good, athletic greens.com forward slash juice box, there are links in the show notes of the podcast players you're listening in right now, and links at juicebox podcast.com, to all of the sponsors, and they're not a sponsor. But if you go to the T, one D exchange AT T, one D exchange.org, forward slash juice box, join their registry and fill out their survey, you'll be supporting people with type one diabetes, and helping to move diabetes research forward, you also end up supporting the show by completing the survey. So they're not quite a sponsor, but you are supporting the show when you complete the survey. I want to say again, that this podcast is it's a full time job, it is a ton of work. And without ad support, this would not be my job. And today, you would not be hearing this information. And I'm very grateful for the people who support the show. And for the people who support the sponsors, if you have the need. And I have the advertiser, I hope you use my link, because it's actually a huge help. Let's get back to Jake.

Out of pocket costs, is it going to be similar to G six?

Jake Leach 26:22
Yeah. So yeah, basically out of pocket cost coverage? So that's a really good question, Scott. So we anticipate a GS six ng seven will be very similar. In the beginning, though, when you launch a new product coverage is, you know, some there will be some coverage. And then it continues to build over time. And so we've the second we've got approval, we can now start kind of finalizing all of those agreements with payers, Medicare appeals. And so what we we do intend, though, even at time of launch to have some very accessible cash pay options for people whose coverage hasn't quite kicked in there, they can stand at six for, you know, until they have their g7 coverage, or they can switch right over and we'll have some, like I said, very accessible cash paid pricing for them.

Scott Benner 27:07
Can people still soak their sensors with g7? Define soak, they want to put them on and wear them for a few hours before they start them?

Jake Leach 27:17
Yeah, yeah. Now you could do well actually on to be real precise their ID, you can insert a g7 sensor. What happens is though, the second you insert it, it starts the sensor session. So all of that information is being recorded on the display device, or I mean, on the g7 itself. And so you know, it has the 30 minute warmup time, as soon as 30 minutes goes by, after insertion, it's going to start calculating and saving data. When you pair it to it. It'll be up and running.

Scott Benner 27:46
But if some so if I'm wearing one now, and I and I say this one, I don't know it's done in six hours. I want to put this one on now and let it soak. But as soon as I do that, do I lose the first one I'm wearing? Or I can just decide to just watch the first one while they are just losing the life of the second one during that. Yeah, exactly.

Jake Leach 28:07
That's it. Yeah, use the none of the devices, whether it's an insulin pump, or zebra or phone, they don't talk to to CGM to, you know, she says the same time you said you have to you have to switch over. When you're ready to the other one, it's just it's more around the unique feature ng seven as the auto start the second you deploy, it starts session, which is great, because I've talked to customers who would insert sensors and then forget to start their session and then realize, Oh, now I started, I have to wait two hours before I have data. So the g7 is much faster.

Scott Benner 28:38
I've not pushed that button once or twice. Will is this gonna be a pharmacy a DME? Both just one? Oh, yeah, we

Jake Leach 28:46
have customers that get product through different channels, you know, vast majority of get product through the pharmacy. And so we'll continue to push that. But we also support DME for for Medicare and for men and for others.

Scott Benner 28:59
If I'm in a household where multiple people have type one diabetes, can I follow a G seven and a G six on the follow up at the same time? Yes, you can. Excellent. See how easy this is tick. I can't believe people are so kind like just yesterday, I was like give me questions. I have enough questions here. We could make a training manual for everyone. So can alarms be silent for certain durations of times? That's going to be a no right now. Right?

Jake Leach 29:24
Right. It's basically the ability to sounds Alerts is just like GS six, but we are we do want to bring that feature. It's on the short list of things to put into the US product. We're working closely with FDA to get them comfortable with it and then we'll get it out very quickly.

Scott Benner 29:40
Your new readings every five minutes. Do you ever consider doing it? With I mean every minute or why is it every five minutes I guess.

Jake Leach 29:51
It's basically it's kind of a it's a balance of a lot of things like like almost any kind of engineering design project. There's a you're balancing multiple things So the system measures glucose continuously all the time, it's not like every five minutes, it takes a measurement, it's measuring the entire time you're wearing the sensor, it's just every five minutes is when the glucose reading is communicated between the wearable and the display devices. And so that's kind of a balance of, you know, battery power. As well as you know, the frequency of glucose change all of those things around five minutes, you know, we've we've contemplated doing it more frequently, but we haven't found a specific use case, where it's, it makes sense to do that, and change the way the whole system works. But it is something that we've, you know, we've talked about in the past, but five minutes, we feel pretty comfortable with it, you know, and with the extremely minimal lag time of the sensors. Now, it's it's much less of an issue than it was, you know, years ago when it took quite a while to see the glucose change in your CGM after you made a treatment.

Scott Benner 30:56
Right. So as time goes on that kind of adage of like, the next column is showing you something that happened in the past. It's becoming less and less of the past really. Yeah, yeah. A piggy back to that question. On the follow up, it'll tell you basically, it's been three minutes since the since the number changed. And I know for parents, like sometimes you lay in bed going Okay, one more minute. Let me just refresh this app one more time. Will you ever put that countdown on the user's app?

Jake Leach 31:26
Ah, that's a good. That's an interesting idea. Well, I don't know if our team has contemplated that. But basically add, so the user knows when that things come on. Yeah, it's a Yeah. Because when you I guess, when you're sitting there, you've made a treatment. And you're basically trying to see the glucose change. I understand. Yeah, exploring a

Scott Benner 31:45
low blood sugar when you're sort of like, yeah, tests do I drink? Do I eat like that kind of thing? What's the Bluetooth range from the g7? To the phone? Is that the phone?

Jake Leach 31:56
Yeah, it's the same as G six. Yeah, it? You know, it depends a lot on the, you know, the environment that you're in and how the distance, right? It's really good when it's just like, line of sight, you can get, you know, well north of 10 feet. But, you know, in crowded environments, it's less that, but it's the same as G six.

Scott Benner 32:14
Since it's been out already in Europe. Are you already working on things that you've seen? Like, have you? Are you making adjustments on what you're learning already? Yeah.

Jake Leach 32:26
Yeah, we've, we've got quite a few. I mean, many of the, you know, with any product, you do an initial launch, and you're always improving it, you're learning things about, you know, the way it's manufactured, you learn ways, but the way it performs. We haven't seen any surprises in the US launch in terms of product performance. And we have we have a number of updates, that will be cutting it over time that will basically be invisible to users. But you know, continuing to improve reliability. And, you know, just meeting all the needs of users. So yeah, I'd say the most exciting thing we've learned from our LRS launches that more than half of the customers are brand new to Dexcom. So they haven't, they're not just upgrading from G six G seven, they're actually new users coming in to Dexcom family. So it really helps us. You know, reiterate the fact that G seven is a really good platform for expanding the use of CGM.

Scott Benner 33:20
Is there been any change on compression lows? Do you see fewer with the new design?

Jake Leach 33:27
Um, you know, we haven't done a study that compares that exactly. But what one of the things that I've talked to folks about that of Warren G seven, as well as kind of experience myself as the size of g7 allows you to move it around a little bit more in terms of the locations where you can wear it. And that seems to be the best way to avoid compression laws is to find a place that you aren't compressing as often. Yeah, we're gonna for myself, it's I went up on the top of my upper arm that tends to help me

Scott Benner 33:57
okay. Okay, so Canada, Australia, this year, not not 2022. But do you see them in 2023? Having g7?

Jake Leach 34:07
Yep, very, very likely. They're both of those are their, you know, their approval processes, right? Regulatory submissions. g7 is already in New Zealand, and so open to bring it Australia soon. So yeah, I mean, we're, the vast majority of the countries will switch over to g7 in 2023. And then there's a few of the longer regulatory cycles that will take us into early 24.

Scott Benner 34:31
So somebody asked this question, what, it's the internet. So I don't know. I hadn't heard this. But are you seeing any lost connection data on g7 in Europe, to the point where you think of it as a problem?

Jake Leach 34:44
No, no, I think it's similar to G six, it can happen. And we actually do have technologies in our pipeline that we've been working on, that we implemented on G six some of it and we're also looking to do it on G seven to even further enhance the Bluetooth range and capabilities. But I think one of the things with a new product anytime you experienced something, it's like, oh, is it the new product that's causing that? So? It's no, it's definitely not a problem. But we do something that we are striving to improve it always.

Scott Benner 35:15
Yeah, I never know the difference between like, something someone heard, and now they're asking, and you know, I'm pretty clued into this space. And I was like, I hadn't heard that. So I think it's obvious I saved the big questions for the end. And so here they are. I know this isn't your company, and but you're gonna have as much insight to it right now is anybody that I have access to talk to on this day? So how soon until people who have just decided I want to use on the pod five or people who using control like whew, like when they're they're all at home, like looking at their sensors, trying to decide like Toyota or G six one more time? Like, how soon do you expect those companies? I mean, you guys must have conversations about it. Right? Like, when is February to work with that stuff? Yeah, we work

Jake Leach 36:02
super close with those partners, to ensure that the g7 is the integration goes smoothly. So they've both both tandem and solid. And our other partners have been working on the g7 integration for quite a while because the technology has been around. And so they, you know, when it comes to actually launching those upgrades for users, it's really, they're in control of the timing there. Now that we have the FDA approval for use with AI D. It's really around them doing their upgrades. I think their public comments, a tandem, I think is talked about middle of 23. So that's not too long after we launch, and then I think insulates a little they're a little bit farther behind that. So but they they've made and they continually update their public comments around when they'll have that compatibility. But the trust me they're working very diligently on getting those those systems upgraded.

Scott Benner 36:53
I wouldn't imagine that they're taking their time. Jake, I have to tell you, I know we're going your institutional knowledge of Dexcom is it's incredible. Like I just out of order. We I didn't send you these questions. I'm rattling things off. I'm jumping from topic to topic. And you're like that, yeah, this this that? Yeah, like, it's very impressive. So please, please work there for as at least as long as I have this podcast. Because this was very easy and just full of information. And I'm gonna pat myself on the back for getting through that many questions in 30 minutes, because I feel like my head is spinning down like, look, I'm watching this list window in front of me. And I'm like, No, don't ask that as this one. That's that one. So anyway, I congratulations for me. And for everybody listening, everybody said thank you. It's a big deal. We were all really excited yesterday. And you know what I'm, you know what, you know, what people are gonna want you to do next go make Dexcom GA right now, Jake, you can maybe take a couple of days off, but then we would like we're working on it. We'd like to see it as big as the head of a pin. And I'd like to be able to wear it on my watch. If you don't mind. Go ahead, get going.

Jake Leach 37:56
lots lots innovation still to come. We're not nearly done. So yeah, appreciate the time, Scott. It's been great. And I look forward to bringing g7 to us here very soon.

Scott Benner 38:07
You guys push this space forward in a way that just wasn't happening before. Dexcom. And I'm there. I've been around this a long time. I'm never gonna forget, you know, when a new meter every three years seemed like a big deal. So thank you. Thank you very much. I hope you have a great night. Appreciate it. Thanks,

Jake Leach 38:23
Guy Garth. Yeah.

Scott Benner 38:30
Well, I'd like to thank Jake for coming on the show so soon after the announcement. And of course, thank all the people who listen to the podcast for the great questions. How did I get them? You might be wondering, well, I got them. In my private Facebook group Juicebox Podcast, type one diabetes. on Facebook. It's a private group with over 32,000 people in it. People who live with type one diabetes, type two their parents of people with type one, they have type one themselves. The gamut is run in there. You don't even you don't even have to say anything to learn in that group. It's amazing. Juicebox Podcast type one diabetes. Thank you all for the great questions. I hope you enjoyed this episode. I hope you check out some others. Tell a friend share this episode with people. There's a Share button in your podcast app or you can if you're listening online, send somebody the link. When you share the show, you're helping it to grow. And the truth is that's that's the crazy best part of this whole thing is you guys and how supportive you are. Thank you so much for listening. I'll be back very soon with another episode of The Juicebox Podcast.

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#805 Bold Beginnings: Illness Ketone Management

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

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

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+ Click for EPISODE TRANSCRIPT

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

Scott Benner 0:00
Hello friends, and welcome to episode 805 of the Juicebox Podcast.

Well, you would think that I would have learned after saying that the Pro Tip series was only going to be 10 episodes, and now it's like 25, you would think I would have learned not to say we're all done, like I did at the end of the bulk beginning series, because here we are back with something that fits in the bowl beginning series. Jenny Smith and I are going to talk today about how to treat illness ketones. Please remember while you're listening, that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, always consult a physician before making any changes to your healthcare plan, or becoming bold with insulin. If you're a US resident who has type one diabetes, or is the caregiver of someone with type one, it would mean a lot to me. And it would mean a lot to people living with diabetes. If you took a short survey that's available at T one D exchange.org. Forward slash juicebox. This survey helps move type one diabetes research forward. And it's something that you can do from the comfort of your home. It's also something that may open up other possibilities to you if you want them. And if you don't, doesn't matter. T one D exchange.org forward slash juice box fill out that survey helped move research forward. This episode of The Juicebox Podcast is sponsored by touched by type one, a wonderful organization helping people with type one diabetes, that you can learn more about on Instagram, Facebook, or at touched by type one.org. The podcast is also sponsored today by Ian pen from Medtronic diabetes Learn more at in pen today.com. And last but not least today's show is being sponsored by U S med. Us bed.com forward slash juice box or call 888-721-1514 to get your diabetes supplies the way we do from us med. You may remember a time when I told you we were all done with the bulb beginning series. Yes, that was a lie. So here we are.

Jennifer Smith, CDE 2:24
Okay, what did we lie? Or what did we not complete? I should say we might not lie. It

Scott Benner 2:29
wasn't a purposeful it was a it was we didn't know. So for today, I'd like to do a bold beginnings episode about how to deal with ketones. Because as I'm standing here or sitting, and Arden has now had diabetes since she was four, and she's 18. I would admit, I don't 100% know what I'm doing, especially around illness. So I think we should probably try to help people out a little bit with that.

Jennifer Smith, CDE 2:59
Yes. And I think for clarity there, too, I think you've had you've always been very bold with insulin, right. And so I, I have a sense that despite art and having higher blood sugars, you've attacked it with the knowledge of even if there are ketones there and you haven't tested for them, you're adding insulin, that is probably what we would recommend adding in excess of correction. That's helping to clear the ketones. So I think you've gotten away with it, for lack of a better way to explain, because you're just like, I'm not going to deal with the high. I'm just going to bring the high down and this much didn't work. So let's add more. You don't really have a science to how you're doing the more.

Scott Benner 3:50
And I do want to talk about that a little bit so that people have here's my last recollection of it. Arden had the flu, but she was well we both had the flu when she was like my god, four years old, maybe, like really little. And she and I are in bed together just like I mean, we were a mess, you know? And we that's when I learned how to use a lollipop to keep her blood sugar up. Because I was I didn't know what to do. She wouldn't eat. I think sports drinks helped a little bit but it was a lollipop I kept I kept them around. I was like here suck on this. And that she could kind of get away with

Jennifer Smith, CDE 4:26
it probably helped if she was nauseous too. If she had like stomach piece of the flu. Oh sweetness. Probably yeah, often sucking on things if you're nauseous can really help to calm

Scott Benner 4:38
the nausea action of sucking the sucking. Yeah,

Jennifer Smith, CDE 4:41
in fact, I mean, they have you know, in pregnancy, they've got all these fancy products, the preggie pops that they're called like these. They're literally just soccer by it. I mean, I got through actually the early part of my pregnancy is sucking on. They're made by the ginger people. They're just like they look like little All cough drops but they're a gram and a half of carb apiece. They taste like ginger. Ginger is really good for calming the stomach. So stuff like that. It's probably the reason along with supplying the sugar to keep her blood sugar up. It helped to calm some of the nausea. Maybe she might not have told you what she was feeling like as a four year old but

Scott Benner 5:19
well, you just messed up my my internet searching now because I'm going to start getting ads for preggy pop because I didn't I almost believe you that they existed. There are preggie pops, which are lollipops are also preggy pop drops, I guess. That women how about that. All right. Well, there's my there's my the ads. I'm gonna get served now. Google thinks I'm pregnant. Alright, well, that got off the track pretty quick there. Yeah. So. So what I remember from that time was, is that back then Arden was peeing on a strip to to see if she had ketones we Yes. We saw that she had ketones called the the sick line for her for her endos office. And I mean, the rest of it. I can't remember. Was it one unit for like, if our ketones were two, we were supposed to like put in a unit to bring our ketones the one? And is that right? Or whatever?

Jennifer Smith, CDE 6:24
It depends? Yeah, I mean, so you did, you did learn an adjustment strategy, based on like adjustment for insulin strategy to help to clear the ketones and if your blood sugars are high, and not only are you using the corrective insulin that either you're calculating, or your pump is helping to correctly, you know, calculate for you. But you also have to add on top of that based on mild or moderate or even large ketones, an amount of extra insulin to clear the ketones, and that's dependent on how much some some places recommend basing it on total daily insulin. Other places recommend looking at your Basal dose that you take or that your pump provides. And then dependent on whether you have mild or moderate ketones. It's either a 510, or 15% of that total daily Basal that you calculate, and then you add that on to your corrective dose. So let's say you know, let's say your blood sugar is high and your pump recommends two units for correcting that high. With ketones present, that correction is not going to bring the blood sugar down as effectively, but your ketones are not going to get cleared well. So we need to add on to that. And if we're saying mild ketones, let's say you need five to 10%. Let's say your total daily dose is of basil is 10 units a day 10% One extra unit. So you're gonna add on to the two units of corrective insulin, the one unit to bring your ketones down along with address the hi

Scott Benner 8:09
a couple of things here. First of all, what I realize now is that all that time ago, I thought they were telling me one unit for this number, but it turns out they may have been looking at other things about Arden's insulin usage that I didn't even know about.

Jennifer Smith, CDE 8:22
They could have been exactly. Okay. And

Scott Benner 8:25
the other thing I remember from that time was the abject horror because Arden's blood sugar was lower. It was like 90, and, and she had ketones, and the woman is like, so give her insulin. I was like, listen, she can't eat. And her blood sugar's 90, and a unit bill like Crusher, because she was little. And she's like, No, it won't. And I'm like what she's like, it'll just clear the ketones. That's a leap of faith right there. Because yes, yeah, I was like, wait, what so so you just kind of

Jennifer Smith, CDE 8:57
I have to say that your your clinical team then was a little bit more on the aggressive side of adjustment. Many people will go home with directions, if they do get anything for ketone clearance, they'll go home with directions that unless the blood sugar is above this value, you have to get the blood sugar high in order to give the correct IV dose and to clear the ketones with the adjusted ketone dose. Many clinics will not tell you to just take a unit even though your blood sugar's 90, and you're not eating anything. So it's a pretty progressive thinking clinic.

Scott Benner 9:33
There's, listen, I, the the problem is the reason I don't have more information about this is even though Arden is sick at the moment, we don't generally get sick in our house, or neither. And we don't get the kinds of illnesses that come with, like nobody vomits in my house. Right? Like, you know, families are either vomit or they're not, you know, like we don't we don't throw up and so I'm putting that on my tombstone. You're alive, Scott. Never really act. But so we don't have the problem with what we can't keep something down. Like it's not fun to drink or eat when you're sick. But Arden can she can power through it, right? Sure. So I've never really been in that situation. And I do take a lot of, I do believe what you said that we're just very aggressive with insulin so that even if Arden has been in a situation where there are ketones, we might not even know about it, because we're, we'd be bringing them down. Correct. There's a connection in there that um, oh, I know what it is. You hear a lot of people online get told. It's a variation of what you just said. You just said like push the blood sugar up so that you can put in a bunch of insulin. And I've also heard people told like, you know, Bolus but then drink like sports drinks at the same time. Correct. And that's

Jennifer Smith, CDE 10:54
actually I think, if your blood sugar is low, and you can take something in especially kiddos, often Pedialyte will sit, okay, sometimes just sucking on a popsicle, or like you did a sucker can be okay. Sometimes if kids aren't willing to take anything, put some honey, you know, in their mouth, it can get absorbed through the mouth tissue, essentially. But why would you leave ketones where they are and drive your blood sugar up just to take some insulin. So another strategy is to use some carbs that can be taken in and not cover those, okay? And then allow the ketone coverage alone without a Bolus for any of the carbs that you've intake, or you've taken in?

Scott Benner 11:41
What's the reason for that?

Jennifer Smith, CDE 11:43
The reason for that would be if your blood sugar was lower already, and you're worried, you know, Arden's blood sugar was 90, and you're like, No, we we can't give her a unit of insulin. This makes no sense to me, right? So had she been able to take something you would have essentially let the carbs go in without covering those at a lower blood sugar value? Because with ketones present, you need insulin to clear that.

Scott Benner 12:08
So correct. The blood sugar with carbs Bolus? Are the ketones. Correct? Right. This is this whole dance here is why a lot of people who are people who vomit, people, I can't believe I've designated there are people who vomit and don't but anyway, you don't even more prone to it. They often have a prescription for like Zofran in the house, right? A lot of type ones do that. So yeah, when nausea comes, you can treat the blood sugars treat the ketones if they exist, and have the safety of knowing that you can keep something in your stomach and not that I guess. I mean, let's just go over it. If you Bolus for something, and you eat it, but then it comes back out before you've digested it, then you don't have the impact of the carbs. All you have is the act of insulin. And that is the quick way to seizure Vil. Yeah,

Jennifer Smith, CDE 13:00
correct? Absolutely. I mean, it's the big reason that with stomach bugs, specifically where you are throwing up or potentially the opposite of that, right? Whether it's coming out one way or another, you're really not also absorbing everything that you're even able to put in. And because your digestive system is irritated. And with that we you say take in the carbs that you can and wait until you know it's going to stay down before you Bolus for it. And then reduce the Bolus for the carbs you ate by about 50 Maybe 60%.

Scott Benner 13:38
So some insolence happening, but not super aggressive. Correct? Yeah. Okay. All right. So now we're talking about illness ketones? Yes, these do land people in the hospital all the time, because then they can put you on a drip to keep your blood sugar up and give you insulin at the same time. They can bypass your digestive system basically and get your ketones down. Right. Can you tell people a little bit about why you don't want your ketones to be high?

Jennifer Smith, CDE 14:06
Yeah, absolutely. I mean ketones, ketones that are specific to illness and high blood sugar or ketones that are relative to lack of intake because you have a stomach bugs, we're talking about illness based ketones. We're not talking about nutritional ketosis are those on a ketogenic diet. Right. So ketones in general in an in a state where you're sick, it's like having waste in your body, right? You know, the ash that's kind of in a fireplace once you've burned the logs, right? That's kind of what ends up happening when you have the not desired ketones in your body. It's like waste product from having your body break down. Pieces of your body, right? And so your body tries very hard to flush that out. And which is The reason that we use to test ketones using urine ketone test strips, because your body will try to flush as much as possible out. Hydration thus is very important if you have ketones whether they're mild or moderate or absolutely high. Need hydration, I want to talk about like a water bottle an hour of hydration with ketones like flush, flush, flush, drink, drink, drink. But you so that's essentially the reason that ketones are present, your body doesn't have enough insulin to clear the high blood sugar. And that often blood sugar's over about 240 or 250. If they're left lingering high for hours on end, you're more likely, especially with an illness to have ketones show up.

Scott Benner 15:46
Okay, and this is just from the CDC. But decay develops when your body doesn't have enough insulin to allow blood sugar into your cells for the use of for use as energy. Instead, your liver breaks down fat for fuel a process that produces acids called ketones, when too many ketones are produced too quickly, they can build up to dangerous levels in your body. And decay in an illness situation can come on fast. And it can be deadly like, Yeah, seriously. Yeah.

Jennifer Smith, CDE 16:15
And that's another big one with that, you know, another testing piece that they often look at, if you do go in, and especially DKA, or electrolytes. And so with illnesses that are the vomiting kind of illness, so to speak, you may have a difficult time keeping in enough hydration, and electrolytes then get very off, which does not help in this scenario with ketones present. So I

Scott Benner 16:45
believe that beyond her, her initial diagnosis, Arden's only been in decay one time, and I don't know if she was in it or not. All I can tell you is that there was this one time, we had a kinked cannula that we didn't know about in a changed pump in the evening. So she went to bed and didn't get insulin, and then woke up in the morning, and was like, she had a really high blood sugar. And as soon as I saw it, I was like, That's odd. It's a long time ago. And I tested it. Change the pump saw the kink. And I thought, Ooh, Oh, no, no, no, this is bad. And you know, so I said to her, she was old enough to have a decision. It turns off, I said, Listen, if you can drink a lot of water right now. Hold on a second place.

Jennifer Smith, CDE 17:35
Yes. Are you defining a lot? Oh, much water is a lot.

Scott Benner 17:42
Well, back then. I, I told her to bottles, that if you can get two bottles of water, and I think I can get your blood sugar down in the next couple of hours. And she did not feel well. I mean, she felt terrible. And she kind of was like, I can't do that. And I said, that's no problem. But if you can't, we have to go to the hospital. They're gonna give you an IV and everything. She just like, I wish you could have seen me the water bucket action movie, she like grabbed the water bottle. She was like, just pushed it in. And I remember saying to Kelly like I put a timer on it. I was like, Listen, if you know, in three hours from now, like I said, an hour from now we're not seeing movement. But if we see movement that will go to two hours. And then after we get under a number, but I was making it up on the fly. I didn't know what I was like, You know what I mean? So

Jennifer Smith, CDE 18:36
you're actually at what you did was right in the timeframe. I mean, you're talking about not illness space, but but a pump failure really insulin, right? She didn't have any insulin. So in that case, right? You did the right thing, we recommend checking or looking at blood sugar after testing for ketones. And if you don't have a way to test ketones, assume with a consistent high blood sugar, that it's probably a pump site failure. Change it out, take insulin to get it down. Hydrate, check again, you know, I mean, now with continuous monitors, you have the ability to see where things are obviously going but if you don't really checking blood sugar is about every hour to two hours checking ketones somewhere between you know that timeframe, every about every two to four ish hours. Check ketones again, if they're coming down, great, continue with the water correct as your pump recommends, you can correct and continue to check your ketones until they're you know, down.

Scott Benner 19:36
So one of the more interesting conversations that I see online every year is around this. Somebody pops up into the private Facebook group. They're like, hey, my kid is sick, and they have ketones. What do I do?

You're getting your diabetes applies from somewhere. But is that a pleasant experience? Only, you know, here's what I can tell you. We've gotten gotten, we've received Ardens diabetes supplies from a number of places. None of them have ever been as good as us med. Us med.com forward slash juicebox or call 888-721-1514 To get your free benefits check. And you would do that to be part of a company that has an A plus rating with the Better Business Bureau who accepts Medicare nationwide over 800 insurances. They carry everything from insulin pumps and diabetes testing supplies to the latest CGM, like the Dexcom G six and the FreeStyle Libre three EU. And us med always provides 90 days worth of supplies and fast and free shipping, better service and better care is what you're going to get from us med a company that has served over 1 million people with diabetes since 1996. number one rated distributor index com customer satisfaction surveys. Who is that? Oh, that's us. But how about number one fastest growing tandem distributor, we're the number one distributor from the pod dash, US meds where we get on the pod supplies from we also get Dexcom supplies from them. You can get your libre stuff, your tandem stuff, just head over now, US med.com forward slash juice box or call 888-721-1514. So you want the functionality or at least some of the functionality that is offered by an insulin pump. But you're not ready for an insulin pump where you just don't want one. In that case, you should really look into the in pen from Medtronic diabetes, head to N pen today.com. Right now you can kind of follow along with what I'm saying. The M pen is an insulin pen, but it's attached. Connected I should say to an app on your phone that helps you with things like seeing your current level of glucose After pairing your CGM to the in pen app. Ooh, how about that? What about meal history, dosing history and activity log, where you can see a list of recent actions including doses meals and glucose readings. You can make reports to share with yourself or your doctor, I guess you don't share things with yourself, you just look at them, but you get what I mean. And the app also has a dosing calculator, and much more should head over and take a look at it right now. And if you happen to be ready to buy when you get there, it's possible that you may pay as little as $35 for the implant. Isn't that crazy? You know, I should say that the offer is available to people with commercial insurance in terms of conditions apply. But as little as $35. Go check out their hands on product training, online educational resources, and 24 hour technical support. All of this is that in pen today.com. And there are links in the show notes of the podcast player you're listening in now. And links at juicebox podcast.com. To in pen to us med to touch by type one and all the sponsors that you click on. I just hit something while I was talking. I apologize. When I'm talking with my hands right now I don't usually do that. When you click on my links, you're supporting the production of the podcast and keeping it free for listeners. So if you want it in Penn, if you want to switch to us med do it, but use my links and if you don't want to, I don't really care. Do what you want to do. But if you're doing my stuff, use the links this all makes sense to you right? Don't forget there are also links to the other sponsors Dex comm on the pod. G vo Capo pen Contour Next One blood glucose meter. Wow, a lot of sponsors. Feel like I can't remember them all. If I haven't said your name yet don't get Don't Don't get mad at me. Now I set them. Yeah, I got it. I mean, you know, take the T one D exchange survey that links they're touched by type one we already talked about today. Just use my legs please. Thank you. Oh geez. I'm all over the place. I have to say in pen requires a prescription in settings from your healthcare provider. You must use proper settings and follow the instructions as directed. Or you could experience high or low blood glucose levels. For more safety information visit in Penn today.com. I almost forgot to do that. But then I remembered at the end and they have ketones. What do I do? Somebody who has had a bad experience with it or is afraid right away says good hospital. They don't even ask any questions. I go to the hospital to last but then other people come in and say Well listen, like are they able to keep food down? You know, can they drink a sports drink? You can give them insulin like how high are the ketones? Are they really large? Are they moderate? Are they small? Like you know you might be able to manage this on your own. It's a very it's a very interesting conversation to watch happen because there is fear from people who have either been in decay because of this or have been in a situation where they can't keep down food. And then there's the other people on the other side who are Like, I guess not yakkers. And they're like, you know, they're like, oh, no, you can manage this, as long as it's not too out of hand, if it's too big, you should go. And I always think, like, what a horrible situation to be in, you really don't know what the right answer is, you know, call the sick line for your thing. Some people call the sick line, nobody gets back to them for a while and correct,

Jennifer Smith, CDE 25:20
or they give them information that that's not specific to their individual need, because the sick line really isn't. I mean, if it's within your healthcare network, they could potentially look up your information and see what's there. But they really don't know the day to day, you know, nuances of your management and how sensitive you are and whatnot. It's really just a, an off the list of do this, then do this and then do this and adjust based on what your calculated insulin dose should be.

Scott Benner 25:53
It also gets messy are messy is the wrong word. It's gonna be funny in a second, because a lot of people have urine, Keystone, urine ketone strips still so they're like, why Amelia, get this, like, it's a baby or like, you know, a kid or like, I don't want to be it. That's why I don't know what you have in your house. But we've had a blood ketone meter for a very

Jennifer Smith, CDE 26:13
long time, we in fact, that's the only thing we recommend. Yeah,

Scott Benner 26:17
I use the precision extra. I've used it forever. They're not. They're not sponsors. I've just had it forever. It works great.

Jennifer Smith, CDE 26:24
And they're, they're nice, because the test strips come individually wrapped. So you don't have to open a whole bottle, which is only then good for 90 days after you've opened it. Unlike the ketone, the urine ketone strips, once that bottle is open, you might use 10 out of the bottle of 100 over a sick period of time or a day when you had a high blood sugar because of a pump sight issue or whatnot. But then, hopefully, you don't have to use the rest of them in the next 90 days. But really, then that that battle is like, done there. And you know, you're in ketones also. They're old information, right? It's a couple of hours old, comparative to real time being a blood value of ketones.

Scott Benner 27:09
Well, as soon as Arden got sick this week, like we got her set up in a room and the first thing I said to Kelly was like, Well, I'm gonna check her ketones, get the meter out, make sure we have it, you know, have a baseline like right now she doesn't have any that's good. But I guess I want to talk a little bit about what we're really talking about here is meet the need, right? Like you. Generally speaking, you have a need for insulin, you have a different need for insulin during an illness. And by the way, not all illnesses hit people the same. So right, you know, you could like Arden had ketones with the flu. But now more recently, she has a sinus infection. She doesn't have ketones with a sinus infection. You know, the Hoos and whys of that are not important just that sometimes this might happen. And sometimes it might not correct in general, in whether it's this ketone situation or not, you have a you have an increased need for insulin, and you're not meeting it. That's all. That's all it is. It's, it's scary. And it's different. And there's the piece about, oh, what if I can't keep food down, which I think ratchets up ratchets up the fear about 1,000,000%, because I can still remember being scared giving her that insulin when she was like four.

Jennifer Smith, CDE 28:20
Right? Absolutely. And I think there's a there's a definition, kind of to make between high blood sugar illness and ketones. And the main illness that really doesn't drive blood sugar up, in fact, you may run lower, and your insulin needs may look like they go down on the base level of what you need. But if you have a stomach bug, and you're running lower blood sugars, as we said before, you may check ketones and ketones may be present. And they may be more mild. They may even get up to moderate because what you're doing is you're now not taking in any food. Right? Your body has to derive energy from something so you get this low level of ketones more from a starvation base. This isn't driven because of high blood sugars, because your blood sugar's aren't high is driven because you're not really taking anything in and so then it's sort of like the question, well, I've had a lot lower Basal insulin needs, I'm not eating anything, but I have ketones, and now I'm supposed to take insulin.

Scott Benner 29:30
You know, and the other side of this too, is that like you mentioned it earlier, just there are starvation ketones, which you could also see if you were doing an ultra low carb diet, these do not put you into decay.

Jennifer Smith, CDE 29:43
So not not at all. In fact, many people if you've been tested just just so that you figured out how to use the machine, like in a baseline setting and you're not sick or anything. Check your ketones first thing in the morning. Many people actually have a really mild, low low level of ketones because overnight, your body's supposed to go into this sort of like fasting. It's not supposed to be digesting food until you eat at midnight, the steak and fries and cheese sauce and whatever it

Scott Benner 30:15
is. We you and I talked about this is episode 287. It's a pro tip called illness injury and surgery and actually in Episode 288 is the defining diabetes about ketones. Oh, I actually think it comes up also in how we eat episode with a person who was on the show, but you should go listen to you should understand the difference, but you know, keeping it to just illness. Okay, so let's kind of like, let's go back over what we've talked about. So sure, kids sick with two options, two sets two scenarios, kids sick and keep food down kids sick or your adult sick doesn't matter. Can't keep food down. So if you can keep food down, and you have ketones present, is there I mean, you know, me I'm like just thinking like, just use more insulin. But I mean, what did they do, like call the doctor.

Jennifer Smith, CDE 31:10
So obviously, calling your Health Care Protect practitioner is really it's an important first step. Based on what their recommendations I would even say, rather than a, you know, a PCP, you really should be calling your endocrine team, because they're the ones that could help to dictate well, how much more insulin to clear the ketones. The baseline is typically again, one of two formulas, if you want a more precise dosing rather than us take two extra units because you got you know, ketones present. And I know I need more, so this must be more, right. But you know, if you're using it, looking at your total daily dose of insulin, and then you may need about 10% more than what you average total daily, if you have mild ketones. If you have moderate ketones, then about 15% More of what your total daily dose is. Other Other practices go more based on just basil. And that then would say mild ketones, you would look at just what your Basal rate is, or what your Basal doses and you would take 5% of that and add it on to your corrective dose if you also need corrective insulin at that time. Okay. And again, how often I that's a question when we're, when I'm talking with the people I work with, you know about, well, how much and how often can I give it really it's about every two to four ish hours is the kind of watch point right, where you're checking ketones again, about two hours later, again, hydration, the extra insulin, you should be starting to see some difference. And this is where the benefit of using a blood ketone meter really does come in, because it gives you decimal values to ketones. So you're starting ketone levels, maybe it's moderate. And maybe it's come down by, you know, point four over the time period that you've been testing and adjusting. And every that's a difference. Absolutely. You're making a dent in your ketones. They look like they're falling. So continue to do hydration, watch your blood sugar's watch the ketone levels, with kind of a testing plan of about every two to four hours, you

Scott Benner 33:25
can't stop paying attention to it, because it comes on quickly. Are there physical signs to look for? When you should? Like, is there anything physical that would make you think we're not winning this battle? Maybe the hospital is the right way to go?

Jennifer Smith, CDE 33:39
Well, if blood sugars are high enough, in ketones are present, obviously, somebody's going to be more thirsty. Definitely there. Also, ketones often make people nauseous. Like that feeling that you said Arden had ketones feel horrible. Okay. So those symptoms now again, in kids that are old enough to tell you how they're feeling or teens or even you're the adult, you know, managing everything. There's a little bit more ability to tell how you're feeling. But little kids are, I think they're harder. And so they're the ones that a lot more watchful, honestly, I would say under the age of six, more testing more watching. Because they may be the ones that end up needing to go in,

Scott Benner 34:27
right. So and you're in, you're clearing these ketones with water, if you're lucky enough to be able to drink it. And with insulin, those are the two ways you can clear it out of yours.

Jennifer Smith, CDE 34:36
Yep. And I usually even say try to try to go off and on with water and then maybe an electrolyte beverage that does have carbs in it. Because remember getting in some carb and if your blood sugar is high and you're doing carbs, obviously you're doing correction insulin, you're doing the carb insulin base, electrolyte drink, and you're doing the ketone. So you're doing kind of a three level of insulin. there because just because your blood sugar is high, your body still needs some energy

Scott Benner 35:04
in an illness situations where people are still eating, but they seem insulin resistant. That's, that can be fairly common during an illness. Yeah, so our didn't had it this week with this, with this sinus infection every night after dinner until like two o'clock in the morning, I gave her I mean enough insulin to put down a pony, you know, like, and it was, we were barely holding her blood sugar 200. And, you know, it just it takes a lot of time and experience to be able to say, I'm going to use a significant amount of insulin more than I then what would normally be needed here. And right, you know, I don't even know how to tell you to get into that headspace. It just it takes time, you have to do it over and over again. But there was a moment when I came in. I said, I was like, I'm gonna go get a syringe. And we're going to just shoot like five or six units. And, you know, because this 200 is creeping, it's going to go to 40 and five seconds like we're not ahead of it. insolence not touching you. Right? And I need to my thought there was, it's interesting, I'm almost not as aggressive as I sound there. I just don't want it to skyrocket because I know I'm putting all this insulin into her. And at some point, it might start working and put her in the wrong direction to correct. So I'm being super aggressive. If I told you I thought I might have used twice as much insulin. But I had her I had her basil doubled. Or basil was like at two units an hour. And we were bolusing. It felt like every 90 minutes, just to hold it where it was like every time it tried to go up. I was like no, no, no, no, like more, you know, and we were up watching what do we watch? on Hulu? Does Oh, only murders in the building. And we sat. We sat up all Arden was sick watching that for a couple of nights. And we just kept pushing. But the problem was is that she she hadn't lost her appetite. And on top of everything else was going for comfort food while she was sick. Right? So it wasn't just it was the illness. We were trying to hydrate her. But God knows how well that was going. She was drinking a lot. But then she's eating food that's more comfort food. And I mean it was a journey like it.

Jennifer Smith, CDE 37:25
I think you bring actually, an important point here in a sense is that when you're talking about illness, most illnesses that are the chest cold, the sinus infection and ear infection, even like a bad like tooth infection or whatnot, those will drive your insulin needs up because of the stress of the illness. And if you're not staying on top of that need to add more and by how much more mild mild cold when you're still up and around just feel sniffy, you might need 10% More Basal insulin, whether it's injected insulin or in your pump, you may need to use Temp Basal increases or whatever, you know system you're using to accommodate more. Yeah, you've got a nasty bug that is driving your blood sugar's up, and you're not adjusting your Basal up 2030 and 50%. I remember my insulin needs I wasn't even on a pump in college, I had mono. And I, I could barely like drink like broth. And my blood sugars are high. And my endo was like you need to just increase the Basal amount. I was amazed at how much my insulin needs went up, just because I was so sick. So I think if you don't stay on top of that with an illness early on, you're more likely to get ketones. Because you because you haven't brought the blood sugars down based on the illness. Yes.

Scott Benner 38:50
Right. So you could almost have because of the situation as such high blood sugars, you might have ketones that are just from high blood sugars that aren't specifically from illness. Charities. Yeah, and you know, there's always I'll let you go in a minute, but that's okay. Inevitably, I see someone online who's sick. And they have a CGM, and everyone who has a CGM has ever seen this knows how frightening it looks like. There's a ceiling to the CGM, like it only goes to like 400 or something. It's flat and that it just runs this dotted line across the top flat. And somebody posted recently, I've been sick for days. And my blood sugar has been like this for days. And I'm like, oh, no, no, no, no, no, no. And you know, and people are saying, like, do this do that I just popped into their head, I was like, use more insulin, use more Basal insulin, inject it to like bring it down. Like even if you can get it to 200. Like better I would be much better because also high blood sugars impede wellness in general and healing.

Jennifer Smith, CDE 39:52
Absolutely. The longer you leave high blood sugars while you're sick, the more likely you're going to be sick longer, right? Yeah, really.

Scott Benner 40:00
All right, well, I appreciate you doing this with me, because it just seems like something that people struggle with constantly. And it doesn't matter if you're newly diagnosed, or if you've had diabetes for a while, but I thought that it would fit into the beginning series. So

Jennifer Smith, CDE 40:13
it does I think the only thing that I, I think, because we have those levels of mild, moderate, and large for ketones, I think the last question a lot of people end up having is, when do when do I go into the emergency department? Yeah, right. When should I go, I've done all this stuff, things aren't moving, things are getting worse. You know, if your ketone levels, I think, one. You're trying to drive blood sugar down, it's not working. Let's say you've even while you're sick, you've done a site change because you think, Well, besides being sick, maybe it's my pump, right? Your blood sugar's aren't really moving. Your ketones aren't moving or are going up, that's more of a time, you may be behind the curve in terms of hydration and other the electrolyte balance and all of that in your body, you may need to go to the emergency department, you may need their assistance. So I think, just to clear up like, when should you really go?

Scott Benner 41:14
Well, Jenny, to be completely candid, this is a hard episode to do. Because there's a lot of nuance, and everyone listening is not going to be in the same situation, right? And really, honestly, I mean, there'll be a disclaimer at the beginning that says like, this is not medical advice, because I don't know your situation. And you might need to go to the hospital and like bringing up those Facebook posts where people run into like, go to the hospital. Those are people were like, I don't know what's happening there. And it sounds like you don't know, either. So go find somebody who understands

Jennifer Smith, CDE 41:47
this. Go somewhere who else who has a medical degree and can at least maybe hook you up to an IV?

Scott Benner 41:53
Right? Yeah, I mean, I think the way I think about it is the way I described it when Arden had the bent cannula, right, which by the way, I just want to say, only Ben cannula the entire time, she said diabetes, just one, which I think is Wow, not bad, right? Oh, but in my mind, when I saw that, I thought, if I can start bringing this down right away, if she can hold water, and I'm moving quickly, at a reduction, okay. But I am not going to mess around with this like so, you know, I you have to use your own personal intuition. And you know, it's don't genuine aren't telling you what to do. But, you know, I just thought maybe this would help guide people through it a little bit. It is a really weird thing. Like, I seriously in this space, sometimes you'll think Why does no one ever talk about this? Or that? And the answer is, because I don't know. Like, I don't want to tell you absolutely something and it not be right. And I'll give you an example. What's an episode that we have on our list that we never get to? How low of a blood sugar causes damage to a person? Everyone wants an episode about that? They bug me constantly, I get notes about it. I say to Jenny, how do we do this? And we're both like, I don't know, like, like, right? Yeah, you could difficult.

Jennifer Smith, CDE 43:11
That's a difficult one, because it's kind of like it's like ketones. It's you've been given these tools, you've been given this guideline to utilize. And every person I mean, what is it? It's your diabetes may vary, right?

Scott Benner 43:29
Yeah, me, right. Yeah. And by the way, some people are dizzy at 70. And some people are dizzy at 50. And some people never get dizzy and etc. And right. But the question people have over and over again is when does damage happen? Like, where can I let and listen, I can tell you that last night hardens, blood sugar dipped down to 55 for a couple minutes. It went up to 61. I looked at it. I said if this keeps rising, I'm okay. But it went back down again. So I gave her some juice. I didn't want her to sit there. Do I think that she's three IQ points dumber today because of that? No, no. But you know, but I also am not comfortable saying that out loud. Like as a certainty, you know, correct. And

Jennifer Smith, CDE 44:08
Reese, I mean, references or research often focus a lot heavier on what are what are the problems that come from high blood sugars. There's minimal. There is information but there's minimal information about what value creates problems with long term like mental health, right? And most of the research identifies under 55. So if you're looking for value, I would even say, let's say under 60, just to be safe, right? But honestly, it's it's the duration of the low blood sugar. And that's a general that's a general statement, right? If you're having duration one day into the next into the next into the next, it's very likely that you're impacting your brain cells,

Scott Benner 44:57
but if you're 60 for a half an hour It's a different situation.

Jennifer Smith, CDE 45:01
It's a different situation. I think that's the, that's the best, simplest way to say too much is too much and will likely create issues. So let's aim for less lows and defining lows as under 60. Let's aim for less of those.

Scott Benner 45:20
One one day, maybe we'll try to tackle it and see how it goes. But I just wanted to make the point that this is not this ketones thing. It's there's no real certainty in it. Like I don't know when to tell you to go to the hospital. So good luck. And try not to get sick. I'll tell you right now, Jenny. I don't miss COVID. But I miss everybody staying away from me and nobody gets sick. I love that time. But he's been so secure for so long, I would go back to being locked down. I have to feel like this.

Jennifer Smith, CDE 45:50
Hopefully, you guys are all on the mend.

Scott Benner 45:53
I hope so too. All right, I really appreciate it. Thank you. So welcome, of course. First, I want to thank my sponsors in pen from Medtronic diabetes and remind you to go to in pen today.com Also want to thank us med us med.com forward slash juice box or call 888-721-1514. And of course touched by type one is touched by type one.org. They also have a bustling Facebook and Instagram presence. Go find them. If you're looking for more bold beginnings, episodes, head to juicebox podcast.com. Go up to the top to the menu and it says it right there bold beginnings. Actually, a lot of the series are up there. Ask Scott and Jenny after dark algorithm pumping defining diabetes, diabetes, pro tip the variable series, mental wellness to finding thyroid. It's all there where you can just search your podcast app if you just said juicebox one word. And then like bold beginnings, I think you would get a list of all the episodes right your podcast player. I hope you enjoyed this episode. Thank you so much for listening. Let me remind you that Jenny works at integrated diabetes.com Who wants to hire her head over there. And I appreciate you listening and sharing the show. As the year comes to an end, I find myself very reminiscent of the past year I think back that's not the word reminiscent. What am I don't remember the word. I'm feeling good. So another long year of making the podcast for me. And I'm just thrilled with how it went. I'm thrilled with how you guys enjoy the show your feedback and how you share it. It grew exponentially this year. Doubling downloads over last year, maybe more than doubling downloads over Yes, sir. Anything. Yes, more than doubling the downloads from last year. It's just taking off because you guys are great listeners who not only download and subscribe and follow but you tell other people about the show. And that's why it's growing. And that's why we get content like this and I just can't thank you enough. I'll be back very soon with another episode of The Juicebox Podcast.

Test your knowledge of episode 805

1. How should blood sugar levels be managed during exercise?

• By ignoring them
• By closely monitoring and adjusting insulin as needed
• By avoiding physical activities
• By reducing insulin dosage

2. What is the role of insulin therapy in managing diabetes?

• To manage blood sugar levels
• To eliminate the need for exercise
• To reduce blood pressure
• It has no role

3. Why is carbohydrate counting important in diabetes management?

• It helps in accurate insulin dosing
• It has no impact on blood sugar levels
• It is only relevant for type 2 diabetes
• It should be avoided

4. What should be done if blood sugar levels are low during exercise?

• Stop exercising and consume fast-acting carbs
• Ignore it and continue exercising
• Increase insulin dosage
• Drink water

5. How does physical activity affect insulin sensitivity?

• It increases insulin sensitivity
• It has no effect
• It decreases insulin sensitivity
• It should be avoided

6. Why is it important to adjust insulin doses based on the type and duration of exercise?

• To maintain stable blood sugar levels
• To avoid taking insulin
• To increase blood sugar levels
• It is not important

7. What types of exercise are beneficial for people with diabetes?

• Only aerobic exercises
• Only anaerobic exercises
• Both aerobic and anaerobic exercises
• No exercises are beneficial

8. How often should a person with diabetes exercise to see benefits?

• Once a month
• Once a week
• Regularly, several times a week
• Every day, without rest

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